Effect of delirium motoric subtypes on administrative documentation of delirium in the surgical intensive care unit

This study compares the proportions of surgical intensive care unit (ICU) patients with delirium detected using the Confusion Assessment Method for the ICU (CAM-ICU) who received administrative documentation for delirium using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes, stratified by delirium motoric subtypes. This retrospective cohort study was conducted at a surgical ICU from 06/2012 to 05/2013. Delirium was assessed twice daily and was defined as having ≥1 positive CAM-ICU rating. Delirious patients were categorized into hyperactive/mixed and hypoactive subtypes using corresponding Richmond Agitation Sedation Scales. Administrative documentation of delirium was defined as having ≥1 of 32 unique ICD-9-CM codes. Proportions were compared using Pearson’s Chi-square test. Of included patients, 40 % (423/1055) were diagnosed with delirium, and 17 % (183/1055) had an ICD-9-CM code for delirium. The sensitivity and specificity of ICD-9-CM codes for delirium were 36 and 95 %. ICD-9-CM codes for delirium were available for 42 % (95 % CI 35–48 %; 105/253) of patients with hyperactive/mixed delirium and 27 % (95 % CI 20–34 %; 46/170) of patients with hypoactive delirium (relative risk = 1.5; 95 % CI 1.2–2.0; p = 0.002). ICD-9-CM codes yielded a low sensitivity for identifying patients with CAM-ICU positive delirium and were more likely to identify hyperactive/mixed delirium compared with hypoactive delirium.     

Effects of Cadmium and Lead on Muscle and Liver Glycogen Levels of Climbing Perch (Anabas testudineus)

The aim of this study was to assess the glycogen content in the muscle and liver tissues of the climbing perch (Anabas testudineus) exposed to sublethal concentrations of Cd and Pb over 28 days of exposure and 14 days of depuration. Muscle and liver glycogen levels in A. testudineus after Pb or Cd treatment were significantly lower (p?<?0.05) than that of A. testudineus in the control group during the exposure phase. In the recovery phase, muscle, and liver glycogen levels in A. testudineus increased in all Pb treatment groups, whereas they continuously decreased in all Cd treatment groups. Fish affected by Cd had obvious difficulties recovering from the stress response. It was concluded that exposure to the tested concentrations of Pb and Cd could be a potent endocrine activity disruptor, which may lead to adverse impacts on the health of A. testudineus.

     

Unintentional ingestion of Cordyceps fungus-infected cicada nymphs causing ibotenic acid poisoning in Southern Vietnam

Background: Cordyceps fungus found in infected cicada nymphs (“cicada flowers”) is utilized in traditional Chinese medicine. Cordyceps fungus toxicity in humans has not been previously reported. We report 60 cases of apparent Cordyceps poisoning in Southern Vietnam.

Methods: We retrospectively collected demographic and clinical data from the medical records (21 cases) and by telephone interview (39 cases) of patients admitted to seven hospitals in Southern Vietnam following ingestion of cicada flowers between 2008 and 2015. We also determined the species of Cordyceps present in the cicada flowers and performed a partial chemical analysis of the fungus.

Results: Sixty cases of toxic effects following ingestion of cicada flowers were documented. Symptom onset occurred within 60?minutes following ingestion. Symptoms included dizziness, vomiting, salivation, mydriasis, jaw stiffness, urinary retention, seizures, agitated delirium, hallucinations, somnolence and coma. None of the patients suffered liver or kidney injury. There was one fatality. The Cordyceps fungus involved in these poisoning was identified as Ophiocordyceps heteropoda. The presence of ibotenic acid was confirmed, but musimol and muscarine were absent.

Conclusions: Cicada infected with Ophiocordyceps heteropoda in Vietnam contain ibotenic acid and are associated with a clinical syndrome consistent with its effects.     

The relation between oral hygiene skills and the prevalence of dental caries among 4 - 6-year-old children

AIM OF THE STUDY. To evaluate the tooth brushing skills and the prevalence of dental caries as well as its intensity in relation to oral hygiene skills among 4 - 6-year-old children. MATERIAL AND METHODS. The cross-sectional study was performed from November 16, 2009 to January 12, 2010. 235 children (4 - 6-year old) were randomly selected from kindergartens in Plung? and Jonava in Lithuania. The results of study were registered in the special forms prepared in accordance with the recommendations of WHO. Parents of the children were asked to fill in the questionnaires. RESULTS. The results of the study show that 91% (Plung?) and 90% (Jonava) of 4 - 6-year-old children have caries in their primary teeth. The prevalence of caries is different in relation to age: 78.7% of 4-year-old children, 97.3% of 5-year-old children, and 95.3% of 6-year-old children. The intensity of caries is as follows: 4.9 (SN=±4.9), 7.5 (SN=±4.5), and 8.2 (SN=±4.7). CONCLUSIONS. There is the high prevalence of caries, particularly of not treated forms, among 4 - 6-year-old children. The oral hygiene index is just satisfactory.     

Association of C-reactive protein with reduced forced vital capacity in a nonsmoking U.S. population with metabolic syndrome and diabetes

OBJECTIVE—A relationship between inflammation, measured by C-reactive protein (CRP), and forced vital capacity (FVC) in diabetes or metabolic syndrome (MetS) has not been established. We investigated whether high CRP is related to reduced FVC in MetS and diabetes.RESEARCH DESIGN AND METHODS—We examined the association of MetS/diabetes and CRP (normal ≤3 mg/l, high >3 mg/l) with predicted FVC in 4,272 nonsmoking U.S. adults aged 18–79 years without lung disease in the Third National Health and Nutrition Examination Survey. Logistic regression examined odds of FVC <80% by CRP and MetS/diabetes.RESULTS—Mean FVC in individuals with MetS and high CRP (95.7%) and those with diabetes and high CRP (93.7%) was lower than in those with no MetS/diabetes and normal CRP (101.7%) (P < 0.01) and was lower in those with MetS and high CRP (95.7%) than in those with MetS and normal CRP (98.5%) (P < 0.01). The odds ratio (95% CI) of FVC <80% was highest in individuals with MetS and high CRP (odds ratio 4.26 [95% CI 2.08–8.73], P < 0.01) compared with those with no MetS/diabetes and normal CRP.CONCLUSIONS—Elevated CRP is associated with lower FVC in people with MetS.Cross-sectional (1,2) and prospective (3) studies have demonstrated impaired lung function in individuals with diabetes and metabolic syndrome (MetS). Recent studies show that reduced lung function may be a precursor of diabetes (4). People with reduced lung function have greater levels of inflammation (5), and people with diabetes or MetS (6,7), including those with elevated C-reactive protein (CRP) (8), are at increased risk of cardiovascular disease. Although the interplay among MetS, diabetes, and insulin resistance has been thoroughly investigated and extensively published, their role in systemic inflammation and lung function impairment has not been firmly established. We examined whether increased levels of CRP may help identify lung function impairment in individuals with MetS/diabetes.