Who takes care of intensive care? Changes over the last two decades.

OBJECTIVE: Intensive care units are very important across various fields of medicine, and there are many high-quality journals that publish about intensive care. However, there is a lack of information regarding which disciplines publish the most in these journals. We aim to evaluate the intensive care literature. MATERIALS AND METHODS: We searched the papers published in the American Journal of Respiratory and Critical Care Medicine, Intensive Care Medicine, Critical Care Medicine and Critical Care to gain information regarding authors' specializations. We collected specialization data from PubMed, Google Scholar, and also from various journal websites. We examined the changes in the proportion of disciplines that are actively contributing to intensive care literature. RESULTS: Regardless of the year and the journal, intensivists were the most common writers (1,047/4,807, 21.8%) overall. This was followed by pulmonology (843, 17.5%), anesthesia (827, 17.2%), others (602, 12.5%), and pediatrics (374, 7.8%). The United States of America (1,470/30.8%), France (573/11.2%), and Germany (332/6.9%) were at the top of the list in terms of productivity. CONCLUSIONS: With the increase in the number of intensive care units and the development of an understanding of intensive care, we observed that intensivists are publishing more in intensive care literature.

Treatment of chronic delta hepatitis with lamivudine vs lamivudine + interferon vs interferon.

Chronic delta hepatitis is the most severe form of chronic viral hepatitis for which interferon (IFN) is the only available treatment. In 39 patients (25 were treatment-naïve, 14 had previously used IFN), efficacy of 1-year treatment with IFN (9 MU, t.i.w.) or lamivudine (LAM; 100 mg, q.d.) alone was compared with IFN and LAM combination (2 months of LAM to be followed by combination treatment). IFN monotherapy was given only to treatment-naïve patients. In both treatment-naïve and previous IFN users, end of treatment virological and biochemical responses were similar with IFN-LAM combination and superior to LAM monotherapy (P < 0.05). Improvement in liver histology occurred more often with IFN +/- LAM than with LAM alone (P < 0.05). In treatment-naïve patients, combination treatment was not superior to IFN monotherapy. After treatment discontinuation, virological and biochemical response rates decreased in LAM and IFN combination and IFN monotherapy. On treatment virological response at month 6 of treatment predicted sustained virological response. The results of this study suggest that addition of LAM to IFN for the treatment of delta hepatitis is of no additional value and that both treatment modalities are superior to LAM monotherapy.

Direct atomic absorption spectrometry determination of tin, lead, cadmium and zinc in high-purity graphite with flame furnace atomizer.

This work described methodology of Sn, Pb, Cd and Zn impurities determination in high-purity graphite at direct atomic absorption spectrometry (AAS) with flame furnace (FF) atomizer. It was evidence that quality of AAS measurements are depended from sample amount, its homogeneity, particle size, as well as calibration procedure and operation parameters of FF atomizer. Prior to analysis the method has been developed and optimized with respect to the furnace heating temperature and flame composition of FF atomizer. Conditions of absorption peak areas (Q(A)) formation to each element were studied on the basis of contribution into its value some of individual parameters of analytes, including mass-transporting process from increasing mass of graphite samples into gas phase. Because particle size and homogeneous distribution of analyte in powdered materials has an enormous influence on accuracy and precision of measurement results, graphite as well as appropriate series of powdered reference standards was previously ground and investigated. Graphite samples to be analyzed and standard reference materials with mass from 0.025 to 0.200g was previously briquetted as pellet and insert on corresponding hole in furnace. The characteristic mass (g(0)) of Sn, Pb, Cd and Zn were 0.35, 0.1, 0.008 and 0.025ng, respectively, and relative standard deviation (S(r)) not more than 20%.

A pilot study of 2 years of interferon treatment in patients with chronic delta hepatitis.

High dose interferon treatment for 1 year is the only established treatment for chronic hepatitis D, but it is associated with a high relapse rate after treatment discontinuation. In this study, patients were treated with 10 MU interferon alpha 2b, thrice weekly for 2 years. Twenty-three patients were recruited and 15 completed the 2-year treatment and 6 months follow-up periods. Treatment response was assessed biochemically [normal alanine aminotransferase (ALT)], virologically (undetectable hepatitis D virus RNA) and histologically (at least 2 point decrease in the Knodell score) at the end of treatment (EOT) and at the end of follow-up. Out of 15 patients who finished the 2-year treatment period, seven patients (47%) had a biochemical response but only two (13%) had a normal ALT after follow-up. ALT decreased from the baseline value of 143.1 +/- 121.7 (mean +/- SD) to 39.7 +/- 20.6 (P < 0.01) at EOT. Virological response was observed in six patients at EOT and in two patients at follow-up. Two patients lost hepatitis B surface antigen. Of the 12 patients with paired liver biopsies, a histological improvement was observed in eight patients. Interferon treatment leads to a complete or partial response in a substantial number of patients but 2 years of treatment does not appear to increase sustained response rates over 1 year treatment.

Risk of heparin lock-related bleeding when using indwelling venous catheter in haemodialysis.

BACKGROUND: The indwelling venous catheter such as Dual-Cath or Twin-Cath is widely used in haemodialysis. Although the manufacturer recommends filling the catheter lumen with heparin after the dialysis session to prevent clotting, little is known about the systemic effects of such a procedure. METHODS: Twenty haemodialysis patients with Dual-Cath were studied. Dialysis anticoagulation was achieved by injecting a bolus of dalteparin. The patient/control ratio of activated partial thromboplastin time (aPTT) was determined at the end of the session immediately before and 10 min after locking with 2 ml of undiluted heparin (10,000 U/catheter). We also determined the catheter volume for each patient and measured aPTT immediately before and 10 min after heparin locking with this patient-specific volume. Catheter patency was followed over a 2-week period. RESULTS: The aPTT values determined at the end of two consecutive dialysis sessions were nearly normal, respectively 1.29 (+/-0.17) and 1.33 (+/-0.22), whereas all patients had uncoagulable blood (aPTT >3.75) 10 min after locking with 2 ml of heparin. When catheter volumes were individually calculated, they were found to be substantially lower than 2.0 ml (1.21+/-0.12 for the arterial branch and 1.27+/-0.13 for the venous branch). aPTT was only 2.42+/-0.73 10 min after locking with the estimated volumes except in one patient (aPTT >3.75). No catheter clotting was observed despite these smaller locking volumes. CONCLUSIONS: A risk of inducing serious bleeding does indeed exist with Dual-Cath heparin locking, especially in postoperative patients. This risk can be reduced by measuring catheter length at the time of placement in order to ensure an appropriate lock volume. Sodium citrate, polygeline, or urokinase are possible alternatives to heparin.