Neutrophil Gelatinase-Associated Lipocalin as a Diagnostic Marker for Acute Kidney Injury in Oliguric Critically Ill Patients: A Post-Hoc Analysis

__Background:__ Oliguria occurs frequently in critically ill patients, challenging clinicians to distinguish functional adaptation from serum-creatinine-defined acute kidney injury (AKIsCr). We investigated neutrophil gelatinase-associated lipocalin (NGAL)'s ability to differentiate between these 2 conditions. __Methods:__ This is a post-hoc analysis of a prospective cohort of adult critically ill patients. Patients without oliguria within the first 6 h of admission were excluded. Plasma and urinary NGAL were measured at 4 h after admission. AKIsCr was defined using the AKI network criteria with pre-admission serum creatinine or lowest serum creatinine value during the admission as the baseline value. Hazard ratios for AKIsCr occurrence within 72 h were calculated using Cox regression and adjusted for risk factors such as sepsis, pre-admission serum creatinine, and urinary output. Positive predictive values (PPV) and negative predictive values (NPV) were calculated for the optimal cutoffs for NGAL. __Results:__ Oliguria occurred in 176 patients, and 61 (35%) patients developed AKIsCr. NGAL was a predictor for AKIsCr in univariate and multivariate analysis. When NGAL was added to a multivariate model including sepsis, pre-admission serum creatinine and lowest hourly urine output, it outperformed the latter model (plasma p = 0.001; urinary p = 0.048). Cutoff values for AKIsCr were 280 ng/ml for plasma (PPV 80%; NPV 79%), and 250 ng/ml for urinary NGAL (PPV 58%; NPV 78%). __Conclusions:__ NGAL can be used to distinguish oliguria due to the functional adaptation from AKIsCr, directing resources to patients more likely to develop AKIsCr

Targeting urine output and 30-day mortality in goal-directed therapy: A systematic review with meta-analysis and meta-regression.

Background: Oliguria is associated with a decreased kidney- and organ perfusion, leading to orga

Vitamin D deficiency as a risk factor for infection, sepsis and mortality in the critically ill: systematic review and meta-analysis

INTRODUCTION: In Europe, vitamin D deficiency is highly prevalent varying between 40% and 60% in the healthy general adult population. The consequences of vitamin D deficiency for sepsis and outcome in critically ill patients remain controversial. We therefore systematically reviewed observational cohort studies on vitamin D deficiency in the intensive care unit.METHODS: Fourteen observational reports published from January 2000 to March 2014, retrieved from Pubmed and Embase, involving 9,715 critically ill patients and serum 25-hydroxyvitamin D3 (25 (OH)-D) concentrations, were meta-analysed.RESULTS: Levels of 25 (OH)-D less than 50 nmol/L were associated with increased rates of infection (risk ratio (RR) 1.49, 95% (confidence interval (CI) 1.12 to 1.99), P = 0.007), sepsis (RR 1.46, 95% (CI 1.27 to 1.68), P <0.001), 30-day mortality (RR 1.42, 95% (CI 1.00 to 2.02), P = 0.05), and in-hospital mortality (RR 1.79, 95% (CI 1.49 to 2.16), P <0.001). In a subgroup analysis of adjusted data including vitamin D deficiency as a risk factor for 30-day mortality the pooled RR was 1.76 (95% CI 1.37 to 2.26, P <0.001).CONCLUSIONS: This meta-analysis suggests that vitamin D deficiency increases susceptibility for severe infections and mortality of the critically ill

Residential mobility and associated factors as predictors of psychological well-being among Somali refugees in London

PhDBackground: Previous research has consistently documented that residential mobility creates stress, of various degrees, on the individuals involved. However, when the process of mobility compounds other stressful postmigration events such as poor housing, lack of relocation choice, deprivation and disruption to the social support networks, it may have more devastating health impact on vulnerable groups. Objective: To explore the relationship between residential mobility and mental health of Somali refugees and whether mobility across primary care trust (PCT) boundaries, choice over move and distances moved are associated with higher risk of mental disorder. Methods: Of the 150 individuals planned, 143 (95.3%) were successfully interviewed. 100 subjects were recruited from qualitatively mapped non-health community venues and 43 from General Practitioners’ (GP) registers in two boroughs of London. The present study assessed the mental status of the study participants using culturally adopted Mini Neuro-psychiatric Interview (MINI). Modified Accommodation Record Questionnaire collected information on their residential movements and choice of relocation in the preceding five and half years. Results: Overall, 108 (75.5%) of the participants made one or more moves in the last 5.5 years. Of these, 60 (55.6%) were females and 48 (44.4%) males; (χ2 = 4.8, df =1, p<0.03). The majority of the movers 71 (65.7%) were recruited from non-health community venues while the remaining 37 (34.3%) were recruited from the General Practice (GP) registers; χ2 = 3.7, df =1, p<0.05. In logistic regression analysis, when fully adjusted for age, gender, marital status, social network beyond household, insult because of race or religion, immigration status, tenure current and period of stay in the UK; risk of mental disorder was associated with residential mobility (Odds Ratio [OR], 3.8; 95% 5 CI: 1.2 – 9.9, P < 0.02), Crossing Primary Care Trust Boundaries (OR, 4.0; 95%CI = 1.4 – 11.5; p = 0.005), lack of choice over move (OR, 4.3; 95% CI = 1.5 – 12.4; p = 0.008), most recent move (5.1; 95%CI = 1.6 – 16.1; p = 0.005) and moving longer distances than 10.2km (OR, 4.6; 95% CI = 1.4 – 15; p = 0.01). Men who were cases were more likely to change address (OR, 4.9; 95%CI: 1.3 – 19; p < 0.02) than women (OR, 2.0; 95%CI: 0.5 - 11.1; p < 0.2) even after adjusting for all possible confounding variables. Conclusion: In addition to documented post-migration difficulties, residential mobility, lack of choice in the process of moving and longer distances moved were all associated with mental disorders in Somali refugees and asylum seekers living in London. Involving clients in the decision making during the relocation process and also taking into account the practical social support network may lessen the burden of mental disorders of the study population

High Early Fluid Input After Aneurysmal Subarachnoid Hemorrhage: Combined Report of Association With Delayed Cerebral Ischemia and Feasibility of Cardiac Output–Guided Fluid Restriction

Background: Guidelines on the management of aneurysmal subarachnoid hemorrhage (aSAH) recommend euvolemia, whereas hypervolemia may cause harm. We investigated whether high early fluid input is associated with delayed cerebral ischemia (DCI), and if fluid input can be safely decreased using transpulmonary thermodilution (TPT). Methods: We retrospectively included aSAH patients treated at an academic intensive care unit (2007-2011; cohort 1) or managed with TPT (2011-2013; cohort 2). Local guidelines recommended fluid input of 3 L daily. More fluids were administered when daily fluid balance fell below +500 mL. In cohort 2, fluid input in high-risk patients was guided by cardiac output measured by TPT per a strict protocol. Associations of fluid input and balance with DCI were analyzed with multivariable logistic regression (cohort 1), and changes in hemodynamic indices after institution of TPT assessed with linear mixed models (cohort 2). Results: Cumulative fluid input 0 to 72 hours after admission was associated with DCI in cohort 1 (n=223; odds ratio [OR] 1.19/L; 95% confidence interval 1.07-1.32), whereas cumulative fluid balance was not. In cohort 2 (23 patients), using TPT fluid input could be decreased from 6.0 ± 1.0 L before to 3.4 ± 0.3 L; P =.012), while preload parameters and consciousness remained stable. Conclusion: High early fluid input was associated with DCI. Invasive hemodynamic monitoring was feasible to reduce fluid input while maintaining preload. These results indicate that fluid loading beyond a normal preload occurs, may increase DCI risk, and can be minimized with TPT

Seroprevalence of bovine brucellosis in agro pastoral areas of Jijjiga zone of Somali National Regional State, Eastern Ethiopia

A cross-sectional study was carried out from October 2008- March 2009 to determine the sero-prevalence of bovine brucellosis in four districts of Jijjiga Zone, eastern Ethiopia. Purposive sampling technique was employed to select the four districts and nine peasant associations (PAs). A total of 435 blood samples were collected from cattle of 6 or more months of age with no history of previous vaccination against brucellosis. All serum samples were initially screened by Rose-Bengal- Plate Test (RBPT) and those positive reactors to RBPT (n=8) were further tested by complement fixation test (CFT) for confirmation. Out of the 8 RBPT positive sera 6 were found to be positive to CFT. Accordingly, the overall seroprevalence of bovine brucellosis in Jijjiga Zone was 1.38% (6/435). The seroprevalence of bovine brucellosis in the four districts namely Awbare, Harshi, Kebribayah and Fafan districtes were 0.78%, 2.91%, 2.06% and 0%, respectively. Statistically there is no significant deference among the four districts (÷2 = 3.37, df = 3, P = 0.268). The study also revealed absence of significant statistical variation in the seroprevalence of brucellosis in different age and sex groups of the study animals (P > 0.05). Result of this study showed that the seroprevalence of bovine brucellosis in the study area is low. However, it is highly likely that the disease spreads in unaffected animals and herds given the extensive production system prevailing in the area which may allow contact of animals during grazing and at watering points. The public in general and high risk group in particular should be made aware of the zoonotic importance of bovine brucellosis

Urine Output Based Fluid Management in the Critically Ill: assessing hypovolemia and preventing hypervolemia

Intravenous fluids have become commonplace in medical care, and are used to hydrate patients who are either not allowed or temporarily unable to eat, restore or maintain intravascular volume, or as a dilutive agent for intravenous medication. In the critically ill, there appears to be a mismatch between intravenous fluid administration and fluid loss via urine output, which leads to fluid overload and related adverse events. The main aim of this thesis is to investigate whether additional fluid administration aimed at improving urine output has the desired effect, whether this effect can be predicted, and whether this effect impacts patients’ outcome

Early versus Later Rhythm Analysis in Patients with Out-of-Hospital Cardiac Arrest

Background In a departure from the previous strategy of immediate defibrillation, the 2005 resuscitation guidelines from the American Heart Association–International Liaison Committee on Resuscitation suggested that emergency medical service (EMS) personnel could provide 2 minutes of cardiopulmonary resuscitation (CPR) before the first analysis of cardiac rhythm. We compared the strategy of a brief period of CPR with early analysis of rhythm with the strategy of a longer period of CPR with delayed analysis of rhythm. Methods We conducted a cluster-randomized trial involving adults with out-of-hospital cardiac arrest at 10 Resuscitation Outcomes Consortium sites in the United States and Canada. Patients in the early-analysis group were assigned to receive 30 to 60 seconds of EMS-administered CPR and those in the later-analysis group were assigned to receive 180 seconds of CPR, before the initial electrocardiographic analysis. The primary outcome was survival to hospital discharge with satisfactory functional status (a modified Rankin scale score of ≤3, on a scale of 0 to 6, with higher scores indicating greater disability). Results We included 9933 patients, of whom 5290 were assigned to early analysis of cardiac rhythm and 4643 to later analysis. A total of 273 patients (5.9%) in the later-analysis group and 310 patients (5.9%) in the early-analysis group met the criteria for the primary outcome, with a cluster-adjusted difference of −0.2 percentage points (95% confidence interval, −1.1 to 0.7; P=0.59). Analyses of the data with adjustment for confounding factors, as well as subgroup analyses, also showed no survival benefit for either study group. Conclusions Among patients who had an out-of-hospital cardiac arrest, we found no difference in the outcomes with a brief period, as compared with a longer period, of EMS-administered CPR before the first analysis of cardiac rhythm. (Funded by the National Heart, Lung, and Blood Institute and others; ROC PRIMED ClinicalTrials.gov number, NCT00394706.

Sick building syndrome and its associated factors among adult people living in Hodan district Moqadishu Somalia

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