Telemedicine Enhances Communication in the Intensive Care Unit

Patients admitted to the Intensive Care Unit (ICU) are critically ill and often at extremely high risk of death. These patients receive aggressive interventions to prolong their lives. Despite these measures, many patients still succumb to their illness. Although ICU physicians are good at predicting which patients have a high risk of mortality, they are still offering interventions that do not prolong life, but potentially cause more suffering at the end of life. This is because there is a lack of high quality and early communication to discuss prognosis and establish patients\u27 goals of care. This gap in communication is even more profound when patients are transferring from rural hospitals to busy tertiary care centers. This dissertation discusses the utilization of tele-video conferencing to enhance early communication with family members/loved ones of critically ill patients prior to their transfer from a rural hospital to a tertiary care center. It begins with a description of telemedicine and its uses in the ICU to date. Chapter 2 discusses the poor prognoses of patients receiving high intensity interventions such as cardiopulmonary resuscitation (CPR). The extremely dismal outcomes underscore the importance of early, thorough discussions regarding prognosis and goals of care in these patients. The next chapter describes a pilot study utilizing telemedicine to conduct formal unstructured telemedicine conferences with family members prior to transfer. This study demonstrated that palliative care consultations can be provided via telemedicine for critically ill patients and that adequate preparation and technical expertise are essential. Although this study is limited by the nature of the retrospective review, it is evident that more research is needed to further assess its applicability, utility and acceptability. Chapter 4 describes an investigation into the barriers and facilitators of conducting conferences via telemedicine and the perceptions of clinicians regarding the use of telemedicine for this purpose. This chapter identified unique barriers and facilitators to the use of telemedicine that will need to be addressed when designing a telemedicine intervention for conducting family conferences. This thesis describes the importance and process of implementation of telemedicine for the novel purpose of enhancing early communication among physicians and family members of critically ill loved ones. Further studies are needed to refine and investigate patient and family centered clinical outcomes utilizing this intervention

Purification of cytochrome P-450 in mycobacteria

Purification of cytochrome P-450 from Mycobacterium smegmatis, M. chelonae, M. fortuitum and M. tuberculosis H37RV was undertaken. The electrophoretic pattern revealed a single band corresponding to a molecular weight of 66 kDa in all the four species. Cytochrome P-450 purified from drug-resistant M. tuberculosis showed a different pattern from that of the sensitive bacteria, and the former was similar to the purified product obtained from phenobarbitalinduced cytochrome P-450 in M. tuberculosis H37RV. It therefore appears that different forms of cytochrome P-450 are present in drug-sensitive and resistant M. tuberculosis, and that there is similarity in the pattern between drug-resistant and phenobarbital-induced M. tuberculosis

Effect of rifampicin and isoniazid on cytochrome P-450 in mycobacteria

Background & objectives: Rifampicin and isoniazid are the most important first line drugs used in the treatment of tuberculosis. These drugs are also used in combination with other medications to treat co-infections. It, therefore, becomes important to study the effect of these drugs on the drug metabolizing system, namely, cytochrome P-450, not only in the host but also in the bacteria. We report the effect of rifampicin and isoniazid on the cytochrome P-450 activity in Mycobacterium smegmatis and M tuberculosis H37Rv. Methods: Subinhibitory concentrations of rifampicin and isoniazid were added to the organisms after they had attained the growth phase and cytochrome P-450 activity was estimated in the membranous fractions of the bacteria at different time points. Results: Rifampicin was able to significantly enhance cytochrome P-450 in both M. smegmatis and M. tuberculosis H37Rv. Isoniazid was found to inhibit cytochrome P-450 in M. tuberculosis H37Rv, While there seemed to be no effect in M. smegmatis. Interpretation & conslusion: We report here the effect of rifampicin and isoniazid on mycobacterial cytochrome P-450. These findings are similar to those found in eukaryotic organisms. The role of mycobacterial cytochrome P-450 in the metabolism of drugs within the bacteria needs to be elucidated

Bioavailability of rifampicin following concomitant administration of ethambutol or isoniazid or pyrazinamide or a combination of the three drugs

Background & Objectives: Poor bioavailability of rifampicin (R) in combination with other anti-tuberculosis drugs such as isoniazid (H), pyrazinamide (Z), and ethambutol (E) is a subject of much concern for the last few decades. This could be due to an interaction between R and other drugs. An investigation was therefore undertaken to examine the bioavailability of R in the presence of H, Z and E or a combination of the three drugs. Methods: The study included eight healthy volunteers, each being investigated on four occasions at weekly intervals once with R alone and with three of the four combinations on the three remaining occasions. A partially balanced incomplete block design was employed and the allocation of R or the drug combinations was random. Plasma concentrations of R at intervals upto 12 h were determined by microbiological assay using Staphylococcus aureus as the test organism. The proportion (%) dose of R as R plus desacetyl R (DR) in urine excreted over the periods 0-8 and 8-12 h was also determined. Bioavailability was expressed as an index (BI) of area under time concentration curve (AUC) calculated from the plasma concentrations or proportion of dose of R excreted as R plus DR in urine with the combinations to that with R alone. Results: The bioavailability indices based on AUC were 0.96 with RE, 0.76 with RH, 1.08 with RZ and 0.65 with REHZ. The indices based on urine estimations (0-8 h) were similar, the values being 0.94, 0.84, 0.94 and 0.75, respectively. A second investigation revealed that the decrease of bioavailability of R with H was not due to the excipients present in H tablets. Interpretation & conclusion: Isoniazid alone or in combination with E and Z reduces the bioavailability of R. Urinary excretion data offer a simple and non invasive method for the assessment of bioavailability of R

Gastro-intestinal absorption of isoniazid and rifampicin in patients with intestinal tuberculosis

The gastro-intestinal absorption of isoniazid and rifampicin was studied in 12 patients with intestinal tuberculosis (10 slow and 2 rapid acetylators of isoniazid) and compared with that in 18 patients with pulmonary tuberculosis (8 slow and 10 rapid acetylators). Exposure (area under the time-concentration curve), calculated on the basis of serum concentrations of the two drugs at 1, 2, 3, 6 and 8 hours, and the proportion of dose of isoniazid excreted in urine collected over the period (0-8½) hours as isoniccotinyl compounds after drug administration were similar in the 2 groups suggesting no impairment of gastro-intestinal absorption of the 2 drugs in patients with intestinal tuberculosis. It was also observed that there was no delay in the absorption of the 2 drugs in patients with intestinal tuberculosis as compared to that in patients with pulmonary tuberculosis. The absorption of D-xylose, used to assess the absorptive capacity of the proximal small intestine, was also similar and normal in both groups of patients

Synthesis And Characterisation Of CdxZn1–xS Nanocomposites

CdxZn1 – xS nanoparticles have been synthesized using hydrothermal method. Structural characterization was done by XRD where the lattice structure gradually changes from hexagonal to cubic with increasing percentage of Zn inCdxZn1 – xS nanoparticles. Optical spectroscopy provided evidence that the absorption edges of those nanoparticles can be varied from blue to UV. The nanoparticles exhibit emission peaks that shift to shorter wavelength with increasing percentage of Zn in the compounds CdxZn1 – xS. The control of the composition of CdxZn1 – xS nanoparticles may lead the development of ideal materials for short wavelength diode laser applications. When you are citing the document, use the following link http://essuir.sumdu.edu.ua/handle/123456789/951

Pharmacokinetics of isoniazid and rifampicin in patients with renal failure undergoing continuous ambulatory peritoneal dialysis (CAPD) Running Head : Pharmacokinetic of INH & RMP in renal failure (CAPD)

The pharmacokinetics of isoniazid (INH) and rifampicin (RMP) was determined in 22 renal failure patients, 11 each with low and high membrane permeabilities (LMP and HMP) undergoing Continuous Ambulatory Peritoneal Dialysis (CAPD). Blood samples were collected at different time points following oral administration of INH and RMP. Estimations of INH and RMP in blood were carried out by standard procedures and certain pharmacokinetic variables were calculated based on their concentrations in blood. The INH inactivation status was determined based on salivary levels of INH. The pharmacokinetic variables of INH and RMP did not differ significantly between LMP and HMP groups. The study results suggest that renal failure patients on CAPD may not require reduction in the dosage of RMP or INH in rapid acetylators. Slow acetylators might require dose reduction of INH. Determination of INH inactivation status is important when patients with renal failure and tuberculosis are treated with INH-containing regimens

Acetylator status influences bioavailability of isoniazid in patients with advanced HIV disease

Patients with advanced HIV disease may exhibit malabsorption of anti-tuberculosis(TB) drugs. We evaluated the effect of isoniazid (INH) acetylator status on the bioavailability of INH in HIV-infected patients with and without tuberculosis, based on urinary excretion of the drug. Estimation of INH in urine collected up to 8 hours after oral administration of 300 mg INH were undertaken in 23 TB, 40 HIV and 26 HIV-TB patients. Determination of acetylator status of all these patients was also carried by differential estimations of INH and acetyl INH in urine collected between 5 and 6 hours after oral administration of 300 mg INH. Both slow and rapid acetylators in HIV and HIV-TB groups had significantly lower concentration of INH in urine compared to TB patients. The percent decrease in urinary excretion of INH was significantly higher in rapid than in slow acetylators, when compared to the corresponding TB patients. Acetylator status has an impact on the bioavailability of INH. Malbsorption in patients with advanced HIV disease may lead to decreased bioavailability of INH, particularly in rapid acetylators. Urinary estimation of INH provides reliable information on the bioavailability of the drug

Research priorities in Maternal, Newborn, & Child Health & Nutrition for India:An Indian Council of Medical Research-INCLEN Initiative

In India, research prioritization in Maternal, Newborn, and Child Health and Nutrition (MNCHN) themes has traditionally involved only a handful of experts mostly from major cities. The Indian Council of Medical Research (ICMR)-INCLEN collaboration undertook a nationwide exercise engaging faculty from 256 institutions to identify top research priorities in the MNCHN themes for 2016-2025. The Child Health and Nutrition Research Initiative method of priority setting was adapted. The context of the exercise was defined by a National Steering Group (NSG) and guided by four Thematic Research Subcommittees. Research ideas were pooled from 498 experts located in different parts of India, iteratively consolidated into research options, scored by 893 experts against five pre-defined criteria (answerability, relevance, equity, investment and innovation) and weighed by a larger reference group. Ranked lists of priorities were generated for each of the four themes at national and three subnational (regional) levels [Empowered Action Group & North-Eastern States, Southern and Western States, & Northern States (including West Bengal)]. Research priorities differed between regions and from overall national priorities. Delivery domain of research which included implementation research constituted about 70 per cent of the top ten research options under all four themes. The results were endorsed in the NSG meeting. There was unanimity that the research priorities should be considered by different governmental and non-governmental agencies for investment with prioritization on implementation research and issues cutting across themes

Food & nutrition security: Challenges in the new millennium

The World Food Summit in 1996 provided a comprehensive definition for food security which brings into focus the linkage between food, nutrition and health. India has been self sufficient in food production since seventies and low household hunger rates. India compares well with developing countries with similar health profile in terms of infant mortality rate (IMR) and under five mortality rate (U5 MR). India fares poorly when underweight in under five children is used as an indicator for food insecurity with rates comparable to that of Subsaharan Africa. If wasting [low body mass index (BMI) for age in children and low BMI in adults] which is closely related to adequacy of current food intake is used as an indictor for the assessment of household food security, India fares better. The nineties witnessed the emergence of dual nutrition burden with persistent inadequate dietary intake and undernutrition on one side and low physical activity / food intake above requirements and overnutrition on the other side. Body size and physical activity levels are two major determinants of human nutrient requirements. The revised recommended dietary allowances (RDA) for Indians takes cognisance of the current body weight and physical activity while computing the energy and nutrient requirements. As both under- and overnutrition are associated with health hazards, perhaps time has come for use of normal BMI as an indicator for food security