Causes and outcomes of hyponatraemia at Mater Dei Hospital, Malta

CONTEXT: Hyponatraemia is the most common electrolyte balance disorder in clinical practice, amounting to 15–20% of casualty visits. While there is general agreement that associated mortality rates are high, most studies are uncontrolled.OBJECTIVE: To determine the characteristics, causes and outcome of severe hyponatraemia (<125 mmol/l) in hospitalised patients and to indentify mortality predictors.DESIGN: This is a retrospective case-controlled study of all medical admissions in the months of February, June and November, who at any point during the index admission developed a serum sodium <125 mmol/l. For each case, an age- and gender-matched control was identified.RESULTS: A total of 5195 medical admissions were reviewed. Of these, 193 patients had a sodium level <125 mmol/. 26 patients were excluded from the case group leaving a total of 167 cases and 193 controls. Length of hospital stay was more prolonged in the case group (12 vs 8 days, P<0.001). There was a highly significant excess mortality, both during the index admission (25% in cases vs 7% in controls (P < 0.001)) as well as till the end of the follow-up period (52% in cases vs 22% in controls (P<0.001)). Mortality was unrelated to severity of hyponatraemia. Patients who developed the lowest serum sodium later on during their admission (ie sodium levels continued falling during the admission or fell de novo), had a higher rate of mortality than patients whose lowest serum sodium was on the day of admission (64.3% vs 45%, P 0.019). A cox regression analysis showed that hyponatraemia (P<0.001), male gender (P 0.033), age (P 0.021), and serum creatinine level (P 0.008) were independent risk factors for mortality. There was no statistically significant difference between the rates of ITU admission at different levels of hyponatraemia <125 mmol/l (P=0.497). Thus, serum sodium levels of <125 mmol/l should be used to identify patients who need more intensive monitoring and therapy irrespective of the degree of hyponatraemia. Only 41% of cases developed neurological symptoms, of these, confusion and altered level of consciousness were the more prevalent at 12% each, followed by falls (9%), unsteady gait (4%) and seizures (4%). The cause for hyponatraemia was frequently poorly evaluated and in 23% of cases no definite diagnosis was made.CONCLUSION: Data on assessment, investigation and management of hyponatraemia illustrates variability and shortcomings in clinical practice. The question remains whether the relationship between hyponatraemia and increased mortality is causal or associative.peer-reviewe

Case number 6 : narcolepsy and cataplexy

A 35-year-old woman from Serbia presented to the neurology department with a 20 year history of excessive daytime sleepiness and recurrent episodes of dropping to the floor whilst still retaining consciousness. These episodes were brought on by laughing or strong emotions.peer-reviewe

Surveillance of invasive pneumococcal disease in 30 EU countries: Towards a European system?

In this era of new pneumococcal conjugate vaccines (PCV), we described and compared surveillance of invasive pneumococcal disease (IPD) and PCV policies in 30 European countries to provide guidance for Europe-wide surveillance. We confirmed the heterogeneity of surveillance systems and case definitions across countries but identified elements common to all countries, such as the availability of serotyping and the surveillance of pneumococcal meningitis. PCV impact was monitored in 11/15 countries using it. We propose steps for the monitoring of incidence rates and serotype distribution at EU level, to assess the need to introduce PCV and monitor its impact once introduced.Comparative StudyJournal ArticleResearch Support, Non-U.S. Gov'tSCOPUS: ar.jinfo:eu-repo/semantics/publishe

Transcriptome and toxin family analysis of the paralysis tick, Ixodes holocyclus

© 2017 Australian Society for Parasitology. The Australian paralysis tick (Ixodes holocyclus) secretes neuropathic toxins into saliva that induce host paralysis. Salivary glands and viscera were dissected from fully engorged female I. holocyclus ticks collected from dogs and cats with paralysis symptoms. cDNA from both tissue samples were sequenced using Illumina HiSeq 100bp pair end read technologies. Unique and non-redundant holocyclotoxin sequences were designated as HT2-HT19, as none were identical to the previously described HT1. Specific binding to rat synaptosomes was determined for synthetic HTs, and their neurotoxic capacity was determined by neonatal mouse assay. They induced a powerful paralysis in neonatal mice, particularly HT4 which produced rapid and strong respiratory distress in all animals tested. This is the first known genomic database developed for the Australian paralysis tick. The database contributed to the identification and subsequent characterization of the holocyclotoxin family that will inform the development of novel anti-paralysis control methods

Copernicus Marine Service Ocean State Report, Issue 5

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