Does Socioeconomic Status or Methamphetamine use Impact Discharge Opioid Requirements in Burn Injured Patients?

Methamphetamine (MA) use is associated with lower socioeconomic status (SES) and increased opioid use. Though MA use itself has been linked to larger burn injuries and increased length of stay, studies examining the effect of SES on opioid use in this patient population remain limited. The aim of this work was to examine how both SES and/or MA use in burn patients impacted discharge opioid requirements. Records of burn patients admitted to an ABA verified burn center were reviewed from January 2016 to December 2017. Patients were grouped into MA positive (MPOS) or negative groups (MNEG) based on admission urine toxicology screening. Pain scores, oral morphine opioid equivalents (OE), and adjunct pain medication use reported within 24 hours of discharge were examined. SES was determined by zip code. No difference was found between MPOS and MNEG groups regarding discharge OE (p=0.4), OE/TBSA (p=0.79), or pain score (p=0.09). Low SES was more prevalent in MPOS patients (p<0.0001) but low SES was not a predictor of discharge OE (p=0.7), OE/TBSA (p=0.7), or pain score (p = 0.15). Discharge OE and OE/TBSA requirements correlated with discharge pain score (p<0.0001) and LOS (p<0.01), but not SES. Multivariate linear regression found that MNEG status (p=0.005), pain score (p < 0.0001), concurrent use of benzodiazepines and gabapentin (p<0.001), but not low SES, were independently associated with increased OE. Although lower SES was seen in patients using MA, SES was not associated with discharge opioid use or pain scores. Additional work will be necessary to determine factors affecting opioid use in this population.

Medial temporal lobe functional connectivity predicts stimulation-induced theta power

Focal electrical stimulation of the brain incites a cascade of neural activity that propagates from the stimulated region to both nearby and remote areas, offering the potential to control the activity of brain networks. Understanding how exogenous electrical signals perturb such networks in humans is key to its clinical translation. To investigate this, we applied electrical stimulation to subregions of the medial temporal lobe in 26 neurosurgical patients fitted with indwelling electrodes. Networks of low-frequency (5–13 Hz) spectral coherence predicted stimulation-evoked increases in theta (5–8 Hz) power, particularly when stimulation was applied in or adjacent to white matter. Stimulation tended to decrease power in the high-frequency broadband (HFB; 50–200 Hz) range, and these modulations were correlated with HFB-based networks in a subset of subjects. Our results demonstrate that functional connectivity is predictive of causal changes in the brain, capturing evoked activity across brain regions and frequency bands.

Direct electrical brain stimulation can induce widespread changes in neural activity, offering a means to modulate network-wide activity and treat disease. Here, the authors show that the low-frequency functional connectivity profile of a stimulation target predicts where induced theta activity occurs.

Nutritional rickets in young Nigerian children in the Sahel savanna

OBJECTIVES

To determine the prevalence of clinical and biochemical rickets in an under-five out-patient population, relate the prevalence of biochemical rickets (BR) to the sociocultural characteristics of families and determine the response of nutritional rickets to vitamin D therapy.

DESIGN

Prospective cross-sectional and retrospective case-series surveys.

SETTING

Paediatric general out-patient and consultant clinics.

SUBJECTS

One hundred and ninety eight out-patients and twenty two patients aged >1 to 60 months treated for nutritional rickets.

INTERVENTIONS

Clinical examination, interview with mothers and determination of biochemical abnormalities of under-fives and management of patients with rickets using stosstherapy.

MAIN OUTCOME MEASURES

Prevalence of BR and response to stosstherapy.

RESULTS

Eight (4%) patients in the survey had clinical and biochemical rickets while 33 (17%) had biochemical rickets only; 92 (47%) other patients had isolated hypocalcaemia and/or hypophosphataemia. The prevalence of BR was higher in males (p <0.05), and increased with age (p <0.001). The prevalence was lower in families who were indigenous to the area (p <0.05), children of Moslem families (p <0.05) and children whose mothers were full-time housewives, unskilled or traders (p <0.01), and who lacked any formal western education (p = 0.157). Three of the seven evaluable patients who received stosstherapy responded late.

CONCLUSION

The results support the hypothesis that deficiency or reduced availability of dietary calcium may be of at least equal importance with vitamin D deficiency in the aetiology of nutritional rickets in the Sahel savanna.

Hypoglycaemia: a major biochemical complication in eclampsia- its risk factors and prognostic value

In this two year prospective study, random blood glucose levels were determined in 52 eclamptic patients and 38 controls, at the University of Maiduguri Teaching Hospital and Specialist Hospitals in Maiduguri, Nigeria. Eclamptic mothers had lower glucose levels (mean value = 3.5 mmol/l) than controls (mean value = 6.8 mmol/l) (P < 0.001). Nineteen eclamptics (36.5%) had hypoglycaemic glucose levels (mean value = 2.3 mmol/l). These values returned to normal following intravenous administration of dextrose. Risk factors for hypoglycaemia identified in these mothers included lack of antenatal care, unsupervised labour at home, labour lasting more than 14 hours, obstructed labour, maternal hyperpyrexia, convulsions four or more times, deranged liver function especially HELLP syndrome (syndrome of haemolysis, elevated liver enzymes and low platelet count), poor energy supply in labour, low socio-economic class status and anaemia. A scoring panel derived from these risk factors was tested on a separate group of 48 eclamptics and this was found to be 96% sensitive. Infusion of 50% dextrose reversed coma in seven of eight comatose eclamptics and corrected fetal heart rate irregularities in 13 of 15 hypoglycaemic eclamptics. Seven of nine patients who suffered from posteclamptic psychosis had hypoglycaemic glucose levels. Three mothers with hypoglycaemia and HELLP syndrome died after developing hyperglycaemia following infusions of 50% and 10% dextrose. Hypoglycaemia should be considered a major biochemical complication of eclampsia. Its risk should be identified and its treatment be considered in the protocol of the management of eclamptics.