Is acute idiopathic pericarditis associated with recent upper respiratory tract infection or gastroenteritis? A case–control study

OBJECTIVES: The aim of this study was to assess the association of a clinical diagnosis of acute idiopathic pericarditis (AIP), and a reported upper respiratory tract infection (URTI) or gastroenteritis (GE) in the preceding month. DESIGN: Patients who were hospitalised with a first diagnosis of AIP were retrospectively compared with a control group of patients admitted with deep vein thrombosis (DVT), matched by gender and age. SETTING: Primary and secondary care level; one hospital serving a population of about 170 000. PARTICIPANTS: A total of 51 patients with AIP were included, of whom 46 could be matched with 46 patients with control DVT. Only patients with a complete review of systems on the admission note were included in the study. MAIN OUTCOME MEASURE: Conditional logistic regression was used to assess the association of a clinical diagnosis of AIP and an infectious episode (URTI or GE) in the month preceding AIP diagnosis. RESULTS: Patients with AIP had more often experienced a recent episode of URTI or GE than patients with DVT (39.1% vs 10.9%, p=0.002). The multivariate conditional regression showed that AIP was independently associated with URTI or GE in the last month preceding diagnosis (OR=37.18, 95% CI=1.91 to 724.98, p=0.017). CONCLUSIONS: This is, to the best of our knowledge, the first study demonstrating an association between a recent episode of URTI or GE and a clinical diagnosis of AIP

Bilateral and gender differences during single-legged vertical jump performance in healthy teenagers

The determination of physiologic lower limb functional imbalance among healthy teenagers is important to follow the rehabilitation progress and return to normal activity of injured subjects. We investigated the differences in vertical jump capacity between both legs in a group of healthy boys and girls, considering the performances in the dominant vs. non-dominant, and in the most vs. least efficient leg. Strength and power performances were compared in 117 boys and 106 girls aged 10-16 years during a single-leg vertical countermovement jump (SLVCJ) test. When leg dominance was defined subjectively by the participant, no difference was noted between the 2 legs. Statistically significant differences were recorded between the most and less efficient leg in strength and power performances for both genders. Girls had significantly greater peak strength than did age-matched boys, but boys showed significant increases in maximal power outputs compared with that shown by age-matched girls. When the results were analyzed according to the percentage of participants falling within certain bands of limb asymmetry, approximately 20-30% showed a difference of >15% between the 2 limbs without any relation to gender. Subjective expression of leg dominance cannot be used as a predictor of SLVCJ performance. Differences of <15% in SLVCJ performance between both legs should be considered as the physiological norm in this age group. A greater appreciation of the potential diagnostic value of the SLVCJ test may be obtained if the results are interpreted in terms of the percentage of subjects falling within certain bands of limb asymmetry. Gender-based differences in the SLVCJ test vary and depend upon whether the results are interpreted in terms of strength or power output

A low observed-to-expected postoperative mortality ratio in a Swiss high-standard peri-operative care environment – an observational study

Questions under study/principles: The objective was to assess observed-to-expected in-hospital postoperative 30-day mortality and to identify associated risks.Methods: A single centre, retrospective study was performed in Geneva University Hospitals, Switzerland. Hospitalised adult surgical patients who received anaesthesia and stayed in the Post Anaesthesia Care Unit - Intermediate Care Unit (PACU-IMC) between July 2008 and June 2011 were included. Outcome measure was in-hospital 30-day mortality. Expected probabilities of in-hospital death were estimated with the surgical mortality probability model (S-MPM). Descriptive statistics were calculated. Univariate and multivariate logistic regressions (odds ratio [OR] with 95% confidence interval [95% CI]) were used to identify risk factors of mortality.Results: Overall in-hospital mortality was 0.8% (176/24 160 patients). Observed 30-day in-hospital mortality was 0.7%; expected mortality from the S-MPM was 1.2%. Independent risk factors were age (OR 1.05, 95% CI 1.03-1.06), American Society of Anesthesiologists Physical Status score (ASA PS 3-5 vs ASA PS 1-2: OR 5.48, 95% CI 3.12-9.63), nonelective surgery (vs elective surgery) (OR 3.15, 95% CI 2.04-4.86), head surgery (OR 2.83, 95% CI 1.41-5.67) and duration of PACU-IMC stay (OR 1.00, 95% CI 1.00-1.00). A protective factor was a high body mass index (OR 0.92, 95% CI 0.89-0.96). The procedural risk, type and time of anaesthesia and day of intervention were not independent risk factors of mortality.Conclusion: The postoperative observed-to-expected mortality ratio was favourable. Independent postoperative risk factors for mortality were well-established factors such as age, ASA PS, non elective surgery but also duration of PACU-IMC stay which was considered as a surrogate of postoperative complications.</p

Incidence and risk factors of perioperative respiratory adverse events in children undergoing elective surgery

Adverse respiratory events remain one of the major causes of morbidity during anaesthesia, especially in children. The purpose of this prospective study was to determine the incidence of perioperative respiratory adverse events (PRAE) during elective paediatric surgery and to identify the risk factors for these events

What is the real impact of upper limb cast immobilisation on activity-related energy expenditure in children?

Upper limb fractures and subsequent cast immobilisation constitute a potential cause of reduction in childhood levels of physical activity (PA), with subsequent decrease of energy consumption. The main objective of this study was thus to quantify the decrease of activity-related energy expenditure (AEE) due to upper limb cast immobilisation

Prehospital risk factors of mortality and impaired consciousness after severe traumatic brain injury: an epidemiological study

Background: Severe traumatic brain injury (TBI) is a significant health concern and a major burden for society. The period between trauma event and hospital admission in an emergency department (ED) could be a determinant for secondary brain injury and early survival. The aim was to investigate the relationship between prehospital factors associated with secondary brain injury (arterial hypotension, hypoxemia, hypothermia) and the outcomes of mortality and impaired consciousness of survivors at 14 days.Methods: A multicenter, prospective cohort study was performed in dedicated trauma centres of Switzerland. Adults with severe TBI (Abbreviated Injury Scale score of head region (HAIS) >3) were included. Main outcome measures were death and impaired consciousness (Glasgow Coma Scale (GCS) ≤13) at 14 days. The associations between risk factors and outcome were assessed with univariate and multivariate regression models.Results: 589 patients were included, median age was 55 years (IQR 33, 70). The median GCS in ED was 4 (IQR 3-14), with abnormal pupil reaction in 167 patients (29.2%). Median ISS was 25 (IQR 21, 34). Three hundred seven patients sustained their TBI from falls (52.1%) and 190 from a road traffic accidents (32.3%). Median time from Out-of-hospital Emergency Medical Service (OHEMS) departure on scene to arrival in ED was 50 minutes (IQR 37-72); 451 patients had a direct admission (76.6%). Prehospital hypotension was observed in 24 (4.1%) patients, hypoxemia in 73 (12.6%) patients and hypothermia in 146 (24.8%). Prehospital hypotension and hypothermia (apart of age and trauma severity) was associated with mortality. Prehospital hypoxemia (apart of trauma severity) was associated with impaired consciousness; indirect admission was a protective factor.Conclusion: Mortality and impaired consciousness at 14 days do not have the same prehospital risk factors; prehospital hypotension and hypothermia is associated with mortality, and prehospital hypoxemia with impaired consciousness.</p

Microstructural alterations of trabecular and cortical bone in long-term HIV-infected elderly men on successful antiretroviral therapy

Progress in antiretroviral therapy (ART) has resulted in an almost normal life expectancy for HIV-infected individuals, but an increased risk of fragility fractures has been identified. We investigated the influence of long-term HIV infection on successful ART on bone microstructure in elderly men