Induction of anaesthesia with propofol according to the adjusted ideal body mass in obese and non-obese patients: an observational study

Background: Obesity changes body composition including fat free mass (FFM), regarded as the "pharmacologically active mass". Scaling drug doses to obese patients by total body mass (TBM) results in overdose. We aimed to determine the success rate of inducing anaesthesia in normal, overweight and obese patients with propofol, using an adjusted body mass scalar (ABM), which embodies the increased FFM of obese patients. Methods: Ninety-six patients were divided into three groups according to body mass index (BMI): normal, overweight and obese. Propofol 2 mg/kg ABM was administered according to the equation: ABM = IBM + 0.4(TBM ­ IBM), where IBM = ideal body mass. Induction success was assessed clinically and by electroencephalographic spectral entropy. Results: The groups were similar regarding gender, age, height and IBM. One patient was morbidly obese (BMI = 44). State entropy (SE) decreased to < 60 in 33/33, 28/29 and 33/34 patients in the normal-weight, overweight and obese groups respectively, an overall success rate of 97.5% (95% confidence interval 92.7% to 99.4%). Median lowest achieved SE values and median times that SE remained < 60 did not differ between groups, however the individual values ranged widely in allthree groups. Induction failed in the two patients whose SE did not decrease to < 60 (one overweight and one obese). Conclusions: The ABM-based propofol induction dose has a high success rate in normal, overweight and obese patients. Further studies are required to determine the feasibility among morbidly obese patients

Association between obesity and impaired glucose tolerance in new providence adolescents as demonstrated by the HbA1c test / Asociación entre la obesidad y los trastornos de tolerancia a la glucosa entre los adolescentes de nueva providencia según lo demostrado por la prueba de HbA1c

OBJECTIVE: To explore the association between obesity and the development of impaired glucose tolerance (IGT) in Bahamian adolescents. METHODS: Eight hundred and seventy-three adolescents were randomly selected from five high schools in New Providence. Each student's weight, height, and waist and hip circumferences were recorded to determine body mass index (BMI). Individuals with BMIs above the 84th and 95th percentiles were classified as overweight and obese, respectively. Venous blood samples were collected from each subject and haemoglobin Ai c (HbAi c) levels were measured using a direct immunoassay method. The criterion established by the International Expert Committee for the diagnosis of IGT (HbA i c concentration of 6.0-6.4%) was used. An analysis of covariance was performed to evaluate the relationship between obesity and IGT, and a logistic regression analysis predicted the risk of IGT based on BMI classification. RESULTS: Of the 861 adolescents who completed the study, 15.0% were classified as overweight, 15.2% as obese and 7.9% as severely obese. The overall cumulative prevalence of IGT based on HbAi c levels was 16 100 cases per 100 000 adolescents and was greater in males than in females. Higher percentages of overweight and obese students were identified as having IGT compared with their normal-weight counterparts. An analysis of covariance with post hoc analyses revealed that severely obese males and females, respectively were almost 26 (OR = 25.54, 95%CI 9.92, 65.77) or 23 (OR = 22.96, 95% CI 9.81, 53.73) times more likely to develop IGT than their normal-weight counterparts (p < 0.005). CONCLUSION: The data show a strong positive association between IGT and obesity among Bahamian adolescents.

OBJETIVO: Explorar la asociación entre la obesidad y el desarrollo de trastornos de tolerancia a la glucosa (IGT) en los adolescentes de Bahamas. MÉTODOS: Ochocientos setenta y tres adolescentes fueron seleccionados aleatoriamente de cinco escuelas secundarias en Nueva Providencia. Se registraron peso, altura, y las circunferencias de cintura y cadera de cada estudiante, para determinar el índice de masa corporal (IMC). Las personas con IMC por encima de los percentiles 84 y 95 fueron clasificados como con sobrepeso y obesos, respectivamente. Se obtuvieron muestras de sangre venosa de cada sujeto, y se midieron los niveles de hemoglobina A 1c (HbAc utilizando un método de inmunoensayo directo. Se utilizó el criterio establecido por el Comité Internacional de expertos para el diagnóstico de IGT (concentración de HbA 1c de 6.0-6.4%). Se realizó un análisis de covarianza para evaluar la relación entre la obesidad y IGT, y un análisis de regresión logística para predecir el riesgo de IGT sobre la base de la clasificación del IMC. RESULTADOS: De los 861 adolescentes que completaron el estudio, 15.0% fueron clasificados como con sobrepeso, 15.2% como obesos, y 7.9% como extremadamente obesos. La prevalencia acumulativa general de IGT basada en los niveles de HbA 1c fue 16 100 casos por 100 000 adolescentes, y fue mayor en los varones que en las mujeres. Mayores porcentajes de estudiantes con sobrepeso y obesidad fueron identificados con IGT en comparación con sus contrapartes de peso normal. Un análisis de covarianza con análisis post-hoc reveló que los varones y hembras extremadamente obesos, respectivamente, fueron casi 26 (OR = 25.54, 95%CI 9.92, 65.77) o 23 (OR = 22.96, 95% CI 9.81, 53.73) veces más propensas a desarrollar IGT que sus contrapartes de peso normal (p < 0.05). CONCLUSIÓN: Los datos muestran una fuerte asociación positiva entre IGT y obesidad entre los adolescentes de las Bahamas.

A comparison of EEG spectral entropy with conventional quantitative EEG at varying depths of sevoflurane anaesthesia

Background and Aim: Recently an electroencephalographic (EEG) spectral entropy module (M-ENTROPY) for an anaesthetic monitor has become commercially available. We compared its performance as an indicator of the state of anaesthesia with that of an older conventional quantitative EEG (QEEG) module (M-EEG) by the same manufacturer (Datex-Ohmeda Division; Instrumentarium Corp.; Helsinki; Finland). Methods: There were 40 ASA class I or II subjects; aged between 16-60 years; who underwent elective abdominal surgery. EEG data were collected from the printouts of the respective modules. The data presented here were related to four levels of anaesthesia: Pre-anaesthetic wakefulness (state A); 2 sevoflurane endtidal (ET) concentration after completion of surgery (state B); low ET sevoflurane concentrations (~ 0.5) just prior to regaining responsiveness (state C); and post-anaesthetic responsiveness (state D). Results: In terms of the prediction probability (Pk statistic); response entropy (RE) and state entropy (SE) produced higher values (0.95-1.0) than the best performing QEEG variable; frontal amplitude (0.86-0.95). Only RE scores did not overlap between states A and B or between B and D. The misclassification of subjects between states C and D was far lower for RE (28) than for any of the conventional QEEG measures (90). Conclusion: In on-line monitoring spectral entropy is superior in distinguishing states of anaesthesia and is also easier to use than conventional QEEG. It is speculated that the artefact rejection strategies accorded spectral entropy might significantly benefit conventional QEEG analysis

A survey of chronic renal failure in Jamaica

The prevalence of chronic renal failure (CRF)/end stage renal disease and the accessibility of long term renal replacement therapy in Jamaica were evaluated. The study was conducted at six Jamaican healthcare facilities between July 1998 and December 1999 and included 605 patients with CRF. Men with CRF (57 of patients, mean age of 56.7 years) were significantly older than women (mean age 53.2 years). Hypertension was the most commonly associated medical condition (60.8 of patients) followed by diabetes mellitus (31.4 of patients). The estimated crude point prevalence of CRF in persons 20 years and over at the end of 1999 was 327 per million population. More than one-third of patients with CRF (39) were receiving renal replacement therapy, the most common modality being haemodialysis, and only 1.8 of patients had received kidney transplantation. The prevalence of chronic renal failure was not increased in areas known to have high soil cadmium levels. Chronic renal failure is a significant public health problem in Jamaica and is placing an increasing financial burden on the healthcare sector

Persistent gestational trophoblastic disease presenting as left hemiparesis in a Jamaican teenager

A 19-year-old woman, who delivered a macerated stillborn at 32 weeks' gestation and had persistent postpartum vaginal bleeding, presented with a left hemiparesis three and a half months after delivery. A clinical diagnosis of persistent gestational trophoblastic disease (GTD) was made, based on quantitative serum beta-hCG of more than 200,000 IU/ml, cannon ball metastases on chest X-ray and two ring enhancing lesions, metastases, in the right parietal lobe on Computed Axial Tomography (CAT) scan of the brain. Despite combination chemotherapy, with methotrexate, cyclophosphamide and actinomycin D, her condition worsened and she died.

Estudio histopatológico de glándulas salivales menores en alcohólicos / Histopathological study of minor salivary glands in alcoholics

A qualitative and quantitative histological analysis of minor salivary glands was carried out in 60 alcoholics and 20 matched control patients. Minor salivary glands biopsies were obtained and samples were processed for conventional light microscopy. A quantitative morphometrical assessment was carried out by counting the number of acinar cells present in an area by means of a squared grid eye piece. Neither hipertrophic nor atrophic responses were found in the quantitative analysis. Histological changes such as acinar degeneration, hyperemia, mononuclear inflammatory and fat infiltration were found in both experimental and control samples. None of these findings reached statistical significance. Eleven adult alcoholics with liver damage (ASD) presented duct dilatation. On the other hand, only 3 adult alcoholics with liver damage (ACD) developed this response. This difference was statistically significant (p=0.02). Perhaps no difference was found when we compared ASD group with its respective control group (p=0.699). Whe could not differentiate if this change was due to alcoholism or another undeterminated factor. At least under the scope of this study, we may conclude that minor salivary glands are acarcely affected by alcoholism even when liver damage has been established

Estudio histopatológico de glándulas salivales menores en alcohólicos / An histopathological study of minor salivary glands in alcoholic patients

El presente estudio fue realizado con el fin de verificar si las glándulas salivales menores de pacientes alcohólicos presentan cambios histopatológicos. Se seleccionó un grupo experimental conformado por 10 pacientes alcohólicos crónicos y un grupo control constituido por 10 individuos adultos no alcohólicos sin antecedentes mórbidos. Las edades de ambos grupos fluctuaban entre los 45 y 65 años. Los pacientes presentabn lesiones patológicas en la región labial inferior que justificaron la toma de la biopsia. Las muestras fueron procesadas para microscopía óptica convencional y se tiñeron con hematoxilina-eosina, tricrómico de Van Gieson-Ponceau y Sudan. Los resultados mostraron un incremento en el número de acinos por campo en el grupo experimental (p < 0,003). Esta hiperplasia de células acinares podría corresponder a una etapa temprana de sialadenosis. las muestras de los pacientes alcohólicos presentaban las células acinares hipertrofiadas, con ruptura de las membranas celulares y dilatación de los ductos. Estos hallazgos podrían explicar la hipersalivación observada en pacientes alcohólicos