Evaluation of Sleep Architecture using 24-hour Polysomnography in Patients Recovering from Critical Illness in an Intensive Care Unit and High Dependency Unit: a Longitudinal, Prospective, and Observational Study.

BACKGROUND AND OBJECTIVE: The sleep architecture of critically ill patients being treated in Intensive Care Units (ICU) and High Dependency Units (HDU) is frequently unsettled and inadequate both qualitatively and quantitatively. The study aimed to investigate and elucidate factors influencing sleep architecture and quality in ICU and HDU in a limited resource setting with financial constraints, lacking human resources and technology for routine monitoring of noise, light and sleep promotion strategies in ICU. METHODS: The study was longitudinal, prospective, hospital-based, analytic, and observational. Insomnia Severity Index (ISI) and the Epworth Sleepiness Scale (ESS) pre hospitalisation scores were recorded. Patients underwent 24-hour polysomnography (PSG) with the simultaneous monitoring of noise and light in their environments. Patients stabilised in ICU were transferred to HDU, where the 24-hour PSG with the simultaneous monitoring of noise and light in their environments was repeated. Following PSG, the Richards-Campbell Sleep Questionnaire (RCSQ) was employed to rate patients' sleep in both the ICU and HDU. RESULTS: Of 46 screened patients, 26 patients were treated in the ICU and then transferred to the HDU. The mean (SD) of the study population's mean (SD) age was 35.96 (11.6) years with a predominantly male population (53.2% (n=14)). The mean (SD) of the ISI and ESS scores were 6.88 (2.58) and 4.92 (1.99), respectively. The comparative analysis of PSG data recording from the ICU and HDU showed a statistically significant reduction in N1, N2 and an increase in N3 stages of sleep (p<0.05). Mean (SD) of RCSQ in the ICU and the HDU were 54.65 (7.70) and 60.19 (10.85) (p-value = 0.04) respectively. The disease severity (APACHE II) has a weak correlation with the arousal index but failed to reach statistical significance (coeff= 0.347, p= 0.083). CONCLUSION: Sleep in ICU is disturbed and persisting during the recovery period in critically ill. However, during recovery, sleep architecture shows signs of restoration.

The study of association of Vitamin B12 deficiency in type 2 diabetes mellitus with and without diabetic nephropathy in North Indian Population.

AIM: Diabetic Mellitus is the chronic metabolic disorder associated with various complications of heart, eyes, nerves, kidney etc. Diabetic Nephropathy is one of the leading causes of death in diabetic patient. We hypothesized that decrease Vitamin B12 levels is associated with Diabetic Nephropathy. Aim of our study is to study the serum Vitamin B12 levels in type 2 diabetes mellitus patients with and without nephropathy. METHODS: Our study population consist of 100 subjects out of which 50 cases of Diabetes Mellitus without Diabetic Nephropathy and 50 cases of Diabetes Mellitus with Diabetic Nephropathy. We measured various routine lab parameters, apart from it, we measured spot urinary albumin to creatinine ratio to assess diabetic nephropathy and in special investigation we measured serum Vitamin B12 by chemiluminesence based immunoassay. RESULT: Serum Vitamin B12 level in the group with nephropathy (181.6±17.6pg/dl) was significantly lower than in the group without nephropathy (286±30.1pg/dl) (p=0.03). CONCLUSION: Our study points towards the decrease levels of serum Vitamin B12 levels associated with the complication of diabetic mellitus such as diabetic nephropathy. So treatment of Vitamin B12 deficiency by supplementing could prevent the development and progression of diabetic nephropathy and improves the overall management of diabetic patient.

Thrombocytopenia in HIV patients coinfected with tuberculosis.

Thrombocytopenia is one of the most common hematological manifestations seen in HIV patients with approximately 40% of the patients developing thrombocytopenia during their course of illness. Opportunistic infection like tuberculosis is a rare but curative cause of thrombocytopenia in these patients. Clinically, it is a challenge to determine the exact cause and decide the treatment of thrombocytopenia in these patients as both infections can lead to significant thrombocytopenia by varied mechanisms. The treatment options are limited by drug antitubercular treatment highly active antiretroviral therapy (ATT and HAART)-induced thrombocytopenia. A 25-year-old male patient presented with low grade, intermittent fever with left-sided pleuritic chest pain for 2 months along with dry cough, weight loss, malaise, and lethargy. Hematological examination showed anemia, leukopenia, and thrombocytopenia. The patient was found to be HIV reactive. Chest X-ray revealed nonhomogenous opacity with cavitation in the left upper and middle zone suggestive of tuberculosis. He received multiple units of blood and platelets and was started on isoniazid, rifampicin, pyrazinamide, and ethambutol. HAART was initiated 2 weeks after starting ATT. Patient's hematological parameters improved and he was discharged on ATT and HAART with recovery of the platelet counts. Thrombocytopenia is a complication associated with both HIV and tuberculosis and hence determining the cause and deciding the appropriate treatment is challenging. Decision about whom and when to treat has to be taken cautiously considering all possible contributors and treatment has to be individualized.

The Association of Folic Acid Deficiency and Diabetic Nephropathy in Patients with Type 2 Diabetes Mellitus.

INTRODUCTION: Diabetic Mellitus is the chronic metabolic illness characterised by hyperglycemia and various complications of heart, eyes, nerves, kidney etc. Diabetic Nephropathy is the leading causes of morbidity and mortality in diabetic patient. We hypothesized that decreased serum folic acid levels are associated with Diabetic Nephropathy. MATERIALS AND METHOD: Our study population consist of 100 subjects out of which 50 cases of Diabetes Mellitus are without Diabetic Nephropathy and 50 cases of Diabetes Mellitus with Diabetic Nephropathy. We measured various routine lab parameters, apart from that, we measured spot urinary albumin to creatinine ratio to assess diabetic nephropathy and we used chemiluminesence based immunoassay to measure serum folic acid. RESULT: Serum folic acid in the group with nephropathy was significantly lower than that of the group without nephropathy (4.9 ± 0.4 ng/dl) vs (6.8 ± 0.5 ng/dl) p = 0.05. We found that serum folic acid was negatively correlated with spot urinary albumin ratio and on multivariate logistic regression analysis we found that decrease in folic acid significantly (p < 0.05) increases the chances of diabetes with nephropathy by 19.9 %. CONCLUSION: Our study tilt toward the deficiency of serum folic acid levels in diabetes mellitus patient with nephropathy. So if we would correct folic acid deficiency in diabetic patient then we could prevent the development of various complication associated with diabetes and help in reducing the morbidity and mortality of diabetic patient.