Foetal serum but not urinary β2-microglobulin correlates with histological injury to the kidney

In a context of foetal obstructive uropathies, biochemical markers can be helpful to assess the renal function, but most studies to date have focused on their correlation with ultrasound findings and neonatal outcome. Our aim was to evaluate foetal β2-microglobulin as an index of histological injury to the kidney.     

Use of the Internet by patients: not a threat to nursing, but an opportunity?

The Internet poses numerous challenges for health care professionals. A significant one is the way in which patients, clients and carers now have access to large amounts of unfiltered, specialized health information, much of which was, hitherto, solely the province of the professionals. The specific problems that this poses, in terms of the effect that it might have on the therapeutic relationship, are discussed, along with some of the proposed solutions, such as the National Electronic Library for Health initiative and NHS Direct Online. Since this change is inevitable, it is recommended that nurses should seek to build on their role as educators of patients and carers. One of the ways in which they can do this is by guiding patients' and carers' use of the Internet, and helping them to evaluate the information that they find.     

Measurement of the glucocorticoid receptor: Relevance to the diagnosis of critical illness–related corticosteroid insufficiency in children

Diagnosis and management of critical illness–related corticosteroid insufficiency (CIRCI) in children continues to remain difficult and controversial in that no consensus for either exists among pediatric critical care physicians. Critical illness–related corticosteroid insufficiency is defined as a corticosteroid response that is inadequate for the severity of the illness experienced by the patient. Critical illness–related corticosteroid insufficiency manifests as an insufficient corticosteroid mediated down-regulation of proinflammatory cytokines, due to either corticosteroid tissue resistance and/or inadequate circulating levels of cortisol. The tissue resistance is likely due to alterations in the functionality of the intracellular receptor for corticosteroids, the glucocorticoid receptor (GR). This article details the role of the GR during critical illness with a focus upon the measurement of the GR, as a potentially important means by which to clinically assess the level of corticosteroid tissue–resistant in patients suspected of CIRCI. Measurement of the GR may be particularly useful as a means by which to determine the judicious administration of steroids, maximizing their therapeutic potential, whereas minimizing the morbidity that can be associated with their use.     

Brain-derived neurotrophic factor and neuron-specific enolase, but not S100β, levels are associated to the occurrence of delirium in intensive care unit patients

Purpose

The aim of this study was to determine the association between serum concentrations of brain-derived neurotrophic factor (BDNF), neuron-specific enolase (NSE), and S100β and the occurrence of delirium in critically ill patients.

Material and Methods

This case-control study included 30 patients with delirium and 30 matched controls in a 16-bed general intensive care unit (ICU). Serum BDNF, NSE, and S100 concentrations were determined by enzyme-linked immunosorbent assay assays at the time of ICU admission and on the day before delirium was diagnosed. Delirium was diagnosed by confusion assessment method for the ICU.

Results

At ICU admission, serum BDNF levels were significantly higher in delirious patients than in nondelirious controls (2.89 ± 1.48 vs 1.79 ± 0.89 ng/mL, respectively). When we compared serum S100 levels, there were no significant differences between the groups. Neuron-specific enolase values were significantly higher in the delirious patients than in the nondelirious controls (0.79 ± 0.03 ng/mL vs 0.59 ± 0.01 ng/mL, respectively). When patients who earlier developed delirium were separately analyzed, it was determined that serum NSE and BDNF levels at admission were significant higher only in this group.

Conclusions

Our results suggest that admission serum BDNF and NSE levels are associated with the occurrence of delirium in ICU patients.     

Standard of living in the retirement survey: A predictor of six-year functional limitation onset and mortality in women,but not in men from ages 55 – 69 years

Purpose.?To investigate the predictive validity for health decline of a standard of living, a measure that combines basic necessities and consumer durables.

Method.?A nationally representative sample of those aged 55?–?69 years was interviewed at home in the Great Britain Retirement and Retirement Plans Survey, (1988; n?=?3541). In 1994, 2247 were re-interviewed, response rate being 70% of survivors. Relationships between socioeconomic status and health decline were investigated using polytomous logistic regression modelling. The outcomes were onset of functional limitation and mortality.

Results.?Standard of living was an independent predictor of 6-year functional limitation onset (Odds Ratio compared to good standard of living 2.2; 95% Confidence Interval 1.3?–?3.8) and mortality (OR?=?4.6; 95% CI 2.3?–?8.9) in women, with age, household type, educational qualifications and social class taken into account. However, in men, weaker associations were largely accounted for by differences in education and social class (adjusted OR for functional limitation onset 1.0; 95% CI 0.5?–?1.9; adjusted OR for mortality 1.4; 95% CI 0.6?–?2.9). A combined indicator of housing tenure and property value was also an independent predictor of functional limitation onset in women.

Conclusions.?Poor standard of living identifies women but not men at risk of health decline who are missed by social class and educational level. Measures of current home-based material resources are a useful addition to minimum datasets for monitoring health inequalities.