Δευτέρα, 15 Αυγούστου 2016

Type 2 diabetes: genetic data sharing to advance complex disease research

Nature Reviews Genetics 17, 535 (2016). doi:10.1038/nrg.2016.56

Authors: Jason Flannick & Jose C. Florez

As with other complex diseases, unbiased association studies followed by physiological and experimental characterization have for years formed a paradigm for identifying genes or processes of relevance to type 2 diabetes mellitus (T2D). Recent large-scale common and rare variant genome-wide association studies (GWAS) suggest that

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The life aquatic: advances in marine vertebrate genomics

Nature Reviews Genetics 17, 523 (2016). doi:10.1038/nrg.2016.66

Authors: Joanna L. Kelley, Anthony P. Brown, Nina Overgaard Therkildsen & Andrew D. Foote

The ocean is hypothesized to be where life on earth originated, and subsequent evolutionary transitions between marine and terrestrial environments have been key events in the origin of contemporary biodiversity. Here, we review how comparative genomic approaches are an increasingly important aspect of understanding evolutionary

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Ceftaroline Plus Ampicillin Against Gram-Positive Organisms: Results from E-Test Synergy Assays

Microbial Drug Resistance , Vol. 0, No. 0.

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Alterations in Outer Membrane Permeability Favor Drug-Resistant Phenotype of Klebsiella pneumoniae

Microbial Drug Resistance , Vol. 0, No. 0.

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The Burden of Comorbidity Is Associated with Antibiotic Resistance Among Institutionalized Elderly with Urinary Infection: A Retrospective Cohort Study in a Single Italian Nursing Home Between 2009 and 2014

Microbial Drug Resistance , Vol. 0, No. 0.

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Immune Checkpoint Blockers Provide a New Way to Explore Autoimmune Thyroid Diseases

Clinical Thyroidology Aug 2016, Vol. 28, No. 8: 241-243.

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Automated Method for Measuring TSIs Using TSHR-Binding Properties Has Good Sensitivity and Specificity for Graves’ Disease

Clinical Thyroidology Aug 2016, Vol. 28, No. 8: 235-237.

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Potential Direct Regulators of the Drosophila yellow Gene Identified by Yeast One-Hybrid and RNAi Screens

The regulation of gene expression controls development, and changes in this regulation often contribute to phenotypic evolution. Drosophila pigmentation is a model system for studying evolutionary changes in gene regulation, with differences in expression of pigmentation genes such as yellow that correlate with divergent pigment patterns among species shown to be caused by changes in cis- and trans-regulation. Currently, much more is known about the cis-regulatory component of divergent yellow expression than the trans-regulatory component, in part because very few trans-acting regulators of yellow expression have been identified. This study aims to improve our understanding of the trans-acting control of yellow expression by combining yeast-one-hybrid and RNAi screens for transcription factors binding to yellow cis-regulatory sequences and affecting abdominal pigmentation in adults, respectively. 45 of the 670 transcription factors included in the yeast-one-hybrid screen showed evidence of binding to one or more sequence fragments tested from the 5' intergenic and intronic yellow sequences from D. melanogaster, D. Pseudoobscura, and D. willistoni, suggesting that they might be direct regulators of yellow expression. 124 of the 670 transcription factors included in the yeast-one-hybrid screen, plus another TF previously shown to be genetically upstream of yellow, were also tested using RNAi, and 32 showed altered abdominal pigmentation. Nine transcription factors were identified in both screens, including four nuclear receptors related to ecdysone signaling (Hr78, Hr38, Hr46, Eip78C). This finding suggests that yellow expression might be directly controlled by nuclear receptors influenced by ecdysone during early pupal development when adult pigmentation is forming.

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Thyroid Autoimmunity in Euthyroid Women: No Effects on Early Reproduction but Confirmed Consistency for Risk of Miscarriage and Preterm Delivery.

Clinical Thyroidology Aug 2016, Vol. 28, No. 8: 226-228.

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Regulation of the MEI-1/MEI-2 Microtubule-Severing Katanin Complex in Early Caenorhabditis elegans Development

After fertilization, rapid changes of the Caenorhabditis elegans cytoskeleton occur in the transition from meiosis to mitosis, requiring precise regulation. The MEI-1/MEI-2 katanin microtubule-severing complex is essential for meiotic spindle formation but must be quickly inactivated to allow for proper formation of the mitotic spindle. MEI-1/MEI-2 inactivation is dependent on multiple redundant pathways. The primary pathway employs the MEL-26 substrate adaptor for the CUL-3/cullin based E3 ubiquitin ligase, which targets MEI-1 for proteosomal degradation. Here we use quantitative antibody-staining to measure MEI-1 levels to determine how other genes implicated in MEI-1 regulation act relative to CUL-3/MEL-26. The anaphase-promoting complex/cyclosome, APC/C, the DYRK (Dual-specificity tyrosine-regulated kinase), MBK-2, and the CUL-2 based E3 ubiquitin ligase act together to degrade MEI-1, in parallel to MEL-26/CUL-3. CUL-2 is known to keep MEL-26 low during meiosis, so CUL-2 apparently changes its target from MEL-26 in meiosis to MEI-1 in mitosis. RFL-1, an activator of cullin E3 ubiquitin ligases, activates CUL-2 but not CUL-3 for MEI-1 elimination. HECD-1 (HECT/Homologous to the E6AP carboxyl terminus domain) E3 ligase acts as a MEI-1 activator in meiosis but functions as an inhibitor during mitosis, without affecting levels of MEI-1 or MEI-2. Our results highlight the multiple layers MEI-1 regulation that are required during the switch from the meiotic to mitotic modes of cell division.

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Early Pregnancy Normal Serum TSH and Free FT4 Levels Changes Are Revisited at Weekly Intervals

Clinical Thyroidology Aug 2016, Vol. 28, No. 8: 221-225.

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An Inversion Disrupting FAM134B Is Associated with Sensory Neuropathy in the Border Collie Dog Breed

Sensory neuropathy in the Border Collie is a severe neurological disorder caused by the degeneration of sensory and, to a lesser extent, motor nerve cells with clinical signs starting between two and seven months of age. Using a genome-wide association study approach with three cases and 170 breed matched controls, a suggestive locus for sensory neuropathy was identified which was followed up using a genome sequencing approach. An inversion disrupting the candidate gene FAM134B was identified. Genotyping of additional cases and controls and RNAseq analysis provided strong evidence that the inversion is causal. Evidence of cryptic splicing resulting in novel exon transcription for FAM134B was identified by RNAseq experiments. This investigation demonstrates identification of a novel sensory neuropathy associated mutation, by mapping using a minimal set of cases and subsequent genome sequencing. Through mutation screening it should be possible to reduce the frequency of or completely eliminate this debilitating condition from the Border Collie breed population.

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Lower Serum TSH Concentrations within the Normal Range Do Not Improve General Health Status and Well-Being, Mood, or Memory

Clinical Thyroidology Aug 2016, Vol. 28, No. 8: 229-231.

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Both TIRADS and the ATA Guidelines Provide Effective Malignancy Risk Stratification for 
Thyroid Nodules

Clinical Thyroidology Aug 2016, Vol. 28, No. 8: 238-240.

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Collective Schema, As a New Concept Suggesting and a View to Proverbs from Cognitive Behavioral Point of View

Source: Journal of Cognitive-Behavioral Psychotherapy and Research
Cognitive Behavioral Tharapy doctrine and clinical accumulation have shown that there is a causal link between moods, paradigms, and assessments. These cognitive contents are named as automatic thoughts and schemas. Rational- adaptive automatic thoughts and schemas while bring to person good mood, irrational-maladaptive automatic thoughts and schemas bring to patology. On the other hand this cognitive structures have fed by accepted culture by society and components of this culture such as songs and proverbs which possess necessity and rules. The basic aim of this study is put forth concept of collective schema which will be assessable content in Cognitive Behavioral Approach , and clarifying bases of this concept deal with proverbs. In this sense, adaptive and maladaptive aspects of collective shema concept, have been commented, cognitive disortions which fed by maladaptive schemas deal with collective aspect, have been categorised and illustrated with proverbs. With this study we aimed create a groundwork for previous studies.

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Childhood Cancer Survivors Are at High Risk for Thyroid and Other Endocrine Disorders

Clinical Thyroidology Aug 2016, Vol. 28, No. 8: 232-234.

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Cross Talk between the TSH and IGF-1 Receptors Plays a Role in Causing Graves’ Orbitopathy

Clinical Thyroidology Aug 2016, Vol. 28, No. 8: 244-246.

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Source: Çocuk ve Gençlik Ruh Sağlığı Dergisi / Turkish Journal of Child and Adolescent Mental Health

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Anne-Babalar Neden Çocuklarının Dışadönük Olmasını İsterler ?! Bir Kitabın Çağrıştırdıkları

Source: Çocuk ve Gençlik Ruh Sağlığı Dergisi / Turkish Journal of Child and Adolescent Mental Health
Türkbay T..

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Britanya’da Çocuk Ve Ergen Psikiyatrisi Eğitimi Üzerine Serbest Çağrışımlar

Source: Çocuk ve Gençlik Ruh Sağlığı Dergisi / Turkish Journal of Child and Adolescent Mental Health

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Klinik Önemlilik Göstergesi Bir Ölçüt: NNT

Source: Çocuk ve Gençlik Ruh Sağlığı Dergisi / Turkish Journal of Child and Adolescent Mental Health

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Bilişsel Davranışçı Terapide Temel Kavramlar: Bir Teknisyen Olarak Terapistin Malzeme Çantasına Genel Bakış

Source: Çocuk ve Gençlik Ruh Sağlığı Dergisi / Turkish Journal of Child and Adolescent Mental Health

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Sleep Problems In Chıldren And Adolescents With Autism Spectrum Disorder

Source: Çocuk ve Gençlik Ruh Sağlığı Dergisi / Turkish Journal of Child and Adolescent Mental Health
Türkoğlu S.
Objective: Autism spectrum disorders (ASD) are heterogeneous neurodevelopmental disorders. Children and adolescents with ASD suffer from sleep problems, particularly insomnia, at a higher rate than typically developing children, ranging from 40% to 80%. Sleep disorders have a significant effect on daytime activities and quality life of the family. This review aimed to evaluate and discuss the prevalence, course, possible etiology and treatment of sleep problems in ASD. Method: In this paper, articles were searched from national and international databases to review theoretical knowledge related to sleep problems in ASD. Results: Sleep problems in ASD might occur as a result of complex interactions between biological, psychological, social/environmental, and family factors, including child rearing practices. The cornerstone of treatment should target the cause. . If behavioral interventions are not effective enough, pharmacological treatment options should be considered. Discussion: Clinicians should be aware of the fact that recognition and treatment of these neglected issues may improve the function and outcome of children with ASD.

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Catatonia in Adolescence Depression with Psychotic Features Outgoing Case

Source: Çocuk ve Gençlik Ruh Sağlığı Dergisi / Turkish Journal of Child and Adolescent Mental Health
Atar B, Kardaş Ö, Özbaran NB, Köse S, Bildik T..
Catatonia was first described by Kahlbaum. Previously catatonia was associated with psychiatric conditions such as schizophrenia (catatonic type), later on it was recognized in mood disorder and other mental disorders. Catatonia can also occur due to general medication conditions (endocrine disorders, electrolyte imbalances, neurological disorders, renal and hepatic dysfunction, and infections). Catatonia is categorized in schizophrenia and related disorders in DSM-5. Etiology of catatonia is not well explained. İt is suggested that catatonic symptoms are based on insufficiency of GABA (primary inhibitory neurotransmitter) in basal ganglia area. In this case report we will discuss acute onset of catatonia secondary to depressive symptoms. After differential diagnosis of catatonic symptoms with general medication conditions and other psychiatric diseases that can cause catatonia, we emerged out treatment on this case. The catatonic symptoms diminished with benzodiazepine treatment and we find out that catatonia was seconder to depression, and we added fluoxetine treatment for his depression, aripiprazole was also added in follow up period. In catatonia can be seen in adolescent period and we should keep in mind further by differential diagnosis of adolescents.

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Methylphenidate Use In The Presence of Attention Deficit Hyperactivity In Cases With Autism Spectrum Disorder: A Review

Source: Çocuk ve Gençlik Ruh Sağlığı Dergisi / Turkish Journal of Child and Adolescent Mental Health
Akyol Ardıç Ü, Ercan ES..
Objective: Attention deficit hyperactivity disorder (ADHD) and pervasive developmental disorders (PDD) are psychiatric disorders that constitute a substantial area in neurodevelopmental disorders of childhood, and have high rates of being comorbid with each other. PDDs are classified under the headline of Autism Spectrum Disorders (ASD) regarding current DSM-5 criteria. While having the diagnosis of ASD was among exclusion criteria for ADHD diagnosis in DSM-IV, DSM-5 has given the possibility of diagnosing ASD cases with ADHD. Research on treatment of ADHD in ASD cases that are a commonly encountered clinical situation, is ongoing. Methylphenidate (MPH) is the most studied agent in the treatment of ADHD,. Although studies so far have shown that MPH has favourable efficiency and safety profile, conflicting results have been obtained in studies about MPH treatment in ASD cases with ADHD comorbidity. Aim of this review was to summarize the current data in the literature regarding treatment of cases that have concurrent symptoms of ADHD and ASD while maintaining a possible directory for the management and treatment of these cases and their treatment that are classified under this headline, in the future. Method: A literature search was performed within the context of the aim of this and 6 placebo-controlled and 5 non-controlled clinical studies were found. These studies included the results from a total of 760 patients, where 193 were from controlled, and 567 from uncontrolled studies. Results: Among the total number of 11 studies, 640 patients were boys (84.2%), and 120 were girls (15.8%), and they were between 0 to 21 years of age. According to the findings, favourable response to MPH was obtained in cases diagnosed with ASD+ADHD from 10 studies. In these studies, improvements in ADHD symptoms such as attention deficiency, hyperactivity, impulsivity and oppositional defiant behaviour. However, some studies reported an increase in adverse effects. One remaining study reported that stimulants were tolerated poorly in patients with ASD, and this response was also varied among ASD subtypes. Conclusion: Even though psychostimulant therapy generally yields to positive outcomes in the treatment of ASD patients with ADHD comorbidity, reported increases in adverse effects suggest that more comprehensive randomized controlled studies about the treatment would be required in these patients.

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An Adolescent Case That Has Benefited From Use of Quetiapine For Tardive Dyskinesia

Source: Çocuk ve Gençlik Ruh Sağlığı Dergisi / Turkish Journal of Child and Adolescent Mental Health
Akça ÖF, Yılmaz S..
Tardive dyskinesia (TD) is an extrapyramidal hyperkinetic movement disorder characterized by involuntary choreoathetoid movements due to use of long-term antipsychotic medication. It is well known that clozapine has therapeutic effect on TD. However, reports indicating the effectiveness of other atypical antipsychotics are limited. There are few reports of substantial and rapid improvement in TD symptoms in adult patients with quetiapine in the literature, though no information on this matter had been yet published in children and adolescents up to this date. In this paper, we report an adolescent patient who developed TD during risperidone treatment, and gradual improvement of symptoms achieved within short term such as five weeks after quetiapine administration.

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Successful Outcome with Methylphenidate In Treatment of Kleine-Levin Syndrome: A Case Report

Source: Çocuk ve Gençlik Ruh Sağlığı Dergisi / Turkish Journal of Child and Adolescent Mental Health
Akyol Ardıç Ü, Ercan ES..
Kleine-Levin Syndrome (KLS) is characterized by hypersomnia, hyperphagia, and hypersexuality that is encountered mainly in male adolescents. Effective treatment modalities have not yet been established for both symptom control and recurrence prevention. This is a case report about a14year-old boy that had presented with KLS symptoms where osmotic release oral system-methylphenidate (OROS-MPH) yielded successful symptom control.

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Psychiatric Disorders Related with Childhood Epilepsy: A Case Report

Source: Çocuk ve Gençlik Ruh Sağlığı Dergisi / Turkish Journal of Child and Adolescent Mental Health
Ayvaz FB, Yurtbaşı P..
There is a strong association between epilepsy and psychiatric disorders, especially in childhood. We describe an 11-year-old boy who presented with extreme mood swings, anger outbursts, insomnia in addition to his long-term epilepsy, and discuss the diagnostic and treatment challenges of this case. A collaborative approach of neurology and psychiatry is necessary in pediatric epileptic cases, both to avoid misdiagnosis the psychiatric problems before they get more complicated and to identify most effective drug combinations earlier. This report also emphasizes the need for considering depot antipsychotics in the treatment of severe mood and behavior dysregulation related with epilepsy.

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Abstracts of the XXXVIII Congress of the Spanish Society of Physiological Sciences (SECF), 13-16 September 2016, Zaragoza, Spain

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3 things paramedics need to know about respiratory compromise, pneumonia and sepsis

Recognize the signs and symptoms of pneumonia and understand how capnography can be used to guide treatment for pneumonia and sepsis.

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3 things paramedics need to know about respiratory compromise, pneumonia and sepsis

Pneumonia is the leading cause of infectious death in industrialized countries [1]. According to the American Lung Association, there were more than one million hospitalizations for pneumonia in 2010 [2]. In 2013 there were 53,282 deaths from pneumonia and 16.2 billion dollars were spent to treat it [2].

Much of the morbidity, mortality, and health care costs associated with pneumonia occur when it progresses to sepsis. EMS plays an important role in identifying pneumonia, identifying sepsis caused by pneumonia and treating the respiratory and circulatory complications associated with pneumonia and sepsis.

Here are three things you should know about pneumonia and sepsis:

1. Pneumonia causes inflammation of a section of lung that impairs air exchange.
Pneumonia is caused by an immune response to pathogens that colonize an area of the lung. The inflammatory response causes fluid or pus to accumulate in the alveoli and prevents oxygen exchange over the area affected. Pneumonia can be caused by a bacterial, viral or fungal infection.

The most common route of pneumonia infection is aspiration of saliva or nasal secretions that harbor bacteria. Pneumonia can also be acquired from inhaling droplets containing a bacteria or virus. Streptococcus pneumoniae is the most common bacterial cause of pneumonia, while influenza and respiratory syncytial virus are the most common causes of viral pneumonia [1].

Immunocompromised patients are also at risk of pneumonia by inhaling fungal spores.

A remote infection, such as a urinary tract infection, or infection from an indwelling catheter or tracheostomy, can also travel to the lungs and cause pneumonia.

Aspiration of gastric contents is a non-infectious cause of pneumonia, which occurs when patients who cannot protect their upper airway vomit. Known as chemical pneumonitis, acidic gastric contents produce burning to the tracheobronchial tree when aspirated, followed by inflammation and impaired gas exchange in the lungs.

Elderly, immunocompromised patients, patients with chronic lung disease and smokers have an increased risk for pneumonia [1]. A depressed gag reflex, such as from alcohol intoxication, overdose, head injury, stroke or seizure increases the risk of aspiration pneumonia [3]. Patients whose upper airway is bypassed, such as from intubation or a tracheostomy, are also at high risk for aspiration pneumonia [1].

The severity of pneumonia from any cause depends on how much surface area of the lung is affected by inflammation, which is based on the virulence of the invading pathogen, the strength of the immune response and the patient's overall health [1].

2. Look for a gradual onset of difficulty breathing, fever and localized abnormal lung sounds to identify pneumonia.
Patients with pneumonia usually report a gradual onset of difficulty breathing, along with fever and chills, a productive cough and chest pain associated with the cough. Localized or unilateral crackles, rhonchi, wheezes or diminished breath sounds may be heard over the affected area of the lungs [1]. However, elderly and immunocompromised patients may not have a fever with infection. Cough reflex also diminishes with age, so elderly patients with pneumonia may not have a productive cough. Consider pneumonia as a differential diagnosis in elderly patients with vague complaints, such as altered mental status.

A definitive pneumonia diagnosis is made by chest X-ray in the hospital.

Pneumonia can cause hypoxia and increased work of breathing. Assess skin color and pulse-oximetry to identify hypoxia and administer oxygen via nasal cannula or nonrebreather mask to titrate a pulse oximetry reading of 94 percent.

For patients who are awake and protecting their airway, CPAP can improve work of breathing and oxygenation in patients who remain hypoxic after supplemental oxygen. CPAP works by increasing pressure in the lungs and improves oxygenation and ventilation across the area affected by pneumonia and recruits collapsed alveoli surrounding the affected area [4].

In addition to auscultating lung sounds, waveform capnography is a useful tool to identify bronchospasm in pneumonia. Patients with wheezes or diminished breath sounds, along with a slurred, shark fin appearance on the capnogram, have constricted lower airways and benefit from nebulized albuterol.

The more pronounced the shark fin on the capnograph, the more severe the bronchospasm. Shifts in the capnography waveform toward or away from a normal rectangular shape show how well the patient is responding to treatment.

Pneumonia can cause respiratory failure and decreased mentation. Patients may have secretions in their upper airway that require suctioning and require assisted ventilation with a bag valve mask.

Waveform capnography can be used with a bag valve mask or advanced airway to determine airway patency and effective air exchange in the lungs. Capnography is also the most reliable method to confirm advanced airway placement and provides continuous feedback on respiratory rate to help avoid hypo or hyperventilation.

Patients with pneumonia are also frequently dehydrated [1]. Consider administering IV fluids to suspected pneumonia patients who are hypotensive, feel weak, have dry mucus membranes or poor skin turgor.

3. Look for vital sign changes and abnormal ETCO2 to identify pneumonia with sepsis.
When the body's immune response to pneumonia becomes systemic and causes sepsis, the respiratory compromise may be further complicated by metabolic acidosis and shock. Sepsis is a systemic immune response that can progress to cause widespread vasodilation, fluid to leak out of the vascular space and microclots to form in small blood vessels, which leads to tissue hypoxia and organ failure.

Early identification, IV fluid administration and antibiotic administration are key to patient survival from severe sepsis. Many EMS systems are involved in sepsis alert programs to notify the hospital and streamline treatment similar to trauma, STEMIs and stroke systems.

For patients with suspected pneumonia, consider sepsis in patients with two or more of the following vital signs that suggest systemic inflammatory response syndrome (SIRS):

  • Pulse above 90
  • Respiratory rate above 20
  • Temperature above 38C (101F) or or below 36C (97F)

In addition to vital signs and physical exam, capnography has been shown to determine the severity of sepsis and predict mortality in patients with sepsis [5]. Tissue hypoxia leads to anaerobic metabolism, which causes metabolic acidosis. As the patient's respiratory rate increases to compensate for metabolic acidosis, excess CO2 is eliminated.

Normal end-tidal CO2 level is between 35 and 45 mm Hg. A study 201 adult patients in Orlando found that abnormal ETCO2 (above 45 mm Hg or below 35 mm Hg) in patients who meet SIRS criteria (from all causes) had a mortality rate six and a half times higher than those with normal ETCO2 levels. The authors also concluded that a persistent ETCO2 reading below 25 mm Hg correlated with an lactate level above 4 mmol/L, which is a blood test used to detect metabolic acidosis and organ dysfunction from severe sepsis [5].

For pneumonia patients, an abnormal ETCO2 level identifies patients who are at high risk for decompensation. In addition to managing respiratory problems associated with pneumonia, administer IV fluid boluses (20 to 30 ml/kg) to patients with suspected sepsis, even if they are not hypotensive. Abnormal ETCO2 with pneumonia also identifies pneumonia patients who should receive an urgent triage assignment in the emergency department.

A limitation to using capnography to detect sepsis is that patients with pneumonia may have an abnormal baseline ETCO2, especially if they have COPD (COPD patients were excluded from the Orlando study) [5]. Consider the patient's history and whether the capnogram has a shark-fin appearance when when using capnography to assess pneumonia patients who may have sepsis.

For pneumonia patients in respiratory failure, capnography should be used with caution to guide assisted ventilation rate. While waveform capnography has been used to avoid hyperventilation in intubated head injured patients, the ETCO2 of septic patients with pneumonia may be low before assisted ventilation [5,6]. Titrating assisted ventilation rate to the normal range of 35 to 45 mm Hg in pneumonia patients with sepsis may cause hypoventilation. Use feedback from capnography to ventilate pneumonia patients at 10 to 12 breaths per minute, but not to titrate a normal ETCO2 level.

EMS recognition and treatment of pneumonia and sepsis can have a significant effect on patient outcomes. Use history, physical exam and monitoring tools to identify pneumonia and sepsis, to guide treatment decisions and assess response to treatment.


1. Kamangar N, Harrington A, Byrd R. Bacterial pneumonia. Medscape. 2015, October 8. Retrieved from: http://ift.tt/2aYSOzx

2. American Lung Association. Trends in pneumonia and influenza morbidity and mortality. Epidemiology and Statistics Unit Research and Healthcare Education Division (2015, November). Retrieved from: http://ift.tt/2bzBFkc

3. Swaminathan A, Varkey B, Stearns D, Varkey A. Aspiration pneumonitis and pneumonia. Mediscape. 2016, July 1. Retrieved from: http://ift.tt/2aYTG7u

4. Cosentini R, Brambilla AM, Aliberti S, et al. Helmet continuous positive airway pressure vs. oxygen therapy to improve oxygenation in community-acquired pneumonia: A randomized, controlled trial. Chest. 2010; 138:114–120.

5. Hunter C, Silvestri S, Dean M, Falk J,Papa L. End-tidal carbon dioxide is associated with mortality and lactate in patients with suspected sepsis. American Journal of Emergency Medicine, 2013, 31(1), 64-71.

Davis DP, Dunford JV, Ochs M, et al. The use of quantitative end-tidal capnometry to avoid inadvertent severe hyperventilation in patients with head injury after paramedic rapid sequence intubation. Journal of Trauma 2004; 56(4):808-814.

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A Survey of Energy Drink Consumption Patterns Among College Students at a Mostly Hispanic University

Journal of Caffeine Research , Vol. 0, No. 0.

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A Survey of Energy Drink Consumption Patterns Among College Students at a Mostly Hispanic University

Journal of Caffeine Research , Vol. 0, No. 0.

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A Review of Radiation-Induced Coagulopathy and New Findings to Support Potential Prevention Strategies and Treatments

Radiation Research, Volume 186, Issue 2, Page 121-140, August 2016.

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Extracellular Vesicles and Vascular Injury: New Insights for Radiation Exposure

Radiation Research, Volume 186, Issue 2, Page 203-218, August 2016.

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Recombinant Thrombomodulin (Solulin) Ameliorates Early Intestinal Radiation Toxicity in a Preclinical Rat Model

Radiation Research, Volume 186, Issue 2, Page 112-120, August 2016.

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Radiation-Induced Microvascular Injury as a Mechanism of Salivary Gland Hypofunction and Potential Target for Radioprotectors

Radiation Research, Volume 186, Issue 2, Page 189-195, August 2016.

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Transplantation of Endothelial Cells to Mitigate Acute and Chronic Radiation Injury to Vital Organs

Radiation Research, Volume 186, Issue 2, Page 196-202, August 2016.

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Nuclear Countermeasure Activity of TP508 Linked to Restoration of Endothelial Function and Acceleration of DNA Repair

Radiation Research, Volume 186, Issue 2, Page 162-174, August 2016.

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Hemodynamic Flow-Induced Mechanotransduction Signaling Influences the Radiation Response of the Vascular Endothelium

Radiation Research, Volume 186, Issue 2, Page 175-188, August 2016.

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A Molecular Profile of the Endothelial Cell Response to Ionizing Radiation

Radiation Research, Volume 186, Issue 2, Page 141-152, August 2016.

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Understanding the Pathophysiology and Challenges of Development of Medical Countermeasures for Radiation-Induced Vascular/Endothelial Cell Injuries: Report of a NIAID Workshop, August 20, 2015

Radiation Research, Volume 186, Issue 2, Page 99-111, August 2016.

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Ionizing Radiation-Induced Endothelial Cell Senescence and Cardiovascular Diseases

Radiation Research, Volume 186, Issue 2, Page 153-161, August 2016.

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Test Post - PD

This is a test and will be closed on 8/16/2016. Please disregard. R, Lyons

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Succession planning: 5 keys to developing paramedic chiefs and EMS leaders

Succession planning is useful to develop personnel for all levels of leadership in your EMS agency.

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A salty tale: What EMS personnel need to know about electrolyte disorders

You may have wondered what the emergency department physician is looking for when she orders lab tests on a patient's electrolyte levels. The answer is fairly straightforward; without an adequate balance of electrolytes, the body is unable to perform many mission-critical functions. In fact, certain electrolyte imbalances can quickly become life-threatening.

While EMS providers generally are unable to determine electrolyte levels in the field, a careful analysis of the patient's presentation, coupled with a well-conducted history taking, can bring an electrolyte disorder to light.

Chemically, electrolytes are salts. They dissolve (or disassociate) in water to form electrically-charged ions. An ion that is positively (+) charged is called a cation; an ion that is negatively (-) charged is called an anion. For example, sodium chloride (NaCL) becomes sodium ions (Na+) and chloride anions (Cl-) when dissolved in water.

Electrolytes are essential to the conduction of the electrical pulses needed to control all living functions within the body. It is the amount and location of the cations and anions that allows energy to be conducted. Other essential life functions include the regulation of water within and outside the cells, muscle contraction and maintaining the general balance of the cell's operating environment.

Here are the key electrolytes for homeostasis, along with associated signs and symptoms when their levels are too high or too low.

Why sodium is important:
Sodium (Na+) is found mostly outside of cells. Its major role is to regulate the amount of water inside the body. As the kidney excretes sodium, water follows it, creating urine. Sodium is also a key electrolyte in creating electrical impulses both within and across cells, which allow a wide variety of functions to occur. This is critical for the brain, nervous system and muscles.

A normal lab value for sodium is 135–145 mEq/L.

When sodium levels get too high: Kidney disease, excessive water loss from massive diarrhea and vomiting, or too little water intake are the major causes of hypernatremia. Patients complain of excessive thirst. Tachycardia, anxiety and fatigue are other pertinent signs and symptoms. In severe cases of hypernatremia, altered mental status and seizures may occur.

When sodium levels get too low: Liver disease, some forms of kidney disease, congestive heart failure, burns and rarely overhydration can cause hyponatremia. Signs and symptoms include fatigue, nausea, vomiting, muscle spasms and weakness. Seizures may also occur in severe circumstances.

Why potassium is important:
Potassium (K+) is found mostly inside cells. It works in conjunction with sodium to propagate electrical signals in cells. Sodium-potassium pumps are embedded into the cell membrane, and work like pumps to keep levels of potassium high in the cell and sodium levels high in the surrounding interstitial space.

This creates a polarized electrical state across the cell's membrane. An electrical stimulus from a nearby cell triggers sodium and potassium channels to quickly open in sequence. This allows sodium to rush into the cell first, changing the cell's polarized state. Potassium then rushes out, dampening the effect.

This creates a depolarization of the cell, creating an electrical signal that triggers a wide range of effects, such as muscle contraction, hormones released from glands, and contraction of the heart. The sodium-potassium pumps then push the electrolytes back across the membrane, allowing the polarized state to exist again.

Normal lab values for potassium are 3.5–5.0 mEq/L.

When potassium levels are too high: Similar to sodium, the potassium levels are regulated by excretion through the kidneys. Patients with renal disease are at risk for developing hyperkalemia. Certain medications can also cause potassium levels to rise, such as potassium-sparing diuretics — spironolactone, triamterene), NSAIDs, ACE inhibitors and heparin.

Hyperkalemia is a potentially lethal condition that can manifest itself quickly. As levels rise, patients complain of muscle weakness, fatigue, numbness or tingling and nausea and vomiting. At high doses, bradycardia, hypotension and respiratory arrest. On an EKG, wide QRS complexes and unusually tall, peaked T waves can be seen.

When potassium levels are too low: Kidney disease, excessive vomiting or diarrhea, overuse of laxatives, excessive sweating, medications such as diuretics related to furosemide, beta-2 agonists such as albuterol, and certain antimicrobials such as penicillin can cause hypokalemia. Patients with hypokalemia may have symptoms similar to hyperkalemia, including weakness, fatigue, cramping and constipation. Lethal dysrhythmias appear as levels drop to dangerously low levels.

Why chloride is important:
Chloride (Cl-) is the major anion found mostly outside of the cell. Its major functions are to help keep fluid levels in balance and help to balance acidity levels.

Normal lab values for chloride are 98 - 108 mmol/L.

When chloride levels are too high: Hyperchloremia is more rare than hypernatremia and hyperkalemia. It usually results from major diarrhea, certain kidney diseases and occasionally from parathyroid gland disease. Patients may complain of headaches, nausea and fatigue. They may be tachypneic in order to compensate for the corresponding metabolic acidosis. In severe cases of hyperchloremia, hypotension and ventricular fibrillation may occur.

When chloride levels are too low: Hypochloremia can result from excessive sweating or urination. Vomiting can also cause chloride levels to fall, as well as adrenal gland disease. Patients may experience tetany (muscle spasms), muscle weakness, difficulty breathing and fever.

Why calcium is important:
Calcium (Ca2+) is the most common cation in the body, with most of it found in bone and teeth. It also has a critical function in conducting electrical signals, as well as muscle contraction and blood clotting.

Normal lab values for calcium are 9–11 mg/dL or (4.5–5.5 mEq/L).

When calcium levels are too high: Hypercalcemia primarily results from noncancerous tumors that cause parathyroid glands to over secrete their hormones. Cancer, certain medications like lithium, or ingesting excessive calcium supplements are other potential causes.

Signs of hypercalcemia can be organized according to the following mnemonic:

  • Moans: abdominal pain, nausea, constipation
  • Groans: lethargy, weakness, confusion and coma
  • Stones: polyuria, kidney stones, renal failure
  • Bones: bone aches and pains, fractures).

In severe cases, changes in the patient's EKG include a shortened QT interval associated with a shortened ST segment, flattened T waves and the presence of Osborn waves.

When calcium levels are too low: Hypocalcemia tends to occur most commonly in chronic and acute renal failure. Deficiencies in magnesium or vitamin D can also cause a drop in calcium levels, as well as hypoparathyroidism and acute pancreatitis. Severe cases of hypocalcemia include confusion, lethargy, muscle cramping or weakness and paresthesia.

Why phosphate is important:
Phosphorous is the second most abundant mineral in the body. The anion phosphate (HPO4-) is found mostly in the skeleton, along with calcium. However, it is a major component in adenosine triphosphate (ATP) production, the primary energy source for cells. It is also involved in cell reproduction and repair.

Normal lab values for phosphate are 2.4–4.7 mg/dL.

When phosphate levels are too high: Like other electrolytes, most cases of hyperphosphatemia result from some form of kidney disease. Excessive intake of phosphate is a less common cause. Hypoparathyroidism and metabolic or respiratory acidosis can cause phosphate levels to rise as well. Signs of hyperphosphatemia are similar to hypocalcemia, as the two conditions are often correlated.

When phosphate levels are too low: Hyperparathyroidism prevents the kidneys from retaining adequate levels of phosphate, as well as calcium, causing hypophosphatemia. Poor diet, especially related to alcoholism, can cause phosphate levels to drop. Hypophosphatemia can also be seen in patients being treated for diabetic ketoacidosis, or patients with respiratory alkalosis. Weakness, bone pain, rhabdomyolysis and altered mental status are the most common presenting features of persons with symptomatic hypophosphatemia.

Why is magnesium important:
Magnesium (Mg2+) plays a major role in maintaining normal function in the nervous system, muscle contraction, and cardiac physiology. It also is a major component of DNA and RNA synthesis as well as bone formation.

Normal lab values for magnesium are 1.8–3.0 mg/dL (1.5–2.5 mEq/L).

When magnesium levels are too high: Hypermagnesemia is usually due to kidney disease. Excessive intake, lithium therapy, hypothyroidism and Addison's disease are other less common causes. Severe cases of hypermagnesemia may be lethal, resulting in respiratory depression, failure or arrest, hypotension and cardiac arrest. Milder cases may result in lethargy, poor deep tendon reflexes, nausea or vomiting and skin flushing.

When magnesium levels are too low: Hypomagnesemia is often associated with alcoholism. Chronic diarrhea, burns, polyuria (excessive urination) and hypercalcemia can cause magnesium levels to fall. Patients may experience generalized weakness, muscle tremors, tetany parathesia and heart palpitations.

Electrolyte disorders: 4 Take home points
Differentiating electrolyte disturbances can be difficult in the field, with many overlapping signs and symptoms. Here are a couple of key points for patient assessment and treatment:

  1. Of the different disorders, hyperkalemia is the most significant one to be aware of. Patients with kidney disease, especially those requiring dialysis are at significant risk for hyperkalemia.
  2. Suspect an electrolyte disorder if the patient has had a period of prolonged nausea, vomiting and or diarrhea. Suspicions should rise if there is a history of renal disease.
  3. Unexplained weakness, muscle spasms and numbness or tingling may point to an electrolyte disturbance.
  4. An electrolyte imbalance may be the underlying cause in patients with altered mental status or reduced level of consciousness.

Finally, it is not the field provider's primary responsibility to identify the specific electrolyte disturbance. However, by paying attention to the history of the illness and some of the more subtle signs and symptoms, EMS providers can provide a more detailed report to emergency department personnel, alerting them to the possibility of an electrolyte imbalance emergency. Perhaps more importantly, recognizing that a severe electrolyte imbalance may exist can better prepare you to respond quickly if the patient suddenly takes a turn for the worse while in your care.

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Ill. paramedic: Delivering baby in ambulance is 'best feeling in the world'

By Hannah Leone
The Beacon-News

AURORA, Ill. — A 21-year-old woman was in labor.

It seemed like a routine dispatch to Aurora Fire Department Paramedic Chris Davison, who was among the first on the scene.

He helped get the woman into a cot and move her to an ambulance. From the home in the 100 block of Grove Street, they started driving toward Rush-Copley Medical Center in Aurora.

After a few minutes, it became clear the baby wasn't going to wait much longer, Davison said. The woman's contractions were becoming more frequent, according to fire officials.

Davison made the call.

"I told my partner we were going to have to stop," Davison said.

The ambulance driver pulled over to the side of the road, for safety.

Five paramedics and firefighters were in the ambulance, and they each took on different roles.

Davison's job, as the charge paramedic, was to deliver the baby.

"I wasn't so much nervous," Davison said. "Just kind of surprised."

He had helped with a delivery once before, about seven years ago, when he was a student in paramedic school.

"It's weird, it all just came back from school," Davison said. "Any of the training we had done or studying we do, it all kind of kicked back in."

Aurora Fire Department ambulances are all equipped with kits specifically for delivering babies, although it's unusual to need them, Davison said.

Davison has no children of his own. In his six years as a paramedic, this was the first time he's witnessed a woman giving birth on the way to the hospital.

"I've had people that have delivered before and after, bit it's rare that it would happen in the middle," he said.

But it did, and at 1:43 p.m. Tuesday, Davison delivered a boy to his mother.

"It was the best feeling in the world," Davison said.

The firefighters assessed the new mother and child. They dried the baby boy, made sure he was warm and gave him to his mother. Then they got back on the road and continued to the hospital.

As of Thursday afternoon, both mother and child were "doing fine," according to a statement from fire officials.

Copyright 2016 The Beacon-News

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Infudibulofolliculitis-A Case Raport

Source: Case Study and Case Report
Antigona Begolli Gerqari,,Mybera Ferizi, Sadije Halimi, Aferdita Daka, Syzana Hapciu, Ilir Begolli, Mirije Begolli, Idriz Gerqari.
Disseminated and recurrent infundibullofolliculitis is a very rare condition witch main signs are follicular papules that are often pruritic with a random localization on the neck trunk and limbs. The most affected population is black population, but there are cases reported in other ethnicities too. Ethyology of the disease is not defined but there are theories of familiar base, or constitution linked to atopic constitution. The treatment consists on a treatment with corticosterides, antibiotics tetracyclines specially, retinoides and in local treatment with local retinoids ,UVA therapy and local antibiotics. We present a case of a 38 years old white woman, with a 10 year history of the round alopecia with a central follicular papules and pustules, with a consequent atrophy of the skin. The skin problems where aggravated with permanent itching, the skin flashing and a filing of the burning skin. The patient was successfully treated with tetracyclines and corticosteroids and referred in a much better condition.

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On the capability to model the background and its uncertainty of CTBT-relevant radioxenon isotopes in Europe by using ensemble dispersion modeling


Publication date: November 2016
Source:Journal of Environmental Radioactivity, Volume 164
Author(s): Pieter De Meutter, Johan Camps, Andy Delcloo, Benoît Deconninck, Piet Termonia
Knowledge on the global radioxenon background is imperative for the Comprehensive Nuclear-Test-Ban Treaty verification. In this paper, the capability to simulate the radioxenon background from regional sources is assessed at two International Monitoring System stations in Europe. An ensemble dispersion modeling approach is used to quantify uncertainty by making use of a subset of the Ensemble Prediction System of the European Centre for Medium-Range Weather Forecasts. Although the uncertainty quantification shows promising results, the ensemble shows a lack of spread that could be attributed to emission uncertainty from nuclear power plants, which is not taken into account. More knowledge on the emissions of nuclear power plants can help improve our understanding of the radioxenon background.

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Radiocesium contamination in living and dead foliar parts of Japanese cedar during 2011–2015

Publication date: November 2016
Source:Journal of Environmental Radioactivity, Volume 164
Author(s): Toshihiro Yoshihara, Hideyuki Matsumura, Shin-nosuke Hashida, Ko Nakaya
Radiocesium (137Cs) activity concentrations, mainly derived from the Fukushima accident of March 2011, were measured in green foliar parts without separation by age (bulk green foliar parts; GL) and litterfall (LF) of Japanese cedar (Cryptomeria japonica) from 2011 to 2015. In all samples, 137Cs concentrations decreased exponentially over time, but were always higher in LF (7.36–0.58 Bq g-DW−1) than in GL (2.10–0.06 Bq g-DW−1). The difference in the decreasing rate between GL and LF would reflect a difference in the dominant factor of the decrease between living and dead tissues (i.e., internal translocation and weathering, respectively). Over this same timeframe, potassium (K) concentrations in both GL and LF experienced repetitive periodical changes within a certain range (0.38–3.0 mg g-DW−1 for LF and 2.08–4.77 mg g-DW−1 for GL, respectively). Thus, there was no specific correlation between 137Cs and K concentrations in LF and GL. However, analyses of the age classified green foliar parts (GL-S) and dead foliar parts still retained on trees (DL) could indicate another view. The annual changes in residual rates of both 137Cs and K concentrations in GL-S demonstrated very similar two-phase reductions (i.e., a faster reduction in each expansion year than in the following years) and an obvious linear correlation between each other. Radiocesium concentration in DL were always higher than in any part of GL-S sampled at the same timing, but K concentrations showed the reverse relation. It is probable that 137Cs is basically translocated from older parts to the developing parts (as long as the former are alive) via a seasonal nutritional flow of K; however, a part of 137Cs translocation would cease considerably earlier than the cessation of K translocation.

Graphical abstract


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