Bowel management in the intensive care unit

The area of bowel care in the intensive care unit (ICU) is often overlooked in the holistic care of the critically ill individual. With the primary concern of optimising patients to preserve life the problem of bowel care has been given less priority. The guidelines included within this service improvement paper offer a simple approach to bowel care management with the use of an algorithm and visual display score to be used in conjunction with the algorithm. This was developed in the intensive care unit of the Royal Free Hospital, London and is presently in use.     

The predisposing factors of pericoronitis of mandibular third molars in a Jordanian population.

OBJECTIVES: The purpose of this study was to identify the most frequently encountered predisposing factors in relation to the etiology of pericoronitis in young adults and to compare these findings with similar studies. METHOD AND MATERIALS: The patients included in this prospective study were those presenting for treatment of signs and symptoms of pericoronitis in the mandibular third molar area during an 8-year period from 1994 to 2001. A standard check sheet of subjective and objective observations was completed, and female patients were asked about menstruation or pregnancy. Each patient with a diagnosis of pericoronitis was interviewed and observations were recorded. Patients were asked about the symptoms relating to the pericoronitis. Patients were divided into five 5-year age groups ranging from 16 to 40 years. RESULTS: During the 8-year period, 2,151 patients presented diagnosed cases of pericoronitis; 932 (43.3%) patients were male and 1,219 (56.7%) were female. The peak age of occurrence of pericoronitis varied from 21 to 25 years (55.2% of the patients). The incidence of pericoronitis was highest in September (207 [9.6%]), followed by April (181 [8.4%]); for subacute pericoronitis, the highest was in February (128 [5.95%]) and April (112 [5.2%]), followed by October (97 [4.5%]). The most frequently seen predisposing factor was upper respiratory tract infection in 815 (37.9%) patients, followed by stress in 473 (22%) patients. CONCLUSION: It was concluded that the upper respiratory tract infection was the most frequently predisposing factor, which could precipitate pericoronitis.     

Effects of dietary magnesium and/or manganese variables on the growth rate and metabolism of mice

The effects of seven feeding schedules differing only in their Mg and Mn contents on the growth rates and some metabolic aspects of Swiss albino female mice were studied. The animals were placed for 5 weeks on the seven dietary regimens and weighed weekly according to the following scheme: (1) normal diet fed (control) group; (2) Mg-deficient fed group; (3) Mn-deficient fed group; (4) coupled-deficient fed group; (5) Mg-supplemented fed group; (6) Mn-supplemented fed group, and (7) coupled-supplemented fed group. Dietary Mg and/or Mn deficiencies were found to exert unfavorable effects on the growth rate of the animals. However, dietary supplementation of Mg has a favorable influence on the growth rate of the animals. Also, several biochemical tests on the plasma and livers of the tested animals were carried out and discussed accordingly.     

Postretention changes in mandibular crowding: a review of the literature.

Posttreatment stability is one of the challenges facing orthodontists today. Relapse of the mandibular anterior segment during the postretention period is perhaps the most predictable and frustrating of all orthodontic relapses. This type of relapse is sometimes erroneously construed as a sign of inappropriate treatment or evidence of misdiagnosis or incorrect mechanics. This article reviews mandibular incisor postretention stability outcomes in the setting of different treatment techniques and different ages of beginning orthodontic treatment. Mandibular incisor relapse is almost inevitable, regardless of orthodontic techniques and timing of orthodontic treatment. However, mandibular incisor relapse might be reduced when palatal expansion is combined with prolonged retention.     

O-acylsalicylamides as possible prodrugs for salicylamide I. Kinetics and mechanisms of their degradation and reaction with enzymes and sodium bisulfite

Three prodrugs of salicylamide, O-acetylsalicylamide (1), O-acetylsalicylsalicylamide (II), and O-glutarylsalicylamide (III) were prepared and their rates of degradation were studied over a wide pH range. These compounds were found to undergo O → N acyl transfer to the corresponding imide even in acidic environments. This reaction was followed spectrophotometrically at 355 nm.The effect of horse serum esterases on the hydrolysis of compounds I and III was also studied. In the presence of esterases and human plasma, the above prodrugs were found to cleave exclusively to salicylamide and not to the imide.In the presence of sodium bisulfite, the prodrugs I and III were found to undergo two parallel reactions and resulted in the formation of the imide and salicylamide.     

Effect of zinc supplementation on the dietary intake and weight gain of Bangladeshi children recovering from protein-energy malnutrition

Sixty severely malnourished children aged between 5 and 60 months were studied during nutritional rehabilitation. They all received a rice-based diet ad libitum plus vitamins and iron supplementation. Thirty children received zinc supplements (10 mg/kg/d for those weighing less than 6 kg and 50 mg daily for those over 6 kg) on a random basis. Zinc was started from the 15th hospital day when they were free of infection and continued for a period of 3 weeks. Both groups had a mean energy intake of 200 kcal/kg/d, but the majority of the supplemented children had a better rate of weight gain: 66 per cent of the supplemented compared with 33 per cent of the controls gained more than 10 g/kg body weight/d. Moreover, 76 per cent of the supplemented children compared with 23 per cent of the controls were over 90 per cent of Harvard median weight for height on discharge. It appears from this study that zinc supplementation promotes growth and enhances the rate of clinical recovery from severe PEM.     

The course of hyperbilirubinemia in the very low birth weight infant treated with phenobarbital

We examined the effect of early phenobarbital therapy on the course of jaundice in 57 infants with birth weight below 1,500 g. The study group of 28 infants was treated with a phenobarbital loading dose of 20 mg/kg at 4.2 (3.6) [mean (SD)] hours of age, followed by a maintenance dose of 5 mg/kg/day for one week; 29 infants served as controls. Seventeen study and 19 control infants suffered from periventricular-intraventricular hemorrhage (IVH). The two groups had comparable risk factors that can potentially affect the course of hyperbilirubinemia. Peak serum bilirubin concentration was 7.9 (1.8) mg/dl in the treated group and 8.6 (2.2) mg/dl in the control group. Three infants in the treated group and seven infants in the control group had peak serum bilirubin concentration above 10 mg/dl. These differences in the peak serum bilirubin concentration or in the number of infants with peak serum bilirubin concentrations above 10 mg/dl are not statistically significant. However, treated infants achieved peak serum bilirubin concentration earlier (mean age 90 hours as compared to 138 hours in control infants), and required phototherapy for a shorter duration of time (5.5 days in the treated group as compared to 7.5 days in the control group). While these differences in the two groups with regard to age of peak serum bilirubin concentration and duration of phototherapy are statistically significant, they do not seem to be clinically important. Thus, in our group of very low birth infants phenobarbital failed to show any clinically important effects on the course of jaundice when used in conjunction with phototherapy.     

Effect of prazosin on microvascular perfusion during middle cerebral artery ligation in the rat

The purpose of this study was to evaluate the effects of prazosin, an alpha 1-adrenoceptor antagonist, on morphometric indexes of the total and perfused cerebral microvascular bed 1 hour after middle cerebral artery (MCA) ligation in pentobarbital-anesthetized rats. We hypothesized that this agent would prevent catecholamine-induced vasoconstriction in the ischemic brain. Cerebral blood flow (CBF) was determined with 14C-iodoantipyrine, and the perfused microvascular bed was visualized using fluorescein isothiocyanate-dextran. MCA occlusion did not alter systemic hemodynamic or blood gas parameters. CBF averaged 29 +/- 15 (mean +/- SD) ml/min/100 g in the MCA-ligated cortex and 49 +/- 18 in the other examined brain regions. Prazosin did not significantly alter these CBF values, averaging 26 +/- 14 and 48 +/- 10, respectively. There were no significant regional differences in total capillaries/mm2 in either group. The percent of the capillaries/mm2 perfused (51 +/- 6%) was similar in the two groups in all examined regions except the ischemic cortex. In the MCA-ligated cortex, 22 +/- 8% of the capillary volume was perfused in comparison with 49 +/- 8% in the prazosin-treated group. Prazosin-treated rats had an increased percentage of their microvasculature perfused despite a similarly reduced CBF. Prazosin appeared to reduce diffusion distances in the ischemic cortex. This might be due to its alpha 1-adrenoceptor blocking activity.