A cross-sectional study of preoperative medication adherence and early postoperative recovery.

STUDY OBJECTIVE: To quantify the impact of preoperative medication adherence on recovery length of stays and complication rates. DESIGN: Cross-sectional analytical study. SETTING: Postanesthetic care unit (PACU) of a single-center tertiary hospital. PATIENTS: Surgical patients admitted for surgery at our institution over a 4-month period. INTERVENTION: A data collection tool was used to collect demographic data, length of stay in recovery, prespecified conditions likely to impact on PACU recovery (chronic pain, insulin-dependent diabetes, epilepsy, hypertension, on a methadone program, and Parkinson disease), medication compliance, and complications in PACU. MEASUREMENTS: Differences among categorical variables were assessed for significance using the χ2 test; continuous parametric data were compared using a time to survival analysis via Kaplan-Meier estimates and Cox proportional hazard regressions to account for possible confounders. MAIN RESULTS: Preoperative medication compliance for the prespecified conditions was 65.1%. Patients with a preoperative condition spent more time in the PACU compared to patients without a preoperative condition. Time in PACU was not significantly longer for patients who took their medications compared to those who failed to take their medications. Patients with multiple prespecified conditions were more likely to incur a postoperative complication compared to patients without a prespecified condition. Patients with preoperative hypertension and insulin-dependent diabetes incurred higher complication rates in PACU for medication nonadherence compared to medication adherence. CONCLUSION: This study taken together with accruing evidence suggests that preoperative medication omission remains an ongoing issue that can influence complication rates in the PACU. Patients with preoperative conditions stay longer in PACU, and medication omission was associated with higher rates of certain postoperative complications in PACU. This identifies patients likely to require more interventions and greater recovery resources. Further research into the impact of medication omission on recovery parameters after discharge from the PACU is warranted.

The effect of nutritional habits on maternal-neonatal lipid and lipoprotein serum levels in three different ethnic groups.

AIM: To investigate the effect of nutritional habits on lipid profiles in mothers of three different ethnic groups and in their newborns. SUBJECTS AND METHODS: Lipids and lipoproteins were determined in 7-day dietetic diaries of 9,134 mothers (Greeks n = 3,118, Albanians n = 3,050, Muslim Asians n = 2,966), in their sera and in the cord blood of their newborns with routine methods. RESULTS: Monounsaturated fat intake (35 +/- 12 g/day) was similar among the groups. Total fat, saturated fat and cholesterol intakes were significantly lower in Asians than those in Albanians and Greeks. Significantly lower lipid and lipoprotein concentrations (cholesterol 5.09 +/- 0.85 mmol/l, triglyceride, TG, 2.38 +/- 0.58 mmol/l, low-density lipoprotein cholesterol, LDL-C, 2.90 +/- 0.78 mmol/l, very-low-density lipoprotein cholesterol, VLDL-C, 0.32 +/- 0.11 mmol/l) were measured in the Muslim Asian mothers and in their newborns (cholesterol 1.06 +/- 0.26 mmol/l, TG 0.52 +/- 0.16 mmol/l, LDL-C 0.49 +/- 0.10 mmol/l and VLDL-C 0.10 +/- 0.02 mmol/l; p < 0.001). Higher levels of the mentioned biochemical parameters were found in Greek mothers versus their newborns (cholesterol 5.20 +/- 0.98 mmol/l, TG 2.37 +/- 0.62 mmol/l, LDL-C 3.40 +/- 0.85 mmol/l and VLDL-C 0.48 +/- 0.13 mmol/l vs. cholesterol 1.55 +/- 0.31 mmol/l, TG 0.56 +/- 0.20 mmol/l, LDL-C 0.65 +/- 0.15 mmol/l and VLDL-C 0.12 +/- 0.01 mmol/l; p < 0.001) and Albanian mothers versus their newborns (cholesterol 7.1 +/- 0.78 mmol/l, TG 2.55 +/- 0.60 mmol/l, LDL-C 4.1 +/- 0.88 mmol/l and VLDL-C 0.52 +/- 0.13 mmol/l vs. cholesterol 1.6 +/- 0.40 mmol/l, TG 0.59 +/- 0.15 mmol/l, LDL-C 0.70 +/- 0.21 mmol/l and VLDL-C 0.12 +/- 0.01 mmol/l; p < 0.001). The highest HDL-C levels were observed in the Asian mothers (1.60 +/- 0.31 mmol/l vs. 1.4 +/- 0.39 mmol/l in Greeks and 1.31 +/- 0.39 mmol/l in Albanians; p < 0.001). CONCLUSION: The normal lipid profile in Greeks, the high one in Albanians and the low profile in Muslim Asians may be due to their nutritional habits and their socioeconomic status affecting those of their newborns.

Isotretinoin therapy induces DNA oxidative damage.

BACKGROUND: Isotretinoin (Iso) is currently indicated for the treatment of cystic acne (CA) and is related to marked teratogenicity. AIM: The aim of the study was to evaluate the relationship between total antioxidant status (TAS) and a serum marker of DNA oxidative damage, 8-hydroxy-2-desoxyguanosine (8-OHdG), in patients on Iso treatment. PATIENTS AND METHODS: Patients with CA (n=18) were evaluated before and 45 days after Iso (0.5 mg/kg per day) treatment and non-diseased controls (n=22) were tested only once. Plasma TAS levels and 8-OHdG were measured spectrophotometrically and with an immunoassay, respectively. Liver biochemical parameters and muscle enzymes were measured on a blood chemistry analyzer. RESULTS: TAS levels were significantly (p<0.0001) lower in patients before treatment (921+/-124 micromol/L) compared with those after treatment (1335+/-93 micromol/L) and in controls (1536+/-126 micromol/L). In contrast, 8-OHdG serum levels were two-fold higher in patients after treatment (0.21+/-0.03 ng/mL) than before treatment (0.11+/-0.02 ng/mL) and three-fold higher than in controls (0.07+/-0.01 ng/mL; p<0.0001). Negative correlations were found between TAS and 8-OHdG (r=-0.754, p<0.0001) in patients before therapy and positive correlations were found between creatine kinase (CK) and 8-OHdG (r=0.488, p<0.001) and liver enzymes after Iso treatment. CONCLUSIONS: High serum levels of 8-OHdG in patients on Iso therapy may be due to a direct effect of Iso on liver, muscle and skin epidermal cells. Regular evaluation of 8-OHdG in sera of patients, especially of women of reproductive age, on Iso treatment could be a sensitive follow-up biomarker of DNA oxidation.