Geriatric critical care

Demographic compulsions are inescapable. There has been a 50% increase in life expectancy at birth for persons born in 1980 compared to those born in 1900. Not only do critical care units utilize up to a third of hospital expenditures and about 1% of GNP, the critically ill elderly consume a disproportionate amount of ICU resources. Outcome prediction models for very elderly critically ill patients have been proposed with age as one of numerous model variables; but such models have not been widely validated. Despite the burgeoning emphasis on evidence-based population approach to health care, there is insufficient research to guide the critical care clinician. There remains a modicum of subjectivity in crucial decisions that affect the elderly patient receiving intensive care. Older age is also one of the factors that lead to a physician bias in refusing ICU admission; this has recently been borne out in a multivariate analysis. Physicians generally consider their older patients' quality of life to be worse than do the patients, although other studies that have assessed the quality of live show no age-related differences among ICU survivors. Furthermore, physicians' estimations of patient quality of life significantly influence physicians' attitudes to futility of care issues, in contrast to patients' perceptions. Threshold for life-sustaining treatment in the elderly will continue to be different among the ICUs. In critical care of the elderly, geography may well be destiny. Clinical decisions will be subjected to many ethical, legal, and socioeconomic pressures. Personal and religious beliefs will inevitably influence societal expectations and clinician practices. Severity of illness has the biggest influence on outcome in a critical illness. Age alone is not a predictor of short-term or long-term outcome in the older patient who is critically ill. Critical illness in the elderly remains a fertile area for future research.     

Pyridoxine therapy in a patient with severe hydrazine sulfate toxicity

OBJECTIVE: To report hydrazine sulfate as a cause of severe encephalopathy and to report its response to high-dose pyridoxine therapy. DESIGN: Case report. SETTING: An adult six-bed medical/surgical intensive care unit of a general hospital. PATIENT: One patient who developed severe encephalopathy after hydrazine sulfate. INTERVENTION: 5 g i.v. pyridoxine. MEASUREMENTS AND MAIN RESULTS: After 180 mg/day for 2 wks followed by 360 mg/day of hydrazine sulfate ingestion, our patient suffered severe encephalopathy. He received mechanical ventilation with attendant supportive measures and high-dose pyridoxine. The patient's encephalopathy resolved 24 hrs after receiving pyridoxine. CONCLUSION: Severe encephalopathy could result from hydrazine sulfate toxicity. High-dose pyridoxine is an effective treatment to reverse this encephalopathy.     

Influence of Metal Nanoparticles (NPs) on Germination and Yield of Oat (Avena sativa) and Berseem (Trifolium alexandrinum)

Proceedings of the National Academy of Sciences, India Section B: Biological Sciences - Assessment of effect of nanoparticles on plant growth is essential before adopting nanotechnology in...     

Therapeutic equivalence of a low dose artemisinin formulation in falciparum malaria patients

We have evaluated the therapeutic equivalence of a beta-cyclodextrin-artemisinin complex at an artemisinin dose of 150 mg, with a commercial reference preparation, Artemisinin 250 at a recommended dose of 250 mg. One hundred uncomplicated falciparum malarial patients were randomly assigned to orally receive either beta-cyclodextrin-artemisinin complex (containing 150 mg artemisinin) twice daily for five days or the active comparator (containing 250 mg artemisinin) twice daily for five days. The patients were hospitalized for seven days and were required to attend follow up assessments on days 14, 21, 28 and 35. All patients in both treatment groups were cured of the infection and achieved therapeutic success. At day seven of treatment, all patient blood was clear of the parasites and the sublingual temperature of all patients was less than 37.5 degrees C. Moreover, the parasite clearance time in both treatment groups was similar, being approximately three days after initiation of treatment. Comparable plasma artemisinin concentrations were observed between patients in both treatment groups at 1.5 and 3.0 h, although slightly higher levels were obtained with patients in the beta-cyclodextrin-artemisinin complex-treated group. The beta-cyclodextrin-artemisinin complex at a dose of 150 mg artemisinin was therapeutically equivalent to 250 mg Artemisinin 250. Additionally, patients receiving beta-cyclodextrin-artemisinin complex showed less variability in their plasma artemisinin concentrations at 1.5 h post-dosing, which suggested a more consistent rate of drug absorption.     

Korean Scutellaria baicalensis water extract inhibits cell cycle G1/S transition by suppressing cyclin D1 expression and matrix-metalloproteinase-2 activity in human lung cancer cells

Aim of the study

Scutellaria baicalensis Georgi is a widely used medicinal herb in several Asian countries including Korea. The various medicinal properties attributed to Scutellaria baicalensis include anti-bacterial, anti-viral, anti-inflammatory and anti-cancer effects. The present study investigated the cytotoxicity of Scutellaria baicalensis water extract (SBWE) on A549 non-small-cell-lung cancer cells and the A549 expression of cyclin D1, cyclin-dependent kinase 4 (CDK4) and matrix metalloproteinase-2 (MMP-2), and the effects of SBWE on cell cycle progression, especially the G1/S phase, and on cell motility.

Materials and methods

SBWE cytotoxicity was assessed by a standard colorimetric assay utilizing 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) and expression of cyclin D1 and CDK4 protein in SBWE-treated A549 cells was assessed by Western blot analysis. Flow cytometry analysis was performed to determine the effect of SBWE on A549 cell cycle progression. A549 cell MMP-2 activity was examined by zymography. Cell motility and migration was assessed by a scratch wound healing assay.

Results

SBWE was not cytotoxic. The production of Cyclin D1, CDK4 and MMP-2 activity were significantly decreased in a SBWE dose-dependent manner, with maximum inhibition occurring at SBWE concentrations of 250 μg/ml and 500 μg/ml. SBWE inhibited cell cycle progression in the G1/S phase and significantly inhibited the motility of A549 cells.

Conclusions

Cyclin D1 protein may be associated with MMP-2 activity and cell motility. Thus, SBWE promotes a strong protective effect against MMP-2 mediated metastasis and cell proliferation through the down-regulation of cyclin D1. SBWE may be a useful chemotherapeutic agent for lung cancer.     

Palladium nanoparticles-anchored dual-responsive SBA-15-PNIPAM/PMAA nanoreactor: a novel heterogeneous catalyst for a green Suzuki–Miyaura cross-coupling reaction

To develop a sustainable and cost-effective catalyst for cross-coupling reactions, dual (temperature and pH)-responsive poly(N-isopropyl acrylamide-co-methacrylic acid) (PNIPAM/PMAA) functionalised SBA-15 was synthesised via free radical polymerisation using potassium persulfate as an initiator and decorated with palladium nanoparticles (PdNPs-SBA-15-PNIPAM/PMAA). The X-ray photoelectron spectroscopic analysis revealed that the Pd content in the zero oxidation state of the catalyst was 1.21 wt%. The dynamic light scattering studies showed that the catalyst exhibited swelling behaviours at low temperatures (<32 °C) and high pH (>4), but exhibited deswelling behaviours at high temperatures (>32 °C) and low pH (<4). To examine the performance of the catalyst, Suzuki–Miyaura cross-coupling (SMC) reaction was conducted under batch reaction conditions. The reaction conditions were optimised with various parameters using phenylboronic acid and bromobenzene as the model substrates. High conversions (>90%) were realized for the room-temperature SMC reaction in an aqueous medium for various substituted aryl halides, while the conversion was low at relatively high temperatures (>32 °C). The conversion was dependent on the different electronic effects between the electron-releasing and electron-withdrawing groups of the aryl halides. After the experiment, the catalyst was successfully recovered without any loss of heterogeneity and could be reused at least up to the fifth cycle.

Palladium nanoparticles-anchored dual-responsive SBA-15-copolymer nanoreactor was developed as a novel heterogeneous catalyst for green Suzuki–Miyaura cross-coupling reaction.