Safety and efficacy of a graduated intravenous insulin infusion protocol in critically ill trauma patients receiving specialized nutritional support

OBJECTIVE: The intent of this study was to evaluate the safety and efficacy of our protocol for providing continuous intravenous regular human insulin (RHI) infusion to hyperglycemic critically ill trauma patients receiving specialized nutritional support. METHODS: Capillary blood glucose (BG) concentrations were determined every 1-2 h. Glucose control was defined as a BG concentration in the target range of 70-149 mg/dL (3.9-8.3 mmol/L). Data were recorded for 1 d before the RHI infusion and for a maximum of 8 d thereafter while receiving the RHI infusion. RESULTS: Forty adult critically ill trauma patients received 102 +/- 62 units of RHI daily for 10 +/- 6 d. BG control was achieved within 5 +/- 3 h. BG decreased from 194 +/- 55 mg/dL (10.8 +/- 3.1 mmol/L) to 134 +/- 19 mg/dL (7.4 +/- 1.1 mmol/L) after 1 d of RHI infusion (P < 0.001). Average daily BG ranged from 119 to 124 mg/dL and the target range was maintained for 19.6 +/- 4.7 h/d. None of the patients experienced severe hypoglycemia (<40 mg/dL); 14 patients had asymptomatic hypoglycemia (<60 mg/dL or <3.3 mmol/L) for a total of 23 episodes out of 4140 measurements (0.56%). Estimated creatinine clearance for those with hypoglycemia was 69 +/- 32 mL/min compared with 117 +/- 58 mL/min for the others (P < 0.01). CONCLUSION: Our protocol was safe and effective for the management of hyperglycemia in critically ill trauma patients receiving specialized nutritional support but should be used with caution in patients with renal insufficiency.     

Hypermobile Ehlers-Danlos syndromes: Complex phenotypes,challenging diagnoses,and poorly understood causes

The Ehlers-Danlos syndromes (EDS) are a group of heritable, connective tissue disorders characterized by joint hypermobility, skin hyperextensibility, and tissue fragility. There is phenotypic and genetic variation among the 13 subtypes. The initial genetic findings on EDS were related to alterations in fibrillar collagen, but the elucidation of the molecular basis of many of the subtypes revealed several genes not involved in collagen biosynthesis or structure. However, the genetic basis of the hypermobile type of EDS (hEDS) is still unknown. hEDS is the most common type of EDS and involves generalized joint hypermobility, musculoskeletal manifestations, and mild skin involvement along with the presence of several comorbid conditions. Variability in the spectrum and severity of symptoms and progression of patient phenotype likely depend on age, gender, lifestyle, and expression domains of the EDS genes during development and postnatal life. In this review, we summarize the current molecular, genetic, epidemiologic, and pathogenetic findings related to EDS with a focus on the hypermobile type.     

Regional specific groundwater arsenic levels and neuropsychological functioning: a cross-sectional study

Background: The purpose of the study was to examine the link between geographic information system (GIS)-estimated regional specific groundwater levels and neuropsychological functioning in a sample of individuals with and without cognitive impairment. Methods: This cross-sectional study design analyzed data from 1390 participants (733 Alzheimer’s disease, 127 Mild Cognitive Impairment, and 530 with normal cognition) enrolled in the Texas Alzheimer’s Research and Care Consortium. GISs analyses were used to estimate regional specific groundwater arsenic concentrations using the Environmental Systems Research Institute and arsenic concentrations from the Texas Water Development Board. Results: In the full cohort, regional specific arsenic concentrations were positively associated with language abilities (p?=?0.008), but associated with poorer verbal memory, immediate (p?=?0.008), and delayed (p?p?=?0.02), and delayed (p?Conclusions: Overall, estimated regional specific groundwater arsenic levels were negatively associated with neuropsychological performance.     

Presence of human noroviruses on bathroom surfaces: a review of the literature

Enteric viruses are the most common cause of acute gastroenteritis worldwide with most cases of illness attributed to caliciviruses, such as human noroviruses (HuNoV). While environmental transmission of HuNoV is reported to be low, environmental surfaces could be a source of secondary transmission. As many vomiting/fecal episodes occur in bathrooms, bathroom surfaces could be an important vehicle for transmitting HuNoV. We systematically reviewed the literature to determine the presence of HuNoV on bathroom surfaces. Our review included 22 eligible studies conducted in commercial and institutional settings. Under outbreak conditions, 11 studies reported detection rates of 20–100 %. Six studies implicated bathroom surfaces as primary sources of HuNoV infection while three reported HuNoV present on bathroom surfaces but indicated different primary sources. Under non-outbreak conditions, five studies reported detection rates of 2–17 %. Factors associated with HuNoV presence in bathrooms included population density, setting type, employee numbers, food handler knowledge, awareness, and behaviours, and cleaning/disinfecting procedures. Our review suggests bathrooms could be vehicles that transmit HuNoV under both outbreak and non-outbreak conditions.     

Experimental effects of chocolate deprivation on cravings, mood, and consumption in high and low chocolate-cravers

This study examined how deprivation of chocolate affects state-level chocolate cravings, mood, and chocolate consumption in high and low trait-level chocolate-cravers. After identifying high and low chocolate cravers (N = 58), half of the participants were instructed not to eat any chocolate for 2 weeks. This created four experimental groups: deprived high-cravers (n = 14), deprived low-cravers (n = 14), non-deprived high-cravers (n = 15), and non-deprived low-cravers (n = 15). Following 2-week deprivation, state-level food cravings, mood, and chocolate intake were measured in a laboratory setting and compared across groups. Analyses revealed that anxiety increased over time for high-cravers (both deprived and non-deprived); state-level chocolate- and food-craving increased over time for both deprived groups and non-deprived high-cravers; non-deprived high-cravers ate the most chocolate; and, high-cravers were more joyful and guilty than low-cravers after eating chocolate in the laboratory. Theoretically, these results suggest that chocolate consumption may be better explained by trait-level of chocolate craving than by deprivation and highlighted significant differences in mood, state-level cravings, and chocolate intake between cravers and non-cravers following deprivation.     

Examination of the Cognitive Diathesis-Stress Conceptualization of the Hopelessness Theory of Depression in Children With Chronic Illness: The Moderating Influence of Illness Uncertainty

This study utilized a cognitive diathesis-stress conceptualization to examine the relationship of attributional style and illness uncertainty to depression in children with type 1 diabetes, asthma, or cystic fibrosis. Children ages 8 to 12 completed measures of illness uncertainty, attributions for illness-unrelated negative events, and depressive symptoms. Results indicated that general attributions for negative events predicted higher levels of depressive symptoms under conditions of both high and low illness uncertainty. Subsequent plotting of the regressions revealed that depressive symptoms were greater at higher levels of uncertainty when attributions were stable and global. Findings support a diathesis-stress conceptualization in pediatric chronic illness and highlight the importance of interventions targeting management of illness uncertainty and maladaptive cognitions.