Topical vasoconstrictor use for nasal intubation during pregnancy complicated by cardiomyopathy and preeclampsia

Ankylosing spondylitis presents challenges for the obstetric anesthesiologist in administering neuraxial anesthesia or managing the airway. A pregnant patient with ankylosing spondylitis, cardiomyopathy and preeclampsia requiring cesarean delivery was managed with an awake nasotracheal fiberoptic intubation. The use of topical cocaine, epinephrine, phenylephrine, and oxymetazoline to produce nasal vasoconstriction is discussed. Selective alpha-2 agonists that can potentially provide nasal mucosa vasoconstriction and placental vasculature vasodilation are also discussed.

Molecular disruption of NBS1 with targeted gene delivery enhances chemosensitisation in head and neck cancer

BACKGROUND

a fibroblast growth factor 2 (FGF2)-targeted adenoviral system can alter viral tropism and allow for improved transduction and reduced systemic toxicity. This study is to investigate if the FGF2-targeted adenoviral mutant Nijmegen breakage syndrome 1 (FGF2-Ad-NBS1) gene transfer can enhance cisplatin chemosensitisation not only by targeting DNA repair, but also through the induction of antiangiogenesis, whereas at the same time reducing toxicities in treating head and neck squamous cell carcinoma (HNSCC).

METHODS

the human HNSCC cell line was treated in vitro and in a nude mouse xenograft model. We conducted verification of binding ability of mutant NBS1 and downregulation of MRN complex, evaluation of transduction efficiency and combined antitumour activities. The antiangiogenesis mechanism was also investigated. Finally, we estimated the distribution of adenoviral vector in the liver.

RESULTS

the mutant NBS1 protein retains the binding ability and effectively suppresses the expression level of the MRN in infected cells. Transduction efficiency in vitro and cisplatin chemosensitisation were upregulated. The FGF2-Ad-NBS1 also showed detargeting the viral vectors away from the liver. The downregulation of NF-κB expression was supposed to correlate with increased antiangiogenesis.

CONCLUSIONS

FGF2-targeted adenoviral system enhances the cisplatin chemosensitisation of mutant NBS1 and may avoid viral-associated liver toxicities.

Assessment of radiological hazards of clay bricks fabricated in the Punjab province of Pakistan

The Punjab is the most populous among the four provinces of Pakistan, which has around 72 million of people and 205 344 km(2) of land. The majority of the population of this province lives in houses made of clay bricks that contain variable amounts of naturally occurring radioactive material (NORM). The concentration level of NORM in clay bricks used to construct dwellings may pose health hazards to inhabitants if it exceeds the permissible limits. For radiological surveillance, activity concentrations of the primordial radionuclides (40)K, (226)Ra and (232)Th were measured in 140 brick samples collected from 35 districts of the Punjab province. A high-purity germanium gamma-ray detector coupled with a personal computer-based multichannel analyzer was employed for the measurement of activity concentrations of primordial radionuclides in the brick samples. The province-wide average activity concentrations and the range (given in parenthesis) of (40)K, (226)Ra and (232)Th were found to be 624 ± 133 (299-918), 35 ± 7 (21-47) and 42 ± 8 (22-58) Bq kg(-1), respectively. The values lie within the range of activity concentration values for clay bricks of some countries of Asia. Potential radiological constraint was checked in the form of hazard indices calculated from the measured activity concentrations; the indices were found to be less than their limiting values. Indoor external dose was calculated for a standard size room made of clay bricks, and the dose rate was 159 ± 30 (83-219) nGy h(-1). The average value of the dose rate is comparable to that of Asian countries and is about twice the worldwide average value. Annual effective dose E(ff) in the bricks-made room was calculated and the average value of the dose was 0.80 mSv y(-1), which is about twice the worldwide background value of 0.41 mSv y(-1).

Neovascular AMD: an overlooked risk factor for injurious falls

While those with neovascular age-related macular degeneration (NV-AMD) may be at increased risk of injurious falls risk due to poor central vision and suboptimal responses when falling, preserved peripheral vision and decreased activity levels may actually be protective. Compared with control participants, patients with NV-AMD had a significantly greater number of falls and almost twice the risk of injurious falls.

INTRODUCTION

Impaired vision, particularly peripheral visual function, is a key risk factor for injurious falls. NV-AMD is a leading cause of severely impaired vision among older adults but is associated with a profound central, rather than peripheral, deficit. The objective was to determine whether older women with NV-AMD are at an increased risk of falls or injurious falls.

METHODS

We conducted a 12-month prospective cohort study of community-dwelling older (>or=70 years) women, enrolling 114 with NV-AMD and 132 without from a retinal clinic in Vancouver, Canada. Fall incidence was determined through monthly telephone follow-up, with fall severity classified by a blinded reviewer. We compared mean injurious falls per person-year between groups using negative binomial regression.

RESULTS

A mean of 0.37 injurious falls per person-year were experienced among NV-AMD participants, compared to 0.16 injurious falls per person-year among non-NV-AMD participants (p = 0.006). The age-adjusted incidence rate ratio for injurious falls, for an individual with NV-AMD compared to without, was 1.77 (1.07-3.02).

CONCLUSIONS

Older women with NV-AMD are at almost twice the risk of injurious falls compared to those without. Clinicians caring for older adults should recognise NV-AMD as an important risk factor for injurious falls.

Introduction of Portable Computed Tomography Scanners, in the Treatment of Acute Stroke Patients via Telemedicine in Remote Communities

Background

Thrombolysis is an established treatment in selected patients who present early to hospital after symptoms of acute ischaemic stroke. Treatment can only be offered after the patient has been assessed by highly trained physicians and imaging studies have ruled out a brain haemorrhage. This limits the wider availability of thrombolysis to patients in remote communities, especially in countries with limited resources. There has been considerable success with the use of TeleStroke to overcome such barriers. TeleStroke is feasible in remote hospitals provided there is an available computed tomography scanner, a fundamental prerequisite in the assessment of acute stroke and thrombolysis. This is a luxury not widely available, especially in remote sites. Recently, Neurologica introduced a portable computed tomography scanner that can be operated after minimal training.

Methods

We report our preliminary experience with the portable computed tomography scanner in a remote community where Telemedicine was successfully used to evaluate and treat patients presenting with symptoms suggestive of an acute ischaemic stroke. The University of Alberta Hospital in Edmonton, Canada was the ‘hub’ site and Wainwright Community Hospital was the ‘spoke’ site.

Results

Over a 3-month period, 18 patients were evaluated in the emergency department of the remote hospital where the referring physician felt that symptoms indicated potential for thrombolysis. All patients were evaluated remotely by a stroke neurologist in a TeleStroke service situated 207 km from the rural site. After clinical examination, cranial computed tomography scans were obtained with the portable scanner and evaluated by the stroke neurologist. In three patients, thrombolysis was not offered because the computed tomography showed evidence of brain haemorrhage: two intracerebral haemorrhage and one subarachnoid haemorrhage. Three patients meeting the standard criteria received thrombolysis within 4·5 h from onset of symptoms. There was a significant improvement in two patients. One patient did not make a good recovery. Repeat computed tomography scans showed a small haemorrhagic transformation in one patient. In the remaining 12 subjects, symptoms improved rapidly, were outside the window for thrombolysis, or were not consistent with an acute ischaemic stroke.

Interpretations

Our preliminary study shows that the portable scanner can be used successfully in the evaluation of patients in remote regions that are not within timely reach of stroke experts or do not have available conventional imaging with computed tomography scans. Telemedicine, in combination with the use of portable scanners, offers hope to a large remote population base that would otherwise not have access to appropriate acute stroke treatment.

Radon monitoring in water sources of Balakot and Mansehra cities lying on a geological fault line

This paper relates to a series of systematic studies regarding measurement of radon concentration in the earthquake-affected areas of northern Pakistan. Radon is a radioactive alpha-particle-emitting gas originating from the decay series of uranium and thorium and is found anywhere in soil, air and water. The nature of water does not matter with regard to the presence of radon, however, the level of radon concentration varies in different types of water. The present survey is carried out in water samples from the fault zone of Balakot and Mansehra regions, North West Frontier Province, Pakistan, which is important for geological consideration and protection from radiation hazards. The measurements were made on a Pylon system that is based on the radon gas measurement with a Lucas cell. In 72 water samples in the equilibrium state between radon and its progeny, the concentration level of radon is measured. The results show that the radon concentrations are in the range of 4.99-24.52 kBq/m(3), with an average value of 15.52 kBq/m(3) for all types of water taken in this survey.

Hip protectors: recommendations for conducting clinical trials--an international consensus statement (part II)

INTRODUCTION

While hip protectors are effective in some clinical trials, many, including all in community settings, have been unable to demonstrate effectiveness. This is due partly to differences in the design and analysis. The aim of this report is to develop recommendations for subsequent clinical research.

METHODS

In November of 2007, the International Hip Protector Research Group met to address barriers to the clinical effectiveness of hip protectors. This paper represents a consensus statement from the group on recommended methods for conducting future clinical trials of hip protectors.

RESULTS AND CONCLUSIONS

Consensus recommendations include the following: the use of a hip protector that has undergone adequate biomechanical testing, the use of sham hip protectors, the conduct of clinical trials in populations with annual hip fracture incidence of at least 3%, a run-in period with demonstration of adequate adherence, surveillance of falls and adherence, and the inclusion of economic analyses. Larger and more costly clinical trials are required to definitively investigate effectiveness of hip protectors.

Hip protectors: recommendations for biomechanical testing--an international consensus statement (part I)

INTRODUCTION

Hip protectors represent a promising strategy for preventing fall-related hip fractures. However, clinical trials have yielded conflicting results due, in part, to lack of agreement on techniques for measuring and optimizing the biomechanical performance of hip protectors as a prerequisite to clinical trials.

METHODS

In November 2007, the International Hip Protector Research Group met in Copenhagen to address barriers to the clinical effectiveness of hip protectors. This paper represents an evidence-based consensus statement from the group on recommended methods for evaluating the biomechanical performance of hip protectors.

RESULTS AND CONCLUSIONS

The primary outcome of testing should be the percent reduction (compared with the unpadded condition) in peak value of the axial compressive force applied to the femoral neck during a simulated fall on the greater trochanter. To provide reasonable results, the test system should accurately simulate the pelvic anatomy, and the impact velocity (3.4 m/s), pelvic stiffness (acceptable range: 39-55 kN/m), and effective mass of the body (acceptable range: 22-33 kg) during impact. Given the current lack of clear evidence regarding the clinical efficacy of specific hip protectors, the primary value of biomechanical testing at present is to compare the protective value of different products, as opposed to rejecting or accepting specific devices for market use.