Complications associated with prolonged tourniquet application on the battlefield

The use of a tourniquet to control bleeding is a necessity in both surgical and prehospital settings. Tourniquet application, if performed properly, can be a lifesaving procedure, particularly in a traumatic setting such as the battlefield. A tourniquet is easily applied and requires the use of a relatively uncomplicated piece of equipment. However, improper or prolonged placement of a tourniquet because of poor medical training can lead to serious injuries, such as nerve paralysis and limb ischemia. Here we present five case reports of improper tourniquet applications on the battlefield that resulted in nerve damage. We conclude that there is a need for improved training among medical personnel in the use of tourniquets, as well as a need for an adjustable-pressure, commercial-type sphygmomanometer cuff with a large surface area that is appropriate for application to all limbs parts. We also recommend that, in cases requiring the use of a tourniquet, the caregiver remove the tourniquet every 2 hours and assess the bleeding; if the bleeding has stopped, then the tourniquet should be replaced with a pressure bandage to minimize tissue damage.     

Allergens from fish and egg

Allergens from fish and egg belong to some of the most frequent causes of food allergic reactions reported in the literature. Egg allergens have been described in both white and yolk, and the egg white proteins ovomucoid, ovalbumin, ovotransferrin and lysozyme have been adopted in the allergen nomenclature as Gal d1–d4. The most reported allergen from egg yolk seems to be alpha-livitin. In fish, the dominating allergen is the homologues of Gad c1 from cod, formerly described as protein M. A close cross-reactivity exists within different species of fish between this calcium-binding protein family, denominated the parvalbumins. This cross-reactivity has been indicated to be of clinical relevance for several species, since patients with a positive double-blind, placebo-controlled food challenge to cod will also react with other fish species, such as herring, plaice and mackerel. In spite of the importance of these two allergen systems, only a few studies have been performed, and the scarcity of cloned allergens from both of the systems is emphasized.     

Systemische Photoprotektion durch Karotinoide

Zusammenfassung Nahrungsergänzungsmittel werden in zunehmendem Maß zum Schutz der menschlichen Haut vor Umweltnoxen, insbesondere ultravioletter Strahlung propagiert. Im Handel erhältliche Sonnenschutzmittel zur endogenen Anwendung enthalten als wirksame Bestandteile Karotinoide, meist -Karotin. Bisher vorliegende Studien zur systemischen Anwendung von -Karotin als oralem Sonnenschutzmittel zeigen, dass nach einer Einnahme von 15–30 mg pro Tag über einen Zeitraum von etwa 10–12 Wochen Schutzeffekte erzielt werden können. Beobachtet wird eine verminderte Ausprägung des Erythems nach UV-Bestrahlung. Ähnliche Wirkungen werden nach Gabe von Gemischen verschiedener Karotinoide oder der kontinuierlichen Zufuhr karotinoidreicher Nahrungsmittel beobachtet. Die Einnahme von Karotinoiden erhöht den Grundschutz der Haut. Diese protektive Wirkung ist nicht ausreichend, um einen vollständigen Schutz bei starker Sonnenexposition zu gewährleisten. Hier sind zusätzliche Schutzmaßnahmen erforderlich.     

Insomnia, worry, anxiety and depression as predictors of the occurrence and persistence of paranoid thinking

Purpose

Our theoretical model proposes that insomnia, worry, and negative affect are important determinants of paranoid thinking. Anxiety produces anticipation of threat, depression increases the sense of vulnerability, worry leads to implausible ideas, and insomnia exacerbates negative affect and creates an altered perceptual state. The study objective was to examine for the first time these factors as predictors of the onset of new paranoid thinking and of the persistence of existing paranoid thinking.

Method

A total of 2,382 participants in the 2000 British National Psychiatric Morbidity Survey were followed-up 18?months after their first assessment. Baseline assessments were used to predict the development and persistence of paranoid thinking at follow-up. Data were weighted to be representative of the general household population.

Results

Insomnia, worry, anxiety, depression and depressive ideas were each substantial predictors both of new inceptions of paranoia and of the persistence of existing paranoid thinking. Worry and insomnia were the strongest predictors. For example, insomnia at the first assessment led to a more than threefold increase in later inceptions of paranoid thinking.

Conclusions

The study indicates that insomnia, worry, anxiety and depression are potential risk factors for new inceptions of paranoid thinking. The results also corroborate an emerging literature indicating that anxiety, worry and depression may encourage the persistence of paranoid thinking. The study provides the first longitudinal evidence linking insomnia and paranoia. The important clinical implication is that the use of interventions for common mental health difficulties in people with psychosis may have the additional benefit of reducing paranoia.     

Relation between hydration status in children and their dietary profile - results from the DONALD study

OBJECTIVE: To describe associations between hydration status and dietary behaviour in children, as current research indicates that hydration status is influenced by nutrition vice versa, hydration status may influence dietary behaviour. DESIGN: Cross-sectional analyses of data from the Dortmund Nutritional and Anthropometric Longitudinally Designed Study, (DONALD) using 24-h urine samples to determine the hydration status and 3-day weighed food records to describe the dietary profile of the children. SETTING: Secondary analyses of data from an observational study. SUBJECTS: A group of 4-11 year old children living in Dortmund, Germany; N=717. METHODS: Hydration status was determined by calculating the 'free water reserve', using analyses of the 24-h urine samples. Nutrient intake per day was calculated from the 3-day weighed food records. Children were categorized into groups of hydration status and analysed for significant differences in their dietary profile. RESULTS: Children in the highest group of the hydration status had significant higher total water intake, lower energy density of the diet and a lower proportion of metabolic water compared to children in the lowest group of the hydration status. In addition, analyses showed - although not significant in all subgroups - that better hydrated children consumed more water from beverages and water-supplying foods and less energy from fat. CONCLUSIONS: Euhydrated children, that are children in the highest group of hydration status, had a more preferable dietary profile than children at risk of insufficient hydration. SPONSORSHIP: Funding for the DONALD Study and its analyses is provided by the Ministry of Innovation, Science, Research and Technology of the State of North Rhine-Westphalia, Germany.     

Premenopausal overweight women do not lose bone during moderate weight loss with adequate or higher calcium intake

BACKGROUND: Weight loss is associated with bone loss, but this has not been examined in overweight premenopausal women. OBJECTIVE: The aim of this study was to assess whether overweight premenopausal women lose bone with moderate weight loss at recommended or higher than recommended calcium intakes. DESIGN: Overweight premenopausal women [n = 44; x (+/-SD) age: 38 +/- 6.4 y; body mass index (BMI): 27.7 +/- 2.1 kg/m(2)] were randomly assigned to either a normal (1 g/d) or high (1.8 g/d) calcium intake during 6 mo of energy restriction [weight loss (WL) groups] or were recruited for weight maintenance at 1 g Ca/d intake. Regional bone mineral density and content were measured by dual-energy X-ray absorptiometry, and markers of bone turnover were measured before and after weight loss. True fractional calcium absorption (TFCA) was measured at baseline and during caloric restriction by using a dual-stable calcium isotope method. RESULTS: The WL groups lost 7.2 +/- 3.3% of initial body weight. No significant decrease in BMD or rise in bone turnover was observed with weight loss at normal or high calcium intake. The group that consumed high calcium showed a strong relation (r = 0.71) between increased femoral neck bone mineral density and increased serum 25-hydroxyvitamin D. No significant effect of weight loss on TFCA was observed, and the total calcium absorbed was adequate at 238 +/- 81 and 310 +/- 91 mg/d for the normal- and high-calcium WL groups, respectively. CONCLUSION: Overweight premenopausal women do not lose bone during weight loss at the recommended calcium intake, which may be explained by sufficient amounts of absorbed calcium.     

Assessing emerging technologies--the case of organ replacement technologies: volume, durability, cost

OBJECTIVES: The aim of this study was to estimate thresholds for production volume, durability, and cost of care for the cost-effective adoption of liver organ replacement technologies (ORTs). METHODS: We constructed a discrete-event simulation model of the liver allocation system in the United States. The model was calibrated against UNOS data (1994-2000). Into this model, we introduced ORTs with varying durability (time to failure), cost of care, and production volume. Primary outputs of interest were time to 5 percent reduction in the waiting list and time to 5 percent increase in expected transplant volume. RESULTS: Model output for both calibration and validation phases closely matched published data: waiting list length (+/-2 percent), number of transplants (+/-2 percent), deaths while waiting (+/-5 percent), and time to transplant (+/-11 percent). Reducing the waiting list was dependent on both ORT durability and production volume. The longer the durability, the less production volume needed to reduce the waiting list and vice versa. However, below 250 ORT/year, durability needed to be >2 years for any significant change to be seen in the waiting list. For base-case costs, all ORT production volume and durability scenarios result in more transplants per year at less total cost of care/patient than the current system. ORTs remain cost saving until manufacturing costs are >5 times base-case costs, production is less 500 ORT/year, and durability <6 months. CONCLUSIONS: Although there remain many technical challenges to overcome, as long as ORTs can meet these threshold criteria, they have the potential of transforming the world of end-stage liver disease.     

A randomized, double-blinded, placebo-controlled oral challenge study to evaluate the allergenicity of commercial, food-grade fish gelatin

Background. Recent interest in the labeling of foods and food proteins derived from allergenic sources necessitates determination of the potential allergenicity of such food ingredients. Fish gelatin is extracted from the skin of fish species known to elicit allergic reactions in sensitized individuals.

Objective. To determine the allergenicity of fish gelatin by double-blinded, placebo-controlled food challenges (DBPCFC) in clinically fish-allergic individuals.

Methods. Thirty fish-allergic patients diagnosed according to the EAACI Guidelines were included (age 9–50 years). Skin prick tests (SPT) and Histamine Release tests (HR) were performed with fish gelatin and codfish, and codfish-specific IgE was measured. All patients underwent DBPCFC with a cumulative dose of 14.61 g fish gelatin.

Results. In all 30 patients SPT, HR, and specific IgE to codfish were positive. SPT and HR with fish gelatin were positive in 3/30 and 7/30, respectively. One patient showed mild reaction to placebo and no reaction to the active challenge. Two patients reported mild subjective reactions to active challenge. Upon re-challenge one of them described subjective symptoms again to the active challenge (7.61 g cumulated dose of fish gelatin) with no reaction to placebo, while the other experienced very mild subjective symptoms to placebo and nothing to the active. The proportion of truly sensitive patients was estimated to 0.03 in the total study group.

Conclusion. None of 30 fish allergic patients reacted adversely to the ingestion of 3.61 g cumulative dose of fish gelatin. In this study fish gelatin presents no risk to fish-allergic patients at the doses typically used. Statistically, these results indicate that there is 95% certainty that 90% of fish-allergic consumers will not react to ingestion of a 3.61 g cumulative dose of fish gelatin.