Gilbert Berdine

The association between glucose levels and hospital outcomes in patients with acute exacerbations of chronic obstructive pulmonary disease

BACKGROUND: Corticosteroids used for chronic obstructive pulmonary disease (COPD) exacerbations can cause hyperglycemia in hospitalized patients, and hyperglycemia may be associated with increased mortality, length of stay (LOS), and re-admissions in these patients. MATERIALS AND METHODS: We did three retrospective studies using charts from July 2008 through June 2009, January 2006 through December 2010, and October 2010 through March 2011. We collected demographic and clinical information, laboratory results, radiographic results, and information on LOS, mortality, and re-admission. RESULTS: Glucose levels did not predict outcomes in any of the studied cohorts, after adjustment for covariates in multivariable analysis. The first database included 30 patients admitted to non-intensive care unit (ICU) hospital beds. Six of 20 non-diabetic patients had peak glucoses above 200 mg/dl. Nine of the ten diabetic patients had peak glucoses above 200 mg/dl. The maximum daily corticosteroid dose had no apparent effect on the glucose levels. The second database included 217 patients admitted to ICUs. The initial blood glucose was higher in patients who died than those who survived using bivariate analysis (P = 0.015; odds ratio, OR, 1.01) but not in multivariable analysis. Multivariable logistic regression analysis also demonstrated that glucose levels did not affect LOS. The third database analyzing COPD re-admission rates included 81 patients; the peak glucose levels were not associated with re-admission. CONCLUSIONS: Our data demonstrate that COPD patients treated with corticosteroids developed significant hyperglycemia, but the increase in blood glucose levels did not correlate with the maximum dose of corticosteroids. Blood glucose levels were not associated with mortality, LOS, or re-admission rates.

Is the sinonasal questionnaire a useful screening instrument for chronic sinonasal diseases in pulmonary clinics

Dixon and coworkers (Dixon AE, Sugar EA, Zinreich SJ, et al. Criteria to screen for chronic sinonasal disease. Chest 2009; 136: 1324–1332.) recently developed a five-item questionnaire for diagnosing chronic sinonasal disease in patients with asthma. Our study was designed to determine how frequently patients attending pulmonary clinics have chronic sinonasal disease and the relationship between questionnaire results and a history of sinus disease and current treatment for sinus disease. The participants were patients in pulmonary clinics at Texas Tech University Health Science Center, who answered the sinonasal questionnaire (SNQ). Additional information included a history of sinus disease or sinus/nasal surgery, smoking status, and current relevant medications. The participants included 28 men and 51 women. Patient ages ranged from 38 to 94 years (mean 62.2 years). Of all the patients, 28 patients (35.4%) had prior sinus disease, 10 (12.7%) had history of sinus or nasal surgery, 24 (30.4%) had history of asthma, and 10 (12.7%) were current smokers. Of them, 14 patients (17.7%) used nasal steroids, 12 (15.2%) used antihistamines, four (5.1%) used decongestants, nine (11.4%) used leukotriene inhibitors, 13 (16.5%) used oral corticosteroids, and two (2.5%) used combinations. The SNQ identified 39 patients (49.4%) as having chronic sinonasal diseases. Therefore, 14% of the participants had sinonasal symptoms but no prior diagnosis of sinus disease. Patients with prior sinus disease and nasal steroid use were more likely to have positive questionnaire result (p < 0.001 and p < 0.032, respectively). The SNQ can identify patients with chronic sinonasal disease in pulmonary clinics. However, the significance of sinonasal disease and its treatment in these patients needs more study.

FloTrac® Monitoring System: What Are Its Uses in Critically III Medical Patients?

Abstract:The FloTrac®/Vigileo device uses arterial pressure waveform analysis to calculate stroke volume and cardiac output; it does not require calibration against an independent measurement of cardiac output. Consequently, it provides a method to determine hemodynamic status, changes in the clinical course and responses to therapeutic interventions in patients who have arterial catheters in place. These devices perform relatively well in stable patients undergoing surgery and having an acceptable percentage error in differences between the FloTrac® device and invasive monitoring using pulmonary catheters. However, in patients with septic shock and other clinical states associated with low systemic vascular resistances, such as cirrhosis, the FloTrac® does not provided acceptable correlation with independent measurements with pulmonary artery catheters. FloTrac® measurements often underestimate the cardiac output and have unacceptably high percent error, which ranges from 30% to 60%. There is a moderate correlation with changes in cardiac output after fluid administration, but a poor correlation with changes in cardiac output after increases or decreases in norepinephrine administration. The bias between measurements increases as the systemic vascular resistance decreases. Consequently, cardiac output measurements using the FloTrac® device are not accurate enough for use in patients with septic shock, advanced liver disease and other medical conditions associated with decreased vascular tone.

The Dust Bowl: Combining art, literature and science

Corresponding author: Gilbert Berdine Contact Information: Gilbert.berdine@ttuhsc.edu. DOI: 10.12746/swrccc.v6i22.441 must not repeat the same mistakes, no matter how much we are tempted to do so. The primary cause of the dust bowl was over farming. Why did the farmers systematically make the mistake of over farming? Governments caused natural shortages through the deprivations during World War I. The U.S. government guaranteed the high prices as an incentive for farmers to cultivate more land. Cultivate they did, increasing the number of acres for wheat production by 70% from 1917–1919. The recently formed Federal Reserve compounded the problem by making credit artificially cheap, encouraging farmers to expand their farms and to buy new equipment thinking the high prices would be forever. The crash in crop prices caused by the glut produced under the price guarantees would have bankrupted the farmers even without the problems of the Dust Bowl. The dust storms resulting from plowing land that should have been left as grass prairie compounded the misery. Financial bust always follows the credit induced booms.

The undead in culture and science

ABSTRACT The undead have a significant role in mythology, religion, folklore, and literature. In the 1800s, the word zombie was used to describe reanimated corpses in the Caribbean who often worked on plantations doing long, arduous field work. The movie White Zombie was released in 1932 and exploited this folklore, but it ignored the fact that zombies represent one outcome in Vodou religious beliefs regarding death and the migration of spirits following death. The interest in zombies eventually led to sociological and medical investigations into zombification. Wade Davis reported that powders used by malevolent priests (bokors) contained tetrodotoxin, which could cause the neurologic changes underlying the zombie phenotype. Recent clinical studies have indicated that synthetic cannabinoids and synthetic cathinones can cause bizarre zombie-like behavior. According to Haitian folklore, zombies can develop when bokors reanimate someone who suddenly died from an acute illness or who was purposely poisoned. Recent studies in molecular biology suggest that the sequence of programmed cell death can be reversed when the stressor is removed and that cells, tissues, and bodies (at least in Drosophila flies) can recover. These scientific studies would support the remote possibility that the near dead might recover under certain circumstances but have residual neuropsychological dysfunction. Alternatively, the bokors could maintain control of their victims using drugs with properties similar to those of synthetic cannabinoids. The concept of zombification needs to be considered in the context of culture, religion, and science.

Pulmonary artery aneurysm secondary to congenital pulmonic valve stenosis

Pulmonary artery (PA) aneurysms are uncommon and often diagnosed post-mortem. They are characterized by a PA/aorta diameter ratio greater than 2 on transthoracic echocardiography or a pulmonary artery diameter greater than 4 or 5 cm on computed tomography. The most common conditions associated with pulmonary artery aneurysm are congenital heart defects with left-to-right shunts and pulmonic valve abnormalities. There are also numerous causes of acquired pulmonary artery aneurysms, including infection, vasculitis, pulmonary arterial hypertension, trauma, neoplasm and pulmonary embolism. Symptoms of PA aneurysm are usually non-specific, and physical examination findings are variable depending on the underlying cause. Work-up includes various imaging modalities, transthoracic echocardiography, and right heart catheterization. The gold standard treatment is surgery, but in select patients, conservative management with close monitoring can be pursued.

The receiver operating characteristic (ROC) curve

Corresponding author: Shengping Yang Contact Information: Shengping.yang@ttuhsc.edu DOI: 10.12746/swrccc.v5i19.391 Results from routine blood tests can be used potentially as biomarkers for identifying disease. An example would be using the hemoglobin concentration to identify patients with iron deficiency anemia. We want a binary (Yes/No) answer, but the values of these predictive tests are continuous; I am wondering how to use them to facilitate a diagnosis.

The Paradox of Good Health and Poverty: Assessing Cuban Health Outcomes under Castro

In spite of being poor and lacking in economic opportunities, the population of Cuba enjoyed significant improvements in health outcomes under the Castro regime. Many have praised the ability of the regime to overcome the barriers of poverty and economic stagnation in order to improve health outcomes. Many have also argued that efficient features of Cuba’s health policy should be imported regardless of political considerations. In this paper, we argue that these improvements are probably overestimated, but that they are real nonetheless. We also argue that some of these improvements were an integral part of health policy and could only have been realized by the use of extremely coercive institutions. While efficient at fighting certain types of diseases, coercive institutions are generally unable to generate economic growth. On the other hand, the poverty such coercive institutions engender may have actually helped improve health outcomes, providing us with a false impression of the efficacy of the health care system in Cuba.