Appropriateness,diagnostic value,and outcomes of repeat testing following index echocardiography

Aims

Emergency admission to hospital is associated with an economic burden and mortality. Echocardiography is often the first‐line cardiovascular imaging investigation. Repeat testing is common; however, there are sparse data on the prevalence, appropriateness, or outcome of repeat testing.

Methods

We performed an electronic database search for patients with emergency admissions to our institution in February 2015. An electronic patient record review of inpatient echocardiograms was undertaken. Indications for echocardiography were classified as appropriate, may be appropriate, or rarely appropriate. One‐year follow‐up for repeat testing and mortality was investigated.

Results

A total of 409 of 2306 (17.7%) unplanned/emergency admissions underwent inpatient echocardiography. Abnormalities were identified in 165/409 (40.3%) of these patients; 154 of 409 (37.7%) had a repeat echocardiogram within the next year. Rarely appropriate indications for echocardiography occurred in 51 (33%) of repeat vs 53 (16%) of index echocardiograms, P < .0001. Repeat testing was associated with a change in findings in 17/154 (11%) patients overall. All of whom had an abnormal index echocardiogram and had an appropriate indication. There was no difference in mean survival time between patients who underwent repeat and those who only underwent a single index echocardiogram (310 days vs 327 days), P = .34.

Conclusion

Inpatient echocardiography in emergency hospital admissions identifies clinically important pathology. Repeated testing is common within 1 year of hospital admission. New diagnostic findings occurred in 11% of patients and only in patients with appropriate studies and an abnormal index echocardiogram. Identification of methods to reduce repeat testing and implement appropriateness criteria is warranted.     

Metabolic response of Ephestia kuehniella Zeller (Lepidoptera: Pyralidae) to essential oil of Ajwain and thymol

The effects of Carum copticum essential oil (CC EO) and thymol were assayed against fourth instar of Ephestia kuehniella Zeller by determining insecticidal activities and enzymatic responses. Concentrations of 5.42 and 6.81?μl/ml were obtained as LC₅₀ values for CC EO and thymol, respectively. The activities of esterases, aminotransferases, aldolase, and lactate dehydrogenase significantly decreased in the treated larvae by CC EO and thymol. Significant increases in glutathione S-transferases, γ-glutamyl transferase, and phosphatases were observed after treatment. Results revealed that CC EO and thymol significantly influenced the enzymatic activities of E. kuehniella leading to disruption of survival and metabolic responses.     

Benign mesenchymal tumours and tumour‐like lesions in end‐stage renal disease

Aims: Mesenchymal neoplasms of the kidney are rare, and most represent sporadic angiomyolipomas. A few haemangiomas have been reported in end‐stage renal disease (ESRD) but, to date, no study has focused on the frequency and morphological spectrum of mesenchymal lesions in ESRD. Methods and results: We evaluated retrospectively 90 nephrectomy specimens with ESRD. Haemangiomas were detected in eight cases (8.8%; six males and two females; mean age: 55 years); four were multifocal and four had concurrent renal epithelial neoplasms. Lesions involved the medulla (three), cortex (two) or both (three), and the size range was 1–25 mm (mean 4.8 mm). Histologically, all were capillary haemangiomas with an at least focally detectable spleen‐like anastomosing pattern. All tumours stained positively for CD31 and FLI‐1, but none expressed pankeratin (KL‐1), podoplanin/D2‐40, HHV8 or GLUT‐1. Minute angiomyolipomas (mean size 2.3 mm) were detected in four patients (mean age 49.5 years). Tumour‐like smooth muscle proliferations were seen surrounding muscular arteries (eight), occasionally admixed with fat extending from the renal sinus mimicking angiomyolipoma. No similar tumours were found in 105 control kidneys. Conclusions: Benign haemangiomas are not uncommon in ESRD, but may be under‐recognized. They display distinctive morphology and should be distinguished from angiosarcomas and capillary‐rich renal cell carcinomas.     

Use of rating of perceived exertion for determining plyometric exercises intensity in physically active men

The purpose of this study was to use rating of perceived exertion (RPE) scale to evaluate popular bilateral plyometric exercise intensities. Fourteen physically active men (age 20.64 ± 1.4 years; height 176.93 ± 6.83 cm; weight 75.28 ± 11.1 kg) volunteered to participate in this study and performed a set of ten repetitions plyometric exercises to depth jump from 35 cm box, 35 cm box jump, depth jump from 60 cm box, 60 cm box jump, pike jump, tuck jump, and squat jump in a session with 5-min rest in between exercises. RPE was measured following the completion of each exercise using 0–10 Borg RPE scale. Data were analyzed using repeated measures ANOVA and the level of significant was set at p <0.05. The results indicated that squat jump was harder than other types of bilateral plyometric exercises such as 35 cm box jump, depth jump from 35 cm box, and tuck jump (p < 0.05). Moreover, the 35 cm box jump was easier than other plyometric exercises (p < 0.05). With regard to the results of this investigation, it can be recommended that athletes and strength and conditioning professionals use these findings to design plyometric training in their training schedule and keep in their mind that plyometric exercises have different intensities, however, the total volume was matched.     

Patterns of marriage and reproductive practices: is there any relationship?

Today, a transition from traditional to modern marriages can be observed in many countries. This shift in patterns of marriage has evidently affected childbearing and reproductive practices. This study aimed to examine the relationship between patterns of marriage and reproductive practices in Iran. Hence, 880 married women, aged 15–49 years old, living in the North of Iran were selected using a multi-stage cluster sampling strategy and their patterns of marriage and reproductive practices were cross sectionally studied. The results revealed that there were no significant differences in the reproductive practices by three main patterns of marriage in Babol, Iran. The study also indicated that there were no significant differences in reproductive practices in three patterns of marriage after controlling for socio-economic variables. It seems that apart from the patterns of marriage, other influencing factors are the determinants of fertility in women, and the policy-makers of Iran need to pay attention to these determinants before making any decisions in this area.     

Ensuring cultural sensitivity for Muslim patients in the Australian ICU: Considerations for care

Australia is a diverse and multicultural nation, made up of a population with a predominant Christian faith. Islam, the second largest religion in the world, has demonstrated significant growth in Australia in the last decade. Coming from various countries of origin and cultural backgrounds, Muslim beliefs can range from what is considered ‘traditional’ to very ‘liberal’.It is neither possible nor practical for every intensive care clinician to have an intimate understanding of Islam and Muslim practices, and cultural variations amongst Muslims will mean that not all beliefs/practices will be applicable to all Muslims. However, being open and flexible in the way that care is provided and respectful of the needs of Muslim patients and their families is essential to providing culturally sensitive care.This discussion paper aims to describe the Islamic faith in terms of Islamic teachings, beliefs and common practices, considering how this impacts upon the perception of illness, the family unit and how it functions, decision-making and care preferences, particularly at the end of life in the intensive care unit.