Magnesium deficiency and other risk factors for diabetic retinopathy.

A case control study was carried out to detect the relation between magnesium deficiency and diabetic retinopathy and to study other risk factors for diabetic retinopathy. The study involved 30 cases with diabetic retinopathy, 30 diabetics and 30 non-diabetics with normal retina as controls. Serum magnesium was significantly lower in the diabetic control group than both other groups. Significant association between diabetic retinopathy and hypertension, poor control of blood sugar, irregularity in drug treatment, lack of routine fundus examination, high gravidity and low socioeconomic status were found. Multiple regression analysis was used to adjust for all variables mentioned. Magnesium deficiency was found to be statistically significantly associated with diabetic retinopathy after considering the effects of other variables.

The pediatric disposable end-tidal carbon dioxide detector role in endotracheal intubation in newborns.

OBJECTIVE: To determine the practical value of the new pediatric disposable ETCO2 detector Pedi-CAP in verifying endotracheal tube placement in neonatal resuscitation. METHODS: Infants who required endotracheal intubation in the delivery room or the neonatal intensive care unit (NICU) were included in a prospective study in which the endotracheal tube placement was determined clinically and simultaneously by the Pedi-CAP and confirmed by chest radiograph. The Pedi-CAP and clinical evaluation determination times of the endotracheal tube placement were measured and compared. The accuracy and ease of the Pedi-CAP use were tested. RESULTS: Forty-five newborns (450 to 4620 gm) who needed endotracheal intubation were included in the study. Twenty-four (53.3%) were intubated in the delivery room and 21 (46.7%) in the NICU. The Pedi-CAP color indicator correlated with the clinical evaluation and radiograph findings of proper intubation in 30 of 33 patients (sensitivity 91%, specificity 100%, positive predictive value 100%, and negative predictive value 80%). There were three false-negative results in patients with severe cardiorespiratory depression. The Pedi-CAP color indicator correlated with the clinical evaluation for the ET-tube being in the esophagus in 12 of 12 patients (sensitivity, specificity, and positive and negative predictive value were all 100%). The time required to determine the tube position by clinical evaluation was 0 to 90 seconds (mean = 39.7 seconds; SD +/- 15.3 seconds). The time required with the disposable ETCO2 detector was 4 to 12 seconds (mean = 8.1 seconds; SD +/- 2.9 seconds; p < 0.001). CONCLUSION: The use of a disposable pediatric endotracheal CO2 detector significantly reduces the time spent in verifying the endotracheal tube position (trachea versus esophagus) in newborns, including premature babies with body weight < 1000 gm. This is of particular benefit to babies who are erroneously intubated in the esophagus, because using the device allows much faster detection of this problem and much earlier reintubation.

Ascitic fluid alpha 1-antitrypsin.

Ascitic fluid alpha 1-antitrypsin (AF-AAT) was compared with ascitic fluid total protein (AF-TP) and the serum-ascites albumin gradient (SAAG) in the differential diagnosis of ascites. The study included 82 consecutive patients of which 42 had cirrhosis, 8 hepatoma (with cirrhosis), and 27 malignant ascites (peritoneal 18, liver 9). The concentration of AF-AAT (milligrams per deciliter) was significantly elevated (P less than 0.001) in hepatoma (174 +/- 123), malignant liver disease (232 +/- 119) and peritoneal neoplasms (376 +/- 106) in comparison with cirrhotics (66 +/- 33). In separating ascites caused by cirrhosis or malignancy, AF-AAT (discriminating limit of 120 mg/dl) had a 96% sensitivity, 95% specificity, and 96% diagnostic efficacy, which was superior to the 87% observed for AF-TP and 86% for the SAAG. Similar results were obtained for the A/S AAT ratio but this test was not available in all patients. AF-AAT was particularly useful in patients with malignancy causing portal hypertension as assessed by SAAG (hepatoma, malignant liver disease). We conclude that AF-AAT may be a valuable parameter in the differential diagnosis of ascites.