An intravenous insulin protocol for strict glycemic control in acute ischaemic stroke.

BACKGROUND AND PURPOSE: There is a J-shaped association between admission glycemia and outcome. We designed an intravenous insulin protocol aiming at rapid and strict glucose control in hyperglycemic ischaemic stroke patients. Here, we describe the initial experience, safety, and efficacy of this protocol to achieve and maintain euglycemia in the first 48h. METHODS: The protocol is based on parallel scales for adjustment of insulin infusion rate according to current glycemia and the rate of change of glycemia, which was recommended in our stroke unit in 4/2007 in acute ischaemic stroke patients with glycemia >6mM. Data were registered in the Acute Stroke Registry and Analysis of Lausanne (ASTRAL). Capillary blood glycemia was measured hourly with fingerprick test at onset of treatment and after each scale change. Target glycemia was 4.0-6.0mM pre-prandially (5.5-8.0mM post-prandially). Hypokalemia was defined as serum potassium <3.5mM and measured every 12h. Specific algorithms were employed during meals and for patients leaving temporarily the stroke unit for diagnostic or therapeutic workup. RESULTS: In the 90 protocol patients, the first normoglycemia was achieved within 8h of treatment in 91.1% of patients (median interval 4h (interquartile range (IQR): 3-6). During the median treatment duration of 25.5h (IQR: 19.7-37.7), median glucose reduction was 2.5mM (IQR: 1.3-4.3mM). The overall rate of hypoglycemias was 4.5% and hypokalemias 18.5%. There was a significant increase in the proportion of hypokalemias on the first on-treatment measurement compared to admission (24.4% vs. 8.9%, P=0.002). CONCLUSIONS: The proposed intravenous insulin protocol controls acute post-stroke hyperglycemia but frequently leads to hypokalemia. This issue needs to be addressed for the protocol to be suitable for use in larger, randomized controlled trial to explore its clinical effect.

Impact of Integrating Rabies Education Into the Curriculum of Public Elementary Schools in Ilocos Norte, Philippines on Rabies Knowledge, and Animal Bite Incidence.

As part of a province wide rabies elimination program, rabies specific information was integrated into the curriculum of all public elementary schools in Ilocos Norte, Philippines using a specifically developed teachers' manual. The rabies educational messages included rabies, animal bite prevention, bite management and responsible pet ownership and were integrated into lessons in several subjects. Four elementary schools were randomly selected and an assessment of the change in student's rabies knowledge and animal bite incidence were conducted. The study tested all students in grades 1-5 before the curriculum integration was implemented and retested these cohorts 1 year later, after implementation. Awareness of rabies was high before the implementation, likely due to the province-wide elimination campaign. However, awareness still increased significantly across all schools, and detailed knowledge of rabies increased significantly in all but one school and age cohort. Bite incidence in the 6 months prior to each survey was also recorded and the percentage of students suffering animal bites fell significantly between the two tests. The data suggested that knowledge increase correlated with decreased bite incidence in some groups but not all, suggesting a more complex relationship between knowledge acquisition and behavioral change which warrants further investigation.

Determination of oligofructose, a soluble dietary fiber, by high-temperature capillary gas chromatography.

A high-temperature capillary gas chromatographic method was developed for the quantitative determination of oligofructose in foods and food products. Sample preparation involves oxymation and silylation of the extracted sugars. The oximetrimethylsilyl derivatives are analyzed on an apolar capillary column, with detection by flame ionization. The method is accurate, with recovery of spiked samples at >96%. Repeatability was excellent; RSD values of 1.1% were obtained. Other common oligosaccharides, such as malto-, isomalto-, and galactooligosaccharides, and levan do not interfere, making the method specific and reliable.

[Drug users outside medical treatment: methodological and practical aspects]. / Consommateurs de drogues hors traitement médical: Aspects méthodologiques et pratiques.

A legal context that classifies the consumption of heroin and cocaine as an illegal act, poses a considerable methodological challenge to research on users of these substances. This is in particular the case for research on those users who are not in treatment and, therefore, cannot be recruited through treatment settings. In a research project on heroin and/or cocaine users outside treatment settings, a sample of 917 individuals was recruited through "Privileged Access Interviewers" in the whole of Switzerland. In the first part of this article, we discuss matters of reliability as well as of validity concerning this method of data collection. In the second part of the article, we discuss the use of low threshold syringe exchange schemes by the user groups represented in the sample. Only intravenous drug users frequent those services - they are however a minority in the sample (n = 238). In several regions of Switzerland syringe exchange schemes do not exist. Where they do exist, they appear to correspond to a need which they are able to cover largely. In the regions without such services, intravenous drug users get their supply of syringes more frequently from pharmacies. However, pharmacies do not compensate the absence of specific syringe exchange schemes. In regions without such schemes, injections with used syringes are more frequent. Thus, regarding Aids-Prevention, there is an urgent need to develop syringe exchange schemes in all parts of the country.

[Exchange of syringes or apprenticeship? The buses of Bienne and Geneva]. / Echange de seringues ou apprentissage? Les bus de Bienne et Genève.

In Switzerland, the health ministry (Office Fédéral de la Santé Publique) has systematically encouraged the evaluation of low threshold services. In this article, we discuss the evaluation of two of these: the buses for syringes exchange in Geneva and Bienne, the implementation of these two services, the success obtained and the contacts established. Even if the design of such an evaluation was relatively complicated, with one monitoring and two specific surveys, the principal aim of this article is not to measure the efficacy as such but to show how an learning process has occurred between the actors: government, administration, police, service's team, drug's users and neighbourhood's inhabitants. The efficacy for a long period of time and the implementation's success are largely linked to such learning processes.

Simulating respiratory loads and tuning of closed-circuit underwater breathing apparatus.

An experimental apparatus for simulating respiratory loads in closed-circuit underwater breathing systems comprises a partly submerged vertical tube having a dual path exit on the submerged end of the tube. One path is controlled by a valve that alters the inertance of the system, changes the natural frequency, and provides the tuning. The vertical tube provides elastic loading to simulate a counterlung or breathing bag in an underwater breathing apparatus (UBA). The experimental apparatus was connected to a breathing machine controlled by a signal generator to simulate a diver's breathing. The benefits of reactance tuning of this apparatus are demonstrated. A mathematical model describes both the simulator and UBA. The simulator can be used with human subjects to study respiratory response to changes in impedance.

Diver respiratory responses to a tunable closed-circuit breathing apparatus.

Respiratory impedance of closed-circuit underwater breathing apparatus (UBA) is comprised of resistive, elastic, and inertial elements in series. Impedance is at a minimum when a UBA operates at its resonant frequency (f(n)). This study investigated the respiratory responses of 12 male U.S. Navy divers to changes in the f(n) of a simulated closed-circuit UBA. Respiratory effort, breathing comfort and ventilatory parameters were assessed during open- and closed-circuit breathing at rest and while exercising at 75 W on a bicycle ergometer in the dry at 1 atm abs. During closed-circuit breathing, the f(n) of the system was adjusted to different frequencies between 0.2 Hz and 0.4 Hz (12 and 24 breaths/min) by varying UBA inertance. When the simulated UBA was switched from open to closed-circuit breathing the subjects changed their breathing frequency in a direction toward the f(n) of the system and attempted to maintain minute ventilation constant by adjusting tidal volume. Results suggest that when divers breathe on a closed-circuit system with different f(n)'s they attempt to improve breathing comfort and reduce respiratory effort by adopting a breathing pattern that reduces their peak-to-peak mouth pressures.

Characterization and measurement of elastance with application to underwater breathing apparatus.

The elastic loads inherent in underwater breathing apparatus (UBA) can affect diver performance. This work quantitatively examines elastance, its measurement by static tests, and its relationship to UBA. A rigid, fixed-volume container and a vertical water column with straight and parallel sides produce elastic loads that have application to closed-circuit UBA. We derived equations to describe the pressure-volume relationships of these elements from first principles and tested the equations experimentally for system pressure produced by a swept volume in a breathing machine. Our work demonstrates that simplified equations to describe elastance may not be sufficiently accurate for all situations. In addition, static measurements of elastance of a UBA or other element will not be reproducible unless all the volumes within the testing apparatus are accounted for; we provide experimental and mathematical techniques for doing so.