D. J. Jakobson and I. Shemesh
Background: Goal-oriented ultrasound examination is gaining a place in the intensive care unit. Some protocols have been proposed but the applicability of ultrasound as part of a routine has not been studied.
Objectives: To assess the influence of ultrasound performed by intensive care physicians.
Methods: This retrospective descriptive clinical study was performed in a medical-surgical intensive care unit of a university-affiliated general hospital. Data were collected from patients undergoing ultrasound examinations performed by a critical care physician from January 2010 to June 2011.
Results: A total of 299 ultrasound exams were performed in 113 mechanically ventilated patients (70 males, mean age 65 years). Exams included trans-cranial Doppler (n=24), neck evaluation before tracheostomy (n=15), chest exam (n=83), focused cardiac echocardiography (n=60), abdominal exam (n=41), and comprehensive screening at patient admission (n=30). Ultrasound was used to guide invasive procedures for vascular catheter insertion (n=42), pleural fluid drainage (n=24), and peritoneal fluid drainage (n=7). One pneumothorax was seen during central venous line insertion but no complications were observed after pleural or abdominal drainage. The ultrasound study provided good quality visualization in 86% (258 of 299 exams) and was a diagnostic tool that induced a change in treatment in 58% (132 of 226 exams).
Conclusions: Bedside ultrasound examinations performed by critical care physicians provide an important adjunct to diagnostic and therapeutic performance, improving quality of care and patient safety.
O. Havakuk, M. Entin-Meer, J. Ben-Shoshan, P. Goryainov, S. Maysel-Auslender, E.l Joffe and G. Keren
Background: Vitamin D has been shown to induce beneficial effects on cardiovascular and renal morbidity by regulating inflammation and tissue fibrosis.
Objectives: To evaluate the effect of vitamin D analogues on cardiac function and fibrosis in an animal model of cardiorenal syndrome.
Methods: Unilateral nephrectomy was performed and myocardial infarction induced in rats. Rats were treated with vitamin D receptor activator (VDRA, paricalcitol, 40 ng/250 g x 3/week) versus a vehicle. A third group of animals, which served as the control, underwent sham surgery and received no treatment. After 4 weeks of treatment, cardiac function and fibrosis were assessed by trans-thoracic echo and histology, respectively. As a parameter of systemic inflammation, previously shown to be altered in acute coronary syndrome, T regulatory (Treg) cell levels were measured by flow cytometry. Renal dysfunction was documented by standard laboratory tests.
Results: After 4 weeks of treatment, no significant improvement in cardiac function parameters was noted following VDRA administration. VDRA treatment did not significantly alter Treg cell systemic levels. Consistently, despite a trend toward less extent of myocardial fibrosis, we found no clear beneficial effects of VDRA on myocardial tissue inflammation and remodeling.
Conclusions: Vitamin D treatment showed no beneficial effects on cardiac function parameters and fibrosis in an animal model of cardiorenal syndrome.
N. Sarid, R. Eshel, E. Rahamim, M. Carmiel, I. Kirgner, M. Shpringer, S. Trestman, R. Marilus, C. Perry, A. Polliack, E. Naparstek and Y. Herishanu
Background: Janus kinase-2 (JAK2) is mutated in a high proportion of patients with polycythemia vera and in a smaller number with essential thrombocythemia and primary myelofibrosis. Mutated JAK2 is an important diagnostic marker for myeloproliferative neoplasm (MPN) and may also play a major role in the pathogenesis of MPN.
Objectives: To evaluate the prevalence of mutated JAK2 (JAK2-V617F) among patients with major intraabdominal vein thrombosis who had normal blood counts at diagnosis of the initial event.
Methods: The medical records of patients who presented with a major intraabdominal venous thrombosis and normal peripheral blood counts were obtained. JAK2-V617F mutation status was determined by real-time polymerase chain reaction.
Results: Twenty-two patients were available for this analysis and 9 (41%) were found to have JAK2-V617F. Patients with positive JAK2-V617F were younger and had more frequent clinical splenomegaly than those with wild-type JAK2.
Conclusions: A high proportion of patients presenting with “idiopathic” major intraabdominal vein thrombosis and normal blood counts carry JAK2-V617F. We recommend searching for the mutation in this clinical setting to detect patients with occult MPN.
M. Dotan, L. Ashkenazi-Hoffnung, Z. Samra, G. Livni, H. Yarden-Bilavsky, J.b Amir and E. Bilavsky
Background: Respiratory syncytial virus (RSV) is a common cause of lower respiratory tract disease and hospitalization in infants and young children. Infants of multiple births, which are often premature, might be more susceptible to developing a more severe RSV infection than singletons.
Objective: To assess the impact of multiple births on the severity of RSV infection and define risk factors for acquiring RSV infection in infants of multiple birth.
Methods: Clinical data on infants hospitalized with RSV infection between 2008 and 2010 were retrospectively collected.
Results: Twins comprised 7.6% (66/875) of hospitalized infants with RSV bronchiolitis during the study period. Infants in the twin group were younger (122.4 ± 131.7 vs. 204.5 ± 278.8 days, P = 0.014), had a lower mean gestational age (35.3 ± 2.6 vs. 38.6 ± 2.5 weeks, P < 0.001), and were more likely to have been born prematurely compared with singleton infants (65.6% vs. 13%, P < 0.001). On a multivariable logistic regression analysis, young age, early gestational age and male gender were the only variables identified as risk factors for pediatric intensive care unit admission (P < 0.001, P < 0.001 and P = 0.03, respectively). In contrast, the mere fact of a child being a twin was not found to be a significant risk factor for disease severity. In addition, if one twin is hospitalized due to RSV infection, the other has a 34% chance of also being hospitalized with bronchiolitis. Young age was a significant risk factor for hospitalization of the second twin (P < 0.001).
Conclusions: Our findings suggest that twins hospitalized with RSV bronchiolitis do not have an increased risk for severe infection as compared to singletons. However, a twin of an infant hospitalized with RSV infection has a considerable risk of also being hospitalized with bronchiolitis, thus close monitoring is recommended.
E. Ganelin-Cohen and A. Ashkenasi
There is a well-established correlation between sleep disturbances and attention deficit hyperactivity disorder (ADHD). A large number of pediatric patients diagnosed with ADHD have sleep problems, while patients with sleep disturbances often display behavioral patterns that resemble some features of ADHD. Despite these observations, the relationship between sleep problems and ADHD is not yet fully understood. It is often difficult to pinpoint which of the disorders is the primary and which a byproduct of the other. A complicating factor is that stimulant medication such as methylphenidate, a drug of choice for ADHD, may adversely affect sleep quality in ADHD patients. However, there have also been reports that it may actually improve sleep quality. This review examines the latest trends in the contemporary literature on this clinical dilemma.
R. Harel and R. Spiegelmann
M. P. Cruz-Domínguez, O. Vera-Lastra, A. Deras-Quiñones, F. Jandete-Rivera, P. Grajeda-Lopez, D. Montes-Cortes, G. Medina and L. J. Jara
J. C. Pineda, J. C. Díaz, A. Agualimpia and J, F. García
M. Zlojtro, S. Roginic, V. Nikolic-Heitzler, Z. Babic, M. K. Dusanka and A. Marinko