THE COURSE OF ASTHMA DURING PREGNANCY IN A RECENT, MULTICASE-CONTROL STUDY ON RESPIRATORY HEALTH

Background Over the years it has been widely stated that approximately one third of asthmatic women experience worsening of the disease during pregnancy. However, the literature has not been reviewed systematically and the meta-analytic reviews include old studies. This study aimed to examine whether the prevalence of worsening asthma during pregnancy is still consistent with prior estimate or it has been reduced. Methods A detailed Clinical Questionnaire on respiratory symptoms, medical history, medication, use of services, occupation, social status, home environment and lifestyle was administered to random samples of the Italian population in the frame of the Gene Environment Interactions in Respiratory Diseases (GEIRD) study. Only clinical data belong to 2.606 subjects that completed the clinical stage of the GEIRD study, were used for the present study. Results Out of 1.351 women, 284 self-reported asthma and 92 of them had at least one pregnancy. When we considered the asthma course during pregnancy, we found that 16 women worsened, 31 remained unchanged, 25 improved. Seven women had not the same course in the different pregnancies and 13 did not know. The starting age of ICS use almost overlaps with that of asthma onset in women with worsening asthma during pregnancy (19 years \ub11.4), unlike the other women who started to use ICS much later (30.3 years \ub112). In addition, the worsening of asthma was more frequent in women with an older age of onset of asthma (18 years \ub19 vs 13 years \ub110). Among women who completed the ACT during the clinical interview, the 50% of women who experienced worsening asthma during pregnancy (6/12) had an ACT score below 20. Conclusion Asthma was observed to worsen during pregnancy in a percentage much lower to that generally reported in all the previous studies. There is still room in clinical practice to further reduce worsening of asthma during pregnancy by improving asthma control, with a more structured approach to asthma education and management prepregnanc

Dimethylarginines in critically ill patients with severe sepsis or septic shock

Objective:We investigated the trend of asymmetric dimethylarginine (ADMA) and symmetryc dimethyarginine (SDMA) in patients with severe sepsis and septic shock, and the relationship between dymethylarginines, organ failure, sepsis status and intensive care unit (ICU) mortality. Design: A prospective observational study carried out in three general adults Italian ICUs. Patient: Consecutive patients with severe sepsis or septic shock admitted to ICUs between December 2004 and March 2007. Methods: Plasma ADMA and SDMA were determined immediately after enrolment and on the third, sixth and twelfth days. Organ failure score, sepsis status, standard blood parameters and ICU outcome were collected. Resul\uc3\ub2ts: Twenty-nine consecutive patients were enrolled. ADMA and SDMA were higher in patients than in healthy volunteers. Sixteen patients who suffered from septic shock during ICU stay had a higher avarage value of daily ADMA and SDMA. ADMA was significantly related to arterial pH level, daily Sequential Organ Failure Assessment score and creatinine. Independent variables predicting ICU mortality were Simplified Acute Physiology Score II, mean Sequential Organ Failure Assessment score and SDMA. Conclusions: Dimethylarginines are not only markers of body catabolism may have a high metabolic activity, tightly related to the risk of adverse outcome of sepsis syndrome

Tight glycemic control does not affect asymmetric-dimethylarginine in septic patients

OBJECTIVE: We investigated whether preventing hyperglycemia in septic patients affected the plasma concentration of asymmetric-dimethylarginine and if this was associated with clinical benefit. DESIGN: A prospective, multicenter, randomized, controlled, clinical study. SETTING: Intensive care units (ICU) in three university hospitals. PATIENTS: A total of 72 patients admitted for severe sepsis or septic shock, who stayed at least 3 days in the ICU. At admission the patients were assigned to receive either tight or conventional glycemic control. INTERVENTIONS: Determination of circulating levels of asymmetric-dimethylarginine, arginine, interleukin-6, C-reactive-protein and tumor-necrosis-factor-alpha. MEASUREMENTS AND RESULTS: Blood was sampled at admission (no differences between groups), and on the 3rd, 6th, 9th, and 12th (T12) days. Sequential organ failure assessment was scored at each sampling time. All the data were analyzed on an intention-to-treat basis. The control and treatment groups received the same energy intake, glycemia (110.4 +/- 17.3 vs. 163.0 +/- 28.9 mg/dL, P < 0.001) and insulin (P = 0.02) supply differed. No differences were found in high plasma levels of asymmetric-dimethylarginine (P = 0.812) at any time during the ICU stay. The clinical course, as indicated by markers of inflammation, average and maximum organ failure score, ICU stay and ICU and 90-day mortality, was the same. CONCLUSIONS: Intensive insulin treatment, while achieving glucose control, did not reduce asymmetric-dimethylarginine in high-risk septic patients fed with no more than 25 kcal/kg per day to limit ventilatory demand and to simplify glucose control. DESCRIPTOR: 45 (SIRS/sepsis: clinical studies)

Prevalence of traumatic brain injury and mental health problems among individuals within the criminal justice system.

Traumatic brain injury (TBI) is associated with increased aggression and antisocial behavior. This review examined existing literature regarding TBI prevalence and associated adverse mental health among individuals within the criminal justice system. TBI prevalence varied between 12 and 82% for youths, and 23 and 87% for adults. TBI was associated with a range of negative outcomes, particularly substance abuse. However, confounding factors, including differing control groups, lack of information for timing and severity of TBI, and use of self-report measures for TBI history made it difficult to determine whether TBI was a risk factor. Future research should eliminate or counter for these confounds, to provide accurate prevalence rates of TBI and the direction of association between TBI and offending behaviors

Anaesthesia and orphan diseases : difficult tracheal intubation in a child with Frank-ter Haar syndrome

We present a case of a child affected by Frank\u2013ter Haar syndrome with a difficult airway whom we intubated with a fibreoptic bronchoscope (FOB) through the AirQ intubating laryngeal airway (ILA) device (Cookgas LLC, Mercury Medical, Clearwater, Florida, USA)4 after two unsuccessful videolaryngoscopy attempts using Glidescope (Verathon Medical Europe, Ijsselstein, Netherlands) and McGrath (Aircraft Medical Ltd, Edinburgh, UK) devices

The effect of cognitive status and visuospatial performance on affective theory of mind in Parkinson's disease

It is now well accepted that theory of mind (ToM) functioning is impaired in Parkinson's disease (PD) patients. However, what remain unknown are the functions that underlie this impairment. It has been suggested that cognitive skills may be key in this area of functioning; however, many of the cognitive tests used to assess this have relied on intact visuospatial abilities. This study aimed to examine whether deficits in ToM were generated by cognitive or visuospatial dysfunction and the mediating effect of visuospatial function on ToM performance. Fifty PD patients (31 male, 19 female; mean age = 66.34 years) and 49 healthy controls (16 male, 33 female; mean age = 67.29 years) completed a ToM task (reading the mind in the eyes) and visuospatial task (line orientation). The results revealed that current cognitive status was a significant predictor for performance on the ToM task, and that 54% of the total effect of cognitive status on ToM was mediated by visuospatial abilities. It was concluded that visuospatial functioning plays an important mediating role for the relationship between executive dysfunction and affective ToM deficits in PD patients, and that visuospatial deficits may directly contribute to the presence of affective ToM difficulties seen in individuals with PD

The effect of cognitive status and visuospatial performance on affective theory of mind in Parkinson&#39;s disease

Audrey McKinlay,1,2 Michelle Albicini,2 Phillip S Kavanagh31Department of Psychology, University of Canterbury, Christchurch, New Zealand; 2Department of Psychology and Psychiatry, Monash University Clayton, VIC, Australia; 3School of Psychology, Social Work and Social Policy, University of South Australia, ADL, AustraliaAbstract: It is now well accepted that theory of mind (ToM) functioning is impaired in Parkinson&#39;s disease (PD) patients. However, what remain unknown are the functions that underlie this impairment. It has been suggested that cognitive skills may be key in this area of functioning; however, many of the cognitive tests used to assess this have relied on intact visuospatial abilities. This study aimed to examine whether deficits in ToM were generated by cognitive or visuospatial dysfunction and the mediating effect of visuospatial function on ToM performance. Fifty PD patients (31 male, 19 female; mean age = 66.34 years) and 49 healthy controls (16 male, 33 female; mean age = 67.29 years) completed a ToM task (reading the mind in the eyes) and visuospatial task (line orientation). The results revealed that current cognitive status was a significant predictor for performance on the ToM task, and that 54% of the total effect of cognitive status on ToM was mediated by visuospatial abilities. It was concluded that visuospatial functioning plays an important mediating role for the relationship between executive dysfunction and affective ToM deficits in PD patients, and that visuospatial deficits may directly contribute to the presence of affective ToM difficulties seen in individuals with PD.Keywords: Parkinson&#39;s disease, theory of mind, visuospatial function, social cognition, executive functio

ASYMMETRIC (ADMA) AND SYMMETRIC (SDMA) DIMETHYLARGININE IN SEPTIC PATIENTS

Rationale: Endothelium-derived NO plays a critical rule in regulation of blood pressure, preservation of organ perfusion and interaction between vascular endothelium and blood platelets/leukocytes. ADMA is an endogenous nonselective inhibitor of nitric oxide (NO) synthase and SDMA competes with arginine for cellular transport. The aim of the study was to investigate if ADMA and SDMA are increased in \u2018\u2018sepsis syndrome\u2019\u2019 due to protein catabolism and eventually to decreased epato-renal elimination. Methods: Twenty-nine consecutive septic patients, as defined by the ACCP/SCCM1 were enrolled. Blood sampling was performed on admission day (T0), 3rd(T3), 6th(T6), 9th(T9), 12th(T12). ADMA and SDMA (mmol/L)were measured by HPLC. ADMA and SDMA were also measured in 77 healthy volunteers. SAPSII at ICU admission, SOFA score, and sepsis status1 were recorded daily. Data are presented as mean7SD. Differences between groups were analysed with Student\u2019s t-test, ANOVA and Scheffe` test. Significance was set at po0.05. Results: Mean ADMA (1.0470.44 vs 0.4670.13, n \ubc 116, po0.0000) and SDMA levels (2.271.3 vs 0.470.09, n \ubc 116, po0.0000), all samples together, are higher than in healthy volunteers. SDMA level during Severe Sepsis/Septic Shock(1)days is significantly higher than during Sirs/Sepsis days (2.471.35 vs 1.8871.22, n \ubc 116, p \ubc 0.038) while ADMA (1.170.51 vs 0.9570.29, n \ubc 116, p \ubc 0.07) shows a trend. Patients who developed Septic Shock along ICU stay have higher values of ADMA (1.1370.5, n \ubc 64 vs 0.937 0.32, n \ubc 52, po0.013) and SDMA (2.6271.48, n \ubc 64 vs 1.6970.86, n \ubc 52, p \ubc 0.0001). Conclusions: ADMA and SDMA levels are consistently higher in critically ill septic patients than in healthy volunteers. These values are even higher in Severe Sepsis/Septic Shock status