Publications (70) View all
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Article: Low serum concentrations of vitamin b6 and iron are related to panic attack and hyperventilation attack.
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ABSTRACT: Patients undergoing a panic attack (PA) or a hyperventilation attack (HVA) are sometimes admitted to emergency departments (EDs). Reduced serotonin level is known as one of the causes of PA and HVA. Serotonin is synthesized from tryptophan. For the synthesis of serotonin, vitamin B6 (Vit B6) and iron play important roles as cofactors. To clarify the pathophysiology of PA and HVA, we investigated the serum levels of vitamins B2, B6, and B12 and iron in patients with PA or HVA attending an ED. We measured each parameter in 21 PA or HVA patients and compared the values with those from 20 volunteers. We found that both Vit B6 and iron levels were significantly lower in the PA/HVA group than in the volunteer group. There was no significant difference in the serum levels of vitamins B2 or B12. These results suggest that low serum concentrations of Vit B6 and iron are involved in PA and HVA. Further studies are needed to clarify the mechanisms involved in such differences.Acta medica Okayama 04/2013; 67(2):99-104. · 0.84 Impact Factor -
Article: Accuracy of blood glucose measurements using glucose meters and arterial blood gas analyzers in critically ill adult patients: systematic review.
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ABSTRACT: INTRODUCTION: Glucose control to prevent both hyperglycemia and hypoglycemia is important in an intensive care unit. Arterial blood gas analyzers and glucose meters are commonly used to measure blood glucose concentration in an intensive care unit; however, their accuracies are still unclear. METHODS: We performed a systematic literature search (January 1, 2001 to August 31, 2012) to find clinical studies comparing blood glucose values measured by glucose meters and/or arterial blood gas analyzers with those simultaneously measured by a central laboratory machine in critically ill adult patients. RESULTS: We reviewed 879 articles and found 21 studies in which the accuracy of blood glucose monitoring by arterial blood gas analyzers and/or glucometers using central laboratory methods as references was assessed in critically ill adult patients. Of those 21 studies, 11 studies in which International Organization for Standardization criteria, error grid method or percentage of values within 20% of the error of a reference were used were selected for evaluation. The accuracy of blood glucose measurements by arterial blood gas analyzers and glucose meters using arterial blood was significantly higher than that of measurements by glucose meters using capillary blood (odds ratios for error: 0.04, p<0.001 and 0.36, p<0.001). The accuracy of blood glucose measurements by arterial blood gas analyzers tended to be higher than that of measurements by glucose meters using arterial blood (p=0.20). In the hypoglycemic range (defined as less than 81 mg/dL), the incidence of errors using these devices was higher than that in the non-hypoglycemic range (odds ratios for error: arterial blood gas analyzers: 1.86, p=0.15; glucose meters using capillary blood: 1.84, p=0.03; glucose meters using arterial blood: 2.33, p=0.02). Unstable hemodynamics (edema and use of a vasopressor) and use of insulin were associated with increased error of blood glucose monitoring using a glucose meters. CONCLUSIONS: Our literature review showed that the accuracy of blood glucose measurements by arterial blood gas analyzers was significantly higher than that of measurements by glucose meters using capillary blood and tended to be higher than that of measurements by glucose meters using arterial blood. These results should be interpreted with caution because of the large variation of accuracy among devices. Since blood glucose monitoring was less accurate within or near the hypoglycemic range, especially in patients with unstable hemodynamics or receiving insulin infusion, we should aware that current blood glucose monitoring technology has not reached a high enough degree of accuracy and reliability that leads to appropriate glucose control in critically ill patients.Critical care (London, England) 03/2013; 17(2):R48. · 4.61 Impact Factor -
Article: Hypoglycemia and outcome in critically ill patients.
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ABSTRACT: To determine whether mild or moderate hypoglycemia that occurs in critically ill patients is independently associated with an increased risk of death. Of patients admitted to 2 hospital intensive care units (ICUs) in Melbourne and Sydney, Australia, from January 1, 2000, to October 14, 2004, we analyzed all those who had at least 1 episode of hypoglycemia (glucose concentration, <81 mg/dL). The independent association between hypoglycemia and outcome was statistically assessed. Of 4946 patients admitted to the ICUs, a cohort of 1109 had at least 1 episode of hypoglycemia (blood glucose level, <81 mg/dL). Of these 1109 patients (22.4% of all admissions to the intensive care unit), hospital mortality was 36.6% compared with 19.7% in the 3837 nonhypoglycemic control patients (P<.001). Even patients with a minimum blood glucose concentration between 72 and 81 mg/dL had a greater unadjusted mortality rate than did control patients (25.9% vs 19.7%; unadjusted odds ratio, 1.42; 95% confidence interval, 1.12-1.80; P=.004.) Mortality increased significantly with increasing severity of hypoglycemia (P<.001). After adjustment for insulin therapy, hypoglycemia was independently associated with increased risk of death, cardiovascular death, and death due to infectious disease. In critically ill patients, an association exists between even mild or moderate hypoglycemia and mortality. Even after adjustment for insulin therapy or timing of hypoglycemic episode, the more severe the hypoglycemia, the greater the risk of death.Mayo Clinic Proceedings 02/2010; 85(3):217-24. · 5.70 Impact Factor -
Article: Correction: Association of body temperature and antipyretic treatments with mortality of critically ill patients with and without sepsis: multi-centered prospective observational study.
Critical care (London, England) 10/2012; 16(5):450. · 4.61 Impact Factor -
Article: The association between early arterial oxygenation and mortality in ventilated patients with acute ischaemic stroke.
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ABSTRACT: There are conflicting data that suggest that hyperoxia may be associated with either worse or better outcomes in patients suffering a stroke. To investigate the association between PaO(2) in the first 24 hours in the intensive care unit and mortality among ventilated patients with acute ischaemic stroke. Retrospective cohort study. Data were extracted from the Australian and New Zealand Intensive Care Society Adult Patient Database. Adults ventilated for ischaemic stroke in 129 ICUs in Australia and New Zealand, 2000-2009. The primary outcome was the odds ratio for in hospital mortality associated with "worst" PaO(2) considered as a categorical variable, with data divided into deciles and compared with the mortality of the 10th decile. For patients on an FiO(2) of _50% at any time in the first 24 hours, "worst" PaO(2) was defined as the PaO(2) associated with the highest alveolar-arterial (A-a) gradient. For patients on an FiO(2) of <50%, it was defined as the lowest PaO(2). Secondary outcomes were ICU and hospital length of stay and the proportion of patients in each decile discharged home. Of the 2643 patients eligible for study inclusion, 1507 (57%) died in hospital. The median "worst" PaO(2) was 117mmHg (interquartile range, 87-196mmHg). There was no association between worst PaO(2) and mortality, length of stay or likelihood of discharge home. We found no association between worst arterial oxygen tension in the first 24 hours in ICU and outcome in ventilated patients with ischaemic stroke.Critical care and resuscitation: journal of the Australasian Academy of Critical Care Medicine 03/2012; 14(1):14-9. · 1.67 Impact Factor
