Prevalence and patterns of diverticulosis in patients undergoing colonoscopy in a southern Indian hospital

The prevalence of diverticular disease of colon of colon is reportedly low in Asian compared to Western countries. We analyzed the prevalence of colonic diverticulosis in a selected cohort of patients undergoing colonoscopy. Retrospective study of records of patients undergoing colonoscopy in a tertiary hospital in southern India.     

A Global Vision of Prehospital Care

Abstract

Background. Out-of-hospital tracheal intubation is controversial because of questions regarding its safety as well as its impact on patient care. Factors contributing to the controversy include failed intubations, number of attempts required, prolonged periods without ventilation, and misplaced tracheal tubes. However, the most important factors are the decision-making and clinical skills of the intubator. Unfortunately, the limited number of outcome studies adds to the controversy. New technology, the video laryngoscope, has been introduced to facilitate tracheal intubation. At least one model of video laryngoscope (GlideScope Ranger) has been designed for out-of-hospital use. In an effort to assess the effect this technology might have on out-of-hospital intubation, a study comparing traditional laryngoscopy (TL) versus video laryngoscopy (VL) was performed. The study endpoint was the number of attempts to achieve intubation. Data were also collected on time to intubate, nonventilated periods, unrecognized misplaced tubes, and complications of the procedure. Methods. Data were collected on 300 consecutive patients, 6 years of age or older, weighing at least 20 kg, who were intubated using TL. They were compared with data on 315 patients who were intubated using VL. All intubations were confirmed by visualization where possible, auscultation, misting, and capnography. In addition, all were continuously monitored by capnography. Results. The average time to intubate in the VL group was 21 seconds (range 8–43 seconds) versus 42 seconds (range 28–90 seconds) in the TL group. The average number of attempts was 1.2 (range 1–3) in the VL group versus 2.3 (range 1–4) in the TL group. Successful intubation was 97%% in the VL group versus 95%% in the TL group. There were no unrecognized misplaced tubes in either group. For failed intubations, an alternative airway was successful in 99%% of the VL group and 99%% of the TL group. Maximum nonventilated time during any one intubation attempt was 37 seconds in the VL group and 55 seconds in the TL group. Conclusions. The numbers of attempts were significantly reduced in the VL group. This suggests that the use of VL has a positive effect on the number of attempts to achieve tracheal intubation.     

The practitioner as policy analyst: a study of student reflections of an interprofessional course in higher education

Health and welfare practitioners in the United Kingdom have experienced and continue to experience considerable turbulence as services and occupational boundaries undergo restructuring. To a significant extent such turbulence is driven by policies that promote interprofessional agendas. This paper reports on an evaluation of a higher education programme that adopted a social policy approach to the analysis of interprofessional working. The retrospective views were sought of nursing, midwifery, social work and community and youth work post-qualifying students with use of semi-structured questionnaires and focus groups. Although difficulties were encountered with the political science focus to the programme, overall the participants very positively evaluated the opportunity to engage in policy analysis in a shared learning environment. Given the highly politicised, complex and shifting environment of interprofessional working, it is suggested that the study lends support to the argument that 'policy acumen' is a central skill for contemporary health and welfare practitioners. The paper, therefore, starts to explore issues of particular relevance for educationalists involved in developing frameworks for interprofessional programmes particularly in higher education.     

Splenic Artery Embolization after Delayed Splenic Rupture Following Blunt Trauma: Is Nonoperative Management Still an Option in This Cohort?

Patients treated with splenic artery embolization (SAE) >48 hours after a blunt injury for a delayed splenic rupture (DSR) were assessed for the need for a subsequent splenectomy. Thirty-four patients underwent SAE for DSR over 10 years at our level 1 trauma center, performed at a median of 4.5 days after the injury (interquartile range = 5.5), and the patients were followed up for a median of 11 months (interquartile range = 31). There were 3 occurrences of rebleeds, and 2 patients required splenectomy (5.9%). This study showed that treatment with SAE after DSR results in splenic salvage in 94.1% of patients.     

A randomized cross-over trial to define neurophysiological correlates of AV-101 N-methyl-d-aspartate receptor blockade in healthy veterans

The kynurenine pathway (KP) is a strategic metabolic system that combines regulation of neuronal excitability via glutamate receptor function and neuroinflammation via other KP metabolites. This pathway has great promise in treatment of depression and suicidality. The KP modulator AV-101 (4-chlorokynurenine, 4-Cl-KYN), an oral prodrug of 7-chlorokynurenic acid (7-Cl-KYNA), an N-methyl-d-aspartate receptor (NMDAR) glycine site antagonist, and of 4-chloro-3-hydroxyanthranilic acid (4-Cl-3-HAA), a suppressor of NMDAR agonist quinolinic acid (QUIN), is a promising potential antidepressant that targets glutamate functioning via the KP. However, a recent placebo-controlled clinical trial of AV-101 in depression found negative results. This raises the question of whether AV-101 can penetrate the brain and engage the NMDAR and KP effectively. To address this problem, ten healthy US military veterans (mean age = 32.6 years ± 6.11; 1 female) completed a phase-1 randomized, double-blind, placebo-controlled, crossover study to examine dose-related effects of AV-101 (720 and 1440 mg) on NMDAR engagement measured by γ-frequency band auditory steady-state response (40 Hz ASSR) and resting EEG. Linear mixed models revealed that 1440 mg AV-101, but not 720 mg, increased 40 Hz ASSR and 40 Hz ASSR γ-inter-trial phase coherence relative to placebo. AV-101 also increased 4-Cl-KYN, 7-Cl-KYNA, 4-Cl-3-HAA, 3-HAA, and KYNA in a dose-dependent manner, without affecting KYN and QUIN. AV-101 was safe and well tolerated. These results corroborate brain target engagement of 1440 mg AV-101 in humans, consistent with blockade of interneuronal NMDAR blockade. Future studies should test higher doses of AV-101 in depression. Suicidal behavior, which has been associated with high QUIN and low KYNA, is also a potential target for AV-101.Subject terms: Biomarkers, Neurophysiology, Neuroscience     

Potassium channel opening: a subtle two-step

Voltage-gated K⁺ channels undergo a voltage-dependent conductance change that plays a key role in modulating cellular excitability. While the Open state is captured in crystal structures of Kv1.2 and a chimeric Kv1.2/Kv2.1 channel, the Close state and the mechanism of this transition are still a subject of debate. Here, we propose a model based on mutagenesis combined with measurements of both ionic and gating currents which is consistent with the idea that the Open state is the default state, the energy of the electric field being used to keep the channel closed. Our model incorporates an 'Activated state' where the bulk of sensor movement is completed without channel opening. The model accounts for the well characterized electrophysiology of the 'V2' and 'ILT' mutations in Shaker, where sensor movement and channel opening occur over distinct voltage ranges. Moreover, the model proposes relatively small protein rearrangements in going from the Activated to the Open state, consistent with the rapid transitions observed in single channel records of Shaker type channels at zero millivolts.     

Effect of different swallow time intervals on the nutcracker esophagus

OBJECTIVE: Nutcracker esophagus (NE) is defined as the presence of peristaltic contractions in which the average distal esophageal amplitude is greater than 180 mm Hg. The underlying mechanism responsible for these abnormalities is not known. The aim of this study was to test the hypothesis that NE might be caused by a defect in the inhibitory pathway controlling esophageal peristalsis. METHODS: Eight patients with NE (seven women, 1 man, mean age 50 yr) and eight age- and sex-matched normal volunteers (seven women, 1 man, mean age 48 yr) underwent a special protocol using three-channel (3, 8, and 16 cm above the lower esophageal sphincter) solid state esophageal manometry to evaluate deglutitive inhibition. Ten pairs of 5 ml of wet swallows were given at each of five different time intervals (30, 20, 15, 10, and 5 s). Pairs of swallows were spaced by 30 s, and different time intervals were spaced by 1 min. Tracings were recorded using a computer program and blindly automatically analyzed for both amplitude and duration of the contraction separately for the first and second swallow of each pair. Presence of deglutitive inhibition or muscle refractoriness was assessed according to interactions between the first and second swallow of the pair. Results were found abnormal when larger than the mean percent variation of the second and first swallow calculated for the 30-s interval, considered as baseline for each participant. Statistics included paired and nonpaired nonparametrical comparisons as appropriate. RESULTS: The median amplitude for the NE was 202 mm Hg (range 186-376) and for the controls was 118 mm Hg (range 64-167) (p = 0.0002). The median duration in the NE group was 5.1 s (range 4-9.3) versus 4.1 (range 3.3-5.0) for the controls (p = 0.02). The percent variation in duration (p = 0.31), amplitude (p = 0.42), and propagation velocity of the peristaltic waves (p = 0.69) did not differ between the control and NE groups. Peristalsis frequency dropped at the 5-s interval for both studied groups (p = 0.84). CONCLUSION: Central and local inhibitory mechanisms induced by closely timed swallows are preserved in the NE and do not explain the mechanism of the high amplitude and long duration contractions.