To examine whether admission to bed number 13 on our intensive care unit has any negative impact on the patient's hospital mortality.
We conducted a retrospective cohort study of 1568 patients ...admitted to our ICU over a two-year period. Observed hospital mortality, predicted mortality using the ICNARC and APACHE II scoring systems and standardised mortality ratios were used to compared patients admitted to bed number 13 with those admitted to beds number 14–24.
Of the 1568 patients admitted to ICU, 110 were placed in bed number 13 and 1458 into bed numbers 14–24. Demographics and ICNARC and APACHE II scores were similar between the two groups. There was no significant difference in the ICNARC predicted hospital mortality (mean 21.0%, median8.5% in bed 13 compared with a mean 17.5%, median 6.4% in beds 14–24, p = 0.33), APACHE II predicted hospital mortality (mean 18.4%, median 9.9% in bed 13 compared with mean 18.7%, median 8.9% in beds 14–24, p = 0.74), or observed hospital mortality (20.2% compared with 15.2%, OR 1.41 (CI 0.87 to 2.30), p = 0.17).
Admission to bed number 13 was not associated with a significant increase in hospital mortality when compared to admission to other bed numbers.
•Phobia and superstition of the number 13 exist in popular Western culture.•No previous work has examined a link between bed number 13 and patient outcome.•We conclude admission to ICU bed 13 is not associated with reduced chance of survival.
Hunter syndrome (MPS type II) is a rare X-linked recessive disease caused by lysosomal enzyme iduronate-2-sulfatase deficiency, characterized by frequent and variable brain and skull involvement. Our ...objective was determine the frequency of closed cephaloceles in a large cohort of subjects affected with Hunter syndrome and to investigate possible correlations with clinical and neuroradiologic findings.
Brain MR imaging of 33 patients (32 males and 1 female, age range 2.5-30.8 years, mean age 10.4 years) affected with Hunter syndrome were retrospectively evaluated. Eleven (age range 3.6-30.8 years; mean age 15.1) presented with an "attenuated" phenotype, while 22 (age range 2.5-19.1 years; mean age 8.2) had a "severe" phenotype.
A closed cephalocele was detected in 9/33 patients (27%) at the level of anterior and middle fossa in 6 and 3 cases, respectively; 6/9 subjects were affected with the attenuated phenotype and 1/9 suffered from epilepsy. Closed cephaloceles did not show a significant association with other brain and spine MR imaging features of Hunter disease, such as enlargement of perivascular spaces, cisterna magna, pituitary sella, ventricles and subarachnoid spaces, craniosynostosis, dens hypoplasia, white matter abnormalities, spinal stenosis due to periodontoid cap, platyspondylia, or intervertebral disk anomalies.
Closed cephaloceles are frequent in Hunter syndrome and should be considered a neuroradiologic feature of this disease.
Purpose
The shortage of organs for transplantation is an important medical and societal problem because transplantation is often the best therapeutic option for end-stage organ failure.
Methods
We ...review the potential deceased organ donation pathways in adult ICU practice, i.e. donation after brain death (DBD) and controlled donation after circulatory death (cDCD), which follows the planned withdrawal of life-sustaining treatments (WLST) and subsequent confirmation of death using cardiorespiratory criteria.
Results
Strategies in the ICU to increase the number of organs available for transplantation are discussed. These include timely identification of the potential organ donor, optimization of the brain-dead donor by aggressive management of the physiological consequence of brain death, implementation of cDCD protocols, and the potential for ex vivo perfusion techniques.
Conclusions
Organ donation should be offered as a routine component of the end-of-life care plan of every patient dying in the ICU where appropriate, and intensivists are the key professional in this process.
The prognostic role of SEPs in neonatal hypoxic-ischemic encephalopathy (HIE) was documented before the advent of therapeutic hypothermia (HT). Brain MRI as an established role as outcome measure in ...neonatal HIE. The prognostic role of the SEP has not been studied. The aim of this study is to evaluate the prognostic role of SEP in neonatal HIE undergoing HT, using MRI as an outcome measure, since it has not been studied. We prospectively recruited 40 neonates with HIE treated with IT using TOBY’s criteria (2009–2011). The protocol includes SEP within the 1st week of life and brain MRI at the 2nd week of life. The recordings and the images were scored by Suppiej et al. (2010) and Glass et al. (2011), respectively. Bilateral absence of cortical SEP was associated to moderate and severe neuroimaging lesions with a PPV of 80% and NPV of 81% (sensitivity of 44% and specificity of 96%). Bilateral absence of cortical SEP is associated with MRI severe lesions, which are known to predict severe neuromotor disabilities. These data suggest that the prognostic role of SEPs is confirmed in neonatal HIE treated with IT.
Sickle Cell Disease (SCD) is a congenital familial pathology of the haemoglobin and it is classified as the most common genetic disease in the world. Neurological complications are very frequent: ...symptomatic stroke occurs in 11% of the SCD patients before they reach 20 years of age, while 35% of the patients shows silent damages at the RMN with cognitive impairments and learning disabilities. The aim of this study is to verify the hypothesis that a different cerebral maturation between children with SCD and healthy controls exists. This has been achieved with the spectral analysis of electroencephalographic (EEG) rhythms and with the LORETA program that estimates the cortical sources of these rhythms. The study demonstrates that, according to both spectral and source analysis, the control group shows a consistent pattern while SCD patients show a great variability: some SCD children show a similar pattern as controls whereas others have a form which is compatible with a delayed degree of maturation. For these reasons, prompt cognitive and pharmacological treatments are advisable in SCD children that show impairments in neuropsychological tests. To this purpose, prospective studies on the effects of the hydroxyurea in the prevention of haemodynamics alterations would be useful.
Among male patients affected by Kallmann syndrome, a genetically determined disease due to defective neural migration leading to hypogonadropic hypogonadism and hypo/anosmia, about 40% present the ...peculiar phenomenon of mirror movements, i.e. involuntary movements mirroring contralateral voluntary hand movements. Several pathogenic hypotheses have been proposed, but the ultimate neurological mechanisms are still elusive.
The aim of the present study was to investigate brain anatomical substrates of mirror movements in Kallmann syndrome by means of a panel of quantitative MRI analyses. Forty-nine male Kallmann syndrome patients underwent brain MRI. The study protocol included 3D-T1-weighted gradient echo, fluid attenuated inversion recovery and diffusion tensor imaging. Voxel-based morphometry, sulcation, curvature and cortical thickness analyses and tract based spatial statistics were performed using SPM8, Freesurfer and FSL. All patients underwent a complete physical and neurological examination including the evaluation of mirror movements (according to the Woods and Teuber criteria).
Kallmann syndrome patients presenting with mirror movements (16/49, 32%) displayed the following brain changes: 1) increased gray matter density in the depth of the left precentral sulcus behind the middle frontal gyrus; 2) decreased cortical thickness in the precentral gyrus bilaterally, in the depth of right precentral sulcus and in the posterior portion of the right superior frontal gyrus; and 3) decreased fractional anisotropy in the left hemisphere involving the temporal lobe and peritrigonal white matter. No differences were shown by cortical curvature and sulcation analyses.
The composite array of brain changes observed in Kallmann syndrome patients with mirror movements likely represents the anatomical–structural underpinnings leading to the peculiar derangement of the complex circuitry committed to unilateral hand voluntary movements.
•We analyzed brain MRI of 43 Kallmann syndrome (KS) patients.•KS patients with mirror movement (MM) present cortical/subcortical changes.•Motor cortex and globus pallidus are primarily involved.•Cortico-spinal tract and corpus callosum do not show significant changes.•Gray matter structural changes underlie MM phenomenon in KS.
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