Prime pubmed iceberg phenomenon journal articles from pubmed anoxia meaning

Constipation is a common childhood condition that health professionals will encounter in many different settings. The majority of these cases of childhood constipation are idiopathic in nature. It is considered to exhibit the ‘tip of the iceberg’ phenomenon as a large number of cases remain undetected due to under-recognition by families, embarrassment regarding the condition, fear of receiving a negative response from health professionals, or parental belief there is actually something more seriously wrong and failure to accept the diagnosis. Prompt evaluation and management is likely to be associated with better outcomes. To ensure this, fast recognition of symptoms, with care taken to exclude any ‘red flag’ symptoms that could indicate an organic cause and subsequently a different treatment pathway, is essential.Anoxia meaning nurses, given their regular contact with families in different settings, are suitably placed to detect these symptoms early and can play a vital role in successful management of the condition. Laxatives are the first line in management of constipation. Polyethylene glycol 3350 is the laxative that evidence-based guidelines from the national institute for health and care excellence (2010) recommend as the initial pharmacological management. Advice should also be given about supportive measures, including diet and lifestyle changes.

West nile fever (WNF) is a zoonotic disease, occurring nearly globally. In madagascar, west nile virus (WNV) was first detected in 1978 from wild birds and the virus is currently distributed across the island, but no epidemic or epizootic period has been recorded.Anoxia meaning one fatal human case of WNV infection was reported in 2011, suggesting a tip of the iceberg phenomenon of a possible WNF epidemic/epizootic on the island. The main objective of this literature-based survey is to review patterns of WNV circulation in madagascar from the entomological and ornithological points of view. Among the 235 mosquito species described from madagascar, 29 species are widely associated with WNV infection; 16 of them are found naturally infected with WNV on the island and categorized into major, candidate, and potential vectors of WNV according to their vector capacity. This study upholds the hypothesis that WNV enzooticity is independent of annual movements of migratory birds passing through madagascar.Anoxia meaning moreover, the lack of regular migratory bird flux between africa and madagascar would reduce the probability of transmission and the subsequent reintroduction of the virus into locally occurring mosquito species. Given that palearctic migratory birds are strongly implicated in the transmission of WNV, we highlight notable differences in the movements and species diversity of these birds in madagascar as compared to eastern and northern africa. Risk factors from this two-pronged approach are presented for the emergence of WNF outbreak.

We focused mainly on the spatial variation and influencing factors of hydrogen and oxygen stable isotopes between water samples collected at the surface and different depths in the lashi lake in august, 2014.Anoxia meaning hydrological supply characteristics of the lake in typical temperate glacier region were discussed. The results showed that the values of δ¹⁸o and δd in the lashi lake ranged from -12.98 per thousand to -8.16 per thousand with the mean of -9.75 per thousand and from -99.42 per thousand to -73.78 per thousand with the mean of -82.23 per thousand, respectively. There was a reversed spatial variation between δ¹⁸o and d. Relatively low values of δ¹⁸o with high values of d were found at the edge of the lake where the rivers drained into. Meanwhile, the values of d in the vertical profile varied little with depth, suggesting that the waters mixed sufficiently in the vertical direction. The d values increased at first and then decreased from east to west at different layers, but both increase and decrease exhibited different velocities, which were related to the river distribution, the locality of the lake and environmental conditions etc.Anoxia meaning river water and atmospheric precipitation were the main recharge sources of the lashi lake, and the melt-water of snow and ice might also be the supply resource. The δ¹⁸o values of lake water in glacier region decreased along the elevation (except for lashi lake), generally, this phenomenon was called altitude effect. Moreover, high isotopic values of the lake water from non-glacier region were due to the evaporation effect.

Little is known on the natural history of crohn’s disease (CD) before diagnosis. By the time the patient is diagnosed, the disease has often produced considerable damage to the intestinal mucosa and sometimes other organs. Such period before diagnosis might involve both a silent and a symptomatic phase.Anoxia meaning the silent phase, or preclinical CD, might last several years after the biological disease onset. Evidence is accumulating that the symptomatic phase might also go undiagnosed for months or years. In fact, for each established case of CD, there are probably several undiagnosed cases, a classic iceberg phenomenon of disease. Such status quo–lagging behind diagnostic standards for many other diseases–effectively hampers efforts to block disease evolution and the development of complications. This is no longer tenable because CD is a debilitating, severe, and costly affection, whose incidence is rapidly rising worldwide. Here, we will review what is currently known on preclinical and undiagnosed CD and what could be done to improve accuracy and timeliness of diagnosis.Anoxia meaning

There is an increasing body of evidence that drainage of lumbar cerebrospinal fluid (CSF) improves functional neurological outcome after reperfusion injury to the spinal cord that occasionally follows aortic reconstructive surgery. This beneficial effect is considered owing to lowering of the CSF pressure thereby normalising spinal cord blood flow and reducing the ‘secondary’ cord injury caused by vascular congestion and cord swelling in the relatively confined spinal canal. Whilst lacking definitive proof, there are convincing randomised controlled trials (rcts), cohort data and systematic reviews supporting this intervention. The therapeutic window for lumbar CSF drainage requires further elucidation; however, it appears to be days rather than hours post insult.Anoxia meaning we contend that the same benefit is likely to be achieved following other primary spinal cord injuries that cause cord swelling and elicit the ‘secondary’ injury. Traditionally the concept of CSF drainage has been considered more applicable to the brain as contained in a ‘closed box’ by lowering intracranial pressure (ICP) to improve cerebral perfusion pressure (CPP). The control of CPP is intended to limit ‘secondary’ brain injury and is a key concept of brain injury management. Using microdialysis in the spinal cords of trauma patients, it has been shown that intraspinal pressure (ISP) needs to be kept below 20 mmhg and spinal cord perfusion pressure (SCPP) above 70 mmhg to avoid biochemical evidence of secondary cord damage.Anoxia meaning vasopressor have also been used in spinal cord injury to improve perfusion, however complications are common, typically cardiac in nature, and require very careful monitoring; the evidence supporting this approach is notably less convincing. Decompression illness (DCI) of the spinal cord is treated with recompression, hyperbaric oxygen, various medications designed to reduce the inflammatory response and fluid administration to normalise blood pressure and haematocrit. These management protocols are based largely on anecdote and transferred evidence from conventional cord trauma, as the low numbers and sporadic nature of DCI in divers makes rcts nigh on impossible. Unfortunately even with best management, some patients are left with significant neurological deficit.Anoxia meaning the ‘iceberg phenomenon’, occurs when patients with DCI of the cord make a good neurological recovery but actually have profound cord damage as revealed in one case some four years later at post mortem and another example in a diver who developed late functional deterioration due to loss of neuronal reserve. This clinical evidence, together with animal study data, support the notion that even a modest preservation of spinal cord axons is associated with significant improvement in neurological outcome. In the light of the positive level two evidence in the vascular literature that CSF drainage limits ‘secondary’ injury thereby improving neurological outcome, we propose that centres with appropriate clinical experience consider using lumbar CSF drainage to normalise SCPP, as an adjunct to the conventional treatment of severe spinal cord DCI.Anoxia meaning divers with severe spinal cord DCI are generally in the most productive years of their lives and, given the potentially devastating impact of this condition, should be given the benefit of any possible adjuvant treatment that may serve to improve long-term outcome. New search next