Fi Rst Week Research Articles

DYNAMICS OF BONE MINERAL COMPOSITION OF RABBIT LOWER JAW AFTER BONE-DESTRUCTIVE TRAUMA

The properties of bone tissue, in particular its strength and hardness, depend on the mineral component of the bone. The aim of our work was to study the content of four mineral macronutrients – calcium, phosphorus, magnesium and sodium in the bone tissue of the rabbit lower jaw and to analyze the posttraumatic dynamics. Research was done on 20 adult 6-7-month-old rabbits, having 2.5-3.0 kg weight, which were segregated into experimental (15 animals) and control (5 animals) groups. Animals of the experimental group under combined anesthesia were subjected to bilateral bone-destructive trauma with a dental drill, that disrupted the integrity of the bone tissue of the alveolar part of the lower jaw. 1, 2, and 3 weeks after the injury the animals were taken out of the experiment, and were subjected to lower jaw disarticulation. To determine the mineral composition of the bone tissue, we used the method of atomic absorption spectral analysis. The content of four mineral elements (Ca, P, Mg, Na) was determined. It was found that calcium content more than doubled by the end of the fi rst week after injury, slightly decreased by the end of the second week, and slightly increased again during the third week. Bone phosphorus content increases by the end of the fi rst week after injury, and decreases during the next two weeks. The amount of sodium decreases slightly at the end of the fi rst week after injury, but increases during the next two weeks and exceeds the norm at the end of the third week. The amount of magnesium in the bone tissue decreases during the two weeks after injury, and increases by the end of the third week, almost returning to normal levels. The results of the study allowed us to conclude that within three weeks after surgical bone-destructive trauma, the studied macronutrients in bone tissue have a pronounced dynamic, diff erent and specifi c for each element.

PATHOMORPHOLOGICAL CHANGES IN THE RETINAL LAYERS AT THE END OF THE SEVENTH DAY OF EXPERIMENTAL OPIOID EXPOSURE

The aim of the work was to clarify the fundamental issues regarding the dynamics of early changes in the retinal layers under experimental exposure of opioids. Research was done on 15 adult 4-months-old mature male mongrel rats, having 100.0-160.0 g weight. Opioid eff ects were modelled by daily intramuscular injections of nalbuphine 1 time per day in one period of time (10-11 am) for 7 days. The initial dose of nalbuphine was 0.212 mg ̸kg. Histological slides were prepared according to generally accepted methods using the dyes, as hematoxylin, eosin and azan according to the Heidenhain method.All animals were kept in the vivarium and the work was carried out according to the European Convention for t he Protection of Vertebrate Animals used for experimental and other scientifi c purposes [Strasbourg, 1985]. During the experimental opioid administration after one week of research the changes in the structure of the retinal layers were established. In the early stages of low-dose opioid analgesia administration, the fi rst pathomorphological changes were de tected during the fi rst week, in the form of initial manifestations of vacuole dystrophy of the pigmental epithelium, signs of microcystic degeneration of the outer retinal and neurofi brous layers with the vacuole dystrophy of retinal ganglion cells appearance.

Hemocytopoiesis and microelements metabolism’s indices in calves under the infl uence of national vitamin-amino-acid complex

In Ukrainian veterinary medicine the study of the eff ectiveness of new complex drugs remains relevant. The eff ect of the vitamin-mineral complex "Alphabet for Animals" on the state of hemocytopoiesis and the microelements metabolism in calves of 1.5‒2.5 months of age were studied. The composition of this drug includes the biologically active substances: vitamins A, D3, E, B1, B3, B5, B6, B12, K3 and essential amino-acids: DL-methionine, L-lysine and arginine. It is used in farm animals and poultry for the normalization of hemocytopoiesis, the prevention and treatment of vitamins and trace elements metabolism’s disorders. In the fi rst week of drug administration, the number of erythrocytes in the experimental animals group has increased signifi cantly (p<0.05) and after its second feeding, the positive eff ect on erythrocytopoiesis in calves has became even greater (p<0.001), compared to the calves in control group. The level of hemoglobin in calves of experimental group also increased signifi cantly from the beginning of the drug to the end of the experiment, whereas in calves of the control group there was a tendency to decrease its level throughout the all experiment. The color index and erythrocyte saturation by hemoglobin (MCH) at the fi rst and second blood samples were signifi cantly decreased (p<0.05) in control calves group, whereas in animals of experimental group there was no signifi cant diff erence between these parameters (p<0.1). The average volume of red blood cells did not diff er between control and test calves during the experiment (p<0.1). Under the drugs infl uence the Ferum blood content in calves of experimental group increased by 24.2 %. In the control calves group, this tendency was not so noticeable (the increase of Ferum serum level at the end of experiment was only +7.8 % (p<0.1), compared to the initial indices). The Zinc metabolism, on the contrary, has not undergone signifi cant changes. The Cuprum serum level in experimental calves group remained always signifi cantly higher than in control animals group. “Alphabet for Animals” has a positive eff ect on hemocytopoiesis in calves due to its complex composition (fat-soluble and water-soluble vitamins, aminoacids) and improves the metabolism of microelements, including Ferum and Cuprum. The infl uence on these processes the vitamins of B group, which are a part of this drug, we consider especially valuable in the conditions of the unformed rumen digestion in young cattle. Key words: vitamin-amino acid complex, erythrocytopoiesis, hypochromia, microcytosis, hemoglobin, color index, hematocrit.

Postoperative Atrial Fibrillation and its association with the Atrial Substrate and the electrophysiological properties of the Atrial Myocardium

Postoperative atrial fi brillation (AF) has a high prevalence, affecting up to 45% of coronary artery bypass graft surgery patients within the fi rst week of the operation [1-4]. Interestingly, asymptomatic AF was reported more likely to occur after the fi rst 4 days following the cardiac surgery.

Impact of Calorie Intakes on the Risk of Bronchopulmonary Dysplasia in Extremely Preterm Infants

Aim: To examine whether caloric intake during the fi rst week of age infl uences the risk of Bronchopulmonary Dysplasia (BPD) in extremely preterm infants.

Comparison of Different Doses of Escitalopram in the Prophylaxis of Dementia in Patients with Depression and Moderate Cognitive Dysfunction in Chronic Cerebral Ischemia

Objective – to compare different doses of escitalopram (Cipralex) in the prophylaxis of dementia in patients with depression and moderate cognitive dysfunction on the background of chronic cerebral ischemia. Materials and methods. Two groups of patients, aged 65–78 years, with chronic cerebral ischemia and mild-moderate depression and moderate cognitive dysfunction were studied and treated with different doses of escitalopram: 30 patients received escitalopram at a dose of 5 mg/day throughout the treatment period; 42 patients received escitalopram at a dose of 5 mg/day for the fi rst week and then 10 mg/day. Treatment duration was six months and the observation period was eight months. Results and conclusions. Escitalopram was shown to be effective not only in the treatment of depression-associated cognitive dysfunction in patients with chronic cerebral ischemia but also in decreasing the risk of dementia in the long term. The effectiveness of the prophylaxis of dementia was found to depend on the escitalopram dose used.

Nutritional support for critically ill children: A Cochrane review summary

Background: The need for nutritional support for critically ill children is a contentious issue that has not been well investigated (Joffe et al., 2016 ). When children are critically ill, the suggestion that their metabolic rate increases is questioned; there is evidence during the fi rst week of illness that metabolism is more likely at, or even below, the child ’ s predicted basal metabolic rate (Framson et al., 2007 ). The provision of nutritional support during illness is considered a priority by both parents and health professionals. However, there may be reasons to warrant reducing caloric intake during a critical illness. Animal studies have demonstrated improved survival from critical illness is associated with reduced caloric intake. (Alexander et al., 1989 ) In adult studies, high caloric intake is associated with delay in weaning from ventilators( Singer et al., 2011 ), and underfeeding during critical illness associated with improved mortality and reducing length of hospital stay. (Boitano, 2006 )

Characteristics of Infectious Diseases in Hospitalized Patients During the Early Phase After the 2011 Great East Japan Earthquake: Pneumonia as a Significant Reason for Hospital Care

Natural catastrophes increase infectious disease morbidity rates. On March 11, 2011, a 9.0-magnitude earthquake and associated Pacific coast tsunami struck East Japan. The aim of this study was to investigate the characteristics of patients with infectious diseases who needed hospitalization after this disaster. We searched the medical records of 1,577 patients admitted to Tohoku University Hospital in the Sendai area within 1 month (March 11, 2011-April 11, 2011) after the disaster. We examined (1) changes in the rates of hospitalizations for infectious diseases over time and (2) the variety of infectious diseases. The number of hospitalized patients with infectious diseases increased after the fi rst week to double that during the same period in 2010. Pneumonia comprised 43% of cases, and 12% consisted of skin and subcutaneous tissue infection, including tetanus. Pneumonia was prevalent in elderly patients (median age, 78 years) with low levels of serum albumin and comorbid conditions, including brain and nervous system disorders. Sputum cultures contained Streptococcus pneumoniae, Moraxella catarrhalis, and Haemophilus influenzae , known pathogens of community-acquired pneumonia in Japan. In addition, 20.5% of patients had positive results for urinary pneumococcal antigen. Among hospitalized patients, infectious diseases were significantly increased after the disaster compared with the same period in 2010, with pneumonia being prominent. The analyses suggest that taking appropriate measures for infectious diseases, including pneumonia, may be useful for disaster preparedness and medical response in the future.

Hospital Faces Uncertainty as It Copes With Surge of Patients With Fungal Meningitis

IN THE FIRST WEEK AFTER NEWS BROKE in early October that contaminated steroid injections from a New England compounding pharmacy were the likely cause of a multistate outbreak of fungal meningitis, dozens of patients who had been exposed to potentially contaminated injections at a private pain management practice began presenting each day in the emergency department of a nearby hospital, St Joseph Mercy Ann Arbor Hospital in Ypsilanti, Mich. “In that first week, there was a day our emergency department did more than 60 spinal taps,” said Anurag Malani, MD, an infectious disease specialist at the hospital. “We had this massive influx of [exposed] patients, probably a couple hundred that first week.” Before the initial reports of the outbreak, however, the hospital had already seen 6 cases of patients with fungal meningitis, although clinicians weren’t quite sure of the cause of this cluster, explained Malani. Although this first group of patients presented with meningitis symptoms such as headache, photophobia, and neck stiffness, the symptoms were less severe than typically seen in patients with bacterial meningitis, and tests for bacterial meningitis came back negative. But patients would return to the emergency department with persistent symptoms. “We started to have an inkling something wasn’t right,” Malani said. “The US Centers for Disease Control and Prevention [CDC] notice really put things together.” The notice (http://tinyurl.com/cnvm83q) alerted physicians to the outbreak and the ongoing investigation. By early December 2012, more than 590 cases had been reported to the CDC; 152 of these patients were treated at the 537-bed hospital in Ypsilanti. Of those 152 patients, 63 remained hospitalized at press time, and 7 had died. For clinicians and the hospital administrators at St Joseph Mercy, the outbreak has created unprecedented challenges. In addition to dealing with a huge influx of patients and developing treatment protocols for an extremely rare condition, they have been preparing for what is likely to be at least several more months of care for many of the patients.

Effect of Routine Lactobacillus reuteri DSM 17938 use on Rates of Late-onset infection in Extremely-low-birth-weight Infants

Background: Preterm infants are at high risk for late-onset infections due to gram-negative or fungal organisms. Evidence supports that a common source for these organisms may be the gastrointestinal tract. One theoretical way to change the infection rate is to alter the bacterial flora inhabiting the newborn gastrointestinal tract using probiotics. This study examines the impact of routine use of a probiotic, Lactobacillus reuteri DSM 17938 (BioGaia®), on the rate of late-onset gram-negative and fungal infection in neonates with birth weight ≤ 1000 grams. Methods: This is a retrospective cohort study comparing the rates of gram-negative bacterial and fungal infections in neonates with birth weight ≤ 1000 grams. The groups are separated into those neonates born from January 2004 to June 30, 2009, before introduction of L. reuteri, and neonates born July 2009 through July 2012 who received routine L. reuteri prophylaxis. Neonates were excluded if they died or were transferred within the fi rst week of life. The remainder were included in the study and recorded as either having late onset infection related to gram negative organisms or fungi, or not having late onset infection. Since no major changes occurred in our NICU practice in recent years, and the introduction of L. reuteri as routine prophylaxis was abrupt, we attributed the post-probiotic changes to the introduction of this new therapy. Rates of infection were compared using Chi square analysis with Fisher exact t-test. Results: Medical records for 354 neonates were reviewed, 232 before- and 122 after-introduction of L. reuteri prophylaxis. Despite a marked reduction in necrotizing enterocolitis and mortality, the incidence of late-onset infection varied from year-to-year, but was not signifi cantly altered by the introduction of routine L. reuteri. No adverse events related to use of L. reuteri were noted. Conclusions: Prophylactic initiation of L. reuteri as a probiotic does not decrease late-onset infection.

Comparison of RIFLE with and without urine output criteria for acute kidney injury in critically ill patients: a task still not concluded!

In a recent issue of Critical Care, we read with interest the article by Wlodzimirow and colleagues [1], who prospectively studied the Risk Injury Failure Loss Endstage renal disease (RIFLE) [2] classifi cation with serum creatinine (SCr) and urine output (UO) (RIFLE SCr+UO ) and without UO criteria (RIFLE SCr ) for acute kidney injury (AKI) in 260 critically ill patients. RIFLE SCr signifi cantly underestimated the presence of AKI on admission and during the fi rst week in the intensive care unit and signifi cantly delayed AKI diagnosis. Th ose are important fi ndings that corroborate the utility of simultaneously using both criteria as proposed by the Acute Dialysis Quality Initiative workgroup [2]. Th e authors also found that RIFLE SCr was associated with higher mortality than RIFLE SCr+UO . Th is observation should be interpreted with extreme caution, as this association has not been tested by multivariate analysis. Data regarding the impact on mortality of RIFLE defi ned by SCr and UO or by SCr are not conclusive. For example, in a systematic review, the relative risk for death among studies that used RIFLE SCr+UO was lower than in those using RIFLE SCr [3]. Previously, however, we did not fi nd any diff erence in terms of mortality for RIFLE SCr+UO (Risk, odds ratio (OR) 2.69; Injury, OR 2.01; Failure, OR 3.59; AKI of any category, 2.78; area under the receiver operator characteristic (AUROC), 0.733) or for RIFLE SCr (Risk, OR 2.63; Injury, OR 2.12; Failure, OR 3.2; AKI of any category, 2.68; AUROC, 0.729) [4]. Th erefore, prospective studies with a large number of patients are still needed to better determine the impact on mortality of RIFLE defi ned by SCr+UO criteria or by SCr criteria.

ACUTE BILIRUBIN ENCEPHALOPATHY IN HEALTHY TERM NEONATES REQUIRING EXCHANGE TRANSFUSION

During the 2- year period, 140 term newborn infants underwent ET; 7 of these patients were excluded; 133 patients were followed and 69 patients were selected without BIND, and 64 were assigned to the group with BIND. This study showed that 48% of jaundiced newborn infants who underwent exchange transfusion, manifested bilirubin induced neurological dysfunction. Unsuccessful breast feeding was found to be a statistically signifi cant risk factor for BIND(p:0.001), sex, route of delivery, family history of jaundice, mean maternal age, number of gravity, parity, abortion, and babies mean admission age ,mean age at jaundice presentation, amount of weight loss, mean total serum bilirubin level were not found to signifi cantly infl uence BIND. Conclusion Of the healthy term neonates who developed jaundice within the fi rst week of life, 48% without hemolysis who underwent exchange transfusion demonstrated BIND. It is still not clear whether acute bilirubin encephalopathy affects neurodevelopmental outcome or not. Unsuccessful breast feeding was found to be a statistically signifi cant risk factor.

Verbal autopsy to ascertain causes of neonatal deaths in a community setting: A study from Morang, Nepal

Clinical registration of the cause of death is available for less than one-third of the global newborn deaths, but the need for good quality data on causes of death for public health planning has renewed the interest in the Verbal Autopsy (VA). We aimed to determine the cause of neonatal deaths by VA in Morang district of Nepal. Caretakers of the deceased were interviewed using a semi-structured VA questionnaire by female community health volunteers. The cause of death was assigned by two senior pediatricians independently and disagreements in ascertaining the proximate cause of death were resolved by consensus. The proximate causes of deaths were infections (41%), birth asphyxia (37.2%), prematurity (11.5%), and low birth weight related causes (6.9%). There was no significant statistical difference in deaths due to infection seen in non-institutional deliveries (43.5%) than institutional deliveries (34.6%). More than half of the deaths (58.5%) occurred within the first three days of life where the predominant cause of death was birth asphyxia (60.7%). Analysis of verbal autopsies demonstrates that the major causes of death still are infections and birth asphyxia. The timing of deaths suggests that neonatal interventions should be aimed at the first week of life. There is no comparative advantage between institutional deliveries at below district level institutions and non-institutional deliveries to prevent neonatal infection. Thus, further study on the quality of care at institutes below the district level should be conducted. Disparities still occur in deaths, with most deaths in Morang occurring in non-institutional deliveries and in disadvantaged groups.

Child safety: a neglected priority

During the fi rst week of 2009 a number of children were treated in the Trauma Unit at the Red Cross War Memorial Children's Hospital in Cape Town. A 2-year-old girl visiting from the province fell in front of a bus while her mother was being robbed of a cell phone in one of the suburbs. The bus could not avoid the little girl, crushed her and killed her. A 6-yearold girl travelling back from the city to her home with her family was severely injured when someone threw a brick at the front windscreen of the car, breaking it and instantly killing the driver, after which the car left the road and all the passengers were seriously injured. Three children were electrocuted when their homes, which were disconnected by the municipality because of nonpayment, and were illegally rewired, leaving live wires exposed and killing the children. Another 6-year-old girl was hit by a stray bullet in a gang fight. Although all these deaths are quite different in nature, a similar pattern is recognizable. Adults, in active chase for their own gratifi cation are injuring children lethally in the process. It is unlikely that in any of these cases the children were directly targeted, however, they died while adults were pursuing their own criminal interests. A study performed a few years ago at the Red Cross Children's Hospital indicated that of all children presenting with head injuries after abuse, almost 50% of them were injured when adults were fi ghting with each other.

Research News: Pre-Operative Patient Scrub

DURING THE FIRST WEEK OF 2010, USA Today (January 7, 2010, p. 6D) highlighted a study of the effects of preoperative patient scrubs on surgical site infection.1 A picture of President Obama greeting folks was immediately beneath the brief article. In many ways, the political energy on health care reform is shedding light on medical and nursing research that may have been ignored otherwise. That is one thing that we can celebrate! This particular study has relevance for surgical patients in general and perianesthesia nurses in particular.

A souvenir from the Canary Islands

In April, 2004, a previously fi t 67-year-old retired surgeon was referred to our clinic with fever and malaise. Between January and March, 2004, he had holidayed in the Canary Islands. His diet had included cheese, fresh vegetables, salads, fi sh, and wine. At the end of his vacation he experienced lumbosacral pain, which was treated by acupuncture when he returned to Germany. On the last day of treatment he developed fever of 40°C, associated with mild nausea, headache, and myalgia. His general practitioner noted fever, absence of leucocytosis, and a high concentration of C-reactive protein (CRP) of 74 mg/L (normal <5 mg/L). He was treated with roxithromycin for 9 days. Ofl oxacin was added when there was no improvement of his symptoms. Since he remained unwell, his general practitioner referred the patient to us. On presentation to our clinic, physical examination was unremarkable. Blood tests showed a slightly high leucocyte count (12·8×109/L), CRP (81 mg/L), and ESR (106 mm/h). Results of liver function tests were abnormal: alanine aminotransferase 112 IU/L (normal <45 IU/L); aspartate aminotransferase 91 IU/L (normal <50 IU/L); γ-glutamyl transpeptidase 67 IU/L (normal <55 IU/L); and alkaline phophatase 137 IU/L (normal <129 IU/L); but bilirubin was normal. The patient’s activated partial thromboplastin time (APTT) was prolonged at 71 s (normal 26–40 s), but prothrombin time and bleeding time were normal. Anticardiolipin antibodies were high (58 kU/L; normal <10 kU/L). Several blood cultures and examination of bone marrow and cerebrospinal fl uid gave no indication of an infectious agent; serological tests for Q fever were also negative. Abdominal ultrasonography, CT of the head, thorax, and abdomen, transoesophageal echocardiography, and MRI of the spine were also unhelpful. Our patient fulfi lled the Petersdorf criteria for fever of unknown origin (FUO). Although his liver enzyme measurements improved during the fi rst week of admission, we thought liver biopsy would be prudent; doughnut granulomas with a fi brin ring were seen (fi gure). A second serological test for Q fever 2 weeks later was positive for phase II antigens of Coxiella burnetii (IgG 470 kIU/L, normal <50 kIU/L; IgM positive; ELISA assay for IgG and IgM, Serion, Wurzburg, Germany). A diagnosis of acute Q fever infection with hepatic involvement was made. Treatment with doxycycline 200 mg daily for 14 days was initiated but the fever persisted. PCR for C burnetii was negative. A reducing dose of prednisolone 40 mg, 20 mg, and 10 mg daily, each for 48 h was introduced. It resulted in a prompt defervescence and resolution of symptoms within 24 h. During the subsequent weeks, the patient’s liver enzyme measurements, APTT, and anticardiolipin antibodies returned to normal, and in August, 2005, he was still doing well. Hepatic involvement of Q fever is not as common as pneumonia; however, in Spain and the Canary Islands, Q fever often results in liver involvement. In our case, the agent was probably contracted by consumption of cheese made from sheep’s milk; hepatic involvement was probably an autoimmune triggered process. The absence of C burnetii on PCR and the presence of the characteristic granulomas in the liver biopsy sample supports the autoimmune hypothesis, although we cannot exclude the possibility that the negative PCR was due to previous antibiotic treatment. This case highlights the importance of considering Q fever in patients with FUO returning from Spain and the Canary Islands. Q fever should not be excluded if initial serology is negative; liver biopsy can be helpful in these patients, and should be considered in those with abnormal liver function. Furthermore, in Q feverhepatitis, steroids should be added to treatment with doxycycline if clinical symptoms do not improve.

The Changing Face of Job Loss in the United States, 1981-1995

IN THE FIRST WEEK of January 1996, AT&T announced it was restructuring its operations and reducing its managerial work force by 40,000. This was only the latest a string of widely publicized large labor force reductions announced by major American corporations. The public perceives that corporations are responding to increased competitive pressure by restructuring and downsizing their work forces, particularly their white-collar work forces, to an unprecedented degree and that the workers so displaced are suffering substantial economic hardship. I In this study I examine evidence from Displaced Workers Surveys (DWSs) from 1984 to 1996 to provide a comprehensive picture of the incidence and consequences of job loss between 1981 and 1995 to determine the extent to which labor force data support these perceptions. Data limitations make it difficult to know what groups of workers jobs before the 1980s. The DWSs, which have been regular supplements to the Current Population Survey (CPS) at two-year intervals since 1984, have useful information on job loss, however.2 Specifically, these surveys ask workers if in the past five (past three years the 1994 and 1996 DWSs) they have lost or left a job because of a

26 ERYTHROPOIETIN PRODUCTION AFTER THE FIRST WEEK OF LIFE

26 ERYTHROPOIETIN PRODUCTION AFTER THE FIRST WEEK OF LIFE

THE S-T SEGMENT AND T WAVE DURING THE FIRST WEEK OF LIFE.

THE S-T SEGMENT AND T WAVE DURING THE FIRST WEEK OF LIFE.

P wave duration and P-R interval during first week of life.

P wave duration and P-R interval during first week of life.