Venous thromboembolism prophylaxis in ENT surgery: a survey of current practice.

BACKGROUND: Venous thromboembolism is uncommon in ENT practice. There are no specific venous thromboembolism prophylaxis guidelines for ENT surgery, despite the bleeding risks associated with ENT surgery and the low incidence of venous thromboembolism. METHODS: An online poll of the ENT UK expert panel was conducted on the use of venous thromboembolism prophylaxis. RESULTS: A total of 132 responses were received. Of the respondents, 84.5 per cent routinely assess all of their patients for venous thromboembolism risk. In addition, 75.4 per cent use local health trust guidelines, with the National Institute for Health and Care Excellence being the most common source of national guidelines. There was significant heterogeneity in the use of low molecular weight heparin. Only 53.7 per cent of respondents felt that the guidelines they currently used reflect their practice. CONCLUSION: There is significant heterogeneity in venous thromboembolism prophylaxis. There is therefore scope for revision of the ENT UK venous thromboembolism prophylaxis guidelines to reflect general ENT practice.

Sarcopenia is associated with toxicity in patients undergoing neo-adjuvant chemotherapy for oesophago-gastric cancer.

BACKGROUND: Patients with potentially curative oesophago-gastric cancer typically undergo neo-adjuvant chemotherapy prior to surgery. The majority of anti-cancer drugs have a narrow therapeutic index. The aim of this study was to determine if features of body composition, assessed using computed tomography (CT) scans, may be predictive of dose-limiting toxicity (DLT) in patients undergoing neo-adjuvant chemotherapy for oesophago-gastric cancer. The influence of sarcopenia and DLT on overall survival was also evaluated. METHODS: 89 Patients having potentially curative oesophago-gastric cancer surgery were studied. Patients studied had histologically confirmed oesophago-gastric cancer with no evidence of distant metastasis on pre-operative staging. CT scan was performed in all cases at diagnosis. DLT was defined as toxicity leading to postponement of treatment, a drug dose reduction or definitive interruption of drug administration. RESULTS: DLT occurred in 37 out of 89 patients (41.6%) undergoing chemotherapy. Sarcopenia (odds ratio, 2.95; 95% confidence interval, 1.23-7.09; p = 0.015) was associated with DLT on multivariate analysis. Median overall survival for patients who were sarcopenic was 569 days (IQ range: 357-1230 days) vs. 1013 days (IQ range: 496-1318 days) for patients who were not sarcopenic (p = 0.04). There was no significant difference in overall survival in patients who experienced DLT compared with those that did not (p = 0.665). CONCLUSIONS: Sarcopenia is a significant predictor of DLT in oesophago-gastric cancer patients undergoing neo-adjuvant chemotherapy. These results raise the potential for use of assessment of skeletal muscle mass using CT scans to predict toxicity and individualize chemotherapy dosing.

Selenite adsorption using leached residues generated by reduction roasting-ammonia leaching of manganese nodules.

This study was carried out to investigate the adsorption characteristics of leached manganese nodule residue (MNR), generated from the reduction roasting-ammonia leaching process, towards aqueous selenite. Physicochemical characterization revealed that the leached residue was a complex mixture of oxides of mainly manganese and iron along with MnCO(3). Adsorption studies of the water washed leached residue (wMNR) at varying the pH, selenite ion concentration, wMNR dosage, heat treatment condition indicated that selenite uptake increased with increasing pH and heat-treatment temperature of wMNR. The maximum value of selenite uptake was obtained at pH ~5.0 with wMNR heat-treated at 400°C and thereafter decreased on increasing the pH and heat-treatment temperature further. The adsorption data were best fitted by the Freundlich isotherm model. The derived monolayer selenite adsorption capacities increased from, X(m)=9.50 mg Se/g (for untreated wMNR) to 15.08 mg Se/g (for wMNR heat-treated at 400°C). The results of the studies may be useful for possible utilization of MNR as an adsorbent for the removal of selenite ions from contaminated water bodies.

Oxidative decolorization of methylene blue by leached sea-nodule residues generated by the reduction-roasting ammoniacal leaching process.

The leached residue, generated after selective extraction of Cu, Ni and Co by reductive-roasting ammoniacal leaching of sea nodules, was characterized by various physicochemical methods. The finely divided residue, containing mainly manganese carbonate/silicates and manganese (III, IV) (hydr)oxides along with iron oxides, showed a lower surface area (66.3 m2 g(-1)) than that of the parent sea nodule (130 m2 g(-1)). The catalytic efficiency of water-washed sea nodule residue (WSNR) was evaluated taking oxidative decolorization of methylene blue (MB) as the test reaction. The extent of decolorization was decreased with increase in pH but increased in the presence of H2O2 or NaCl. Decolorization of MB occurred in two consecutive steps; the rate constant of the first step was -10 times higher than that of the second step. The formation of a surface precursor complex between WSNR and MB at a rate-limiting step, followed by electron transfer from MB to the active metal centre of WSNR and release of product(s), was proposed as the decolorization process.

Indoor air quality risk factors for severe lower respiratory tract infections in Inuit infants in Baffin Region, Nunavut: a pilot study.

Inuit infants have extremely high rates of lower respiratory tract infection (LRTI), but the causes for this are unclear. The aims of this study were to assess, in young Inuit children in Baffin Region, Nunavut, the feasibility of an epidemiologic study of the association between indoor air quality (IAQ) and respiratory health; to obtain data on IAQ in their housing; and to identify and classify risk factors for LRTI. Twenty houses in Cape Dorset, Nunavut with children below 2 years of age, were evaluated using a structured housing inspection and measurement of IAQ parameters, and a respiratory health questionnaire was administered. Twenty-five percent of the children had, at some time, been hospitalized for chest illness. Houses were very small, and had a median of six occupants per house. Forty-one percent of the houses had a calculated natural air change rate <0.35 air changes per hour. NO(2) concentrations were within the acceptable range. Smokers were present in at least 90% of the households, and nicotine concentrations exceeded 1.5 microg/m(3) in 25% of the dwellings. Particulates were found to be correlated closely with nicotine but not with NO(2) concentrations, suggesting that their main source was cigarette smoking rather than leakage from furnaces. Mattress fungal levels were markedly increased, although building fungal concentrations were low. Dust-mites were virtually non-existent. Potential risk factors related to IAQ for viral LRTI in Inuit infants were observed in this study, including reduced air exchange and environmental tobacco smoke exposure. Severe lower respiratory tract infection is common in Inuit infants. We found reduced air change rates and high occupancy levels in houses in Cape Dorset, which may increase the risk of respiratory infections. This suggests the measures to promote better ventilation or more housing may be beneficial. Further health benefits may be obtained by reducing bed sharing by infants and greater turnover of mattresses, which were found to have high levels of fungi.

Preoperative fasting for preventing perioperative complications in children.

BACKGROUND: Children, like adults, are required to fast before general anaesthesia with the aim of reducing the volume and acidity of their stomach contents. It is thought that fasting reduces the risk of regurgitation and aspiration of gastric contents during surgery. Recent developments have encouraged a shift from the standard 'nil-by-mouth-from-midnight' fasting policy to more relaxed regimens. Practice has been slow to change due to questions relating to the duration of a total fast, the type and amount of intake permitted. OBJECTIVES: To systematically assess the effects of different fasting regimens (duration, type and volume of permitted intake) and the impact on perioperative complications and patient wellbeing (aspiration, regurgitation, related morbidity, thirst, hunger, pain, comfort, behaviour, nausea and vomiting) in children. SEARCH STRATEGY: We searched Cochrane Wounds Group Specialised Register, the Cochrane Central Register of Controlled Trials, MEDLINE, CINAHL, the National Research Register, relevant conference proceedings and article reference lists and contacted experts. SELECTION CRITERIA: Randomised and quasi randomised controlled trials of preoperative fasting regimens for children were identified. DATA COLLECTION AND ANALYSIS: Data extraction and trial quality assessment was conducted independently by two authors. Trial authors were contacted for additional information including adverse events. MAIN RESULTS: Forty-three randomised controlled comparisons (from 23 trials) involving 2350 children considered to be at normal risk of regurgitation or aspiration during anaesthesia. Only one incidence of aspiration and regurgitation was reported. Children permitted fluids up to 120 minutes preoperatively were not found to experience higher gastric volumes or lower gastric pH values than those who fasted. The children permitted fluids were also less thirsty and hungry, better behaved and more comfortable than those who fasted. Clear fluids preoperatively did not result in a clinically important difference in the children's gastric volume or pH. Evidence relating to the preoperative intake of milk was sparse. The volume of fluid permitted during the preoperative period did not appear to impact on children's intraoperative gastric volume or pH contents. AUTHORS' CONCLUSIONS: There is no evidence that children who are not permitted oral fluids for more than six hours preoperatively benefit in terms of intraoperative gastric volume and pH over children permitted unlimited fluids up to two hours preoperatively. Children permitted fluids have a more comfortable preoperative experience in terms of thirst and hunger. This evidence applies only to children who are considered to be at normal risk of aspiration/regurgitation during anaesthesia.

Effect of granulocyte-macrophage colony-stimulating factor on candidacidal activity of neutrophils, monocytes or monocyte-derived macrophages and synergy with fluconazole.

The effect of in-vitro granulocyte-macrophage colony-stimulating factor (GM-CSF) treatment of neutrophils, monocytes or monocyte-derived macrophages (MDM) on candidacidal activity was tested. Synergy of effector cells with fluconazole (FCZ) for enhanced killing was also investigated. Incubation of neutrophils with GM-CSF 0.67 microg/L plus Candida albicans Sh27 for 24 h significantly increased candidacidal activity (36% versus 74%). Synergy with FCZ for killing was also significantly increased from 93% to 97% when neutrophils were incubated with GM-CSF. Monocytes cultured with GM-CSF and C. albicans for 24 h had significantly increased fungistatic activity compared to controls and synergy with FCZ for killing was significantly enhanced from 40% to 59%. Monocytes cultured for 3 days with GM-CSF had increased fungistatic activity compared to control MDM and showed synergy with FCZ for significantly enhanced killing (46%) compared to control MDM (12%).

Enzootic calcinosis in sheep: soil-plant-animal relationship.

Chemical compositions of soil, water, feeds, and forages on a farm where sheep were affected with calcinosis (experimental site) and a farm with sheep not affected with calcinosis (control site) were determined. The study lasted 1 year. It was observed that water from the experimental site had higher electrical conductivity and calcium level than from the control site. Higher conductivity indicated greater mineral content in the water. Soil from the experimental site had lower levels of potassium, nitrogen, and phosphorus and higher content of exchangeable calcium as compared with these values of the control site. Exchangeable Ca:Mg ratio for soil of the experiemntal site was twice greater than that of the control site. Forage plants of the experimental site had lower concentrations of nitrogen, phosphorus, calcium, magnesium, and copper, but higher values of potassium and sulfur. The K:Ca + Mg, K:P, and K:Ca ratios for plants from the experimental site were higher and Ca:P ratio was lower than those of the control site. Analysis of ruminal content of the affected sheep revealed higher K:Ca + Mg, K:P, and Ca:P ratios than those of the control sheep. Due to the close relationship of metabolism of calcium, phosphorus, potassium, and magnesium, evidence of the existance of their imbalances in feeds and forages of the affected farm possibly contributing to the causation of the pathologic calcification of soft tissues of the sheep has been presented.