Time to TAVI: streamlining the pathway to treatment.

Introduction: Severe aortic stenosis is a major cause of morbidity and mortality. The existing treatment pathway for transcatheter aortic valve implantation (TAVI) traditionally relies on tertiary Heart Valve Centre workup. However, this has been associated with delays to treatment, in breach of British Cardiovascular Intervention Society targets.

The prevalence of gender stereotypes in pharmacy student simulated counseling sessions utilizing standardized patients.

Introduction: Simulation in healthcare has been a widely adopted modality to gain practical experience prior to working directly with patients. While simulation in academic settings affords many opportunities to enhance learning, it may also present an opportunity to identify cultural stereotypes. The objective of this study was to assess the prevalence of gender stereotypes in pharmacy student simulated counseling sessions.

The Use of Neuromuscular Blockers to Prevent Shivering in the Setting of Postcardiac Arrest Targeted Temperature Management: A Narrative Review of an Off-Label Indication.

Targeted temperature management (TTM) has become a standard of care over the past two decades for the improvement in neurologic function and mortality in postcardiac arrest patients. There are various mechanisms by which hypothermia helps to improve these outcomes, one of which is by reducing oxygen requirements. Less established is the use of nondepolarizing neuromuscular blockers (NMBs) to prevent shivering during TTM.

A Review of the Food and Drug Administration Adverse Event Reporting System for Tramadol-Related Hypoglycemia.

Hypoglycemia is a rare adverse effect of tramadol that is described in the medical literature and package insert. The purpose of this study was to review reports of tramadol and hypoglycemia in the Food and Drug Administration Adverse Event Reporting System (FAERS) database to determine a potential association. Disproportionality analysis with Bayesian correction was used to compare tramadol and hypoglycemia with other medications in FAERS.

Variation between Point-of-care and Laboratory HbA1c testing in Clinical Practice.

Objective: The aim of this study was to identify potential disparities between point-of-care testing (POCT) and laboratory hemoglobin A1c (HbA1c) reporting at a Federally Qualified Health Center (FQHC).

Methods: The electronic medical record was reviewed to identify POCT HbA1c done at a FQHC and centralized laboratory venous HbA1c performed on the same day. Manual data extraction was used to identify potential variables that could account for disparities between POCT and laboratory testing.

'Genome skimming' with the MinION hand-held sequencer identifies CITES-listed shark species in India's exports market.

Chondrichthyes - sharks, rays, skates, and chimeras, are among the most threatened and data deficient vertebrate species. Global demand for shark and ray derived products, drives unregulated and exploitative fishing practices, which are in turn facilitated by the lack of ecological data required for effective conservation of these species. Here, we describe a Next Generation Sequencing method (using the MinION, a hand-held portable sequencing device from Oxford Nanopore Technologies), and analyses pipeline for molecular ecological studies in Chondrichthyes.

Clinicopathological features of squamous cell carcinoma of the oral cavity and oropharynx in young patients.

Our aim was to examine the clinicopathological features of squamous cell carcinoma (SCC) of the oral cavity and oropharynx in a group of young patients who were dignosed during a 15-year period (2000-2014). Patients' clinical details, risk factors, and survival were obtained from medical records. Formalin-fixed, paraffin-embedded, tissue was tested for high-risk human papillomavirus (HPV).

Pharmacologic Interventions for Intractable and Persistent Hiccups: A Systematic Review.

Background: Chlorpromazine is the only drug approved by the US Food and Drug Administration for the treatment of hiccups; however, many other pharmacologic treatments have been proposed for intractable and persistent hiccups. Currently, there is little evidence to support the use of one agent over another.

Objective: This review aims to identify literature concerning the use of pharmacologic treatments for intractable and persistent hiccups with the goal of evaluating therapies in terms of their level of evidence, mechanism of action, efficacy, dosing, onset of action, and adverse effects.

Comparing methods of naloxone administration: A narrative review.

The effectiveness and safety of naloxone for the reversal of opioid toxicity are reviewed. A literature search was performed using PubMed, the Cochrane Library, CINAHL, and Medline. Clinical trials comparing either the clinical efficacy or pharmacokinetic/pharmacodynamic properties displayed by intravenous, intramuscular, intranasal, subcutaneous, and nebulized naloxone were included; however, trials with primary endpoints evaluating oral or endotracheal naloxone were excluded.

Crystal structure of 4-carbamoylpyridinium chloride.

The hydro-chloride salt of isonicotinamide, C6H7N2O(+)·Cl(-), has been synthesized from a dilute solution of hydro-chloric acid in aceto-nitrile. The compound displays monoclinic symmetry (space group C2/c) at 150 K, similar to the related hydro-chloride salt of nicotinamide. The asymmetric unit contains one protonated isonicotinamide mol-ecule and a chloride anion.

Cardiac devices with class 1C antiarrhythmics: a potentially toxic combination.

A patient taking regular flecainide for paroxysmal atrial fibrillation presented with broad complex tachycardia and circulatory compromise. With no history of pacemaker insertion and no pacing spikes visible on the ECG, this was presumed to be ventricular tachycardia and treated with electrical cardioversion, leading to p-wave asystole. An indwelling pacemaker was now recognised and ventricular capture was eventually attained by significantly increasing ventricular lead output.

Delayed cardiac dysrhythmias after fingolimod administration.

A 51-year-old woman with relapsing-remitting multiple sclerosis was initiated on fingolimod. She developed a Mobitz Type I (Wenckebach)second-degree atrioventricular (AV) heart block during the initial 6-hour monitoring. She was transferred to the emergency department for further monitoring, where she went into a junctional tachycardia then went back into a Mobitz Type I AV block.

Pancreatic herniation: a rare cause of acute pancreatitis?

Acute pancreatitis is a common and potentially fatal condition, with several well-known causes including gallstones, excessive alcohol consumption and specific medications. We report a case of an 89-year-old man presenting with acute pancreatitis, which we believe to be secondary to a diaphragmatic herniation of the pancreas. This extremely rare anatomical abnormality can be found incidentally in the asymptomatic patient or may present with a variety of acute symptoms.

Hemorrhagic gastritis with dabigatran in a patient with renal insufficiency.

Background: Dabigatran etexilate is the first oral direct thrombin inhibitor approved in the United States. Unlike warfarin, dabigatran has no known antidote. Providers should be aware of patients that may be at risk for dabigatran coagulopathies and recognize potential treatment options.

Free-ranging little brown myotis (Myotis lucifugus) heal from wing damage associated with white-nose syndrome.

White-nose syndrome (WNS) is having an unprecedented impact on hibernating bat populations in the eastern United States. While most studies have focused on widespread mortality observed at winter hibernacula, few have examined the consequences of wing damage that has been observed among those bats that survive hibernation. Given that WNS-related wing damage may lead to life-threatening changes in wing function, we tested the hypothesis that reduced abundance of free-ranging little brown myotis (Myotis lucifugus) with severe wing damage as the summer progresses is due to healing of wing tissue.

Feedback on doctors' performance from parents and carers of children: a national pilot study.

Objectives: To evaluate the reliability and validity of a children's carers' feedback tool, to explore the feasibility of delivering this nationally and to determine acceptability to doctors of this assessment.

Participants: 122 UK paediatricians on the specialist register undertaking outpatient consultations.

Design: Participants were each sent 50 forms for distribution to carers.

Thermoregulation during flight: body temperature and sensible heat transfer in free-ranging Brazilian free-tailed bats (Tadarida brasiliensis).

Bat wings are important for thermoregulation, but their role in heat balance during flight is largely unknown. More than 80% of the energy consumed during flight generates heat as a by-product, and thus it is expected that bat wings should dissipate large amounts of heat to prevent hyperthermia. We measured rectal (T(r)) and surface (T(s)) temperatures of Brazilian free-tailed bats (Tadarida brasiliensis) as they emerged from and returned to their daytime roosts and calculated sensible heat transfer for different body regions (head, body, wings, and tail membrane).

How paediatricians can prepare for revalidation.

Revalidation has begun with relicensing in 2009. All paediatricians will have to demonstrate that they meet generic standards in the General Medical Council's (GMC) Good Medical Practice for continued relicensing. Paediatricians on the specialist register will have to demonstrate that they meet the specialist standards set by the College and approved by the GMC in order to recertify.

Increased opportunity for sexual conflict promotes harmful males with elevated courtship frequencies.

Mating systems have a profound influence on the probability of conflict occurring between the sexes. Promiscuity is predicted to generate sexual conflict, thereby driving the evolution of male traits that harm females, whereas monogamy is expected to foster reproductive cooperation, thus rendering such traits redundant. We tested these predictions using experimentally evolved Drosophila pseudoobscura subject to different mating systems.

Experimental manipulation of sexual selection promotes greater male mating capacity but does not alter sperm investment.

Sexual selection theory makes clear predictions regarding male spermatogenic investment. To test these predictions we used experimental sexual selection in Drosophila pseudoobscura, a sperm heteromorphic species in which males produce both fertile and sterile sperm, the latter of which may function in postmating competition. Specifically, we determined whether the number and size of both sperm types, as well as relative testis mass and accessory gland size, increased with increased sperm competition risk and whether any fitness benefits could accrue from such changes.

The 2-week rule for suspected head and neck cancer in the United Kingdom: referral patterns, diagnostic efficacy of the guidelines and compliance.

A retrospective audit of 1079 2-week referrals between 1 January 2004 and 31 December 2006 was undertaken. The aims of this audit were to assess compliance of referrals with Department of Health (DoH) guidelines; the effectiveness of the 2-week referral route in detecting head and neck cancers, and to determine whether this route identified more early stage cancers. Of 1079 2-week referrals, 71.

The effect of subthalamic nucleus deep brain stimulation on precision grip abnormalities in Parkinson's disease.

We have studied grip force performance in a group of 10 patients who were in a stable state after implantation of bilateral stimulating electrodes in the subthalamic nuclei (Stn) to counter drug-resistant or drug-induced symptoms of advanced Parkinson's disease. The patients were required to use a precision grip to lift an object which recorded grip force development and lift dynamics. Lifting was performed with stimulation on and with stimulation off under optimal medication.

Grip force abnormalities in de novo Parkinson's disease.

In recent years it has been shown that a variety of movement disorders are associated with abnormalities of the fine motor control of the hand. In Parkinson's disease (PD), these changes consist of a slowing of the rate of grip force development and the use of abnormally large grip forces both during lifting and static holding of an object. It has been suggested, however, that these changes are a direct effect of the patient's levodopa medication or associated with levodopa induced dyskinesias.

Microvascular histopathology in head and neck oncology.

A histological study of both recipient and flap vessels was performed in 30 patients with head and neck cancer, and relevant preoperative risk factors were assessed. A total of 35 free flaps were transferred in 30 patients; 16 patients had preoperative radiotherapy, 13 were smokers, eight had hypertension and six had peripheral vascular disease. No significant venous pathology was found in either the flap or the neck veins.