Background and aim : Straining during bowel movements (BMs) is a common in constipation but has been relatively understudied as a modifiable therapeutic target. This study aimed to characterize patient perceptions, behaviors, and beliefs surrounding straining. Methods: Adults with self-reported constipation were recruited nationwide via an online research panel (Cint USA, Inc.). Participants completed a structured survey assessing symptoms, toileting behaviors, attitudes, and beliefs related to straining. Results : A total of 124 participants with self-reported constipation completed the survey with 54.0% reporting constipation for >1 year, and 8.1% met Rome IV criteria for chronic constipation. Straining in at least 25% of BM was common (49.6%), but only moderately effective (mean helpfulness score 5.3 ± 2.6 on 10-point scale). Despite only 23% expressing concern about long-term consequences of straining, 75.0% would like to reduce straining. Participants who strained during more than 50% of BMs demonstrated significantly longer toilet sitting times (p = 0.031), were more likely to attempt defecation in the absence of urge (p = 0.026), and reported more acute physiological symptoms of straining (p < 0.001). No differences were observed between frequent and infrequent strainers in perceived helpfulness of straining or concern about long-term effects. Conclusion : Straining is a common and burdensome symptom, but not very helpful in producing BM. Most participants showed interest in interventions to reduce straining. These findings highlight an important opportunity to advance treatment approaches that address straining as a modifiable component of constipation, informed by both psychological drivers and defecatory mechanics.
BACKGROUND:Acetaminophen overdose remains one of the leading causes of both intentional and unintentional medication-related liver injury and acute liver failure in both adults and children. Although N-acetylcysteine remains the standard of care and is highly effective when administered early, massive ingestions and delayed presentation cases may exceed its ability to prevent hepatocellular injury. Fomepizole, a CYP2E1 inhibitor traditionally used for toxic alcohol poisoning, has emerged as a potential adjunctive therapy for high-risk acetaminophen overdoses. OBJECTIVE:This article reviews the mechanism of action of acetaminophen, the pathophysiology of acetaminophen-induced hepatotoxicity, outlines current management strategies, and examines the emerging role of fomepizole as an adjunctive therapy. Added focus is given to implications for nursing practice, including safe preparation, administration, and monitoring. SUMMARY:Acetaminophen toxicity develops when glutathione stores become depleted, leading to accumulation of the toxic metabolite N-acetyl-p-benzoquinone imine. N-acetylcysteine replenishes glutathione and mitigates early injury; however, extremely high acetaminophen concentrations can overwhelm detoxification pathways. Fomepizole inhibits CYP2E1 and reduces conversion of acetaminophen to N-acetyl-p-benzoquinone imine, potentially limiting hepatic damage. Evidence from animal studies and small human case series suggests benefit in massive ingestions, although large, randomized-controlled trials are lacking. IMPLICATIONS:Further research is needed to establish and standardize protocols and further clarify the role of fomepizole in the management of acetaminophen overdose cases.
Heart failure (HF) remains a leading cause of global mortality. Remote ischemic conditioning (RIC), a non-invasive technique involving brief episodes of non-lethal limb ischemia and reperfusion, has been investigated as a potential cardioprotective and vascular-conditioning strategy, but its role in chronic HF remains uncertain. This review evaluated the effect of RIC on cardiac biomarkers, coronary microcirculation, left ventricular function, hemodynamics, functional capacity, safety, and clinical outcomes in adults with chronic HF irrespective of etiology. PubMed, Embase, CENTRAL, Web of Science, Scopus, and CINAHL were searched from inception through August 2026 without language restrictions; ClinicalTrials.gov, WHO ICTRP, conference literature, and citation searching were also examined. After deduplication, 966 records were screened. Eight completed studies with outcome data were identified, including seven independent studies with peer-reviewed full-text reports and one abstract-only study, encompassing 215 patients with HF. Small studies reported numerical reductions in BNP/NT-proBNP and selected favorable microvascular, hemodynamic, and ventricular-function findings; however, objective exercise-capacity outcomes were predominantly neutral, and no eligible study was adequately powered to assess mortality or HF hospitalization. The evidence base is limited by small samples, heterogeneous RIC protocols, methodological limitations, risk of bias, and reliance on surrogate endpoints. RIC remains investigational, and larger sham-controlled multicenter trials using contemporary guideline-directed medical therapy and patient-important outcomes are required.
Pancreatic ductal adenocarcinoma (PDAC) is a highly aggressive malignancy that frequently presents at an advanced stage. This report describes a case involving a middle-aged male who initially presented with a localised tumour in the pancreatic head accompanied by obstructive symptoms. While he received inpatient management with intravenous fluid hydration, parenteral nutrition and endoscopic stent placement, he subsequently developed an acute abdomen characterised by peritoneal signs. Surgical exploration revealed extensive peritoneal carcinomatosis within 3 weeks, with bowel involvement devoid of necrotic changes. Molecular analysis identified a KRAS G12D mutation and homozygous deletion of the CDKN2A/B tumour suppressor genes. This case exemplifies a hyper-aggressive PDAC phenotype with fatal outcomes, termed 'flash carcinomatosis', whereby tumour biology substantially exceeded standard diagnostic timelines, resulting in a highly truncated course culminating in mortality.
Multiple sclerosis (MS) can present with a wide range of symptoms in affected individuals. We report the case of a 56-year-old African-American woman with a history of hypertension who was admitted to the hospital due to persistent generalized weakness and intermittent seizures. According to her son, these symptoms began after starting antihypertensive therapy. She had experienced multiple hospital admissions for intermittent weakness and received treatment for a UTI and ruptured acute appendicitis. During one admission, she was prescribed Keppra at a dose of 500 mg twice daily. However, her symptoms persisted with no significant improvement, leading to an increased Keppra dosage of 750 mg twice daily. Imaging studies, including CT scans from all admissions, showed chronic ischemic changes but no acute abnormalities. An EEG was normal, but an MRI of the head and cervical spine revealed lesions characteristic of MS, including white matter inflammation, demyelination, and scarring. Her symptoms resolved following treatment with a 500 mg pulse dose of steroids for an MS exacerbation. This case highlights that effective seizure management often improves with appropriate treatment of the underlying disease. Once MS was identified and treated, her seizures resolved, and she continued on 750 mg of Keppra.
