a Background and Aims. Delirium is an acute brain dysfunction and a frequent complication in critically ill patients. When present it significantly worsens the prognosis of patients. The aim of this study was to evaluate the incidence of delirium and risk factors for delirium in a mixed group of trauma, medical and surgical ICU patients. Methods. A prospective observational study was conducted in one of the six-bed Intensive Care Units of the University Hospital Ostrava in the Czech Republic during a 12-month period. We evaluated the incidence of delirium and its predisposing and precipitating risk factors. All patients were assessed daily using the Confusion Assessment Method for the ICU (CAM-ICU). Results and Conclusions. Of the total of 332 patients with a median APACHE II (the Acute Physiology and Chronic Health Evaluation) score of 12, who were evaluated for delirium, 48 could not be assessed using CAM-ICU (47 due to prolonged coma, 1 due to language barriers). The incidence of delirium was 26.1%, with trauma and medical patients being more likely to develop delirium than surgical patients. Risk of delirium was significantly associated with age ≥ 65 years, and alcohol abuse in their anamnesis, with APACHE II score on admission, and with the use of sedatives and/or vasopressors. Delirious patients who remained in the ICU for a prolonged period showed a greater need for ventilator support and had a greater ICU-mortality.
Background and Objectives: The key pathogenetic mechanism of glucose metabolism disorders, insulin resistance (IR), can be assessed using the Homeostasis Model Assessment of IR (HOMA-IR). However, its application in clinical practice is limited due to the absence of cut-offs. In this study, we aimed to define the cut-offs for the Czech population. Methods: After undergoing anthropometric and biochemical studies, the sample of 3539 individuals was divided into either nondiabetics, including both subjects with normal glucose tolerance (NGT, n = 1947) and prediabetics (n = 1459), or diabetics (n = 133). The optimal HOMA-IR cut-offs between subgroups were determined to maximize the sum of the sensitivity and specificity for diagnosing type 2 diabetes mellitus (T2DM) or prediabetes. The predictive accuracy was illustrated using receiver operating characteristic (ROC) curves. Logistic regression was performed to assess the association between a target variable (presence/absence of T2DM) depending on the HOMA-IR score as well as on the age and sex. Results: The HOMA-IR cut-off between nondiabetics and diabetics for both sexes together was 3.63, with a sensitivity of 0.56 and a specificity of 0.86. The area under the ROC curve was 0.73 for T2DM diagnosing in both sexes. The HOMA-IR cut-off between the NGT subjects and prediabetics was 1.82, with a sensitivity of 0.60 and a specificity of 0.66. Logistic regression showed that increased HOMA-IR is a risk factor for the presence of T2DM (odds ratio (OR) 1.2, 95% confidence interval (CI) 1.14–1.28, p < 0.0001). The predictive ability of HOMA-IR in diagnosing T2DM is statistically significantly lower in females (OR 0.66, 95% CI 0.44–0.98). The results are valid for middle-aged European adults. Conclusions: The results suggest the existence of HOMA-IR cut-offs signaling established IR. Introduction of the instrument into common clinical practice, together with the known cut-offs, may contribute to preventing T2DM.
Mild Cognitive Impairment (MCI) may be a precursor of Alzheimer's disease (AD). There is a boundary area between normal aging and dementia. In practice, the term "age related cognitive decline" has been used interchangeably with "normal aging". Alternatively, the term "aging associated cognitive decline" was introduced and defined by a performance on a standardized cognitive scale focused on learning and memory, attention and cognitive speed, language, or visuoconstructional abilities. The term "mild cognitive impairment" was adopted by Petersen in 2004 to describe a period in the course of neurodegenerative disease where cognition is no longer normal relative to age expectations, however, daily functions are not sufficiently disrupted to correlate with the diagnosis of dementia. Most of the literature refers to the amnestic form of MCI, which is likely a precursor of AD. The rate of conversion from amnestic form of MCI to AD is estimated to reach 10-15% per year. That is why MCI generated a great deal of research. When considering MCI a precursor of AD, it seems reasonable to study AD genetic markers in the MCI patients. In AD, association studies focus on genetic polymorphisms assumed to have an effect on the expression and modulation function of genes associated with AD pathogenesis (ApoE, APP, presenilin 1, presenilin 2, tau protein), and on polymorphisms related to metabolism of the aforementioned proteins (splicing, degradation). Neuropsychological assesment plays a substantial role in the diagnosis of MCI, especially in the case of identification of different MCI subtypes or typical profiles of cognitive performance in prodromal phases of neurodegenerative diseases. The optimal composition of diet may increase an average age and prevent impairment of cognitive functions at the same time. Despite the progress in early diagnosis of MCI and dementia, further research is needed on differential diagnosis and treatment. In amnestic subtype of MCI some genetic markers may already be present, predicting possible future development of AD. Pointing to the need of secondary prevention, lifestyle modifications and possible early treatment could be implemented.
were used. To evaluate the exposures both short-term (hourly and daily) data and long term (yearly) data during 45 years were analysed. For health risk assessment the relationship between exposure and biological effects of pollutants published by the WHO and the US EPA were employed.Results: During the studied period annual average concentrations of PM 10 ranged from 25 to 96 µg/m 3 ; PM 2.5 from 24 to 45 µg/m 3 ; SO 2 from 3.4 to 101.5 µg/m 3 ; NO 2 from 17.76 to 51.17 µg/m 3 ; benzene from 0.24 to 9.2 µg/m 3 ; benzo[a]pyrene from 2.1 to 14 ng/m 3 ; arsenic from 1.2 to 9.5 ng/m 3 . Since the turn of the 80s and 90s of the 20th century trend of air pollutant concentrations has been decreasing until the turn of millennium, when it stopped, and it has been constant until present time. However, presented results demonstrate that the citizens of Ostrava have been exposed to relatively high concentrations of pollutants in comparison to other similar cities. The most significant pollutants contributing to health risks are airborne dust (PM 10 , PM 2.5 ), benzene and benzo[a]pyrene. The long-term average health risk of PM 10 has increased in case of postneonatal infant mortality up to 30%; prevalence of bronchitis in children up to 61%; and incidence of chronic bronchitis in adults up to 89%. The long-term average health risk of PM 2.5 increased for all-cause mortality in persons aged 30+ years up to 22%; cardiopulmonary related mortality up to 25%; and lung cancer related mortality up to 39%. The highest carcinogenic risk is observed in benzo[a]pyrene, when the range of individual lifetime carcinogenic risk is up to 1.25*10 −3 . This assessment is valid according to the strict carcinogenic risk by the WHO, while the maximum carcinogenic risk according the US EPA is 7.2*10 −5 . Conclusions: A significant reduction of the pollutants' concentrations in Ostrava in the nineties of the last century does not mean a required improvement of outdoor air quality to the desired level. Persisting episodes with a very strong short-term increase of the concentration of PM 10 and PM 2.5 , as well as long-term load of these substances on the population is very high. Health risks from such burdens are likely to lead to a higher mortality and morbidity especially from specific diseases.
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