Hepatic and Renal Biochemical Markers as Predictors of Mortality Among Critically Ill Systemic Inflammatory Response Syndrome Patients.

Systemic inflammatory response syndrome (SIRS) is a frequently encountered complication seen in intensive care unit patients and remains a common cause of mortality. Assessing prognosis of those becomes a priority and indeed we have various efficient scoring systems for the same. However they use enormous data and involve complex calculations for scoring. We intended to find a simple, inexpensive, accurate diagnostic tool of certain markers to predict mortality outcome among critically ill SIRS patients and to evaluate their efficiency in comparison to Acute Physiology and Chronic Health Evaluation II (APACHE II) scoring system. Eighty-seven patients were selected and general hepatic, renal and urinary investigations were done for them at 24 h of admission and were followed up for a period of 4 weeks from admission date to classify them as survivors and non-survivors. Twenty-one percent patients had succumbed to death during study period. Urine albumin-creatinine ratio, alanineaminotransferase, aspartate aminotransferase and prothrombin time/International Normalized Ratio were found to be correlating with APACHE II scores and mortality significantly. Specific individual cut-offs were found for these parameters and were combined to form combined predictors which showed good discrimination (AUC = 0.715) and good calibration (p = 0.811) with specificity of 98.6% in predicting mortality. SIRS patients falling above combined predictor's cutoff are 54 times more likely to have an unfavorable outcome compared to the ones below. Overall predictive accuracy of first day combined predictors was such that within 24 h of ICU admission 87% of ICU SIRS admissions could be given a risk estimate for hospital death.

Does oxidative stress play a role in altered plasma protein homeostasis in pregnancy-induced hypertension?

BACKGROUND: Pregnancy-induced hypertension (PIH) is associated with oxidative stress and low plasma proteins. This study explored the effect of oxidative stress on plasma protein level in PIH. METHODS: Serum total proteins (TP), albumin, globulin, malondialdehyde, protein carbonyls (PC) and protein bound sialic acid (PBSA) were measured in gestational hypertensive, pre-eclamptic, eclamptic and healthy pregnant women (n=20/group). Serum proteins were separated by electrophoresis for assessing protein damage. RESULTS: Serum TP and albumin decreased and malondialdehyde, PC & PBSA increased significantly in all PIH subgroups as compared to healthy pregnant subjects. Serum globulin levels decreased only in eclampsia. Malondialdehyde and PC negatively correlated with albumin level. Protein fragmentation and aggregation in eclampsia were evident from electrophoretogram. CONCLUSION: We conclude that oxidative damages to proteins contribute to decreased serum protein levels in PIH and hypersialylation of plasma proteins is probably body's protective mechanism to combat oxidative protein damage in PIH.

Prevalence of prehypertension and its relationship to cardiovascular disease risk factors in Puducherry.

Prehypertension (PHT) leads to hypertension (HT) and cardiovascular (CVD) disease risk. Identification of CVD risk factors in PHT will reduce the burden of HT and CVD in the population. Three hundred staffs of a medical college were screened for prehypertension (PHT). Sixty five PHT and 91 normotensives (NT) were enrolled. Anthropometric measurements and fasting blood glucose and lipid variables were measured. Prevalence of PHT was 22% (males 71%; females 29%). Hip circumference, waist circumference (WC), body mass index (BMI), fasting blood glucose (FBS) and atherogenic lipid indices triglycerides (TG), VLDL cholesterol, TG/HDL and LDL/HDL were increased in PHT. PHT showed significant positive association with BMI, WC, FBS, TG and TG/HDL. Regression analysis revealed BMI, TG and TG/HDL as the independent CVD risk factors in PHT. PHT is predominant in males and BMI, TG are the independent CVD risk factors in Puducherry.

Formulation of questions followed by small group discussion as a revision exercise at the end of a teaching module in biochemistry.

Undergraduate medical students get fewer opportunities to clarify their doubts and to reinforce their understanding of concepts after lecture classes. There is no information available in the literature that addresses the question of usefulness of prior formulation of questions followed by small group discussion by undergraduate medical students as a revision exercise. The purpose of this work is to evaluate the effect of formulation of objective type short answer questions by undergraduate medical students followed by small group discussion on the answers of the questions prepared as a revision exercise on their understanding of the topic "amino acid metabolism" and the retention of the gain after 15 days. At the end of a regular teaching module on the topic of amino acid metabolism, undergraduate medical students were asked to prepare 16 objective type short answer questions on the various aspects of the topic as homework. Small group discussions involving 12-14 students in each group and lasting one hour were conducted on the questions and answers prepared by them in the presence of a faculty member. The effects on low, medium, and high achievers were evaluated with multiple choice questions by pre-test and post-tests before and after the group discussion. Formulation of questions was highly effective in improving understanding on the topic for all the students. The overall mean post-test scores after the formulation of questions (12.6) and after the small group discussion that followed (14.7) were significantly higher than the mean pre-test score (8.5). For high achievers, the gain from formulation of questions was higher than the gain from small group discussion. Small group discussion was highly effective for all students. The gain from small group discussion was higher among the low and medium achievers in comparison with the high achievers. The gain from the exercise was retained among the low, medium, and high achievers after 15 days. In conclusion, formulation of short answer questions followed by small group discussion on the answers of the questions prepared by the undergraduate medical students is an effective revision exercise for improving their understanding on a selected topic.