Hospital Unit Research Articles

Dependency and frailty in the older haemodialysis patient

BackgroundFrailty among older adults undergoing hemodialysis is increasingly prevalent, significantly impacting cognitive function, mobility, and social engagement. This study focuses on the clinical profiles of very older adults in hemodialysis, particularly examining the interplay of dependency and frailty, and their influence on dialysis regimens.MethodsIn this observational, descriptive study, 107 patients aged over 75 from four outpatient centers and one hospital unit were examined over a year. Patient data encompassed sociodemographic factors, dialysis specifics, analytical outcomes, lifestyle elements, and self-reported post-treatment fatigue. Malnutrition-inflammation scale was used to measure the Nutritional status; MIS scale for malnutrition-inflammation, Barthel index for dependency, Charlson comorbidity index; FRIED scale for frailty and the SF12 quality of life measure.ResultsThe study unveiled that a substantial number of older adults on hemodialysis faced malnutrition (55%), dependency (21%), frailty (46%), and diminished quality of life (57%). Patients with dependency were distinctively marked by higher comorbidity, severe malnutrition, enhanced frailty, nursing home residency, dependency on ambulance transportation, and significantly limited mobility, with 77% unable to walk. Notably, 56% of participants experienced considerable post-dialysis fatigue, correlating with higher comorbidity, increased dependency, and poorer quality of life. Despite varying clinical conditions, dialysis patterns were consistent across the patient cohort.ConclusionsThe older adult cohort, averaging over four years on hemodialysis, exhibited high rates of comorbidity, frailty, and dependency, necessitating substantial support in transport and living arrangements. A third of these patients lacked residual urine output, yet their dialysis regimen mirrored those with preserved output. The study underscores the imperative for tailored therapeutic strategies to mitigate dependency, preserve residual renal function, and alleviate post-dialysis fatigue, ultimately enhancing the physical quality of life for these patients.

Physio-Anatomical complications in short and long surgical procedures with General Anesthesia. A comparative cross-sectional study

Background: The complication intensity of short- and long-term anesthesia during different surgeries depends upon the age, medical history and general lifestyle of a patient. Aims and objectives: The aims and objectives of present study were to evaluate the risks associated with general anesthesia during various surgical procedures. Methodology: Current comparative cross-sectional study was conducted in ICU, general surgery and gynecology units of Ghurki Trust and Teaching Hospital from July 2023 to February 2024. Total 100 patients of appendectomy and hysterectomy were selected as study subjects and divided into two groups. In Group-A (short surgery group) 65patients with appendectomy and in Group-B (Long surgery group) 35 women patients with hysterectomy were included. All of the clinical and demographic data were recorded on MS Excel and SPSS version 2024 were used to process, analyze, and distribute the data as needed and graph pad prism was used to plot graphical data representation. Results: The study identified a significant association between anesthesia duration and increased postoperative complications, notably in patients aged 51-55 years. Enhanced risks included postoperative pain, nausea, and respiratory distress, emphasizing the need for tailored anesthesia strategies based on surgical length and patient demographics. Conclusion: General anesthesia is largely safe but linked to some complications, necessitating innovative improvements and further research with larger sample sizes for enhanced safety.

Indications for Tube Thoracostomies and Factors Associated with Complications among Patients Admitted to Bugando Medical Centre, Mwanza, Tanzania

Introduction: Tube thoracostomy is the procedure used in management of traumatic and atraumatic chest conditions. Despite its relative safety, it can still lead to potentially severe complications during or post its insertion.  Objective: To determine the common indications and complications for tube thoracostomies with their associated factors.  Patients and methods: This was a prospective longitudinal study for a total duration of 6 months involving patients who underwent tube thoracostomy during the study period. Recruitment of the patients was done under Convenience sampling technique from all hospital wards and units. A standardized structured questionnaire with TT Complication Reporting Tool incorporated into it was used and all data were entered into an Excel sheet then transferred to STATA version 15.0 software for analysis.  Results: Tuberculous and malignant effusion were the commonest indication by 36.9% followed by thoracic empyema (10.81%) in atraumatic category. In trauma; 16.22% had hemo-pneumothorax followed by pneumothorax (13.5%). 15.3% underwent tube thoracostomy as a post thoracotomy requirement. The observed 33.3% complications rate was significantly associated with age and tube duration where by tube size and urgency showed significant association with the depicted individual complications.  Conclusions: The usefulness of tube thoracostomy cuts across both atraumatic and traumatic indications. Despite its usefulness, it is not without complications as factors like age and tube duration are highly associated with its occurrence. We therefore emphasize on the utilization of proper measures towards complication rates reduction whilst accommodating its desired management outcome.

Impact of Left Renal Vein Ligation on Renal Function Following En Bloc Resection of Segmental Inferior Vena Cava and Right Kidney.

Renal function after left renal vein (LRV) ligation following en bloc resection of segmental inferior vena cava (IVC) and right kidney is understudied. We assessed the impact of LRV ligation on postoperative renal function following en bloc resection of segmental IVC and right kidney. We retrospectively reviewed 28 patients who underwent LRV ligation during en bloc resection of segmental IVC and right kidney. Patient demographics, tumor characteristics, intraoperative factors, complications, length of hospital and intensive care unit (ICU) stay, and patient survival were collected. Pre- and postoperative renal function was retrospectively analyzed. Twenty patients underwent robot-assisted surgery and eight patients underwent open surgery. The median operative time was 162 min and estimated blood loss was 350mL. Ten patients had normal renal function and 12 patients had an initial increase in creatinine but improved gradually. Six patients developed acute renal failure; five patients gradually recovered in 5-32 days after temporary hemodialysis. Renal replacement therapy significantly correlated with maximal anterior-posterior diameter of the LRV (p = 0.001). Complications were observed in 11 cases, four of which were Clavien-Dindo grades I-II. Thirteen patients were alive with no recurrence, nine patients were alive with metastasis, and six cases died during the follow-up period. LRV ligation following en bloc resection of segmental IVC and right kidney is feasible, with no significant long-term impact on renal function. The maximum anterior-posterior diameter of the LRV is a reliable method for predicting renal replacement therapy in the absence of collateral circulation.

An Analysis on Link of Maternal Lipid Profile and Gestational Diabetes Mellitus: A Case Control Study of 120 Women

BACKGROUND: Gestational diabetes mellitus GDM is a clinical condition, or disease, wherein, a marked reduction in the sensitivity of insulin, during pregnancy, is attributed to the metabolic disturbance that occurs widespread. Although, information on the association among dyslipidaemia and GDM remains uncertain till date. The main objective of the present investigation is to detect any correlation between lipid profile of GDM subjects and healthy control women,using biochemical indicators. METHODS: A careful clinical case study was performed, involving a total of 120 subjects, comprising two distinct groups. Group I includes 60 pregnant women, those were recently detected as GDM cases. Group ll covers healthy control subjects collected from Open Patients unit and Registry of Diabetic Unit of Dhanalakshmi Srinivasan Institute Medical science and Hospital, Perambalur, Tamil Nadu. Both groups' subjects were bifurcated, based on their age groups, and found to be 25 to 45 years. Estimation of glycemic condition, in prior and post fasting was performed, using an analyzer appropriately. Similarly, maternal lipid profile for both groups was also determined. Moreover, HbAl c, an important biochemical indicator was also detected for both groups of subjects with respect to their age, using HPLC technique. Received data were pooled and a statistical analysis was performed, using Student t test to identify the significance difference or association between GDM group and healthy subjects, in specific, on the maternal lipid profile. FINDING: Analysis showed that there is a significant difference observed in the maternal lipid profile of GDM group, when compared with healthy subjects. The P value of Very Low Lipid protein VLDL, low density lipoprotein LDL, High density lipoprotein HDL was found to be 0.01, 0.028, and 0.038 respectively. Whereas, p value for HbAl c was recorded as 0.02, and found significant difference at 0.01 percent level. Interestingly, no difference was observed in the limit of FG, and Triglycerides limit, and were reported as p _0.28, and p- 0.316 respectively. A marked difference was also detected among the 30 to 35 yrs age group. INTERPRETATION: Present investigation elucidated that there is a strong correlation between GDM subjects and dyslipidemia. Further, this study strengthened and promised that elevated maternal lipid profile is highly linked with GDM condition.

Ionized hypocalcemia as a prognostic factor of early mortality in traumatic brain injury

ABSTRACT Traumatic brain injury (TBI) is a common neurological condition. It can affect mental, physical, and cognitive functions and is a common cause of mortality. Electrolytes imbalance is common in those patients. Effective therapy of electrolytes abnormalities improves neurological outcome and reduces mortality. Therefore, we studied the predictive significance of ionized hypocalcemia for early mortality in TBI patients. Patients and method This observational study in the intensive care units of the Ain Shams University hospitals was done on sixty adult patients with TBI of both sexes, divided into two groups: group A (ionized hypocalcemic patients), and group B (normocalcemic patients). On admission, medical history, physical examination including neurological evaluation, and appropriate investigations were performed. Ionized calcium was measured at the start of the 28-day study and then every five days after that. Results There was no statistically significant difference between the two groups for demographic data, brain injury type, or the number of intubated patients (p > 0.05). There was a statistically significant difference for diffuse axonal damage, subdural hemorrhage, cerebral edema, GCS, and mean blood pressure (p < 0.001). Serum ionized calcium in group A was significantly lower than in group B on the day of admission and day five (p < 0.001). On the day of admission, there was a significant difference in serum sodium (p < 0.05). In both groups, there was a significant difference in the ICU stay as regards survivors (p < 0.001). There was a statistically significant difference in 28-day mortality between the two groups (p = 0.001). Conclusion In TBI patients, ionized hypocalcemia on admission and on day five, hypernatremia and disturbed conscious level are strongly linked to greater fatality rates.

Is there a role for intra-aortic balloon pump in patients with cardiogenic shock? predictors of success

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Hospital Clínico San Carlos Madrid. Background Cardiogenic shock (CS) remains a clinical challenge associated with unacceptable high mortality rates. Early revascularization is the cornerstone for CS management. However, CS patients usually requires further advanced therapies such as vasopressors and mechanical circulatory support devices. Intra-aortic balloon pump (IABP) is not routinely used in patients with CS according to the current recommendations. However, this device could be associated with potential benefit in selected patients and we believe it is underutilized. Our aim was to assess for potential predictors of success after IABP implantation in patients with CS. Methods From 2013 to 2023, 136 consecutive patients diagnosed with CS and admitted to an Acute Cardiac Care Unit in a tertiary care hospital were recruited. Demographic, clinical, and analytical variables were retrospectively collected. SCAI classification was used to define shock state. Patient were followed-up to November-2023 and clinical events were also recorded. For purposes of analysis, patients were classified in two groups: IABP success (N=70) and IABP failure (N=66). Success, in terms of IABP use, was defined as patient’s survival to the index event. Failure of IABP was defined as in-hospital death. A multivariate logistic regression analysis was performed to identify potential predictors of success. Results Mean age was 67.2±12.2 years and 64.7% were females. There were no significant differences in cardiovascular risk factors and comorbidities between groups: hypertension (56.6% vs 43.5%, p 0.132), diabetes (40.9% vs 59.1%, p 0.088), chronic kidney disease (50% vs 50%, p 0.800), previous stroke (53.9% vs 41.2%, p 0.857) in "Success-group" vs "Failure-group" respectively. STEMI was the most frequent cause of CS requiring an IABP (65.9%). Non-ST elevation myocardial infarction was more common in the "Success-group", whereas cardiac arrest was more common in the "Failure-group" (Table 1). Regarding the CS classification, patients with IABP failure were more frequently in SCAI D and E categories (Table 1). In addition, patients in the failure-group had worse hemodynamic and analytic parameters (Table 1) and the IABP failed to significantly improve them. There were no significant differences in coronary artery disease burden and treatment. Complete revascularization was accomplished in a similar proportion of patients in both groups (Table 1). The multivariate analysis showed that SCAI B&amp;C states were independently associated with success after IABP implantation, whereas lactate level prior to IABP implantation was associated with failure (Table 2). Conclusion Selecting the appropriate timing for IABP implantation is critical for the prognosis, as success rates are higher in less advanced stages of cardiogenic shock. Preimplantation lactate levels are also associated with success rates.

Gender differences in cardiogenic shock: characteristics and prognosis

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Hospital Clinico San Carlos. Background Cardiogenic shock (CS) is a life-threatening condition caused by severe heart dysfunction. While significant advances have been made in the management and treatment of cardiogenic shock, there is growing recognition of the importance of considering gender-specific differences in the presentation and outcomes of this condition. Recent research highlights gender-related variations in how the condition is presented, managed, and its outcomes. Understanding these differences is crucial for tailored and effective treatment. Our goal is to identify potential gender differences in terms of the characteristics and prognosis of CS. Methods From 2013 to 2023, 142 consecutive patients diagnosed with CS in and admitted to an Acute Cardiac Care Unit in a tertiary care hospital were recruited. Demographic, clinical, and analytical variables were retrospectively collected. Patient were followed-up to November-2023 and clinical events were also recorded. For purposes of analysis, patients were classified in woman (N=95) and men (N=47). Success, in terms of IABP use, was defined as patient’s survival to the index event. Failure of IABP was defined as in-hospital death. A multivariate logistic regression analysis was performed to identify potential predictors of success. A descriptive analysis of clinical, analytical, and demographic parameters was performed in both groups, followed by a survival curve analysis to assess differences in prognosis between both sexes. Results Mean age was 67.3±12.2 years and 67.0% were females. There were no significant differences in cardiovascular risk factor and comorbidities between groups: hypertension (61.2% vs 38.8%, p 0.077), diabetes (65.9% vs 34.1%, p 0.866), chronic kidney disease (75% vs 25%, p 0.465), previous stroke (61.5% vs 38.5%, p 0.666) in woman vs men group respectively. STEMI was the most frequent cause of CS requiring an IABP in men (33.7%) but NSTEMI was in women (67.7%). Regarding the CS classification, both groups had a similar distribution of the severity and complexity of the shock (Figure 1). There were also no differences in hemodynamic parameters, analytical results, complete revascularization, and left ventricular ejection fraction (LVEF) between men and women (Figure 1). There were also no differences in hemodynamic parameters, analytical results, complete revascularization, and left ventricular ejection fraction (LVEF) between men and women (Figure 1). The complications, mortality (Figure 2), and long-term mortality were also similar in both groups. Conclusions In our observational study, there were no differences between genders in terms of characteristics, shock complexity, and prognosis.

Differences in clinical features according to survival and gender in patients admitted for cardiac arrest

Abstract Funding Acknowledgements None. Introduction Cardiac arrest (CA) is a condition with poor vital and neurological prognosis. Although there are widely known clinical features modifying prognosis –such as time to return of spontaneous circulation (ROSC) and neuron-specific enolase values-, there is uncertainty around whether gender, ischemic etiology or classic cardiovascular risk factors may influence in the management and prognosis. Purpose The aim of this study was to analyze the differences in baseline characteristics and management between survivors and non survivors, among patients admitted for CA in an Intensive Cardiac Care Unit. Methods A prospective unicentric registry was performed from January 2010 to December 2021, including all consecutive cardiac arrest patients admitted to an intensive cardiac care unit of a university hospital. Patients were classified into survivors –to hospital discharge- and non-survivors –deceased during hospital admission, irrespective of time of death. Univariate analysis were performed using Chi-square and Student t tests, and logistic regression was used for a multivariate analysis to compare both groups. Results A total of 324 patients were included, mean age 59.7 (DE 12.2) years, 17.9% were women. In-hospital mortality was 42% (136 patients) and 188 patients survived to hospital discharge. Survivors were significantly younger (mean of 57,37 vs 62,98 years) and had less prevalence of diabetes (17 vs 33%) and previous myocardial infarction (15 vs 25%) than non-survivors. Among survivors, there was a higher prevalence of in-hospital CA (26,6 vs 12,5%), CA due to acute coronary syndrome (68,62 vs 57,78%) and shockable first rhythm (90,43 vs 72,06%). They also had shorter ROSC (mean 22,13 vs 34,25 minutes) and no flow times (mean 2,54 vs 5,67 minutes). Gender, arterial hypertension, dyslipidemia and smoking habit did not modify prognosis. When comparing genders, women had significantly less prevalence of smoking habit and previous ischemic heart disease, their time to ROSC was lower and they received less coronary angiographies than men. The multivariate analysis showed significant in-hospital mortality risk increase with age (OR 1,04 per year), ROSC (OR 1,04 per minute) and no-flow (OR 1,09 per minute) times, out of hospital CA (OR 2,26) and non shockable rhythm. Conclusions In a consecutive cohort of 324 patients admitted after cardiac arrest, survivors were significantly younger, and had less prevalence of diabetes mellitus and previous myocardial infarction. In-hospital arrest, shockable rhythm, and shorter ROSC and no-flow times were associated with better survival. No differences in survival were found between genders, although women had significantly shorter resuscitation times.Univariate analysisMultivariate analysis

Occupational Therapy in Psychiatric Short-Term Hospitalization Units: Scoping Review.

Given the context, the overarching aim is to identify scientific publications on occupational therapy in Psychiatric-Short-Term-Hospitalization-Units. Specific objectives include: (a) Analyzing the historical development of this research area; (b) Synthesizing existing evidence on the nature of documentary sources on occupational therapy in in Psychiatric-Short-Term-Hospitalization-Units; (c) Detailing the volume of scientific literature on occupational therapy in these units; (e) Evaluating available evidence on occupational therapy interventions to improve functionality, quality of life, and recovery in individuals admitted to in Psychiatric-Short-Term-Hospitalization-Units. A scoping review method was employed to conduct a historical mapping of research on in Psychiatric-Short-Term-Hospitalization-Units. The review proceeded in five stages following PRISMA guidelines. After applying selection criteria, the search identified 446 references. Findings are presented under three headings: (a) Historical trends in the scientific literature on occupational therapy and in Psychiatric-Short-Term-Hospitalization-Units; (b) Nature and volume of articles included in the occupational therapy synthesis in Psychiatric Short-Term Hospitalization Units; (c) Data extraction on methodological variables in the research of occupational therapy articles in in Psychiatric-Short-Term-Hospitalization-Units; and (d) Data extraction on research outcome variables of occupational therapy articles in Psychiatric Short-Term Hospitalization Units. The growth of occupational therapy in in Psychiatric-Short-Term-Hospitalization-Units is emphasized, with an increase in qualitative studies. Occupational therapy is underscored as an integral part of care, supporting the diversity and effectiveness of interventions. Common diagnoses include schizophrenia and depressive disorders. Group interventions and the spiritual dimension positively influence the quality of care and meaningful routines for recovery in in Psychiatric-Short-Term-Hospitalization-Units.

MORBIDITY AND MORTALITY PROFILE OF NEONATES ADMITTED IN NEONATAL INTENSIVE CARE UNIT IN A TERTIARY CARE HOSPITAL, SOUTH-EASTERN RAJASTHAN, JHALAWAR MEDICAL COLLEGE, JHALAWAR: A RETROSPECTIVE STUDY

Objective: The objective of this study was to study the morbidity and mortality patterns in a special newborn care unit (SNCU)/neonatal intensive care unit (NICU) of a tertiary care teaching hospital. Methods: A retrospective study was carried out in the SNCU/NICU of Jhalawar Medical College, Jhalawar. The duration of the study was 3 years. A retrospective case record review and analysis was done. Secondary data collected from the online SNCU Software (National Health mission Government of India). Results: Eight thousand seven hundred and forty-eight neonates were admitted in NICU. 2488 (59.9%) were male and 1657 (40.1%) were female, 4047 (46.3%) were normal birth babies, and 4701 (53.7%) were low birth weight babies. According to the outcome, total 6753 (77.19%) were discharged successfully, 1464 (16.66%) died, 382 (4.36%) were referred, and 149 (1.7%) were leave against medical advice. Birth asphyxia was the most common morbidity 2404 (27.36%) followed by neonatal sepsis (18.06%) and neonatal jaundice (15.44%). Birth asphyxia were more in inborn unit (p&lt;0.0001). Sepsis is more prevalent in out born unit (p&lt;0.0001). Hypoxic ischemic encephalopathy/moderate-to-severe birth asphyxia was the most common cause of death (28.23%), followed by neonatal sepsis (20.62%) and respiratory distress syndrome (19.35%), and major congenital malformations were cause of death in 106 (7.24%). Mortality due to neonatal sepsis was significantly high in outborn unit (p&lt;0.0001). Conclusion: Birth asphyxia, neonatal sepsis, and respiratory distress syndrome were the leading causes of mortality in this study. These leading causes of mortality in the study could be prevented by adequate training of nursing staff and doctors, timely referral to tertiary care if required.

The impact of nurse’s sense of calling, organizational commitment, job stress, and nursing work environment on patient safety management activities in comprehensive nursing care service units during the covid-19 pandemic

BackgroundAs the number of COVID-19 patients rises, there has been a notable increase in the workload for nurses. However, medium-sized hospitals lacked standardized protocols or consistent approaches to address the specific working conditions of nurses. Furthermore, concerns about patient care have heightened as the issue of nursing shortages coincides with the expansion of the comprehensive nursing care services project.PurposeThis study aimed to investigate the factors that influence patient safety management activities, such as calling, organizational commitment, job stress, and nursing work environment, among comprehensive nursing care service unit nurses during the COVID-19 pandemic.MethodsA conceptual framework based on the Job Demand-Resource model and literature review of patient safety management activities was used to develop structured questionnaires that were distributed to 206 participants working in 7 comprehensive nursing care service units of small and medium-sized hospitals with at least 300 beds in the S and K provinces. Data analysis was conducted using descriptive statistics, chi-squared tests, t-tests, ANOVA, and hierarchical regression with the SPSS/WIN 23.0 program.ResultsThe results showed that calling (β =.383, p<.001) and job stress (β= -.187, p=.029) significantly influenced patient safety nursing activities in comprehensive care service ward nurses. The explanatory power of the model was 26.0% (F= 6.098, p<.001).ConclusionsOur findings suggest that comprehensive care service ward nurses' career, income, COVID-19 patient nursing anxiety, calling, and job stress were important factors that influence patient safety nursing activities. Therefore, it was essential to develop calling education programs and improve the nursing work system and establish a fair compensation system during the pandemic situation.

Cost Evaluation for Capacity Planning Based on Patients’ Pathways via Semi-Markov Reward Modelling

In the present paper, we develop a non-homogeneous semi-Markov reward model, deriving expressions for a healthcare system’s expected structure along with the expected costs generated by medical services and patients’ holding times in the states. We provide a novel definition and investigation for states’ availability, which is critical for capacity planning based on service demand in an environment of limited resources. The study is based on patients’ mobility through hospital care, where each patient spends an amount of time in every state of the hospital (emergency room, short-term acute care, hospitalization, surgery room, and intensive care unit). Multiple outcomes, such as discharge or death, can also be taken into account. We envisage a situation where any discharges are immediately replaced by a number of new admissions that carry on the pathways of the patients who exit. By assuming an expanding system, the new idea of states’ inflows is considered due to new patients who create pathways through hospital care, along with internal entrances. The theoretical results are illustrated numerically with simulated hospital data informed by aggregated public data of the Greek public health sector. The framework can be used for both strategic planning and cost evaluation purposes for hospital resources.

Impact of liver fibrosis on COVID-19 in-hospital mortality in Southern Italy.

SARS-Cov-2 infection manifests as a wide spectrum of clinical presentation and even now, despite the global spread of the vaccine, contagiousness is still elevated. The aim of the study was the evaluation of the impact of liver fibrosis assessed by FIB-4 and liver impairment, assessed by cytolysis indices, on intrahospital mortality in COVID-19 subjects. This is a retrospective observational cohort study, which involved 23 COVID Hospital Units in Campania Region, Italy. Exposure variables were collected during hospital admission and at discharge. According to FIB-4 values, we subdivided the overall population in three groups (FIB-4<1.45; 1.45<FIB-4<3.25; FIB-4>3.25), respectively group 1,2,3. At the end of the study, 938 individuals had complete discharged/dead data. At admission, 428 patients were in group 1 (45.6%), 387 in group 2 (41.3%) and 123 in group 3 (13.1%). Among them, 758 (81%) subjects were discharged, while the remaining 180 (19%) individuals died. Multivariable Cox's regression model showed a significant association between mortality risk and severity of FIB-4 stages (group 3 vs group 1, HR 2.12, 95%CI 1.38-3.28, p<0.001). Moreover, Kaplan-Meier analysis described a progressive and statistically significant difference (p<0.001 Log-rank test) in mortality according to FIB-4 groups. Among discharged subjects, 507 showed a FIB-4<1.45 (66.9%, group 1), 182 a value 1.45<FIB-4<3.25 (24.1%, group 2) and 69 a FIB-4>3.25 (9.0%, group 3). Among dead subjects, 42 showed a FIB-4<1.45 (23.3%, group 1), 62 a value 1.45<FIB-4<3.25 (34.4%, group 2) and 76 a FIB-4>3.25 (42.3%, group 3). FIB-4 value is significantly associated with intrahospital mortality of COVID-19 patients. During hospitalization, particularly in patients with worse outcomes, COVID-19 seems to increase the risk of acute progression of liver damage.

Clinical analysis of colistin sulfate in the treatment of pneumonia caused by carbapenem-resistant Gram-negative bacteria.

Multidrug-resistant Gram-negative bacteria, exacerbated by excessive use of antimicrobials and immunosuppressants, are a major health threat. To study the clinical efficacy and safety of colistin sulfate in the treatment of carbapenem-resistant Gram-negative bacilli-induced pneumonia, and to provide theoretical reference for clinical diagnosis and treatment. This retrospective analysis involved 54 patients with Gram-negative bacilli pneumonia admitted to intensive care unit of The General Hospital of the Northern Theater Command of the People's Liberation Army of China from August 2020 to June 2022. After bacteriological culture, the patients' airway secretions were collected to confirm the presence of Gram-negative bacilli. The patients were divided into the experimental and control groups according to the medication used. The research group consisted of 28 patients who received polymyxin sulfate combined with other drugs through intravenous, nebulization, or intravenous combined with nebulization, with a daily dosage of 1.5-3.0 million units. The control group consisted of 26 patients who received standard dosages of other antibiotics (including sulbactam sodium for injection, cefoperazone sodium sulbactam for injection, tigecycline, meropenem, or vaborbactam). Of the 28 patients included in the research group, 26 patients showed improvement, treatment was ineffective for two patients, and one patient died, with the treatment efficacy rate of 92.82%. Of the 26 patients in the control group, 18 patients improved, treatment was ineffective for eight patients, and two patients died, with the treatment efficacy rate of 54.9%; significant difference was observed between the two groups (P < 0.05). The levels of white blood cell (WBC), procalcitonin (PCT), and C-reactive protein (CRP) in both groups were significantly lower after treatment than before treatment (P < 0.05), and the levels of WBC, PCT, and CRP in the research group were significantly lower than those in the control group (P < 0.05). Compared with before treatment, there were no significant changes in aspartate aminotransferase, creatinine, and glomerular filtration rate in both groups, while total bilirubin and alanine aminotransferase decreased after treatment (P < 0.05) with no difference between the groups. In patients with good clinical outcomes, the sequential organ failure assessment (SOFA) score was low when treated with inhaled polymyxin sulfate, and specific antibiotic treatment did not improve the outcome. Sepsis and septic shock as well as a low SOFA score were independent factors associated with good clinical outcomes. Polymyxin sulfate has a significant effect on the treatment of patients with multiple drug-resistant Gram-negative bacilli pneumonia and other infections in the lungs and is safe and reliable. Moreover, the administration route of low-dose intravenous injection combined with nebulization shows better therapeutic effects and lower adverse reactions, providing new ideas for clinical administration.

Clinical and diagnostic substantiation for computed tomography of internal organs in acute lung injury in intensive care unit

Objective. To conduct a clinical and diagnostic substantiation of computed tomography (CT) of internal organs in acute lung injury (ALI) in intensive care.Methods. 96 patients of the intensive care unit of the Clinical hospital No 1(Smolensk) were examined. CT scans of the lungs, liver, and brain were performed using a tomograph GE Revolution EVO64. Clinical structure of the patients: 49 – with pneumonia, 15 – septic condition, 12 – Inhalation of toxic substances, 8 – aspiration of toxic liquids, 3 – aspiration of disosmolar liquids, 3 – disseminated intravascular coagulation, 3 – pulmonary contusion, 3 – shock condition. Statistical processing of the results was carried out in the Statistica 6.0 program.Results. Of the 15 patients without changes of the lungs on CT scan, in 12 patients’ attenuation value of liver parenchyma was 14–28HU, brain attenuation value was 24–30HU. In patients with established changes in lung tissue (n=81), the density of liver tissue less than 54HU, brain density less than 32HU in 80.2 % of cases allowed us to predict an unfavorable course of ALI. 10 deaths were recorded, 6 patients were in critical condition for a long period of time. Treatment of hemostasis disorders, normalization of water-electrolyte homeostasis, elimination of hypoxemia, prescription of hepatoprotective, antibacterial, detoxification therapy helped to avoid an unfavorable outcome.Conclusions. 1. It is recommended to consider of criteria for an unfavorable course in patients with acute lung injury the attenuation value of liver parenchyma less than 54HU and brain tissue attenuation value less than 32HU on CT (r=0.969 and r=0.988). 2. CT scan of the liver and brain allows the resuscitator to correct therapy and decide whether it is necessary to involve other specialists. 3. Diagnostic and prognostic significance of a complex CT scan in patients with acute lung injury, at the patient’s admitting AUROC 0.998; CI 0.901–0.999; at follow-up AUROC 0.835; CI 0.822–0.847.

The Effect of Progressive Relaxation Exercises on Fatigue, Nausea and Vomiting in Patients with Breast Cancer Receiving Chemotherapy

Objective: The research was designed experimentally to evaluate the effectiveness of progressive relaxation exercises (PRE) in the prevention of chemotherapy-induced fatigue, nausea and vomiting in patients diagnosed with breast cancer. Methods: 50 patients diagnosed with breast cancer received doxorubicin and taxane-based treatment who applied to the chemotherapy unit of a private hospital were participated in the study. 24 patients were included in the experimental group, and 26 patients were included in the control group, who were selected by simple random method and agreed to want to get in the research. The participants in the intevention group were provided with one-to-one relaxation training accompanied by Relaxation Exercises CD of the Turkish Psychological Association before the initiation of treatment. Data were collected using “Patient Identification Form”, “Piper Fatigue Scale (PFS)” and “Rhodes Index of Nausea, Vomiting and Retching (RINVR)” forms. Results: Most of the patients who attended in the research were married (76%) and the mean age was 52.72±10.17. A total of 54% of the participants received doxorubicin-based treatment and 46% of them was on taxane-based treatment. When we investigated the effect of PRE on fatigue, nausea and vomiting, it was found out that fatigue and “nausea, vomiting and retching (NVR) experience, occurrence and distress” scores on the day of treatment were significantly lower than those of the other five days, but there wasn’t difference in five-day symptom scores between the groups. Conclusion: It was concluded that PRE were not an effective approach in decreasing the symptoms of fatigue, nausea, vomiting in the research group patients with breast cancer and receiving chemotherapy.

Evaluating the relationship between aEEG findings and two-year prognosis in neonates with severe hyperbilirubinemia

ObjectiveIdentifying factors that can better predict the prognosis of neonates with hyperbilirubinemia is important. In this study, we aimed to evaluate the relationship between electroencephalography (EEG) findings and two-year prognosis in neonates with severe hyperbilirubinemia. Methods & materialsIn a cohort prospective study, we studied neonates with a total serum bilirubin level of higher than 18 mg/dL, who were admitted to the neonatal intensive care unit (NICU) of Ghaem hospital, Mashhad, Iran. EEG was recorded upon admission, for all neonates. Patients' data, including demographic characteristics, admission information, and pregnancy and birth data were gathered by obtaining history from parents and studying case files. Also, the relationship between initial EEG findings and final developmental status was assessed. ResultsMean and standard deviation age of patients were 5.46 ± 3.13 days and average serum total bilirubin level was 23.97 ± 4.34 mg/dL at admission. Our findings revealed a significant correlation between the presence of trace alternant on EEG and developmental delay (P = .001). Presence of trace alternant waves on initial EEG at admission was significantly associated with developmental delay in the two year (P = .005). ConclusionThese results indicate a relationship between developmental prognosis and the severity of hyper bilirubinemia in neonates. Also, our findings show that the presence of trace alternate waves on the initial EEG is significantly associated with developmental delay of the neonate in the future.

Cerebral hemodynamics and optic nerve sheath diameter acquired via neurosonology in critical patients with severe coronavirus disease: experience of a national referral hospital in Peru.

We aimed to describe the neurosonological findings related to cerebral hemodynamics acquired using transcranial Doppler and to determine the frequency of elevated ICP by optic nerve sheath diameter (ONSD) measurement in patients with severe coronavirus disease (COVID-19) hospitalized in the intensive care unit of a national referral hospital in Peru. We included a retrospective cohort of adult patients hospitalized with severe COVID-19 and acute respiratory failure within the first 7 days of mechanical ventilation under deep sedoanalgesia, with or without neuromuscular blockade who underwent ocular ultrasound and transcranial Doppler. We determine the frequency of elevated ICP by measuring the diameter of the optic nerve sheath, choosing as best cut-off value a diameter equal to or >5.8 mm. We also determine the frequency of sonographic patterns obtained by transcranial Doppler. Through insonation of the middle cerebral artery. Likewise, we evaluated the associations of clinical, mechanical ventilator, and arterial blood gas variables with ONSD ≥5.8 mm and pulsatility index (PI) ≥1.1. We also evaluated the associations of hemodynamic findings and ONSD with mortality the effect size was estimated using Poisson regression models with robust variance. This study included 142 patients. The mean age was 51.39 ± 13.3 years, and 78.9% of patients were male. Vasopressors were used in 45.1% of patients, and mean arterial pressure was 81.87 ± 10.64 mmHg. The mean partial pressure of carbon dioxide (PaCO2) was elevated (54.08 ± 16.01 mmHg). Elevated intracranial pressure was seen in 83.1% of patients, as estimated based on ONSD ≥5.8 mm. A mortality rate of 16.2% was reported. In the multivariate analysis, age was associated with elevated ONSD (risk ratio [RR] = 1.07). PaCO2 was a protective factor (RR = 0.64) in the cases of PI ≥ 1.1. In the mortality analysis, the mean velocity was a risk factor for mortality (RR = 1.15). A high rate of intracranial hypertension was reported, with ONSD measurement being the most reliable method for estimation. The increase in ICP measured by ONSD in patients with severe COVID-19 on mechanical ventilation is not associated to hypercapnia or elevated intrathoracic pressures derived from protective mechanical ventilation.

Bronchiectasis in Türkiye: Data from a Multicenter Registry (Turkish Adult Bronchiectasis Database).

Bronchiectasis is a chronic lung disease characterized by permanent bronchial wall dilatation. Although it has been known as an orphan disease, it has recently gained attention because of registry-based studies and drug research. We aimed to use a multicenter database to analyze and compare data regarding the etiology, associated comorbidities, microbiological characteristics, and preventive strategies of bronchiectasis in Türkiye to those of other countries. A multicenter prospective cohort study. The multicenter, prospective cohort study was conducted between March 2019 and January 2022 using the Turkish Adult Bronchiectasis Database, in which 25 centers in Türkiye participated. Patients aged > 18 years who presented with respiratory symptoms such as cough, sputum, and dyspnea and were diagnosed with non-cystic fibrosis bronchiectasis using computed tomography were included in the study. Demographic information, etiologies, comorbidities, pulmonary functions, and microbiological, radiological, and clinical data were collected from the patients. Of the 1,035 study participants, 518 (50%) were females. The mean age of the patients was 56.1 ± 16.1 years. The underlying etiology was detected in 565 (54.6%) patients. While postinfectious origin was the most common cause of bronchiectasis (39.5%), tuberculosis was identified in 11.3% of the patients. An additional comorbidity was detected in 688 (66.5%) patients. The most common comorbidity was cardiovascular disease, and chronic obstructive pulmonary disease (COPD) and bronchiectasis was identified in 19.5% of the patients. The most commonly detected microbiological agent was Pseudomonas aeruginosa (29.4%). Inhaled corticosteroids (ICS) were used in 70.1% of the patients, and the frequency of exacerbations in the last year was significantly higher in patients using ICS than in nonusers (p < 0.0001). Age [odds ratio (OR): 1.028; 95% confidence interval (CI): 1.005-1.051], cachexia (OR: 4.774; 95% CI: 2,054-11,097), high modified medical research council dyspnea scale score (OR: 1,952; 95% CI: 1,459-2,611), presence of chronic renal failure (OR: 4,172; 95% CI: 1,249-13,938) and use of inhaled steroids (OR: 2,587; 95% CI: 1,098-6,098) were significant risk factors for mortality. Mortality rates were higher in patients with COPD than in those with no COPD (21.7-9.1%, p = 0.016). Patients with bronchiectasis and COPD exhibited more frequent exacerbations, exacerbation-related hospitalizations, and hospitalization in the intensive care unit in the previous year than patients without COPD. This is the first multicenter study of bronchiectasis in Türkiye. The study results will provide important data that can guide the development of health policies in Türkiye on issues such as infection control, vaccination, and the unnecessary use of antibiotics and steroids.