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Medical Sciences71%
Life Sciences28%

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    Selected Abstracts

    Emergency Physician,Verified Out-of-hospital Intubation: Miss Rates by Paramedics

    ACADEMIC EMERGENCY MEDICINE, Issue 6 2004
    James H. Jones MD
    Abstract Objectives: To prospectively quantify the number of unrecognized missed out-of-hospital intubations by ground paramedics using emergency physician verification as the criterion standard for verification of endotracheal tube placement. Methods:The authors performed an observational, prospective study of consecutive intubated patients arriving by ground emergency medical services to two urban teaching hospitals. Endotracheal tube placement was verified by emergency physicians and evaluated by using a combination of direct visualization, esophageal detector device (EDD), colorimetric end-tidal carbon dioxide (ETCO2), and physical examination. Results: During the six-month study period, 208 out-of-hospital intubations by ground paramedics were enrolled, which included 160 (76.9%) medical patients and 48 (23.1%) trauma patients. A total of 12 (5.8%) endotracheal tubes were incorrectly placed outside the trachea. This comprised ten (6.3%) medical patients and two (4.2%) trauma patients. Of the 12 misplaced endotracheal tubes, a verification device (ETCO2 or EDD) was used in three cases (25%) and not used in nine cases (75%). Conclusions: The rate of unrecognized, misplaced out-of-hospital intubations in this urban, midwestern setting was 5.8%. This is more consistent with results of prior out-of-hospital studies that used field verification and is discordant with the only other study to exclusively use emergency physician verification performed on arrival to the emergency department. [source]

    Climate change causes rapid changes in the distribution and site abundance of birds in winter

    GLOBAL CHANGE BIOLOGY, Issue 11 2008
    ILYA M. D. MACLEAN
    Abstract Detecting coherent signals of climate change is best achieved by conducting expansive, long-term studies. Here, using counts of waders (Charadrii) collected from ca. 3500 sites over 30 years and covering a major portion of western Europe, we present the largest-scale study to show that faunal abundance is influenced by climate in winter. We demonstrate that the ,weighted centroids' of populations of seven species of wader occurring in internationally important numbers have undergone substantial shifts of up to 115 km, generally in a northeasterly direction. To our knowledge, this shift is greater than that recorded in any other study, but closer to what would be expected as a result of the spatial distribution of ecological zones. We establish that year-to-year changes in site abundance have been positively correlated with concurrent changes in temperature, but that this relationship is most marked towards the colder extremities of the birds' range, suggesting that shifts have occurred as a result of range expansion and that responses to climate change are temperature dependent. Many attempts to model the future impacts of climate change on the distribution of organisms, assume uniform responses or shifts throughout a species' range or with temperature, but our results suggest that this may not be a valid approach. We propose that, with warming temperatures, hitherto unsuitable sites in northeastern Europe will host increasingly important wader numbers, but that this may not be matched by declines elsewhere within the study area. The need to establish that such changes are occurring is accentuated by the statutory importance of this taxon in the designation of protected areas. [source]

    High circulating levels of N-terminal pro-brain natriuretic peptide and interleukin 6 in patients with mixed cryoglobulinemia,

    JOURNAL OF MEDICAL VIROLOGY, Issue 2 2010
    Alessandro Antonelli
    Abstract Many patients with mixed cryoglobulinemia and chronic HCV infection experience symptoms, such as dyspnea, which sometimes do not seem to indicate the involvement of the liver but rather the symptoms of heart failure. To our knowledge, there has been no other study evaluating the serum levels of N-terminal pro-brain natriuretic peptide (NTproBNP) and Interleukin 6 (IL-6) in such patients. Serum NTproBNP and IL-6 were assayed in 54 patients with mixed cryoglobulinemia and chronic HCV infection, and in 54 sex- and age-matched controls. Cryoglobulinemic-patients showed significantly higher mean NTproBNP and IL-6 levels than the controls (P,=,0.005). By defining a high NTproBNP level as a value higher than 125,pg/ml (the single cut-off point for patients under 75 years of age), 30% of patients with mixed cryoglobulinemia and chronic HCV infection and 7% of controls had high NTproBNP (chi-square; P,<,0.003). With a cut-off point of 300,pg/ml (used to rule out heart failure in patients under 75 years of age), 5/49 patients with mixed cryoglobulinemia and chronic HCV infection and 0/54 controls had high NTproBNP (chi-square; P,<,0.04). With a cut-off point of 900,pg/ml (used for including heart failure in patients aged between 50 and 75, such as the patients in this study) 3/51 of patients with mixed cryoglobulinemia and chronic HCV infection and 0/54 controls had high NTproBNP (chi-square; P,=,0.07). The study revealed high levels of circulating NTproBNP and IL-6 in patients with mixed cryoglobulinemia and chronic HCV infection. The increase in NTproBNP could indicate the presence of a subclinical cardiac dysfunction. J. Med. Virol. 82:297,303, 2010. © 2009 Wiley-Liss, Inc. [source]

    Faster clearance of omeprazole in mutant Nagase analbuminemic rats: possible roles of increased protein expression of hepatic CYP1A2 and lower plasma protein binding

    BIOPHARMACEUTICS AND DRUG DISPOSITION, Issue 3 2009
    Dae Y. Lee
    Abstract It is well known that there are various changes in the expression of hepatic and intestinal CYPs in mutant Nagase analbuminemic rats (NARs). It has been reported that the protein expression of hepatic CYP1A2 was increased, whereas that of hepatic CYP3A1 was not altered, and it was also found that the protein expression of the intestinal CYP1A subfamily significantly increased in NARs from our other study. In addition, in this study additional information about CYP changes in NARs was obtained; the protein expression of the hepatic CYP2D subfamily was not altered, but that of the intestinal CYP3A subfamily increased in NARs. Because omeprazole is metabolized via hepatic CYP1A1/2, 2D1, 3A1/2 in rats, it could be expected that the pharmacokinetics of omeprazole would be altered in NARs. After intravenous administration of omeprazole to NARs, the Clnr was significantly faster than in the controls (110 versus 46.6 ml/min/kg), and this could be due to an increase in hepatic metabolism caused by a greater hepatic CYP1A2 level in addition to greater free fractions of the drug in NARs. After oral administration of omeprazole to NARs, the AUC was also significantly smaller (80.1% decrease) and F was decreased in NARs. This could be primarily due to increased hepatic and intestinal metabolism caused by greater hepatic CYP1A2 and intestinal CYP1A and 3A levels. In particular, the smaller F could mainly result from greater hepatic and intestinal first-pass effect in NARs than in the controls. Copyright © 2009 John Wiley & Sons, Ltd. [source]

    Effects of N-acetylcysteine on substance use in bipolar disorder: A randomised placebo-controlled clinical trial

    ACTA NEUROPSYCHIATRICA, Issue 6 2009
    Michelle Bernardo
    Objective: To evaluate the effect of N-acetylcysteine (NAC) on substance use in a double-blind, placebo-controlled trial of NAC in bipolar disorder. It is hypothesised that NAC will be superior to placebo for reducing scores on the Clinical Global Impressions scale for Substance Use (CGI-SU). Methods: Participants were randomised to a 6-months of treatment with 2 g/day NAC (n = 38) or placebo (n = 37). Substance use was assessed at baseline using a Habits instrument. Change in substance use was assessed at regular study visits using the CGI-SU. Results: Among the 75 participants 78.7% drank alcohol (any frequency), 45.3% smoked tobacco and 92% consumed caffeine. Other substances were used by fewer than six participants. Caffeine use was significantly lower for NAC-treated participants compared to placebo at week 2 of treatment but not at other study visits. Conclusions: NAC appeared to have little effect on the participants who were using substances. A larger study on a substance-using population will be necessary to determine if NAC may be a useful treatment for substance use. [source]

    Effects of N -acetylcysteine on substance use in bipolar disorder: a randomised placebo-controlled clinical trial

    ACTA NEUROPSYCHIATRICA, Issue 5 2009
    Michelle Bernardo
    Objective: To evaluate the effect of N -acetylcysteine (NAC) on substance use in a double-blind, placebo-controlled trial of NAC in bipolar disorder. It is hypothesised that NAC will be superior to placebo for reducing scores on the Clinical Global Impressions scale for Substance Use (CGI-SU). Methods: Participants were randomised to 6-months of treatment with 2 g/day NAC (n = 38) or placebo (n = 37). Substance use was assessed at baseline using the Habits instrument. Change in substance use was assessed at regular study visits using the CGI-SU. Results: Amongst the 75 participants 78.7% drank alcohol (any frequency), 45.3% smoked tobacco and 92% consumer caffeine. Other substances were used by fewer than six participants. Caffeine use was significantly lower for NAC-treated participants compared with placebo at week 2 of treatment but not at other study visits. Conclusion: NAC appeared to have little effect on substance use in this population. A larger study on a substance using population will be necessary to determine if NAC may be a useful treatment for substance use. [source]

    Pharmacokinetics and tolerability of intravenous busulfan in hematopoietic stem cell transplantation

    CLINICAL TRANSPLANTATION, Issue 3 2007
    Yo-Han Cho
    Abstract:, Intravenous (IV) busulfan has been developed to overcome variable absorption of oral busulfan and tested in several trials. We tested its pharmacological properties and tolerability in 16 Korean stem cell transplantation (SCT) patients. IV busulfan was administered at 0.8 mg/kg every six h for a total of 16 doses (days ,7 to ,4), which was followed by cyclophosphamide administration at 60 mg/kg every 24 h for two d (days ,3 and ,2). The median AUCinf values (at the first dose) and AUCss (at the steady state) were 1060.4 ,M·min (range: 511.1,1812.7) and 1092.5 ,M·min (range: 539.7,1560.8) respectively. All patients had an AUCinf of <1500 ,M·min at the first dose, and 13 of the 16 (81.3%) maintained AUCss levels between 800 and 1500 ,M·min. Thirteen of 16 patients showed successful engraftments but four patients (25%) developed hepatic VOD (two of which were fatal), three of whom had advanced disease at the time of SCT. Overall, pharmacokinetics of IV busulfan in our SCT patients appeared comparable with those observed in other study. However, hepatic VOD was a major morbidity in patients with advanced disease. [source]