Mesenteric blood flow, glucose absorption and blood pressure responses to small intestinal glucose in critically ill patients older than 65 years.

PURPOSE: To compare nutrient-stimulated changes in superior mesenteric artery (SMA) blood flow, glucose absorption and glycaemia in individuals older than 65 years with, and without, critical illness. METHODS: Following a 1-h 'observation' period (t (0)-t (60)), 0.9 % saline and glucose (1 kcal/ml) were infused directly into the small intestine at 2 ml/min between t (60)-t (120), and t (120)-t (180), respectively. SMA blood flow was measured using Doppler ultrasonography at t (60) (fasting), t (90) and t (150) and is presented as raw values and nutrient-stimulated increment from baseline (Δ). Glucose absorption was evaluated using serum 3-O-methylglucose (3-OMG) concentrations during, and for 1 h after, the glucose infusion (i.e. t (120)-t (180) and t (120)-t (240)). Mean arterial pressure was recorded between t (60)-t (240). Data are presented as median (25th, 75th percentile). RESULTS: Eleven mechanically ventilated critically ill patients [age 75 (69, 79) years] and nine healthy volunteers [70 (68, 77) years] were studied. The magnitude of the nutrient-stimulated increase in SMA flow was markedly less in the critically ill when compared with healthy subjects [Δt (150): patients 115 (-138, 367) versus health 836 (618, 1,054) ml/min; P = 0.001]. In patients, glucose absorption was reduced during, and for 1 h after, the glucose infusion when compared with health [AUC(120-180): 4.571 (2.591, 6.551) versus 11.307 (8.447, 14.167) mmol/l min; P < 0.001 and AUC(120-240): 26.5 (17.7, 35.3) versus 40.6 (31.7, 49.4) mmol/l min; P = 0.031]. A close relationship between the nutrient-stimulated increment in SMA flow and glucose absorption was evident (3-OMG AUC(120-180) and ∆SMA flow at t (150): r (2) = 0.29; P < 0.05). CONCLUSIONS: In critically ill patients aged >65 years, stimulation of SMA flow by small intestinal glucose infusion may be attenuated, which could account for the reduction in glucose absorption.

Assessment of Discomfort Experienced by School Children While Performing 'ART' and 'MCP'-An Experimental Study.

OBJECTIVE: Atraumatic Restorative Treatment (ART) is a minimal intervention technique in the management of carious lesions, which results in negligible discomfort to the patient. The aim of this study was to assess and compare the discomfort levels during Atraumatic Restorative Treatment and Minimal Cavity Preparation (MCP: a method using rotary instruments) treatment procedures in a sample of school children in Davangere city. MATERIALS AND METHODS: An experimental study was performed aimed at comparing discomfort levels as measured by subjective (Venham index) and objective (Heart rate) methods at six specified moments during the treatment. A total of 200 children were randomly divided into two groups of 100 each. In each child, one class II restoration with GIC in a deciduous molar was performed. One group received treatment using rotary instruments (MCP) and the other group with ART. Discomfort levels were measured using Venham index (behavioural dimension) and heart rate (physiological dimension). RESULTS: The behavioural measurement revealed that in ART group the majority of the children(64%) showed an overall Venham score of '<1'(relaxed) as compared to MCP group in which the majority of children (76%) showed a Venham score of '1'(uneasy). The physiological measurement revealed that the children in ART group experienced less discomfort when compared to children in MCP group. CONCLUSION: The results of the study suggest that ART induces less discomfort; is patient friendly and has a higher extent of community acceptance when compared to MCP.