Early mobilization improves functional outcomes in critically ill patients

Background\ud Long-term complications of critical illness include intensive care unit (ICU)-acquired weakness and neuropsychiatric disease. Immobilization secondary to sedation might potentiate these problems.\ud \ud Methods\ud Objective\ud To assess efficacy of combining daily interruption of sedation with physical and occupational therapy on functional outcomes in patients receiving mechanical ventilation in intensive care.\ud \ud Design\ud Open label randomized clinical trial.\ud \ud Setting\ud Study was conducted at two university hospitals on patients receiving sedation and mechanical ventilation. Subjects were those who received mechanical ventilation for < 72 hrs, were functionally independent prior to hospitalization, and were expected to continue for at least 24 hrs after enrollment.\ud \ud Subjects\ud 104 mechanically ventilated patients in the ICU.\ud \ud Intervention\ud Patients were randomized to receive either early exercise and mobilization (physical and occupational therapy) during periods of daily interruption of sedation (intervention; n = 49) or daily interruption of sedation with therapy as ordered by the primary care team (control; n = 55). Therapists who undertook patient assessments were blinded to treatment assignment.\ud \ud Outcomes\ud The primary endpoint was the number of patients returning to independent functional status at hospital discharge defined as the ability to perform six activities of daily living and the ability to walk independently. Secondary endpoints included duration of delirium and ventilator-free days during the first 28 days of hospital stay.\ud \ud Results\ud The return to independent functional status at hospital discharge occurred in 29 (59%) patients in the intervention group compared with 19 (35%) patients in the control group (p = 0.02; odds ratio 2.7 [95% CI 1.2-6.1]). Patients in the intervention group had shorter duration of delirium (median 2.0 days, IQR 0.0-6.0 vs 4.0 days, 2.0-8.0; p = 0.02), and more ventilator-free days (23.5 days, 7.4-25.6 vs 21.1 days, 0.0-23.8; p = 0.05) during the 28-day follow-up period than did controls. There was one serious adverse event in 498 therapy sessions (desaturation less than 80%). Discontinuation of therapy as a result of patient instability occurred in 19 (4%) of all sessions, most commonly for perceived patient-ventilator asynchrony.\ud \ud Conclusions\ud A strategy for whole-body rehabilitation consisting of interruption of sedation and physical and occupational therapy in the earliest days of critical illness was safe and well tolerated, and resulted in better functional outcomes at hospital discharge, a shorter duration of delirium, and more ventilator-free days compared with standard care

A survey study on use of over the counter (OTC) drugs among medical students, nursing and clerical staff of a tertiary care teaching rural hospital

Aim: The study was conducted to evaluate use of over the counter (OTC) drugs among the medical students, nursing and clerical staff of tertiary care teaching rural hospital to determine the awareness and disadvantages on use of OTC.Methods: Responses to a feedback questionnaire covering various aspects on usage of OTC drugs were obtained from 100 medical students, 100 nursing and 100 clerical staff.Results: Among 300 respondents, 84% used OTC, commonly purchased by self. Majority of them started self medication within 2 days of their illness. The frequently reported illness that prompted self-medication included headache, cough and cold, fever, generalised weakness, acidity, dysmenorrhoea, and sleep disturbances. Majority of them obtained OTC by mentioning name of drug (81%), 35% by telling symptom and 15% by showing old prescription. We found that 87% people share OTC among relatives and friends.Conclusions: Usage of OTC was highest amongst medical students and nursing staff. Time consumption for consultation, the consultation fees and frequent visits were the commonly mentioned reasons for self medication. It was analysed that none of the clerical staff were aware of the drug, dose, frequency of administration and adverse reactions. While very little awareness of medication was found even among nursing staff and medical students. Therefore it is suggested that the public has to be educated on the type of illnesses to be self-diagnosed and medicated, dangers of OTC on misuse which would possibly lead to delay in detection of more serious underlying ailment and timely medication

A prospective survey study on premenstrual syndrome in young and middle aged women with an emphasis on its management

Premenstrual syndrome (PMS) is defined as the recurrence of psychological and physical symptoms in the luteal phase, which remit in the follicular phase of the menstrual cycle. Symptoms of which fall in three domains: emotional, physical and behavioural e.g. irritability, anger, headache, fatigue, food cravings etc. The survey study of was conducted among 50 young & 50 middle aged women of S.B.K.S Medical Institute and Research Centre to find the prevalence of premenstrual syndrome with an emphasis on its management. Responses to a feedback questionnaire covering various aspects related PMS were obtained from 50 participants belonging to each group. The participants belonged to different range of literacy. It was found that 42% faced PMS regularly, while 58% occasionally. Of the 100 participants 68% suffered with backache, 64% leg cramps, 62% fatigue, breast tenderness and anger whereas 58% suffered with anxiety and generalized body ache. Of all the sufferers only 34% had received the treatment for PMS. Irrespective of the age PMS is common problem faced by women. With our study we observed that literacy has not mattered in the management of this health problem. Since there are reports stating that the severity of PMS can hamper the daily routine and even lead to suicidal tendency, it is essential that awareness programs need to be conducted to address the importance of managing the issue by pharmacological and non-pharmacological methods

Estimation of biochemical factors responsible for resistance to root and collar rot (Macrophomina phaseolina (Tassi) Goid.) in okra

Twenty okra genotypes were screened for their resistance to root and collar rot incited by Macrophomina phaseolina in the experimental fields of Department of Plant Pathology, B. A. College of Agriculture, Anand Agricultural University. Based on their disease reaction, they were grouped into four categories i.e., resistant, moderately resistant, susceptible and highly susceptible. The biochemical analysis of the resistant and susceptible genotypes revealed that the total soluble sugar, reducing sugar and non reducing sugar decreased following inoculation by the pathogen. The decrease in total soluble sugar, reducing sugar and non reducing sugar were 21.54, 21.73 and 21.42 per cent in resistant variety, whereas in highly susceptible variety it was 6.06, 6.10 and 3.03 per cent, respectively. The total phenol content, soluble protein and peroxidase activity increased on inoculation with the pathogen. In the resistant variety, the increase in phenol content, soluble protein and peroxidase activity was 23.4, 32.56 and 63.86 per cent whereas in moderately resistant variety this was 19.85, 21.63 and 55.29 per cent, respectively. Susceptible and highly susceptible genotypes had low to moderate increase in the three parameters. The experimental results confirmed the importance of these biochemical factors in imparting the host resistance to root and collar rot

Comparative study to evaluate the awareness about anemia and its complications, among undergraduate and postgraduate medical students- a cross sectional survey study

Background: Anemia is a condition in which numbers of red blood cells or their oxygen carrying capacity is insufficient to meet the physiologic needs which vary by age, sex, altitude, smoking and pregnancy status. Iron deficiency anemia is the most common type of anemia in the world. Aim of the study was to compare and evaluate awareness about anemia and its complications among the undergraduate and postgraduate medical students.Methods: A prospective, cross sectional, questionnaire based, survey study was carried out at S.B.K.S. Medical institute and RC, Vadodara. The well-defined, structured questionnaire was prepared, distributed and collected when it was duly filled by undergraduate and postgraduate students. The questionnaire was mainly based upon basic knowledge of anemia, its investigations, treatment, and complications. The answers were evaluated in a structured format and further depending on the scores the participants were grouped as poor (70%). Later, it was subjected to Chi-square test and p value <0.05 were considered to be significant.Results: This study shows that the basic knowledge of anaemia and knowledge pertaining to treatment of anaemia is lacking in undergraduate students as compared to postgraduate students. However it was observed in both the study groups that knowledge about various aspects of anaemia is not optimal.Conclusions: It is a need of hour to impart knowledge of common disorders including anemia to both undergraduate and postgraduate students for the larger benefit of society

A prospective study on the use of magnesium sulfate in prevention and management of eclampsia with emphasis on adverse drug reactions

Introduction: The hypertensive disorders in pregnancy are the leading causes of maternal and perinatal mortality. Management of preeclampsia and eclampsia remains controversial even today. Several drugs with different regimens are available at present. As a consequence; women are treated in various ways by different regimens.Aim: Our work aimed to study the use of various magnesium sulfate regimens used in management of eclampsia in a tertiary care teaching rural hospital.Methods: A prospective, observational, non-interventional study was carried out among the eclamptic patients admitted to obstetrics ward. After explaining the purpose and method of study, through the patient information sheet, patients willing to sign the informed consent form were enrolled for the study. Relevant data was gathered from their case files and by direct interview with the patients that were recorded in the case record form.Results: Of the 35 cases of eclampsia recorded during the study period, we observed that all the patients were treated with Pritchard’s regimen of Magnesium Sulfate. It was noticed that there was improvement in all the patients with no adverse drug reactions recorded during the time of management.Conclusion: Maternal and perinatal mortality can be reduced to major extent by prevention of eclampsia. Prompt diagnosis and institution of therapy by selecting an ideal anticonvulsant is essential as the maternal and perinatal mortality progressively rises with increase no of convulsions. Magnesium Sulfate is a potent anticonvulsant with mild antihypertensive activity with less adverse effects.

Synthesis of some 6,6' -methylene- and 6,6' -sulphone-biscoumarins

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Initial psychological responses to influenza A, H1N1 ("Swine flu")

Background The outbreak of the pandemic flu, Influenza A H1N1 (Swine Flu) in early 2009, provided a major challenge to health services around the world. Previous pandemics have led to stockpiling of goods, the victimisation of particular population groups, and the cancellation of travel and the boycotting of particular foods (e.g. pork). We examined initial behavioural and attitudinal responses towards Influenza A, H1N1 ("Swine flu") in the six days following the WHO pandemic alert level 5, and regional differences in these responses. Methods 328 respondents completed a cross-sectional Internet or paper-based questionnaire study in Malaysia (N = 180) or Europe (N = 148). Measures assessed changes in transport usage, purchase of preparatory goods for a pandemic, perceived risk groups, indicators of anxiety, assessed estimated mortality rates for seasonal flu, effectiveness of seasonal flu vaccination, and changes in pork consumption Results 26% of the respondents were 'very concerned' about being a flu victim (42% Malaysians, 5% Europeans, p < .001). 36% reported reduced public transport use (48% Malaysia, 22% Europe, p < .001), 39% flight cancellations (56% Malaysia, 17% Europe, p < .001). 8% had purchased preparatory materials (e.g. face masks: 8% Malaysia, 7% Europe), 41% Malaysia (15% Europe) intended to do so (p < .001). 63% of Europeans, 19% of Malaysians had discussed the pandemic with friends (p < .001). Groups seen as at 'high risk' of infection included the immune compromised (mentioned by 87% respondents), pig farmers (70%), elderly (57%), prostitutes/highly sexually active (53%), and the homeless (53%). In data collected only in Europe, 64% greatly underestimated the mortality rates of seasonal flu, 26% believed seasonal flu vaccination gave protection against swine flu. 7% had reduced/stopped eating pork. 3% had purchased anti-viral drugs for use at home, while 32% intended to do so if the pandemic worsened. Conclusion Initial responses to Influenza A show large regional differences in anxiety, with Malaysians more anxious and more likely to reduce travel and to buy masks and food. Discussions with family and friends may reinforce existing anxiety levels. Particular groups (homosexuals, prostitutes, the homeless) are perceived as at greater risk, potentially leading to increased prejudice during a pandemic. Europeans underestimated mortality of seasonal flu, and require more information about the protection given by seasonal flu inoculation

Targeted Doxorubicin Delivery to Brain Tumors via Minicells: Proof of Principle Using Dogs with Spontaneously Occurring Tumors as a Model

BACKGROUND: Cytotoxic chemotherapy can be very effective for the treatment of cancer but toxicity on normal tissues often limits patient tolerance and often causes long-term adverse effects. The objective of this study was to assist in the preclinical development of using modified, non-living bacterially-derived minicells to deliver the potent chemotherapeutic doxorubicin via epidermal growth factor receptor (EGFR) targeting. Specifically, this study sought to evaluate the safety and efficacy of EGFR targeted, doxorubicin loaded minicells (designated EGFRminicellsDox) to deliver doxorubicin to spontaneous brain tumors in 17 companion dogs; a comparative oncology model of human brain cancers. METHODOLOGY/PRINCIPLE FINDINGS: EGFRminicellsDox were administered weekly via intravenous injection to 17 dogs with late-stage brain cancers. Biodistribution was assessed using single-photon emission computed tomography (SPECT) and magnetic resonance imaging (MRI). Anti-tumor response was determined using MRI, and blood samples were subject to toxicology (hematology, biochemistry) and inflammatory marker analysis. Targeted, doxorubicin-loaded minicells rapidly localized to the core of brain tumors. Complete resolution or marked tumor regression (>90% reduction in tumor volume) were observed in 23.53% of the cohort, with lasting anti-tumor responses characterized by remission in three dogs for more than two years. The median overall survival was 264 days (range 49 to 973). No adverse clinical, hematological or biochemical effects were observed with repeated administration of EGFRminicellsDox (30 to 98 doses administered in 10 of the 17 dogs). CONCLUSIONS/SIGNIFICANCE: Targeted minicells loaded with doxorubicin were safely administered to dogs with late stage brain cancer and clinical activity was observed. These findings demonstrate the strong potential for clinical applications of targeted, doxorubicin-loaded minicells for the effective treatment of patients with brain cancer. On this basis, we have designed a Phase 1 clinical study of EGFR-targeted, doxorubicin-loaded minicells for effective treatment of human patients with recurrent glioblastoma