Incidence and Genetic Bases of Nitrofurantoin Resistance in Clinical Isolates of Two Successful Multidrug-Resistant Clones of Salmonella enterica Serovar Typhimurium: Pandemic “DT 104” and pUO-StVR2

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


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Small world brain network characteristics during EEG Holter recording of a stroke event

Several studies revealed that cerebral ischemia provokes transient or permanent disruption of functional connections both locally and distantly from the lesion. Recently, brain connectivity has been described using graph theory, a mathematical approach which depicts the brain as a network in order to simplify its complex topology. The human brain consists of complex inhibitory and excitatory circuits located in specialized areas, which are engaged in sharing and integrating information with a time-varying interplay at resolution in the millisecond range.

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Rethinking blinking: No cognitive modulation of reflex eye protection in early onset blindness

The neurological consequences of blindness have been widely studied. One area that has escaped attention however, is the effect of blindness on defensive reflexes that subserve the protection of vision. The hand-blink reflex (HBR) provides an excellent method to address this topic because the modulation of its brainstem circuitry has been clearly characterised, and it can be easily interrogated with non-invasive methods. The HBR is elicited by electrical stimulation of the median nerve at the wrist, and consists in a rapid contraction of the orbicularis oculi muscles, with a clear defensive value for the eyes (Valls-Solé et al.

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Y o u `r Payed to help, -or Hate ..?

Brenda Myers Powell "Dreamcatcher- A Story of Personal Strength" Posted on EMS1: Brian Pritt: ""I have heard people say that this demeans drug addicts and can hurt their feelings/pride... GOOD, nothing else seems to be working and this is a major problem in our area. Maybe a dose of reality might set in and make them think, maybe it will hurt their feelings and they get help, however if you think hurt feelings is the bigger issue, then obviously you have idea how bad it is! ! ! "" http://ift.tt/1ERoFM9 The film: https://youtube/RBHpJrSDWB4 Pink Floyd -"Hey You": https://youtube/TFjmvfRvjTc ... -It takes a village ..! Shot 5 times, stabbed 13... She`s a true heroine, IMHO ! I tip my hat... ExEMTNor

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Y o u `r Payed to help, -or Hate ..?

Brenda Myers Powell "Dreamcatcher- A Story of Personal Strength" Posted on EMS1: Brian Pritt: ""I have heard people say that this demeans drug addicts and can hurt their feelings/pride... GOOD, nothing else seems to be working and this is a major problem in our area. Maybe a dose of reality might set in and make them think, maybe it will hurt their feelings and they get help, however if you think hurt feelings is the bigger issue, then obviously you have idea how bad it is! ! ! "" http://ift.tt/1ERoFM9 The film: https://youtube/RBHpJrSDWB4 Pink Floyd -"Hey You": https://youtube/TFjmvfRvjTc ... -It takes a village ..! Shot 5 times, stabbed 13... She`s a true heroine, IMHO ! I tip my hat... ExEMTNor

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Decreased expression of the macrophage scavenger receptor MARCO is associated with tumour progression and poor prognosis in human hepatocellular carcinoma

Journal of Gastroenterology and Hepatology

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Interventions to optimize recovery after laparoscopic appendectomy: A scoping review

Surgical Endoscopy

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Higher incidence of HCV in females compared to males who inject drugs: A systematic review and meta-analysis

Journal of Viral Hepatitis

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Helicobacter pylori colonization and pregnancies complicated by preeclampsia, spontaneous prematurity, and small for gestational age birth

Helicobacter

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Role of HBsAg decline in patients with chronic hepatitis B HBeAg-negative and E genotype treated with pegylated-interferon

Antiviral Research

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Procalcitonin is a useful biomarker to predict severe acute cholangitis: A single-center prospective study

Journal of Gastroenterology

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Sorafenib combined with radio-frequency ablation compared with sorafenib alone in treatment of hepatocellular carcinoma invading portal vein: A Western Randomized Controlled Trial

Anticancer Research

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The clinical value of hepatic extracellular volume fraction using routine multiphasic contrast-enhanced liver CT for staging liver fibrosis

Clinical Radiology

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Impact of SPARC expression on outcome in patients with advanced pancreatic cancer not receiving nab-paclitaxel: A pooled analysis from prospective clinical and translational trials

British Journal of Cancer

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Feasibility of per-oral cholecystoscopy and advanced gallbladder interventions after EUS-guided gallbladder stenting (with videos)

Gastrointestinal Endoscopy

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Polymorphisms in microRNA binding sites of mucin genes as predictors of clinical outcome in colorectal cancer patients

Carcinogenesis

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Oncological impact of anastomotic leakage after laparoscopic mesorectal excision

British Journal of Surgery

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Effectiveness and safety of sofosbuvir plus ribavirin for HCV genotype 2 patients 65 and over with or without cirrhosis

Antiviral Research

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Risk of attenuated live vaccine-induced infection in infants of mothers receiving anti-tumor necrosis factor agents for inflammatory bowel disease

Gastroenterology

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Differences in microsatellite instability profiles between endometrioid and colorectal cancers

Journal of Molecular Diagnostics

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Benchmarks for the interpretation of esophageal high-resolution manometry

Neurogastroenterology & Motility

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Hepatitis C disease transmission and treatment uptake: Impact on the cost-effectiveness of new direct-acting antiviral therapies

The European Journal of Health Economics

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Patient perspectives about follow-up care and weight regain following sleeve gastrectomy

Obesity Surgery

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To assess the role of multisite instillation of bupivacaine-xylocaine combination for reducing post-operative pain after elective laparoscopic cholecystectomy

2016-11-03T02-25-19Z
Source: International Journal of Research in Medical Sciences
Jignesh A. Gandhi, Pravin H. Shinde, Pratik D. Patil, Samarth A. Thakkar, Rohan D. Digarse.
Background: Pain following laparoscopic surgery is multifactorial, arising from trocar sites (somatic pain), operative site (visceral pain) and shoulder pain (referred from diaphragmatic irritation because of pneumo-peritoneum). Currently no standard of care exists to reduce post-operative pain by use of local analgesia in laparoscopic cholecystectomy. Despite many studies, there are contradictory results. Aim of the study was to assess whether instillation of local anaesthetics at trocar sites and intraperitoneally, reduces the amount of pain experienced in the immediate postoperative period after laparoscopic cholecystectomy. Methods: This prospective study was carried out in the Department of General Surgery in a tertiary medical Centre in Mumbai. 75 subjects were randomized into 2 groups. Group A consisting of 38 patients were subjected to multisite instillation of LA combination (bupivacaine+xylocaine) at trocar site, gall bladder fossa, sub diaphragmatic space. Group B, (control group) consisting of 37 patients was given no such LA. Post operatively, pain was assessed by VAS scale (0-100) at 1,4,24 hours. Both the groups were compared and analysed. Results: Group A showed significantly reduced pain scores at 1, 4 and 24 hours post operatively as compared to group B. Conclusions: Our results indicate that multisite infiltration of local anesthetic combination (bupivacaine+xylocaine) after laparoscopic cholecystectomy surgery significantly reduces pain at 1, 4 and 24 hours postoperatively.


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Vitamin deficiency prevalence in primary school children in Punjab, India

2016-11-03T02-25-19Z
Source: International Journal of Research in Medical Sciences
Meenal Batta, Naveenta Gupta, Geetika Goyal, Amit Jain.
Background: Vitamin deficiencies are the conditions which are prevalent in the society and parents are unaware of them due to their asymptomatic nature. Overcoming this deficiency is integral in achieving the second Sustainable Development Goal charted out by the United Nations. Treatable and preventable nature of these conditions needs to be emphasized. Aims and objectives of the study were to study the prevalence of clinical features of vitamin deficiencies in primary school children. Methods: This single point cross sectional study was conducted in primary school children in Faridkot and comprised of students in the age group of 5-11 years. A total of 849 students were clinically examined. The clinical features of vitamin deficiencies were recorded. Descriptive analysis was used for interpretation. Results: Overall incidence of vitamin deficiency features was 18.96%. The features of vitamin A, B complex, C, and D deficiency were seen in 7.18%, 18.02%, 3.06% and 8.48% respectively. Some children have more than one deficiency features. Conclusions: The primary school children do suffer from vitamin deficiencies and there should be timely evaluation for these diseases. Larger studies substantiated with blood levels would provide more insight into these conditions.


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Study of gastrointestinal toxicity of selective COX-2 inhibitors in comparison with conventional NSAIDs

2016-11-03T02-25-19Z
Source: International Journal of Research in Medical Sciences
Hima Bindu K., Venkat Rao G..
Background: Adverse gastrointestinal events are the commonest unwanted effects of the NSAIDs, and are believed to result mainly from the inhibition of gastric COX-1, which is responsible for the synthesis of prostaglandins that normally inhibit acid secretion and protect the mucosa. Previous studies report, that selective COX-2 inhibitors are safer when compared to non-selective cyclooxygenase inhibitors, regarding their adverse effects on gastrointestinal system. But, recent studies reveal, that gastrointestinal safety of these selective COX-2 inhibitors is not much better than that of conventional NSAIDs. In view of the wider usage of selective COX-2 inhibitors, the study has been taken up to report, whether selective COX-2 inhibitors have got any advantages over conventional NSAIDs or not, in regard to their gastrointestinal side effects. Methods: Patients were divided into eight groups, fifteen patients of each. Each group was given one of the NSAIDs from the eight drugs those were selected for the study, for 15 days. In the selected group, along with the symptomatic assessment of gastric toxicity, both pre and post-treatment values of Hb% are estimated, tabulated & subjected to statistical analysis. Results: Both the drugs, diclofenac & meloxicam have shown significant changes in the Hb% values (p value 0.02 each), whereas selective COX-2 inhibitors like nimesulide & celecoxib were no less in gastric toxicity, in comparison with diclofenac, on symptomatic assessment. Conclusions: In our short-term study, selective COX-2 inhibitors did not show any advantage over non-selective NSAIDs regarding their gastrointestinal toxicity.


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Computed tomography guided fine needle aspiration cytology of thoracic lesions: 10 year experience of an interventional pulmonologist

2016-11-03T02-25-19Z
Source: International Journal of Research in Medical Sciences
Varinder Saini, Kranti Garg, Uma Handa, Surabhi Jaggi, Ravi Kumar Garg.
Background: Diagnosis of thoracic lesions may be challenging, due to various factors associated with the lesion and subsequent invasive investigations. Computed tomography guided fine needle aspiration cytology (CT-guided FNAC) is a minimally invasive method for thoracic lesions considered non approachable by other modalities. Methods: Retrospective analysis of patients subjected to CT-guided FNAC during year 2004 to 2014 was done. In these patients, non-invasive and invasive methods like fibre-optic bronchoscopy/ ultrasound guided FNAC were inconclusive/ expected to be inconclusive. Records were statistically analyzed for patient related, lesion related and procedure related factors, and their effect on yield and complications. Results: 435 patients underwent CT-guided FNAC. Age ranged from 10 to 95 years, with male preponderance. Diagnostic yield was 80.2%. Neoplastic lesions (255/435 (58.6%)) were most commonly diagnosed with majority (206/255 (80.8%)) being non-small cell lung cancer (NSCLC). This was followed by non-neoplastic lesions (94/435 (21.6%)) with Tuberculosis (42/94(44.7%)) being most common in this group. In 227/435 patients, other details like side and size of the lesion, position of patient during the procedure, depth of lesion from skin surface, number of passes undertaken and complications, if any, were also available. They were separately analyzed. Mean size of lesion was 5.7575 X 5.4173cms (maximum vertical X maximum horizontal diameter). Mean depth to which needle was inserted was 5.6663cms. Mean number of passes per patient were 1.98. Right sided lesions were more commonly sampled than left. Supine positioning was most commonly employed. Overall complication rate was 4% (9/227). Conclusions: CT-guided FNAC for thoracic lesions can serve as early diagnostic tool and guide in planning effective management strategies.


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Low dosage iron supplementation: the impact of hemoglobin levels and the side effect of non-anemic pregnant women in Denpasar city, Bali, Indonesia, 2016

2016-11-03T02-25-19Z
Source: International Journal of Research in Medical Sciences
Novia Arini, Sukma Adnyani.
Background: Nearly 95% of anemia in pregnancy is caused by iron deficiency. Iron tablet is recommended in pregnant women, but only 18% who consume iron tablet. One of the factors that influence compliance is the side effects such as constipation, nausea and vomiting. Pregnant women need additional iron supplementation of 30 mg / day, along with folic acid and vitamin C. Based on the above it is necessary to create Iron tablet formulations with low doses but can be optimally absorbed by the body. Methods: Randomized pre and posttest control group design. The inclusion criteria pregnant women 20-35 years, a distance of children ≥2 years, live in Denpasar city and the number of single fetus. Simple random sampling technique to determine the treatment group and the control group. The statistical test used in analyzing is the normality test, homogeneity, Chi-Square test and test the T-group. Results: During research of 44 respondents obtained the results of 44 (100%) are in a healthy reproductive age and no respondents were vegetarian. The analysis data with statistical test T-test, obtained no difference between low-dose iron supplementation and conventional doses of the hemoglobin of non-anemic pregnant women. Also showed that the low-dose iron supplementation can significantly lower incidence of side effects of iron supplementation in non-anemic pregnant women. Conclusions: The proper used of iron in the appropriate dose, will affect the effectiveness of absorption in the body and helps in reducing the side effects that arise from taking iron tablets during pregnancy.


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Determination of loss of consciousness: a comparison of clinical assessment, bispectral index and electroencephalogram: An observational study

BACKGROUND: Computer-processed algorithms of encephalographic signals are widely used to assess the depth of anaesthesia. However, data indicate that the bispectral index (BIS), a processed electroencephalography monitoring system, may not be reliable for assessing the depth of anaesthesia. OBJECTIVE: The aim of this study was to evaluate the ability of the BIS monitoring system to assess changes in the level of unconsciousness, specifically during the transition from consciousness to unconsciousness, in patients undergoing total intravenous anaesthesia with propofol. We compared BIS with the electroencephalogram (EEG), and clinical loss of consciousness (LOC) defined as loss of verbal commands and eyelash reflex. DESIGN: This was an observational cohort study. SETTING: University Hospital Linköping, University Hospital Örebro, Finspång Hospital and Kalmar Hospital, Sweden from October 2011 to April 2013. PATIENTS: A total of 35 ASA I patients aged 18 to 49 years were recruited. INTERVENTIONS: The patients underwent total intravenous anaesthesia with propofol and remifentanil for elective day-case surgery. Changes in clinical levels of consciousness were assessed by BIS and compared with assessment of stage 3 neurophysiological activity using the EEG. The plasma concentrations of propofol were measured at clinical LOC and 20 and 30 min after LOC. MAIN OUTCOME MEASURES: The primary outcome was measurement of BIS, EEG and clinical LOC. RESULTS: The median BIS value at clinical LOC was 38 (IQR 30 to 43), and the BIS values varied greatly between patients. There was no correlation between BIS values and EEG stages at clinical LOC (r = −0.1, P = 0.064). Propofol concentration reached a steady state within 20 min. CONCLUSION: There was no statistically significant correlation between BIS and EEG at clinical LOC. BIS monitoring may not be a reliable method for determining LOC. CLINICAL TRIALS REGISTRY: This trial was not registered because registration was not mandatory at the time of the trial.

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A severe complication after ultrasound-guided thoracic paravertebral block for breast cancer surgery: total spinal anaesthesia: A case report

No abstract available

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Postoperative nausea and vomiting: is everything now solved or still more questions than answers?

No abstract available

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Determination of the appropriate sizes of oropharyngeal airways in adults: correlation with external facial measurements: A randomised crossover study

BACKGROUND: Two external facial measurements have been recommended as reference criteria for estimating appropriate oropharyngeal airway sizes: the distances between the maxillary incisors to the angle of the mandible, and that from the corner of the mouth to the angle of the mandible. OBJECTIVE: To compare the two guidelines and to determine the optimal external facial measurements for the selection of an appropriately sized airway in adults. DESIGN: Randomised crossover study. SETTING: Operating theatres in a university hospital. PATIENTS: A total of 113 patients requiring tracheal intubation for general anaesthesia. INTERVENTIONS: Two oropharyngeal airway sizes were selected on the basis of two external facial measurements (tip of the upper central maxillary incisors to the angle of the mandible and corner of the mouth to the angle of the mandible). After assessing manual and pressure-controlled ventilation without an airway, the adequacy of ventilation with each oropharyngeal airway was assessed in a similar manner. Before changing the oropharyngeal airway, the view at the distal end of each airway was evaluated using endoscopy via a fibreoptic bronchoscope. MAIN OUTCOME MEASURES: Ventilation parameters and the endoscopic views at the distal ends of the airways were assessed. RESULTS: In the maxillary incisors to the angle of the mandible group, there was clear manual ventilation through the oropharyngeal airway in all patients, whereas partially obstructed ventilation was observed in 6% of patients in the corner of the mouth to the angle of the mandible group. In the maxillary incisors to the angle of the mandible group, mechanical ventilation through the oropharyngeal airway was adequate in all patients but in the corner of the mouth to the angle of the mandible group, inadequate ventilation was observed in 7% patients. In the maxillary incisors to the angle of the mandible group, the endoscopy did not identify any patient with complete obstruction of the airway by the tongue but in the corner of the mouth to the angle of the mandible group, 40% of patients had complete obstruction by the tongue. In the maxillary incisors to the angle of the mandible group, the tip of the airway passed beyond the tip of the epiglottis in 22% of patients, in contrast, none of the airways in the corner of the mouth to the angle of the mandible group passed beyond the tip of the epiglottis. CONCLUSION: With regard to adequate ventilation in conjunction with an acceptable endoscopic view, an oropharyngeal airway whose size is based upon the distance from the maxillary incisors to the angle of the mandible is more advantageous than if based upon the distance from the corner of the mouth to the angle of the mandible. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT01945411. The clinical trial was registered before patient enrolment.

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Recommended practice for out-of-hospital emergency anaesthesia in adults: Statement from the Out-of-Hospital Emergency Anaesthesia Working Group of the Emergency Medicine Research Group of the German Society of Anaesthesiology and Intensive Care

No abstract available

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Risk prediction instruments to guide perioperative care in elderly patients with advanced disease: A basic necessity

No abstract available

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Impact of a prophylactic combination of dexamethasone–ondansetron on postoperative nausea and vomiting in obese adult patients undergoing laparoscopic sleeve gastrectomy during closed-loop propofol–remifentanil anaesthesia: A randomised double-blind placebo-controlled study

BACKGROUND: In obese patients, the incidence of postoperative nausea and vomiting (PONV) following sleeve gastrectomy under titration of total intravenous anaesthesia (TIVA) and the relevance of risk factors to indicate prophylaxis is unknown. OBJECTIVES: The hypothesis was that after automated TIVA, prophylaxis reduces PONV following laparoscopic sleeve gastrectomy. Our objective was to determine the incidence of PONV and evaluate the efficacy of dexamethasone and ondansetron as prophylaxis when automated intravenous anaesthesia is employed. DESIGN: A randomised, placebo-controlled, single-centre, double-blinded study. SETTING: Secondary care centre in New Caledonia from June 2013 to January 2014. PATIENTS: A total of 122 patients were randomised and 117 (92 women) were included in the analysis (58 in the prophylaxis group and 59 in the placebo group). Eligibility criteria included at least two of the known risk factors for PONV: female sex, nonsmoking status, prior history of PONV or motion sickness and expected postoperative opioid analgesia. Exclusion criteria included disorders limiting the use of the bispectral index. INTERVENTIONS: All patients received propofol and remifentanil controlled by the same automated system during induction and maintenance of general anaesthesia. The controller modifies the calculated effect-site concentrations according to bispectral index values. Patients received either intravenous dexamethasone 4 mg after tracheal intubation and ondansetron 4 mg during skin closure, or placebo. MAIN OUTCOME MEASURES: The primary endpoint was the cumulative incidences of 24-h PONV and severe PONV (vomiting or nausea with a score of ≥4 on an 11-point verbal rating scale). Data are presented as percentage (95% confidence interval). RESULTS: PONV in the first 24 h occurred in 45 (34 to 60)% of patients who received prophylaxis and 54 (41 to 67)% in the placebo group (P = 0.35). The numbers of patients who suffered severe PONV [19 (10 to 32)% in the prophylaxis group vs. 20 (11 to 33)%, P = 1, in the placebo group] and who required rescue antiemetic drugs [55 (41 to 68) vs. 63 (49 to 75)%, P = 0.46] were similar between the groups. CONCLUSION: The combination of dexamethasone and ondansetron was not effective in preventing PONV or severe PONV in obese patients undergoing laparoscopic sleeve gastrectomy after TIVA. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT01876290.

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Effects of hyperventilation on cerebral oxygen saturation estimated using near-infrared spectroscopy: A randomised comparison between propofol and sevoflurane anaesthesia

BACKGROUND: Near-infrared spectroscopy estimates cerebral regional tissue oxygen saturation (rSO2), which may decrease under hyperventilation. Propofol and sevoflurane act differently on cerebral blood vessels. Consequently, cerebral blood flow during hyperventilation with propofol and sevoflurane anaesthesia may differ. OBJECTIVES: The first aim of this study was to compare the changes in rSO2 between propofol and sevoflurane anaesthesia during hyperventilation. The second aim was to assess changes in rSO2 with ventilation changes. DESIGN: A randomised, open-label study. SETTING: University of Yamanashi Hospital, Yamanashi, Japan from January 2014 to September 2014. PARTICIPANTS: Fifty American Society of Anesthesiologists physical status 1 or 2 adult patients who were scheduled for elective abdominal surgery were assigned randomly to receive either propofol or sevoflurane anaesthesia. Exclusion criterion was a known history of cerebral disease such as cerebral infarction, cerebral haemorrhage, transient ischaemic attack and subarachnoid haemorrhage. INTERVENTIONS: After induction of anaesthesia but before the start of surgery, rSO2, arterial carbon dioxide partial pressure (PaCO2) and arterial oxygen saturation were measured. Measurements were repeated at 5-min intervals during 15 min of hyperventilation with a PaCO2 around 30 mmHg (4 kPa), and again after ventilation was normalised. MAIN OUTCOME MEASURES: The primary outcome was the difference of changes in rSO2 between propofol anaesthesia and sevoflurane anaesthesia during and after hyperventilation. The second outcome was change in rSO2 after the initiation of hyperventilation and after the normalisation of ventilation. RESULTS: Changes of rSO2 during hyperventilation were −10 ± 7% (left) and −11 ± 8% (right) in the propofol group, and −10 ± 8% (left) and −9 ± 7% (right) in the sevoflurane group. After normalisation of PaCO2, rSO2 returned to baseline values. Arterial oxygen saturation remained stable throughout the measurement period. The rSO2 values were similar in the propofol and the sevoflurane groups at each time point. CONCLUSION: The effects of hyperventilation on estimated rSO2 were similar with propofol and sevoflurane anaesthesia. Changes in rSO2 correlated well with ventilation changes. TRIAL REGISTRATION: Japan Primary Registries Network (JPRN); UMIN-CTR ID; UMIN000010640

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Rhabdomyolysis and acute kidney injury: creatine kinase as a prognostic marker and validation of the McMahon Score in a 10-year cohort: A retrospective observational evaluation

BACKGROUND: High-volume fluid resuscitation and the administration of sodium bicarbonate and diuretics have a theoretical renoprotective role in patients at high risk of acute kidney injury (AKI) following rhabdomyolysis. Abnormally elevated creatine kinase has previously been used as a biological marker for the identification of patients at high risk of AKI following rhabdomyolysis. OBJECTIVE: To assess the sensitivity and specificity of plasma creatine kinase (admission and peak values) for the prediction of AKI requiring renal replacement therapy (RRT) or of death in patients with confirmed rhabdomyolysis. To compare the diagnostic performance of creatine kinase with the McMahon score. DESIGN: Retrospective observational study. Data collection included McMahon and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores; daily creatine kinase; daily creatinine and electrolytes; ICU length of stay and mortality. SETTING: Neurosciences and Trauma Critical Care Unit (Cambridge, UK). PATIENTS: In total, 232 adults with confirmed rhabdomyolysis (creatine kinase > 1000 Ul−1) admitted to Neurosciences and Trauma Critical Care Unit between 2002 and 2012. MAIN OUTCOME MEASURES: AKI, RRT and mortality. RESULTS: Forty-five (19%) patients developed AKI and 29 (12.5%) patients required RRT. Mortality was significantly higher in patients who developed AKI (62 vs. 18%, P 

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C-MAC videolaryngoscope compared with direct laryngoscopy for rapid sequence intubation in an emergency department: A randomised clinical trial

BACKGROUND: Airway management in the emergency room can be challenging when patients suffer from life-threatening conditions. Mental stress, ignorance of the patient's medical history, potential cervical injury or immobilisation and the presence of vomit and/or blood may also contribute to a difficult airway. Videolaryngoscopes have been introduced into clinical practice to visualise the airway and ultimately increase the success rate of airway management. OBJECTIVE: The aim of this study was to test the hypothesis that the C-MAC videolaryngoscope improves first-attempt intubation success rate compared with direct laryngoscopy in patients undergoing emergency rapid sequence intubation in the emergency room setting. DESIGN: A randomised clinical trial. SETTING: Emergency Department of the University Hospital, Zurich, Switzerland. PATIENTS: With approval of the local ethics committee, we prospectively enrolled 150 patients between 18 and 99 years of age requiring emergency rapid sequence intubation in the emergency room of the University Hospital Zurich. Patients were randomised (1 : 1) to undergo tracheal intubation using the C-MAC videolaryngoscope or by direct laryngoscopy. INTERVENTIONS: Owing to ethical considerations, patients who had sustained maxillo-facial trauma, immobilised cervical spine, known difficult airway or ongoing cardiopulmonary resuscitation were excluded from our study. All intubations were performed by one of three very experienced anaesthesia consultants. MAIN OUTCOME MEASURES: First-attempt success rate served as our primary outcome parameter. Secondary outcome parameters were time to intubation; total number of intubation attempts; Cormack and Lehane score; inadvertent oesophageal intubation; ease of intubation; complications including violations of the teeth, injury/bleeding of the larynx/pharynx and aspiration/regurgitation of gastric contents; necessity of using further alternative airway devices for successful intubation; maximum decrease of oxygen saturation and technical problems with the device. RESULTS: A total of 150 patients were enrolled, but three patients had to be excluded from the analysis, resulting in 74 patients in the C-MAC videolaryngoscopy group and 73 patients in the direct laryngoscopy group. Tracheal intubation was achieved successfully at the first attempt in 73 of 74 patients in the C-MAC group and all patients in the direct laryngoscopy group (P = 1.0). Time to intubation was similar (32 ± 11 vs. 31 ± 9 s, P = 0.51) in both groups. Visualisation of the vocal cords, represented as the Cormack and Lehane score, was significantly better using the C-MAC videolaryngoscope (P 

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Implementation of patient blood management remains extremely variable in Europe and Canada: the NATA benchmark project: An observational study

BACKGROUND: Preoperative anaemia is associated with increased postoperative morbidity and mortality. Patient blood management (PBM) is advocated to improve patient outcomes. OBJECTIVES: NATA, the 'Network for the advancement of patient blood management, haemostasis and thrombosis', initiated a benchmark project with the aim of providing the basis for educational strategies to implement optimal PBM in participating centres. DESIGN: Prospective, observational study with online data collection in 11 secondary and tertiary care institutions interested in developing PBM. SETTING: Ten European centres (Austria, Spain, England, Denmark, Belgium, Netherlands, Romania, Greece, France, and Germany) and one Canadian centre participated between January 2010 and June 2011. PATIENTS: A total of 2470 patients undergoing total hip (THR) or knee replacement, or coronary artery bypass grafting (CABG), were registered in the study. Data from 2431 records were included in the final analysis. MAIN OUTCOME MEASURES: Primary outcome measures were the incidence and volume of red blood cells (RBC) transfused. Logistic regression analysis identified variables independently associated with RBC transfusions. RESULTS: The incidence of transfusion was significantly different between centres for THR (range 7 to 95%), total knee replacement (range 3 to 100%) and CABG (range 20 to 95%). The volume of RBC transfused was significantly different between centres for THR and CABG. The incidence of preoperative anaemia ranged between 3 and 40% and its treatment between 0 and 40%, the latter not being related to the former. Patient characteristics, evolution of haemoglobin concentrations and blood losses were also different between centres. Variables independently associated with RBC transfusion were preoperative haemoglobin concentration, lost volume of RBC and female sex. CONCLUSION: Implementation of PBM remains extremely variable across centres. The relative importance of factors explaining RBC transfusion differs across institutions, some being patient related whereas others are related to the healthcare process. The results reported confidentially to each centre will allow them to implement tailored measures to improve their PBM strategies.

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Enhanced Recovery for Major Abdominopelvic Surgery

No abstract available

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