ST-Elevation myocardial infarction patient with ventricular septal rupture complication: A Case Report.

Abstract: Ventricular septal rupture (VSR) is an uncommon but very significant mechanical complication of acute myocardial infarction (AMI), with typically severe hemodynamic effects. Until surgical closure of the defect and revascularization of the coronary bypass surgery graft (CABG), the patient at Wahidin Sudirohusodo Hospital with VSR reports sequelae of MI with stable hemodynamic condition.

The Measurement Of Nurses’ Mental Workload Using Nasa-Tlx Method (A Case Study)

@#Nurse is a profession that has a quite high workload. It can be seen from how often they should encounter situations which compel them to undergo precisely right decision in saving patients’ lives. Various environmental conditions increase the frustration rate of the nurses, such as noise of the crowds and medical equipment, as well as smell of medicines and wounds at once. Moreover, demands from the patients’ family make it even tougher for them. Therefore, this study aims to measure the mental workload of the nurses at Intensive Care Unit (ICU) and emergency unit (IGD) in the Hospital ZA based on their years of service. The study was conducted using the method of NASA-TLX (National Aeronautics and Space Administration – Task Load Index). It measured the workload in six dimensions: Mental Demand (MD), Physical Demand (PD), Temporal Demand (TD), Own Performance (P), Effort (EF), and Frustration Rate (FR). The results of the study show that the average value of the nurses’ workload at ICU and IGD is in the category very high (respectively 80 and 83) for the nurses with 0-3 years of service, and the most contributing factor for both the primary groups is the effort (EF).

Surgical and functional outcomes of cochlear implantation in post-lingual and cross-over patients: First 5-year review of the National Ministry of Health Malaysia cochlear implant programme.

INTRODUCTION: There has been a paradigm shift in the management of acquired sensory neural deafness in the past 30years. This is due to the emergence of implantable hearing devices such as the cochlear implant. The objective of this study is to identify surgical and functional outcomes of post-lingual and cross-over patients implanted with a cochlear implant under the National Ministry of Heath Cochlear Implant (CI) Program between 2009-2013. MATERIALS AND METHODS: We retrospectively reviewed all postlingual and cross-over recipients of cochlear implants under the National Ministry of Heath CI Programme from 2009 to 2013. The outcomes measured were surgical complications and functional outcome. Surgical complications were divided into major and minor complications. Functional outcomes were measured using Categorical Auditory Performances (CAP) scale. RESULTS: A total of 41 post-lingual and 15 cross-over patients were implanted between 2009 and 2013. The age of implantees ranged from 3.6 years to 63.2 years old. There were two major complications (3.6%), one is a case of electrode migration at three months post implantation, and six months post second implantation. Another was a case of device failure at about one-year post implantation. Both patients were reimplanted in the same ear. There was no minor complication. The CAP score for both groups (overall) showed significant improvement with 96.4% achieved CAP score of five and above at 24 months after implantation (p<0.001). The CAP score showed marked improvement at the first 6 months post implantation and continued to improve with time in both groups. CONCLUSION: The Malaysian National Ministry of Health Cochlear implant (CI) Program between 2009-2013 has been a successful programme with good surgical and functional outcomes among the post lingual and cross-over patients.

The enhancement of sensory blockade by clonidine selectively added to mepivacaine after midhumeral block.

Clonidine added to local anesthetics results in an increased duration of anesthesia or analgesia after brachial plexus block. We investigated the effect of selective application of clonidine to the median and musculocutaneous nerves during midhumeral block, a technique allowing selective nerve blocks with the use of different local anesthetics. Initially, 58 patients scheduled for hand surgery were prospectively enrolled to receive a midhumeral block. These patients were randomly allocated into two groups. The Control group (n = 28) received 10 mL of plain mepivacaine 1.5% for each nerve (median, musculocutaneous, ulnar, and radial). The Clonidine group (n = 30) received 10 mL of plain mepivacaine 1.5% for each nerve, but the median and musculocutaneous nerves also received a dose of 50 microg clonidine. One patient in the Control group and two patients in the Clonidine group with a failed block were therefore excluded from the analysis. The onset time of surgical anesthesia was recorded. The durations of sensory and motor blocks were checked every 15 min. The plasma mepivacaine concentration was analyzed from 10 patients in each group. Onset times for complete sensory block were similar between the two groups. Adding 50 microg clonidine to the median and musculocutaneous nerves resulted in a significant increase in the duration of sensory block in these nerves (P < 0.0001). Recovery of motor block was not different between the two groups. No significant difference was found between the two groups in the mean plasma mepivacaine concentration.

First report on sensitization to allergens of a house dust mite, Suidasia pontifica (Acari: Saproglyphidae).

A species of house dust mite, Suidasia pontifica, was recently shown to produce allergens affecting man. The species may be as important as other allergen producing mite in sensitization and causing allergic symptoms in Malaysians. Surveys conducted demonstrated that 80% of the houses surveyed were positive for this mite with densities ranged from 2 to 50 mites per gram of dust. Colonies of the species has been successfully established and materials from those colonies have been used to produce extracts for studies on sensitization to the mites. A total of 85 suspected allergic rhinitis patients were tested and 74.1% demonstrated positive reactions. Extract of this mite should be considered for routine diagnostic testing and possible immunotherapy.

[Analgesia using continuous axillary block after surgery of severe hand injuries: self-administration versus continuous injection]. / Analgésie par bloc axillaire continu après chirurgie des traumatismes graves de la main: auto-administration versus injection continue.

OBJECTIVE: To compare analgesia produced after surgery for severe hand trauma, by a continuous axillary block obtained either with a continuous injection (CA) or controlled by the patient (PCA). STUDY DESIGN: Prospective, randomized study. PATIENTS: Forty-two ASA physical class 1 and 2 patients were enrolled over a twelve-month period and randomly allocated either into the CA or the PCA group. METHODS: After recovery from the surgical block, the axillary plexus was located using a nerve stimulator and a 20 G catheter (Contiplex B Braun) inserted over 5 centimeters into the axillary sheath. In the CA group (n = 21) patients received 0.1 mL.kg-1.h-1 of 0.25% bupivacaine and in the PCA group (n = 21) patients received 0.1 mL.kg-1 boluses of 0.25% bupivacaine with a one hour lock-out period. Data collected were pain intensity rated according to he visual analog scale (VAS), the total volume of bupivacaine injected, the quantity of nalbuphine administered as 10 mg boluses when VAS was = 5, and the patient's satisfaction after removal of the catheter. Statistical analysis used Student t test, ANOVA and chi 2 test. RESULTS: The mean duration of catheter use was 5 +/- 3 days. During this period the amount of bupivacaine was significantly reduced in the PCA group when compared to the CA group (P < 0.001). Similarly, the PCA group required significantly less nalbuphine. Finally, in this group, the satisfaction index was higher than in the CA group (95 versus 52% respectively, P < 0.01). CONCLUSION: Continuous axillary plexus blockade provides safe and effective postoperative analgesia. With the PCA technique results a lower quantity of bupivacaine is required and patient's satisfaction better.

Isolation of the ornithine-delta-aminotransferase cDNA and effect of salt stress on its expression in Arabidopsis thaliana.

To evaluate the relative importance of ornithine (Orn) as a precursor in proline (Pro) synthesis, we isolated and sequenced a cDNA encoding the Orn-delta-aminotransferase (delta-OAT) from Arabidopsis thaliana. The deduced amino acid sequence showed high homology with bacterial, yeast, mammalian, and plant sequences, and the N-terminal residues exhibited several common features with a mitochondrial transit peptide. Our results show that under both salt stress and normal conditions, delta-OAT activity and mRNA in young plantlets are slightly higher than in older plants. This appears to be related to the necessity to dispose of an easy recycling product, glutamate. Analysis of the expression of the gene revealed a close association with salt stress and Pro production. In young plantlets, free Pro content, Delta1-pyrroline-5-carboxylate synthase mRNA, delta-OAT activity, and delta-OAT mRNA were all increased by salt-stress treatment. These results suggest that for A. thaliana, the Orn pathway, together with the glutamate pathway, plays an important role in Pro accumulation during osmotic stress. Conversely, in 4-week-old A. thaliana plants, although free Pro level also increased under salt-stress conditions, the delta-OAT activity appeared to be unchanged and delta-OAT mRNA was not detectable. Delta1-pyrroline-5-carboxylate synthase mRNA was still induced at a similar level. Therefore, for the adult plants the free Pro increase seemed to be due to the activity of the enzymes of the glutamate pathway.

Description of local adaptation of national guidelines and of active feedback for rationalising preoperative screening in patients at low risk from anaesthetics in a French university hospital.

OBJECTIVE: To describe the effect of local adaptation of national guidelines combined with active feedback and organisational analysis on the ordering of preoperative investigations for patients at low risk from anaesthetics. DESIGN: Assessment of preoperative tests ordered over one month, before and after local adaptation of guidelines and feedback of results, combined with an organisational analysis. SETTING: Motivated anaesthetists in 15 surgical wards of Bordeaux University Hospital, Region Aquitain, France. SUBJECTS: 42 anaesthetists, 60 surgeons, and their teams. MAIN OUTCOME MEASURES: Number and type of preoperative tests ordered in June 1993 and 1994, and the estimated savings. RESULTS: Of 536 patients at low risk from anaesthetics studied in 1993 before the intervention 80% had at least one preoperative test. Most (70%) tests were ordered by anaesthetists. Twice the number of preoperative tests were ordered than recommended by national guidelines. Organisational analysis indicated lack of organised consultations and communication within teams. Changes implemented included scheduling of anaesthetic consultations; regular formal multidisciplinary meetings for all staff; preoperative ordering decision charts. Of 516 low risk patients studied in 1994 after the intervention only 48% had one or more preoperative tests ordered (p < 0.05). Estimated mean (SD) saving for one year if changes were applied to all patients at low risk from anaesthesia in the hospital 3.04 (1.23) mFF. CONCLUSIONS: A sharp decrease in tests ordered in low risk patients was found. The likely cause was the package of changes that included local adaptation of national guidelines, feedback, and organisational change.

Treatment of acute bacterial diarrhea: a multicenter international trial comparing placebo with fleroxacin given as a single dose or once daily for 3 days.

This study was designed to test the efficacy of 400 mg fleroxacin given orally as a single dose or once daily for 3 days against acute bacterial diarrhea. A group of 508 adults with acute diarrhea were entered into a randomized, double-blind, placebo-controlled, multicenter trial. Patients were examined and asked about numbers of liquid stools daily for 3 days and at 5 days after start of treatment. Repeat stool samples were obtained for culture on days 3 and 5 after start of treatment. A total of 332 patients showed stool cultures positive for bacterial pathogens sensitive to fleroxacin and completed their treatments. Patients treated with fleroxacin, both single-dose and 3-day regimens, showed faster clinical improvement than did placebo-treated patients, as shown by earlier cessation of diarrhea (p < 0.001) and reduction in mean number of loose stools per day on days 2, 3, and 5 after start of therapy (p < 0.05). Bacteriologic efficacy was demonstrated by negative stool cultures for initial pathogens on days 3 and 5 after start of therapy in 94% of patients treated with single doses of fleroxacin and in 93% of patients treated with three doses of fleroxacin as compared with 57% of patients treated with placebo (p < 0.001). Patients with cholera, shigellosis, and infections due to Vibrio parahaemolyticus showed both clinical and bacteriologic responses to fleroxacin treatment, whereas patients with salmonellosis showed only bacteriologic responses. The good overall clinical and bacteriologic responses of most patients with acute bacterial diarrhea of fleroxacin indicate that this convenient single-dose therapy should be advantageous for empiric treatment of certain diarrheal illnesses.

A comparison of severe tardive dystonia and severe tardive dyskinesia.

The authors present a demographic study comparing tardive dystonia with severe tardive dyskinesia (TD) patients. Tardive dystonia was more common among young men, while severe TD was more common in older women. Neuroleptics were distributed equally in both groups before the onset of the movement disorders. Drug-free periods were common in the history of severe TD than in tardive dystonia patients.

Circadian rhythms of melatonin and cortisol in aging.

The relationship of age to the circadian rhythms of melatonin and cortisol was investigated in 44 men and 27 women (age range 19-89 years). Subjects were physically and psychiatrically normal. Four hourly serial blood samples were drawn from 8:00 AM until 8:00 AM the next day, with additional samples at 10:00 PM and 2:00 AM. The indoor illumination was restricted to 300 lux during day and 50 lux during the night. Plasma melatonin and cortisol were estimated by radioimmunoassay. Results show that the means of melatonin and cortisol values decreased significantly with age when the subjects were divided into three age groups, i.e., 19-25 years, 42-65 years, and 66-89 years. They also showed a significant negative correlation with age. The acrophases of the two hormonal rhythms, however, showed different relationships to age. The acrophase of melatonin rhythm showed a positive correlation with age (r = 0.38, p less than 0.001), and cortisol showed a negative correlation with age (r = -0.56, p greater than 0.001). It is suggested that this may indicate a weakened responsiveness of the circadian system in the elderly to the day-night cycle and an altered relationship between the pacemakers driving melatonin and cortisol circadian rhythms. This may thus represent a biomarker for the intrinsic process of the aging of the brain.

The prevalence of tardive dyskinesia in fluphenazine-treated patients.

One hundred thirty-five outpatients were evaluated for tardive dyskinesia (TD). Of the fluphenazine-treated patients (N = 63), 32 were found to have TD as compared with 29 of 72 non-fluphenazine-treated patients. This difference was not statistically significant. There was no difference in duration and total dose of fluphenazine injections between TD and non-TD patients. However, patients receiving fluphenazine injections were found to require fewer hospitalizations after fluphenazine therapy was started.

Baclofen-induced psychosis: two cases and a review.

The authors describe two patients who were being treated with baclofen for tardive dyskinesia. One patient developed withdrawal symptoms after baclofen was stopped, and the other developed a manic attach while receiving the drug. The authors review the literature concerning these side effects and explore the possible mechanisms responsible for these effects.

Propranolol in the treatment of tardive akathisia: a report of two cases.

The authors present two patients suffering from tardive akathisia. They also review the available literature on the subject. Propranolol was found to be an effective treatment of tardive akathisia in both patients. The implications of this finding are discussed.

Carbamazepine and hyponatremia in patients with affective disorder.

The authors assessed 20 carbamazepine-treated patients for the development of hyponatremia. None of the patients had readings below 135 meg/liter of sodium before carbamazepine therapy, but five (25%) did have such readings after carbamazepine therapy. Three of these patients developed frank symptoms of hyponatremia within 1-3 months of the start of therapy. In one patient, hyponatremia developed after rechallenge with carbamazepine. The authors suggest that caution be used in prescribing carbamazepine to patients with low or borderline low sodium values.

Late-onset bipolar disorder.

Mania in old age is not as rare as it was once thought to be. It may constitute up to 5 per cent of admissions in the psychogeriatric department. The clinical picture, for the most part, seems to correspond with mania in younger patients, although some patients may have atypical presentations. Secondary mania should be excluded first, before a firm diagnosis of primary affective disorder is made. The prognosis and treatment of late onset mania do not seem to differ appreciably from those in younger patients.

Effect of sulpiride, an atypical neuroleptic, on apomorphine-induced growth hormone secretion.

Sulpiride (100 mg IM), an atypical neuroleptic, which does not block dopamine (DA) receptors that are linked to adenylate cyclase, abolished the growth hormone (GH) response to the DA receptor agonist, apomorphine (Apo) HCl (0.5 mg SC) in seven healthy male subjects. These results suggest that Apo increases GH secretion in man by an effect on DA receptors that are not linked to adenylate cyclase.