Michele C. Walsh

Initial urinary epinephrine and cortisol levels predict acute PTSD symptoms in child trauma victims

BACKGROUNDnPrevious research examining biological correlates of posttraumatic stress disorder (PTSD) in children has suggested that children with chronic PTSD have altered levels of catecholamines and cortisol compared to similarly traumatized children who do not meet diagnostic criteria. The present study extended these findings by examining whether urinary hormone levels collected soon after a trauma were related to subsequent acute PTSD symptoms in child trauma victims.nnnMETHODSnInitial 12-h urine samples were collected from 82 children aged 8-18 admitted to a Level 1 trauma center. Collection was begun immediately upon admission, and samples were assayed for levels of catecholamines and cortisol. PTSD and depressive symptomatology were assessed 6 weeks following the accident.nnnRESULTSnInitial urinary cortisol levels were significantly correlated with subsequent acute PTSD symptoms (r=0.31). After removing the variance associated with demographic variables and depressive symptoms, urinary cortisol and epinephrine levels continued to predict a significant percentage (7-10%) of the variance in 6-week PTSD symptoms. Examination of boys and girls separately suggested that significance was primarily driven by the strength of the relationships between hormone levels and acute PTSD symptoms in boys.nnnCONCLUSIONSnThe present findings suggest that high initial urinary cortisol and epinephrine levels immediately following a traumatic event may be associated with increased risk for the development of subsequent acute PTSD symptoms, especially in boys.

Blood transfusions: a hidden source of lead exposure

3 Roff SR. Underascertainment of multiple myeloma challenges robustness of third NRPB study of nuclear veterans. Published online March 7, 2003. http://bmj.com/cgi/eletters/326/7387/468/d# 30234 (accessed June 30, 2003). 4 Johnson JC, Thaul S, Page WF, Crawford H. Mortality of Veteran Participants in the CROSSROADS Nuclear Test. Washington, DC: National Academy Press, 1996. 5 Darby SC, Kendall GM, Fell TP, et al. A summary of mortality and incidence of cancer in men from the United Kingdom who participated in the United Kingdom’s atmospheric nuclear weapon tests and experimental programmes. BMJ 1988; 296: 332–38. longer incubation period, can be treated with plasma exchange or other measures. The complex logistics of distant organ procurement, large recipient pools, and surgical urgencies invite errors. The last-minute tests that protect against a mistake are the redcell and HLA crossmatching tests. Is it not time that red-cell crossmatching, which has been obligatory for blood transfusions, also be compulsory for organ transplantation? Paul I Terasaki

Recently tested strategies to reduce nosocomial infections in the neonatal intensive care unit

Recent years have witnessed a renewed interest in reducing hospital-acquired infections in critically ill patients. We review three recently tested strategies to decrease nosocomial infections specifically in the neonatal intensive care unit. These include improvement of hand hygiene, the incorporation of hand-hygiene practices into broader care bundles, and the prophylactic administration of antimicrobials, especially fluconazole, to infants at high risk prior to the onset of infection. The effectiveness of the first two interventions is well supported, particularly in older patient populations, while the effectiveness of the third is counterbalanced by the threat of the emergence of resistant-organism infections.