Impact of Enteral Tube Feeding Compared to Oral Hand Feeding on Mortality, Pneumonia, Hospitalization and Quality of Life in Patients With Advanced Dementia: A Review

Objectives To assess the effectiveness of enteral tube feeding in comparison to oral hand feeding in improving survival, hospitalization, pneumonia incidence, and quality of life in adults 60 years and older with advanced dementia. Methods PubMed, CINAHL, Cochrane Library, and Academic Search Premier, supplemented by hand-searching, were probed for articles published between January 2006-June 2020. Eligible articles compared clinical outcomes (mortality, survival, pneumonia, hospitalization, and quality of life) amongst patients 60 years and older with advanced dementia, fed via an enteral tube or oral hand-feeding route. Of the 53 articles screened and assessed, 4 cohort studies involving 508 patients were extracted after excluding based on the above criteria and summarized for this review. Results Of the 4 articles, 3 were prospective cohort studies and 1 was a retrospective cohort study. Half of the studies reported significantly increased rates of mortality in groups of advanced dementia patients fed via enteral tube. Meanwhile, 1 study reported a similar nonsignificant increase in mortality rates in those fed via oral hand route. Half of the studies indicated a nonsignificant increase in hospitalization frequency for those fed via enteral tube. Additionally, 1 study reported an increased risk of pneumonia in patients fed via nasogastric tube. Regarding quality of life, 1 article reported significantly increased complaints of pain and discomfort from patients fed via oral hand feeding, that severity of dementia may have contributed to. Conclusions Concerning clinical outcomes and mortality, these findings suggest no significant advantage to using enteral tube feeding options in older patients with advanced dementia. Thus, the healthcare professional should place primary emphasis on the patient's advance directives and provide the primary caregiver a thorough review of feeding options. Funding Sources None.

Effect of Ketamine/Propofol Admixture on Peri-Induction Hemodynamics: A Systematic Review and Meta-Analysis

To evaluate the effectiveness of an admixture of ketamine and propofol on peri-induction hemodynamics during airway manipulation, we searched electronic databases of randomized controlled trials from January 1, 2000, to October 17, 2018. Trial screening, selection, and data extraction were done independently by two reviewers with outcomes pooled across included trials using the random-effects model. We included 10 randomized trials (722 patients, mean age of 53.99 years, 39.96% female). American Society of Anesthesiologists physical status was reported in 9 trials with classes I and II representing the majority. Ketamine/propofol admixture was associated with a nonsignificant increase in heart rate (weighted mean difference, 3.36 beats per minute (95% CI, −0.88, 7.60), I2 = 88.6%), a statistically significant increase in systolic blood pressure (weighted mean difference, 9.67 mmHg (95% CI, 1.48, 17.86), I2 = 87.2%), a nonsignificant increase in diastolic blood pressure (weighted mean difference, 2.18 mmHg (95% CI, −2.82, 7.19), I2 = 73.1%), and a nonsignificant increase in mean arterial pressure (weighted mean difference, 3.28 mmHg (95% CI, −0.94, 7.49), I2 = 69.9%) compared to other agents. The risk of bias was high and the certainty of evidence was low. In conclusion, among patients undergoing airway manipulation and needing sedation, the use of a ketamine/propofol admixture may be associated with better hemodynamics compared to nonketamine/propofol sedation. This trial is registered with CRD42019125725.

DNA Methylation Changes Induced by Cold in Psychrophilic and Psychrotolerant Naganishia Yeast Species

The involvement of DNA methylation in the response to cold stress of two different yeast species (Naganishia antarctica, psychrophilic, and Naganishia albida, psychrotolerant), exhibiting different temperature aptitudes, has been studied. Consecutive incubations at respective optimum temperatures, at 4 °C (cold stress) and at optimum temperatures again, were performed. After Methylation Sensitive Amplified Polymorphism (MSAP) fingerprints a total of 550 and 423 clear and reproducible fragments were amplified from N. antarctica and N. albida strains, respectively. The two Naganishia strains showed a different response in terms of level of DNA methylation during cold stress and recovery from cold stress. The percentage of total methylated fragments in psychrophilic N. antarctica did not show any significant change. On the contrary, the methylation of psychrotolerant N. albida exhibited a nonsignificant increase during the incubation at 4 °C and continued during the recovery step, showing a significant difference if compared with control condition, resembling an uncontrolled response to cold stress. A total of 12 polymorphic fragments were selected, cloned, and sequenced. Four fragments were associated to genes encoding for elongation factor G and for chitin synthase export chaperon. To the best of our knowledge, this is the first study on DNA methylation in the response to cold stress carried out by comparing a psychrophilic and a psychrotolerant yeast species.

Safety of Prophylactic Heparin in the Prevention of Venous Thromboembolism After Spontaneous Intracerebral Hemorrhage: A Meta-analysis

Objectives Patients with spontaneous intracerebral hemorrhage (sICH) have a nearly fourfold greater risk for venous thromboembolism (VTE) than those with acute ischemic stroke, and VTE after sICH is associated with high risk for in-hospital mortality. The benefit from prophylactic heparin for VTE remains uncertain because its safety is not documented. In this study, we used an updated meta-analysis to evaluate the safety of heparin for the prevention of VTE in patients with sICH. Methods Electronic databases Medline and Embase from January 1990 to November 2017 and the Cochrane Library were searched using these keywords: intracerebral hemorrhage, stroke, hemorrhagic stroke, subarachnoid hemorrhage, heparin, heparinoids, low-molecular-weight heparin, anticoagulants, prophylactic, low dose, prevention, deep venous thrombosis, pulmonary embolism, venous thrombosis, randomized controlled trial, controlled clinical trial, and outcome. We evaluated the quality of included studies according to the bias risk in the Cochrane Handbook for Systematic Reviews of Interventions v.5.1.0. All statistical analyses were performed with RevMan v.5 software (Cochrane Collaboration, London, United Kingdom). Tests of heterogeneity were conducted with the Mantel-Haenszel method. Results Nine studies involving 4,055 patients with sICH met the inclusion criteria in this meta-analysis. Of these studies, only one met all specific criteria and had a low probability of bias, whereas eight studies met only some of the criteria and had a moderate probability of bias. In comparison with non-heparin treatments, low-molecular-weight heparin or unfractionated heparin was associated with a nonsignificant increase in any hematoma enlargement, a nonsignificant reduction in extracranial hemorrhage, a nonsignificant increase in mortality, a nonsignificant increase in the number of modified Rankin Scale scores of 3 to 5, and a nonsignificant increase in numbers of Glasgow Outcome Scale scores of 2 to 3. Conclusion Prophylactic heparin was associated with a nonsignificant increase in any hematoma enlargement and mortality, a nonsignificant reduction in extracranial hemorrhage, and a nonsignificant increase in the incidence of major disability in patients with sICH. It is probably safe to administer heparin to prevent VTE in patients with sICH.

Discontinuation of Postoperative Prophylactic Antibiotics After Noninstrumented Spinal Surgery: Results of a Quality Improvement Project

Background: Numerous medical society guidelines recommend discontinuation of antibiotics at a maximum of 24 hours after noninstrumented spinal surgery, even when a drain is left in place. As a result of these recommendations, our institution’s Neurosurgery Quality Improvement Committee decided to stop administering prolonged prophylactic systemic antibiotics (PPSAs) to patients with drains after noninstrumented spinal surgery. Methods: We retrospectively reviewed data for patients who had noninstrumented spinal surgery performed by a neurosurgeon at our institution between December 2012 and July 2014 (PPSA period) and December 2014 and July 2016 (non-PPSA period) and had a drain left in place postoperatively. In the PPSA period, patients received antibiotics until drain removal. In the non-PPSA period, patients received antibiotics for a maximum of 24 hours. Results: We identified 58 patients in the PPSA period and 55 in the non-PPSA period. Discontinuation of PPSAs resulted in a nonsignificant increase in the frequency of surgical site infections (SSIs; 0% in the PPSA period vs 4% in the non-PPSA period; P = .24). Conclusion: After discontinuing PPSAs for patients with noninstrumented spinal procedures, as is recommended for quality improvement, we saw a nonsignificant increase in our rate of SSIs. Further monitoring of this population is warranted.

Condition of Specific Immunity to Pertussis in Different Age Groups of Children

The present study of antipertussis immunity stress and level in young and school children who was vaccinated ADTP vaccine showed that on the average 28.3% of them were seronegative. The lowest parts of seronegative children were detected in the age group of infants under 12 months of age (12.3%) and in that of 15 - 17 years old teenagers (12.1%). The maximum percent of seronegative children were detected in the age group of 6 - 8 years - 38.8%. Despite the nonsignificant increase of this indicator, compared to the previous age group, it is advisable to supplement serological monitoring of indicator group 6- 7 years. The researchers did not discover the reliable correlation between the pertussis incidence in different age groups and proportion of seronegative children in those groups. The obtained results suggest that there is an occult circulation of pertussis causing agent. They also showed that it is necessary to revise the indicator age groups for serologic monitoring of antipertussis immunity.

Comparative immunologic and physiologic study of Broiler vaccinated with five different Gumboro vaccines

Two hundred and four Broiler chicks was used, divided into six equal groups, each group was vaccinated with one vaccine as fellows: BUR-706 group1 (G1), IBD-L (G2), TAD (G3), CH/80 (G4), D78 (G5) and Control (G6). ELISA test was used to estimate ND and Gumboro disease antibodies. Aspartate amino transferase (AST), Alanin amino transferase (ALT), Alkaline phosphatase (ALP) activities, total protein and albumin and globuline concentrations in blood serum were estimated. Newcastle disease antibodies titers were high in G1 but low in G5 significantly. Gumboro disease titers were nonsignificant increase(p>0.05) in G1, G2 and G3 but nonsignificant low(p>0.05) in G4 and G5. Normal total protein, albumin and globuline concentrations and nonsignificant increase(p>0.05) in AST was noticed in vaccinated groups. ALT was significantly increased(p<0.05) in G1, G3, G4 while ALP activity was significantly increased.the BUR_706 and IBDL vaccines showed better results than others in broiler chicks,whileTAD and CH/80 vaccines were better D78.

Measurement of the CO2 apneic threshold in newborn infants: possible relevance for periodic breathing and apnea

We measured the Pco2 apneic threshold in preterm and term infants. We hypothesized that, compared with adult subjects, the Pco2 apneic threshold in neonates is very close to the eupneic Pco2, likely facilitating the appearance of periodic breathing and apnea. In contrast with adults, who need to be artificially hyperventilated to switch from regular to periodic breathing, neonates do this spontaneously. We therefore measured the apneic threshold as the average alveolar Pco2 (PaCO2) of the last three breaths of regular breathing preceding the first apnea of an epoch of periodic breathing. We also measured the PaCO2 of the first three breaths of regular breathing after the last apnea of the same periodic breathing epoch. In preterm infants, eupneic PaCO2 was 38.6 ± 1.4 Torr, the preperiodic PaCO2 apneic threshold was 37.3 ± 1.4 Torr, and the postperiodic PaCO2 was 37.2 ± 1.4 Torr. In term infants, the eupneic PaCO2 was 39.7 ± 1.1 Torr, the preperiodic PaCO2 apneic threshold was 38.7 ± 1.0 Torr, and the postperiodic value was 37.9 ± 1.2 Torr. This means that the PaCO2 apneic thresholds were 1.3 ± 0.1 and 1.0 ± 0.2 Torr below eupneic PaCO2 in preterm and term infants, respectively. The transition from eupneic PaCO2 to PaCO2 apneic threshold preceding periodic breathing was accompanied by a minor and nonsignificant increase in ventilation, primarily related to a slight increase in frequency. The findings suggest that neonates breathe very close to their Pco2 apneic threshold, the overall average eupneic Pco2 being only 1.15 ± 0.2 Torr (0.95–1.79, 95% confidence interval) above the apneic threshold. This value is much lower than that reported for adult subjects (3.5 ± 0.4 Torr). We speculate that this closeness of eupneic and apneic Pco2 thresholds confers great vulnerability to the respiratory control system in neonates, because minor oscillations in breathing may bring eupneic Pco2 below threshold, causing apnea.

Assessments of flow by transcranial Doppler ultrasound in the middle cerebral artery during exercise in humans

This study examined the consistency between three indexes of cerebral blood flow (CBF) obtained by using transcranial Doppler ultrasound in eight human volunteers. Each subject undertook three sessions of graded exercise, consisting of 6 min of rest, 6 min at 20% of maximal oxygen uptake (V˙o 2 max), 6 min at 40% V˙o 2 max, and 6 min of recovery. Values were obtained every 10 ms for the velocity associated with the maximal frequency of the Doppler shift ( V P), the intensity-weighted mean velocity ( V IWM), and total signal power ( P). Beat-by-beat averages for three indexes ([Formula: see text] P,[Formula: see text] IWM,[Formula: see text]provided significantly different results for the percent changes in CBF with exercise. At 20% ofV˙o 2 max,[Formula: see text] P and[Formula: see text] IWM showed significant ( P < 0.05) increases of 8 and 6%, respectively, whereas[Formula: see text]showed a nonsignificant increase of 3%. At 40% ofV˙o 2 max,[Formula: see text] P and[Formula: see text] IWM showed significant ( P < 0.05) increases of 14 and 8%, respectively, whereas[Formula: see text]showed a nonsignificant increase of 4%. Our results suggest that the increase in CBF with exercise that has been reported with transcranial Doppler ultrasound needs to be treated with caution, as much of the response could arise as an artifact from the increase in amplitude and frequency of the arterial pressure waveform.

Enhancing Taxi Performance under Low Visibility: Are Moving Maps Enough?

We report the results of an experiment evaluating the separate and combined effects of a 3-D perspective moving map and newly developed Head-Up Display symbology on taxi performance in low visibility. Nine commercial airline pilots completed a series of gate-to-runway taxi routes at a simulated Chicago-O'Hare. Relative to a baseline condition, in which in-the-cockpit navigation support was confined to Jeppesen paper map, the 3-D moving map yielded a nonsignificant increase in taxi speed. The combination of electronic moving map and Head-Up Display yielded a considerably larger and statistically significant increase in taxi speed. These results suggest that in low visibility, Head-Up Displays can substantially improve taxi performance, over and above any improvements associated with 3-D moving maps.