Factors affecting mortality of critical care trauma patients

Background

Critically-ill trauma patients have a high mortality.

Objective

To study the factors affecting the mortality of ICU trauma patients treated at Al-Ain Hospital, United Arab Emirates (UAE).

Methods

All trauma patients who were admitted to the ICU were prospectively collected over three years (2003–2006). Univariate and multivariate analysis were used to compare patients who died and who did not. Gender, age, nationality, mechanism of injury, systolic blood pressure and GCS on arrival, the need for ventilation, presence of head or chest injuries, AIS for the chest and head injuries and the ISS were studied.

Results

There were 202 patients (181 males). The most common mechanism of injury was road traffic collisions (72.3 %). The overall mortality was 13.9%. A direct logistic regression model has shown that factors that affected mortality were decreased GCS (p < 0.0001), mechanism of injury (p = 0.004) with burns having the highest mortality, increased age (p = 0.004), and increased ISS (p = 0.02). The best GCS that predicted mortality was 5.5 while the best ISS that predicted mortality was 13.5.

Conclusion

Road traffic collision is the most common cause of serious trauma in UAE followed by falls. Decreased GCS was the most significant factor that predicted mortality in the ICU trauma patients.     

Genital asymmetry in men

This study examined genital asymmetry in a large sample of men. The probands were 6544 non-delinquent men who were interviewed by the Kinsey Institute for Research in Sex, Gender and Reproduction from 1938 to 1963. The measures were four indicators of penile and scrotal asymmetry, along with self-reported handedness, from Kinsey's interview protocol. Most men reported some degree of lateral asymmetry in their flaccid penis and in their testicles; less asymmetry was reported for their erect penis. The asymmetry typically occurred in the left direction, and this pattern occurred in both right- and nonright- handers. However, this 'leftward' pattern was significantly less pronounced in nonright-handers. The results are discussed in relation to previous findings of genital asymmetry in men, the possible relationship of genital asymmetry to functional cerebral asymmetry, and recent data suggesting genital asymmetry may predict patterns of cognitive performance and genital/sexual organ cancers.      

Nerve fibres in peritoneal endometriosis

BACKGROUND: Endometriosis is a gynaecological disease that can be associated with severe pelvic pain; however, the mechanisms by which pain is generated remain unknown. METHODS: Peritoneal endometriotic lesions and normal peritoneum were prepared from women with and without endometriosis (n = 40 and 36, respectively). Specimens were also prepared from endosalpingiosis lesions (n = 9). These sections were stained immunohistochemically with antibodies against protein gene product 9.5, neurofilament (NF), nerve growth factor (NGF), NGF receptor p75 (NGFRp75), substance P (SP), calcitonin gene-related peptide (CGRP), acetylcholine (ACh) and tyrosine hydroxylase (TH) to demonstrate myelinated, unmyelinated, sensory, cholinergic and adrenergic nerve fibres. RESULTS: There were significantly more nerve fibres identified in peritoneal endometriotic lesions than in normal peritoneum (P < 0.001) or endosalpingiosis lesions (P < 0.001). These nerve fibres were SP, CGRP, ACh or TH immunoreactive. Many of these markers were co-localized. There was an intense NGF immunoreactivity near endometriotic glands, and NGFRp75 immunoreactive nerve fibres were present near endometriotic glands and blood vessels in the peritoneal endometriotic lesions. CONCLUSIONS: Peritoneal endometriotic lesions were innervated by sensory Adelta, sensory C, cholinergic and adrenergic nerve fibres. These nerve fibres may play an important role in the mechanisms of pain generation in this condition.     

Vitamin K status in cystic fibrosis

Appearance of PIVKA-II (protein induced by vitamin K absence-II) in serum is a biochemical sign of insufficient vitamin K-dependent carboxylation of prothrombin. Plasma concentrations of PIVKA-II and vitamin K1 were determined in 24 children with cystic fibrosis. Eight were supplemented with vitamin K1. The purpose of the study was to determine the occurrence of vitamin K deficiency in cystic fibrosis and to evaluate the effect of vitamin K supplementation. PIVKA-II was detectable in only one unsupplemented child. In this patient, the concentration of vitamin K1 was below the limit of detection of 60 ng/l. Vitamin K1 levels in the other unsupplemented children were normal (mean 476 ng/l = 1 mmol/l). The supplemented patients showed extremely high levels of vitamin K1 (mean 22445 ng/l = 50 nmol/l). In conclusion, vitamin K deficiency occurs infrequently in cystic fibrosis. Checking the coagulation system is advised, but routine vitamin K supplementation is not recommended. If additional vitamin K is needed, the starting dose should not exceed 1 mg daily.     

Prenatal diagnosis of aniridia

OBJECTIVE: To use molecular genetic techniques to prenatally screen for aniridia. DESIGN: Case report. METHODS: DNA was extracted from cultured fibroblasts obtained through amniocentesis. Two mutation detection methods, Ava1 restriction digestion and single-strand conformational polymorphism electrophoresis, were used to screen the PAX6 gene. MAIN OUTCOME MEASURES: The results from the amniocentesis sample were compared with DNA obtained from the affected father, firstborn infant, and unaffected mother to determine whether the fetus carried the PAX6 mutation. RESULTS: DNA from the fetus demonstrated the same banding pattern as the affected father and firstborn infant. CONCLUSIONS: The fetus carried the mutated PAX6 allele and was predicted to develop aniridia. This was later confirmed when the child was born. This case report illustrates an important use of genetic mutation screening in the clinical setting.     

Bay K 8644, modifier of calcium transport and energy metabolism in rat heart mitochondria: a new intracellular site of action.

1. The dihydropyridine Ca2+ channel agonist Bay K 8644 (10-200 microM) produced a concentration-dependent increase in State 4 respiration in the rat heart mitochondria with the highest concentration (200 microM) increasing the rate from 33.1 +/- 0.7 to 187.0 +/- 13.3 ng atoms O2 consumed min-1 mg-1 protein. 2. Bay K 8644 (200 microM) reduced State 3 respiration from 247.2 +/- 11.7 to 174.4 +/- 0.06 ng atoms O2 min-1 mg-1 protein, reduced the respiratory control index (RCI) from 5.3 +/- 0.45 to 1.1 +/- 0.03 and reduced the ADP:O ratio from 2.75 +/- 0.03 to 1.3 +/- 0.15. 3. A similar, but smaller, stimulation of State 4 respiration was seen with nitrendipine (25-200 microM), the rate increasing from 22.6 +/- 1.0 to 33.1 +/- 1.8 ng atoms O2 consumed min-1 mg-1 protein in the presence of 200 microM nitrendipine. 4. Bay K 8644 (10-60 microM) increased the total Ca2+ uptake into rat heart mitochondria, the total increasing from 248.8 +/- 8.4 to 406.9 +/- 17.6 ng Ca2+ mg-1 protein at 60 microM Bay K 8644 (EC50 = 18.9 +/- 1.4 microM). 5. Bay K 8644 (10-60 microM) produced a concentration-dependent reduction in the Ca2+ influx rate (IC50 = 52.5 +/- 2.8 microM). Similar effects were seen with (+)-Bay K 8644 and (-)-Bay K 8644. 6. Nitrendipine (40-120 microM) stimulated Ca2+ efflux from mitochondria preloaded with the ion; the efflux rate increasing from 2.9 +/- 0.05 to 114.2 +/- 6.2 nmol Ca2+ min-1 mg-1 protein (EC50 = 57.3 +/- 1.3 microM).(ABSTRACT TRUNCATED AT 250 WORDS)     

Does levodopa alter depression and psychopathology in Parkinsonism patients?

Twenty-seven Parkinsonism patients and 31 controls, matched for age and verbal IQ, were tested on an objectively scored personality test (Minnesota Multiphasic Personality Inventory) at the beginning of the patients' levodopa therapy and three months later. Patients, but not the controls, were retested after 15 months of levodopa treatment. The patients, all of whom were intact intellectually, obtained MMPI scores indicating moderate depression before beginning levodopa treatment. There was no test evidence to indicate that levodopa significantly increased or decreased the amount of depression in the patients after three or 15 months of levodopa. The patient group, however, significantly increased their Index of Psychopathology (Ip) score after 15 months of levodopa but not after three months.