When is an organ donor not an organ donor?

The Uniform Anatomical Gift Act (UAGA) grants any competent adult the legal right to designate whether he or she wishes to donate his or her organs for transplantation after death. However, contextual issues may interfere with organ donation by individuals who want to be organ donors. This case report describes a 58-year-old male who had properly documented his desire to donate his organs after his death, but was not allowed to be an organ donor because of his relatives' opinions. Ethical and legal aspects of the case are discussed.     

Fire extinguisher: an imminent threat or an eminent danger?

Acute phosphate toxicity following rectal administration of phosphate-containing preparations was documented earlier. However, acute phosphate toxicity due to inhalation of monoammonium phosphate (MAP) is rarely reported. The present report describes the systemic toxicity following intentional inhalation of MAP, a dry chemical powder present in fire extinguishers, in a 25-year-old healthy man with normal renal function resulting in hyperphosphatemia (11.0 mg/dL), hypocalcemia (ionized calcium, 1.18 mg/dL; total calcium, 3.6 mg/dL), hypomagnesemia (1.2 mg/dL), seizures, and 4 episodes of pulseless polymorphic ventricular tachycardia requiring defibrillation. In view of the easy accessibility of fire extinguishers and its likely use for suicidal or homicidal purposes, physicians and practitioners working in emergency departments should be aware of this entity. Early recognition, removal of phosphate by hemodialysis, and supportive care have prevented this case from acute phosphate nephropathy and further complications.     

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m based on 16-bits singlechip computer is presented. In the system, the capacity of driving load can be improved by employing robust current control technique and current prediction technique is adopted to shorten the dead time of current control, which     

Is prostacyclin an inodilator?

Intensive Care Medicine -     

Donor safety in an individualized plasmapheresis program – Results of an interim analysis

Background and objectivesAlthough plasma donation by plasmapheresis is generally considered to be safe, there are still concerns about the long-term effects of intensive plasma donation on the levels of certain blood components, such as immunoglobulin G (IgG). The IPS study aims to assess donor safety during individualized plasma donation according to pre-donation IgG levels and body weight compared with plasma donation under current German guidelines.Study design and methodsThis ongoing prospective multicenter study allows eligible donors to choose between an individualized plasma donation program or plasma donation according to current German guidelines. Adverse events (AEs), serious AEs (SAEs) and serum IgG levels are systematically documented for up to 12 years, with AE/SAE recording from study start until 8 months after the last donation on-study.ResultsAt data cut-off (30 th June 2019), 1,919,334 donations in 20,598 donors were documented. The donation-based incidence for all AEs/SAEs was 2.07% in the control group (n = 2155) and 2.22% in the individualized program group (n = 18,443). For related AEs/SAEs, incidences were 1.23% and 1.62%, respectively. Most AEs/SAEs were of mild or moderate severity; events related to venepuncture were most frequent (46.8%). The majority of withdrawals with known causes were due to non-medical reasons. After an initial drop, IgG levels remained stable for up to 10 years.ConclusionsThe results of this interim analysis showed no critical difference in donor safety between donors in an individualized program and those who donated according to current guidelines, supporting the concept of donor stratification by pre-donation IgG levels     

Hypertension 2005: an evidence-based approach to diagnosis and treatment – an American perspective

Midway into the first decade of the 21st century, evidence-based medicine has become the predominant methodology for the education and practice of medicine. In the ascent to this pre-eminent position, evidence-based medicine has challenged several methodologies through which medicine was taught and practiced throughout the 20th century, including the clinical anecdote, the concept that medicine is an art, the notion that the physician acts as the filter through which medical knowledge is individualized for the patient, and to some extent, the application of principles of pathophysiology to guide individual patient care. Indeed, it appears that in many cases, this mechanism-based approach to disease has been replaced by a broad strokes population-based approach based on outcomes research. However, as in the law, evidence is open to interpretation, varying opinion and nuance. Perhaps nowhere is this more evident than in the field of hypertension, which arguably can be credited with developing the field of evidence-based medicine with randomized clinical trials in the early 1960s and early adaptation and promotion of outcomes-based research, beginning with the first Joint National Committee report on prevention, detection, evaluation and treatment of high blood pressure in the 1970s. The purpose of this chapter is to review the evidence in the diagnosis and treatment of essential hypertension, focusing on the following areas. First, use of ambulatory and home blood pressure monitoring as diagnostic and prognostic tools; second, recent clinical trials in the treatment of essential hypertension that form the basis of evidence-based therapeutics; and third, presentation of the key features of the Joint National Committee (JNC) 7, which forms the current basis of treatment for essential hypertension.     

Does an aerobic endurance programme have an influence on information processing in migraineurs?

Background

Migraine is a disorder of central information processing which is characterized by a reduced habituation of event-related potentials. There might be positive effects of aerobic exercise on brain function and pain. The aim of this study was to investigate the influence of exercise on information processing and clinical course of migraine.

Methods

33 patients completed a ten-week aerobic exercise programme. To examine the influence of the treatment on information processing and attention, Trail Making Test (TMT) A and B, d2-Letter Cancellation Test (LCT) and recordings of the Contingent Negative Variation (CNV) were performed before and after the training.

Results

Patients showed a significant reduction of the migraine attack frequency, the iCNV-amplitude and the processing time for TMT-A and TMT-B after treatment. Moreover, there was a significant increase of the habituation and positive changes in parameters of attention (d2-LCT) after the training.

Conclusions

This study demonstrates that aerobic exercise programme influences central information processing and leads to clinical effects on the migraine symptomatology. The results can be interpreted in terms of an improvement of a dysfunctional information processing and a stimulus selection under aerobic exercise.     

Medical students’ perceptions of an emergency medicine clerkship: an analysis of self-assessment surveys

Introduction

An effective international response to a disaster requires cooperation and coordination with the existing infrastructure. In some cases, however, international relief efforts can compete with the local work force and affect the balance of health-care systems already in place. This study seeks to evaluate the impact of the international humanitarian response to the 12 January 2010 earthquake on Haitian health-care providers (HHP).

Methods

Fifty-nine HHPs were surveyed in August of 2010 using a modified World Health Organization Quality of Life-Brief questionnaire (WHOQoL-B) that included questions on respondents' workload before the earthquake, immediately after, and presently. The study population consisted of physicians, nurses, and technicians at public hospitals, non-governmental organization (NGO) clinics, and private offices in Port-au-Prince, Haiti.

Results

Following the earthquake, public hospital and NGO providers reported a significant increase in their workload (15 of 17 and 22 of 26 respondents, respectively). Conversely, 12 of 16 private providers reported a significant decrease in workload (p < 0.0001). Although all groups reported working a similar number of hours prior to the earthquake (average 40 h/week), they reported working significantly different amounts following the earthquake. Public hospital and NGO providers averaged more than 50 h/week, and private providers averaged just over 33 h/week of employment (p < 0.001). Health-care providers working at public hospitals and NGOs, however, had significantly lower scores on the WHOQoL-B when answering questions about their environment (p < 0.001), and in open-ended responses often commented about the lack of potable water and poor access to toilets. Providers from all groups expressed dissatisfaction with the scope and quality of care provided at public hospitals and NGO clinics, as well as disappointment with the reduction in patient volume at private practices.

Conclusions

The emergency medical response to the January 2010 earthquake in Haiti had the unintended consequence of poorly distributing work among HHPs. To create a robust health-care system in the long term while meeting short-term needs, humanitarian responses should seek to better integrate existing systems and involve local providers in the design and implementation of an emergency program.