Evaluation of serum calcium differences in hypertensive crises and control patients: A randomly matched case-control study

The role of calcium in blood pressure has been widely studied among hypertensive patients; however, no study has explored the role of calcium in hypertensive crises. The primary objective of this study is to evaluate the differences in serum calcium levels between hypertensive crises patients and a 1:1 random matched controls (age‐, sex‐, race‐, diabetes, and body mass index matched). This study is a single‐center, retrospective, chart review, case‐control study of patients with hypertensive crises (case group) and patients without hypertensive crises (control group). Patients were included in the case group if they were 18 years of age or older with hypertensive crises and have a documented calcium level. The control group patients were required to be 18 years of age or older, have a documented calcium level, and have no diagnosis of hypertensive crises. The primary outcome of the study was to compare the mean serum calcium in patients with hypertensive crises vs patients without hypertensive crises. Five hundred and sixty‐six patients were included in the study: 283 patients in both the case group and control group. The primary outcome results showed that serum calcium concentration was not significantly different between the case group (8.99 ± 0.78 mg/dL) and control group (8.96 ± 0.75 mg/dL) (P = .606). This study found no significant difference in serum calcium levels in patients with hypertensive crises compared to a random matched control group. Larger observational or experimental studies may be useful to evaluate the effect of calcium on blood pressure in hypertensive crises.

Evaluation of serum magnesium differences in hypertensive crises and control patients: A randomly matched case-control study

Although the role of magnesium in blood pressure has been well studied among hypertensive patients, no study has explored the role of magnesium in hypertensive crises. The primary objective of this study is to evaluate the differences in serum magnesium levels between hypertensive crises patients and matched controls (age‐, sex‐, race‐, and diabetes‐matched) in a 1:1 random match. This study is a single‐center, retrospective, chart review, case‐control study of patients with hypertensive crises (case group) and patients without hypertensive crises (control group). Patients were included in the case group if they were 18 years of age or older with hypertensive crises and have a documented magnesium level. The control group patients were required to be 18 years of age or older, have no diagnosis of hypertensive crises, and have a documented magnesium level. The primary outcome of the study was to compare the mean serum magnesium in patients with hypertensive crises versus patients without hypertensive crises. Three hundred and fifty‐eight patients were included in the study: 179 patients in both the case group and control group. The primary outcome results showed that serum magnesium concentration was not significantly different between the case group (1.89 ± 0.29 mg/dl) and control group (1.90 ± 0.31 mg/dl) (p = .787). This study found no significant difference in serum magnesium levels in patients with hypertensive crises compared to a random matched control group. Larger observational or experimental studies may be useful to evaluate the effect of magnesium on blood pressure in hypertensive crises.

B-type natriuretic peptide predicts long-term survival after major non-cardiac surgery

BACKGROUND

The prediction of long-term survival after surgery is complex. Natriuretic peptides can predict short-term postoperative cardiac morbidity and mortality. This study aims to determine the long-term prognostic significance of preoperative B-type natriuretic peptide (BNP) concentration after major non-cardiac surgery.

METHODS

We conducted a prospective single-centre observational cohort study in a West of Scotland teaching hospital. Three hundred and forty-five patients undergoing major non-cardiac surgery were included. The primary endpoint was long-term all-cause mortality.

RESULTS

Overall survival was 67.8% (234/345), with 27 postoperative deaths (within 42 days) and 84 deaths at subsequent follow-up (median follow-up 953 days). A BNP concentration of >87.5 pg ml(-1) best predicted mortality, and the mean survival of patients with an elevated BNP (>87.5 pg ml(-1)) was 731.9 (95% CI 613.6-850.2) days compared with 1284.6 days [(95% CI 1219.3-1350.0), P<0.001] in patients with a BNP<87.5 pg ml(-1). BNP was an independent predictor of survival.

CONCLUSIONS

BNP is an independent predictor of long-term survival after major non-cardiac surgery. A simple preoperative blood test can provide predictive information on future risk of death, and potentially has a role in preoperative risk assessment.

Are routine microbiological investigations indicated in the management of non-perianal cutaneous abscesses?

BACKGROUND

It is common practice to take a specimen of pus for microscopy and bacterial culture during drainage of abscesses. The aim of this study was to determine if routine culture and sensitivity had any therapeutic value in the care of patients with non-perianal cutaneous abscesses.

PATIENTS AND METHODS

A retrospective analysis ofall patients undergoing drainage ofa cutaneous abscess during a two year period (June 2003 - June 2005) was performed. Patients were identified from the hospital database and theatre records, and those with perianal, pilonidal or surgical wound sepsis were excluded. Notes were reviewed for clinical details, culture results, subsequent admissions and attendance at follow-up.

RESULTS

Of the 239 patients treated during this period, 74 patients had 77 operations to drain abscesses that matched the inclusion criteria. Specimens were sent from 52 (67.5%) procedures. Only 65.4% had an organism identified, of which methicillin-sensitive Staphylococcus aureus (MSSA) was the most commonly isolated organism (36.5%). Forty-one point six per cent of patients received antibiotics as part of their treatment. The results of the bacterial culture and antibiotic sensitivities were not known prior to discharge of any patient.

CONCLUSION

This study shows that bacteriology swabs are frequently taken during incision and drainage of non-perianal cutaneous abscesses and had little impact on the subsequent treatment, though these results may not be applicable to immune-compromised patients.

The detection of the big liver and spleen agent in infected tissues via intravenous chick embryo inoculation

Partially purified homogenates prepared from the livers of birds affected with BLS were used to inoculate intravenously young adult broiler breeder hens and incubating chicken embryos. Following inoculation, the broiler breeders developed pathological and serological responses typical of BLS infection. The same antigen resulted in persistent antigenaemia in chickens which were inoculated during various stages of incubation. This technique was very sensitive and could be used for detection and titration of virus in tissue preparations. Methods for optimization of the technique were investigated. Chick embryos demonstrated the greatest susceptibility to agent replication when inoculated at 11 days of embryonation. After hatching, agent replication appears to increase with age. Inoculated chickens bled at 8 days of age showed increased incidence of antigenaemia by this procedure.

Determination of vancomycin in serum by liquid chromatography–high resolution full scan mass spectrometry

A liquid chromatography-mass spectrometry (LC-MS) method was developed for the analysis of vancomycin (VCM) in human serum. The method was based on full scan data with extracted ions for the accurate masses of VCM and the atenolol internal standard obtained by Fourier transform MS. VCM was extracted from serum using strong cation exchange (SCX) solid phase extraction (SPE). The method was found to be linear in the range 0.05-10 microg/ml, which was adequate for quantification of VCM in serum samples, with a limit of quantification (LOQ) of 0.005 microg/ml and a limit of detection (LOD) of 0.001 microg/ml. Intra-day precision (n=5) was +/-3.5%, +/-2.5%, +/-0.7% at 0.05, 0.5 and 5 microg/ml, respectively. Inter-day precision (n=5) was +/-7.6%, +/-6.4%, +/-3.9% at 0.05, 0.5 and 5 microg/ml, respectively. The process efficiency for VCM was in the range 89.2-98.1% with the recovery for the atenolol internal standard (IS) being 97.3%. The method was used to determine VCM levels in patients during peri-operative infusion of the drug, which was found to result in drug levels within the required therapeutic window.

B-type natriuretic peptide predicts cardiac morbidity and mortality after major surgery

Background

The objective of this study was to determine whether measurement of B-type natriuretic peptide (BNP) concentration before operation could be used to predict perioperative cardiac morbidity.

Methods

A prospective derivation study was performed in high-risk patients undergoing major non-cardiac surgery, with a subsequent validation study. A venous blood sample was taken the day before surgery for measurement of plasma BNP concentration. Screening for cardiac events (non-fatal myocardial infarction and cardiac death) was performed using clinical criteria, cardiac troponin I analysis and serial electrocardiography.

Results

Forty-one patients were recruited to the derivation cohort and 149 to the validation cohort. In the derivation cohort, the median (interquartile range) BNP concentration in the 11 patients who had a postoperative cardiac event was 210 (165–380) pg/ml, compared with 34·5 (14–70) pg/ml in those with no cardiac complications (P &lt; 0·001). In the validation cohort, the median BNP concentration in the 15 patients who had a cardiac event was 351 (127–1034) pg/ml, compared with 30·5 (11–79·5) pg/ml in the remainder (P &lt; 0·001). BNP concentration remained a significant outcome predictor in multivariable analysis (P &lt; 0·001). Using receiver–operator curve analysis it was calculated that a BNP concentration of 108·5 pg/ml best predicted the likelihood of cardiac events, with a sensitivity and specificity of 87 per cent each.

Conclusion

Preoperative serum BNP concentration predicted postoperative cardiac events in patients undergoing major non-cardiac surgery independently of other risk factors.

Sequence data suggests big liver and spleen disease virus (BLSV) is genetically related to hepatitis E virus

A monoclonal antibody (mAb) that reacted specifically with a 16 kDa big liver and spleen disease virus (BLSV) protein was used to identify the protein in western immunoblots of infected liver extracts and enable partial amino acid sequence analysis of the protein. Based on this sequence, a degenerate primer was designed that was used in conjunction with random hexamers in a reverse transcriptase-POR (RT PCR), to amplify a 523 bp product from RNA extracted from homogenates of BLSV-infected livers. There was 62% nucleotide sequence identity between this sequence and the sequence of the helicase gene of human hepatitis E virus (HEV). POR primers designed from this 523 bp fragment were able to amplify a 490 bp product from livers of virus-infected chickens but not chickens from virus-free flocks.

Distraction osteogenesis for correction of transverse mandibular deficiency: a preliminary report

PURPOSE

This article reviews the early results with distraction osteogenesis to correct transverse width deficiencies in the mandible.

PATIENTS AND METHODS

Nine patients with congenital/developmental maxillofacial skeletal deformities had distraction osteogenesis performed. All patients had study casts and cephalometric and dental radiographs obtained before and after surgery. Eight of the nine patients also had simultaneous surgical assisted-rapid palatal expansion (SA-RPE). The other patient had nonsurgical RPE.

RESULTS

Successful completion of the planned mandibular symphyseal distraction was achieved in eight of nine patients. Four of the nine experienced failure of the distraction appliance because of stripping of the distraction tram. Three of them underwent reoperation. The mean expansion achieved in the anterior mandible measured at the canines was 3.9 mm.

CONCLUSIONS

These preliminary results suggest that distraction osteogenesis is a viable option to correct transverse discrepancies of the mandible.

An antigen detection immunoassay for big liver and spleen disease agent

An enzyme-linked immunosorbent assay (ELISA) able to detect an antigen associated with infection with big liver and spleen (BLS) agent was developed. The assay is a capture ELISA (C-ELISA) procedure using ELISA plates coated with mouse monoclonal antibody (mAb 1H4) for antigen capture and a polyclonal chicken Ig preparation, extracted from yolk of BLS antibody positive birds, for detection of captured BLS antigen. mAb 1H4 was produced to a partially purified antigen preparation from liver suspensions of naturally BLS infected birds. The C-ELISA was evaluated for specificity and sensitivity in naturally and experimentally BLS infected and uninfected broiler and layer breeds of domestic fowl.

Neuropeptide Y fails to increase intraoral intake in rats

Neuropeptide Y (NPY) has a potent orexigenic effect when administered either into the third ventricle or directly into hypothalamic nuclei, but the mechanism by which NPY increases intakes is poorly understood. The present study tested the ability of NPY to increase intake of the rat in the intraoral intake test, which focuses on the highly stereotyped consummatory phase of ingestion by introducing a 0.1 M sucrose solution directly into the oral cavity of rats via indwelling intraoral cannulas. Doses of 3, 9.5, and 30 micrograms of NPY, when administered into the third ventricle, all failed to change intraoral intake compared with a saline control. Food deprivation (24 h), however, nearly doubled intraoral intake. Additionally, in separate experiments, 9.5 micrograms of NPY significantly increased both 1-h food intake and 1-h bottle intake of 0.1 M sucrose. These results are consistent with two conclusions. 1) NPY does not affect the consummatory phase of ingestion. 2) NPY administration does not completely mimic the stimulus state associated with food deprivation, since food deprivation but not NPY administration increases intake in the intraoral intake test.

Immunity to Pasteurella multocida in protein-deficient chickens

Studies were conducted to determine the effects of dietary protein restriction on the humoral immunity (HI) and cell-mediated immunity (CMI) of chickens. New Hampshire chickens were separated into two dietary treatment groups: basal, containing 3,200 kcal/kg and 21% protein; or protein restricted (PR), containing 3,200 kcal/kg and 7% protein. In studies involving HI, half of the birds in each dietary treatment were vaccinated against fowl cholera at 4 and 8 wk of age. Blood samples were collected weekly beginning at 4 wk of age. Overall, unvaccinated birds had lower titers than vaccinated birds and PR groups generally showed lower titers than basal groups. All birds were challenged by palatine cleft inoculation of live, virulent Strain X-73 of Pasteurella multocida. The vaccinated PR group survived live challenge as well as the vaccinated basal group, but all unvaccinated birds died as a result of the challenge, regardless of antibody titer. In studies involving CMI, half of the birds in each dietary treatment were vaccinated at 5 wk of age. At 2 to 3 wk postvaccination, representative birds from each treatment were bled for total and differential blood counts. Also, birds were sacrificed and spleen cells collected. Cells were cultured in Roswell Park Memorial Institute (RPMI) medium with phytohemagglutinin-M (PHA-M), sonicated P. multocida (X-73), or RPMI only.(ABSTRACT TRUNCATED AT 250 WORDS)