Intensive Care Unit Facilities Research Articles

Critical care services in Bagmati province of Nepal: A cross sectional survey

Background This study aimed to assess the current status of critical care services in 13 districts of Bagmati Province in Nepal, with a focus on access, infrastructure, human resources, and intensive care unit (ICU) services. Methods A cross-sectional survey was conducted among healthcare workers employed in 87 hospitals having medical/surgical ICUs across Bagmati Province. Data were collected through structured questionnaires administered via face-to-face and telephone survey. Descriptive analysis was used for data analysis, involving frequencies and percentages. Results From 87 hospitals, a total of 123 ICUs were identified in the province, providing 1167 beds and 615 functioning ventilators. The average ICU bed availability per 100,000 population was 19, ranging from 3.6 in Makwanpur to 33.9 in Kathmandu. Out of 13 districts, 95% of beds were concentrated in just four districts, while six had no ICU facilities. Of the available facilities, 69.9% were owned by private entities. One-to-one nurse-to-ventilated bed ratio was maintained by 63.4% of ICUs during daytime, and 62.6% at nighttime. Furthermore, 74.8% of ICUs had consultants trained in critical care medicine. While essential equipment availability was higher in Bagmati province, gaps existed in the availability of oxygen plants and isolation rooms. Similarly, many ICUs offered continuous medical education and cardiopulmonary resuscitation (CPR) training, but improvements were necessary in clinical audits, antibiotic stewardship programs, and research engagement. Conclusions Disparities in critical care resources were evident across districts in Bagmati Province, highlighting the need for a balanced and decentralized approach to ensure equitable access to care. Although there were disparities, numerous ICUs were effectively carrying out multiple critical care procedures. This study suggests conducting a nationwide mapping of ICU resources, prioritizing infrastructure development, optimizing resource allocation, and establishing national protocols.

Critical care services in Bagmati province of Nepal: A cross sectional survey.

This study aimed to assess the current status of critical care services in 13 districts of Bagmati Province in Nepal, with a focus on access, infrastructure, human resources, and intensive care unit (ICU) services. A cross-sectional survey was conducted among healthcare workers employed in 87 hospitals having medical/surgical ICUs across Bagmati Province. Data were collected through structured questionnaires administered via face-to-face and telephone interviews. Descriptive analysis was used for data analysis, involving frequencies and percentages. From 87 hospitals, a total of 123 ICUs were identified in the province, providing 1167 beds and 615 functioning ventilators. The average ICU bed availability per 100,000 population was 19, ranging from 3.6 in Makwanpur to 33.9 in Kathmandu. Out of 13 districts, 95% of beds were concentrated in just four districts, while six had no ICU facilities. Of the available facilities, 69.9% were owned by private entities. One-to-one nurse-to-ventilated bed ratio was maintained by 63.4% of ICUs during daytime, and 62.6% at nighttime. Furthermore, 74.8% of ICUs had consultants trained in critical care medicine. While essential equipment availability was higher in Bagmati province, gaps existed in the availability of oxygen plants and isolation rooms. Similarly, many ICUs offered continuous medical education and cardiopulmonary resuscitation (CPR) training, but improvements were necessary in clinical audits, antibiotic stewardship programs, and research engagement. Disparities in critical care resources were evident across districts in Bagmati Province, highlighting the need for a balanced and decentralized approach to ensure equitable access to care. Although there were disparities, numerous ICUs were effectively carrying out multiple critical care procedures. This study suggests conducting a nationwide mapping of ICU resources, prioritizing infrastructure development, optimizing resource allocation, and establishing national protocols.

Translation, psychometric testing and implementation of the perineal assessment tool for assessing incontinence-associated dermatitis risk in semi-intensive care patients

Skin injury is a growing issue among older adults, especially when admitted to an intensive care unit or long-term care facility. Skin prevention is a key point in dealing with this issue, and prompt and effective screening instruments should be used to identify risks and start preventive interventions and care. This descriptive study aimed to translate and examine the psychometric property and implement the Perineal Assessment Tool for incontinence associated dermatitis risk assessment. The English version was translated into Thai following the international guidelines from the World Health Organization by the bilinguals. From May to June 2023, 119 patients from the semi-intensive care unit were included using a consecutive sampling method. The research instruments included the demographic questionnaires, the original English version, and the translated Thai version. The Thai Version had a content validity index, an index of item-objective congruence, a Pearson correlation coefficient of percent agreement, the Pearson correlation coefficient of the interrater reliability, the Kappa coefficient of interrater reliability, the Pearson correlation coefficient of the intra-rater reliability, and the Kappa coefficient of intra-rater reliability ranked from 0.75 to 1.00. The 21.95% had a high risk of developing incontinence-associated dermatitis, which was associated with females, the length of stay in hospital and semi-intensive care unit longer than or equal to four days, receiving antibiotics, disease severity greater than or equal to 20 points, the albumin level less than 3.8 g/dl, and neuropathy and brain disorders. In conclusion, this instrument has high validity and reliability and can assess patients at risk of incontinence-associated dermatitis. This tool will help with early risk detection and guide for planning to manage various risk conditions to prevent dermatitis instead of taking care of them after the skin has already been damaged.

Digital-twin co-simulation framework to support informed decision in healthcare planning and management

This manuscript aims to show the proof-of-concept for the integration of digital twin (DT) and discrete event co-simulation through its application to forward simulation of physical activities of care providers and robots in an intensive care unit (ICU). Co-simulation focuses on modular integration of heterogeneous simulation components to capture the complexity inherent in systems. Advancing this conception, the proposed co-simulation attempted to narrow gaps with real-world systems by using DT while simultaneously leveraging the forward simulation capacity of discrete event simulation (DES). In particular, we created a co-simulation for human–robot interactions in a simulated ICU facility, which modeled the hospital layout including the facility, robot, avatars for healthcare professionals, equipment, patient bed, and vital signs, which comprise physical twin (PT). In addition, specific patient-care scenarios were defined to drive PT for which the states of interest were represented in the DT, and then used for a dynamic input to the discrete event co-simulation. At the onset of the co-simulation, the parameters needed to run DES were manually configured to align the parameters with those of the DT. For internal validation, this DES was replicated under different work-system policies, and the co-simulation outcomes were interpreted in clinical context. Our co-simulation approach has potential for application to a broader class of problems in healthcare planning and management by supporting informed decision-making. Methodologically, timely information exchanges of PT with DT, and ensuing model updates in the Discrete Event System Specification (DEVS) is a promising approach for co-simulation, to maintain robustness against perturbations to real-world systems.

Critical care services in Bagmati province of Nepal: A cross sectional survey

Background This study aimed to assess the current status of critical care services in 13 districts of Bagmati Province in Nepal, with a focus on access, infrastructure, human resources, and intensive care unit (ICU) services. Methods A cross-sectional survey was conducted among healthcare workers employed in 87 hospitals having medical/surgical ICUs across Bagmati Province. Data were collected through structured questionnaires administered via face-to-face and telephone interviews. Descriptive analysis was used for data analysis, involving frequencies and percentages. Results From 87 hospitals, a total of 123 ICUs were identified in the province, providing 1167 beds and 615 functioning ventilators. The average ICU bed availability per 100,000 population was 19, ranging from 3.6 in Makwanpur to 33.9 in Kathmandu. Out of 13 districts, 95% of beds were concentrated in just four districts, while six had no ICU facilities. Of the available facilities, 69.9% were owned by private entities. One-to-one nurse-to-ventilated bed ratio was maintained by 63.4% of ICUs during daytime, and 62.6% at nighttime. Furthermore, 74.8% of ICUs had consultants trained in critical care medicine. While essential equipment availability was higher in Bagmati province, gaps existed in the availability of oxygen plants and isolation rooms. Similarly, many ICUs offered continuous medical education and cardiopulmonary resuscitation (CPR) training, but improvements were necessary in clinical audits, antibiotic stewardship programs, and research engagement. Conclusions Disparities in critical care resources were evident across districts in Bagmati Province, highlighting the need for a balanced and decentralized approach to ensure equitable access to care. Although there were disparities, numerous ICUs were effectively carrying out multiple critical care procedures. This study suggests conducting a nationwide mapping of ICU resources, prioritizing infrastructure development, optimizing resource allocation, and establishing national protocols.

Preparedness for severe maternal morbidity in European hospitals: The MaCriCare study

PurposeTo evaluate obstetric units (OUs) and intensive care units (ICUs) preparedness for severe maternal morbidity (SMM). MethodsFrom September 2021 to January 2022, an international multicentre cross-sectional study surveyed OUs in 26 WHO Europe Region countries. We assessed modified early obstetric warning score usage (MEOWS), approaches to four SMM clinical scenarios, invasive monitoring availability in OUs, and access to high-dependency units (HDUs) and onsite ICUs. Within ICUs, we examined the availability of trained staff, response to obstetric emergencies, leadership, and data collection. Results1133 responses were evaluated. MEOWS use was 34.5%. Non-obstetric early warning scores were being used. 21.4% (242) of OUs provided invasive monitoring in the OU. A quarter lacked access to onsite HDU beds. In cases of SMM, up to 13.8% of all OUs indicated the need for transfer to another hospital. The transfer rate was highest (74.0%) in small units. 81.9% of centers provided onsite ICU facilities to obstetric patients. Over 90% of the onsite ICUs provided daily specialist obstetric reviews but lacked immediate access to key resources: 3.4% - uterotonic drugs, 7.5% - neonatal resuscitation equipment, 9.2% - neonatal resuscitation team, 11.4% - perimortem cesarean section equipment. 41.2% reported obstetric data to a national database. ConclusionGaps in provision exist for obstetric patients with SMM in Europe, potentially compromising patient safety and experience. MEOWS use in OUs was low, while access to invasive monitoring and onsite HDU and ICU facilities was variable. ICUs frequently lacked resources and did not universally collect obstetric data for quality control.

A Retrospective Public Health Assessment and Management in Terms of the Social and Clinical Risk Factors of Respiratory Syncytial Virus Infection in Northern Canada.

Background The predominant source of respiratory infections in Northern Canada stems from RSV, leading to potentially life-threatening lower respiratory tract infections in children below the age of 2. Typically, RSV begins to appear in November or December and persists until April or May. Synagis® (Palivizumab), a monoclonal antibody, is employed to mitigate or reduce the effects of RSV. Past research indicated a reduction in hospitalizations with the use of Synagis®. Aim The aim is to estimate the cost-benefit analysis by comparing the health services cost with Synagis® program cost. Also evaluate the association of identified risk factors with the severity of RSV infection. Material and methods The dependent variable is categorized as: "Mild-Medium"cases that didn't undergo intubation or require medical evacuation; "Severe" cases that underwent intubation, required medical evacuation, and intensive care unit facilities. We also calculate the cost of health services and Synagis® of each year. Results It has been found that babies who exclusively breastfed and regularly took vitamin D did not develop severe forms of infection. Prenatal smoking and shared and crowded accommodations contribute to the spreading of RSV. The average cost of health services per participant was higher than that of the Synagis program. Conclusion They are promoting the Synagis® program during the season. Standardize the regulations prohibiting smoking around small children since they are more vulnerable to infection. Practice breastfeeding up to 24-month-old babies.

Preoperative frailty assessment with ultrasound in elderly patients scheduled for total knee arthroplasty.

Frailty, a decline in physical and cognitive reserve capacity, renders patients susceptible to various stressors and has been linked to adverse outcomes and increased healthcare utilization. This study aimed to determine whether ultrasound measurements of the rectus abdominis (RA) and biceps brachii (BB) could predict frailty in patients scheduled for total knee arthroplasty. Frailty was assessed using the Clinical Frailty Scale in adults aged ≥60 years. Ultrasound measurements of the rectus abdominis, BB, and quadriceps femoris muscles, along with thigh circumference measurements, were obtained before surgery. The predictive ability of the unadjusted and BMI- and body surface area (BSA)-adjusted measurements were evaluated using receiver operating characteristic curve analysis and area under the curve (AUC) values. Postoperative outcomes, such as admission to the intensive care unit or skilled nursing facility, delirium, falls, re-hospitalization, and 30-day mortality were recorded. We analyzed data from 148 patients. BB thickness provided a fair prediction of frailty. Average measurements of both BB adjusted for BMI (0.708, 95% CI 0.602-0.814; P<0.001), and BSA (0.708, 95% CI 0.598-0.817; P<0.001) had the highest AUC values. RA muscle measurements could not discriminate frailty. The BMI-adjusted measurements for: right quadriceps femoris thickness (AUC 0.614, 95% CI 0.503-0.725; P=0.044), left thigh circumference (AUC 0.648, 95% CI 0.528-0.769; P=0.016), and average thigh circumference (AUC 0.630, 95% CI 0.511-0.750; P=0.033) had statistically significant but poor AUC values. Preoperative ultrasound measurements of the bilateral BB can fairly predict frailty in patients scheduled for total knee arthroplasty.

Impact of socioeconomic status on presentation, care quality and outcomes of patients attended by emergency medical services for dyspnoea: a population-based cohort study

BackgroundLow socioeconomic status (SES) has been linked to poor outcomes in many conditions. It is unknown whether these disparities extend to individuals presenting with dyspnoea. We aimed to evaluate the...

Primary indication for admissions to a multi-specialty paediatric intensive care unit in Sri Lanka

It is critical to analyse the pattern of admissions made to a multi-specialty ICU (Intensive Care Unit) facility in order to enhance the standard of care, update resources, and to train the PICU (Paediatric Intensive Care Unit) personnel. Policymakers, funders, healthcare practitioners and administrators must be aware of the epidemiology and patterns of ICU admissions improve existing health services and plan for future delivery of intensive care.Objectives was to describe the primary indication for admissions to a multi-specialty Paediatric Intensive Care Unit of Teaching Hospital, Karapitiya, Sri Lanka. Children from birth to 16 years of age treated in the PICU from 1st April 2022 to 31st March, 2023 were retrospectively analysed. Information was collected on age, sex, home town, mode of admission, primary specialty indication, length of stay, main system involved, requirement of mechanical ventilation and survival.A total of 341 children were admitted and were included in the study. 60.5 % of the study population were males. Transfers within hospitals (62.1%) outnumbered transfers outside hospitals (37.9%).The average PICU stay was 5.8 days. Respiratory illnesses accounted for 54.4% of medical admissions and was the most common reason for intensive medical care. Other indications included neurological problems (21.3%) and multiorgan sepsis (8.4%). Leading cause of surgical specialty admissions was post-operative care (80.8%). Overall survival rate was 87.9% and mortality rate was 12.1%.Respiratory and neurological problems and multi-organ sepsis were the most common reasons for medical admission to the PICU. Leading cause of surgical specialty admissions was post-operative care. Overall survival rate was 87.9%.

Critical care services in Bagmati province of Nepal: A cross sectional survey

Background This study aimed to assess the current status of critical care services in 13 districts of Bagmati Province in Nepal, with a focus on access, infrastructure, human resources, and intensive care unit (ICU) services. Methods A cross-sectional survey was conducted among healthcare workers employed in 87 mixed medical/surgical ICUs across Bagmati Province. Data were collected through structured questionnaires administered via face-to-face and telephone interviews. Descriptive analysis was used for data analysis, involving frequencies and percentages. Results A total of 123 ICUs were identified in the province, providing 1167 beds and 615 functioning ventilators. The average ICU bed availability per 100,000 population was 19, ranging from 3.6 in Makwanpur to 33.9 in Kathmandu. Out of 13 districts, 95% of beds were concentrated in just four districts, while six had no ICU facilities. Of the available facilities, 69.9% were owned by private entities. One-to-one nurse-to-ventilated bed ratio was maintained by 63.4% of ICUs during daytime, and 62.6% at nighttime. Furthermore, 74.8% of ICUs had consultants trained in critical care medicine. While essential equipment availability was higher in Bagmati province, gaps existed in the availability of oxygen plants and isolation rooms. Similarly, many ICUs offered continuous medical education and cardiopulmonary resuscitation (CPR) training, but improvements were necessary in clinical audits, antibiotic stewardship programs, and research engagement. Conclusions Disparities in critical care resources were evident across districts in Bagmati Province, highlighting the need for a balanced and decentralized approach to ensure equitable access to care. Although there were disparities, numerous ICUs were effectively carrying out multiple critical care procedures. This study suggests conducting a nationwide mapping of ICU resources, prioritizing infrastructure development, optimizing resource allocation, and establishing national protocols.

Nutritional practices in medical intensive care units: Multicenter, one-day point prevalence study

Background/AimNutritional planning is an important aspect of Intensive Care Unit (ICU) care. The present study aimed to evaluate the nutritional practices adopted in medical ICUs in Turkiye and to investigate their compliance with current international guidelines. MethodsThis multicenter, cross-sectional study was performed on a predetermined study date. Centers were required to fill three groups of questionnaires: One on ICU characteristics and facilities, one on patients included, and one on outcomes of patients. Forms on patients had questions on demographics and their nutritional status. ResultsA total of 12 sites participated and 132 patients were recorded in the study and 109 patients were included in analyses. The median age was 72 [57–83] years and 55 (50%) of them was female. The median APACHE II score was 23 [18–29], median SOFA score was 6 [4–9] and median BMI was 25.32 [21.22–29.38]. More than 50% of patients were fed enterally; for most, it was started within the first 24hours of admission. On the study day, the median energy intake of the patients during the last 24hours was 21.62 [15.9–27.3] kcal/kg and the median amount of protein intake was 1.02 [0.7–1.3] g/kg, representing 83.1% and 78.9% of the targets, respectively. A total of 64 (58.7%) patients were alive on the 28th day of the study, of them 23 (21.1% of all patients) were still in the ICU. ConclusionNutrition therapy in medical ICUs was initiated early after ICU admission, the enteral route was preferred and target calories were calculated using weight-based formulas. These results suggest that multi-dimensional planning of critical care management of patients by intensivists may provide better nutritional care for the critically ill.

Comparing Opioid with Opioid-free Anesthesia Technique in Neonates Undergoing Tracheoesophageal Fistula Repair.

Tracheoesophageal fistula (TEF) is a congenital disorder that presents as a surgical emergency in neonates. In regions where neonatal intensive care unit facilities and resources are inadequate and skilled personnel are scarce, not extubating neonates on table, contributes to mortality. Our aim was to assess and compare the on-table extubation rate, extubation time, and postoperative pain scores between opioid and opioid-free anesthesia techniques in neonates undergoing surgical repair of TEF. We conducted a prospective, single-blind, randomized trial over 18 months between January 2021 and June 2022 in Safdarjung Hospital, New Delhi on 60 full-term neonates scheduled for TEF surgeries randomly allocated to two groups according to the mode of analgesia administered. Group O were given fentanyl injection 1 µg/kg intravenous (IV) loading dose with IV injection. acetaminophen at 7.5 mg/kg and top-up of 0.25 µg/kg fentanyl IV si opus sit. Group NO were given pre-surgical local infiltration and intercostal block with 0.25% and 0.5% bupivacaine, respectively, with IV acetaminophen at 7.5 mg/kg. Mean age in days, gender distribution, and weight in both groups were statistically comparable. The difference in the number of neonates extubated on table was statistically significant (p =0.002) in group NO compared to group O. Lower mean extubation time was seen in group NO (9.0 min 40.0 secs±3.0 min 3.0 secs) compared to group O (16.0 min 45.0 secs±8.0 min 5.0 secs) (p < 0.001). There was a statistically significant (p =0.010) lower Neonatal Infant Pain Scale score in group NO with mean and SD as 1.8±0.8 compared with group O, 2.5±1.1 at 90 min. In neonates undergoing TEF repair, opioid-free anesthesia is a safe and effective method, providing a better extubation rate, faster time to extubation, and better postoperative pain control.

Burnout levels and associated factors among Intensive Care Unit workers during the first wave of the COVID-19 pandemic in Chile: A cross-sectional study.

The COVID-19 pandemic resulted in an unpredictable healthcare crisis with a high psychological burden on healthcare workers. To evaluate burnout levels and their associated demographics and occupational factors among intensive care unit healthcare workers during the COVID-19 pandemic in a single hospital in the city of Temuco, Chile. A cross-sectional design in which a sociodemographic questionnaire and the Maslach Burnout Inventory for Human Services were sent to health care workers in a single Chilean Intensive Care Unit during the pandemic COVID-19. Burnout levels, demographic, and occupational factors are reported using descriptive statistics; correlations between burnout levels and demographic-occupational factors were analyzed using Spearman's and rank-biserial correlation coefficients; and multiple linear stepwise regression was used to assess the contribution of demographic and occupational factors to participants' burnout levels. A total of 84 participants (46 women and 38 men) were included in the analysis. Depersonalization and low personal accomplishment were evidenced in 95.2% and 98.8% of the intensive care unit healthcare workers, respectively. Emotional exhaustion was positively correlated with having children ( = 0.72; < 0.01). Age ( = 0.79; < 0.05), sex ( = 0.30; < 0.05), and prior experience in intensive care unit facilities ( = 0.71; < 0.05) were correlated with depersonalization. Feeling of personal accomplishment was positively correlated with with sex ( = 0.70; < 0.05) and type of work shift ( = 0.29; < 0.01). The intensive care unit healthcare workers in this study reported high levels of depersonalization and low feelings of personal accomplishment during an advanced stage of the COVID-19 pandemic. Older age, being female, having children, having intensive care unit experience, and working at 4th shift were factors related to burnout dimensions.

The Utility and Safety of a Continuous Glucose Monitoring System (CGMS) in Asphyxiated Neonates during Therapeutic Hypothermia.

The present study was designed to assess the feasibility and reliability of a Continuous Glucose Monitoring System (CGMS) in a population of asphyxiated neonates during therapeutic hypothermia. This non-randomized feasibility study was conducted in the Neonatal Intensive Care Unit (NICU) facilities of Fondazione Policlinico A. Gemelli IRCSS. Infants matching the criteria for hypothermic treatment were included in this study and were connected to the CGMS (Medtronic, Northridge, CA, USA) within the first 12 h of life. Hypoglycemia was defined as a glucose value ≤ 47 mg/dL, and hyperglycemia was defined as a glucose value ≥ 180 mg/dL. Data obtained via the CGMS were compared with those obtained via a point-of-care blood glucometer (GTX). The two measuring techniques were compared using the Modified Clarke Error Grid (MCEG). Sixteen infants were enrolled. The sensor had an average (standard deviation) duration of 93 (38) h. We collected 119 pairs of glycemia values (CGMVs) from the CGMS vs. GTX measurements. The CGMS detected twenty-five episodes of hypoglycemia and three episodes of hyperglycemia. All the CGMVs indicating hyperglycemia matched with the blood sample taken via the point-of-care glucometer. The use of a CGMS would be useful as it could detect more episodes of disglycemia than standard care. Our data show poor results in terms of the accuracy of the CGMS in this particular setting.

Demographic Characteristics and Disease Pattern Among Non-COVID-19 Patients Admitted to Medical Units of a Tertiary Care Hospital in Sri Lanka During Lockdown of the COVID-19 Pandemic: A Comparison During and Before Lockdown.

The COVID-19 infection was rapidly spreading almost all over the world, and the first case was confirmed on 27th January 2020 by a foreign tourist in Sri Lanka. The first Sri Lankan citizen with COVID-19 was confirmed on 11th March 2020. Soon after the confirmation of the disease, long days of lockdown were imposed in almost all parts of the world, including Sri Lanka, to control the spread of the disease. Objectives: To determine the demographic characteristics such as age, sex, number of patients, and disease pattern among non-COVID-19 patients admitted to the medical units during the lockdown of the COVID-19 pandemic and to compare these characteristics with the data before the lockdown. This was a cross-sectional analytical study. It was conducted at the Teaching Hospital in Batticaloa, Sri Lanka. All the non-COVID-19 patients admitted to medical wards and intensive care units (ICU) were included in this study. Patients admitted to the medical intensive care unit (MICU) and coronary care unit (CCU) were considered ICU admissions in this study. They were studied over a period of one month during lockdown (11th March 2020 to 10th April 2020) and compared with the patients admitted one month prior to the lockdown (11th February 2020 to 10th March 2020). Totally, 2340 non-COVID-19 patients (52.5% males) were admitted before the lockdown, and 1376 non-COVID-19 patients (56.2% males) were admitted during the lockdown. This reduction in admission is statistically significant (p-value is <0.001, df=3715). Patients admitted to the wards before lockdown were 2283 (97.6%) and during lockdown were 1309 (95.1%). ICU admissions were N=57 (2.4%) before lockdown and N=67 (4.9%) during lockdown. The common age distribution before the lockdown showed that 26.4% were 31-50 and 41.5% were 51-70 years. Similarly, during lockdown, the age distribution disclosed that 28.9% were 31-50 years and 42.9% were 51-70 years. The disease pattern demonstrated that before lockdown, the majority of patients were admitted for routine hemodialysis (13.2%), to get an injection (9.9%), ischemic heart disease (8.4%), chronic kidney disease (7.3%), and viral fever, including dengue (7.2%). Likewise, during lockdown, more patients were admitted for routine hemodialysis (10.7%), viral fever, including dengue (9.3%), ischemic heart disease (8.8%), to get an injection (8.5%), and chronic kidney disease (5.9%). Conclusion: There was a significant reduction in the number of non-COVID-19-related admissions during the period of lockdown. However, there was not much difference in the proportion of admissions according to gender, age, and disease pattern before and during lockdown. More number of male patients were admitted than female patients. Most of the admitted patients were under the age group of 51-70 years. The highest number of patients were admitted for routine hemodialysis before and during lockdown. However, a slightly higher number of patients were admitted to the ICU during lockdown. Therefore, strengthening the ICU facilities may be an important preparation to accommodate more patients in the future if a similar kind of emergency lockdown occurs in a pandemic situation. In addition, admissions due to non-communicable diseases (NCD) didn't fall in proportion during the pre-COVID-19 period and the lockdown period. Therefore, the redistribution of healthcare facilities needs to be done wisely to face the challenges caused by the NCDs.

COVID-19-associated pulmonary aspergillosis

Abstract Invasive pulmonary aspergillosis (IPA) is now been recognized as a possible secondary infection affecting COVID-19 recovery and increasing mortality. It can be explained due to factors such as direct epithelial injury, hypercoagulable and hyperinflammatory states, and the use of immunosuppressive treatment. We managed five such cases in a post-COVID intensive care unit facility at a tertiary care institute in North India. All patients had high oxygen demand, positive serum galactomannan (GM) index, and significant chest X-ray changes. All patients showed an initial improvement after receiving intravenous antifungal treatment with voriconazole. Systemic markers were suboptimal for the diagnosis of COVID-19-associated pulmonary aspergillosis (CAPA) with a sensitivity of less than 50%. GM assay has been validated in BAL and serum in numerous studies. Serum GM is a sensitive marker for IPA in patients with neutropenia; however, in nonneutropenic critically ill patients, serum GM exhibited a sensitivity of 25%, although a negative serum result cannot exclude the diagnosis of CAPA. The diagnosis of CAPA is challenging, and in patients with severe COVID-19 pneumonia may be associated with a worse prognosis. GM levels can be used for the diagnostic purpose of probable CAPA cases and administration of prophylactic treatment with voriconazole is still under debate.

Simultaneous 3-way Paired Exchange Liver Transplantation Without Nondirected Donation: Novel Strategy to Expand the Donor Pool.

Simultaneous 3-way Paired Exchange Liver Transplantation Without Nondirected Donation: Novel Strategy to Expand the Donor Pool.

LOW TRIIODOTHYRONINE (T3) SYNDROME IN ACUTE HEART FAILURE AND ASSOCIATION WITH SHORT-TERM OUTCOME

Introduction: Heart failure (HF) is a clinical syndrome caused by structural and/or functional cardiac abnormality that causes decreased cardiac output and/or elevated intracardiac pressures. The prognosis of cardiac diseases may be negatively impacted by low-T3 states and was independently linked to higher all-cause mortality in hospitalized HF patients. Objectives: The objectives of the study were to find an association between low T3 syndrome and short-term outcome in patients admitted with acute HF. Methods: 176 patients diagnosed as acute HF fulfilling inclusion criteria were enrolled. Serum fT3, fT4, and thyroid-stimulating hormone were measured. Patients were followed up and length of hospital stay, need for inotropes, mechanical ventilation, and intensive care unit (ICU) facility were compared with thyroid function tests. End points were discharge or death. Data were entered into structured pro forma and analyzed. Results: There was a statistically significant association between need for ICU/high dependency unit (HDU) facility care and T3 status (χ2=27.82; p&lt;0.001). There was a statistically significant association between the need for mechanical ventilation with the levels of T3 (χ2=16.14; p&lt;0.001). There is a statistically significant difference in mean T3 among the patients who expired and patients who were discharged (2.31±0.74 vs. 1.71±0.66; p=0.019). Conclusion: Low T3 correlated with a higher rate of ICU/HDU admissions (53.5% vs. 14.7%, p&lt;0.001) and an increased need for invasive mechanical ventilation (35.6% vs. 9.3%, p&lt;0.001). Low T3 syndrome is frequently found in patients with acute HF and is associated with a poor short-term outcome in terms of need for intensive care and mechanical ventilation.

Major Symptoms and Outcome of Covid-19 Positive Patients: A Study in a Tertiary Care Hospital in Bangladesh

Background: An outbreak of Covid-19 caused by the SARS-Cov-2 initially emerged in China in December 2019 and the first Covid-19 patient was detected on 8 March 2020 in Bangladesh. The preconception about the major symptoms and outcomes of Covid-19-positive patients may be helpful for healthcare professionals in the management of Covid-19 patients. This study aimed to evaluate the major symptoms and outcomes of covid-19 positive patients.&#x0D; Methods: This prospective observational study was conducted in the Department of Medicine, Rajshahi Medical College Hospital, Rajshahi, Bangladesh from January 2021 to December 2021. In total 67 confirmed Covid-19 cases by RT-PCR tests who attended the mentioned hospital were enrolled in this study as the study population. For data collection, a pre-designed questionnaire was used. Along with demographic and clinical features data regarding in-hospital mortality, intensive care unit (ICU) admission, use of invasive mechanical ventilation, total hospital length of stay, complications, and treatment patterns were recorded. Collected data were processed, analyzed and disseminated by using the MS Excel program.&#x0D; Results: The highest number of patients were with a cough which was found among 49% of cases. Besides this, shortness of breath, hypoxemia/oxygen use, lower limb swelling and bleeding were found among 39%, 27%, 12% and the rest 7% of patients respectively. The highest number of patients were with hypertension (HTN) as comorbidity which was found in 15% of cases. Besides this, diabetes mellitus (DM), chronic kidney diseases (CKD), chronic respiratory diseases (CRD), cancer/immunodeficiency and cardiac diseases were found among 12, 10%, 7%, 4% and the rest 1% of patients, respectively. As the outcomes, the cure rate was found up to 97% and death occurred in only 3% (n=2) cases. We observed that 10% of patients did not stay at the hospital even for a single day. For only 7% of patients, ventilation facilities were in needed and the average ventilation time was 13.5 days.&#x0D; Conclusion: Cough and shortness of breath are two major symptoms for Covid-19 patients. Proper ventilation and ICU facilities can decrease the suffering, mortality as well as morbidity of Covid-19 patients.