Background: One major problem encountered in the intensive care unit is differentiating the inflammatory response from an infective process. Clinical and standard laboratory tests are not very helpful because most critically ill patients develop some degree of inflammatory response, whether or not they have sepsis. Numerous biomarkers have been evaluated to predict mortality in critically ill patients, although none have proved entirely useful. Objective of the study was to evaluate eosinophil count and neutrophil-lymphocyte count ratio with C-reactive protein levels in patients with sepsis.Methods: 71 patients >18 years of age of either sex with a diagnosis of sepsis were enrolled in this one-year observational study. Patients were classified according to the criteria of the American College of Chest Physicians/Society of Critical Care Medicine into sepsis group (n=50) and no sepsis group (n=21). Sepsis group were further divided into subgroups: sepsis (n=19), severe sepsis (n=16) and septic shock (n=15). Absolute eosinophil cell, neutrophil and lymphocyte counts for first 4 consecutive days and then on alternate days up to one week were also noted down. C-reactive protein levels on day 3 were also noted down.Results: In the sepsis group, mean eosinophil count was significantly (p<0.0001) low, mean neutrophil/lymphocyte count ratio was significantly (p<0.0001) high, mean CRP count was significantly (p=0.019) more as compared to that of no sepsis group. Among 16 mortalities, significant (p<0.05) decrease was noted in mean eosinophil count from day 3 onwards in patients of sepsis and septic shock subgroups. Mean N/L ratio showed no significant difference in patients of sepsis, severe sepsis or septic shock. Mean CRP count showed significant (p<0.05) increase in severe sepsis patients and mean Apache II score showed significant (p<0.05) deterioration in patients of septic shock.Conclusions: Neutrophil/lymphocyte count ratio (NLCR) and absolute eosinophil count (AEC) came out as better independent biomarker of sepsis in critically ill patients with infection admitted in intensive care unit. Diagnostic performance was better in these two diagnostic markers as compared to CRP marker. NLCR presented with sensitivity of 89.58%, AEC with 82.35% and CRP with 80.77%. Outcomes of NLCR and AEC were quick, easy and economical in establishing diagnosis of sepsis.
The purpose of present study was to find out a suitable alternative to glycated haemoglobin (HbA1c) for the assessment of glycaemic control in diabetic individuals. For the purpose of the study (HbA1c), fasting plasma glucose (FPG), postprandial plasma glucose (PPG) and random plasma glucose (RPG) levels of 500 individuals were assessed. Mean plasma glucose (MPG) was calculated by using the equation (FPG + PPG)/2. On correlation analyses, it was found that correlation of MPG with HbA1c was better than that of FPG, PPG or RPG with HbA1c. Thus MPG seems to be a suitable alternative to HbA1c in the situations where high cost, medical conditions or standardization issues preclude the use of HbA1c assays. We suggest using a cut-off of 145.8 mg/dl for MPG to predict HbA1c ≥6.5%. For those centers that are estimating HbA1c levels, we suggest eMPG-I (Estimated Mean Plasma Glucose-Indian) study equation (28.455 x HbA1c) - 46.78 for predicting the estimated mean plasma glucose of a patient in mg/dl, as it is easier to converse with the patients in terms of glucose levels. Key words: Diabetes, Plasma glucose, HbA1c, Glycaemic control
PURPOSE: Remodulin (treprostinil) infusion is indicated to treat pulmonary arterial hypertension (PAH) to diminish exerciseassociated symptoms. The pediatric safety profile is not established. Real-world data were analyzed for adverse drug reactions (ADR) in pediatrics versus adults.METHODS: This retrospective study compared United Therapeutics' pharmacovigilance data of pediatrics (<18 yo) versus adults ($18 yo) to determine any significant difference between the two populations. The database search ranged from 03Feb1998 to 01Sep2020 and included postmarketing surveillance and unblinded serious clinical trial reports of patients with PAH. The ADRs compared are listed events for Remodulin. The difference in ADR percentage for pediatrics versus adults, the 95% CI of the difference, and ADRs occurring at frequency of $4% were summarized.RESULTS: A total of 6,128 adults and 338 pediatric patients were analyzed. Infusion Site Pain (23% vs. 19%), Diarrhea (10.7% vs. 20.1%), Vomiting (9.1% vs. 7.9%), Nausea (8.2% vs. 16.8%), and Headache (6.3% vs. 19.9%) were the most frequently experienced ADRs in pediatrics and adults respectively. ADRs more frequent in pediatrics were Infusion Site Erythema (15.1% vs. 10.2%), Pyrexia (7.9% vs. 3.0%), Oxygen Saturation Decreased (6.0% vs. 3.0%), Infusion Site Discharge (6.0% vs. 2.8%), Dehydration (4.1% vs. 1.7%), and Infusion Site Reaction (4.1% vs. 0.9%). The lower bound of 95% CI of the difference for pediatrics versus adults is >0. Of ADRs occurring $4%, Infusion Site Pain (23%), Infusion Site Erythema (15.1%), Diarrhea (10.7%), Infusion Site Swelling (10.4%), and Dyspnea (7.9%) were most frequent in pediatrics, while Dyspnea (20.4%), Diarrhea (20.1%), Headache (19.9%), Infusion Site Pain (19%), and Nausea (16.8%) were most frequent in adults. A fatal outcome of progressive disease was 5.7% and 17.5% in pediatrics versus adults respectively. CONCLUSIONS: Remodulin safety profile is comparable between pediatric and adult PAH population. However, local reactions were observed more in pediatrics.
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