Changes in vitamin D metabolites at the time of critical illness and 6 months later-A prospective observational study.

BACKGROUND: Despite multiple studies suggesting that low 25(OH)D-vitamin levels are associated with worse outcomes in critically ill individuals, attempts to mitigate the outcomes by fixed dose enteral supplementation unguided by baseline or target blood levels have been unsuccessful. Since a single measurement of 25(OH)D may not optimally reflect an individual's vitamin D status, we studied the plasma concentration of different vitamin D metabolites and their recovery during and following resolution of acute critical illness. METHODS: A prospective observational study including patients 18 years and older admitted to a mixed medical-surgical ICU in Reykjavik, Iceland, located at a high-northern altitude (64° N). Vitamin D metabolites were measured at three timepoints; On admission (S1), 3-5 days following admission (S2) and after recovery from acute illness (median 178 days) (S3). Concentrations of total 25(OH)D-vitamin, cholecalciferol (D3 ), total 24,25(OH)D-vitamin, vitamin D binding protein (VDBP) were measured with LC-tandem mass spectrometry (LC-MS/MS) and free 25-(OH)D was measured with enzyme-linked immunosorbent assay. RESULTS: Most individuals were vitamin D deficient when assessed during critical illness, with 25(OH)D-vitamin levels under 30 ng/ml for 37/40 individuals at timepoint S1 and 34/38 at S2. After recovery, 18/30 patients were deficient at S3. Levels of all vitamin D metabolites measured were low during critical illness but rose substantially following resolution of acute illness. No strong correlation was found between markers of acute illness severity or duration and resolution of vitamin D metabolites in the interval between acute illness and recovery. CONCLUSIONS: In critically ill patients, levels of multiple vitamin D metabolites are low but substantial recovery occurs following resolution of acute illness. It is unclear whether a single metabolite is sufficient to assess vitamin D status of critically ill patients and guide potential supplementation.

Penetrating stab injuries in Iceland: a whole-nation study on incidence and outcome in patients hospitalized for penetrating stab injuries.

BACKGROUND: Studies on penetrating injuries in Europe are scarce and often represent data from single institutions. The aim of this study was to describe the incidence and demographic features of patients hospitalized for stab injury in a whole nation. MATERIALS AND METHODS: This was a retrospective nationwide population-based study on all consecutive adult patients who were hospitalized in Iceland following knife and machete-related injuries, 2000-2015. Age-standardized incidence was calculated and Injury Severity Score (ISS) was used to assess severity of injury. RESULTS: Altogether, 73 patients (mean age 32.6 years, 90.4% males) were admitted during the 16-year study period, giving an age-standardized incidence of 1.54/100,000 inhabitants. The incidence did not vary significantly during the study period (P = 0.826). Most cases were assaults (95.9%) occurring at home or in public streets, and involved the chest (n = 32), abdomen (n = 26), upper limbs (n = 26), head/neck/face (n = 21), lower limbs (n = 10), and the back (n = 6). Median ISS was 9, with 14 patients (19.2%) having severe injuries (defined as ISS > 15). The median length of hospital stay was 2 days (range 0-53). Forty-seven patients (64.4%) underwent surgery and 26 of them (35.6%) required admission to an intensive care unit (ICU), all with ISS scores above 15. Three patients did not survive for 30 days (4.1%); all of them had severe injuries (ISS 17, 25, and 75). CONCLUSION: Stab injuries that require hospital admission are rare in Iceland, and their incidence has remained relatively stable. One in every five patients sustained severe injuries, two-thirds of whom were treated with surgical interventions, and roughly one-third required ICU care. Although some patients were severely injured with high injury scores, their 30-day mortality was still low in comparison to other studies.

Survival and neurodevelopmental outcome of ELBW children at 5 years of age: comparison of two cohorts born 10 years apart.

AIM: To examine survival and outcome of extremely low-birth-weight (ELBW) children (birth weight < 1000 g) in two 5-year periods, 10 years apart. METHODS: In a retrospective population-based study, information on all ELBW children born in Iceland in 1991-1995 and in 2001-2005 was obtained from the National Birth Registry, hospital charts and medical records. The two periods were compared. RESULTS: In 1991-1995, 102 of 22.261 newborn children (0.5%) were extremely low birth weight compared with 70 of 20.923 newborns (0.33%) in 2001-2005 (p = 0.04). At 5 years of age, 52% (35/67) of live-born children born in 1991-1995 were alive compared with 63% (31/49) of children born in 2001 - 2005 (p = 0.2). Six ELBW children (17%) born 1991-1995 were diagnosed with disabilities at 5 years of age, three with major neurodevelopmental disabilities compared with six (19%) born 2001-2005, thereof one with severe neurodevelopmental disabilities (p = 0.57). CONCLUSION: The incidence of childhood disabilities in ELBW children in Iceland remains stable despite an increase in survival rate. The severity of neurodevelopmental disabilities has decreased.

Increasing minimally invasive hysterectomy: effect on cost and complications.

OBJECTIVE: In a 3-year period, the main mode of access for hysterectomy at Brigham and Women's Hospital changed from abdominal to laparoscopic. We estimated potential effects of this shift on perioperative outcomes and costs. METHODS: We compared the perioperative outcomes and the cost of care for all hysterectomies performed in 2006 and 2009 at an urban academic tertiary care center using the χ² test or Fisher's exact test for categorical variables and two-sided Student's t test for continuous variables. A multivariate regression analysis was also performed for the major perioperative outcomes across the study groups. Cost data were gathered from the hospital's billing system; the remainder of data was extracted from patients' medical records. RESULTS: This retrospective study included 2,133 patients. The total number of hysterectomies performed remained stable (1,054 procedures in 2006 compared with 1,079 in 2009) but the relative proportions of abdominal and laparoscopic cases changed markedly during the 3-year period (64.7% to 35.8% for abdominal, P<.001; and 17.7% to 46% for laparoscopic cases, P<.001). The overall rate of intraoperative complications and minor postoperative complications decreased significantly (7.2% to 4%, P<.002; and 18% to 5.7%, P<.001, respectively). Operative costs increased significantly for all procedures aside from robotic hysterectomy, although no significant change was noted in total mean costs. CONCLUSION: A change from majority abdominal hysterectomy to minimally invasive hysterectomy was accompanied by a significant decrease in procedure-related complications without an increase in total mean costs.