The use of chloride–sodium ratio in the evaluation of metabolic acidosis in critically ill neonates

Acid-base disturbances have been usually evaluated with the traditional Henderson-Hasselbach method and Stewart's physiochemical approach by quantifying anions of tissue acids (TA). It is hypothesized that an increase in tissue acids during metabolic acidosis would cause a compensatory decrease in the plasma chloride (Cl) relative to sodium (Cl-Na ratio) in order to preserve electroneutral balance. Therefore, we aimed to investigate the use of Cl-Na ratio as a bedside tool to evaluate the identifying raised TA in neonates as an alternative to complex calculations of Stewart's physiochemical approach. This retrospective study was conducted between January 2008 and December 2009. Infants were included in the study when blood gas analysis reveals a metabolic acidosis; pH?<7.25 and sHCO(3) concentration was <22?mEq/L. The Cl-Na ratio, sodium-chloride difference (Diff(NaCl)), anion gap (AG), albumin-corrected AG (AG(corr)), strong ion difference (SID), unmeasured anions (UMA), and TA were calculated at each episode of metabolic acidosis. A total of 105 metabolic acidosis episodes occurred in 59 infants during follow-up. Hypochloremic metabolic acidosis occurred in 17 (16%) of samples, and all had increased TA. The dominant component of TA was UMA rather than lactate. There was a negative correlation between the Cl-Na ratio and SID, AG(corr), UMA, and TA. Also, there was a positive correlation between Diff(NaCl) and SID, AG(corr), UMA, and TA. Base deficit and actual bicarbonate performed poorly in identifying the TA. In conclusion, our study suggested that Diff(NaCl) and Cl-Na ratio are simple and fast, and may be an alternative method to complex Stewart's physiochemical approach in identifying raised UMA and TA in critically ill neonates.     

Temperament traits and psychopathy in a group of patients with antisocial personality disorder

Objective

The Psychopathy Checklist Revised (PCL-R) and Temperament and Character Inventory (TCI) have been used extensively in research of personality disorders; however, no previous study has investigated the relation between psychopathy factors and temperament and character traits in patients with antisocial personality disorder (ASPD). Our aim was to fill this gap in the literature.

Methods

The PCL-R Factor scores and the TCI temperament and character scores were evaluated in 68 men with ASPD and 65 healthy male controls.

Results

The ASPD cases had significantly higher PCL-R Factor 1, Factor 2, and Total scores, as well as significantly higher TCI Novelty Seeking and Harm Avoidance scores, whereas the control group had higher TCI Reward Dependence, Persistence, Self-Directedness, and Cooperativeness scores. Correlation analysis revealed that, in the whole study group, PCL-R Factor 1, Factor 2, and Total scores were positively correlated with Novelty Seeking and Harm Avoidance scores and negatively correlated with Reward Dependence, Persistence, Self-Directedness, and Cooperativeness scores. When each group was analyzed separately, the correlations were not significant. Regression analysis supported the main findings.

Conclusion

Our results showed that both PCL-R Factor 1 score, which is claimed to reflect “core psychopathy,” and PCL-R Factor 2 score, which reflects criminal behaviors, were positively correlated with Novelty Seeking and Harm Avoidance and were negatively correlated with Reward Dependence in the whole sample. The reduced variance of PCL-R in each group might lead to nonsignificant associations within groups. Without the subjects with severe psychopathy in the present study, it might not be possible to show the association.     

<Emphasis Type="Bold">18th Annual Scientific Meeting of the European Society of Musculoskeletal Radiology (ESSR), Crete,Greece—June 9–11, 2011</Emphasis>

Abstracts

18th Annual Scientific Meeting of the European Society of Musculoskeletal Radiology (ESSR), Crete, Greece—June 9–11, 2011     

Sinus node paucity in hyperekplexia

We report a newborn with hyperekplexia and uncontrolled tonic spasms which did not respond to intravenous phenobarbitone and phenytoin, and midazolam infusion. Serum biochemistry, electrocardiography, electroencephalography, lumbar puncture and neuroimaging were normal. Continous cardiac monitoring revealed that tonic spasm episodes were accompanied by sinus node paucity and severe bradycardia. Duration and number of tonic spasm episodes decreased with clonazepam therapy, and she was discharged. At 4 months of age sudden infant death occured. Sudden infant death could be related to the paucity of sinus node. Cardiac pacemaker implantation should be considered even if the medical treatment is successful.     

Bolton tooth size discrepancies in skeletal Class I individuals presenting with different dental angle classifications

The objective of this study was to investigate the frequency and association of Bolton tooth size discrepancies with dental discrepancies. Forty-eight skeletal Class I, 60 Class II, and 44 Class III subjects with similar skeletal characteristics were included in this study. Analysis of variance was performed to compare the mean ratios of Bolton analysis as a function of the Angle classification and sex. To determine the prevalence of tooth size imbalances among the three groups of occlusions and the two sexes, chi-square tests were performed. To determine the correlation of tooth size imbalances with certain dental characteristics, Pearson's correlation coefficients were calculated. No statistically significant differences were determined for the prevalence of tooth size discrepancies and the mean values of Bolton's anterior and overall ratios among the occlusal groups and sexes. Bolton's anterior ratio discrepancies had significant correlations with midline shifts (P < .05) in Angle Class I cases, with U1-SN angle (P < .01) in Angle Class II cases, and with L1-APog distance (P < .05) in Angle Class III cases. Bolton discrepancies related to overall ratio had significant correlations with overjet (P < .05) in Class I cases, with overbite (P < .05) and U1-SN angle (P < .01) in Class II cases, and with IMPA (P < .01) in Class III cases. A high prevalence of tooth size discrepancies in an orthodontic patient population and the statistically significant correlation of some of these with some dental characteristics suggest that the measurement of interarch tooth size ratios might be clinically beneficial for treatment outcomes.