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Objectives Anaphylaxis is an acute, life-threatening immediate allergic reaction caused by the sudden systemic release of mediators from mast cells. This study aims to assess the current practice of emergency management of children and adults diagnosed with anaphylaxis at the Royal Hospital, Muscat, Oman, in line with the National Institute for Health and Clinical Excellence (NICE) guidelines. Methods This is an observational retrospective study of all anaphylaxis cases seen at the emergency department (ED) from January 2013 to January 2018 and compared with the management of anaphylaxis in the ED as per the NICE guidelines. Inclusion criteria were all patients, children (age 16 and below), and adults diagnosed with anaphylaxis based on the World Allergy Organization (WAO) criteria. Exclusion criteria are all cases labeled as anaphylaxis that did not match the WAO criteria for anaphylaxis. Results Of 100 patients with a preliminary diagnosis of anaphylaxis, 49 patients (49%) were true-anaphylaxis cases based on the WAO definition 16 were children (age 16 years and below), and 33 were adults ( age 16 years and above). The other 51 patients (51%) with misdiagnosed anaphylaxis were later diagnosed with spontaneous urticaria, septic shock, vocal cord dysfunction, severe asthma, and anxiety attack. All 49 patients with true-anaphylaxis appropriately received adrenaline intramuscularly at the ED. All 16 children were admitted, seen by an allergist, and received an adrenaline auto-injector when indicated. Only 5 of the 33 adults were admitted and seen by an allergist, and 4 of those required an adrenaline auto-injector upon discharge. The remaining 28 adults were discharged from the ED, and only 3 of these were referred to the allergist. None received an adrenaline auto-injector upon discharge from the ED, and no mention in the ED notes on patient education regarding allergen avoidance. Conclusion Third of the patients who presented to ED were children (16 years), and two third were adults. Insect venom was the main reason for anaphylaxis in both age groups. There was an underutilization of adrenaline auto-injector prescriptions for adult patients. This could be very well improved by disseminating policies and guidelines to adult physicians.

International audience; Drawing on Fairness Heuristics Theory (Lind, 2001) and Cue Consistency Theory (Maheswaran & Chaiken, 1991; Slovic, 1966), we test a moderated mediation model that examines whether the institutionalization of organizational socialization tactics enhances or constrains the beneficial effects of supervisory and coworker‐referenced justice and support on newcomer role clarity and social integration. The findings of a three‐wave study of 219 French newcomers show that while institutionalized tactics strengthen the positive indirect effects of supervisory interpersonal and informational justice on role clarity, via perceived supervisor support, it also acts as a substitute that weakens the positive indirect effect of coworker‐referenced interpersonal justice on social integration, via perceived coworker support. Implications of the findings for socialization research and practice are discussed.

Refractory coeliac disease (RCD) is a rare complication of coeliac disease (CD) and involves malabsorption and villous atrophy despite adherence to a strict gluten-free diet (GFD) for at least 12 months in the absence of another cause. RCD is classified based on the T-cells in the intra-epithelial lymphocyte (IEL) morphology into type 1 with normal IEL and type 2 with aberrant IEL (clonal) by PCR (polymerase chain reaction) for T cell receptors (TCR) at the β/γ loci. RCD type 1 is managed with strict nutritional and pharmacological management. RCD type 2 can be complicated by ulcerative jejunitis or enteropathy associated lymphoma (EATL), the latter having a five-year mortality of 50%. Management options for RCD type 2 and response to treatment differs across centres and there have been debates over the best treatment option. Treatment options that have been used include azathioprine and steroids, methotrexate, cyclosporine, campath (an anti CD-52 monoclonal antibody), and cladribine or fluadribine with or without autologous stem cell transplantation. We present a tertiary centre's experience in the treatment of RCD type 2 where treatment with prednisolone and azathioprine was used, and our results show good response with histological recovery in 56.6% of treated individuals.

Au moyen d’une étude qualitative, cet article s’intéresse à l’impact de la financiarisation sur le travail des acheteurs et la gestion des relations avec les fournisseurs. L’analyse se base sur les théories de la justice organisationnelle et de l’échange social et montre que les acheteurs ne sont pas neutres face aux dispositifs et au système de significations imposés par la direction pour financiariser les relations d’achats. Les résultats indiquent que cette financiarisation crée chez eux des sentiments d’injustice distributive, procédurale, interpersonnelle et informationnelle qui les amènent à mobiliser des stratégies d’action pour développer des relations d’échange social avec les fournisseurs.

Background: Celiac disease (CD) is a lifelong disorder. Patients are at increased risk of complications and comorbidity. Objectives: We conducted a review of the literature on patient support and information in CD and aim to issue recommendations about patient information with regards to CD. Methods: Data source: We searched PubMed for English-language articles published between 1900 and June 2014, containing terms related to costs, economics of CD, or education and CD. Study selection: Papers deemed relevant by any of the participating authors were included in the study. Data synthesis: No quantitative synthesis of data was performed. Instead we formulated a consensus view of the information that should be offered to all patients with CD. Results: There are few randomized clinical trials examining the effect of patient support in CD. Patients and their families receive information from many sources. It is important that health care personnel guide the patient through the plethora of facts and comments on the Internet. An understanding of CD is likely to improve dietary adherence. Patients should be educated about current knowledge about risk factors for CD, as well as the increased risk of complications. Patients should also be advised to avoid other health hazards, such as smoking. Many patients are eager to learn about future non-dietary treatments of CD. This review also comments on novel therapies but it is important to stress that no such treatment is available at present. Conclusion: Based on mostly observational data, we suggest that patient support and information should be an integral part of the management of CD, and is likely to affect the outcome of CD.

Micro-psychological studies of corporate social responsibility (CSR) analyze employees’ responses to CSR initiatives in the workplace but not how CSR might influence their socially responsible beha...

Refractory coeliac disease (RCD) is a recognised complication, albeit very rare, of coeliac disease (CD). This condition is described when individuals with CD continue to experience enteropathy and subsequent or ongoing malabsorption despite strict adherence to a diet devoid of gluten for at least 12 months and when all other causes mimicking this condition are excluded. Depending on the T-cell morphology and T-cell receptor (TCR) clonality at the β/γ loci, RCD can be subdivided into type 1 (normal intra-epithelial lymphocyte morphology, polyclonal TCR population) and type 2 (aberrant IELs with clonal TCR). It is important to differentiate between the two types as type 1 has an 80% survival rate and is managed with strict nutritional and pharmacological management. RCD type 2 on the other hand has a 5-year mortality of 50% and can be complicated by ulcerative jejunitis or enteropathy-associated T-cell lymphoma (EATL). Management of RCD type 2 has challenged many experts, and different treatment approaches have been adopted with variable results. Some of these treatments include immunomodulation with azathioprine and steroids, methotrexate, cyclosporine, alemtuzumab (an anti CD-52 monoclonal antibody), and cladribine or fludarabine sometimes with autologous stem cell transplantation. In this article, we summarise the management approach to patients with RCD type 2.

Dear editor We read with great interest the expert opinion of Ditsatham et al1 on an extremely interesting case. Ditsatham describes a patient who presented with both appendicitis and an indirect inguinal hernia. There is very little known on the subject of concurrent appendicitis and hernia throughout the literature. There were some aspects to the history that stood out. The past medical history was particularly revealing. The patient had presented with pectus excavatum, which had been repaired by Nuss procedure. There is little information in the literature on the etiology of pectus excavatum; however, a link between the condition and connective tissue disorders has been made.2 One can infer from Redlinger et al2 that if pectus excavatum is exhibited in over two-thirds of Marfan syndrome patients, it may be linked to the connective tissue, specifically collagen. The presence of a collagen abnormality, even one that may not be synonymous with a diagnosis, can still pose certain health problems. Klinge et al3 present the link between collagen abnormalities and an increased risk of recurrent abdominal hernia. Parallels can be drawn to our patient who presented with a reducible inguinal mass 4 years prior to his described presentation. The risk of such a rare concurrent event may be increased if linked with a connective tissue disorder. Further research should be undertaken in this field to look for a causative relationship. Conditions with unusual presentation of appendicitis have been described; this paper made reference to a rare condition, Amyand hernia, named after an English surgeon. This is relevant since Amyand hernias are often misdiagnosed as a strangulated hernia, and so, the incidence of possible concurrent appendicitis and hernia is higher than reported.4 Concurrent appendicitis and other acute abdomen conditions have also been reported. Eggleston and Afzal5 describe a case of concurrent appendicitis and cecal bascule. In the case reported by Ditsatham, interest diverts to link the two conditions. Could the strangulation of appendix secondary to the traction of omentum in the hernia sac cause appendicitis? The rare presentation of these two conditions makes the viability of an observational study difficult. To conclude, it can be said that this young man may have had a mild underlying collagen abnormality that has led to an increased risk of hernia, thus increasing his 0.0009% risk of developing a concurrent appendicitis and inguinal hernia. The systemic effects of connective tissue disease need to be further explored, with particular attention being paid to the manifestations in the bowel. An important learning point highlighted by this case is that you should always be thorough with your examination and never rule out the possibility of concurrent pathology.

Dans les etudes par les Methodes du Journal Personnel (MJP), les individus reportent des evenements et des experiences a intervalles reguliers pendant une periode de temps donnee. Ces methodes sont particulierement adaptees a l’etude des evenements et des experiences de la vie quotidienne au travail puisqu’elles permettent d’integrer explicitement la dynamique temporelle et de tester les inferences causales avec plus d’acuite et de precision que les methodes de recherche traditionnelles telles que les enquetes par questionnaire. L’objectif de ce manuscrit est de presenter une synthese theorique et un guide de mise en œuvre des MJP sur la base des etats de l’art et des travaux adoptant ces methodes dans les recherches en organisations. Nous discuterons les principales caracteristiques des MJP, leurs avantages et inconvenients et nous presenterons une typologie des questions de recherche adaptees a leur utilisation, ainsi qu’un guide pratique recouvrant les etapes de mise en œuvre d’une etude par les MJP.

International audience

International audience; Cet article mobilise les recherches menées sur la socialisation organisationnelle, le soutien social et la justice organisationnelle pour explorer les interactions entre les déterminants relationnels, organisationnels et individuels de l'intégration des nouvelles recrues. Plus spécifiquement, nous examinons les effets d'interaction du soutien perçu du superviseur (PSS), des tactiques organisationnelles de socialisation, des perceptions de justice globale et de la proactivité des nouveaux arrivants sur leurs niveaux de maîtrise de la tâche, de clarté de leur rôle et de satisfaction au travail. Les résultats d'une étude longitudinale, en deux temps de mesure, menée auprès de 104 nouveaux arrivants d'une grande banque française montrent qu'une socialisation efficace est le résultat de la synergie entre les facteurs relationnels, individuels et organisationnels de la socialisation. Nous suggérons notamment que les effets socialisants du soutien perçu du superviseur (PSS) sont plus forts quand on constate à la fois l'existence de tactiques de socialisation institutionnalisées, quand la justice globale perçue par les nouveaux arrivants est élevée et quand ces deniers ont un niveau élevé de personnalité proactive. Les implications à la fois théoriques et managériales de ces résultats sont discutées.

Celiac disease (CD) is an enteropathy-induced immune response that occurs on exposure to toxic gluten in the diet and is reversible in most cases once gluten is withdrawn. A gluten-free diet (GFD) is the preferred treatment for CD and leads to reversal of villous atrophy. Individuals with untreated CD may experience significant health complications. Managing CD can potentially prevent or cure some of the associated conditions, such as neurologic complications, nutritional deficiencies, and osteoporosis. Counseling, nutritional support, and follow-up are vital aspects in CD management. GFD remains the mainstay of treatment in CD. Adhering to a strict GFD remains challenging for some individuals, and it has its limitations and other alternatives are called for. There are new and novel treatments emerging, which will be discussed here.

Introduction Early identification of pNETs is a key element to reducing morbidity and mortality in MEN1 patients. Prognosis is associated with tumour size and many pNETs are small subcentimetre lesions and only become symptomatic when the tumour is large. Conventional radiology is suboptimal in detecting such lesions, thus missing the window to remove them at an earlier stage. We compared: (a) linearEUS detection of pNETs in patients with confirmed MEN1 vs triple-phase contrast-enhanced CT/MRI pancreas and (b) incremental benefit of EUS to cross-sectional imaging for detection of small pNETs and quantity of pNETs in this cohort Methods Between Jan 2008- Oct 2015, a total of 20 patients with clinically confirmed MEN1 underwent baseline assessment with EUS, CT/MRI and biochemical screening. Data were retrospectively retrieved from the hospital electronic records database. Statistical analysis was performed using SPSS v20 on the size and number of pNET detection by EUS and CT/MRI using the Wilcoxon Signed Rank Test and McNemar Chi-square Results A total of 28 EUS procedures and an equal number of cross sectional imaging (CT/MRI) were performed. pNETs were identified in 95% of all 20 MEN1 cases. Overall median pNET size was 7.1 mm on EUS and 14.5 mm on CT/MRI (p = 0.007). Median value for smallest pNETs detected by EUS was 4.6 mm and 12.7 mm on CT/MRI (p = 0.001). EUS detected more pancreatic lesions/pNETs compared to CT/MRI (p Conclusion EUS offers higher sensitivity than cross sectional imaging (CT/MRI) in terms of detecting the number of positive pNET cases as well as a greater number of pancreatic lesions especially subcentimetre ones. EUS should be considered a standard tool in the algorithm for MEN1 workup, instead of an adjunct reserved for diagnostic dilemmas Disclosure of Interest None Declared

Introduction MII-pH catheter studies measure both acid and non-acid reflux and are considered by some to be the gold standard in the diagnosis of GORD. Wireless pH capsule (Bravo) may increase the diagnostic yield of standard 24 hr catheter-based studies by overcoming the limitation of day-to-day reflux variability. This study aims to assess the additional diagnostic yield of extended Bravo recordings (up to 96 hours) in patients with normal 24 hr MII-pH results. Methods A total of 44 patients with typical GORD symptoms but negative 24 hr MII-pH studies off proton pump inhibitor(PPI) were referred for Bravo capsule studies. Bravo studies were performed beyond 48 hrs (up to 96 hrs). Bravo analysis was conducted using the ‘Worst Day Analysis’ (WDA) and ‘Average Day Analysis’ (ADA). Reference values for MII-pH and Bravo equivalent were adopted from internationally established studies (Table 1). Subgroup analyses were made on cohorts whose MII-pH showed normal AET with (A) normal number of total reflux events (TRE), (B) normal number of non-acid reflux (NAR) events and (C) increased number of NAR events. Statistical analysis was performed using SPSS V20. Results Our study group (male = 14, female =30) successfully completed Bravo studies up to 96 hours in 77.3% and beyond 48 hours in 97.7%. Using the WDA and ADA respectively, Bravo (AET cut-off >4.2%) captured an additional 59.1% and 43.2% of patients with increased AET (p Conclusion Extended Bravo studies (>48hours) diagnosed GORD in more than half of cases with an initial normal MII-pH. Half of those with increased NAR events on MII-pH showed positive acid reflux on prolonged Bravo. This additional yield can alter diagnosis from functional heartburn/hypersensitive oesophagus to GORD in difficult cases and influence management. Disclosure of Interest None Declared

Introduction Prolonged catheter-free pH monitoring with Bravo capsule up to 96 hours has become possible and enables extended physiological evaluation of gastroesophageal reflux disease (GERD) and response to therapeutic interventions. Aim of the present study was to determine the feasibility of 96 hrs recordings using Bravo capsule that would encompass time periods both off and on therapy with Proton Pump Inhibitors (PPIs). Methods A total of 432 patients reporting symptoms of GERD refractory to conventional therapy underwent 96 hours of Bravo capsule recordings. Patients identified with abnormal acid exposure during the 1st 48 hrs of recordings (off PPIs) underwent the 2nd 48 hrs of recording on twice daily PPIs. The parameters subjected to analysis were percent of time ph Results 132/436 (30.3%) of patients had abnormal acid exposure in the 1st 48 hrs (70 males, mean age 49, range 17–81 years) and the second 48 hrs of recordings was performed on PPIs.98/132 (74.2%) had normal acid exposure on PPIs whereas 34/132 (23.5%) had abnormal acid exposure despite high dose of PPIs. The overall number of symptoms reported in the 2nd 48 hrs was reduced by 68.4% (responsive 76.7% vs refractory 49.9%, p Conclusion Extended pH recording improves the detection of abnormal acid reflux. Combined off and on PPI therapy pH testing provides additional information which can be helpful in the management of patients with PPI refractory GERD. Disclosure of Interest None Declared

Celiac disease (CD) is an enteropathy-induced immune response that occurs on exposure to toxic gluten in the diet and is reversible once gluten is withdrawn. A gluten-free diet is the preferred treatment for CD and leads to reversal of villous atrophy. Counseling, nutritional support, and follow-up are vital aspects in CD management. The pickup rate of CD has improved with the availability of serologic tests, and this has led to a reduction in morbidity in treated CD cases. Managing CD can potentially prevent or cure some of the associated conditions, such as neurologic complications, nutritional deficiencies, and osteoporosis.

Il est de plus en plus evident que l’equite constitue une base motivationnelle importante des attitudes et des comportements des employes au sein de l’organisation, et plus particulierement des contributions qui vont au-dela des roles qui leur sont prescrits. Se basant sur la theorie de l’echange social, la presente recherche propose un modele multi-focus explicatif des effets de la justice sur les comportements de citoyennete organisationnelle. Ce modele soutient que la confiance joue un role de mediation dans la relation entre les dimensions de la justice et les comportements de citoyennete organisationnelle et vise a elargir le champ des recherches existantes en considerant non seulement les relations d’echange entre l’employe, et son organisation consideree comme un systeme, mais aussi la relation qu’il entretient avec son superieur hierarchique et ses collegues de travail. Les resultats d’une enquete examinant ces differents construits apportent un large soutien a nos hypotheses et montrent que, pour les relations entre l’employe, son organisation, son superieur et ses collegues de travail, le niveau de confiance accorde explique les effets des dimensions de la justice sur les comportements de citoyennete orientes vers chacun de ces partenaires. Ces resultats sont discutes et les implications de la recherche, sur le plan theorique et pratique, sont exposees.

Introduction Corticosteroids (CS) are prescribed to control inflammatory and obstructive symptoms in Crohn’s disease (CD). Preoperative CS are associated with higher risk of all complications post-operatively including sepsis, anastomotic breakdown and venous thromboembolic disease.High doses of CS also preclude a primary anastomosis. In our institution, we have implemented a protocol to prevent CS administration or permit a rapid wean in patients requiring ileal/ileocaecal resection, maximising the use of exclusive enteral nutrition (EEN) or parenteral nutrition (PN). This study aimed to determine the achievability of CS avoidance in this setting. Method In patients selected for ileal/ileocaecal resection, EEN (with either Modulen IBD Nestle or Fortisip Nutricia, as tolerated) was prescribed to a target dose of 30 kcal/kg. Acute sepsis was controlled with intravenous and/or oral antibiotics. If EEN was not tolerated because of obstructive symptoms, PN was instituted or surgery expedited. Patients were not offered this protocol if they had minimal symptoms, adequate nutritional status and no CS exposure. Results In total, 39 patients with CD had IC resection over a period of 20 months from January 2013. 9 of these underwent urgent surgery due to symptom severity (severe obstruction or suspected cancer where delay not possible [4 of 9 on CS (45%)]. 8 patients with stable symptoms secondary to fibrotic stricture (4 on biologic, 4 on immunomodulator), adequate nutritional status and CS free were not suitable for the protocol. 22 patients with acute symptoms were therefore included. All had penetrating and/or stricturing disease. 8 patients were receiving CS of whom 7 (88%) successfully weaned off CS for greater than 4 weeks using EEN. 1 did not tolerate EEN and proceeded to surgery on CS. A further 11 of 22 patients successfully treated via protocol to avoid CS (EEN n = 7, PN n = 4) 3 patients did not tolerate/declined EEN/PN and proceeded to expedited surgery. Hence, in all patients suitable for the protocol, CS were successfully avoided (14/14 patients, 100%) and wean >4 weeks successful in majority (7/8 patients, 87.5%). CS exposure was successfully avoided in 21 patients via protocol (95.5%). Conclusion Aggressive use of EEN or PN provides an effective approach to avoid CS exposure, optimise nutrition and control acute symptoms in patients selected for IC resection. The implementation of the protocol requires close liaison between gastroenterologists, colorectal surgeons and dieticians. The protocol does not delay emergency surgery. Disclosure of interest None Declared.

La vie est ponctuée d'événements quotidiens, prenant la forme de décisions, d'engagements, et d'actes, et suscitant des réactions émotionnelles, attitudinales et comportementales. Une analyse de la vie des salariés dans les organisations, basée sur l'étude des événements semble dés lors cruciale pour la compréhension des expériences quotidiennes vécues dans un contexte de travail. Puisque des événements plus ou moins importants se produisent à toute heure dans une journée de travail, la vie des salariés est régulièrement soumise aux aléas que ces expériences engendrent, même si elle donne l'impression d'une certaine stabilité. Ces événements et ces expériences en évolution quotidienne font que notre humeur peut changer d'un jour à l'autre. Les attitudes et les traits de personnalité sont certes importants, cependant leur impact sur nos vies passe inéluctablement par les événements et les expériences quotidiens. Pour exprimer cela plus formellement, nous pouvons dire que la vie est un processus dynamique, changeant et continue, impliquant événements, expériences, réflexions, sentiments et motivations qui varient considérablement dans le temps.

International audience; L'objectif de cette communication est de développer et de tester un modèle interactionniste de la socialisation des nouvelles recrues et de leur intégration réussie dans l'entreprise. Ce modèle focalise sur le rôle de la justice organisationnelle et du soutien perçu su supérieur hiérarchique et intègre un ensemble de variables modératrices telles que les tactiques de socialisation et l'incertitude perçue du nouvel environnement organisationnel. Nombre d'auteurs ont montré que le succès de l'intégration des nouvelles recrues repose sur la combinaison synergétique des pratiques de socialisation de l'organisation, des prédispositions proactives des recrues et du soutien des agents internes tels que les managers et collègues (Reichers, 1987 ; Bauer et al., 2007 ; Bauer et Erdogan, 2010). À notre connaissance, il n'existe pas de travaux qui ont testé des modèles interactionnistes de socialisation en intégrant aussi un antécédent organisationnel comme la justice organisationnelle. En nous basant sur cette approche interactionniste et en utilisant les apports des théories de l'échange social et du management de l'incertitude, nous avons testé notre modèle grâce à des données longitudinales collectées auprès de 104 nouvelles recrues d'une grande banque française. Les résultats de l'analyse de la médiation modérée selon la démarche d'Edwards et Lambert (2007) montrent le rôle significatif de la médiation par le soutien perçu du supérieur et les effets modérateurs des perceptions de l'incertitude et des tactiques de socialisation entre les perceptions de justice par les nouvelles recrues et leur satisfaction au travail. Les implications théoriques et managériales sont enfin discutées