Management of patient with impaction secondary to undigested sunflower seed bezoar: A case report

Introduction: Bezoars are aggregates of undigested plant fibers, hair, or seeds that may impact in any portion of the GI tract. These bezoars if left can lead to significant complications, including perforation and peritonitis. Methods: We report a case of a 4-year-old female patient who presented to the emergency department with constipation and severe lower abdominal pain following unsupervised consumption of a large unknown volume of sunflower seeds. Initial radiograph revealed an undigested bezoar of seeds in the sigmoid colon and rectum. The patient was managed with mineral oil enema and manual disimpaction under conscious sedation. Subsequent radiographs revealed a large seed burden remaining in the colon after repeat disimpaction. The patient was discharged after 48 hours of observation with instructions to the parents to return if any worsening pain or distention was noted. We conducted a review of the literature to analyze cases of patients with fecal impaction secondary to seed bezoars. Results: Previous reports in the literature document the use of enema and digital disimpaction for management of seed bezoars. Some reports recommend possible endoscopy or surgical management for retrieval of seeds if complications such as GI ulceration occur secondary to impaction. Discussion: Management of seed bezoars is dependent on various factors, such as the location of the bezoar in the GI tract, the size of the seed burden, and the degree of symptomatology and complications from the impaction. Future directions of research involve investigating the resolution of impaction over time, the frequency of follow-up visits, and necessity for endoscopic procedures vs. serial imaging to monitor patients after discharge

Efficacy of partially hydrolyzed guar gum (PHGG) supplemented modified oral rehydration solution in the treatment of severely malnourished children with watery diarrhoea: a randomised double-blind controlled trial

Objectives: To examine whether PHGG added ORS reduce duration of diarrhoea, stool output and enhance weight gain. Methods: In a double-blind controlled clinical trial, 126 malnourished children (weight for length/weight for age < 123 Z-score with or without pedal edema), aged 6 \u2013 36 months with acute diarrhoea <7 days were studied in two treatment groups; 63 received modified WHO ORS (Na 75, K 40, Cl 87, citrate 7, glucose 90 mmol/L) with PHGG 15 g/L (study group); 63 received modified WHO ORS without PHGG (control). Other treatments were similar in both groups. The study protocol was approved by Ethics Committee of icddr,b; the study was carried out at the Dhaka Hospital. Results: The mean duration of diarrhoea (h) was significantly shorter in children of the study group (Study vs. control, mean \ub1 SD, 57 \ub1 31 vs. 75 \ub1 39, p = 0.01). Although there was a trend in stool weight reduction in children receiving ORS with PHGG (study vs. control, stool weight (g), mean \ub1 SD; 1st 24 hour, 854.03 \ub1 532.15 vs. 949.11 \ub1 544.33, p = 0.32; 2nd 24 hour, 579.84 \ub1 466.01 vs. 761.26 \ub1 631.64, p = 0.069; 3rd 24 hour, 385.87 \ub1 454.09 vs. 495.73 \ub1 487.61, p = 0.196), especially in 2nd 24 h period, the difference was not statistically significant. The mean time (day) to attain weight for length 80% of NCHS median without edema was significantly shorter in the study group (study vs. control, mean \ub1 SD, 4.5 \ub1 2.6 vs. 5.7 \ub1 2.8, p = 0.027). Conclusion: PHGG added to ORS substantially reduced duration of diarrhoea. It also enhanced weight gain. Further studies might substantiate to establish its beneficial effect. Clinical trial registration number: NCT0182158

EP241 - Managing Cervical Spine fracture in a district general hospital

Introduction Cervical spinal injury affects 2–3% of trauma patients and accounts for 8.2% of all trauma-related deaths. Respiratory complications are cited as the primary cause of mortality with a 14 - >27 % rate in patients aged more than 65 years old. Aim Produce a clear set of guidelines in an aim to reduce mortality in patients > 65 years presenting with cervical spine fracture. Method Data was retrospectively collected for patients aged >65 between September 2021 and August 2022 in a district general hospital. Patients with confirmed cervical spine injury were included in the study. Data was collated and analysed using Excel. Results 36 patients presented to ED with acute cervical spine fracture. 22 (61%) were female and 14 (39%) male with an age range of 66-98 years old. 31 (84%) patients were discussed with a tertiary centre. Complications ranged from constipation, delirium, DVT/PE, chest infections (n=5, 36%) to spinal shock (n= 3, 27%). 11 (30.6%) patients presenting with a c-spine fracture died within 30 days of admission.9 (25%) patients had an outpatient appointment booked in a tertiary centre and 13 (36%) were seen locally in the fracture clinic. 14 (39%) patients did not have any follow ups planned. Conclusions To mitigate in-hospital complications and improve outcomes, shared care with orthopaedics, geriatrics, and physiotherapy is being proposed for this group of patients. It would be beneficial to compare the data from the local network and aim at publishing an up-to-date set of robust guidelines

Evaluation of a national genetic testing service for monogenic endocrine disease in Scotland; enforcement of referral criteria may result in missed opportunities for genetic diagnosis

Background: Establishing a genetic diagnosis in patients presenting with potential monogenic endocrine disorders can provide benefits for the individual and wider family. Next-generation sequencing (NGS) gene panels provide a time- and cost-efficient platform for testing. A Scottish NGS endocrine testing platform, comprising 30 genes (11 individual panels), was established in 2018. A national genomic test-directory provides eligibility criteria for testing, but these are yet to be evaluated against ‘real world’ referrals. Methods: Index cases referred for Endocrine NGS gene panel testing (12/2018-12/2022) were evaluated for baseline clinical characteristics, indication for testing and test outcome. Referrals were assessed against national eligibility criteria (v1.0/2022).Results: 1131 endocrine gene panel requests representing 1057 index cases were identified (>1 panel for some patients), with a mean age of 45 years and a female predominance (~1:2 M:F). Of the most frequently requested panels (Familial Hyperparathyroidism (FHPT) (n=329), Familial Hypocalciuric Hypercalcaemia (FHH) (n=220), Multiple Endocrine Neoplasia1/4/Familial Isolated Pituitary Adenoma (MEN1/4/FIPA) (n=196) and Phaeochromocytoma/Paraganglioma (PPGL) (n=121)), the proportion of index cases with pathogenic/likely pathogenic variants varied markedly (i.e. 5.5%, 22.3%, 3.6%, 18.9%, respectively). Several patients referred for FHPT testing harboured pathogenic CASR variants, consistent with a diagnosis of FHH. Whilst the majority of requests met referral criteria, ~40% of FHH referral contained insufficient/inconsistent biochemical information to assess eligibility. Notably, ~30% of PPGL referrals did not meet testing criteria, including ~10% of cases with a positive genetic test result. Of the more commonly requested panels, PPGL and MEN1/4/FIPA panels were the most and least cost-effective (~£1300 and ~£7000 per positive test, respectively).Conclusions: Combining panels improves diagnostic yields for disorders with overlapping clinical phenotypes (e.g. FHPT & FHH). Strict enforcement of testing eligibility criteria may result in ‘missed’ genetic diagnoses, the implications of which should be considered when reviewing and/or implementing future test criteria

Evaluation of a national genetic testing service for monogenic endocrine disease in Scotland; enforcement of referral criteria may result in missed opportunities for genetic diagnosis

Background: Establishing a genetic diagnosis in patients presenting with potential monogenic endocrine disorders can provide benefits for the individual and wider family. Next-generation sequencing (NGS) gene panels provide a time- and cost-efficient platform for testing. A Scottish NGS endocrine testing platform, comprising 30 genes (11 individual panels), was established in 2018. A national genomic test-directory provides eligibility criteria for testing, but these are yet to be evaluated against ‘real world’ referrals. Methods: Index cases referred for Endocrine NGS gene panel testing (12/2018-12/2022) were evaluated for baseline clinical characteristics, indication for testing and test outcome. Referrals were assessed against national eligibility criteria (v1.0/2022).Results: 1131 endocrine gene panel requests representing 1057 index cases were identified (>1 panel for some patients), with a mean age of 45 years and a female predominance (~1:2 M:F). Of the most frequently requested panels (Familial Hyperparathyroidism (FHPT) (n=329), Familial Hypocalciuric Hypercalcaemia (FHH) (n=220), Multiple Endocrine Neoplasia1/4/Familial Isolated Pituitary Adenoma (MEN1/4/FIPA) (n=196) and Phaeochromocytoma/Paraganglioma (PPGL) (n=121)), the proportion of index cases with pathogenic/likely pathogenic variants varied markedly (i.e. 5.5%, 22.3%, 3.6%, 18.9%, respectively). Several patients referred for FHPT testing harboured pathogenic CASR variants, consistent with a diagnosis of FHH. Whilst the majority of requests met referral criteria, ~40% of FHH referral contained insufficient/inconsistent biochemical information to assess eligibility. Notably, ~30% of PPGL referrals did not meet testing criteria, including ~10% of cases with a positive genetic test result. Of the more commonly requested panels, PPGL and MEN1/4/FIPA panels were the most and least cost-effective (~£1300 and ~£7000 per positive test, respectively).Conclusions: Combining panels improves diagnostic yields for disorders with overlapping clinical phenotypes (e.g. FHPT & FHH). Strict enforcement of testing eligibility criteria may result in ‘missed’ genetic diagnoses, the implications of which should be considered when reviewing and/or implementing future test criteria

Bacterial Resistance in Pneumonia in Developing Countries—A Role for Iron Chelation

Pneumonia represents one of the major infectious diseases in developing countries and is associated with high mortality, in particular in children under the age of five. The main causative bacterial agents are Streptococcus pneumoniae and Haemophilus influenzae type B, accounting for 33% and 16%, respectively, of the mortality in under-fives. Iron modulates the immune response in infectious diseases and increased iron levels can lead to complications such as sepsis and multiorgan failure. This review will look into the use of iron chelators in order to reduce microbial growth and attenuate a dysregulated immune response during infection. Our hypothesis is that temporary restriction of iron will lessen the incidence and complication rate of infections like pneumonia and result in a decrease of mortality and morbidity

Removal of microcystin-LR from aqueous solutions using % burn-off activated carbon of waste wood material

The activated carbon (AC), prepared at different burn-off rates, showed a high uptake of methylene blue. At 93% burn-off, methylene blue uptake was 620 mg/g. Adsorption capacity of microcystin-LR onto rubber wood AC was investigated in a batch system by considering the effects of various parameters like contact time, initial concentration, pH and temperature. Microcystin-LR removal is pH dependent and found to be highest at pH 2.5. Increases in adsorption capacity with increase in temperature indicate that the adsorption reaction is endothermic. Based on this study, the thermodynamic parameters like standard Gibb's free energy (ΔG°), standard enthalpy (ΔH°) and standard entropy (ΔS°) were evaluated. A pseudo second order model was found to explain the kinetics of microcystin-LR adsorption most effectively. The rate of intraparticle diffusion was also evaluated. The Langmuir and Freundlich isotherms were used to describe the adsorption equilibrium studies of rubber wood AC at different temperatures. The Langmuir isotherm shows better fit than Freundlich isotherms in the temperature range studied. The results show that the rubber wood AC can be efficiently used for the removal of microcystin-LR from water. In order to investigate the possibility of regeneration and reuse of exhausted adsorbent, desorption studies were also performed

Forest Vulnerability to Climate Change: A Review for Future Research Framework

Climate change has caused vulnerability not only to the forest ecosystem but also to forest-dependent communities. Therefore, its management is essential to increase forest ecosystem services and reduce vulnerability to climate change using an integrated approach. Although many scientific studies examined climate change impact on forest ecosystems, forest vulnerability assessment, including forest sensitivity, adaptability, sustainability and effective management was found to be scant in the existing literature. Through a systematic review from 1990 to 2019, this paper examined forest vulnerability to climate change and its management practices. In this paper, descriptive, mechanism and thematic analyses were carried out to analyze the state of existing research, in order to understand the concept of vulnerability arising from climate change and forest management issues. The present study proposed a framework for integrated forest assessment and management for addressing such issues in future research. The conversion of forest land into other land uses, forest fragmentation, forest disturbance and the effects of climate change on the forest ecosystem are the existing problems. Forest vulnerability, effective adaptation to forest ecosystems and long-term sustainability are priority areas for future research. This study also calls for undertaking researchers at a local scale to involve communities for the effective management of forest ecosystems