Utility of screening for blunt vascular neck injuries with computed tomographic angiography

PURPOSE: To prospectively study the impact of implementing a computed tomographic angiography (CTA)-based screening protocol on the detected incidence and associated morbidity and mortality of blunt vascular neck injury (BVNI). METHODS: Consecutive blunt trauma patients admitted to a single tertiary trauma center and identified as at risk for BVNI underwent admission CTA using an eight-slice multi-detector computed tomography scanner. The detected incidence, morbidity, and mortality rates of BVNI were compared with those measured before CTA screening. A logistic regression model was also applied to further evaluate potential risk factors for BVNI. RESULTS: A total of 1,313 blunt trauma patients were evaluated. One hundred seventy screening CTAs were performed, of which 33 disclosed abnormalities. Twenty-three were evaluated angiographically, of which 15 were considered to have significant BVNIs, as were 4 of the 10 patients with abnormal CTAs and no angiogram. The incidence of angiographically proven BVNIs in our series was 1.1%. If four patients who were treated for BVNIs based on CTA alone are included, the incidence rises to 1.4%. This is significantly higher than the 0.17% incidence before screening (p < 0.001). In addition, the delayed stroke rate and injury-specific mortality fell significantly from 67% to 0% (p < 0.001) and 38% to 0% (p = 0.002), respectively. Overall mortality also fell significantly, from 38% to 10.5% (p = 0.049). Univariate logistic regression identified the presence of cervical spine injury as a significant predictor of BVNI (p < 0.001). CONCLUSION: CTA screening increases the detected incidence of BVNI 8-fold, with rates similar to angiographically based screening protocols. CTA screening significantly decreases BVNI-related morbidity and mortality in an efficient manner, underlying its utility in the early diagnosis of this injury.     

DEATH AS A STIMULUS TO IMPROVING THE AFRICAN ENVIRONMENT FOR MORE HEALTHFUL LIVING

In D. Leviton's (1991) conception of horrendous death , a poorly managed environment can contribute to widespread mortality, and the deaths so caused can further create an environment for subsequent death. The African environment in particular is characterized by a number of "deathogenic" factors that must be understood and confronted by health educators committed to minimizing or eliminating the impact of horrendous death on the African continent. In this comment, the author argues that attention to characteristic but preventable forms of death in the African context can lead to greater public advocacy among African health educators, contributing to the physical and psychological wellbeing of the populations they serve.     

Determination of the actual height predictors in Iranian healthy children

Height measurement is an important part of nutritional assessment especially in children. However, in such cases as hospitalized or certain kinds of malformations or disabilities, height cannot be measured accurately. We aimed to determine appropriate height predictors in Iranian healthy children for further use in disabled and/or hospitalized children. A total of 730 apparently healthy children aged 7-11 years old from both sexes from Tehran, Meshed and Rasht were enrolled in a cross sectional study. Height, demispan (DS), halfspan (HS), arm length (AL) and tibia length (TL) were all measured using a measuring tape. Linear regression models were established between height, DS, HS, AL and TL. For boys AL (R2=0.783) and TL (R2=0.837) and for girls AL (R2=0.720), TL (R2=0.765), HS (R2=0.771) and age (R2=0.775), respectively, entered the linear regression model. When height predictors were evaluated individually for each city, only in Tehran DS also entered the regression model. Concordance of different percentiles of height estimates based on AL with those of actual height proposed this measure as a reliable height proxy for this age group in clinical as well as field practice.     

Effects of pomegranate juice consumption on oxidative stress in patients with type 2 diabetes: a single-blind,randomized clinical trial

Increased free radicals production due to hyperglycemia produces oxidative stress in patients with diabetes. Pomegranate juice (PJ) has antioxidant properties. This study was conducted to determine the effects of PJ consumption in oxidative stress in type 2 diabetic patients.

This study was a randomized clinical trial performed on 60, 40–65 years old diabetic patients.

The patients were randomly allocated either to PJ consumption group or control. Patients in PJ group consumed 200?ml of PJ daily for six weeks. Sex distribution and the mean age were not different between two groups. After six weeks intervention, oxidized LDL and anti-oxidized LDL antibodies decreased and total serum antioxidant capacity and arylesterase activity of paraoxonase increased significantly in the PJ-treated group compared to the control group. Our data have shown that six weeks supplementation of PJ could have favorable effects on oxidative stress in patients with type 2 diabetes (T2D).     

Biomarkers of periodontal inflammation in the Australian adult population

Background:  Several inflammatory biomarkers are implicated in the pathogenesis of periodontitis including interleukin-1β (IL-1β) and C-reactive protein (CRP). This study investigated the presence of these factors in gingival crevicular fluid (GCF) and their relationship to clinical and social determinants of periodontitis in the Australian population.
Methods:  Equal numbers of periodontitis cases and non-cases were sampled during oral epidemiologic examination in the National Survey of Adult Oral Health. GCF was sampled from four sites where probing pocket depth (PPD) and recession were recorded. From these, IL-1β and CRP were quantified by ELISA and the log amount of GCF IL-1β (pg) per person and the proportion of adults with detectable CRP was computed.
Results:  Periodontitis cases (n = 511) had significantly higher levels of IL-1β and CRP than non-cases (n = 562). PPD, clinical attachment loss, plaque and gingivitis indices were positively associated with elevated levels of both biomarkers. Levels of both were positively associated with age, low socio-economic position and non-Australian birth.
Conclusions:  The presence of IL-1β and CRP in GCF are associated with periodontal disease parameters within the Australian population. The levels of both biomarkers are influenced by age, education and eligibility for public dental care.     

Glycemic optimization may reduce lipid peroxidation independent of weight and blood lipid changes in Type 2 diabetes mellitus

The aim of this study was to determine the effect of diet-therapy on lipid peroxidation in patients with Type 2 diabetes mellitus (T2DM). Fifteen T2DM patients of both sexes, aged between 35-70 years, were given the diet suggested for patients with diabetes by the American Diabetic Association. This diet comprised 50-60% carbohydrate, 10-15% protein, 20-30% fat and about 35 g fiber was given for weight maintenance. Weight and body mass index did not change significantly during 8 weeks of study. Also, no statistically significant difference was observed in serum total cholesterol, triglycerides, LDL- and HDL-cholesterol from before to after dietary intervention. However, the levels of fasting blood sugar, HbA1c and malondialdehyde were lowered significantly after dietary intervention. It was concluded that glycemic optimization, independent of weight and blood lipid profile, through a well-designed diet is likely to be the most effective factor in reducing the process of oxidative stress in T2DM. This may have preventive implications for such diabetic complications as atherosclerosis.