[Study of predictors of delirium incidence in hospitalized patients in intensive care units]

Introduction: Delirium is the most common neurological diagnosis among patients in intensive care units. The prevalence of delirium in the ICU patients is high and this is associated with many complications. Thus, by assessment and identifying predictive factors of delirium, its incidence can largely be prevented in intensive care units

Objective: This study aims to determine predictive factors of delirium incidence in patients hospitalized in intensive care units

Methods: This study is a descriptive-analytic study which included all patients admitted to intensive care units [neurology, general and trauma] in one of the training centers, Rasht for three months in 2013 without any symptoms and signs of delirium before hospitalization. There was no age limit for selection of samples. At least 24 hours after admission to ICU, with and without mechanical ventilation, ability to see and hear, Persian language, conscious or semi-conscious, not receiving neuromuscular blockers, coma, history of severe nerve damage [such as acute stroke, dementia, aphasia], chronic renal failure, alcohol abuse and drug abuse were the study inclusion criteria. Patients who used painkiller and sedatives during the study were excluded. Thus, samples were selected gradually considering the inclusion criteria. Based on the preliminary results with 20 samples, the study sample size was estimated 81. The tools used in this study were Richmond Agitation Sedation Scale [RASS] and Confusion Assessment Method for the Intensive Care Unit [CAM-ICU]. RASS is the standard tool to assess the level of restlessness and sedation in ICU patients. CAM-ICU examines four main characteristics of delirium; acute change or fluctuations in mental status, lack of concentration, disturbance of consciousness and unorganized thinking. The first part consisted of demographic characteristics including age, sex, Charleson comorbidity index, Acute Physiology Score [APS] in three ranges of 0-9, 10-14-and ?15, white blood cell count, serum total bilirubin, days of mechanical ventilation, and days of ICU stay and hospitalization. Charlson comorbidity index had 19 conditions in which the patient is scored based on its potential impact on mortality rate. APS is the biggest part of APATCH [Acute Physiology and Chronic Health Evaluation], obtained from 13 clinical evaluations performed 24 hours after ICU admission in which higher scores is indicative of worsening patient's physical condition. The second part consisted of examining the incidence of delirium in which patients were assessed by RASS in terms of level of consciousness. This tool consisted of 10 items, each representing one level of consciousness [of Combative to Unarousable]. To determine RASS, without any interaction, the patient was only observed and if conscious, she was scored 0 to +4. If the patient was unconscious, his/her name was called loudly and asked to look at the researcher. If the patient responded to call, appropriate score [1-3] was assigned. If there was no response, the patient's shoulder was shaken. If no response was observed, his/her sternum was strongly squeezed and appropriate score [4-5] was given. In case of no consciousness level disorder based on RASS, the subjects were assessed by CAM-ICU for examining delirium which took about 3-5 minutes. The collected data were analyzed using descriptive and analytical statistics [Fisher and chi-square]. For multivariate analysis of the associated factors with delirium, Backward Logistic Regression model was used. P<0.05 was considered the significance level. The probability of exclusion from the model was considered P< 0.1

Results: 64.2% of the subjects were male and most of them [48.1%] were hospitalized in the general ward. The majority of samples [49.4%] scored 0-9 in terms of APS. Charlson comorbidity index also showed most cases [29.6%] with 1-2 scores. The mean and SD of patients were 50.95 +/- 21.33 years, the maximum tracheal intubation days was 146 days. The maximum duration of ICU stay was 147 days and 150 days in the hospital. Furthermore, the maximum total bilirubin was 4.2 mg dl and the highest number of white blood cells was 29.2000 mg dl. Delirium was observed in 27.2% of samples using CAM-ICU. Delirium distribution was not significant based on qualitative variables; sex, ward and Charlson score whereas APS score which was significant [p=0.048]. Distribution of delirium was significant in terms of age [P=0.06]. However, it was not statistically significant in terms of the number of mechanical ventilation days, hospitalization and ICU stay, total bilirubin and white blood cell count. Based on logistic regression model, age, sex, days of tracheal intubation, ICU and hospitalization days, total bilirubin, white blood cell count, and Charlson index were not predictors of delirium. Only APS [considering the range of 0-9 scores as the reference] in two ranges of 10-14 [P<0.038] and ?15 [P<0.043] were identified as predictors of delirium. Thus, individuals with a score of APS=10-14 [OR = 3.3, 95% CI: 1.03-10.71] and APS ?15 [OR = 4.2, 95% CI: 1.08-16.7] had higher delirium compared to those with APS =0-9

Conclusion: Patients with APS points higher than those with lower scores are more likely to develop delirium

[Diagnostic value of magnetic resonance imaging and bone scan to diagnose the vertebral metastases]

The vertebra is the most common site of bone metastases. Diagnosis of metastases particularly in the early stages can improve patients' prognosis and therapy. This study was done to compare the diagnostic value of magnetic resonance imaging and bone scan for the diagnosis of vertebral metastases. This descriptive study was done on 43 patients with any types of primary cancer. Patients underwent spinal magnetic resonance imaging and nuclear scan. Bone scan results were considered as the gold standard. The sensitivity and specificity were calculated for magnetic resonance imaging and nuclear scan. The magnetic resonance imaging diagnosed 19 cases of thoracic vertebral metastases which previously diagnosed as negative by bone scan. Sensitivity and specificity of magnetic resonance imaging compared to bone scan was 90.7% and 95.6%, respectively. The magnetic resonance imaging diagnosed 4 cases of lumbar vertebral metastases which were reported negative in bone scan. Sensitivity, specificity and accuracy of magnetic resonance imaging in compare to bone scan were 97.6%, 97% and 97.2%, respectively. In diagnosis of vertebral metastases, the magnetic resonance imaging is more sensitive than bone scan

Bioaccumulation of heavy metals in fish species collected from former tin mining catchment

This study has been carried out to determine the accumulation of heavy metals [arsenic, copper, lead, tin and zinc] in fish samples collected from former tin mining catchment. Total eight types of fish family having fifteen different species are identified. Cyperinidae is the most abundant family with eight different species found in the catchment. Fish samples were analysed by using inductively coupled plasma optical emission spectrophotometer ICP-OES. The accuracy of method is validated by certified reference material. The highest level of arsenic was observed in Hampala macrolepidota while Osteochilus hasselti shows the least. For Copper concentrations, the maximum was obtained in Mastacembelus armatus and the minimum in Oxyeleotris marmorata. High levels of lead, tin and zinc were found in the Rasbora elegans, Trichogaster trichopterus, Oxyeleotris marmorata respectively while Macrobrachium resenbergii, Mastacembelus armatus, Rasbora elegans had the least concentrations. The sequence of order of the heavy metals measured was Sn > Pb >Zn > Cu> As, respectively. The results showed elevated levels of tin, lead and zinc in all the fish samples although copper and arsenic were available in relatively low concentration in the most samples. Sn, Pb, and Zn concentration in the samples were greater than Malaysia food act permissible levels. Hazard index < 1 suggests unlikely adverse health effects whereas HI > 1 suggests the probability of adverse health effects. Although the heavy metals analysed in the catchment did not pose any immediate health risk to humans but due to the bioaccumulation and magnification of these heavy metals in humans, it is essential to safeguard levels of the metals in the environment

Heavy metals accumulation in plants growing in ex tin mining catchment

The degree of contamination by heavy metals [arsenic, copper, lead, tin and zinc] in soil and transfer to plants has been studied. Specimens of plant species from five locations in an area of 10 x 10 m were sampled with their corresponding soils. Thirty six plant species including two shallow water aquatic plants were identified. Soil and plant specimens were analyzed by using inductively coupled plasma optical emission spectrometry. It was found that metal concentration in soil was highly variable while concentration of metals in plants directly depends on the concentration of metals it was rooted. Roots showed highest metal concentration followed by leaves, shoots and flowers. Bioconcentraion factor and translocation factor were calculated, representing Cyperus rotundus L. as a potential tin-hyperaccumulator plant, previously not reported in literature. Plant Species Imperata cylindrica, Lycopodium cernuum, Melastoma malabathricum, Mimosa pudica Linn, Nelumbo nucifera, Phragmites australis L., Pteris vittata L. and Salvinia molesta, were metal accumulator while Acacia podalyriaefolia G. Don, Bulb Vanisium, Dillenia reticulate King, Eugenia reinwardtiana, Evodia roxburghiania Hk. f. clarke, Gleichenia linearis, Grewia erythrocarpa Ridl., Manihot esculenta Crantz, Paspalum conjugatum Berguis, Passiflora suberosa, Saccharum officinarum, Stenochlaena palustris [Burm.] Bedd. and Vitis trifolia Linn. were tolerated plant species. All other studied plants were excluders. Identified plant species could be useful for revegetation and erosion control in metals contaminated ex-mining sites. Morphological changes such as reduction in size, change in color and deshaping have also been observed in plant species with high metal values

Study of mango biomass [Mangifera indica L] as a cationic biosorbent

Unfertilizable fruiting buds of mango plant Mangifera indica L, an agrowaste, is used as a biomass in this study. The efficacy of the biosorbent was tested for the removal of lead, copper, zinc and nickel metal ions using batch experiments in single and binary metal solution under controlled experimental conditions. It is found that metal sorption increases when the equilibrium metal concentration rises. At highest experimental solution concentration used [150 mg/L], the removal of metal ions were 82.76% for lead, 76.60% for copper, 63.35% for zinc and 59.35% for nickel while at lowest experimental solution concentration [25 mg/L], the removal of metal ions were 92.00% for lead, 86.84% for copper, 83.96% for zinc and 82.29% for nickel. Biosorption equilibrium isotherms were plotted for metal uptake capacity [q] against residual metal concentrations [C f] in solution. The q versus [C f]sorption isotherm relationship was mathematically expressed by Langmuir and Freundlich models. The values of separation factor were between zero and one indicating favourable sorption for four tested metals on the biosorbent. The surface coverage values were approaching unity with increasing solution concentration indicating effectiveness of biosorbent under investigation. The non-living biomass of Mangifera indica L present comparable biosorption capacity for lead, copper, zinc and nickel metal ions with other types of biosorbent materials found in literature and is effective to remove metal ions from single metal solutions as well as in the presence of other co-ions with the main metal of solution

Effects of chamomile extract on biochemical and clinical parameters in a rat model of polycystic ovary syndrome

Polycystic ovary syndrome [PCOS] is a complex endocrine and metabolic disorder associated with ovulatory dysfunction. Presently, little is known about the primary factors that initiate PCOS. Chamomile flowers are used in alternative medicine for its anti-spasmolytic and anti-inflammatory effects. Antispasmodic properties of chamomile ease menstrual cramps and lessen the possibility of premature labor. This medicinal herb also stimulates menstruation. In this study, we evaluated the effects of Chamomile alcoholic-extract on the biochemical and clinical parameters in a rat model of PCOS. Estrous cyclicity of 30 virgin adult cycling rats was monitored by vaginal smears obtained between 0800 and 1200 hours. After about 4 days, each rat received an i.m. injection of Estradiol Valerate [Aburaihan Co., Iran], 2mg in 0.2 ml of corn oil, to induce PCO. Corn oil was injected to the rats in the control group. All the rats in the experimental group were evaluated for follicular cysts 60 days after the injection. Rats with PCOS were treated by multiple doses [25, 50, 75 mg/kg] of intraperitoneal injections of Chamomile alcoholic-extract for ten days. The data were statistically analyzed at a significance level of p<0.05 by ANOVA, followed by the Student Newman-Keuls post hoc test. The histological and hormonal results showed that Chamomile can decrease the signs of PCOS in the ovarian tissue and help LH secretion in rats [p<0.05]. The alcoholic-extract of dried Matricaria chamomilla L. flowers can not only induce recovery from a PCO induced state in rats, but also increase dominant follicles. Additionally better endometrial tissue arrangements can be regarded as another therapeutic effect of Chamomile

[ effects of electrical muscle stimulation on glucose control in type 2 diabetes mellitus]

Diabetes, i.e. lack of proper control of blood sugar, may cause serious complications in patients. The objective of this study was to assess the influence of electrical muscle stimulation on glucose control in type 2 diabetes mellitus. This clinical-trial study was conducted in 2009, in Shiraz, Iran. Forty nine diabetes mellitus patients, Type 2, participated in this study. In 28 cases, dietary and exercise modifications were recommended and electrical muscle stimulation was carried out. For the other 21 cases, only dietary and exercise modifications were recommended. Laboratory tests, including fasting blood sugar [FBS] and glucose tolerance test [GTT], was performed before the study and 6 weeks afterward. The results were analyzed by SPSS version 15.5 software and using t-test. The mean of FBS in the case group before EMS was 156 mg/dl and 6 weeks later changed to 123 mg/dl [p < 0.05], while in the control group these indices were 158 mg/dl and 154 mg/dl respectively. The mean of GTT in patients before EMS was 193 mg/dl and 6 weeks later became 150 mg/dl [p < 0.05], whereas in the control group these figures were 204 mg/dl and 201 mg/dl respectively. The results of this study confirmed that the use of electrical muscle stimulation can be effective on glucose control in type 2 diabetes mellitus

synergic effects of rapamycin and extremely low frequency electromagnetic field on angiogenesis

Angiogenesis, the formation of new blood vessels, is a dynamic and complex activity which is needed for embryogenesis and other physiological processes. However, in many pathological conditions such as solid tumor progression, the disease appears to be associated with persistent up-regulated angiogenesis. In this research we used 0.04 T [tesla] electromagnetic field as a synergic treatment with rapamycin on angiogenesis. In this experimental study, 70 Ross fertilized eggs were randomly divided into 5 groups as following: 1] control, 2] sham-exposed, 3] a group treated with rapamycin, 4] a group treated with electromagnetic field and 5] a group treated with both rapamycin and electromagnetic field. In day 2, a window was opened on eggs in sterile condition. In day 8 a gelatin sponge was placed on chorioalantoic membrane [CAM] and was soaked with 5 micro l rapamycin in group 3 and group 5. Groups 4 and group 5 were placed in 400 Gauss magnetic field for 4 hours in day 10. In day 12, CAMs were examined and photographed by research photo-stereomicroscope in all cases. Data were analyzed using ANOVA and Mann-Whitney tests. Comparison between average number and length of vessels in controls and sham-exposed didn't show any significant differences. In group 3 and 4, a significant decrease was shown in the average number and length compared with controls. Finally, comparison between group 3 and group 5 showed a significant decrease in the average number and length of vessels in group 5 which had been treated with both rapamycin and 400 [Gauss] G electromagnetic field. The results of this study showed that 0.04 T magnetic field has an inhibitory effect on angiogenesis in CAM and can enhance the effect of rapamycin as an anti-angiogenesis drug

[Hemiplegia and facial palsy due to brucellosis [a case report]]

Manifestations involving the nervous system [neurobrucellosis], is a treatable infection, however it is not well documented. Direct invasion of the central nervous system occurs in fewer than 5% of cases. Acute or chronic meningitis is the most frequent nervous system complication. However, hemiplegia and cranial nerve involvement are rarely encountered. In this report we present a patient with "seventh cranial nerve palsy" and "hemiplegia, " as the manifestations of probable neurobrucellosis. Thus, in endemic area, brucellosis should be ruled out in patients who develop unexplained neurological symptoms such as hemiplegia

Terminal ileum schistosomiasis with perianal fistula mimicking Crohn's disease

Schistosomiasis is a parasitic disease related to water contact in the agricultural fields, affecting millions of people in developing countries in tropical and subtropical parts of Africa, Asia, and South America. We report a case of a 27-year-old male, with intestinal schistosomiasis associated with perianal fistula mimicking Crohn's disease, where the terminal ileum showed a cobblestone appearance, and histopathological biopsy showed schistosoma granuloma

Diagnosis and management of urinary incontinence in older patient

To review the various causes of urinary incontinence [UI] in elderly patients and to outline a therapeutic approach to the clinical management of UI. Online search of MEDLINE and additional references selected from the articles found during the search. All peer-reviewed articles and review articles listed on MEDLINE published between 1966 and 2006. Key search terms included urinary incontinence, geriatric, aging, pelvic floor rehabilitation and indwelling catheter. Articles with clinical relevance to the geriatric population were selected based on the robustness of the study and reviews. If applicable, data from studies of healthier or younger populations was extrapolated to the elderly population examined in the reviews. UI is a common occurrence among older adults treated in rehabilitation settings. The causes of UI in the elderly vary, including transient causes, established pathologic states of the urinary tract, and systemat ic multifactorial influences. Both behavioral and pharmacologic management strategies can successfully be implemented for UI, even in the frail elderly. UI can be effectively investigated and treated by rehabilitation practitioners by following a simple, stepwise approach

Differences between colorectal cancer in Egypt and the Western prototype

This study aimed to review patients with colorectal cancer presented to a general surgery unit with special interest in coloproctology in Ain-Shams University concentrating on the differences between the pattern of the disease in Egypt and western countries. The study is a six-year retrospective review of one hundred and fifty-five patients with colorectal cancer. The results showed that 38% of the tumors occurred in patients less than 40 years and only 15% of patients were above 60 years of age. 3% of the tumors were Dukes A and 58% were Dukes C. 6% of the tumors were irresectable, 36% of the resections were palliative and 29% of curative operations entailed massive resection of nearby organ or tissue. Synchronous adenomas were present in 5.2% of patients and bilharziasis in 3.2%. At a mean follow up of 52 months, 58% of curative resection patients had recurrence, 38% died of their disease or secondary to its treatment and 42% were alive and disease free

Ultrastructure of the gall bladder epithelium in guinea pig

The present study was performed to thorough the light on the fine structure of the gall bladder epithelium where there is no available literatures on this respect in guinea pig. This study was carried out on ten adult guinea pigs. They were sacrificed and the gall bladders were removed and were cut into different regons.The specimems were divided into small pieces for parafin sections and very small pieces immersed in glutaraldehyde for E/M. From the ultrastructural study, it can be concluded that: the lining epithelium is composed of ordinary epithelial [clear] cells, pencil [dark] and basal cells. The first two types of cells possess microvilli on their luminal surface. The apical ends of the lateral walls appear denser than the basal segments due to the presence of tight junctions. The lateral cell walls show infolded membranes. The basal plasma membrane is attached to the lamina propria by peg - and-socket interdigitations.The gall bladder epithelium of guinea pig is capable of actively secreting mucus droplets and do so as a merocrine secretion.The cytoplasm presents cuticular, subcuticular, supranuclear, nuclear and basal zones. Large dense and stippled granules are found in the subcuticular zone. Also, the cytoplasm contains mitochondria and endoplasmic reticulum, mainly in the subcuticular zone.The guinea pig has a well developed gall bladder, much similar to that of man

Long acting thyroid stimulator in Grave's diseases

Fifty eight patients suffering front Graves Disease [GD] and 30 normal healthy controls were studied to evaluate some of the immunological aspects of etiopathogenesis of Graves' Disease. Patients of GD included 14 first reported patients 22 hyper thyroid patients on drgus and 22 euthyroid patients in remission GD patients were diagnosed on the basis of clinical history, physical examination and laboratory investigations such as Radio Active Iodine Uptake .[RAIU] Serum Tri-iodothronine [T3] and Serum Thyroxine [T4] by Radio-immunoassay and thyroid scintigram. Mckenzie. Mouse Biological Assay was performed to detect and estimate Long Acting Thyroid Stimular [LATS] in GD -orients. Sixty four percent first reported and 54% hyperthyroid patients on drugs were LATS positive. LATS-Response Index [LATS-RI] was calculated in all LATS positive patients. This study, first of its kind in Pakistan, confines the presence of auto-antibodies in GD patients and is expected to stimulate further work in auto-immune thyroid disease in country