Clinical aspects of endocrinology: parathyroid and adrenal gland disorders

The parathyroid glands are responsible for calcium homoeostasis, which is necessary for appropriate functioning of the musculoskeletal and nervous systems. Parathyroid adenoma remains the most common indication for surgery. Anaesthetic considerations for parathyroid surgery include good hydration, appropriate positioning, monitoring renal function along with serum electrolytes. The adrenal cortex is mainly responsible for secretion of mineralocorticoids, glucocorticoids, and androgens whereas the medulla consists of pre-ganglionic sympathetic ganglion, which secretes epinephrine, nor-epinephrine and dopamine. Adrenocortical disease results in disturbance of water balance, electrolytes, cardiovascular instability and metabolic disturbances. Correction of water, electrolyte imbalance, blood pressure control with invasive monitoring, appropriate positioning, analgesia with appropriate hormone replacement therapy form the key principles of the anaesthetic management.     

Fat‐Modified Enteral Formula Improves Feeding Tolerance in Critically Ill Patients: A Multicenter,Single‐Blind,Randomized Controlled Trial

Background: Improvement of fat digestion and absorption was supposed to relieve feeding intolerance. This trial aimed to evaluate the effect of a fat‐modified enteral formula on feeding tolerance in critically ill patients. Materials and Methods: This trial was conducted in 7 hospitals in China. In total, 144 intensive care unit (ICU) patients with estimated need of enteral nutrition (EN) for at least 5 days were randomly given fat‐modified enteral formula containing medium‐chain triglycerides (MCT), carnitine, and taurine (interventional feed group, n = 71) or standard enteral formula (control feed group, n = 73). EN intake, feeding intolerance (diarrhea, vomiting, gastric retention, and abdominal distension) and outcomes (mechanical ventilator‐free days of 28 days, length of ICU stay, length of hospital stay, and in‐hospital mortality) were collected. Results: Daily calories and protein intake were increased in the interventional feed group compared with the control feed group (P < .01). Total incidence of feeding intolerance was 42.3% in the interventional feed group and 65.7% in the control feed group (P < .001). Daily incidence of feeding intolerance was 11.3%, 18.3%, 14.1%, 25.4%, and 26.1% in the interventional feed group and 31.5%, 32.9%, 34.2%, 34.2%, and 30.4% in the control feed group from study days 1–5 (P = .0083). Incidence of feeding intolerance without abdominal distention was 32.9% in the interventional feed group and 49.3% in the control feed group (P = .047), while the incidence of abdominal distension was 26.8% in the interventional feed group and 43.8% in the control feed group (P = .03). No significant differences existed in outcomes between the 2 groups. Conclusions: The fat‐modified enteral formula containing MCT, carnitine, and taurine may improve feeding tolerance in critically ill patients.     

Assistive technologies for hearing,and speaking impaired people: a survey

This study presents a novel method for evaluating the scientific research papers in the field of assistive technologies pertaining to different impairment conditions. The objectives are to understand the technologies used for addressing the needs of PWD by identifying relevant criteria for the assessment, explore the implications of these technologies in their lives and identify the gaps among certain technologies in assisting PWD. In this article, we reviewed around 40 research scientific papers in relation to the technologies used to assist PWD in their daily activities. A novel quantitative assessment methodology based on Multi-weighted Scoring Model (MWSM) has been developed. It is based on the judgement of clinical experts according to thirteen well-defined criteria. The proposed method is useful because it assesses the scientific studies related to PWD qualitatively according to efficient research coverage, as well as quantitatively in order to have good comparative judgment. Moreover, this method recognizes the research gap or areas which need further investigation and identifies the research papers that have good coverage of the respective criteria.

• Implications for Rehabilitation

• Human computer interface (HCI) solutions are critical for addressing the main issues facing people with disabilities (PWD) in their life.

• Assessment of scientific research papers according to well-defined criteria that address PWD needs would assist in verifying their suitability for PWDs.

• Novel quantitative assessment methodology is used for assessing these research papers using judgment of experienced researchers according to 13 well-defined criteria that have been weighted according to relevancy to different impairment groups.

• Identifying research papers that have good coverage of defined criteria and knowing the research area that needs further investigation by researchers and developers, would ultimately address the rehabilitation needs for PWD.

     

Combined vesical and abdominal endometriosis following abdominal hysterotomy and tubal ligation

The article reports on the case of a 29 year old patient who developed abdominal endometriosis 4 years after having had hysterotomy and tubal ligation. About a month after the excision of the endometrial tissue she was examined for suprapubic pains, strangury, and frequency of micturition. A nodule was found in the deepest part of the abdominal wall and the patient was treated for 6 months, without success, with medroxyprogesterone acetate. A subsequent laparotomy showed bladder endometriosis, obviously still an endometrial implant at the time of hysterotomy, which was missed at the time of the first excision. Total hysterectomy was carried out and the patient recovered successfully. Bladder endometriosis is the most common site of involvement among urinary tract endometriosis. The peculiarity of the case presented here is in the total absence of hematuria, and in the fact that pains had no relation with the menstrual cycle. Hormonal therapy is often ineffective, and surgery often the only advisable form of treatment.     

The impact of preschool education component of ICDS on mental and cognitive development of children

The aim of this evaluation was to assess the impact of nonformal preschool education of the mental and cognitive development of rural and urban children from the Ludhiana Integrated Child Development Services (ICDs) district, Punjab, India; comparisons were made with non-ICDs attenders. 30 anganwadi community workers (AWWs) with ICDs were randomly selected equally from a total of about 200 workers in urban and rural blocks. 360 children aged 3-6 years; equally divided among urban and rural areas, were selected; 180 of these children, equally divided between urban and rural areas, were controls of nonattenders of preschool. Information about cognitive and mental development was obtained from AWWs records and interviews, parents, and a cognitive ability test. Mean test scores among rural ICDS attenders aged 3-4 years of age were 73.77 compared with 67.33 for nonattenders. The scores for rural ICDs attenders 4-5 years old was 95.60 vs. 82.20 for nonattenders. For the 5-6 year old group, scores for rural ICDs attenders were 104.23 compared with 93.27 for nonattenders. The scores were statistically significant for score differences for all age groups in the rural population and the urban population. Urban ICDS attenders scored 73/87 compared with 65.57 for nonattenders aged 3-4 years. Urban ICDS attenders aged 4-5 years scored 92.97 compared with 83.23 for nonattenders. Urban ICDS attenders aged 5-6 years scored 105.03 compared with 92.57 for nonattenders. There were no significant differences between rural and urban attenders or nonattenders for any age group. There was a significant (p .001) correlation between age and cognitive ability: rural attenders, r = .81; rural nonattenders, r = .78; urban attenders, r - 84, urban nonattenders r = 86. The findings supported previous studies, by, for instance, Adhish et al. on cognitive differences between children in ICDs and non ICDs villages. Place of residence was not found to be related to mental development. There was an increase in the cognitive development with the advancement of age.