Effect of Calcium-Channel Blockade on the Cold-Induced Vasodilation Response.

INTRODUCTION: Cold-induced vasodilation (CIVD) is seen in the extremities during exposure to cold. A strong vasodilation response has been associated with a decreased risk of cold injury. Increasing CIVD might further decrease this risk. The calcium-channel blocker nifedipine causes vasodilation and is used to treat Raynaud's syndrome and chilblains. Nifedipine is also used for high altitude pulmonary edema and could potentially serve a dual purpose in preventing frostbite. The effects of nifedipine on CIVD have not been studied. METHODS: A double-blind crossover study comparing nifedipine (30 mg SR (sustained release) orally twice daily) to placebo was designed using 2 sessions of 4 finger immersion in 5°C water, with 24 h of medication pretreatment before each session. Finger temperatures were measured via nailbed thermocouples. The primary outcome was mean finger temperature; secondary outcomes were mean apex and nadir temperatures, first apex and nadir temperatures, subjective pain ranking, and time of vasodilation onset (all presented as mean±SD). RESULTS: Twelve volunteers (age 29±3 [24-34] y) completed the study. No significant difference in finger temperature (9.2±1.1°C nifedipine vs 9.0±0.7°C placebo, P=0.38) or any secondary outcome was found. Pain levels were similar (2.8±1.6 nifedipine vs 3.0±1.5 placebo, P=0.32). The most common adverse event was headache (32% of nifedipine trials vs 8% placebo). CONCLUSIONS: Pretreatment with 30 mg of oral nifedipine twice daily does not affect the CIVD response in healthy individuals under cold stress.

Lung Consolidation Locations for Optimal Lung Ultrasound Scanning in Diagnosing Pediatric Pneumonia.

OBJECTIVES: Lung ultrasound (US) has been shown to be accurate in diagnosing pneumonia in children. Evidence to inform an optimal scanning protocol is limited. Our objective is to describe an optimized lung US scanning protocol for pediatric pneumonia based on the anatomic location and transducer orientation. METHODS: We performed a secondary analysis of data and images from 2 prospective lung US studies for the emergency department diagnosis of pneumonia in children (0-21 years). The anatomic location of each lung consolidation was mapped to 1 or more of 6 anatomic zones on the chest, noting the transducer orientation (sagittal or transverse) in which it was identified. RESULTS: Seventy-eight patients were included; 51% were female, and the median age was 3 years (interquartile range, 1-7 years). Overall, 46.5% (95% CI confidence interval [CI], 37.9%-55.1%) of lung zones with a visible consolidation were posterior; 31.0% (95% CI, 23.0%-39.0%) were anterior; and 22.5% (95% CI, 15.3%-29.1%) were axillary. A total of 54.3% (95% CI, 45.7%-62.9%) of affected lung zones were in the lower lung compared to the upper lung (8.5%; 95% CI, 3.7%-13.3%) and middle lung (37.2%; 95% CI, 28.9%-45.5%). Most lung consolidations were seen in both transducer orientations: 96.2% (95% CI, 92.0%-100%) of patients had a visible consolidation on the transverse view, whereas 85.9% (95% CI, 78.2%-93.6% had a consolidation on the sagittal view. CONCLUSIONS: Efficient lung US scanning may start with the posterior, anterior, and then lateral chest zones if no pneumonia is identified. A transverse transducer orientation detects more pneumonia than a sagittal orientation. Omission of either orientation or any lung zone may miss pneumonia.

Who will manage American patients with diabetes? Residents' career preferences and perceptions of diabetes care.

OBJECTIVE: To identify the factors that encourage or discourage internal medicine and pediatric residents regarding specializing in endocrinology with a focus on diabetes. METHODS: We conducted an electronic survey of internal medicine and pediatric residents using a $10 participation incentive. A total of 653 residents responded to the survey (estimated response rate of 9.2%)-626 from residency programs that were contacted for our survey and 27 from referrals. RESULTS: Among internal medicine and pediatric residents surveyed, 39 respondents (6.0%) planned to specialize in endocrinology, and 27 of these (4.1% of total respondents) planned to focus on diabetes. "Intellectual satisfaction," "emotional satisfaction," and "work-life balance" were identified by respondents as the most important factors in their choice of a specialty, with ratings of 5.5, 5.4, and 5.3 on a 6-point Likert scale. Among these factors identified as most important to a medical career, endocrinology with a focus on diabetes scored poorly with regard to intellectual and emotional satisfaction but received high ranking with regard to lifestyle. With regard to other factors, endocrinology was rated negatively on "compensation," "number of procedures," and "patient adherence to prescribed treatment." Exposure to diabetes during training had no major influence on the decision to enter endocrinology. CONCLUSION: Endocrinology with a focus on diabetes care is not an attractive specialty for most internal medicine and pediatric residents. Therefore, new strategies to attract residents to the field of diabetes care are needed.