Statin initiation and acute kidney injury following elective cardiovascular surgery: a population cohort study in Denmark†.

OBJECTIVES: Acute kidney injury (AKI) is a serious complication of cardiac surgery. Statins may prevent post-surgical AKI, yet methodological concerns about existing studies raise questions about the magnitude of a protective effect. We sought to determine the effect of initiating a statin prior to elective cardiac surgery on post-surgical AKI in a regional Danish surgical cohort. METHODS: We identified adults who underwent cardiac surgery during 2006-11 using the Western Denmark Heart Registry. Presurgical medication use, pre- and post-surgical serum creatinine (sCr) measures, and other patient characteristics were obtained from Danish population-based registries. Post-surgical AKI was assessed using sCr measures within 5 days of surgery. The adjusted risk ratio (RR) of AKI and 95% confidence interval (CI) were estimated for patients who initiated a statin within 100 days prior to surgery compared with patients without prior statin use; long-term statin users were excluded to reduce healthy-user bias. Subanalyses were stratified by surgery type: coronary artery bypass grafting (CABG) and non-CABG surgeries. RESULTS: We identified 1929 CABG and 1775 non-CABG patients. AKI occurred in 25% of CABG and 28% of non-CABG surgeries, and in 29% of the non-users and 21% of the statin initiators. Half of CABG patients and 9% of non-CABG patients initiated a statin prior to surgery. The adjusted RRs for the effect of statin initiation on AKI were as follows: all surgeries combined, RR = 0.86 (95% CI: 0.74, 0.98); CABG, RR = 0.88 (0.74, 1.05); non-CABG RR = 0.87 (0.68, 1.11). CONCLUSIONS: Presurgical statin initiation is associated with a reduction in AKI risk after cardiac surgery.

Acute respiratory failure secondary to esophageal dilation from undiagnosed achalasia.

Achalasia is an idiopathic motility disorder causing progressive dysphagia and dilation of the esophagus. Rarely this esophageal dilation can cause acute respiratory insufficiency and/or failure. We describe a 63-year-old woman presenting for total knee arthroplasty in whom induction of anesthesia was complicated by pulmonary aspiration requiring postoperative ventilation, hypotension requiring vasopressor therapy, and postextubation, recurrent, acute respiratory failure. Computed tomography of the chest performed for suspected pneumothorax revealed severe esophageal dilation with a mass effect. As this case describes, achalasia may present with the life-threatening complication of respiratory failure and requires a high index of suspicion for timely diagnosis and appropriate interventions.

Phylogenetic lineage and pilus protein Spb1/SAN1518 affect opsonin-independent phagocytosis and intracellular survival of Group B Streptococcus.

Opsonin-independent phagocytosis of Group B Streptococcus (GBS) is important in defense against neonatal GBS infections. A recent study indicated a role for GBS pilus in macrophage phagocytosis (Maisey et al Faseb J 22 2008 1715-24). We studied 163 isolates from different phylogenetic backgrounds and those possessing or lacking the gene encoding the pilus backbone protein, Spb1 (SAN1518, PI-2b) and spb1-deficient mutants of wild-type (WT) serotype III-3 GBS 874391 in non-opsonic phagocytosis assays using J774A.1 macrophages. Numbers of GBS phagocytosed differed up to 23-fold depending on phylogenetic background; isolates possessing spb1 were phagocytosed more than isolates lacking spb1. Comparing WT GBS and isogenic spb1-deficient mutants showed WT was phagocytosed better compared to mutants; Spb1 also enhanced intracellular survival as mutants were killed more efficiently. Complementation of mutants restored phagocytosis and resistance to killing in J774A.1 macrophages. Spb1 antiserum revealed surface expression in WT GBS and spatial distribution relative to capsular polysaccharide. spb1 did not affect macrophage nitric oxide and TNF-alpha responses; differences in phagocytosis did not correlate with N-acetyl d-glucosamine (from GBS cell-wall) according to enzyme-linked lectin-sorbent assay. Together, these findings support a role for phylogenetic lineage and Spb1 in opsonin-independent phagocytosis and intracellular survival of GBS in J774A.1 macrophages.

Development of an obesity counseling model based on a study of determinants of intentional sustained weight loss.

BACKGROUND: Overweight and obesity are at epidemic proportions. This study examines the attitudes and actions of Oklahoma clinicians in obesity treatment, and the characteristics and perceptions of a subset of their patients who lost weight and were able to maintain weight loss. METHODS: Our study was a small mixed method study involving both surveys and interviews. Descriptive statistics were calculated, content analysis of interviews performed, and a model outline for obesity counseling was developed. RESULTS: Only 38% of the 66 clinicians surveyed try to motivate their patients to lose weight. Patients interviewed recommended that clinicians treat obesity as a medical problem. We incorporated themes from the patient interviews into the S-MASS model for obesity screening and counseling.This was positively reviewed by clinicians and patients. CONCLUSION: The S-MASS model can function as a guide to help the clinician/patient team develop successful strategies for weight loss and maintenance of weight loss.

Nurse and physician patient counseling about tobacco smoking in Jordan.

The objective of this study was to identify whether nurses are as likely as physicians to feel prepared to assist patients to quit smoking, to have smoked in front of patients, or to have received training on counseling patients about smoking cessation. The sample consisted of 262 nurses and 251 physicians, ages 18 years and older, from public and private hospitals in Jordan. It was found that nurses were more likely than physicians to receive training on counseling patients about smoking cessation (41% vs. 18%); more likely to currently smoke (30% vs. 19%); and less likely to feel prepared to assist patients to quit smoking (78% vs. 95%). Smoking status and training were associated with counseling patients about smoking. Approximately 19% of nurses and 81% of physicians who currently or formerly smoked had previously smoked in front of patients. Nurses compared with physicians have lower agreement with statements involving smoking-related responsibilities and views on smoking policy, but higher agreement that second-hand smoke is related to selected diseases. Physicians felt more strongly than nurses that they should serve as role models for the public, routinely advise their smoking patients to quit, and speak to lay groups about smoking. In conclusion, a greater level of smoking cessation training among physicians and nurses in Jordan is warranted.

Smoking prevalence, attitudes, and perceived smoking prevention and control responsibilities and behaviors among physicians in Jordan.

This study identifies smoking prevalence among physicians in Jordan. It also assesses their attitudes, perceived smoking prevention, and control responsibilities and behaviors. A cross-sectional survey was administered to 251 physicians from public and private hospitals in Jordan. The response rate was 67%. The prevalence of smoking is 22.4% for male and 9.1% for female physicians. Among current or former smokers, 81.1% (n = 73), 29.1% overall, had smoked in front of a patient. The physicians believed that physician counseling could more effectively prevent patients from smoking than influencing patients to quit smoking. Approximately 56.2% of physicians had ever counseled patients about smoking and 34.3% regularly counseled patients about smoking. Only 18.3% (n = 46) had received training, either in medical school or thereafter, on counseling patients about smoking. Physicians with training on counseling patients about smoking cessation were significantly more likely to have counseled or to routinely counsel patients to help them quit or not start smoking. Training also lowered the percentage of smokers who smoked in front of patients.