Ambulatory blood pressure in type I diabetes mellitus. Comparison to presence of incipient nephropathy in adolescents and young adults.

AMBP measurements were obtained at 20-min intervals during the day and at 60-min intervals during the night in 38 adolescents and young adults (12-25 yr old) with type I diabetes, and in 36 healthy, nondiabetic control subjects of comparable age. The group of patients with elevated AER (greater than 15 micrograms/min) had higher mean 24-h sBP, dBP, and BPB (defined as the prevalence of systolic readings greater than 130 mm Hg or diastolic readings greater than 85 mm Hg) compared with both the group of patients with type I diabetes and AER less than 15, and the control group. The normal diurnal variation in BP and BPB was observed in the control group and the group with type I diabetes and AER less than 15, whereas the nocturnal decrease observed in the group with type I diabetes and AER greater than 15 was not statistically significant. Elevations in AMBP of the patient group with AER greater than 15 were reflected in random BP measurements. Even though the mean random BP measurements of all groups were within the normal range for age, the mean random sBP and dBP of the type I diabetes patients with AER greater than 15 was higher than both the control group and the group with type I diabetes and AER less than 15. The GFR, determined by the clearance of 99Tc-DTPA, was associated negatively with measures of AMBP and AER in the group with AER greater than 15.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effective use of streptokinase for peritoneal catheter failure

The fibrinolytic enzyme streptokinase (streptase) was infused into the peritoneal catheter in 19 episodes of catheter failure in 16 patients. Intraabdominal bleeding prior to infusion was seen in seven of these episodes. Fibrin strands and clots were present in four additional successful cases. Streptokinase successfully relieved the obstruction in 13 episodes in 11 patients. The procedure failed in two cases of omental ingrowth and in another with catheter malposition. Streptokinase infusion also failed in two patients with Pseudomonas aeruginosa and one patient with Staphylococcus epidermidis peritonitis. Intraperitoneal streptokinase infusion is simple and free of side effects. Its use should be considered in peritoneal catheter failure, particularly in cases where bleeding or fibrin accumulation may play a role.     

Hyperlipidemia, hypercoagulability, and accelerated thrombosis: studies in congenitally hyperlipidemic rats and in rats and monkeys with induced hyperlipidemia

Inbred Carworth Farms Nelson (CFN) congenitally hyperlipidemic rats had significantly shorter coagulation and prothrombin times and higher levels of coagulation factors, II, V, VII, VIII, and X than did controls. Conversely, congenitally hypolipidemic rats of the same strain had significantly longer coagulation and prothrombin times and lower levels of factors II, V, VII, X and XII and of blood platelets than did controls. A loop-shaped polyethylene cannula was inserted into the aorta to assess the potential for thrombosis. The hyperlipidemic group obstructed this significantly faster and the hypolipidemic group slower than did the controls. Normal CFN rats made hypertensive by unilateral renal artery clip developed hypertension together with significantly elevated serum cholesterol and factor VII and X levels. Rhesus monkeys with diet-induced hyperlipidemia showed shorter prothrombin times and higher factor X levels than did controls on normal diet. By selective breeding, two groups of squirrel monkeys were obtained. Both groups had similar serum cholesterol levels on a normal diet but one group (hyperresponders) showed higher serum cholesterol levels on a cholesterol-containing diet than did the other (hyporesponder) group. Both groups showed significantly elevated levels of factors II, V, VII, IX and X on a cholesterol-containing diet. There was good correlation between the levels of many coagulation factors and serum cholesterol in both rats and monkeys. If thrombosis is important in the genesis of atherosclerosis, these findings could indicate that elevation of plasma lipids may play a role, via the coagulation pathway, in the production of human vascular disease.     

涂阳肺结核患者诊断延误及影响因素分析

目的对2009年10~12月武汉市结核病防治所住院的痰标本直接涂片抗酸杆菌镜检阳性(涂阳)肺结核患者诊断延误及其影响因素进行研究。方法采用自行设计的问卷,对224例涂阳肺结核患者进行面访式调查。采用Wilcoxon符号秩和检验对首诊延误、卫生系统延误及诊断延误分别进行单因素分析,用逐步logistic回归法对3种延误分别进行多因素分析。结果首诊延误、卫生系统延误及诊断延误中位数分别为8、12及35 d;首诊延误的危险因素为:男性(OR=2.134,95%可信区间1.115~4.083),初中及以下文化(OR=1.879,95%可信区间1.048~3.368),无咯血(OR=2.194,95%可信区间1.056~4.559)及结核知识得分低(OR=4.060,95%可信区间2.232~7.385);卫生系统延误危险因素为:首诊为区以下医疗单位(OR=2.938,95%可信区间1.339~6.446),保护因素为:就诊次数≤1次(OR=0.056,95%可信区间0.025~0.126);诊断延误危险因素为结核知识得分低(OR=3.036,95%可信区间1.654~5.572),自卑及自我羞耻感水平高(OR=2.012,95%可信区间1.103~3.676),保护因素为:就诊次数≤1次(OR=0.216,95%可信区间0.117~0.396)。结论武汉市住院涂阳肺结核患者存在一定的诊断延误,但延误水平不高。应加强对人群特别是文化程度低的人群的结核相关知识宣教;加强基层医务人员对结核病的警觉性并提高诊断能力;应避免患者反复多次就诊于同一水平医疗机构,从而缩短诊断延误时间。     

Simple Mobile Application for Calculating “Ergotrauma” Made Using an Excel Sheet

How to cite this article: Anand A, Saigal S, Panda R, Kodamanchili S, Shrivastava P, Das A, et al. Simple Mobile Application for Calculating “Ergotrauma” Made Using an Excel Sheet. Indian J Crit Care Med 2021;25(9):1081.     

Reanalyzing the Mortality Analysis of COVID-19 Deaths in a Tertiary Care Center in India

How to cite this article: Anand A, Panghal R, Kaler P, Saigal S, Panda R, Kodamanchili S, et al. Reanalyzing the Mortality Analysis of COVID-19 Deaths in a Tertiary Care Center in India. Indian J Crit Care Med 2021; 25(10):1211.

Sir,Recently, one of the most awaited publications by the premier government medical institute of our country, titled “Clinicoepidemiological Features and Mortality Analysis of Deceased Patients with COVID-19 in a Tertiary Care Center”, was a very delightful read.¹ All the intensivists of India look up to this institute for regular guidelines of management of COVID-19. It is a very informative and learning piece analyzing mortality among the patients admitted to one of the (intensive care units) ICU of this center.When compared with other similar studies across the globe, this paper does not provide supplementary data that could have answered questions like how many of the admitted patients were intubated in total and what was the mortality rate among the subgroup who were intubated.^2,3 Rather a retrospective approach of data representation has been employed, which tells that among the total 247 deceased patients, 24.2% were intubated and 30.3% of total deceased were intubated within 24 hours. Even this representation does not throw light on how many patients of total 654 patients were intubated during their ICU stay. The policy guiding intubation of patients should also be specified as if it was decided by the intensivist on duty or by any fixed institutional criteria.The incidence of pulmonary embolism (PE) among the deceased in the original paper is 2.8%, which is quite less than reported by Mahmoud et al. in a meta-analysis who reported the overall PE rate in ICU to be 19%, and on autopsy, 22% of deceased patients were found to have PE in COVID-19.⁴ The question that remains unanswered is how were those patients, who died in this published paper, diagnosed with PE. The diagnosis of PE was a clinical diagnosis or radiological diagnosis or by autopsy should have been specified. If the incidence of PE is so less than what was the antithrombotic practice of the institute as this piece of information can help to save many lives.