non-CI Group Research Articles

The burden of deliberate self-harm on the critical care unit of a peri-urban referral hospital in the Eastern Cape: A 5-year review of 419 patients

Buffalo City Municipality (BCM) in the Eastern Cape (EC) has the highest susceptibility to deliberate self-harm (DSH) of any South African city. The EC also has a shortage of critical care beds. OBJECTIVE; This study reviewed DSH admissions over 5 years to the critical care unit (CCU) of Cecilia Makiwane Hospital (CMH), a large peri-urban hospital in the EC. It also examined the financial burden that DSH exerts on public-sector critical care. DSH cases admitted to CMH's CCU between January 2006 and December 2010 were retrospectively reviewed. Patients under 13 years of age were excluded. Age, gender, admission duration, agent used, outcome and toxicology results were recorded. Cost was estimated using the Department of Health 2012 fee schedule. A total of 419 patients, comprising 17% of total CCU admissions, were included in the study. Cholinesterase inhibitors (CIs) were the most common agents ingested (55%). Compared with non-CI groups, CI patients where admitted for twice as long from admission to discharge (p<0.0001), but had a lower mortality rate (p=0.0344). No significant difference was found between gender and survival (p=0.5725) and between the yearly DSH CCU admission means (p=0.052). CI cases cost a minimum of R15 966.29 per admission and DSH CCU cases cost over R1 million per annum. DSH imposes an appreciable burden on the CCU services in the EC. There is a need to better control the unregulated availability of CIs (and related public education) as well as to improve psychiatric and psychological services in the EC rural areas.

Only low frequency event-related EEG activity is compromised in multiple sclerosis: insights from an independent component clustering analysis.

Cognitive impairment (CI), often examined with neuropsychological tests such as the Paced Auditory Serial Addition Test (PASAT), affects approximately 65% of multiple sclerosis (MS) patients. The P3b event-related potential (ERP), evoked when an infrequent target stimulus is presented, indexes cognitive function and is typically compared across subjects' scalp electroencephalography (EEG) data. However, the clustering of independent components (ICs) is superior to scalp-based EEG methods because it can accommodate the spatiotemporal overlap inherent in scalp EEG data. Event-related spectral perturbations (ERSPs; event-related mean power spectral changes) and inter-trial coherence (ITCs; event-related consistency of spectral phase) reveal a more comprehensive overview of EEG activity. Ninety-five subjects (56 MS patients, 39 controls) completed visual and auditory two-stimulus P3b event-related potential tasks and the PASAT. MS patients were also divided into CI and non-CI groups (n = 18 in each) based on PASAT scores. Data were recorded from 128-scalp EEG channels and 4 IC clusters in the visual, and 5 IC clusters in the auditory, modality were identified. In general, MS patients had significantly reduced ERSP theta power versus controls, and a similar pattern was observed for CI vs. non-CI MS patients. The ITC measures were also significantly different in the theta band for some clusters. The finding that MS patients had reduced P3b task-related theta power in both modalities is a reflection of compromised connectivity, likely due to demyelination, that may have disrupted early processes essential to P3b generation, such as orientating and signal detection. However, for posterior sources, MS patients had a greater decrease in alpha power, normally associated with enhanced cognitive function, which may reflect a compensatory mechanism in response to the compromised early cognitive processing.

Association between poor nutritional status and severe depression in Korean cerebral infarction patients

ObjectiveThe purpose of this study was to assess the association between cerebral infarction (CI), nutritional status, and depression.MethodsSubjects with and without CI (n = 146; 73 CI vs. 73 non-CI) were recruited from Kyung Hee University Medical Center (Seoul, Korea) and were matched according to age and gender. The subjects’ medical histories, health-related behavioral habits, food intake, nutritional assessment, and depression status were analyzed.ResultsThe prevalence of hypertension or diabetes were much higher in subjects in the CI group than in the non-CI group (P < 0.001). Subjects with CI registered lower dietary intakes of potassium, dietary fiber, fish, fruits, and vegetables than non-CI subjects (P < 0.05). By the mini-nutritional assessment (MNA) classification, malnutrition affected 57.5% of subjects in the CI group, but none of the subjects in the non-CI group (P < 0.001). The average Beck depression inventory (BDI) score was 43.6 ± 7.7 points in the CI group and 20.6 ± 13.1 points in the non-CI group (P < 0.001). Higher MNA scores (well-nourished status) were inversely associated with CI prevalence (odds ratio (OR) = 0.23; 95% CI: 0.07, 0.79) after controlling for age, gender, medical history, and health-related factors, whereas BDI was not associated with CI prevalence (OR = 1.32; 95% CI: 0.90, 1.94).DiscussionCI patients had several comorbidities, inappropriate health-related behavioral habits, malnourished status, and severe depression prior to CI onset. Indices of well-nourished status were inversely associated with CI. Accordingly, it would be desirable to develop a protocol for medical nutrition therapy in CI patients to improve nutritional status.

Colon ischemia following abdominal aortic aneurysm repair in the era of endovascular abdominal aortic repair

To review, in the era of endovascular abdominal aortic repair (EVAR), the clinical spectrum of colonic ischemia (CI) following abdominal aortic aneurysm (AAA) repair and to assess the rate, overall mortality, and associated factors of occurrence. Between 1995 and 2005, 1174 patients with infrarenal AAA were treated either by open surgery (n = 682) or by EVAR (n = 492). Preoperative risk factors, clinical presentation, intraoperative data, and early postoperative outcomes were prospectively assessed. Overt colonic ischemia as proven by colonoscopy and/or by operation was considered as a validating event and was correlated to collected variables. CI occurred in 34 patients (2.9%). Eighteen out of 34 (53%) patients died within 1 month. At 2 years, the survival rate was 35% in the CI group vs 86% in the non-CI group. Associated factors of occurrence of CI were: type of operation (open group = 27/682 [4%] vs EVAR = 7/492 [1.4%] [P = .01]), aneurysm rupture (11/88 [12.5%] vs 23/1086 [2.1%], P < .001), preoperative renal insufficiency (4/30 [13.3%] vs 29/1133 [3.1%], P = .01), preoperative respiratory insufficiency (8/157 [7%] vs 23/1005 [2%], P = .01), duration of operation (<2 hours [518] = 1.7%, between 2 to 4 hours [558] 2.9%, more than 4 hours [66] 13.6%, P = .001). Mean blood loss was greater in patients with CI (CI = 2000 ml [650-3350] than in those without CI = 1000 ml [500-1800] P = .008). Logistic regression analysis showed that rupture (OR 6.03 [interval of confidence (IC) 95% 2.68-13.5] P = .0001), duration of operation (OR 5.73 [IC 95% 2.06-15.9] P = .001) and creatinin > 200 mol/l (OR 4.67 [IC 95% 1.39-15.7] P = .028) were independent factors of CI. The mortality due to colonic ischemia was not statistically different between open surgery 14/27 (52%) and EVAR 4/7 (57%). CI remains a serious complication following AAA repair. In the univariate analysis, EVAR was associated with a lower rate of colonic ischemia. However, the logistic regression analysis showed that only rupture, long duration of operation, and prior renal disease were independently associated with CI. Within the two treatment modalities, the mortality rate remained identical.

Exercise Training May Enhance Functional Capacity and Improve Heart Rate Impairment in Coronary Artery Disease Patients with Chronotropic Incompetence

This study investigated whether coronary artery disease patients with chronotropic incompetence (CI) can significantly improve their functional capacity after exercise training. Forty-two men (mean age: 55.3±9.3yr) underwent coronary revascularization and without beta-blockade participated in a threemonth outpatient exercise training program. Patients were separated into a CI group (n=18) and a non-CI group (n=24) based on whether they could reach 85% of the age-predicted peak heart rate (HR). Chronotropic incompetence was defined as failure to achieve 85% of the age-predicted maximal HR. Bicycle exercise workouts were conducted three times weekly. The exercise duration was 30 minutes per session included 5 minutes warm up and 5 minutes cool down, and the exercise intensity was adjusted to the subject's ventilatory threshold (VeT). Graded exercise tests with gas analysis were conducted before and after training to evaluate changes in cardiorespiratory function. Before training, the CI group displayed lower peak oxygen uptake (VO(subscript 2peak)), HR and work rate than the non-CI group (p＜0.01). After training, the VO(subscript 2pea)k increased from 19.5±3.4 to 25.1±5.5 mL•kg-1•min^(-1) in the CI group, while it increased from 22.0±3.9 to 25.4±5.4 mL•kg^(-1)•min^(-1) in the non-CI group. At VeT, the CI group also displayed greater increase in VO2 than the non-CI group. In conclusion, although pre-training V O(subscript 2peak) was lower for the CI group than the non-CI group, both groups can achieve a similar level of functional capacity. CI thus appears not to be a limiting factor for improvement during cardiac rehabilitation.

Relationship between the Thromboxane A2 Receptor Gene and Susceptibility to Cerebral Infarction

The risk of cerebral infarction (CI) in an individual is dependent on the interplay between genetic risk factors and environmental influences. Binding of thromboxane A2 (TXA2) to its receptor (TP) modulates thrombosis/hemostasis and plays a significant role in the pathogenesis of CI. The aim of the present study was to investigate the relationship between human TP gene single nucleotide polymorphisms (SNPs) and haplotypes and CI in a Japanese population. A genetic association study was performed in 194 CI patients and 365 non-CI subjects by specifically characterizing 6 SNPs in the human TP gene (rs2271875, rs768963, rs2238634, rs11085026, rs4523 and rs4806942). Analysis demonstrated that there were significant differences in the overall distribution of genotypes and dominant or recessive models of rs2271875 and rs768963 between the CI and the non-CI groups. Multiple logistic regression analysis revealed that the C allele of rs768963 was significantly associated with CI (p = 0.029), even after adjusting for confounding factors (odds ratio: 2.41). Further, the C-T-C haplotype of rs768963-rs2238634-rs4806942 was significantly more frequent in the CI group (23.0%) than in the non-CI group (17.7%). These results suggest that specific SNPs and haplotypes may have utility as genetic markers for the risk of CI and that TP or a neighboring gene is associated with the increased susceptibility to CI.

Interaction of the endothelin system and calcineurin inhibitors after kidney transplantation.

Plasma endothelin (ET)-1 concentrations have been shown to be elevated in patients receiving calcineurin-inhibitors (CI). We investigated urinary and plasma ET-1 (uET-1, pET-1), BigET-1 (uBigET-1, pBigET-1) concentrations, and plasma soluble endothelin-converting enzyme (ECE) concentrations in 381 adult caucasian kidney allograft recipients with graft survival of more than 2 years from the outpatients department of our clinic. Blood and urine probes were always drawn immediately before morning dosage of immunosuppressants. Mean of urinary protein excretion (meanProt) and mean of serum creatinine (meanCrea) were calculated from all available measurements in the most recent year. uET-1 and uBigET-1 were adjusted for urinary protein excretion by calculating uET-1/meanProt and uBigET-1/meanProt. Patients (n=310) were on a cyclosporine A or FK506 (CI-group) based immunosuppression protocol, and 71 patients were immunosuppressed without use of CI (nonCI group). Time since transplantation was similar in both groups (mean+/-S.D.; CI-group: 7.55+/-2.50; nonCI-group: 7.74+/-3.06 years, P=0.240) as well as meanCrea (mean+/-S.D.; CI-group: 1.97+/-1.34; nonCI-group: 1.77+/-1.29 mg/dl, P=0.326). pET-1 was significantly higher in the CI-group, compared with nonCI (mean+/-S.D.; 0.87+/-1.4 versus 0.56+/-0.76 fmol/ml, P=0.011). pBigET-1 was similar (mean+/-S.D.; 0.85+/-1.41 versus 0.70+/-1.21 fmol/ml, P=0.33). ECE concentrations were higher in the CI group (mean+/-S.D.; 14.30+/-18.02 versus 9.23+/-7.42 ng/ml, P=0.001). uET-1/meanProt and uBigET-1/meanProt concentration were similar in the CI-group compared with the nonCI-group (mean+/-S.D.; uET-1/meanProt: 15+/-24 versus 21+/-40 pmol/g, P=0.139; uBigET-1/meanProt: 34+/-55 versus 19+/-23pmol/g, P=0.248). pET-1 elevation in patients receiving CI might be more likely to be due to elevated conversion of pBig-ET-1 by more ECE, and not to higher concentrations of pBigET-1.

An Insertion/Deletion Polymorphism in Intron 18 of the Type B Human Natriuretic Peptide Receptor Gene Is Not Associated with Cerebral Infarction.

The natriuretic peptide (NP) system may play a crucial role in the development of cardiovascular and renal diseases. C-type NP dilates arteries and lowers blood pressure, and it inhibits the proliferation of vascular smooth muscle cells via the type B NP receptor (NPRB). We determined and analyzed the structure of the NPRB gene and found an insertion/deletion (I/D) polymorphism in intron 18. In this experiment, we studied this I/D polymorphism in the NPRB gene in 241 subjects, including 118 patients with cerebral infarction (the CI group) and 123 control subjects (the non-CI group). Our goal was evaluate the association of this polymorphism with cerebral infarction. Our findings showed that genotype frequencies of the I/D polymorphism were in Hardy-Weinberg equilibrium. The frequencies for the II, ID, and DD alleles were 0.569, 0.374, and 0.057, respectively, in the non-CI group and 0.576, 0.356, and 0.068, respectively, in the CI group. No association was found between this polymorphism and cerebral infarction. These results suggest that this polymorphism in the NPRB gene is not linked to a pathogenic CI gene.

Comprehension of language in congenitally deaf children with and without cochlear implants

The consequences of profound early deafness on oral language in children are drastic. The modern cochlear implant (CI) has been shown to enhance speech production skills in prelingually deaf children. Many factors may contribute to a poor or an excellent outcome, making it difficult to compare groups of children wearing or not wearing cochlear implants. The present study compared receptive language levels in matched pairs of children from CI group and non-CI groups. The pre-op receptive language development curve suggest a possible growth over time with the maturation and the speech therapy. Comparison showed that the slope for post-op CI children to be greater than for non-CI children, and that this difference is statistically significant, and that the slope for CI children to be greater post- than pre-operatively. The main conclusion is that receptive language scores grow significantly higher over time after surgery in CI than in pair-matched non-CI children, despite better initial pure tone audiometric thresholds of the latter.

Study of left ventricular function in cerebral thrombosis with pulsed Doppler echocardiography

To evaluate the cardiac dysfunction of the cerebral infarction (cerebral thrombosis) patients in the chronic period, non-invasive studies were performed on 45 cerebral infarction patients (CI group: 25 males and 16 females, mean age 64.1 y). Forty hospitalized patient without cerebral infarction served as controls (non-CI group: 23 males and 19 females, mean age 64.8 y). The CI and non-CI group were divided into two sub-groups: patients with a past history of hypertension (HT) and without (NT). In each sub-group, the cardiac functions were compared between CI and non-CI by M-mode and Doppler echocardiography. In echocardiography, research based on the premise that the function of the left ventricle can be divided into preload (EDVi), afterload (SVR), contractility (EF, mVcf, SBP/ESV) and distensibility (E/A). On results show that there were no significant differences in preload, afterload and contractility of the left ventricle between CI and non-CI group in each HT and NT sub group. However, a significant difference was demonstrated in the diastolic function the left ventricle between the two groups in the HT (p = 0.007) and NT (p = 0.04) sub-groups. In conclusion, left ventricle diastolic function was deteriorated in cerebral infarction patients although systolic function not deteriorated. Because diastolic dysfunction may be caused by existing latent heart failure and/or silent myocardial ischemia, echocardiographic study is useful for early detection of left ventricle impairments in cerebral infarction patients.