Airway Management in Accident and Emergency

Accidents are associated with airway complications. Tracheobronchial injury, pneumothorax, pneumomediastinum, atelectasis, and subcutaneous emphysema can be observed. Therefore airway management in emergency medicine requires skills and equipment. Rapid-sequence intubation, effective preoxygenation, apneic oxygenation, manual inline stabilization technique should be used properly. Rapid-sequence intubation consists of sedation, analgesia, and muscle paralysis components. Videolaryngoscopes, supraglottic and extraglottic airway devices, bougie and surgical airway tools are among training materials. A range of training materials have been described to improve providers’ understanding and knowledge of patient safety. In conclusion providing oxygenation, minimizing the risk of complications and choosing the appropriate devices constitute the airway management’s pearls

Airway Management during Pregnancy and Labor

Pregnant women undergo non-obstetric surgeries as well as cesarean operations. Airway management can be complicated due to physiological changes which occur in the respiratory system of labors. The most common causes of pregnancy-specific hypoxic respiratory failure are eclampsia, preeclampsia, and pulmonary edema that develops secondary to tocolytics. Approximately 10–15% of pregnant women undergo emergency cesarean section. Regional anesthesia is a preferred technique worldwide most commonly, and general anesthesia is applied with rapid sequence induction for the rest of the patients. Difficult Airway Society Master Algorithm for Obstetric Patients is a useful method to manage the airway in labors

Assessment of the relationship between a narrow fragmented QRS complex and coronary slow flow

Background: The coronary slow flow (CSF) phenomenon is a delayed antegrade progression of contrast agent to the distal branch of a coronary artery in the absence of obstructive coronary artery disease (CAD). A narrow fragmented QRS (fQRS) has been reported as a significant predictor of sudden cardiac death in patients with idiopathic dilated cardiomyopathy. The present study aimed to investigate the relationship between a narrow fQRS on the admission electrocardiogram (ECG) and CSF on coronary angiography. Methods: This study included 165 consecutive patients (112 CSF, 53 controls) who underwent first-time diagnostic conventional coronary angiography for suspected CAD. Coronary flow was quantified by thrombolysis in myocardial infarction (TIMI) frame count (TFC). The patients were divided into two groups according to the presence or absence of a narrow fQRS complex on the admission ECG. Results: Forty four patients were in the fQRS group (mean age, 52.97 ± 3.13 years). There was no difference between the two groups with respect to age, gender, body mass index, family history, hyperlipidemia, hypertension, or diabetes mellitus. The extent of CSF was significantly greater in the fQRS group compared to the non-fragmented group (p < 0.001). A significant correlation was also found between mean TFC values and fQRS (p < 0.001). On multivariate analysis, only CSF (p = 0.03) was a significant independent predictor for narrow fQRS, after adjustment for other parameters. Conclusions: The narrow fQRS is a simple, inexpensive, and readily available noninvasive ECG parameter that may be a new potential indicator of myocardial damage in patients with CSF.

Short-term effects of transcatheter aortic valve implantation on left atrial appendage function

Background: The beneficial effects of the transcatheter aortic valve implantation (TAVI) on echocardiographic parameters including left atrial (LA) and left ventricular (LV) functions were described by previous studies. The aim of this study was to analyze the effects of TAVI on left atrial appendage (LAA) function assessed by transthoracic and transesophageal echocar­diography. Methods: Fifty-five patients with severe symptomatic aortic stenosis were included in this prospective study. LAA early and late emptying velocities, LAA filling velocity, peak early diastolic (EM), late diastolic (AM), and systolic (SM) velocities were measured with pulsed wave Doppler and tissue Doppler imaging, and E/Em ratio was calculated before and 7.1 ± 2.8 days after TAVI. A subgroup analysis was performed in accordance with the left ventricular ejection fraction (LVEF) of the patients and the severity of their LV diastolic dysfunction. Results: Although the post-procedure peaks and mean gradients of the patients decreased sig­nificantly, the LVEF increased significantly in those who had low LVEF before the procedure. The post-procedure E/Em ratio decreased significantly (p < 0.001). The post-procedural LAA mean filling velocity and EM velocity were significantly higher than the pre-procedural filling velocity (p < 0.001, p = 0.002, respectively). In the subgroup analysis, the post-procedural LAA filling velocity, early and late LAA emptying velocities, in addition to the mean velocity of the EM, AM, and SM were significantly higher than before the procedure in patients with LVEF of < 50% and E/Em ratios of > 15. Conclusions: LAA function improved soon after the TAVI procedure, especially in patients with low LVEF and marked LV diastolic dysfunction

Ecology and genomics of an important crop wild relative as a prelude to agricultural innovation

Domesticated species are impacted in unintended ways during domestication and breeding. Changes in the nature and intensity of selection impart genetic drift, reduce diversity, and increase the frequency of deleterious alleles. Such outcomes constrain our ability to expand the cultivation of crops into environments that differ from those under which domestication occurred. We address this need in chickpea, an important pulse legume, by harnessing the diversity of wild crop relatives. We document an extreme domestication-related genetic bottleneck and decipher the genetic history of wild populations. We provide evidence of ancestral adaptations for seed coat color crypsis, estimate the impact of environment on genetic structure and trait values, and demonstrate variation between wild and cultivated accessions for agronomic properties. A resource of genotyped, association mapping progeny functionally links the wild and cultivated gene pools and is an essential resource chickpea for improvement, while our methods inform collection of other wild crop progenitor species

Facial emotion recognition in adolescent depression: The role of childhood traumas, emotion regulation difficulties, alexithymia and empathy

Introduction: Facial emotion recognition (FER) is crucial for effective social competency, and problems in this skill are linked depression during adolescence. In this study, we aimed to find the rates of FER accuracy for negative (fearful, sad, angry, disgusted), positive (happy, surprised), and neutral emotions, and the possible predictors of FER skill for most confusing emotions. Subjects and Methods: A total of 67 drug-naive adolescents with depression (11 boys, 56 girls; 11-17 years) were recruited for the study. The facial emotion recognition test, childhood trauma questionnaire and basic empathy, difficulty of emotion regulation, and Toronto alexithymia scales were used. Results: The analysis demonstrated that adolescents have more difficulties in recognizing negative emotions when compared the positive ones. The most confusing emotion is fear (39.8% of fear was recognized as surprise). Boys have lower fear recognition skill than girls and higher childhood emotional abuse, physical abuse, emotional neglect, and difficulty in describing feelings to predict lower fear recognition skill. For sadness recognition skill, emotional neglect, difficulty in describing feelings, and depression severity were the negative predictors. Emotional empathy has a positive effect on disgust recognition skill. Conclusion: Our findings demonstrated that impairment of FER skill for negative emotions is associated with childhood traumas, emotion regulation difficulties, alexithymia, and empathy symptoms in adolescent depression

Hepatitis B vaccination response of treatment-naive patients with juvenile idiopathic arthritis.

To evaluate the vaccine response of treatment-naive juvenile idiopathic arthritis (JIA) patients who were fully vaccinated against Hepatitis B Virus (HBV) and then compare their antibody status with healthy controls. In this multicenter study, initial visit hepatitis B surface antigen (HbsAg) and anti-hepatitis B surface antibody (anti-Hbs) titers of 262 treatment-naive JIA patients who were followed up regularly between May 2015 and October 2019 were evaluated retrospectively from patients' medical records and compared with 276 healthy peers. Both HbsAg and anti-Hbs antibody titers were tested by the ELISA technique. Anti-HBs titers >= 10 IU/L were considered as reactive indicating seroprotection against HBV. In the JIA group, seropositivity rate was 59.1% while 72.9% of the control group were immune against HBV (p = 0.002). The median titer for anti-Hbs was 14 (range: 0-1000) IU/L in the patient group and 43.3 (range: 0-1000) IU/L in the control group (p = 0.01). Neither JIA patients nor healthy controls were positive for HbsAg. Patients with JIA vaccinated according to the national vaccination schedule were evaluated at their first visit in pediatric rheumatology outpatient clinics for anti-Hbs presence and it was found that they have lesser seroprotectivity than their age and sex-matched routinely vaccinated, healthy peers. So, to complete missing vaccines and booster vaccine doses, assessing the immune status of the patients at the time of diagnosis against HBV should be in the check-list of physicians dealing with pediatric rheumatic diseases

Evaluation of Time-Dependent Temperature Changes during Different Interdental Stripping Procedures by Thermal Imaging: An In Vitro Study

Purpose: To investigate the temperature changes in pulp chamber of incisor and canine teeth during different stripping procedures with thermal imaging. Materials and Methods: Intact and freshly extracted human permanent 40 maxillary lateral incisor, 40 mandibular canine and 40 mandibular incisor teeth were selected for this study. Diamond bur, tungsten carbide bur and perforated diamond-coated disc were used for interdental stripping in high and low speed handpieces by air and water cooling. Temperature changes and cooling time of the tooth groups were recorded by a thermal imaging system. Paired t test and one-way analysis of variance (ANOVA) tests were performed for intragroup and intergroup comparisons of temperature changes and cooling time values. Results: Stripping procedures created a statistically significant temperature rise in all study groups (p < 0.05). For maxillary lateral incisors and mandibular incisors, the greatest temperature rise was calculated during stripping with tungsten bur and perforated disk under air cooling (p < 0.001), while no statistically significant difference was found between the temperature rise values of mandibular canine teeth during different stripping procedures (p = 0.053). The lowest temperature rise and cooling time values among all tooth groups were observed during stripping with diamond bur under water cooling and the longest cooling time values were detected during stripping with perforated disc under air cooling (maxillary incisor; p < 0.001, mandibular incisor; p < 0.05, mandibular canine; p < 0.05). Conclusion: For all tooth groups, stripping with diamond bur in a high speed handpiece under water cooling produced the lowest temperature rise in the pulp chamber and the shortest cooling time values among different stripping procedures

Airway management in penetrating thoracic trauma

Penetrating thoracic trauma accounts for 20–25% of all deaths due to trauma in the first four decades of life. About 33% of deaths from thoracic trauma occur due to penetrating trauma. In an autopsy study that enrolled 1178 trauma patients, 82% of the patients with tracheobronchial injuries died at the incidence site. In another study, 30% of those who could be transferred to the hospital died. This review aimed to revisit penetrating thoracic trauma with respect to complications and the strategies for airway management. While the risk of death in injuries with a sharp object is normally 1–8%, it reaches 25–28% when the cardiac box is included, and still, most of the patients are lost before they can come to the hospital. The consequences and management of penetrating thoracic trauma are mainly dependent on the extent of the injury to internal organs, as well as on the skill of the clinicians, airway obstruction, respiratory failure, and bleeding. Chest computed tomography (CT) is better than chest radiography in diagnosing the main bronchus or lobe/segment rupture. However, with the use of multi-channel multi-detector CT, the sensitivity of CT imaging has increased to 94% in the diagnosis of tracheobronchial injuries. While standard orotracheal intubation is sufficient in 75% of the patients, flexible bronchoscopy, intubation through the open wound or tracheostomy is required for airway provision in the rest. Clinical suspicion is the first diagnostic tool in a patient with penetrating airway trauma, and early treatment with multidisciplinary teamwork is life-saving