A systematic review of the use of aromatherapy in treatment of behavioral problems in dementia

We aimed to fill the literature gap by identifying the clinical benefits of aromatherapy in older adults with dementia, and its efficacy in reducing behavioral and psychological symptoms of dementia (BPSD) based on available randomized controlled trials (RCT). A systematic review of 11 clinical trials shortlisted from electronic databases from 1995 to 2011 was carried out. The RCT showed that aromatherapy had positive effects on reduction of BPSD, improvement in cognitive functions, increasing quality of life, enhancing independence of activities of daily living and so on. However, adverse effects were noted in some studies. Limitations on methodology are discussed and suggestions on directions of further studies are made. It is recommended that aromatherapy shows the potential to be applied as a therapeutic and safe complementary and alternative therapy for the management of BPSD on more evidence collected from better designed RCT. Geriatr Gerontol Int 2012; 12: 372–382.     

A one-step Du test in microplates

A one-step Du test, developed for use in automated microplate systems, uses anti-D with 0.6 percent dextran to potentiate the reaction. Because the washing and reagent-adding steps of the antiglobulin test are not required, the Du test can be performed in the same microplate as the ABO/Rh test. A set of reactions prepared with this technique was visually interpreted and also classified by an automated microplate ABO/Rh system. Visual interpretation of reactions resulted in a sensitivity and specificity close to those of the antiglobulin test, although the sensitivity of the test was reagent-dependent. When the automated microplate blood grouping system was used, the test was not as sensitive or as specific as the antiglobulin test, although it may be sufficient for many applications.     

Donor-specific transfusions. Donor-recipient HLA compatibility, recipient HLA haplotype, and antibody production

HLA profiles of 25 donor-specific transfusion (DST) kidney donor-recipient pairs were analyzed for HLA antigen compatibility. Serum samples collected during and after DST were tested for cytotoxic antibodies against T and B lymphocytes of the donors and 30 normal individuals. Eleven recipients did not produce cytotoxic antibodies to the antigens of their DST donors, and eight produced cold and/or warm, broadly reactive B-cell antibodies. Six patients (24%) produced HLA-A, B, C, and/or DR antibodies. Three of these individuals produced antibodies after two immunizations, while others required three immunizations. Three of the 11 antibody nonproducers (17%) had not received previous transfusions, as compared to three of the eight antibody producers (43%). Comparison of HLA profiles revealed 22 percent of the HLA-A, B, DR identities between the transfusion donor and recipient in antibody nonproducers as compared to 9 percent of the HLA-A, B, DR identities in antibody producers. The HLA-A2, B40, DR4 haplotype and HLA-DRW6 antigen were more common among antibody producers than among nonproducers, who had an excess of the HLA-B8, DR3 haplotype. These results are consistent with the hypothesis that there may be high- and low-responder HLA haplotypes that control immunologic responsiveness to histocompatibility antigens.     

Antibodies against double-stranded DNA and development of polymyositis during treatment with interferon

Alpha interferons have become effective palliative treatments for patients with neuroendocrine tumours such as carcinoids and endocrine pancreatic tumours. However, several reports indicate an increased incidence of both autoantibodies and autoimmune diseases in patients treated with interferon-alpha (IFN-alpha). We studied the development of antibodies against double-stranded DNA (dsDNA) and clinical signs of autoimmune disease in 214 patients with malignant carcinoids or endocrine pancreatic tumours consecutively admitted for treatment with IFN-alpha. Seventeen patients (8%) developed antibodies against dsDNA, predominantly females (12 females and 5 males). One patient had clinical and laboratory signs of polymyositis. Among the other 16 patients, three developed hypothyroidism and in six patients the anti- dsDNA autoantibodies normalized despite continuing therapy. Although a significant number of patients developed autoantibodies against dsDNA, overt autoimmune disease related to these antibodies is a rare event and many patients spontaneously normalize these titres despite continuing IFN-alpha treatment.      

Dialyzer-dependent changes in solute and water permeability with bleach reprocessing

The effects of bleach reprocessing on the performance of high-flux dialyzers have not been comprehensively characterized. We compared the effects of automated bleach/formaldehyde reprocessing on solute and hydraulic permeability for cellulose triacetate (CT190) and polysulfone (F80B) dialyzers using an in vitro model. Dialyzers were studied after initial blood exposure (R0) and after 1 (R1), 5 (R5), 10 (R10), and 15 (R15) reuse cycles. Ultrafiltration coefficient (K(uf)), serial clearances, and/or sieving coefficients (SCs) of urea, creatinine, vancomycin, inulin, myoglobin, and albumin were determined. Urea, creatinine, and vancomycin clearances and SCs did not significantly differ from R0 to R15 with either dialyzer. Inulin clearances and SC also did not significantly change from R0 to R15 for the CT190. However, these same values for the F80B significantly increased (P < 0.05). The inulin clearance and SC values for the CT190 dialyzer were significantly higher than those for the F80B at all stages except R15. Myoglobin clearances significantly increased over 15 reuses for both dialyzers (P < 0.01). However, CT190 myoglobin clearances were significantly higher at all stages (R0 = 37.7 +/- 9.7; R15 = 52.5 +/- 8.8 mL/min) than the F80B (R0 = negligible; R15 = 41.3 +/- 16.5 mL/min; P < 0.01). Albumin pre- and postdialysis SCs significantly increased for both dialyzers (P < 0.01). K(uf) for R0 and R15 were 52.3 +/- 3.3 and 52.6 +/- 7.6 mL/h/mm Hg for CT190 (P = not significant) and 48.8 +/- 4.4 and 87.3 +/- 7.0 mL/h/mm Hg for F80B (P < 0.0001). We conclude that bleach reprocessing significantly increases larger solute and hydraulic permeability of high-flux cellulosic and polysulfone dialyzers. This effect is more pronounced for the polysulfone membrane. Until 10 reuses or greater, the removal of solutes greater than 1,500 d is significantly compromised with the polysulfone dialyzer used in this study.     

ICU-acquired Candidemia in COVID-19 Patients: An Experience from a Tertiary Care Hospital in Kerala,South India

How to cite this article: Niyas VKM, Rahulan SD, Arjun R, Sasidharan A. ICU-acquired Candidemia in COVID-19 Patients: An Experience from a Tertiary Care Hospital in Kerala, South India. Indian J Crit Care Med 2021;25(10):1207–1208.

We read with interest the article by Rajni et al. analyzing the prevalence and etiology of bloodstream infections in coronavirus disease-2019 (COVID-19) patients.¹ The authors concluded that the incidence of bloodstream infections was low in COVID-19 patients. Particularly interesting was the fact that only one case of candidemia occurred in 1,578 patients, a significantly lower rate compared to the incidence of candidemia in other studies.^2–4 We believe that data would have been more informative if the incidence of infections was expressed per patient days.We retrospectively analyzed the data of intensive care unit (ICU)-acquired blood stream infections (BSI), including candidemia in patients admitted to COVID-19 ICU in our hospital (KIMSHEALTH, Thiruvananthapuram, Kerala, South India). ICU-acquired BSI was defined as pathogen isolation from ≥1 blood specimen obtained at more than 48 hours after ICU admission. In patients with ≥2 BSIs, only the first one was included, unless the subsequent episode was fungal. Clinical and laboratory characteristics of patients who developed ICU-acquired candidemia were particularly analyzed.During the time period between July 5, 2020 and February 28, 2021, 209 patients were admitted to our ICU dedicated for COVID-19 patients, accounting for 1,283 patient days. BSI was diagnosed in 22 patients (10.52 %), accounting for 17.14 BSI in 1,000 patient days. The organisms isolated were Burkholderia cepacia (four patients), Candida spp. (four patients), Klebsiella pneumoniae (three patients), Acinetobacter baumannii (three patients), Enterococcus faecalis (two patients), Enterobacter cloacae (two patients), Pseudomonas aeruginosa (one patient), methicillin-sensitive Staphylococcus aureus (one patient), and Achromobacter spp. (one patient) and Escherichia coli (one patient). We specifically analyzed the data of ICU-acquired candidemia in COVID-19 patients.Candidemia accounted for 18.18% of the total BSI, affecting 1.91% of the admitted patients. The incidence of candidemia was 3.9 per 1,000 patient days. The distribution of Candida species was as follows: Candida parapsilosis (two patients), C. auris (one patient), and C. albicans (one patient). The clinical details of the patients are summarized in