An Outcome Study on the Management of Alleged Fish Bone Ingestion Using Fibre-Optic Endoscope by Emergency Physician

Background

Patient with alleged fish bone ingestion with negative oropharyngeal examination requires an upper gastrointestinal (GI) endoscopy for definitive care.

Aim

To study the competency and cost-effectiveness in patients with alleged fish bone ingestion using fibre-optic endoscope by emergency physician.

Method

A retrospective study in patients with endoscopy for alleged fish bone ingestion for a period of six months from January to June 2001. A telephone survey was conducted specifically asking for post-endoscopy or fish bone ingestion related complications.

Results

Ninety-six patients were recruited in the study. There were 42 males and 54 females with a ratio of 1:1.3. The detection rate was 32%. Eighty-seven percent of the fish bones was retrieved, and 13% was dislodged. Over 90% of fish bones were found in oropharynx and laryngopharynx. In the telephone survey, 81 patients (84.4%) could be contacted by phone and they experienced uneventful outcome after endoscopy. Of those who could not be contacted, there was no documented attendance or admission in any other hospital (under Hospital Authority) according to the computer records in Clinical Management System. Ninety-six hospital bed-days, which were equal to $350,400, could be saved under our approach in alleged fish bone ingestion without admitting patients into surgical unit for treatment.

Conclusion

Emergency physician was competent enough in performing upper GI endoscopy, and this method of managing alleged fish bone ingestion was shown to be safe and cost saving.

A Retrospective Study of Geriatric Patients Presenting with Fever to an Accident and Emergency Department in Hong Kong

Objectives

To study the characteristics and outcome of geriatric patients presenting with fever to an emergency department in Hong Kong and to analyse the factors affecting their length of stay.

Methods

Retrospective study. Patients aged ≥65 who complained of fever, or with temperature ≥37.5°C (aural) presenting to the Accident and Emergency Department (AED) of Caritas Medical Centre in Hong Kong from 14 November 2006 to 13 December 2006 were enrolled. The demographic data, clinical information and outcomes were studied. The characteristics of short stay and long stay patients were compared.

Results

There were 370 patients in the study. Their median age was 80. Of these patients, 64.9% were category 3 or above, i.e. urgent, emergent or critical. The most common chief complaints were fever, shortness of breath, dizziness and cough. The admission rate was 81.9%. The median length of stay in hospital was 4.3 days. The most common hospital discharge diagnoses were chest infection, urinary tract infection, and fever with unknown cause. The discharge rate within 48 hours was 24.6%. With further analysis, temperature, walking ability, triage category and neutrophil count were significantly different between short stay (≤48 h) and long stay (>48 h) patients. For those discharged alive either from the AED or ward, 20.1% re-attended the AED within 14 days of discharge, and 17.5% of those previously discharged were admitted again for fever or other problems.

Conclusion

Elders with fever are a major challenge to the AED and health care facilities. The admission rate for this group of patients is usually high. Elders with poor walking ability, high triage category, high temperature and neutrophil count were prone to have longer stay.

The Effectiveness of Using a Lipido-Colloid Dressing for Patients With Traumatic Digital Wounds

This study compares the effect of a daily gauze dressing with that of a lipidocolloid dressing on the time taken to make up the dressing and efficacy of the management of traumatic digitalwounds. This is a randomized controlled trial of 28 patients (16 experimental and 12 control) with injuries to their fingers and loss of tissue. The patients in the experimental and control groups were given a lipido-colloid dressing and a daily gauze dressing, respectively. The patients'wounds were assessed in terms of the size of thewound and the time it took for thewound to heal. The findings showed that patients in the experimental group had a faster recovery time from the healing of their wound than the control group ( p= .024). The findings can help to establish an evidence-based practice in the management of traumatic digital wounds in clinical settings.

Assessment of heavy metals/metalloid (As, Pb, Cd, Ni, Zn, Cr, Cu, Mn) concentrations in edible fish species tissue in the Pearl River Delta (PRD), China

The major aim of this study was to investigate heavy metal content of edible fish in the PRD. Eleven species of fish (consisting of 711 individuals) [catfish (Clarias fuscus), tilapia (Oreochromis mossambicus), grass carp (Ctenopharyngodon idellus), bighead carp (Aristichthys nobilis), mandarin fish (Siniperca kneri), snakehead (Channa asiatiea), black bass (Micropterus salmoides), mangrove snapper (Lutjanus griseus), star snapper (Lutjanu stellatus), snubnose pompano (Trachinotus blochii) and orange-spotted grouper (Epinephelus coioides)] were collected for the analyses of heavy metals. Overall concentrations (mg/kg, ww) in the fish muscles were: As (0.03-1.53), Pb (0.03-8.62), Cd (0.02-0.06), Ni (0.44-9.75), Zn (15.7-29.5), Cr (0.22-0.65), Cu (0.79-2.26), Mn (0.82-6.91). Significant level of Pb were found in tilapia at all locations. It is recommended that heavy metal concentrations in different fish species must be determined on a regular basis in the future so as to reduce human health risks from acute and chronic food intoxication.

Influenza vaccinations of young children increased with media coverage in 2003

OBJECTIVE

We sought to evaluate the impact of intense influenza media coverage during the 2003-2004 influenza season on the influenza vaccination status of children 6 to 59 months of age.

METHODS

Children 6 to 59 months of age who presented to a large, academic pediatric continuity clinic or affiliated acute care clinic in the summer of 2004 were enrolled. A parental survey ascertained the influenza vaccination status of the child and family members during the 2003-2004 influenza season and factors that influenced their vaccination status. For children vaccinated in the clinic or health department, influenza vaccination dates were confirmed in a computerized medical chart or state immunization registry.

RESULTS

Of 256 enrolled children, 98 (38%) parents reported that their child had received the 2003-2004 influenza vaccine, and 64 (65%) had confirmed influenza vaccination dates. Unlike the previous influenza season in which confirmed influenza vaccination dates from a similar study population were distributed more evenly from October through December, most children (75%) with confirmed vaccination dates received the vaccine after the media coverage in mid-November. Influenza vaccinations per week increased dramatically after the media coverage began (2.4 vs 8.6 per week; t test: P < .001). In late November and December 2003, the influenza-related media coverage, which focused primarily on an early, severe influenza season, increased dramatically and explained 85% of the variation in influenza vaccinations. Multivariate analysis showed that recalling a physician recommendation (odds ratio [OR]: 6.8; 95% confidence interval [CI]: 2.3-19.7), having a family member who had received the influenza vaccine (OR: 9.5; 95% CI: 4.3-21.3), having a continuity clinic visit between October and January (OR: 4.5; 95% CI: 2.0-10.1), and having a high-risk medical condition (OR: 2.9; 95% CI: 1.1-7.8) strongly predicted the influenza vaccination status in the children.

CONCLUSION

Media coverage in conjunction with explicit physician recommendation for children and their contacts are key factors that are associated with influenza vaccination rates in children.

Laparoscopic management of large ovarian cysts: more than cosmetic considerations

Laparoscopic management of three cases, each with a large ovarian cyst, is reported. Appropriate preoperative assessment, patient counselling, and good laparoscopic skills are the cornerstones of successful laparoscopic management in such patients.

The physiological and pathophysiological modulation of the endocrine function of the heart

Under physiological conditions, the endocrine heart contributes to the maintenance of cardiovascular homeostasis through the polypeptide hormones ANF and BNP, which are members of the natriuretic peptide (NP) family. Given that NPs are of interest from the basic and clinical points of view, the genetic expression and secretion of ANF and BNP as well as the nature of the interaction of these hormones with their receptors has been the subject of extensive studies since the discovery of ANF in 1980. Following hemodynamic overload, increased secretion of NPs by the heart can be seen. This change may occur without an increase in gene expression as observed for atrial NPs following acute volume expansion, or it can occur with an increase in both ANF and BNP gene expression in atria only as seen in mineralocorticoid escape during which it is obvious that a critical decrease in hormone stores must be reached before transcriptional activation occurs. Chronic hemodynamic pressure or volume overload results in increased expression of NPs in atria and ventricles. Under these circumstances, the increased production of BNP by hypertrophic ventricles changes the normal plasma concentration ratio of ANF to BNP, a fact that has clinical diagnostic and prognostic implications. There are exceptions to this rule: chronic, severe L-NAME hypertension, which may occur without left ventricular hypertrophy, does not cause this effect and increased ventricular NP gene expression can occur in mineralocorticoid hypertension before detectable ventricular hypertrophy. Atrial and ventricular NP gene expression appears to be under different transcriptional control because pharmacological treatments such as chronic ACE inhibition or ET(A) receptor blockade can reverse the increased ventricular NP expression but has no detectable effect on atrial NP gene expression. This is not unlike the myosin heavy chain switch that is observed in certain pathologies, and can be pharmacologically reversed in a manner similar to NPs in the ventricles but it does not occur in atrial muscle. These observations made in vivo or using isolated adult atria often differ strikingly from results obtained using the mixed phenotype afforded by cardiocytes in culture, indicating that the kinds of questions addressed by each approach must be judiciously chosen. G-protein coupled receptor-mediated actions of neurohumors such as endothelin and phenylephrine are normally used to stimulate NP gene expression and release in different in vitro models. The main physiological stimulus for increased ANF release, atrial muscle stretch, also appears to rely on G-protein-coupled mechanisms. Alternative agonists and receptor types at play are suggested by the finding that circulating levels of BNP are selectively increased before and during overt cardiac allograft rejection episodes in human patients. The data suggest that enhanced BNP plasma levels could form a basis for a noninvasive test for cardiac allograft rejection. However, the molecular mechanism by which expression of NPs are regulated in the transplanted heart is not well understood. Conditioned medium from mixed lymphocyte reaction cultures, considered an in vitro model of transplantation immunity, induces specific upregulation of BNP as do individual pro-inflammatory cytokines. Findings such as these suggest that the study of NPs will continue to produce a wealth of information relevant to basic and clinical scientists.

Noise adaptive soft-switching median filter

Existing state-of-the-art switching-based median filters are commonly found to be nonadaptive to noise density variations and prone to misclassifying pixel characteristics at high noise density interference. This reveals the critical need of having a sophisticated switching scheme and an adaptive weighted median filter. We propose a novel switching-based median filter with incorporation of fuzzy-set concept, called the noise adaptive soft-switching median (NASM) filter, to achieve much improved filtering performance in terms of effectiveness in removing impulse noise while preserving signal details and robustness in combating noise density variations. The proposed NASM filter consists of two stages. A soft-switching noise-detection scheme is developed to classify each pixel to be uncorrupted pixel, isolated impulse noise, nonisolated impulse noise or image object's edge pixel. "No filtering" (or identity filter), standard median (SM) filter or our developed fuzzy weighted median (FWM) filter will then be employed according to the respective characteristic type identified. Experimental results show that our NASM filter impressively outperforms other techniques by achieving fairly close performance to that of ideal-switching median filter across a wide range of noise densities, ranging from 10% to 70%

A new diamond search algorithm for fast block-matching motion estimation

Based on the study of motion vector distribution from several commonly used test image sequences, a new diamond search (DS) algorithm for fast block-matching motion estimation (BMME) is proposed in this paper. Simulation results demonstrate that the proposed DS algorithm greatly outperforms the well-known three-step search (TSS) algorithm. Compared with the new three-step search (NTSS) algorithm, the DS algorithm achieves close performance but requires less computation by up to 22% on average. Experimental results also show that the DS algorithm is better than the four-step search (4SS) and block-based gradient descent search (BBGDS), in terms of mean-square error performance and required number of search points.

Tri-state median filter for image denoising

In this work, a novel nonlinear filter, called tri-state median (TSM) filter, is proposed for preserving image details while effectively suppressing impulse noise. We incorporate the standard median (SM) filter and the center weighted median (CWM) filter into a noise detection framework to determine whether a pixel is corrupted, before applying filtering unconditionally. Extensive simulation results demonstrate that the proposed filter consistently outperforms other median filters by balancing the tradeoff between noise reduction and detail preservation.

Phosphorylation sensitizes microtubule-associated protein tau to Al(3+)-induced aggregation

In Alzheimer's disease the microtubule-associated protein tau becomes hyperphosphorylated and aggregates into paired helical filaments (PHFs). Although the biochemical basis of the aggregation of tau into PHFs is not very clear, Al3+ has been suggested to play some role. Previous studies have shown that Al3+ alters the phosphorylation state and causes aggregation of tau in experimental animals and cultured neurons. In this study Al3+ inhibited phosphorylation of tau by neuronal cdc2-like kinase and dephosphorylation of phosphorylated tau by phosphatase 2B. These inhibitions are very likely due to Al(3+)-induced aggregations of various proteins present in phosphorylation/dephosphorylation assay mixtures since Al3+ caused aggregations of all proteins examined. Furthermore, compared to other proteins, tau displayed only an average sensitivity towards Al(3+)-induced aggregation. However upon phosphorylation, tau's sensitivity towards Al3+ increased 3.5 fold. In the presence of the metal chelator EDTA, Al(3+)-induced aggregates of tau became soluble, whereas Al(3+)-induced phosphorylated tau aggregates were insoluble in the buffer containing EDTA and remained insensitive to proteolysis. Our data suggest that phosphorylation sensitizes tau to Al3+ and phosphorylated tau transforms irreversibly into a phosphatase and protease resistant aggregate in presence of this metal ion.

Theophylline-associated seizures with "therapeutic" or low toxic serum concentrations: risk factors for serious outcome in adults

We report 12 adults with seizures associated with serum theophylline levels between 14 and 35 mg/l. The seizures were frequently prolonged, and outcome was generally poor with eight deaths. Although we did not identify comparable control groups, possible risk factors for serious outcome in theophylline-associated seizures were age, previous brain injury or disease, severe pulmonary disease, and possibly low serum albumin level. In patients with these risk factors, serum theophylline levels should be maintained below 10 to 15 mg/l.