Background: Tight glycemic control (TGC) may improve outcomes in hyperglycemic neurosurgical patients. The adoption of TGC has been limited by a lack of adequate data on optimal insulin delivery protocols and serum glucose concentration and by concerns about the risks of hypoglycemia.
Objective: This study was designed as a meta-analysis of outcomes to compare intensive insulin therapy and TGC with conventional insulin therapy and conventional glucose control. The secondary objective was to determine retrospectively whether a particular glucose range correlates with better outcomes.
Methods: Using electronic databases, we retrieved all English language studies published between January 1997 and December 2010 reporting outcomes in neurological and neurosurgical patients as a function of glucose levels and insulin protocols. We conducted a meta-analysis around 4 outcome measures: infection, neurological outcome, hypoglycemia, and mortality. Effect sizes in each study were individually correlated with target intensive insulin therapy glucose levels. Individual studies were assessed for quality by use of the Jadad scale.
Results: Nine studies reporting on 1459 patients met the inclusion criteria. Five were restricted to neurosurgical patients. Four included neurological patients. Compared with conventional glucose control, TGC lowered infection rates (odds ratio, 0.59; 95% confidence interval, 0.47-0.76; P < .001) and yielded better neurological outcomes (odds ratio, 1.72; 95% confidence interval, 1.36-2.16; P < .001). Beneficial effects increased as glucose limits tightened and study quality improved (R > 0.9 for both). TGC resulted in a higher rate of hypoglycemic events (odds ratio, 8.04; 95% confidence interval, 4.85-13.31; P < .001). Mortality was not affected.
Conclusion: TGC reduced infection risk and improved neurological outcome despite increased rates of hypoglycemic events. An optimal target for serum glucose concentrations could not be determined.
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http://dx.doi.org/10.1227/NEU.0b013e3182631eb4 | DOI Listing |
JAMA Neurol
December 2024
Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
Importance: Gestational hypertension, preeclampsia, and eclampsia are established risk factors for stroke and dementia later in life. Whether these pregnancy complications are associated with an increased risk of new-onset neurological disorders within months to years after giving birth is not known.
Objective: To explore whether gestational hypertension, preeclampsia, and eclampsia are associated with new-onset migraine, headache, epilepsy, sleep disorder, or mental fatigue within months to years after giving birth.
Rheumatology (Oxford)
December 2024
AP-HP, Université Paris Saclay, department of internal medicine and clinical immunology, Bicêtre Hospital, Le Kremlin Bicêtre, France.
Objective: To describe presentation, treatment and outcome of immune checkpoint inhibitor (ICI) associated-vasculitis in cancer patients in a multicentre study.
Methods: Thanks to the ImmunoCancer International Registry (ICIR), a multidisciplinary network focused on the research of the immune related adverse events related to cancer immunotherapies, patients presenting with a clinical and/or radiological suspicion of vasculitis, and histological evidence of vasculitis after being exposed to ICIs were retrospectively identified.
Results: Twenty eight cases were identified in the ICIR registry.
Epilepsia
December 2024
Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota, USA.
Objective: We aimed to quantify and predict lacosamide exposure during pregnancy by developing a pregnancy physiologically-based pharmacokinetic model, allowing the prediction of potential dose increases to support maintaining a patient's preconception lacosamide concentrations.
Methods: Models for nonpregnant adults and pregnant female patients were constructed using physiochemical and pharmacological parameters identified from literature review. Evaluation of plasma concentration data from human males was digitized from the literature.
Am J Med Genet A
December 2024
Division of Medical Genetics, Department of Specialized Medicine, McGill University Health Centre, Montreal, Quebec, Canada.
Biallelic variants in GLDN have recently been associated with lethal congenital contracture syndrome 11 (LCCS11), a form of fetal akinesia deformation sequence (FADS) with high neonatal mortality. In this report, we describe five individuals from two Canadian Inuit families originating from different communities in Nunavik all affected with FADS and harboring a rare homozygous missense variant, [NM_181789.4:c.
View Article and Find Full Text PDFAim: The optimal arterial partial pressure of carbon dioxide (PaCO) for patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR) remains unknown. We aimed to investigate the association between post-resuscitation PaCO and neurological outcomes.
Methods: This retrospective cohort study analyzed data from the Study of Advanced Life Support for Ventricular Fibrillation with Extracorporeal Circulation in Japan, a multicenter registry study across 36 hospitals in Japan, including patients with out-of-hospital cardiac arrest (OHCA) admitted to intensive care units (ICU) after ECPR between 2013 and 2018.
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