Neuroprotective effects of erythropoietin in patients with severe closed brain injury

Aim: Our research was focused on the neuroprotective function of erythropoietin (Epo) in patients with severe closed traumatic brain injury (TBI). Material and Methods: Our model examined the influence of the outcome and neurological recovery in 42 adults with TBI who were admitted to ICU within 6 hours of their injury and were recruited into a randomized controlled study of two groups; only the patients of the intervention group received 10,000 i.u. of Epo for 7 consecutive days. A prognostic model based on CRASH II injury model and outcome was measured by survival and Glasgow Outcome Scale-Extended version (GOS-E) score at 6 months post-injury. Results: Six patients (18.7%) died during the first two weeks; 4 of the control group and 2 of the intervention group. A mortality rate of 22.2% and 8.3% for the control and intervention group respectively was observed. A lower rate of good outcome (GOS-E score > 4) at 6 months was mentioned among patients of the control group. Conclusion: The study provides evidence of lower mortality and better neurological outcome for the patients who received Epo increasing the possibility that Epo therapy could be used in clinical practice, limiting neuronal damage induced by TBI

Monitoring plasma voriconazole levels following intravenous administration in critically ill patients: An observational study

Data relating to the pharmacokinetics of voriconazole in critically ill patients are lacking. A prospective observational study was conducted on 18 non-consecutive critically ill patients aged 24-97 years, comprising 12 patients with normal renal function (NRF) [creatinine clearance (CLCr) ≥60mL/min] and 6 patients with moderate renal impairment (MRI) (CLCr 40-55mL/min), administered voriconazole intravenously (6mg/kg loading dose and 3-4mg/kg twice daily thereafter) in order to determine the suitability of these doses in this patient population. Steady-state blood levels were monitored and liver and renal function were recorded throughout treatment. Large variability in patient plasma levels was observed, ranging from 37% at ≤1mg/L (minimum inhibitory concentration at which, for most fungal pathogens, 90% of isolates are susceptible) to 19% at >5.5mg/L. Moreover, maintaining trough concentrations above clinical breakpoints was not consistently achieved because 16/30 (53%) were ≤1mg/L. In a few MRI patients, average concentrations were found to be significantly different compared with those of NRF patients administered the same dose, however this difference was not noted in pharmacokinetic parameters following dose normalisation. None of the patients experienced deterioration in renal or liver function. Recommended voriconazole doses are inadequate to achieve drug concentrations >1μg/mL over the entire dosing interval in some critically ill patients. © 2010 Elsevier B.V. and the International Society of Chemotherapy

Percepciones sobre servicios ambientales y pérdida de humedales arbóreos en la comunidad de Monte Gordo, Veracruz

Abstract: This study investigates the perceptions of environmental services provided by forested wetlands by inhabitants of Monte Gordo, Veracruz. Information from key informants in the community was collected through semi-structured interviews. Data were analyzed and reinforced with perceptions obtained during a pilot test, and the latter were categorized according to potentially productive population (PP) and younger students (PE). The analysis included perception and reflections between young and adult people (generational). We found that perceptions of environmental services such as considering wetlands as wildlife habitat, natural water treatment areas and using them as landfill sites varied according to groups of PP and PE as compared to the reflective level generational analysis. Key informants perceived that the major ecosystem services that wetlands provide are: foodstuff, raw materials for construction, and as a tourist attraction. The role of wetlands as sites of flooding and coastal protection was not clearly perceived. Wetland loss is perceived as a situation that has increased over time in the community, however, the situations that have caused it and the local importance varied among respondents regarding their activities. Food resources and other wetland services affect them collectively so that local initiatives are required so that they integrat the villagers, local authorities and landowners from the upland areas of the community whose activities also affect the current status of wetlands in Monte Gordo. Collective action for the common good must be strengthened.Resumen: Este estudio indaga las percepciones de los habitantes de Monte Gordo, Veracruz sobre los servicios ambientales que proveen los humedales arbóreos. Se recolectaron opiniones de informantes clave de la comunidad mediante entrevistas semi-estructuradas. Los datos se analizaron y reforzaron con las percepciones obtenidas durante una prueba piloto y estos últimos se categorizaron de acuerdo con la población productiva (PP) y jóvenes estudiantes (PE). El análisis de percepciones incluyó las reflexiones de jóvenes y adultos (generacional). Se encontró que las percepciones sobre los servicios ambientales de los humedales (hábitat de vida silvestre y tratamientos naturales de agua) y uso de los humedales (áreas de basureros) variaron significativamente entre los grupos de PP y PE al igual que el análisis reflexivo de nivel generacional. Los informantes clave percibieron que los principales servicios ambientales que los humedales proveen son: productos alimenticios, materia prima para construcción y como atracción turística. La función de humedales como sitios de protección a inundaciones y costas no fue claramente percibida. La pérdida de humedales se percibió como una situación que ha incrementado a través del tiempo en la comunidad, sin embargo, las situaciones que lo han provocado y su importancia a nivel local varió entre los entrevistados con respecto a sus actividades. Los recursos alimenticios y otros servicios de los humedales les atañen de forma colectiva por lo que se requieren iniciativas locales de acción colectiva en donde se integre a los habitantes del pueblo, autoridades municipales y a dueños de terrenos de las zonas más altas a la comunidad cuyas actividades también repercuten en la situación actual de los humedales de Monte Gordo

Is routine ultrasound examination of the gallbladder justified in critical care patients?

Objective. We evaluated whether routine ultrasound examination may illustrate gallbladder abnormalities, including acute acalculous cholecystitis (AAC) in the intensive care unit (ICU). Patients and Methods. Ultrasound monitoring of the GB was performed by two blinded radiologists in mechanically ventilated patients irrespective of clinical and laboratory findings. We evaluated major (gallbladder wall thickening and edema, sonographic Murphy's sign, pericholecystic fluid) and minor (gallbladder distention and sludge) ultrasound criteria. Measurements and Results. We included 53 patients (42 males; mean age 57.6±2.8 years; APACHE II score 21.3±0.9; mean ICU stay 35.9±4.8 days). Twenty-five patients (47.2%) exhibited at least one abnormal imaging finding, while only six out of them had hepatic dysfunction. No correlation existed between liver biochemistry and ultrasound results in the total population. Three male patients (5.7%), on the grounds of unexplained sepsis, were diagnosed with AAC as incited by ultrasound, and surgical intervention was lifesaving. Patients who exhibited <2 ultrasound findings (30.2%) were managed successfully under the guidance of evolving ultrasound, clinical, and laboratory findings. Conclusions. Ultrasound gallbladder monitoring guided lifesaving surgical treatment in 3 cases of AAC; however, its routine application is questionable and still entails high levels of clinical suspicion. © 2012 Pavlos Myrianthefs et al