Hospital Day Research Articles

Orthoplastic Management of Lower Limb Traumas: A Retrospective Study on Polytraumas Versus Isolated Injuries.

Open fractures of the lower limb represent a common challenge for trauma centers. Even where national guidelines are available, these standards are frequently missing. Our study evaluates the influence of polytrauma on the adherence to the timing and management required in an orthoplastic approach. A retrospective review was performed on 36 patients affected by a Gustilo-Anderson grade IIIA, IIIB, or IIIC fracture of the lower limb between 2018 and 2022. Data related to patient management were analyzed: time to the first evaluation by a plastic surgeon, time to soft tissue coverage, time to definitive osteosynthesis, days in intensive care unit (ICU), days of hospitalization, and total cost of hospital stay. Patient satisfaction was evaluated through the administration of 2 questionnaires: the Enneking and the Foot Function Index (FFI). In 23 patients (63.9%), a soft tissue reconstruction was required. Of these, 13 were polytraumas (PT) (56.5%) and 10 were affected by an isolated lower limb fracture (ILLF) (43.5%). The median time to wound excision was 7.0 days (IQR, 0-16.0) in the PT group and 12.5 days (IQR, 1-41.0) in the ILLF group, whereas the mean time to soft tissue coverage was 15.0 days (IQR, 4.0-17.0) in the PT group and 38.0 days (IQR, 25.0-65.0) in the ILLF group. Mean time to definitive fixation was 33.0 days (IQR, 6.5-70.0) in the PT group and 16.5 days (IQR, 3.0-26.0) in the ILLF group. Statistically significant difference was reported on mean time to soft tissue coverage, whereas not relevant differences were reported on mean time to plastic surgeon involvement, first debridement, definitive fixation, days of hospitalization, costs, and Enneking and FFI score. This is the first study comparing the effectiveness of the orthoplastic approach between isolated lower limb fractures and polytraumas. According to our study, open lower limb fracture management is paradoxically more effective in polytraumas rather than in isolated injuries because a multidisciplinary approach is mandatory in severely injured and compromised patients.

Dynamics and prognostic repeatability of qualitative and quantitative blood characteristics in patients with new coronavirus infection

The study presents the possibility of using clinical blood test indicators characterizing the red hematopoietic germ in diagnosing the severity of the clinical condition of patients with COVID-19.Aim: Dynamic monitoring of changes in the quantitative and qualitative characteristics of erythrocytes and reticulocytes to identify parameters that characterize the severe course of a new coronavirus infection in patients with cardiovascular pathology.Material and Methods. The study included 94 patients with a confirmed diagnosis of a novel coronavirus infection (NCI), hospitalized in the department for the treatment of patients with CVD and COVID-19 with intensive care unit on the basis of the Academician L.S. Barbarasha between February and March 2022. Clinical blood analysis was performed on the 1st, 3rd and 7th day of hospitalization. Whole blood with K2EDTA was studied on a Sysmex XN-1000 hematological analyzer.Results. To determine the diagnostically significant indicators of a clinical blood test, patients were divided into 2 comparison groups: group 1 – 71 people with a mild infection, group 2 – 23 people with moderate, severe and extremely severe NCI. On the first day of observation, 70% of patients in the group of unfavorable course were diagnosed with anemia, while in the group of mild course, 38% of patients were diagnosed. In patients with unfavorable development of the disease, normoblastemia was observed, which, according to the results of regression analysis, increased the risk of an unfavorable course by 5 times OR 0.24 (95% CI 0.07–0.884). Also in the severe group, there was a decrease in hemoglobin saturation of reticulocytes, which was expressed in deficient Ret-He and negative Delta-Hb values. Using binary logistic regression, it was found that a negative Delta-Hb 6 times increases the risk of an unfavorable course of NCI, OR 6.18 (95% CI 1.971–19.3).Conclusion. The parameters of a clinical blood test that characterize the hemoglobinization of reticulocytes reflect the severity of the course of a new coronavirus infection and can be used to assess the clinical condition of patients with this infection.

Sensitivity of Fall Risk Perception and Associated Factors in Hospitalized Patients with Mental Disorders

PurposeTo reduce falls in hospitalized patients with mental disorders, the patients should be sensitive to fall risk perception. This study identified the sensitivity to fall risk perceptions and associated factors, including demographic, clinical, and fall-related factors, among inpatients with mental disorders. MethodsWe used a descriptive, cross-sectional design, recruiting 170 inpatients with mental disorders from two psychiatric hospitals in South Korea. Sensitivity to fall risk perception was classified using fall occurrence and the Fall Risk Perception Questionnaire. ResultsThe prevalence of falls was 16.5%. Approximately 47% of falls occurred within 10 days of hospitalization, 67.9% within 1 month, and 85.7% within 2 months. Among the 28 participants who fell, 60.7% had inadequate-low sensitivity to fall risk perception. Among the 142 participants who did not fall, 11.3% had inadequate-high sensitivity to fall risk perception. Low sensitivity to fall risk perception was related to diagnosis, psychiatric symptoms, and fall history due to the mental disorder. High sensitivity to fall risk perception was related to age at onset of the mental disorder, urinary or bowel problems, and fear of falling. The multiple logistic regression found that the diagnosis and fall history due to the mental disorder were associated with inadequate-low sensitivity, and age at onset and fear of falling were associated with inadequate-high sensitivity to fall risk perception. ConclusionsOver 60% of patients who fell had low sensitivity to fall risk perception. Inadequate-low and high sensitivity to fall risk perception are related to the demographic, clinical, and fall-related characteristics among inpatients with mental disorders. Therefore, nurses should assess fall risk perception, consider these factors together during this assessment, and manage them appropriately in hospitalized patients with mental disorders.

Severe Salicylate Poisoning Due to Teaberry Flavoring Ingestion: A Case Report

BackgroundCurrently there are many commercial uses of methyl salicylate including fragrances, flavoring, topical pain relief, and polymer restoration. Most recorded instances of human toxicity due to methyl salicylate are the result of topical or accidental exposures. However, this is a previously unreported case of an adult patient who intentionally ingested teaberry flavoring causing life-threatening salicylism. Case ReportA 22-year-old man presented to the Emergency Department with the chief complaint of nausea, vomiting and abdominal pain. Triage nursing noted the patient's vomit smelled strongly of wintergreen. Further history indicated the patient had ingested approximately 40 mL of teaberry oil while using it to make ice cream. The initial serum salicylate concentration was 111 mg/dL. The medical toxicology team was consulted, and the patient was given a singular dose of activated charcoal by mouth. He was also administered both an intravenous sodium bicarbonate bolus and sodium bicarbonate infusion. He was admitted to the intensive care unit while the nephrology service was consulted to initiate emergent hemodialysis (hD). After the single hD treatment with concomitant serum and urine alkalization, the patient had progressive improvement of salicylate concentrations. He was discharged on hospital day three in normal condition. Why should an emergency physician be aware of this?Emergency physicians should be aware of novel etiologies of life-threatening salicylate poisoning.

Role of Heart Rate, Acidosis, Consciousness, Oxygenation, and Respiratory Rate Score in Predicting Outcomes of Noninvasive Ventilation in Chronic Obstructive Pulmonary Disease Patients.

In patients with chronic obstructive pulmonary disease (COPD), early detection of noninvasive ventilation (NIV) failure is a promising technique for decreasing mortality. The objective of this study was to evaluate the efficacy of heart rate, acidosis, consciousness, oxygenation, and respiratory rate (HACOR) score in predicting NIV outcome in COPD-associated respiratory failure. A prospective observational study was conducted on 100 COPD patients with acute respiratory failure who were initiated on NIV. HACOR score was calculated at the start of NIV and after 1-2, 12, and 24 hours. NIV failure was defined as progression to invasive mechanical ventilation or death. NIV success was defined as liberation from NIV prior to hospital day seven and not meeting criteria for failure. In this study, 100 patients with COPD and respiratory failure were enrolled. Their mean age was 65.34 years [standard deviation (SD) 8.19]. Male patients were predominant (n = 81). Eighty-nine percent of patients were smokers, and the remaining had exposure to biomass fuel. At the initiation of NIV, the median HACOR score was 3 (interquartile: 2, 4). In 13% of patients, there was NIV failure. There were 17 (17%) patients whose HACOR score at initiation was ≥5. In patients with a HACOR score ≥5, the NIV failure rate was 76.4% and mortality was 41.1%. The area under the curve (AUC) for prediction of NIV failure by HACOR score at initiation was 0.980 (p-value < 0.05). The HACOR score had high sensitivity as well as specificity at initiation in the prediction of NIV failure. A higher HACOR score predicts a high chance of NIV failure. Obtaining the HACOR score at the bedside makes it convenient for assessing the efficacy of NIV in patients with COPD.

Identifying factors associated with post-hospital falls in older patients: a territory-wide cohort study

ObjectivesPost-hospital falls impose a substantial healthcare burden on older adults, yet contributing factors remain inadequately examined. This study aimed to investigate underinvestigated factors associated with post-hospital falls. Study designRetrospective territory-wide cohort study. MethodsWe examined the electronic medical records of patients aged ≥65 who were discharged from public hospitals in Hong Kong (2007–2018). During the 12 months following discharge, participants were monitored to identify falls based on diagnosis codes or clinical notes from inpatient episodes, the emergency department (ED) visits, and death records. Falls were categorized into two groups: those only requiring ED visits and those requiring hospitalizations. Binary logistic and multinomial logistic regressions examined the associated factors for post-hospital falls and subcategories of falls, respectively. ResultsAmong 606,392 older patients, 28,593 (4.71%; 95% CI = 4.66%–4.77%) experienced falls within 12 months after discharge. Of those, 8438 (29.5%) only required ED visits, and 20,147 (70.5%) required hospitalizations. Discharge from non-surgical wards, length of stay over two weeks, receiving the Geriatric Day Hospital and Rehabilitation Day Program, advancing age, being female, having more comorbidities, taking more fall risk increasing drugs, previous admission for falls, and living in Hong Kong Island were associated with increased fall risk. Receiving allied health service or nurse service was associated with reduced risk. The same factors were more associated with falls requiring hospitalizations rather than falls only requiring ED visits. ConclusionsOlder patients with identified factors were particularly vulnerable to post-hospital falls leading to rehospitalizations. Fall risk assessment and tailored prevention should prioritize this group.

Clinical and statistical analysis of the course of preterm birth based on the materials of communal enterprise «Regional Perinatal Center of the Rivne Regional Council» in 2013–2023 years

One of the priority tasks of modern medical science and practice is the preservation of reproductive health and the gene pool of the nation. It is especially difficult to perform this task during the russian war in Ukraine, which has been going on for more than ten years. According to sociologists, the outcomes of a low birth rate for the country will be catastrophic precisely because of the war.One of the reasons for the decline in the quality of health in the future is the increase in the specific weight of premature births, the frequency of which, according to the World Health Organization, has increased in Ukraine already after six months of full-scale war.The objective: to conduct an analysis of the course of premature births in the conditions of war based on the materials of the communal enterprise (CE) “Regional Perinatal Center of the Rivne Regional Council” for 2013–2023.Materials and methods. A retrospective clinical and statistical analysis of 2,742 histories of pregnancy and childbirth of women who were in labor between 22/0–36/6 weeks of gestation in obstetric departments of the communal enterprise “Regional Perinatal Center of the Rivne Regional Council” in 2013–2023 was carried out.Results. According to CE “Regional Perinatal Center of the Rivne Regional Council”, a progressive decrease in the total number of births by 41.9% was observed in the Rivne Region from 2013 to 2023. At the same time, in the general population of women giving birth, the specific rate of premature births did not have a tendency to increase.In the structure of preterm births, early and late preterm births prevailed. The specific gravity of very early preterm births, which are the most unfavorable for perinatal outcomes, did not have a sustained upward trend. At the same time, the frequency of too early premature births among residents of districts and territorial communities of the Rivne region has significantly increased (2013 – 19 (79.2%) cases, 2023 – 17 (100.0%) cases; p&lt;0.05).Every second premature birth occurred within the first day of hospitalization of a pregnant woman, while the specific rate of such too early premature births increased by 3.4 times during the analyzed period, which significantly worsens the chances of survival of newborns and is the reason for their high perinatal morbidity.The number of premature births in pregnant women with multiple pregnancies remains stable. Every third preterm birth took place on the background of early premature rupture of the fetal membranes, while a significant increase in the frequency of this complication was found in women who gave birth at 22/0–27/6 weeks of pregnancy.Traditionally, the specific rate (55.7–57.5%) of surgical delivery by caesarean section of pregnant women and mothers with premature births remains high, which contributed to a reliable reduction of the perinatal mortality rate of premature babies by 13.7% due to the reduction of antenatal losses. Indicators of early neonatal death were formed at the expense of newborns from too early and early premature births in the same ratio.Conclusions. According to thedata of CE “Regional Perinatal Center of the Rivne Regional Council”, there was a progressive decrease in the birth rate in the Rivne Region with a simultaneous stabilization of the number of premature births. The widespread use of a holistic approach during the medical care of pregnant women and the introduction of modern methods of care for premature newborns ensured a significant decrease in the rate of perinatal death of premature infants due to the reduction of antenatal losses.

Combined Korean Medicine Treatment of a Patient Diagnosed with Posterior Limb of Internal Capsule Infarction Presenting with Hiccups as the Chief Complaint - A Case Report

Objective: Hiccup is a sudden, involuntary contraction of the diaphragm and intercostal muscles, followed by laryngeal closure. Persistent hiccups can occur in the central nervous system following a cerebral infarction. While medications, for example chlorpromazine, are commonly used for treatment, they often fail to fully resolve the hiccups, showing little to no improvement in symptoms. The aim of this study was to present the treatment response of a patient diagnosed with posterior limb of internal capsule (PLIC) infarction, who was experiencing hiccups and was treated with combined Korean medicine after taking chlorpromazine.Case Presentation: A 71-year-old male diagnosed with left PLIC infarction was experiencing problems in daily life due to hiccups and dysarthria. During the 10-day hospitalization, he received treatment that included herbal medicine (modified Hyeolbuchugeo-tang, Xiěfǔzhúyūtāng), acupuncture (GV20, LI11, ST36, LI4, LR3, and submandibular area acupoint), moxibustion, cupping, and physical therapy. After 10 days of hospitalization, the patient’s hiccups disappeared, and he did not have to take any chlorpromazine. The score on the Numerical Rating Scale fell from 7-8 to 1-2. The 5-level EQ-5D version (EQ-5D-5L) fell from 11 to 7, and the EQ Visual Analogue Scale (EQ-VAS) rose from 20 to 80. The frequency (times per minute) of hiccups decreased and almost disappeared. During outpatient treatment, the patient stated that he did not experience hiccups for 7 months, and no significant side effects were observed.Conclusion: This study suggests that a patient with hiccups as a chief complaint can be effectively treated with combined Korean medicine. However, more studies with control groups are needed to confirm these findings.

Real-world effectiveness of inactivated vaccine on COVID-19 patients with comorbidities.

Patients with underlying diseases do not respond adequately to vaccines. Thus, continued research on the effects of vaccination in patients with comorbidities is crucial to evaluate the necessity of vaccination in this population. This study assessed the protective effects of inactivated vaccines on the severity and prognosis of COVID-19 in patients with comorbidities. A real-world retrospective cohort study was conducted from April 7, 2022, to June 6, 2022, at the Fudan University Pudong Medical Center. The collected data included demographic characteristics, symptoms, clinical severity, and outcomes of the COVID-19 patients. A total of 3,996 indigenous confirmed cases and asymptomatic infections with the Omicron variant were enrolled. Of these, 1322 (33.1%) patients had chronic comorbidities. Compared to others, COVID-19 patients with comorbidities were older, had lower vaccination rates, longer days of nucleic acid conversion and hospitalization, and a higher incidence of severe-critical illness and composite endpoint. Multivariable analyses suggested that in the comorbidity group, two-dose- (odds ratio [OR] 0.38, 95% CI 0.24-0.60; OR 0.20, 95% CI 0.08-0.51) and three-dose vaccinated patients (OR 0.26, 95% CI 0.14-0.47; OR 0.21, 95% CI 0.08-0.58) had a lower risk of aggravation and the composite endpoint; similar results were observed in the non-comorbidity group. Two or more doses of inactivated vaccines could prevent deterioration and poor prognosis in Omicron-infected patients, regardless of the presence of an underlying disease. Our findings support maximizing coverage with inactivated vaccines in highly vaccinated populations, such as those in China.

The unique metabolic and lipid profiles of patients with severe COVID-19 compared to severe community-acquired pneumonia: a potential prognostic and therapeutic target

ABSTRACT Background Compare the changes and differences in metabolome and lipidome profiles among severe COVID-19 and CAP patients with ARF to identify biomarkers that could be used for personalized diagnosis, prognosis, and treatment. Research design and methods Plasma samples were taken at hospital admission (baseline) and on the 5th day of hospitalization (follow-up) and examined by RP-LC-QTOF-MS and HILIC-LC-QTOF-MS. Results 127 patients, 17 with CAP and 110 with COVID-19, were included. The analysis revealed 87 altered metabolites, suggesting changes in the metabolism of arachidonic acid, glycerolipids, glycerophospholipids, linoleic acid, pyruvate, glycolysis, among others. Most of these metabolites are involved in inflammatory, hypoxic, and thrombotic processes. At baseline, the greatest differences were found in phosphatidylcholine (PC) 31:4 (p < 0.001), phosphoserine (PS) 34:3 (p < 0.001), and phosphatidylcholine (PC) 36:5 (p < 0.001), all of which were notably decreased in COVID-19 patients. At follow-up, the most dysregulated metabolites were monomethyl-phosphatidylethanolamine (PE-Nme) 40:5 (p < 0.001) and phosphatidylcholine (PC) 38:4 (p < 0.001). Conclusions Metabolic and lipidic alterations suggest inhibition of innate anti-inflammatory and anti-thrombotic mechanisms in COVID-19 patients, which might lead to increased viral proliferation, uncontrolled inflammation, and thrombi formation. Results provide novel targets for predictive biomarkers against CAP and COVID-19. Trial registration Not applicable.

Consequences of Delayed Access to Community Social Care for Older Hospital Inpatients with Frailty

Abstract Background The social care system is currently under enormous pressure leading to delays in home care provision and often unnecessarily prolonged hospital stays for frail, older people. The risks of prolonged hospital admissions for frail older people are well-recognised. The aim of this study therefore was to examine the rate of hospital-associated complications (HAC) amongst older inpatients who are otherwise medically optimised for discharge but are awaiting home care to facilitate discharge home. Methods Electronic medical records of patients ≥65 years with delayed transfer of care (DTOC) while awaiting provision of home care provision were examined for incidence of delirium, falls and infection. A smaller cohort of current inpatients (n=14) awaiting home care were interviewed with focus on quality-of-life (CASP-19), loneliness (UCLA Scale) and depressive symptoms (CES-D). Results 59% (57/97) of patients (median 82 years, 60% female, median Clinical Frailty Scale 6) developed a HAC (delirium, fall or infection) while considered medically optimised for discharge. Logistic regression models demonstrated that for every additional day spent awaiting home care, the likelihood of a HAC increased by 4% (Adjusted Odds Ratio 1.04 (95% CI 1.00 – 1.08; p=0.027; z=2.21). Almost half of interview respondents reported that quality-of-life had declined while discharge home was delayed, while over 1/3 (5/14) met criteria for clinically significant depressive symptoms (CES-D-10 ≥10). Conclusion Almost 60% of frail, older inpatients who are medically optimised have a HAC while awaiting home care provision, with the likelihood increasing significantly for every additional day in hospital awaiting care. Long delays to home care package provision are having a hugely detrimental impact on the health of frail, older people in hospital. While addressing the crisis in social care is challenging, interventions to tackle this deficit in home care provision are required urgently.

The current status of early nursing for emergency pancreatitis and analysis of factors influencing prognosis: A retrospective study.

This study is to investigate the incidence of pain and the influencing factors of prognostic complications in early admission care of pancreatitis in the emergency department patients. This provides a basis for clinical nursing management and prognosis improvement. Hundred patients with acute pancreatitis admitted to the tertiary hospital between January 2021 and December 2023 were selected according to the inclusion and exclusion criteria. It collected basic baseline data and medical data of patients during admission, clarifies whether patients have complications, and analyzed the length of hospital stay. Comparing hospital stays >7 days with <7 days. A questionnaire on patient psychological status was collected, and single factor analysis was conducted on different prognostic factors. Binary logistic regression was used for single factor analysis, and P < .05 was considered statistically significant. The presence or absence of complications during treatment is the main criterion for determining the prognostic impact of pancreatitis in the emergency department patients. Among 100 patients, 26 (26%) had complications during hospitalization, 74 (74%) had no complications during hospitalization, and 64 (64%) had a stay of >7 days. There were statistically significant differences (P < .05) in smoking status and history of hypertension between the complication group and the non-complication group. In the comparison between the group with <7 days of hospitalization and the group with >7 days of hospitalization, age, education level, smoking status, and history of hyperlipidemia showed statistical significance (P < .05). The fasting days, BISAP score, first bowel movement time, C-reactive protein, blood urea nitrogen, albumin, duration of severe pain within 24 hours of admission, and duration of severe pain within 24 to 48 hours of admission were all statistically significant (P < .05). Pancreatitis in the emergency department patients are prone to exacerbation and prolonged pain during early hospitalization. In nursing, timely attention should be paid to the patient's pain issues, timely pain relief measures should be taken, and the occurrence of complications should be reduced, reducing the patient's hospitalization time. Meanwhile, it is necessary to constantly pay attention to changes in the patient's gastrointestinal function and experimental indicators.

Virus Load Kinetics in Lassa Fever Patients Treated With Ribavirin: A Retrospective Cohort Study From Southern Nigeria

Abstract Background The standard of care for Lassa fever is the use of ribavirin with supportive therapy. There is little information on the course of viremia and its relationship with clinical outcomes in patients treated with ribavirin. Methods We conducted a retrospective analysis of virologic and clinical parameters of 152 reverse transcription polymerase chain reaction–confirmed Lassa fever cases admitted and treated with ribavirin therapy. We describe the Lassa virus RNA kinetics in blood in relation to the clinical course of the patients. Results The overall mortality was 9%. The median duration (interquartile range [IQR]) of illness before admission was 8 (5–12) days. Median (IQR) Ct values on admission (t0) were lower among patients who died (21 [20–27]) than in those who survived (34 [30–37]; P &amp;lt; .01). The receiver operating characteristics curve of the association between outcome and Ct value at t0 had a high classification performance, with an AUC of 0.92 (95% CI, 0.86–0.98). The median time to viral clearance (IQR) was 10 (5–15) days. The viral load decreased steadily with the duration of treatment, and all survivors achieved viral clearance within 25 days of hospitalization. Conclusions Our study demonstrates that the Ct value on admission has prognostic value and Lassa fever patients treated with ribavirin typically clear the virus within 3–4 weeks of hospitalization. This kinetics has implications for the design of clinical case management and future clinical trial protocols.

The feasibility and safety of ultrasound-guided puncture for treatment of septic arthritis in children

BackgroundIn septic arthritis, joint lavage can be performed using arthrocentesis (articular needle aspiration) or arthrotomy. The use of fluoroscopy to guide the puncture involves radiation. Ultrasound (US) guidance is still little recommended to guide the treatment of septic arthritis in children. We wanted to know whether treating septic arthritis in children was feasible and safe under ultrasound (US) guidance.MethodsWe retrospectively included 67 children (mean age, 3.0 years; range: 1 month–12 years) treated for septic arthritis of the hip, shoulder, or ankle using arthrocentesis or arthrotomy under US or fluoroscopic guidance (non-US group) with at least two years of follow-up.ResultsWe found no significant difference between the groups. After arthrocentesis, patients in the US group remained in hospital for 0.8 days longer than those in the non-US group, but the difference was not significant. After arthrotomy, the arthrotomy-US group required 0.4 more days of hospitalization than the non-US group, but the difference was not significant. Patients in the US group exhibited higher initial CRP and WBC values than patients treated without US, although the differences were not significant. The WBC values of the arthrocentesis-US groups were higher than those of the non-US groups initially and at 72 h, but non significantly so; they became similar on day 5. Three puncture failures required arthrotomy (two under US guidance). Three patients required early revision surgery: one had undergone arthrocentesis with US, one arthrocentesis without US, and one arthrotomy without US. At the last follow-up, there were no clinical sequelae but two hip arthrotomies (one US and one non-US child) showed asymptomatic calcifications.ConclusionsUS guidance is feasible and safe for treating septic arthritis in children, visualizing structures not shown by X-rays and avoiding radiation exposure during surgery.Level of evidenceIV (case series).Trial registrationIRB-MTP_2021_05_202100781

Quality of Life of Patients with Heart Failure Due to Myocardial Ischemia.

Heart failure caused by myocardial ischemia is a common cause encountered in clinical practice. A significant problem in heart failure is its progressive, unfavorable course and the associated increased frequency of repeated hospitalizations, as well as a significant deterioration in the functioning of patients, leading to their inability to function independently and a significant decline in the quality of life. This study aimed to assess the quality of life of patients with heart failure due to myocardial ischemia, considering the left ventricular ejection fraction, the number of "diseased" coronary arteries, co-occurring diseases, and cardiovascular risk factors. A total of 204 patients with decompensated heart failure due to chronic myocardial ischemia were included in this study and examined twice: A: on the first day of hospitalization; A': from 4 to 8 weeks. For the individual assessment of the quality of life, the WHOQOL-BREF (The World Health Organization Quality of Life - BREF) questionnaire was used. In the group of patients with heart failure in the decompensation stage a statistically significant positive relationship was observed between the number of comorbidities and the social domain (R(A) = 0.197; p(A) = 0.005), the number of diseased coronary arteries and the mental (R(A) = 0.184; p(A) = 0.184) and environmental (R(A) = 0.149; p(A) = 0.034) domains, left ventricular ejection fraction (LVEF%) and quality of life (R(A) = 0.235; p = 0.001) and satisfaction with health (R(A) = 0.235; p = 0.001) and somatic domain (R(A) = 0.194; p = 0.005). A similar result was observed among patients in the long-term follow-up. A statistically significant negative correlation was demonstrated in the mentioned group between the LVEF% value and the social domain (R(A) = -0.235; p = 0.001), as well as in the long-term follow-up (R(A') = -0.191, p = 0.026). The level of self-assessment of quality of life and satisfaction with health was statistically significantly higher among patients with heart failure in the long-term follow-up (3.20 ± 0.62) than in patients in the decompensation stage (1.98 ± 0.69). The quality of life of the examined patients with heart failure caused by chronic myocardial ischemia was poor, although it improved to average in the long-term follow-up. It was determined by left ventricular ejection fraction, the number of "diseased" coronary arteries, comorbidities, and risk factors.

The relationship between Neutrophil to Lymphocyte Ratio (NLR), Platelet to Lymphocyte Ratio (PLR), and Monocyte to Lymphocyte Ratio (MLR) with the clinical severity level of COVID-19 patients at Udayana University Hospital

Background: COVID-19 is an pandemic with a high transmission rate. Due to its widespread availability, complete blood count has the potential to be used as an initial screening for clinical severity. Objective: This study aims to determine the relationship between NLR, PLR, and MLR with the clinical severity level of patients with COVID-19. Method: A cross-sectional study was conducted at Udayana University Hospital on COVID-19 patients hospitalized from March 2020 to March 2021. Subjects were divided into critical and non-critical groups and analyzed for their relationship with the components of the complete blood count on the first day of hospitalization. Result: The analysis found that the study subjects had a mean (± standard deviation) age of 54.20 (± 15.57) years. The mean (± SD) hemoglobin level was found to be 13.44 (± 4.05) g/dL, and the platelet count was 245.75 (± 107.36) x 103/μL. The median (interquartile range) leukocyte count was found to be 7.78 (4.91) x 103/μL, neutrophils 5.72 (4.91) x 103/μL, basophils 0.01 (0.01) x 103/μL, eosinophils 0.01 (0.01) x 103/μL, monocytes 0.53 (0.41) x 103/μL, lymphocytes 1.10 (0.89) x 103/μL, NLR 5.21 (7.77), PLR 193.34 (153.54), and MLR 0.51 (0.42). Conclusion: NLR, PLR, and MLR are significantly associated with the clinical severity level in COVID-19 patients at Udayana University Hospital. These findings can assist clinicians in assessing the potential for worsening clinical severity from mild to severe or critical levels in COVID-19 patients.

Respiratory muscle strength and oxygenation as predictors of length of hospital stay in patients with COVID-19

The aim was to analyze the prognostic value of ventilation/ gas exchange dissociation markers to predict the treatment length in patients with the acute phase of COVID-19.Materials and methods: The analysis was performed using a database of 384 randomly selected patients from December 2021 to May 2022 with a confirmed diagnosis of the acute phase of COVID-19, aged 61±16 years. Spirometry of maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) was performed on 2,2±0,2 day of hospitalization with a portable MicroRPM device (CareFusion, UK) and measurement of surrogate oxygenation index (SpO2/FiO2), ROX index (SpO2/ FiO2)/respiratory rate) was carried out in all patients. Log-regression models were used (STATISTICA 10) to determine cutoff values for these functional variables and their ability to predict the patients length of hospital stay from the date of examination (≤ 7 vs &gt; 7 days).Results: The lowest sensitivity (SE) and specificity (SP) were shown in models using only the respiratory muscle strength markers MIP (SE=54%, SP=70%) and MEP (SE=73%, SP=47%), that were the same in the combination of MIP and MEP (SE=65%, SP=58%). The areas under ROC were equal to 0.6 in all three models. The models based on hypoxia markers had a higher classification power (AUC 0,7) compared to the previous three, and the sensitivity value was higher in the model using the ROX index (SE = 58% and SP = 78%), but the specificity was better in the surrogate oxygenation index model (SE = 48% and SP = 88%). A complex model based on a combination of the two integral hypoxia indices, as well as a diaphragm strength marker (SpO2/FiO2+MIP*ROX+MIP) had the best sensitivity (67%) and specificity (84%), and the area under ROC reached 0.8.Conclusion: Indicators of respiratory muscle strength and oxygenation are suitable markers for combined models and algorithms for predicting hospital length of stay in COVID-19 patients.

Challenges and peculiarities of nursing activities in intermediate care units compared with internal medicine wards: A prospective study

AbstractBackgroundIntermediate Care Units (IMCs) are specialized facilities located within other departments in many Western countries. They are designed to manage patients with conditions that are not severe enough to require an intensive care unit. IMCs aim to fill the gap between regular wards and intensive care units, necessitating an adequate allocation of nursing resources.AimsThe aims of the study are to (1) evaluate and compare the nursing workload for patients admitted to a regular ward or to an IMC; (2) quantify nursing workload in terms of activities and time spent to perform them; and (3) evaluate which patient characteristics predict nursing work overload.Study Design and MethodsThis is an observational, prospective, single‐centre study. We included patients admitted to the Internal Medicine department in a general hospital in Italy, between 1 September and 31 December 2022, either in the regular ward or in the IMC. Clinical characteristics, comorbidity, functionality, frailty, severity and acuity of patients were recorded using validated assessment tools. Nursing activities in the first 3 days of hospitalization were recorded and standardized as activities/5 min/patient/day. An average number of nursing activities/5 min/patient/day exceeding the 85th percentile was considered nursing work overload. Multivariate logistic regression models were conducted to identify patient‐related risk factors associated with nursing work overload.ResultsWe included 333 patients, 55% (183/333) admitted to the IMC and 45% (150/333) to the regular ward. In the IMC, the average nursing activities were 32.4/5 min/patient/day compared with 22.6 in the regular ward. Nursing work overload was found in 6% (9/150) of patients admitted to the regular ward compared with 23% (42/183) in the IMC.ConclusionThere is a significantly higher demand for nursing care among patients in the IMC, with higher daily average of nursing activities.Relevance to Clinical PracticeThe allocation of nursing resources within the IMC should be greater than in the regular ward because of higher workload.

Pituitary Apoplexy Induced by Anticoagulant Therapy in Patient with AcuteCoronary Syndrome

Pituitary apoplexy, defined as bleeding or infarcton the pituitary gland often occurs in undiagnosed pituitary tu mors . The patientpresented to the emergency room with complaints of chest pain in the last four hours. Electrocardiographic (ECG) and laboratoryexamination results lead to an acute coronary syndrome (ACS) event. Patients were given fondaparinux, aspirin, and clopidogre l. Onthe four th day of hospitaliz ation, the patient experienced a severe headache, projectile vomiting, and double vision. Radiologicalexamination reveals a pituitary tumors apoplexy. The patient improved after a conservative approach by the surgeon. In conclusion,pituitary tumors may be a relative contraindication to dual antiplatelets and anticoagulants in acute coronary syndromes especially inpatients with renal or liver comorbidities.

Rectus Abdominis Sheath Hematoma Following Cesarean Section: A Case Series

This case series describes two patients who underwent Cesarean section complicated by a rectus abdominis sheath hematoma that did not immediately resolve following exploratory laparotomy. One of the patients required an additional procedure by interventional radiology. Both patients had similar presentations. Both were noted to have symptomatic anemia on postoperative day 1 with an acute drop in hemoglobin. This was accompanied by severe abdominal pain and distension on physical exam. Computerized tomography (CT) abdomen/pelvis demonstrated evidence of active bleeding within the anterior abdominal wall musculature. Due to increasing concern for intrabdominal hemorrhage in the setting of an acute abdominal exam, the decision was made to proceed with an exploratory laparotomy. A substantial amount of blood was evacuated from the abdomen with greater than 1500 cc of estimated blood loss in both cases. A Jackson-Pratt drain was placed and had increased output immediately postoperatively. Both patients received blood products. One developed a consumptive coagulopathy. Interventional Radiology was consulted following exploratory laparotomy to consider intravascular embolization of the inferior epigastric arteries, which was eventually performed in one of the cases. The patients were discharged on hospital day 5 in good condition. Rectus abdominis sheath hematomas are a rare complication that can lead to significant postpartum hemorrhage. Prompt recognition and management is vital to avoid significant morbidity and mortality. Algorithms exist to guide treatment and standardize patient care. Despite using sound clinical judgment in line with existing algorithms, both patients had delayed resolution of their bleeding following initial management, requiring additional intervention.