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2 Minute Medicine Rewind May 19th, 2025
1. The blood urea nitrogen to albumin ratio is an independent and superior predictor of mortality in ICU patients with acute pancreatitis.
Evidence Rating Level: 2 (Good)
Acute pancreatitis (AP) is a prevalent gastrointestinal condition requiring intensive care in severe cases, with up to 20% of patients developing life-threatening complications. Early prognostic indicators are critical for guiding timely interventions. While the blood urea nitrogen to albumin ratio (BAR) has been identified as a predictor of mortality in various critical illnesses, its utility in AP remained unexamined. This retrospective cohort study used the MIMIC-IV database to evaluate the association between BAR and all-cause mortality in 514 ICU-admitted AP patients. Patients were stratified into high (≥7.62) and low (<7.62) BAR groups. Cox regression analyses, adjusted for confounders including age, clinical scores, complications, and interventions, showed that a high BAR was independently associated with increased short- and long-term mortality at 28, 60, 90, and 360 days. Notably, the 28-day mortality hazard ratio (HR) for high BAR was 6.83 (95% CI: 2.62–17.82, P<0.001). The predictive performance of BAR (AUC = 0.78 at 28 days) exceeded traditional scores such as SOFA and OASIS. Subgroup analysis confirmed the robustness of BAR across demographics and comorbidities, except in diabetic patients at 360 days. These findings suggest BAR is a simple, objective biomarker with superior prognostic value in critically ill AP patients.
1. Low-frequency electrical stimulation yields greater stimulation efficiency than kilohertz-frequency stimulation in stroke patients with arm paresis, though both modalities produce similar force, discomfort, and fatigue profiles.
Evidence Rating Level: 2 (Good)
Stroke frequently results in upper limb paresis, severely impacting daily functioning. Electrical stimulation (ES) is a standard therapeutic intervention, but the optimal stimulation frequency for improving wrist extensor function in stroke patients remains unclear. This randomized crossover trial compared the acute effects of 1.0 kilohertz (kHz) versus low-frequency ES on stimulation efficiency, force production, discomfort, and fatigue in 20 stroke patients with arm paresis. Participants received both ES types in randomized order across two sessions, each including a stepwise intensity protocol and a muscle fatigue protocol. The primary outcome, stimulation efficiency (force per stimulation intensity), was significantly greater with low-frequency stimulation (mean difference 0.14 N/mA, p = .031). However, no significant differences were observed between current types for secondary outcomes including electrically induced force, perceived discomfort, or muscle fatigue. Force and discomfort increased with stimulation intensity regardless of frequency, while fatigue showed a consistent decline in force over repetitions for both conditions. Notably, large interindividual variability was present, emphasizing the importance of personalized treatment settings. Although both ES types are viable, low-frequency stimulation demonstrated superior efficiency at submaximal intensities, while kilohertz stimulation may offer advantages in early neuroactivation stages post-stroke.
1. Paravertebral blocks significantly reduced early postoperative opioid use and pain compared to wound infiltration in children undergoing thoracotomy for cardiac surgery.
Evidence Rating Level: 1 (Excellent)
Postoperative pain management remains a challenge in pediatric cardiac surgery, particularly following thoracotomies, where opioid use can delay recovery and increase complications. Paravertebral blocks (PVB) have been shown to provide effective analgesia in adults but their benefit in children is less established. This double-blind, randomized controlled trial compared unilateral PVB to local wound infiltration with ropivacaine in 100 children aged 6–14 undergoing thoracotomy for congenital heart defect repair. The primary outcome was 24-hour postoperative sufentanil consumption. Secondary outcomes included pain scores (Faces Pain Scale-Revised), opioid use incidence, and time to opioid requirement. Children receiving PVB had significantly lower opioid consumption (0.3±0.4 µg/kg vs 0.6±0.5 µg/kg, p = 0.004) and reduced pain scores at 6, 12, and 18 hours postoperatively, with the greatest benefit at 6 hours (1.7 vs 3.3, p < 0.001). Time to pain score ≥4 was also delayed (11 vs 5 hours, p = 0.001). No significant differences were observed in ICU stay, hospitalization, mechanical ventilation duration, or adverse events. These findings indicate that while PVB did not accelerate overall recovery, it provided effective early analgesia with reduced opioid need and minimal risk.
Neuropathic pain in diabetic polyneuropathy: a 5-year prospective study
1. Neuropathic pain in diabetic polyneuropathy is dynamic over time, with distinct clinical and sensory predictors associated with both its development and resolution.
Evidence Rating Level: 2 (Good)
Neuropathic pain in diabetic polyneuropathy (P-DPN) remains poorly characterized in longitudinal research. This 5-year prospective study investigated the progression and predictors of neuropathic pain among 102 patients with at least probable diabetic polyneuropathy at baseline, selected from a larger Danish cohort of newly diagnosed type 2 diabetes patients. Comprehensive assessments—including bedside sensory testing, quantitative sensory testing (QST), skin biopsies, and nerve conduction studies—were performed at both baseline and follow-up. Over the study period, the prevalence of probable P-DPN rose from 11.5% to 14.8%. Among patients with nonpainful DPN at baseline, 38.2% developed neuropathic pain, while 28.9% of those with pain at baseline reported relief at follow-up. Baseline dysesthesia significantly predicted pain development, especially in women, and was linked to diminished warm detection and lower sural sensory nerve action potentials. Conversely, pain resolution correlated with lower BMI and cholesterol, and greater baseline sensitivity to cold, mechanical, and vibratory stimuli. These findings highlight specific clinical and neurophysiological markers associated with both onset and relief of neuropathic pain in type 2 diabetes.
Long-Term Fatigue Following Transient Ischemic Attack: A Prospective Cohort Study
1. Over half of TIA patients experience persistent fatigue up to one-year post-event, with early fatigue and prior anxiety/depression strongly predicting long-term symptoms.
Evidence Rating Level: 2 (Good)
Although transient ischemic attacks (TIAs) are defined by the resolution of symptoms within 24 hours, emerging evidence suggests that many patients experience persistent fatigue. This prospective cohort study assessed fatigue in 354 TIA patients over a 12-month period using the Multidimensional Fatigue Inventory (MFI-20) and Fatigue Severity Scale at 14 days, and again at 3, 6, and 12 months post-discharge. Of 287 respondents at baseline, over half consistently reported pathologic fatigue (MFI-20 General Fatigue ≥12) throughout the year, with 53.8% still affected at 12 months. Fatigue levels remained relatively stable over time. Importantly, the presence of acute infarction on imaging was not associated with fatigue, whereas a history of anxiety or depression was twice as prevalent among fatigued patients. A regression model incorporating early fatigue levels, sex, age, and infarction status explained significantly more variability in 12-month fatigue outcomes than models excluding baseline fatigue (p < 0.001). These findings underscore the persistence of fatigue in a substantial proportion of TIA patients and highlight early self-reported fatigue and mental health history as key predictors.
Image: PD
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