Effect of primary percutaneous coronary intervention on stress hyperglycaemia in myocardial infarction

AIM

To measure the effect of primary percutaneous coronary intervention on stress hyperglycaemia induced by ST segment elevation myocardial infarction.

METHODS

We measured blood glucose before primary percutaneous coronary intervention and 1 h after intervention in all patients presenting with ST segment elevation myocardial infarction for 2 months in our unit. A paired t-test was used for a statistical analysis.

RESULTS

From 157 patients accepted for primary percutaneous coronary intervention, 90 patients were included in the analysis. Blood glucose before intervention was 8.4 ± 2.46 mmol/l (mean ± SD) and after intervention was 7.9 ± 2.0 mmol/l (mean ± sd) (P = 0.003). In the subset of 15 patients with hyperglycaemia (glucose greater than 10 mmol/l), glucose before intervention was 12.7 ± 2.62 mmol/l (mean ± SD) and after intervention was 9.8 ± 3.42 mmol/l (mean ± sd) (P = 0.0002).

CONCLUSIONS

Blood glucose in patients with ST segment elevation myocardial infarction is significantly lower after primary percutaneous coronary intervention and this reduction is most marked in patients with hyperglycaemia. Waiting for the stress response to diminish means that 11.1% of patients' glucose levels fell below the treatment threshold of 10 mmol/l. Using the post-intervention blood glucose level avoids the need for treatment with insulin in this population. Further randomized studies are warranted to investigate the impact on mortality and morbidity of administering insulin triggered by pre-invention blood glucose vs. post-intervention blood glucose.

Communication strategies in acute health care: evaluation within the context of infection prevention and control

BACKGROUND

Communication in healthcare settings has recently received significant attention in the literature. However, there continues to be a large gap in current understanding of the effectiveness of different communication channels used in acute healthcare settings, particularly in the context of infection prevention and control (IPC).

AIM

To explore and evaluate the main communication channels used within hospitals to communicate with healthcare workers (HCWs) and to propose practical recommendations.

METHODS

Critical review of the main communication channels used within acute health care to communicate information to HCWs, and analysis of their impact on practice.

FINDINGS

The analysis covers verbal communications, standardization via guidelines, education and training, electronic communications and marketing strategies. Traditional communication channels have not been successful in changing and sustaining best practice in IPC, but newer approaches (electronic messages and marketing) also have pitfalls.

CONCLUSION

A few simple recommendations are made in relation to the development, implementation and evaluation of communications to HCWs; top-down vs bottom-up communications; and the involvement of HCWs, particularly ward personnel.

Isolation of filamentous fungi from sputum in asthma is associated with reduced post-bronchodilator FEV1

Background

Fungal sensitization is common in severe asthma, but the clinical relevance of this and the relationship with airway colonization by fungi remain unclear. The range of fungi that may colonize the airways in asthma is unknown.

Objective

To provide a comprehensive analysis on the range of filamentous fungi isolated in sputum from people with asthma and report the relationship with their clinico-immunological features of their disease.

Methods

We recruited 126 subjects with a diagnosis of asthma, 94% with moderate-severe disease, and 18 healthy volunteers. At a single stable visit, subjects underwent spirometry; sputum fungal culture and a sputum cell differential count; skin prick testing to both common aeroallergens and an extended fungal panel; specific IgE to Aspergillus fumigatus. Fungi were identified by morphology and species identity was confirmed by sequencing. Four patients had allergic bronchopulmonary aspergillosis.

Results

Forty-eight percent of asthma subjects were IgE-sensitized to one fungal allergen and 22% to ≥ 2. Twenty-seven different taxa of filamentous fungi were isolated from 54% of their sputa, more than one species being detected in 17%. This compared with 3 (17%) healthy controls culturing any fungus (P < 0.01). Aspergillus species were most frequently cultured in isolation followed by Penicillium species. Post-bronchodilator FEV₁ (% predicted) in the subjects with asthma was 71(± 25) in those with a positive fungal culture vs. 83 (± 25) in those culture-negative, (P < 0.01).

Conclusion and Clinical Relevance

Numerous thermotolerant fungi other than A. fumigatus can be cultured from sputum of people with moderate-to-severe asthma; a positive culture is associated with an impaired post-bronchodilator FEV₁, which might be partly responsible for the development of fixed airflow obstruction in asthma. Sensitization to these fungi is also common.

Early clinical experience with the Anaconda re-deployable endograft in 106 patients with abdominal aortic aneurism: the west of Scotland Anaconda registry

Endovascular repair of abdominal aortic aneurysm is a common procedure and not without complications. The aim of this study was to evaluate the early results of the Anaconda endograft (Vascutek Ltd., Inchinnan, Scotland, UK) in 106 patients in three hospitals in the west of Scotland. A prospective registry of 106 consecutive patients undergoing endoluminal repair of their abdominal aortic aneurysms using the Anaconda device was set up to record the clinical outcomes, with a mean follow-up of two years. There was no 30-day perioperative mortality in the 106 patients. Only type II endoleaks were detected on serial computed tomography scanning at follow-up. Technical success was achieved in 99% (105/106) in this study; one patient was converted to open surgical repair. Two cases of proximal device migration (>1 cm) were detected at one month and 19 months, respectively, with no associated endoleak or sac enlargement. Five cases of endograft limb thrombosis were noted in this study. Our early clinical experience with the Anaconda endograft compares favourably with other commercially available endografts in the treatment of abdominal aortic aneurysms. The main advantages of this device are that it is re-deployable and that it has a magnetic wire system which makes it easy to implant.

The forkhead transcription factor, Foxo1, coordinates an adaptive, pro-survival response to calorie restriction in T cells (47.3)

In addition to longevity enhancement, calorie restriction has been reported to slow the appearance of aging-related T cell abnormalities. However, the molecular mechanism underlying this phenomenon in T cells is ill-defined. We report that short-term calorie restriction in wild type mice inhibited the spontaneous apoptosis of naïve CD8+ T cells by approximately three fold, as compared to cells isolated from mice fed ad libitum. An ortholog of the forkhead transcription factor, Foxo1, is required for the longevity benefits of calorie restriction in C. elegans. Therefore, mice with a conditional, T cell-specific deficiency of Foxo1 (Foxo1 cKO) were also subjected to calorie restriction. Indeed, the pathway through which calorie restriction results in reduced naïve CD8+ T cell apoptosis appears to involve Foxo1, as calorie restriction in the absence of Foxo1 did not result in reduced naïve CD8+ T cell apoptosis. Instead, naïve CD8+ T cell apoptosis was similarly high for cells isolated from ad libitum wild type, ad libitum Foxo1 cKO, and calorie restricted Foxo1 cKO mice. Thus, Foxo1 coordinates an adaptive, pro-survival transcriptional response to calorie restriction. To our knowledge, Foxo1 is the first transcription factor identified to contribute to this process in mice.

Screening of metabolic side effects of antipsychotics in patients with mental disorder

This audit was undertaken to evaluate what screening is undertaken for metabolic side effects of antipsychotic drugs in patients under the care of Ceredigion Community Mental Health.

Raise awareness with Local health Board regarding metabolic screening Raise awareness regarding four aspects of metabolic syndrome.

Audit tool based on POMH (Prescribing Observatory for Mental Health) Topic 2B Audit Data was collected from medical notes, abstracted and inputted into Microsoft Excel. The sample consisted of 15 service users; 11(73%) male and 4(27%) female.

Most individuals where of white British/Irish ethnicity, (14, 93%).

Most (14, 93%) patients primary clinical psychiatric diagnosis based on the ICD10 category was F20–F29.

Six (40%) individuals in the sample smoked, of which two (33%) were offered help with smoking cessation. There was evidence of diabetes in three case notes. In one (33%) case note it was Mental Health services that uncovered the diabetes. One service users file had evidence of a known diagnosis of Hypertension. This was not discovered by Mental Health services. Three service users had evidence of a disturbed lipid profile. In two (66%) of these notes it was Mental Health services that discovered the disturbed lipid profile.

Lifestyle management pack: guidance and resources for staff and service users around diet, exercise, smoking cessation and other health lifestyle issues. Physical health check reminder cards: A patient-held card to record the results of physical health checks and due dates for new appointments.