Palliative care and prehospital emergency medicine: analysis of a case series.

Palliative care, which is intended to keep patients at home as long as possible, is increasingly proposed for patients who live at home, with their family, or in retirement homes. Although their condition is expected to have a lethal evolution, the patients-or more often their families or entourages-are sometimes confronted with sudden situations of respiratory distress, convulsions, hemorrhage, coma, anxiety, or pain. Prehospital emergency services are therefore often confronted with palliative care situations, situations in which medical teams are not skilled and therefore frequently feel awkward.We conducted a retrospective study about cases of palliative care situations that were managed by prehospital emergency physicians (EPs) over a period of 8 months in 2012, in the urban region of Lausanne in the State of Vaud, Switzerland.The prehospital EPs managed 1586 prehospital emergencies during the study period. We report 4 situations of respiratory distress or neurological disorders in advanced cancer patients, highlighting end-of-life and palliative care situations that may be encountered by prehospital emergency services.The similarity of the cases, the reasons leading to the involvement of prehospital EPs, and the ethical dilemma illustrated by these situations are discussed. These situations highlight the need for more formal education in palliative care for EPs and prehospital emergency teams, and the need to fully communicate the planning and implementation of palliative care with patients and patients' family members

Kecernaan Bahan Kering Dan Bahan Organik Ransum Ternak Kambing Kacang Yang Diberi Suplementasi Dedak Padi Dan Daun Turi

Dry And Organic Matter Digestibility Of Kacang Goats Offered Native Grass Supplemented With Rice Meal And Sesbania Leafs. A study on the effect of rice meal and sesbania leafs supplementation on dry and organic matter digestibility of kacang goats offered native grass has been carried out using 12 male goats (6-9 months old) in a block completely randomized design. The goats were grouped into 4 and then each group was treated as R0 = 100% native grass (control), R1 = 75% native grass + 20% sesbania leafs + 5% rice meal, R2 = 50% native grass + 40% sesbania leafs + 10% rice meal or R3 = 25% native grass + 60% sesbania leafs + 15% rice meal. Replication was 3 times for each treatment so there are 12 experimental units. Data was analyzed by Analysis of variance (ANOVA) and the difference among treatments was further analyzed by Duncan\u27s multiple range tests. Results showed that there is a strong significant difference (P<0.01) among dry matter digestibility. Further test showed that there is a strong significant difference (P<0.01) between R3 and either R0, R1 or R2. Between R2 and R0 there is only a significant (P<0.05) difference. There is no difference (P>0.05) between R2 and R1 as well as R1 and R0. Organic matter digestibility was significantly (P<0.01) differ among treatments. Further test showed that a strong significant (P<0.01) difference was recorded between R3 and either R0, R1 or R2. Similarly, the difference between R2 and R0 as well as R1 and R0 was recorded. There is no significant difference (P>0.05) between R2 and R1. It can be concluded that dry and organic matter digestibility of kacang goats increases according to the increase of sesbania leafs and rice meal supplementation. It was suggested to use sesbania leafs and rice meal in the ration of fattening goats and also it was suggested a further experiment by using different ration formulation composed of these feedstuffs

Low sensitivity of qSOFA, SIRS criteria and sepsis definition to identify infected patients at risk of complication in the prehospital setting and at the emergency department triage.

Sepsis is defined as life-threatening organ dysfunction caused by a host response to infection. The quick SOFA (qSOFA) score has been recently proposed as a new bedside clinical score to identify patients with suspected infection at risk of complication (intensive care unit (ICU) admission, in-hospital mortality). The aim of this study was to measure the sensitivity of the qSOFA score, SIRS criteria and sepsis definitions to identify the most serious sepsis cases in the prehospital setting and at the emergency department (ED) triage. We performed a retrospective study of all patients transported by emergency medical services (EMS) to the Lausanne University Hospital (CHUV) over twelve months. All patients with a suspected or proven infection after the ED workup were included. We retrospectively analysed the sensitivity of the qSOFA score (≥2 criteria), SIRS criteria (≥2 clinical criteria) and sepsis definition (SIRS criteria + one sign of organ dysfunction or hypoperfusion) in the pre-hospital setting and at the ED triage as predictors of ICU admission, ICU stay of ≥3 days and early (i.e. 48 h) mortality. No direct comparison between the three tools was attempted. Among 11,411 patients transported to the University hospital, 886 (7.8%) were included. In the pre-hospital setting, the sensitivity of qSOFA reached 36.3% for ICU admission, 17.4% for ICU stay of three days or more and 68.0% for 48 h mortality. The sensitivity of SIRS criteria reached 68.8% for ICU admission, 74.6% for ICU stay of three days or more and 64.0% for 48 h mortality. The sensitivity of sepsis definition did not reach 60% for any outcome. At ED triage, the sensitivity of qSOFA reached 31.2% for ICU admission, 30.5% for ICU stay of ≥3 days and 60.0% for mortality at 48 h. The sensitivity of SIRS criteria reached 58.8% for ICU admission, 57.6% for ICU stay of ≥3 days 80.0% for mortality at 48 h. The sensitivity of sepsis definition reached 60.0% for 48 h mortality. Incidence of sepsis in the ED among patients transported by ambulance was 3.8 percent. This rate, associated to the mortality of sepsis, confirms the necessity to dispose of a test to early identify those patients. The sensitivity performance of all three tools was suboptimal. The qSOFA score, SIRS criteria and sepsis definition have low identification sensitivity in selecting septic patients in the pre-hospital setting or upon arrival in the ED at risk of complication

The Effect of Varied Doses of Nicotine on Some Morphometric Parameters of the Testis in Albino Wistar Rats

Background: This study is aimed at determining the effect of nicotine on male fertility by evaluating some morphometric parameters of male Wistar rat such as testicular weight, seminiferous tubule diameter, height of epithelium, sertoli-germ cell ratio and Johnsen’s score  in order to assess the spermatogic  index. Methods: 20 adult male rats were randomly divided into four groups, the test groups were administered with 0.2mg/100g, 0.4/100g and 0.6/100g body weight of nicotine base daily for 30 days using a polythene catheter orally , while the control were administered with 2mls 0.9%physiological saline. Histological slides of the testis were made and data obtained from the slides. Results: nicotine caused a significant reduction (P < 0.05) and (P< 0.01) in the mean values of the morphometric parameters of the test group compared with control. The Johnsen’s Score results were 5.4 ± 0.51*, 5.2 ± 0.37* for groups 2 and 3 respectively. For seminiferous tubule diameter the significant values were 208.0±4.22**, 184.5±11.31**in groups 2 and 3, whilst the height of epithelium showed a significant reduction of 153.9± 13.58*, 101.6 ± 1.35**, 76.6 ± 6.65** for groups 1, 2 and 3 respectively. Sertoli-germ cell ratio showed a significant reduction in groups 2 and 3 with values of 3.6 ± 0.77 ** , 1.5 ±  0.16**for groups 2, and 3 respectively, testicular weight showed significant reduction of 1.2±0.05**,1.1±0.05** for group 2 and 3.The results stated are only those that showed a significant reduction at 95% confidence level when compared with the control. Conclusion:  It was concluded that nicotine exerted an adverse effects on the spermatogenic index with concomitant reduction in reproductive potentials of the male rat. Nicotine and nicotine- based products should therefore be taken with caution in cases of infertility in man and animal. Key words: Morphometric parameters ,Johnsen’s Score,Spermatogenic index , fertilit

The flip side of Cell Talk in Exercise: Cell Noise

The article makes an effort to study, assess, and bring additional depth to the concept of cell talk, crosstalk, and cell noise -highlighting molecular-level occurrences such as signaling activity that affect different metabolic processes, gene expression, and protein synthesis. It also establishes the idea of "cell noise," or "dysregulated cell signaling," which is defined as cell activity that may worsen or result in cellular injury, oxidative stress, and inflammation. There is abundant evidence that consistent, lifelong exercise extends lifespan and delays the onset of chronic illnesses like cardiovascular disease, diabetes, cancer, hypertension, obesity, depression, and osteoporosis. The aforementioned highlights the need for metered or regulated physical training that takes into account genetic and environmental variances among individuals. Everyone is advised to engage in structured, well-chosen workouts that will promote longevity of life and result in the human body functioning at its best. Keywords: Cell Talk in Exercise, Cell Noise DOI: 10.7176/JBAH/13-8-05 Publication date:May 31st 202

INTERET DU DOSAGE DU NT- PROBNP DANS LE DIAGNOSTIC DIFFERENTIEL D’UNE DYSPNEE AIGUE AU SERVICE DES

Objective: the N-terminal fraction of the precursor of the natriuretic peptide of type B (NT-proBNP) is a marker of cardiac failure. In this work we evaluated the performances as regards diagnosis of a dyspnea which this marker can bring to the urgentists of our formation in order to direct in an adequate way the patients dyspneic, towards the various services of the Military hospital of Instruction Mohammed V Rabat. Material and method: our study was carried out among 40 patients dealt with by the team of the service of the urgencies of the Military hospital of Instruction Mohammed V for nontraumatic acute dyspnea accompanied or not by thoracic pain. The Middle Age of the studied population is 54 years with the extreme ones going from 30 to 78 years. The patients were studied on the clinical level by the medical antecedents; risk factors cardiovascular and on the biological level by the ionogramme, the NFS, gases of blood and the proportioning of the NT-proBNP. Results: the patients are classified in three groups: On the one hand according to the rate of NT-proBNP. 27 patients presented values of NT-proBNP > 1200 pg/ml, but it was not retained that 23 patients because the 4 others had been excluded because of the impaired renal function. The clinical and radiological diagnosis was obvious among 17 patients is 74%. Among 6 other patients (26%), the rate of high NT-proBNP justified the orientation of these patients in cardiology for additional investigations. The diagnoses retained by the cardiologists confirmed the cardiac presence of pathology among these patients. As for the patients whose rate of NT-proBNP lies between 250 and 1200 pg/ml (N = 3), their orientation took account of the clinical context. 10 patients presented values of NT-proBNP 1200 pg/ml, mais on n’a retenu que 23 patients car les 4 autres avaient été exclus à cause de l’insuffisance rénale. Le diagnostic clinique et radiologique était évident chez 17 patients soit 74%. Chez les 6 autres patients (26%), le taux de NT-proBNP élevé a justifié l’orientation de ces patients en cardiologie pour des investigations supplémentaires. Les diagnostics retenus par les cardiologues confirmaient la présence de pathologie cardiaque chez ces malades. Quant aux patients dont le taux de NT-proBNP est compris entre 250 et 1200 pg/ml (n = 3), leur orientation a tenu compte du contexte clinique. 10 patients présentaient des valeurs de NT-proBNP < 250 pg/ml. Aucun événement cardiaque n’a été décelé par les examens complémentaires réalisés à posteriori. D’autre part, en fonction des données clinique et paraclinique le médecin urgentiste a orienté 16 patients en pneumologie 19 patients en cardiologie 5 patients en néphrologie et réanimation. Conclusion : le NT-proBNP est d’une fiabilité manifeste par rapport aux données cliniques et paracliniques, permettant non seulement une prise en charge rapide des patients mais aussi d’éviter la prescription de bilans non justifiés  parfois très coûteux et une prolongation de la durée d’hospitalisation du malade

DREPANOCYTOSE SC REVELEE PAR UNE OSTEONECROSE DE LA TETE HUMERALE EN POST PARTUM

The double heterozygocity point SC occupies the second place of sickle cell disease syndromes major. The diagnosis, often late, is usually asked on the occasion of a complication. The association "sickle cell anemia-pregnancy" causes the alteration of maternal prognosis on the slope and haematological fetal on the plan midwifery. Among the maternal complications related to this pathology, are found the crises vasoocclusives with the bilateral necrosis of femoral heads or heads of humerales, These crises are all the more serious in that they can be complicated by syndromes acute chest in report with a pulmonary embolism greasy or deadly syndrome vasculorenal. The support of such a haemoglobinopathy need a prophylactic transfusion or better an exchange transfusion of the 28th week of gestation to obtain a rate of HbA greater than 50%. In postpartum, the risk of complications is increased, the systematic support should include even in the early days, warming, oxygenation, hydration hydro-electrolytic and sy.La double hétérozygotie SC occupe la deuxième place des syndromes drépanocytaires majeures. Le diagnostic, souvent tardif, est habituellement posé à l’occasion d’une complication. L’association « drépanocytose-grossesse » entraîne l’altération du pronostic maternel sur le versant hématologique et fœtal sur le plan obstétrical. Parmi les complications maternelles liées à cette pathologie, sont retrouvées les crises vasoocclusives avec la nécrose bilatérale des têtes fémorales ou des têtes humérales, notamment en post partum, tel chez notre jeune patiente. Ces crises sont d’autant plus graves qu’elles peuvent se compliquer de syndromes thoraciques aigus en rapport avec une embolie pulmonaire graisseuse mortelle ou de syndrome vasculorénal. La prise en charge d’une telle hémoglobinopathie nécessite une transfusion prophylactique ou mieux un échange transfusionnel dès la 28ème semaine d’aménorrhée pour obtenir un taux d’ HbA supérieur à 50%. En post-partum, le risque de complications est accrue, la prise en charge systématique doit comprendre, dés les premiers jours, un réchauffement, une oxygénation, une hydratation hydro-éléctrolytique et une antibiothérapie systématique