This study describes: 1. The therapeutic effects on anorexia nervosa (AN) and bulimia nervosa (BN) patients of a psycho-nutritional intensive day-hospital program; 2. The possible correlation between ...the changes observed in the psychometric tests and the variations of a number of biological parameters. Forty-six female patients (24 AN and 22 BN) were assessed through a semi-structured clinical interview based on DSM-IV criteria for Eating Disorders (ED) and a number of psychometric tests (SCL-90R, BDI, EDI-2, EAT-40, BITE, BAT) at the beginning and at the end of treatment, and after a 6-month follow-up. At these three times, we also assessed the plasma level of leptin, cortisol, luteinizing hormone (LH), follicle-stimulating hormone (FSH) and 17beta-estradiol together with body mass index (BMI) and menstrual cycle. From beginning to discharge, the scores on all psychometric tests improved in the whole sample, except for the Perfectionism subscale of EDI-2 in both groups (AN and BN), the Anger-Hostility, Phobic Anxiety and Paranoid Ideation subscales of SCL-90 and the Interpersonal Distrust subscale of EDI-2 in the BN group. At follow-up, there was a worsening of the BITE scores and of a number of EDI-2 subscales, especially in the AN subgroup - with these changes correlating with the trend of BMI. In AN patients, plasma leptin levels changed from the beginning to the end of treatment and at follow-up according to BMI changes. The mean plasma leptin level in the BN subgroup was higher than in the AN one. We found a statistically significant correlation with the scores of BDI, SCL-90R Depression and Ineffectiveness subscales, EAT-40, BITE-Symptom subscale and the trend of menses dividing these patients into two subgroups (according to the plasma leptin concentration, higher or lower than the top leptin level in the anorexics). These data seem to confirm that leptin secretion doesn't correlate univocally to BMI.
To determine the prognostic value of multimodal evoked potentials (EPs) and event-related (ERPs) potentials in coma (Glasgow Coma Score <8), after severe traumatic brain injury (TBI).
Prospective, ...longitudinal study of neurophysiological responses recorded during traumatic coma.
Intensive Care Unit, Frenchay Hospital, Bristol, UK.
Fifty-four comatose TBI patients (age range 1-80 years, mean 36.4).
Neurophysiological responses were recorded from 11 scalp electrodes with earlobe reference. Conduction times were measured for brainstem auditory, flash visual and somatosensory, short-latency EPs. Peak latencies and amplitudes were determined for long-latency components of visual and auditory ERPs, generated by passive "oddball" paradigms. These neurophysiological and various clinical parameters were correlated with patient outcome using Pearson's coefficient.
Three month Glasgow Outcome Scale (GOS).
Highly significant (P <0.001) correlations exist between long-latency ERP components and 3-month outcome. Short-latency EPs, brainstem (wave I-V) and somatosensory conduction times also correlate significantly with the GOS (P <0.01). Of the clinical measurements, pupillary response patterns, APACHE II and Glasgow Coma Scores (GCS) correlate significantly with outcome, as do the retrospective measures of duration of coma and post-traumatic amnesia (PTA) in survivors. Unfortunately, due to variance of long-latency responses, even in controls, absolute values cannot be relied upon as prognosticators. The presence of "mismatch negativity" predicted the return of consciousness (89.7% sensitivity and 100% specificity) and preceded changes in GCS. Its latency was the single best indicator of 90-day outcome from coma (r = -0.641).
We have studied the effects of extracranial ischaemia and intracranial hypoxia on measurement of cerebral oxygenation using near-infrared, reflectance-mode, cerebral oximetry (Invos 3100 cerebral ...oximeter) in healthy adult subjects. Under stable systemic conditions, scalp ischaemia induced by a pneumatic tourniquet caused an apparent reduction in mean regional cerebral oxygenation (rSo2) from mean 72 (SD 6)% to 59 (7)% (n = 8, P < 0.001). rSo2 returned to control values within 1 min of release of the tourniquet. Local scalp ischaemia induced by rapid frontalis muscle exercise caused a significant reduction (4.5 (2)%) in rSo2 (n = 12, P < 0.001). The effect of systemic hypoxia on rSo2 was examined during controlled scalp ischaemia. A decrease in mean SpO2 from 98 (2)% to 66 (6)% was associated with a decrease in mean rSo2 from 57 (4)% to 41 (6)%. There was a significant correlation between the percentage reduction in rSo2 and Spo2 during hypoxia (r = 0.81, P < 0.001). We conclude that the lnvos cerebral oximeter was capable of detecting tissue hypoxia deep to the scalp under carefully controlled conditions but that it also was affected significantly by changes in extracranial blood flow and oxygenation which may affect its reliability in clinical practice. Further work is necessary to define those situations in which cerebral oximetric monitoring is useful and valid.
This guidance offers consensus opinion on the optimum management of non-heart-beating organ donation in adult critical care units. The guidance is not meant to dictate practice but rather to offer ...suggestions as to what might be considered reasonable practice. The following sections mainly relate to the medical aspects of non-heart-beating organ donation. Fuller guidance on other aspects of organ and tissue donation is available on the Society's website (www.ics.ac.uk). There are a number of parallel areas of work, such as the law on consent, the definition of death and revision of the original Code of Practice describing brainstem testing, which means that many aspects of organ donation are changing rapidly. This guidance is designed to help critical care practitioners while these issues are resolved.
Abstract
Background
Coronavirus disease 2019 (COVI-19) has resulted in considerable morbidity ans mortality worldwide since December 2019. Cardiac complications are a common condition among patients ...with COVID-19. The association between elevated hypersensitivity troponin T in COVID-19 disease and risk of mortality remains unclear but data suggest it could be associated with higher risk of in-hospital mortality.
Purpose
The present study examine the potential association between the level of hypersensitive troponin T (Hs TnT) in emergency department (ED) and mortality among patients hospitalized with COVID-19.
Methods
Consecutive patients admitted in two hospitals from ED with confirmed PCR COVID-19 were included in this retrospective study. The data were collected from October 1, 2020 to December 31, 2020. The demographic characteristics (age and sex), clinical data (symptoms, comorbidities, laboratory findings, treatments, complications, and outcomes), and results of cardiac examinations (cardiac biomarkers and electrocardiogram) were collected in an electronic database. There data were analyzed and the mortality at 1 month was compared for patients with normal or elevated Hs TnT (>14 ng/L).
Results
The study population included 413 hospitalized patients with a confirmed PCR COVID-19. The median age was 82. The comorbidities like cardiovascular diseases, cerebrovascular diseases, pulmonary diseases and renal insufficiency are associated with a significant higher mortality (P<0.05). Clinicals findings like tachypnea (respiratory rate >20/minute) or hypotension (<90 mmHg systolic blood pressure) also result an increased mortality (P<0.05). In this cohort, 90 patients had an analysis of Hs TnT in the ED. The mortality at 1 month was higher in patients with elevated Hs TnT (>14 ng/L) compared to the patients with normal levels of Hs TnT and the correlation was significant (P<0.05). The relative risk of fatal outcome is 3.86 when the troponin level is >14ng/L.
Conclusion
Elevated Hs TnT levels in the emergency department appear to be a predictive factor of mortality at one month for patients with COVID-19 infection requiring admission.
Funding Acknowledgement
Type of funding sources: None.
Studies on the effects of anaesthesia on event-related potentials and long latency auditory-evoked potentials (AEP) are sparse. Both provide information on cortical processing and may have potential ...as monitors of awareness. We studied the effect of propofol on the event-related potential mismatch negativity (MMN) and the long-latency AEP N I.
Twenty-one patients received l μg ml–1 stepped increases in the target concentration of propofol using Diprifusor™ until a maximum of 6 μg ml–1 was achieved or the patient had lost consciousness. Neurophysiological responses (MMN and NI) and the patients' level of consciousness were recorded before the administration of propofol and at a target effector site concentration of propofol of 1,2, 3, 4, and 6 μg ml–1. Grand average evoked potentials were computed at baseline, before the administration of propofol (A); at the highest propofol concentration at which each patient was responsive (B); and at the concentration of propofol at which the patient became unconscious (C).
Patients lost consciousness at different target concentrations of propofol, all being unresponsive by 4 μg ml–1. The response to the deviant stimuli used to elicit duration-shift MMN was significantly more negative than to the standard stimuli at A (mean difference 2.58 μV, P=0.0011) but this difference was virtually abolished at point B, before the patients lost consciousness (mean difference 0.63 μV, P=ns). The amplitude of NI evoked by standard stimuli was negative compared with electrical baseline at both point A (mean amplitude –3.81 μV, P<0.00l) and at point B (mean amplitude –2.2 μV, P=0.002), but was no longer significantly different to baseline at point C (mean amplitude 0.51 μV, P=ns). The change in the mean amplitude of NI from last awake (point B) to first unconscious (point C) was also significant (mean difference in amplitude 1.69 μV, P=0.02).
MMN is unlikely to be a clinically useful tool to detect awareness in surgical patients. In contrast, the loss of NI may identify the transition from consciousness to unconsciousness and deserves further study.
PDF
