Bedridden Status Research Articles

The occurrence of and risk factors for developing acute critical illness during quarantine as a response to the COVID-19 pandemic

Background/PurposeEarly detection and timely quarantine measures are necessary to control disease spread and prevent nosocomial outbreaks of Coronavirus disease 2019 (COVID-19). In this study, we aimed to investigate the impact of a quarantine strategy on patient safety and quality of care.MethodsThis retrospective cohort study enrolled patients admitted to the quarantine ward in a tertiary hospital in southern Taiwan. The incidence and causes of acute critical illness, including clinical deterioration and unexpected complications during the quarantine period, were reviewed. Further investigation was performed to identify risk factors for acute critical illness during quarantine.ResultsOf 320 patients admitted to the quarantine ward, more than two-thirds were elderly, and 37.8% were bedridden. During the quarantine period, 68 (21.2%) developed acute critical illness, which more commonly occurred among patients older than 80 years and with a bedridden status, nasogastric tube feeding, or dyspnea symptoms. Bedridden status was an independent predictor of acute critical illness. Through optimization of sampling for COVID-19 and laboratory schedules, both the duration of quarantine and the proportion of acute critical illness among bedridden patients during quarantine exhibited a decreasing trend. There was no COVID-19 nosocomial transmission during the study period.ConclusionThe quarantine ward is a key measure to prevent nosocomial transmission of COVID-19 but may carry a potential negative impact on patient care and safety. For patients with multiple comorbidities and a bedridden status, healthcare workers should remain alert to rapid deterioration and unexpected adverse events during quarantine.

Homebound versus Bedridden Status among Those with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.

Persons living with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) vary widely in terms of the severity of their illness. It is estimated that of those living with ME/CFS in the United States, about 385,000 are homebound. There is a need to know more about different degrees of being homebound within this severely affected group. The current study examined an international sample of 2138 study participants with ME/CFS, of whom 549 were severely affected (operationalized as ‘Homebound’). A subsample of 89 very severely affected participants (operationalized as ‘Homebound-bedridden’) was also examined. The findings showed a significant association between severely and very severely affected participants within the post-exertional malaise (PEM) symptom domain. The implications of these findings are discussed.

Case Report: Ventriculoperitoneal Shunt Catheter Migration and Transanal Extrusion in Persistent Vegetative State Adult Patient

The complications of ventriculoperitoneal (VP) shunts are many and are reported in literature extensively. The complication of transanal extrusion after bowel perforation is known although rare. This complication is very well described amongst the children. The authors describe the case of bowel perforation and transanal extrusion of a VP shunt occurring in a 51-year-old adult patient. The patient has a history of craniotomy for acute subdural hematoma after severe head injury one year ago continued with VP shunt for post-traumatic hydrocephalus. Home care with bedridden conditions is done at home until finally, the family gets the catheter extrude from the transanal. Bowel perforation and transanal extrusion of VP shunt catheter is a rare but serious problem. The exact pathogenesis of shunt-related organ perforation and extrusion through the anus is unclear, and various mechanisms have been suggested, Among many factors, age is the prominent factor for bowel perforation.1 Because of weak bowel musculature and stronger peristaltic activity, children are more susceptible to bowel perforation than adult patients. In adult shunted patient, one of the risk factors is related to PVS with chronic immobilization, as described in this case. Risk factors of bowel perforation in adult are quite distinct from children. Persistent vegetative state (PVS) with chronic immobilization is one of the risk factors to be aware of.

Risk Factors for Pneumonia in Patients with Acute Ischaemic Stroke- A Retrospective Study

Introduction: The most common non-neurological complication of stroke is infection. Stroke, associated with pneumonia is one among them. A few studies have identified prognostic predictors of pneumonia in stroke. Aim: To identify the risk factors of pneumonia in acute ischaemic stroke patients. Materials and Methods: This retrospective cohort study included medical records of 470 adult patients with acute ischaemic stroke between June 2015 to June 2020 (five years) in a Tertiary Care Medical College and Hospital. Among them, 173 had stroke associated with pneumonia. The clinical parameters-age, gender, lesion location, stroke severity (Glasgow Coma Scale (GCS)) , National Institute of Health Stroke Scale (NIHSS), Modified Barthel Activities of Daily Living (ADL) index, water swallow test, vascular risk factors and co-existing conditions (pre-existent Chronic Obstructive Pulmonary Disease (COPD), atrial fibrillation, renal electrolyte dysfunction, hypoproteinaemia) were compared. Chi-square test and logistic regression analysis were used for statistical analysis. Results: In this study, the following factors were associated with increased risk of developing pneumonia-age >70 years, bed ridden status, GCS ≤13, NIHSS ≥5, water swallow test score ≤2. Among them, multivariate analysis identified bed ridden status and water swallow test as independent predictors. Conclusion: Bed ridden status and water swallow test score were significant risk factors of ischaemic stroke associated with pneumonia. Hence, an early identification of these factors and a better knowledge of them may help in better care and prevention of pneumonia in acute ischaemic stroke.

In-Hospital Outcomes after Endovascular Therapy for Acute Limb Ischemia: A Report from a Japanese Nationwide Registry [J-EVT Registry

Aim: The aim of the current study was to describe the clinical profile, frequency of in-hospital complications, and predictors of adverse events in patients undergoing endovascular therapy (EVT) for acute limb ischemia (ALI), and to compare them with those of patients undergoing EVT for chronic symptomatic peripheral artery disease (PAD). Methods: The current study compared 2,398 cases of EVT for ALI with 74,171 cases of EVT for chronic symptomatic PAD performed between January 2015 and December 2018 in Japan. We first compared the clinical profiles of ALI patients with those of PAD patients. We then evaluated the proportion of in-hospital complications and investigated their risk factors in the ALI patients. The association of clinical characteristics with the risk of in-hospital complications was analyzed via logistic regression modeling. Results: Patients with ALI were older and had a higher prevalence of female sex, impaired mobility, and history of cerebrovascular disease, but a lower prevalence of cardiovascular risk factors and history of coronary artery disease. The proportion of in-hospital EVT-related complications in ALI was 6.1% and was significantly higher compared with those in chronic symptomatic PAD patients (2.0%, P ＜0.001). Bedridden status (adjusted odds ratio [aOR], 1.74 [1.14 to 2.66]; P =0.010), history of coronary artery disease (aOR, 1.80 [1.21 to 2.68]; P =0.004), and a suprapopliteal lesion (aOR, 1.70 [1.05 to 2.74]; P =0.030) were identified as independent risk factors for in-hospital complications. Conclusion: The current study demonstrated that ALI patients with significant comorbidities show a higher proportion of in-hospital complications after EVT.

Junctional bradycardia caused by subarachnoid hemorrhage

The electrocardiogram in subarachnoid hemorrhage patient is in many ways. A 69-year-old female felt headache and then collapsed an hour prior to arrival of emergency room. Her vital signs were a body temperature of 37 °C, heart rate of 51 beats per minute, and blood pressure of 224/135 mm Hg. Physical examinations revealed comatose with Glasgow Coma Scale E1V1M1 and fast glucose level test showed 238 mg/dl. Initial electrocardiogram (ECG) revealed junctional bradycardia (51 beats per minute) with T inversion over lead V2 to V6. Cranial computed tomography (CT) scan was performed and revealed diffuse subarachnoid hemorrhage (SAH) in the subarachnoid cisterns, bilateral sylvian fissures, left frontal sulci, left temporal cortical sulci, and interhemispheric fissure as well as lateral, third and fourth ventricles. External ventricular drainage was placed by neurosurgeon and patient was then admitted to intensive care unit. She was discharged with a bedridden and aphasic status 32 days later. Repolarization abnormalities, such as ST-segment change, T wave inversion and QTc prolongation, are also commonly seen in ECGs of patients with SAH. Physicians should keep in mind of junctional bradycardia not certainly as a cardiac problem, it may appear in cranial emergency.

Characteristics of urinary tract infections in older patients in a tertiary hospital in Greece.

Urinary tract infections (UTIs) are commonly encountered. They are more commonly caused by Enterobacteriaceae, while antimicrobial resistance is an emerging problem in their management, with extended-spectrum-β-lactamase (ESBL) producing Gram-negative bacteria and multidrug-resistant (MDR) Pseudomonas aeruginosa being increasingly common. The purpose of this study was to investigate the epidemiology and outcomes of UTIs in patients admitted in a tertiary hospital, which mostly admits geriatric patients, and compare the effects of antimicrobial resistance on patient outcomes. A retrospective observational study was conducted at a University Hospital in Crete, Greece. Epidemiology and clinical characteristics of patients with a UTI were recorded. During the 3-year period of the study, 204 UTIs were recorded. Mean age was 83.3 years and 38.7% were male. The most common isolated pathogens were Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis and Enterococcus faecalis. Among all patients with UTI, 15.7% had an infection from ESBL, MDR, extensively drug-resistant or vancomycin-resistant enterococci pathogens. Recent antimicrobial use or hospitalization, dementia, bedridden state and sex were independently associated with mortality, while being a nursing home resident was independently associated with a higher possibility of infection from ESBL, MDR, extensively drug-resistant or vancomycin-resistant enterococci pathogens. Infection by such a resistant pathogen led to increased duration of hospitalization but not to increased mortality. Alarming antimicrobial resistance rates were noted in patients with UTIs, and this led to longer duration of hospitalization even though it did not have an impact on mortality, which was otherwise higher than in other studies. Geriatr Gerontol Int 2020; 20: 1228-1233.

Survival and Predictors of Mortality Among Adult HIV/AIDS Patients Initiating Highly Active Antiretroviral Therapy in Debre-Berhan Referral Hospital, Amhara, Ethiopia: A Retrospective Study.

BackgroundAcquired immune deficiency syndrome is one of the most destructive epidemics the world has ever witnessed. An estimated 36.9 million people were living with HIV in 2017. HIV/AIDS is the major contributing factor for morbidity and mortality in low- and middle-income countries. Although different studies on survival and predictors of mortality among HIV/AIDS patients after initiation of antiretroviral therapy were conducted, there are inconsistencies in the findings of those studies. Furthermore, to the authors’ knowledge, there was a dearth of studies conducted in this study area.PurposeThe purpose of this study was to assess the survival and predictors of mortality among adult patients starting highly active antiretroviral therapy at Debre Berhan Referral Hospital, North Showa, Amhara, Ethiopia.Patients and MethodsAn institution-based retrospective study was conducted among the medical records of 447 study subjects’ selected using simple random sampling from January 1t, 2013 to December 30, 2018. The data was collected using a structured data abstraction checklist and analyzed using Kaplan–Meier statistics and Cox regression models.ResultsAmong 447 adult patients, 54 patients (12.1%) had died, giving a crude death rate of 4.18 per 100 person years (95% CI=3.20–5.45). The overall estimated survival rate after initiation of antiretroviral therapy was 81.7% (95% CI=75.36–86.54%) at 72 months of follow-up. The independent predictors of mortality were clinical stage IV (HR=15.6, 95% CI=6.609–36.948), baseline opportunistic infections (HR=1.86, 95% CI=1.048–3.330), baseline Hgb<10 mg/dL (HR=4.655, 95% CI=2.253–9.619), baseline CD4<200 cells/µL (HR=4.71, 95% CI=2.275–9.751), the presence of comorbidity (HR=2.56 95% CI=1.391–4.740), being widowed (HR=3.475, 95% CI=1.412–8.550), and bedridden functional status (HR=3.069, 95% CI=1.111–8.480).ConclusionPatients with opportunistic infections, advanced clinical stage disease, bedridden functional status, baseline Hgb<10 mg/dL, baseline CD4<200 cells/µL, and comorbidity should be given special care.

A Pediatric Case of Long-term Untreated Distal Renal Tubular Acidosis

Distal renal tubular acidosis (dRTA) is a rare renal tubular disorder characterized by normal anion gap metabolic acidosis, hypokalemia, and high urine pH. It can be inherited or acquired. In untreated pediatric patients with dRTA, rickets and growth retardation are common. We report the case of a 12-year-old Lao girl who presented with typical clinical features of dRTA with severe bone deformities that developed after a bed-ridden state due to a bicycle accident at the age of 8 years. Initial laboratory tests revealed metabolic acidosis with a normal anion gap, hypokalemia, and alkali urine. Renal ultrasonography revealed bilateral medullary nephrocalcinosis. Whole exome sequencing revealed no pathogenic mutations. After treatment with oral alkali, potassium, and vitamin D, she could walk and run. Later, she underwent corrective orthopedic surgeries for bony deformities. Thus, in pediatric dRTA patients, despite severe symptoms remaining untreated, accurate diagnosis and proper management can improve quality of life. Key words: Distal renal tubular acidosis; Failure to thrive; Bony deformity; Muscle paralysis

Balloon-assisted sacroplasty as a successful procedure for osteoporotic sacral insufficiency fractures after failure of the conservative treatment

Osteoporotic vertebral fractures without prior adequate traumatization are frequent diagnosed in orthopedics because of the increasing life expectancy and incidence of osteoporosis. The associated high mortality is caused by reduced mobilization which leads to a higher risk of infection and a bedridden state. On the other hand the diagnosis of sacral insufficiency fractures is often prolonged because of unspecific symptoms while being associated with similar risks. This article presents an overview of the present scientific literature and a retrospective analysis of patients treated via balloon-assisted sacroplasty. In 8 years, ten patients (three men and seven women) were treated. The average age was 78.4 years and the average time until the diagnosis 4.6 weeks. In most patients a significant pain reduction after the failure of conservative treatment thanks to operative treatment as well as increased mobility was observed. Only one experienced a minor surgical complication being cement leakage with nerval impaction which did not compromise her clinical outcome or satisfaction with the procedure. Balloon-assisted sacroplasty can possibly be seen as an effective symptomatic therapy in osteoporotic insufficiency fractures.

Prognostic Factors of Patients with Stercoral Perforation of the Colon.

The incidence of stercoral perforation of the colon (SPC) is expected to rise, given the increased life expectancy and the aging population. On the other hand, the prognostic factors of mortality after surgery for SPC remain unclear. This study examined the prognostic factors of patients with SPC after surgery. The medical records of 145 patients who underwent surgery for colonic perforation between April 2010 and May 2019 were reviewed retrospectively. In 145 patients, 22 patients who underwent SPC surgery were categorized into the following two groups according to in-hospital survival after surgery: alive (group A, n=15) and dead (group B, n=7). In all enrolled patients, the mean age was 75.7±9.0 years, with a female predominance (female patients, n=19, 86.4%). Sixteen patients (72.7%) had chronic constipation with medications, and five patients (22.7%) were bedridden. The rate of preoperative bedridden status was significantly higher in group B than group A (6.7% vs. 57.1%; p=0.021). Univariate analysis revealed immobility, a sequential organ failure assessment (SOFA) score, and lactate levels of more than 2.0 mmol/L to be factors associated with increased mortality rates in the postoperative period. Multivariate analysis revealed abnormal lactate levels to be the only factor related to mortality (hazard ratio 16.50, 95% CI 1.48-183.07, p=0.022). Preoperative abnormal serum lactate levels may be a risk factor for mortality after surgery in patients with stercoral perforation. Further research will be needed to identify the postoperative prognostic SPC factors.

TB/HIV Co-Infected Patients’ Mortality Rate and its Predictors in Dire Dawa, Eastern Ethiopia, 2018

Background: Tuberculosis and human immunodeficiency virus (TB/HIV) co-infection is an important global public health problem. The consequence of co-infection is multidirectional. The mortality rate of co-infected patients’ comes from many aspects or factors. Identification of these factors is important for planning and for the intervention of care and treatment.Objective: To assess tuberculosis and human immunodeficiency virus co-infected patients’ mortality rate and its predictors in Dire Dawa, Eastern Ethiopia. Method: Institution based retrospective cohort study was employed among 471 randomly selected TB/HIV co-infected patients enrolled from January, 2012 to December, 2016. Relevant variables of data were collected from patients ‘medical cards. The collected data were entered into Epi-data 4.2.0.0 and exported to SPSS version 24 for analysis. Univariate analyses were used to describe the baseline characteristics of the patients. Kaplan Meir curve were used for the comparison of time to recovery among the different groups of patients and Cox model was used to identify independent predictors. Result: A total of 79(16.8%) deaths occurred during the median follow-up period of 685 days. being infected with pulmonary tuberculosis(PTB) [AHR=1.99(95%CI:1.16-3.41)], WHO clinical stage III [AHR=2.88(95%CI:1.56-5.30)], IV[AHR=4.20(95%CI:2.21-8.01)], ambulatory functional status[AHR=4.15(95%CI:1.57-10.98)], bedridden functional status [AHR=6.34(95%CI:2.43-16.59)] and delayed Co-trimoxazole preventive therapy [AHR=2.45(95%CI:1.54-3.91)] were important predictors associated with high mortality rate of TB/HIV co-infected patients. Conclusion: About one to six TB/HIV co-infected persons died in their course of treatment follow-up. Important contributing factors were PTB infection, WHO clinical staging III and IV, ambulatory and bed ridden functional status and delayed Co-trimoxazole preventive therapy.Key words: Dire Dawa, Ethiopia, Retrospective cohort, mortality rate, TB/ HIV co-infection. Funding Statement: No financial support was gained to conduct the study. Declaration of Interests: The authors state that they have no competing interests. Ethics Approval Statement: This study has got ethical approval from Haramaya University College of Health and Medical Sciences, Institutional Health Research Ethical Review Committee (IHRERC). Permission for data collection was also secured from each hospitals and Health Centers.

Vitamin D and Sarcopenia: Potential of Vitamin D Supplementation in Sarcopenia Prevention and Treatment.

Skeletal muscle, the largest organ in the human body, accounting for approximately 40% of body weight, plays important roles in exercise and energy expenditure. In the elderly, there is often a progressive decline in skeletal muscle mass and function, a condition known as sarcopenia, which can lead to bedridden conditions, wheelchair confinement as well as reducing the quality of life (QOL). In developed countries with aging populations, the prevention and management of sarcopenia are important for the improvement of health and life expectancy in these populations. Recently, vitamin D, a fat-soluble vitamin, has been attracting attention due to its importance in sarcopenia. This review will focus on the effects of vitamin D deficiency and supplementation on sarcopenia.

Factors influencing the length of hospital stay during the intensive phase of multidrug-resistant tuberculosis treatment at Amhara regional state hospitals, Ethiopia: a retrospective follow up study

BackgroundThe length of hospital stay is the duration of hospitalization, which reflects disease severity and resource utilization indirectly. Generally, tuberculosis is considered an ambulatory disease that could be treated at DOTs clinics; however, admission remains an essential component for patients’ clinical stabilization. Hence, this study aimed to identify factors influencing hospital stay length during the intensive phase of multidrug-resistant tuberculosis treatment.MethodsA retrospective follow-up study was conducted at three hospitals, namely the University of Gondar comprehensive specialized, Borumeda, and Debremarkos referral hospitals from September 2010 to December 2016 (n = 432). Data extracted from hospital admission/discharge logbooks and individual patient medical charts. A binary logistic regression analysis was used to identify factors associated with more extended hospital stays during the intensive phase of multidrug-resistant tuberculosis treatment.ResultMost patients (93.5%) had a pulmonary form of multidrug-resistant tuberculosis and 26.2% had /TB/HIV co-infections. The median length of hospital stays was 62 (interquartile range from 36 to 100) days. The pulmonary form of tuberculosis (Adjusted odds ratio [AOR], 3.47, 95% confidence interval [CI]; 1.31 to 9.16), bedridden functional status (AOR = 2.88, 95%CI; 1.29 to 6.43), and adverse drug effects (AOR = 2.11, 95%CI; 1.35 to 3.30) were factors associated with extended hospital stays.ConclusionThis study revealed that the length of hospital-stay differed significantly between the hospitals. The pulmonary form of tuberculosis decreased functional status at admission and reported adverse drug reactions were determinants of more extended hospital stays. These underscore the importance of early case detection and prompt treatment of adverse drug effects.

Epidemiology of survival pattern and its predictors among HIV positive patients on highly active antiretroviral therapy in Southern Ethiopia public health facilities: a retrospective cohort study

BackgroundIn resource poor countries like Ethiopia, little is known about the survival of patients treated with antiretroviral therapy which depends on different factors. Evidence shows that mortality has been high particularly in the first 3 to 6 months of initiating antiretroviral therapy. Hence, the study aimed to assess the Epidemiology of survival pattern and its determinants among adult HIV positive patients on highly active antiretroviral therapy.MethodsRetrospective cohort study was employed among a total of 455 records of patients who were enrolled on antiretroviral therapy from September 2006 to August 2010. Socio-demographic, clinical, immunological, behavioral, and date of antiretroviral treatment initiation including date of follow up status were extracted. Significant predictor variables were identified by fitting Cox’s proportional hazard model using a backward stepwise method and statistical significance variables were declared based on a p-value less than 0.05.ResultsA total of 455 adult HIV/AIDS patients on ART contributed to 886.05-person-year of observation and 65.7% were alive and on treatment, 17.1% were lost to follow up and 7.5% died. The study showed that the estimated mortality was 4.4%, 5.3%, 6.1%, 7%, 7.5% and 7.5% at 6, 12, 24, 36, 48 and 60 months of follow up period, respectively. The overall incidence rate of mortality was 4.2 per 100 person-years of observation. In multivariate analysis age 45 and above (AHR: 3.72, 95% CI 1.21–11.4), bedridden functional status (AHR: 17.4, 95% CI 6.21–48.79), poor ART drug adherence (AHR: 4.52,95% CI 2.05–9.96), Tuberculosis co-infection (AHR: 4.1, 95% CI 1.84–9.13), non-disclosure (AHR: 4.9, 95% CI 1.82–12.89) and severe anemia (AHR: 5.1, 95% CI 1.81–14.21) were found predictors.ConclusionPatients with older age, tuberculosis infection, bedridden patients and severe anemia were predictors. Tracing poorly adhered patients and giving drug counseling as well as encouraging them for disclosure to their families is crucial to improve their survival.

Incidence and Predictors of Initial Antiretroviral Therapy Regimen Change Among HIV-Infected Adults Receiving Antiretroviral Therapy at Arba Minch General Hospital, Southern Ethiopia.

BackgroundThe effectiveness of the initial antiretroviral therapy regimen is the key to treatment success. However, regimen change affects this treatment success. Yet, evidence on the incidence and predictors of regimen change is scarce. Therefore, the aim of this study was to assess the incidence and predictors of initial antiretroviral therapy regimen change among HIV-infected adults receiving antiretroviral therapy.MethodsAn institutional-based retrospective cohort study was conducted. Data were collected from patients’ charts selected by simple random sampling. Data entered into EpiData version 4.43 and analyzed by STATA version 13. The life table was used to estimate cumulative survival. Kaplan–Meir curve and Log-rank test were used to compare the survival experience of explanatory variables. Cox proportional hazard model was used to identify predictors.ResultsFive hundred and eight patients were followed for 871.87 person-years of observation with the median follow-up period of 16.12 months. The incidence rate of initial ART regimen change was 11.36 (95% CI: 9.32–13.83) per 100 person-year and the median survival time is 54 months. Not disclosing HIV status (adjusted hazard ratio (AHR) = 5.41, 95% CI = 2.38–12.27), co-medication with ART (AHR = 4.64, 95% CI = 1.43–15.10), occurrence of side effect on initial regimen (AHR = 7.32, 95% CI = 4.43–12.10), baseline CD4 count <200 cells/mm3 (AHR = 2.18, 95% CI = 1.37–3.47), ambulatory/bedridden baseline functional status (AHR = 3.55, 95% CI = 2.30–5.48) were significant predictors of initial regimen change.ConclusionThe incidence rate of initial ART regimen change was found to be low. HIV disclosure status, co-medication with ART, the occurrence of side effects on an initial regimen, low baseline CD4 count, ambulatory and bedridden baseline functional status were found to be predictors.

Role of topical use of natural honey in chronic non healing ulcer: a prospective non randomized comparative trial on 150 patients

Background: Natural honey procured from any source on topical application on chronic non-healing ulcer has unique property to reduce pain, inflammation, oedema, deodorization, rapid disinfection, stimulate desloughing, promote neo vascularization, granulation, collagen synthesis, epithelialization and thus boost the process of ulcer healing.Methods: In this study a prospective, non-randomized trial was done on 150 patients divided in two groups of 75 each (group-A with honey dressing and group-B without honey dressing), of different age and sex having chronic non healing ulcers situated on various parts of the body. Natural honey available from various sources was used.Results: Most of the patients fall in their most productive and active 3rd and 4th decade of life. Pain and fever were the main reason of restricted mobility and absence from work reflecting productivity. Bacterial contamination, presence of necrotic tissue, bed ridden condition, old age, debility, DM, ulcer present in the vicinity of joint were found major cause of delay in the process of healing. The cost effectiveness, easy availability, ease of application makes natural honey a better alternative in the management of chronic non healing ulcer.Conclusions: Cost effectiveness, easy availability, ease of application, increasing healing process makes natural honey a better alternative in the management of chronic non healing ulcer and safe to use in diabetic patients as well.

A survival analysis of patients with an acute exacerbation of chronic obstructive pulmonary disease discharged from the respiratory intensive care unit.

To analyse the survival of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) after discharge from respiratory intensive care unit (RICU) and the adverse factors affecting patient's survival, so as to improve the follow-up work in the future. A retrospective observational study was conducted in the RICU. Patient demographic and clinical data were collected before discharge. All patients were followed for 2 years after discharge. Living status was collected. The LogRank test was used to compare the survival distributions at 24 months, and the Kaplan-Meier curve was plotted. Multivariate Cox regression analysis was performed. A total of 159 patients were admitted to the RICU; 19 patients died in the hospital. The post-hospitalization mortality was 18.24% (29/159), 27.04% (43/159), and 37.11% (59/159), respectively, at 6, 12 and 24 months. Data from a total of 140 discharged patients were collected and analysed. Old age, no education, low BMI, bedridden status, comorbidity with bronchiectasis, and comorbidity with cancer were risk factors affecting the survival rate of patients with an acute exacerbation of chronic obstructive pulmonary disease (COPD) as analysed by the Log-Rank test. Multivariate Cox regression analysis showed that old age, no education, and low BMI were independent factors affecting patient survival. In China, there are many older patients who have no education, and it may be very important for patients with an acute exacerbation of COPD to have additional specialized health education after discharge.

Prognostic nutritional index in elderly patients hospitalized for acute heart failure.

AimsAcute heart failure (AHF) represents a frequent cause of hospitalization and is associated with significant mortality among elderly patients. Risk assessment models like the prognostic nutritional index (PNI) have been proposed to stratify the risk of death and identify patients requiring more intensive levels of care. We evaluated the predictive value of PNI for in‐hospital and overall mortality in a cohort of consecutive elderly patients hospitalized for AHF.Methods and resultsPrognostic nutritional index, laboratory, and clinical parameters were collected upon admission. PNI values were calculated from albumin concentration and lymphocyte count and reported on a continuous scale with lower values indicating worse prognosis. The primary outcome was overall all‐cause mortality defined as death from any cause occurring during hospitalization up to 6 months after discharge. Cox proportional regression analysis was used to calculate hazard ratios (HRs) and the relative 95% confidence intervals (CIs). The study population included 344 patients (median age 84 years, range 65 to 101). During a median follow‐up of 158 days (range 2 to 180 days), 75 patients (21.8%) died of whom 28 (8.1%) died during hospitalization. The median PNI was 34 (range 17 to 55). In univariable analysis, PNI was inversely associated with overall mortality (HR 0.90; 95% CI, 0.87 to 0.94) and in‐hospital mortality (HR 0.91; 95% CI, 0.85 to 0.98). In multivariable analysis, PNI remained a significant predictor of overall mortality (HR 0.93; 95% CI, 0.89 to 0.98) after adjustment for age, anaemia, NT‐proBNP values, and bedridden status. PNI values ≤34 were associated with a two‐fold higher risk of overall mortality (HR 2.54; 95% CI, 1.52 to 4.24) and three‐fold higher risk of in‐hospital mortality (HR 3.37; 95% CI, 1.14 to 9.95).ConclusionsLow PNI values are associated with short‐term and long‐term mortality among elderly patients hospitalized for acute decompensated heart failure. Future studies are warranted to confirm these findings and evaluate the use of PNI to guide therapeutic decisions.

Retrospective study for the results of proximal femoral nailing in subtrochanteric fractures

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Subtrochanteric fractures are prevalent in young and old age groups and one of the most notorious to achieve a stable fixation which allows early union and mobilization. This was a retrospective study to analyse the outcomes of proximal femur nailing in subtrochanteric fractures and assess the functional outcome, radiological union and compare that with studies of other modalities.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This was a retrospective study of 40 patients with sub trochanteric fractures classified by Sienshiemer classification and operated by proximal femoral nail implant. Clinical evaluation was done by Harris hip score.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The average union time in our study was 5.12 months lower than some of the union rates of series with other implants (AO blade plate 7.7%). The conducive environment provided by proximal femoral nail (PFN) allows early mobility, independence to the patient and lessens the complications due to the bed ridden state and decrease the time in returning to work.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Our study suggests that PFN being and intramedullary implant gives stable fixation and early union as compared to extramedullary implants with less blood loss and less complications.&lt;/p&gt;