Iodine deficiency in pregnant women in the ACT

In response to growing concern of an iodine deficiency emergence in Australia, this study was conducted to document the iodine status of pregnant women in the ACT. One hundred women presenting to the antenatal clinic at The Canberra Hospital answered a brief dietary questionnaire and provided a spot urine sample for the measurement of urine iodine excretion. The results revealed that the majority of women were consuming a diet low in iodine, confirmed by suboptimal concentrations of iodine in their urine

Newer cardiac troponin I assays have similar performance to troponin T in patients with end-stage renal disease

Background: Troponin T is present in the blood of a majority of patients with end-stage renal disease (ESRD) undergoing regular dialysis and presence of troponin T is a predictor of adverse outcome in these patients. With several new formulations of troponin I assays available, this study was performed to see whether these newer assays were able to detect troponin I in these patients more effectively than the older assays. Methods: One hundred and forty-three patients undergoing regular haemodialysis or peritoneal dialysis had plasma collected and troponin T and troponin I measured by a variety of assays. Results: The newer troponin I assays (Abbott Architect, Bayer Centaur and Beckman Accu-TnI) were able to detect troponin I (>75% of samples) as effectively as the Roche assay was able to detect troponin T, while other troponin I assays had a much lower rate of detection of troponin - DPC Immulite 2000 16% and Abbott AxSYM 35%. However, the troponin T assay had more samples detected at concentrations corresponding to an assay CV of 10% (59% of samples) than did the newer troponin I assays (highest on the Bayer Centaur at 37%). Conclusions: Newer assays demonstrate that troponin I is present in a similar number of samples as is troponin T, in the blood of patients with dialysis-dependent renal failure, and these newer troponin I assays identify patients at risk of experiencing a cardiac event

Contrasting longitudinal and cross-sectional relationships between insulin resistance and percentage of body fat, fitness, and physical activity in children - the LOOK study

Telford RD, Cunningham RB, Shaw JE, Dunstan DW, Lafferty ARA, Reynolds GJ, Hickman PE, Southcott E, Potter JM, Waring P, Telford RM. Contrasting longitudinal and cross-sectional relationships between insulin resistance and percentage of body fat, fitnes

The use of probiotics in intestinal protection / by Emma Southcott.

Bibliography: leaves 154-199.x, 199 leaves : ill. (some col.) ; 30 cm.While studies have suggested that gastrointestinal pathogenicity associated with conditions such as inflammatory bowel disease and chemotherapy induced mucositis can be improved by the use of probiotics, the mechanisms of probiotic protection are not clearly understood. Such knowledge is necessary to achieve maximum benefit from such forms of treatment. This thesis describes investigations undertaken, initially to establish a non-invasive measure of intestinal barrier function, and then to examine the protective effects of different yoghurts on conditions which cause loss of barrier function: chemotherapy induced mucositis, inflammatory bowel disease and athletes in training. It was found that the function of the small intestine can be compromised under stress and that probiotics may improve compromised intestines through enhancing recovery of the intestinal mucosa and the barrier function.Thesis (Ph.D.)--University of Adelaide, Dept. of Physiology, 200

Establishment of pediatric reference intervals on a large cohort of healthy children

Background: Reference intervals are essential in assessing the significance of laboratory results. There have been limited studies generating reference intervals from pediatric populations. We have studied a large cohort of healthy children on 3 separat

Prognostic efficacy of cardiac biomarkers for mortality in dialysis patients

Background: The high prevalence of cardiovascular mortality in the end-stage renal disease population is well established. The aim of this current study was to document the relative prognostic significance of established cardiac biomarkers troponin T (TnT), troponin I (TnI), B-type natriuretic peptide (BNP) and N-terminal pro-BNP (NT-pro-BNP) in this population. Methods: A prospective cohort study of dialysis patients undertaken in a single tertiary centre in Australia. Relevant clinical and biochemical information was collected at entry and all patients followed up prospectively without any loss to follow up. End-point of interest was all-cause mortality. Statistical analysis using Cox proportional hazards was used to study relationship between competing covariates and outcome. A total of 143 patients with a mean age of 59.67 ± 15.49 years was followed up for a median duration of 30 months. Of these patients, 89.3% were white Australians of European ancestry. Twenty-seven per cent had an established diagnosis of diabetes mellitus. The mean concentrations (±SD) of TnT, TnI, BNP and N-terminal peptide pro-BNP (NT-pro-BNP) were 0.08 ± 0.04g/L, 0.09 ± 0.2g/L, 270 ± 117 ng/L and 1434 ± 591 ng/L respectively. Results: Twenty-eight subjects died during the period of follow up. By univariate analysis, all cardiac markers (TnT, TnI, BNP, NT-pro-BNP and C-reactive protein) were significantly associated with an increase in mortality. On Cox proportionate hazards analysis, only albumin and NT-pro-BNP showed a significant association with mortality, with hazard ratios of 0.834, 95% confidence interval (CI) 0.779-0.893, P < 0.001, and 1.585, 95%CI 1.160-20165, P = 0.004 respectively. Conclusion: In patients with end-stage renal failure on dialysis NT-pro-BNP provides greater prognostic information compared with TnT and TnI

Elevated serum cardiac troponin I in older patients with hip fracture: incidence and prognostic significance

Introduction: Cardiovascular complications are the main causes of morbidity and mortality in patients with osteoporotic hip fracture (HF). The aim of this prospective study was to evaluate the incidence and prognostic significance of elevated cardiac troponin I (cTnI) in the early peri-operative period in older patients with HF. Materials and methods: A blind evaluation of myocardial injury as detected by cTnI elevation in 238 consecutive older patients with low-trauma HF (mean age 81.9 ± 7.8 (SD) years; 72% females). Data on demographic and clinical characteristics, in-hospital mortality, hospital length of stay and discharge destination were collected prospectively. Serum cTnI level was analysed from blood collected routinely in the first 72 h of hospital admission. Results: Sixty-nine (29%) patients had elevated cTnI (>0.06 μg/l) but myocardial injury was clinically recognised in only 23 (33%) and only 24 (34.8%) had a history of coronary artery disease (CAD). Patients with elevated cTnI were significantly older, more often had American Society of Anaesthesiologist status score ≥3, a history of CAD or stroke and more often were current smokers than the patients without cTnI elevation. In multivariate regression analysis only age was an independent predictor of cTnI elevation. Patients with cTnI release were twice as likely to have a length of stay ≥20 days (P = 0.047) and 2.7 times more likely to be discharged to a long-term residential care facility (RCF) (P = 0.013). cTnI level ≥1 μg/l was a strong independent predictor of all-cause mortality with 98.3% specificity and 89.1% negative predictive value. Conclusion: Peri-operative myocardial injury is common in older HF patients but is frequently unrecognised clinically. Elevated blood cTnI level is an independent predictor of prolonged length of hospital stay (≥20 days), need for long-term RCF and mortality (if cTnI ≥1 μg/ l)

Assessment of functional capacity before major non-cardiac surgery: an international, prospective cohort study.

BACKGROUND: Functional capacity is an important component of risk assessment for major surgery. Doctors' clinical subjective assessment of patients' functional capacity has uncertain accuracy. We did a study to compare preoperative subjective assessment with alternative markers of fitness (cardiopulmonary exercise testing [CPET], scores on the Duke Activity Status Index [DASI] questionnaire, and serum N-terminal pro-B-type natriuretic peptide [NT pro-BNP] concentrations) for predicting death or complications after major elective non-cardiac surgery. METHODS: We did a multicentre, international, prospective cohort study at 25 hospitals: five in Canada, seven in the UK, ten in Australia, and three in New Zealand. We recruited adults aged at least 40 years who were scheduled for major non-cardiac surgery and deemed to have one or more risk factors for cardiac complications (eg, a history of heart failure, stroke, or diabetes) or coronary artery disease. Functional capacity was subjectively assessed in units of metabolic equivalents of tasks by the responsible anaesthesiologists in the preoperative assessment clinic, graded as poor (10). All participants also completed the DASI questionnaire, underwent CPET to measure peak oxygen consumption, and had blood tests for measurement of NT pro-BNP concentrations. After surgery, patients had daily electrocardiograms and blood tests to measure troponin and creatinine concentrations until the third postoperative day or hospital discharge. The primary outcome was death or myocardial infarction within 30 days after surgery, assessed in all participants who underwent both CPET and surgery. Prognostic accuracy was assessed using logistic regression, receiver-operating-characteristic curves, and net risk reclassification. FINDINGS: Between March 1, 2013, and March 25, 2016, we included 1401 patients in the study. 28 (2%) of 1401 patients died or had a myocardial infarction within 30 days of surgery. Subjective assessment had 19·2% sensitivity (95% CI 14·2-25) and 94·7% specificity (93·2-95·9) for identifying the inability to attain four metabolic equivalents during CPET. Only DASI scores were associated with predicting the primary outcome (adjusted odds ratio 0·96, 95% CI 0·83-0·99; p=0·03). INTERPRETATION: Subjectively assessed functional capacity should not be used for preoperative risk evaluation. Clinicians could instead consider a measure such as DASI for cardiac risk assessment. FUNDING: Canadian Institutes of Health Research, Heart and Stroke Foundation of Canada, Ontario Ministry of Health and Long-Term Care, Ontario Ministry of Research, Innovation and Science, UK National Institute of Academic Anaesthesia, UK Clinical Research Collaboration, Australian and New Zealand College of Anaesthetists, and Monash University.This study was supported by grants from the Canadian Institutes of Health Research, Heart and Stroke Foundation of Canada, Ontario Ministry of Health and Long-Term Care, Ontario Ministry of Research, Innovation and Science, UK National Institute of Academic Anaesthesia, UK Clinical Research Collaboration, Australian and New Zealand College of Anaesthetists, and Monash University (Melbourne, VIC, Australia). DNW is supported by a New Investigator Award from the Canadian Institutes of Health Research. DNW and BHC are partly supported by Merit Awards from the Department of Anesthesia at the University of Toronto. RMP is a Career Development Fellow for the British Journal of Anaesthesia and Royal College of Anaesthetists, and a professor for the UK National Institute for Health Research. TEFA is a clinical research training fellow for the UK Medical Research Council and British Journal of Anaesthesia. MPWG holds the British Oxygen Company Chair of Anaesthesia of the Royal College of Anaesthetists, which is awarded by the UK National Institute of Academic Anaesthesia. We thank the Li Ka Shing Knowledge Institute of St Michael's Hospital (Toronto, ON, Canada) for generously supporting the costs of international trial insurance for this study, and all the participating patients and staff across the 25 study sites