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Biomedical subjects

A Mallick

Publications and source records attributed to A Mallick.

36 records · Page 2Linked to original sources
PubMed1997

Initial evaluation of diaspirin cross-linked hemoglobin (DCLHb) as a vasopressor in critically ill patients.

OBJECTIVE: To evaluate the hemodynamic effects and any toxicologic effects of diaspirin cross-linked hemoglobin (DCLHb) in critically ill patients. DESIGN: A prospective, observational study. SETTING: A seven-bed intensive care unit (ICU) in a University teaching hospital. PATIENTS: Fourteen critically ill patients requiring vasopressor therapy to maintain adequate mean arterial pressure (MAP). All patients had secondary organ dysfunction. INTERVENTIONS: Administration of 100 mL boluses of 10% diaspirin cross-linked hemoglobin, up to a maximum of 500 mL, given over 15 mins and separated by 60 to 90 mins. MEASUREMENTS AND MAIN RESULTS: Hemodynamic parameters, norepinephrine and inotropic requirements, arterial and mixed venous blood gases, urine output, and biochemical and hematologic analyses were measured before diaspirin cross-linked hemoglobin administration and at multiple time points up to 72 hrs. MAP was maintained at approximately preinfusion values and the reduction in norepinephrine requirements was used as the main end point to assess the efficacy of diaspirin cross-linked hemoglobin as a vasopressor. Diaspirin cross-linked hemoglobin demonstrated a marked vasopressor action, allowing norepinephrine requirements to be reduced from 0.29 +/- 0.15 (SD) microgram/kg/min to 0.15 +/- 0.14 and 0.07 +/- 0.10 microgram/kg/min after the first (at 1.5 hrs, p < .001) and last (at 7.5 hrs, p < .0001) boluses, respectively. These reductions in norepinephrine requirements were maintained at 24, 48, and 72 hrs (p < .01 at all time points). These hemodynamic changes began within 5 mins of starting the diaspirin cross-linked hemoglobin infusion. MAP, heart rate, central venous pressure, pulmonary artery occlusion pressure, mean pulmonary arterial pressure (MPAP), systemic vascular resistance index, and urine output did not demonstrate any significant changes from preinfusion values. Pulmonary vascular resistance index increased at 7.5 hrs despite nonsignificant increases in MPAP. Cardiac index and oxygen delivery index decreased significantly at 7.5 hrs and 24 hrs. Total plasma bilirubin increased significantly from baseline at 24 and 48 hrs, before returning to baseline values within 5 days. Platelet count was significantly reduced at 6 and 24 hrs. No other biochemical or hematologic analyses were altered significantly post diaspirin cross-linked hemoglobin. CONCLUSIONS: This preliminary study demonstrated that diaspirin cross-linked hemoglobin is a potent vasopressor agent in critically ill patients with septicemic shock or systemic inflammatory response syndrome. This vasopressor characteristic of diaspirin cross-linked hemoglobin may have future clinical applications.

Adult↗
PubMed1997

MDMA induced hyperthermia: a survivor with an initial body temperature of 42.9 degrees C.

A young male survived hyperpyrexia (42.9 degrees C) following MDMA ("Ecstasy") ingestion. He developed convulsions, rhabdomyolysis, metabolic acidosis, and respiratory failure. This was successfully managed by assisted ventilation, aggressive fluid therapy, and the early administration of dantrolene, in addition to cooling measures. This is the first report of a survivor with such a severe hyperpyrexia.

Adult↗
PubMed1997

Lack of agreement between bioimpedance and continuous thermodilution measurement of cardiac output in intensive care unit patients.

BACKGROUND: Bolus thermodilution is the standard bedside method of cardiac output measurement in the intensive care unit (ICU). The Baxter Vigilance monitor uses a modified thermodilution pulmonary artery catheter with a thermal filament to give a continuous read-out of cardiac output. This has been shown to correlate very well with both the 'gold standard' dye dilution method and the bolus thermodilution method. Bioimpedance cardiography using the Bomed NCCOM 3 offers a noninvasive means of continuous cardiac output measurement and has been shown to correlate with the bolus thermodilution method. We investigated the agreement between the continuous bioimpedance and continuous thermodilution methods, enabling acquisition of a large number of simultaneous measurements. RESULTS: A total of 2390 paired data points from seven patients were collected. There was no correlation (r2 = 0.01) between the methods. The precision (1.16 l/min/m2) of agreement between the Vigilance and the Bomed, assessed by the Bland-Altam method, was very poor although the bias (-0.16 l/min/m2) appeared fair. CONCLUSIONS: The Bomed NCCOM 3 bioimpedance monitor shows poor agreement with the Baxter Vigilance continuous thermodilution monitor in a group of general ICU patients and cannot be recommended for cardiac output monitoring in this situation.

Journal Article↗
PubMed1996

Local anaesthesia to the airway reduces sedation requirements in patients undergoing artificial ventilation.

Patients in the intensive care unit require large doses of sedative/analgesic drugs to tolerate the presence of a tracheal tube and other unpleasant stimuli. The ideal regimen for sedatives and analgesics has not yet been found. We have investigated the effects of topical local anaesthesia to the pharynx and airway on sedative/analgesic requirements in 30 ICU patients (25-75 yr old) with no obvious brain injury, undergoing mechanical ventilation. Oral tracheal tubes were changed to a modified tube which allowed instillation of local anaesthetic solutions onto the pharyngeal, laryngeal and tracheal mucosa. Lignocaine 1% (5 ml) or 5 ml of 0.9% saline were instilled hourly for 12 h each for a total of 24 h, in a double-blind, randomized crossover design. Baseline sedation was maintained with propofol or alfentanil infusions, or both, which were titrated to patient comfort and to maintain an optimum sedation score throughout. Twenty-five patients completed the study. Mean total propofol and alfentanil requirements were 766 (SD 524) mg and 17 (7.6) mg, respectively, during 12 h of lignocaine instillation, and 1321 (862) mg and 25 (11.4) mg, respectively, during 12 h of saline instillation. There was a significant reduction (P < 0.05) in the requirements for both agents during the period of lignocaine instillation.

Adult↗
PubMed1992

Humoral antibody response in Leishmania tropica infection.

A small epidemic of Leishmania tropica infection was detected in Rajasthan, India. Most cases were in the 21-25 years age group and were possibly related to outdoor activity. Nearly one third of the patients had more than five lesions, the maximum number of lesions being confined to the face, neck and extremities. As determined by ELISA, 90% cases had leishmania antibodies with an OD range of 0.8-1.1. The serum of 60% of patients was positive by CIEP against L. tropica promastigote soluble antigen. By immunofluorescence, 96% persons were positive when L. tropica promastigotes were used as the substrate. The prevalence of infection with L. tropica appears to be much higher than that reported earlier.

Adolescent↗
PubMed1987

Use of tuning fork in diagnostic auscultation of fractures.

This study was conducted on 50 patients in the Central Institute of Orthopaedics, Safdarjung Hospital, New Delhi, from June to October 1985. With the help of a child's stethoscope and a tuning fork of 128 Hz, the sound conducted by an injured limb was compared with that by the uninjured limb. The presence of a fracture reduced or abolished the conduction of sound by a bone. This method allows a quick examination without causing any pain, which is an advantage in an uncooperative patient. It is also reliable in the unconscious. The test is so simple that paramedical staff can use it. The results were correct in 94 per cent of patients and were confirmed by radiological examination whereas clinical diagnosis was correct in only 88 per cent of cases.

Auscultation↗
PubMedDate not supplied

Modified haemoglobins as oxygen-transporting blood substitutes.

Haemoglobin solutions have been developed as red cell substitutes from various sources, e.g. outdated human blood, and bovine and recombinant haemoglobins. Haemoglobins have been modified to reduce their high oxygen affinity, oncotic activity and to prolong their intravascular half-life. Aside from oxygen carriage, modified haemoglobin solutions have other interesting properties, including vasopressor effects and improvements in regional blood flow.

Animals↗