Glycaemic control for patients with severe acute brain injury: Protocol for a systematic review

Background

Hyperglycaemia is common in patients with acute brain injury admitted to an intensive care unit (ICU). Many studies have found associations between development of hyperglycaemia and increased mortality in hospitalised patients. However, the optimal target for blood glucose control is unknown. We want to conduct a systematic review with meta-analysis and trial sequential analysis to explore the beneficial and harmful effects of restrictive versus liberal glucose control on patient outcomes in adults with severe acute brain injury.

Methods

We will systematically search medical databases including CENTRAL, Embase, MEDLINE and trial registries. We will search the following websites for ongoing or unpublished trials: http://www.controlled-trials.com/ , http://www.clinicaltrials.gov/ , www.eudraCT.com , http://centerwatch.com/ , The Cochrane Library's CENTRAL, PubMed, EMBASE, Science Citation Index Expanded and CINAHL. Two authors will independently review and select trials and extract data. We will include randomised trials comparing levels of glucose control in our analyses and observational studies will be included to address potential harms. The primary outcomes are defined as all-cause mortality, functional outcome and health-related quality of life. Secondary outcomes include serious adverse events including hypoglycaemia, length of ICU stay and duration of mechanical ventilation, and explorative outcomes including intracranial pressure and infection. Trial Sequential Analysis will be used to investigate the risk of type I error due to repetitive testing and to further explore imprecision. Quality of trials will be evaluated using the Cochrane Risk of Bias tool, and quality of evidence will be assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach.

Discussion

The results of the systematic review will be disseminated through peer-reviewed publication. With the review, we hope to inform future randomised clinical trials and improve clinical practice.     

Sex Disparities in Risk of Mortality Among Children With ESRD

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Serum zinc and copper levels in healthy South African women at term and during the first year after childbirth

Serum zinc and copper levels were measured longitudinally in 55 healthy middle and upper socio-economic group white mothers living in Cape Town from the birth of the baby to 12 months after parturition. Mean maternal serum zinc levels showed a significant rise (P less than 0.05) from delivery (66.34 +/- 21.07 micrograms/100 ml) to 12 weeks (87.88 +/- 15.93 micrograms/100 ml), but no further changes were detected at 24, 36 and 52 weeks after parturition. The mean maternal serum copper levels decreased from 217.73 +/- 64.34 micrograms/100 ml at delivery to 141.65 +/- 45.60 micrograms/100 ml at 12 weeks (P less than 0.05); they remained constant at all the other sampling periods. No differences (P greater than 0.05) were noted at all the different sampling periods between mean serum zinc levels of primiparous and multiparous mothers, but mean serum copper levels were significantly higher (P less than 0.05) in the primiparas. The mean serum zinc and copper levels of healthy white South African mothers at delivery and 12 months after parturition correspond with those for Northern American mothers. Normal non-pregnant adult serum zinc and copper levels were attained within 12 weeks of delivery.