Food insecurity is associated with an unhealthy lifestyle score in middle- and older-aged adults: findings from the EPIPorto cohort

The association of food insecurity with the combined effect of lifestyles is still limited. This study evaluated the association between food insecurity and a lifestyle score in middle- and older-aged adults. A cross-sectional study (2013-2016) was performed among 595 individuals (≥ 50 years) from the EPIPorto cohort (Porto, Portugal). Food security status was assessed using the US Household Food Security Survey Module: Six-Item Short Form. Information on fruit and vegetable consumption (F&V), physical activity (PA) practice, tobacco smoking, and alcohol consumption were included in a lifestyle score. Those with F&V < five portions/day, < 150 min/week of moderate-intensity PA or < 75 min/week of vigorous-intensity PA, current smokers, consumers of > one drink of alcoholic beverages in women, and > two in men were assigned with one point; all the others had nil points. The score could range from 0 to 4, and was further categorised into three categories. Food insecurity was positively associated with an unhealthy lifestyle profile (OR = 2.272; 95%CI:1.079-4.782), independently of the adjustment variables. Analysing each lifestyle component, food insecurity was associated with low PA practice (OR = 2.365; 95%CI:1.020-5.485). Individuals from food insecure households were more likely to have an unhealthy lifestyle profile. Public health strategies should be developed among food insecure individuals to promote healthy lifestyles.

Neurocritical care management supported by multimodal brain monitoring after acute brain injury

OBJECTIVE

To evaluate the association between different intensive care units and levels of brain monitoring with outcomes in acute brain injury.

METHODS

Patients with traumatic brain injury and subarachnoid hemorrhage admitted to intensive care units were included. Neurocritical care unit management was compared to general intensive care unit management. Patients managed with multimodal brain monitoring and optimal cerebral perfusion pressure were compared with general management patients. A good outcome was defined as a Glasgow outcome scale score of 4 or 5.

RESULTS

Among 389 patients, 237 were admitted to the neurocritical care unit, and 152 were admitted to the general intensive care unit. Neurocritical care unit management patients had a lower risk of poor outcome (OR = 0.228). A subgroup of 69 patients with multimodal brain monitoring (G1) was compared with the remaining patients (G2). In the G1 and G2 groups, 59% versus 23% of patients, respectively, had a good outcome at intensive care unit discharge; 64% versus 31% had a good outcome at 28 days; 76% versus 50% had a good outcome at 3 months (p < 0.001); and 77% versus 58% had a good outcome at 6 months (p = 0.005). When outcomes were adjusted by SAPS II severity score, using good outcome as the dependent variable, the results were as follows: for G1 compared to G2, the OR was 4.607 at intensive care unit discharge (p < 0.001), 4.22 at 28 days (p = 0.001), 3.250 at 3 months (p = 0.001) and 2.529 at 6 months (p = 0.006). Patients with optimal cerebral perfusion pressure management (n = 127) had a better outcome at all points of evaluation. Mortality for those patients was significantly lower at 28 days (p = 0.001), 3 months (p < 0.001) and 6 months (p = 0.001).

CONCLUSION

Multimodal brain monitoring with autoregulation and neurocritical care unit management were associated with better outcomes and should be considered after severe acute brain injury.

Oral glucose tolerance testing at 1 h and 2 h: relationship with glucose and cardiometabolic parameters and agreement for pre-diabetes diagnosis in patients with morbid obesity

BACKGROUND

One hour plasma glucose concentration (1hPG) during an oral glucose tolerance test (OGTT) may be an alternative to 2-h plasma glucose concentration (2hPG) in the identification of individuals at increased risk of hyperglycaemia, although its role is not fully understood.

AIM

We aim to investigate the relationship of these measures with other glucose parameters, as well as their relationship with cardiometabolic risk markers and the level of agreement for prediabetes mellitus diagnosis, in a sample of patients with morbid obesity.

METHODS

We retrospectively evaluated 656 patients with morbid obesity without diagnosed diabetes. To define prediabetes with 2hPG, 2022 American Diabetes Association guidelines criteria were used, while for 1hPG, glucose ≥ 155 mg/dL was considered. Cohen's Kappa coefficient was used to assess the agreement between both measures of prediabetes mellitus diagnosis.

RESULTS

A Cohen's Kappa coefficient of 0.405 (p < 0.001) was obtained. The 1hPG were positively correlated with homeostatic model assessment for insulin resistance (HOMA-IR) (ρ = 0.281, p < 0.001), fasting plasma glucose (FPG) (ρ = 0.581, p < 0.001), glycated haemoglobin (Hb1AC) (ρ = 0.347, p < 0.001) and were negatively correlated with homeostatic model assessment for cell-β function (HOMA-β) (ρ = -0.092, p = 0.018). 2hPG were also correlated with the same parameters, except for HOMA-β.

CONCLUSION

A fair agreement between 1 and 2hPG was verified. 1hPG criteria may be a useful indicator of β-cell dysfunction and insulin resistance in patients with morbid obesity without diabetes diagnosis.

Food Insecurity in Portugal during the COVID-19 Pandemic: Prevalence and Associated Sociodemographic Characteristics

Introduction

The current worldwide COVID-19 pandemic has been having a considerable impact not only on health but also on the economy of societies, emphasizing food insecurity as a significant public health concern.

Aim

The objective of this study was to characterize the scenario of food insecurity in Portugal during the COVID-19 pandemic and explore its related sociodemographic characteristics.

Methodology

This is a cross-sectional study, using data from an online survey, performed from November 2020 until February 2021, including 882 residents aged 18 years or older in Portugal. Data on sociodemographics and food security status were collected, the latter was evaluated using the United States Household Food Security Survey Module: Six-Item Short Form. Crude and adjusted logistic regression models were performed (covariates: education, household income perception, and the working status during the COVID-19 pandemic). The odds ratio (OR) and respective 95% confidence intervals (CI) were estimated.

Results

Most participants were women (71.3%), with a mean age of 36.8 years (SD 11.0). Food insecurity prevalence was 6.8%. Less-educated individuals (≤12 years of schooling; OR 2.966; 95% CI 1.250–7.042), and those who were and remained unemployed since the beginning of the pandemic (OR 2.602; 95% CI 1.004–6.742) had higher odds of belonging to a food-insecure household, regardless of education, working status during the COVID-19 pandemic, and household income perception. Moreover, lower odds of belonging to a food-insecure household were observed among those reporting a comfortable household income (OR 0.007; 95% CI 0.001–0.062) than those who perceived their household income as insufficient, independently of education and the working status during the COVID-19 pandemic.

Conclusions

These findings highlight the population groups that are at a greater risk of food insecurity during the current COVID-19 pandemic. Effective public health strategies should be developed aiming to address food insecurity during this crisis, especially among the higher risk groups.

Adequate magnesium level as an associated factor of pre-diabetes and diabetes mellitus remission in patients with obesity submitted to bariatric surgery

Bariatric surgery (BS) can lead to remission of type 2 diabetes mellitus (T2DM), however, the evidence on the influence of preoperative serum magnesium levels on this reversal is scarce. To study the influence of preoperative serum magnesium levels on the pre-T2DM and T2DM remission one year after BS. Retrospective study carried out among 1656 patients with obesity who underwent BS in the Centro Hospitalar Universitário São João. T2DM and pre-T2DM remission were defined as being normal glycaemic measures of at least one year's after BS and without pharmacological therapy. To assess the association between preoperative serum magnesium levels and pre- and T2DM remission, logistic regression models, crude and adjusted for sex, age and body mass index were computed. Patients with normoglycaemia presented hypomagnesaemia less often than those patients with pre-T2DM and T2DM (17.0% vs. 21.3% vs. 39.9%) (p < 0.001). One year after BS, 62.9% of patients with pre-T2DM or T2DM before BS showed remission. Adequate magnesium levels were positively associated with T2DM and pre-T2DM remission, one year after BS (OR 1.79; 95% CI 1.34-2.38), independently of sex, age, and body mass index. Adequate preoperative serum magnesium levels showed to be an important clinical parameter for pre-T2DM and T2DM remission.

Association between children’s food insecurity and a Healthy Eating Index in Portuguese children

Background

Evidence on the association between children's food insecurity (FI) and a priori-defined dietary patterns is scarce, particularly in Europe. This study assessed the association between children's FI and a diet quality index in a population-based sample of children.

Methods

A cross-sectional study including 2800 children from the 10-year-old follow-up of a Portuguese birth cohort, the Generation XXI study, was performed. Data on food security status, assessed by the Self-administered Food Security Survey Module for Children (SAFSSMC), dietary intake, assessed by a validated FFQ, and socio-demographic characteristics were collected. An adaptation of the Healthy Eating Index (HEI) was used, by including 7 food groups (fruit and vegetables, dairy products, fish and eggs, meat and meat products, sweet snacks, salty snacks and soft drinks) scored from 1 to 4 according to increasing quartiles of daily consumption. For the last 4 groups, a reverse score was assigned. Scores were summed up (the highest the score, the highest diet quality). Linear and logistic regression models (HEI score and its food groups divided by the sample median) were performed.

Results

The FI prevalence was 9.4%. The median (P25;P75) HEI score was 18.0 (15.0;21.0). Children's FI was inversely associated with diet quality (β=-0.671;95%CI:-1.129;-0.213), independently of maternal education, caregivers' unemployment and child's sex. By using the SAFSSMC raw score, FI increased the odds for lower (below the median) fruit and vegetables intake (OR = 1.069;95%CI:1.002-1.139), and higher intake (above the median) of meat and meat products (OR = 1.075;95%CI:1.011-1.144) and soft drinks (OR = 1.074;95%CI:1.008-1.145), independently of maternal education, caregivers' unemployment, child's sex and the other food groups consumption.

Conclusions

Food insecure children have poorer diet quality, specifically a lower fruit and vegetables consumption, and higher intake of meat and meat products, and soft drinks.

Key messages

FI was reported by 9.4% of children, and poorer diet quality was observed among food insecure children, when compared to food secure ones. Public health interventions targeting food insecure children should be developed to promote healthy dietary habits in the context of populations vulnerable to FI.

1284Food insecurity and mental health features and behaviours in adults from Portugal

Background

COVID-19 pandemic has been affecting population’s health and economies, in which food insecurity appears as important concern, particularly considering its associations with mental health and adverse behaviours. This study explored the relationship between food insecurity and mental health features and behaviours in adults from Portugal.

Methods

A cross-sectional study using data from an online survey was performed, including Portugal’s residents aged ≥18 years. Data on sociodemographics, behaviours, mental health features and food security status were collected. Food security status was evaluated with the United States Household Food Security Survey Module: Six-item Short Form. Chi-square test or Fisher's exact test, as appropriate, were used to explore the relationship between food security status and categorical variables.

Results

Food insecurity prevalence was 6.8%; showed to be significantly higher among less educated individuals (≤12 years of schooling) (p&lt;0.001), those who were employed and remained since the beginning of the pandemic (p&lt;0.001) and among those reporting need to be careful about expenses (p&lt;0.001). Comparing to individuals who were food secure, food insecure participants were more likely to smoke (p=0.009), to report depressive symptoms (p&lt;0.001) and anxiety (p&lt;0.001), measured by the Hospital Anxiety and Depression Scale.

Conclusions

From the present study, it can be concluded that the COVID-19 pandemic can affect food security in different subpopulations.

Key messages

The findings of this study have several implications for health policy and reinforce the need for investment in contexts of populations vulnerable to food insecurity

Monitoring of Cerebrovascular Reactivity in Intracerebral Hemorrhage and Its Relation with Survival

INTRODUCTION

Neuromonitoring analysis for intracerebral hemorrhage (ICH) is still rare, especially regarding vascular reactivity patterns. Our goal was to analyze neuromonitoring data and 28-day mortality for ICH patients.

METHODS

Neuromonitoring records were retrospectively reviewed from a cohort of ICH patients admitted to a neurocritical care unit between 2013 and 2016. Variables considered were intracranial pressure (ICP), cerebral perfusion pressure (CPP), optimal CPP, and pressure reactivity index (PRx), as well as ICP dose, PRx dose, and time percentage above critical value (T%abv). Information regarding demographics, surgical drainage, external ventricular drain placement, and 28-day mortality was recorded. Statistical analysis was performed using the t-test and Kaplan-Meier curves.

RESULTS

Forty-six patients were analyzed, with a mean of 263 ± 173 h of signal records and a median length of stay in the intensive care unit of 22 (interquartile range of 13) days. The mean age was 62.6 ± 11.8 years old, and 24 (52%) of the patients were male. Patients who died within 28 day (37.0%) had significantly higher mean ICP, PRx, ICP dose, PRx dose, and T%abv. Although their mean ICP was under 20 mmHg, they presented PRx > 0.25, indicating impaired cerebrovascular reactivity (0.30 ± 0.26). Also, patients with PRx > 0.25 had a lower survival rate, with a proportion of 14% at 28 days, as opposed to 85% of those with PRx < 0.25 (p < 0.001).

CONCLUSION

The data suggest that autoregulation indexes are associated with 28-day mortality for ICH patients.

Type 2 Diabetes Mellitus Remission in Obese Patients Under Bariatric Surgery: The Role of Preoperative Triglycerides Levels

Background: There is abundant evidence reporting the relationship between triglycerides levels and type 2 diabetes mellitus, however few studies confirmed the influence of triglycerides levels on the incidence of diabetes. Bariatric surgery may lead to the remission of type 2 diabetes mellitus, but the effect of basal serum triglycerides levels on this reversal is unknown. This study aimed to assess the association between preoperative triglycerides levels and pre- and type 2 diabetes mellitus remission in obese patients one year after bariatric surgery.

Methods: A retrospective study was conducted among 1959 obese patients who underwent bariatric surgery in our entre. Data on socio-demographic and clinical characteristics were used. Pre-diabetes and type 2 diabetes mellitus remission was defined as normal glycaemic measures at least one year’s duration without pharmacological therapy. Logistic regression models, crude and adjusted for sex, age, preoperative serum triglycerides levels and type of bariatric surgery, were used.

Results: The median of preoperative serum triglycerides level was 121.00 (SD=75.00) mg/dL, and 34.7% and 30.0% of patients presented pre- and type 2 diabetes mellitus, respectively, at baseline. Preoperative serum triglycerides levels were higher in type 2 diabetes mellitus patients (139.00 vs. 106.00 mg/dL, in normal glycaemic patients; p<0.001) and showed to be significantly correlated with fasting glycaemia, glycated

haemoglobin, homeostasis model assessment of insulin resistance and homeostasis model assessment of β-cell function. One year after bariatric surgery, 62.5% of patients with pre- or type 2 diabetes at baseline showed remission. Preoperative serum triglycerides levels were negatively associated with this remission (OR: 0.997; 95%CI=0.995–0.998), independently of, sex, age and type of bariatric surgery. Conclusions: One year after bariatric surgery, 62.5% of patients showed pre- or type 2 diabetes mellitus remission, being the preoperative serum triglycerides levels an important clinical parameter for remission.

Keywords: triglycerides, diabetes, remission, obesity, bariatric surgery

MON-584 Albuminuria and Obesity - Which Are the Associated Factors?

Introduction

The association between obesity and renal dysfunction has been widely studied. Albuminuria is a cardiovascular risk factor and the most prevalent marker of kidney injury in people with obesity. Despite the higher prevalence of hypertension and diabetes in those patients, other contributing factors are still unknown.

We aimed to explore the factors related to albuminuria in obesity, analyzing its variation after bariatric surgery.

Methods

We evaluated 2518 patients undergoing bariatric surgery, of those, 1243 with preoperative albuminuria measurement were included in this study. Albuminuria was determined by the albumin-creatinine ratio (RAC) in an occasional urine sample (mg/g) or by the 24-hour urine albumin excretion rate (TEA) (mg/24h). Means and medians were compared using Student’s T-test or Mann-Whitney tests, respectively. Spearman correlation was used.

Results Age (ρ = 0.073; p = 0.010), body mass index (BMI) (ρ = 0.139; p <0.001), waist circumference (WC) (ρ = 0.220; p <0.001), glycated hemoglobin (HbA1C) (ρ = 0.221; p <0.001), systolic blood pressure (SBP) (ρ = 0.203; p <0.001), diastolic blood pressure (DBP) (ρ = 0.134; p <0.001), uricemia (ρ = 0.141; p <0.001) and C-reactive protein (CRP) levels (ρ = 0.090; p = 0.017) were positively correlated with albuminuria.Patients with albuminuria (TEA / RAC≥30) had higher BMI (45.0 ± 6.0 vs.43.2 ± 5.6kg / m2; p <0.001), WC (129.3 ± 13.1 vs. 122.0 ± 12.9cm; p <0.001), SBP (142.7 ± 18.0 vs.134.1 ± 16.5mmHg; p <0.001), DBP (88.0 ± 12.6 vs.83, 2 ± 10.3mmHg; p <0.001), uricemia (6.1 ± 1.5 vs.5.4 ± 1.4mg / dL; p <0.001) and CRP (11.3 (16.4) vs.8, 3 (9.6) mg / L; p <0.001).Excluding patients with diabetes and hypertension, BMI and WC remained statistically positively correlated with urinary albumin excretion. After surgery, the decrease of albuminuria was correlated with the reduction of HbA1C (ρ = 0.144; p <0.001) and CRP (ρ = 0.113; p = 0.037).

Conclusion Anthropometric, inflammatory and metabolic factors, namely WC, CRP and uricemia, may be involved in the etiopathogenesis of albuminuria in obese patients. Bariatric surgery is the most effective method to reverse obesity and it has been shown to be a promising therapy on the treatment of associated renal dysfunction.

Secular trend in age at menarche in women in Portugal born between 1920 and 1992: Results from three population-based studies

OBJECTIVES

Worldwide data on age at menarche suggest a gradually earlier maturation, which is stabilizing in some societies. The interplay between socioeconomic, behavioral, and environmental factors generates uncertainty about the current status and future trend of age at menarche in most societies. Therefore, we aimed to describe trends in age at menarche during the 20th century in Portugal.

METHODS

A sample of 11 274 women born between 1920 and 1992 in northern Portugal, recruited to participate in three population-based cohorts (EPIPorto, EPITeen, and Generation XXI) was evaluated. Age at menarche across birth year categories was compared using ANOVA and the rate of change over time using linear regression.

RESULTS

Age at menarche decreased with birth year (-31.1 days per 5 years; β = -.017, P < .001), women born before 1930 having a significantly higher age at menarche than those who were born after 1990 (mean (SD) = 13.1 (1.83) vs 12.0 (1.25), P < .001).

CONCLUSIONS

The decrease in age at menarche in northern Portugal suggests that a plateau is yet to be reached. Attention to time trends in age at menarche is relevant for health promotion since there is a possible relationship between pubertal timing and the later development of the metabolic syndrome.

Application of the mixture item response theory model to the Self-Administered Food Security Survey Module for Children

Background

The Self-Administered Food Security Survey Module for Children was developed to assess food insecurity of individual children and has not been used in Portugal. We aimed to apply the mixture item response theory model to the Self-Administered Food Security Survey Module for Children, to assess its reliability and validity, and to estimate the cut-offs of the food security status for Portuguese children.

Methods

The scale was self-administered to 2132 children of the Generation XXI birth cohort. The internal consistency was assessed using Cronbach’s alpha. We evaluated dimensionality and/or clustering, and Latent Class Analysis, Latent Trait Analysis and Mixture Latent Trait Analysis were tested. The number of classes and/or traits were defined according to the Akaike Information Criterion, Bayesian Information Criterion, Adjusted Bayesian Information Criterion, Vuong-Lo-Mendell-Rubin Likelihood Ratio Test, Bootstrapped Likelihood Ratio Test and Entropy. Construct validity was explored using socio-demographic characteristics. The classification tree was used to define cut-offs to predict cluster membership.

Results

The best model was a Mixture Latent Trait Analysis with 1 factor and 2 classes (food security and food insecurity), assuming class variant item parameters (for items 1 and 3). Based on the estimated posterior probabilities, the food insecurity prevalence was 17.6%. Cronbach’s alpha was 0.617. A higher proportion of less-educated mothers and low-income households was observed in the food insecurity class. The classification tree showed an accuracy of 100.0% by identifying the food security and food insecurity groups.

Conclusion

Our results supported that the Self-Administered Food Security Survey Module for Children provides a valid and reliable measure, which allows the identification of food insecurity among Portuguese children.

Food Insecurity in Portugal Among Middle- and Older-Aged Adults at a Time of Economic Crisis Recovery: Prevalence and Determinants

BACKGROUND

To characterize the scenario of food insecurity in Portugal at a time of economic crisis recovery is of the utmost relevance.

OBJECTIVE

This study aimed to estimate the prevalence and to identify the determinants of food insecurity during economic crisis recovery in a population-based urban sample of middle- and older-aged Portuguese adults.

METHODS

A cross-sectional study including 604 participants of the EPIPorto cohort was conducted. Data on sociodemographic characteristics and on food security status were collected. Food security status was assessed using the US Household Food Security Survey Module: Six-Item Short Form. Logistic regression models, crude and adjusted for sex, age, education, and household income perception, were performed.

RESULTS

The prevalence of food insecurity was 16.6%. Women (odds ratio [OR] = 1.96; 95% confidence interval [CI]: 1.09-3.54), those less educated (OR = 5.46; 95% CI: 2.84-10.46), and those who had the perception of an insufficient household income (OR = 10.39; 95% CI: 5.00-21.56) were more likely to belong to a food insecure household. Unmarried individuals (OR = 1.79; 95% CI: 1.05-3.06) and lower white-collar workers (OR = 2.22; 95% CI: 1.03-4.77) were also more prone to live within a food insecure household, regardless of sex, age, education, and household income perception.

CONCLUSIONS

The obtained information is valuable for the development of intervention strategies to reduce food insecurity in middle- and older-aged adults, suggesting that women, unmarried, less educated individuals, less skilled workers, and lower income families should be targeted.

Open heart surgery for management of right auricular thrombus related to central venous catheterization

Central venous catheters are widely used in critically ill patients; however, they are also associated with increased morbidity and mortality. The literature may underestimate the incidence of catheter-inducible right atrial thrombi that are asymptomatic but potentially life threatening. The recognized risk factors for its development include infections related to the catheter, endothelial injury secondary to mechanical and chemical damage induced by certain medications and infused fluids. The characteristics of the patient and the catheter, such as size, material, type, location and ease of insertion, as well as the duration of placement play an additional role. We report the case of a 38-year-old man, who developed an asymptomatic catheter-inducible right atrial thrombi requiring open heart surgery, after taking a central venous catheter for thirty-five days. The present case highlights existing limitations in making a correct and fast diagnosis, which should be anticipated in patients with multiple risk factors for thrombosis. Given the limited recommendations available, we consider that the most appropriate strategy should be individualized.

Optimal Cerebral Perfusion Pressure Management at Bedside: A Single-Center Pilot Study

BACKGROUND

Guidelines recommend cerebral perfusion pressure (CPP) values of 50-70 mmHg and intracranial pressure lower than 20 mmHg for the management of acute traumatic brain injury (TBI). However, adequate individual targets are still poorly addressed, since patients have different perfusion thresholds. Bedside assessment of cerebral autoregulation may help to optimize individual CPP-guided treatment.

OBJECTIVE

To assess staff compliance and outcome impact of a new method of autoregulation-guided treatment (CPPopt) based on continuous evaluation of cerebrovascular reactivity (PRx).

METHODS

Prospective pilot study of severe TBI adult patients managed with continuous multimodal brain monitoring in a single Neurocritical Care Unit (NCCU). Every minute CPPopt was automatically estimated, based on the previous 4-h window, as the CPP with the lowest PRx indicating the best cerebrovascular pressure reactivity. Patients were managed with CPPopt targets whenever possible and otherwise CPP was managed following general/international guidelines. In addition, other offline CPPopt estimates were calculated using cerebral oximetry (COx-CPPopt), brain tissue oxygenation (ORxs-CPPopt), and cerebral blood flow (CBFx-CPPopt).

RESULTS

Eighteen patients with a total multimodal brain monitoring time of 5,520 h were enrolled. During the total monitoring period, 11 patients (61 %) had a CPPopt U-shaped curve, 5 patients (28 %) had either ascending or descending curves, and only 2 patients (11 %) had no fitted curve. Real CPP correlated significantly with calculated CPPopt (r = 0.83, p < 0.0001). Preserved autoregulation was associated with greater Glasgow coma score on admission (p = 0.01) and better outcome (p = 0.01). We demonstrated that patients with the larger discrepancy (>10 mm Hg) between real CPP and CPPopt more likely have had adverse outcome (p = 0.04). Comparison between CPPopt and the other estimates revealed similar limits of precision. The lowest bias (-0.1 mmHg) was obtained with COx-CPPopt (NIRS).

CONCLUSION

Targeted individual CPP management at the bedside using cerebrovascular pressure reactivity seems feasible. Large deviation from CPPopt seems to be associated with adverse outcome. The COx-CPPopt methodology using non-invasive CO (NIRS) warrants further evaluation.

Pressures, flow, and brain oxygenation during plateau waves of intracranial pressure

BACKGROUND

Plateau waves are common in traumatic brain injury. They constitute abrupt increases of intracranial pressure (ICP) above 40 mmHg associated with a decrease in cerebral perfusion pressure (CPP). The aim of this study was to describe plateau waves characteristics with multimodal brain monitoring in head injured patients admitted in neurocritical care.

METHODS

Prospective observational study in 18 multiple trauma patients with head injury admitted to Neurocritical Care Unit of Hospital Sao Joao in Porto. Multimodal systemic and brain monitoring of primary variables [heart rate, arterial blood pressure, ICP, CPP, pulse amplitude, end tidal CO₂, brain temperature, brain tissue oxygenation pressure, cerebral oximetry (CO) with transcutaneous near-infrared spectroscopy and cerebral blood flow (CBF)] and secondary variables related to cerebral compensatory reserve and cerebrovascular reactivity were supported by dedicated software ICM+ ( www.neurosurg.cam.ac.uk/icmplus) . The compiled data were analyzed in patients who developed plateau waves.

RESULTS

In this study we identified 59 plateau waves that occurred in 44% of the patients (8/18). During plateau waves CBF, cerebrovascular resistance, CO, and brain tissue oxygenation decreased. The duration and magnitude of plateau waves were greater in patients with working cerebrovascular reactivity. After the end of plateau wave, a hyperemic response was recorded in 64% of cases with increase in CBF and brain oxygenation. The magnitude of hyperemia was associated with better autoregulation status and low oxygenation levels at baseline.

CONCLUSIONS

Multimodal brain monitoring facilitates identification and understanding of intrinsic vascular brain phenomenon, such as plateau waves, and may help the adequate management of acute head injury at bed side.

Comparison of fertility, regular returns-to-estrus, and calving interval between Ovsynch and CO-synch + CIDR protocols in dairy cows

The main aims of the present study were to compare the pregnancy rate (PR), regular returns-to-estrus, and calving interval of a CO-Synch + controlled internal drug release (CIDR) device, commonly used to synchronize ovulations in beef cows, with the classical Ovsynch protocol in high-producing dairy cows. Holstein-Friesian cows (n = 128) from six commercial dairy herds, ≥40 days postpartum and not previously inseminated, were randomly assigned to one of two treatments. Cows submitted to Ovsynch protocol (group OS as control group; n = 66) received 10 μg of a GnRH analogue 7 days before and 48 hours after 25 mg PGF2α, followed by artificial insemination (AI) 16 hours after the second GnRH administration. Cows submitted to CO-Synch + CIDR (1.38 g of progesterone) inserted for 7 days beginning at the first GnRH administration (group CoS + CD; n = 62) had the second administration of GnRH concurrent with AI, 64 hours after CIDR removal/PGF2α administration. Nonpregnant cows with return-to-estrus between 18 and 24 days after first AI were reinseminated (second AI). Logistic regressions were used to analyze PR and returns-to-estrus. No effect of group or herd was observed in PR at first timed AI. However, the sum of cows pregnant at first AI and nonpregnant cows with regular returns-to-estrus and the total PR (first + second AI) were influenced by group treatment. Overall, cows of group CoS + CD (total PR = 56.5%) were 2.1 times more likely to became pregnant after AI and until first regular returns-to-estrus than cows of group OS. The calving interval was lower in group CoS + CD (425.9 ± 78.8 days; ±SD) than in group OS (475.3 ± 83.7 days). The CO-Synch + CIDR protocol was reliable to use in dairy herds and provided reproductive advantages when compared with Ovsynch protocol.