Correction of hyperglycemia after surgery for diabetic foot infection and its association with clinical outcomes.

OBJECTIVE: Constantly high glycemia levels might influence outcomes in the management of patients undergoing surgery for diabetic foot infections (DFI). In our center for DFI, we performed a case-control study using a multivariate Cox regression model. Patients developing a new DFI could participate in the study several times. RESULTS: Among 1013 different DFI episodes in 586 individual adult patients (type I diabetes 148 episodes [15%], 882 [87%] with osteomyelitis; median antibiotic therapy of 21 days), professional diabetes counselling was provided by a specialized diabetes nurse in 195 episodes (19%). At admission, blood glucose levels were elevated in 110 episodes (11%). Treatments normalized glycemia on postoperative day 3 in 353 episodes (35%) and on day 7 for 321 (32%) episodes. Glycemia levels entirely normalized for 367 episodes (36%) until the end of hospitalization. Overall, treatment of DFI episodes failed in 255 of 1013 cases (25%), requiring surgical revision. By multivariate analysis, neither the provision of diabetes counseling, nor attaining normalizations of daily glycemic levels at day 3, day 7, or overall, influenced the ultimate incidence of clinical failures. Thus, the rapidity or success of achieving normoglycemia do not appear to influence the risk of treatment failure for operated DFI episodes.

Cardiovascular Safety of Clonidine and Dexmedetomidine in Critically Ill Patients after Cardiac Surgery.

PURPOSE: The aim of this retrospective study was to assess the haemodynamic adverse effects of clonidine and dexmedetomidine in critically ill patients after cardiac surgery. METHODS: 2769 patients were screened during the 30-month study period. Heart rate (HR), mean arterial pressure (MAP), and norepinephrine requirements were assessed 3-hourly during the first 12 hours of the continuous drug infusion. Results are given as median (interquartile range) or numbers (percentages). RESULTS: Patients receiving clonidine (n = 193) were younger (66 (57-73) vs 70 (63-77) years, p=0.003) and had a lower SAPS II (35 (27-48) vs 41 (31-54), p=0.008) compared with patients receiving dexmedetomidine (n = 141). At the start of the drug infusion, HR (90 (75-100) vs 90 (80-105) bpm, p=0.028), MAP (70 (65-80) vs 70 (65-75) mmHg, p=0.093), and norepinephrine (0.05 (0.00-0.11) vs 0.12 (0.03-0.19) mcg/kg/min, p < 0.001) were recorded in patients with clonidine and dexmedetomidine. Bradycardia (HR < 60 bpm) developed in 7.8% with clonidine and 5.7% with dexmedetomidine (p=0.51). Between baseline and 12 hours, norepinephrine remained stable in the clonidine group (0.00 (-0.04-0.02) mcg/kg/min) and decreased in the dexmedetomidine group (-0.03 (-0.10-0.02) mcg/kg/min, p=0.007). CONCLUSIONS: Dexmedetomidine and the low-cost drug clonidine can both be used safely in selected patients after cardiac surgery.

EEG oscillatory power dissociates between distress- and depression-related psychopathology in subjective tinnitus.

Recent research has used source estimation approaches to identify spatially distinct neural configurations in individuals with chronic, subjective tinnitus (TI). The results of these studies are often heterogeneous, a fact which may be partly explained by an inherent heterogeneity in the TI population and partly by the applied EEG data analysis procedure and EEG hardware. Hence this study was performed to re-enact a formerly published study (Joos et al., 2012) to better understand the reason for differences and overlap between studies from different labs. We re-investigated the relationship between neural oscillations and behavioral measurements of affective states in TI, namely depression and tinnitus-related distress by recruiting 45 TI who underwent resting-state EEG. Comprehensive psychopathological (depression and tinnitus-related distress scores) and psychometric data (including other tinnitus characteristics) were gathered. A principal component analysis (PCA) was performed to unveil independent factors that predict distinct aspects of tinnitus-related pathology. Furthermore, we correlated EEG power changes in the standard frequency bands with the behavioral scores for both the whole-brain level and, as a post hoc approach, for selected regions of interest (ROI) based on sLORETA. Behavioral data revealed significant relationships between measurements of depression and tinnitus-related distress. Notably, no significant results were observed for the depressive scores and modulations of the EEG signal. However, akin to the former study we evidenced a significant relationship between a power increase in the ß-bands and tinnitus-related distress. In conclusion, it has emerged that depression and tinnitus-related distress, even though they are assumed not to be completely independent, manifest in distinct neural configurations.