New drug targets for cholera therapy

Intestinal infection with Vibrio cholerae results in secretory diarrhea with potentially massive fluid losses and volume depletion. Morbidity and mortality associated with cholera remain a major problem in the developing world despite the success of oral rehydration therapy. New research aiming to inhibit cholera toxin binding to receptors in the intestine provides an attractive strategy for cholera therapy. Together with anti-secretory agents, including inhibitors of enkephalinase and of the cystic fibrosis transmembrane conductance regulator, new treatment options for managing severe diarrhea in cholera could soon be available.     

Longevity and Complication Rates of Ultrasound Guided Versus Traditional Peripheral Intravenous Catheters in a Pediatric Emergency Department

Background

Ultrasound-guided peripheral intravenous lines are frequently used in patients with difficult access. We have previously reported on the longevity and complication rates of ultrasound-guided peripheral intravenous lines, but there are limited data comparing outcomes of ultrasound-guided peripheral intravenous lines to traditionally placed peripheral intravenous lines in children. The aim of this study was to compare the longevity and complication rates of ultrasound-guided peripheral intravenous lines to traditionally placed intravenous lines in a pediatric population.

CFTR Inhibitors for Treating Diarrheal Disease

Secretory diarrhea remains a major health challenge worldwide. Excessive fluid secretion in the intestine caused by enterotoxins results in activation of luminal Cl(-) channels on enterocytes. The cystic fibrosis transmembrane conductance regulator (CFTR) protein is the major cyclic adenosine monophosphate (cAMP)-regulated Cl(-) channel activated in cholera as well as in diarrheas caused by other bacterial enterotoxins. Small-molecule screens have yielded CFTR inhibitors with half-maximal inhibitory concentration (IC(50)) values as low as 4 nmol/l. The data from proof-of-concept studies in animal models support the development of CFTR inhibitors for antidiarrheal therapy.     

Validating the food behavior questions from the elementary school SPAN questionnaire

BackgroundThe School Physical Activity and Nutrition (SPAN) questionnaire was developed as a surveillance instrument to measure physical activity, nutrition attitudes, and dietary and physical activity behaviors in children and adolescents. The SPAN questionnaire has 2 versions.ObjectiveThis study was conducted to evaluate the validity of food consumption items from the elementary school version of the SPAN questionnaire.DesignValidity was assessed by comparing food items selected on the questionnaire with food items reported from a single 24-hour recall covering the same reference period.Setting5 elementary schools in Indiana.ParticipantsFourth-grade student volunteers (N = 121) from 5 elementary schools.Main Outcome MeasureAgreement between responses to SPAN questionnaire items and reference values obtained through 24-hour dietary recall.AnalysisThe agreement between the questionnaire and the 24-hour recall was measured using Spearman correlation, percentage agreement, and kappa statistic.ResultsCorrelation between SPAN item responses and recall data ranged from .25 (bread and related products) to .67 (gravy). The percentage agreement ranged from 26% (bread and related products) to 90% (gravy). The kappa statistic varied from .06 (chocolate candy) to .60 (beans).Conclusions and implicationsResults from this study indicate that the SPAN questionnaire can be administered in the classroom quickly and easily to measure many previous day dietary behaviors of fourth graders. However, questions addressing consumption of “vegetables,” “candy,” and “snacks” need further investigation.     

Sitcom syncope: a case series and literature review of gelastic (laughter-induced) syncope

Syncope is a common complaint that is frequently evaluated without identifying a precipitating cause. Gelastic (laughter-induced) syncope is an uncommon and poorly understood condition. We describe 3 patients who experienced loss of consciousness during vigorous laughter. Each patient had an extensive medical evaluation, including a comprehensive history and physical examination, 12-lead electrocardiography, chest radiograph, routine blood analysis, polysomnography, tilt table testing, 2-dimensional transthoracic echocardiography, nuclear or echocardiographic stress testing, and 24-hour Holter monitoring. All 3 patients had an abnormal response to head-up tilt table testing, with either a significant decrease in systolic blood pressure or inappropriate heart rate response on achieving an upright position. These observations together with our review of the literature suggest that gelastic syncope may be a variant of vasodepressor syncope. Knowledge of this condition, its pathophysiology, and potential treatment options may be of value to clinicians when evaluating patients with unexplained loss of consciousness.     

Torsion of the normal fallopian tube in pregnancy.

Two cases of torsion of the normal fallopian tubes during the third trimester of pregnancy are presented. The etiology and clinical features of this complication are discussed. Although uncommon, it should be included in the differential diagnosis of abdominal pain in pregnancy.