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1.
Brain Behav ; : e02088, 2021 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-33662185

RESUMO

BACKGROUND: The relationship between traumatic injury and subsequent mental health diagnoses is not well understood and may have significant implications for patient screening and clinical intervention. We sought to determine the adjusted association between traumatic injury and the subsequent development of post-traumatic stress disorder (PTSD), depression, and anxiety. METHODS: Using Department of Defense and Veterans Affairs datasets between February 2002 and June 2016, we conducted a retrospective cohort study of 7,787 combat-injured United States service members matched 1:1 to combat-deployed, uninjured service members. The primary exposure was combat injury versus no combat injury. Outcomes were diagnoses of PTSD, depression, and anxiety, defined by International Classification of Diseases 9th and 10th Revision Clinical Modification codes. RESULTS: Compared to noninjured service members, injured service members had higher observed incidence rates per 100 person-years for PTSD (17.1 vs. 5.8), depression (10.4 vs. 5.7), and anxiety (9.1 vs. 4.9). After adjustment, combat-injured patients were at increased risk of development of PTSD (HR 2.92, 95%CI 2.68-3.17), depression (HR 1.47, 95%CI 1.36-1.58), and anxiety (HR 1.34, 95%CI 1.24-1.45). CONCLUSIONS: Traumatic injury is associated with subsequent development of PTSD, depression, and anxiety. These findings highlight the importance of increased screening, prevention, and intervention in patients with exposure to physical trauma.

2.
Artigo em Inglês | MEDLINE | ID: mdl-33670145

RESUMO

A growing body of literature on military personnel and veterans' health suggests that prior military service may be associated with exposures that increase the risk of cardiovascular disease (CVD), which may differ by race/ethnicity. This study examined the hypothesis that differential telomere shortening, a measure of cellular aging, by race/ethnicity may explain prior findings of differential CVD risk in racial/ethnic groups with military service. Data from the first two continuous waves of the National Health and Nutrition Examination Survey (NHANES), administered from 1999-2002 were analyzed. Mean telomere length in base pairs was analyzed with multivariable adjusted linear regression with complex sample design, stratified by sex. The unadjusted mean telomere length was 225.8 base shorter for individuals with prior military service. The mean telomere length for men was 47.2 (95% CI: -92.9, -1.5; p < 0.05) base pairs shorter for men with military service after adjustment for demographic, socioeconomic, and behavioral variables, but did not differ significantly in women with and without prior military service. The interaction between military service and race/ethnicity was not significant for men or women. The results suggest that military service may contribute to accelerated aging as a result of health damaging exposures, such as combat, injury, and environmental contaminants, though other unmeasured confounders could also potentially explain the results.

4.
J Gen Intern Med ; 2020 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-32959346

RESUMO

BACKGROUND: A better understanding of the long-term health effects of combat injury is important for the management of veterans' health in the Department of Defense (DoD) and Veterans Affairs (VA) health care systems and may have implications for primary care management of civilian trauma patients. OBJECTIVE: To determine the impact of traumatic injury on the subsequent development of hypertension (HTN), diabetes mellitus (DM), and coronary artery disease (CAD) after adjustment for sociodemographic, health behavior, and mental health factors. DESIGN: Retrospective cohort study of current and former US military personnel with data obtained from both the DoD and VA health care systems. PARTICIPANTS: Combat injured (n = 8727) service members between 1 February 2002 and 14 June 2016 randomly selected from the DoD Trauma Registry matched 1:1 based on year of birth, sex, and branch of service to subjects that deployed to a combat zone but were not injured. MAIN MEASURES: Traumatic injury, stratified by severity, compared with no documented injury. Diagnoses of HTN, DM, and CAD defined by International Classification of Diseases 9th or 10th Revision Clinical Modification codes. KEY RESULTS: After adjustment, severe traumatic injury was significantly associated with HTN (HR 2.78, 95% CI 2.18-3.55), DM (HR 4.45, 95% CI 2.15-9.18), and CAD (HR 4.87, 95% CI 2.11-11.25), compared with no injury. Less severe injury was associated with HTN (HR 1.14, 95% CI 1.05-1.24) and CAD (HR 1.62, 95% CI 1.11-2.37). CONCLUSIONS: Severe traumatic injury is associated with the subsequent development of HTN, DM, and CAD. These findings have profound implications for the primary care of injured service members in both the DoD/VA health systems and may be applicable to civilian trauma patients as well. Further exploration of pathophysiologic, health behavior, and mental health changes after trauma is warranted to guide future intervention strategies.

5.
Disaster Med Public Health Prep ; : 1-9, 2020 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-32484129

RESUMO

OBJECTIVE: Dialysis patients may not have access to conventional renal replacement therapy (RRT) following disasters. We hypothesized that improvised renal replacement therapy (ImpRRT) would be comparable to continuous renal replacement therapy (CRRT) in a porcine acute kidney injury model. METHODS: Following bilateral nephrectomies and 2 hours of caudal aortic occlusion, 12 pigs were randomized to 4 hours of ImpRRT or CRRT. In the ImpRRT group, blood was circulated through a dialysis filter using a rapid infuser to collect the ultrafiltrate. Improvised replacement fluid, made with stock solutions, was infused pre-pump. In the CRRT group, commercial replacement fluid was used. During RRT, animals received isotonic crystalloids and norepinephrine. RESULTS: There were no differences in serum creatinine, calcium, magnesium, or phosphorus concentrations. While there was a difference between groups in serum potassium concentration over time (P < 0.001), significance was lost in pairwise comparison at specific time points. Replacement fluids or ultrafiltrate flows did not differ between groups. There were no differences in lactate concentration, isotonic crystalloid requirement, or norepinephrine doses. No difference was found in electrolyte concentrations between the commercial and improvised replacement solutions. CONCLUSION: The ImpRRT system achieved similar performance to CRRT and may represent a potential option for temporary RRT following disasters.

6.
J Am Assoc Lab Anim Sci ; 59(3): 322-327, 2020 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-32204749

RESUMO

Accurate assessment of coagulation in porcine studies is essential. We sought to establish normal values for porcine rotational thromboelastometry (ROTEM) according to the American Society for Veterinary Clinical Pathology guidelines and to assess the effects of various preanalytical parameters on those measurements. Healthy Yorkshire-cross pigs (n = 81; 46 males and 35 females) were anesthetized. By using a 18-gauge needle attached to a vacuum phlebotomy tube, blood was acquired from the cranial vena cava. Tubes were filled in the following order: evacuation clot tube, EDTA tube, heparin tube, and 2 citrate tubes. The citrate tubes were randomly assigned to 30 min with or without constant agitation on a rocker. The following parameters were reported according to the manufacturer's recommendations: clotting time, clot formation time, α, (tangent to the clot formation curve when the clot firmness is 20 mm), clot firmness after 10 and 20 min, maximal clot firmness, maximum lysis, and lysis indexes at 30 and 45 min. Reference intervals were reported as mean ± 2 SD (parametric distribution) or 2.5th and 97.5th percentile of the population's results (nonparametric distribution). The effects of sex, sampling order, and agitation on ROTEM results were analyzed through linear regression. Neither sex nor sample agitation influenced any of the ROTEM parameters. Combined reference intervals were established for each ROTEM parameter by pooling data from the nonagitated tubes for both male and female pigs. This study is the first to establish ROTEM reference intervals from a large number of male and female adult Yorkshire-cross pigs and to provide a detailed description of preanalytical sample processing.

7.
Mil Med ; 185(Suppl 1): 413-419, 2020 01 07.
Artigo em Inglês | MEDLINE | ID: mdl-32074349

RESUMO

INTRODUCTION: Musculoskeletal (MSK) conditions are commonly seen among military service members (SM) and Veterans. We explored correlates of award of MSK-related service-connected disability benefits (SCDB) among SM seeking care in Veterans Affairs (VA) hospitals. MATERIALS AND METHODS: Department of Defense data on SM who separated from October 1, 2001 to May 2017 were linked to VA administrative data. Using adjusted logistic regression models, we determined the odds of receiving MSK SCDB. RESULTS: A total of 1,558,449 (79% of separating SM) had at least one encounter in VA during the study period (7.8% disability separations). Overall, 51% of this cohort had at least one MSK SCDB (88% among disability separations, 48% among normal). Those with disability separations (as compared to normal separations) were significantly more likely to receive MSK SCDB (odds ratio 2.37) as were females (compared to males, odds ratio 1.15). CONCLUSIONS: Although active duty SM with disability separations were more likely to receive MSK-related service-connected disability ratings in the VA, those with normal separations also received such awards. Identifying those at highest risk for MSK-related disability could lead to improved surveillance and prevention strategies in the Department of Defense and VA health care systems to prevent further damage and disability.


Assuntos
Avaliação da Deficiência , Pessoas com Deficiência/reabilitação , Previsões/métodos , Militares/estatística & dados numéricos , Doenças Musculoesqueléticas/complicações , Adulto , Campanha Afegã de 2001- , Pessoas com Deficiência/estatística & dados numéricos , Feminino , Humanos , Guerra do Iraque 2003-2011 , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Doenças Musculoesqueléticas/epidemiologia , Estados Unidos , United States Department of Veterans Affairs/organização & administração , United States Department of Veterans Affairs/estatística & dados numéricos , Veteranos/estatística & dados numéricos
8.
Mil Med ; 185(Suppl 1): 296-302, 2020 01 07.
Artigo em Inglês | MEDLINE | ID: mdl-32074380

RESUMO

INTRODUCTION: We explore disparities in awarding post-traumatic stress disorder (PTSD) service-connected disability benefits (SCDB) to veterans based on gender, race/ethnicity, and misconduct separation. METHODS: Department of Defense data on service members who separated from October 1, 2001 to May 2017 were linked to Veterans Administration (VA) administrative data. Using adjusted logistic regression models, we determined the odds of receiving a PTSD SCDB conditional on a VA diagnosis of PTSD. RESULTS: A total of 1,558,449 (79% of separating service members) had at least one encounter in VA during the study period (12% female, 4.5% misconduct separations). Females (OR 0.72) and Blacks (OR 0.93) were less likely to receive a PTSD award and were nearly equally likely to receive a PTSD diagnosis (OR 0.97, 1.01). Other racial/ethnic minorities were more likely to receive an award and diagnosis, as were those with misconduct separations (award OR 1.3, diagnosis 2.17). CONCLUSIONS: Despite being diagnosed with PTSD at similar rates to their referent categories, females and Black veterans are less likely to receive PTSD disability awards. Other racial/ethnic minorities and those with misconduct separations were more likely to receive PTSD diagnoses and awards. Further study is merited to explore variation in awarding SCDB.


Assuntos
Avaliação da Deficiência , Disparidades em Assistência à Saúde/estatística & dados numéricos , Militares/estatística & dados numéricos , Transtornos de Estresse Pós-Traumáticos/terapia , United States Department of Veterans Affairs/estatística & dados numéricos , Adulto , Campanha Afegã de 2001- , Feminino , Humanos , Guerra do Iraque 2003-2011 , Masculino , Pessoa de Meia-Idade , Militares/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Estados Unidos , United States Department of Veterans Affairs/organização & administração
9.
J Hypertens ; 38(7): 1293-1301, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31990903

RESUMO

BACKGROUND: Although the long-term effects of combat injury are not well understood, there is emerging concern that exposure to combat environments and subsequent injury may increase the risk of hypertension through changes in inflammatory responses, psychological stress and mental health, and health behaviors. METHODS: Data from the Millennium Cohort Study and the Department of Defense Trauma Registry were used to identify combat-exposed and combat-injured participants. Incident hypertension diagnoses were ascertained from the Millennium Cohort survey. The associations between combat exposure/injury and hypertension risk was estimated using multivariable complementary log-log survival models. RESULTS: The final analysis sample consisted of 38 734 participants. Of these, 50.8% deployed but were not exposed to combat, 48.6% deployed and were exposed to combat, and 0.6% had combat injury. Overall prevalence of hypertension was 7.6%. Compared with participants who deployed but did not experience combat (mild exposure), elevated odds of hypertension were observed among those who experienced combat but not wounded (moderate exposure; AOR, 1.28; 95% CI, 1.19-1.38) and those wounded in combat (high exposure; AOR, 1.46; 95% CI, 1.07-2.00). Sleep duration of less than 4 h (AOR, 1.21; 95% CI, 1.03-1.43), sleep duration of 4-6 h (AOR, 1.16; 95% CI, 1.05-1.29), posttraumatic stress disorder (AOR, 1.54; 95% CI, 1.26-1.87), and overweight (AOR, 1.77; 95% CI, 1.61-1.95) and obese (AOR, 2.77; 95% CI, 2.45-3.12) status were also associated with higher odds of hypertension. CONCLUSION: Results support the hypotheses that combat exposure increases hypertension risk and that combat injury exacerbates this risk.

10.
Ann Surg ; 2019 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-31714315

RESUMO

OBJECTIVE: To determine whether persistent opioid use after injury is associated with subsequent long-term development of clinically recognized opioid abuse. SUMMARY BACKGROUND DATA: Opioid abuse is an epidemic in the United States and trauma can initiate persistent use; however, it remains unclear whether persistent opioid use contributes to the subsequent development of opioid abuse. The care of combat casualties by the Departments of Defense and Veterans Affairs uniquely allows investigation of this long-term outcome. METHODS: This retrospective cohort study randomly selected 10,000 battle-injured United States military personnel. We excluded patients who died during initial hospitalization or within 180 days of discharge, had a preinjury opioid abuse diagnosis, or had missing data in a preselected variable. We defined persistent opioid use as filling an opioid prescription 3 to 6 months after discharge and recorded clinically recognized opioid abuse using relevant diagnosis codes. RESULTS: After exclusion, 9284 subjects were analyzed, 2167 (23.3%) of whom developed persistent opioid use. During a median follow-up time of 8 years, 631 (6.8%) patients developed clinically recognized opioid abuse with a median time to diagnosis of 3 years. Injury severity and discharge opioid prescription amount were associated with persistent opioid use after trauma. After adjusting for patient and injury-specific factors, persistent opioid use was associated with the long-term development of clinically recognized opioid abuse (adjusted hazard ratio, 2.39; 95% confidence interval, 1.99-2.86). CONCLUSIONS: Nearly a quarter of patients filled an opioid prescription 3 to 6 months after discharge, and this persistent use was associated with long-term development of opioid abuse.

11.
Ethn Dis ; 29(3): 451-462, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31367165

RESUMO

Objective: To determine: 1) rates of cardiovascular disease (CVD) among individuals with and without prior US military service; and 2) variation in CVD outcomes by race/ethnicity. Methods: We performed a cross-sectional study of the 2011-2016 Behavioral Risk Factor Surveillance System during 2018-2019. Groups with (n=369,844) and without (n=2,491,784) prior service were compared overall, and by race/ethnicity. CVD odds were compared using logistic regression. Rate-difference decomposition was used to estimate relative contributions of covariates to differences in CVD prevalence. Results: CVD was associated with military service (OR=1.34; P<.001). Among non-Hispanic Blacks, prior service was associated with a lower odds of CVD (OR=.69; P<.001), fully attenuating the net difference in CVD between individuals with and without prior service. Non-Hispanic Whites who served had the highest odds of CVD, while Hispanics with prior service had the same odds of CVD as non-Hispanic Whites without prior service. After age, smoking and body mass index status were the largest contributors to CVD differences by race/ethnicity. Conclusions: Results from this study support an association between prior military service and CVD and highlight differences in this association by race/ethnicity. Knowledge of modifiable health behaviors that contribute to differences in CVD outcomes could be used to guide prevention efforts.


Assuntos
Doenças Cardiovasculares/etnologia , Grupos Étnicos/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Militares/estatística & dados numéricos , Adulto , Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Idoso , Sistema de Vigilância de Fator de Risco Comportamental , Estudos Transversais , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Comportamentos Relacionados com a Saúde , Hispano-Americanos/estatística & dados numéricos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Estados Unidos
12.
J Am Coll Surg ; 229(5): 508-515.e1, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31326536

RESUMO

BACKGROUND: Risk prediction is important during combat operations because resources are limited and triage decisions must be rapid and accurate. We evaluated 2 point-of-care urinary biomarker tests for risk prediction in combat casualties. STUDY DESIGN: This was an observational cohort study of critically injured military personnel admitted to Craig Joint Theater Hospital in Afghanistan from October 2012 to December 2013. We collected urine within 3 hours of admission and measured urinary biomarkers with NephroCheck and a neutrophil gelatinase-associated lipocalin dipstick (NGALds) to evaluate their ability to predict a combined end point of need for renal replacement therapy or death. Odds ratios (ORs) were calculated and receiver operator characteristic curves were generated for both tests. RESULTS: A total of 89 patients were included for analysis. The median Injury Severity Score was 18 and the combined end point occurred in 12 (13.5%) patients. NephroCheck was not associated with the combined end point (OR 1.56; 95% CI 0.81 to 3.03; p = 0.19) and the area under the curve of the receiver operator characteristic curve was 0.65. The NGALds was highly associated with the combined end point (OR 4.93; 95% CI 2.18 to 11.14; p < 0.001) and the area under the curve of the receiver operator characteristic curve was 0.84. The NGALds remained significantly associated with the combined end point in a logistic regression model that included Injury Severity Score as a covariate (OR 4.10; 95% CI 1.74 to 9.67; p = 0.001). CONCLUSIONS: Measurement of urinary biomarkers with an NGALds, but not NephroCheck, predicts poor outcomes in combat casualties. An NGALds is a simple urine dipstick that could be deployed to combat zones to prioritize aeromedical evacuation, help with triage decisions, and predict resource use.


Assuntos
Biomarcadores/urina , Militares , Sistemas Automatizados de Assistência Junto ao Leito , Ferimentos e Lesões/urina , Adulto , Afeganistão , Feminino , Humanos , Escala de Gravidade do Ferimento , Lipocalina-2/urina , Masculino , Valor Preditivo dos Testes , Estudos Prospectivos , Estudos Retrospectivos , Medição de Risco , Estados Unidos
13.
Mil Med ; 184(3-4): 81-83, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30215751

RESUMO

Trauma-induced acute kidney injury (AKI) has affected many U.S. warfighters throughout history. We seek to provide a historical review of the epidemiology of combat-acquired AKI and to highlight the importance of adapting current renal replacement therapy (RRT) capabilities to prepare for the next armed conflict. While severe AKI was rare in the recent conflicts in Iraq and Afghanistan, an analysis of prior wars suggests that it will be more common in future combat operations characterized by prolonged evacuation times, limited resuscitation capabilities, and delayed aeromedical evacuation. Therefore, the military community must develop RRT capabilities to satisfy the demands of prolonged field care and austere environments. We propose a series of solutions such as re-enforcing forward deployment of conventional RRT capabilities as well as novel therapies such as improvised dialysis systems or sorbent-based RRT.


Assuntos
Lesão Renal Aguda/terapia , Terapia de Substituição Renal/métodos , Lesão Renal Aguda/etiologia , Distúrbios de Guerra/complicações , Distúrbios de Guerra/terapia , Previsões/métodos , Humanos , Terapia de Substituição Renal/tendências
14.
Ecol Evol ; 8(22): 11158-11168, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30519433

RESUMO

Top predators have cascading effects throughout the food web, but their impacts on scavenger abundance are largely unknown. Gray wolves (Canis lupus) provide carrion to a suite of scavenger species, including the common raven (Corvus corax). Ravens are wide-ranging and intelligent omnivores that commonly take advantage of anthropogenic food resources. In areas where they overlap with wolves, however, ravens are numerous and ubiquitous scavengers of wolf-acquired carrion. We aimed to determine whether subsidies provided through wolves are a limiting factor for raven populations in general and how the wolf reintroduction to Yellowstone National Park in 1995-1997 affected raven population abundance and distribution on the Yellowstone's Northern Range specifically. We counted ravens throughout Yellowstone's Northern Range in March from 2009 to 2017 in both human-use areas and wolf habitat. We then used statistics related to the local wolf population and the winter weather conditions to model raven abundance during our study period and predict raven abundance on the Northern Range both before and after the wolf reintroduction. In relatively severe winters with greater snowpack, raven abundance increased in areas of human use and decreased in wolf habitat. When wolves were able to acquire more carrion, however, ravens increased in wolf habitat and decreased in areas with anthropogenic resources. Raven populations prior to the wolf reintroduction were likely more variable and heavily dependent on ungulate winter-kill and hunter-provided carcasses. The wolf recovery in Yellowstone helped stabilize raven populations by providing a regular food supply, regardless of winter severity. This stabilization has important implications for effective land management as wolves recolonize the west and global climate patterns change.

15.
Am J Nephrol ; 48(6): 399-405, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30428460

RESUMO

BACKGROUND: Although rhabdomyolysis has been associated with acute kidney injury and mortality in the short term, the long-term consequences of an episode of rhabdomyolysis remain unknown. We sought to identify the long-term outcomes of rhabdomyolysis, including mortality, renal function, and incidence of hypertension (HTN), among service members initially admitted to the intensive care unit after sustaining a combat injury in Iraq or Afghanistan between February 1, 2002 and February 1, 2011. METHODS: Information on age, sex, injury severity score, mechanism of injury, serum creatinine, burn injury, presenting mean arterial pressure, and creatine kinase were retrospectively collected and analyzed for 2,208 patients. Standard descriptive tests were used to compare characteristics of patients with and without rhabdomyolysis. Competing risk Cox proportional hazards models were performed to assess the associated risk of rhabdomyolysis with both HTN and poor renal function. RESULTS: While rhabdomyolysis was associated with HTN on univariate analysis (hazard ratio [HR] 1.30, 95% CI 1.03-1.64; p = 0.029), this difference did not persist on multivariable analysis (HR 1.27, 95% CI 0.99-1.62; p = 0.058). The median estimated glomerular filtration rate (eGFR) was 119 (interquartile range [IQR] 103-128) among those with rhabdomyolysis, compared with 108 (IQR 94-121) in the group without rhabdomyolysis (p < 0.001). CONCLUSION: After adjustment, patients with rhabdomyolysis were not at an increased risk of HTN compared to patients without rhabdomyolysis. eGFR was paradoxically higher in patients with rhabdomyolysis. There was no association found between rhabdomyolysis and mortality.


Assuntos
Lesão Renal Aguda/epidemiologia , Hipertensão/epidemiologia , Rabdomiólise/epidemiologia , Lesões Relacionadas à Guerra/complicações , Lesão Renal Aguda/etiologia , Adulto , Estado Terminal , Feminino , Seguimentos , Taxa de Filtração Glomerular , Humanos , Hipertensão/etiologia , Incidência , Escala de Gravidade do Ferimento , Masculino , Militares/estatística & dados numéricos , Estudos Retrospectivos , Rabdomiólise/etiologia , Estados Unidos/epidemiologia , Lesões Relacionadas à Guerra/diagnóstico , Lesões Relacionadas à Guerra/mortalidade , Adulto Jovem
16.
Shock ; 50(6): 677-683, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30427323

RESUMO

INTRODUCTION: The standard of care for refractory hyperkalemia is renal replacement therapy (RRT). However, traditional RRT requires specialized equipment, trained personnel, and large amounts of dialysate. It is therefore poorly suited for austere environments. We hypothesized that a simplified hemoperfusion system could control serum potassium concentration in a swine model of acute hyperkalemia. METHODS: Ten pigs were anesthetized and instrumented. A dialysis catheter was inserted. After bilateral nephrectomy, animals received intravenous potassium chloride and were randomized to the control or treatment group. In both groups, blood was pumped through an extracorporeal circuit (EC) with an in-line hemodialyzer. In the treatment arm, ultrafiltrate from the hemodialyzer was diverted through cartridges containing novel potassium binding beads and returned to the EC. Blood samples were obtained every 30 min for 6 h. RESULTS: Serum potassium concentration was significantly lower in the treatment than in the control group over time (P = 0.02). There was no difference in serum total calcium concentration for group or time (P = 0.13 and 0.44, respectively) or platelet count between groups or over time (P = 0.28 and 1, respectively). No significant EC thrombosis occurred. Two of five animals in the control group and none in the treatment group developed arrhythmias. All animals survived until end of experiment. CONCLUSIONS: A simplified hemoperfusion system removed potassium in a porcine model. In austere settings, this system could be used to temporize patients with hyperkalemia until evacuation to a facility with traditional RRT.


Assuntos
Hiperpotassemia/sangue , Hiperpotassemia/terapia , Animais , Pressão Arterial/fisiologia , Glicemia/efeitos dos fármacos , Glucose/uso terapêutico , Hemodinâmica/efeitos dos fármacos , Hemoperfusão , Hiperpotassemia/fisiopatologia , Masculino , Fenilefrina/farmacologia , Potássio/sangue , Taxa Respiratória/fisiologia , Suínos
17.
J Hepatol ; 2018 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-29729369

RESUMO

The publisher regrets that this article has been temporarily removed. A replacement will appear as soon as possible in which the reason for the removal of the article will be specified, or the article will be reinstated. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.

18.
Hypertension ; 71(5): 824-832, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29555664

RESUMO

The associations between injury severity, posttraumatic stress disorder (PTSD), and development of chronic diseases, such as hypertension, among military service members are not understood. We sought to (1) estimate the prevalence and incidence of PTSD within a severely injured military cohort, (2) assess the association between the presence and chronicity of PTSD and hypertension, and (3) determine whether or not initial injury severity score and PTSD are independent risk factors for hypertension. Administrative and clinical databases were used to conduct a retrospective cohort study of 3846 US military casualties injured in the Iraq and Afghanistan conflicts between February 1, 2002, and February 1, 2011. Development of PTSD and hypertension after combat injury were determined using the International Classification of Diseases, Ninth Revision codes. Multivariable competing risk regression models were used to assess associations between injury severity score, PTSD, and hypertension, while controlling for covariates. Overall prevalence of PTSD was 42.4%, and prevalence of hypertension was 14.3%. Unadjusted risk of hypertension increased significantly with chronicity of PTSD (1-15 diagnoses: hazard ratio, 1.77; 95% confidence interval, 1.46-2.14; P<0.001; >15 diagnoses: hazard ratio, 2.29; 95% confidence interval, 1.85-2.84; P<0.001) compared with patients never diagnosed with PTSD. The association between injury severity score (hazard ratio, 1.06 per 5-U increment; 95% confidence interval, 1.03-1.10; P<0.001) and hypertension was significant, with little change in effect in the multivariable model (hazard ratio, 1.05 per 5-U increment; 95% confidence interval, 1.01-1.09; P=0.03). In a cohort of service members injured in combat, we found that chronicity of PTSD diagnoses and injury severity were independent risk factors for hypertension.


Assuntos
Hipertensão/diagnóstico , Hipertensão/epidemiologia , Militares , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Ferimentos e Lesões/epidemiologia , Adulto , Distribuição por Idade , Doença Crônica , Estudos de Coortes , Comorbidade , Bases de Dados Factuais , Feminino , Humanos , Hipertensão/tratamento farmacológico , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prevalência , Modelos de Riscos Proporcionais , Análise de Regressão , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Distribuição por Sexo , Transtornos de Estresse Pós-Traumáticos/terapia , Análise de Sobrevida , Estados Unidos/epidemiologia , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/terapia
19.
Epilepsia ; 57(9): 1354-62, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27374986

RESUMO

Peripheral biomarkers have myriad potential uses for treatment, prediction, prognostication, and pharmacovigilance in epilepsy. To date, no single peripheral biomarker has demonstrated proven effectiveness, although multiple candidates are in development. In this review, we discuss the major areas of focus including inflammation, blood-brain barrier dysfunction, redox alterations, metabolism, hormones and growth factors.


Assuntos
Biomarcadores/metabolismo , Epilepsia/genética , Epilepsia/metabolismo , Animais , Barreira Hematoencefálica/fisiopatologia , Humanos , Inflamação/metabolismo , Peptídeos e Proteínas de Sinalização Intercelular/genética , Peptídeos e Proteínas de Sinalização Intercelular/metabolismo
20.
J Antimicrob Chemother ; 66(5): 1117-9, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-21393210

RESUMO

OBJECTIVES: To report on the temporal relationship between administration of trimethoprim/sulfamethoxazole to medically immunosuppressed HIV-negative renal patients with Pneumocystis jirovecii pneumonia (PCP) and the development of an acute psychosis. METHODS: We investigated a retrospective case series of renal transplant and immunosuppressed patients with PCP within an ongoing outbreak in the northwest of England since 2009. Four patients with PCP developed psychosis following treatment with trimethoprim/sulfamethoxazole. RESULTS: Four of twenty patients developed acute psychoses following administration of trimethoprim/sulfamethoxazole, including one accidental re-challenge. Symptoms resolved within 24 h of changing the therapy. The striking temporal relationship between the initiation and discontinuation of the drug and the behavioural changes suggests a causal relationship. CONCLUSIONS: With increasing solid organ transplantation and the use of immunosuppressants, vigilance regarding trimethoprim/sulfamethoxazole dose modification is required and the routine use of therapeutic drug monitoring should be considered.


Assuntos
Transplante de Rim , Transtornos Mentais/induzido quimicamente , Pneumonia por Pneumocystis/tratamento farmacológico , Pneumonia por Pneumocystis/epidemiologia , Transplante , Combinação Trimetoprima e Sulfametoxazol/administração & dosagem , Combinação Trimetoprima e Sulfametoxazol/efeitos adversos , Adulto , Idoso , Inglaterra/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumocystis carinii/efeitos dos fármacos , Estudos Retrospectivos
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