Is vitamin D deficiency associated with development of Acinetobacter baumannii infections in critically ill patients?

Purpose

A growing number of evidence demonstrates deficiency of vitamin D in critically ill patients. We aimed to evaluate the vitamin D status of our critically ill patients and its relevance to infections in these patients.

Material and Methods

We conducted a prospective observational study in 201 critically ill patients admitted to the medical intensive care unit of Gazi University Hospital between October 2009 through March 2011.

Results

Sixty-nine percent of the patients were found to be vitamin D deficient. Infection rate was higher in the deficient group, though without statistical significance (P = .117). Infections with Acinetobacter baumannii was significantly more frequent in patients with Vitamin D deficiency (25% vs 10%, P = .012). The median level of 25-hydroxyvitamin D levels was 11.8 [6.3-17.2] ng/mL and 15.7 [8.1-28.9] ng/mL in patients with and without A baumannii infections respectively (P = .024). Logistic regression analysis demonstrated that vitamin D deficiency (P = .042) and invasive mechanical ventilation (P = .001) were the 2 independent risk factors in the development of A baumannii infections, in addition.

Conclusions

Vitamin D deficiency is common in critically ill patients. Even though there was no statistical difference between vitamin D deficient and sufficient patients regarding development of infections in general, A baumannii infections were significantly more frequent in the deficient group. Vitamin D deficiency was found as one of the independent risk factors for A baumannii infections. Further multicenter studies with a larger sample size are required to validate our data.     

Decreased respiratory rate variability during mechanical ventilation is associated with increased mortality

Objective

Patients on ventilatory support often experience significant changes in respiratory rate. Our aim was to determine the possible association between respiratory rate variability (RRV) and outcomes in these patients.

Design

A longitudinal, prospective, observational study of patients mechanically ventilated for at least 12 h performed in a medical-surgical intensive care unit. Patients were enrolled within 24 h of the initiation of ventilatory support. We measured airway signals continuously for the duration of ventilatory support and calculated expiratory flow frequency spectra at 2.5-min intervals. We assessed RRV using the amplitude ratio of the flow spectrum’s first harmonic to the zero frequency component. Measures of the amplitude ratio were averaged over the total monitored time. Patients with time-averaged amplitude ratios <40 % were classified as high RRV and those ≥40 % as low RRV. All-cause mortality rates were assessed at 28 and 180 days from enrollment with a Cox proportional hazards model adjusted for disease acuity by the simplified acute physiology score II.

Results

We enrolled 178 patients, of whom 47 had high RRV and 131 low RRV. Both groups had similar disease acuity upon enrollment. The 28- and 180-day mortality rates were greater for low RRV patients with hazard ratios of 4.81 (95 % CI 1.85–12.65, p = 0.001) and 2.26 (95 % CI 1.21–4.20, p = 0.01), respectively. Independent predictors of 28-day mortality were low RRV, i.v. vasopressin, and SAPS II.

Conclusions

Decreased RRV during ventilatory support is associated with increased mortality. The mechanisms responsible for this finding remain to be determined.     

Acute Aortic Regurgitation with Myocardial Infarction: An Important Clue for Aortic Dissection

Background

Aortic dissection is an important cause of acute chest pain that should be rapidly diagnosed, as mortality increases with each hour this condition is left untreated. The diagnosis can be challenging, especially if concomitant myocardial infarction is present. Echocardiography is an important tool for the differential diagnosis.

Objectives

To stress the importance of recognizing aortic regurgitation for the differentiation of myocardial infarction and aortic dissection.

Case Report

An 80-year-old woman was admitted to our hospital with chest pain that was diagnosed as inferior and lateral wall myocardial infarction based on electrocardiographic findings. The diagnosis was reevaluated when aortic regurgitation was detected on echocardiography. Closer inspection of the ascending aorta revealed a dissection flap as the cause of aortic regurgitation.

Conclusion

Detection of aortic regurgitation in a patient with myocardial infarction and normal valves should prompt the search for a possible aortic dissection, whether or not the dissection flap can be visualized.     

Subclinical inflammation after laser in situ keratomileusis in corneal grafts

PURPOSE: To evaluate postoperative inflammatory reaction in the eye after laser in situ keratomileusis (LASIK) in corneal grafts. SETTING: Department of Ophthalmology, Helsinki University Central Hospital, Helsinki, Finland. METHODS: Ten eyes of 9 patients with penetrating keratoplasty (PKP) and significant postoperative refractive errors and astigmatism had LASIK 22 months or more after the PKP. All patients were treated with the VISX Star excimer laser and the Bausch & Lomb Hansatome microkeratome. Preoperative and early postoperative inflammation was evaluated by quantifying the aqueous flare intensity with a laser flare photometer (Kowa FM-500). A full ophthalmic assessment was also performed before LASIK and up to 6 months postoperatively. RESULTS: The inflammatory response was mild and limited to the first postoperative hour. The mean anterior chamber flare increased from 6.0 photons/millisecond (ph/ms) preoperatively to 14.0 ph/ms at 1 hour and then decreased to 6.7 ph/ms (hour 3), 6.8 ph/ms (day 1), and 8.2 ph/ms (day 7). The mean spherical equivalent (SE) refraction decreased from -3.81 diopters (D) (range -9.63 to -0.25 D) to -0.46 D (range -1.13 to +0.38 D), and the mean preoperative astigmatism decreased from 3.0 D (range 6.5 to 0.5 D) to 0.7 D (range 0.0 to 2.0 D). At the last examination, 9 eyes were within +/-1.0 D (6 within +/-0.5 D) and all were within +/-1.5 D of the intended SE refraction. Three eyes achieved full cylinder correction, and 7 were within +/-1.0 D of the intended correction. Eight eyes had a best corrected visual acuity of 20/40 or better (unchanged or gain of 1 to 4 lines [6], loss of 1 line [1], and loss of 3 lines [1]), and 8 had an uncorrected visual acuity of 20/50 or better. CONCLUSIONS: Uneventful LASIK induced subtle, short-lasting anterior chamber flare when measured by the laser flare meter. In corneal grafts, LASIK appeared to be a safe and effective procedure for residual refractive errors.     

The study of sirtuins in breast cancer patients before and after radiotherapy

Background/aimTargeting the new and unique proteins is an important medical strategy for treating breast cancer. It is quite important to find out proteins that have a role in the development of cancer. Sirtuins (SIRT) are well related in different physiological activities and connected with cancer. We aimed to determine the effect of radiotherapy on SIRT1 and SIRT2, which have not been yet been clarified as a tumor suppressor or promoter.Materials and methodsTwenty-two women with nonmetastatic breast cancer enrolled in the study. Blood samples were taken before and after radiotherapy, soluble SIRT1 and SIRT2 levels were determined with ELISA kits.ResultsThere was no difference in SIRT1 levels before and after radiotherapy (p = 0.548). SIRT2 levels were significantly found to be decreased after radiotherapy (p = 0.042). There was a strong and positive correlation before radiotherapy (p < 0.001), and a moderate and positive correlation after radiotherapy (p = 0.007) between SIRT1 and SIRT2.ConclusionThese results suggest that SIRT2 may provide a new strategy for follow-up of breast cancer treatment. Additionally, by emphasizing the importance of SIRT2 in breast cancer, it opens ways to provide grounds for the development of the next generation of SIRT2-specific radiotracers. Finally, the most important thing, in fact, the positive correlation between SIRT1 and SIRT2 both before and after radiotherapy, appears to be clear evidence suggesting more oncogenic roles of sirtuins.     

Darkness hormone or daylight hormone in women with systemic lupus erythematosus?

Clinical Rheumatology - In this study, it was aimed to compare the effects of both melatonin and 25-hydroxyvitamin D3, defined as an immune modulator, on laboratory diagnostic criteria parameters...     

A Placebo-Controlled,Multicenter, Randomized,Double-Blind,Flexible-Dose,Two-Way Crossover Study to Evaluate the Efficacy and Safety of Sildenafil in Men With Traumatic Spinal Cord Injury and Erectile Dysfunction

Background/objective: To show the efficacy, safety, and tolerability of sildenafil in men with erectile dysfunction (ED) associated with complete or incomplete spinal cord injury (SCI) and to assess its effects onquality of life (Qol) using the Life-Satisfaction Check List.

Methods: This was a placebo-controlled, multicenter, randomized, double-blind, flexible-dose, 2-way crossover study with a 2-week washout period between each phase. Patients with ED attributable to SCI(Sexual Health Inventory-Male score ≤21) received 50 to 100 mg sildenafil (n = 24) or placebo (n = 26).

Results: Compared with placebo, sildenafil produced higher levels of successful sexual stimulation,intercourse success, satisfaction with sexual life and sexual relationship, erectile function, overall sexual satisfaction, and an improved Erectile Dysfunction Inventory of Treatment Satisfaction score, with no clinically relevant effects onvital signs. Sildenafil seemed more effective in patients with incomplete SCI than in those with complete SCI, producing significant improvements, compared with placebo, in a number of measures only in patients with incomplete SCI. All patients who expressed a preference selected sildenafil over placebo, although the drug had no effect on patient Qol. Sildenafil was well tolerated, with a profile comparable to that of placebo.

Conclusions: Compared with placebo, treatment with oral sildenafil safelyand effectively improved erectile function in patients with ED attributable to SCI, especially in those with incomplete injury, and was theagent of choice in those who expressed a preference.