Reliability and accuracy of bedside capillary blood glucose measurement by glucometers compared to venous blood glucose in critically ill patients: A facility based cross-sectional study

BACKGROUND

The traditional reference standard, venous blood glucose requires venipuncture and laboratories usually return the test results after 60 min. Our aim was to determine the agreement accuracy of glucose (capillary) levels obtained by POC glucometers with glucose (venous) values by standard laboratory method (glucose-oxidase) and to assess whether and to what extent the glucometers perform uniformly well across the entire range of blood glucose values.

METHODS

We compared the diagnostic accuracy of two-point of care glucometers with laboratory venous glucose, the reference standard using Bland-Altman plots and Clark error grid method to analyse the results.

RESULTS

This study included a total of 110 patients (38[34 %] women; mean age 52.1 years (SD, 17.3); range 14-85 years. Fourteen patients (12 %) were known to have diabetes. The mean glucose value (glucometer 1) was 152.9 mg/dL (SD 83.1); range = 48-501 mg/dL; that by glucometer 2 was 152.2 mg/dL (SD 76.2); range = 30-458 mg/dL and by the laboratory was 148.6 mg/dL (SD 81.5); range = 52-480 mg/dL. Of the 110 subjects, 2(2 %) had blood glucose below 70 mg/dL; 85(77 %) between 70 and 180 mg/dL and 23(21 %) had blood glucose exceeding 180 mg/dL. The Bland-Altman plot showed a bias of 4 mg% (95%CI -9.8 to +1.1); and the limits of agreement were -63 and + 54 mg%. The area under the receiver operating characteristic curve for the two glucometers was 0.92 and 0.93 respectively.

CONCLUSIONS

Point of care glucose, measured by glucometers was in agreement with the venous glucose estimation. Both glucometers were equally accurate and performed uniformly well across the wide range of blood glucose values.

Association of Benign Prostatic Hyperplasia With Multimorbidity Among Older Adults: Insights From the Longitudinal Ageing Study in India (LASI), First Wave

Introduction Population ageing is expected to be accompanied by an increase in multi-morbidity, i.e. the co-occurrence of multiple chronic conditions simultaneously. Benign prostatic hyperplasia (BPH) is a non-malignant disease prevalent in ageing men. Both BPH and multi-morbidity are known to have a significant impact on quality of life. The objective of this study was to determine the association between BPH and multimorbidity among older adults and the elderly population in India. Methods This is an analytical cross-sectional study involving secondary data from the nationally representative Longitudinal Ageing Study in India (LASI) Wave I 2017-18. Multivariable logistic regression analysis was conducted to study the association between BPH and multimorbidity while accounting for other associated factors. Results Compared to those having no co-morbidities, the odds of having BPH increased with the increasing number of co-morbidities. Those with at least two co-morbidities were twice as likely (aOR=2.19; 95%CI 1.78-2.72), and those with at least four co-morbidities were almost six times as likely (aOR=5.78; 95%CI 2-16.72) to have BPH as compared to those with no co-morbidities. The association was stronger among males >60 years. Conclusion Self-reported benign prostatic hyperplasia was found to be strongly associated with multi-morbidity. The need of the hour is the inclusion of BPH within the framework of a national health programme. Health technology assessment of high-risk screening strategies for BPH may be conducted among patients with multimorbidity. Research into the impact on the quality of life of those affected by both BPH and multimorbidity will help highlight this as a priority problem for decision-makers.

Heart beats brain: The problem of detecting alpha waves by neuronal current imaging in joint EEG–MRI experiments

It has been suggested recently that the influence of the neuro-magnetic field should make electrical brain activity directly detectable by MRI. To test this hypothesis, we performed combined EEG-MRI experiments which aim to localize the neuronal current sources of alpha waves (8-12 Hz), one of the most prominent EEG phenomena in humans. A detailed analysis of cross-spectral coherence between simultaneously recorded EEG and MRI time series revealed no sign of alpha waves. Instead the EEG-MRI approach was found to be hampered by artefacts due to cardiac pulsation, which extend into the frequency band of alpha waves. Separate brain displacement mapping experiments confirmed that not only the EEG but also the MRI signal is confounded by harmonics of the cardiac frequency even at 10 Hz and beyond. This well-known ballistocardiogram artefact cannot be avoided or eliminated entirely by available signal processing techniques. Therefore we must conclude that current EEG-MRI methodology based on correlation analysis lacks not only the sensitivity but also the specificity required for the reliable detection of alpha waves.

Synchronization facilitates removal of MRI artefacts from concurrent EEG recordings and increases usable bandwidth

Investigating human brain function non-invasively by simultaneous EEG and fMRI measurements is gaining in popularity as more and better solutions to the inherent technical challenges emerge. We demonstrate the use of a commercially available frequency divider and phase-locking device for the purpose of synchronizing an MRI acquisition with a simultaneous recording of the EEG. Synchronization hugely improves the effectiveness of MRI artefact removal from the EEG signal by the common mean template subtraction method. It complements or substitutes post-processing techniques like filtering, thereby increasing the usable bandwidth of the EEG signal to about 150 Hz. This is important for covering the full range of human Gamma band activity. Similarly, synchronization eliminates the necessity for over-sampling of the EEG signal.