Evaluation of perfusion index as a tool for pain assessment in critically ill patients

Pain is a common and undertreated problem in critically ill patients. Pain assessment in critically ill patients is challenging and relies on complex scoring systems. The aim of this work was to find out the possible role of the perfusion index (PI) measured by a pulse oximeter (Masimo Radical 7; Masimo Corp., Irvine, CA, USA) in pain assessment in critically ill patients. A prospective observational study was carried out on 87 sedated non-intubated patients in a surgical intensive care unit. In addition to routine monitoring, a Masimo pulse oximeter probe was used for PI measurement. The sedation level of the patients was assessed by using the Richmond Agitation-Sedation Scale (RASS). The pain intensity was determined by applying the behavioral pain scale for non-intubated (BPS-NI) patients. The PI, arterial blood pressure, heart rate, RASS, and BPS-NI values before and after the application of a standard painful stimulus (changing the patient position) were reported. Correlation between the PI and other variables was carried out at the two measurements. Correlation between changes in the PI (delta PI) and in the hemodynamic variables, RASS, and BPS-NI was also done. Changing the patient position resulted in a significant increase in SBP (128 ± 20 vs 120.4 ± 20.6, P = 0.009), DBP (71.3 ± 11.2 vs 68.7 ± 11.3, P = 0.021), heart rate (99.5 ± 19 vs 92.7 ± 18.2, P = 0.013), and BPS-NI (7[6–8] vs 3[3–3], P < 0.001) values and a significant decrease in the PI (1[0.5–1.9] vs 2.2[0.97–3.6], P < 0.001) value compared to the baseline readings. There was no correlation between the values of the PI and the ABP, BPS-NI, and RASS at the two measurements. A good correlation was found between the delta PI and delta BPS-NI (r = ?0.616, P < 0.001). A weak correlation was observed between the PI and heart rate after the patient positioning (r = ?0.249, P < 0.02). In surgical critically ill non-intubated patients, the application of a painful stimulus was associated with decreased PI. There was a good correlation between the change in the PI and the change in BPS-NI values after the application of painful stimulus.     

Prevalence of Psychiatric Symptoms and Mental Health Services in Students with Specific Learning Disabilities in Tehran,Iran

Children with specific learning disabilities are at a greater risk of mental health problems than their non-disabled peers. Further interventions and research will be required. This is a cross-sectional study. A sample of 107 students (7 to 11 years old) with specific learning disabilities were randomly selected from educational and rehabilitation settings in Tehran. The Child Symptom Inventory-4 (CSI-4) (parent checklist) was administered. Among children studied, 86 subjects (82.8 %) in some of the categories of psychiatric symptoms gained scores above the cut-off point. The most prevalent psychiatric symptoms were related to attention-deficit/hyperactivity disorder, generalized anxiety disorder and oppositional defiant disorder. There were not any statistically significant differences between the genders. In addition to direct education, 15 subjects (14 %) were receiving medication, 2 subjects (1.9 %) were receiving only occupational therapy, 2 subjects (1.9 %) were receiving only speech therapy, and 5 subjects (4.7 %) were receiving both occupational and speech therapy. The emphasis on considering co-morbid symptoms and usage of mental health services are important issues for students with specific learning difficulties.     

The antioxidant activity of some curcuminoids and chalcones

The antioxidant properties of the synthetic compound (C1)–(C8), which comprised 7 curcuminoids and a chalcone, were evaluated by two complementary assays, DPPH and β-carotene/linoleic acid. It was found that, in general, the free radical scavenging ability of (C1)–(C8) was concentration-dependent. Compounds (C1) and (C4), which contained (4-OH) phenolic groups, were found to be highly potent antioxidants with higher antioxidant values than BHT suggesting that synthetic curcuminoids are more potent antioxidants than standard antioxidants like BHT. Using β-carotene-linoleic acid assay, only the water-soluble 2, 4,6-trihydroxyphenolic chalcone (C5) showed 85.2 % inhibition of the formation of conjugated dienes reflecting on its potent antioxidant activity.     

非穿透性小梁切除术与传统小梁切除术治疗开角型青光眼的系统评价

目的系统评价非穿透性小梁切除术与传统小梁切除术治疗开角型青光眼的疗效。方法按Cochrane系统评价方法，计算机检索MEDLINE（1966～2008．5）、EMbase（1980～2008．5）、Cochrane图书馆（2007年2期）和中国生物医学文献数据库（1979～2008．5），并手工检索相关会议文献。文献语种限制为中英文。收集所有相关随机对照试验，采用RevMan5．0软件进行Meta分析。结果共纳入3篇随机对照试验，包括127例患者（144只患眼）。Meta分析结果显示：与非穿透性小梁切除术相比，传统小梁切除术能提高开角型青光眼术后眼压降低水平[WMD=2．78，95％CI（1．41，4．15）]和手术成功率[RR=0．53，95％CI（0．37，0．77）]，能减少术后抗青光眼药用量[WMD=0．96，95％CI（0．84，1．08）]。非穿透性小梁切除术能降低术后并发症发生率[RR=17．00，95％CI（8．00，26．00）]。结论与非穿透性小梁切除术相比，传统小梁切除术能提高眼压降低水平和手术成功率，并减少术后抗青光眼药用量；而非穿透性小梁切除术能降低术后并发症发生率。但两种术式与视野缺损进展、视神经纤维层丢失、视盘损坏等指标的关系尚待进一步研究。因本系统评价纳入研究病例数较少，上述结论尚需更多设计严谨的大样本随机对照试验加以验证。     

The effect of sensory-motor training on hand and upper extremity sensory and motor function in patients with idiopathic Parkinson disease

Study design

Blinded randomized controlled trial.

Lived experiences of immigrant nurses in New South Wales, Australia: searching for meaning

Recognising the potential value of immigrant nurses in multicultural Australia, this study sought to understand immigrant nurses' experiences in order to throw some light on their under representation in the nursing workforce. Using a Heideggerian phenomenological approach the purpose of this study was to explore, describe and analyse the lived experiences of five immigrant nurses, four from non-English-speaking backgrounds, practising in New South Wales, Australia. Through naturalistic open-ended interviews, the everyday experiences of immigrant nurses were described and hermeneutically analysed. The lived experiences, and the meaning of such experiences which emerged from analysis included: professional negation, experienced in lack of support; otherness, experienced in cultural separateness; silencing, experienced in language and communication difficulties and a number of other related experiences and feelings. The study highlights the continuing existence of a social and cultural distance between nurses of the dominant culture and nurses from culturally and linguistically diverse backgrounds.     

Assessment of Intestinal Permeability with a Two-Hour Urine Collection

The differential urinary excretion of orally administered lactulose and mannitol is used to evaluate intestinal permeability. This test usually involves a 5- to 6-hr urine collection. We hypothesized that a shorter collection time would give an equivalent result. Forty-three patients with a variety of gastrointestinal symptoms and diagnoses (group 1) and 42 patients with Crohn's disease (group 2) had a standard lactulose/mannitol permeability test. The lactulose and mannitol urinary excretion was calculated using the first urine (group 1) or the 1-hr and 2-hr urine (group 2) and was compared to the values calculated from the routine 5- or 6-hr collection. Lactulose excretion kinetics, expressed as the percent of the total urinary excretion within a given time period, were as follows: 21% in first hour (group 2), 29% in second hour (group 2), and 46% in first 2.5 hr (group 1). Mannitol urinary excretion kinetics were 16%, 31%, and 44%, respectively. The lactulose/mannitol ratio based on a standard urine collection correlated well with the ratio based on just the first urine produced by the patient (R² = 0.94; P < 0.001; group 1) and the 2-hr urine (R² = 0.464; P < 0.001; group 2). Future use of the lactulose/mannitol ratio to assess intestinal permeability may be able to be simplified by shortening the urine collection time.     

Persistent alanine aminotransferase elevation among the general Iranian population： Prevalence and causes

AIM： To determine the prevalence and causes of persistently elevated alanine aminotransferase （ALT） levels among the general population in northern Iran.
METHODS： A total of 2292 （1376 female, aged 18-75 year）, were selected by systematic clustered random sampling from the cities and villages of Gonbad and Kalaleh in Golestan Province and invited to participate in the study. A comprehensive history regarding alcohol drinking and medication was taken. Body mass index （BMI）, viral markers and ALT levels were measured. If ALT level was ≥ 40 U/L, it was rechecked twice within 6 mo. Those with ≥ 2 times elevation of ALT were considered as having persistently elevated ALT level. Non-alcoholic fatty liver disease （NAFLD） was diagnosed based on evidence of fatty liver upon sonography and excluding other etiology.
RESULTS： A total of 2049 （1351 female） patients participated in the study, 162 （7.9%） had elevated ALT level at the first measurement. Persistently elevated ALT level was detected in 64 （3.1%） participants, with51 （79.6%） with no obvious etiology, six （9.3%） with Hepatitis B, four （6.2%） with Hepatitis C virus （HCV） infection and three （4.6%） with alcoholic hepatitis. The prevalence of NAFLD and alcoholic hepatitis was 2.04% （42 patients） and 0.1% （three）, respectively. There was correlation between NAFLD and male gender, overweight, diabetes and living in an urban area [odds ratio = 3.03 （95% CI： 1.6-5.72）, 4.21 （95% CI： 1.83-9.68）, 2.86 （95% CI： 1.05-7.79） and 2.04 （95% CI： 1.00-4.16） respectively].
CONCLUSION： NAFLD is the most common cause of persistently elevated serum ALT level among the general population of Iran.     

Simple clinical risk stratification and the safety of ambulation two hours after 6 French diagnostic heart catheterization

Heart catheterization is frequently applied in patients with coronary artery disease for diagnostic and therapeutic implications. Using the femoral approach, post-procedure bed rest of 4 to 6 hours is recommended to prevent groin complications. This extended strict bed rest is associated with patient discomfort and increased medical costs, and interferes with more efficient catheterization laboratory management of referred outpatients. Accordingly, we tested a simple clinical approach to identify low-risk patients who may benefit from ambulation within two hours after sheath removal. Ninety-eight outpatients were stratified to early (time=1.5 to 2.0 hours; n=74) or conventional ambulation (time=4 to 5 hours; n=24) based on difficulties in obtaining arterial access, presence of oozing or hematoma after completing manual compression. Ecchymosis was the most frequent complication, noted in one early ambulated and three conventionally ambulated patients at hospital discharge and in eleven early ambulated and six conventionally ambulated patients at one-week follow-up. No large hematomas, retroperitoneal bleeding or need for blood transfusion occurred in any patients. Using simple clinical parameters, most outpatients who undergo elective diagnostic catheterization may benefit from safe early ambulation.