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Spädbarnskolik är ett vanligt hälsoproblem. När ett barn lider av kolik är detta oftast påfrestande för barnets föräldrar. Dessa föräldrar upplever ofta oro, trötthet och en känsla av hjälplöshet, vilket kan påverka relationen mellan barnet och föräldrarna negativt och öka barnets skrikande. Känslor av frustration och ilska, vilka kan upplevas av trötta och stressade föräldrar, ökar risken för att föräldrar ska skaka eller ta hårt i barnet, vilket kan leda till att barn får allvarliga skador. BHV-sjuksköterskor är viktiga aktörer inom barnahälsovården och det är av stor vikt att de effektivt hjälper och stödjer föräldrar till barn med kolik. Syftet med denna studie är att undersöka vilket stöd och vilken hjälp föräldrar till barn med kolik önskar sig från BHV-sjuksköterskor. Denna studie utfördes som en systematisk litteraturstudie. För studien valdes nio vetenskapliga artiklar ut. De utvalda artiklarna är från Sverige, Norge, USA och Sydafrika. Bland de utvalda artiklarna är sju artiklar med kvalitativ metod och två har utförts med blandad metod med kvalitativa intervjuer och deskriptiv statistik. Samtliga utvalda artiklar belyser föräldraperspektivet, med avseende på spädbarnskolik. Studiens resultat visar att förståelse och stöd från vårdpersonal har stor betydelse för föräldrar, för att de ska kunna klara av att hantera den svåra kolikperioden. Föräldrar önskar ofta att sjuksköterskor erbjuder systematisk rådgivning och systematisk uppföljning samt att barnets tillstånd undersöks noggrant. Flertalet föräldrar är även intresserade av att få information om metoder med bristande evidens. Det framgick i studien att sjuksköterskor kan misslyckas med att hjälpa familjer med kolik på grund av att sjuksköterskor kan se annorlunda på kolikproblemet än föräldrarna själva eller att föräldrar kan ifrågasätta sjuksköterskors kompetens vad gäller kolikhantering. Ett annat hinder kan vara att föräldrarnas förmåga att acceptera stöd kan vara försämrad på grund av bland annat social isolering. Resultaten av denna studie tyder även på att kolikdiagnosen kan upplevas både som positiv och negativ av föräldrar och att när spädbarnskolik ibland normaliseras av vårdpersonal kan detta upplevas som negativt av föräldrar. En viktig poäng som framgick i studien, är att föräldrar till barn med kolik har olika behov och kan uppskatta olika typer av stöd och av andra vårdinsatser. Utifrån studiens resultat är det viktigt att sjuksköterskor och annan vårdpersonal alltid lyssnar på föräldrar, bemöter föräldraperspektivet och anpassar alla vårdinsatser utifrån föräldrars individuella behov.

Introduction: Inconsolable infant fussing and/or crying is a common reason for parent´s to seek help with professionals and is a cause of great stress within the family. Aim: To produce and evaluate a leaflet about infantile colic and elucidate how parents experienced their child’s colic period. Method: The study was based on a descriptive survey containing thirteen open questions assessing parents’ experiences of the colic period and the support from the Child Health Care (CHC) nurse. The questions also addressed the design and content of the leaflet. Ten mothers completed the survey and the results were analysed using qualitative content analysis. Results: The main theme found was; “The infantile colic overshadowed everything – and created feelings of insufficiency in the parenting role”. Seven categories were identified; Wessel’s definition of infantile colic agreed, Sleep- and breastfeeding experiences, Thought´s about the colic period, Strong emotions developed during the colic period, Coping strategies, Support and advice, Content in the information brochure.   Conclusion: Infantile colic effected the entire family, caused crisis and strong feelings such as powerlessness when nothing would calm or ease the baby´s cry. The feeling of being insufficient would create problems with the attachment to the baby. The CHC nurse should support the family members and strengthen them in their ability to cope with their baby´s cry. The leaflet “Infantile colic – the infant´s cry the first months in life” could reduce parents’ self-accusation and feelings of insufficiency. It could help parents´ attain a sense of control over the situation and encourage the development of a secure attachment. The leaflet will be corrected with advice of using a diary to elucidate the time of crying. It will also contain information about the risk of shaken baby syndrome.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Medicine in Diagnostic Radiology Johannesburg, 2017 / INTRODUCTION: Intussusceptions may cause significant morbidity and mortality if not treated timeously. One method of conservative management is pneumatic reduction, the outcome of which is dependent on a number of factors. AIM: To determine the proportion of children with intussusception who have evidence of bowel obstruction on initial abdominal radiograph, and the failure rate of pneumatic reduction in patients with and without bowel obstruction. The study also looked into whether there were any associations between the radiological presence or absence of bowel obstruction and pneumatic reduction outcome, the finding of necrotic bowel at surgery, and CRP and WCC levels. METHOD: A retrospective study was performed using an existent paediatric surgery intussusception database. Three different readers read the baseline abdominal radiographs and subjectively determined whether bowel obstruction was present or not. Treatment choices, outcomes of the pneumatic reduction, and if available, clinical presentation and lab results were captured from the patient’s discharge summary and NHLS portal. RESULTS: A sample size of 45 patients was studied. The median age of presentation was 7 months, with 83% of the patients having had symptoms for 3 days or less. 80% of patients had bowel obstruction on initial X-ray, and of these patients, only 17% had successful pneumatic reduction. No significant association was found between bowel obstruction and the presence/absence of necrotic bowel. 64% had their symptoms documented, and only 26 % and 42 % had CRP and WCC documented respectively, which did not meet sample size requirements. CONCLUSIONS: Even though a strong association was shown between evidence of bowel obstruction and pneumatic reduction outcome, the sample study was too small to make between-group comparisons. Due to this limitation, it is recommended that further investigation be done, possibly by including patients from other South African tertiary hospitals in order to obtain statistically significant results. / MT2018

Diss. (sammanfattning). Uppsala : Sveriges lantbruksuniv. / Härtill 5 uppsatser.

Horses are at high risk to develop systemic inflammation due to the release of bacterial endotoxin from an inflamed gastrointestinal tract. Neutrophils are critical for mounting an immune response to bacterial endotoxins. Neutrophil activation following engagement of bacterial endotoxin expands their lifespan through suppression of their constitutive apoptosis. The prolonged lifespan of neutrophils propagates acute inflammation and delays the resolution of inflammation. Since equine neutrophil lifespan has not been well-studied, I investigated the occurrence of equine neutrophil apoptosis in vitro and in vivo. First, I investigated the effect of Escherichia coli lipopolysaccharide (LPS) treatment on the occurrence of equine neutrophil apoptosis in vitro. LPS treatment delayed in vitro equine neutrophil apoptosis in a dose-dependent manner at concentrations of 0.1-10 μg/ml through toll-like receptor (TLR)-4 signaling and down-regulation of the intrinsic pathway of apoptosis, specifically through reduced caspase-9 activity. Next, I found that ex vivo neutrophil apoptosis was delayed in two models of intestinal inflammation, jejunal ischemia and reperfusion (IR) and oligofructose-induced colitis, through down-regulation of both the intrinsic and extrinsic apoptosis pathways via reduced caspase-3, -8, and -9 activities. Pulmonary intravascular macrophages (PIMs) depletion with systemic gadolinium chloride (GC) prevented the prolongation of ex vivo neutrophil lifespan in horses undergoing jejunal IR through modulation of caspase-3, -8 and -9 activities. PIM depletion in IR horses resulted in an earlier and greater increase in tumor necrosis factor-alpha and a concomitant decrease in interleukin-10 to suggest an enhanced systemic pro-inflammatory response. I examined the effect of neutrophil concentration and co-incubation with aged, apoptotic neutrophils on the occurrence of neutrophil apoptosis in vitro. Neutrophil apoptosis was delayed with increasing concentrations of neutrophils in vitro, which may contribute to delayed neutrophil apoptosis in systemic inflammation. However, co-incubation with aged, apoptotic neutrophils did not alter in vitro neutrophil lifespan. Taken together, the data show that LPS delays equine neutrophils apoptosis in vitro in a TLR4-dependent manner through inhibition of caspase-9. Ex vivo neutrophil apoptosis was also delayed with systemic inflammation via down-regulation of caspase activity. A novel finding of this work was the reversal of delayed neutrophil apoptosis by depletion of PIMs in horses experiencing intestinal IR.

Systemic hydration, plasma electrolytes, ingesta and fecal hydration and gastrointestinal passage of cobalt (after CoEDTA administration via nasogastric tube) in horses fed large grain meals or treated with enteral fluid therapy, IV fluid therapy and enteral laxatives were investigated. In the first study, 0.9% NaCl (10 L/h/8h) was administered slowly via a small-bore nasogastric tube or as 10 L boluses via a large-bore nasogastric tube to four normal horses. In the other studies, horses with a right dorsal colon fistula were used. To create the right dorsal colon fistula, a cannula with 5 cm internal diameter was implanted 2 to 6 weeks after a right dorsal colopexy had been created. Six horses with the right dorsal colostomy were alternately used to test three feeding regimes for 48 h: 1- hay free choice; 2- hay free choice plus 4.5 kg of sweet feed twice daily after a period of 5 days of adaptation; 3- sudden change from hay to hay plus sweet feed. Seven horses with the right dorsal colostomy were alternately used to test 6 experimental conditions while fasted for 24 h: 1- control (no treatment), 2- enteral MgSO4 (1 g/kg), 3- enteral Na2SO4 (1 g/kg), 4- IV lactated Ringer's solution (5 L/h/12 h), 5- enteral water (5 L/h/12 h), 6- enteral electrolyte solution (5 L/h/12 h). In the last study, four horses with the right dorsal colostomy were alternately treated with enteral electrolyte solution (10 L/h/6h) and enteral MgSO4 (1 g/kg) plus IV fluid therapy (10 L/h/6h). Despite the administration regimen, enteral administration of 0.9% NaCl produced diarrhea, hypernatremia and hyperchloremia. Colostomy allowed serial collection of large ingesta samples. Grain ingestion did not change PCV or plasma protein, but affected plasma electrolytes and produced dehydration of ingesta and formation of frothy ingesta. Fasting delayed gastrointestinal transit. Enteral fluid therapy was the most effective treatment in promoting ingesta hydration. Enteral water, MgSO4, Na2SO4, IV fluid therapy and enteral MgSO4 plus IV fluid therapy were either ineffective in promoting ingesta hydration or produced marked plasma electrolyte imbalance. These findings support the use of enteral fluid therapy in horses with gastrointestinal impaction. / Ph. D.

The temporal organization underlying durational components of naturally occurring infant cries was examined in 46 1-month-old infants, half of whom had been diagnosed as having colic. In a standard 90-sec crying bout for each infant, the presence or absence of expired cry sound was determined at .05-sec intervals. Binary spectrum analysis of the data detected between 8 and 23 reliable cycles in the expiration of sound in the cries of all infants. The data were characterized by a wide range of individual differences in the frequencies at which these cycles occurred and in other characteristics of the spectra. Although infants with and without colic did not reliably differ in the mean, variability, or range of the durations of expirations or bursts, the two groups were distinguished by their distributions of the total number of peaks in the power spectrum and by the frequencies at which the highest power peak, slowest cycle, and fastest cycle occurred. This study provides the first known systematic examination of the rhythmicities underlying infant crying. / Master of Science

Le but de notre travail a été d’évaluer l’effet de la réduction de la dose d’irradiation en TDM multibarrette quant à la performance diagnostique, la confiance de l’observateur dans le diagnostic proposé, la capacité à suggérer un diagnostic alternatif dans quelques pathologies courantes et/ou caractérisées par des situations de faibles contrastes entre les structures anatomiques normales ou pathologiques. Nous avons donc comparé ces paramètres entre des TDM à doses réduites et à doses standard telles que couramment rapportées dans la littérature dans les circonstances suivantes : • La suspicion clinique de colique néphrétique: le contraste naturel élevé du calcium avec les structures voisines suggère de pouvoir réduire fortement la dose, dans une pathologie potentiellement récidivante et qui intéresse des patients jeunes dont le pronostic est excellent. Notre étude a montré qu’une dose 10 fois inférieure à celle générée par des examens TDM courants permet des performances diagnostiques semblables à la TDM à dose conventionnelle. • La suspicion clinique de sinusite chronique: le contraste naturel élevé entre l’air des cavités sinusales, la muqueuse nasale et les os de la face permet de réduire fortement la dose, dans cette pathologie potentiellement récidivante et qui intéresse des patients jeunes dont le pronostic est excellent. Notre étude a montré qu’une dose 10 à 25 fois inférieure à celle générée par des examens TDM courants, et dès lors inférieure à celle générée par quatre incidences radiographiques, permet des performances diagnostiques semblables à la TDM à dose conventionnelle. • La suspicion clinique d’appendicite aiguë: L’appendice est situé dans une atmosphère anatomique caractérisée par un faible contraste entre les structures. Néanmoins, comme l’appendicite est une pathologie qui concerne l’adolescent et l’adulte jeune, nous avons tenté de réduire la dose des TDM dans ce contexte. Notre étude a montré qu’une dose 3 à 10 fois inférieure à celle générée par des examens TDM courants, et dès lors inférieure à celle générée par trois incidences radiographiques, permet des performances diagnostiques semblables à la TDM à dose conventionnelle. • La suspicion clinique de diverticulite aiguë du colon: la diverticulite aiguë du colon est également caractérisée par une atmosphère anatomique de faible contraste entre les structures. Néanmoins, comme cette pathologie peut concerner l’adulte jeune et récidiver, nous avons tenté de réduire la dose des TDM dans ce contexte. Notre étude a montré qu’une dose 3 à 10 fois inférieure à celle générée par des examens TDM courants, permet des performances diagnostiques semblables à la TDM à dose conventionnelle. • Le diagnostic d’embolie pulmonaire aiguë: la TDM spiralée occupe une position centrale dans le diagnostic d’embolie pulmonaire aiguë mais impose l’injection intraveineuse de produit de contraste iodé. La comparaison d’images obtenues à des doses variables d’irradiation a nécessité leur traitement à posteriori pour simuler la réduction de dose. Notre étude a montré qu’une dose 9 fois inférieure à celle générée par des examens TDM conventionnels permet des performances diagnostiques semblables. Ces investigations ont été complétées par l’investigation de l’influence du genre, de l’indice de masse corporelle et de l’âge sur la modulation automatique du courant au tube radiogène (6). Cette investigation a montré que la modulation automatique ne réduit la dose d’irradiation que d’au plus 20% avec peu ou pas de différence en fonction du genre, de l’âge ou de l’indice de masse corporel des patients ; indiquant ainsi qu’elle ne pouvait pas remplacer la réduction de la charge volontaire de l’opérateur.

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / It is estimated over 20 million people aged 20‐74 have gallbladder disease, with biliary colic being a common and painful symptom in these patients. Likely due to the relatively recent approval of intravenous ibuprofen use for fever and pain in adults, no assessment of its analgesic efficacy for biliary colic currently exists in the literature. In this double‐blind, randomized, controlled trial we aim to assess the analgesic efficacy of intravenous (IV) ibuprofen given in the emergency department (ED) for the treatment of biliary colic. Analgesic efficacy was evaluated using a visual analog scale (VAS) to assess for a decrease in pain scores. A VAS score decrease of 33% in relation to the VAS taken at the time of therapy drug administration was considered a minimum clinically important difference (MCID) in patient‐perceived pain. A VAS was administered in triage upon enrollment, at the time of therapy administration, at 15‐minute intervals during the first hour post‐administration, and 30‐minute intervals in the second hour. As the standard of care for suspected biliary colic at the study institution is administration of a one‐time dose of IV morphine, patients were not denied initial morphine analgesia and were permitted to receive “rescue” morphine analgesia at any point during their ED course. A total of 22 patients completed the study. 9 were randomized to the IV ibuprofen arm, 9 to placebo, and 4 were excluded for a diagnosis other than biliary colic. Mean VAS values at time 0 to time 120 decreased from 5.78 to 2.31 in the ibuprofen group, and from 5.89 to 2.67 in the control group. There was no statistically significant difference in treatment status of ibuprofen vs. placebo (p‐value (p.) 0.93), though there was a significant decrease in the measured VAS scores over time (0 minutes to 120 minutes, p.0.031) in both ibuprofen and placebo groups. A statistically significant and clinically important decrease in average VAS scores were seen in both placebo and ibuprofen groups (55% and 60%, respectively). There was no difference in time needed to achieve a clinically significant reduction in pain between groups. The sample size of this study may be inadequate to fully assess the analgesic efficacy of IV ibuprofen for biliary colic. In the analysis group (n=18) no significant difference in treatment status of ibuprofen vs. placebo was seen, however there was a statistically and clinically significant decrease in pain in both groups. Two potential confounding factors may have affected the trial’s results: administration of standard‐of‐care IV morphine following initial triage assessment, and the inherent episodic and self‐limited nature of biliary colic.