The Neck Disability Index (NDI) and its correlation with quality of life and mental health measures among patients with single-level cervical disc disease scheduled for surgery.

BACKGROUND: The Neck Disability Index (NDI) is widely used as a self-rated disability score in patients with cervical radiculopathy. The purpose of this study was to evaluate whether the NDI score correlated with other assessments of quality of life and mental health in a specific group of patients with single-level cervical disc disease and corresponding radiculopathy. METHODS: One hundred thirty-six patients were included in a prospective, randomized controlled clinical multicenter study on one-level anterior cervical discectomy with arthroplasty (ACDA) versus one-level anterior cervical discectomy with fusion (ACDF). The preoperative data were obtained at hospital admission 1 to 3 days prior to surgery. The NDI score was used as the dependent variable and correlation as well as regression analyses were conducted to assess the relationship with the short form-36, EuroQol-5Dimension-3 level and Hospital Anxiety and Depression Scale. RESULTS: The mean age at inclusion was 44.1 years (SD ±7.0, range 26-59 years), of which 46.3 % were male. Mean NDI score was 48.6 (SD = 12.3, minimum 30 and maximum 88). Simple linear regression analysis demonstrated a significant correlation between NDI and the EuroQol-5Dimension-3 level [R = -0.64, 95 % confidence interval (CI) -30.1- -19.8, p < 0.001] and to a lesser extent between NDI and the short form-36 physical component summary [R = -0.49, 95 % CI (-1.10- -0.58), p < 0.001] and the short form-36 mental component summary [R = -0.25, 95 % CI (-0.47- -0-09), p = 0.004]. Regarding NDI and the Hospital Anxiety and Depression Scale, a significant correlation for depression was found [R = 0.26, 95 % CI (0.21-1.73), p = 0.01]. Multiple linear regression analysis showed a statistically significant and the strongest correlation between NDI and the independent variables in the following order: EuroQol-5Dimension-3 level [R = -0.64, 95 % CI (-23.5- -7.9), p <0.001], short form-36 physical component summary [R = -0.41, 95 % CI (-0.93- -0.23), p = 0.001] and short form-36 mental component summary [R = -0.36, 95 % CI (-0.53- -0.15), p = 0.001]. CONCLUSION: The results from the present study show that the NDI correlated significantly with a different quality of life and mental health measures among patients with single-level cervical disc disease and corresponding radiculopathy.

Toxicogenetics--cytochrome P450 microarray analysis in forensic cases focusing on morphine/codeine and diazepam.

Genetic polymorphisms in cytochrome P 450 (CYP) enzymes could lead to a phenotype with altered enzyme activity. In pharmacotherapy, genotype-based dose recommendations achieved great importance for several drugs. In our pilot study, we ask if these genetic tests should be applied to forensic problems as a matter of routine. Starting from 2004 through 2008, we screened routine cases for samples where the relation of parent compound to metabolite(s) (P/M ratio), particularly morphine to codeine ratios and diazepam to its metabolites, was noticeable or not consistent with the information provided by the defendants. We found 11 samples with conspicuous results. These were analyzed for polymorphisms of the CYP 2D6 and 2C19 genes using the Roche AmpliChip Cytochrome P450 Genotyping test. If not previously conducted, a general unknown analysis by gas chromatography/mass spectrometry (GC/MS) was additionally carried out. For CYP 2D6, we found two cases with the genotype poor metabolizer (PM), three cases with heterozygote extensive metabolizer genotype classified as an intermediate metabolizer (IM) with probably reduced enzyme activities, but no ultrarapid metabolizer genotype. For CYP 2C19, two cases were characterized as IM phenotypes, with no PM found. Once we achieved no appropriate amounts of DNA, one case was excluded after GC/MS analysis. Only in one case could the polymorphism clearly explain the changes in drug metabolism. More frequently, a drug-drug interaction was thought to have a stronger impact. Additionally, our results suggest that IM genotypes may be more relevant than previously suspected. With respect to the small number of cases in which we thought a genotyping would be helpful, we conclude that the overall relevance of toxicogenetics in forensic problems is moderate. However, in some individual cases, a genotyping may provide new insight.

[Revista Médica de Chile in the year 2012]. / La Revista Médica de Chile en el año 2012.

During the year 2012, 539 manuscripts were submitted to this journal, following an increasing trend in the recent decade. Rejection rate was 33%. This higher number of submissions demanded a larger number and wider scope of external reviews, retarding the editorial process. The mean time lapse from reception to acceptance (or rejection) was 6.3 months (range 2-14) and from acceptance to publication 5.3 months (range 3-7). Research articles were 43.9% of published manuscripts and the remaining articles were Reviews, Special Articles, Case Reports, articles on Medical Ethics, Medical Education, Evidence Based Medicine, Public Health, History of Medicine, Letters to the Editor and others. Thirty seven published manuscripts (14.6%) came from foreign countries and 9 of them were published with full text in English. The 2012 Impact Factor was 0.360, showing little variation from previous years, locating the journal in the upper part of quartil 4 in the ISI-JCR category "Medicine, General and Internal", while the SCImago Journal & Country Rank locates the Revista in quartil 2 of its category "Medicine (miscellaneous)". In contrast with the low citation rate, the number of visits to the open access electronic version in www.scielo.cl averages over 3 million visits per year, illustrating that the interest among readers outnumbers the country's expectable readership. Only 22% of articles declared to have received financial help from entities external to the institution where the work was performed, coming mainly from Chilean Governmental competitive funds. The aim of Revista Médica de Chile is to provide readers and authors a valuable source of information about current relevant topics in general and internal medicine, progress in related specialties and updates in basic sciences, rendering them available to Health professionals in Chile and worldwide, following international standards of ethical and scientific quality in medical publications.

[The 140th anniversary of Revista Médica de Chile]. / El aniversario 140 de la Revista Médica de Chile.

Revista Médica de Chile was founded in 1872 and thus is one of the oldest medical journals being published since the 19th Century. The sponsoring institution--"Sociedad Médica de Santiago", founded in 1869--initially was the only scientific society in Chile, gathering medical doctors from every existing specialty. With the splitting of independent organizations representing specific specialties, including subspecial-ties of internal medicine, Sociedad Médica de Santiago focused its scope of action to become the "Chilean Society of Internal Medicine". Its official journal -Revista Médica de Chile--is currently a general and internal medicine journal that also publishes articles on scientific and technological advances in many fields of medicine and health sciences. While initially all authors were Chilean, the journal is now open to submissions from abroad and since the year 2000 articles are published in English when the local language of authors is not Spanish. The number of articles received determines an increasing administrative and editorial burden and, together with the high cost of publishing, will require changes in publication policies. The journal will participate in continuing medical education programs as soon as reaccreditation of medical specialties becomes officially organized in Chile.

[Mechanical ventilation in patients with acute brain injury]. / Ventilación mecánica en el paciente con lesión cerebral aguda.

In about 20% of patients admitted to an Intensive Care Unit (ICU) the indication of mechanical ventilation (MV) is a neurological disease. These patients have a prolonged MV stay and high mortality. The appropriate use of MV in patients with acute brain injury (ABI) is critical considering that MV by itself is able to induce or worsen an underlying lung injury. Patients with ABI have a higher risk to develop pulmonary complications. During endotracheal intubation the activation of airway reflexes should be prevented, because they may increase intracranial pressure. Tracheostomy is indicated to improve airway management and it is performed in about 33% of these patients. Indications for MV are loss of spontaneous respiratory effort, changes in lung compliance, gas exchange impairment and ventilatory failure due to muscle fatigue or neuromuscular junction dysfunction. During MV, hypoxemia should be avoided. The pC0(2) level has a critical role in cerebral blood flow regulation; therefore a normal pCO must be maintained in order to guarantee an optimal cerebral blood flow. Despite that, hypocapnia has been used in patients with increased intracranial pressure, at the present it is not recommended. Its use should be limited to the emergency management of intracranial hypertension, while the underlying cause is being treated. Non-conventional ventilatory modes as prone position ventilation, high-frequency oscillatory ventilation and extracorporeal C02 removal can be used in patients with ABI. All of them have specific risks and should be employed cautiously This paper reviews upper airway management and MV in patients with acute brain injury.

[The relevance and fate of abstracts presented in scientific meetings]. / La importancia y el destino de los resúmenes presentados en reuniones científicas.

Abstracts presented in scientific meetings are indispensable tools to diffuse the latest research in the field. They provide the authors with an opportunity to receive feedback from a critical audience so they can prepare a final manuscript to be submitted to a peer-reviewed journal. However, several studies in a wide range of medical specialties and other related sciences showed that no more than 50% of abstracts presented in annual meetings of learned societies are published in a 5-year follow up after the meeting. Therefore, abstracts are considered "preliminary publications" and it is recommended not to include them as bibliographic references unless they have been published recently (less than 3 years) in peer-reviewed journals (regular issues or supplements) or in their official websites. Databases dependent on the National Library of Medicine (USA) or SciELO do not index individual abstracts from a meeting. Authors and reviewers should be reminded that manuscripts that have shaped current knowledge probably had also been presented as abstracts in scientific meetings, sometime before their final publication.

[Epidemiologial profile of invasive candidiasis in intensive care units at a university hospital]. / Perfil epidemiológico de la candidiasis invasora en unidades de pacientes críticos en un hospital universitario.

UNLABELLED: Invasive candidiasis (IC) epidemiology has changed in critically ill patients and limited data are available in Chile. OBJECTIVE: To describe the epidemiological and microbiological profile of IC in critically ill patients. METHODS: Observational prospective study conducted from October 2001 to August 2003 in critically ill adults with suspected or confirmed IC. RESULTS: 53 patients met criteria for IC, finding 18 (33.9%) candidemias, 22 (41.5%) disseminated IC, and 13 (24.5%) local IC. We identified 8 (44.4%) C. albicans and 10 (55.6%) non-albicans Candida in candidemias. C. tropicalis was the predominant non-albicans species (27.7%). An 88.8 % of Candidas sp recovered in candidemias were fluconazole susceptible. Overall hospital mortality was 24.5%. Mortality in candidemia was significantly lower than in disseminated IC (16.6 vs 31.8%, p = 0.02). CONCLUSIONS: A higher proportion of non-albicans Candida was observed in candidemias from critically ill patients. However, most of these strains were fluconazole susceptible. A lower overall mortality was observed in candidemias.

[Use of psychotropic substances by the elderly and driving accidents]. / Altere Menschen und psychotrope Substanzen im Strassenverkehr.

In the context of a study for the Federal Highway Research Institute (Bundesanstalt für Strassenwesen), a database containing almost 40,000 toxicological blood analysis results from drivers with various traffic offences (time frame 1998-2001) from throughout Germany was evaluated. The database contains the results of 25 laboratories in Germany performing toxicological blood analysis of driving offences. Of these laboratories, 23 gave information about their methodology for toxicological analysis by questionnaire. This database and the results from 10,000 toxicological blood analyses of traffic offences in Hamburg (time frame 2003-2008) were evaluated. The number of elderly driver cases, the spectrum of detectable substances, the type of offence and the medical findings were compared to the results of the total sample in the corresponding period. The number of traffic offences with elderly drivers has risen in recent years but to a much smaller degree than the total number of traffic offences. The relative frequency of detection decreased from 2% in 1998 to 1.1% in 2001 (Germany wide) and from 2.3% (2003) to 1.4% (2008) in Hamburg. In the group of elderly drivers, only 39% (43% in Hamburg) of the sample showed positive results for medical drugs or drugs of abuse (73.9% of all samples). The medical diagnosis on the symptomatic level of intoxication, which had been assigned by medical doctors after blood sampling, did not correlate with the actual presence of therapeutic drugs in the blood. This demonstrates the interactions of senso-motor and physical frailties with potential additive, substance-related effects when driving skills appear to be compromised in the elderly. Drugs of abuse were detected in 5.6% (10.6% in Hamburg) among the senior drivers. Benzodiazepines were detected in 24.5% (23% in Hamburg) of the cases with a high frequency of detection in traffic accidents compared to traffic offences without accident. The type of offence was given in 87 of benzodiazepine-positive cases (20 in Hamburg), 59 of them (11 in Hamburg) were traffic accidents. Keeping the increasing percentage of senior drivers in mind, the results show that most of the elderly drivers are very careful with medical therapy and driving. However traffic-related safety advice including pharmaceutical side effects on driving ability given by general practitioners is important and necessary.

Acute venous thromboembolic disease and paradoxical embolism.

BACKGROUND: We report two cases of paradoxical cerebral embolism associated with acute venous thromboembolic disease. CASE REPORT: The first case corresponds to a 49-year-old woman with sudden onset of dyspnea and syncope, followed by right upper extremity paresis, aphasia and dysarthria. The admission brain computed tomography (CT) was unremarkable, but lung CT showed multilobar and multisegmentary pulmonary embolism. Echocardiography showed dilated right ventricle with impaired systolic function, moderate tricuspid regurgitation, moderate pulmonary hypertension and positive bubble test, suggestive of a patent foramen ovale (PFO) which was successfully closed by endovascular Amplatzer device placement. The patient was discharged with anticoagulation therapy and permanent antiplatelet aggregation therapy. The second case is a 60-year-old woman found unconscious. Neurological examination revealed expressive aphasia, right hemianopsia, right central facial paralysis and right-sided paresis with a National institute of Health Stroke Scale of 19. Brain CT showed signs of acute left middle cerebral artery infarction. Later, she developed greater impairment of consciousness. A new brain CT showed significant edema with mass effect requiring a decompressive craniotomy. Echocardiography showed PFO and lower extremities' Doppler ultrasound showed a left infrapopliteal posterior tibial right deep venous thrombosis. An inferior vena cava filter was placed and two days after surgery, anticoagulation was started.

Clinical profile and management of heart failure: rural community hospital vs. metropolitan heart center.

BACKGROUND: Knowledge on clinical characteristics and prognosis of patients with heart failure originates from studies of selected populations in clinical trials or from epidemiological observations. Reports on the large numbers of patients with heart failure treated in community hospitals are sparse. OBJECTIVE: Are there differences in patient characteristics and heart failure management between a metropolitan heart center (HC) and a rural community hospital (RCH)? PATIENTS AND METHODS: Retrospective analysis of medical charts from all patients admitted for heart failure (ICD 428.x, NYHA II-IV, EF<45%) between May 1997 and April 1998 and discharged alive from a rural community hospital. A similar, but prospective registry was available at the HC. Follow-up information was obtained by request at registration authorities. RESULTS: Patient groups comprised 120 in RCH and 146 in HC. Mean age was 75+/-11 and 66+/-11 years, respectively (P<0.001); 48% (RCH) vs. 74% (HC) of patients were male (P<0.001). On admission the proportion of functional class IV was 69% (RCH) vs. 17% (HC) (P<0.001). At discharge, the rate of ACE-inhibitors was 74% (RCH) vs. 98% (HC); 11% (RCH) vs. 43% (HC) of patients received beta-blocker therapy. Ninety-six percent of patients in HC underwent and 22% in RCH had undergone invasive diagnostics. One-year mortality rate of patients discharged alive was 26% in RCH and 19% in HC (P=n.s. after adjustment for age and gender). CONCLUSION: Heart failure management according to current guidelines, using beta-blockers and ACE inhibitors, and invasive cardiac examination was significantly less performed in the rural community hospital than in the metropolitan heart center. Therefore, strategies to improve heart failure management according to guidelines are urgently needed.

Electric chips for rapid detection and quantification of nucleic acids.

A silicon chip-based electric detector coupled to bead-based sandwich hybridization (BBSH) is presented as an approach to perform rapid analysis of specific nucleic acids. A microfluidic platform incorporating paramagnetic beads with immobilized capture probes is used for the bio-recognition steps. The protocol involves simultaneous sandwich hybridization of a single-stranded nucleic acid target with the capture probe on the beads and with a detection probe in the reaction solution, followed by enzyme labeling of the detection probe, enzymatic reaction, and finally, potentiometric measurement of the enzyme product at the chip surface. Anti-DIG-alkaline phosphatase conjugate was used for the enzyme labeling of the DIG-labeled detection probe. p-Aminophenol phosphate (pAPP) was used as a substrate. The enzyme reaction product, p-aminophenol (pAP), is oxidized at the anode of the chip to quinoneimine that is reduced back to pAP at the cathode. The cycling oxidation and reduction of these compounds result in a current producing a characteristic signal that can be related to the concentration of the analyte. The performance of the different steps in the assay was characterized using in vitro synthesized RNA oligonucleotides and then the instrument was used for analysis of 16S rRNA in Escherichia coli extract. The assay time depends on the sensitivity required. Artificial RNA target and 16S rRNA, in amounts ranging from 10(11) to 10(10) molecules, were assayed within 25 min and 4 h, respectively.

Surfactant solubilization of hydrophobic compounds in soil and water : I. Dodecylsulphate monomer and micellar partition coefficients for 28 polychlorinated biphenyls (PCBs) [41].

Reductions in the apparent soil-water partition coefficients (Kd (*)) for 28 polychlorinated biphenyls (PCBs) caused by the surfactant sodium dodecylsulphate (SDS) in the aqueous phase were studied. Above the critical micelle concentration (CMC) of the surfactant, Kd (*) was reduced by 2-3 orders of magnitude, but even far below CMC at environmentally relevant surfactant concentrations significant reductions in Kd (*) were observed. The plot of the soil-water partition coefficient (Kd) divided by Kd (*) versus the concentration of SDS allowed for the calculation of monomer (Kmn (oc)) and micellar (Kmc (oc)) surfactant-water partition coefficients normalized to organic carbon for each PCB congener. Kmn (oc) values were comparable with published values for the partition of PCBs between natural dissolved organic matter and lake water. Kmc (oc) values were up to 30 times higher than Kmn (oc) values and comparable with published octanol-water distribution coefficients. The findings of the present study underline the potential of surfactants at concentrations below their CMC to mobilize otherwise strongly bound hydrophobic compounds in soil-water systems.

Surfactant solubilization of hydrophobic compounds in soil and water : II. The role of dodecylsulphate-soil interactions for hexachlorobenzene.

The soil/water partition coefficient (Kd) of hexachlorobenzene (HCB) ranged from 220 1/kg to 1800 1/kg for eight soils having a wide range of physico-chemical properties. Kd normalised to soil organic carbon (Koc) was found to be 28000 ± 4800 1/kg. Anionic surfactant dodecylsulphate (DS) present at concentrations above the critical micellar concentration (CMC) caused reductions in the apparent soil/water partition coefficient (Kd (*)) in the range of 3-26 times for most soils and up to 36-91 times for sandy soils. Below CMC, at environmentally relevant surfactant concentrations, Kd (*) was reduced by a factor of 1-13. For clay and calcareous soils significant adsorption/complexation/precipitation of DS occurred. At the lowest DS concentration this produced a two-fold increase in Kd (*). At increasing DS concentrations this effect was shielded by the solubihzing effect from DS. Monomer (Kmn) and micellar (Kmc) surfactant/water partition coefficients for HCB were determined to be, 980 ± 190 1/kg and 21000 ± 1600 1/kg, respectively.

An overview of gamma-hydroxybutyric acid: pharmacodynamics, pharmacokinetics, toxic effects, addiction, analytical methods, and interpretation of results.

Abuse of gamma-hydroxybutyric acid (GHB) has been known since the early 1990's, but is not as widespread as the consumption of other illegal drugs. However, the number of severe intoxications with fatal outcomes is comparatively high; not the least of which is brought about by the consumption of the currently legal precursor substances gamma-butyrolactone (GBL) and 1,4-butanediol (1,4-BD). In regards to previous assumptions, addiction to GHB or its analogues can occur with severe symptoms of withdrawal. Moreover, GHB can be used for drug-facilitated sexual assaults. Its pharmacological effects are generated mainly by interaction with both GABA(B) and GHB receptors, as well as its influence on other transmitter systems in the human brain. Numerous analytical methods for determining GHB using chromatographic techniques were published in recent years, and an enzymatic screening method was established. However, the short window of GHB detection in blood or urine due to its rapid metabolism is a challenge. Furthermore, despite several studies addressing this problem, evaluation of analytical results can be difficult: GHB is a metabolite of GABA (gamma-aminobutyric acid); a differentiation between endogenous and exogenous concentrations has to be made. Apart from this, in samples with a longer storage interval and especially in postmortem specimens, higher levels can be measured due to GHB generation during this postmortem interval or storage time.

Gamma-hydroxybutyrate in urine and serum: additional data supporting current cut-off recommendations.

Besides the use of Gamma-Hydroxybutyrate (GHB) as a recreational drug, use of GHB as an agent in drug-facilitated crime should also be considered. In these cases, there is often a delay of several hours from the incident to collection of the samples. As GHB has a very short plasma half-life, the window of detection is small and in the majority of these specimens, levels of GHB are low. Because GHB is naturally occurring in humans, discrimination between endogenous and exogenous GHB is complicated, particularly in those samples with low concentrations. In this study, endogenous GHB levels of 50 serum and 50 urine samples were determined by GC-MS after conversion to trimethyl-silyl-derivatives. Concentrations in serum ranged from 0.62 to 3.24 mg/L (mean=1.14 mg/L; median=0.97 mg/L) and from 0.64 to 4.20mg/L (mean=1.21 mg/L; median=0.96 mg/L) in urine. Based on this substantial data, the current suggested lower cut-off of 4 mg/L in ante mortem serum samples could be confirmed. For urine, we propose the lower cut-off of 6 mg/L instead of 10mg/L to avoid false negative interpretation.

Aspergilosis traqueobronquial necrotizante en paciente crítico / Necrotizing tracheobronchial aspergillosis in an immunosuppressed patient. Report of one case

Necrotizing tracheobronchitis due to Aspergillus spp is a rare form of invasive aspergillosis. This infection is limited to or predominant in the bronchial tree. The clinical evolution is gradual: from mild non-specific manifestations of acute tracheobronchitis to severe acute respiratory insufficiency determined by a bronchial obstruction syndrome. We report a 38 years old female with systemic lupus erythematosus treated with methylprednisolone and cyclophosphamide. She developed an invasive aspergillosis, severe respiratory failure with predominant tracheobronchial damage and upper respiratory complications.