Sodium bicarbonate use and the risk of hypernatremia in thoracic aortic surgical patients with metabolic acidosis following deep hypothermic circulatory arrest.

Objective: Metabolic acidosis after deep hypothermic circulatory arrest (DHCA) for thoracic aortic operations is commonly managed with sodium bicarbonate (NaHCO3). The purpose of this study was to determine the relationships between total NaHCO3 dose and the severity of metabolic acidosis, duration of mechanical ventilation, duration of vasoactive infusions, and Intensive Care Unit (ICU) or hospital length of stay (LOS). Methods: In a single center, retrospective study, 87 consecutive elective thoracic aortic operations utilizing DHCA, were studied. Linear regression analysis was used to test for the relationships between the total NaHCO3 dose administered through postoperative day 2, clinical variables, arterial blood gas values, and short‑term clinical outcomes. Results: Seventy‑five patients (86%) received NaHCO3. Total NaHCO3 dose averaged 136 ± 112 mEq (range: 0.0–535 mEq) per patient. Total NaHCO3 dose correlated with minimum pH (r = 0.41, P < 0.0001), minimum serum bicarbonate (r = −0.40, P < 0.001), maximum serum lactate (r = 0.46, P = 0.007), duration of metabolic acidosis (r = 0.33, P = 0.002), and maximum serum sodium concentrations (r = 0.29, P = 0.007). Postoperative hypernatremia was present in 67% of patients and peaked at 12 h following DHCA. Eight percent of patients had a serum sodium ≥ 150 mEq/L. Total NaHCO3 dose did not correlate with anion gap, serum chloride, not the duration of mechanical ventilator support, vasoactive infusions, ICU or hospital LOS. Conclusion: Routine administration of NaHCO3 was common for the management of metabolic acidosis after DHCA. Total dose of NaHCO3 was a function of the severity and duration of metabolic acidosis. NaHCO3 administration contributed to postoperative hypernatremia that was often severe. The total NaHCO3 dose administered was unrelated to short‑term clinical outcomes.

Unique Congenital Malformation of the Mitral Valve Associated with Anomalous Coronary Arteries and Stroke

A 55-year-old male presented with stroke. Transesophageal echocardiogram and cardiac computed tomography revealed an unrecognized congenital malformation of the anterior mitral leaflet associated with anomalous left coronary circumflex artery, arising from the right coronary artery, diagnosed first by echocardiogram. This case represents a unique unforeseen mitral valve anomaly that might be considered as potential cardiac source of embolism. This finding broadens the spectrum of known mitral valve anomalies.

El fortalecimiento de la publicación de los estudios observacionales en epidemiología (STROBE, por su sigla en inglés): declaración: guías para publicar estudios observacionales / The strengthening the reporting of observational studies in epidemiology (STROBE): statement: guidelines for reporting observational studies

Una cantidad importante de la investigación biomédica es de naturaleza observacional. La comunicación de este tipo de investigación es, muchas veces, inadecuada, lo que perjudica la evaluación de sus fortalezas y debilidades así como también la posibilidad de generalizar los resultados de sus estudios. La iniciativa Fortalecimiento de la Publicación de los Estudios Observacionales en Epidemiología (STROBE, por su sigla en inglés) elaboró recomendaciones acerca de lo que debería incluirse en la presentación de un estudio observacional para que este fuese preciso y completo. Decidimos limitar el alcance de las recomendaciones a tres grandes modalidades de estudios: cohorte, caso y control y de corte transversal. Organizamos un taller de dos días en septiembre de 2004 con metodólogos, investigadores y editores de revistas para elaborar una lista de temas. Esta lista fue revisada posteriormente en varias reuniones del grupo de coordinación y en las conversaciones por correo electrónico con el grupo más grande de participantes de STROBE, teniendo en cuenta la evidencia empírica y consideraciones metodológicas. El taller y el posterior proceso iterativo de consulta y revisión desembocaron en una lista de 22 ítems (la Declaración STROBE) relacionados con el título, la introducción, el resumen, los métodos, los resultados y la discusión de los artículos. Dieciocho de los ítems son comunes a los tres diseños de estudio y cuatro de los 22 son específicos para los estudios de cohorte, caso y control o de corte transversal. El documento titulado Una Explicación Detallada y Elaborada (A detailed Explanation and Elaboration) se publica por separado y está disponible gratuitamente en los sitios web de PLoS Medicine, Annals of Internal Medicine y Epidemiology. Esperamos que la Declaración de STROBE contribuya a mejorar la calidad de las publicaciones de los estudios observacionales.

Photo-Voice as a Tool for Analysis and Activism in Response to HIV and AIDS Stigmatisation in a Rural KwaZulu-Natal School

Objective: This paper focuses on the use of participatory approaches to research and intervention and explores the uses of photo-voice as a methodology and a means of promoting childhood and youth activism in the context of HIV and AIDS.Method: Photo-voice; a visual participatory methodology; was used with 21 Grade 8 and 9 learners in one of three schools participating in a larger project; to identify; understand and interpret incidents related to stigma and discrimination against people living with and affected by HIV and AIDS; as well as the strategies proposed by the learners to possibly reduce stigma. Results: Three themes emerged: awareness of HIV and AIDS; awareness of HIV-related stigma and its impacts; and acceptance of personal agency and taking action. Conclusions: Understandings of and perceptions about HIV and AIDS are improving; yet significant pockets of ignorance about the dynamics of HIV infection still remain among the youth. Negative attitudes towards people infected with and affected by the virus remain; and stigmatisation continues. The use of photo-voice and other participatory methodologies offers alternative strategies for involving youth in their own knowledge production; as well as in the development of an individual sense of agency for taking action

Photo-Voice as a Tool for Analysis and Activism in Response to HIV and AIDS Stigmatisation in a Rural KwaZulu-Natal School

Objective:This paper focuses on the use of participatory approaches to research and intervention and explores the uses of photo-voice as a methodology and a means of promoting childhood and youth activism in the context of HIV and AIDS.Method: Photo-voice; a visual participatory methodology; was used with 21 Grade 8 and 9 learners in one of three schools participating in a larger project; to identify; understand and interpret incidents related to stigma and discrimination against people living with and affected by HIV and AIDS; as well as the strategies proposed by the learners to possibly reduce stigma. Results: Three themes emerged: awareness of HIV and AIDS; awareness of HIV-related stigma and its impacts; and acceptance of personal agency and taking action. Conclusions: Understandings of and perceptions about HIV and AIDS are improving; yet significant pockets of ignorance about the dynamics of HIV infection still remain among the youth. Negative attitudes towards people infected with and affected by the virus remain; and stigmatisation continues. The use of photo-voice and other participatory methodologies offers alternative strategies for involving youth in their own knowledge production; as well as in the development of an individual sense of agency for taking action

Photo-voice as a tool for analysis and activism in response to HIV and AIDS stigmatisation in a rural KwaZulu-Natal school

Objective: This paper focuses on the use of participatory approaches to research and intervention and explores the uses of photo-voice as a methodology and a means of promoting childhood and youth activism in the context of HIV and AIDS. Method: Photo-voice; a visual participatory methodology; was used with 21 Grade 8 and 9 learners in one of three schools participating in a larger project; to identify; understand and interpret incidents related to stigma and discrimination against people living with and affected by HIV and AIDS; as well as the strategies proposed by the learners to possibly reduce stigma. Results: Three themes emerged: awareness of HIV and AIDS; awareness of HIV-related stigma and its impacts; and acceptance of personal agency and taking action. Conclusions: Understandings of and perceptions about HIV and AIDS are improving; yet significant pockets of ignorance about the dynamics of HIV infection still remain among the youth. Negative attitudes towards people infected with and affected by the virus remain; and stigmatisation continues. The use of photo-voice and other participatory methodologies offers alternative strategies for involving youth in their own knowledge production; as well as in the development of an individual sense of agency for taking action

Inositol 1, 4, 5-trisphosphate receptors in the heart

Inositol 1,4,5-trisphosphate (InsP3) is an established calcium-mobilizing messenger, which is well-known to activate Ca2+ signaling in many cell types. Contractile cardiomyocytes express hormone receptors that are coupled to the production of InsP3. Such cardioactive hormones, including endothelin, may have profound inotropic and arrhythmogenic actions, but it is unclear whether InsP3 underlies any of these effects. We have examined the expression and localization of InsP3 receptors (InsP3Rs), and the potential role of InsP3 in modulating cardiac excitation-contraction coupling (EC coupling). Stimulation of electrically-paced atrial and ventricular myocytes with a membrane-permeant InsP3 ester was found to evoke an increase in the amplitudes of action potential-evoked Ca2+ transients and to cause pro-arrhythmic diastolic Ca2+ transients. All the effects of the InsP3 ester could be blocked using a membrane-permeant antagonist of InsP3Rs (2-aminoethoxydiphenyl borate; 2-APB). Furthermore, 2-APB blocked arrhythmias evoked by endothelin and delayed the onset of positive inotropic responses. Our data indicate that atrial and ventricular cardiomyocytes express functional InsP3Rs, and these channels have the potential to influence EC coupling.

A study of the prevalence of and risk factors for ear diseases and hearing loss in primary school children in Hat Yai, Thailand.

2,184 primary school children in Hat Yai Municipality, Southern Thailand were screened for ear diseases and hearing loss using screening audiometry, portable tympanometry and otoscopy to identify children with possible ear problems, 754 children failed the initial screen, 728 were retested and a group of 243 were referred for ENT examination and standard audiometry-tympanometry. Children with hearing loss and otitis media were thus identified. A questionnaire to identify possible risk factors was administered. The prevalence of otitis media in this population was found to be 3.25 per cent (AOM 0.69%, OME 1.14%, COM 1.74%). No risk factor identified as significant were found. Non-significant factors included sex, age, URI last month, father smoking, mother smoking and method of transport to school as an indication of social status. This study contrasts with a previous study in 1990 which showed a 3.5 per cent prevalence of COM.