Prevalence and associated risk factors of sleep-disordered breathing symptoms in young and middle-aged Pakistani employed adults

Purpose  

The objective of this study was to evaluate the prevalence of self-reported sleep-disordered breathing (SDB symptoms and its associated risk factors in Pakistani employed adults.     

PCR diagnosis of invasive candidiasis: systematic review and meta-analysis

Invasive candidiasis (IC) is a significant cause of morbidity and mortality. Diagnosis relies on culture-based methods, which lack sensitivity and delay diagnosis. We conducted a systematic review assessing the diagnostic accuracy of PCR-based methods to detect Candida spp. directly in blood samples. We searched electronic databases for prospective or retrospective cohort and case-control studies. Two reviewers abstracted data independently. Meta-analysis was performed using a hierarchical logistic regression model. Random-effects metaregression was performed to assess the effects of study methods and infection characteristics on sensitivity or specificity values. We included 54 studies with 4,694 patients, 963 of whom had proven/probable or possible IC. Perfect (100%) sensitivity and specificity for PCR in whole-blood samples was observed when patients with cases had candidemia and controls were healthy people. When PCR was performed to evaluate patients with suspected invasive candidiasis, the pooled sensitivity for the diagnosis of candidemia was 0.95 (confidence interval, 0.88 to 0.98) and the pooled specificity was 0.92 (0.88 to 0.95). A specificity of >90% was maintained in several analyses considering different control groups. The use of whole-blood samples, rRNA, or P450 gene targets and a PCR detection limit of ≤ 10 CFU/ml were associated with improved test performance. PCR positivity rates among patients with proven or probable IC were 85% (78 to 91%), while blood cultures were positive for 38% (29 to 46%). We conclude that direct PCR using blood samples had good sensitivity and specificity for the diagnosis of IC and offers an attractive method for early diagnosis of specific Candida spp. Its effects on clinical outcomes should be investigated.     

Israeli hospital preparedness for terrorism-related multiple casualty incidents: Can the surge capacity and injury severity distribution be better predicted?

Background

The incidence of large-scale urban attacks on civilian populations has significantly increased across the globe over the past decade. These incidents often result in Hospital Multiple Casualty Incidents (HMCI), which are very challenging to hospital teams.15 years ago the Emergency and Disaster Medicine Division in the Israeli Ministry of Health defined a key of 20 percent of each hospital's bed capacity as its readiness for multiple casualties. Half of those casualties are expected to require immediate medical treatment. This study was performed to evaluate the efficacy of the current readiness guidelines based on the epidemiology of encountered HMCIs.

Methods

A retrospective study of HMCIs was recorded in the Israeli Defense Force (IDF) home front command and the Israeli National Trauma Registry (ITR) between November 2000 and June 2003. An HMCI is defined by the Emergency and Disaster Medicine Division in the Israeli Ministry of Health as ≥10 casualties or ≥4 suffering from injuries with an ISS ≥ 16 arriving to a single hospital.

Results

The study includes a total of 32 attacks, resulting in 62 HMCIs and 1292 casualties. The mean number of arriving casualties to a single hospital was 20.8 ± 13.3 (range 4-56, median 16.5). In 95% of the HMCIs the casualty load was ≤52. Based on severity scores and ED discharges 1022 (79.2%) casualties did not necessitate immediate medical treatment.

Conclusion

Hospital preparedness can be better defined by a fixed number of casualties rather than a percentile of its bed capacity. Only 20% of the arriving casualties will require immediate medical treatment. Implementation of this concept may improve the utilisation of national emergency health resources both in the preparation phase and on real time.     

Response of olfactory axons to loss of synaptic targets in the adult mouse

Glomerular convergence has been proposed to rely on interactions between like olfactory axons, however topographic targeting is influenced by guidance molecules encountered in the olfactory bulb. Disruption of these cues during development misdirects sensory axons, however little is known about the role of bulb-derived signals in later life, as new axons arise during turnover of the olfactory sensory neuron (OSN) population. To evaluate the contribution of bulb neurons in maintaining topographic projections in adults, we ablated them with N-methyl-d-aspartate (NMDA) in P2-IRES-tauLacZ mice and examined how sensory axons responded to loss of their postsynaptic partners. NMDA lesion eliminated bulb neurons without damage to sensory axons or olfactory ensheathing glia. P2 axons contained within glomeruli at the time of lesion maintained convergence at these locations; there was no evidence of compensatory growth into the remnant tissue. Delayed apoptosis of OSNs in the target-deprived epithelium led to declines in P2 neuron number as well as the gradual atrophy, and in some cases complete loss, of P2 glomeruli in lesioned bulbs by 3 weeks. Increased cell proliferation in the epithelium partially restored the OSN population, and by 8 weeks, new P2 axons distributed within diverse locations in the bulb remnant and within the anterior olfactory nucleus. Prior studies have suggested that initial development of olfactory topography does not rely on synapse formation with target neurons, however the present data demonstrate that continued maintenance of the sensory map requires the presence of sufficient numbers and/or types of available bulbar synaptic targets.     

Hemorrhagic and thrombotic complications in bone marrow transplant recipients

Hemostatic challenges occur throughout the period of stem cell transplantation (SCT). Endothelial cells injury due to chemotherapy, growth factors, intravenous catheter, and graft-versus-host disease and profound thrombocytopenia are the major components involved in the hemostatic complications. Diffuse alveolar hemorrhage and hemorrhagic cystitis are severe complications in SCT recipients with high morbidity and mortality rate and no effective treatment. Common thrombotic manifestations include Veno-occlusive disease (VOD) and central venous lines thrombosis. More intensive conditioning regimens and mismatch donors increase the risk of hemostatic complications. Management of hemostatic and thrombotic complications is discussed including current data on the role of recombinant factor VIIa for severe hemorrhage and defibrotide for VOD.     

Medical students’ views on training in intellectual disabilities

OBJECTIVE

To examine undergraduate medical training in the field of intellectual disabilities (ID) from the perspective of clinical clerks.

DESIGN

Cross-sectional self-administered survey.

SETTING

Clerkship rotations at Queen’s University in Kingston, Ont, and the University of Toronto in Ontario in 2006.

PARTICIPANTS

A total of 196 upper-year undergraduate medical students (clerks).

MAIN OUTCOME MEASURES

Contact with people with ID, training in the field of ID, perceptions of current training in ID, and views on ways to improve the curriculum in the area of ID.

RESULTS

Most students (85.6%) had received some didactic and clinical training in managing patients with ID, but most of these (93.3%) believed that curriculum enhancements, especially more contact with patients with ID and more time in the curriculum for training in care of people with ID, were necessary.

CONCLUSION

This study found that the curriculum enhancements long recommended by experts in the field of ID were also desired by clinical clerks. This finding adds considerable weight to the recommendation that improvements in training in ID should be incorporated into undergraduate medical education programs.     

Peritoneal hydatid cyst perforation: a rare cause of emergency abdominal surgeries

Introduction  In hydatid cyst disease, perforation and spontaneous fistula formation are rare, yet very serious, complications. In this study we describe five cases of hydatid cyst disease in which the cysts perforated. Methods  In this retrospective study we evaluated five patients who were surgically treated for perforated hydatid cysts between 2002 and 2006. All patients were admitted to a local hospital with acute abdominal symptoms. Results  The mean age of the patients (four males and one female) was 39 years. The perforations occurred spontaneously in four patients, and were the result of trauma in one. Three of the hydatid cysts were located in the liver and two in the spleen. Only one patient had a recurrent hydatid cyst. Diagnostic tools included ultrasonography (n=5), computerized tomography (n=1), and diagnostic peritoneal lavage (n=1). The cysts were treated by radical (n=2) or conservative (n=3) methods. There was no postoperative morbidity or mortality, and no recurrences of hydatid disease after follow-up (mean: 14 months). Conclusion  Cyst perforation in the peritoneal cavity is a serious complication of hydatid disease and should be treated immediately. The literature suggests that recurrences may be related to the operative technique, the location of the cyst, and inadequate irrigation of the peritoneal cavity with scolicidal agents. The findings of this study suggest that if treated promptly, cyst perforation can be successfully treated.