Brain Death in Children

Brain death (BD) is a distinct mode of death in pediatric intensive care units, accounting for 16–23% of deaths. Coma, absent brainstem reflexes, and apnea in a patient with acute irreversible neurological insult should alarm the attending physician to start the appropriate actions to establish or refute the diagnosis for BD. BD diagnosis is clinical, starting with the preconditions that should be met, and based on the examination of all brainstem reflexes, including the apnea test. Apnea testing should be conducted according to standard criteria to demonstrate the absence of spontaneous respirations, in the case of an intense ventilatory stimulus, setting at increased PaCO2 levels ≥60 and ≥20 mm Hg, compared to baseline. When elements of clinical examination and/or apnea test cannot be performed, ancillary studies to demonstrate the presence/absence of electrocerebral silence and/or cerebral blood flow are guaranteed. Two clinical examinations by qualified physicians at set intervals are required. Time of death is the time of second examination and ventilator support should stop at that time, except for organ donation. The use of check list in documentation of BD helps in the uniformity of diagnosis and fosters further trust from medical, family, and community personnel

Essentialism in social representations of citizenship: an analysis of Greeks’ and migrants’ discourse

Following a Social Representations approach, the article examines the representations of citizenship held by both migrants and Greek citizens in Greece after the announcement of a heavily debated citizenship legislation. Essentialism, a way of representing social categories as holding an underlying essence that determines their characteristics, was used as an analytical tool to understand the inclusive or exclusive function of representations of citizenship towards migrants. Findings showed that Greeks construct representations based on ethnic, civic, and cultural ideas, while migrants construct representation of citizenship based on civic and cultural ideas. Essentialism was a way of constructing ethnic and cultural representations of citizenship and functioned in both exclusive and inclusive ways, but assimilatory terms accordingly. Civic and cultural representations of citizenship were constructed in nonessentialist ways and functioned in inclusive ways. However, from Greeks' perspective, civic inclusion was conditioned upon an often-questioned legality of migrants and upon cultural assimilation terms. Studying both the content and the essentialist/nonessentialist formulation of representations of citizenship is an important tool in understanding the politics of inclusion and exclusion of citizens in the social arena

An umbrella review of the evidence associating diet and cancer risk at 11 anatomical sites

There is evidence that diet and nutrition are modifiable risk factors for several cancers, but associations may be flawed due to inherent biases. Nutritional epidemiology studies have largely relied on a single assessment of diet using food frequency questionnaires. We conduct an umbrella review of meta-analyses of observational studies to evaluate the strength and validity of the evidence for the association between food/nutrient intake and risk of developing or dying from 11 primary cancers. It is estimated that only few single food/nutrient and cancer associations are supported by strong or highly suggestive meta-analytic evidence, and future similar research is unlikely to change this evidence. Alcohol consumption is positively associated with risk of postmenopausal breast, colorectal, esophageal, head & neck and liver cancer. Consumption of dairy products, milk, calcium and wholegrains are inversely associated with colorectal cancer risk. Coffee consumption is inversely associated with risk of liver cancer and skin basal cell carcinoma

International labour migration and food production in rural Europe: a review of the evidence

Since Hoggart and Mendoza's paper on ‘African immigrant workers in Spanish agriculture' in Sociologia Ruralis in 1999 there has been a proliferation of interest in labour migration to/ in rural Europe. It is now clear that the rural realm has been, and is being, transformed by immigration, and that low-wage migrant workers in the food production industry are playing a particularly prominent role in this transformation. This paper takes stock of the literature and identifies seven key issues associated with low-wage labour migration, contemporary food production, and rural change. Most notably, since the 1990s, there has been growing demand for migrants in the segmented, and sometimes exploitative, labour markets of the European food production industries. This demand has been met across a variety of contexts, with states and labour market intermediaries playing a largely supportive role. However, migrants' integration into rural communities has often been problematic, with the emphasis being on the need for, rather than needs of, low-wage migrant workers

A successfully thrombolysed acute inferior myocardial infarction due to type A aortic dissection with lethal consequences: the importance of early cardiac echocardiography

Thrombolysis, a standard therapy for ST elevation myocardial infarction (STEMI) in non-PCI-capable hospitals, may be catastrophic for patients with aortic dissection leading to further expansion, rupture and uncontrolled bleeding. Stanford type A aortic dissection, rarely may mimic myocardial infarction. We report a case of a patient with an inferior STEMI thrombolysed with tenecteplase and followed by clinical and electrocardiographic evidence of successful reperfusion, which was found later to be a lethal acute aortic dissection. Prognostic implications of early diagnosis applying transthoracic echocardiography (TTE) are described

Short-term effects of manual therapy plus capacitive and resistive electric transfer therapy in individuals with chronic non-specific low back pain : a randomized clinical trial study

Background and Objectives: Chronic non-specific low back pain (CNSLBP) is defined as back pain that lasts longer than 12 weeks. Capacitive and resistive electric transfer (TECAR) therapy utilizes radiant energy to generate endogenous heat and is widely used for the treatment of chronic musculoskeletal pain. The aim of this study was to investigate the efficacy of manual therapy (MT) program combined with TECAR therapy in individuals with CNSLBP. Materials and Methods: Sixty adults with CNSLBP were randomly divided equally into three groups. The first group followed an MT protocol in the lumbar region (MT group), the second group followed the same MT protocol combined with TECAR therapy (MT + TECAR group) using a conventional capacitive electrode as well as a special resistive electrode bracelet, and the third group (control group) received no treatment. Both intervention programs included six treatments over two weeks. Pain in the last 24 h with the Numeric Pain Rating Scale (NPRS), functional ability with the Roland–Morris Disability Questionnaire (RMDQ), pressure pain threshold (PPT) in the lumbar region with pressure algometry, and mobility of the lumbo-pelvic region through fingertip-to-floor distance (FFD) test were evaluated before and after the intervention period with a one-month follow-up. Analysis of variance with repeated measures was applied. Results: In the NPRS score, both intervention groups showed statistically significant differences compared to the control group both during the second week and the one-month follow-up (p 0.05). Conclusions: The application of an MT protocol with TECAR therapy appeared more effective than conventional MT as well as compared to the control group in reducing pain and disability and improving PPT in individuals with CNSLBP. No further improvement was noted in the mobility of the lumbo-pelvic region by adding TECAR to the MT intervention

Mobility and Migrations in the Rural Areas of Mediterranean EU Countries

AbstractThis chapter focuses on the ambivalent nature of contemporary migrations in European rural areas. The growing presence of immigrants in these areas is a direct result of the restructuring of agriculture and global agri-food chains. Evidence indicates that while agricultural work and rural settings are decreasingly attractive to local populations, they represent a favourable environment to international newcomers, due to the higher chances to access livelihood resources. The non-visibility and informality that characterise rural settings and agricultural work arrangements provide on the one side opportunities for employment, while also fostering illegal labour practices and situations of harsh exploitation

Phase II trial of oral cyclophosphamide, prednisone, and diethylstilbestrol for androgen-independent prostate carcinoma

BACKGROUND The authors evaluated the combination of oral cyclophosphamide, oral prednisone, and diethylstilbestrol (DES) in patients with androgen-independent prostate carcinoma (AIPC). METHODS Thirty-seven patients with prostate carcinoma refractory to androgen ablation who had undergone antiandrogen withdrawal (if previously treated with an antiandrogen) were enrolled in the current study. They were treated with oral cyclophosphamide 100 mg per day on Days 1–20, prednisone 10 mg per day continuously, and DES 1 mg continuously, on a 30-day cycle. Warfarin 1 mg per day was given as prophylaxis for thrombosis. Patient levels of prostate-specific antigen (PSA) were monitored on a monthly basis, with imaging studies every 3 months. Patients continued to receive therapy until disease progression or the occurrence of significant toxicity. The effect of therapy on the patient's quality of life was assessed using the Functional Assessment of Cancer Therapy–Prostate. RESULTS Thirty-six patients were evaluable for response. Of the 36 patients, 15 (42%) had a 50% or greater decline in PSA levels from pretreatment levels and 1 patient (6%) with measurable disease had a partial response to therapy. The median duration of response was 4.5 months (range, 4–18 months). The overall median survival period was 16.4 months. The treatment was well tolerated, with only three patients removed from the study for toxicities associated with treatment. One patient, who had been treated for more than 24 months, developed acute leukemia. Quality of life evaluation in 17 patients showed a significant improvement in responders, whereas nonresponders had no deterioration while receiving therapy. CONCLUSIONS Cyclophosphamide, prednisone, and DES represent a well tolerated, low-cost combination therapy with significant activity in the treatment of patients with AIPC. Cancer 2003. © 2003 American Cancer Society. DOI 10.1002/cncr.11686Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/34381/1/11686_ftp.pd