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Risk assessment study of the pressure ulcers in intensive care unit patients

In this research, we studied the incidence of pressure ulcer and risk factors and screening of the patients for pressure ulcers at intensive care unit on the first day of admission in 142 patients. All patients were evaluated according to National Pressure Ulcer Advisory Panel during the ICU period strictly. Pressure ulcer risk evaluation was performed according to Norton Scale. Nutritional state was evaluated according to nutritional risk screening 2002. Age, hospitalization period, mean arterial pressure, pressure ulcer degree, hemoglobin and albumin levels, body mass index, APACHE-II scores and comorbidities were evaluated. In the following parameters, first value represents PU (+) cases, and second value represents PU (-) cases. On the admittance: 14 (9.8%) patients had PU (prevalence). NRS-2002: 5.4+/-1.9 and 4.3+/-2.1 (p<0.05), Norton score: 8.4+/-4.7 and 13.9+/-4.6 (p<0.05), albumin 2.7+/-0.7 g/dl and 3.2+/-0.8 g/dl (p<0.05). MAP and hemoglobin levels were not different (p>0.05). Mean pressure ulcer degree was 2.15. On the discharge: first values represent new developed PU (+) patients and second values represent PU (-) cases. 25 (17.6%) patients had PU. Incidence was 7.8%. NRS-2002: 6.4 and 3.6 (p<0.05), Norton score: 7.1 and 14.4 (p<0.05), albumin 2.2 g/dl and 3.0 g/dl (p<0.05). MAP 55.15+/-24.10 mm Hg and 79.76+/-18.12 mm Hg (p<0.05), APACHE-II score 22.3+/-4.2 and 18.2+/-6.2 (p<0.05). Hospitalization period: 18.3+/-10.3 days and 6.6+/-4.3 days (p<0.05) respectively. BMI and hemoglobin levels were not different (p>0.05). Two or more co morbidity, neurophyschiatric disorders, infections and medications were more prevalent in PU (+) group (p<0.05). Results of this study show us the PU incidence of ICU patients may be low if we perform PU screening all patients at the admission and put into practice NPUAP strictly. Age, low Norton score, hospitalization period, high APACHE-II score, hypotension, malnutrition and hypoalbuminemia were significant in patients with PU; however, BMI and hemoglobin were not significant. The studies focusing on the relation between the effect of optimization of these parameters from the first day of admittance and pressure ulcer are required.

Albumin, hemoglobin, body mass index, cognitive and functional performance in elderly persons living in nursing homes

The aim of this study is to produce the relation between cognitive and functional performance and some biochemical parameters in elderly population. So, we searched for the correlation between the activities of daily living (ADL), mini-mental state examination (MMSE) and body weight, age, hemoglobin, albumin, serum sodium level of 180 elderly people in five nursing homes. Face-to-face interviews and questionnaires were applied to evaluate ADL. To evaluate the cognitive function we used the MMSE. The average age of 180 people contacted was 71.5+/-5.1 (+/-S.D.), ranging 65-91 years; 112 of them were women (62.2%), 68 were men (37.8%). Of these elderly people, 25% had no medically diagnosed illnesses, whereas 17 of them (9.4%) were bedridden. There was a positive correlation between ADL and hemoglobin, albumin, body weight, cognitive function parameters and a negative one with age and serum sodium. There was a positive correlation between cognitive functions and hemoglobin, body weight, ADL and a negative one with serum sodium. Hemoglobin concentrations indicating anemia were observed in 30% of subjects, 3.9% of them had hyponatremia and 26.7% displayed a hypernatremia. There was a positive correlation between cognitive and physical function scores and hemoglobin, albumin levels in elderly patients. These results suggest that restoration of hemoglobin and albumin levels could improve cognitive and physical functional status in the elderly population.

Serum interleukin 1α and interleukin 2 levels in patients with schizophrenia

It has been suggested that altered interleukin (IL) regulation may be involved in the pathogenesis of schizophrenia. In this cross-sectional, case-controlled study, patients with schizophrenia and a control group of healthy subjects, matched by age, sex and body mass index, were evaluated. The levels of IL-1α and IL-2 in blood serum were measured by enzyme-linked immunosorbent assay. The fasting serum IL-2 levels were significantly higher in patients with schizophrenia compared with the control subjects, but there was no difference between the fasting serum levels of IL-1α in patients with schizophrenia and the control subjects. Our results suggest that patients with schizophrenia have altered IL-2, but not IL-1α, regulation.

The effects of valsartan on insulin sensitivity in patients with primary hypertension.

Insulin resistance is an important risk factor of cardiovascular disease. This study was performed to determine the effects of valsartan on insulin sensitivity in patients with primary hypertension. In this study, non-obese subjects with primary hypertension and a reference group of healthy subjects matched by age, sex and body mass index were evaluated; patients with any other causes of peripheral insulin resistance and hyperlipidaemia were excluded. The effect of valsartan on insulin resistance, assessed by homeostasis model assessment (HOMA-IR), fasting serum insulin levels, determined by radioimmunoassay, and fasting blood glucose concentrations, measured by the glucose oxidase method, were evaluated. All obtained data were evaluated by Pearson correlation analysis. Before valsartan treatment, the fasting serum insulin levels were significiantly elevated in the 20 hypertensive patients with primary hypertension compared with the 20 subjects in the reference group (19.6 ± 7.1 versus 8.7 ± 1.9 μIU/ml). The fasting serum insulin levels correlated with HOMA-IR. Correlation analysis also showed a significant relationship between HOMA-IR and both systolic and diastolic blood pressures (r = 0.71 and r = 0.77, respectively). In our study, we showed that patients with primary hypertension have a decreased insulin sensitivity that was reflected in high serum fasting insulin levels. Anti-hypertensive treatment with valsartan increases insulin sensitivity.

Relationship between anaemia and cognitive functions in elderly people

BACKGROUND The primary goal of the present study was to investigate the effects of anaemia on the cognitive functions and daily living activities in elderly people. METHODS This sectional study was performed using 180 elderly people. Face-to-face interviews and questionnaires were conducted to evaluate daily activities. To evaluate cognitive functions we used the Folsteins Mini-Mental State Examination (MMSE). RESULTS The mean age of the anaemic group and the nonanaemic group were 76.0+/-11.7 and 72.5+/-15.2 years, respectively. The average haemoglobin level among the anaemic population was 10.4 g/dL compared with 13.6 g/dL among the nonanaemic population; a statistically significant difference. There was more impairment in functional status (Katz ADL) (6.8+/-4.3 vs 9.3+/-3.7) and cognition (MMSE) (17.9+/-6.4 vs 21.7+/-6.7) in anaemic than nonanaemic groups, respectively. Albumin and body mass index were lower and the percentage of two or more comorbidities was higher in anaemic group compared to the nonanaemic group, which was a statistically significant variation. The anaemic group was more dependent in terms of bathing, dressing, toileting and transferring. CONCLUSION In the elderly anaemic group, the dependency for daily activities that require physical effort was higher compared to the nonanaemic group. The MMSE score in the elderly anaemic group was lower than subjects who had normal haemoglobin levels. We conclude that anaemia may impair cognitive functions and some daily living activities in the elderly.

Mönckeberg's sclerosis: an unusual presentation--a case report.

Calcification of the media of peripheral arteries is referred to as Mönckebergs sclerosis and occurs commonly in aged individuals. However, it also occurs in younger patients with diabetes mellitus and chronic renal failure. In diabetic patients, medial calcification appears to be a strong independent predictor of cardiovascular mortality. In this report, we have presented a 20 year-old-patient with extensive peripheral artery calcification. The etiology of calcification was not identified. It has been suggested that this was an unusual form of Mönckebergs sclerosis.

Increased iron and oxidative stress are separately related to cognitive decline in elderly.

Aim:  The aim of this study is to examine the relation between body iron, oxidative stress and cognitive function in elderly.

The Relationship between Left Ventricular Mass Index and Insulin Sensitivity, Postprandial Glycaemia, and Fasting Serum Triglyceride and Adiponectin Levels in Patients with Type 2 Diabetes

The relationship between left ventricular mass index (LVMI) and insulin sensitivity, postprandial glycaemia, fasting serum triglyceride and adiponectin was investigated in 70 patients with type 2 diabetes. Serum fasting insulin, C-peptide, high-sensitivity C-reactive protein (hs-CRP), glycated haemoglobin (HbA1c), postprandial glycaemia, lipids and fasting serum adiponectin levels were measured. Ventricular hypertrophy was assessed at rest by electrocardiography and echocardiography. Insulin sensitivity was assessed using the homeostasis model assessment index (HOMA-IR). LVMI was assessed using the Devereux formula. Study patients had lower than normal HOMA-IR, and higher than normal serum fasting insulin levels and LVMI, and tended to have reduced insulin sensitivity. Pearsons correlation coefficient showed a statistically significant correlation between fasting serum adiponectin and LVMI, fasting serum insulin, HOMA-IR, HbA1c, serum postprandial glucose and hs-CRP. There were no statistically significant correlations between LVMI and serum hs-CRP or HOMA-IR. The results indicate the importance of fasting serum adiponectin in the development of cardiovascular complications, such as increased LVMI.

Serum Interleukin 2 Levels in Patients with Rheumatoid Arthritis and Correlation with Insulin Sensitivity

Interleukin 2 (IL-2), a Th1 lymphocyte-derived cytokine, is thought to play an important role in the pathogenesis of type 2 diabetes and rheumatoid arthritis (RA). The aim of our study was to evaluate changes in serum IL-2 levels and their correlation with glucose metabolism abnormalities, such as insulin resistance, in patients with RA. Thirty-six subjects with varying degrees of disease activity and 20 healthy age-, sex- and body mass index-matched control individuals were evaluated. Patients with any causes of peripheral insulin resistance were excluded. After a 12-h overnight fast, fasting insulin levels, homeostatic model assessment-insulin resistance (HOMA-IR) estimated insulin sensitivity, and serum IL-2 levels were significantly higher in all patients with RA than in the control individuals. Fasting insulin, HOMA-IR scores and IL-2 levels were correlated in the RA group. This study showed that patients with RA have altered IL-2 regulation, and that there was a significant correlation between serum IL-2 levels and insulin sensitivity.

Comparison of the effects of hypertonic saline and crystalloid infusions on haemodynamic parameters during haemorrhagic shock in dogs

Haemorrhagic shock, a leading cause of mortality, frequently accompanies cardiac interventions. The administration of small volumes of hypertonic saline solutions and crystalloid solutions may reduce the severity and duration of shock, and result in a decrease in adverse outcomes. Under general anaesthesia, hypotension was induced in 12 healthy dogs. After 30 min, dogs received either hypertonic saline solution or lactated Ringers solution for fluid resuscitation. In both groups, decreases in haemodynamic variables were observed during the shock period. Following resuscitation, increases in haemodynamic variables were observed. This increase lasted longer in dogs receiving hypertonic saline. In both groups, haematocrit and oxygen content values decreased after resuscitation and lactate levels increased. During resuscitation, lactate levels decreased. Sodium and osmolarity increased with resuscitation, then subsequently decreased. In conclusion, in a model of haemorrhagic shock, the administration of hypertonic saline solutions provides haemodynamic stability and tissue oxygenation more rapidly.