DIVERTICULAR DISEASE OF THE COLON

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DIVERTICULAR DISEASE OF THE COLON

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DIVERTICULAR DISEASE OF THE COLON

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Community–groundwater compatibility assessments: An approach towards sustainable groundwater development

To address water availability problems in a semi-arid country like South Africa, the National Water Act (RSA, 1998) proposes that specialists adopt an approach that is strategic, deliberate and dictated by socio-political reforms and socioeconomic development needs on a programmatic basis for long-term sustainability. To achieve this goal an approach is developed to determine community–groundwater compatibility as part of the initial stages of regional rural groundwaterdevelopment projects in the Eastern Cape Province, South Africa. The steps followed in the community–groundwater compatibility assessment include:• A desktop study where available literature is collected and reviewed. From this information and history, the sociopolitical challenges that will have to be faced for the successful completion of the groundwater-development project in the study area can often be established. This is valuable information to assist the hydrogeological team in planning the community–groundwater compatibility assessment, taking note of pitfalls and lessons learnt from previous approaches that might not always have been successful.• A socio-economic characterisation includes setting up a contact database for the community authorities and technical managers within the study. The contact database includes all contact details of the ward  councillors/technical managers as well as any relevant information or comments made by the ward councillor/technical manager during the conversation. All identified stakeholders must also be contacted, informing them of the project and study. The data obtained from the role-players are used to develop a social-character map.• Site surveys and sampling are based on the social-character map. The study team assesses the knowledge communities carry concerning groundwater as well as their general attitude towards the use of  groundwater.• Data processing and analyses include the statistical processing of the collected data to assess the comprehensive measure of groundwater compatibility per area, and the individual indicators of the groundwater-compatibility index are given a relative score. This enables the different indicators for groundwater compatibility per area to be combined to give a single composite score for each spatial area. Target areas are finally characterised in terms of their ‘community–groundwater compatibility index’. Maps showing the social and basic hydrogeological character of target areas are valuable tools towards assisting local authorities indecision-making

Norepinephrine: more of a neurohormone than a vasopressor

Septic shock causes unpredictable cardiovascular responses through adrenoreceptor-mediated changes in cardiac function and vascular responsiveness. The use of norepinephrine should be regarded as neurohormonal augmentation therapy to defend decompensating haemodynamic function rather than as a rescue therapy to treat shock. Recent trials represent a perceptible change in clinical practice to preferentially use norepinephrine early in resuscitation to defend the mean arterial pressure and to use norepinephrine as a neurohormone rather than as a vasopressor

New sepsis definition changes incidence of sepsis in the intensive care unit

Sepsis lacks pathognomonic clinical features and a definitive biochemical or histological diagnostic test. As a result, since 1992, diagnosis of sepsis has been based on the presence of two or more of the criteria characterising the systemic inflammatory response syndrome (SIRS) (Table 1) arising from suspected or proven infection. In response to data questioning this construct, new criteria redefining sepsis, based on the Sequential Organ Failure Assessment (SOFA) score, have been proposed: Sepsis-3 (Table 1). The epidemiological and clinical implications of adopting these new criteria are currently unknown. We aimed to estimate the impact of adopting SOFA-based diagnostic criteria for sepsis on the diagnosis and apparent mortality of sepsis in Australian and New Zealand intensive care units

Intravenous angiotensin II for the treatment of high-output shock (ATHOS trial): a pilot study

INTRODUCTION: Patients with distributive shock who require high dose vasopressors have a high mortality. Angiotensin II (ATII) may prove useful in patients who remain hypotensive despite catecholamine and vasopressin therapy. The appropriate dose of parenteral angiotensin II for shock is unknown. METHODS: In total, 20 patients with distributive shock and a cardiovascular Sequential Organ Failure Assessment score of 4 were randomized to either ATII infusion (N =10) or placebo (N =10) plus standard of care. ATII was started at a dose of 20 ng/kg/min, and titrated for a goal of maintaining a mean arterial pressure (MAP) of 65 mmHg. The infusion (either ATII or placebo) was continued for 6 hours then titrated off. The primary endpoint was the effect of ATII on the standing dose of norepinephrine required to maintain a MAP of 65 mmHg. RESULTS: ATII resulted in marked reduction in norepinephrine dosing in all patients. The mean hour 1 norepinephrine dose for the placebo cohort was 27.6 ± 29.3 mcg/min versus 7.4 ± 12.4 mcg/min for the ATII cohort (P =0.06). The most common adverse event attributable to ATII was hypertension, which occurred in 20% of patients receiving ATII. 30-day mortality for the ATII cohort and the placebo cohort was similar (50% versus 60%, P =1.00). CONCLUSION: Angiotensin II is an effective rescue vasopressor agent in patients with distributive shock requiring multiple vasopressors. The initial dose range of ATII that appears to be appropriate for patients with distributive shock is 2 to 10 ng/kg/min. TRIAL REGISTRATION: Clinicaltrials.gov NCT01393782. Registered 12 July 2011