Is there a difference between strong ion gap in healthy volunteers and intensive care unit patients?

Purpose

Abnormalities of strong ion gap (SIG) are common in critically ill intensive care unit (ICU) patients in conjunction with a high incidence of acid-base abnormalities. However, it is unknown whether abnormalities in SIG are also seen in ICU patients without active acid-base abnormalities. Thus, we conducted this pilot study to examine differences in quantitative acid-base variables between healthy adult volunteers and stable ICU patients with no suspected acid-base abnormalities.

Methods

The study used a prospective observational study of 2 cohorts, 15 healthy adult volunteers and 15 stable adult patients just before ICU discharge who were not receiving renal replacement therapy and had no known active acid-base derangements. We analyzed venous blood for acid-base variables (potential hydrogen in central venous blood [pH_CV], partial tension of carbon dioxide in central venous blood [p_CVco₂], standard base excess [SBE], lactate, Na⁺, K⁺, Cl⁻, Mg²⁺, Ca²⁺, phosphate, and albumin). From these, we calculated strong ion difference (SID) and SIG for both cohorts.

Results

Although mean values for pH_CV, p_CVCO₂, and SBE were within the normal range in both cohorts, 10 (66.7%) of 15 of ICU patients were found to have occult acid-base disorders. The ICU patients also had reduced albumin and SID measurements and significantly greater mean SIG (5.1 ± 2.9 mEq/L) compared to healthy controls (1.4 ± 1.8 mEq/L) (P = .0002). None of the healthy controls had a SIG higher than 5.0 mEq/L, whereas 7 (46.7%) of 15 of ICU patients had a SIG higher than 5.0 mEq/L. Even among ICU patients with no abnormalities of pH_CV, p_CVCO₂, and SBE, mean SIG was 6.4 (±3.3 mEq/L).

Conclusions

Stable ICU patients have much higher levels of unexplained anions when comparing with healthy controls. Whether this finding represents occult acid-base disorders or simply metabolic differences among the critically ill is uncertain. Further study in larger populations is warranted to establish the significance of high SIG in otherwise stable ICU patients.     

Is there a difference between women and men in characteristics and outcome after in hospital cardiac arrest?

AIM: To describe the characteristics and outcome among patients suffering from an in-hospital cardiac arrest in women and men. METHODS: All patients who suffered an in-hospital cardiac arrest during a 4 year period in Sahlgrenska Hospital G?teborg, Sweden, where the cardiopulmonary resuscitation (CPR) team was called, were recorded and described prospectively in terms of characteristics and outcome. RESULTS: There were 557 patients suffering in-hospital cardiac arrest in whom the CPR-team was alerted. Among them, 217 (39%) were women. Women differed from men having a lower prevalence of earlier myocardial infarction, angina pectoris, renal disease and a higher prevalence of rheumatic disease. In terms of aetiology of the cardiac arrest, 47% men and 48% women were judged to have had a confirmed or possible AMI. More men than women were found in ventricular fibrillation/ventricular tachycardia (VF/VT) (57 vs. 41%; P<0.001), whereas more women were found in pulseless electrical activity (30 vs. 15%; P<0.0001). Cerebral performance categories (CPC)-score at discharge did not differ between men and women. Among women, 36.4% survived to discharge as compared with 38.0% among men (NS). Survival from VF/VT was 64.3% in women and 52.7% in men (NS). When correcting for dissimilarities at baseline, the adjusted odd ratio for being discharged alive from hospital among women as compared with men was 1.66 (95% confidence limit 1.06-2.62; P=0.028). CONCLUSION: Thirty nine percent of patients suffering in-hospital cardiac arrest for whom the CPR-team was alerted, were women. Women were less frequently found in VF/VT than men. After correcting for dissimilarities at baseline, female gender was associated with a small improvement in survival.     

Is there a difference in diagnostic accuracy and clinical impact between endoscopic ultrasonography and magnetic resonance cholangiopancreatography?

BACKGROUND AND STUDY AIMS: It is still unknown whether there is a difference in diagnostic accuracy and clinical impact between endoscopic ultrasonography (EUS) and magnetic resonance cholangiopancreatography (MRCP). PATIENTS AND METHODS: The test performance and potential clinical impact of EUS and MRCP, had each investigation been performed as the first examination method, were compared prospectively in 163 patients admitted for and examined by endoscopic retrograde cholangiopancreatography (ERCP). RESULTS: The accuracies of EUS and MRCP were 0.93 and 0.91, respectively (no significant difference, P > 0.05). Had EUS or MRCP been performed as the first investigation in the 75 patients who had a presumed high probability for needing therapeutic ERCP, only 15 and nine patients, respectively, would have avoided ERCP. In this group of patients, one patient needed other diagnostic investigations following EUS compared with 11 patients following MRCP ( P = 0.004). For the 57 patients with an intermediate probability of needing endoscopic therapy, EUS and MRCP would have spared 37 and 38 patients, respectively, from the need to have an ERCP. In 31 patients with a presumed low risk of needing endoscopic therapy, 30 and 29 patients would have been spared from ERCP had EUS and MRCP, respectively, been performed initially. CONCLUSIONS: There was no difference in the diagnostic accuracy and clinical impact between EUS and MRCP in the majority of the patients. The impact of EUS or MRCP on the ERCP workload was highly dependent on the presumed probability of needing endoscopic therapy.     

Is there a relationship between plasma phenylalanine and cholesterol in phenylketonuric patients under dietary treatment?

OBJECTIVES: To study the lipid profile in a group of treated phenylketonuric patients (PKU; n = 61) compared with a group of inborn error of intermediary metabolism patients (IEM; n = 22), a group of hyperphenylalaninemic children (HPA; n = 37), and a control group without dietary restriction (n = 41). DESIGN AND METHODS: Phenylalanine was analyzed by ion exchange chromatography and triglycerides, cholesterol and HDL were determined by standard procedures with the Cobas Integra analyzer. RESULTS: Serum total cholesterol concentrations were significantly lower in PKU patients compared with IEM patients (whose cholesterol daily intake was similar to those of PKU patients), HPA children and the control group. A negative correlation was observed between cholesterol and phenylalanine concentrations in the PKU patients. CONCLUSIONS: Our findings support the hypothesis of a relationship between high plasma phenylalanine levels and an inhibition of cholesterogenesis, although the low cholesterol intake of the special diets may also decrease serum cholesterol values.     

Is there a relationship between the blood cholinesterase and QTc interval in the patients with acute organophosphate poisoning?

Organophosphates cause poisoning as a result of the excessive accumulation of acetylcholine at the cholinergic synapses due to inhibition of acetylcholinesterase (ChE). In the literature, it has been reported that there have been electrocardiographic abnormalities, including QT-interval prolongation in most patients with acute organophosphate poisoning (OPP), and a relation between blood ChE level and clinical severity in acute OPP. The aim of this study is to assess the relationship between blood ChE level and QTc interval in the patients with acute OPP. This retrospective study consists of 20 patients admitted to the emergency intensive care unit. A total of 93 QTc interval and blood ChE measures obtained on the same day from 20 cases were compared for their correlation. There were prolonged QTc intervals in 35.4% of the ECGs. There was a negative correlation between QTc interval and blood ChE measures. In following up the patients with acute OPP, QTc interval may be useful when blood ChE levels are low and may provide complementary information concerning the severity of poisoning. However, further prospective studies, supporting the present results, are needed.     

Patients admitted to the emergency department with acute chest pain--is there a difference between patients in an urban and a rural area?

The aim of this study was to compare the characteristics and outcome for patients coming to the emergency department with acute chest pain in a city university hospital, representing an urban area, and a county hospital, representing a rural area. This was a retrospective survey of all chest pain patients at Sahlgrenska University Hospital, G?teborg, covering an area with 706 inhabitants/km2, and at Uddevalla County Hospital, Uddevalla, covering an area with 34 inhabitants/km2, over a period of 6 months. In all 2,297 patients were registered at Sahlgrenska University Hospital and 1062 at Uddevalla Hospital (per 100,000 inhabitants and year 1,502 and 1,342 patients, respectively). The patients in the urban area were more frequently sent home from the emergency department than in the rural area (30% versus 23%; p < 0.0001). Patients in the urban area had a lower prevalence of previous cardiovascular diseases. An obvious acute myocardial infarction (AMI) or a strong suspicion of AMI at initial evaluation was less frequent in the urban area whereas no suspicion of AMI was twice as common (46% versus 24%; p < 0.0001). Furthermore, there was a difference in the use of medications; various cardiovascular drugs were more frequently used in the rural area. Despite these differences at baseline the 30-day mortality was similar (3.5% in the urban area and 3.6% in the rural area; NS), as well as the 2-year mortality (14.0% and 12.7%, respectively; NS). It is concluded that the number of patients admitted to the emergency department with acute chest pain/100,000 was slightly higher in the urban than in the rural area. Patients in the urban area differed from those in the rural area having a lower prevalence of previous cardiovascular diseases, a lower initial suspicion of AMI, they were less frequently hospitalized and less frequently prescribed various cardiovascular drugs. Mortality did not differ between the two cohorts.     

Is there a correlation between hippocampus and amygdala volume and olfactory function in healthy subjects?

Both amygdala (AG) and hippocampus (HC) are integral parts of the olfactory system. The present study, including a large number of healthy subjects, was performed to compare HC and AG volumes, measured by manual tracing, in relation to specific olfactory functions, including odor threshold, discrimination, identification, and odor memory tasks. It also aimed to provide age-related normative data about the volume of the HC and AG.A total of 117 healthy volunteers participated (age range 19-77 years, mean age 37 years; 62 women, 55 men). Using the “Sniffin' Sticks”, subjects received lateralized tests for odor threshold, and odor discrimination. In addition, an odor memory and an odor identification task were performed bilaterally. A Mini-Mental-State test excluded dementia. MR scans were performed using a 1.5 T scanner for later manual volumetric measurements.Volumetric measurements exhibited a good reproducibility. The average volume for the right HC was 3.29 cm³ (SD 0.47), for the left HC it was 3.15 cm³ (SD 0.47). The average right AG had a volume of 1.60 cm³ (SD 0.31), left 1.59 cm³ (SD 0.3). Increasing age was accompanied by a decrease of HC and AG volumes, which were much more pronounced for the right compared to the left side. Only the volume of the right HC showed a small but significant correlation with odor threshold (r₁₁₇ = 0.21; p = 0.02). Importantly, this correlation was not mediated by age as indicated by the significant partial correlation when controlling for age (r₁₁₄ = 0.18; p = 0.049).In conclusion, the present data obtained in a relatively large group of subjects demonstrates a small correlation between the volume of the HC, as an integral part of the olfactory system, and smell function. In addition, these data can be used as the basis for normative values of HC and AG volumes, separately for men, women and different age groups. This is of potential interest in diseases with acute or chronic impairment of olfactory function, in metabolic or neurodegenerative diseases or in disorders with damage of areas involved in adult neurogenesis.     

Is there a correlation between family functioning and functional recovery in patients with acquired brain injury? An exploratory study

BackgroundAcquired Brain injury (ABI) is a very critical event in a family, as it is a highly distressing and traumatic experience, imposing a very deep reorganization of the whole family.ObjectiveThis study aims to evaluate the possible correlation between the family aspects and the patients' functional outcomes after rehabilitation.MethodsFifteen patient-caregiver pairs were enrolled in the study. All the patients were assessed by using specific neuropsychological and functional scales, including the Family Adaptability and Cohesion Evaluation Scales, before and after treatment.ResultsThe results reveal that when the caregiver is the son or the spouse (p = 0,71), the perception of the emotional and physical burden is stronger, while the scores related to the burden were lower in the presence of other kinds of relationship. The family functioning seems to be connected to the burden level for the caregivers. Furthermore, there is a significant correlation between the improvements observed in the patients during their rehabilitative training and the family dynamics.Conclusionsin our opinion, the family plays a key role in allowing a suitable compliance of the patient to the treatments, and supports the processes of adaptive reorganization.     

Memories following physical trauma in patients treated in the ICU: does gender and head injury make a difference?

The aim of this study was to explore differences between male and female survivors and describe the relation between head injury and memories in men and women. This multi-centre study included 239 trauma patients who answered a self-administered questionnaire (ICUM tool) 6-18 months after discharge from the ICU. Few gender differences were found regarding their memories before, during and after the ICU stay. The univariate and multivariate analyses showed that more women than men reported memories from the time in hospital before being admitted to the ICU. Women also recalled a significantly higher number of memories of feelings than men. Furthermore, patients without head injury had more memories from the time before and during their stay in the ICU than patients with head injury but did not report more memories from the time after the ICU. The ISS mean score was higher for men than for women, more men than women had renal failure and more men than women received opioid treatment. The conclusion is that gender is of less importance concerning memories from the time before, during and after the stay in the ICU.     

Is there a relationship between nutritional goal achievement and pressure injury risk in intensive care unit patients receiving enteral nutrition?

ObjectivesTo assess pressure injury risk and time until pressure injury development according to the achievement of nutritional goals, i.e. caloric and protein intake within the first 72 hours of the intensive care admission.MethodProspective observational cohort study conducted in two units at a public university hospital. The development of pressure injury was considered the dependent variable. Survival curves were prepared with the Kaplan Meier method. Univariate and multivariate Cox regression analysis was used to identify factors associated with the development of pressure injury.ResultsThe study sample included 181 patients, of which 56.4% were male and the average age was 55 years. Neurological pathologies were the most frequent cause of hospitalisation (44.8%). The average length of stay was 17.5 days and mortality 30.4%. With regards to nutritional goals, 105 patients (58.0%) achieved their caloric goal, 130 (71.8%) achieved protein goals, and 98 (54.1%) achieved both. The frequency of pressure injury occurrence was 31.5%. Caloric intake (hazard ratio [HR] 2.3, 95% confidence interval [CI] 1.24-4.36) and protein intake (HR 3.21, 95% CI 1.76-5.86), were identified as independently associated with pressure injury development. Higher Braden scores were identified as a protective factor (HR 0.65, 95% CI 0.56-0.77).ConclusionsThese results indicate that the time to pressure injury development in the group of patients who did not achieve nutritional goals was shorter compared to those who achieved nutritional goals. Further studies should be conducted to confirm these data and to study the relationships in greater detail.     

Is there a relationship between fatigue questionnaires and gait mechanics in persons with multiple sclerosis?

Huisinga JM, Filipi ML, Schmid KK, Stergiou N. Is there a relationship between fatigue questionnaires and gait mechanics in persons with multiple sclerosis?

Objective

To evaluate reported fatigue levels and gait deficits in patients with multiple sclerosis (MS) to determine the relationships that may exist between fatigue in patients with MS and alterations in gait mechanics.

Design

Cross-sectional.

Setting

Biomechanics laboratory.

Participants

Subjects with MS (n=32) and age- and sex-matched controls (n=30).

Interventions

None.

Main Outcome Measures

Fatigue Severity Scale (FSS), Modified Fatigue Index Scale (MFIS), and 36-Item Short Form Health Survey (SF-36) to assess fatigue and general health. Biomechanical gait analysis was performed to measure peak joint torques and powers in the sagittal plane at the ankle, knee, and hip. Correlations were performed between fatigue measures and degree of deficit within each patient with MS for each joint torque and power measure.

Results

FSS score significantly correlated with deficits in ankle power generation at late stance and walking velocity. MFIS score significantly correlated with deficits in peak knee extensor torque and knee power absorption at early stance. SF-36 subscale scores correlated with several joint torque and power variables.

Conclusions

Subjective fatigue rating scale scores alone should not be used as an indicator of motor disability or disease progression as it affects walking performance of patients with MS.     

MRI features of perianal fistulas: is there a difference between Crohn’s and non-Crohn’s patients?

Purpose

Though perianal fistulas are commonly seen in patients with Crohn’s disease, they can also be seen in patients without inflammatory bowel disease. The purpose of this study was to evaluate MR imaging differences of perianal fistulas in patients with and without Crohn’s disease.

Methods

Our retrospective search from January 2012 to December 2015 of the Radiology database for perianal fistula yielded 207 patients. Only patients with dedicated MR fistula protocol studies were included, whereas patients with previous anal surgery or anastomosis, anorectal tumors, and equivocal findings that could not be definitely assessed as a fistula were excluded. The following features were assessed: anatomic type of fistula (Parks Classification), luminal origin (hour clock position), anal verge distance, signs of acute inflammation, circumference of anus involved by inflammation, presence of rectal inflammation. and abscess.

Results

One hundred and twenty six of 207 patients met inclusion criteria. Of these, 96 (76.2%) had Crohn’s disease and 30 (23.8%) did not. The most common fistulas identified were transphincteric (38.5% of Crohn’s and 50% of non-Crohn’s) and intersphincteric (33.3% of Crohn’s and 35.4% of non-Crohn’s). An abscess was associated in 41 cases, 32 (33.3%) in the Crohn’s group and 9 (30.0%) in the non-Crohn’s group. Rectal inflammation was present in 29 patients with Crohn’s disease (29.2%) and in 2 without Crohn’s (6.7%). This finding was statistically significant (p = 0.0009).

Conclusions

Our study demonstrates that while both groups can have similar MR imaging features, accompanying rectal inflammation was more commonly seen in Crohn’s disease.