Criteria Of Discharge Research Articles

Diagnosis, treatment, and prevention of community-acquired pneumonia in children: an evidence-based clinical practice guideline adapted for the use in Egypt using ‘Adapted ADAPTE’

BackgroundWe recently adapted a guideline for Community-Acquired Pneumonia (CAP) in children to the Egyptian health system. Adaptation of evidence-based clinical practice guidelines to the local healthcare context is a valid alternative to de novo development that can upgrade their application without enforcing a major burden on resources. The objective of this manuscript is to elucidate diagnosis, treatment, and prevention of CAP as well as methods used for the adaptation process to produce the 1st National Guideline for Community-Acquired Pneumonia in children in Egypt using Adapted ADAPTE method. The full process was described extensively with all three phases of set up, adaptation, and finalization. An adaptation group and an external review including clinical content experts and methodologists conducted the process.ResultsThe authors adapted 10 principal categories of recommendations from three source Clinical Practice Guidelines. Recommendations incorporate; common clinical manifestations, indications for hospitalization and intensive care unit admission, indications for laboratory investigations and radiology in diagnosis, choice of empiric antibiotic therapy in the outpatient and hospitalized children with non-complicated CAP and the duration of therapy, the role of influenza antiviral therapy, follow-up anticipated response to therapy, management of non-responding pneumonia, criteria of safe discharge, and prevention of CAP. Many tools were gathered and established to improve implement ability containing two clinical algorithms for management of non-complicated CAP and for non-responding pneumonia in children, pathway for assessment of severity of CAP in primary care facilities, medication tables, simplified Arabic patient information, PowerPoint slide presentation lecture for management of CAP, and online resources.ConclusionThe final clinical guideline supports pediatricians and related healthcare workers with evidence-based applicable guidance for managing community-acquired pneumonia in Egypt. This work demonstrated the efficiency of Adapted ADAPTE and highlighted the importance of a cooperative clinical and methodological professional group for adaptation of national guidelines.

Malnutrition associated with readmission in elderly patients with chronic obstructive pulmonary disease.

Malnutrition associated with readmission in elderly patients with chronic obstructive pulmonary disease.

Criteria of day surgery discharge post elective laparoscopic cholecystectomy among adult patients

Background: Laparoscopic cholecystectomy is a minimally invasive and the most performed procedure for gallbladder resection. Despite published studies demonstrating the safety of early discharge of patients after lap-cholecystectomy, many have not accepted this approach. The present study aims to identify adult patients who are discharged late or require re-admission after laparoscopic cholecystectomy in King Abdulaziz Medical City (KAMC) in Riyadh, Saudi Arabia, due to the lack of information regarding a patient's discharge time or re-admittance. Methods: A cross-sectional study, questionnaire-based chart review was conducted at KAMC in Saudi Arabia, Riyadh, targeting 347 patients, chosen through simple random sampling, that underwent laparoscopic cholecystectomies from January 2016 to December 2020. The p-value < 0.05 was considered significant for all the tests applied. The postoperative length of stay predictors was measured using linear regression modeling. Results: Among the study subjects, females accounted for up to 76.4%, the largest population (27%) was aged between 51 and 65 years, and the least (23%) were aged between 41 and 50 years. Further 82.2% were not diabetic, and the remaining (35%) had increased HbA1c. The majority had a body mass index

Procalcitonina y proteína C reactiva séricas como biomarcadores predictivos de dehiscencia de anastomosis intestinal en cirugía colorrectal.

There has been recent interest in the seric levels of procalcitonin (PCT) and C reactive protein (PCR) as a marker of intraabdominal infection after a colorrectal surgery, however, the actual literature remains inconclusive. To test if C-Reactive Protein (PCR) and procalcitonin (PCT) as predictive factors of anastomotic leak after colorectal surgery. Retrospective cohort, of patients with ileostomy or colostomy who had intestinal transit restitution by general surgeons in our center, from march 2018 to march 2020. We registered 4 (36.4%) anastomotic leaks. We compared median PCR and PCT between group 1 (without anastomotic leak) and group 2 (with anastomotic leak). Median PCT3PO was 4.86 ng/ml in group 1 vs 13.7 ng/ml in group 2, and PCT5PO was 1.3071 ng/ml vs 6.74 ng/ml (DS: 5.04 vs. 11.53 and 0.779 vs. 10.44). Median PCR3PO and PCR5PO was 194.7 mg/l in group 1 vs 100.97 mg/l in group 2, and 159.8 mg/l vs 65.67 mg/l, (DS: 88.78 vs. 82.01 and 94.77 vs. 58.009). Persistent higher levels of seric PCR and PCT at 3rd and 5th postoperative day could be an anastomotic leackage. This biomarkers might be added as additional criteria of discharge.

Safety and Feasibility of a Discharge within 23 Hours after Colorectal Laparoscopic Surgery.

Background: Enhanced or accelerating recovery programs have significantly reduced hospital length stay after elective colorectal interventions. Our work aims at reporting an initial experience with ambulatory laparoscopic colectomy (ALC) to assess the criteria of discharge and outcomes. Methods: Between 2006 and 2016, data regarding patients having benefited from elective laparoscopic colorectal resections in two main centres in the United Kingdom have been analysed. Both benign and malignant pathologies were included. A standardised enhanced recovery program was performed for each patient, except epidural analgesia was replaced with single shot spinal infiltration. Patients were followed up through a telephone call system by a nurse. Short-term clinical outcomes were analysed. Results: A total of 833 patients were included and 51 (6.1%) were discharged within 24 h following surgery. Of these, 4 out of 51 (7.8%) patients came back hospital within 30 days of discharge; 2 (3.9%) required reoperation (Small bowel obstruction and wound abscess drainage). Conclusions: This study highlights that a 24-h discharge following elective laparoscopic colorectal interventions seems safe and feasible in selected patients. Although challenging to achieve, a standardised approach to laparoscopic surgery in combination with strict adherence to an enhanced recovery protocol are the fundamental elements of this path.

The role of microductectomy in the diagnosis and treatment in women with pathologic nipple discharge

Objectives: Approximately one tenth of the patients who apply to the breast polyclinics complain of nipple discharge. Apart from pregnancy and lactation, spontaneous, unilateral, bloody or serous discharge originating from a single duct describes the Pathological Nipple Discharge (PND). The aim of this study is to show that precancerous breast lesions, which can be easily overlooked by conventional diagnostic methods, are detected with the microductectomy performed with the correct indication and it is possible to complete the appropriate treatment. Methods: Fifty-five microductectomy procedures were performed in 55 female patients who applied to the relevant clinic with the complaint of nipple discharge between January 2013 and August 2018 and who met at least two of the three criteria of pathological nipple discharge (spontaneous, single ductus, bloody or serous) except pregnancy and lactation. Prospectively collected information was evaluated retrospectively. Results: The average age of the patients in the study ranged from 23 to 73 years (mean age 45.5 years, median age 47 years). Out of 55 procedures, 28 (50.9%) were performed in women of reproductive age, 27 (49.1%) were performed in women in menopause. The discharge was localized to the right breast in 28 patients, and to the left breast in 27 patients. Forty-one of the 55 patients included in the study met all of the criteria for pathological nipple discharge, while the other 14 patients had at least two of the three criteria. Final pathologies were classified as follows; intraductal papilloma / papillomatosis with atypia, intraductal papillary carcinoma (IPC) and ductal carcinoma in situ (DCIS); Potential Neoplastic and Malignant Lesion (PNML). Conclusions: In cases where direct intraductal imaging methods cannot be applied in patients admitted to the polyclinic with pathological nipple discharge, microductectomy emerges as an effective diagnosis and treatment method that can be applied with low morbidity.

Bipolar hemiarthroplasty for the treatment of femoral neck fractures with minimally invasive anterior approach in elderly

ObjectivesThe purpose of the study was to evaluate the efficacy of hemiarthroplasty with minimally invasive direct anterior approach (DAA) for the treatment of femoral neck fracture in elderly patients. We aimed to compare the DAA and the standard anterolateral approach (ALA), assessing multiple peri‑ and post-operative parameters. Design and settingBetween December of 2015 and May of 2017, patients operated with medial femoral neck fractures using bipolar hemiarthroplasty with DAA or ALA were evaluated. The volume of bleeding and transfusion, postoperative level of pain, mobilisation and functional outcome were assessed retrospectively. ParticipantsPatients between the age of 75 and 85, suffering Garden Type III Pauwels Type III and Garden Type IV medial femoral neck fractures were entered to the study. Patients had no history of anticoagulant therapy; the operation was performed in the first 48 h. All patients received similar postoperative pain management and physiotherapy. The type of implants was determined by the patients’ bone morphology and quality. Main outcome measuresThe outcomes of interest were the level of postoperative pain, blood loss, rate of recovery and physiotherapy, altered gait pattern and accuracy of leg length, related to DAA and ALA techniques. ResultsThe 51 patients operated with DAA showed significantly less pain, based on VAS (visual analogue scale), starting of the first postoperative day. Those patients who were subjected to DAA met with the criteria of hospital discharge 1.68 days earlier, compared to ALA patients. The length of leg was accurately set in 21% of ALA vs 54.9% of DAA patients. On the 12th week follow-up, limping was detected only 5.9% of DAA vs 46% of ALA groups. On the postoperative 2nd and 6th weeks, the HHS (Harris Hip Score) was significantly better in patients with DAA, compared to ALA (77 vs 65 and 91 vs 77, p < .05). ConclusionThe bipolar hemiarthroplasty with DAA allows earlier mobilisation, reduced postoperative pain and need for rehabilitation with an overall better functional outcome, compared to ALA. DAA is proven a reliable choice for femoral neck fractures, offering good outcome and faster recovery, similarly to total hip arthroplasties with degenerative arthritis.

A Clinical Profile and Immediate Outcome of Acute Glomerulonephritis (AGN) in Hospitalized Children

Introduction: Acute glomerulonephritis includes renal diseases in which immunologic mechanism triggers inflammation and proliferation of glomerular tissue that can result in damage to the basement membrane, proliferation of mesangium, capillary endothelium. Objectives: The objective of this study is to know the clinical profile and immediate outcome of acute glomerulonephritis in hospitalized children. Material & Methods: The study was done in Chittagong Medical College Hospital Pediatric Unit during the period of June 2007 to February 2008. All patients admitted with AGN, with or without complications were included in this study. Diagnostic criteria were scanty urine (infrequent and less than normal in amount as stated by the parents), swelling, high colored urine with or without albuminuria, no past history of similar attack and microscopic or naked eye haematuria. Criteria of discharge from the hospital were absence of puffiness and oedema, adequate urine formation, absence of heart failure and hypertensive encephalopathy. These were taken as clinical recovery. No long-term follow up was done. Results: Seventy-eight cases of acute glomerulonephritis (AGN) in children under 12 years of age were studied. Male to female ration 3:2. Scanty urine (84.0%), puffy face (88.5%) h, haematuria (80.0%), hypertension (82.5%), heart failure (11.5%) convulsion (14%) anuria (3.8%), RBC (92.3%), RBC cast (41%), albumin one (+) (52.6%) two + (14.1%) three + (14.1%), raised s. creatinine was (25.6%), blood urea (26.9%). Four patients were died. Among them three was due to hypertension and heart failure. One due to the development of acute renal failure. History of skin infection like scabies was present in 61.4% patient. Conclusion: Skin infection is the commonest cause of acute glomerulonephritis. Nephritic presentation (scanty urine oedema, haematuria, hypertension and heart failure) was the commonest mode of presentation. Immediate prognosis was excellent- Long term follow up is recommended.

Same-day discharge after elective percutaneous coronary intervention: A single-center experience

Advances in vascular access techniques, stent technology, and anti-platelet therapy have facilitated changes in discharge patterns following percutaneous coronary intervention (PCI). Overnight stay strategy remains the reference attitude although no recommendation has been published regarding the optimal duration of surveillance after uncomplicated PCI. To assess the feasibility and safety of same-day discharge (SDD) after elective PCI in Rouen University Hospital. All consecutive patients with stable coronary artery disease (CAD) scheduled for elective PCI in Rouen University Hospital between October 2017 and May 2018 were prospectively enrolled in our study. The eligibility criteria of same-day discharge (after 4 to 6 hours of surveillance) have been defined a priori . We evaluated the feasibility of same-day discharge and its safety by a combined endpoint including 30-day mortality, myocardial infarction, stent thrombosis, stroke, vascular complication, and readmission. From October 2017 and May 2018, 246 patients were included and 52 (21%) were discharged the same day (SDD patients). SDD patients were significantly younger than patients with overnight hospitalization (66.5 ± 11.4 vs. 70.3 ± 11.2 years, P = 0.03). A radial approach was more frequent in the SDD group (88.4% vs. 63.9%, P = 0.001). No major complications occurred during hospital surveillance in both groups and no events occurred within 30 days in SDD patients. Same-day discharge after elective PCI is feasible and safe in patients with stable CAD. Further studies are required to confirm our results and to evaluate the medico-economic impact of this strategy.

BISOPROLOL VERSUS ENALAPRIL ON HEMODYNAMICS UNDER GENERAL ANESTHESIA

Background: Systemic arterial hypertension is a common disease in patients undergoing surgery. Bisoprolol and Enalapril are anti-hypertensive drugs that affect the perioperative hemodynamics (blood pressure and pulse rate) in different manners. Objectives: The aim of the present study was to compare the effect of general anesthesia on the hemodynamics of hypertensive patients undergoing elective surgery and controlled on Enalapril versus Bisoprolol as a primary outcome, and criteria of discharge from recovery room, postoperative pain assessment, and adverse effects as a secondary outcome. Patients and Methods: In this comparative clinical randomized study, thirty hypertensive patients of both sexes, aged from 40 to 60 years, according to the American Society of Anesthiologists (ASA) physical status class II, undergoing elective surgery under general anesthesia of less than two hours duration (Abdominal and upper limb surgery), and controlled on antihypertensive medication regularly administered for at least six months duration (Enalapril versus Bisoprolol) were enrolled in the study. The study started from January, 2016 to February, 2018. Patients were randomly allocated into equal two groups, group (A) hypertensive patients controlled on Enalapril 10 mg and group (B) hypertensive patients controlled on Bisoprolol 5 mg. To evaluate intraoperative arterial blood pressure:( systolic arterial blood pressure, diastolic arterial blood pressure and mean arterial blood pressure) and Heart rate as follow: preoperative basal arterial blood pressure and pulse rate reading (0), immediately after induction, (1), every 5 minutes for 20 minutes and every 15 minutes till the end of the operation. Results: Hypertensive patients controlled on Enalapril (group E) had more statistically significant decrease in blood pressure (systolic-diastolic-mean) after induction of general anesthesia and more hypotensive episodes in the first 30 minutes after induction than patients treated with Bisoprolol 5 mg (group B) while, group A had more increase in blood pressure post-intubation, post-extubation and on exposure to noxious stimuli. When comparing heart rate changes between both studied groups the results showed that hypertensive patients controlled on Bisoprolol (group B) had more statistically significant heart rate control (decrease) all over the operation especially at periods of intraoperative stress as post-intubation, 1st 30 minutes of operation and post extubation than hypertensive patients controlled on Enalapril (group A). The remaining intraoperative periods of the operation are nearly comparable between both studied groups (A and B) as regard blood pressure and heart rate. Patients of both groups (A and B) had no statistically significant difference as regard criteria of discharge from recovery room, postoperative pain assessment and adverse effects. Conclusion: Bisoprolol as a beta blocking antihypertensive drug was associated with effective control of pulse rate and blood pressure and attenuation of pressor response to all stressful events all over the operation especially after laryngoscopy, intubation, extubation and the first 30 minutes of operation ensuring more hemodynamic stability under general anesthesia when compared to hypertensive patients controlled on Enalapril. Recommendation: Beta blockers (Bisoprolol) are recommended before surgery even for those who do not use them when exposed to anesthesia unless there are contraindications.

Paquimeningitis y glomerulonefritis crescéntica en vasculitis p-ANCA: Reporte de caso

Las vasculitis asociadas a anticuerpos contra el citoplasma del neutrófilo configuran patologías multisistémicas caracterizadas por afectar pequeños vasos. Se ha reportado compromiso de sistema nervioso central en 2% a 8% de los casos, rara vez al inicio del cuadro clínico.&#x0D; Se reporta el caso de un hombre de 67 años de edad con vasculitis p-ANCA, quien debutó con proptosis, paquimeningitis y disfagia severa. Posteriormente deterioro renal, necesidad de hemodiálisis, ciclofosfamida y recambio plasmático terapéutico con lo cual alcanza criterios de remisión parcial y egresa de diálisis. Las vasculitis ANCA se relacionan con una amplia gama de signos y síntomas inespecíficos. La edad de aparición, creatinina inicial y requerimiento de diálisis, son factores pronósticos. El inicio oportuno del tratamiento es fundamental, requiriendo por tanto un alto índice de sospecha

A Study on the Effective Half-life after the High Dose Radioactive Iodine (131I) Therapy for Thyroid Cancer Patients

High-dose 131I therapy has been generally carried out to remove remaining thyroid tissue or to cure metastasize lesion of patients who received full thyroidectomy due to differentiated thyroid cancers. In case high-dose 131I therapy is carried out for a patient, the patient should be hospitalized being isolated for a certain period in order to restrict the amount of exposure to radiation of people at large from the patient within the limit of a level of radiation. Effective half-life is an important value to calculate how family members are exposed to radiation from a patient or to decide the period of isolation of the patient from the family members. Therefore, in this study we calculated the effective decay constant, effective half-life and period of isolation of high-dose 131I therapy patient using NM670 SPECT/CT. As a result of carrying out this study, the effective half-life of high-dose 131I therapy patients was derived and the time to reach the discharge level of 1.2 GBq was confirmed. When they were compared with each other in each of curative doses, the effective half-life did not have significant difference, but the time when the level of radiation remaining in the interior of the body to reach the criteria of isolation and discharge showed significant difference and it could be confirmed that the higher the curative dose the longer the period of isolation becomes. When the effective half-lives in each type of preparation were compared with each other, they did not show significant difference. However, When the times to reach the level of radiation that is the criteria of isolation and discharge in each type of preparations, they showed significant difference. The cause of the shortening of the isolation period for rhTSH patients group is decided to be low curative dose. Accordingly, if the current national health insurance (the insurance is applied to using of rhTSH in 3.7 GBq or lower) is maintained, while discerning them in each of types of preparation, we would be able to discharge patients at the time earlier than the current period of isolation (2 nights and 3 days).

Conservative Management of Synchronous Intrauterine Molar Pregnancy and Cervical Ectopic Pregnancy : A case Report

Background: Systemic arterial hypertension is a common disease in patients undergoing surgery. Bisoprolol and Enalapril are anti-hypertensive drugs that affect the perioperative hemodynamics (blood pressure and pulse rate) in different manners. Objectives: The aim of the present study was to compare the effect of general anesthesia on the hemodynamics of hypertensive patients undergoing elective surgery and controlled on Enalapril versus Bisoprolol as a primary outcome, and criteria of discharge from recovery room, postoperative pain assessment, and adverse effects as a secondary outcome. Patients and Methods: In this comparative clinical randomized study, thirty hypertensive patients of both sexes, aged from 40 to 60 years, according to the American Society of Anesthiologists (ASA) physical status class II, undergoing elective surgery under general anesthesia of less than two hours duration (Abdominal and upper limb surgery), and controlled on antihypertensive medication regularly administered for at least six months duration (Enalapril versus Bisoprolol) were enrolled in the study. The study started from January, 2016 to February, 2018. Patients were randomly allocated into equal two groups, group (A) hypertensive patients controlled on Enalapril 10 mg and group (B) hypertensive patients controlled on Bisoprolol 5 mg. To evaluate intraoperative arterial blood pressure:( systolic arterial blood pressure, diastolic arterial blood pressure and mean arterial blood pressure) and Heart rate as follow: preoperative basal arterial blood pressure and pulse rate reading (0), immediately after induction, (1), every 5 minutes for 20 minutes and every 15 minutes till the end of the operation. Results: Hypertensive patients controlled on Enalapril (group E) had more statistically significant decrease in blood pressure (systolic-diastolic-mean) after induction of general anesthesia and more hypotensive episodes in the first 30 minutes after induction than patients treated with Bisoprolol 5 mg (group B) while, group A had more increase in blood pressure post-intubation, post-extubation and on exposure to noxious stimuli. When comparing heart rate changes between both studied groups the results showed that hypertensive patients controlled on Bisoprolol (group B) had more statistically significant heart rate control (decrease) all over the operation especially at periods of intraoperative stress as post-intubation, 1st 30 minutes of operation and post extubation than hypertensive patients controlled on Enalapril (group A). The remaining intraoperative periods of the operation are nearly comparable between both studied groups (A and B) as regard blood pressure and heart rate. Patients of both groups (A and B) had no statistically significant difference as regard criteria of discharge from recovery room, postoperative pain assessment and adverse effects. Conclusion: Bisoprolol as a beta blocking antihypertensive drug was associated with effective control of pulse rate and blood pressure and attenuation of pressor response to all stressful events all over the operation especially after laryngoscopy, intubation, extubation and the first 30 minutes of operation ensuring more hemodynamic stability under general anesthesia when compared to hypertensive patients controlled on Enalapril. Recommendation: Beta blockers (Bisoprolol) are recommended before surgery even for those who do not use them when exposed to anesthesia unless there are contraindications.

Kshar sutra in Pilonidal sinus: a minimal invasive modality of management

Pilonidal sinus is an infective condition between the natal cleft in young males. Chronic Pilonidal disease normally needs a surgical treatment for eradication of septic focus, which ranges from cutting of the tract to complex rotation flap. Kshar sutra is an age old treatment modality practiced since times of Sushruta. Lack of established evidence in the evidence based scenario is the rationale for current study. It is a tertiary care hospital based case series with inclusion criteria of pain and discharge in and around the natal cleft. Clinically diagnosed as Pilonidal sinus with two openings one in natal cleft and other outside the natal cleft. The patients with multiple sinuses, previous treatment and co-morbid conditions are excluded. The study factor was of Kshar sutra threading of Pilonidal Sinus done under local infiltration of anaesthesia around the tract and changed 2-3 times during entire treatment period on clinical judgement. The outcome factors were duration of cutting open of tract and duration for total healing, number of times Kshar sutra was changed and local complications. A total of 5 cases, all males with median age of 21 years and median presentation duration of 8 months were recruited. The median cutting duration of the tract was 23 days and total tract healing time was 29 days. Kshar sutra was changed 2-3 times during the entire duration of treatment. There was no post-operative complication and recurrence after 20.4 months of follow up. Kshar sutra is a minimal invasive procedure in Pilonidal sinus which has encouraging results but need large sample and an RCT to provide quality evidence.

Comparison of visual, clinical, and microbiological diagnosis of symptomatic vaginal discharge in the reproductive age group

Background Symptomatic vaginal discharge is the most frequent symptom in women of reproductive age group. Discharge may be physiological or pathological, for which bacterial vaginosis is the most common cause, followed by candidiasis and trichomonas. Multiple infections can also coexist. Aim This study aimed to determine the microbiological and clinical profile of symptomatic vaginal discharge and its utility in the management of genital tract infection. Participants and methods This was a prospective study of 200 women with vaginal discharge referred for clinical examination and pelvic examination through a speculum examination according to the criteria of vaginal discharge. To determine the cause, high vaginal swab by Ayre’s spatula was obtained for the Microbiology Department through transport media. The collected data were tabulated and analyzed. Results Bacterial vaginosis is the most common cause of vaginal discharge, followed by candidiasis and trichomonas in our setup. For the etiological diagnosis of symptomatic vaginal discharge, the microbiological diagnostic approach is the best. A specific diagnosis was made in 83.5% of cases, whereas an etiology was not found in 16.5% of cases. Conclusion Treatment on the basis of a clinical diagnosis is not accurate. Thus, the most ideal approach in this study is the microbiological diagnostic approach for the etiological diagnosis of symptomatic vaginal discharge.

Environmental impact of RO units installation in main water treatment plants of Basrah city/south of Iraq

The citizens of Basrah city are suffering from the problem of high salinity water supply. This problem is proposed to be solved by installing RO units in 16 water treatment plants of Basrah city. RO units produce high-salinity brine water. The aim of this study is to predict the environmental impact of RO units installation measured in terms of TDS increase of Shatt Al-Arab River water. The TDS increase was predicted using HEC-RAS software. The software was applied to simulate twelve cases of TDS distribution in water of Shatt Al-Arab River. During each of the twelve simulation cases, the proposed RO units were assumed to have recovery percent (RP) of 50% and 85%. The simulation results indicated that when the proposed RO units have RP of 85%, the max percentage of TDS increase is 5.9%. While, when the proposed RO units have RP of 50%, the max percentage of TDS is 2.7%. The comparison of these results with the regulation criteria of brine water discharge shows that; when the installed RO units have RP of 85%, the percentages of TDS increase will exceed the salinity limit of most regulation criteria (5%).

Adherence to standard admission and discharge criteria and its association with outcome of pediatric intensive care unit cases in Al-Ahrar Hospital Zagazig

BackgroundThe effective use of pediatric intensive care unit (PICU) beds is an important issue as they are expensive and have limited resources. Adherence to well-defined admission and discharge criteria for PICU cases will be very helpful for better PICU bed utilization. Aim of the studyThe aim of the present study is to evaluate of criteria of admission and discharge of all admitted and discharged patients to the PICU in Al-Ahrar Hospital, Zagazig, Egypt, in comparison to the standard criteria of admission and discharge of the American Academy of Pediatrics (AAP). MethodsThis study included 125 children admitted to the PICU with different diagnoses during a six month period from July 2013 to December 2013. The recorded data of the recruited patients include demographic data, cause of referral, criteria of admission, physical examination, provisional diagnoses at admission, diagnostic studies, definite diagnoses, outcome and criteria of discharge. Pediatric index of mortality second version (PIM-2) was calculated from the collected information within one hour period from the time of admission to the PICU. ResultsThe admission of male children to PICU was slightly higher than females (51.2% versus 48.8%). Incompatible admission represented 18.4% of all admitted cases. Complicated gastroenteritis was the most frequent final diagnosis in our PICU (16.8%). This was followed by pneumonia (15.2%), traumatic brain injury (12%), status epilepticus (8.8%), sepsis (6.4%) and meningitis (4.8%). Overall mortality rate was 14.4% (18 out of 125). The highest mortality rate was in traumatic cases (33.3%), followed by multiple organ dysfunction syndrome (MODS) in sepsis cases (22.2%) and neurological cases (22.2%). Incompatible discharge represented 4.8% of all discharged cases. Average LOS and mean PIM-2 were significantly higher in non-survivors group than in survivors group (18.3days and 34.1% versus 5.4days and 2.1%, respectively). These two factors were also the only significant predictors of outcome. The optimal cutoff value of PIM-2 to predict mortality rate in the studied patients was >5% with high sensitivity and specificity (100% and 95.3%, respectively). ConclusionPICU facilities at Al-Ahrar Hospital, Zagazig are insufficient to meet the demand. An admission score based on the PIM-2 score could assist in the selection of patients for these limited PICU facilities.

Partial discharge occurrence induced by crack defect on GIS insulator operated at 1100 kV

It was observed that partial discharges were not detected from GIS insulators with the crack defects operated at 1100 kV in the UHV substation in China. The question is that whether crack defects can induce partial discharge at the operated voltage. In order to obtain the relationships between PD occurrence and crack configuration on GIS insulator operated at 1100 kV, the electric field strengths in the crack, changed with crack length, crack depth, crack direction, crack position, were simulated on a 1100 kV GIS insulator at operation voltage. The simulated results indicated that the field strength in the cracks, which located on the surface of the insulator or paralleled to the electric field direction, were close to that in the insulator around the crack, and the crack cannot induce partial discharge. However, the field strength in the cracks, which located in the deep position of insulator and in perpendicular to the electric field direction, was much higher than that in the insulator around the crack. For example, in the case of the crack located close to high voltage conductor, field strength in deep crack perpendicular to electric field direction could be 5.6 times of the field strength in the insulator around the crack, and it close to the field criteria of gas discharge, leading partial discharge occurred at operation voltage. The simulated results were verified by the experiment conducted on the insulators with cracks. The experimental results indicated that the crack could produce partial discharge, only when it is located in deep insulator material and in perpendicular to the electric field direction, and close to high voltage conductor.

Assessment of land use impact on hydraulic threshold conditions for gully head cut initiation

Abstract. A gully as an accelerated erosion process is responsible for land degradation under various environmental conditions and has been known as a threshold phenomenon. Although the effects of gullying processes have been well documented, few soil erosion models have taken into account the threshold condition necessary for gully development. This research was devoted to determining the effects of land use change on hydraulic threshold condition and stream power of water flow through an in situ experimental flume (15 m × 0.4 m). Results indicated that head cut initiation and detachment rates showed a better correlation to stream power indices than shear stress (τcr). The threshold unit stream power value (ωu) for head cut initiation in rangeland, abandoned land, and dry farming land was 0.0276, 0.0149, and 4.5 × 10−5 m s−1, respectively. Moreover, the micro-relief condition of soil surface and surface vegetation affected the flow regime of discharge and velocity. It is seen that the composite hydraulic criteria of Froude number (Fr) and discharge (Q) can clearly discriminate the land uses' threshold. In fact, the remarkable decrease of τcr in dry farming was related to the effect of tillage practice on soil susceptibility and aggregate strength. The findings indicated that using the unit steam power index instead of critical shear stress could increase the models' precision for prediction of head cut development. Compared to the Ephemeral Gully Erosion Model (EGEM) equation for critical shear stress, it is important to point out that for modelling of gully erosion, using single soil attributes can lead to an inaccurate estimation for τcr. In addition, based on the findings of this research, the use of threshold values of τcr = 35 dyne cm−2 and ωu = 0.4 cm s−1 in physically based soil erosion models is susceptible to high uncertainty when assessing gully erosion.

Multi-center prospective evaluation of discharge criteria for hospitalized patients with Crimean-Congo Hemorrhagic Fever

IntroductionThe information of discharge criteria in patients with Crimean-Congo Hemorrhagic Fever (CCHF) is limited. In this study, we aimed to determine the clinical and laboratory parameters used in discharging the patients by the experienced centers. Materials and methodsThe study was done in 9 reference centers of CCHF from May 1, 2015 to December 1, 2015 and included laboratory-confirmed patients with CCHF. The study was prospective, observational and non-interventional. ResultsThe study included 260 patients. Mean age was 51.3 ± 16.3 years; 158 (60.8%) were male. Mean hospital stay was 7 ± 2.6 days. The decision of discharging was taken considering clinical and laboratory findings. On discharge, no patients had fever or hemorrhage. The patients were followed-up clinically and a repeat CCHF PCR was not studied. All centers considered the following criteria for discharge: no fever and hemorrhage, improvement in clinical findings and laboratory studies. For all patients except one, platelet count was >50,000/mm3 and had a tendency to increase.Prothrombin time and international normalized ratio (INR) were normal in 258 (99.6%) and 254 (98.1%) patients respectively. Alanine aminotransferase (ALT) was either normal or not higher than 10-fold and had a tendency to decrease in 259 (99.6%) patients. ALT and aspartate aminotransferase (AST) levels were not taken as discharge criteria with priority. During 30 days following the discharge, complication, relapse, or secondary transmission were not reported. ConclusionsThe discharging practice of the centers based on clinical and laboratory parameters seems safe considering no complications, relapses, or secondary infection thereafter. Current discharge practice of the centers composed of no fever and hemorrhage, improvement in clinical findings, platelet count of either >100,000/mm3 or >50,000/mm3 with a tendency to increase, and normal bleeding tests can be used as the criteria of discharge.