Arterial pulse waves and velocity and systolic time intervals in diabetic children

Arterial pulse wave velocities, pulse wave contours, and systolic time intervals were recorded in thirty-nine diabetic children and were compared with recordings taken in twenty-seven normal children. Systolic time intervals were similar in the two groups of subjects. However, brachial and aortic pulse wave velocities were significantly greater in the diabetic than in the normal children (p < 0.025 and < 0.005, respectively). Also, in the diabetic children the time interval from the incisura to the midpoint of the dicrotic wave (I-D) was significantly shortened in both the brachial (p < 0.005) and carotid (p < 0.05) pulse waves as compared to the normal children. These changes in pulse wave velocity and contour are associated with increased wall stiffness that occurs with aging and suggest that the large arteries of diabetic children may exhibit acceleration of the aging process. The severity of these changes bore no direct correlation with the degree of carbohydrate intolerance as judged by insulin requirement.     

Motivations,Barriers, and Outcomes of Patient-Reported Shared Decision Making in Eosinophilic Esophagitis

Digestive Diseases and Sciences - Little is known about patient choice in treatment of eosinophilic esophagitis (EoE). Determine motivators and barriers to using common EoE therapies and describe...     

Case Report: Utility of Ketamine,Lidocaine, and Mexiletine as Nonopioid Adjuvants in Complex Cancer-Associated Pain

ABSTRACT

Ketamine, lidocaine, and mexiletine are potential nonopioid adjuvant medications for the use of refractory cancer-related pain, particularly when opioids are demonstrating limited objective benefit. This is a case report of a single patient admitted to a large academic medical center in the United States. The patient is a 43-year-old woman with a history of Crohn's disease complicated by rectal squamous cell carcinoma and complex, progressive, and intractable pelvic and rectal pain. Over the course of hospitalization, her pain demonstrated limited opioid responsiveness despite marked fluctuations of her oral morphine equivalent doses. She also demonstrates variable responsiveness to ketamine. Lidocaine continuous infusion ultimately proves beneficial, and she is discharged after conversion to oral mexiletine. An overview of the hospital system's protocols for ketamine and lidocaine continuous infusions for pain and considerations for transitioning to mexiletine from lidocaine infusion are included.     

Synthetic cannabinoid “Black Mamba” infidelity in patients presenting for emergency stabilization in Colorado: a P SCAN Cohort

Background: Use of new psychoactive substances (NPS) has increased over the last decade. During this period, variability of both clinical presentations and chemical compositions of these compounds has increased. Synthetic cannabinoids (SCs) are the most commonly used NPS and there are more than 100 documented unique molecules in this class. “Black Mamba”, often associated to ADB-FUBINACA, is the most commonly used SC in Colorado. It has been linked to kidney injury, myocardial toxicity, seizures, and death.

Objectives: We aim to identify the chemical constituents and quantification of eight cases of reported “Black Mamba” use in order to further understand the clinical variability in patients presenting for emergency stabilization.

Methods: We report data from eight cases of reported “Black Mamba” use prospectively captured through the Colorado site of the Psychoactive Surveilance Consortium and Analysis Network (P SCAN). P SCAN is a geographically representative group of academic hospitals that capture clinical presentation, outcome, and biologic samples from patients that present for emergency stabilization following NPS use. Serum and urine samples were analyzed and quantified by liquid chromatography-quadrupole time-of-flight mass spectrometry after a qualitative screen for over 600 unique NPS compounds.

Results: In the reported eight cases, the median age was 28 years old. There were four male and four females. Four patients had agitation/delirium and four patients had chest pain. Normal saline, benzodiazepines and ondansetron were the common treatment provided in the emergency department (ED). Two patients were discharged from the ED and six patients being admitted for emergency observation with a median length of stay (LOS) of six hours. No deaths were reported. Confirmatory testing revealed that only five patients (62.5%) had SCs found in blood or urine samples. Cocaine, NRG-3, 3-methoxyphencyclidine hydrochloride (MeO-PCP), and methamfetamine were identified in other presentations.

Conclusions: The wide range of clinical presentations from “Black Mamba” use may be explained by the wide variability of chemical constituents found by laboratory analysis.     

Drivers of Inpatient Hospital Experience Using the HCAHPS Survey in a Canadian Setting

ObjectiveTo identify factors associated with patients’ overall rating of inpatient hospital care.ConclusionsOur results are novel in the Canadian population. Several questions for future research have been generated, in addition to opportunities for quality improvement within our own organization.