Iron metabolism disturbance as a marker of the severity of pathology in resuscitation patients

Forty-eight patients of resuscitation wards were examined, including 15 patients with purulent peritonitis, 12 patients with acute pancreatitis, 11 patients with thermal skin damages, and 10 patients with severe acetic acid intoxication. An increase in the serum iron, ferritin, and free hemoglobin contents of blood plasma influenced the severity of endotoxicosis. This was expressed in progressive fever, increase in the leukocytic intoxication index and concentrations of low-and middle-molecular-weight substances on erythrocytes and in the blood plasma, intensification of lipid peroxidation, and insufficiency of the antioxidant defense system, which resulted in the development of multiple organ failure in patients with the above-mentioned diseases.     

Serum bone alkaline phosphatase in assessing illness severity of infected neonates in the neonatal intensive care unit

Background: Infections can influence bone metabolism of neonates, which may lead to changes in some bone metabolism biomarkers. The purpose of this study was to determine whether serum bone alkaline phosphatase (BALP), osteocalcin (OC) and beta carboxy-terminal peptide of type I collagen (CTX), as specific biomarkers of bone metabolism, can be used to assess the severity of neonatal infections.Methods: Sixty-three neonates in the NICU were enrolled in this study. The neonates were divided into infected group (n=33) and non-infected group (n=30). The scores for neonatal acute physiology-perinatal extension II (SNAPPE-II) were calculated and interleukin-6 (IL-6), procalcitonin (PCT), BALP, OC and CTX were measured among the neonates with or without infections, and among the infected neonates before and after treatment.Results: The serum BALP levels were lower in the infected group than that in the non-infected group (p<0.01). The serum BALP levels increased markedly in the infected neonates after treatment (p<0.01). The serum BALP levels were also inversely correlated with SNAPPE-II of infected neonates before and after treatment (r=-0.56, p<0.05; r=-0.37, p<0.05, respectively). In infected neonates, the differences between serum BALP levels before and after treatment were inversely correlated with those of IL-6 levels (p<0.05). There were no significant changes in the OC, CTX and PCT levels in the infected or non-infected group before and after treatment.Conclusion: Our data suggest that serum BALP level might be used as a marker for assessing the severity of illness in infected neonates.     

Tryptase as a marker of severity of aortic valve stenosis

Background

Severe aortic valve stenosis is one of the most common cause of mortality in adult patients affected with metabolic syndrome, a condition associated with an active inflammatory process involving also mast cells and their mediators, in particular tryptase. The aim of this study was to characterize the possible long-term prognostic role of tryptase in severe aortic valve stenosis.

Case presentation

The baseline serum tryptase was measured in 5 consecutive patients admitted to our Hospital to undergo aortic valve replacement for severe acquired stenosis. Within 2 years after, the patients were evaluated for the occurrence of major cardiovascular events (MACE). The tryptase measurements were higher in patients experiencing MACE (10.9, 11.7 and 9.32 ng/ml) than in non-MACE ones (5.69 and 5.58 ng/ml).

Conclusions

In patients affected with severe aortic stenosis, baseline serum tryptase may predict occurence of MACE. Further studies are needed to demonstrate the long-term prognostic role of this biomarker.

     

Aluminum balance in intensive care patients

Aluminum (Al) is a well known contaminant of intravenous solutions. The aim of the present study was the estimation of the aluminum load in patients of an intensive care unit (ICU). 15 patients with normal renal function took part. The study period was 15 days. Al was measured in serum, 24h-urine and 132 samples of parenterals. Daily Al doses were recorded. Al balance was calculated on the basis of the iatrogenic Al dose and renal Al excretion. Al analysis was performed by graphite furnace atomic absorption spectrometry (AAS) with Zeeman background correction under careful quality control. Solutions with Al levels >100 μg/l were: calcium salts, additives for parenteral nutrition solutions, antibiotics, acetylcysteine, triflupromazine, catecholamines and colloids. The Al content of solutions for parenteral nutrition ranged from 4.3 to 69 μg/l. Al doses amounted to 46 – 456 (median 119) μg/d, equivalent to 0.7 to 6.5 (median 1.7) μg/kg b.w. Renal Al excretion ranged from 10.5 to 723.1 μg/d (median 53 μg/d). These amounts partly exceeded the maximal dose (2 μg/kg b.w. per day), recommended by ASPEN/ASCN. Despite of the highly elevated renal Al excretion the median serum concentration of Al was only moderately increased (6.1 μg/l; range: <1.5 to 23.6 μg/l). However, calculations on the basis of the iatrogenic Al dose and renal Al excretion resulted in a net Al uptake (median) of 61 μg/d (maximum: 291 μg/d). Al amounts of this magnitude must be considered potentially harmful in ICU patients, especially with impaired renal function. Parenteral therapy resulted in a considerable Al dose with a positive Al balance in ICU patients. Threshold values for Al contamination of parenterally administered drugs and solutions should be established.     

Leptin as a marker for severity and prognosis of aneurysmal subarachnoid hemorrhage

Leptin has been identified as a plasma marker for outcomes in traumatic brain injury and intracerebral hemorrhage. We further investigated whether leptin might serve as a marker for severity and prognosis in aneurysmal subarachnoid hemorrhage. One hundred and eight consecutive patients and 108 sex and age – matched healthy subjects were recruited. Plasma leptin levels were measured by enzyme-linked immunosorbent assay. Clinical severity was assessed using World Federation of Neurological Surgeons score and Fisher score. Mortality and poor long-term outcome (Glasgow outcome scale scores of 1–3) at 6 months were recorded. Plasma leptin levels on admission were substantially higher in patients than in healthy controls, and were significantly associated with the clinical severity. There was also a significant association between leptin levels and clinical outcomes at 6 months in multivariate logistic regression analysis. Using receiver operating characteristic curves, we calculated areas under the curve for clinical outcomes at 6 months. The predictive performance of leptin was similar to, but did not obviously improve those of World Federation of Neurological Surgeons score and Fisher score. Thus, leptin may indicate clinical severity of the initial bleeding and also have prognostic value for clinical outcomes in aneurysmal subarachnoid hemorrhage and may therefore help in guiding treatment decisions in the setting of aneurysmal subarachnoid hemorrhage.     

Humanizing the impostor: object relations and illness equations in the neonatal intensive care unit

In this paper I explore a seemingly mundane and inconsequential act—that of placing dolls and stuffed animals into newborns' incubator machines, in what I dub a kind of teddy bear diplomacy, whereby mothers ornament their babies' high tech life-support prostheses with commonplace toys and trinkets. Using hospital ethnography and maternal interviews, I probe the psychodynamic significations of these ornamenting acts, which aspire to domesticate, animate and even humanize the incubator, itself a cyborg womb that displaces maternal purpose and problematizes bonding. The stress triggered by a high-risk infant and the double bind imposed by the therapeutic protocol lead me to here examine the intersubjectivity of illness in mothers' comorbidity and satellite syndromes. I argue that teddy bears and like artifacts serve as countertransitional objects to materially symbolize and perform the imagined mother–child dyad. Moreover, as autopoetic devices in the metamorphosis of maternal identity, they may empower a mother's vicarious participation in her child's healing, and thereby work towards closure of her own intersubjective afflictions.     

Skatole metabolites in urine as a biological marker of pigs with enhanced hepatic metabolism

Boar taint is a quality defect in meat, related to accumulation of skatole and androstenone in male pigs. The levels of skatole and its main metabolites in plasma and urine samples were measured with a validated liquid chromatography-MS method and related to activity of hepatic cytochrome P450 (CYP450) in order to identify ‘fast metabolizing’ pigs. Urine (n=46), blood (n=12), liver (n=25) and adipose tissue (n=46) were sampled from a total of 46 entire male pigs. Skatole levels in fat were negatively correlated to CYP2E1 activity and positively to 3-hydroxy-3-methyloxindole (HMOI), indole-3-carboxylic acid (ICA) and 2-aminoacetophenone in urine. HMOI and ICA levels in urine were the best predictors of high skatole levels in fat. In summary, the present study provided further evidence for the key role of CYP2E1 in skatole metabolism and suggested that measurement of HMOI and/or ICA in urine might provide information about skatole levels in live pigs.     

Iron metabolism in the yeast

Current data concerning transport, storage and utilization of iron in the yeast cells, particularly Saccharomyces cerevisiae are summarized in the paper. It has been marked that iron uptake in the cells provides by high affinity system, it function is carried out by protein complex Fet3-Ftr1, and Fet4, protein with low affinity to iron ion. The both systems utilize Fe(II). Furthermore, the active site of the protein Fre1 is exposed on the outer side of plasmalemma. This protein, due to ferrireductase activity, provides availability of Fe(III) to the cell. The information regards to participation of siderophores and metal-proton plasma membrane exchangers Smf1 in iron transport is brought. Particular attention is given to regulation of expression of the genes, coding the iron metabolic systems. Some aspects of iron utilization for Fe-S-containing enzymes synthesis are lighted. It has been concluded that the yeast is a perspective subject for studying balance of living organisms between iron essentiality and its ability to trigger free radical reactions.     

Candidaemia in cancer patients and in children in a neonatal intensive care unit

The species most frequently found in the group of neonates wasC. parapsilosis, its incidence reaching 48%. Other yeasts isolated from blood wereC. albicans (41%),C. tropicalis (7%),C. krusei andC. pseudotropicalis (2% each). Six yeast species (C. albicans 44%,C. parapsilosis 28%,C. tropicalis 11%,C. krusei 8%,C. guilliermondii 6%,C. lusitaniae 3%) were detected in cancer patients. The presence of an intravenous catheter as a possible risk in the development of candidaemia was identified in all neonates and in 69% of cancer patients.C. krusei candidaemia was associated with prophylactic fluconazole therapy.     

Follistatin-like protein 1: a serum biochemical marker reflecting the severity of joint damage in patients with osteoarthritis

Introduction  

Follistatin-like protein 1 (FSTL1) is a secreted glycoprotein that has been implicated in arthritis pathogenesis in a mouse model. The aim of this study is to detect FSTL1 expression and to further assess its potential utility as a biomarker of joint damage in osteoarthritis (OA) patients.     

Hypothermia in a surgical intensive care unit

Background

Inadvertent hypothermia is not uncommon in the immediate postoperative period and it is associated with impairment and abnormalities in various organs and systems that can lead to adverse outcomes. The aim of this study was to estimate the prevalence, the predictive factors and outcome of core hypothermia on admission to a surgical ICU.

Methods

All consecutive 185 adult patients who underwent scheduled or emergency noncardiac surgery admitted to a surgical ICU between April and July 2004 were admitted to the study. Tympanic membrane core temperature (Tc) was measured before surgery, on arrival at ICU and every two hours until 6 hours after admission. The following variables were also recorded: age, sex, body weight and height, ASA physical status, type of surgery, magnitude of surgical procedure, anesthesia technique, amount of intravenous fluids administered during anesthesia, use of temperature monitoring and warming techniques, duration of the anesthesia, ICU length of stay, hospital length of stay and SAPS II score. Patients were classified as either hypothermic (Tc ≤ 35°C) or normothermic (Tc> 35°C). Univariate analysis and multiple regression binary logistic with an odds ratio (OR) and its 95% Confidence Interval (95%CI) were used to compare the two groups of patients and assess the relationship between each clinical predictor and hypothermia. Outcome measured as ICU length of stay and mortality was also assessed.

Results

Prevalence of hypothermia on ICU admission was 57.8%. In univariate analysis temperature monitoring, use of warming techniques and higher previous body temperature were significant protective factors against core hypothermia. In this analysis independent predictors of hypothermia on admission to ICU were: magnitude of surgery, use of general anesthesia or combined epidural and general anesthesia, total intravenous crystalloids administrated and total packed erythrocytes administrated, anesthesia longer than 3 hours and SAPS II scores. In multiple logistic regression analysis significant predictors of hypothermia on admission to the ICU were magnitude of surgery (OR 3.9, 95% CI, 1.4–10.6, p = 0.008 for major surgery; OR 3.6, 95% CI, 1.5–9.0, p = 0.005 for medium surgery), intravenous administration of crystalloids (in litres) (OR 1.4, 95% CI, 1.1–1.7, p = 0.012) and SAPS score (OR 1.0, 95% CI 1.0–1.7, p = 0.014); higher previous temperature in ward was a significant protective factor (OR 0.3, 95% CI 0.1–0.7, p = 0.003). Hypothermia was neither a risk factor for hospital mortality nor a predictive factor for staying longer in ICU.

Conclusion

The prevalence of patient hypothermia on ICU arrival was high. Hypothermia at time of admission to the ICU was not an independent factor for mortality or for staying longer in ICU.     

Iron testes: sperm mitochondria as a context for dissecting iron metabolism

A recent paper in BMC Developmental Biology reports that a mitochondrial iron importer is required for Drosophila male fertility and normal mitochondrial shaping in spermatids. This suggests that mitochondrial morphogenesis during insect spermatogenesis may be a useful new context in which to study iron metabolism.     

Procalcitonin as a prognostic marker in patients with acute myocardial infarction

Background: Procalcitonin is involved in the inflammatory response and is associated with adverse prognosis in certain conditions.

Aims: To investigate the association between procalcitonin and major adverse cardiac events (MACE), left ventricular (LV) function and remodelling following acute myocardial infarction (AMI).

Methods: Plasma procalcitonin was measured in 977 patients with AMI. Subjects were followed for MACE (median 671 days). A subgroup underwent echocardiography at discharge and follow-up LV function and volume assessment.

Results: Procalcitonin was associated with MACE on uni- and multivariable analysis. Kaplan–Meier assessment revealed an adverse outcome in subjects with procalcitonin above the median. Procalcitonin was related to markers of LV dysfunction and remodelling.

Conclusion: Procalcitonin is associated with MACE, LV dysfunction and remodelling post-AMI.