Utilization pattern and cost of sedation, analgesia and neuromuscular blockade in a multidisciplinary intensive care unit / Patrón de utilización y costo de la sedación, analgesia y bloqueo neuromuscular en una unidad multidisciplinaria de cuidados intensivos

OBJECTIVES: To study the utilization pattern and the cost of sedatives, analgesics and neuromuscular blocking agents in a multidisciplinary intensive care unit (ICU) METHODS: A prospective observational study was conducted in the ICU of the Eric Williams Medical Sciences Complex, Trinidad and Tobago, for a period of twelve weeks. All patients admitted to the ICU were enrolled. No interventions were done. Data collected included demographics, diagnoses on admission, length of stay in the ICU, status of mechanical ventilation, patient outcome, quantity of sedatives, analgesics and neuromuscular blocking agents used in every patient and their cost. RESULTS: There were 333 patient-days encountered from 34 patients studied. Midazolam, fentanyl and cisatracurium were the most commonly used sedative, opioid and neuromuscular blocking agents respectively. The total cost of drugs used for sedation, analgesia and neuromuscular blockade was approximately US$ 19 600 per annum. Cost for this treatment alone accounted for more than 50% of the total ICU drug costs. The costs were significantly higher in patients who stayed more than two weeks in the ICU when compared to those who stayed less than two weeks (p < 0.001). CONCLUSIONS: The study highlights the utilization pattern and financial burden of sedation, analgesia and neuromuscular blockade in the delivery of critical care.

OBJETIVOS: Estudiar el patrón de utilización y costo de los sedantes, analgésicos, y agentes de bloqueo neuromuscular en una Unidad Multidisciplinaria de Cuidados Intensivos (UCI). MÉTODOS: Se llevó a cabo un estudio prospectivo en la UCI del Complejo de Ciencias Médicas Eric Williams, en Trinidad y Tobago, por un período de doce semanas. Todos los pacientes ingresados a la UCI fueron enrolados. No se realizaron intervenciones. Los datos recogidos incluyeron demografías, diagnósticos de ingreso, longitud de la estadía en la UCI, estatus de ventilación mecánica, evolución del paciente, así como la cantidad y el costo de los sedantes, analgésicos y agentes de bloqueo neuromuscular usados en cada paciente. RESULTADOS: Se encontraron 333 días-pacientes a partir de 34 pacientes estudiados. La midazolama, el fentanil y el cisatracurio fueron los agentes sedativos, opioides y de bloqueo neuromuscular más comúnmente usados. El costo total de los medicamentos usados para la sedación, la analgesia y el bloqueo neuromuscular fue de aproximadamente $19 600 USD por año. El costo sólo para este tratamiento representó más del 50% del total de los costos de medicamentos de la UCI. Los costos fueron significativamente más altos en pacientes que permanecieron más de dos semanas en la UCI, en comparación con aquellos que permanecieron menos de dos semanas (p < 0.001). CONCLUSIONES: El estudio pone de relieve el patrón de utilización de la carga financiera de la sedación, analgesia y bloqueo muscular a la hora de ofrecer atención crítica.

Acute poisoning in children. Cases hospitalized during a three-year period in Trinidad

The aim of this study is to describe the epidemiological features of acute poisoning in children less than 16 years old who were admitted to a paediatric hospital in north Trinidad. The specific objectives included the determination of the age range most susceptible to poisoning, which agents are mainly responsible, an examination of the need for preventive strategies and educational programmes as well as to evaluate the need for a poison control centre in the country. Data were extracted from the medical records of 169 patients (83 males (49) and 86 females (51) with acute poisoning during the period of January 1998 to December 2000. The results revealed that the majority of cases of poisoning were accidental (84.6), suicide (11.2) and forced poisoning (4.1). The largest category of poisoning was a miscellaneous group (24.8) followed by the drug category (21.8), kerosene (19.5), pesticides (15.9) and bleach (9.4). Paraquat ingestion constituted 5.3 of cases. The highest prevalence of acute poisoning occurred within the age group of 0-4 years (69.2), followed by the age group of 10-13 years (13.6), 5-9 years (9.4) and the age group with the lowest incidence was 14-16 years (7.6). The only fatality was a female (10-13 year-group) and this was due to suicidal ingestion of paraquat. All other cases were treated and subsequently discharged. The frequency of accidental poisoning in Trinidad merits more widespread public education aimed at preventing exposure to toxic substances while increasing the use of deterrents such as child-resistant containers

Screening of local plant extracts against a human leukemia cell line

A number of crude extracts from folk medicinal plants were screened for cytotoxicity against the human T-cell leukemia cell line. Fixed aliquots from a quantified cell suspension were incubated for three days in the presence of a control and several different concentrations of the given plant extract

Chemotherapy in Hodgkin's disease.

OBJECTIVE: To assess the efficacy of primary chemotherapy in patients with clinically staged Hodgkin's disease. DESIGN: Non randomized study. SETTING: Pediatric Oncology Division of Regional Cancer Center. SUBJECTS: Twenty nine children with Hodgkin's disease. INTERVENTIONS: Chemotherapy was given to 21 patients whose parents agreed for the same. Sixteen children received COPP regimen and 5 received MOPP regimen. RESULTS: Complete remission was achieved in 19 patients. The relapse free survival and overall survival in these patients were 76% and 86%, respectively at 5 years. There was no death related to chemotherapy toxicity. CONCLUSION: Combination chemotherapy is an effective modality of treatment for children with Hodgkin's disease.

Altered biological distribution and decreased neuromuscular toxicity of niosome encapsulated vincristine.

Effects of encapsulation within niosomes (nonionic surfactant vesicles) on the biological distribution and toxicity of vincristine-a widely used anticancer drug have been investigated. Plasma kinetics, tissue distribution profile and neuromuscular toxicity of niosomal vincristine (NVCR) were compared with those of free vincristine (FVCR). NVCR was cleared from the plasma much more slowly [t1/2(beta) = 1.388 hr] than FVCR [t1/2(beta) = 0.74 hr]. Over the 48 hr period of experiment, the niosome formulation delivered significantly more drug to the plasma compartment than FVCR and resulted in reduced accumulation of drug in gut and skeletal muscle. Encapsulation caused a marked alteration in the tissue disposition of the drug. NVCR was less toxic both in terms of mortality and morbidity. Importantly, histopathological studies of skeletal muscle, spinal cord and sciatic nerve of NVCR treated albino wistar rats demonstrated the less toxic potential of encapsulated vincristine. Further, the biochemical studies, estimation of enzymes plasma creatine phosphokinase and lactate dehydrogenase, confirmed the safety profile of NVCR. The decreased partitioning of NVCR to non active sites resulted in a significant amelioration of the toxic side effects, gastrointestinal and myological in particular, of the drug. The results indicate that the delivery of vincristine by encapsulating it in niosomes offer an efficient means of decreasing its toxic effects.

Neuroblastoma with testicular metastasis. Review of literature and report of a case.

Eventhough neuroblastoma presents with wide spread tumour dissemination, metastasis to testes had rarely been reported. We report a case of Stage IV neuroblastoma who developed metastasis to both testes. He had massive infra-diaphragmatic disease with involvement of left supraclavicular lymph node at presentation. Treatment received by him was not adequate and five months later he developed metastasis to both testes. Hematogenous spread might have been the possibility in this case.

Role of exogenous ascorbic acid in tissue status of ascorbic acid-2-sulphate in guinea pigs.

Guinea pigs were given ascorbic acid orally in two doses; a low and a high dose. The tissue levels of ascorbic acid-2-sulphate was estimated in these animals after 15 days of feeding and a subsequent deprivation period of 15 days. The specific activity of the enzymes ascorbic acid sulphotransferase and ascorbic acid-2-sulphate sulphohydrolase was studied. During higher ascorbic acid intake, the activity of ascorbic acid sulphotransferase was increased, whereas ascorbic acid-2-sulphate sulphohydrolase showed a decreased activity. But when ascorbic acid intake was lowered or ceased, the activity of the above enzymes showed a reverse pattern. Possible reasons for the lack of antiscorbutic activity of ascorbic acid-2-sulphate in guinea pigs is discussed.