A population-based study on epidemiology of intensive care unit treated traumatic brain injury in Iceland.

BACKGROUND: Traumatic brain injury is a worldwide health issue and a significant cause of preventable deaths and disabilities. We aimed to describe population-based data on intensive care treated traumatic brain injury in Iceland over 15 years period. METHODS: Retrospective review of all intensive care unit admissions due to traumatic brain injury at The National University Hospital of Iceland 1999-2013. Data were collected on demographics, mechanism of injury, alcohol consumption, glasgow come scale upon admission, Injury Severity Scoring, acute physiology and chronic health evaluation II score, length of stay, interventions and mortality (defined as glasgow outcome score one). All computerized tomography scans were reviewed for Marshall score classification. RESULTS: Intensive care unit admissions due to traumatic brain injury were 583. The incidence decreased significantly from 14/100.000/year to 12/100.000/year. Males were 72% and the mean age was 41 year. Majority of patients (42%) had severe traumatic brain injury. The most common mechanism of injury was a fall from low heights (36.3%). The mortality was 18.2%. Increasing age, injury severity score, Marshall score and acute physiology and chronic health evaluation II score are all independent risk factors for death. Glasgow coma scale was not an independent prognostic factor for outcome. CONCLUSIONS: Incidence decreased with a shift in injury mechanism from road traffic accidents to falls and an increased rate of traumatic brain injury in older patients following a fall from standing or low heights. Mortality was higher in older patients falling from low heights than in younger patients suffering multiple injuries in road traffic accidents. Age, injury severity score, acute physiology and chronic health evaluation II score and Marshall score are good prognostic factors for outcome. Traumatic brain injury continues to be a considerable problem and the increase in severe traumatic brain injury in the middle age and older age groups after a seemingly innocent accident needs a special attention.

Release of anti-inflammatory drugs from a silicone elastomer matrix system.

The focus of the current study was to overcome the obstacles to incorporating non-steroidal anti-inflammatory drugs (NSAIDs) into a medical silicone elastomer and to investigate how the physicochemical properties of the drugs affect the curing process and drug release. Five representative NSAIDs were selected with different molecular weights and physicochemical properties. Silicone blends with 1% (w/w) drug in the sodium salt form could be obtained in a fully cured medical elastomer matrix whereas drugs in various other salt forms or the free acid form interfered with the curing process. The release rate was mainly dependent on the solubility in the drug-salt elastomer matrix, with ibuprofen sodium showing the fastest rate. These results indicate that inclusion of the NSAID salts in the silicone matrix does not change the microstructure or the permeability of the silicone matrix, and channel formation is minimal. The properties of NSAID-containing silicone blends are compatible with processes used for the manufacture of medical devices from silicone such as silicone stents or catheters, and could therefore be considered for such devices to reduce inflammation at the site of an implant and also for local delivery.

[Homocysteine, folate and cobalamin in Icelandic men and women.].

OBJECTIVE: To determine reference intervals and interquartile ranges for total homocysteine (Hcy) folate and cobalamin in Icelandic men and women and to evaluate the correlation of Hcy to serum levels of the vitamins folate and cobalamin. MATERIAL AND METHODS: Blood samples were collected from 449 individuals over a period of three months, 291 men (mean age 48.3 years) and 158 women (mean age 49.8 years). Plasma Hcy was measured by a HPLC method with fluorescence detection; folate and cobalamin levels in serum were measured by an electroimmunochemical method on an ELECSYS system from Roche. RESULTS: The reference interval for Hcy, between 2.5% and 97.5% fractiles, estimated by parametric statistics, are 6.2-17.5 micromol/L for men and 4.8-14.1 micromol/L for women. Similarly the 95% reference intervals for folate and cobalamin were estimated using parametric statistics. A significant negative correlation was found between concentrations of folate and Hcy for both men and women (p<0.01) with a correlation coefficient of -0.39 and also between cobalamin and Hcy where the correlation coefficient is -0.20. CONCLUSIONS: Reference interval for Hcy from the general presumed healthy population is estimated here for the first time in Icelandic men and women and will be of value in cardiovascular risk assessments. The negative correlation between Hcy and folate and also Hcy and cobalamin, is in agreement with results from other studies and suggests that an improved vitamin status might be beneficial in lowering Hcy in a section of the population as has been suggested in numerous studies in other countries.