Low-density lipoprotein subfraction profiles in dialysis patients

Summary: Uraemic dyslipidaemia is a major risk factor for cardiovascular disease in end-stage renal failure patients. In patients without renal failure, high levels and qualitative abnormalities of low-density lipoprotein (LDL) are known to be atherogenic. Recently, LDL subfraction analysis has associated premature coronary artery disease with a high prevalence of small, dense LDL particles characterizing the LDL subclass phenotype B. We therefore examined the lipid profiles, LDL subfraction distribution and phenotypes in our population of haemodialysis (HD; n = 30) and peritoneal dialysis patients (PD; n = 17), and compared them to 40 asymptomatic, non-uraemic volunteers. Dialysis patients had significantly higher triglyceride and VLDL cholesterol concentrations and lower HDL cholesterol and smaller LDL peak particle diameters. PD patients had significantly higher total cholesterol, glycated haemoglobin and fasting blood glucose levels with smaller LDL peak particle diameters (24.4 [0.1] vs 24.8 [0.1 nm] than HD. Both groups showed significant negative correlations between plasma triglyceride and LDL peak particle diameter, and positive correlations between HDL cholesterol and LDL peak particle diameter. All the PD patients expressed the B phenotype (LDL peak diameter ± 25.5 nm) compared to 73% of HD patients. This study demonstrates that HD and especially PD patients have atherogenic lipid profiles which are associated with a predominance of small dense LDL particles and the highly atherogenic LDL subclass phenotype B.     

Brain plasticity following psychophysiological treatment in learning disabled/ADHD pre-adolescents.

This research investigated the effects of a psychophysiological treatment methodology on brain plasticity as reflected in event-related brain potential topographic mapping and morphology along with School-marks and Mangina-Test performance in three different groups of pre-adolescents at baseline and 8 months later: (a) Learning Disabled/ADHD pre-adolescents who were treated; (b) Non-treated Learning Disabled/ADHD pre-adolescents; (c) Normal controls. Results indicate that: (1) the Event-Related Brain Potentials topographic mapping was significantly modified in post-treatment condition for the treated Learning/Disabled/ADHD group as opposed to pre-treatment baseline (P < 0.001). This was mainly due to the enhanced pre-frontal and frontal N450 amplitudes along with higher P450 components over posterior regions in post-treatment condition (P < 0.001); (2) for group comparisons at baseline, no significant topographic mapping differences were found between the treated Learning Disabled/ADHD group and the non-treated Learning Disabled/ADHD control group (P > 0.05) and significant differences were present between the treated Leaning Disabled/ADHD and the normal control group (P < 0.001); (3) 8 months later, in post-treatment condition, group comparisons revealed significant topographic mapping differences between the treated Learning Disabled/ADHD group and the non-treated Learning Disabled/ADHD control group (P < 0.001) and none between the treated Learning Disabled/ADHD group and the normal control group (P > 0.05); (4) the topographic mapping of both components was similar at baseline and 8 months later in both control groups (P > 0.05); (5) at baseline, school-marks and Mangina-Test performance of treated Learning Disabled/ADHD were not significantly different than those of the non-treated Learning Disabled/ADHD (P > 0.05) and significantly lower than those of the normal control group (P < 0.001); (6) the treated Learning Disabled/ADHD group in post-treatment condition had significantly higher school-marks and Mangina-Test performance than those of non-treated Learning Disabled/ADHD controls (P < 0.001) and were similar to those of normal controls 8 months later (P > 0.05); (7) school-marks and Mangina-Test performance at baseline for non-treated Learning Disabled/ADHD controls were not modified 8 months later (P > 0.05) and normal controls maintained their high performance within the same time interval (P > 0.05). These findings provide evidence of the impact of the psychophysiological treatment methodology on brain plasticity and regulation as reflected in significantly improved neurophysiology of pre-frontal, frontal and posterior brain regions concomitantly with higher school-marks and neuropsychometric performance in the Mangina-Test.     

The narcissistically vulnerable system: A case study of the public mental hospital

The present paper introduces the concept of the narcissistically vulnerable system by suggesting that organizations may manifest some of the same pathological characteristics as narcissistic individuals. The public mental hospital was chosen as an example of such a system. Reasons for its vulnerability were suggested and specific defenses, employed at the system level, were discussed. Finally, remedies for the repair of the narcissistically vulnerable system were considered.     

Nursing involvement in euthanasia: how sound is the philosophical support?

Abstract  Preference utilitarians are concerned to maximize the autonomous choices of individuals; for this reason, they argue that nurses ought to advocate for those patients who desire assistance with ending their lives. This approach prompts us to consider, then, the moral validity of nursing involvement in measures intended to end the lives of patients. In this article, the terms of preference utilitarianism are set out and considered in order to determine whether this approach offers sufficient philosophical support for sanctioning a role for nursing in euthanasia. Ultimately, it is found that preference utilitarianism is lacking in this respect, as well as in its fitness for guiding nursing activity in general. In particular, it is found that nurses are required to exchange a handmaiden relationship with the medical profession for an equally undignified relationship with patients. If nursing involvement in measures intended to end the lives of patients is to find sufficient philosophical support, then we need to look elsewhere.     

Pulmonary complications after tricyclic antidepressant overdose

We studied 82 consecutive patients admitted to the ICU with predominant tricyclic antidepressant overdose (mean plasma tricyclic level, 1,025 ng/ml) to determine the nature and incidence of respiratory complications. The majority of patients (80.4 percent) had a decreased arterial to alveolar oxygen tension ratio (PaO2/PAO2) on initial emergency room arterial blood gas analysis (mean, 0.56). Mechanical ventilation was required in 76.8 percent of the patients for a mean duration of 46.2 h. Chest radiograph abnormalities developed during the first 48 h in 32/82 patients (39 percent). The group with radiographic abnormalities had higher mean drug levels than the group without (p less than 0.05). Of 82 patients, nine (11 percent) developed radiographic evidence of bilateral alveolar infiltrates suggestive of acute lung injury. This group had significantly higher mean drug levels than the groups with other types of radiographic abnormalities (p less than 0.001). Charcoal was recovered from the airway of 18/72 patients who received activated charcoal slurry by nasogastric tube in the emergency room after endotracheal intubation. The group who aspirated did not show statistically significant difference in the incidence of chest radiograph abnormalities, gas exchange, or survival compared with the group that did not aspirate.