Changes in sleep architecture after burn injury: ‘Waking up’ to this unaddressed aspect of postburn rehabilitation in the developing world

BACKGROUND:

Changes in sleep architecture are common phenomena observed in post-traumatic patients; such altered sleeping patterns have negative implications on various phases of rehabilitation. Sleep is an essential process, without which one cannot function effectively and, hence, any aberrations in the quality of sleep in such patients need to be critically analyzed.

OBJECTIVE:

To probe the quality of sleep in postburn patients at one year compared with a group of adequately matched controls.

METHODS:

Quality of sleep in postburn patients at one year was measured using the Pittsburg Sleep Quality Index questionnaire and compared with a group of adequately matched controls. Data were tabulated and subjected to statistical analysis using Pearson’s χ² test.

RESULTS:

The relationship between the postburn state and sleep disturbances was found to be statistically significant. Other relevant parameters are also highlighted and discussed.

DISCUSSION:

Sleep is one of aspect of functioning that may be least taken into account by professionals during the phase of postburn rehabilitation because more obvious threats receive preferred treatment. Unless these problems are dealt with in the postburn period, rehabilitation can never be complete.

CONCLUSION:

Postburn patients experience significant changes in sleep architecture, which need to be taken into account to enable complete rehabilitation of the patient.     

True benefit or selection bias: an analysis of laparoscopic versus open splenectomy from the ACS-NSQIP

Background

By virtue of the benefits associated with minimally invasive approaches, laparoscopic splenectomy (LS) is believed to have better patient-related outcomes compared to open splenectomy (OS). However, there are limited data directly comparing the two techniques.

Methods

Patients who underwent elective LS and OS between 2005 and 2010 were identified from the public use file of the ACS-NSQIP database using the Current Procedural Terminology codes 38120 and 38100. Patients who had concomitant procedures were excluded. Because of the nonrandom assignment of surgical techniques, a selection bias could have been responsible for the differences in patient outcomes. Therefore, patient characteristics and comorbidities that were available and could have been potential confounders were compared and regression analysis was performed to determine independent risk factors associated with serious and overall morbidity as well as mortality.

Results

During the study period 1,644 and 851 patients underwent LS and OS, respectively. Compared to patients who underwent LS, patients who had OS had a longer median length of hospital stay (3 vs. 6 days, P < 0.0001) and higher incidences of serious (7 vs. 17 %, P < 0.0001) and overall morbidity (12 vs. 25 %, P < 0.0001) and mortality (1.4 vs. 3.3 %, P = 0.02). However, there were certain significant differences in the characteristics and comorbidities of the patients that could have confounded outcomes. On regression analysis, OS was not associated with higher mortality (OR = 1.43, 95 % CI 0.7–2.7, P = 0.28) but was associated with higher serious morbidity (OR = 1.8, 95 % CI 1.4–2.3, P = 0.001) and overall morbidity (OR = 2.0, 95 % CI 1.6–2.4, P = 0.0001).

Conclusion

After adjusting for available confounders, patients who underwent LS had lower morbidity and similar mortality rates. Although certain confounders such as previous surgical history, underlying pathology, and spleen size could still have potentially influenced outcomes, the data suggest that patient outcomes after LS are excellent and when technically possible a minimally invasive technique should be the preferred approach for splenectomy.     

Anion gap among patients of multiple myeloma and normal individuals

OBJECTIVE: To compare the Anion gap between patients of multiple myeloma and normal individuals presenting at a tertiary care hospital. DESIGN AND METHODS: This is a matched case-control study conducted at Aga Khan University Hospital, Karachi, from July 10, 2004 to April 30, 2006. The anion gap (AG) from the medical records of the 82 diagnosed cases of multiple myeloma (MM) and 104 controls were compared. Immunoglobulins (IgG and IgA) were measured by array nephelometric assay. Staging for MM patients were performed based on Salmon-Durie method. AGs were compared by independent sample t-test. Pearson coefficient of correlation was used to correlate paraprotein IgG concentration and anion gap. RESULTS:: Of the 186 study subjects (82 cases and 104 controls), 70% were males and 30% were females. The mean ages of MM and controls were 59.68+/-11.94 and 60+/-9.2 years respectively. There was a significant difference in mean AG, 11.2+/-1.7 mmol/L in control group (p<0.001) compared to 6.8+/-4.6 mmol/L for IgG MM and 8.4+/-4.37 mmol/L for IgA MM patients. Multiple myeloma patients stratified by clinical stages had anion gap of 8.7+/-1.7 in stage I, 7.93+/-0.47 in stage II and 5.65+/-0.31 in stage III. A significant correlation was found in IgG myeloma when anion gap was expressed as a function of the serum monoclonal protein concentration. CONCLUSION: The anion gap is significantly lower in multiple myeloma patients compared to controls. Lowered anion gap is more specific feature of the IgG type MM. We suggest that correlation of AG with the disease severity and with paraproteins concentration could potentially be useful in monitoring patients for disease progression. However, longitudinal studies are required to confirm the utility of anion gap in monitoring patients with MM.     

Protective effect of a novel,potent inhibitor of poly(adenosine 5'-diphosphate-ribose) synthetase in a porcine model of severe bacterial sepsis

OBJECTIVE: To determine whether activation of the nuclear enzyme poly(adenosine 5'-diphosphate [ADP]-ribose) synthetase (PARS) contributes to mortality rate, myocardial dysfunction, and cardiovascular collapse in a porcine model of sepsis induced by implantation of an infected clot. DESIGN: Prospective, random animal study. SETTING: Research laboratory at Rush Presbyterian St. Luke's Medical Center. SUBJECTS: Twenty pigs were chronically instrumented with intracardiac transducers to measure left ventricular pressure, sonomicrometer crystals in the left ventricle to measure short axis diameter, an ultrasonic flow meter to measure cardiac output, and catheters in the pulmonary artery and aorta to measure blood pressures and collect samples. INTERVENTIONS: By using a randomized study design, we administered either the novel potent PARS inhibitor PJ34 (10 mg/kg for 1 hr, 2 mg x kg(-1) x hr(-1) for 96 hrs) or vehicle to pigs immediately before intraperitoneal implantation of Escherichia coli 0111.B4 (2.3 +/- 0.1 x 10(10) colony-forming units/kg)-laden fibrin clots to produce peritonitis and bacteremia. MEASUREMENTS AND MAIN RESULTS: In vehicle-treated pigs, 12% survival was recorded at 24 hrs, whereas 83% and 66% survival was recorded in the PJ34-treated animals at 24 and 96 hrs, respectively (p <.05). PJ34 treatment attenuated bacteremia-induced increases in systemic and pulmonary vascular resistances. In controls, peritonitis induced rapid increase in plasma tumor necrosis factor-alpha. PJ34 treatment significantly attenuated this cytokine response. The formation of peroxynitrite and the activation of PARS were confirmed in hearts and lungs of the septic pigs by the immunohistochemical detection of nitrotyrosine and poly(ADP-ribose), respectively. Inhibition of PARS with PJ34 abolished poly(ADP-ribose) formation in septic animals. CONCLUSIONS: Treatment with a potent PARS inhibitor improved survival and cardiovascular status and attenuated an important mediator component of the inflammatory response in a lethal porcine model of sepsis.     

Double cascade dressed MOSFET from doped Eu3+and Pr3+ in a host YPO4

In this paper, we study double cascade dressed optical metal oxide semiconductor field-effect transistor (MOSFET) by exploiting enhancement and suppression for mixed-phase (hexagonal + tetragonal) of Eu³⁺:YPO₄ and different phases (hexagonal + tetragonal and pure tetragonal) of Pr³⁺:YPO₄ crystals. We report variation of fine structure energy levels in different doped ions (Eu³⁺ and Pr³⁺) in the host YPO crystal. We compared multi-level energy transition from a single dressing laser with single level energy transition from double cascade dressing lasers. Gate delay facilitates multi-energy level dressed transition and is modeled through a Hamiltonian. Based on the results of double cascade dressing, we have realized MOSFET for logic gates (inverter and logic not and gate) with a switching contrast of about 92% using a mixed phase of Pr³⁺:YPO₄.

By changing different parameters of single and double lasers, we observed the dressed energy level transition from single to multi-level with a single laser. Each sample responded based on their ions'' structure and phase symmetry in the host YPO crystal.     

Genetic polymorphisms of HbE/beta thalassemia related to clinical presentation: implications for clinical diversity

Annals of Hematology - HbE/Beta thalassemia (HbE/β-thalassemia) is one of the common genetic disorders in South East Asia. It is heterogeneous in its clinical presentation and molecular...