Complications of different ventilation strategies in endoscopic laryngeal surgery: a 10-year review.

BACKGROUND: Spontaneous ventilation, mechanical controlled ventilation, apneic intermittent ventilation, and jet ventilation are commonly used during interventional suspension microlaryngoscopy. The aim of this study was to investigate specific complications of each technique, with special emphasis on transtracheal and transglottal jet ventilation. METHODS: The authors performed a retrospective single-institution analysis of a case series of 1,093 microlaryngoscopies performed in 661 patients between January 1994 and January 2004. Data were collected from two separate prospective databases. Feasibility and complications encountered with each technique of ventilation were analyzed as main outcome measures. RESULTS: During 1,093 suspension microlaryngoscopies, ventilation was supplied by mechanical controlled ventilation via small endotracheal tubes (n = 200), intermittent apneic ventilation (n = 159), transtracheal jet ventilation (n = 265), or transglottal jet ventilation (n = 469). Twenty-nine minor and 4 major complications occurred. Seventy-five percent of the patients with major events had an American Society of Anesthesiologists physical status classification of III. Five laryngospasms were observed with apneic intermittent ventilation. All other 24 complications (including 7 barotrauma) occurred during jet ventilation. Transtracheal jet ventilation was associated with a significantly higher complication rate than transglottal jet ventilation (P < 0.0001; odds ratio, 4.3 [95% confidence interval, 1.9-10.0]). All severe complications were related to barotraumas resulting from airway outflow obstruction during jet ventilation, most often laryngospasms. CONCLUSIONS: The use of a transtracheal cannula was the major independent risk factor for complications during jet ventilation for interventional microlaryngoscopy. The anesthetist's vigilance in clinically detecting and preventing outflow airway obstruction remains the best prevention of barotrauma during subglottic jet ventilation.

Burden of Diabetes in Iowa 1991-2009, Final Report, May 2010

The Iowa Diabetes Prevention and Control Program provides educational opportunities for health care providers via the Iowa Communications Network interactive fiber optic system. The program also certifies diabetes outpatient education programs in Iowa based on minimum criteria for quality programs. In Iowa during the past 20 years, the prevalence rate of diagnosed diabetes increased dramatically among adults: Between 1991 and 2009 the crude diabetes prevalence rate rose by 84%, from 3.8% to 7.0%. Between these years, the age‐adjusted adult diagnosed diabetes prevalence rate increased by 64%, rising from 3.7% to 6.4%. During the 18 years 1991‐93 through 2006‐08, the number of Iowa adults with diagnosed diabetes more than doubled, increasing from 78,000 to 162,000. While the Iowa Behavioral Risk Factor Surveillance System (BRFSS), upon which the numbers cited above are based, provides reliable state‐level self‐reported data on adults with diagnosed diabetes, it is unable to provide estimates of undiagnosed diabetes. National estimates put the prevalence of undiagnosed adult diabetes at about 5%, raising the estimated adult diabetes prevalence rate in Iowa to 12% (280,000 adults) (Cowie,2009). Another 5% of all Iowa adults are estimated to have diagnosed pre‐diabetes, while 25% of all Iowa adults, based on national estimates from the 2005‐06 National Health and Nutrition and Examination Survey (NHANES), likely have undiagnosed pre‐diabetes. (Cowie, 2009)

Burden of Diabetes in Iowa 1990-2009, Final Report, April 2011

The Iowa Diabetes Prevention and Control Program provides educational opportunities for health care providers via the Iowa Communications Network interactive fiber optic system. The program also certifies diabetes outpatient education programs in Iowa.

Les infections endo-artérielles, complications redoutables des infections à salmonelles non typhi [Endarterial infections, redoubtable complications of non-typhi salmonella infections].

Three cases are reported of salmonella aortitis observed in three men aged 55, 60 and 48 years, the last of whom had a prosthetic aortic valve and ascending aorta. The microorganisms were S. typhi murium, S. paratyphi B, and S. wien. Despite antibiotic treatment two patients died of perforating aortitis. The third patient developed S. wien gastroenteritis a few days after surgical replacement of the aortic valve and the ascending aorta. Five years later he presented with several bacteremic episodes due to S. wien, which recurred despite several courses of cotrimoxazole treatment. He has now been asymptomatic for over one year under prolonged cotrimoxazole treatment. Since vascular infection may occur following non typhi salmonellosis in 5% of patients over 50, or who have underlying endothelial lesions, the question arises as to whether non typhi S. gastroenteritis should be treated with antibiotics in these high risk patients, in contrast to present recommendations.

Prédire la survenue d'un diabète: la place de scores cliniques et/ou génétiques [Genetic and/or clinical scores to anticipate the onset of diabetes]

Diabetes represents an important health burden on our society: for example in Lausanne (Switzerland) 16% of the adult population have abnormal glucose homeostasis and 6% have diabetes, of which about a third is not aware. Some guidelines identify the "at risk" population for which screening seems indicated. Simple clinical scores have been developed at allow to better estimate the risk of diabetes and hence to potentially better target screening of the disease. The recent discovery of more that 18 genetic variants associated with an increased risk to develop the diseased has allowed to include individual genotype into genetic risk scores. We will discuss in this article the usefulness of these genetic score, how they compare to clinical score, their implication for clinical practice as well as their potential ethical or economical consequences.

Reproducibility of diabetes quality of care indicators as reported by patients and physicians.

INTRODUCTION: Self-report of diabetes care has moderate validity and is prone to under- and over-reporting. We assessed reproducibility of a range of processes and outcomes of diabetes care as reported by patients and physicians. METHODS: In a Swiss community-based survey, patients with diabetes and physicians independently reported past 12 months processes of care (HbA1c, lipids, microalbuminuria, blood pressure, weight, foot and eye examinations) and last measured values of HbA1c, height, weight and blood pressure. For dichotomous variables, we assessed reliability by Cohen's kappa and agreement by uniform kappa. For continuous measures, we used Lin's concordance correlation coefficient and limits of agreement, respectively. RESULTS: Mean age of the 210 patients was 65 years; 40% were women, and 51% had diabetes for >10 years. Agreement was good for recommended processes of care such as blood pressure (uniform kappa = 0.94), HbA1c (0.93), weight (0.88) and lipid (0.78), but lower for microalbuminuria, foot and eye examinations (all <0.50). Cohen's kappa values were all low (<0.25). Comparisons of reported continuous variables showed large limits of agreement for height (±6 cm) and weight (8-10 kg) despite high concordance correlation coefficients (0.93 and 0.97). Concordance correlation coefficients were smaller for HbA1c (0.72) and blood pressure (0.5-0.6), with large limits of agreement (±2% and ±25 mmHg). CONCLUSION: While agreement of routine processes of care was good, agreement was less satisfactory for microalbuminuria, foot and eye examinations. Reports of continuous outcomes yielded good reliability but too wide limits of agreement. Quality of care evaluation relying on self-report only should be made cautiously.

Complications of systemic juvenile idiopathic arthritis: risk factors and management recommendations.

Systemic juvenile idiopathic arthritis (SJIA) is an inflammatory condition characterized by fever, lymphadenopathy, arthritis, rash and serositis. Systemic inflammation has been associated with dysregulation of the innate immune system, suggesting that SJIA is an autoinflammatory disorder. IL-1 and IL-6 play a major role in the pathogenesis of SJIA, and treatment with IL-1 and IL-6 inhibitors has shown to be highly effective. However, complications of SJIA, including macrophage activation syndrome, limitations in functional outcome by arthritis and long-term damage from chronic inflammation, continue to be a major issue in SJIA patients' care. Translational research leading to a profound understanding of the cytokine crosstalk in SJIA and the identification of risk factors for SJIA complications will help to improve long-term outcome.

Genotypic classification of patients with Wolfram syndrome: insights into the natural history of the disease and correlation with phenotype

Purpose: Wolfram syndrome is a degenerative, recessive rare disease with an onset in childhood. It is caused by mutations in WFS1 or CISD2 genes. More than 200 different variations in WFS1 have been described in patients with Wolfram syndrome, which complicates the establishment of clear genotype-phenotype correlation. The purpose of this study was to elucidate the role of WFS1 mutations and update the natural history of the disease. Methods: This study analyzed clinical and genetic data of 412 patients with Wolfram syndrome published in the last 15 years. Results: (i) 15% of published patients do not fulfill the current ­inclusion criterion; (ii) genotypic prevalence differences may exist among countries; (iii) diabetes mellitus and optic atrophy might not be the first two clinical features in some patients; (iv) mutations are nonuniformly distributed in WFS1; (v) age at onset of diabetes mellitus, hearing defects, and diabetes insipidus may depend on the patient"s genotypic class; and (vi) disease progression rate might depend on genotypic class. Conclusion: New genotype-phenotype correlations were established, disease progression rate for the general population and for the genotypic classes has been calculated, and new diagnostic criteria have been proposed. The conclusions raised could be important for patient management and counseling as well as for the development of treatments for Wolfram syndrome.

Complications liées aux piercings [Complications of body piercing].

Au sein de la population générale, de plus en plus de personnes arborent des piercings, en particulier parmi les jeunes adultes. Hormis les réactions inflammatoires et les infections locales, les complications liées à ces piercings sont méconnues. Les personnes ne sont en général pas informées des risques avant de réaliser un piercing et leurs antécédents, traitements médicamenteux ou comorbidités éventuelles, sont largement négligés par les personnes qui réalisent le geste. Les complications sont le plus souvent locales et bénignes, mais des complications sérieuses et parfois mortelles ont été décrites dans la littérature. Cet article propose une revue des problématiques possibles auxquelles pourrait être confronté un médecin de premier recours, face à un patient qui souhaiterait réaliser un piercing ou présenterait des complications suite à la mise en place d'un tel dispositif. The trend of body piercing has grown in popularity in the past decade within the general population and especially among young adults. Complications of body piercing include local inflammation and infections, but severe complications are also possible and largely underestimated. People are usually not aware of the risks before making a piercing, and their medical history, medication and comorbidities are largely neglected by the people who realise the piercing. This article presents a review of the complications that a primary care physician may observe, for a patient who wishes to make a piercing, or presents complications due to the implementation of such a device.

Diabetes mellitus: la pandemia del siglo XXI

La diabetes mellitus (DM) constituye uno de los principales problemas de salud pública debido a su elevada prevalencia, al hecho de que puede afectar a personas de cualquier edad, sexo, clase social y área geográfica, a su elevada morbilidad y mortalidad y a su elevado coste sanitario. Tanto la DM tipo 1 (DM1) como la DM tipo 2 (DM2) cursan con hiperglucemia lo que puede originar complicaciones agudas hiperglucémicas e hipogucémicas, debido al tratamiento, y graves complicaciones crónicas macrovasculares y microvasculares, que pueden producir infarto de miocardio, accidente vascular...

Diabetes mellitus: la pandemia del siglo XXI

La diabetes mellitus (DM) constituye uno de los principales problemas de salud pública debido a su elevada prevalencia, al hecho de que puede afectar a personas de cualquier edad, sexo, clase social y área geográfica, a su elevada morbilidad y mortalidad y a su elevado coste sanitario. Tanto la DM tipo 1 (DM1) como la DM tipo 2 (DM2) cursan con hiperglucemia lo que puede originar complicaciones agudas hiperglucémicas e hipogucémicas, debido al tratamiento, y graves complicaciones crónicas macrovasculares y microvasculares, que pueden producir infarto de miocardio, accidente vascular...

Complications of guided surgery and immediate loading in oral implantology: a report of 12 cases

Objectives: The growing interest in minimally invasive surgery, together with the possibility of fitting prostheses with immediate function, have led to the development of software capable of planning and manufacturing a surgical guide and prosthesis that can be placed upon conclusion of the implant surgery step. The present study evaluates the surgical and prosthetic complications of implant treatment with the guided surgery technique, together with patient comfort during and after treatment. Patients and methods: A retrospective observational study was made of 19 patients with partially or totally edentulous upper and/or lower maxillae, involving the placement of a total of 122 implants. All cases were planned and operated upon with the guided surgery technique. Results: A total of 122 implants were placed in 14 males and 5 females. The intraoperative surgical complications comprised a lack of primary stability, while the postoperative complications consisted of infections and a lack of implant osteointegration. Ten implants failed. The prosthetic complications in turn comprised loosening of the provisional prosthesis screws, prosthesis tooth fracture, and a lack of passive fit of the immediate prosthesis. The degree of patient satisfaction was evaluated using a verbal scale. Conclusions: Implant restoration with the guided surgery technique and immediate functional loading is a predictable procedure, provided patient selection and the surgical technique are adequate, affording lesser postoperative morbidity and increased patient satisfaction thanks to the immediate restoration of esthetics and function

Proporción de carga asistencial generada por la diabetes mellitus en las consultas de enfermería de atención primaria de salut

Objetivo La mayoría de enfermos con diabetes mellitus tipo 2 (DM2) se controla en atención primaria de salud (APS). La atención y educación proporcionadas por enfermería son clave para controlar la glucemia y prevenir las complicaciones macro y microangiopáticas de la DM. El objetivo de este trabajo es conocer la proporción de carga asistencial atribuible a la DM en consultas de enfermería de APS. Material y método Estudio observacional, analítico y transversal. Durante 2 semanas consecutivas se registraron datos de todos los enfermos que acudieron a 15 consultas de enfermería de APS ubicadas en 14 Áreas Básicas de Salud (ABS) de la provincia de Barcelona. Las variables de estudio fueron: edad, sexo, situación laboral, motivo de consulta, duración de la visita, presencia de DM y, en los enfermos diabéticos, el tipo de tratamiento. La recogida de datos se realizó en 2 períodos. El primero entre noviembre del año 2003 y enero del 2004 y el segundo en abril de 2005. Se realizó un análisis descriptivo de estas variables con un intervalo de confianza del 95% y la asociación entre variables mediante el programa SPSS v.11.1. Resultados Tenía DM el 29% de los pacientes. La DM es el primer motivo de consulta (29,1%), aumenta con la edad y llega al 40% en mayores de 65 años. La duración media de una visita por DM es de 14,59 min, un 30,8% más elevada que la duración media del resto de los problemas de salud. Globalmente, las mujeres consultan más que los varones (56,6%) excepto en DM, curas y hábito tabáquico. Conclusiones La DM es el problema de salud que genera más demanda y consume más tiempo de enfermería en la APS. Esta realidad y el futuro que se prevé con relación al incremento de la prevalencia de DM exigen considerar nuevas estrategias organizativas y formativas, y establecer criterios para mejorar la gestión de recursos y promover estrategias educativas más efectivas.