Performance of a multi-profile critical care testing analyzer.

BACKGROUND: Modern blood gas analyzers are often coupled to electrolyte and metabolite analyzers. We evaluated a Stat Profile Critical Care Xpress analyzer (STP CCX) for the rapid point-of-care measurement of blood gases (pH, pCO2, pO2, sO2), hematocrit (Hct), total hemoglobin (tHb), sodium (Na+), potassium (K+), chloride (Cl-), glucose (Glu), lactate (Lac), urea (BUN), ionized calcium (iCa) and ionized magnesium (iMg). METHODS: The analyzer was evaluated in terms of imprecision and recovery using the STP CCX control. Fresh blood samples were also measured to determine the between-day imprecision. Correlation was assessed by clinical sample comparison with the Nova Stat Profile Ultra C and Dimension RxL systems for Cl- and BUN. We used Deming regression, correlation coefficients, mean differences, and the Wilcoxon signed-rank test for data analysis. RESULTS: The coefficients of variation for all analytes were within desirable limits, ranging from 0.1% to 4.3%, and the recovery was 100%+/-3%. Between-day imprecision using fresh blood samples showed good results, ranging from 0.2% to 3.4%. The comparison results showed high to very high correlation. However, statistically significant mean differences with large bias were found for pCO2, pO2 and Cl-. CONCLUSIONS: This analyzer is suitable as a simple and fast diagnostic tool in the laboratory and the critical care unit. However, users should be aware of biases that may lead to clinically significant errors in the assessment of acid-base status.     

Adoption of the chronic care model to improve HIV care: In a marginalized,largely aboriginal population

Objective

To measure the effectiveness of implementing the chronic care model (CCM) in improving HIV clinical outcomes.

Design

Multisite, prospective, interventional cohort study.

Setting

Two urban community health centres in Vancouver and Prince George, BC.

Participants

Two hundred sixty-nine HIV-positive patients (18 years of age or older) who received primary care at either of the study sites.

Intervention

Systematic implementation of the CCM during an 18-month period.

Main outcome measures

Documented pneumococcal vaccination, documented syphilis screening, documented tuberculosis screening, antiretroviral treatment (ART) status, ART status with undetectable viral load, CD4 cell count of less than 200 cells/mL, and CD4 cell count of less than 200 cells/mL while not taking ART compared during a 36-month period.

Results

Overall, 35% of participants were women and 59% were aboriginal persons. The mean age was 45 years and most participants had a history of injection drug use that was the presumed route of HIV transmission. During the study follow-up period, 39 people died, and 11 transferred to alternate care providers. Compared with their baseline clinical status, study participants showed statistically significant (P < .001 for all) increases in pneumococcal immunization (54% vs 84%), syphilis screening (56% vs 91%), tuberculosis screening (23% vs 38%), and antiretroviral uptake (47% vs 77%), as well as increased viral load suppression rates among those receiving ART (72% vs 90%). Stable housing at baseline was associated with a 4-fold increased probability of survival. Aboriginal ethnicity was not associated with better or worse outcomes at baseline or at follow-up.

Conclusion

Application of the CCM approach to HIV care in a marginalized, largely aboriginal patient population led to improved disease screening, immunization, ART uptake, and virologic suppression rates. In addition to addressing underlying social determinants of health, a paradigm shift away from an “infectious disease” approach to a “chronic disease management” approach to HIV care for marginalized populations is strongly recommended.     

The protective effects of Phyllanthus emblica Linn. extract on ethanol induced rat hepatic injury

This study was undertaken to investigate the protective effects of Phyllanthus emblica Linn. (PE) extract on ethanol induced rat hepatic injury. PE (0.5 and 1 mg/ml) increased cell viability of rat primary cultured hepatocytes being treated with ethanol (96 microl/m) by increasing % MTT and decreasing the release of transaminase. Hepatotoxic markers studied in rats included serum transaminases (AST and ALT), serum triglyceride (STG), hepatic triglyceride (HTG), TNF-alpha and IL-1beta together with histopathological examination. Pretreatment of rats with PE at oral dose of 25, 50 and 75 mg/kg or SL (silymarin, a reference hepatoprotective agent) at 5 mg/kg, 4 h before ethanol, lowered the ethanol induced levels of AST, ALT and IL-1beta. The 75 mg/kg PE dose gave the best result similar to SL. Treatment of rats with PE (75 mg/kg/day) or SL (5 mg/kg/day) for 7 days after 21 days with ethanol (4 g/kg/day, p.o.) enhanced liver cell recovery by bringing the levels of AST, ALT, IL-1beta back to normal. Histopathological studies confirmed the beneficial roles of PE and SL against ethanol induced liver injury in rats.     

Antioxidant Activity and Lipid-Lowering Effect of Essential Oils Extracted from Ocimum sanctum L. Leaves in Rats Fed with a High Cholesterol Diet

It has been reported that Ocimum sanctum L. (OS) leaves decrease serum lipid profile in normal and diabetic animals. No experimental evidences support the anti-hyperlipidemic and antioxidative actions against hypercholesterolemia. Moreover the identity of the specific chemical ingredients in OS leaves responsible for these pharmacological effects are unknown. Since OS leaves are rich in essential oil (EO). Therefore the present study was conducted to investigate the anti-hyperlipidemic and antioxidative activities of EO extracted from OS leaves in rats fed with high cholesterol (HC) diet. EO was extracted by the hydrodistillation method and the chemical constituents were then identified by Gas Chromatography-Mass Spectrometry. The experiment was performed in Male Wistar rats fed with 2.5 g%(w/w) of cholesterol diet for seven weeks. During the last 3 weeks, rats were daily fed with EO. The results showed that phenyl propanoid compounds including eugenol and methyl eugenol were the major constituents of EO. EO suppressed the high serum lipid profile and atherogenic index as well as serum lactate dehydrogenase and creatine kinase MB subunit without significant effect on high serum levels of aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase in rats fed with HC diet. In addition, EO was found to decrease the high levels of thiobarbituric acid reactive substances (TBARS), glutathione peroxidase (GPx) and superoxide dismutase (SOD) without impacting catalase (CAT) in the cardiac tissue while in the liver, it decreased high level of TBARS without significantly effecting GPx, SOD and CAT. Histopathological results confirmed that EO preserved the myocardial tissue. It can be concluded that EO extracted from OS leaves has lipid-lowering and antioxidative effects that protect the heart against hypercholesterolemia. Eugenol that is contained in EO likely contribute to these pharmacological effects.     

Estimation of plasma small dense LDL cholesterol from classic lipid measures

Calculated low-density lipoprotein cholesterol (cLDL-C) may differ from direct measurement (dLDL-C), and this difference may depend on presence of small, dense LDL (sdLDL) particles in addition to variation in triglycerides (TG) and high-density lipoprotein cholesterol (HDL-C) concentrations. The presence of such dependence would offer a simple means to estimate sdLDL. We studied dependence of sdLDL on cLDL-C, dLDL-C, and other variables. We measured the levels of glucose, creatinine, total cholesterol, TG, HDL-C, and dLDL-C using standardized methods in 297 samples. For sdLDL cholesterol (sdLDL-C), a novel homogeneous assay was used. The cLDL-C was calculated using the Friedewald formula for 220 subjects after excluding for liver or renal disease. Using stepwise regression analysis identified non-HDL-C, cLDL-C, and dLDL-C as significant variables (P < .001; R(2) = 0.88). The regression equation was as follows: sdLDL-C (mg/dL) = 0.580 (non-HDL-C) + 0.407 (dLDL-C) - 0.719 (cLDL-C) - 12.05. The sdLDL-C concentration can be estimated from non-HDL-C, dLDL-C, and cLDL-C values. Identification of a simple, inexpensive marker for sdLDL particles provides a cost-effective method for screening cardiovascular disease risk.     

Curcumin Extract for Prevention of Type 2 Diabetes

OBJECTIVE

To assess the efficacy of curcumin in delaying development of type 2 diabetes mellitus (T2DM) in the prediabetic population.

RESEARCH DESIGN AND METHODS

This randomized, double-blinded, placebo- controlled trial included subjects (n = 240) with criteria of prediabetes. All subjects were randomly assigned to receive either curcumin or placebo capsules for 9 months. To assess the T2DM progression after curcumin treatments and to determine the number of subjects progressing to T2DM, changes in β-cell functions (homeostasis model assessment [HOMA]-β, C-peptide, and proinsulin/insulin), insulin resistance (HOMA-IR), anti-inflammatory cytokine (adiponectin), and other parameters were monitored at the baseline and at 3-, 6-, and 9-month visits during the course of intervention.

RESULTS

After 9 months of treatment, 16.4% of subjects in the placebo group were diagnosed with T2DM, whereas none were diagnosed with T2DM in the curcumin-treated group. In addition, the curcumin-treated group showed a better overall function of β-cells, with higher HOMA-β (61.58 vs. 48.72; P < 0.01) and lower C-peptide (1.7 vs. 2.17; P < 0.05). The curcumin-treated group showed a lower level of HOMA-IR (3.22 vs. 4.04; P < 0.001) and higher adiponectin (22.46 vs. 18.45; P < 0.05) when compared with the placebo group.

CONCLUSIONS

A 9-month curcumin intervention in a prediabetic population significantly lowered the number of prediabetic individuals who eventually developed T2DM. In addition, the curcumin treatment appeared to improve overall function of β-cells, with very minor adverse effects. Therefore, this study demonstrated that the curcumin intervention in a prediabetic population may be beneficial.The impacts of type 2 diabetes mellitus (T2DM) on global health care and economy are enormous (1). According to the World Health Organization, there are ∼311 million people worldwide who live with T2DM. This number continues to rise, especially in the newly developing and poorer countries in Asia and elsewhere. Because T2DM is currently incurable, a common treatment approach is to try to control the disease with lifelong use of antidiabetes drugs. Limiting the number of newly developed T2DM cases should be one of the better key strategies to restrict the global impacts of T2DM (2). In order to limit the number of new T2DM cases, the lifestyle of the prediabetic population has to be changed. However, this has been shown to be challenging (3). One of the alternative approaches to prevent development of T2DM is to intervene with the prediabetic population before disease progresses into fully developed T2DM (3). The intervention approach is appealing. It relies on timely identification of prediabetic individuals and provision of preventive treatment before the disease fully progresses. The intervention represents a chance for the diabetes-prone population to halt the disease progression and maintain a normal and healthy life. In recent years, several effective T2DM intervention regimens have been developed, with encouraging results (3–5). However, these regimens are not usually economically accessible, and they are not well-tolerated because of treatment-related toxicities (4,5). The focus now is to identify new effective therapeutic agents, with relatively low cost and low toxicity, that can be used regularly to control a progression of T2DM in the prediabetic population.Curcumin is the principal curcuminoid found in turmeric (Curcuma longa Linn.), a popular spice in Asian cuisine. It is widely consumed and generally believed to be beneficial for human health (6). Curcumin extract from rhizomes of turmeric has been shown to contain anti-inflammation and antidiabetic properties (7–13). In addition, it could delay development of T2DM, improve β-cell functions, prevent β-cell death, and reduce insulin resistance in animals (8–16). This study aimed to determine the effectiveness of curcumin extract as an intervention agent to prevent T2DM development. We assessed T2DM progression and several indicative T2DM parameters in a large randomized, double-blinded, and placebo-controlled cohort. We found that curcumin extract effectively reduced the number of prediabetic individuals who progressed toward T2DM as well as improved functions of β-cells.     

Effect of the discipline of formal faculty advisors on medical student experience and career interest

ObjectiveTo examine whether the discipline (family medicine vs other specialty) of formally assigned faculty advisors affected medical student experience and career interest.DesignSurvey.SettingUniversity of Calgary in Alberta.ParticipantsA total of 104 medical students from the graduating class of 2011.ResultsOverall, 89 (86%) surveys were returned. Significant differences were noted when the discipline of the faculty advisor (family medicine vs Royal College specialty) was considered. Family medicine faculty advisors met with their students more often (P = .03) and were more likely to have a beneficial effect on the medical school experience (P = .005). Having a relationship with a family medicine faculty advisor significantly increased family medicine career interest (P = .01), although a faculty advisor in any other discipline did not erode family medicine interest. The discipline of the faculty advisor had no statistically significant influence on a student’s intended selection of family medicine in the Canadian Resident Matching Service match.ConclusionFamily medicine faculty advisors appear particularly active in their role as mentors and appear beneficial to the medical student experience. Career interest in family medicine was enhanced by being paired with a family medicine advisor and not eroded by an advisor from another specialty.     

Regional Hepatic Blood Flow Studied by Intrahepatic Injection of 133Xenon in Normals and in Patients with Primary Carcinoma of the Liver, with Particular Reference to the Effect of Hepatic Artery Ligation

Summary: Measurement of regional hepatic blood flow using radioactive xenon by Gelin's method was studied in 20 controls and 21 patients with primary carcinoma of the liver, eight of whom had associated cirrhosis. The mean value of blood flow for controls was 28.77±9.50 ml/min/100 g, for carcinomatous nodules 12.21±5.83, for normal areas in the liver with primary carcinoma 37.88±12.88 and for cirrhotic areas in the liver with primary carcinoma 21.50±10.16. The blood flow of carcinomatous tissue is significantly less than of normal parenchyma and this can be explained by the histopathological and angiographic findings. Temporary reduction in the blood flow was obtained by ligation of the hepatic artery and postoperative angiography demonstrated the formation of collateral arteries to the liver.