Anesthetic management for emergent Cesarean section in a patient with toxic epidermal necrolysis -A case report-

Toxic epidermal necrolysis (TEN) is rare but serious cutaneous reaction with significant mortality and long-term morbidity. Various etiologies, particularly numerous medications and infectious agents have been implicated. It is characterized as inflammatory bullous lesions of the skin and mucous membrane and can develop serious complications such as pneumonia, pneumothorax, sepsis and renal failure. In general, patients with TEN are managed as severe second-degree burn patients with preventing excessive fluid deficit and infections. In this case, we aimed to present anesthetic management of a 26-year-old pregnant woman with TEN who received general anesthesia during emergent cesarean section

Update on the Management of Antibiotic Allergy

Drug allergy to antibiotics may occur in the form of immediate or non-immediate (delayed) hypersensitivity reactions. Immediate reactions are usually IgE-mediated whereas non-immediate hypersensitivity reactions are usually non-IgE or T-cell mediated. The clinical manifestations of antibiotic allergy may be cutaneous, organ-specific (e.g., blood dyscracias, hepatitis, interstitial nephritis), systemic (e.g., anaphylaxis, drug induced hypersensitivity syndrome) or various combinations of these. Severe cutaneous adverse reactions manifesting as Stevens Johnson syndrome or toxic epidermal necrolysis (TEN) may be potentially life-threatening. The management of antibiotic allergy begins with the identification of the putative antibiotic from a detailed and accurate drug history, complemented by validated in-vivo and in-vitro allergological tests. This will facilitate avoidance of the putative antibiotic through patient education, use of drug alert cards, and electronic medical records with in-built drug allergy/adverse drug reaction prescription and dispensing checks. Knowledge of the evidence for specific antibiotic cross-reactivities is also important in patient education. Apart from withdrawal of the putative antibiotic, immunomodulatory agents like high-dose intravenous immunoglobulins may have a role in TEN. Drug desensitization where the benefits outweigh the risks, and where no alternative antibiotics can be used for various reasons, may be considered in certain situations. Allergological issues pertaining to electronic drug allergy alerts, computerized physician prescriptions and decision support systems, and antibiotic de-escalation in antimicrobial stewardship programmes are also discussed

ATRIA OYJ:N KRIISIVIESTINNÄN KEHITTÄMINEN: ITIKKA OSUUSKUNNAN JA LIHAKUNNAN KRIISIVIESTINTÄSUUNNITELMA

Tämä opinnäytetyö on tehty toimeksiantona elintarvikealan suuryritykselle Atria Oyj:lle. Opinnäytetyö käsittelee Atria Oyj:n Suomen liiketoiminta-alueen kriisiviestinnän kehittämistä. Työn tarkoituksena on tehdä yhteinen kriisiviestintäsuunnitelma Itikka osuuskunnalle ja Lihakunnalle, jotka ovat Atria Oyj:n tärkeitä yhteistyökumppaneita ja pörssiyhtiön suurimmat osakkeenomistajat. Tehokkaan kriisiviestintäsuunnitelman luomiseksi on työn teoriaosassa käsitelty laajasti yritysmaailman kriisejä ja niiden hallintaa monipuolisessa mediakentässä. Kirjallisuuslähteinä on käytetty kriisiviestintään erikoistuneiden viestinnän ammattilaisten teoksia. Tärkeinä tietolähteinä opinnäytetyön toteutuksessa ovat olleet Itikka osuuskunnan ja Lihakunnan toimitusjohtaja sekä Atria Oyj:n viestintäpäällikkö. Haastattelujen lisäksi tutkimusmenetelmänä käytettiin Itikan ja Lihakunnan hallituksen ja hallitusneuvoston jäsenille suunnattua kyselyä. Kyselytutkimus käsitteli osuuskuntien jäsenten kriisivalmiutta ja toiveita kriisivalmiuden kehittämiseksi. Kyselytutkimuksen avulla saatiin tärkeää tietoa kriisisuunnitelman luomiseen. Vastauksista selvisi, että kriisiviestintäohjeistus on tarpeellinen myös tuotantotiloilla. Opinnäytetyön produktiivisena tuotoksena on Itikka osuuskunnan ja Lihakunnan kriisiviestintäsuunnitelma, joka tehostaa Atria Oyj:n kriisinhallintaprosessia. Osuuskunnille luotu kriisiviestintäsuunnitelma on organisaatioille ensimmäinen kriisisuunnitelma. Sen avulla selvennetään viestintävastuita ja yhtenäistetään Atrian ja osuuskuntien viestintää kriisitilanteissa. Kriisiviestintäsuunnitelman pohjalta tehtiin erillinen kriisi-ohjeistus osuuskunnan jäsenille.This thesis is commissioned by the Finnish food company Atria Plc. The objective is to improve crisis communications management in Artia Plc by creating a crisis com-munications plan for Atria´s two largest shareholders, Itikka and Lihakunta cooperatives. The aim of this thesis is to create a functional and effective crisis communications plan. The idea was to create a plan that gives general guidance for cooperatives in their crisis communications and clarifies the responsibilities in a crisis situation. The goal was to create a crisis communications plan that instructs the cooperatives to act in a crisis situation by the rules and principals of Atria Plc. Based on the crisis communications plan, guidelines for the meat producers were generated. To reach the appointed goals the theoretical part of the thesis covers a diverse range of information from crisis management literature. This thesis covers the main points that must be considered in crisis communications, in addition to the aspects of crisis management, from preparation to action and analyzing the crisis. In order to implement a plan that is suitable for the cooperatives, this thesis was created in close cooperation with chief executive officer of Itikka and Lihakunta and with the corporate communications manager of Atria. In addition to this an enquiry was made to the members of the cooperatives. This way the perspective of the meat producers was also used in creating the crisis communications plan. The crisis communications plan for the cooperatives contains all the required information for Itikka and Lihakunta to act effectively in a crisis situation. The plan will be used by the crisis management team of cooperatives in a crisis situation. Guidelines for the producers will be published on the web page of the cooperatives

Flight test method development for a quarter-scale aircraft with minimum instrumentation

A flight test method was developed for a quarter-scale model aircraft with minimum onboard instrumentation for the determination of the Drag Polar, the Thrust Required curve and the Power Required curve. The test included a wind tunnel test for propeller efficiencies and thrust coefficients, a torque test for engine shaft horsepower, and a flight test for flight speeds at measured operating conditions. The only additional onboard instrumentation besides that for radio control was a small cassette recorder. Two methods are described for data manipulation and an error analysis is provided for each method.http://archive.org/details/flighttestmethod00bamiCaptain, Hellenic Air ForceApproved for public release; distribution is unlimited

Association between serum CRP and plasma fibrinogen with cardiovascular morbidity and mortality in patients on hemodialysis

Aim: Cardiovascular events are the more frequent causes of death in patients undergoing chronic hemodialysis treatment. Significant risk factor in these patients, among other things, is considered an “accelerating” form of atherosclerosis. Atherosclerosis has been connected recently with chronic inflammation. The aim of present study therefore, was the investigation of any possible relation of inflammatory indices, and more specifically of serum CRP and plasma fibrinogen, with the appearance of cardiovascular mortality in Greek hemodialysis patients. Increased serum CRP concentrations in hemodialysis patients, are considered as an independent risk factor for death from all-causes. However these patients have many reasons to present transient increase of serum CRP. Moreover there is no information regarding patients with permanent increased concentrations of CRP (in more than one measurement) in this population. In this study we investigated the above problems in a population of hemodialysis patients of Northern Greece.Σκοπός: Η καρδιαγγειακή νόσος είναι η συχνότερη αιτία θανάτου μεταξύ των ασθενών που υποβάλλονται σε χρόνια περιοδική αιμοκάθαρση. Σημαντικός παράγων κινδύνου στους ασθενείς αυτούς θεωρείται η “επιταχυνόμενη” αθηρωσκλήρυνση η οποία, μεταξύ των άλλων, έχει συνδεθεί τα τελευταία χρόνια και με τη χρόνια φλεγμονή. Σκοπός της παρούσας μελέτης λοιπόν, ήταν η διερεύνηση πιθανής συσχέτισης δεικτών της φλεγμονής και ειδικότερα της CRP ορού και του ινωδογόνου πλάσματος, με τον κίνδυνο πρόκλησης καρδιαγγειακής θνησιμότητας σε Έλληνες ασθενείς οι οποίοι υποβάλλονται σε αιμοκάθαρση. Στη διεθνή βιβλιογραφία, η ανεύρεση αυξημένης συγκέντρωσης της CRP ορού σε αιμοκαθαιρόμενους ασθενείς, σε μία και μόνο μέτρηση, αναφέρεται ως δείκτης κινδύνου θανάτου. Ωστόσο οι ασθενείς αυτοί έχουν πολλούς λόγους να παρουσιάζουν συχνά, παροδική (περιστασιακή) αύξηση της CRP. Συγχρόνως δεν υπάρχουν πληροφορίες σχετικά με τους ασθενείς που εμφανίζουν σταθερά αυξημένες συγκεντρώσεις της CRP ορού (σε περισσότερες από μία μετρήσεις) στον ίδιο πληθυσμό. Η μελέτη λοιπόν αυτή προσπαθεί να διερευνήσει το παραπάνω πρόβλημα σε πληθυσμό αιμοκαθαιρόμενων ασθενών της Βόρειας Ελλάδας

Clinical case seminar: Functional analysis of a novel GATA3 mutation in a family with the hypoparathyroidism, deafness, and renal dysplasia syndrome

The hypoparathyroidism, deafness, and renal dysplasia (HDR) syndrome is an autosomal dominant disorder caused by mutations of a member of the GATA-binding family of transcription factors, GATA3. This dual zinc finger transcription factor binds DNA with its C-terminal zinc finger (ZnF2) and stabilizes this binding with its N-terminal zinc finger (ZnF1). ZnF1 also interacts with other zinc finger proteins, notably Friend of GATA (FOG). The HDR syndrome has been described in patients with mutations affecting both ZnF1 and ZnF2 domains; the former result in inefficient interaction with FOG, and the latter result in disruption of DNA binding. We report a patient with renal failure, hypoparathyroidism, and bilateral hearing loss. Assessment of family members indicated that the disease arose as a de novo mutation in her mother. Analysis of GATA3 in the family revealed a heterozygous missense mutation resulting in a nonconservative change of a single amino acid (R276P) in the ZnF1 domain. Functional analysis using dissociation electrophoretic mobility shift and yeast two-hybrid assays showed reduced binding affinity to the GATA motifs but normal interaction with FOG in vitro. These results are consistent with the predicted functions of human GATA3-ZnF1 from three-dimensional molecular modeling and with HDR being a result of GATA3 haploinsufficiency. Copyright © 2005 by The Endocrine Society