Stepwise rising CO2 insufflation as an ischemic preconditioning method

BACKGROUND: The pneumoperitoneum (Pp) is associated with ischemia and reperfusion (I/R) injury and oxidative stress. Various ischemic-preconditioning (IP) methods were used to reduce ischemic injury in intra-abdominal organs. In this experimental, randomized, controlled trial with a blind assessment of the outcome, we evaluated the effects of a new IP method, stepwise rising CO(2) insufflation, on oxidative stress and inflammatory cytokine response. METHODS: Twenty-one rats were divided into three groups. Rats in the control group were subjected to general anesthesia for only 60 minutes. The stepwise group was subjected to 5 mm Hg for 10 minutes, 10 mm Hg for 10 minutes, and 15 mm Hg of CO(2) insufflation for 60 minutes without deflation. In the Pp15 group, the pressure of CO(2) insufflation was fixed at 15 mm Hg for 60 minutes without deflation. Liver and blood samples were examined to determine malondialdehyde (MDA), the antioxidant, superoxide dismutase (SOD), and inflammatory cytokine (tumor necrosis factor-alpha [TNF-alpha], interleukin-6 [IL-6]) levels. Histopathologic scores of liver tissue were examined in all groups. RESULTS: The highest plasma and liver MDA, TNF-alpha, and IL-6 values were in the Pp15 group, followed by the stepwise and control groups. However, plasma and liver SOD levels determined in the control group were significantly higher, compared to stepwise and Pp15 groups. The lowest plasma and liver levels of SOD were in the Pp15 group, followed by the stepwise and control groups. Significantly higher histopathologic scores were found in the Pp15 group, followed by the stepwise and control groups, as well as MDA and inflammatory cytokine (TNF-alpha, IL-6) levels. CONCLUSIONS: We concluded that the stepwise rising CO(2) insufflation method may be an alternative IP method that may lead to a reduction in I/R injury.     

Adverse relationships of adiposity and gait parameters: A survey of stroke patients undergoing rehabilitation

Poor adiposities are risk factors for major morbidities, but reports on how these relate with gait function of stroke patients undergoing rehabilitation is sparse and need further investigation. A convenience sample of 94 ambulatory stroke survivors and 94 matched apparently healthy individuals were assessed for adiposity markers (body mass index, waist circumference, thigh girth, waist-hip ratio, and percent body fat) and gait parameters (cadence, step length, stride length, stride width, gait velocity, and cycle). Mean age of the stroke and apparently healthy participants were 57 ± 5.2 years and 56.9 ± 4.8 years, respectively. We found significant (p < 0.05) relationships between waist circumference and each of gait cycle (r = 0.67) namely, cadence (r = −0.68), stride length (−0.62), step length (−0.61), and gait velocity (−0.75). Fairly similar correlations existed between body mass index, waist-hip ratio, percent body fat, thigh girth, and each of gait parameters, with only the thigh girth significantly correlating with stride width (r = 0.79). Obesity more than triples the odds of low gait velocities (odds ratio: 3.28; 95% confidence interval: 1.60–6.74). Findings provide clinicians with likely influence of adiposities on gait parameters of stroke patients. This may inform treatment decision and help to prioritize interventions through adiposity management for stroke patients undergoing rehabilitation.     

Public attitudes toward organ donation

A survey of public attitudes toward organ donation and transplantation was conducted in a Turkish community. The 1030 subjects were chosen using a random, stratified method. Some 50.5% of those interviewed were willing to donate their organs while 33.7% refused and 15.8% were uncertain. A total of 53.6% said they would consent to donate a deceased relative's organs. Reasons for refusal to donate organs were as follows: fear that their body would be cut into pieces (43.8%), religious beliefs (26.2%), no reason (23.1%) and the belief that they would need their body and organs for their second life (6.9%). Attitudes toward organ donation were clearly related to level of education, age, sex, and socioeconomic status.     

Burden, features, and outcome of neurological involvement in acute falciparum malaria in Kenyan children

Context  Plasmodium falciparum appears to have a particular propensity to involve the brain but the burden, risk factors, and full extent of neurological involvement have not been systematically described. Objectives  To determine the incidence and describe the clinical phenotypes and outcomes of neurological involvement in African children with acute falciparum malaria. Design, Setting, and Patients  A review of records of all children younger than 14 years admitted to a Kenyan district hospital with malaria from January 1992 through December 2004. Neurological involvement was defined as convulsive seizures, agitation, prostration, or impaired consciousness or coma. Main Outcome Measures  The incidence, pattern, and outcome of neurological involvement. Results  Of 58 239 children admitted, 19 560 (33.6%) had malaria as the primary clinical diagnosis. Neurological involvement was observed in 9313 children (47.6%) and manifested as seizures (6563/17 517 [37.5%]), agitation (316/11 193 [2.8%]), prostration (3223/15 643 [20.6%]), and impaired consciousness or coma (2129/16 080 [13.2%]). In children younger than 5 years, the mean annual incidence of admissions with malaria was 2694 per 100 000 persons and the incidence of malaria with neurological involvement was 1156 per 100 000 persons. However, readmissions may have led to a 10% overestimate in incidence. Children with neurological involvement were older (median, 26 [interquartile range {IQR}, 15-41] vs 21 [IQR, 10-40] months; P<.001), had a shorter duration of illness (median, 2 [IQR, 1-3] vs 3 [IQR, 2-3] days; P<.001), and a higher geometric mean parasite density (42.0 [95% confidence interval {CI}, 40.0-44.1] vs 30.4 [95% CI, 29.0-31.8] x 10³/µL; P<.001). Factors independently associated with neurological involvement included past history of seizures (adjusted odds ratio [AOR], 3.50; 95% CI, 2.78-4.42), fever lasting 2 days or less (AOR, 2.02; 95% CI, 1.64-2.49), delayed capillary refill time (AOR, 3.66; 95% CI, 2.40-5.56), metabolic acidosis (AOR, 1.55; 95% CI, 1.29-1.87), and hypoglycemia (AOR, 2.11; 95% CI, 1.31-3.37). Mortality was higher in patients with neurological involvement (4.4% [95% CI, 4.2%-5.1%] vs 1.3% [95% CI, 1.1%-1.5%]; P<.001). At discharge, 159 (2.2%) of 7281 patients had neurological deficits. Conclusions  Neurological involvement is common in children in Kenya with acute falciparum malaria, and is associated with metabolic derangements, impaired perfusion, parasitemia, and increased mortality and neurological sequelae. This study suggests that falciparum malaria exposes many African children to brain insults.      

Health survey of residents living near farm fields permitted to receive biosolids

The authors studied the health status of residents living in Wood County, OH, near farm fields that were permitted to receive biosolids. They mailed a health survey to 607 households and received completed surveys from 437 people exposed to biosolids (living on or within 1 mile of the fields where application was permitted) and from 176 people not exposed to biosolids (living more than 1 mile from the fields where application was permitted). The authors allowed for up to 6 surveys per household. Results revealed that some reported health-related symptoms were statistically significantly elevated among the exposed residents, including excessive secretion of tears, abdominal bloating, jaundice, skin ulcer, dehydration, weight loss, and general weakness. The frequency of reported occurrence of bronchitis, upper respiratory infection, and giardiasis were also statistically significantly elevated. The findings suggest an increased risk for certain respiratory, gastrointestinal, and other diseases among residents living near farm fields on which the use of biosolids was permitted. However, further studies are needed to address the limitations cited in this study.     

Glomus tumours of the hand. About 10 cases

BACKGROUND: The glomus tumour is a rare benign cutaneous tumour, it is characterized by its clinical and evolutive particular features. AIM: The aim of this work is to bring out the various characteristics of the glomus tumours of the hand which remain relatively ignored by practioners. METHODS: The authors report a series of 10 cases of glomus tumours of the hand, the mean age at the moment of diagnosis was 36 years with a female prevalence of 70% of the cases. The diagnosis delay average was 2 years and half. The tumour was located on the right side in 6 cases and on the left one in 4 cases. The glomus tumour was developed under the nail in 8 cases and was latero pulpar in the both other cases. The diagnosis of glomus tumour was clinical in front of the existence of the three painful symptoms: spontaneous pain, pain on the cold and pain on the pressure. An RMI complement was carried out for two patients having no univocal symptomatology what made possible to confirm the diagnosis and to locate the tumour. A surgical biopsy of the tumour was performed for all patients. The histological study confirmed our clinical and per operational presumptions and showed a glomus tumour. RESULTS: After one year and two months of average retreat, our patients announced a spectacular transformation of their daily activities because of the disappearance of painful symptomatology, two cases of nail dystrophia were noted and there was no recurrence. CONCLUSION: The glomus tumour are rare benign cutaneous tumours, its diagnostic is essentially clinical and the treatment is exclusively surgical.