Although the variations in brachial artery branching patterns are commonly observed, only 3.75% exhibit a high ulnar artery variation1. An even fewer number present with a bilateral superficial ulnar artery, as was reported by Fadel and Amonoo-Kuofi2. The compounding variations of a high bifurcation of the brachial artery and a superficial ulnar artery may be asymptomatic, but demonstrate important clinical significance in relation to accidental intra-arterial injections, errors in blood pressure readings, as well as orthopedic, plastic and vascular surgeries of the upper limbs1. This study aims to expand upon previous literature and provide additional insight to the field of clinical anatomy, while educating physicians of the possible presentations and potentially severe risks associated with these variations.
Background and Review of Literature: Postoperative nausea and vomiting (PONV) is one of the most common patient complications following general anesthesia. Recent literature supports the practice of supplemental intravenous fluid administration to patients receiving general anesthesia with no risk of fluid volume overload.
Purpose: The purpose of this DNP project was to assess the overall occurrence of PONV and to determine if patients who experienced PONV after receiving general anesthesia, were administered supplemental intravenous fluids during the intraoperative period.
Methods: The project consisted of a retrospective chart review. A total of 342 electronic health records (EHRs) were reviewed and 57 patients were included in the DNP project.
Implementation Plan: A project site was identified; a retrospective chart review was conducted, examining one month of patient EHRs who underwent general anesthesia. Data was collected and analyzed via Microsoft Excel, which included the amount of intravenous fluids received during the intraoperative period, weight, gender, surgical procedure, and ASA physical status.
Implications/Conclusions: At the completion of the retrospective chart review, it was discovered that 57 (17%) out of 342 patients who underwent general anesthesia were treated for PONV. Of the 57 patients, 50 (88%) did not receive intraoperative supplemental intravenous fluids. Only 7 (12%) patients received greater than 15mL/kg of intravenous fluid during the intraoperative period.
Atlantoaxial instability (AAI) is a term that is used to describe instability at the atlantoaxial joint of the cervical spine. This is often from alar ligament instability causing the dens of the axis to be prone to move posterior or sublux. The inferior
portion of the medulla oblongata and the superior portion of the spinal cord can be compressed by the posterior movement of the dens causing lifethreatening effects. In this presentation, a surgical therapy to atlantoaxial instability will be examined for the purpose of educating future medical students. We will specifically be examining AAI with spina-bifida occulta at C1
The spread of antibiotic resistance among bacteria is a potential threat to the effectiveness of antibiotics currently used for controlling common human pathogens. Also, the resistance to current antibiotics is spreading at a relatively high rate and is becoming prevalent in many environments. Therefore, survey of multidrug resistant bacteria (MDR) and distribution of types of antibiotic resistance genes (ARGs) in natural environments is urgently needed. Here, we investigated the presence of MDR bacteria in a lake situated in Nina Mason Pulliam Ecolab (NMPE), a 55 acre natural prairie wetland ecosystem. The lake overflows into the nearby White River which winds through the City of Indianapolis making EcoLab an important urban wetland conservation area. In this study, the presence of natural antibiotic resistance bacteria (ARB) in lake water was screened using 20 currently used antibiotics, for example, penicillin, ciprofloxacin, erythromycin, trimethoprim, tetracycline, sulfamethoxazole, gentamicin etc. Three replicate water samples from 6 sites were collected to enumerate resistant bacteria in the lake bacterial community. Preliminary results confirm the presence of multidrug resistance bacteria in the lake water. Currently, we plan to investigate the “resistome” (antibiotic resistance gene pool) of Ecolab aquatic environments using specific primers and probes. An additional aim is to explore possible mechanisms of resistance emergence to these antibiotics using techniques such as replica plating, the Luria-Delbrück Fluctuation Test, the Newcombe Test, and the 16S rRNA sequencing. This study provides a baseline understanding of the urban freshwater ecosystem and quantitatively examines the level of resistance emergence which may be crucial in the spread of MDR in the Greater Indianapolis Area.
Bone morphogenetic proteins (BMPs) constitute the largest subdivision of the TGF-? family of ligands and are unequivocally involved in regulating stem cell behavior. Appropriate regulation of canonical BMP signaling is critical for the development and homeostasis of numerous human organ systems, as aberrations in the BMP pathway or its regulation are increasingly associated with diverse human pathologies. In this review, we provide a wide-perspective on strategies that increase or decrease BMP signaling. We briefly outline the current FDA-approved approaches, highlight emerging next-generation technologies, and postulate prospective avenues for future investigation. We also detail how activating other pathways may indirectly modulate BMP signaling, with a particular emphasis on the relationship between the BMP and Activin/TGF-? pathways.