Cerebral injury during cardiopulmonary bypass: Emboli impair memory

AbstractObjectives: Cognitive deficits occur in up to 80% of patients after cardiac surgery. We investigated the influence of cerebral perfusion and embolization during cardiopulmonary bypass on cognitive function and recovery. Methods: Cerebrovascular reactivity was measured in 70 patients before coronary operations in which nonpulsatile bypass was used. Throughout the operations, middle cerebral artery flow velocity and embolization were recorded by transcranial Doppler and regional oxygen saturation was recorded by near-infrared spectroscopy. Cognitive function was measured by a computerized battery of tests before the operation and 1 week, 2 months, and 6 months after surgery. Elderly patients undergoing urologic surgery served as controls. Results: Cerebrovascular reactivity was impaired preoperatively in 49 patients. Median (interquartile range) regional cerebral oxygen saturation fell during bypass by 10% (6%-15%), indicating increased oxygen extraction, whereas mean middle cerebral flow velocity increased significantly by a median of 6 cm/s (both P <.0001, Wilcoxon), suggesting increased arterial tone. More than 200 emboli were detected in 40 patients, mainly on aortic clamping and release, when bypass was initiated, and during defibrillation. Cognitive function deteriorated more in patients having cardiopulmonary bypass than in control patients having urologic operations but recovered in most tests by 2 months. Measures of cerebral perfusion (poor cerebrovascular reactivity, low arterial pressures, and flow velocity in the middle cerebral artery) predicted poor attention at 1 week (r = 0.3, P <.01, Spearman). Emboli were associated with memory loss (r = 0.3, P <.02, Spearman). Conclusions: Cognitive deficits were common after cardiopulmonary bypass. Occult cerebrovascular disease was more severe than expected and predisposed to attention difficulties, whereas emboli caused memory deficits. We believe this to be the first report of differing cognitive effects from emboli and hypoperfusion. (J Thorac Cardiovasc Surg 2001;121:1150-60

Hypoadrenalism is not associated with early mortality during tuberculosis treatment in Malawi.

Item does not contain fulltextSETTING: In the developing world, early mortality within 1 month of commencing tuberculosis (TB) treatment is high, particularly with human immunodeficiency virus (HIV) co-infection. In Malawi, 40% of those who die do so in the first month of treatment. Reasons remain unclear and may include delayed diagnosis, opportunistic infections, immune restoration inflammatory syndrome (IRIS) or malnutrition. One possible contributing factor is underlying hypoadrenalism associated with TB-HIV, exacerbated by rifampicin (RMP) induction of P450 and glucocorticoid metabolism. OBJECTIVE: To assess the prevalence of hypoadrenalism in TB patients before and after commencement of TB treatment, and relationship with early mortality. DESIGN: Prospective descriptive study assessing hypoadrenalism before and after anti-tuberculosis treatment, HIV status and outcome up to 3 months post-treatment. RESULTS: Of 51 patients enrolled, 29 (56.9%) were female (median age 32 years, range 18-62). Of 43 patients HIV-tested, 38 (88.3%) were HIV-positive and 15.7% died within the first month. At 3 months, 11 (21.6%) were known to have died. Adequate cortisol levels were found in 49/51 (95.9%) before commencing RMP. Neither of the two with reduced response died. All 34 patients revealed adequate cortisol responses at 2 weeks. CONCLUSION: No evidence of hypoadrenalism was found in this first study to assess adrenal function and outcome of anti-tuberculosis treatment

Severe Anemia in Malawian Children

Background Severe anemia is a major cause of sickness and death in African children, yet the causes of anemia in this population have been inadequately studied. Methods We conducted a case¿control study of 381 preschool children with severe anemia (hemoglobin concentration

Severe Anemia in Malawian Children

Background Severe anemia is a major cause of sickness and death in African children, yet the causes of anemia in this population have been inadequately studied. Methods We conducted a case¿control study of 381 preschool children with severe anemia (hemoglobin concentration

Impact of the quality of life of inseminators on the results of artificial insemination programs in beef cattle Impacto da qualidade de vida dos inseminadores nos resultados de programas de inseminação artificial em bovinos de corte

The objective of the present study was to evaluate the effect of factors of personal life and work conditions on the results obtained by inseminators in conventional and fixed-timed artificial insemination programs in beef cattle. Inseminators from three farms (21 in the total) were interviewed and evaluated according to the general obtained pregnancy rates. The differences among the pregnancy rates obtained in the farms, motivation and its association with the obtained pregnancy rate and the effect of each variable of the groups of needs on the pregnancy rate at first insemination were evaluated. The open questions were grouped by similarity and then analyzed by frequency of the answers. Pregnancy rates obtained by the inseminators ranged from 12 to 57%, with a mean service index of 3.10 ± 1.62 doses/pregnancy. It was also observed that the satisfaction of biological, financial, and training needs was more intimately related to the pregnancy rate than the satisfaction of the other needs, although none had shown an antagonistic relationship with it. Factors concerned to life quality and to the work can be important in determining the performance of these professionals.<br>Objetivou-se avaliar o efeito de fatores ligados à vida pessoal e ao trabalho sobre os resultados obtidos por inseminadores em programas de inseminação artificial convencional e em tempo fixo em bovinos de corte. Inseminadores de três propriedades rurais (21 no total) foram entrevistados e avaliados quanto à taxa de gestação geral obtida. Foram avaliadas as diferenças entre as taxas de gestação obtidas nas fazendas, a motivação e sua associação com a taxa de gestação obtida e o efeito de cada variável dos grupos de necessidades sobre a taxa de gestação à primeira inseminação. As questões abertas, depois de agrupadas por similaridade, foram analisadas por frequência de respostas. A taxa de gestação obtida pelos inseminadores variou entre 12 e 57%, com índice de serviço de 3,10 ± 1,62 doses/prenhez. A satisfação das necessidades biológicas, financeiras e de treinamento foi mais intimamente relacionada à taxa de gestação que a satisfação das demais necessidades, embora nenhuma delas tenha apresentado relação antagônica com a taxa de gestação. Fatores ligados à qualidade de vida e ao trabalho podem ser importantes na determinação do desempenho dos inseminadores