ABSTRACT
Background : There has been a steady rise in the geriatric population in India and increasing number of elderly patients are being admitted in Critical Care Unit (CCU). They need mechanical ventilation during their hospital stay. Hence, there is continued need for evaluation and research to develop a validating scoring systems used to predict the outcome of CCU patients supported by mechanical ventilation. Objective : Analysis to predict the outcome (survival or mortality) of mechanically ventilated elderly patients in different age groups at the CCU. Material and Method : A Prospective observational study was done in CCU for a period of one year. A group of 40 elderly ventilated patients greater than 60 years of age (Group 1-elderly case group) and another group of 40 ventilated patients less than 60 years of age (Group-2- control group) were included in the study. A clinical database was collected which included age, sex, Acute Physiology and Chronic health Evaluation II (APACHE II) score and an Sequential Organ Failure Assessment (SOFA) scores were calculated in the first 24 hours of ventilation,indication of mechanical ventilation, co-morbidity, according to the Charlson Comorbidity Index (CCI), functional capacity according to the Barthel Index (BI). Patients outcome (survival or mortality) were analyzed. All the patients in two groups were on ventilation support. Result : In case group (n=40), mortality was 55%. In control group (n=40), mortality was 52.5%. On comparison of outcome between two groups (case with control group) the difference was not statistically significant (p= 0.8225). In case group, association of outcome to different age groups (60-65 years, 66-75years, more than75years) (p=0.3357) andto gender (p=0.3854) was not statistically significant. Multivariate logistic regression analysis of the study variables showed APACHE II score to be statistically significant for outcome (p=0.0229). Conclusion : Mortality of elderly patients supported by mechanical ventilation at CCU were slightly higher(55%) than in mechanically ventilated younger populations (52.5%) though the difference was not statistically significant between two groups (p=0.82). APACHE II, score measured within 24 hours of ventilation was a significant predictor of mortality in the patients on mechanical ventilation.
ABSTRACT
Centella asiatica (L.) Urban is a perennial herb with high utility in traditional medicines and pharmaceutical industries. In India the wild populations C. asiatica are overexploited at an unrestrained rate to cope up with its high market demands. The aim of this study was to identify potential chemotype of C. asiatica from different geographical region in India and optimized in vitro micropropagation protocol of the elite ecotype was established for commercial purposes. Five C. asiatica accessions were collected from different geographic locations and their active biological components were analyzed. Among these accessions total phenolic and flavonoid content combined with ascorbic acid was found to be significantly higher in CA-4 compared to other ecotypes. The free radical scavenging activity as well as reducing power of the CA-4 ecotype also corroborate the higher phenolic content. Therefore the elite ecotype CA-4 was selected for in vitro conservation and micropropagation. Shoot-tips explants was inoculated on Murashige and Skoog basal medium with different concentrations and combinations of cytokinins and auxins. Optimum multiplication was achieved on medium containing 6-benzyl-aminopurine (2.0 mg L–1) and indole-3-acetic acid (0.2 mg L–1). In vitro rooting of multiplied individual shoots was achieved on half strength Murashige and Skoog medium supplemented with IBA (1.5 mg L–1), with a maximum of 16.4 ± 0.22 roots. These micropropagated plants were successfully established in soil after hardening with 94.55 % survival rate.