Patients with poorly controlled diabetes mellitus have an increased risk of lower limb infection and gangrene. In Malaysia, they frequently present late and are often in septic shock with multi-organ dysfunction. We report on two patients who presented for lower limb amputation in a desperate attempt to control sepsis and save their lives. Both patients were classified as ASA 5. Both patients had successfully undergone surgery under low dose unilateral spinal anaesthesia. The anaesthetic management of these critically ill patients in view of limited resources is discussed.
We adapted a previous protocol to assess children's ability to spontaneously associate a novel cause with a novel emotional expression. An experimenter opened a series of boxes and generated an expression based on what was inside (the cause of the emotion). Participants (4- to 9-year-olds; N = 72) guessed what the experimenter saw from four possible objects linked to four expressions: stickers (happy), a broken balloon (sad), a spider (scared), and a novel object, pax (novel puffed cheeks expression). Children were then invited to open a series of boxes and generate expressions for the experimenter. Results suggest that children used a process of elimination to associate the novel pax object with the puffed cheeks expression. Some children also re-produced the puffed cheeks expression in a later task. As a final trial, when children were asked how people would feel when seeing the pax object, younger children tended to use positive labels and older children used negative labels. These results show that children are able to quickly associate novel facial expressions with precipitating events as early as 4 years of age, comparable to their performance in linking familiar expressions and objects.
Polymorphism of the beta2-adrenergic receptor (beta2 AR) gene is an important determinant of the function of this receptor. It affects receptor down-regulation and beta2-agonist responses. It has also been a focus of interest in attempts to elucidate the genetic basis of asthma, hypertension, obesity and cystic fibrosis. Several different techniques have been established to determine beta2 AR genotypes but none of these methods are simple enough to detect simultaneously all the five alleles of our research interest (Arg16/Gly16, -20T/C, Gln27/Glu27, -47T/C and Thr164/Ile164).