The prevalence of hypercapnia during acute infection in children on chronic noninvasive ventilation: A retrospective study.

BACKGROUND/AIM: Children on chronic noninvasive ventilation are at risk for nonelective hospitalizations, mainly for acute infections. This study examined the prevalence of hypercapnia in children on chronic ventilatory support during an acute admission. METHODS: This retrospective study included children aged 0 to 18 years who regularly used bilevel positive airway pressure or continuous positive airway pressure at home, and who were diagnosed with an acute infection, and were hospitalized at the pediatrics department or pediatric intensive care unit. Capillary blood gas analysis and parameters of the built-in software of the home ventilator were recorded. RESULTS: Among the 43 cases included, hypercapnia was prevalent in 23% with a mean partial pressure of carbon dioxide of 51.7 ± 6.4 mm Hg. These children also had lower oxygen saturation levels. The respiratory rate 48 hours before admission was significantly higher in the hypercapnic group and the volume guarantee mode was less frequently used in the hypercapnic group. CONCLUSION: Approximately, a quarter of the cases of chronic home ventilation experience hypercapnia during an acute infection. Our data warrant a prospective study on the monitoring of respiratory rate in patients with chronic respiratory insufficiency as an indicator for hospitalizations with hypercapnia; we also recommend the use of volume guarantee mode of ventilation to prevent hypercapnia.

The effect of low-dose naltrexone on solid Ehrlich carcinoma in mice: The role of OGFr, BCL2, and immune response.

AIMS: Cancer is a major worldwide health problem. Cancer cells express opioid growth factor (OGF) which controls their growth. Naltrexone in low dose (LDN) blocks opioid receptors intermittently and controls the replication of cancer cells. The aim of this study was to investigate the effect of LDN and its chemotherapeutic additive effect on the growth of solid Ehrlich carcinoma in mice with focus on the OGFr and immune responses. MAIN METHODS: Sixty female Swiss albino mice were assigned into 5 groups (n: 12 mice each): (i): normal control, (ii): Solid Ehrlich carcinoma (SEC), (iii): SEC treated with LDN, (iv): SEC treated with 5-fluorouracil (5-FU), (v): SEC treated with LDN + 5-FU. All drugs were started when the tumor became palpable on 9th day. At the end of the study animals were sacrificed, blood and tissue samples were collected. Tumor weight and volume were measured. Splenocytes and myeloid derived suppressor cells (MDSC) were counted. Tumor expression of opioid growth factor receptors (OGFr), serum level of IFN-γ, tumor histopathology (H&E) and immunohistochemistry staining of p21, p53, Bcl2 were assessed. KEY FINDINGS: All drug-treated groups showed reduction in tumor weight and volume, significant increase of splenocyte with tendency to reduce MDSC cell counts. LDN led to significant increase in OGFr both in solo and in combination with 5FU. Serum IFN-γ is significantly increased by LDN but decreased by 5-FU. Also, LDN and 5FU increased immunehistochemical staining of p21 while decreased immunostaining of Bcl2. In animals treated with a combination of LDN and 5FU a maximal downregulation of the antiapoptotic mediator BCL2 was observed. SIGNIFICANCE: The current study suggested that LDN may play a role in inhibiting cancer cell growth and highlights the possibility of promising combination with cancer chemotherapeutics, which guarantee further clinical studies for approval.

A case report: mechanical mitral valve thrombosis in pregnancy.

BACKGROUND: Pregnancy in women with mechanical valves has a high risk of both valve thrombosis and bleeding as well as adverse effects on the foetus. There is limited data on achieving optimal anticoagulation in pregnancy and management of valve thrombosis, to achieve a successful foetal outcome, while prioritizing the mother's health. While warfarin may carry a lower risk of valve thrombosis, warfarin is teratogenic in the first trimester and is associated with increased foetal loss throughout the pregnancy. Heparin does not cross the placenta but is associated with increased maternal morbidity and mortality. CASE SUMMARY: We describe the case of a pregnant patient with thrombosis of a mechanical mitral valve presenting with an embolic stroke at 22 weeks of pregnancy. The stroke was treated with clot retrieval and resulted in no residual neurological deficit. Two previous pregnancies had been managed with low molecular weight heparin, and both resulted in foetal loss. The patient was determined to continue this pregnancy. She was treated with intravenous unfractionated heparin during the remainder of the pregnancy. She developed worsening heart failure due to persisting valve thrombosis despite maintenance of therapeutic anticoagulation. The patient deteriorated rapidly prior to a planned early elective delivery. Emergency Caesarean section was required followed by valve replacement using extracorporeal membrane oxygenation support with an ultimately successful maternal and foetal outcome. Anticoagulation regimes and treatment of mechanical valve thrombosis in pregnancy are discussed. DISCUSSION: The management of pregnant patients with mechanical valves is complex, especially when valve thrombosis and other complications occur. A multidisciplinary approach is essential and in this case led to successful outcome.

Determinants of physician utilization, emergency room use, and hospitalizations among populations with multiple health vulnerabilities.

Understanding the factors that influence differing types of health care utilization within vulnerable groups can serve as a basis for projecting future health care needs, forecasting future health care expenditures, and influencing social policy. In this article the Behavioral Model for Vulnerable Populations is used to evaluate discretionary (physician visits) and non-discretionary (emergency room visits, and hospitalizations) health utilization patterns of a sample of 1466 respondents with one or more vulnerable health classification. Reported vulnerabilities include: (1) persons with substance disorders; (2) homeless persons; (3) persons with mental health problems; (4) victims of violent crime; (5) persons diagnosed with HIV/AIDS; (6) and persons in receipt of public benefits. Hierarchical logistic regression is used on three nested models to model factors that influence physician visits, emergency room visits, and hospitalizations. Additionally, bivariate logistic regression analyses are completed using a vulnerability index to evaluate the impact of increased numbers of vulnerability on all three forms of health care utilization. Findings from this study suggest the Behavioral Model of Vulnerable Populations be employed in future research regarding health care utilization patterns among vulnerable populations. This article encourages further research investigating the cumulative effect of health vulnerabilities on the use of non-discretionary services so that this behavior could be better understood and appropriate social policies and behavioral interventions implemented.

Use of Mental Health Services among People with Co-Occurring Disorders and other Mental Health co-morbidities: Employing the Behavioral Model of Vulnerable Populations.

BACKGROUND: Persons with mental disorders frequently have other co-occurring problems such as substance related disorders and HIV/AIDS. Individuals with co-occurring medical and mental disorders encounter great obstacles to receiving mental health services. AIMS: This paper uses the Behavioral Model of Vulnerable Populations to evaluate use of mental health services among groups with co-occurring disorders (CODs) and other co-morbid relationships. The association between receipt of mental health treatment and traditional/vulnerable predisposing, enabling, and need factors are examined. METHODS: Bivariate analysis and two-stage hierarchical logistic regression were completed. RESUTLS: A sample of 553 persons who reported mental health problems within the past year had one or more of the following vulnerabilities: (1) substance disorders; (2) homelessness; (3) victims of violent crime; (4) diagnosed with HIV/AIDS; (5) recipient of public benefits; and 31.3% reported having received some form of mental health treatment. Both traditional and vulnerable characteristics are significant predictors of receipt of mental health treatment. Vulnerable predictors indicated decreased odds of receiving mental health treatment were associated with injection and chronic drug use, (OR = .42, CI: .22 - .77) and (OR = .38, CI: .22 - .64) respectively. CONCLUSION: The Behavioral Model of Vulnerable Populations could be employed in future research of CODs and other co-morbid group's utilization of mental health treatment.

Inner-City African-American Women's Adolescence as Stressful Life Events: Understanding Substance Abusing Behavior.

Lula Beatty (2003:59) asks, "What makes a black woman, voluntarily take a substance into her body which alters her perceptions and feelings of well-being?" This research examines African American women's substance abuse as a response to stressful life events grounded in adolescence, drawing in part on the cognitive-transactional approach and distal stressor model to discuss the effects of stressors on mental health and substance abusing behavior. Most respondents viewed their adolescent experiences and the associated stress as tribulations or lessons to be lived through, rather than a signal of needed change in their social, cultural, and ecological life circumstances. The effect of exposure to constant stressors early in the life course coupled with proximal stressors often resulted in negative active responses to stress (i.e. substance abuse) and continued stunted emotional growth. Thus, our findings indicate that the experience of African American women as adolescents contributes to understanding substance abuse amongst this population. These findings further help develop the cognitive-transactional model, while adding to the distal stressors and life process model as a way of considering gender, race, and structural forces.

["Medical devices and European regulations"]. / "Les dispositifs médicaux et la réglementation européenne".

In order to put on the European Market, the medical devices shall be in conformity with two European Directives transcribed in national regulation: Directive 90/385/CEE--20 June 1990: concerning the implantable active medical devices, mandatory since the 1/01/95; Directive 93/42/CEE--13 June 1993: concerning the medical devices, applicable since the 1/01/95 and mandatory the 14/06/98. Both impose the conformity to essential requirements which can be proved by different procedures of evaluation verified by notify bodies. Then, the CE mark, technical passport, can be apposed. To demonstrate this conformity, the manufacturers can use harmonized european standards without obligation. The "Safety clause" allows to follow the "well-founded" of the CE marking and the national systems of vigilance to register and evaluate the incidents and to define corrective actions.