Hyperparathyroidism Presenting as Acute Pancreatitis: Case Report of Mortality

Background: Acute pancreatitis may be caused by a myriad of factors, hypercalcemia secondary to hyperparathyroidism, albeit is a rare cause of acute pancreatitis but not unheard of. If the underlying cause of acute pancreatitis is diagnosed, goal-directed management becomes possible, reducing morbidity and mortality. Though acute pancreatitis on its own presents significant mortality, hypercalcemia, especially detected late, augments this. Case Report: We report a case of acute pancreatitis secondary to hyperparathyroidism. The patient was undiagnosed at the time of admission and presented with non-specific gastrointestinal symptoms. After admission, he developed multi-organ dysfunction and was managed by intensive care. The patient died within hours of admission despite our best efforts. Diagnosis of acute pancreatitis secondary to hyperparathyroidism was suspected on the basis of hypercalcemia, confirmed by a posthumous result of a raised parathyroid hormone assay. Conclusion: When a patient is admitted in the emergency department with a suspicion of acute pancreatitis, serum calcium levels and its reporting should be expedited to as early as possible. Hypercalcemia in the setting of acute pancreatitis merits a multidisciplinary approach and expedited parathyroid hormone levels sent with a high suspicion of long standing untreated hyperparathyroidism. Hyperparathyroidism is a cause of silent hypercalcemia and can be lethal if not diagnosed in time

The Empirical Development of a Curriculum on Faith Development

Problem. Professional and lay leaders in the Seventh-day Adventist church need to be sensitive to the dynamics of faith development as it interfaces with human development over the life span, and with its practical implications. Currently, there is no curriculum available, empirically developed or otherwise, to explore this issue. Method. The underlining philosophy of the approach to curriculum design utilized in this study is that curriculum is likely to be more effective when it is developed in a cooperative spirit between an instructor and learners rather than written in isolation, and when there is emphasis on both the cognitive and affective domains of the learning process. The product was empirically developed through 10 systematic steps. They included establishing the need for the product, formulation of behavioral objectives, design of the pre- and post-tests for each session, and the process of trial and revision of the instruction and all supplemental materials. General mastery for cognitive domain was established at the 80% level; that is, at least 80% of the subjects would need to achieve the specified mastery of the criteria established for each of the 24 behavioral objectives. The test for the affective domain was administered and analyzed before and after the series of lectures. In order to complement the objectives of the curriculum in the cognitive and affective domains, a process objective was formulated and outcomes were discussed. After the sessions with a small number of learners, the curriculum was modified. This process was repeated with increasing numbers of learners until mastery was achieved at the predetermined level. Results. The development included four trials of the curriculum with four groups of subjects. The last group of 35 subjects achieved cognitive mastery at the specified levels for each of the objectives, achieved statistically significant modification of affect as measured by the instrument of affect, and realized the process objective. Conclusions. This empirically developed curriculum on faith development provided an insight into the role of the curriculum developer in the process of empirical development. The product is ready for adaptation by qualified instructors in the Seventh-day Adventist church in North America, or, in an appropriately modified version, with other audiences

Suicide Attempt and Characteristics of Religiously Affiliated Puerto Rican Adolescents and Young Adults

Problem. Recent research has identified several risk factors associated with attempted suicide among the general population. Puerto Ricans, in general, and Puerto Rican Seventh-day Adventists (SDAs), in particular, may face unique challenges that are related to their familial, social, and religious environment that may affect the suicidal attempts among this group. Therefore, this study examined family-related factors, history of being abused, religiosity factors, sexuality factors, gender, substance abuse, age, and socioeconomic status factors among a sample of religiously affiliated Puerto Ricans (73.2% SDAs) living on the island. Methodology. The data for the study came from the Avance PR study. Avance PR is a continuation of the Avance study, the largest denominational study among the Hispanic population of any denomination in the U.S. (Ramirez-Johnson & Hernandez, 2003). The youth sample (ages 13-25) consisted of 598 males and 788 females (N = 1,406). A total of 35 independent variables (22 numerical and 13 categorical) were studied. These variables were tested using ANOVA, chisquare, two-way ANOVA, and Discriminant Analysis. Results. Of the total sample, 12.5% admitted having attempted suicide in the 12-month period prior to the survey. Analysis of the numerical variables using ANOVA indicated 16 of them being significantly related to suicide attempt (p\u3c .05). Of the categorical variables tested using Chisquare, 11 variables were found significantly related to suicide attempt (p\u3c .05). Analysis of four selected dichotomous variables (gender, age groups, sexual orientation and family status) using two-way ANOVAs, indicated significant interaction between these variables on suicide attempt with several numerical variables (p\u3c .05). Finally, discriminant analysis of 28 variables that were found significant in previous analyses yielded a significant function. Conclusions. Religiously affiliated Puerto Rican adolescents and young adults have a rate of suicide attempts similar to the rate in the general population. Seven variables were significantly related to suicide attempt in various analyses and showed a large effect size. These were: family cohesion, parental understanding, parental knowledge of youth activities, verbal abuse, sexual abuse, physical abuse, and substance abuse

Nurses' Knowledge Towards Severe Acute Malnutrition Management Protocol and Its Associated Factors

For appropriate management of severe acute malnutrition skilled, knowledgeable and concerned health professionals are critical for child survival. Thus assessing the knowledge of nurses towards management protocol of severe acute malnutrition is crucial step for targeted interventions. This study aimed to assess Knowledge towards Severe Acute Malnutrition Management Protocol and its Associated Factors among Nurses working in Hiwot Fana Specialized University Hospital, 2018. Cross-sectional study was conducted among eligible 132 nurses. Data were collected using self-administered questionnaire prepared from the national SAM management guideline of Ethiopia. SPSS version 20.0 software using frequency, tables, graphs, percentages and mean was used. Student t test and analysis of variance with F statistics and P value was computed. Overall, 65 (49.2%) of nurses had poor knowledge on SAM management. More than half, 100 (75.8%) of the nurses had experience in SAM management previously. Males were more likely to be knowledgeable (AOR=1.27) as compared to females. Nurses with the previous experience of managing malnourished child had 1.70) times more likely to be knowledgeable as compared to their counterparts. Having SAM training was associated with having higher knowledge score (AOR=1.56). Having SAM training was found to have significantly higher knowledge score (p=0.034). Knowledge level of nurses towards SAM management is not satisfactory. Those who ever involved in SAM management, having recent malnutrition training and gender were predictors of high knowledge score. There should be regular capacity building schemes for nurses especially for those who are involved in management of SAM at emergency or SAM unit

Spin dynamics of the spin-Peierls compound CuGeO_3 under magnetic field

The magnetic field--driven transition in the spin-Peierls system CuGeO_3 associated with the closing of the spin gap is investigated numerically. The field dependence of the spin dynamical structure factor (seen by inelastic neutron scattering) and of the momentum dependent static susceptibility are calculated. In the dimerized phase (H<H_c), we suggest that the strong field dependence of the transverse susceptibility could be experimentally seen from the low temperature spin-echo relaxation rate 1/T_{2G} or the second moment of the NMR spectrum. Above H_c low energy spin excitations appear at incommensurate wave vectors where the longitudinal susceptibility chi_{zz}(q) peaks.Comment: 4 pages, LaTeX, postscript figures include

MECHANISMS OF DISEASE Acute Oxygen-Sensing Mechanisms

JOSEPH PRIESTLEY, ONE OF THE THREE SCIENTISTS CREDITED WITH THE discovery of oxygen, described the death of mice that were deprived of oxygen. However, he was also well aware of the toxicity of too much oxygen, stating, “For as a candle burns much faster in dephlogisticated [oxygen enriched] than in common air, so we might live out too fast, and the animal powers be too soon exhausted in this pure kind of air. A moralist, at least, may say, that the air which nature has provided for us is as good as we deserve.”1 In this review we examine the remarkable mechanisms by which different organs detect and respond to acute changes in oxygen tension. Specialized tissues that sense the local oxygen tension include glomus cells of the carotid body, neuroepithelial bodies in the lungs, chromaffin cells of the fetal adrenal medulla, and smooth-muscle cells of the resistance pulmonary arteries, fetoplacental arteries, systemic arteries, and the ductus arteriosus. Together, they constitute a specialized homeostatic oxygen-sensing system. Although all tissues are sensitive to severe hypoxia, these specialized tissues respond rapidly to moderate changes in oxygen tension within the physiologic range (roughly 40 to 100 mm Hg in an adult and 20 to 40 mm Hg in a fetus)Junta de Andalucí

Does Foot Massage Relieve Acute Postoperative Pain? a Literature Review

Purpose: This study aimed to examine the current state of knowledge regarding foot massageto determine if foot massage has an effect on relieving acute postoperative pain.Method: The following questions were used to guide this review: How does pain occur?What is the pain management modalities used in relieving acute postoperative pain? Does footmassage relieve acute postoperative pain? A comprehensive systematic search of publishedliterature and journal articles from Science Direct, CINAHL, PubMed, ProQuest and fromrelevant textbooks was conducted. The universal case entry website, Google-scholar was usedas well. The following keywords were used: foot massage, pain management, andpostoperative pain. Eight studies on foot massage and more than thirty related articles werereviewed.Result: Postoperative pain is caused by tissue damage that induces release of chemicalmediators from the surgical wound. The four processes of pain are transduction, transmission,perception and modulation. Pain medication is the goal standard for acute postoperative painrelief. In addition, foot massage is a modality that can be used in relieving acute postoperativepain. Massage stimulates large nerve fibers and dermatome layers which contain tactile andpressure receptors. The receptors subsequently transmit the nerve impulse to the centralnervous system. The gate control system in the dorsal horn is activated through the inhibitoryinterneuron, thus closing the gate. Subsequently, the brain does not receive the pain message.Eight reviewed studies demonstrated that foot massage relieves acute postoperative pain.However, there were some methodological limitations of these studies.Conclusion: It is recommended to examine the effect of foot massage on acute postoperativepain with high homogenous samples using various duration of massage and range of time forpain measurement at different settings

The Features of Acute Brucellosis in Azerbaijan Republic

It is well known, that the injury of organs and systems and also immunological rates considerably determine clinical course and the result of brucellosis. In the article are presented the results of examination of 120 patients with acute brucellosis. The control group included 30 practically healthy persons. Groups were representative by the age and sex. The diagnosis of brucellosis was set on the base of complaints, anamnesis, epidemiological and clinical data and the results of serological examination of the blood. All patients also underwent the fixation of interleukin -6, іinterleukin-4 and TLR-2 in the blood serum. The detailed epidemiological, clinical and immunological characteristic of patients with brucellosis was presented. Among examined persons prevailed men, persons of young able-bodied persons and rural dwellers. It was revealed, that the dominating way of transmission was the contact one. The highest level of infection was fixed among the workers of farm enterprises and veterinarians. The season features were also revealed, the highest level of morbidity was in summer-autumn period. The main clinical features were: fever, arthralgia, risen disposition to perspire, hepatosplenomegaly. It was revealed, that the level of pro-inflammatory interleukins considerably prevailed over the level of anti-inflammatory ones. Despite the high sensitivity of PCR diagnostics, the positive results in our research were received only in one third of patients

Predominant Nursing Students\u27 Learning Profile and Nursing Faculty Teaching Styles as Related to Final Course Grade in a Baccalaureate Nursing Program in Puerto Rico

Problem. The purpose o f this study was to investigate the relationship between students’ predominant learning profile, faculty teaching preferences, and the final course grade in a 4-year nursing program at a private Christian university in Puerto Rico. Method. A non-experimental descriptive research design was used for this study. The Learning Profile Indicator was administered to all nursing students («=138) while the Teaching Style Inventory was given to all faculty («=9). Demographic sheets were also given to both students and faculty Students’ final course grades were obtained from the faculty. Descriptive (frequency, means and standard deviations) and inferential statistics (Chi-square test o f association, and two-way analysis o f variance) were used to analyze the data. Results. In this study, most students (53.6%) had the Sensing-Thinking learning style. On the other hand, most faculty preferred the Sensing-Feeling (44.4%) and Intuitive- Thinking (33.3%) teaching style. Chi-Square test of association resulted in no statistically significant relationship between learning style and year in the nursing program (%^= 5.68, df= 6, p =0.46). Similarly, no significant relationship between learning style and teaching preferences was indicated (%^= 4.49, df= 4, p =0.34). Students with Intuitive-Feeling learning style (m=71.75, srf=10.40) scored significantly lower than students with Sensing-Thinking (m=83.97, sd=92%), Sensing-Feeling (im=83.73, 5ff=8.58) or Intuitive-Thinking (m=87.87, sJ=6.84) learning styles. Students taught by the one faculty member who had an Intuitive-Feeling teaching preference scored significantly higher (m=93.5, sd=3.79) than students taught by faculty with other teaching preferences. There was no interaction between learning style and teaching preferences. Conclusion. The match between faculty teaching preferences and student learning styles is quite low (about 20%). Learning styles is not related to year in nursing program or faculty teaching preferences. However, final course grade is related to learning styles and teaching preferences