Applying the Gender Lens to Emergency Care: From Bench to Bedside

This article outlines the history, need, and evolution of gender medicine in emergency care research. Clinical examples are used where sex and gender play a role in diagnosis, management, or prognosis of patients in the emergency department (ED). The ED serves as an ideal setting to advance sex‐ and gender‐specific research as the primary access point for health care for much of the U.S. population, with more than 136 million annual visits. Gender medicine provides the biologic and social framework to provide high‐quality, safe, equitable, and cost‐effective sex‐ and gender‐specific care in the ED. With a 24‐hour hospital presence, and with access to high‐acuity patients, emergency physicians are well positioned to lead sex‐ and gender‐specific clinical studies for time‐sensitive conditions and also to serve as vital partners in interdisciplinary research projects. The ED also provides the primary access point for less life‐threatening conditions such as substance abuse, mental health, and pain management (both acute and chronic). Because one‐fifth of the U.S. population is without health insurance, and many more lack a regular provider or rapid access to their providers, the ED is often the only point of contact for advancing gender medicine in this population.     

Using suture anchors for cervical laminoplasty: a reliable, safe, and simple technique

Cervical spondylomyelopathy from spinal stenosis is a debilitating disease that often progresses with neurologic deficits in the upper and lower extremities. Spinal stenosis may be treated operatively with expansive open-door laminoplasty. We describe the technique of laminoplasty using suture anchors. Suture anchors may be used to perform laminoplasty in a safe, time-efficient, and reliable manner.     

Removal of hexavalent chromium ions using micellar modified adsorbent: isothermal and kinetic investigations

Hexavalent chromium is a very poisonous oxyanion and has had a negative impact on human health. This study assessed the viability of removing chromium(vi) using micellar modified adsorbents. In this study, chromium(vi) was removed from locally accessible wheat bran using separate applications of anionic sodium dodecyl sulfate (SDS) and cationic cetyltrimethylammonium bromide (CTAB) surfactants. The initial chromium content (5–12 ppm), pH (2–12), adsorbent dose (1–6 g/100 mL), agitation time (15–240 min), agitation speed (50–300 rpm), and temperature (15–50 °C) were all varied in the adsorption investigation. Pseudo first-order and second-order kinetic models were utilized to analyze the kinetic investigation. To determine thermodynamic parameters, the van''t Hoff relationship was used. The maximum result for chromium(vi) uptake was obtained as 87.7%, 83.5% and 98.9% for WB, SDS-mWB, and CTAB-mWB, respectively, at an agitation time of 240 min (i.e., 4 h), temperature (i.e., 25–30 °C), agitation speed (150 rpm). However, both WB and CTAB-mWB derives metal ion removal at lower pH levels (2–4), whereas SDS-mWB requires a pH between 4 and 6 for maximum percentage removal of Cr(vi). The equilibrium data of WB and SDS-mWB were modeled by the Langmuir adsorption isotherm, while the data of CTAB-mWB fitted well in the Freundlich isotherm model. The kinetic analysis of WB, SDS-mWB, and CTAB-mWB revealed that the pseudo-second-order kinetic model provides a thorough explanation for each of these adsorbents. It was found that CTAB-mWB can preferably be used for the removal of chromium(vi) due to its high affinity with adsorbate molecules and adsorption capacity.

In this investigation, anionic sodium dodecyl (SDS) and cationic cetyltrimethylammonium bromide (CTAB) surfactants were separately applied to locally accessible wheat bran to remove chromium(vi).     

Fidaxomicin Therapy in Critically Ill Patients with Clostridium difficile Infection

Fidaxomicin use to treat proven Clostridium difficile infection (CDI) was compared between 20 patients receiving care in critical care units (CCUs) and 30 patients treated on general medical floors. At baseline, the CCU patients had more initial CDI episodes, more severe and complicated disease, and more concurrent broad-spectrum antibiotic coverage. On multivariate analysis, the response to fidaxomicin therapy among the critically ill patients was comparable to that among patients in the general medical wards.     

Lessons from the infuse trials: do we need a classification of bias in scientific publications and editorials?

The original 13 Food and Drug Administration industry-sponsored recombinant human bone morphogenetic protein-2 (rhBMP-2) trials investigating its use in spinal fusion all reported no associated adverse events. However, subsequent series of studies began reporting complication rates that were much higher than those that were initially published. Critical analysis of the original rhBMP-2 industry-associated data found systematic alignment favoring positive outcomes with no proven clinical advantage over bone graft. The sources of potential bias leading to inaccurate reporting of original rhBMP-2 efficacy and safety profile include flawed study design, methodological technique, data reporting and analysis, and significant financial conflict of interest. As such, to ensure the integrity of the scientific literature, further measures should be taken by researchers, surgeons, authors, journal editors and reviewers to assess for potential sources of bias.     

Potentially lethal ACE‐inhibitor‐induced angioedema in a child

We report a case of a 9‐year‐old female with known end‐stage kidney disease who presented with sudden onset tongue swelling. A diagnosis of angiotensin‐converting enzyme inhibitor‐induced angioedema related to bradykinin accumulation was made. Her symptoms resolved shortly after discontinuation of captopril. Early diagnosis can save patients from severe upper airway obstruction.