Intestinal obstruction caused by a Meckel’s diverticulum adherent to an infected urachal cyst

Urachal remnant diseases are rare and frequently misdiagnosed, as the clinical presentation is similar to more common causes of intra-abdominal and pelvic disease. We report the rare case of a 1½-year-old boy with small-bowel obstruction caused by an adhesion band between a Meckel’s diverticulum and an infected urachal cyst. The condition was initially misdiagnosed and treated as a periappendiceal abscess on the basis of clinical examination and ultrasonography findings. In addition to the case report, we present an overview of urachal diseases

Effects Of Implementing A Clinical Pharmacist Service In A Mixed Norwegian Icu

Цели: Неприемливо висок процент пациенти, приети в отделения по интензивно лечение (ОИЛ), развиват свързани с приема на лекарства проблеми (СЛП). СЛП могат да причинят увреждания и да увеличат разноските и продължителността на престоя. Доказано е, че въвеждането на клинично фармацевтично обслужване разкрива голям брой СЛП и ефективно допринася за разрешаването на същите в различни системи на здравеопазване. Обаче това не е проучено в перспектива в смесени третични норвежки ОИЛ.Методи: През 12-месечен период от м. октомври 2012 г. насетне един клиничен фармацевт се посвети на прегледи на лекарства 3 часа на ден (от понеделник до петък). СЛП бяха докладвани на срещата на ОИЛ и включваха консултация от страна на фармацевта за всеки отделен случай. Всички СЛП бяха категоризирани и клиничното въздействие бе документирано за по-нататъшен анализ. Бяха категоризирани свързаните с лекарства въпроси от страна на персонала и бе даден отговор на същите.Резултати: 363 от 549 приети в ОИЛ пациенти получиха рецензии за лекарствата. Бяха установени 641 СЛП у 194 от тези пациенти (средно по 1,8 СЛП на пациент, диапазон 0-25). Сред най-често установените СЛП бяха твърде високи дози, значими взаимодействия на лекарства и ненужни или неподходящи лекарства. 87% от консултациите, дадени от страна на фармацевта, бяха приети или взети предвид. Типичните въпроси от страна на медицинските сестри бяха свързани с приготвянето на лекарства, генерични еквиваленти и прием на лекарства. Въпросите от страна на лекарите най-често бяха свързани с дозировката на лекарствата, ефикасността и нежеланите ефекти.Изводи: Добавянето на специален клиничен фармацевт към екипа на ОИЛ подобрява качеството и безопасността на лекарствата в смесеното норвежко ОИЛ.Objectives: An unacceptably high proportion of patients admitted to intensive care units (ICUs) develop drug-related problems (DRPs). DRPs might cause harm and increase costs and length of stay. The implementation of a clinical pharmacist service has been shown to detect a high number of DRPs and contributes effectively to solving these across different healthcare systems. However, this has not been prospectively studied in a mixed tertiary Norwegian ICU.Methods: During a 12-month period from October 2012, a clinical pharmacist was dedicated to review medications 3 h daily (Monday to Friday). DRPs were reported at the ICU conference and included advice by the pharmacist for each case. All DRPs were categorized and the clinical impact was documented for later analysis. Drug-related questions from the staff were categorised and answered.Results: 363 of 549 patients admitted to the ICU received medication reviews. 641 DRPs were detected in 194 of these patients (mean 1.8 DRPs per patient, range 0-25). Too high a dose, significant drug interactions and unnecessary or inappropriate drugs were among the most frequently detected DRPs. 87% of advice given by the pharmacist was accepted or taken into consideration. Typical questions from the nursing staff were related to drug preparation, generic equivalents and drug administration. Questions from doctors were most frequently related to drug dosage, efficiency and adverse effects.Conclusions: The addition of a dedicated clinical pharmacist to the ICU team improves the quality and safety of medication in a mixed Norwegian ICU

Quantum theory of successive projective measurements

We show that a quantum state may be represented as the sum of a joint probability and a complex quantum modification term. The joint probability and the modification term can both be observed in successive projective measurements. The complex modification term is a measure of measurement disturbance. A selective phase rotation is needed to obtain the imaginary part. This leads to a complex quasiprobability, the Kirkwood distribution. We show that the Kirkwood distribution contains full information about the state if the two observables are maximal and complementary. The Kirkwood distribution gives a new picture of state reduction. In a nonselective measurement, the modification term vanishes. A selective measurement leads to a quantum state as a nonnegative conditional probability. We demonstrate the special significance of the Schwinger basis.Comment: 6 page

Determinants and prognostic implications of Cardiac Troponin T measured by a sensitive assay in Type 2 Diabetes Mellitus

<p>Abstract</p> <p>Background</p> <p>The cardiac troponins are biomarkers used for diagnosis of myocardial injury. They are also powerful prognostic markers in many diseases and settings. Recently introduced high-sensitivity assays indicate that chronic cardiac troponin elevations are common in response to cardiovascular (CV) morbidity. Type 2 diabetes mellitus (T2DM) confers a high risk of CV disease, but little is known about chronic cardiac troponin elevations in diabetic subjects. Accordingly, we aimed to understand the prevalence, determinants, and prognostic implications of cardiac troponin T (cTnT) elevations measured with a high-sensitivity assay in patients with T2DM.</p> <p>Methods</p> <p>cTnT was measured in stored, frozen serum samples from 124 subjects enrolled in the Asker and Bærum Cardiovascular Diabetes trial at baseline and at 2-year follow-up, if availabe (96 samples available). Results were analyzed in relation to baseline variables, hospitalizations, and group assignment (multifactorial intensive versus conventional diabetes care for lowering CV risk).</p> <p>Results</p> <p>One-hundred thirteen (90 %) had detectable cTnT at baseline and of those, 22 (18 % of the total population) subjects had values above the 99th percentile for healthy controls (13.5 ng/L). Levels at baseline were associated with conventional CV risk factors (age, renal function, gender). There was a strong correlation between cTnT levels at the two time-points (r = 0.92, p > 0.001). Risk for hospitalizations during follow-up increased step-wise by quartiles of hscTnT measured at baseline (p = 0.058).</p> <p>Conclusions</p> <p>Elevations of cTnT above the 99th percentile measured by a highly sensitive assay were encountered frequently in a population of T2DM patients. cTnT levels appeared to be stable over time and associated with conventional CV risk factors. Although a clear trend was present, no statistically robust associations with adverse outcomes could be found.</p

Bacteriocin-mediated competition in cystic fibrosis lung infections

Bacteriocins are toxins produced by bacteria to kill competitors of the same species. Theory and laboratory experiments suggest that bacteriocin production and immunity play a key role in the competitive dynamics of bacterial strains. The extent to which this is the case in natural populations, especially human pathogens, remains to be tested. We examined the role of bacteriocins in competition using Pseudomonas aeruginosa strains infecting lungs of humans with cystic fibrosis (CF). We assessed the ability of different strains to kill each other using phenotypic assays, and sequenced their genomes to determine what bacteriocins (pyocins) they carry. We found that (i) isolates from later infection stages inhibited earlier infecting strains less, but were more inhibited by pyocins produced by earlier infecting strains and carried fewer pyocin types; (ii) this difference between early and late infections appears to be caused by a difference in pyocin diversity between competing genotypes and not by loss of pyocin genes within a lineage over time; (iii) pyocin inhibition does not explain why certain strains outcompete others within lung infections; (iv) strains frequently carry the pyocin-killing gene, but not the immunity gene, suggesting resistance occurs via other unknown mechanisms. Our results show that, in contrast to patterns observed in experimental studies, pyocin production does not appear to have a major influence on strain competition during CF lung infections

Plasma osteoprotegerin is related to carotid and peripheral arterial disease, but not to myocardial ischemia in type 2 diabetes mellitus

<p>Abstract</p> <p>Background</p> <p>Cardiovascular disease (CVD) is frequent in type 2 diabetes mellitus patients due to accelerated atherosclerosis. Plasma osteoprotegerin (OPG) has evolved as a biomarker for CVD. We examined the relationship between plasma OPG levels and different CVD manifestations in type 2 diabetes.</p> <p>Methods</p> <p>Type 2 diabetes patients without known CVD referred consecutively to a diabetes clinic for the first time (n = 305, aged: 58.6 ± 11.3 years, diabetes duration: 4.5 ± 5.3 years) were screened for carotid arterial disease, peripheral arterial disease, and myocardial ischemia by means of carotid artery ultrasonography, peripheral ankle and toe systolic blood pressure measurements, and myocardial perfusion scintigraphy (MPS). In addition, plasma OPG concentrations and other CVD-related markers were measured.</p> <p>Results</p> <p>The prevalence of carotid arterial disease, peripheral arterial disease, and myocardial ischemia was 42%, 15%, and 30%, respectively. Plasma OPG was significantly increased in patients with carotid and peripheral arterial disease compared to patients without (p < 0.001, respectively), however, this was not the case for patients with myocardial ischemia versus those without (p = 0.71). When adjusted for age, HbA1c and U-albumin creatinine ratio in a multivariate logistic regression analysis, plasma OPG remained strongly associated with carotid arterial disease (adjusted OR: 2.12; 95% CI: 1.22-3.67; p = 0.008), but not with peripheral arterial disease or myocardial ischemia.</p> <p>Conclusions</p> <p>Increased plasma OPG concentration is associated with carotid and peripheral arterial disease in patients with type 2 diabetes, whereas no relation is observed with respect to myocardial ischemia on MPS. The reason for this discrepancy is unknown.</p> <p>Trial registration number</p> <p>at <url>http://www.clinicaltrial.gov</url>: <a href="http://www.clinicaltrials.gov/ct2/show/NCT00298844">NCT00298844</a></p