Quantitative Study of the Beliefs and Attitudes Toward Organ Donation and the Opt-Out System Among the Sikh Community in the United Kingdom

In the United Kingdom, there is a paucity donors from ethnic minorities; however, the number of recipients from ethnic minorities is increasing annually. Following implementation of the opt-out system (OOS) in Wales, a wider debate has started whether the system should be adopted elsewhere in the United Kingdom. We studied Sikh opinion with regard to organ donation and the OOS.

The effects of atherosclerosis on the hypertrophied rabbit heart.

We studied the effects of high cholesterol diet and atherosclerosis on the development of left ventricular hypertrophy (LVH) in rabbits. The suprarenal aorta was banded in rabbits on a normal diet and in rabbits on a 4% cholesterol diet. A group of sham-operated rabbits was fed a normal diet, and another group of sham-operated rabbits was fed a 4% cholesterol diet. All four groups were sacrificed after approximately 6 months, when hypertrophy in the banded rabbits had stabilized. The LV- and RV-to-body weight ratios were determined. LV to body weight increased from a value in controls of 0.78 ± 0.052 to 1.02 ± 0.085 gm/kgm (P < 0.05) in the banded group on a normal diet and to 1.03 ± 0.031 gm/kgm (P < 0.05) in the sham-operated group on a cholesterol diet. The increase in the LV-to-body weight ratio to 1.21 ± 0.072 gm/kgm was largest (P < 0.05) in the banded group on the high cholesterol diet. RV to body weight did not change in any group. The development of LVH in atherosclerotic rabbits was associated with an increase in arterial pressure. Myocardial ischemia could not be responsible for LVH since hypertrophy was confirmed only in the left ventricle even in the presence of right ventricular myocardial ischemia. Atherosclerosis increased the degree of LVH induced by aortic banding in an additive manner. Therefore, the findings indicate that LVH in the atherosclerotic rabbit was due to increased arterial pressure induced by the atherosclerosis and that atherosclerosis further increased the degree of hypertrophy induced by aortic banding by increasing the arterial pressure proximal to the band.     

Cerebral Air Embolism after Esophagogastroduodenoscopy: Insight on Pathophysiology,Epidemiology, Prevention and Treatment

BackgroundAir embolism is an extremely rare complication that can follow gastrointestinal endoscopy. The most accepted treatment of cerebral air embolism (CAE) is hyperbaric oxygen (HBO). Limited evidence suggests that lidocaine may have a neuroprotective effect. The exact mechanism does not appear to be well elucidated.MethodsWe conducted a literature search using multiple combinations of keywords from PubMed and Ovid Medline databases according to the PRISMA guidelines. We included articles with cases of air embolism caused by an esophagogastroduodenoscopy (EGD). We excluded cases related to other procedures e.g. colonoscopy, endoscopic retrograde cholangiopancreatography, cholangioscopy, Kasai procedure, bronchoscopy, laparoscopy or thoracoscopy. We were able to identify 30 cases of CAE associated with EGD. We included our experience in treating one patient with CAE after elective EGD.ResultsGiven the results of our literature search and this patient's characteristics, we chose to treat our patient with HBO and lidocaine infusion. Our case series consists of 31 patients of post EGD CAE, the mean age was 63.7 ± 11.14 years, 38.7% of the patients were women (n = 12). 38.7% of the cases underwent esophageal dilatation (n = 12), while 19.35% had EGD biopsy (n = 6), 9.6% had variceal ligation (n = 3), and 3.22% had variceal banding (n = 1). In 20 out of 31 cases, echocardiography has been documented, 20% of those patients (n = 4) had patent foramen ovale. HBO was used in treatment of 48% of cases (n = 15), among the included patients, 61% survived (n = 19). Our patient showed significant neurological improvement.ConclusionsDespite the rare incidence of CAE during or after EGD, physicians should be aware of this potential complication. In patients who develop sudden acute neurological symptoms, early diagnosis and intervention may prevent devastating neurological injury and death. The most accepted emergent treatment for CAE includes HBO, consideration of lidocaine, and work-up of source of the air embolism.     

Role of proinflammatory cytokines in the inhibition of hippocampal neurogenesis in mesial temporal lobe epilepsy

Background

In mesial temporal lobe epilepsy, reduced hippocampal neurogenesis correlates with severe impairment in declarative learning and memory. The proinflammatory cytokines interleukin 1β and high-mobility group box 1 (HMGB1) and their receptors have key roles in generating and perpetuating seizures. This study aimed to assess their potential role in inhibiting neurogenesis in patients with mesial temporal lobe epilepsy and whether any effect would be pharmacologically reversible as a possible mechanism to restore learning and memory deficits.