Users' Guides to the Medical Literature III. How to Use an Article About a Diagnostic Test B. What Are the Results and Will They Help Me in Caring for My Patients?

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Effects of high intraoperative inspired oxygen on postoperative nausea and vomiting in gynecologic laparoscopic surgery

Study objective: To assess the efficacy of intraoperative different inspired oxygen fractions (FIO2) of 0.8 and 0.5 when compared with standard FIO2 0.3 in prevention of postoperative nausea and vomiting (PONV). Design: A prospective, controlled, randomized, double-blind study. Setting: General hospital, postanesthesia care unit (PACU) and gynecologic floor room. Patients: 120 ASA physical status I and II women, aged 21 to 76 y, undergoing elective gynecologic laparoscopic surgery. Interventions: Patients were randomized to receive gas mixture of 30% oxygen in air (FI O2=0.3, group G30), 50% oxygen in air (FIO2=0.5, group G50) or 80% oxygen in air (FIO2=0.8, group G80), n=36 in each group. A standardized sevoflurane general anesthesia, postoperative pain management and antiemetic regimen were used. Measurements: The incidence of nausea, vomiting or both was assessed for early (0-2h) and late PONV (2-24h) along with the use of rescue antiemetic, degree of nausea and severity of pain. Main results: There was no overall difference in the incidence of PONV at early and late assessment periods among the three groups. Patients in G80 had significantly less vomiting than G30 at 2 hours, 3% (1/36) vs. 22% (8/36), respectively, P=0.028. Nausea scores, rescue antiemetic use, pain scores and opioid consumption were not different among the groups. Conclusion: High intraoperative FIO2 of 0.8 and FIO2 of 0.5 does not prevent PONV in patients without antiemetic prophylaxis. Intraoperative FIO2 of 0.8 has beneficial effect on early vomiting only

Fresh Fruits and Vegetables Really Do Keep the Doctor Away: Symptomatic Vitamin Deficiency in a Middle Aged Man

Introduction We present a clinical case of symptomatic vitamin deficiency typically seen only in resource limited environments or alcoholics, presenting in an adult male with frequent oral intake, but limited diet of prepared foods, as well as co-occurring pernicious anemia. Clinical Findings The patient presented with complaints of ascending paresthesia leading to near syncope, lower extremity edema and hyperpigmentation on his anterior legs bilaterally which had been present for years. Diagnosis and interventions He was found to have mixed B12, thiamine, and folate deficiency. These were attributed to a combination of nutritional deficiency due to a diet of exclusively cooked foods, and pernicious anemia. He was treated with parenteral and oral vitamin supplementation and noted to improve, but was lost to follow up. Conclusion This case highlights the importance of social and nutritional history in health maintenance, as well as the clinical significance of prolonged mixed vitamin deficiency

Stephen Klein Wellness Center Patient Satisfaction Survey: Development and Preliminary Results

Study design: •Selected the CAHPS® with Patient Centered Medical Home question set to administer to patients receiving medical care at SKWC (52 questions) •Included 2 supplemental questions to assess patients’ likelihood to refer others to SKWC •Developed an additional survey for patients receiving behavioral health services (16 questions) Participant recruitment and data collection: •Calculated a target number of 130 participants based on CAHPS® guidelines of 50 surveys per Full Time Employee •Observed patient flow and developed recruitment strategy for a convenience sample •Eligibility criteria: patient ≥18 y/o and had a medical appointment in the last 12 months •Participants were invited to enter an optional raffle to win a $25 gift card to the Fresh Grocer Data analysis: •Responses were coded and entered into Microsoft Excel Database •Average scores and response frequencies for each survey question were calculatedhttps://jdc.jefferson.edu/cwicposters/1029/thumbnail.jp

Novel Therapies for Intracerebral Hemorrhage

INTRODUCTION Intracerebral hemorrhage is by far the most destructive form of stroke1. Apart from the management in a specialized stroke or neurological intensive care unit (NICU), no specific therapies have been shown to consistently improve outcomes after ICH2. Current Guidelines endorse early aggressive optimization of physiologic derangements with ventilatory support when indicated, blood pressure control, reversal of any preexisting coagulopathy, intracranial pressure monitoring for certain cases, osmotherapy, temperature modulation, seizure prophylaxis, treatment of hyerglycemia, and nutritional support in the stroke unit or NICU. Ventriculostomy is the cornerstone of therapy for control of intracranial pressure patients with intraventricular hemorrhage. 3, 4 Surgical hematoma evacuation does not improve outcome for most patients, but is a reasonable option for patients with early worsening due to mass effect due to large cerebellar or lobar hemorrhages. Promising experimental treatments involve targeting of molecular mechanisms implicated in inflammation, blood product degradation, and secondary neuronal damage. Pages: 11-14

Signs of Psychosis Leading to a Diagnosis of Progressive Multifocal Leukoencephalopathy: A Case Report

Introduction: Progressive multifocal leukoencephalopathy (PML) is a rare demyelinating process of the central nervous system that occurs in in the setting of severe immunocompromise. Patients with PML develop varying focal neurological deficits and mental status changes that have not been well-described previously. Clinical findings: We present a patient who was found by security wandering the lobby of this hospital. He was oriented only to self and unable to state a reason for presentation. Medical records were limited and included a visit to an outside hospital that documented a past medical history of HIV infection. He exhibited multiple signs of psychosis such as thought blocking and a disorganized thought process. Main diagnoses, therapeutic interventions, and outcomes: After thorough evaluation, he was diagnosed with HIV-associated PML based on a CD4 count of 68 cells/microliter, subcortical white matter signal abnormalities on brain MRI, and positive CSF PCR for JC polyomavirus. Despite initiation of antiretroviral therapy, he unfortunately clinically declined and was ultimately transitioned to hospice care. Conclusions: While survival from PML has significantly improved with the advent of antiretroviral therapy, the overall prognosis remains poor. This case report emphasizes that PML should be included in the differential diagnosis for any immunocompromised patients with mental status changes even if they do not present with overt focal neurological deficits. It also highlights the importance of continuous HIV medical care to minimize the risk of patients developing such devastating complications

Short telomeres in patients with chronic schizophrenia who show a poor response to treatment

Objective: Telomere shortening has been observed in many human diseases, including atherosclerosis, cancer, aging syndromes, Alzheimer disease and vascular dementia. The present study aimed to investigate the mean telomere lengths of patients with schizophrenia. Methods: We analyzed the lengths of telomeric DNA, comparing 2 groups of patients with schizophrenia (34 good responders and 34 poor responders). A control group of 76 healthy volunteers was also included. Blood samples were obtained, and telomere length was measured by Southern blot analysis on the mean length of terminal restriction fragment (TRF). Results: Compared with the control group, a significant amount of telomere shortening was found in peripheral blood leukocytes from patients with schizophrenia who experienced poor response to antipsychotics (p < 0.001). Conclusion: Shortened telomere length in chronic schizophrenia may be a trait marker caused by oxidative stress, and the ensuing cellular dysfunction may be a factor contributing to the progressive deterioration in treatment-resistant schizophrenia. Objectif : On a observé un raccourcissement des télomères dans beaucoup de maladies humaines, y compris l'athérosclérose, le cancer, les syndromes du vieillissement, la maladie d'Alzheimer et la démence vasculaire. L'étude visait à analyser la longueur moyenne des télomères chez les patients atteints de schizophrénie. Méthodes : Nous avons analysé la longueur de l'ADN télomérique en comparant deux groupes de patients atteints de schizophrénie (34 qui réagissaient bien et 34 qui réagissaient mal). L'étude comportait aussi un groupe témoin de 76 volontaires en bonne santé. On a prélevé des échantillons de sang et mesuré la longueur des télomères par transfert de Southern portant sur la longueur moyenne du fragment de restriction terminal (FRT). Résultats : Comparativement au groupe témoin, on a constaté un raccourcissement important des télomères dans les leucocytes du sang périphérique des patients atteints de schizophrénie qui réagissaient mal aux antipsychotiques (p < 0,001). Conclusion : Le raccourcissement des télomères dans les cas de schizophrénie chronique peut constituer un marqueur caractéristique causé par le stress oxydatif , et le dysfonctionnement cellulaire qui en découle peut contribuer à la détérioration progressive dans les cas de schizophrénie résistant au traitement