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To determine the causes, predictors and outcomes of reintubation. Retrospective analysis of data collected from the trauma data base registry was conducted to identify the extubation failure cases in Trauma ICU at Hamad General Hospital, the only Level I trauma center in Qatar between January 2009 and December 2010. Demographics, mechanism of Injury, complications, injury severity score [ISS], Glasgow Coma Scale [GCS], ICU-length of stay [LOS], and mortality were analyzed among trauma patients who need reintubation within 48 hrs after extubation [group 1] compared to successfully extubated patients [group 2]. A total of 954 patients were admitted to the trauma ICU, of which 343 were intubated orotracheally. The mean age of patients was 32 +/- 12 years with male predominance [95%]. Motor vehicle crash [41%], pedestrian injury [20%] and falls [18%] were the most common mechanisms of injury. Reintubation [group 1] was required in 24 patients [7%]. Patients in group 1 had higher rate of head injury mainly SAH [88%], pneumonia [79%] and pulmonary contusion [58%]. The mean ICU-LOS was higher in the reintubated patients [p=0.010] in comparison to group 2. Forty-six percent of reintubated patients required tracheostomy. The mean age, ISS, GCS and tube size was comparable among the two groups. Furthermore, reintubation was not associated with higher mortality rate [p=0.910]. However, Ventilator-associated pneumonia [VAP] [odd ratio=3.61 [95% CI 1.25-10.44]; p=0.020] and ventilator days [odd ratio=1.09 [95% CI 1.024-1.153]; p=0.006] were independent predictors of reintubation by multivariate analysis. Re-intubation is associated with increased ICU-LOS and need for tracheostomy. VAP and prolonged intubation are independent predictors of re-intubation. Our finding addresses the value of prevention and early treatment of infection in intubated patients. This study may represent an audit of local practice as well
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Gentamicin induces nephrotoxicity, hence the present study explores protective and curative effects of alpha-lipoic acid and selenium alone and in combination in gentamicin-induced nephrotoxicity. Forty rabbits were randomly segregated into control, protective and curative groups. The groups A and B received water [10 ml/kg/day] and gentamicin [I/M, 80 mg/kg/day], respectively as normal and gentamicin controls. Four hours before gentamicin nephrotoxic dose, the protective subgroups C, D and E received alpha-lipoic acid, selenium and combination [50 mg/kg/day alpha-lipoic acid and 10 mg/kg/day selenium], respectively and then continued for 20 days. Nephrotoxicity was induced in curative subgroups F, G and H with gentamicin sulphate for 9 days and from 10[th] day onwards, followed the same treatments as for protective group for 26 days. Blood urea nitrogen [BUN], creatinine and antioxidant activity [AOA] were measured in all the groups. Combination of alpha-lipoic acid [50 mg/kg/day] and selenium [10 mg/kg/day] significantly reduced BUN [58.64%] and creatinine [17.48%] in protective subgroups treated for 20 days as compared to control without affecting AOA [p<0.05]. Decrease of 82.19% BUN and 77.38% creatinine, and 46.66% increase in AOA was noted on day 26 in curative group treated with the combination of antioxidants. The combination of alpha-lipoic acid and selenium [50 mg/kg/day alpha-lipoic acid and 10 mg/kg/day selenium] was found to be effective in prevention and treatment of gentamicin-induced nephrotoxicity
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Oxidative stress causes the generation of reactive oxygen species [ROS] that lead to nephrotoxicity. An aminoglycoside, gentamicin, has pronounced nephrotoxic effect in humans and animals and this study was planned to observe the nephro-protective effect of antioxidants, vitamin C and Nigella sativa oil. Serum creatinine, blood urea nitrogen, and antioxidant activity were measured as indicators of nephrotoxicity for all the groups of rabbits. Results showed that vitamin C and Nigella sativa oil both had nephro-protective effect as they lowered the values of nephrotoxicity indicators [serum creatinine, blood urea nitrogen, and antioxidant activity] as compared to gentamicin control group values. When these two antioxidants were given as combination, they proved to have synergistic nephroprotective effect
RESUMO
The angiotensin converting enzyme (ACE) is a strong candidate gene for myocardial infarction (MI). Insertion-deletion dimorphism in intron 16 of this gene has been inconclusively found to be associated with it. Several new polymorphisms in the ACE gene have been identified and among these, a dimorphism in exon 17, ACE G2350A, has a significant effect on plasma ACE concentrations. To assess the value of genotyping the ACE G2350A dimorphism in a genetically homogeneous population, we carried out a case-control study of dimorphism G2350A for a putative association with MI among Pakistani nationals. We investigated a sample population of 370 Pakistanis, comprising 163 controls, and 207 patients with clinical diagnosis of acute MI (AMI). ACE G2350A alleles were visualized by assays based on polymerase chain reaction and restriction endonuclease analysis. Frequencies of G alleles were 0.68 among controls and 0.72 among AMI patients. The ACE G2350A dimorphism showed no significant association with MI (c2=0.90, 2 df, P=0.64), plasma levels of homocysteine (P=0.52) or with serum levels of folate (P=0.299). The results indicate that ACE G2350A polymorphism is not associated with risk of myocardial infarction in the Pakistani population investigated here.