Probable gas embolism during operative hysteroscopy caused by products of combustion

PURPOSE: Gas embolism is a rare but well documented entity during operative hysteroscopy, with an incidence of 10-50%. Catastrophic outcomes occur at a rate of three in 17,000 procedures. The purpose of this report is to present a non-fatal case of gas embolism probably caused by the gaseous products of combustion. CLINICAL FEATURES: A 50-yr-old woman with a history of menorrhagia was scheduled for hysteroscopy and endometrial ablation and polypectomy. Fifteen minutes into the procedure, with the patient in lithotomy position, 20 degree head down tilt, and breathing spontaneously, a sudden oxygen desaturation occurred from 97% to 87%. The patient's end-tidal carbon dioxide dropped from 46 mmHg to 27 mmHg. The patient's breathing pattern remained normal, respiratory rate remained 11-12 breaths x min(-1) but amplitude of the reservoir bag movement was increased. Cardiovascular variables remained stable. She responded rapidly to 100% oxygen and made an uneventful recovery. Having ruled out other possible causes, we concluded gas embolism was responsible for the fall in oxygen saturation and end-tidal CO(2). CONCLUSION: With all the precautions in place to minimize the likelihood of fluid overload and ambient air embolism occurring, we surmised that products of combustion were the cause of the gas embolism. During endometrial ablation, gaseous products of combustion, mainly carbon dioxide, accumulate. The gases may then contribute to the rise in uterine pressure that occurs as irrigation fluid enters the uterus and this rise in pressure in turn encourages passage of gas into the open venous sinuses.     

“We’ve Got Our Own Beliefs,Attitudes, Myths”: A Mixed Methods Assessment of Rural South African Health Care Workers' Knowledge of and Attitudes Towards PrEP Implementation

AIDS and Behavior - South Africa maintains the world’s largest HIV prevalence, accounting for 20.4% of people living with HIV internationally. HIV Pre-exposure prophylaxis (PrEP) has...     

Using Wearable Biosensors to Predict Length of Stay for Patients with IBD After Bowel Surgery

Digestive Diseases and Sciences - It remains unknown whether ambulation or sleep predicts postoperative length of stay for patients with IBD. We aim to identify the utility of wearable biosensors...     

Evaluation of the Pharmacokinetic Interaction between Repeated Doses of Rifapentine or Rifampin and a Single Dose of Bedaquiline in Healthy Adult Subjects

This study assessed the effects of rifapentine or rifampin on the pharmacokinetics of a single dose of bedaquiline and its M2 metabolite in healthy subjects using a two-period single-sequence design. In period 1, subjects received a single dose of bedaquiline (400 mg), followed by a 28-day washout. In period 2, subjects received either rifapentine (600 mg) or rifampin (600 mg) from day 20 to day 41, as well as a single bedaquiline dose (400 mg) on day 29. The pharmacokinetic profiles of bedaquiline and M2 were compared over 336 h after the administration of bedaquiline alone and in combination with steady-state rifapentine or rifampin. Coadministration of bedaquiline with rifapentine or rifampin resulted in lower bedaquiline exposures. The geometric mean ratios (GMRs) and 90% confidence intervals (CIs) for the maximum observed concentration (C_max), area under the concentration-time curve to the last available concentration time point (AUC_0–t), and AUC extrapolated to infinity (AUC_0–inf) of bedaquiline were 62.19% (53.37 to 72.47), 42.79% (37.77 to 48.49), and 44.52% (40.12 to 49.39), respectively, when coadministered with rifapentine. Similarly, the GMRs and 90% CIs for the C_max, AUC_0–t, and AUC_0–inf of bedaquiline were 60.24% (51.96 to 69.84), 41.36% (37.70 to 45.36), and 47.32% (41.49 to 53.97), respectively, when coadministered with rifampin. The C_max, AUC_0–t, and AUC_0–inf of M2 were also altered when bedaquiline was coadministered with rifapentine or rifampin. Single doses of bedaquiline, administered alone or with multiple doses of rifapentine or rifampin, were well tolerated, with no safety concerns related to coadministration. Daily administration of rifapentine to patients with tuberculosis presents the same drug interaction challenges as rifampin and other rifamycins. Strong inducers of the cytochrome P450 isoenzyme CYP3A4 should be avoided when considering the use of bedaquiline. (This study is registered at clinicaltrials.gov under identifier {"type":"clinical-trial","attrs":{"text":"NCT02216331","term_id":"NCT02216331"}}NCT02216331.)     

Relationship of blood pressure status,dietary factors and serum electrolytes of in-school adolescents in Ilishan-Remo,Ogun State,Nigeria

BackgroundGlobally, rising blood pressure is of public health concern as it is a major cause of cardiovascular diseases (CVDs), and preventable death. This study accessed the relationship of blood pressure status, dietary factors and serum electrolytes among in-school adolescents in Ilishan-Remo, Ogun State, Nigeria.MethodsA cross-sectional survey of 488 secondary school students (aged 10–19 years). Blood pressures were assessed using auscultatory method and questionnaires were used to obtain food frequency and 24-hour dietary recall data. Blood samples from volunteers were used for serum sodium and potassium assays.ResultsThe mean systolic blood pressure (SBP) increased with age, irrespective of gender. The prevalence of elevated blood pressure and hypertension among participants were 19.3% and 10.5%, respectively, with males and females having similar pattern. Dietary factors like addition of table salt to already prepared foods, higher intake of eggs, and lower intake of vegetables were associated with the development of elevated blood pressure among the adolescents. The estimated mean dietary intakes (mg/person/day) of sodium and potassium were 2289±938.7 and 1321±603.8, respectively, with majority consuming far higher (for sodium – 80%) or far below (for potassium – 95%) recommendations. The mean serum sodium (138.0±18.3 mmolL^-1) and potassium (3.06±1.1 mmolL^-1) were similar across genders. A significant (p<0.05) negative relationship exists between serum potassium and SBP.ConclusionsThe blood pressure status of the adolescents studied are of great concern and are somewhat negatively influenced by poor dietary and lifestyle practices. They require prompt intervention to slow down the development of CVDs in the future.     

Insulin-Like Growth Factor (IGF) System in the Bovine Mammary Gland and Milk

Primary bovine mammary cells express the two IGF receptors (IGF-IR, IGF-IIR),⁴ insulinreceptor, and four IGFBPs (IGFBP-2, -3, -4, and -5). Examination of the IGF-IR during themammary gland lactation cycle shows that IGF-IR number declines at parturition, a changethat coincides with decreases in the blood level of its ligand, IGF-I. IGF-II and IGF-IIR arelargely unchanged. IGFBP-3 is the predominant mammary IGFBP and its concentration alsodeclines in blood and milk during lactation compared to prepartum and involution periods.Time of lactation and pregnancy were the main determinants of milk but not bloodIGFBP-3 levels. IGFBP-3 binds to membrane proteins of bovine mammary tissue; an IGFBP-3 bindingprotein has been identified as bovine lactoferrin. Lactoferrin has the capacity to compete withIGF binding to IGFBP-3. Appearance of both IGFBP-3 and lactoferrin in conditioned mediaof primary cultures of bovine mammary cells was stimulated by all trans retinoic acid (atRA).Furthermore, atRA was necessary for the entry of exogenously added lactoferrin into themammary cell nucleus, while IGFBP-3 entry into the nuclei of atRA treated cells requiredthe presence of lactoferrin. These findings reveal a novel role for lactoferrin, suggesting thatlactoferrin is critically involved in the regulation of the IGF system during the involution period.