ENDOSCOPIC NASOBILIARY DRAINAGE: CURRENT INDICATIONS AND EVALUATION OF THE PRODUCTS

Endoscopic nasobiliary drainage (ENBD) is a well established mode of biliary decompression. Although ENBD is certainly an uncomfortable procedure with the potential risk of spontaneous dislocation or removal of the drainage catheter by disoriented patients, it has several advantages over endoscopic biliary drainage (EBD) using an indwelling stent. The current indications for ENBD are: (i) temporary drainage to treat obstructive jaundice and cholangitis caused by malignant or benign biliary stricture; (ii) urgent drainage to treat suppurative cholangitis primarily caused by common bile duct stones; (iii) temporary drainage after stone removal in patients with suspected incomplete clearance and/or with cholangitis; and (iv) biliary leaks that occur primarily after surgery, as well as other indications. Different types of nasobiliary catheters are currently available that have been designed with various diameters, shapes, and materials. However, the current catheters are not considered by most endoscopists to be sufficient. Further improvements are needed to achieve better drainage and better maneuverability.     

Moving from Implementation Science to Implementation Practice: The Need to Solve Practical Problems to Improve Behavioral Health Services

It is well recognized that the use of evidence-based practices (EBPs) is critical to improving service outcomes for those receiving behavioral health services. However, EBPs are not easily implemented in behavioral health settings, and there are many challenges to supporting these services over time. Recently, research efforts in implementation science (IS) have greatly expanded our understanding of issues that influence the successful implementation of EBPs. Unfortunately, less effort has been devoted to translating this research theory on a practical level to help individual service entities solve the specific problems of putting programs into place. A process is needed where service organizations and practitioners can build their capacity, informed by IS research, to improve service outcomes. The purpose of this commentary is to describe the IS research base, provide an introduction to implementation practice, describe challenges confronting practitioners, and propose necessary steps in building organizational capacity that enables practitioners to implement the most effective services available.

     

Anesthetic management in pediatric interventional cardiology

Interventional cardiology (n = 108) and cardiac angiography (n = 481) procedures in pediatrics performed between January 1996 and December 1998 were reviewed. Means (SD) of duration of anesthesia for interventional cardiology and cardiac angiography were 245 (130) and 152 (48) minutes, respectively (P < 0.001). Incidences of long operations requiring over 6 hours of anesthesia were 12 and 0%, respectively (P < 0.001). Incidences of hemodynamic derangements were 17 and 2.9%, and catheter-related complications were 7.4 and 0.83%, respectively (P < 0.001). Incidences of ICU admission were 7.4 and 0.62% those of emergency surgery were 4.6 and 0%, and those of blood transfusion were 4.6 and 0%, respectively (P < 0.001). Incidences of cardiopulmonary resuscitation, and cardioversion were also higher in interventional cardiology (P < 0.05), and all these emergency cases were rescued successfully. The risk of cardiac angiography is higher compared with general surgery, and the risk of interventional cardiology is higher than cardiac angiography in pediatrics. This study reconfirms that anesthesiologists should play an active role in care of pediatric patients undergoing high-risk procedures outside the operating room.     

Safety and efficacy of azilsartan in paediatric patients with hypertension: a phase 3, single-arm,open-label,prospective study

Clinical and Experimental Nephrology - Azilsartan is an angiotensin II receptor blocker indicated for the treatment of adult hypertension. A previous single-dose study suggested that azilsartan may...     

Distribution pattern of poliovirus potentially infectious materials in the phase 1b medical laboratories containment in conformity with the global action plan III

Background

The containment of poliovirus infectious/potentially infectious materials in all biomedical facilities in Nigeria remain crucial to maintaining gains recorded towards polio eradication. Activities involved in the Nigerian Poliovirus type 2-laboratory containment survey in line with the 3rd Global Action Plan III (GAP III) for poliovirus containment are documented in this study. Through these activities, the overall preparedness for poliovirus eradication in Nigeria is assessed.

Method

A cross-sectional survey was conducted from 19th September-31st October 2016 using structured Laboratory survey and inventory (LSI) questionnaires uploaded onto the SPSS software package in 560 biomedical facilities classified either as high risk or medium risk facilities across the 6 zones in Nigeria.

Results

In total, 560 biomedical facilities were surveyed in Nigeria in conformity with the GAP III. In total, 86% of the facilities surveyed were with laboratories while 14% were without laboratories.Twelve laboratories with poliovirus potentially infectious materials were identified in this exercise. In total, 50% of the 12 laboratories were under the ministry of education for research purposes. While 33% were among those laboratories surveyed in the phase 1a exercise without any recorded inventory, but have acquired some since the phase 1a survey.A total of 13,484 poliovirus infectious materials were found in the 12 laboratories. Only 8% of the materials were immediately destroyed while the remaining materials (62%) were found in Oyo and Borno states scheduled for destruction within 3–4 months according to WHO protocol for destruction of poliovirus infectious materials.

Conclusion

This study has revealed the successful containment of all poliovirus infectious materials in the laboratories surveyed. It has also revealed some surveillance gaps. We recommend that the surveillance system be improved to maintain the gains from the containment exercise and avoid reintroduction of infectious materials into biomedical facilities. This reduces the chances of viral reintroduction to the population in general.

     

Depressive state and paresthesia dramatically improved by intravenous MgSO4 in Gitelman's syndrome

A 69-year-old woman was referred to our department for evaluation of hypokalemia, which had been treated by oral potassium for more than ten years. She complained of headache, knee joint pain, sleeplessness and paresthesia in extremities and, most prominently, depression. Laboratory data suggested Gitelman's syndrome, which is caused by mutations in the gene encoding the thiazide-sensitive Na-Cl cotransporter. Direct sequencing of the gene in this patient revealed homozygous mutation R964Q in exon 25. Intravenous supplement of MgSO4 dramatically improved both the depression and the paresthesia, suggesting that hypomagnesemia played a role in the clinical manifestations.     

Phenanthroindolizidine alkaloids as cytotoxic substances in a Danaid butterfly, Ideopsis similis, against human cancer cells

We previously reported the presence of cytotoxic substances in extracts of the Danaid butterfly, Ideopsis similis. In the present study, we isolated cytotoxic substances against a human gastric cancer cell line, TMK-1, in I. similis pupae, with an activity similar to that of the adult butterfly. The basic fraction, prepared from a methanol extract, accounted for 83% of the cytotoxic activity. Two major cytotoxic substances were purified by HPLC, and one was determined to be a new phenanthroindolizidine alkaloid, trans-(+)-3,14alpha-dihydroxy-6,7-dimethoxyphenanthroindolizidine (1), and the other a known compound, trans-(+)-3,14alpha-dihydroxy-4,6,7-trimethoxyphenanthroindolizidine (2). The IC(50) values for TMK-1 cells were 0.5 ng/mL and 0.7 ng/mL, respectively. These two compounds showed similar cytotoxic potential with four other cancer cell lines including cervical, lung, and colon carcinomas and leukemia. Quantitative analyses indicated the presence of each of the two phenanthroindolizidine alkaloids at levels of 11-74 microg in each larva, pupa, or adult of I. similis. However, 1 was not detected in the leaves of Tylophora tanakae, a host plant for larvae of I. similis, and the level of 2 (2 microg per gram of leaves) was far less than that in the larvae. Since the leaves of T. tanakae are known to contain various phenanthroindolizidines, compounds 1 and 2 are presumably metabolically converted from such alkaloids in larvae of I. similis.     

Can the Proximal Isovelocity Surface Area Method Calculate Stenotic Mitral Valve Area in Patients with Associated Moderate to Severe Aortic Regurgitation? Analysis Using Low Aliasing Velocity of 10% of the Peak Transmitral Velocity

To assess the ability of the proximal isovelocity surface area (PISA) method to accurately measure the stenotic mitral valve area (MVA), and to assess whether aortic regurgitation (AR) affects the calculation, we compared the accuracy of the PISA method and the pressure half-time (PHT) method for determining MVA in patients with and without associated AR by using two-dimensional echocardiographic planimetry as a standard. The study population consisted of 45 patients with mitral stenosis. Seventeen of the 45 patients had associated moderate-to-severe AR. The PISA method was performed using low aliasing velocity (AV) of 10% of the peak transmitral velocity, which provided the most accurate estimation of MVA when compared with planimetry. The maximal radius r of the PISA was measured from the orifice to blue-red aliasing interface. Using the PISA method, MVA was calculated as (2pir(2)) x theta / 180 x AV/Vmax, where theta was the inflow angle formed by mitral leaflets, AV was the aliasing velocity (cm/sec), and Vmax was the peak transmitral velocity (cm/sec). MVA by the PISA method correlated well with planimetry both in patients with AR (r = 0.90, P < 0.001, SEE = 0.17 cm(2)) and without AR (r = 0.92, P < 0.001, SEE = 0.16 cm(2)). However, MVA by the PHT method did not correlate as well with planimetry (r = 0.57, P < 0.05, SEE = 0.37 cm(2)) in patients with associated AR, and the PHT method produced a significant overestimation (24%) of MVA obtained by planimetry in these patients. We conclude that the PISA method allows accurate estimation of MVA and is not influenced by AR.     

Behavior of Bromobutide in Paddy Water and Soil After Application

Behavior of the herbicide bromobutide, (RS)-2-bromo-N-(α,α-dimethylbenzyl)-3,3-dimethylbutyramide, in paddy water and soil after application to paddy fields was investigated to evaluate the degradation to bromobutide-debromo, N-(α,α-dimethylbenzyl)-3,3-dimethylbutyramide, and runoff of the herbicide. The respective maximum concentrations of bromobutide and the metabolite were 1,640–2,230 and 11.1–15.8 μg/L in the paddy water, and 2,210–4,140 μg/kg dry and 74–119 μg/kg dry in the paddy soil, respectively. The runoff ratios of the applied bromobutide from the paddy fields were calculated as 28 ± 16%. The respective mean values of the half-lives of bromobutide in the paddy water and the soil were 2.7 ± 0.34 days and 6.9 ± 2.6 days, respectively.