Role of the Iodine Global Network in Elimination of Iodine Deficiency

BACKGROUND

Iodine deficiency (ID) is a major cause of brain damage if not corrected in early pregnancy. Even mild ID leads to measurable neurointellectual impairment. The iodine global network (IGN), previously the international council for the control of iodine deficiency disorders (ICCIDD), has achieved remarkable progress in facilitating iodine nutritional sufficiency in about 70-80% of countries in the world during the past 3 decades or so.

RESULTS

At present there are 25 countries with documented iodine deficiency. However, there are still many countries, especially in Europe, with mild iodine deficiency which require active interventional strategies to ensure adequate iodine nutrition. In this context, rigorous monitoring of iodine status is essential to ensure adequate iodisation.

CONCLUSION

The IGN, with 10 world-wide regional coordinators and 100 national coordinators is well placed to implement appropriate strategies to achieve these goals. The recent award of a Horizon 20/20 grant to European stakeholders to harmonise iodine supply in Europe emphasises the commitment of the EU to make improvement in the global iodine health. There are no relevant recent patents for this report.

Cerebral oximetry and cognitive dysfunction in elderly patients undergoing surgery for hip fractures: a prospective observational study

Aim:

This study was conducted to examine perioperative cerebral oximetry changes in elderly patients undergoing hip fracture repair and evaluate the correlation between regional oxygen saturation (rSO₂) values, postoperative cognitive dysfunction (POCD) and hospital stay.

Materials and Methods:

This prospective observational study included 69 patients. Data recorded included demographic information, rSO₂ values from baseline until the second postoperative hour and Mini Mental State Examination (MMSE) scores preoperatively and on postoperative day 7. MMSE score ≤23 was considered evidence of cognitive dysfunction. Postoperative confusion or agitation, medications administered for postoperative agitation, and hospital length of stay were also recorded. Data were analyzed with Student’s t-test, Pearson’s correlation or multiple regression analysis as appropriate.

Results:

Patient age was 74±13 years. Baseline left sided rSO₂ values were 60±10 and increased significantly after intubation. Baseline rSO₂ L<50 and <45 was observed in 11.6% and 10.1% of patients respectively. Perioperative cerebral desaturation occurred in 40% of patients. MMSE score was 26.23 ± 2.77 before surgery and 25.94 ± 2.52 on postoperative day 7 (p=0.326). MMSE scores ≤ 23 were observed preoperatively in 6 and postoperatively in 9 patients. Patients with cognitive dysfunction had lower preoperative hematocrit, hemoglobin, SpO₂ and rSO₂ values at all times, compared to patients who did not. There was no correlation between rSO₂ or POCD and hospital stay. Patients with baseline rSO₂ <5 required more medications for postoperative agitation.

Conclusion:

Cognitive dysfunction occurs preoperatively and postoperatively in elderly patients with hip fractures, and is associated with low cerebral rSO₂ values.

Monitoring antiepileptic drugs: a level-headed approach

Despite advances in epilepsy therapeutics, some physicians feel uncomfortable with newer antiepileptic drugs (AEDs) due to difficulty in promptly obtaining blood levels to guide medication adjustment, and even when levels for newer AEDs are obtained, many practitioners feel they are not very useful. Lacking confidence in AEDs whose levels that cannot readily or expeditiously be measured, many clinicians share uncertainty about proper use of the newer AEDs and monitoring AED administration. Similarly, some epilepsy patients inflate the importance of AED blood level monitoring, feeling that blood levels falling within traditionally therapeutic ranges are a fail-safe for seizure control, regardless of their compliance or personal behavior aggravating seizure burden, such as poor sleep or use of illicit substances. This review examines the elusive concept of therapeutic AED blood levels and potential uses and abuses of blood level monitoring, reinforcing appropriate uses for blood levels to ensure compliance and adjust for altered AED pharmacokinetics in the context of aging and disease states, pregnancy, or drug interactions.