Effect of tourniquet on hemodynamic variables

The aim of this study is to identify the effect of time and pressure of tourniquet in blood pressure and pulse rate immediately after the releasing of tourniquet in the upper and lower extremity of the orthopedic surgeries. This retrospective study examined 206 consecutive patients. Comparisons of the systolic and diastolic pressure and heart rate were made before the induction of anesthesia and tourniquet inflation, and immediately after the deflation. In general, there was no significant difference in hemodynamic changes between the upper- and lower-limb with regard to the type of anesthesia. There was no significant correlation between systolic blood pressure and tourniquet pressure, while by increasing the tourniquet time significantly, the systolic blood pressure decreases immediately after the deflation. Interestingly, the considerable increase in age paralleled with a significant decrease in the systolic blood pressure. The effect of tourniquet time is more than the age. There was no significant correlation between the tourniquet pressure and tourniquet time with diastolic blood pressure. Simply the increase in age significantly paralleled with the mild decrease in diastolic blood pressure Orthopedic surgeons are recommended not to rely on the benefits of tourniquet to raise blood pressure due to hypotensive conditions after the deflation especially in the old.     

Experimental doxycycline overdose in rats causes cardiomyopathy

All reports of doxycycline‐induced cardiomyopathy to date have been limited to accidental oral poisoning in calves. Therefore, the current study investigated the cardiomyotoxic effect of experimental doxycycline overdose in rats as a toxicity model which could be monitored using histopathological and biochemical assays. A total of 38‐week‐old male Wistar rats were divided into three groups consisting of 10 each. The first group was an untreated control group (D₀), and the second group (D₅) received doxycycline hyclate 25 mg/kg intragastrically twice daily (8 AM and 8 PM), which is 5‐fold higher than the standard dose. The third group (D₁₀) received 50 mg/kg intragastrically twice daily (8 AM and 8 PM), which is 10‐fold higher than the standard dose. The dose continued for 10 consecutive days and revealed that the doxycycline toxicity was dose dependent. Mortality was recorded in the D₁₀ group only (30%). The D₅ rats exhibited minimal skeletal muscle injury and slight but significant increases in the skeletal muscle damage indicators creatine kinase (CK) and aspartate aminotransferase (AST) compared to controls. The cardiac muscle of the D₅ rats was histologically normal, and the D₅ rats also exhibited normal levels of troponin I (cTnI), an indicator of cardiac muscle damage. In contrast, the D₁₀ rats displayed cardiomyopathy, as well as significant increases in the muscle enzymes alanine aminotransferase (ALT), AST and CK and the cardiac damage indicator cTnI compared to control and D₅ groups. Pulmonary lesions were observed in the D₁₀ rats, primarily cardiac lesion‐related alveolar heart failure cells. Thus the present study is the first to demonstrate that oral doxycycline poisoning (10 times the therapeutic dose)‐induced cardiomyopathy is not limited to calves and could occur without any predisposing factors.     

Late-onset cytomegalovirus infection complicated by Guillain–Barre syndrome in a kidney transplant recipient: case report and review of the literature

Cytomegalovirus (CMV) infection remains a common infection after solid-organ transplantation. In the general population CMV disease is associated with Guillain–Barre syndrome (GBS), an autoimmune disease leading to an acute peripheral neuropathy, in 1 of 1000 cases. Interestingly, GBS is a rarely observed complication in solid-organ transplant recipients, possibly related to maintenance immunosuppression. We describe a case of CMV infection complicated by GBS in a kidney transplant recipient and review the literature.     

What is the Role of Reversal Agents in the Management of Emergency Department Patients with Dabigatran-Associated Hemorrhage?

Background

In 2010, the U.S. Food and Drug Administration (FDA) approved dabigatran as the first non-warfarin oral anticoagulant for use in the United States. At the time of FDA approval, there was no antidote or effective treatment for dabigatran-induced hemorrhage. In 2015, the FDA approved idarucizumab for the treatment of dabigatran-induced hemorrhage. The purpose of this clinical practice statement is to evaluate the role of select reversal agents in the management of patients with dabigatran-associated bleeding.

A new chronotype of Schistosoma mansoni: adaptive significance

Objectives To optimise host‐to‐host transmission, digenean trematodes (parasites) synchronize their cercarial emission patterns with the aquatic activities of their vertebrate hosts. Schistosoma mansoni has a strictly diurnal shedding pattern involving two circadian chronotypes: an early shedding pattern with a mean peak occurring at 11:00 h and a late pattern with a mean peak occurring at 16:00 h. We analysed the cercarial emergence pattern of three schistosome populations from Oman where S. mansoni is resurgent. Methods For each schistosome population, the cercarial emergence pattern was assessed hourly over several days. Because we identified a new chronotype hitherto unknown in S. mansoni, we undertook taxonomic characterisation based on egg morphology and mitochondrial DNA sequence (COX1). Results Taxonomic characterisation revealed that the three schistosome populations belong to the species S. mansoni. Hence, this is the first report of this species exhibiting a nocturnal chronotype, with the mean peak occurring at 20:00 h. We interpreted the new chronotype as being the result of a lateral transfer of S. mansoni from humans to Rattus rattus. Conclusion The cercarial emergence pattern of S. mansoni from Oman is circadian, exhibiting either a diurnal or a nocturnal phenotype.     

Development of anatomically and lesion contrast-guided partial volume correction: new 3D formalisms and validation in phantom and clinical studies

Annals of Nuclear Medicine - The aim of the study was to correct for partial volume effect in positron emission imaging studies which is the most influential factors using three-dimensional (3D)...