Concurrent administration of heparin and activated protein C in a patient with pulmonary embolism and severe sepsis with positive outcome

Results of the PROWESS trial suggested that heparin may reduce the efficacy of recombinant human activated protein C (rhAPC) and the XPRESS study also showed increased bleeding complications in patients receiving heparin with rhAPC. Although it has been shown that heparin prophylaxis may be used along with rhAPC, no study has shown the interaction between continuous heparin infusion and rhAPC. Here, we report a case of severe sepsis with pulmonary embolism who was concurrently administered heparin and rhAPC infusions, with positive results and no bleeding complications.     

Role of steroids in septic shock: Assessment of knowledge, attitudes and practices among intensivists practising in Hyderabad

Context:

Use of steroids in septic shock is an issue of contention, more so with two major trials reporting conflicting results.

Aims:

To assess the current knowledge, attitudes and practices (KAP) related to the role of steroids in septic shock among intensivists practising in Hyderabad.

Setting, Design, Materials and Methods:

Questionnaires containing 10 questions pertaining to the role of steroids in septic shock, were distributed to 76 intensivists during the monthly critical care meeting.

Results:

A great majority of intensivists (82%) agreed that the role of steroids is restricted to septic shock not responding to vasopressors. There was no clear consensus regarding the role of corticotropin stimulation test or the timing of total cortisol level testing, if it has to be performed. Hydrocortisone was clearly the choice of steroid for most intensivists and intravenous bolus injection being the preferred route of administration. There was no agreement regarding the dose of steroids, the role of fludrocortisone and whether steroids should be tapered. Most of the respondents did not extend the steroid therapy beyond seven days and the most common side effect reported was hyperglycemia.

Conclusion:

There is a lot of ambiguity in the knowledge, attitudes or practices regarding role of steroids in septic shock among intensivists in Hyderabad. Uniform policies and protocols need to be devised at institutional level, with multispecialty inputs, and doctors need to be familiarized accordingly.     

Clerodendron glandulosum.Coleb extract ameliorates high fat diet/fatty acid induced lipotoxicity in experimental models of non-alcoholic steatohepatitis

This study evaluates the protective role of Clerodendron glandulosum.Coleb (CG) aqueous extract against high fat diet/fatty acid induced lipotoxicity in experimental models of non-alcoholic steatohepatitis (NASH). Supplementation of NASH mice with CG extract (1% and 3% in high fat diet for 16 weeks) prevented high fat diet induced elevation in liver enzymes, plasma and hepatic lipids, mitochondrial oxidative stress and compromised enzymatic and non-enzymatic antioxidant status and histopathological damage to hepatocytes. Furthermore, results from in vitro study indicates, addition of CG extract (20–200 μg/ml for 24 h) to HepG2 cells minimizes oleic acid induced lipid accumulation, higher lipid peroxidation, cytotoxicity and reduced cell viability. These in vivo and in vitro studies suggest that CG extract has the potential of preventing high fat/fatty acid induced NASH.     

Contribution of arm movement to the force components of a maximum vertical jump

Vertical jump is used commonly as a measure of leg power for evaluation prior to participation in sports activities (RK Gray, KB Start, DJ Glencross, Res Q 33:230-235, 1962; DO Klotz, Doctoral dissertation, University of Iowa, 1948). Unless vertical jump meets the definition of mechanical leg power, it should not be used as a measure of leg power. Measurement of leg power in a vertical jump should not be started with a countermovement of the arms prior to jumping. The purpose of this research was to investigate the kinetic and kinematic contributions of arm movement to the vertical jump. Eighteen subjects performed three vertical jumps on a force platform with arm movement and three jumps without arm movement. The contribution of arm movement to maximum force, work done, power, and the release velocity was found as 6, 14, 15, and 6%, respectively, for this population. The contribution of the arm action to reduce the impact force was 12%. The contribution of arm movement to vertical jump maximum force in this study was less than reported in previous studies. J Orthop Sports Phys Ther 1989;11(5):198-201.     

Consistency of Self-Reported Sexual Behavior in Surveys

Accurate data on sexual behavior have become increasingly important for demographers and epidemiologists, but self-reported data are widely regarded as unreliable. We examined the consistency in the number of sexual partners reported by participants in seven population-based surveys of adults in the U.S. Differences between studies were quite modest and much smaller than those associated with demographic attributes. Surprisingly, the mode of survey administration did not appear to influence disclosure when the questions were similar. We conclude that there is more consistency in sexual partnership reporting than is commonly believed.