Severe hyperkalaemia complicating parathyroidectomy in patients with end-stage renal disease

We evaluated the incidence of perioperative hyperkalaemia in end-stage renal disease (ESRD) patients undergoing parathyroidectomy and investigated possible contributors to this phenomenon. This was a retrospective cohort study looking at patients who had undergone parathyroidectomy for chronic kidney disease-associated mineral bone disease (CKD-MBD) at The Alfred Hospital, Melbourne, since 2001. Baseline demographics including age, gender, aetiology of renal failure and mode of renal replacement therapy as well as anaesthetic technique and duration of surgery were studied as possible contributors. Perioperative potassium values were compared to preoperative baseline. Following stratification into normokalaemic and hyperkalaemic groups, demographic and operative data were compared. Twenty-two patients met the inclusion criteria with a median (interquartile range, IQR) age of 48.5 (42-59) years. There was a male predominance of 68%. The median (IQR) surgical time was 131 (115-164) minutes. Potassium levels rose perioperatively, with a 27.3% incidence of perioperative hyperkalaemia. Median duration of surgery was longer in the hyperkalaemic patients (167 minutes versus 125 minutes). Following the withdrawal of cinacalcet, parathyroidectomy is increasingly required in ESRD patients with CKD-MBD. Potentially life-threatening hyperkalaemia poses a significant risk in the perioperative period. Serial electrolyte monitoring is crucial to safety in this patient group. A multidisciplinary approach to perioperative management is required to ensure optimal timing of renal replacement therapy and appropriate means of serial blood sampling.

Interpersonal dysfunction in personality disorders: A meta-analytic review

Personality disorders are defined in the current psychiatric diagnostic system as pervasive, inflexible, and stable patterns of thinking, feeling, behaving, and interacting with others. Questions regarding the validity and reliability of the current personality disorder diagnoses prompted a reconceptualization of personality pathology in the most recent edition of the psychiatric diagnostic manual, in an appendix of emerging models for future study. To evaluate the construct and discriminant validity of the current personality disorder diagnoses, we conducted a quantitative synthesis of the existing empirical research on associations between personality disorders and interpersonal functioning, defined using the interpersonal circumplex model (comprising orthogonal dimensions of agency and communion), as well as functioning in specific relationship domains (parent-child, family, peer, romantic). A comprehensive literature search yielded 127 published and unpublished studies, comprising 2,579 effect sizes. Average effect sizes from 120 separate meta-analyses, corrected for sampling error and measurement unreliability, and aggregated using a random-effects model, indicated that each personality disorder showed a distinct profile of interpersonal style consistent with its characteristic pattern of symptomatic dysfunction; specific relationship domains affected and strength of associations varied for each personality disorder. Overall, results support the construct and discriminant validity of the personality disorders in the current diagnostic manual, as well as the proposed conceptualization that disturbances in self and interpersonal functioning constitute the core of personality pathology. Importantly, however, contradicting both the current and proposed conceptualizations, there was not evidence for pervasive dysfunction across interpersonal situations and relationships. (PsycINFO Database Record

Anti-parasite treatment, but not mercury burdens, influence nesting propensity dependent on arrival time or body condition in a marine bird

Arctic wildlife can be exposed to high mercury (Hg) levels, and are also naturally exposed to gastrointestinal parasites that can reduce condition and negatively affect reproductive output and/or survival in similar ways. Importantly, both Hg and parasites are increasing in wildlife in some Arctic regions. We studied the northern common eider duck (Somateria mollissima) to explore how Hg in association with both natural levels and experimentally reduced parasitic infections, affect reproduction and survival. Female eiders were measured, banded, and blood sampled to determine blood Hg burdens, prior to breeding. Propensity to nest, clutch size, nest survival, nest attendance, and return rates were assessed in relation to both Hg burden and parasite treatment. Neither reproduction nor return rates of females varied with Hg concentrations, but females arriving late to the colony, or in low body condition, showed increased nesting propensity when given the anti-parasite treatment as compared to placebo treatment. Our results suggest that parasites can play a critical role in decisions to invest in avian breeding annually, particularly among individuals with a late onset to breeding, and in poor condition.

Resource impact of managing suspected Middle East respiratory syndrome patients in a UK teaching hospital

Clinical challenges exist in the management of hospitalized patients returning to the UK with potential Middle East respiratory syndrome coronavirus (MERS-CoV) infection, particularly with its clinical overlap with influenza, as demonstrated in this case-series and cost-analysis review of returning Hajj pilgrims. These patients were hospitalized with acute febrile respiratory illness, initially managed as potential MERS-CoV infections, but were eventually diagnosed with influenza. Additional costs were small, yet enhanced infection prevention measures created significant burdens on isolation rooms and staff time. Planning for predictable events such as Hajj is important for resource management. Here, in-house MERS-CoV diagnostic testing would have facilitated earlier diagnosis and discharge.

Predicting groundwater redox status on a regional scale using linear discriminant analysis

Reducing conditions are necessary for denitrification, thus the groundwater redox status can be used to identify subsurface zones where potentially significant nitrate reduction can occur. Groundwater chemistry in two contrasting regions of New Zealand was classified with respect to redox status and related to mappable factors, such as geology, topography and soil characteristics using discriminant analysis. Redox assignment was carried out for water sampled from 568 and 2223 wells in the Waikato and Canterbury regions, respectively. For the Waikato region 64% of wells sampled indicated oxic conditions in the water; 18% indicated reduced conditions and 18% had attributes indicating both reducing and oxic conditions termed "mixed". In Canterbury 84% of wells indicated oxic conditions; 10% were mixed; and only 5% indicated reduced conditions. The analysis was performed over three different well depths, <25m, 25 to 100 and >100m. For both regions, the percentage of oxidised groundwater decreased with increasing well depth. Linear discriminant analysis was used to develop models to differentiate between the three redox states. Models were derived for each depth and region using 67% of the data, and then subsequently validated on the remaining 33%. The average agreement between predicted and measured redox status was 63% and 70% for the Waikato and Canterbury regions, respectively. The models were incorporated into GIS and the prediction of redox status was extended over the whole region, excluding mountainous land. This knowledge improves spatial prediction of reduced groundwater zones, and therefore, when combined with groundwater flow paths, improves estimates of denitrification.

Breast reconstruction after mastectomy

Multiple options

An effective view

The Victoria Infirmary National Health Service (NHS) Trust, Glasgow, UK has recently completed the pilot phase of implementing an internal Intranet system. The project was initially funded by the NHS Management Executive with the purpose of establishing an internal web to provide non-patient specific clinical and non-clinical information throughout the Trust. The pilot phase has been a great success, with the Intranet content currently consisting of departmental information, protocols, clinical guidelines and notices of meetings. The Intranet is now beginning to take on the function of a hospital handbook.

3D graphics, virtual reality, and motion-onset visual evoked potentials in neurogaming

A brain-computer interface (BCI) offers movement-free control of a computer application and is achieved by reading and translating the cortical activity of the brain into semantic control signals. Motion-onset visual evoked potentials (mVEP) are neural potentials employed in BCIs and occur when motion-related stimuli are attended visually. mVEP dynamics are correlated with the position and timing of the moving stimuli. To investigate the feasibility of utilizing the mVEP paradigm with video games of various graphical complexities including those of commercial quality, we conducted three studies over four separate sessions comparing the performance of classifying five mVEP responses with variations in graphical complexity and style, in-game distractions, and display parameters surrounding mVEP stimuli. To investigate the feasibility of utilizing contemporary presentation modalities in neurogaming, one of the studies compared mVEP classification performance when stimuli were presented using the oculus rift virtual reality headset. Results from 31 independent subjects were analyzed offline. The results show classification performances ranging up to 90% with variations in conditions in graphical complexity having limited effect on mVEP performance; thus, demonstrating the feasibility of using the mVEP paradigm within BCI-based neurogaming.

The 2000 Canine Distemper Epidemic in Caspian Seals (Phoca caspica): Pathology and Analysis of Contributory Factors

More than 10,000 Caspian seals ( Phoca caspica) were reported dead in the Caspian Sea during spring and summer 2000. We performed necropsies and extensive laboratory analyses on 18 seals, as well as examination of the pattern of strandings and variation in weather in recent years, to identify the cause of mortality and potential contributory factors. The monthly stranding rate in 2000 was up to 2.8 times the historic mean. It was preceded by an unusually mild winter, as observed before in mass mortality events of pinnipeds. The primary diagnosis in 11 of 13 seals was canine distemper, characterized by broncho-interstitial pneumonia, lymphocytic necrosis and depletion in lymphoid organs, and the presence of typical intracytoplasmic inclusion bodies in multiple epithelia. Canine distemper virus infection was confirmed by phylogenetic analysis of reverse transcriptase-polymerase chain reaction products. Organochlorine and zinc concentrations in tissues of seals with canine distemper were comparable to those of Caspian seals in previous years. Concurrent bacterial infections that may have contributed to the mortality of the seals included Bordetella bronchiseptica (4/8 seals), Streptococcus phocae (3/8), Salmonella dublin (1/8), and S. choleraesuis (1/8). A newly identified bacterium, Corynebacterium caspium, was associated with balanoposthitis in one seal. Several infectious and parasitic organisms, including poxvirus, Atopobacter phocae, Eimeria- and Sarcocystis-like organisms, and Halarachne sp. were identified in Caspian seals for the first time.

‘Inversion’ Stripping of the Long Saphenous Vein

Objective:

To assess a novel device designed for ‘inversion’ stripping of the long saphenous vein during varicose vein surgery.

Design:

A prospective, randomized trial.

Setting:

The Day Surgery Unit of a District General Hospital.

Patients:

Thirty consecutive patients undergoing unilateral, varicose vein surgery, all fulfilling appropriate requirements for day surgery.

Outcome:

Peroperative assessment of blood loss and postoperative assessment of complications, bruising, pain and length of stripper exit wound.

Results:

‘Inversion’ stripping caused less peroperative blood loss ( p < 0.01). It reduced postoperative morbidity (for pain at 1 week, p = 0.02) and gave an improved cosmetic result (with a smaller stripper exit wound, p < 0.01).

Conclusion:

An easy-to-use, ‘inversion’ stripping device is described that can reduce the postoperative morbidity often associated with primary varicose vein surgery and can enhance cosmesis.

Human eosinophils modulate peripheral blood mononuclear cell response to Schistosoma mansoni adult worm antigen in vitro

High numbers of eosinophils are observed in parasitic infections and allergic diseases, where they are proposed to be terminally differentiated effector cells that play beneficial role in host defence, or cause harmful inflammatory response. Eosinophils have been associated with killing of schistosomulae in vitro, but there is growing evidence that eosinophils can play additional immuno‐regulatory role. Here, we report results of a study that examines peripheral blood mononuclear cell (PBMC) cytokine responses to Schistosoma mansoni adult worm antigen (SWA) when stimulated alone or enriched with autologous eosinophils. Production of the Th‐2 type cytokines interleukin (IL)‐4, IL‐5 and IL‐13 was lower (P = 0·017, 0·018 and <0·001, respectively) in PBMC + eosinophil cultures than in PBMC‐only cultures stimulated with SWA. Substantial levels of IL‐13, IL‐10, interferon gamma and tumour necrosis factor alpha were recorded in cultures of eosinophils, but none of these cytokines showed significant association with the observed eosinophil‐induced drop in cytokine responses of PBMC. Transwell experiments suggested that the observed effect is due to soluble mediators that downmodulate production of Th‐2 type cytokines. This study shows that eosinophils may down‐modulate schistosome‐specific Th‐2 type cytokine responses in S. mansoni‐infected individuals. The mechanism of this immune modulation remains to be elucidated.

PrÉvalence Et DÉterminants De La Non-Vaccination Contre L’hÉpatite B Chez Les Adolescents Au Canada, 2013

HISTORIQUE: Le Comité consultatif national de l’immunisation (CCNI) recommande depuis 1993 la mise en place de programmes de vaccination universelle contre l’hépatite B au Canada. Depuis 1998, des programmes de vaccination universelle contre l’hépatite B sont place partout au pays. Les calendriers de vaccination systématique ne sont toutefois pas harmonisés.

OBJECTIFS: Mesurer la couverture vaccinale pour l’hépatite B rapportés et identifier les facteurs de risques associés à la non-vaccination.

MATÉRIALS/MÉTHODE: Nous avons analysé les données de 6805 adolescents de 17 ans inclus dans l’enquête nationale sur la couverture vaccinale des enfants (ENCVE) de 2013 pour identifier les facteurs socio-démographiques associés à la non-vaccination, c’est-à-dire n’avoir reçu aucune dose du vaccin contre l’hépatite B. Les variables indépendantes incluses dans l’analyse étaient les provinces et territoires, le fait que les adolescents ou les parents soient nés à l’extérieur du Canada ou non, le statut matrimonial des parents et le niveau d’éducation de ces derniers en plus du revenu familial moyen. Les rapports de cotes ont été calculés au moyen de regressions logistiques simples et multiples. Les intervalles de confiance ont été estimés par la méthode bootstrap.

RÉSULTATS: En tout, 87.9% des adolescents avaient reçu au moins une dose du vaccin. Il n’y avait pas d’association significative entre le statut socioéconomique et le statut vaccinal des enfants pour l’hépatite B. Il existe cependant des différences au niveau de couverture vaccinale pour ce vaccin entre les différentes provinces et territoires du Canada. De plus, à 17 ans le fait d’être né à l’extérieur du Canada était associé à un risque plus élevé d’être non-vacciné comparativement aux enfants nés au Canada, et ce à la limite du seuil de signification (p=0.556).

CONCLUSION: Il existe des différences entre les taux de couvertures des provinces et territoires malgré des programmes de vaccination systéma-tique contre l’hépatite B dans toutes les juridictions. Par contre, il ne semble pas y avoir d’inégalité socioéconomique en lien avec le statut vac-cinal de l’hépatite B des adolescents. Ceci est un fait encourageant pour les programmes de promotion en place dans le pays.

Genetic and Environmental Influences on Parent-Child Conflict and Child Depression Through Late Adolescence

Few studies have investigated potential gender differences in the genetic and environmental influences on the prospective associations between parent-child conflict and later depression, a notable gap given substantial gender differences in rates of depression and suggestive evidence of differences in the etiology of depression among females and males. To fill this gap, we evaluated whether the prospective relationship between parent-child conflict and major depressive disorder symptoms varied as a function of parent-child gender composition. A combined twin and adoption sample was used (53% female; 85% European ancestry), containing 1,627 adolescent sibling pairs (789 monozygotic twin pairs, 594 dizygotic/full-biological pairs, 244 genetically unrelated pairs) with assessments at two time points in adolescence (approximate ages 15 and 18). Prospective associations between parent-child conflict and subsequent adolescent depression were explained predominately through common genetic influences for mother-daughter and mother-son pairs but less so for father-daughter and father-son pairs. Results support the notion that processes of gene-environment correlation involved in the prospective associations between parent-child conflict, and later adolescent depression appear to be less relevant to father-child relationships in comparison to mother-child relationships. Notably, results did not show that parent-child conflict was more relevant to the etiology of major depressive disorder (MDD) for girls than boys; gender differences in depression do not appear to be due to differences in the associations between parent-child conflict and child depression.

Volatile organic compounds and particulate matter in child care facilities in the District of Columbia: Results from a pilot study

BACKGROUND

Many young children in the U.S. spend a significant portion of their day in child care facilities where they may be exposed to contaminants linked to adverse health effects. Exposure data on volatile organic compounds (VOCs) and particulate matter (PM) in these settings is scarce.

OBJECTIVE

To guide the design of a larger exposure assessment study in urban child care facilities, we conducted a pilot study in which we characterized indoor concentrations of select VOCs and PM.

METHODS

We recruited 14 child care facilities in the District of Columbia (Washington, DC) and measured indoor concentrations of seven VOCs (n=35 total samples; 2-5 samples per facility): benzene, carbon tetrachloride, chloroform, ethylbenzene, o-xylene, p-xylene, and toluene in all facilities; and collected real-time PM measurements in seven facilities. We calculated descriptive statistics for contaminant concentrations and computed intraclass correlation coefficients (ICC) to evaluate the variability of VOC levels indoors. We also administered a survey to collect general health information on the children attending these facilities, and information on general housekeeping practices and proximity of facilities to potential sources of target contaminants.

RESULTS

We detected six of the seven VOCs in the majority of child care facilities with detection frequencies ranging from 71% to 100%. Chloroform and toluene were detected in all samples. Median (range) concentrations for toluene, chloroform, benzene, o-xylene, ethylbenzene, and carbon tetrachloride were: 5.6µg/m(3) (0.6-16.5µg/m(3)), 2.8µg/m(3) (0.4-53.0µg/m(3)), 1.4µg/m(3) (below the limit of detection or <LOD - 4.4µg/m(3)), 1.1µg/m(3) (<LOD - 35.7µg/m(3)), 1.0µg/m(3) (<LOD - 28.5µg/m(3)), and 1.0µg/m(3) (<LOD - 1.6µg/m(3)), respectively. The ICCs for the VOCs measured ranged from 0.32 to 0.75. Child care facility median concentrations for PM2.5 and PM10 were 20.1µg/m(3) and 26.3µg/m(3), respectively. Chlorine bleach, a source of chloroform, was used in almost all facilities, air fresheners and/or scented candles were used in half of the facilities, and at least one child in each facility had physician-diagnosed asthma (median asthma prevalence rate=10.2%).

CONCLUSION

We found quantifiable levels of VOCs and PM in the child care facilities sampled. Given that exposures to environmental contaminants during critical developmental stages may have long lasting impacts on children's health, larger studies are needed to characterize and identify sources of exposures to these and other indoor contaminants to develop exposure mitigation strategies.

Behaviour, development and metal accumulation in striped marsh frog tadpoles (Limnodynastes peronii) exposed to coal mine wastewater

Coal mining generates large quantities of complex effluent, and this often contains high levels of dissolved solids, suspended solids, metals, hydrocarbons, salts and other compounds. Substantial volumes of mine wastewater are periodically discharged into the environment, through both planned and accidental releases, and this raises concerns about the potential for adverse impacts on aquatic wildlife. There have been few attempts to explore sub-lethal effects of coal mine wastewater on amphibians compared to other organisms, and this is particularly true for Australian species. To address existing knowledge gaps, we exposed striped marsh frog (Limnodynastes peronii) tadpoles to 25, 50 and 100% coal mine wastewater collected from two holding dams (CMW1 and CMW2) located at an open cut mine in Central Queensland, Australia. The exposure lasted for four weeks, after which survival, growth and development, swimming behaviour, and concentrations of metals and metalloids in tail and liver tissues were assessed. Physico-chemical parameters varied considerably between sites, with higher turbidity, nutrients, total and dissolved organic carbon, alkalinity and arsenic (As) concentrations at CMW1, and higher conductivity, salinity, dissolved solids, hardness and sulfate levels at CMW2. There was no mortality in controls and less than 5% mortality in CMW1 treatments, whereas survival was significantly decreased in tadpoles exposed to CMW2 with 40 and 55% mortality in the 50 and 100% treatments, respectively. Development was significantly delayed in 100% CMW1 wastewater, but tadpole size (growth) was not influenced by the exposure. Hepatosomatic indices were significantly increased in tadpoles exposed to 25 and 50% CMW1 but not the 100% treatment group. Exposed tadpoles (predominantly those exposed to CMW1) exhibited increased activity after very short-term exposure (24h), but this did not persist as animals approached metamorphic climax. At the end of the experiment, tadpoles exposed to both wastewaters had elevated levels of selenium (Se), cobalt (Co) and As in tail and liver tissue compared to controls. Manganese (Mn) levels were also elevated in livers and tails of CMW2 exposed tadpoles. Hepatic tissue accumulated 8-9 times higher concentrations of Co, Mn and Se compared to tail tissue, irrespective of treatments. Future research is warranted to explore possible relationships between metal bioaccumulation, morpho-physiological effects during development, and subsequent higher-level outcomes related to individual performance and population fitness.

Environmental stress in the Gulf of Mexico and its potential impact on public health

The Deepwater Horizon (DWH) oil spill in the Gulf of Mexico was the largest maritime oil spill in history resulting in the accumulation of genotoxic substances in the air, soil, and water. This has potential far-reaching health impacts on cleanup field workers and on the populations living in the contaminated coastal areas. We have employed portable airborne particulate matter samplers (SKC Biosampler Impinger) and a genetically engineered bacterial reporter system (umu-ChromoTest from EBPI) to determine levels of genotoxicity of air samples collected from highly contaminated areas of coastal Louisiana including Grand Isle, Port Fourchon, and Elmer's Island in the spring, summer and fall of 2011, 2012, 2013 and 2014. Air samples collected from a non-contaminated area, Sea Rim State Park, Texas, served as a control for background airborne genotoxic particles. In comparison to controls, air samples from the contaminated areas demonstrated highly significant increases in genotoxicity with the highest values registered during the month of July in 2011, 2013, and 2014, in all three locations. This seasonal trend was disrupted in 2012, when the highest genotoxicity values were detected in October, which correlated with hurricane Isaac landfall in late August of 2012, about five weeks before a routine collection of fall air samples. Our data demonstrate: (i) high levels of air genotoxicity in the monitored areas over last four years post DWH oil spill; (ii) airborne particulate genotoxicity peaks in summers and correlates with high temperatures and high humidity; and (iii) this seasonal trend was disrupted by the hurricane Isaac landfall, which further supports the concept of a continuous negative impact of the oil spill in this region.