Systolic blood pressure measurements are unreliable for the management of acute spontaneous intracerebral hemorrhage.

PURPOSE: Whether systolic blood pressure (SBP) is reliable in acute spontaneous intracerebral (sICH) by assessing agreement between simultaneous BP measurements obtained from cuff non-invasive blood pressure (NIBP) and radial arterial invasive blood pressure (AIBP) devices. MATERIAL AND METHODS: Among 766 prospectively screened sICH subjects, 303 (39.5%) had NIBP and AIBP measurements. During the first 24 h, 2157 simultaneous paired measurement readings were abstracted. Paired NIBP/AIBP measurements were included in a Bland-Altman technique with 95% agreement limits and coefficients from regression analysis derived from a bootstrap procedure. RESULTS: Variance for SBP was 66.1 mmHg, which was larger than the 44.3 mg Hg for diastolic blood pressure (DBP) or the 46.1 mmHg for mean arterial pressure (MAP). Pairwise comparison of mean biases showed a significant difference between SBP when compared to DBP (p < 0.0001) or MAP (p < 0.0001). The mean bias between DBP and MAP was not different (p = 0.68). Regression-based Bland Altman analysis found significant bias (slope -0.16, 95% CI -0.23, -0.09, p < 0.05) over the range of mean SBP. Bias over the range of mean DBP or MAP was not significant. CONCLUSIONS: We concluded that SBP is an unreliable blood pressure measurement in patients with sICH.

Neutrophils to lymphocyte ratio as a screening tool for swine influenza.

BACKGROUND & OBJECTIVES: During an outbreak of influenza like illness throat swab culture and virus isolation are done to identify causal virus, and it may cause a significant delay in diagnosis and isolation. There is a need to determine a sensitive laboratory parameter which could play a major role in identifying H1N1 infection among patients presenting with influenza like symptoms. We undertook this study to determine a laboratory parameter to identify swine influenza infection amoung patients presenting with influenza like symptoms while awaiting throat swab culture and virus isolation reports. METHODS: This retrospective study was conducted on patients presenting to A.P TB and Chest Hospital, Hyderabad, with swine influenza symptoms during September-October 2009. They were divided into swine flu positive (SW+) and swine flu negative (SW-) groups, based on their throat swab culture reports and laboratory data. Neutrophils to lymphocyte (N/L) ratio was calculated for every patient and also mean N/L ratio for two groups. Mean WBC count was also noted for both groups. RESULTS: There were 55 patients in each group. The WBC count in SW+ group varied from 3000 to 10600 cells/mm 3 (mean 5714), while in SW- group it varied from 4500 to 14300 cells/mm 3 (10252). The N/L ratio was less than two for 92.7 per cent of patients in SW+ group and for 3.63 per cent patients in SW- group. N/L ratio < 2 as an indicator for swine flu had a sensitivity of 92.7 per cent and specificity of 96.36 per cent. It has a positive predictive value of 96.22 per cent and a negative predictive value of 92.8 per cent. INTERPRETATION & CONCLUSIONS: N/L < 2 along with a decrease in WBC count can be used as a screening tool in patients presenting with influenza like symptoms, while awaiting throat swab culture reports for confirmation.