ABSTRACT
Background: Subsyndromal delirium [SSD] is a frequent condition and has been commonly described as an intermediate stage between delirium and normal cognition. However, the true frequency of SSD and its impact on clinically relevant outcomes in the intensive care unit [ICU] remains unclear
Aim of the study: To evaluate the significance of SSD on adverse clinical outcomes especially mortality and length of hospital stay
Methods: A systematic search was performed in the scientific database particularly MEDLINE [2000-2017], EMBASE [2000- 2017], Cochrane Central Register of Controlled Trials, CINAHL [2000-2017], Google Scholar, and individual journals to identify publications that evaluated SSD in ICU patients
Results: The search yielded five studies involving 2453 patients. SSD was detected in 849 patients [34.6%]. Three studies evaluated only surgical patients. Three studies used the Intensive Care Delirium Screening Checklist [ICDSC] and two used the Confusion Assessment Method [CAM] score to diagnose SSD. The meta-analysis showed an increased hospital length of stay [LOS] in SSD patients [0.29 [95% CI 0.11-0.48], p = 0.002; I [2] = 33%]. Hospital mortality was described in two studies but it was not significant [hazard ratio 0.93 [0.58-1.43], p = 0.88 and [4 [1.0-6.9] vs 9 [3.6-20.4], p = 0.05]. The use of antipsychotics in SSD patients to prevent delirium was evaluated in one study but it did not modify ICU LOS [6.2 [4-8] vs 7 [4-9] days, p = 0.63 and 2 [2-3] vs 3 [2-3] days, p = 0.517] or mortality [9 [25.8%] vs 7 [20.4%], p = 0.51]
Conclusion: Subsyndromal Delirium is a common and adverse condition that is manifested in almost one-third of ICU patients. According to our findings, SSD has increased the length of hospital stay only with low impact on the other outcomes. Nevertheless, studies on a bigger sample size and larger scale are needed for a better understanding of the relevance of SSD in ICU patients as well as its treatment
ABSTRACT
Background: Carpal tunnel syndrome [CTS] is a constellation of symptoms and signs resulting from the local compression of the median nerve inside the carpal tunnel at the wrist. In advanced cases of CTS where the course is unnoticed, atrophy of the thenar muscles may occur, which can be irreversible
Objective: The aim of the present study was to estimate prevalence and severity of CTS in patients with type 2 diabetes mellitus in South Western region of the Kingdom of Saudi Arabia [KSA] and to identify specific at risk groups within these populations by using nerve conduction study
Methods: This cross-sectional study was conducted in Asir Central Hospital, Abha, KSA. The study randomly included all patients with type 2 diabetes mellitus with their place of birth and permanent residence being in Abha or Mohyel cities. History, physical examination, and laboratory data about fasting blood glucose, HbA1c, and lipid profile were collected. Additionally, nerve conduction study of both hands was performed
Results: Out of 131 included subjects, 107 patients [81.7%] had CTS. Approximately one-third [35.1%] of the study subjects had unilateral CTS, and it affected both hands in 46.6% of them. In the majority of cases CTS was of very mild or mild severity [27.5% and 26.7% respectively]. A significant association was found between gender, hypertension, hypothyroidism, ischemic heart disease and the development of CTS
Conclusion: High prevalence of unilateral and bilateral CTS was found among patients with type 2 diabetes mellitus in South Western Saudi Arabia. Different grades of CTS were detected, but the severity of functional impairment was relatively mild. Development of CTS was associated with hypertension, ischemic heart disease, and hypothyroidism. Health care professionals should be aware of this high prevalence, and it will be useful to perform electrodiagnostic studies in diabetic patients in whom CTS is suspected