Lactate Monitoring in Intensive Care: A Comprehensive Review of Its Utility and Interpretation.

Lactate monitoring is critical in managing critically ill patients in intensive care settings. Elevated lactate levels often signify underlying metabolic disturbances such as tissue hypoxia, anaerobic metabolism, or impaired lactate clearance, which are prevalent in conditions like sepsis, shock, and trauma. Understanding the physiological basis of lactate production and its significance in clinical practice is essential for interpreting its diagnostic and prognostic value. This comprehensive review aims to explore the utility of lactate monitoring across various critical care scenarios. It provides an overview of lactate's metabolic pathways, methods of measurement, and the clinical implications of interpreting lactate levels in different contexts. Additionally, the review discusses current evidence on lactate-guided therapeutic interventions and highlights challenges and limitations to their application. By synthesizing the existing literature and clinical insights, this review aims to enhance the understanding of the role of lactate monitoring in assessing disease severity, guiding treatment strategies, and predicting outcomes in critically ill patients. Ultimately, this review underscores the importance of integrating lactate monitoring into routine clinical practice to optimize patient care and improve clinical outcomes in intensive care settings.

A Comparative Study Between Intravenous Esmolol and Oral Clonidine in Attenuating Hyperdynamic Cardiovascular Response to Laryngoscopy and Endotracheal Intubation.

Background In today's era of anesthesia, balanced anesthesia is the main basis of patient care and pain management. Of all the medications given during general anesthesia, premedication, induction agents, and muscle relaxants play a major role in keeping the hemodynamics properly under control. When laryngoscopy is performed to intubate, a pain stimulus will be generated, leading to a rise in blood pressure and heart rate. This stimulus can be avoided without any complications if appropriate premedication is given to the patient at the appropriate dosage. In this research, we compare the influence of injection esmolol and oral clonidine during the time of induction as premedications to suppress the hemodynamic response. Material and methods In a prospective randomized controlled trial, 90 patients were divided into three groups: Group E (esmolol) received 2 mg/kg IV esmolol diluted in 0.9% NS two minutes pre-anesthesia; Group C (clonidine) received oral clonidine 4 mcg/kg 90 minutes pre-anesthesia; and Group P (placebo) received IV normal saline and oral water. Blood pressure, heart rate, and mean arterial pressure were measured at baseline and seven subsequent time points. Results The study compared systolic blood pressure (SBP), mean arterial pressure (MAP), and diastolic blood pressure (DBP) changes over seven minutes in three groups, clonidine (Group C), placebo (Group P), and esmolol (Group E). At one minute, Group E showed a consistent MAP decrease from 95.21 mmHg to 85.92 mmHg, while Group C and Group P exhibited fluctuating trends. DBP decreased across all groups, with Group P ending highest (77.7 mmHg) and Group C lowest (66.8 mmHg). Group E's SBP decreased steadily from 126.2 mmHg to 118.0 mmHg, Group C decreased from 128 mmHg to 116.1 mmHg, and Group P showed more erratic fluctuations in SBP, DBP, and MAP. Conclusion These findings suggest that intravenous esmolol shows a good hemodynamic response having superior control over heart rate and getting the pressure under control quickly without major drop compared with the clonidine and placebo groups.

Morel-Lavallee Lesion Associated With Rhabdomyolysis in Polytrauma.

We describe the case of a 30-year-old man who allegedly had a history of road traffic accidents. While walking on the road, he was hit by a truck. He presented with complaints of facial injuries and being unable to move his right lower limb. On examination, there is a 15x4 cm lacerated wound in the perineal area, with left testes exposed; anal tone could not be assessed; the right lower limb is externally rotated; and deformity is present with palpable peripheral pulses. He was diagnosed with a right sacral ala fracture, a distal one-third shaft of the right tibia fracture, and a right suprapubic rami fracture. Ultrasound of the right thigh showed hematoma and subcutaneous edema all around the gluteal and inguinal regions and fluid collection in the right inguinal region, which is suggestive of Morel-Lavallee lesion (MLL) type 6. On day two of admission, urine was dark in color, and creatinine kinase was elevated, which is suggestive of rhabdomyolysis. He was managed with hydration, electrolyte correction for rhabdomyolysis, and wound debridement for MLL apart from perineal injury, right sacral ala fracture, right suprapubic rami fracture, and distal one-third shaft of the right tibia fracture, with perineal repair and loop colostomy, pelvic binder, and external fixator, respectively. Early identification of the MLL associated with rhabdomyolysis in this polytrauma patient led to recovery and a successful outcome.

A Cross-Sectional Study on Bedside Abdominal Ultrasound Findings as a Diagnostic and Prognostic Tool in Dengue Fever in Manipal Hospital, Bengaluru, India.

Background Dengue fever poses a significant health burden globally, particularly in tropical and subtropical regions. Early diagnosis and effective management are crucial in reducing morbidity and mortality associated with the disease. Bedside abdominal ultrasound has emerged as a promising tool for assessing dengue patients, providing real-time imaging of abdominal organs, and aiding clinical decision-making. Materials and methods This cross-sectional study was conducted in 55 adult emergency departments of Manipal Hospital, Bengaluru, from March 2017 to March 2018. Adult patients presenting with signs and symptoms suggestive of dengue fever were included. Clinical data, laboratory investigations, and bedside abdominal ultrasound findings were systematically recorded and analyzed using appropriate statistical methods. Results Descriptive statistics revealed characteristic clinical measurements and symptom ratings observed in dengue fever patients. Frequency distributions highlighted common symptoms encountered, while statistical analyses demonstrated significant associations between ultrasonic parameters, disease severity, and outcomes. The study found notable correlations between ultrasonic findings and dengue severity levels, emphasizing the potential of bedside ultrasound as a diagnostic and prognostic tool. Conclusion Bedside abdominal ultrasound shows promise as a valuable adjunctive tool in assessing dengue fever patients. The significant associations between ultrasonic parameters and disease severity suggest its utility in risk stratification and guiding clinical management decisions. Incorporating bedside ultrasound into routine practice may improve patient care and outcomes in dengue fever management. Further research is warranted to validate these findings and explore additional bedside ultrasound applications in dengue fever diagnosis and prognosis.

Recent Advances in Immunomodulatory Therapy in Sepsis: A Comprehensive Review.

Sepsis remains a critical healthcare challenge, characterized by dysregulated immune responses to infection, leading to organ dysfunction and high mortality rates. Traditional treatment strategies often fail to address the underlying immune dysregulation, necessitating exploring novel therapeutic approaches. Immunomodulatory therapy holds promise in sepsis management by restoring immune balance and mitigating excessive inflammation. This comprehensive review examines the pathophysiology of sepsis, current challenges in treatment, and recent advancements in immunomodulatory agents, including biologics, immunotherapy, and cellular therapies. Clinical trial outcomes, safety profiles, and future research and clinical practice implications are discussed. While immunomodulatory therapies show considerable potential in improving sepsis outcomes, their successful implementation requires further research, collaboration, and integration into standard clinical protocols.

Echocardiography as a Vital Tool in Assessing Shock: A Comprehensive Review.

Shock is a critical condition characterized by inadequate tissue perfusion, leading to cellular hypoxia and organ dysfunction. Early and accurate assessment is crucial for timely intervention and improved patient outcomes. Echocardiography has emerged as a vital tool in the assessment of shock, offering real-time visualization of cardiac anatomy, function, and hemodynamics. This comprehensive review aims to elucidate the role of echocardiography in shock assessment by providing an overview of its principles, techniques, and clinical applications. We discuss the importance of early diagnosis, identification of underlying pathology, monitoring response to therapy, and prognostic value offered by echocardiography in managing shock. Furthermore, we explore its utility in different types of shock, including hypovolemic, cardiogenic, distributive, and obstructive shock. Challenges and limitations of echocardiography, as well as future directions and innovations, are also discussed. Through a synthesis of current evidence and clinical insights, this review underscores the significance of echocardiography in optimizing shock management and highlights areas for further research and development.

Prediction of muscular paralysis disease based on hybrid feature extraction with machine learning technique for COVID-19 and post-COVID-19 patients.

Many Coronavirus disease 2019 (COVID-19) and post-COVID-19 patients experience muscle fatigues. Early detection of muscle fatigue and muscular paralysis helps in the diagnosis, prediction, and prevention of COVID-19 and post-COVID-19 patients. Nowadays, the biomedical and clinical domains widely used the electromyography (EMG) signal due to its ability to differentiate various neuromuscular diseases. In general, nerves or muscles and the spinal cord influence numerous neuromuscular disorders. The clinical examination plays a major role in early finding and diagnosis of these diseases; this research study focused on the prediction of muscular paralysis using EMG signals. Machine learning-based diagnosis of the diseases has been widely used due to its efficiency and the hybrid feature extraction (FE) methods with deep learning classifier are used for the muscular paralysis disease prediction. The discrete wavelet transform (DWT) method is applied to decompose the EMG signal and reduce feature degradation. The proposed hybrid FE method consists of Yule-Walker, Burg's method, Renyi entropy, mean absolute value, min-max voltage FE, and other 17 conventional features for prediction of muscular paralysis disease. The hybrid FE method has the advantage of extract the relevant features from the signals and the Relief-F feature selection (FS) method is applied to select the optimal relevant feature for the deep learning classifier. The University of California, Irvine (UCI), EMG-Lower Limb Dataset is used to determine the performance of the proposed classifier. The evaluation shows that the proposed hybrid FE method achieved 88% of precision, while the existing neural network (NN) achieved 65% of precision and the support vector machine (SVM) achieved 35% of precision on whole EMG signal.

Methanol extraction revealed anticancer compounds Quinic Acid, 2(5H)­Furanone and Phytol in Andrographis paniculata.

Andrographis paniculata (Ap) has been a part of traditional medicine for its anti-inflammatory effects, treatment of snake bites and liver abnormalities. Several investigations have revealed its bioactive components to be andrographolides. The methanolic extracts of leaves from Ap were characterized, the non-andrographolides were identified and screened for anti-proliferative activity. The extracts showed significant toxicity against numerous cancer cells including HeLa, MCF7, BT549, 293 and A549 cells. Anti-proliferative activity and effect on cancer cell invasion (metastatic potential) and cell migration were examined. The extracts revealed significant inhibition of the ability of HeLa cells in repairing the gap created by a vertical wound made on a confluent cell monolayer. Similarly, a 40% reduction in cell migration was observed in presence of the extracts. Significant anti-angiogenic activity in terms of reduced blood capillary formation was observed on the Chorioallantoic membranes of embryonated hen eggs co-inoculated with HeLa cells and the extracts. Analysis of HeLa cells treated with the extracts using flow cytometry indicated the arrest of cell cycle progression at the G2/M phase. Variation in the Bax/Bcl-2 ratio and elevated caspase-3 levels by immunoblotting confirmed cell death induction via the apoptotic pathway. Investigation of the extracts by gas chromatography-mass spectrometry displayed the predominant components to be 2(5H)-Furanone (14.73%), Quinic acid (17.32%), and Phytol (11.43%). These components have been previously known to have anticancer activity, while being studied individually in other plants. This is the first study, to the best of our knowledge, on the anti-proliferative and anti-angiogenic activity of the non-andrographolide components from Ap.

DiaTreat: a new method of communication for better diagnosis and treatment of dental problems.

AIM: The aim of this article is to present a simple method of communication between two oral health professionals so that the problem can be conveyed easily and treatment options obtained equally easily and quickly, using current electronic communication technologies. BACKGROUND: Treatment of dental problems involves a thorough understanding of the underlying dental and medical conditions. The arena of dentistry being ever changing, with new specialties arising each year, it has become virtually impossible for an average dentist to keep track of all the treatment modalities available for various problems at a given time. It is the duty of a dentist, however, to treat his patients to the best of his ability. Professional ethics bind the other health professionals to render their opinion to the dentist so that the patient will ultimately get the best possible treatment. Method of communication is the only problem remaining in the path to achieving a total oral health care. TECHNIQUE: DiaTreat is a unique method of clinical charting by which a dentist can incorporate all the ailments affecting his patient, and by withholding the patients name and address, can communicate with any of his colleagues for their opinion on the best treatment option for his patient. CONCLUSION: It is a new and innovative method of communication between a dentist and specialist. Even though it has some shortcomings of its own, on a wider range, the advantages far outweigh the drawbacks of the system. CLINICAL AND ACADEMIC SIGNIFICANCE: This can also be used by educational institutes for easy communication during interdisciplinary exchanges. Improvements need to be made yet to incorporate all the ailments known in dental discipline and make communication a comprehensive one.

Effect of pretreatment with a tyrosine kinase inhibitor (PP1) on brain oedema and neurological function in an automated cortical cryoinjury model in mice.

Cerebral oedema is a significant cause of morbidity in neurosurgical practice. To our knowledge, there is no ideal drug for prevention or treatment of brain oedema. Based on the current understanding of the pathogenesis of brain oedema, tyrosine kinase inhibitors could have a role in reducing brain oedema but preclinical studies are needed to assess their effectiveness. We evaluated the role of pretreatment with 4-amino-5-(4-methylphenyl)-7-(t-butyl)pyrazolo(3,4-d)pyrimidine (PP1), an Src tyrosine kinase inhibitor, in reducing cerebral oedema and preserving neurological function measured 24hours after an automated cortical cryoinjury in mice. Sixteen adult male Swiss albino mice were subjected to an automated cortical cryoinjury using a dry ice-acetone mixture. The experimental group (n=8) received an intraperitoneal injection of PP1 dissolved in dimethyl sulfoxide (DMSO) at a dose of 1.5mg/kg body weight 45minutes prior to the injury. The control group (n=8) received an intraperitoneal injection of DMSO alone. A further eight mice underwent sham injury. The animals were evaluated using the neurological severity score (NSS) at 24hours post-injury, after which the animals were sacrificed and their brains removed, weighed, dehydrated for 48hours and weighed again. The percentage of brain water content was calculated as: {[(wet weight - dry weight)/wet weight] × 100}. The mean (standard deviation, SD) NSS was 11.7 (1.8) in the experimental group and 10.5 (1.3) in the control group (p=0.15). The mean (SD) percentage water content of the brain was 78.6% (1.3%) in the experimental group and 77.2% (1.1%) in the control group (p=0.03). The percentage water content in the experimental and control groups were both significantly higher than in the sham injury group. The immediate pre-injury administration of PP1 neither reduced cerebral oedema (water content %) nor preserved neurological function (NSS) when compared to a control group in this model of cortical cryoinjury.

A study to evaluate and compare the shear bond strength of resilient liners with heat cure denture base resins, with and without the effect of saliva: an in vitro study.

AIM: To evaluate and compare the shear bond strength of resilient liners with heat cure denture base resins in the presence or absence of saliva. MATERIALS AND METHODS: Two commercially available heat polymerized acrylics and three commercially available denture liners were immersed in artificial saliva for 7 days and 14 days, respectively. A total of 180 (Acralyn-H, No.90 and Lucitone - 199, No.90) specimens were prepared. Total of 90 overlapping joint specimens were prepared, 45 of them using Acralyn H (AGroup) and rest 45 using Lucitone-199 (L-Group). The specimens were tested for flexural strength with a 3-point bending test on an Instron universal testing machine. The results were analyzed with a one-way analysis of variance (ANOVA). RESULTS: The mean difference in shear bond strength (SBS) at different time intervals was found to be statistically significant (p < 0.001). Lucitone-199 recorded a significantly higher mean SBS compared to Acralyn H (p < 0.001). Further, significant differences between GC and Densply, GC and Aswin liners, and between Dentsply and Aswin were noted (p < 0.001). Difference between baseline and 7 days time interval, as well as, between baseline and 14 days time interval with respect to the mean SBS of these materials were significant (p < 0.001). Also, the mean difference in SBS between 7 days time interval and 14 days time interval was statistically significant (p < 0.001). Among the three different liners, GC yielded a higher mean SBS compared to Aswin and Dentsply at all the three time intervals. The mean SBS recorded in Dentsply and Aswin was almost same at 14 days time interval, but at baseline and 7 days, it was higher in Aswin compared to Dentsply. CONCLUSION: Lucitone-199 recorded a higher mean SBS compared to Acralyn H. As the time interval increases, the mean SBS recorded in both the denture base materials decrease. Among the three different liners, GC yields a higher mean SBS compared to Aswin and Dentsply at all the three time intervals. CLINICAL SIGNIFICANCE: The most common reason for failures of resilient linings in removable dentures is the separation of these linings from the denture base. Therefore, poor adhesive bond properties are one of the serious defects of the material in clinical practice.

A starter's guide to preclinical teeth arrangement: simplified clinometer.

UNLABELLED: Arrangement of artificial teeth in a bilaterally symmetrical fashion with proper inclinations of teeth had been a challenging task for beginners. A variety of tools and guiding equipment have been developed to help students to learn teeth arrangement. Unfortunately, those tools were either costly or unsuitable for use with mean value articulators. This article attempts to introduce a simplified clinometer which can be attached to mean value articulator and can be used as a guide to arrange teeth in a bilaterally symmetrical manner by the undergraduates in both clinical and preclinical set-up. CLINICAL SIGNIFICANCE: Training of the future dentists in sound esthetic principles in a preclinical environment, using this device, will increase the final clinical efficacy of their work. AIM: The aim of this article is to provide a simple but effective device to undergraduate students to help them learn teeth arrangement easily and systematically.

Cephalometric evaluation-based on Steiner's analysis on young adults of Chhattisgarh, India.

AIM: The study was conducted to establish skeletal and dental parameters for Chhattisgarhi young adults, evaluation of variability between male and female Chhattisgarhi normal occlusion subjects and comparison of Cephalometric norms of Chhattisgarh population with Caucasians as well as other non- Caucasian groups. MATERIALS AND METHODS: A Cephalometric study of 80 Chhattisgarhi young adults (40 males and 40 females) with acceptable profile and occlusion was carried out by means of Steiner's analysis. RESULTS: In comparison to the Caucasian samples, the Chhattisgarhi samples were more protrusive skeletally and dentally and exhibited a more horizontal growth pattern than the Caucasians. The females reported with an increased incisor procumbency, prominent chin and prognathic maxilla than their male counterparts. CONCLUSION: The results of the study support the fact that a case of malocclusion cannot be treated to a template of norms which have been derived from mean values of a certain select group of subjects with excellent occlusion and harmonious facial proportions. CLINICAL SIGNIFICANCE: A case of malocclusion needs to be treated based on the individual merits and demerits of that case and not based on template of norms derived from mean values of select subject groups with ideal occlusion and proportion.

Pharmacophoric 2-hydroxyalkyl benzenesulfonamide: a single-step synthesis from benzenesulfonamide via hemiaminal.

ortho-Acylation attempt of benzenesulfonamide afforded the corresponding hemiaminal as major product. The in situ reduction of the reaction mixture, reported herein, directly provided 2-hydroxyalkyl benzenesulfonamide, an important pharmacophoric element for designing drug-like scaffolds. Its application is demonstrated through designing a novel series of 1,5-diarylpyrazoles for cyclooxygenase-2 (COX-2) inhibition.

Rapid opening and closing of the hand as a measure of early neurologic recovery in the upper extremity after surgery for cervical spondylotic myelopathy.

OBJECTIVE: To compare the results of a simple bedside test with the Jebsen-Taylor hand function test, in the assessment of early improvement of neurologic function after surgery for cervical spondylotic myelopathy (CSM). DESIGN: Case series comparing the bedside test with the Jebsen-Taylor test of hand function as the criterion standard in a blinded comparison. SETTING: Referral center, institutional practice, hospitalized care. PARTICIPANTS: One hundred referent subjects and 26 consecutive patients undergoing surgery for CSM. INTERVENTION: Decompressive cervical spine surgery. Main outcome measures Complete, rapid opening and closing of the hand was timed for 20, 40, and 60 repetitions, the Rapid Hand Flick Time (RHFT), preoperatively and in the first week postoperatively. The results of this test were correlated with the Jebsen-Taylor test. RESULTS: There was a 40% to 50% prolongation in the RHFT compared with age-matched referent subjects. Postoperatively, there was a 3.84-second mean improvement in the RHFT for 20 repetitions in the right hand and 2.8 seconds in the left hand. A paired-samples t test, comparing the preoperative and postoperative day 1 and day 7 timings, showed a statistically significant improvement (P<.001). There was no significant change from postoperative day 1 to day 7. In the Jebsen-Taylor test, patients showed a significant postoperative improvement (P<.01) in the writing test, in simulated feeding, and in transfer of small objects in both hands. Pearson correlation coefficient testing for correlation between the RHFT and the Jebsen-Taylor subtests were low, which indicates that, although they both record an improvement after surgery, they probably do not test the same aspects of hand function. CONCLUSIONS: The RHFT is a simple and reliable method of assessing early improvement in hand function and spasticity in patients after surgery for CSM.

Necrotising infections of soft tissues--a clinical profile.

OBJECTIVE: To study the clinical profile and outcome of patients with necrotising soft-tissue infections. DESIGN: Prospective study. SETTING: Teaching hospital, India. SUBJECTS: 75 patients (54 male and 21 female), mean age 40 years (range 8 months-85 years). INTERVENTIONS: Patients were uniformly managed by initial resuscitation, debridement, topical wound care, systemic antibiotics, and enteral hyperalimentation. MAIN OUTCOME MEASURES: Morbidity and mortality. RESULTS: Aetiology of the infections included major and minor trauma, minor skin infections and postoperative infections. 22 patients were diabetic. The extremities were involved in 57 patients, the trunk in 26 and the perineum in 21. 68 presented with local tenderness (91%), 74 with oedema (99%), 54 with erythema (72%), 55 with ulceration (73%), and 54 with a purulent or serous discharge (72%). beta-haemolytic streptococci were isolated from only 10 patients. Staphylococcus aureus was the most common bacteria isolated (n = 30, 46%) followed by Bacteroides fragilis and anaerobic cocci (n = 22, 34% each). Cultures grew fungi in 9 patients. 20 patients died giving a mortality of 27%. Jaundice and serum albumin were the only factors to have a significant influence on mortality. CONCLUSIONS: Necrotising soft tissue infections are potentially fatal. Early recognition and prompt aggressive debridement are the keys to successful management.

INTRAMOLECULAR AND INTERMOLECULAR HYDROXYL REACTIVITY DIFFERENCES IN GINKGOLIDES A, B AND C AND THEIR CHEMICAL APPLICATIONS.

An investigation of the chemistry of ginkgolides A, B and C (1) has revealed an unusual interaction between the hydroxyl groups at C(1) and C(10) which activates their deprotonation to give 2 and provides a method for the interconversion of 1C and 1B. The ginkgolide 7-enol system 7 is more stable than the corresponding 7-keto form 6, which is easily made by selective Jones oxidation of ginkgolide C.