Period-Prevalence and Risk Factors for Delirium in a Tertiary Referral ICU: A prospective cohort study.

BACKGROUND: Delirium is common in intensive care and leads to increases in morbidity, mortality, Intensive Care Unit (ICU) length of stay, and hospital length of stay. Certain risk factors predict the appearance of delirium. STUDY OBJECTIVES: To determine the rates of delirium, the rate of risk factors, and their relationship to the occurrence of delirium in an adult ICU. METHODS: Single-centre, prospective, observational study. Demographic and treatment data were collected. The Confusion Assessment Method for ICU (CAM-ICU) was performed twice daily to assess for delirium continuously during a 3-week period. Statistical analysis was used to determine the relationship between risk factors and the occurrence of delirium. RESULTS: 86 patients were screened, 44 patients were included, and 260 patient-days were analyzed. The incidence of delirium was 42.9%, the prevalence of delirium in ICU was 50%. Urinary catheters and use of opioids were the most common factors with a positive association for occurrence of delirium. Exposure to daylight and sleeping for more than 4 hours at night were the factors most commonly associated with a lack of delirium. CONCLUSION: The rates of delirium in ICU were high and risk factors occurred frequently. Addressing modifiable risk factors, including the promotion of adequate sleep, could improve outcomes.

The effect of topical xylometazoline on Eustachian tube function.

BACKGROUND: Topical nasal decongestants are frequently used as part of the medical management of symptoms related to Eustachian tube dysfunction. OBJECTIVE: This study aimed to assess the effect of topical xylometazoline hydrochloride sprayed in the anterior part of the nose on Eustachian tube active and passive opening in healthy ears. METHODS: Active and passive Eustachian tube function was assessed in healthy subjects before and after intranasal administration of xylometazoline spray, using tympanometry, video otoscopy, sonotubometry, tubo-tympano-aerodynamic-graphy and tubomanometry. RESULTS: Resting middle-ear pressures were not significantly different following decongestant application. Eustachian tube opening rate was not significantly different following the intervention, as measured by all function tests used. Sonotubometry data showed a significant increase in the duration of Eustachian tube opening following decongestant application. CONCLUSION: There remains little or no evidence that topical nasal decongestants improve Eustachian tube function. Sonotubometry findings do suggest that further investigation with an obstructive Eustachian tube dysfunction patient cohort is warranted.

The effect of advance care planning on completion of advance directives and patient satisfaction in people with HIV/AIDS.

The effects of advance care planning are poorly understood. The purpose of this study was to evaluate the effect of an advance care planning intervention on the completion of advance directives (ADs) and patient satisfaction. A volunteer sample of persons with HIV/AIDS received advance directive documents, watched an educational video and received individual counselling on completing an advance directive during three face-to-face interviews over approximately six months. The advance care planning intervention was associated with an increase in advance directive completion rates from 16.4% to 40.7% (p = 0.001), but 23.1% of advance directives reported as completed were legally invalid. There was a trend towards decreased overall patient satisfaction with health care (p = 0.07). Advance are planning increases the rate of AD completion but many 'completed' advance directives are legally invalid. Advance care planning did not improve patient satisfaction with health care.

A case of pseudocholinesterase deficiency in the neonate.

A case of inherited pseudocholinesterase deficiency, which presents in the new-born period, has not been reported previously in the literature. This case highlights the importance of obtaining a complete anesthetic family history in all neonatal surgical conditions.

Chimeric Galpha(q) mutants harboring the last five carboxy-terminal residues of Galpha(i2) or Galpha(o) are resistant to pertussis toxin-catalyzed ADP-ribosylation.

Three widely-used Galpha(q) chimeras harboring the last five residues of Galpha(i), Galpha(o) and Galpha(z) (qi5, qo5 and qz5) were examined for their ability to serve as substrates for pertussis toxin (PTX)-catalyzed ADP-ribosylation. In COS-7 cells coexpressing one of the three opioid receptors (mu, delta, and kappa) and a Galpha(q) chimera, agonist-induced stimulation of phosphoinositide-specific phospholipase C (PI-PLC) was largely insensitive to PTX treatment. Only the qi5-mediated stimulation of PI-PLC by kappa-opioids was partially inhibited by PTX. In betagamma-release assays, PTX treatment did not affect the ability of opioid receptors to activate these chimeras. [32P]ADP-ribosylation labeled Galpha(i/o) but not qi5 or qo5, although the expression of these chimeras was confirmed by immunodetection. Thus, Galpha(q) chimeras with a Galpha(i/o)-like tail are insensitive to PTX treatment.

Role of MRI in the evaluation of ambiguous genitalia.

Diagnostic accuracy of magnetic resonance imaging (MRI) interpretation was assessed prospectively in patients with ambiguous genitalia or intersex problems. MRI depiction of the uterus was possible in 93%, the vagina in 95%, the penis in 100%, the testis in 88%, and the ovary in 74% of patients. The strength of MRI lies in the multiplanar capability and tissue characterization by means of T1- and T2-weighted sequences. MRI contributes to accurate morphologic evaluation of müllerian duct structures, the gonads, and the development of the phallus, all of which are essential for appropriate gender assignment and planning of surgical reconstruction.

Tarsal tunnel syndrome caused by strain of an anomalous muscle: an MRI-specific diagnosis.

Tarsal tunnel syndrome (TTS) is a compression neuropathy of the posterior tibial nerve in the ankle, commonly caused by a mass lesion such as ganglion, tumor, fracture, or post-traumatic fibrosis. Although anomalous muscle is relatively common in the ankle, there has been only one report to date implicating it in TTS. This case demonstrates MR findings of a strained flexor digitorum accessorius longus muscle as an unusual cause of TTS.

Metabolic mapping of the oculomotor system in MPTP-induced parkinsonian monkeys.

The quantitative autoradiographic 2-[14C]deoxyglucose method was used to map the distribution of alterations of local cerebral metabolic rate for glucose (lCMRGlc) in the oculomotor system of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-(MPTP)-induced parkinsonian monkeys. The lCMRGlc was decreased in the frontal eye fields and in the paralamellar mediodorsal thalamus in the parkinsonian monkeys as compared to normal controls. No changes in lCMRGlc were observed in other areas of the oculomotor system. L-Dopa therapy reversed the oculomotor symptoms in these monkeys, as well as the decrease of lCMRGlc in the frontal eye fields and the paralamellar mediodorsal thalamus. Because the frontal eye fields are known to be involved in the initiation of voluntary saccades, these findings suggest a functional anatomical basis for the oculomotor deficits in Parkinson's disease.