Σάββατο, 15 Οκτωβρίου 2016

Editorial Board

Publication date: September 2016
Source:Arab Journal of Gastroenterology, Volume 17, Issue 3





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Large-scale genome-wide scans do not support petaloid toenail as a Mendelian trait

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Publication date: Available online 14 October 2016
Source:Journal of Genetics and Genomics
Author(s): Manfei Zhang, Sijie Wu, Juan Zhang, Yajun Yang, Jingze Tan, Yu Liu, Haijuan Guan, Kun Tang, Jean Krutmann, Shuhua Xu, Li Jin, Yaqun Guan, Hui Li, Sijia Wang




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On the calculation of occlusal bite pressures for fossil hominins

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Publication date: Available online 15 October 2016
Source:Journal of Human Evolution
Author(s): Javier Ruiz, Juan Luis Arsuaga




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Side-by-side placement of bilateral endoscopic metal stents for the treatment of postoperative biliary stricture

Abstract

Postoperative biliary strictures are usually complications of cholecystectomy. Endoscopic plastic stent prosthesis is generally undertaken for treating benign biliary strictures. Recently, fully covered metal stents have been shown to be effective for treating benign distal biliary strictures. We present the case of a 53-year-old woman with liver injury in which imaging studies showed a common hepatic duct stricture. Endoscopic retrograde cholangiopancreatography also confirmed the presence of a common hepatic duct stricture. Temporally fully covered metal stents with dilated diameters of 6 mm were placed in a side-by-side fashion in the left and right hepatic ducts, respectively. We removed the stents 2 months after their placement. Subsequent cholangiography revealed an improvement in the biliary strictures. Although we were apprehensive about the fully covered metal stents obstructing the biliary side branches, we noted that careful placement of the bilateral metal stents did not cause any complications. Side-by-side deployment of bilateral endoscopic fully covered metal stents can be one of the safe and effective therapies for postoperative biliary stricture.



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Bøygard, Koma Heim

Music: Bøygard sisters. Lyrics: A girl who asked if she could use the phone. I just wondered if i could come home, -just for tonight ? The night-shelter is full, and in the basement of the station, -it`s cold and raw I just wondered mom, cos it`s still not to late, -and tonight i`m nearly clean I`v been sitting all day at Tøyen subway station, im cold into the marow? and the body is full of infections I have swollen upp in the face, so i can`t make anny money I`m just wondering, becouse tonight i`m nearly clean mom, I have swollen upp in the face, so i can`t make anny money Im ill and broke, and alone -mom I`m so tiered, i have not slept for several days all i need tonight is a bed i just wondered if i could come home im just wondering, -becouse tonight im nearly clean I`v been sitting all day at Tøyen subway station, Under construction .... ExEMTNor

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Oslo: the overdose capital of Europe

"Yes, we love this country." So begin the lyrics of the Norwegian national anthem. As a someone who is addicted to drugs, though, I have not felt much of this love from my country for as long as I can remember.My government has harassed, punished and chased me and the likes of me since we adopted the American War on Drugs nearly 50 years ago. During the last five years alone, the weakest and most isolated patient group in the country—people who use illegal drugs—have been fined for the total amount of 48 million Norwegian Kroner, something like $6 million, in Bergen and Oslo alone. People have been arrested for use and possession, and had their lives worsened and destroyed by a punitive regime in the name of good morals and policy.But not any more—if we to believe today's statement by Bent Høie http://ift.tt/2e7MOGp Radka Toneff: https://youtube/XtgIxU8TCyY

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Bøygard, Koma Heim

Music: Bøygard sisters. Lyrics: A girl who asked if she could use the phone. I just wondered if i could come home, -just for tonight ? The night-shelter is full, and in the basement of the station, -it`s cold and raw I just wondered mom, cos it`s still not to late, -and tonight i`m nearly clean I`v been sitting all day at Tøyen subway station, im cold into the marow? and the body is full of infections I have swollen upp in the face, so i can`t make anny money I`m just wondering, becouse tonight i`m nearly clean mom, I have swollen upp in the face, so i can`t make anny money Im ill and broke, and alone -mom I`m so tiered, i have not slept for several days all i need tonight is a bed i just wondered if i could come home im just wondering, -becouse tonight im nearly clean I`v been sitting all day at Tøyen subway station, Under construction .... ExEMTNor

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Oslo: the overdose capital of Europe

"Yes, we love this country." So begin the lyrics of the Norwegian national anthem. As a someone who is addicted to drugs, though, I have not felt much of this love from my country for as long as I can remember.My government has harassed, punished and chased me and the likes of me since we adopted the American War on Drugs nearly 50 years ago. During the last five years alone, the weakest and most isolated patient group in the country—people who use illegal drugs—have been fined for the total amount of 48 million Norwegian Kroner, something like $6 million, in Bergen and Oslo alone. People have been arrested for use and possession, and had their lives worsened and destroyed by a punitive regime in the name of good morals and policy.But not any more—if we to believe today's statement by Bent Høie http://ift.tt/2e7MOGp Radka Toneff: https://youtube/XtgIxU8TCyY

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Bøygard, Koma Heim

Music: Bøygard sisters. Lyrics: A girl who asked if she could use the phone. I just wondered if i could come home, -just for tonight ? The night-shelter is full, and in the basement of the station, -it`s cold and raw I just wondered mom, cos it`s still not to late, -and tonight i`m nearly clean I`v been sitting all day at Tøyen subway station, im cold into the marow? and the body is full of infections I have swollen upp in the face, so i can`t make anny money I`m just wondering, becouse tonight i`m nearly clean mom, I have swollen upp in the face, so i can`t make anny money Im ill and broke, and alone -mom I`m so tiered, i have not slept for several days all i need tonight is a bed i just wondered if i could come home im just wondering, -becouse tonight im nearly clean I`v been sitting all day at Tøyen subway station, Under construction .... ExEMTNor

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Oslo: the overdose capital of Europe

"Yes, we love this country." So begin the lyrics of the Norwegian national anthem. As a someone who is addicted to drugs, though, I have not felt much of this love from my country for as long as I can remember.My government has harassed, punished and chased me and the likes of me since we adopted the American War on Drugs nearly 50 years ago. During the last five years alone, the weakest and most isolated patient group in the country—people who use illegal drugs—have been fined for the total amount of 48 million Norwegian Kroner, something like $6 million, in Bergen and Oslo alone. People have been arrested for use and possession, and had their lives worsened and destroyed by a punitive regime in the name of good morals and policy.But not any more—if we to believe today's statement by Bent Høie http://ift.tt/2e7MOGp Radka Toneff: https://youtube/XtgIxU8TCyY

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Near miss in a patient with undiagnosed Brugada syndrome: a case report and literature review

Brugada syndrome is a rare genetic disorder mostly affecting young subjects without any underlying heart disease. Here we are describing 1 patient presented for gastric bypass surgery who had near cardiac arrest under general anesthesia for unknown reason. Postoperative investigation of this case revealed the diagnosis of Brugada syndrome.

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Oslo: the overdose capital of Europe

"Yes, we love this country." So begin the lyrics of the Norwegian national anthem. As a someone who is addicted to drugs, though, I have not felt much of this love from my country for as long as I can remember.My government has harassed, punished and chased me and the likes of me since we adopted the American War on Drugs nearly 50 years ago. During the last five years alone, the weakest and most isolated patient group in the country—people who use illegal drugs—have been fined for the total amount of 48 million Norwegian Kroner, something like $6 million, in Bergen and Oslo alone. People have been arrested for use and possession, and had their lives worsened and destroyed by a punitive regime in the name of good morals and policy.But not any more—if we to believe today's statement by Bent Høie http://ift.tt/2e7MOGp Radka Toneff: https://youtube/XtgIxU8TCyY

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Bøygard, Koma Heim

Music: Bøygard sisters. Lyrics: A girl who asked if she could use the phone. I just wondered if i could come home, -just for tonight ? The night-shelter is full, and in the basement of the station, -it`s cold and raw I just wondered mom, cos it`s still not to late, -and tonight i`m nearly clean I`v been sitting all day at Tøyen subway station, im cold into the marow? and the body is full of infections I have swollen upp in the face, so i can`t make anny money I`m just wondering, becouse tonight i`m nearly clean mom, I have swollen upp in the face, so i can`t make anny money Im ill and broke, and alone -mom I`m so tiered, i have not slept for several days all i need tonight is a bed i just wondered if i could come home im just wondering, -becouse tonight im nearly clean I`v been sitting all day at Tøyen subway station, Under construction .... ExEMTNor

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Paramedic & Critical Care Paramedics - Black River Falls Hospital

Black River Memorial Hospital has immediate openings in our Emergency Department for experienced Critical Care Paramedics. The positions are 24-36 hours per pay period, work 12 hours/on-call for 12 hours We offer a competitive salary and are committed to excellence in patient care. Consider joining us on our Journey to Excellence where we are not just about high tech, but also believe in small town ...

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A Rare Case of Invasive Pancreatitis in an Immunocompromised Host



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Increased Proliferative Activity Accompanies the Local Inflammatory Response of Gastric Mucosa After Intragastric Balloon Insertion

Abstract

Background and Aim

The use of BioEnterics intragastric balloon (BIB) is progressively increasing, owing to the fact that morbid obesity becomes a global epidemic together with risks of bariatric surgery. Yet, the possible local BIB effect on gastric mucosa is not clearly elucidated. The aim of the current study was to assess the histological changes occurring in the gastric mucosa post-BIB insertion.

Methods

Gastric mucosa biopsy was obtained from 87 cases of morbid obesity both pre-BIB and 6 months post-BIB insertion to compare the local changes by histological and immunohistochemical analysis.

Results

An inflammatory reaction was detected in the post-BIB mucosa which displayed a positive CD20, CD3 (p < 0.05), and the proliferation index (Ki67) increased significantly compared with that of the pre-BIB cases. The Ki67 index showed a significant positive correlation with CD20 and CD3 immunoexpression in the post-BIB gastric mucosae.

Conclusion

Our results demonstrated a possible increase in the gastric proliferative activity after BIB insertion accompanied with a remarkable local inflammatory reaction. Although these findings may be reactive and transient, endoscopic follow-up is recommended for early detection of further pathological changes.



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Correlation of fine needle aspiration cytology lymph node with histopathological diagnosis

2016-10-15T00-31-42Z
Source: International Journal of Research in Medical Sciences
Mohan Lal Gupta, Kaushtubh Singh.
Background: Lymphadenopathy is very common presenting symptoms. Fine needle aspiration cytology (FNAC) is used to evaluate the nature of the lesion. Etiology of lymphadenopathy in head and neck region vary from benign reactive hyperplasia to tubercular granulomatous lesion to malignancy. The aim of present study was to evaluate the sensitivity, specificity and predictive value in tuberculosis and metastatic carcinoma. Methods: A total of 80 patients out of 200 patients who underwent FNAC were evaluated by histopathological examination for correlation. Aspiration smears and histopathological slides were evaluated and results were calculated for sensitivity, specificity and predictive value. Results: Reactive lymphadenitis was seen in 40 patients followed by tubercular granulomatous lymphadenitis in 20 patients and malignant lesions in 20 patients. Histology revealed 18 patients of tubercular lymphadenitis, 43 of reactive changes, 12 of metastasis in lymph nodes and 7 of lymphomas. Correlating the findings, we could achieve 100% sensitivity and 96.7% specificity for tubercular lymphadenopathy and for metastatic it was 98.5% and 100% respectively. Conclusions: We have found FNAC a satisfactory tool in the diagnosis of tubercular and malignant lymphadenopathy. FNAC used in conjunction with clinical findings, radiological and laboratory investigations can be a cost effective method for the diagnosis of lymphadenopathy.


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Gender differences in fatigability and muscle activity responses to a short-cycle repetitive task

Abstract

Purpose

Epidemiological research has identified women to be more susceptible to developing neck–shoulder musculoskeletal disorders when performing low-force, repetitive work tasks. Whether this is attributable to gender differences in fatigability and motor control is currently unclear. This study investigated the extent to which women differ from men in fatigability and motor control while performing a short-cycle repetitive task.

Methods

113 healthy young adults (58 women, 55 men) performed a standardized repetitive pointing task. The task was terminated when the subject's perceived exertion reached 8 on the Borg scale. The time to task termination, and changes in means and cycle-to-cycle variabilities of surface electromyography signals from start to end of the task, were compared between women and men, for the upper trapezius, anterior deltoid, biceps and triceps muscles.

Results

Women and men terminated the task after 6.5 (SD 3.75) and 7 (SD 4) min on average (p > 0.05). All four muscles showed an increase of 25–35 % in average muscle activity with fatigue (no significant sex differences). However, men exhibited a higher increase than women in trapezius muscle variability with fatigue (31 vs. 7 %; p < 0.05), and a decrease in biceps muscle variability where women had an increase (−23 vs. 12 %; p < 0.05).

Conclusions

Our results suggest that women and men may not differ in the ability to perform repetitive tasks at low-to-moderate force levels. However, differences in motor control strategies employed in task performance may explain gender differences in susceptibility to developing musculoskeletal disorders when performing repetitive work for prolonged periods in occupational life.



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Blood oxygenation of masseter muscle during sustained elevated muscle activity in healthy participants

Abstract

Background

Myofascial pain associated with temporomandibular disorders has often been linked to pathological muscle hyperactivity. As a result, localized disturbances of intramuscular blood flow could lead to a lower level of oxygen distribution, hypoxia and microcirculatory changes.

Aim

To assess hemodynamic changes in the masseter muscle during sustained elevated muscle activity (SEMA).

Materials and Methods

Sixteen healthy participants performed thirty 1-minute bouts of SEMA with intervals of 1-minute "rest" periods between the bouts on a bite force transducer device. The participants completed three sessions with different percentage of their maximal voluntary occlusal bite force (MVOBF): 0% (no task), 10% or 40% MVOBF. The order of the sessions was randomized with 1-2 weeks intervals. Hemodynamic characteristics of the masseter muscle were estimated with use of a laser blood oxygenation monitor.

Results

Tissue blood oxygen saturation (StO2) during SEMA was lower than during rest (P < 0.001). The relative changes of total hemoglobin (TotalHb) and StO2 were influenced by condition (SEMA and rest) and with interactions between condition and session (0%, 10% and 40% MVOBF tasks).

Conclusions

These results suggest that SEMA may lead to hypoxia in the masseter muscle and that the hemodynamic characteristics and muscle symptoms depend on the magnitude of muscle contractions. Overall, the present findings may help to provide better insights into relationships between jaw muscle activity, hemodynamic changes and symptom developments with implications for clinical conditions such as bruxism characterized by different levels of tooth-grinding and tooth-clenching muscle activity.

This article is protected by copyright. All rights reserved.



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Prevalence of Malnutrition and Feeding Difficulties in Children With Esophageal Atresia.

Objectives: Growth and feeding problems have been described in children with Esophageal Atresia (EA). Ongoing gastrointestinal and respiratory complications such as Gastroesophageal Reflux Disease (GERD), esophageal dysmotility, strictures and respiratory infections may contribute. The aim of the study was to document the prevalence of malnutrition and feeding difficulties and examine predictive factors which may influence feeding and growth in children attending a multidisciplinary EA clinic in Sydney Australia. Methods: A retrospective review of 75 children, aged 0-16 years, who attended a multidisciplinary EA clinic between 2011 and 2014. Data on demographics, comorbidities, nutrition and mealtime behaviours were collected from their initial clinic appointment. Factors that may impact on growth and mealtime behaviours were identified and analysed. Results: Nine percent of children were malnourished and nine percent were stunted. Infants, children with prior fundoplication, at risk of aspiration or those who had surgery in the first year of life additional to EA repair were significantly more likely to be malnourished (p

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Liver Transplantation for Children with Primary Sclerosing Cholangitis and Autoimmune Hepatitis: UNOS Database Analysis.

Objectives: Autoimmune hepatitis (AIH) and primary sclerosing cholangitis (PSC) are progressive immune-mediated inflammatory diseases that may require liver transplant (LT). Outcomes in children undergoing LT for these diseases are poorly studied in the Pediatric End Stage Liver Disease (PELD) era. We aimed to characterize the outcome of LT in children with AIH and PSC. Methods: Children

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Preliminary Study of a Caregiver-based Infant and Child Feeding and Swallowing Screening Tool.

Objectives: The Infant and Child Feeding Questionnaire(C) (ICFQ(C)) was created to facilitate early detection of feeding and swallowing problems. This is achieved by promoting effective communication between caregivers and healthcare providers resulting in referral for evaluation and treatment of feeding and swallowing problems by specialists. The purpose of this pilot study was to determine whether items from the ICFQ(C) could be used to screen for differences between children with known (FP) and without known feeding problems (NFP). Methods: Caregivers of children 36 months of age or younger with FP and NFP were recruited to complete the ICFQ(C) and demographic questions. T-tests were completed to compare demographic characteristics of the research groups. Responses to ICFQ(C) items were analyzed using Receiver Operating Characteristic (ROC) analysis and odds ratios to determine if questionnaire items distinguished between study groups. Results: Sixty-four caregivers of children with FP and 57 caregivers of NFP children were recruited. Three participants in the NFP group did not meet inclusion criteria and were excluded from analysis. A combination of four ICFQ(C) questions distinguished between groups (ROC = .974). Significant odds ratios were also found for 9 feeding behaviors that distinguished between groups. Conclusions: A subset of items from the ICFQ(C) showed promise for distinguishing FP from NFP groups. Future work will expand the regional representation of the participant samples and obtain equal representation of participants across all age-adjusted questionnaires to determine whether the same combination of ICFQ(C) items continues to distinguish between FP and NFP groups. (C) 2016 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Rectal Suction Biopsy in Patients With Previous Anorectal Surgery for Hirschsprung Disease.

Objectives: 1. To determine rates of histologically positive, negative and inconclusive rectal suction biopsies in post-pull-through patients with Hirschsprung disease evaluated for potential residual aganglionosis at our institution. 2. To determine how patients were managed after a post-pull-through rectal suction biopsy. Methods: Thirty-nine post-pull-through suction biopsies from our institution were reviewed. Samples, stained with H&E and often acetylcholinesterase and/or calretinin, were categorized as "histologically" positive, negative or inconclusive for aganglionosis. Subsequent clinical action was categorized as bowel resection, no further procedure, or re-biopsy. Agreement between histologic diagnosis and clinical action was assessed. Results: Histologically, all biopsies were inconclusive (46%) or negative (54%) for residual aganglionosis. Post-biopsy clinical action included re-do pull-through (5%), no further procedure (59%), or re-biopsy (36%). Re-biopsy was sought in 2 of 21 histologically negative patients and in only 12 of 18 histologically indeterminate patients. Eventual re-do pull-through procedures in 6 of 39 patients showed 4 with residual aganglionosis and 2 with abnormalities suggesting residual "transition zone." Conclusions: Our findings show that suction biopsy after pull-through was frequently histologically indeterminate and never definitively positive for residual aganglionosis. When biopsy was histologically indeterminate, re-biopsy was pursued less commonly than might be expected. Our findings emphasize that suction biopsy examination is not a "gold standard" for residual aganglionosis, but instead a component of a diagnosis that ultimately combines clinicopathologic factors, the constellation of which can sometimes spare patients from a more invasive full-thickness biopsy. (C) 2016 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Human Milk Processing: A Systematic Review of Innovative Techniques to the Ensure Safety and Quality of Donor Milk.

Objectives: Pasteurization, performed at 62.5[degrees]C for 30 min (holder pasteurization), is currently recommended in all international human milk banks guidelines, but it affects some human milk bioactive and nutritive components. The present systematic review is aimed at critically reviewing evidence on the suitability of human milk processing techniques other than holder pasteurization, both thermal and non-thermal, to ensure microbiological safety, and on the effects of these techniques on biologically active donor milk components. Methods: Systematic review of English and non-English articles using Medline, Pubmed, Embase, SCOPUS and CAB Abstracts, with no restriction in publication date. Search terms included: human, breast, donor, or banked milk, breastmilk, breast fed, breastfed, breastfeed*; HTST, Flash, High Pressure, UV, ultrasonic or non-thermal; process* pasteuris* pasteuriz*. Only primary research articles published in peer-reviewed journals were included, providing or not a comparison with holder pasteurized human milk, provided that the pasteurization technique was clearly described, and not intended for domestic use. Additional studies were identified by searching bibliographies of relevant articles. Results: Twenty-six studies were identified as being relevant. Two examined both High Pressure Processing (HPP) and High Temperature Short Time (HTST) pasteurization; 10 only examined HPP; 10 only examined HTST; 2 articles examined UV irradiation; 2 articles examined (thermo-)ultrasonic processing. Conclusions: The results indicate that data about safety for microbiological control are still scarce for most of the novel technologies, and that consensus on processing conditions is necessary for non-thermal technologies, before any conclusions on the qualitative and nutritional advantages of these techniques can be drawn. (C) 2016 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Extra-intestinal Manifestations of Celiac Disease: Effectiveness of the Gluten Free Diet.

Objective: To evaluate the effectiveness of the GFD on extra-intestinal symptoms in pediatric and adult celiac populations at the University of Chicago (UofC). Methods: We conducted a retrospective chart review of the UofC Celiac Center clinic charts from January 2002 to October 2014. Demographics, serologic testing, intestinal biopsies, and extra-intestinal symptoms at presentation, 12, 24, and greater than 24 months were recorded. Extra-intestinal symptoms included: abnormal liver enzymes, arthralgia/arthritis, dermatitis herpetiformis (DH), alopecia, fatigue, headache, anemia, stomatitis, myalgias, psychiatric disorders, rashes, seizures, neuropathy, short stature, delayed puberty, osteoporosis and infertility. Results: A total of 737 patients with biopsy confirmed CeD or skin biopsy confirmed DH were included. Patients lost to follow up, or with insufficient data were excluded leaving 328 patients (157 pediatrics

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Yield of Endoscopy in Pediatric Gastroparesis.

Objectives: To quantify the diagnostic yield of upper endoscopy in children with gastroparesis and to develop a clinical model for gastroparesis using common symptoms and screening blood tests. Methods: We retrospectively reviewed charts of 196 patients aged 4-18yrs evaluated for gastroparesis between 2009 and 2013. All patients completed a standard solid-phase gastric emptying scan and upper endoscopy within a 12-month period. We analyzed gross and histologic endoscopy findings. Symptom-based data were collected on dyspeptic symptoms and classic "red-flag" symptoms. Results: Seventy patients with gastroparesis and 126 controls were included. Clinically significant endoscopic findings were noted in 35% of controls (44/126) and 43% of gastroparetics (30/70), P = 0.345. Concordance between gross and histologic findings was low at 50%. Histologic findings included gastritis 60% (17/28), esophagitis 39% (11/28), and duodenitis 7% (2/28). In univariate and multivariate analyses, there was no meaningful correlation between symptoms and/or screening laboratory values and diagnosis of gastroparesis. Conclusions: Clinically significant endoscopy findings were common in both controls and gastroparetics. As more than one third of patients had findings on endoscopy, we conclude that upper endoscopy remains an important part of the evaluation process of patients with dyspeptic symptoms and suspected gastroparesis. As gross abnormalities were frequently not present with histologic changes, routine biopsy is required. There was no association between studied symptoms and the presence of gastroparesis. A comprehensive evaluation of children with dyspeptic symptoms requires endoscopy with biopsy and solid-phase gastric emptying scan to determine the underlying diagnosis. (C) 2016 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Default Drug Doses in Anesthesia Information Management Systems.

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BACKGROUND: In the United States, anesthesia information management systems (AIMS) are well established, especially within academic practices. Many hospitals are replacing their stand-alone AIMS during migration to an enterprise-wide electronic health record. This presents an opportunity to review choices made during the original implementation, based on actual usage. One area amenable to this informatics approach is the configuration in the AIMS of quick buttons for typical drug doses. The use of such short cuts, as opposed to manual typing of doses, simplifies and may improve the accuracy of drug documentation within the AIMS. We analyzed administration data from 3 different institutions, 2 of which had empirically configured default doses, and one in which defaults had not been set up. Our first hypothesis was that most (ie, >50%) of drugs would need at least one change to the existing defaults. Our second hypothesis was that for most (>50%) drugs, the 4 most common doses at the site lacking defaults would be included among the most common doses at the 2 sites with defaults. If true, this would suggest that having default doses did not affect the typical administration behavior of providers. METHODS: The frequency distribution of doses for all drugs was determined, and the 4 most common doses representing at least 5% of total administrations for each drug were identified. The appropriateness of the current defaults was determined by the number of changes (0-4) required to match actual usage at the 2 hospitals with defaults. At the institution without defaults, the most frequent doses for the 20 most commonly administered drugs were compared with the default doses at the other institutions. RESULTS: At the 2 institutions with defaults, 84.7% and 77.5% of drugs required at least 1 change in the default drug doses (P =5% of use for that drug) were included in the most commonly administered doses at the other 2 institutions (P

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A Comparison Between the Conventional and the Laryngoscope-Assisted Lightwand Intubation Techniques in Patients With Cervical Immobilization: A Prospective Randomized Study.

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BACKGROUND: Positioning of a lightwand in the midline of the oral cavity can be challenging in patients with cervical immobilization. Direct laryngoscopy may permit the lightwand tip to more easily access the glottic opening. We tested our hypothesis that a laryngoscope-assisted lightwand technique allows more successful endotracheal intubation than does a conventional lightwand approach. METHODS: A total of 162 patients requiring cervical immobilization during intubation for cervical spine surgery were allocated randomly to 2 groups. The conventional lightwand technique (group C, n = 80) or the laryngoscope-assisted lightwand technique (group L, n = 82) was used for endotracheal intubation. In the group L, a Macintosh laryngoscope was inserted into the oral cavity, advanced until the epiglottis tip was visible, but not used to lift the epiglottis tip. The lightwand tip was placed below the epiglottis under direct view of the epiglottis tip. The primary outcome (the initial intubation success rate) and secondary outcomes (intubation time, hemodynamic changes, and postoperative airway complications) were evaluated. RESULTS: The initial intubation success rate was significantly lower (75% vs 89%; relative risk [95% confidence interval]: 1.2 [1.0-1.4]; P = .034) in group C than group L. The intubation time (22 +/- 13 vs 24 +/- 12 seconds; mean difference [98.33% confidence interval]: 2.4 [-2.3 to 7.2]; P = .217) did not differ between groups. Postoperative sore throat score, incidences of hypertension and tachycardia, postoperative oral mucosal bleeding, and hoarseness also did not differ between groups. CONCLUSIONS: Laryngoscope-assisted lightwand intubation did not increase intubation time, and it increased first attempt intubation rates compared with traditional lightwand intubation in patients requiring cervical immobilization for cervical spine surgery. (C) 2016 International Anesthesia Research Society

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Programmed Intermittent Epidural Bolus for Labor Analgesia During First Stage of Labor: A Biased-Coin Up-and-Down Sequential Allocation Trial to Determine the Optimum Interval Time Between Boluses of a Fixed Volume of 10 mL of Bupivacaine 0.0625% With Fentanyl 2 [mu]g/mL.

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BACKGROUND: Most studies that have compared programmed intermittent epidural bolus (PIEB) with continuous epidural infusion regimens have included patient-controlled epidural analgesia and/or manual bolus as rescue analgesia for breakthrough pain. Consequently, the optimal time interval between PIEB is yet to be determined. We designed a study to establish the optimal time interval between PIEB of 10 mL of bupivacaine 0.0625% with fentanyl 2 [mu]g/mL to produce effective analgesia in 90% of women during first stage of labor without breakthrough pain. METHODS: We conducted a double-blind sequential allocation trial with a biased-coin up-down design to obtain the effective interval 90% for the PIEB regimen. We included American Society of Anesthesiologists physical status 2-3 nulliparous women at term undergoing spontaneous or induced labor requesting epidural analgesia. An ultrasound-assisted epidural catheter placement was performed at L2/3 or L3/4. A test dose of 3 mL of bupivacaine 0.125% plus fentanyl 3.3 [mu]g/mL was followed by a loading dose of 12 mL of the same solution. PIEB was then started in women whose pain scores achieved Verbal Numerical Rating Score

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Fragmented Sleep Enhances Postoperative Neuroinflammation but Not Cognitive Dysfunction.

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BACKGROUND: Sleep is integral to biologic function, and sleep disruption can result in both physiological and psychologic dysfunction including cognitive decline. Surgery activates the innate immune system, inducing neuroinflammatory changes that interfere with cognition. Because surgical patients with sleep disorders have an increased likelihood of exhibiting postoperative delirium, an acute form of cognitive decline, we investigated the contribution of perioperative sleep fragmentation (SF) to the neuroinflammatory and cognitive responses of surgery. METHODS: The effects of 24-hour SF and surgery were explored in adult C57BL/6J male mice. The SF procedure started at 7 AM with cages being placed on a large platform orbital shaker that cycled every 120 seconds (30 seconds on/90 seconds off) for 24 hours. In separate cohorts, stabilized tibial fracture was performed either before or after the 24-hour SF procedure and assessed for systemic and hippocampal inflammation and cognition. RESULTS: SF-induced nonhippocampal memory dysfunction (mean +/- standard deviation [SD] of the difference in time spent between novel and familiar object for control was 4.7 +/- 1.4 seconds, n = 8 versus SF -0.5 +/- 0.2 seconds, n = 11, yielding an estimated treatment effect of 5.2 seconds [95% confidence interval {CI}, 2.6-7.7]; P

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Relationship Between Preoperative Evaluation Blood Pressure and Preinduction Blood Pressure: A Cohort Study in Patients Undergoing General Anesthesia.

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BACKGROUND: For outcomes research where changes in intraoperative blood pressure are a possible causative factor, it is important to determine an appropriate source for a reference value. We studied to what extent preinduction blood pressure values in the operating room differ from those obtained during preoperative evaluation outside the operating room. METHODS: Cohort study including 4408 patients aged 60 years or older undergoing noncardiac surgery. The outcome was the difference between the preinduction mean blood pressure (MBP) and the MBP obtained during preoperative evaluation. A difference of >=10 mm Hg was considered clinically relevant. A paired samples t test was used to estimate the difference. Linear regression was used to obtain estimates adjusted for patient characteristics, comorbidity, medications, type of surgery, and preoperative blood pressure. RESULTS: Complete data were available for 3660 (83%) patients. There were 2228 (61%) patients with a difference of >=10 mm Hg between the preinduction and preoperative MBP. The overall mean difference between both MBPs was 11 mm Hg (95% confidence interval, 10-11) with important variability among individuals. Patients with higher preoperative MBP values had smaller differences. After adjusting for patient characteristics, comorbidity, medications, type of surgery, and preoperative blood pressure, the difference decreased an estimated 5.0 mm Hg (95% confidence interval, 4.7-5.4) for every increase of 10 mm Hg in preoperative MBP. Patient characteristics, comorbidity, type of surgery, or medication were not strongly associated with the difference. CONCLUSIONS: The average preinduction blood pressure was higher than the preoperative blood pressure. This difference between the measurements can be explained by stress-induced effects and regression to the mean. To define an optimal reference value for research purposes or to arrive at a clinical perioperative blood pressure target, one should consider that there is important variability both within and between patients. (C) 2016 International Anesthesia Research Society

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