Inflammatory and cardiometabolic markers at presentation with first episode psychosis and long-term clinical outcomes: A longitudinal study using electronic health records

Approximately one third of patients presenting with a first episode of psychosis need long-term support, but there is a limited understanding of the sociodemographic or biological factors that predict this outcome. We used electronic health records from a naturalistic cohort of consecutive patients referred to an early intervention in psychosis service to address this question. We extracted data on demographic (age, sex, ethnicity and marital status), immune (differential cell count measures and C-reactive protein (CRP)) and metabolic (cholesterol, triglycerides, glucose, glycated haemoglobin, blood pressure, body mass index (BMI)) factors at baseline, and subsequent need for long-term secondary (specialist) psychiatric care. Of 749 patients with outcome data available, 447 (60%) had a good outcome and were discharged to primary care, while 302 (40%) required follow-up by secondary mental health services indicating a worse outcome. The need for ongoing secondary mental healthcare was associated with high triglyceride levels (adjusted odds ratio/OR = 7.32, 95% CI 2.26-28.06), a low basophil:lymphocyte ratio (adjusted OR = 0.14, 95% CI 0.02-0.58), and a high monocyte count (adjusted OR = 2.78, 95% CI 1.02-8.06) at baseline. The associations for baseline basophil (unadjusted OR = 0.27 per SD, 95% CI 0.10-0.62) and platelet counts (unadjusted OR = 2.88, 95% CI 1.29-6.63) attenuated following adjustment for BMI. Baseline CRP levels or BMI were not associated with long-term psychiatric outcomes. In conclusion, we provide evidence that triglyceride levels and several blood cell counts measured at presentation may be clinically useful markers of long-term prognosis for first episode psychosis in clinical settings. These findings will require replication.

Penetration injury to the heart. Nine consecutive cases at a community hospital

During the past 25 years, great progress has been made in saving patients with serious cardiac injuries. This study is based on nine consecutive cases of penetrating wounds to the heart treated successfully by surgical intervention at a community hospital with no facilities for cardiopulmonary bypass. Early surgery is advocated for patients suspected of having penetrating injury of the heart.

Stab wounds of the abdomen. Observe or explore?

This article reviews our experience with 403 cases of stab wounds of the abdomen, with emphasis on our policy of selective management. Forty-six percent (187) of the patients were operated on immediately because of clinical findings. Fifty-four percent (216 patients) were treated conservatively after initial evaluation, and only 4% (16 patients) required subsequent surgical intervention, with no mortalities. The overall morbidity was 9.2%, with a 1.6% mortality in the operative group. With more than 20 years of experience in the management of stab wounds, we found the selective approach to be safe and reliable.