Vital Sign Changes During Intravenous Ketamine Infusions for Depression: An Exploratory Study of Prognostic Indications.

PURPOSE/BACKGROUND: Subanesthetic dosing of intravenous ketamine has shown to be an effective treatment for patients with major depressive disorder. It is unknown whether sympathetic response is related to treatment outcomes. The purpose of this study is to evaluate sympathetic response to ketamine infusions as it relates to treatment outcomes. METHODS/PROCEDURES: This retrospective study examines an outpatient population diagnosed with major depressive disorder or bipolar depression treated with ketamine infusions. Patient characteristics, depressive symptoms measured with the Patient Health Questionnaire (PHQ-9), and vital signs were retrieved by chart review. Patients (n = 145) were categorized as responders (50% reduction in PHQ-9 or less than 10 on final PHQ-9) or nonresponders. Changes in vital signs were recorded during each infusion for the initiation series. FINDINGS/RESULTS: Ketamine responders (51.7%) showed a significant greater increase in systolic blood pressure response during the first infusion when compared with nonresponders. There was no difference seen in diastolic pressure, heart rate, or rate pressure product. Changes in vital signs for subsequent infusions also did not approach significance. IMPLICATIONS/CONCLUSIONS: Physiologic sensitivity to the effects of ketamine may predict treatment responsiveness. Blood pressure and heart rate did not always increase. Further work should examine possible influences on physiologic responses.

Many patients fail to achieve MCID for PROMIS upper extremity and pain interference following nonoperative management of rotator cuff tears.

Background: Efficacy of nonoperative treatment for rotator cuff tears has been debated, especially for full-thickness tears. The purpose of this study was to a) define the minimal clinically important difference (MCID) of nonoperative treatment with regard to Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference (PI) and upper extremity (UE), and b) determine the proportion of patients with both partial and full-thickness tears (PTRCT, FTRCT) who achieve this improvement following initial nonoperative treatment. We hypothesized that >75% of PTRCT and FTRTC patients would achieve MCID for PROMIS PI and UE. Methods: We performed a retrospective cohort study evaluating nonoperatively managed patients with image-confirmed PTRCT and FTRCT. Treatment modalities and follow-up PROMIS scores at least 6 months after their initial visit were recorded. Using a distribution technique, MCID was calculated. Results: A total of 111 FTRCT and 68 PTRCT patients were included with at least 6 months of follow-up. At 6 months from initial presentation, the MCID for PROMIS UE was 3.75 and 3.95 for FTRCT and PTRCT patients, respectively. For PROMIS PI, the MCID was 3.35 and 3.90 for FTRCT and PTRCT, respectively. In total, 41% of FTRCT and 41% of PTRCT achieved MCID for PROMIS UE. Thirty-four percent of FTRCT and 35% of PTRCT achieved MCID for PROMIS PI. Conclusion: The majority of patients undergoing nonoperative treatment for supraspinatus/infraspinatus rotator cuff tears did not achieve MCID at 6 months for PROMIS PI (34% for FTRCT and 35% for PTRCT) or UE (41% for FTRCT and 41% for PTRCT).

Mercury transport and bioaccumulation in riverbank communities of the Alvarado Lagoon System, Veracruz State, Mexico.

The Alvarado Lagoon System (ALS) is located within the Papaloapan River Basin in southern Veracruz, Mexico. The ALS is a shallow system (2 m) connected to the Gulf of Mexico through a narrow sea channel. There are a large number of riverbank communities within the ALS that are dependent upon its biological productivity for comestible and economic subsistence. The purpose of this project was to determine the levels of mercury in water, sediment, fish, and hair samples from within the Papaloapan River Basin and to characterize the risk of Hg exposure to the individuals that reside in these communities. Water and fish samples were collected during the wet (September 2005) and dry (March 2003 and 2005) seasons. Hair samples, dietary surveys, and sediment samples were obtained during the wet and dry seasons of 2005. Total Hg in the water column ranged from 1.0 to 12.7 ng/L. A strong correlation (R(2)=0.82; p<0.001) between total Hg and total suspended solids in the water column suggests that particulate matter is a transport mechanism for Hg within the lagoon system. Total Hg in the sediments ranged from 27.5 to 90.5 ng Hg/g dry weight with no significant difference between the 2005 wet and dry seasons. There was a mild, but significant, correlation between total Hg and % carbon for the March 2005 sediment samples (R(2)=0.435; p=0.020), suggesting that Hg is associated with organic matter on the solid phase. Concentrations of total Hg in fish and shellfish harvested from the ALS ranged from 0.01 to 0.35 microg Hg/g wet. The levels of total Hg in hair ranged from 0.10 to 3.36 microg Hg/g (n=47) and 58% of the samples were above 1.00 microg Hg/g. The findings from this study suggest that individuals who frequently consume fish and shell fish containing low levels of Hg (<0.3 microg/g) can accumulate low to moderate body burdens of Hg, as indicated by hair Hg concentrations>1.0 microg/g, and may be at risk for experiencing low dose mercury toxicity.