Gadebrandt1434
Renal colic, pancreatitis, appendicitis, and headache/migraine showed a linear decrease in pain scores with age whereas dislocation and extremity fractures did not present age differences. check details Mean differences in pain intensity scores between young adults (18-44 years) and patients aged ≥75 years were 0.79 (95% confidence interval [95% CI] 0.5-1.1) for renal colic, 1.1 (95% CI 0.7-1.4) for pancreatitis, 0.70 (95% CI 0.2-1.2) for appendicitis, and 0.86 (95% CI 0.6-1.1) for headache/migraine.
Older patients perceive similar pain for dislocation and extremity fractures and less for visceral and headache/migraine pain; however, these age differences may not be clinically important.
Older patients perceive similar pain for dislocation and extremity fractures and less for visceral and headache/migraine pain; however, these age differences may not be clinically important.
Proteinaceous esophageal food impaction typically requires endoscopic intervention. An alternative approach is the use of proteolytic enzymes. Concerns regarding the use of proteolytic enzymes include the risk of perforation and aspiration pneumonitis.
We retrospectively reviewed our series of 69 patients treated with papain to determine the safety and efficacy of proteolytic enzymes.
Patients were retrospectively reviewed if treated for an esophageal food impaction from 1999 through2008.
Median age was 56years (range 19-91years), with 46 male and 23 female patients. In 27 patients (39%) this was their first presentation, in 14 (20%) it was the second, and 28 (41%) had multiple previous episodes. Meat was the cause in 49 (71%), chicken in 6 (9%), fish in 3 (4%), and unspecified in 11 (16%). All patients presented with dysphagia for solids, 56 (81%) could not tolerate liquids. Papain solution, 1 tsp in 8 oz of water, was given to patients in an unlimited quantity. Papain was successful in relieving the obstruction in 60 patients (87%). The remaining 9 patients (13%) underwent endoscopy with successful retrieval. No patient suffered a perforation, either with papain ingestion or endoscopy. There were no episodes of pneumonitis or pneumonia.
We have used proteolytic enzymes with a high success rate and with minimal complication. Further, if proteolytic enzymes fail, endoscopy can be performed safely and effectively. We recommend the use of proteolytic enzymes as the initial management in all patients with proteinaceous food impaction of the esophagus.
We have used proteolytic enzymes with a high success rate and with minimal complication. Further, if proteolytic enzymes fail, endoscopy can be performed safely and effectively. We recommend the use of proteolytic enzymes as the initial management in all patients with proteinaceous food impaction of the esophagus.
A 29-year-old man was lost in the bush with minimal clothing for almost 2 days.
The patient in this case developed rhabdomyolysis with subsequent acute kidney injury. He was treated with passive warming and intravenous fluids, with resolution of the kidney injury. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS? Patients who present with hypothermia may develop rhabdomyolysis with subsequent acute kidney injury. If not identified, renal failure may develop. This is easily preventable if the practitioner is aware of the possible consequences of cold exposure, orders the appropriate test, and administers corrective treatment.
The patient in this case developed rhabdomyolysis with subsequent acute kidney injury. He was treated with passive warming and intravenous fluids, with resolution of the kidney injury. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS? Patients who present with hypothermia may develop rhabdomyolysis with subsequent acute kidney injury. If not identified, renal failure may develop. This is easily preventable if the practitioner is aware of the possible consequences of cold exposure, orders the appropriate test, and administers corrective treatment.
Intubation of the neurologically injured patient is a critical procedure that must be done in a manner to prevent further neurologic injury. Although many different medications and techniques have been used to meet specific needs, there is little to no evidence to support many claims.
To review the literature regarding important topics relating to intubating patients with neurologic injury.
Airway management requires ideal preoxygenation and airway maneuvers to minimize manipulation of the larynx and to maximize first-pass success. There is no evidence that lidocaine pretreatment decreases intracerebral pressure (ICP). Fentanyl can be used to help blunt the hemodynamic response to intubation. Esmolol is another medication that can blunt the hemodynamic response. Ketamine can be used and is possibly the ideal agent, having a neutral hemodynamic profile. A prefasciculation dose for neuromuscular blockade has not been shown to have any effect on ICP.
Ideal intubation conditions should be obtained through the use of airway manipulation techniques and appropriate medication choice for rapid sequence intubation in patients who are neurologically injured.
Ideal intubation conditions should be obtained through the use of airway manipulation techniques and appropriate medication choice for rapid sequence intubation in patients who are neurologically injured.Aggregate size and density are related to gel morphology. In the context of the water distribution in complex food systems, in this study, it was aimed to investigate whether protein aggregates varying in size and density differ in entrapped and confined water. Heat-set soy protein aggregates (1%, v/v) prepared in the presence of 3.5 mM divalent salts increased in size and decreased in apparent density following the salt type order MgSO4, MgCl2, CaSO4, and CaCl2. In the absence of applied (centrifugal) forces, larger and less dense aggregates entrap more water. When force is applied from larger and more deformable aggregates, more water can be displaced. Entrapped water of ∼8-13 g of water/g of protein is associated with (pelleted) aggregates, of which approximately 4.5-8.5 g of water/g of protein is not constrained in exchangeability with the solvent. The amount of confined water within aggregates was found to be independent of the aggregate density and accounted for ∼3.5 g of water/g of protein. Confined water in aggregates is hindered in its diffusion because of physical structure constraints and, therefore, not directly exchangeable with the solvent. These insights in the protein aggregate size and deformability in relation to water entrapment and confinement could be used to tune water holding on larger length scales when force is applied.
Breast cancer is the second leading cause of cancer mortality among women in the developed world. Mammography screening is especially important for African-Americans because they experience a greater mortality (OR = 1.38) than Caucasians despite having a lower incidence of breast cancer.
The purpose of this study was to compare the effects of two interventions with usual care on mammography adherence among African-American women.
A subsample of African-American women (n = 244) aged 41-65 years who had not had a mammogram in the last 15 months and no history of breast cancer was randomly assigned to receive (1) mailed interactive DVD, (2) computer-tailored telephone counseling, or (3) usual care.
The DVD intervention was five times more effective than usual care for promoting mammography screening at 6 months follow-up among women who earned less than $30,000 (OR = 5.3). Compared to usual care, neither the DVD nor phone produced significant effects for women with household incomes >$30,000.
Use of a mailed DVD for low-income African-American women may be an effective way to increase mammography adherence.
Use of a mailed DVD for low-income African-American women may be an effective way to increase mammography adherence.The present study highlights the role of β-aminobutyric acid (BABA) in alleviating drought stress effects in maize (Zea mays L.). Chemical priming was imposed by pretreating 1-week-old plants with 600 μM BABA prior to applying drought stress. Specific activities of key antioxidant enzymes and metabolites (ascorbate and glutathione) levels of ascorbate-glutathione cycle were studied to unravel the priming-induced modulation of plant defense system. Furthermore, changes in endogenous ABA and JA concentrations as well as mRNA expressions of key genes involved in their respective biosynthesis pathways were monitored in BABA-primed (BABA+) and non-primed (BABA-) leaves of drought-challenged plants to better understand the mechanistic insights into the BABA-induced hormonal regulation of plant response to water-deficit stress. Accelerated stomatal closure, high relative water content, and less membrane damage were observed in BABA-primed leaves under water-deficit condition. Elevated APX and SOD activity in non-primed leaves found to be insufficient to scavenge all H2O2 and O2 (·-) resulting in oxidative burst as evident after histochemical staining with NBT and DAB. A higher proline accumulation in non-primed leaves also does not give much protection against drought stress. Increased GR activity supported with the enhanced mRNA and protein expressions might help the BABA-primed plants to maintain a high GSH pool essential for sustaining balanced redox status to counter drought-induced oxidative stress damages. Hormonal analysis suggests that in maize, BABA-potentiated drought tolerance is primarily mediated through JA-dependent pathway by the activation of antioxidant defense systems while ABA biosynthesis pathway also plays an important role in fine-tuning of drought stress response.Resuspension of bedded sediments was simulated under laboratory-controlled conditions in order to assess the amount of polycyclic aromatic hydrocarbons (PAH) remobilized in the dissolved fraction during one short and vigorous mixing. The desorbed amount of PAH was compared to the exchangeable fraction, the total amount of PAH sorbed on the sediment particles, and the dissolved PAH amount contained in the interstitial pore waters in order to evaluate the contribution of each fraction to the total amount of PAH released. To monitor the desorption of PAH and measure low trace level concentrations, passive samplers were used in an experimental open flow through exposure simulator. Results show that for the selected sediment, a substantial fraction of sorbed PAH (69 % of the total amount) is not available for remobilization in a depleted medium. Obtained data pinpoint that over 9 days, only 0.007 % of PAH are desorbed by passive diffusion through a water-sediment interface area of 415 cm(2) and that an intense resuspension event of 15 min induces desorption of 0.015 % of PAH during the following 9 days. Results also highlight that during resuspension simulation, modifications of the sediment and the water body occurred since partitioning constants of some pollutants between sediment and water have significantly decreased.The formation of polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/F) was explored during de novo tests designed to compare the catalytic activity of copper (II) chloride (CuCl2) with that of iron (III) oxide (Fe2O3) and to test some synergistic effect between these two catalytic compounds. Both copper chloride (CuCl2) and iron oxide (Fe2O3) were earlier proposed as catalysts to explain the PCDD/F emissions from, e.g. municipal solid waste incineration (MSWI). In addition, haematite (Fe2O3) is the main iron ore and could be responsible for the typical iron ore sintering plant fingerprint. A total of nine model fly ash (MFA) samples were prepared by mixing and grinding of sodium chloride (NaCl), activated carbon and a powder matrix of silica (SiO2) with the selected metal compound(s). The conditions of these de novo tests were 1 h in duration, 350 °C in a flow of synthetic combustion gas (10 vol.% oxygen in nitrogen). The effect of Fe-Cu catalyst concentration on yield and distribution pattern of PCDD/F was systematically explored; three strongly differing ratios of [Fe][Cu] were considered (11, 101 and 1001) to study the potential interactions of Fe2O3 and CuCl2 suggested earlier.
