No abstract

How to cite this article : Parameswaran N. Vitamin D and Its Myriad Disease Associations: Can the Heart be Left Behind? Indian J Crit Care Med 2023;27(7):463–464.

Background: The pediatric index of mortality 3 (PIM 3) score is one of the main scores for predicting mortality risk in pediatric intensive care units (PICUs). However, it does not consider nutritional status in its calculation. The inclusion of the same may improve its performance in developing countries. Aims: We aimed to develop a modified PIM 3 score incorporating nutritional status in its calculation. We also aimed to assess the prognostic utility of the modified score and to compare the performance of the modified score with the existing PIM 3 score. Setting and Design: The modified score was developed based on retrospective data analysis from a PICU in a tertiary care hospital in South India. Testing the scores was accomplished through a prospective observational study in the same PICU. Subjects and Methods: All the parameters required to calculate the PIM 3 score and anthropometric parameters were collected. Then, multivariable logistic regression analysis was performed to obtain coefficients for each variable, and an equation for the modified score was framed. The performance of the modified score was prospectively tested in the PICU and compared with the existing PIM 3 score using standardized mortality ratio (SMR) and area under the receiver operator characteristics (ROC) curve. Results: A total of 191 patients were included in the retrospective cohort for developing the modified equation, and the same was tested in 82 patients of the prospective cohort. Out of the 82 patients in the prospective arm, 14 (17%) died in the PICU. Total mortality predicted for the modified and original scores was 15.28 and 9.27, SMR was 0.92 and 1.51 and area under the ROC curve was 0.68 (95% confidence intervals [CI]: 0.48–0.89) and 0.69 (95% CI: 0.49–0.88), respectively. Conclusions: While both scores have poor discrimination ability, the modified PIM 3 score has an SMR value closer to one, suggesting better reliability.

How to cite this article: Subramani S, Parameswaran N. Authors’ Reply on: FOCUS more on POCUS. Indian J Crit Care Med 2023;27(3):226–227.

This study was conducted to determine if application of transdermal 2% nitroglycerine ointment (TDNG) to dogs anesthetized with alpha chloralose would produce splenic dilatation by relaxation of venous smooth muscle. Sonomicrometer crystals were applied to the spleen in each of 15 dogs, and a pressure-measuring catheter was inserted into a splenic vein. The sonomicrometer crystals permitted measurement of splenic dimension, which is known to correlate with splenic volume. Ten dogs were given 2.5 cm TDNG/10 kg, and 5 dogs (vehicle controls) were given only petrolatum, both applied to the inner surface of the auricular pinna. Splenic dimension in all dogs receiving TDNG increased significantly (P .05) by 7.0 4.8%, whereas splenic dimension in dogs receiving petrolatum did not increase. Splenic venous pressures did not change significantly in either group. Spleens began to dilate 482 652 seconds after application of TDNG and achieved maximal dilatation at 861 632 seconds. Splenic dilatation occurred in the absence of elevation of splenic venous pressure, indicating that the dilatation probably resulted from relaxation of splenic smooth muscle. TDNG was absorbed transdermally and produced splenic dilatation in healthy dogs anesthetized with alpha chloralose. If the spleen is a sentinel for peripheral veins, then TDNG may increase venous capacity, retaining blood from the lungs and thereby functioning to reduce pulmonary congestion and edema in dogs with left-sided heart failure.