Calcium-alkali syndrome as a rare cause of severe hypercalcemia requiring dialysis in early twin gestation.

Hypercalcemia is rare in women of child-bearing age, and most cases are due to primary hyperparathyroidism. A 28-year-old woman, 14 weeks pregnant with dichorionic diamniotic twins, presented to hospital with vomiting, muscle cramps, and weakness. She had been taking calcium carbonate for gastric reflux and nausea from 5 weeks of gestation. Investigations revealed severe hypercalcemia, metabolic alkalosis, and renal injury. She was transferred to intensive care, receiving fluid resuscitation and subcutaneous calcitonin followed by dialysis. Investigations revealed suppressed PTH and PTH-related peptide, negative malignancy screening and low vitamin D level. Calcium and renal function quickly normalized and with cessation of calcium carbonate remained normal throughout the rest of pregnancy. Reports of calcium-alkali syndrome causing severe hypercalcemia are scarce, with most cases occurring later in gestation. This case represents a dramatic presentation requiring renal replacement therapy early in twin gestation.

Evaluation of the analgesic effects of diclofenac as a premedication drug in dogs undergoing ovariohysterectomy.

Pre-emptive analgesia consists of administering drugs such as opioids and nonsteroid anti-inflammatory drugs. This study aims to evaluate the intraoperative antinociceptive effects of diclofenac administered alone in premedication or combined with morphine along with its potential influence on recovery of dogs undergoing ovariohysterectomy. A total of 34 dogs (ASA I or II) admitted for ovariohysterectomy were randomly allocated into three groups according to the drugs given in premedication: Diclofenac (D) (n = 11), Morphine (M) (n = 13) and Diclofenac-Morphine (DM) (n = 10) groups. Induction and maintenance of anesthesia were standardized in all dogs. To assess intraoperative nociception, the heart rate (HR) and mean arterial pressure (MAP) were recorded during the surgery and at predefined time points: St (steady-state), Cut (cutaneous incision), P1 (first ovarian manipulation), P2 (second ovarian manipulation) and Cerv (cervical manipulation). The dynamic variation of HR (ΔHR) and MAP (ΔMAP) over 2 min was calculated at each time point. After extubation, early quality of recovery was assessed. Compared to St, a significant increase in HR and MAP at P1, P2 and Cerv was shown in all groups. MAP in the M group was lower at St than in the other groups. The dynamic variation of HR (ΔHR) and MAP (ΔMAP) was significantly less important at P2 and Cerv compared to P1 only in the DM group. Also, a better quality of recovery was shown in the D group compared to the M and DM groups. Diclofenac may be considered a suitable premedication drug and a part of a multimodal anesthetic approach in dogs.

Author's reply to letter-to-the-editor.

We welcome the opportunity to continue the discussion and to clarify issues you raised in your letter. You will find enclosed a point-by-point response to your comments. Please note that all of these points are already discussed in the "discussion" section of our article "Comparison of needle aspiration versus incision and drainage under local anaesthesia for the initial treatment of peritonsillar abscess". Regarding the retrospective design of our study, we think that the length of hospital stay was the best criterion to be used as primary outcome because it is a clinical endpoint and a composite criterion, reflecting the global improvement of the patient. Our study included PTA patients aged under 15 because the management of peritonsillar abscess in children follows specific guidelines and requires specific care, and due to evident issues of understanding, compliance and pain handling, incision and drainage under local anaesthesia is not routinely used in younger children. We fully agree that this subject remains an area of debate and we are perfectly aware that due to methodological limitations and especially the retrospective design, the level of evidence of our study is not sufficient to draw firm conclusions on the superiority of one technique on the other. At this day, only low-quality evidence studies have been published on this subject and the debate remains opened to determine whether needle aspiration or incision and drainage is the most safe and effective technique in treating peritonsillar abscess.

Comparison of needle aspiration versus incision and drainage under local anaesthesia for the initial treatment of peritonsillar abscess.

PURPOSE: The treatment of peritonsillar abscess (PTA) is still controversial regarding the best method of drainage to perform. This study aims to compare effectiveness and safety of needle aspiration versus incision and drainage under local anaesthesia for the initial treatment of PTA. METHODS: A retrospective review of patients (age > 15 years) admitted in two tertiary medical centres for a PTA between November 2010 and October 2016 was performed. Patients were divided into two groups according to the type of drainage: needle aspiration or incision and drainage, under local anaesthesia. The primary outcome was the length of hospital stay; the need to repeat the procedure or to go to the operating room was also assessed. Complications or adverse events were listed in each group to assess safety. RESULTS: Over a 6-year period, 182 patients were admitted for a PTA and included in the analysis, with 82 patients in the aspiration group and 100 patients in the incision group. Mean age was 36.3 years, with a sex ratio of 1.33. The length of hospital stay ranged from 1 to 7 days (mean 2.7 days, median 2 days) with a median length of stay of 3.0 days (interquartile range 2-4) in the aspiration group versus 2.0 days (IQR 2-3) in patients who underwent incision and drainage (p = 0.009). A repetition of the needle aspiration was made for 46.3% of patients versus 10% of repetition of the procedure in the incision group (p = 0.0001). 12 patients (14%) of the aspiration group and 4 patients (4%) of the incision group required an additional drainage under general anaesthesia (p < 0.001). We found no differences regarding safety in both groups. CONCLUSION: Our study showed a significant decrease in the length of hospital stay in patients admitted for a PTA who underwent an initial incision and drainage under local anaesthesia, compared to needle aspiration, as well as a lower risk of repeating the procedure. A well-designed prospective and randomized study on a larger sample of patients is required to support these findings.

Rocuronium vs. succinylcholine for rapid sequence intubation: a Cochrane systematic review.

This systemic review was performed to determine whether rocuronium creates intubating conditions comparable to those of succinylcholine during rapid sequence intubation of the trachea. We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 2), MEDLINE (1966 to February Week 2 2015), and EMBASE (1988 to February 14 2015) for any randomised controlled trials or controlled clinical trials that reported intubating conditions comparing rocuronium and succinylcholine for rapid or modified rapid sequence intubation. The dose of rocuronium was at least 0.6 mg.kg-1 and succinylcholine was at least 1 mg.kg-1 . Sixty-six studies were identified and 50 included, representing 4151 participants. Overall, succinylcholine was superior to rocuronium for achieving excellent intubating conditions (risk ratio (95%CI) 0.86 (0.81 to 0.92), n = 4151) and clinically acceptable intubation conditions (risk ratio (95%CI) 0.97 (0.95-0.99), n = 3992). A high incidence of detection bias amongst the trials coupled with significant heterogeneity means that the quality of evidence was moderate for these conclusions. Succinylcholine was more likely to produce excellent intubating conditions when using thiopental as the induction agent: risk ratio (95%CI) 0.81 (0.73-0.88), n = 2302) with or without the use of opioids (risk ratio (95%CI) 0.85 (0.78-0.93), n = 2292 or 0.85 (0.76-0.95), n = 1428).

Influence of temperature and reducing conditions on the sorption of sulfate on magnetite.

The reactivity of aqueous sulfate toward magnetite was studied between 50 and 275 °C as a function of pH and the redox conditions. Under oxidizing conditions, we did not observe redox reactions and the sorption of aqueous sulfate is promoted under acidic conditions when the magnetite surface is positively charged. The effect of temperature on this retention is moderate but complex. From 50 to 125 °C the sorption edge is shifted toward low pH values, according to the variation of the point of zero charge. Above 125 °C, the effect of temperature is inverted, leading to a shift to basic pH values and an increase of the sorbed quantity. This inversion of the temperature effect is interpreted as related to changes in the nature of the complexes formed, correlated to the evolution of speciation of dissolved S(VI) species. Under reducing conditions (2bar hydrogen), sulfate is involved in redox reactions, likely as a consequence of the catalytic effect of the sorption that enhances the H(2)-sulfate reaction, producing sulfides in the gaseous, liquid, and solid phases. However, this effect is better evidenced at 125 °C than at 275 °C, illustrating the importance of surface speciation, assumed to change with temperature.

An original knee arthrodesis technique combining external fixator with Steinman pins direct fixation.

INTRODUCTION: Knee arthrodesis may be the last possible option for infected total knee arthroplasty (TKA) patients and in revision cases involving severe bone loss and/or extensor mechanism damages. Success in these situations depends on achieving good fixation assembly stability. We report bone fusion results using a fixation technique combining cross-pinning by two Steinman pins with a single-frame external fixator. Remission of infection at long-term follow-up was an additional criteria assessed for those cases initially treated for sepsis. HYPOTHESIS: This fixation modality improves fusion rates. PATIENTS AND METHODS: In six of this series of eight patients (mean age: 59 years), surgery was performed in a context of infection: five cases of infected TKA, and one case of septic arthritis. In the other two cases, arthrodesis was respectively indicated for a severe post-traumatic stiffness compounded by extensor system rupture and for a fracture combined to a complete mechanical implant loosening. In three of the six infection cases, arthrodesis was performed as a single-stage procedure. All patients were operated on using the same technique: primary arthrodesis site stabilization by frontal cross-pinning with two Steinman pins, followed by installation of a sagittal external fixator frame. Results were assessed at a mean 8 year follow-up. RESULTS: All the arthrodeses showed fusion at a mean 3.5 months (range: 2.5 to 6 months) postoperative delay without reintervention. Weight-bearing was resumed at 2 to 3 months. The external fixator was removed at a mean 5.2 months. No recurrence of infection was observed over a mean follow-up of 8.2 years (range: 1 to 15 years). Three complications occurred: one hematoma, managed surgically; one supracondylar fracture treated orthopedically; and one osteitis, managed by surgical curettage. DISCUSSION: This knee arthrodesis technique proved effective, with no failures in this short series, especially in cases of primary infection. It is a reproducible means of osteosynthesis, with little subsequent morbidity. Fixation in two orthogonal planes seemed to provide the stability required to achieve bone fusion. This assembly avoids internal fixation, which is never risk-free in a context of primary sepsis. LEVEL OF EVIDENCE: Level IV. Retrospective study.

Sorption of sulfate ions onto magnetite.

In order to acquire data necessary to understand and predict the behavior of oxide particles in the secondary circuits of pressurized water reactors (PWR) and study the role of redox and interface reactions, the acid-base properties of magnetite and sorption of sulfate ions were studied at 25 degrees C. Redox reactions with magnetite predicted from thermodynamic data were not observed and sulfur species always remain as sulfate. From zetametric measurements, mass titrations and acid-base titrations an IEP at 6.7 and a PZC at 6.2 were found. Acid-base experimental data were modeled in the 2pK surface complexation model in CCM or BSM. Sulfate sorption increase with decreasing pH is typical for anionic species on oxides. For the modeling of sorption data, the choice of surface species was guided by the slope of the sorption curves and by the evolution of zeta potential. In the proposed model, sulfate ions are sorbed essentially as outer-sphere complexes, with a partial sorption as a neutral bidentate inner-sphere complex below pH 5.

Selective removal of dissolved uranium in drinking water by nanofiltration.

A procedure for the selective removal of uranium traces dissolved in drinking water has been studied. Plate module membrane filtration equipment was operated to evaluate the performance and selectivity of three different nanofiltration flat-sheet membranes. Experiments were carried out using various commercial mineral waters with distinct physicochemical compositions. The membranes were first discriminating by their ability to reject uranium in the presence of the main cations found in mineral waters, using a 2 mg L(-1) (2000 ppb) concentration of uranium. The rejection of U(VI) was dependent on the uranyl speciation and the ionic strength. Second, removal of uranium traces (0.02 mg L(-1), 20 ppb) was performed using the nanofiltration membrane showing the highest selectivity for uranium toward alkaline and alkaline-earth ions. The results showed a high performance of the nanofiltration membrane, Osmonics DL, for selective uranium rejection at low pressure (1 bar), illustrating the advantage of nanofiltration for the selective removal of uranium from drinking water.

[One case report of anti-JK1 antibody undetected on plasma sample]. / A propos d'un cas d'allo-immunisation anti-JK1 non dépisté sur plasma.

The sensitivity of the detection of irregular antibodies (DIA) is one of the fundamental bases of transfusion safety. Its implementation is specified in accordance with a very specific framework that allows the use of serum or plasma. The case reported here points out a failure to detect irregular antibodies in plasma sample. Thus a low intensity anti-JK1 antibody detected and identified in serum slipped through unnoticed in plasma. The difficulties to detect and identify this antibody, well-known as a deceptive and dangerous one, are being discussed in order to better assess the limitations of DIA.

Characterization of functional interactions among the Escherichia coli mismatch repair proteins using a bacterial two-hybrid assay.

Vsr mediates very short patch repair in Escherichia coli, correcting T/G mismatches caused by deamination of 5-methylcytosine to thymine. MutS and MutL, part of the post-replication mismatch repair system, stimulate VSP repair. In this study, we use a bacterial two-hybrid assay to show that MutL interacts with Vsr. We also show that interaction between Vsr and MutL inhibits the ability of MutL to dimerize, to interact with MutS and MutH and to mediate a previously unknown interaction between MutS and MutH. This inhibition may explain why high levels of Vsr are mutagenic in vivo. In addition, we show that the Mut fusion proteins are repair proficient in the bacterial two-hybrid assay, making it possible to study their interactions in various genetic backgrounds, or in the presence of DNA damaging agents.

Use and abuse of licit and illicit substances: prevalence and risk factors among students in Lebanon.

OBJECTIVE: This study aims at examining the patterns of 'substance' use in Lebanon among an 'at risk' population, the university students. METHOD: A stratified cluster sample of 1,851 students from two major universities was included in the study and the Diagnostic Interview Schedule (version 3) was administered. RESULTS: The prevalence of nicotine users in the sample was 18.3% and of ever consuming alcohol 49.4%. 2.1% of the sample were alcohol abusers and 2.4% alcohol dependents according to DSM-III criteria. For the remaining substances, tranquilizers were found to have the highest rate of ever use (10.2%), whereas heroin had the lowest rate (0.4%); the rates of abuse and dependence in these categories (other than alcohol and nicotine) following DSM-III criteria ranged from 0.1 to 0.8%. CONCLUSION: University students in Lebanon in this study have relatively low rates of use and abuse of substances but this might be changing.

Adolescent developmental change in topography of EEG amplitude.

EEGs were recorded from 32 channels in 30 normal males, ages 16-22. Delta activity decreased throughout this age range. This decrease was greatest in the left frontal and temporal regions; no occipital lead showed this pattern. Relative EEG amplitude analysis, based on normalized maps, revealed decreases with age across alpha, delta, and theta bands with beta staying the same or increasing. These changes were greatest in the left temporal and left frontal regions. Taken together, these findings suggest that these cortical areas are maturing in the second decade of life. Both delta and theta showed significantly greater decreases with age in the left parietal region than in the right.