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.     

The initial phase of graft‐versus‐host disease is associated with a decrease of CD4+CD25+ regulatory T cells in the peripheral blood of patients after allogeneic stem cell transplantation

The mechanisms that induce and control the alloimmune inflammation of graft‐versus‐host disease (GvHD) after allogeneic stem cell transplantation (allo‐SCT) are still incompletely understood. In the murine system, GvHD can be suppressed by CD4⁺CD25⁺ regulatory T cells (TREG), which are generally involved in the suppression of inflammatory reactions. A disruption of the homeostasis between TREG and conventional T cells might therefore be associated with the inflammatory reactions of GvHD. We repetitively measured the frequency of TREG in the peripheral blood of 29 patients within the first 71–373 days after allo‐SCT and correlated the results with the clinical course. We demonstrate that the initial phase of GvHD is associated with a significant reduction of TREG in the peripheral blood, while at later stages and during intensified immunosuppressive therapy, increased numbers of TREG appear. These results might indicate a pathogenic role for reduced numbers of TREG in the induction of human GvHD.     

Zotarolimus-eluting stent utilization in small-vessel coronary artery disease (ZEUS)

The role of the second-generation zotarolimus-eluting stent RESOLUTE in small-vessel coronary artery disease is unclear. The aim of this study was examine the angiographic results of RESOLUTE in de novo coronary lesions of ≥50 % diameter stenosis in target vessels ≤2.5 mm. From August 2008 to April 2010, 142 symptomatic patients with 159 lesions who fitted the inclusion criteria were treated with RESOLUTE. The mean age of patients was 66 ± 10 years, with male predominance (66 %). Diabetes mellitus was found in 62 (43.7 %) patients, whereas multivessel disease was observed in 105 (73.9 %). The mean stent size and length used were 2.33 ± 0.13 and 22 ± 8 mm, respectively. Follow-up angiography was performed on 143 (89.9 %) lesions in 127 (89.4 %) patients at a mean of 10.3 ± 3.6 months. Angiographic restenosis was found in 9 (6.3 %) lesions; the late loss was 0.26 ± 0.34 mm. At 1-year follow-up there were four cardiovascular deaths, two nonfatal myocardial infarctions, and six repeated revascularizations. The resultant major adverse cardiac event rate was 8.5 %. The use of RESOLUTE to treat small-vessel disease is associated with good clinical and angiographic outcomes at 1 year.     

Hemodynamic Effects and Clinical Determinants of Defibrillation Threshold for Transvenous Atrial Defibrillation Using Biatrial Biphasic Shocks in Patients with Chronic Atrial Fibrillation

We assessed the relationship between the hemodynamic changes and shock intensity in transvenous atrial defibrillation for chronic AF. The correlation between the clinical profile and atrial DFT and the factors predicting maintenance of SR after successful defibrillation were also investigated. Atrial defibrillation using entirely transvenoas leads has been investigated as an alternative means of managing patients with AF. However, the hemodynamic consequence of this technique and the clinical factors predicting defibrillation efficacy have not been evaluated. Thirty-seven patients with chronic AF (4 weeks to 60 months) underwent transvenoas atrial defibrillation. Defibrillation was performed by delivering R wave synchronized, biphasic (3/3 ms) shocks with step-up voltages (20–400 V) between defibrillation catheters in the anterolateral right atrium and the distal coronary sinus. Clinical profile of the patients, the DFT, arterial blood pressure, and RH interval during defibrillation and the 6-month recurrence rate were determined. SR was restored in 33 (89%) of 37 patients and the DFT was 3.7 ± 1.4 J (317 ± 58 V). Transvenous atrial defibrillation resulted in a mild reduction in blood pressure (6 ± 10 mmHg), but substantial prolongation of longest postshock RR intervals (507 ± 546 ms), which were significantly related to the shock intensity (r = 0.5, P < 0.001). There was no ventricular proarrhythmia. The patients'age, body weight, duration of AF, left atrial diameter, and ejection fraction were not related to the success of defibrillation, not the 6-month maintenance rate of SR (39%). However, the patients'age was related to DFT. Apart from transient reduction in blood pressure and shock related pauses that may require backup pacing, transvenous biatrial defibrillation was a highly effective and well-tolerated technique. The absence of clinical determinant for successful defibrillation suggests that restoring SR by transvenous atrial defibrillation could be attempted in most patients with chronic AF.     

早期清创缝合后不使用抗生素的临床分析

目的研究早期清创缝合后不预防性地使用抗生素对创口的影响。方法我科自2004年1月至2005年6月有选择性地对50例皮肤软组织挫裂伤进行了急诊清创缝合,术后未给予抗生素,并连续观察伤口的变化。结果本组所有伤口均未发生感染。结论早期清创及规范的清创缝合术后可以不必预防性地使用抗生素。     

Hematin and Bilirubin Binding to Human Serum Albumin and Newborn Serum

ABSTRACT. In jaundiced newborn infants, hemolytic disease is considered a risk factor for kernicterus due to the suspected competition between bilirubin and other hemoglobin breakdown products for albumin binding. We have studied the effect of hematin on bilirubin-albumin binding using the peroxidase assay and a light-scattering technique for measuring unbound bilirubin. Our results show that hematin does not affect bilirubin-albumin binding. To determine if other albumin binding functions are affected by hematin, we used a microdialysis rate technique employing two ligands, diazepam and monoacetyldiaminodiphenyl sulfone (MADDS). Hematin does not utilize the diazepam binding function of albumin, but does decrease the albumin binding of MADDS. The results of this study indicate that the MADDS and bilirubin binding functions are not identical. The clinical usefulness of reserve albumin equivalent determination using MADDS is discussed.     

Multiple spinal intramedullary cavernous angioma: case report

Spinal cavernous angiomas frequently accompany to cranial cavernous angiomas. Multiple spinal cord cavernous angiomas are very rare and to authors knowledge, only one case has been described having multiple intramedullary cavernous angiomas without cranial involvement until now. In this report, we present a case with acute paraplegia who had thoracic and cervical intramedullary cavernous angiomas and normal cranial magnetic resonance imaging.     

RENAL FUNCTION IN CHRONICALLY CATHETERIZED CONSCIOUS DIABETIC RATS USING CONSTANT AND SERVO-CONTROLLED INFUSION

1. Infusion experiments were performed on chronically catheterized conscious rats to assess kidney function before and after the induction of diabetes mellitus with streptozotocin. 2. Two infusion regimens were used, a conventional constant-infusion protocol and a novel computer-driven, servo-controlled fluid replacement technique. The latter enables body fluid status to be maintained throughout a study occasion by servo-controlled replacement of spontaneous urinary fluid losses. 3. The chronically catheterized conscious rat infused using a servo-controlled system appears to be the optimum model for a study of diabetic renal function. The conscious preparation circumvents problems associated with anaesthesia and acute surgery. The servo-controlled infusion protocol maintains the altered fluid status of the diabetic condition. Both hyperfiltration and polyuria, characteristics of human diabetes often absent in anaesthetized and/or constantly infused diabetic rats, were seen in all conscious servo-controlled diabetic animals. 4. The new regimen enables a more accurate assessment of renal function in experimental diabetes than with previous protocols. It should prove useful in future studies, particularly those assessing the role of anti-diabetic drugs on the kidney.