Frequency Of Mortality In Patients Research Articles

Impact of Negative Fluid Balance on Mortality and Outcome of Patients with Confirmed COVID-19.

Maintaining the proper fluid balance is a fundamental step in the management of hospitalized patients. The current study evaluated the impact of negative fluid balance on outcomes of patients with confirmed COVID-19. We considered the negative fluid balance as a higher output fluid compared to the input fluid. The fluid balance was categorized into four groups (group 4: -850 to -500 ml/day; group 3: -499 to -200 ml/day, group 2: -199 to 0 ml/day, and group 1 : 1 to 1000 ml/day) and included ordinally in the model. The outcomes were all-cause mortality, length of hospitalization, and improvement in oxygen saturation. The fluid balance differed significantly among nonsurvivors and survivors (MD: -317.93, 95% CI: -410.21, -225.69, and p < 0.001). After adjusting for potential confounders, there was a significantly lower frequency of mortality in patients with negative fluid balance compared to the controls (aRR: 0.69, 95% CI: 0.57, 0.84, and p < 0.001). Similarly, the length of hospitalization was significantly shorter in the negative fluid balance group in comparison to the control group (aMD: -1.01, 95% CI: -1.74, -0.28, and p=0.006). We determined that the negative fluid balance was associated with favorable outcomes in COVID-19 patients. The negative fluid balance was associated with the reduced mortality rate and length of hospitalization as well as improvement in oxygen saturation. Moreover, the NT-proBNP >781 pg/mL and fluid balance >-430 mL might be the predictors for positive fluid balance and mortality, respectively.

Frequency of mortality in patients with high AIMS65 score presenting with upper GI bleed

Frequency of mortality in patients with high AIMS65 score presenting with upper GI bleed

Frequency of High MELD Score in Cirrhotic Patients undergoing Liver Resection due to Hepatocellular Carcinoma

Objective: To determine the frequency of high MELD score in cirrhotic patients undergoing liver resection due to hepatocellular carcinoma also compare the frequency of mortality in patients with high or low MELD score. Study Design: Cross sectional study Place and Duration: Department of Gastroenterology, Shaikh Zayed Hospital, Lahore. Duration: 6months i.e. 23 12-2017 to 22-06-2018. Methodology: 75 patients were enrolled. Then blood sample was obtained. Reports assessed and MELD score calculated. Scores were labeled as high or low. Patients underwent liver resection according to BCLC. The mortality was noted. All the collected data was entered and analyzed on SPSS version 22. Results: In this study out of total 75 cases 60 were males and 15 females. The mean age of patients was 39.44±9.76 years, male to female ratio was 4:1. Low MELD class was noted in 45 (60%) cases and high MELD class noted in 30(40%) cases. Mortality occurred in 27(36%) cases. Insignificant difference found between the MELD class with mortality. Conclusion: High MELD score was seen in 40% cirrhotic patients undergoing liver resection due to HCC. Post HCC resection, mortality occurred in 36% patients within three months of surgery. No significant association was found between the mortality and MELD score. Keywords: MELD, Hepatocellular Carcinoma, Mortality, Cirrhosis

OPERATIVE MORTALITY OF CORONARY ARTERY BYPASS GRAFTING IN PATIENTS WITH LOW SERUM ALBUMIN AFTER NUTRITIONAL SUPPORT

Objectives: The aim of this study was to determine the frequency of operative mortality in patients who had low serum albumin on admission and were undergoing coronary artery bypass grafting (CABG) after nutritional support at a tertiary care cardiac center in Karachi, Pakistan. Methodology: A retrospective study was conducted at an adult cardiac surgery department of the largest tertiary care cardiac center in Karachi, Pakistan. Patients who had undergone isolated CABG during January to December 2019 admitted with low serum albumin (less than 3.5mg/dl) and received nutritional treatment before surgery were included in the study. Patients were monitored for a month to measure the 30 day mortality. Results: There were 82.4% male patients and the mean age was 55.49±8.52 years. Preoperative mean serum haemoglobin, serum creatinine, and serum albumin levels were 12.225±1.19 mg/dl, 1.05±0.21 mg/dl, and 2.825±0.39 mg/dl respectively. Postoperative mortality was recorded in 1.7% of the total patients. Conclusion: In patients with low serum albumin levels and had undergone isolated CABG after nutritional pre-treatment, mortality was mainly associated with peri-operative myocardial infarction. While, the incidence of delayed wound healing and atrial fibrillation were found to be high in these patients.

Frequency of High Neutrophil and Lymphocyte Ratio (NLR) Among NSTEMI/USA patients

Background: Neutrophil to lymphocyte ratio (NLR) is comparatively a new prognostic marker used in patients with chronic stable angina (CSA). NLR can help in predicting short and long term moralities in NSTEMI patients. Aim: To evaluate the frequency of high neutrophil and lymphocyte ratio among NSTEMI/USA patients and to compare frequency of mortality in patients of NSTEMI/USA having high NLR with those without high NLR. Study design&amp; duration: Descriptive, case series study from 25th November 2020 to 24th May 2021. Study settings: Department of Medicine and Cardiology, Fatima Memorial Hospital, Lahore. Methods: 185 patients having non ST elevation myocardial infarction (NSTEMI) and/or unstable angina (UA) having 30 to 70 years age and both males and females were included. Patients with sepsis having total Leucocyte count (TLC&gt;11,000/&lt;4000), history of surgery or on steroids in the past three months, history of hematological malignancy, late for fibrinolysis or those with contraindication to fibrinolysis were excluded were excluded. Demographic information (name, age, address, and education) was also noted. Results: Mean age of the participants was 57.99 ± 6.10 years while the age range was from 30 to 70 years. Most of patients 164 were included in the age group of 51 to 70 years. 110 (59.46%) patients were male and 75 (46.54%) of them were females. Frequency of neutrophil and lymphocyte ratio among NSTEMI/USA patients was found in 91 (49.19%) patients. My study has shown higher frequency of mortality in patients of NSTEMI/USA having high NLR 26 (28.57%) compared to normal NLR 06 (6.38%) with p value = 0.0001. Conclusion: Frequency of high neutrophil and lymphocyte ratio among NSTEMI/USA patients is very high with higher mortality in high Neutrophil-to-lymphocyte ratio group as compared to low NLR group. Keywords: Myocardial infarction, Non ST elevation, Neutrophil-to-lymphocyte ratio

To Determine the Mortality and Factors Responsible for Mortality in Patients Presenting with Acute Stroke within 5 Days of Admission at a Tertiary Care Hospital Hyderabad/Jamshoro

Introduction: Stroke is the third most common cause of death and the first leading cause of disability in developed and developing countries. Various clinical variables have been implicated as predictors of final outcome of acute stroke. These predictors are demographic characteristics, types of stroke, co-morbidities and therapy. Identification of modifiable predictors of death is of paramount importance for clinicians in resource poor-setting, so that specific therapies and management strategies can be applied to patients at high risk of dying.&#x0D; Objective: To determine the mortality and factors responsible for mortality in patients presenting with acute stroke within 5 days of admission at a tertiary care Hospital, Hyderabad/Jamshoro.&#x0D; Setting: Medical Unit-I, Liaquat University Hospital, Hyderabad/Jamshoro.&#x0D; Duration: Six months from 01-02-2019 to 31-07-2019&#x0D; Design: prospective, (non -interventional) study.&#x0D; Subject and Methods: Two hundred and fourteen acute stroke patients confirmed by CT scan brain were included in the study. Patients were assessed through history and examination and brief history was taken about the disease and cigarette smoking. Blood Pressure was measured twice. Patients who died during admission were evaluated for the factors responsible for the mortality. The findings of variables were entered in a Pro forma.&#x0D; Results: The average age of the patients was 55.65±8.38 years. Frequency of mortality in patients presenting with acute stroke within 5 days of admission in hospital was observed in 29.91% (64/214) cases. Regarding factors leading to mortality, Rate of mortality was 23 times more like in those patients who had dyslipidemia [OR= 23.13 95%CI= 1.86 to 7.98] similarly mortality in patients was 2 to 4 times more likely in diabetic, hypertensive cases and smokers.&#x0D; Conclusion: Frequency of mortality was high and factors leading to mortality within 5 days were dyslipidemia, diabetic, hypertensive cases. Mortality associated with acute stroke needs prevention and control of risk factors. Treatment and control of diabetes mellitus and hyperlipidemia have contributed to the stroke mortality declines; however, the onset of these interventions is more recent, and thus their impact is less clear.

FREQUENCY OF IN HOSPITAL MORTALITY IN PATIENTS WITH HIGH NEUTROPHIL/LYMPHOCYTE RATIO PRESENTING WITH ST ELEVATION MYOCARDIAL INFARCTION

Objective: To determine the frequency of in-hospital mortality in patients with high NLR presenting with STEMI. Methodology: Consecutive patients with STEMI and high NLR presenting at Cardiology department, Lady Reading Hospital, Peshawar were evaluated for our study. Out of the 236 patients admitted from 1st September 2015 to 28th February 2016, 191 patients qualified for study inclusion. NLR was calculated by dividing the total number of neutrophils over the total number of lymphocytes obtained via a computerized heamogram. A high NLR was defined as value &gt;4.7. In hospital mortality and the effect of various class of patients with or without conventional risk factors was assessed. Results: The mean high NLR in study population was 6.38±1.28. In-hospital mortality due to cardiac cause was 12% (n=23) which included 8.37% (n=16) males. Statistically significant higher values of mean high NLR were found to be associated with in-hospital mortality and presence of conventional risk factors including hypertension, diabetes, and smoking with the exception of hypercholesterolemia. Among the patients who died, more had adverse events in form of higher Killip class and arrythmias. Conclusion: High NLR has fair prognostic value in patients presenting with acute STEMI. Raised values correlate well with the presence of conventional risk factors which increase the risk of post MI adverse events and appears additive to conventional risk factors and biomarkers. Key Words: ST elevation myocardial infarction (STEMI), Neutrophil to lymphocyte ratio (NLR), Total leucocyte count (TLC), Coronary artery disease (CAD), Acute coronary syndrome (ACS)

ASSOCIATION OF VARICEAL BLEED WITH SEVERITY OF LIVER CIRRHOSIS AT A TERTIARY CARE HOSPITAL

Background; A major cause of cirrhosis-related morbidity and mortality is the development of variceal bleeding, a direct consequence of portal hypertension. Each episode of active variceal bleeding is associated with 30 percent mortality. This study was planned to determine frequency of variceal bleeding in patients with liver cirrhosis and frequency of in-hospital mortality of these patients in our population. Objective; To determine the frequency of variceal bleed in hospitalized patients with cirrhosis of liver and its outcome in terms of in-hospital mortality. Material and Methods; Consecutive 139 Patient diagnosed with cirrhosis of liver were included in this cross-sectional study from department of Medicine, Bahawal Victoria hospital Bahawalpur. Complete history and physical examination was assessed to document duration of duration of liver disease, ascites, Hepatic encephalopathy, Previous GI bleed and systemic coagulopathy. All the patients had undergone diagnostic upper GI endoscopic examination to document varices. Results; Of these 139 study cases, 77 (55.4 %) were male and 62 (44.6 %) were female. Mean age of our study cases was 45.50 ± 10.81 years. Mean duration of disease (liver cirrhosis) was 3.25 ± 2.32 years. Majority of our study cases i.e. 94 (67.6%) were having liver cirrhosis for the duration of less than 5 years. Child-Pugh class C was more prevalent i.e. 77 (55.4%) of our study cases. Variceal bleeding was observed in 100 (71.9 %) of our study cases. Frequency of mortality was 35 (25.2%) in our study cases with liver cirrhosis, while frequency of mortality in patients with variceal bleeding was seen in 31 (31%). Variceal bleeding was significantly associated with disease severity (p<0.001). Conclusion; Very high frequency of variceal bleeding was observed in patients with liver cirrhosis. In-hospital mortality was significantly more prevalent in patients with variceal bleeding than without bleed. Variceal bleeding was significantly more seen in patients with increasing age, duration of disease and with more severe level of disease (Child Pugh class C). There was no statistically significant difference of bleeding with regards to gender. Keywords; Liver Cirrhosis, Variceal bleeding, Mortality. DOI : 10.7176/JMPB/62-13 Publication date: December 31 st 2019

Frequency of Mortality in Patients with Post-Partum Eclampsia-A Study at Liaquat University Hospital, Hyderabad, Sindh, India

Postpartum preeclampsia is the occurrence of hypertension and proteinuria after delivery. Preeclampsia plus seizures after delivery is defined as postpartum eclampsia. Objective: To determine the frequency of mortality in patients with post-partum eclampsia; To determine the obstetrical factors leading to maternal mortality in patient with postpartum eclampsia. Methodology: The descriptive case series study was carried out in the department of Department of obstetrics and gynecology LUMHS Hospital Hyderabad from 1st January 2018 to 30 June 2018. All patients who fulfilled the inclusion criteria were included in the study. Informed consent was taken after explaining the procedure, risks and benefits of the study. All patients of postpartum eclampsia with increase blood pressure and proteinuria admitted through out-patient department or emergency within 48 hours of delivery will be included in the study. Patient will be followed for 10 days. All the collected data were entered into the proforma attached at the end. Results: Mean ± SD of age was 27.88±7.77 with C.I (27.02…….28.74) years. Mean ± SD of systolic B.P and urine protein was 161.46±22.09 mmhg and 1432.59±967.33 mg respectively. Out of 369 was occurred mortality in 190 (60%) women. Conclusion: It is to be concluded that mortality is most in eclampctic women followed by patients with Pre-eclampsia. However a study design comprising multiple centers, and a higher number of patients over a longer period of time will be more representative.

Aberrant expression of PDZ-binding kinase/T-LAK cell-originated protein kinase modulates the invasive ability of human pancreatic cancer cells via the stabilization of oncoprotein c-MYC.

High frequency of mortality in patients with pancreatic ductal adenocarcinoma (PDAC) is vastly associated with the invasive and metastatic nature of these cancer cells. Little is known about the factors involved in this invasive/metastatic process. The current challenge in the treatment of these patients is the lack of viable options besides gemcitabine. The aim of this study was to evaluate the role of PDZ-binding kinase (PBK)/T-LAK cell-originated protein kinase (TOPK) in invasive PDAC cells and to determine whether PBK/TOPK expression drives invasiveness in PDAC. Using gain-of-function and loss-of-function studies in established and patient-derived xenograft-PDAC cell lines, and examining patient-derived archival tissue samples, we demonstrate for the first time that PBK/TOPK is upregulated in pancreatic cancer and expression levels are closely associated with the invasive property of pancreatic cancer cells. Modulation of PBK/TOPK causally regulates the invasive ability of PDAC cells. We also demonstrate that two key players in metastatic invasion, matrix metalloproteinases-2 (MMP-2) and MMP-9 gelatinase activity and gene promoter activities, are regulated by PBK/TOPK. Moreover, we demonstrate for the first time that PBK/TOPK provides stability of an oncoprotein, c-MYC, which transcriptionally regulates MMP-2 and MMP-9 in these invasive PDAC cells. Our in vitro and in situ data corroborate that PBK/TOPK is closely associated with the invasive nature of PDAC and reveal a novel mechanism by which the metastatic behavior of human pancreatic cancer cells is regulated. These findings provide a rationale for targeting PBK/TOPK for the therapeutic intervention of invasive/metastatic pancreatic cancer in human.