Objective: To analyze the impact of inflammation and negative nitrogen balance (NBAL) on nutritional status and outcomes after subarachnoid hemorrhage (SAH).Methods: This was a prospective observational study of SAH patients admitted between May 2008 and June 2012. Measurements of C-reactive protein (CRP), transthyretin (TTR), resting energy expenditure (REE), and NBAL (g/day) were performed over 4 preset time periods during the first 14 postbleed days (PBD) in addition to daily caloric intake. Factors associated with REE and NBAL were analyzed with multivariable linear regression. Hospital-acquired infections (HAI) were tracked daily for time-to-event analyses. Poor outcome at 3 months was defined as a modified Rankin Scale score $4 and assessed by multivariable logistic regression.Results: There were 229 patients with an average age of 55 6 15 years. Higher REE was associated with younger age (p 5 0.02), male sex (p , 0.001), higher Hunt Hess grade (p 5 0.001), and higher modified Fisher score (p 5 0.01). Negative NBAL was associated with lower caloric intake (p , 0.001), higher body mass index (p , 0.001), aneurysm clipping (p 5 0.03), and higher CRP:TTR ratio (p 5 0.03). HAIs developed in 53 (23%) patients on mean PBD 8 6 3. Older age (p 5 0.002), higher Hunt Hess (p , 0.001), lower caloric intake (p 5 0.001), and negative NBAL (p 5 0.04) predicted time to first HAI. Poor outcome at 3 months was associated with higher Hunt Hess grade (p , 0.001), older age (p , 0.001), negative NBAL (p 5 0.01), HAI (p 5 0.03), higher CRP:TTR ratio (p 5 0.04), higher body mass index (p 5 0.03), and delayed cerebral ischemia (p 5 0.04).Conclusions: Negative NBAL after SAH is influenced by inflammation and associated with an increased risk of HAI and poor outcome. Underfeeding and systemic inflammation are potential modifiable risk factors for negative NBAL and poor outcome after SAH. Neurology ® 2015;84:680-687 GLOSSARY CRP 5 C-reactive protein; DCI 5 delayed cerebral ischemia; HAI 5 hospital-acquired infection; ICU 5 intensive care unit; IDC 5 indirect calorimetry; mRS 5 modified Rankin Scale; NBAL 5 nitrogen balance; PBD 5 postbleed day; REE 5 resting energy expenditure; SAH 5 subarachnoid hemorrhage; SHOP 5 SAH outcomes project; TTR 5 transthyretin; UUN 5 urine urea nitrogen.Aneurysmal subarachnoid hemorrhage (SAH) is a significant contributor to all stroke-related potential years of life lost before age 65 years.1 Much of this is attributed to delayed cerebral ischemia (DCI).2 However, recent studies have found that both medical and infectious complications are significant independent contributors to morbidity and mortality after SAH.3-5 We previously found an association between poor nutritional status and infectious complications acutely after SAH. 6 Malnutrition has been associated with impaired immunologic function leading to increased rates of infection. 7 An assessment of nutritional profiles measured by indirect calorimetry (IDC) found SAH patients to have average resting energy expenditure (REE) rates ...

The establishment of an independent association between rs1054827 and ICH + PHE volume provides evidence implicating the AQP4 gene in haematoma and oedema formation after ICH. Further investigation is needed to characterise this link.

The purpose of this article is to provide the pediatrician with a thorough review of the variety of osteochondroses that affect children and adolescents. These conditions present in all different parts of the body in a wide range of patients: from the sedentary to athletic, the toddler to the pre-teen.The osteochondroses often are self-limiting and resolve with nonoperative management, but there are a few circumstances when operative treatment may be required. Recent literature confirms the heterogeneity of these conditions with respect to the clinical presentations and musculoskeletal manifestations.We think this article will heighten awareness of these disorders in the pediatric community, so that prompt intervention may be rendered.