The safety of synthetic colloid in critically ill patients with severe traumatic brain injuries

Purpose

Although 4% albumin is associated with increased mortality in patients with traumatic brain injury (TBI), evidence concerning the safety of synthetic colloids is lacking. We aimed to determine if there is an association between synthetic colloids and mortality in patients with severe TBI.

Materials and Methods

A retrospective cohort study of patients with severe TBI was conducted. Data were collected on all intravenous fluids administered during the first 14 days of admission. Multivariable Cox proportional hazards regression was used to model the association between daily cumulative pentastarch quintiles and mortality.

Results

Patients receiving pentastarch had higher Acute Physiology and Chronic Health II scores (23.9 vs 21.6, P < .01), frequency of craniotomy (42.5% vs 21.6%, P = .02), longer duration of intensive care unit stay (12 vs 4 days, P < .01), and mechanical ventilation (10 vs 3 days, P < .01). On unadjusted Cox regression, patients in the highest quintile of cumulative pentastarch administration had a higher rate of mortality compared with those receiving no colloid (hazard ratio, 3.8; 95% confidence interval, 1.2-12.4; P = .03). However, this relationship did not persist in the final multivariable model (hazard ratio 1.0; 95% confidence interval, 0.25-4.1; P = .98).

Conclusion

There was no association between cumulative exposure to pentastarch and mortality in patients with severe TBI.     

Correlation of Intra Vascular Cannula Insertion Technique and Ward Practices with Local Site Infection

Background

Peripheral intravascular cannulas are indispensable in modern day medical care. These cannulas, if not inserted properly, predispose a patient to various morbidities. The present study was carried out to assess the incidence of intravascular cannula associated infections and correlate it with cannula insertion techniques and ward practices.

Methods

The study was carried out in the wards of a tertiary care hospital. The study was divided into two phases, each phase comprising of 50 patients. In phase 1, cannula insertion was carried out after normal ward cleaning practices. In phase 2, cleaning of the site was done by standard surgical cleaning procedure. The cannula samples after removal were cultured and local signs of thrombophlebitis looked for at the site of insertion. Thrombophlebitis was considered a surrogate marker of local infection in the vessel wall.

Result

The relative risk of acquiring thrombophlebitis increased by 2.18 times (applying univariate analysis) by existing methods as compared to the standard method.

Conclusion

Use of standard cleaning protocol had a significant effect on decreasing the incidence of cannula associated infections and cannula related morbidity.Key Words: Intravascular cannula, Peripheral vein thrombophlebitis, Cannula associated infections     

Toxicity of Low-Dose Intermittent Isotretinoin in Recalcitrant Acne

Background

Isotretinoin, an oral retinoid, has been utilized to achieve long term remissions in cases of recalcitrant acne. In the conventional dosage schedule, the use of oral isotretinoin has been limited by the occurrence of biochemical abnormalities such as hypertriglyceridaemia and impaired liver function tests and radiological changes consistent with diffuse idiopathic skeletal hyperostosis. Low-dose intermittent regimen of oral isotretinoin has been evolved as a cost effective alternative to the conventional dosage regimen in cases of acne. This study addresses the issue of adverse effects of low-dose intermittent isotretinoin and the safety of this regimen.

Methods

A total of 60 cases of recalcitrant acne were included in the study. Baseline haematological, biochemical and radiological investigations were carried out. Low-dose intermittent isotretinoin was instituted in a dose of 0.5 mg/kg/day for one week in every four weeks for six months. The investigations were repeated at the end of six months therapy.

Result

High triglyceride levels occurred in 5% of cases whereas impaired liver function tests and skeletal hyperostosis of the spine were not observed in any case after low-dose intermittent isotretinoin.

Conclusion

The low-dose intermittent regimen in cases of acne may be utilized to limit the systemic toxicity of oral isotretinoin.Key Words: Recalcitrant acne, Isotretinoin, Low-dose intermittent regimen     

Changes in mental well-being in the transition to late life: findings from MIDUS I and II

The number of adults aged 65 years and older is increasing rapidly, creating public health challenges. We used data from the 1995 and 2005 national surveys of Midlife in the United States (MIDUS) to compare changes in mental well-being of participants (n = 1007) of 3 age cohorts (ages 45-54 years, 55-64 years, and 65-74 years in 1995). Older adults experienced a slight decline in mental well-being not seen among younger participants and not explained by demographic variables, physical ailments, mental illnesses, or chronic conditions.     

Brain natriuretic peptide: role in cardiovascular and volume homeostasis

The identification of natriuretic peptides as key regulators of natriuresis and vasodilatation, and the appreciation that their secretion is under the control of cardiac hemodynamic and neurohumoral factors, has caused wide interest. The natriuretic peptides are structurally similar, but genetically distinct peptides that have diverse actions on cardiovascular, renal, and endocrine homeostasis. Atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) are of myocardial cell origin, while cardiac natriuretic peptide (CNP) is of endothelial origin. ANP and BNP bind to the natriuretic peptide receptor (NPR-A) which, via 3' 5'-cyclic guanosine monophosphate (cGMP), mediates natriuresis, vasodialation, renin inhibition, and antimitogenic properties. CNP lacks natriuretic action but possesses vasodilating and growth inhibiting effects via the guanyl cyclase linked natriuretic peptide-B (NPR-B) receptor. All three peptides are cleared by natriuretic peptide-C receptor (NPR-C) and degraded by neutral endopeptidase, both of which are widely expressed in kidney, lung, and vascular wall. Recently, a fourth member of the natriuretic peptide, dendroaspsis natriuretic peptide (DNP) has been reported to be present in human plasma and atrial myocardium.