A Case of Brachiocephalic Fistula Steal and the Emergency Physician's Approach to Hemodialysis Arteriovenous Fistula Complications

Publication date: Available online 10 December 2016
Source:The Journal of Emergency Medicine
Author(s): Erica Simon, Brit Long, Kyle Johnston, Shane Summers
BackgroundChronic kidney disease is common in the United States, with many patients maintained on hemodialysis (HD). The process of HD requires vascular access through an arteriovenous (AV) fistula, AV graft, or central venous catheter. Today, as a result of the National Kidney Foundation's “Fistula First” initiative, nearly 55% of HD patients utilize an AV fistula. As there is significant morbidity and mortality associated with fistula placement and recurrent fistula cannulation, emergency physicians must be equipped to recognize and treat fistula complications.ObjectiveTo detail a case study of vascular insufficiency (vascular steal) presenting to an emergency department (ED) and provide an evidence-based approach to the emergency assessment and management of HD AV fistula complications.DiscussionA 66-year-old man presented to the ED with left upper extremity pain, paresthesias, and loss of grip strength of 1-week duration 15 days after placement of left upper extremity brachiocephalic fistula. He was diagnosed with dialysis access-associated steal syndrome and taken to the operating room for revision. Patients with HD fistulas may experience several complications, including vascular insufficiency, hemorrhage, infection, stenosis, thrombosis, aneurysms, or pseudoaneurysms. Emergency physicians must be able to identify these complications and deliver timely treatment.ConclusionsA comprehensive understanding of the appropriate management of AV fistula complications is paramount for the emergency physician. Early recognition and treatment of vascular insufficiency resulting from fistula creation, fistula hemorrhage, fistula infection, stenosis, thrombosis, and aneurysms or pseudoaneurysms is vital to reducing the morbidity and mortality associated with HD.



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Spontaneous Esophageal Dissection

Publication date: Available online 10 December 2016
Source:The Journal of Emergency Medicine
Author(s): Kurt E. Schapira, Eric Tomich




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IJERPH, Vol. 13, Pages 1230: Disadvantaged Social Groups and the Cigarette Epidemic: Limits of the Diffusion of Innovations Vision

The original four-stage model of the cigarette epidemic has been extended with diffusion of innovations theory to reflect socio-economic differences in cigarette use. Recently, two revisions of the model have been proposed: (1) separate analysis of the epidemic stages for men and women, in order to improve generalization to developing countries, and; (2) addition of a fifth stage to the smoking epidemic, in order to account for the persistence of smoking in disadvantaged social groups. By developing a cohort perspective spanning a 35-year time period in France and the USA, we uncover distinctive features which challenge the currently held vision on the evolution of smoking inequalities within the framework of the cigarette epidemic. We argue that the reason for which the model may not be fit to the lower educated is that the imitation mechanism underlying the diffusion of innovations works well with regard to adoption of the habit, but is much less relevant with regard to its rejection. Based on those observations, we support the idea that the nature and timing of the epidemic differs enough to treat the stages separately for high and low education groups, and discuss policy implications.

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IJERPH, Vol. 13, Pages 1229: The Role of Soundscape in Nature-Based Rehabilitation: A Patient Perspective

Nature-based rehabilitation (NBR) has convincing support in research, yet the underlying mechanisms are not fully understood. The present study sought to increase understanding of the role of soundscapes in NBR, an aspect paid little attention thus far. Transcribed interviews with 59 patients suffering from stress-related mental disorders and undergoing a 12-week therapy programme in the rehabilitation garden in Alnarp, Sweden, were analysed using Interpretative Phenomenology Analysis (IPA). Described sounds were categorised as natural, technological or human. The results showed that patients frequently referred to natural sounds as being part of a pleasant and “quiet” experience that supported recovery and induced “soft fascination”. Technological sounds were experienced as disturbing, while perception of human sounds varied depending on loudness and the social context. The study further uncovered how sound influenced patients’ behaviour and experiences in the garden, through examination of three cross-theme dimensions that materialised in the study; sound in relation to overall perception, sound in relation to garden usage, and increased susceptibility to sound. The findings are discussed in relation to NBR; the need for a more nuanced understanding of susceptibility to sound among people suffering from mental fatigue was identified and design considerations for future rehabilitation gardens were formulated.

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IJERPH, Vol. 13, Pages 1228: Facilitators and Barriers of Smokers’ Compliance with Smoking Bans in Public Places: A Systematic Review of Quantitative and Qualitative Literature

Background: Environmental tobacco smoke (ETS) exposure is associated with an increased risk of many diseases. Many countries have ratified a national smoking ban in public places, but studies on factors related to smoking issues in public places post-ban are lacking. Aim: To identify facilitators and barriers that influenced smokers’ compliance with smoking bans in public places. Methods: Using PubMed, MEDLINE, and the Web of Science database, we conducted a systematic search of English articles published before June 2015 on factors of smokers’ compliance with the smoking bans in public places. Results: A total of 390 references were identified, among which seventeen articles (twelve quantitative studies, two qualitative studies, three mixed-method studies) were included in this review. These studies focused on four types of public places including recreational venues (n = 7), hospital (n = 5), school (n = 4), and workplace (n = 1). Factors at the  individual-, interpersonal-, and organizational-level were identified: at the individual level, nicotine dependence, insufficiency of tobacco-related knowledge, and the negative attitudes towards smoking bans were the most commonly identified barriers; at the interpersonal level, the smoking behaviors of people around, close relatives, and friends’ approval were the main barriers; and at the organizational level, the main barriers were inefficient implementation of the bans and the inconvenience of the designative smoking areas. Conclusions: This synthesis of the literature provided evidence of the identified barriers and facilitators of smokers’ compliance with the smoking bans. It will be beneficial for the policy-maker to consider interventions on multiple levels of factors to overcome the barriers and enhance smokers’ compliance with the smoking bans in public places.

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Edible Camphor-induced Histopathological Changes in Hippocampus and Cerebral Cortex Following Oral Administration into Rats

2016-12-10T15-20-04Z
Source: Journal of Interdisciplinary Histopathology
Oluwatobi T Somade, Damilola M. Ogunberu, Toyin T. Fakayode, Adeola O. Animashaun.
Introduction: Raw edible camphor (EC), and as component of herbal infusions are widely used to treat pile, back pain, erectile dysfunction, and as an aphrodisiac especially in preparation for sexual intercourse by men. It has been traced in umbilical cord, blood, fetal, adipose, and other tissues including brain, where it bioaccumulates. Methods: The study, therefore, investigated the possible histopathological changes in brain, heart, and spleen that may result following EC administration in rats. Thirty animals were used for the study and were divided into six groups of five rats each. Group I animals served as normal control, Group II animals served as vehicle control and were orally administered 6 mL/kg corn oil daily for 7 days, while Groups III-VI animals were orally administered 1, 2, 4, and 6 g/kg EC for 7 days daily. Results and Conclusions: Following the administrations of various doses of EC, the histopathological changes seen in the cerebral cortex of the brain include mild submeningeal spongiosis, mild diffuse spongiosis of the parenchyma, a very mild diffuse gliosis, and presences of gitter cells, while in hippocampus, there were mild diffuse gliosis and disruption of the progression of the hippocampal horns, as well as foci of spongiosis around the hippocampal horns, and neuronal cells have open faced nuclei. No effect was seen in heart and spleen except 4 g/kg of EC that revealed moderate diffuse congestion in spleen only. In conclusion, EC may not have any toxic effects on the cardiac and splenic cells, but had toxic effects on the brain hippocampus and cerebral cortex, and may lead to brain cell damage.


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