Aspiration Test Research Articles

408. Evaluation of the negative predictive value of the SARS-CoV-2 PCR respiratory assays in asymptomatic children undergoing surgery

BackgroundUniversal pre-operative screening with SARS-CoV-2 PCR has been adopted by institutions to mitigate risk to healthcare workers (HCW) during aerosol-generating procedures such as intubation. However, there remains uncertainty regarding rates of false negative results and optimal sampling type. The objective was to determine the reliability of single, pre-operative SARS-CoV-2 testing from the nasopharynx in children undergoing general anesthesia.MethodsChildren < 18 years of age who underwent intubation for a procedure received pre-operative testing 24–48 hours prior with a nasopharyngeal (NP) swab or wash, in conjunction with intra-operative nasal wash (NW) and tracheal aspirate (TA) sampling. All paired samples underwent testing using the Simplexa DiaSorin platform or a modified Centers for Disease Control assay. Cohen’s Kappa was used for interrater reliability of each sample result. McNemar’s Test was used to compare result proportions by sample type. Positive and negative predictive values (PPV, NPV) were calculated based on the intraoperative NW as the reference standard. Analyses were conducted using SAS (v 9.4).ResultsWe collected full sample sets from 364 children from April 14 to May 15; 66% of pre-operative samples were NP swabs. The median age was 6 years (IQR 2,13), 55% were male, 68% were white and 41% of children had a high-risk comorbidity. Most surgeries were conducted by general surgery (23%), followed by orthopedics (19%). Only 2.5% of children had respiratory symptoms, and 4.8% had a documented fever within a week of the procedure. SARS-CoV-2 positive samples occurred in 4/364 (1%) of pre-operative samples, 8/363 (2.2%) of intra-operative samples, and 8/348 (2.3%) of TA samples. The pre-operative test had 100% PPV and 99% NPV, and the TA had 100% PPV and 98.6% NPV (Table 1). There was very good agreement (Figure) between pre- and intraoperative upper respiratory sampling, with a Kappa of 0.66, (95% CI 0.35–0.97). There was no statistical difference in results by sample type.Table 1. Comparison of intra-operative and pre-operative nasopharyngeal sample results, test characteristics and test concordance Table 2. Comparison of intra-operative nasopharyngeal and tracheal aspirate sample results, test characteristics and test concordance Figure 1 Percent agreement between pre-operative and intra-operative samples ConclusionThere is a high PPV and NPV of pre-operative SARS-CoV-2 PCR testing among children undergoing anesthesia. These data can help inform guidelines regarding appropriate precautions for HCW performing high risk procedures in asymptomatic pediatric patients.Disclosures Suchitra Rao, MD, BioFire (Grant/Research Support) Samuel Dominguez, MD, PhD, BioFire (Consultant, Research Grant or Support)

Microbiological Testing of Gastric Aspirate Improves the Diagnosis of Pulmonary Tuberculosis in Unconscious Adults with TB Meningitis.

Conventional sputum collection for TB diagnosis is difficult in TB meningitis patients since most of them are admitted with decreased consciousness. It is assumed that unconscious patients swallow their sputum; therefore, gastric aspiration can replace sputum collection in unconscious patients. A prospective study was conducted to see whether examining gastric aspirate could increase the diagnosis certainty of pulmonary TB in such subjects. The inclusion criteria were age 18–60 years, decreased level of consciousness, and use of a nasogastric tube. Subjects who had taken antituberculosis drugs for more than 3 days were excluded. Gastric lavage was performed in the morning after an overnight fast. Specimens were examined for direct smear, culture, and rapid molecular testing. Demographic, clinical, chest X-ray, and laboratory data were also recorded. During the study period, 31 subjects were available. The positivity rates for microbiological tests were 19.3%, 41.9%, and 48.4% for smear, culture, and rapid molecular testing, respectively. All positive smears were confirmed by either culture or rapid molecular testing. Gastric lavage can be considered a tool for improving extraneural TB diagnosis in unconscious patients.

Small-bowel aspiration during upper esophagogastroduodenoscopy: Rao technique.

Small-bowel aspiration during upper esophagogastroduodenoscopy: Rao technique.

Similar Molecular Pattern in Therapy Related Acute Myeloid Leukemia in Patients Treated with Purp Inhibitors for Metastatic Ovarian Cancer

Poly(adenosine diphosphate-ribose) polymerase (PARP) inhibitors exploit defects in DNA repair to induce tumor-selective damage, in fact PARP inhibition can lead to the accumulation of DNA double strand breaks in neoplastic cells sparing normal ones. Olaparib (AZD2281; KU-0059436) is a novel, orally active PARP inhibitor that induces synthetic lethality in homozygous BRCA-deficient cells. It is indicated for the maintenance treatment of adult patients with recurrent epithelial ovarian, fallopian tube or primary peritoneal cancer, who are in a complete or partial response to platinum-based chemotherapy. Overall in clinical trials, the incidence of Myelodysplastic Syndrome/Acute Myeloid Leukemia (MDS/AML) in patients treated with Olaparib monotherapy, including long-term follow up, was &amp;lt;1.5% and the majority of events had a fatal outcome. The duration of therapy with Olaparib in patients who developed secondary MDS/cancer-therapy related AML varied from &amp;lt; 6 months to &amp;gt; 2 years. All of these patients had received previous chemotherapy with platinum agents and/or other DNA damaging agents including radiotherapy. Here we describe 5 consecutive patients affected by metastatic ovarian cancer BRCA+ treated after chemotherapy with PURPi who developed therapy-related AML (sAML) in our center in a short period between June 2019 and July 2020. Patients'characteristics: Median age at ovarian cancer diagnosis was 49y (range 45-53), the median number of chemotherapy lines before PURPi treatment was 4 (range 3-5), the median interval between PURPi treatment and the onset of sAML was 22 months (range 18-24). Four out of 5 patients were submitted to Olaparib administration and one to Niraparib. At the onset of cytopenia all patients were submitted to bone marrow aspiration, molecular and cytogenetic tests; in all cases the diagnosis was of sAML according to WHO classification. Cytogenetic analysis was not evaluable in 1 out 5 patients, in the other cases we discovered: 1) a complex karyotype including chromosome 17 deletion, 2) -5q and -7q, 3) -5q and 4) normal karyotype. None of them had recurrent molecular alterations including NPM1 mutations or FLT3-ITD, but when we analysed subclonal mutations we found that in 4 of them TP53 mutations were recurrent (1 one patient'analysis is still ongoing). We found the following TP53 mutations: c.376-1G&amp;gt;A (splice acceptor), c.78delT, c.524G&amp;gt;A (in two patients). The median variant allelic frequency was 25%. In two of them we were able to study the ovarian tissue collected at cancer diagnosis and the TP53 mutations were not present. This is the first report which describes subclonal mutations in sAML developing after PURP inhibitor therapy In conclusion therapy-related AML is a well described complication of chemotherapy and our patients had exposure to chemotherapy and therefore had higher risk for developing leukemia from exposure to chemotherapy and PARP inhibitors. In the natural history of the ovarian cancer, patients might be exposed to leukemogenic therapies which may have an additive effect and increase the risk of developing AML during PURP inhibitors' therapy. Molecular mechanism undergoing this complications, including mutations of TP53, should be further investigated. Disclosures Sica: F. Hoffmann-La Roche Ltd:Other: All authors received support for third-party writing assistance, furnished by Scott Battle, PhD, provided by F. Hoffmann-La Roche, Basel, Switzerland., Research Funding.

Development of pure red cell aplasia by transmission and persistent infection of parvovirus B19 through a kidney allograft

We report a case of pure red cell aplasia (PRCA) caused by parvovirus B19 (PVB19) infection, which was transmitted through a kidney allograft. The patient underwent a living-donor kidney transplant from his wife at the age of 60. Despite successful engraftment with a normal creatinine level, he developed severe anemia that required frequent blood transfusions 2months after transplantation. Renal anemia was unlikely as his serum erythropoietin level was extremely high. A bone marrow aspiration test demonstrated the existence of large proerythroblasts. Although anti-PVB19 IgM antibody levels were not increased, polymerase chain reaction (PCR) detected PVB19 DNA in his serum. Thus, he was diagnosed as having PRCA induced by PVB19 infection. PCR analysis of total DNA isolated from 0-hour biopsy sections showed the existence of PVB19 DNA. Furthermore, PVB19 proteins was detected on renal tubules of 0-hour allograft by immunoperoxidase staining. Thus, transmission of PVB19 through the allograft was confirmed. A single course of intravenous immunoglobulin (IVIG) therapy resulted in substantial improvement; however, the effect was limited, and severe anemia relapsed after 5-6months. Several courses of IVIG with adjustment of immunosuppressive drugs resulted in long-term remission. Our case demonstrates that donor-transmitted PVB19 infection should be suspected in kidney transplant recipients who develop refractory anemia during the early post-operative phase.

Critical Care Guidance for Tracheostomy Care During the COVID-19 Pandemic: A Global, Multidisciplinary Approach.

Critical care nurses caring for patients with a tracheostomy are at high risk because of the predilection of SARS-CoV-2 for respiratory and mucosal surfaces. This review identifies patient-centered practices that ensure safety and reduce risk of infection transmission to health care workers during the coronavirus disease 2019 (COVID-19) pandemic. Consensus statements, guidelines, institutional recommendations, and scientific literature on COVID-19 and previous outbreaks were reviewed. A global interdisciplinary team analyzed and prioritized findings via electronic communications and video conferences to develop consensus recommendations. Aerosol-generating procedures are commonly performed by nurses and other health care workers, most notably during suctioning, tracheostomy tube changes, and stoma care. Patient repositioning, readjusting circuits, administering nebulized medications, and patient transport also present risks. Standard personal protective equipment includes an N95/FFP3 mask with or without surgical masks, gloves, goggles, and gown when performing aerosol-generating procedures for patients with known or suspected COVID-19. Viral testing of bronchial aspirate via tracheostomy may inform care providers when determining the protective equipment required. The need for protocols to reduce risk of transmission of infection to nurses and other health care workers is evident. Critical care nurses and multidisciplinary teams often care for patients with a tracheostomy who are known or suspected to have COVID-19. Appropriate care of these patients relies on safeguarding the health care team. The practices described in this review may greatly reduce risk of infectious transmission.

Small Intestinal Bacterial Overgrowth (SIBO): Result of Altered Defensive Mechanism in Gastrointestinal – A Review

Small intestinal bacterial overgrowth (SIBO) is a condition that is characterized by an increased number of bacteria in the small intestine or an existence of bacteria type that generally should not be in the small intestine. In SIBO, the number of bacteria found in culture was more than 105 CFU (Colony-Forming unit) per ml. The fundamental problem in which SIBO occurred was the disruption in defensive mechanisms to prevent bacteria from overgrowing, including gastric acid juice, intestine motility, competent immune function, and intact anatomy. Disruption of this defensive mechanism will lead to SIBO, which furthermore will result in not only mild complications, such as abdominal complaints, but also severe complications, such as maldigestion/malabsorption, nutrient deficiency, or even systemic infection and acidosis. The manifestations of SIBO were often unclear so that it is hard to distinguish with other diseases, which much lead to misdiagnosis or underdiagnosis. Diagnosis of SIBO should be conducted very meticulously regarding underlying diseases that resulted in gastrointestinal defensive mechanism disturbance and malassimilation syndrome. Additional examinations for SIBO currently were jejunal aspiration and breath test, but both of them had their limitations in sensitivity and specificity. Therapeutical management consisted of treating the underlying diseases, eradicating bacteria with the antibiotic, particularly rifaximin, and improving nutritional deficiency.

A pervasive review on biomarker in cervical intraepithelial lesions and carcinoma

Basically, medical diagnosis problems are the most effective component of treatment policies. Recently, significant advances have been formed in medical diagnosis fields using data mining techniques. Data mining or Knowledge Discovery is searching large databases to discover patterns and evaluate the probability of next occurrences. In this research, Bayesian Classifier is used as a Non-linear datamining tool to determine the seriousness of breast cancer. The recorded observations of the Fine Needle Aspiration (FNA) tests that are obtained at the University of Wisconsin are considered as experimental data set in this research. The Tabu search algorithm for structural learning of Bayesian classifier and Genie simulator for parametric learning of Bayesian classifier were used. Finally, the obtained results by the proposed model were compared with actual results. The comparison process indicates that seriousness of the disease in 86.18% of cases are guessed very close to the actual values by proposed model.Â

Contribution of fine needle aspiration and auramine tests in diagnosis of Tuberculosis lymphadenitis at Kigali University Teaching Hospital (CHUK), Rwanda

Background&#x0D; Tuberculosis (TB) is an infection caused by Mycobacterium tuberculosis. Tuberculosis affects mainly the lungs but other organs of the body are involved. TB lymphadenitis is most common in extrapulmonary TB. Lymphadenitis is the infection or inflammation of the lymph nodes which are essential in immune response of the body.&#x0D; Objective&#x0D; To evaluate the contribution of fine needle aspiration (FNA) and auramine tests in the diagnosis of TB lymphadenitis.&#x0D; Methods&#x0D; Smears from lymph node aspirates were prepared. Air-dried smears were stained by auramine staining for AFB examination and Diff-Quick staining cytological technique to detect malignant cells and other pathology. The slides were examined by laboratory technologists and the pathologist.&#x0D; Results&#x0D; Results are based on a total number of 137 samples; 58 (42.33%) cases were auramine positive for TB lymphadenitis while other 79 (57.67%) suspected cases were non TB lymphadenitis. Necrotizing lymphadenitis, granulomatous lymphadenitis, chronic lymphadenitis, acute lymphadenitis and reactive lymphadenitis represented 21.19%; 13.14%; 1.42%; 2.19%; and 19.71% respectively.&#x0D; Conclusion&#x0D; The use of auramine test and FNA cytology should be considered as useful in the diagnosis of tuberculosis lymphadenitis. These techniques are less expensive, quick, safe and show low complication rate.&#x0D; Keywords: TB lymphadenitis; fine needle aspiration; auramine test

What is the exact definition of stone dust? An in vitro evaluation.

To propose a size-related definition of stone dust produced by lithotripsy of urinary stones. Stone dust was defined as particles small enough to adhere to the following criteria: (1) spontaneous floating under 40cm H2O irrigation pressure; (2) mean sedimentation time of > 2s through 10cm saline solution; (3) fully suitable for aspiration through a 3.6F working channel. Irrigation, sedimentation, and aspiration tests were set up to evaluate each criterion. Primary outcome was particle size limit agreeing with all three criteria. Stone particles with a given size limit (≤ 2mm, ≤ 1mm, ≤ 500µm, ≤ 250µm, ≤ 125µm and ≤ 63µm) were obtained from laser lithotripsy, including samples from prevailing stone types: calcium oxalate monohydrate, calcium oxalate dihydrate, uric acid, carbapatite, struvite, brushite, and cystine. All particles ≤ 250µm from all stone types were in agreement with all three criteria defining stone dust, except for struvite where size limit for a positive irrigation and sedimentation test was ≤ 125µm. A size limit of ≤ 250µm seems to generally adhere to our definition of stone dust, which is based on floating and sedimentation proprieties of stone particles, as well as on the ability to be fully aspirated through the working channel of a flexible ureteroscope.

Diagnosis and Prognosis Value of Bone Marrow Aspirate Detection for the Bone Marrow Involvement in Non-Hodgkin's Lymphoma Patients

To compare and evaluate the sensitivity, specificity, and prognostic value of various assays for bone marrow involvement in patients with non-Hodgkin's lymphoma (NHL). A total of 351 patients with NHL who underwent concurrent bone marrow biopsy in Third Hospital of Peking University from January 2013 to November 2017 were selected. Bone marrow biopsy (BMB), flow cytometry (FCM), gene rearrangement detection, and bone marrow morphology examination were performed for evaluation of bone marrow involvement. Bone marrow biopsy was used as the gold standard, the sensitivity and specificity of FCM, gene rearrangement and bone marrow morphology of bone marrow aspirate were analyzed, and their ROC curves were drawn. In the survival analysis of 77 patients with NHL, the overall survival (OS) time, progression-free survival (PFS) time, and complete remission rate (CRR) were counted. The survival of patients in the FCM positive group, the gene rearrangement positive group, the positive control group (BMB positive group) and the negative control group were compared. The detection rate of flow cytometry and gene rearrangement of bone marrow aspirate both were higher than that of bone marrow biopsy and bone marrow morphological examination, showing better diagnostic efficacy. The sensitivity of the combined method of flow cytometry and gene rearrangement was 82.5%, while the specificity was 90% and the AUC was 0.863. The gene rearrangement detection of bone marrow aspirate possessed the role suggesting the poor prognosis for NHL patients. The 3-year survival rate of patients in the gene rearrangement-positive group (RG group) was lower than that of patients in the no-bone involvement group (All negative group) (P＜0.05). Although the survival curve of patient in RG group was not significantly different from that of patients in All negative group (P＜0.1), it still showed a poor prognosis for NHL patients. And the significance of predicting death risk was reflected in Cox regression model (P＜0.05). There was no statistical difference in the prognosis of patients in the FCM-positive group (FCM group). In the bone marrow aspirate tests, flow cytometry and gene rearrangement detection have good diagnostic efficiency, and gene rearrangement can suggest the prognosis of patients. The combined detection efficacy of two methods is better.

Esophageal Clearance in Laryngopharyngeal Reflux Disease: Correlation of Reflux Scintigraphy and 24-hour Impedance/pH in a Cohort of Refractory Symptomatic Patients

Objectives:The role of gastroesophageal reflux disease (GERD) in the aetiology of laryngopharyngeal reflux (LPR) is poorly understood and remains a controversial issue. The 24-hour impedance monitoring has shown promise in the evaluation of LPR but is problematic in pharyngeal recording. We have shown the utility of scintigraphic studies in the detection of LPR and lung aspiration of refluxate. Correlative studies were obtained in patients with a strong history of LPR and severe GERD.Methods:A highly selected sequential cohort of patients with a high pre-test probability of LPR/severe GERD who had failed maximal medical therapy were evaluated with 24-hour impedance/pH, manometry and scintigraphic reflux studies.Results:The study group comprised 34 patients (15 M, 19 F) with a mean age of 56 years (range: 28-80 years). The majority had LPR symptoms (mainly cough) in 31 and severe GERD in 3. Impedance bolus clearance and pH studies were abnormal in all patients in the upright and supine position. A high rate of non-acid GERD was detected by impedance monitoring. LOS tone and ineffective oesophageal clearance were found in the majority of patients. Scintigraphic studies showed strong correlations with impedance, pH and manometric abnormalities, with 10 patients showing pulmonary aspiration.Conclusion:Scintigraphic studies appear to be a good screening test for LPR and pulmonary aspiration as there is direct visualisation of tracer at these sites. Impedance studies highlight the importance of non-acidic reflux and bolus clearance in the causation of cough and may allow the development of a risk profile for pulmonary aspiration of refluxate.

Prospective safety evaluation of automated iomeprol 400 injections for CT through peripheral venous cannulas

To evaluate prospectively the safety of contrast medium injection through standard peripheral intravenous cannulas at standard injection sites during clinical routine using iomeprol 400, a contrast agent with high viscosity. Three thousand, five hundred and fourteen clinical CT examinations undertaken at Saarland University Medical Center were included in this prospective observational trial. The size and site of the cannula as well as the contrast medium injection rate and volume were assessed for each patient. In addition, the ability to aspirate blood though the cannula and the occurrence of complications, such as extravasation or abortion of injection by the automated injector, were recorded. The overall complication rate was 30/3,514 (0.85%). With 22 G cannulas, the complication rate was 8/541 (1.48%) applying flow rates of 1-3.5 ml/s (mean 2.1 ml/s). With 20 G cannulas, complications occurred in 21/2,601 cases (0.81%) with flow rates of 1.5-5 ml/s (mean 3 ml/s). The complication rate using 18 G cannulas was 1/377 (0.26%) for flow rates of 2-6 ml/s (mean 3.5 ml/s). No relationship between the site and size of the cannula to the occurrence of complications was found. The inability to aspirate blood correlated with the development of extravasation. The injection of contrast agent using standard peripheral venous cannulas is a safe and reliable procedure yielding diagnostic image contrast, even when using highly viscous contrast agents such as iomeprol 400; an aspiration test should be performed before each injection.

Evidence of altered mucosa-associated and fecal microbiota composition in patients with Irritable Bowel Syndrome

Altered bacterial composition and small intestinal bacterial overgrowth (SIBO) may be associated with irritable bowel syndrome (IBS). This study aimed to determine the fecal and mucosa-associated bacterial composition along the gastrointestinal (GI) tract and to assess SIBO in IBS. Bacterial composition of feces, and mucosa of the duodenum and sigmoid colon was determined by 16S rRNA-amplicon-sequencing. SIBO was evaluated by bacterial culture of duodenal aspirate, glucose and lactulose breath tests. Mucosal antibacterial gene expression was assessed by PCR Array. The bacterial profiles of feces and the mucosa of sigmoid colon, but not duodenum, differed between IBS patients (n = 17) and HS (n = 20). The IBS specific bacterial profiles were linked to the colonic antibacterial gene expression. Fecal bacterial profile differed between IBS subtypes, while the mucosa-associated bacterial profile was associated with IBS symptom severity and breath tests results at baseline (H2 and/or CH4 ≥ 15 ppm). The prevalence of SIBO was similar between IBS patients and HS. This study demonstrates that alterations in the bacterial composition of the sigmoid colon of IBS patients were linked to symptoms and immune activation. While breath tests reflected the mucosa-associated bacterial composition, there was no evidence for high prevalence of SIBO or small intestinal bacterial alterations in IBS.

Intrauterine Insemination- Can we make it more successful?

The success rate of Intrauterine Insemination (IUI) to a great extent depends on the selection of the cohort of women undergoing the procedure. IUI is found to be beneficial in cases of unexplained infertility, unilateral tubal block or patients having early endometriosis with good tubo-ovarian relation. When ovulation stimulation with gonadotropins is undertaken success rate of IUI increases further. It is definitely helpful in younger patients but with advanced age the success rate declines. Usually the group of women more than 35years of age have been seen to be unfavourable with the procedure. [1] Overall success rate of IUI is not more than 20% even in best hands. In some highly selected cases where Post-coital Cervical Mucus and Intra-uterine Aspirate Test (PCT-IUA) proves poor sperm entry, IUI may be beneficial and pregnancy rate goes upto 40-45%. [2] In case of good sperm entry there is about 60% spontaneous conception and IUI is of limited value with only 2% success rate. [2] [3]

649. Prospective Validation of an 11-mRNA Host Immune Signature as a Novel Blood Test for Acute Septic Arthritis

BackgroundSeptic arthritis is an orthopedic emergency requiring immediate surgical intervention. Joint aspirations detect inflammatory cells within hours but often cannot distinguish between infections (e.g., bacterial) or other causes (e.g., gout). Cultures take days, so decisions about surgery are made with incomplete data. Aspirations carry risk and require technical skill and advanced imaging. Novel diagnostics are thus needed. An 11-mRNA host immune blood signature has been validated to distinguish between infectious and noninfectious acute inflammation. It is part of the 29-mRNA HostDx™ Sepsis test that can also distinguish between bacterial and viral infections and predicts severity (currently under development as a rapid point-of-care test). We studied whether the 11-mRNA signature can determine if acute arthritis was due to an infectious cause.MethodsWe conducted a blinded, prospective, noninterventional study on patients undergoing workup for a septic primary joint. Patients received standard-of-care including joint aspiration and lab tests: White Blood Cells (WBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and joint fluid analysis. Simultaneously, blood was drawn (PAXgene RNA tubes). mRNAs were measured on NanoString nCounter™ blinded to clinical results.Results20 patients were included, of which 10 had infections based on positive synovial fluid cultures. The 11-mRNA blood signature had an area under the ROC curve (AUROC) of 0.87 for separating infectious from noninfectious conditions compared with 0.58 (ESR), 0.60 (CRP), and 0.50 (WBC); AUROC for synovial WBC was 0.54. At 100% sensitivity for infection, specificity of the signature was 40%; thus, a substantial fraction of nonseptic patients could have been ruled out for further surgical intervention.ConclusionThe 11-mRNA signature showed markedly increased accuracy in predicting septic joints compared with routine diagnostic markers. As a quick point-of-care test this blood RNA signature may be an important tool for early, accurate identification of acute septic joints and need for emergent surgery, thereby improving clinical care and healthcare spending. These findings further add to the generalizability of results obtained in the HostDx Sepsis test.Disclosures All authors: No reported disclosures.

3248 SIBO and Gastroparesis: Downstream Effects of Diabetes

INTRODUCTION: Homeostasis of the GI mucosal environment depends on gut motility and normal gastric acid secretion. The autonomic nervous system plays an important role in these processes. Diabetes has been shown to injure the enteric nervous system, resulting in slowed motility. Gastroparesis and small intestinal bacterial overgrowth are two consequences of the enteric injury associated with diabetes. CASE DESCRIPTION/METHODS: A 23-year-old male with type 1 diabetes presented with 6 months of diffuse abdominal pain and diarrhea, which had recently worsened. He noted 4-6 loose bowel movements daily and vomiting after food. He had previously been seen by gastroenterology and had an unremarkable colonoscopy, EGD, and celiac testing. He had been trialed on rifaximin and neomycin, which improved his symptoms for a short period. He tried eluxadoline with little effect. On presentation, he was hemodynamically stable with labs significant only for mildly elevated AST (58 units/L). WBC, ESR, CRP, feces ova and parasites, and C. difficile Ag were all unremarkable. A gastric emptying study revealed moderate (24%) gastroparesis. A right upper quadrant ultrasound was unremarkable. Small intestinal bacterial overgrowth related to gastroparesis was suspected. A trial of rifaximin and metoclopramide improved his symptoms leading to empiric diagnosis of SIBO. DISCUSSION: Small intestinal bacterial overgrowth occurs when the normal homeostatic mechanisms that control bacterial populations are in some way disrupted. Frequently, this occurs with decreased gastric acid secretion or dysmotility of the small intestine. The most common symptoms of SIBO include bloating, abdominal discomfort and distention, chronic diarrhea, weight loss, and malabsorption. One proposed theory for SIBO in gastroparesis is the idea that phase 3 migratory motor complexes may be diminished in frequency or altogether absent. While the gold standard for diagnosis requires jejunal aspirate, lactulose and glucose breath testing have been used as indirect measures of SIBO. Multiple studies have been done to analyze the relationship between gastroparesis and SIBO with results showing up to 60-70% of study participants with gastroparesis test positive for SIBO via lactulose breath testing. Once the diagnosis of SIBO has been established, the goal of therapy is to correct the underlying cause, provide nutritional support, and treat overgrowth with a course of antibiotics.

The Feasibility Study of a Revised Standard Care Procedure on the Capacity of Nasogastric Tube Placement Verification Among Critical Care Nurses.

ABSTRACTBackgroundEvidence-based studies propose that the aspirate pH test may be easily and reliably conducted to verify the proper placement of nasogastric tubes (NGTs). Nurses rarely implement this procedure because of the lack of related knowledge.PurposeThe purpose of this study was to explore the feasibility of implementing a revised standard care procedure to enhance nurses' ability to verify placement of the NGT.Methodshis study used a quasi-experimental, longitudinal research design. Nurses from two intensive care units were randomly assigned to the experimental group (n = 35) and the control group (n = 31). A revised standard-of-care procedure to confirm the proper placement of an NGT was incorporated into a slideshow presentation, a printed leaflet, and an audit checklist. The experimental group received continuous education and individual teaching on the revised standard-of-care procedure, whereas the control group did not receive additional education and continued to provide conventional care. The study gathered data using scales designed to address knowledge of and attitudes toward verification of NGT placement and the checklist for auditing the NGT care procedure. Scales were implemented before and after the practice program was conducted, in Months 1, 2, and 3, to evaluate the feasibility of the developed improvement measures.ResultsThis study found significant improvements in the experimental group in terms of knowledge regarding NGT placement verification and the NGT care auditing procedure. The positive improvement of the intervention on the NGT care auditing procedure remained for at least 3 months after the end of the intervention.ConclusionsThe findings suggest that using an aspirate pH test is a feasible approach to verify NGT placement in critical care units, a crucial aspect of care necessary to promote patient safety and quality of care.

A STUDY ON LEVEL OF EDUCATIONAL ASPIRATIONS AMONG 2ND YEAR STUDENTS OF B.ED. COLLEGES IN MYSORE CITY, INDIA

This present study was conducted on “A study on Level of Educational Aspiration among 2 nd year students of B.Ed. colleges in Mysore city”, INDIA. The researcher work smoothly and confine the study to specific frame work, the objectives of the study were; to study the level of educational aspirations among 2 nd year students of B.Ed. colleges in Mysore city, to study The significance difference among the following categories with reference to Educational Aspiration: a) Gender (male and female), b) Locality (Urban and Rural), c) Socio-economic Status (high/low socio economic status); d) Types of schools (Government, Private Aided and Private Unaided). Main variables of the study were Educational Aspiration and background variables were Gender, Locality, Socio-economic status and Types of schools. The study was conducted by using Descriptive Survey research methodology to find the degree to which the interaction affect exists among the selected variables. Population of the study was 2 nd year students of B.Ed. colleges belonging to Government, Private aided and private unaided colleges in Mysore city, Mysore District, Karnataka State. The sample for the study was selected using the proportionate stratified random sampling techniques. The proportion of the sample was selected according to Daryle W. Morgan’s table. In Mysore city there are 37 B.Ed. colleges. According to Morgan’s table 10 colleges were selected out of 37 through lottery system. To collect the required data from the sample of 242 students of B.Ed. colleges the researcher used standard tool “Level of Education Aspiration Test” by Dr. Yasmin Ghani Khan. The research findings were; there is significant difference between male and female of 2 nd year students of B.Ed. colleges’ in Mysore city with respect to their Levels of Educational Aspiration, no significant difference seen between urban and rural with respect to their Levels of Educational Aspiration among 2 nd year students of B.Ed. colleges in Mysore city, there is significant difference between high and low socio economic status of 2 nd year students of B.Ed. colleges in Mysore city with respect to their Levels of Educational Aspiration and no significant difference between Government, private aided and private unaided B.Ed. colleges in Mysore city with respect to their Levels of Educational Aspiration. The study recommends the needs to investigate separately the educational aspiration, vocational aspiration and economic aspiration etc. of B.Ed. colleges’ students and factors determining them in order to have a better understanding of the children and help them to guide in the right direction without losing the most precious resource. Further research may be planned and conducted on the same. Article visualizations:

Incidence of Differentiated Thyroid Carcinoma in Multinodular Goitre Patients in Western UP

Background The prevalence of multinodular goitre in all over the world is high, commonly in developing countries. Incidence of differentiated thyroid carcinoma among patients with multinodular goitre is increased in recent literature. Aim of Study To determine the incidence rate of differentiated thyroid carcinoma among patients with multinodular goitre. Patients and Method This study is a cross sectional study carried out in Surgical Ward of Saraswati Institute Of Medical Sciences,Hapur, during the period from September 2016 to July 2017 on convenient sample of 60 patients with multinodular goitre. Clinical history and examination, fine needle aspiration and postoperative histopathology examination was done to confirm the diagnosis. Results Mean age of patients was 43.9 years, with 5 males and 55 females. Fine needle aspiration test showed that 13 (21.7%) multinodular goitre patients had differentiated thyroid carcinoma, while 47 (78.3%) patients had benign goitre. The histopathology of multinodular goitre patients revealed that 41.7% of them had colloid goitre, 16.7% of them had micro-papillary carcinoma and 38.3% of them had follicular adenoma. Differentiated thyroid carcinoma among multinodular goitre patients was significantly associated with smoking and exposure to ionizing radiation. Conclusions The incidence of differentiated thyroid carcinoma among multinodular goitre patients is high.