Analysis of hypo- and hypermagnesemia in an intensive care unit cohort.

INTRODUCTION: The aim of this study was to evaluate if magnesium deviations correlate with higher 180 day overall mortality or increased morbidity, compared to controls. METHODS: We conducted a retrospective study on 5369 patients with 22,003 magnesium values treated at the Adult Intensive Care Unit at Skåne University Hospital, Lund, Sweden during 2006-2014. The patients were retrospectively divided into a control group with only normal magnesium values 0.7-1.0 mmol/l, and three study groups; hypomagnesemic; Mg2+ < 0.7 mmol/l, hypermagnesemic; Mg2+ > 1.0 mmol/l and an unstable mixed group showing both hypo/hypermagnesemia. Gender, age, disease severity represented by maximum organ system SOFA score, renal SOFA score, lowest potassium value and diagnoses classes were included in a Cox hazard model in order to adjust for confounding factors, with time to death in the first 180 days from the ICU admission as outcome. RESULTS: The hypermagnesemic study group and the mixed group showed increased hazard ratios for mortality; 1.4 (CI 98.3% 1.2, 1.6, P < 0.0001) and 2.1 (CI 98.3% 1.2, 2.8, P < 0.0001) respectively, compared to controls, while the hypomagnesemic group did not reach significance. In addition, patients in the hypermagnesemic and the mixed groups are older, more ill with significantly higher EMR and SOFA scores and show significantly longer ventilator times and ICU stays, compared to controls. CONCLUSIONS: Patients with magnesium deviations are more ill compared to patients with explicitly normal magnesium values throughout the ICU stay. Cox analysis suggests that the magnesium deviation itself might have an impact on mortality.

Roquinimex (Linomide) vs placebo in AML after autologous bone marrow transplantation.

Roquinimex, Linomide, a quinoline derivative with pleiotropic immunomodulatory activity, has previously been shown to enhance natural killer (NK) cell number and activity after ABMT in patients with AML. In this study 278 AML patients in remission were randomized to receive Roquinimex 0.2 mg/kg body weight or placebo twice weekly for 2 years following ABMT. Out of 139 patients in each group, 109 Roquinimex patients and 108 placebo patients were in their first CR. Median age at inclusion was 41 years for Roquinimex patients and 39 years for placebo patients. Twelve patients in each group had their marrow purged prior to reinfusion. Relapse and death were study endpoints. Surviving patients were followed for 2.6 to 6. 9 years. The total number of relapses was 60 in the Roquinimex group and 63 in the placebo group (not significant). Leukemia-free and overall survivals were similar in the two groups. Recovery of platelet counts was significantly delayed in the Roquinimex group as compared to placebo. No other significant differences regarding toxicity parameters were recorded. In conclusion, previous findings on NK cells could not be confirmed and the study showed no benefit for Roquinimex over placebo regarding relapse or survival following ABMT for AML in remission.

A feasibility study of roquinimex (Linomide) and alpha interferon in patients with advanced malignant melanoma or renal carcinoma.

Thirty-one patients with advanced renal carcinoma or malignant melanoma were treated in the first feasibility study of alpha-interferon (Roferon) and the new oral immunomodulating agent, Linomide. Linomide 5 mg or 10 mg p.o. daily was given for 2 weeks; alpha-interferon was then added at 3 MU s.c. three times weekly, escalating in each patient by 3 MU per week, if tolerable, up to 12 MJ. The combination was poorly tolerated with nausea, vomiting, somnolence and myalgia commonly reported. Adverse events accounted for treatment withdrawal in ten patients and contributed to withdrawal in four other patients. Treatment with Linomide alone in the first 2 weeks led to a significant increase in white blood cells, neutrophils and platelets. When alpha-interferon was added, the platelet count decreased significantly over the following 6 weeks. Nineteen patients had white cell phenotype and function measured. After 2 weeks of 5 mg Linomide, a transient but significant decrease in the absolute number of activated T-helper cells (CD4+DR+) was observed. No changes in natural killer (NK) cell number or activity were observed. Twenty-two patients were evaluable for response. One with metastatic renal cell carcinoma had a complete response and six had stable disease. This study does not support the use of the combination because significant toxicity was seen without the anticipated immunological benefits.

First-incidence anxiety in the Lundby Study: course and predictors of outcome.

The aim of the present study was to analyse first-incidence anxiety in the Lundby Study with regard to course and predictors of outcome between 1947 and 1972. The Lundby concept of anxiety corresponds broadly to that of anxiety disorders in DSM-III-R. The Lundby Study is a prospective, psychiatric study of a geographically defined total population. The present study includes 124 subjects (46 men and 78 women) who between 1947 and 1972 developed anxiety as their first mental illness in life. The median total duration of illness was 1.6 years in men and 1.4 years in women. In both sexes episodes of mild impairment dominated. In total, 54% of the men and 71% of the women were mentally healthy at the follow-up in 1972. A minority of the probands (27%) received psychiatric treatment. They significantly more often suffered from panic disorder with agoraphobia during their first episode, and from comorbidity of other mental illnesses, than did untreated subjects. They also had a significantly longer total duration of illness, a variable with a negative predictive influence on the probability of being mentally healthy in 1972. Men with anxiety showed a 55% increase in alcoholism compared to standard values. They also displayed an increased risk of relapsing into mental illness compared to female cases, a result which, in the light of earlier findings of increased mortality rates, suggests that further investigations of men with anxiety syndromes in the general population are warranted.

Predictors of anxiety in the Lundby study: a prospective study of a normal population during 1947-1972.

The aim of the present study was to search for specific premorbid background factors of 'anxiety' in a normal population, the 1947 Lundby cohort. 2,550 probands were repeatedly examined by psychiatrists during a 25-year period, regardless of medical care. The semi-structured examinations included items referring to the proband's mental and physical health, personality, behaviour and socio-economic background. In the present study, only assessments made before the first onset of anxiety were considered. Very strict criteria of 'healthiness' and anxiety regarding the comparison groups were used. Five out of 50 items considered were significantly predictive. The male features share certain similarities with those observed in earlier predictor studies on anxiety and depressive disorders, while the traits found in women seem to predispose for other mental illness as well.

The effect of an ibuprofen-codeine combination for the treatment of patients with pain after removal of lower third molars.

A double-blind randomized crossover analgesic trial was carried out on 70 patients undergoing surgical removal of one lower third molar at each visit. The analgesic efficacy of a two-dose regimen of the combination ibuprofen-codeine, 400 to 60 mg, was compared with ibuprofen, 400 mg. Each of the two doses was taken when the patient needed pain relief and the pain intensity was measured on a visual analog scale during the 10-hour period after the first medication. Because of carryover effects between periods 1 and 2, the analysis was carried out only for period 1 according to a parallel group design. Of the 60 patients who were evaluated for analgesic effect, the mean pain reduction of dose 1 was 63% for the 29 patients given ibuprofen-codeine and 50% for the 31 patients given ibuprofen; the mean duration of effect was 7.5 and 6.3 hours, respectively. The difference in pain reduction index (pain reduction X duration of effect) between the two treatments was significant in favor of the combination, whereas the separate variables of pain reduction and duration of effect were not significantly different. The mean pain reduction was 67% after doses 1 and 2 for patients on ibuprofen-codeine and 52% for those on ibuprofen; the mean duration of effect was 9.4 and 9.2 hours, respectively. For doses 1 and 2, the difference in pain reduction index per dose between the two treatments was significant but not the difference for the separate variables, pain reduction, and duration of effect.(ABSTRACT TRUNCATED AT 250 WORDS)