Common Cause Of Admission Research Articles

Hospital admissions and the financial cost incurred by the elderly patients at a tertiary care centre in Gokarneshwor Municipality, Kathmandu, Nepal

Population ageing is a global phenomenon and proportion of elderly people is also increasing in Nepal. However, the increased burden of chronic disease as a result of population ageing, along with medical cost incurred during hospital stay is yet to be explored in Nepal. With the aim of studying these, data of 527 patients 70 years of age and above admitted to Nepal Medical College Teaching hospital, the largest tertiary care center in Gokarneshwor Municipality, was collected from November 2021 to November 2022 and analyzed. Seventy-four percent of the patients were of 70-80 years of age and male: female ratio was almost equal to 1:1. The most common cause of admission was respiratory problems. The cost was not more than Nepali rupees 19,200 for 82% of the patients and the duration of stay was less than 6 days for 75% of the patients. No significant association was found between duration of hospital stay and the age group or the gender. Similarly, no significant association was found between the medical cost incurred during hospital stay and the age group. However, association was found between the hospital cost and gender with males more likely to have higher cost.

Demographic Profile and Outcome of Pediatric Intensive Care Unit.

Pediatric intensive care provides better observation as well as an intensive treatment, which helps to cure, support, and provide better outcomes for sick children. This study aimed to describe the demographic profile and the outcome of PICU patients, and evaluate the relationship of diagnostic categories with treatment and outcome. This retrospective cross-sectional study was conducted in a six-bedded PICU from 1 March 2021 to 1 March 2022. Bivariate analysis was used to identify the association between dependent and independent variables. The infants admitted below 6 months of age were 63 (22.3%) and had male predominance accounting for 64%. The main portal of entry of the admitted cases was emergency ward 214(75.6%). Most of the patients 153(54.1%) were admitted for intensive monitoring of their abnormal vitals along with critical care according to our PICU protocol. Respiratory illness 122(43.1%), neurosurgical illness 59(20.8%), and primary infectious disease 52(18.3%) were the common reason for PICU admission. Post-major surgery 2(66.7%), hematological illness 3(37.5%), and cardiac disorders 1(20%) had high mortality rates. Among the portal of admission, the majority of the children (80.0 %) who were admitted to the PICU through the emergency ward died before exiting from the PICU (p<0.0001). Respiratory illness was the most common cause of admission and post-major surgery had the highest mortality rate. Portal of entry was statistically associated with patient characteristics and had a significant relationship with the outcome. Similar studies in other health institutions are required to further analyze the demographic profile and outcome of pediatric critical care in Nepal.

Does anaemia increase the risk of acute lower respiratory tract infections in children aged 1-5 years?

Introduction: Anaemia is a major problem in children aged 1-5 years. Lower respiratory tract infection (LRTI) is defined as inflammation of the respiratory tract below the level of the larynx and is a common cause of admission to paediatric units in Sri Lanka. It is reported that anaemic children have a high risk of developing LRTIs.Objectives: To identify the association between anaemia and increased risk of developing LRTI in children aged 1-5 years presenting to a selected children's hospital in Sri Lanka.Method: A case-control study was conducted in all paediatric medical wards and intensive care units in Sirimavo Bandaranayake Children's Hospital, Peradeniya, from November 2022 to March 2023. Children aged 1-5 years admitted with LRTI were selected as cases. Children aged 1-5 years admitted without features of respiratory tract infection were selected as controls to match the age and sex of the cases. Data were collected from a questionnaire to parents and also from patient records. Data were analysed using SPSS version 22.Results: A total of 272 children was included in the study. Anaemia was found in 56.6% of cases and 44.9% of controls. The mean haemoglobin (Hb) levels of the cases and controls were 10.00±0.899 and 10.16±0.8032 respectively. Among cases, there were 57.4% of hypochromic-microcytic peripheral smears. Frequency of anaemia was significantly higher among cases as compared to controls (Odds ratio 1.605; CI: 1.025- 2.590, p-value= 0.045).Conclusions: The frequency of anaemia was significantly higher among cases as compared to controls. Anaemic children were 1.6 times more prone to get LRTI.

Assessment of the quality of care in acute bowel obstruction patients at a tertiary care hospital with the NCEPOD guidelines

Abstract Background Acute bowel obstruction (ABO) is a common cause of admission under the emergency general surgery services offered across the UK. The Aim of this quality improvement project (QIP) was to assess the quality of care for patients with ABO with the national and NCEPOD guidelines in a tertiary care hospital. Method Data was collected for two months in October and November 2022 from an electronic database in the trust and patient notes maintained throughout the admission. Results 35 patients were included in the QIP (19 males and 16 females). Consultant review is recommended in &amp;lt; 14 hours after admission and national statistics show a delay in 15.9% of cases, in our hospital, it was 73.33% (22/30). Pain assessment on admission, the national average is 57% but, in this hospital, it was 42.86% (15/35). Similarly, guidelines recommend assessment of MUST score, hydration status and Rockwood score at admission, which was documented in 0/35, 1/35 and 15/35 cases in our hospital. QIP was presented in the local clinical governance meeting followed by a teaching session to improve the patient care in ABO. Conclusion This QIP showed a lack of documentation in the pain score, hydration status, Rockwood score, MUST score and a delay in the consultant review for patients with ABO when compared with the guidelines of NCEPOD and national statistics. A repeat cycle of this QIP will be conducted in 6 months' time to analyse the effectiveness of the intervention on patient care outcomes.

La diagnosi differenziale del dolore osseo in età pediatrica: quando preoccuparsi

Bone pain is a common cause of admission to the Paediatric Emergency Department. Although in most cases it is associated with benign processes, this symptom should be investigated thoroughly when anamnestic and clinical features suggest the possible presence of an underlying malignant process. This article describes the case of an adolescent presenting with persistent musculoskeletal pain, initially treated as an infectious bone disease that later turned out to be a malignant neoplasm. Based on clinical, laboratory and imaging data the differential diagnosis of paediatric bone pain can sometimes be challenging and includes nonneoplastic diseases, benign bone tumours and malignant bone tumours. Moreover, this article indicates the medical history data to be investigated, the signs and symptoms to be evaluated and the laboratory and imaging investigations to be performed in a paediatric patient with bone pain. In addition, the epidemiological, clinical and radiographic characteristics of the most frequent causes of paediatric bone pain are summarized in a final table.

Causes and outcome of infants admitted with respiratory distress in a tertiary care neonatal unit: A five year review

Background: Respiratory distress is a common cause for admission of infants to a neonatal unit. The aim of this study was to analyze the causes of respiratory distress leading to admission in a neonatal unit.&#x0D; Method: This is a 5 year retrospective review of neonates admitted initially with diagnosis of respiratory distress in the neonatal unit of a tertiary care hospital from November 2017 to October 2022. Cases were identified and analyzed using electronic database maintained in the neonatal unit and were cross checked with electronic discharge summaries where necessary.&#x0D; Results: Respiratory distress was found to be the most common cause for admission to the neonatal unit almost comprising of 46% of total admissions. The commonest cause for respiratory distress on admission was found to be transient tachypnoea of newborn (TTN) in term infants and surfactant deficiency respiratory distress syndrome (RDS) in preterm infants. As compared to babies with TTN, who were all discharged home, 18.4% of those with RDS did not survive. The overall mortality of infants presenting initially as respiratory distress was 9.1%. Other common causes for respiratory distress on admission were sepsis, birth asphyxia, shock, congenital heart disease, seizure and polycythemia.&#x0D; Conclusion: Respiratory distress is a common cause for admission to a neonatal unit in both term and preterm infants. Although TTN in term and RDS in preterm are common causes for respiratory distress in newborns, the underlying cause for respiratory distress is diverse and not just limited to the lungs and heart.

Hospital admissions among people with diabetes: A systematic review.

To describe the reasons for hospital admission among people with diabetes. We searched Emcare, Embase, Medline and Google Scholar databases for population-based studies describing the causes of hospitalisation among people with diabetes. We included articles published in English from 1980 to 2022. For each study, we determined the most frequent reasons for admission. Studies were assessed for quality using the Newcastle Ottawa quality assessment tool. 6920 research articles were retrieved from the search of all sources. After screening the titles and abstracts of these, we reviewed the full text of 135 papers and finally included data from 42 studies. Admissions among the total diabetes were reported in 25 papers: 5 articles reported type 1 diabetes alone, 10 articles reported type 2 diabetes alone and the remaining 2 articles reported type 1 and type 2 diabetes separately. Among the 25 total and type 2 diabetes studies that reported the distribution of hospitalisations in broad categories, cardiovascular diseases (CVD) were the leading cause of admission in 19/25 (76%) of studies. Among the 19 studies that reported CVD admissions by subcategories, ischaemic or coronary heart disease was the leading subtype of CVD in 58% of studies. The other common causes of admissions were infections, renal disorders, endocrine, nutritional, metabolic and immunity disorders. In people with type 1 diabetes, acute diabetes complications were the leading cause of admission. CVD are the leading cause of hospital admission for people with diabetes, with ischaemic or coronary heart disease as the predominant subtype.

In old anticoagulated patients with mild traumatic brain injury, a 24-h observation period should not be recommended without evidence of a clear benefit: a retrospective study of delayed hemorrhagic versus iatrogenic complications.

Mild traumatic brain injury (mTBI) is a common cause of admission to the Emergency Department (ED). Many patients are elderly on oral anticoagulant therapy (OAT) at increased risk of immediate and delayed intracranial hemorrhage (ICH). To investigate the frequency of delayed ICH (DICH) in old patients with mTBI in OAT and the occurrence of complications related to the ED stay. In this single-center retrospective study, we recruited all patients in OAT aged 65 and over, admitted for mTBI to the ED of our Hospital in Florence from March 2019 to February 2021. Clinical variables were collected and cranial computed tomography (CT) scans reviewed. The primary outcome was the frequency of DICH occurring within 30days since the trauma after a first negative CT. Secondary outcomes included need of neurosurgical intervention and death for DICH, and hospital-related complications. Statistical analyses were conducted using IBM SPSS Statistics (version 22). Among 363 enrolled patients, there were 31 acute ICH (8.5%) at the first CT scan, while in the 316 negative included patients, 10 DICH (3.2%) were identified. Among the latter, no neurosurgical treatment, or death due to ICH occurred. Overall, 25 cases (6.9%) had iatrogenic complications during the 24-h observation period, often serious, such as respiratory failure after sedation due to restlessness, or COVID-19 infection. The low frequency of DICH and the occurrence of several iatrogenic complications suggest that the risk-benefit ratio of a 24-h ED observation is not advantageous in elderly with mTBI.

CLINICAL PROFILE OF PATIENTS WITH POISONING ADMITTED TO TERTIARY CARE CENTRE OF NEPAL

Background: Acute poisoning is one of major medical emergencies and a common cause of admission and death in hospitals in Nepal. In our country, agrochemicals including pesticides like Organophosphorus, organochlorine, zinc and aluminium phosphide are most common causative agents used for intentional or accidental poisoning. The study was aimed to assess clinical profile of patients with poisoning admitted to tertiary care centre of Nepal. Methods: This retrospective study was conducted to see clinical profile of patients diagnosed with poisoning in Chitwan Medical College Teaching Hospital for 1 year period from February, 2022 to January, 2023. Data were collected from hospital medical records and Midas software. Data analysis was performed using Statistical package for Social Sciences version 21 and data are presented as frequency and percentage. Results: A total of 150 cases of poisoning presented to our hospital during the one-year period. Among them, 42% patients were males and 58% females (1.38:1). Most of them (34%) belonged to age group of 21-30 years. Majority of the cases were suicidal (86%). Organophosphorus was the most common poison (36.66%), followed by rat poison-(12.66%). About 44% patients went on Leave Against Medical Advice, 28% on Discharge On Request, 23% patients were discharged with full recovery, whereas mortality with treatment was 5%. Conclusions: Poisoning is more prevalent in females and younger age group. The most common agent is Organophosphorus followed by rat poison. Self-poisoning with suicidal intent is the most common mode of poisoning. Mortality in this study was 5.33% which was more among Organophosphorus poisoning.

189 Incidence of hospital admission among Long-Term Care Facility residents versus Community Dwelling older adults: a population based observational study

Abstract Background Long-Term Care Facility (LTCF) residents are prone to acute illness and hospital admission due to underlying factors including advanced age, chronic comorbidity and increased frailty. This study aims to determine the incidence of hospital admission among LTCF residents in comparison to their Community Dwelling (CD) counterparts, and to describe reasons for hospitalisation, and admission-related adverse outcomes. Methods Hospital In-Patient Enquiry (HIPE) data was obtained for all LTCF residents and CD adults over the age of 75 residing in Waterford County, Ireland, who were acutely admitted in 2022. This included demographic data, International Classification of Diseases (ICD-10) diagnosis, Length of Stay (LoS), and discharge outcome. Incidence was calculated by dividing the number of persons admitted to hospital by the total population at risk over a one-year period. Chi-squared test was used to determine significant difference between the two groups. Results Admission incidence was 0.40 for LTCF residents and 0.28 for CD (p &amp;lt; 0.001). Average age was 83 years, and median LOS was seven days in both groups. The most common causes for admission among LTCF residents were infection (56%, n = 147) and falls (12%, n = 31). CD were mostly admitted with infection (31%, n = 805), cardiac issues (16%, n = 414), and falls (12%, n = 303). LTCF residents were more likely than CD to be admitted with Covid-19 infection (9% vs 4%, p = 0.003). There was no difference in mortality rates (8% LTCF vs 6% CD, p = 0.33). LTCF residents were more likely to have a diagnosis of dementia (43% vs 11%, p &amp;lt; 0.001) and develop delirium during admission (30% vs 16%, p &amp;lt; 0.0001). Conclusion LTCF residents are significantly more likely to be hospitalised than CD, and to experience delirium during admission. Proper advanced care planning and provision for treatment with intravenous antibiotics in the LTCF may reduce admissions to hospital, but more importantly will provide person-centred care and potentially improve clinical outcomes.

Sepsis among Patients Admitted to the Intensive Care Unit of a Tertiary Care Centre.

Sepsis is a life-threatening dysfunction and is one of the common causes of admission in intensive care units. Early diagnosis and management improves the outcome of patients. The aim of this study was to find out the prevalence of sepsis among patients admitted to the intensive care unit of a tertiary care centre. A descriptive cross-sectional study was conducted among patients admitted to the intensive care unit of a tertiary care centre after obtaining ethical approval from the Institutional Review Committee. Data of patients admitted from 1 February 2022 to 31 January 2023 was collected between 6 April 2023 to 27 April 2023. Convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Among 1001 patients, the prevalence of sepsis was 278 (27.77%) (25-30.54, 95% Confidence Interval). Among them, 209 (75.17%) developed septic shock. The mean age was 56.6±19.34 years. Pneumonia 43 (15.46%) and genitourinary infection 43 (15.46%) were the most common sources of infection and the source was unknown in 124 (44.60%) of patients. Hypertension 75 (26.97%) was the most common comorbidity. Acute kidney injury 166 (59.71%) was the most common complication followed by thrombocytopenia 165 (59.35%) and transaminitis 79 (28.41%). The prevalence of sepsis among patients admitted to the intensive care unit was higher than other studies done in similar settings. infection; intensive care unit; sepsis; tertiary care centre.

Hospitalizations among children with sickle cell disease enrolled in the Kumasi Sickle Cell Pan African Consortium (SPARCo) database: A cross sectional study.

Sickle cell disease (SCD) is the commonest monogenic haemolytic disorder in Africa. Despite strides made in its management, a significant proportion of patients are hospitalized from the various complications of the disease. This study set out to describe the main causes and outcomes of hospitalizations among pediatric patients with SCD. A cross-sectional study was conducted at the Pediatric Emergency Unit of Komfo Anokye Teaching Hospital within a period of 12 months to recruit pediatric SCD patients. This study looked at causes of admission, length of hospital stay (LOS), and outcome of admission. Of the 201 SCD patients recruited, 57.2% were males and majority were of SCD-SS phenotype 83.1%. The median age was 6 years. The three leading causes of hospitalization were Vaso-occlusive pain events (VOPE) (39.8%), acute chest syndrome (ACS) (25.9%), and infections (12.4%). Ten (5.0%) of the patients presented with a stroke. High admissions were observed in June (12.4%) and November (16.9%). The median (interquartile range [IQR]) LOS was 6 days (IQR: 4-10). Six (3.0%) of the patients died from complications of the disease during hospitalization. VOPE, ACS, infections, and acute anaemia from hyperhaemolysis were observed as the most common causes of admissions among SCD patients. A good outcome of discharge was seen in most of the patients that were hospitalized with a median length of stay of 6 days. This study also strengthens the importance of a good SCD database with patient follow-ups for better outcomes in SCD patients.

Radiomic analysis of abdominal organs during sepsis of digestive origin in a French intensive care unit.

Sepsis is a severe and common cause of admission to the intensive care unit (ICU). Radiomic analysis (RA) may predict organ failure and patient outcomes. The objective of this study was to assess a model of RA and to evaluate its performance in predicting in-ICU mortality and acute kidney injury (AKI) during abdominal sepsis. This single-center, retrospective study included patients admitted to the ICU for abdominal sepsis. To predict in-ICU mortality or AKI, elastic net regularized logistic regression and the random forest algorithm were used in a five-fold cross-validation set repeated 10 times. Fifty-five patients were included. In-ICU mortality was 25.5%, and 76.4% of patients developed AKI. To predict in-ICU mortality, elastic net and random forest models, respectively, achieved areas under the curve (AUCs) of 0.48 (95% confidence interval [CI], 0.43-0.54) and 0.51 (95% CI, 0.46-0.57) and were not improved combined with Simplified Acute Physiology Score (SAPS) II. To predict AKI with RA, the AUC was 0.71 (95% CI, 0.66-0.77) for elastic net and 0.69 (95% CI, 0.64-0.74) for random forest, and these were improved combined with SAPS II, respectively; AUC of 0.94 (95% CI, 0.91-0.96) and 0.75 (95% CI, 0.70-0.80) for elastic net and random forest, respectively. This study suggests that RA has poor predictive performance for in-ICU mortality but good predictive performance for AKI in patients with abdominal sepsis. A secondary validation cohort is needed to confirm these results and the assessed model.

Admission Pattern and Outcome in Paediatric Intensive Care Unit of Tertiary Level Teaching Hospital in Eastern Nepal

Introduction: Paediatric Intensive Care Unit (PICU) is a relatively new concept with rapidly growing paediatric subspecialty in resource limited-countries. Introduced in Nepal in the 1980s, the first PICU was established in 1986 in Kanti Children’s Hospital, Kathmandu with 4 beds. Later in BPKIHS in Eastern Nepal. Currently only a few dedicated PICU running in Nepal. Our PICU was started in 2021 with 8 beds in the private sector for the management of critically ill children.&#x0D; Objectives: To study the admission pattern and outcome of the children at our paediatric intensive care unit.&#x0D; Methodology: This was a Cross Sectional Descriptive study conducted at PICU of Birat Medical College Teaching hospital in Eastern Nepal. From August 2021 to July 2022, records of all possible admissions in PICU were reviewed. Demographic profile, diagnosis, outcome and duration of stay were analysed.&#x0D; Results: Out of 260 analysed data, there were 156 (60%) males and 104 (40%) females. Age wise distribution was 101 (38.85%), 82 (31.5%), 38 (14.6%) and 39 (15%) for 1 months-1 year, 1-5 year, 5-10 year and 10-15 year respectively. Disease wise distribution was 129 (49%) respiratory, 49 (18.8%) neurological and 26 (10%) gastrointestinal, mostly infective causes like Pneumonia (78, 30%), Bronchiolitis (34, 13.1%), febrile convulsion (29, 11.2%) meningitis/encephalitis (19, 7.3%), Sepsis (12, 4.6%), dengue (6, 2.3%) other infections (19,6.3 %). In outcome, discharged (231,88.85%), DOPR (5,1.92%), LAMA (4,1.54%), Death (16,6.2%) and Referral (4,1.54%). Mortality was high (11, 38.6%) in under five years. Sepsis (4, 33.3%), Meningitis / encephalitis (3, 15.8%) and pneumonia (4, 5.1%) were the common causes. Mean duration of PICU stay was 2.73 days (median=2). Overall mortality rate was 6.2% (16). Sepsis, LOS and need of mechanical Ventilation were significant predictors of mortality.&#x0D; Conclusion: Respiratory illnesses including infections were common causes of admission with low mortality (6.2%). Sepsis, Meningoencephalitis and pneumonia were common causes of death in our PICU. Sepsis, LOS and need of mechanical Ventilation were significant predictors of mortality.

Neonatal morbidity and mortality patterns in NICU at Al-Ameen Medical College and Hospital, Bijapur

Background: Despite improvements in perinatal care, there is still a high rate of neonatal morbidity and mortality in developing nations like India. Neonatal period is defined as from birth upto first 28 days of life. Methods: An observational prospective study was done with sample size of 600 babies admitted in NICU at AMCH, Bijapur during the period from January 2021 to August 2022. During the 18 months period of study, data was collected based on babies admitted with respect to gestational age, weight and day of life. Results: The data analysis for morbidity showed that respiratory distress syndrome 24.6%, birth asphyxia with HIE 18.7%, jaundice 17.5%, sepsis 12.3%, meconium aspiration syndrome 4.7%, major congenital anomaly 3.4%, respiratory distress (other causes) 1.8%, others 17.3%. The disease wise mortality among neonates admitted to nicu was studied and were found that respiratory distress syndrome 35.5%, birth asphyxia with HIE 25.4%, sepsis 23.3%, major congenital malformations 6.1%, meconium aspiration syndrome 5.5%, others 4.1%. Conclusions: The most common causes of admission were respiratory distress syndrome, birth asphyxia, jaundice, sepsis, meconium aspiration syndrome and major congenital anomalies. The most common causes of mortality were respiratory distress syndrome, birth asphyxia, sepsis and major congenital malformations.

Relationship between HbA1c with Hypoglycaemic Attack and Diabetic Complications of Patients Admitted in a Tertiary Hospital

Background: Hypoglycemia is a major complication of diabetes mellitus and common causes of admission in hospital. Those who have long duration of diabetes having poor glycemic control, frequently experienced such events were self treated at home. The present study pointed to identify whether hemoglobin A1c (HbA1c) a marker of average plasma glucose, relates with severe hypoglycemia and diabetic complications or not.&#x0D; Materials and methods: A retrospective observational study was conducted in the Department of Medicine, Maa-Shishu-O-General Hospital, Agrabad, Chattogram from April 2019 to September 2021. Total 36 patients were selected, as presenting in Medicine Department with documented hypoglycaemia. All data was taken meeting exclusion criteria and analysed.&#x0D; Results: Hypoglycaemic episodes mostly occurred in elder cases (&gt;61 year of ages) n=16, 44% and HbA1c mostly belongs to between 7.6 to 8 groups. Confusion is the most common presentation, N=63, 63.9%. Neuropathy was found as common complication, (30.6% , n=11) cases and most of the neuropathy found in HbA1c 7.6 to 8.5 groups 54.54% , n=6 . Most of the patients were taking sulfonylurea group of drugs 47.2% , n=17, and mixed acting insulin n=21 ,58.3%.&#x0D; Conclusion: Hypoglycemic admission is not related to extensive Diabetic control rather with related to elder patients , various Diabetic complications and injudicious use of ant diabetic agents.&#x0D; Chatt Maa Shi Hosp Med Coll J; Vol.22 (1); January 2023; Page 44-47

Outcome of Lung Functions in Covid-19 Patients at a Tertiary Care Center of Eastern Nepal

Background: Novel coronavirus infection has myriad clinical manifestations, such as headache, respiratory failure, and long coronavirus disease syndrome. A common cause for admission is pneumonia, and such patients have shown longer periods of respiratory symptoms and exercise intolerance after discharge. The study aimed to determine short-term and long-term lung function outcomes in coronavirus disease patients.&#x0D; Materials and Methods: The prospective, cross-sectional study was conducted in coronavirus disease facility of Birat Medical College Teaching Hospital. A structured proforma including symptoms, modified medical research council dyspnea scale, 6-minute walk test and portable spirometry were recorded during 3 months follow up.&#x0D; Results: A total of 58 coronavirus disease patients were admitted, 4 expired. Common symptoms were dyspnea (98.28%), fever (94.8%), dry cough (86.2%), myalgia (17.2%). Mean Forced expiratory volume in 1 second to forced vital capacity ratio was normal. The mean forced vital capacity was 46.52% at admission, 53.33% at 3 months. The mean forced expiratory flow at 25% to 75% of forced vital capacity was 56.91% at admission, 59.31% at 3 months. Mean values of forced expiratory volume predicted was 47.40% at admission, 51.69% at 3 months. Mean 6-minute walk test distance did not improve during follow-up (240.09m at 1 month, 239.35m at 3 months) and there was no improvement in oxygen saturation at 3 months compared to the first month.&#x0D; Conclusion: Short-term lung function outcome demonstrated persistent dyspnea and development of mixed airways disease in all the survivors. Long-term lung function outcome observed was persistence of dyspnea, mixed airways disease, and low exercise capacity.

Analysis of Neonatal Admission Patterns and Clinical Profiles in a Tertiary Care Center: Focus on Neonates Transferred from the Delivery Room to the Neonatal Intensive Care Unit

Background: Neonatal mortality rate is very high in developing countries despite of advancement in perinatal and neonatal care with reduced neonatal mortality rate in many developed countries. This study aims to identify the reasons of admitting neonates for intensive care after vaginal delivery and their outcome.&#x0D; Materials and Methods: This is an observational descriptive study conducted for over a year at Nobel Medical College Teaching Hospital which included newborns delivered vaginally within the hospital. Demographic data of newborn and mother was obtained, birth weight, reason for admission and final outcome were documented. Outcomes were classified as improved with recovery, mortality and discharge on request prior to recovery. Descriptive statistics such as mean, percentage and standard deviation were obtained.&#x0D; Results: Total 117 neonates were admitted to intensive care out of 3452 vaginal deliveries with male to female ratio of 1.9:2. There were 60 (51.3%) preterm, 55 (47%) full term and 2 (1.7%) post term; and 68 (58.1%) were low birth weight. Prematurity with respiratory distress syndrome was the most common cause of admission (34.2%) along with birth asphyxia (29, 24.8%) and meconium aspiration syndrome (20, 17.1%). Positive Airway Pressure was required in 42 (35.9%). Blood Culture positive growth was seen in 17.9% with most common organism being Staphylococcus aureus. Mean stay was 3.75±2.49 days andmortality in the study population was 6.8%.&#x0D; Conclusion: Prematurity with respiratory distress syndrome, birth asphyxia and meconium aspiration syndrome were major indications for admission of newborns delivered via vaginal deliveries to neonatal intensive care unit. One-fourth required mechanical ventilation.

Pain Management at the End of Life in the Emergency Department: A Narrative Review of the Literature and a Practical Clinical Approach

Access to pain management is a fundamental human right for all people, including those who are at the end of life (EOL). In end-stage patients, severe and uncontrolled pain is a common cause of admission to the emergency department (ED), and its treatment is challenging due to its complex, often multifactorial genesis. The aim of this narrative review was to identify the available literature on the management of severe EOL pain in the ED. The MEDLINE, SCOPUS, EMBASE, and CENTRAL databases were searched from inception to 1 April 2023 including randomised controlled trials, observational studies, systemic or narrative reviews, case reports, and guidelines on the management of EOL pain in the ED. A total of 532 articles were identified, and 9 articles were included (5 narrative reviews, 2 retrospective studies, and 2 prospective studies). Included studies were heterogeneous on the scales used and recommended for pain assessment and the recommended treatments. No study provided evidence for a better approach for EOL patients with pain in the ED. We provide a narrative summary of the findings and a review of the management of EOL pain in clinical practice, including (i) the identification of the EOL patients and unmet palliative care needs, (ii) a multidimensional, patient-centred assessment of the type and severity of pain, (iii) a multidisciplinary approach to the management of end-of-life pain, including an overview of non-pharmacological and pharmacological techniques; and (iv) the management of special situations, including rapid acute deterioration of chronic pain, breakthrough pain, and sedative palliation.

Evaluation of Children with Migraine: Three Years Experience

Background: Headache in pediatric age group is one of the common causes of admission to both general pediatrics and pediatric neurology outpatient clinics. The aim in this study was to retrospectively evaluate the clinical and laboratory findings of our cases diagnosed with migraine. Material and methods: Between 2013 and 2016, patients who applied to the Pediatric Neurology Outpatient Clinic of Dr. Sami Ulus Pediatrics Training and Research Hospital and were diagnosed with migraine were included. Statistical comparison was made between subgroups, which were migraine with aura and migraine without aura. Results: In present study, 11.6% of the patients who applied with the complaint of headache consisted of patients diagnosed with migraine. It was determined that 18.8% (n:27) of migraine patients were under the age of 10, and 81.3% (n:117) were over the age of 10. Forty-four (48.4%) female patients and 13 (24.5%) male patients had migraine with aura, and there was a statistically significant difference in terms of gender (p=0.008). Also there was a statistically significant difference between the mean age and gender of migraine patients with aura and migraine without aura (p=0.017). Conclusion: Since migraine is a chronic disease which is observed more frequently than estimated during childhood. We shared the results of the findings that may make us think of the diagnosis of migraine at the first admission, and may also guide us for migraine with aura in a patient followed up with a diagnosis of migraine.