Main Reasons For Admission Research Articles

Nosocomial Infection Outbreak due to SARS-COV-2 in a Hospital Unit of Particularly Vulnerable Patients

Objectives: To report a COVID-19 outbreak among workers and inpatients at a medical ward for especially vulnerable patients.Methods: Descriptive study of a nosocomial COVID-19 outbreak registered in March-April 2020 at medical ward of onco-hematological patients in an Spanish hospital. Confirmed cases were hospitalized patients, healthcare and non-healthcare workers who tested positive by PCR on a nasopharyngeal swab.Results: Twenty-two COVID-19 cases (12 workers and 10 inpatients) were laboratory-confirmed. Initial cases were a healthcare provider and a visitor who tested positive. The median patients age was 73 years (range 62-88). The main reason of admission was haematological in 8 patients and oncologic in 2. All patients followed an immunosuppressive treatment, 5/10 with high-flow oxygen nebulizations. Five patients presented a moderate/serious evolution, and 5 patients died. The mean workers age was 42.1±10.9. One healthworker required Intensive Care Unit admission, and all of them recovered completely.Conclusions: In the hospital setting, close patients surveillance for SARS-CoV-2 is essential, especially in immunosuppressed patients. Replacing nebulizations or high-flow oxygen therapies, when other equivalent options were available, to reduce dispersion, and controlling ventilation ducts, together with hygiene measures and an active follow-up on inpatients, visitors and workers appear to be important in preventing nosocomial outbreaks.

Immunoglobulin G4-related diseases: Autoimmune pancreatitis and cholangitis

Autoimmune pancreatitis (AIP) and cholangitis are chronic inflammatory diseases characterized by the infiltration of lymphoplasmocytic cells into the pancreas and biliary tract and fibrosis. This is often accompanied by increased serum immunoglobulin G4 (IgG4) levels. An early and accurate diagnosis is extremely important because they display similar features to other malignant diseases of the pancreas and biliary tract and primary sclerosing cholangitis. In this study, we aimed to convey our clinic's experiences on this topic. The patients who were diagnosed with IgG4 (+)/(-) AIP and IgG4 (+) sclerosing cholangitis by excluding other causes with clinical, radiological, serological, and pathological examinations and treatment response between July 2014 and June 2020 were included in the study. The data of the patients were analyzed retrospectively. A total of 12 patients, 8 men and 4 women, were included in the study. The mean age of the patients was 39.4 (13-66) years. Abdominal pain of varying degrees was the main reason for admission in all patients. The time of diagnosis and follow-up was 19.2 (2-66) months on average. The average number of attacks during the follow-up was 2.9 (2-8) times. The average IgG4 level of the patients was calculated as 250.1 (133-409) mg/dL. All the patients were given 24-48 mg methylprednisolone at reduced doses for 6-8 weeks. High serum IgG4 levels are the key indicators for diagnosis, and an early and accurate differential diagnosis is extremely important for malignant diseases of the pancreas and biliary tract. A good response to steroids is an important criterion for diagnosis as well as treatment.

Respiratory virus-associated infections in HIV-infected adults admitted to the intensive care unit for acute respiratory failure: a 6-year bicenter retrospective study (HIV-VIR study)

IntroductionAcute respiratory failure is the main reason for admission to the intensive care unit (ICU) in HIV-infected adults. There is little data about the epidemiology of respiratory viruses in this population.MethodsHIV-infected adults admitted to two intensive care units over a 6-year period for an acute respiratory failure and explored for respiratory viruses with multiplex polymerase chain reaction (mPCR) were retrospectively selected. Objectives were to describe the prevalence of respiratory viruses, coinfections with non-viral pathogens, and hospital outcome.ResultsA total of 123 episodes were included. An HIV infection was newly diagnosed in 9% of cases and 72% of the population were on antiretroviral therapy. Real-time mPCR tests identified at least one respiratory virus in the respiratory tract of 33 (27%) patients, but with a non-viral copathogen in two-thirds of cases. Rhinovirus was predominant, documented in 15 patients, followed by Influenza and Respiratory Syncytial Viruses (both n = 6). The prevalence of respiratory virus-associated infection did not vary along with the level of the CD4 T-cell deficiency, except for Rhinovirus which was more prevalent in patients with a CD4 lymphocyte count below 200 cells/µL (n = 13 (20%) vs. n = 2 (4%), p < 0.01). In multivariate analysis, respiratory virus-associated infection was not associated with a worse prognosis.ConclusionsViruses are frequently identified in the respiratory tract of HIV-infected patients with acute respiratory failure that requires ICU admission, but with a non-viral copathogen in two-thirds of cases. Rhinovirus is the predominant viral specie; its prevalence is highest in patients with a CD4 lymphocyte count below 200 cells/µL.

Outcomes, Mortality Causes, and Pathological Findings in European Hedgehogs (Erinaceus europeus, Linnaeus 1758): A Seventeen Year Retrospective Analysis in the North of Portugal.

Simple SummaryThe Western European hedgehog Erinaceus europaeus (Linnaeus, 1758) is one of the most common mammals in urban areas. We collected data over 17 years (2002–2019) regarding outcomes and causes of mortality on this species from two of the main wildlife rehabilitation centers in the north of Portugal. A total of 740 animals were admitted; the majority were juveniles, with the highest admission rate occurring during summer (36.8%). The main cause of admission was debilitation (30.7%). Of the total number of individuals admitted to these centers, 66.6% were released successfully. The main cause of death was trauma of unknown origin (32.7%).This study aimed to analyze the admission causes, outcomes, primary causes of death, and main lesions observed in the post mortem examinations of Western European hedgehogs, Erinaceus europaeus (Linnaeus, 1758), in the north of Portugal. The data were obtained by consulting the records from the two main wildlife rehabilitation centers located in the north of Portugal (Wildlife Rehabilitation Centre of Parque Biologico de Gaia and the Wildlife Rehabilitation Centre of the University of Trás-os-Montes and Alto Douro). Over 17 years (2002–2019) a total of 740 animals were admitted. Most of the animals were juveniles, with the highest number of admissions occurring during summer (36.8%) and spring (33.2%). The main reasons for admission were debilitation (30.7%) and random finds (28.4%). Of the total number of individuals admitted to these centers, 66.6% were successfully released back into the wild. The most relevant causes of death were trauma of unknown origin (32.7%), nontrauma causes of unknown origin (26.6%), and nutritional disorders (20.2%). The main lesions observed were related to trauma, including skeletal and skin lesions (fractures, hemorrhages, wounds) and organ damage, particularly to the lungs and liver. The hedgehog is a highly resilient and adaptable animal. The urban environment has many benefits for hedgehogs, yet the presence of humans can be harmful. In the future, the public needs to become even more involved in the activities of the wildlife centres, which will make a positive difference for these populations.

Work-Related Burn Injuries in a Tertiary Care Burn Center, 2013 to 2018.

The features of work-related burn (WRB) injuries are not well defined in the literature and they vary depending on geographical location. We wanted to describe these characteristics among patients treated in the UNC Burn Center to evaluate the potential impact of commonly accepted prevention efforts. Adults of working age, admitted between January 1, 2013, and December 31, 2018, were identified using our Burn Center Registry. Demographic data, characteristics of injury, course of treatment, and patients' outcomes were described. Differences between work-related and non-work-related injuries were evaluated using the Chi-square test and Student t-test where appropriate. Three thousand five hundred and forty-five patients were included. WRB cases constituted 18% of the study population, and this proportion remained relatively stable during the study timeframe. Young white males were the majority of this group. When compared with non-WRB patients, they were characterized by fewer co-morbidities, decreased TBSA burns, decreased risk of inhalation injury, shorter time of intensive care treatment, shorter lengths of hospital stay, and lower treatment cost. In contrast to non-WRB, among which flame injuries were the main reason for admission, work-related patients most often suffered scald burns. They also had a dramatically increased proportion of chemical and electrical burns, making the latter the most common cause of death in that group. WRB are characterized by a characteristic patient profile, burn etiologies, and outcomes. Learning specific patterns at this group may contribute to optimize work safety regulations and medical interventions.

The outcome and burden of Chinese patients with neurodegenerative diseases: A 10-year clinical feature study.

As the Chinese population continues to age, the incidence of neurodegenerative diseases (NDDs) has increased dramatically, which results in heavy medical and economic burden for families and society. The objective of this study was to evaluate NDDs in a southern Chinese hospital over a 10-year period and examine trends in demographics, outcome, length of stay (LOS) and cost. Retrospective medical records of patients from January 2010 to December 2019 were collected, including 7231 patients with NDDs (as case group) and 9663 patients without any NDDs (as control group). The information of social demographic data, admission source, reasons for admission, outcomes, LOS, and cost were extracted and analysed. The average hospitalisation age of the patients with NDDs is over 65years (peak age 70-89years). Compared with the control group, the case group had a longer LOS and a higher cost and the numbers of patients with NDDs increased yearly from 2010 to 2019. The LOS shortened while the cost increased. Clinical features affected LOS and cost. Patients suffering from infection, abnormal blood pressure and the imbalance of water-electrolyte homoeostasis as main reasons for admission were decreased; however, heart disease, cerebrovascular accident and mental diseases were significantly increased, the overall change trend of fracture/trauma remained stable. The rate of discharge to home care and mortality declined; discharge to other medical or community facilities increased over 10years. The majority of NDDs patients tended to be older. During the last 10years from 2010 to 2019, the numbers of NDDs patients increased yearly, the trend of LOS became shortening and the cost gradually increasing. The main reasons of admission and outcomes of hospital showed different trends.

Short- and Long-Term Outcome of Chronic Dialyzed Patients Admitted to the ICU and Assessment of Prognosis Factors: Results of a 6-Year Cohort Study.

Data about end-stage kidney disease patients admitted to the ICU are scarce, dated, and mostly limited to short-term survival. The aim of this study was to assess the short- and long-term outcome and to determine the prognostic factors for end-stage kidney disease patients admitted to the ICU. Prospective observational study. Medical ICUs in two university hospitals. Consecutive end-stage kidney disease patients admitted in two ICUs between 2012 and 2017. None. Renal replacement therapy variables, demographic, clinical, and biological data were collected. The requirement of mechanical ventilation and vasopressive drugs were also collected. In-ICU and one-year mortality were estimated and all data were analyzed in order to identify predictive factors of short and long-term mortality. A total of 140 patients were included, representing 1.7% of total admissions over the study period. Septic shock was the main reason for admission mostly of pulmonary origin. Median Simplified Acute Physiology Score II and Sequential Organ Failure Assessment score were at 63 and 6.7, respectively. In-ICU, hospital, and 1-year mortality were 41.4%, 46.4%, and 63%, respectively. ICU mortality was significantly higher as compared with ICU control group non-end-stage kidney disease (25% vs 41.4%; p = 0.005). By multivariate analysis, the short-term outcome was significantly associated with nonrenal Sequential Organ Failure Assessment score, and with the requirement of mechanical ventilation or/and vasoconstrictive agents during ICU stay. One-year mortality was associated with increased dialysis duration (> 3 yr) and phosphatemia (> 2.5 mmol/L), with lower albuminemia (< 30 g/L) and nonrenal Sequential Organ Failure Assessment greater than 8. End-stage kidney disease patients presented frequently severe complications requiring critical care that induced significant short- and long-term mortality. ICU and hospital mortality depended mainly on the severity of the critical event reflected by Sequential Organ Failure Assessment score and the need of mechanical ventilation and/or catecholamines. One-year mortality was associated with both albuminemia and phosphatemia and with prior duration of chronic dialysis treatment, and with organ failure at ICU admission.

End-of-life care in a pediatric intensive care unit: the impact of the development of a palliative care unit

BackgroundThe purpose of this paper is to describe how end-of-life care is managed when life-support limitation is decided in a Pediatric Intensive Care Unit and to analyze the influence of the further development of the Palliative Care Unit.MethodsA 15-year retrospective study of children who died after life-support limitation was initiated in a pediatric intensive care unit. Patients were divided into two groups, pre- and post-palliative care unit development. Epidemiological and clinical data, the decision-making process, and the approach were analyzed. Data was obtained from patient medical records.ResultsOne hundred seventy-five patients were included. The main reason for admission was respiratory failure (86/175). A previous pathology was present in 152 patients (61/152 were neurological issues). The medical team and family participated together in the decision-making in 145 cases (82.8%). The family made the request in 10 cases (9 vs. 1, p = 0.019). Withdrawal was the main life-support limitation (113/175), followed by withholding life-sustaining treatments (37/175). Withdrawal was more frequent in the post-palliative group (57.4% vs. 74.3%, p = 0.031). In absolute numbers, respiratory support was the main type of support withdrawn.ConclusionsThe main cause of life-support limitation was the unfavourable evolution of the underlying pathology. Families were involved in the decision-making process in a high percentage of the cases. The development of the Palliative Care Unit changed life-support limitation in our unit, with differences detected in the type of patient and in the strategy used. Increased confidence among intensivists when providing end-of-life care, and the availability of a Palliative Care Unit may contribute to improvements in the quality of end-of-life care.

Reasons for admission in asylum-seeking and non-asylum-seeking patients in a paediatric tertiary care centre.

In the last decade an increasing number of asylum-seeking children arrived in Europe and local healthcare systems have been challenged to adapt to their health needs. The aim of this study was to compare the spectrum of disease and management of asylum-seeking and non-asylum-seeking children requiring hospital admission. This was a retrospective cohort study including health data from recently arrived asylum-seeking and non-asylum-seeking children admitted between January 2016 and December 2017. Data were collected using electronic administrative and medical records. Of 11,794 admissions of 9407 patients, 149 (1%) were asylum-seeking and 11,645 (99%) from non-asylum-seeking children. In asylum-seeking children the median age was 4 years (interquartile range [IQR] 0&ndash;13) with 61% males and in non-asylum-seeking children 4 years (IQR 0&ndash;11) years with 56% males. Respiratory infections accounted for 17&ndash;19% of admissions in both groups. Rare infectious diseases were more frequent in asylum-seeking children (15 vs 7%; difference in proportions 0.08, 95% confidence interval [CI] 0.02&ndash;0.14; p &lt;0.001,). Injuries were more frequent in non-asylum-seeking children (22 vs 13%; difference in proportions 0.09, 95% CI 0.04&ndash;0.014; p &lt;0.01). Admissions for mental health disorders were infrequent but more common in asylum-seeking children (6 vs 3%; difference in proportions 0.03, 95% CI &minus;0.01 &ndash; 0.07; p = 0.02) Prescription of analgesics was lower in asylum-seeking than non-asylum-seeking children (3.4 vs 6.5 accounting units per admission). Antibiotic prescription was comparable in both groups. Asylum-seeking children represent a small number of total admissions. Age distribution and main reason for admission being diseases of the respiratory system were comparable in asylum-seeking and non-asylum-seeking children. Rare infections and mental health disorders are important diseases in asylum-seeking children and require special attention and training of staff working with paediatric asylum seekers.

Diagnostic uncertainty and urinary tract infection in the emergency department: a cohort study from a UK hospital

BackgroundSuspected urinary tract infection (UTI) syndromes are a common reason for empirical antibiotics to be prescribed in the Emergency Department (ED), but differentiating UTI from other conditions with a similar presentation is challenging. We investigated how often an ED diagnosis of UTI is confirmed clinically/microbiologically, and described conditions which present as UTI syndromes.MethodsObservational study using electronic health records from patients who attended the ED with suspected UTI and had a urine sample submitted for culture. We compared the ED diagnosis to diagnosis at discharge from hospital (ICD-10 codes), and estimated the proportion of cases with clinical/microbiological evidence of UTI.ResultsTwo hundred eighty nine patients had an ED diagnosis of UTI syndrome comprising: lower UTI (191), pyelonephritis (56) and urosepsis (42). In patients admitted to hospital with an ED diagnosis of lower UTI, pyelonephritis or urosepsis, clinical/microbiological evidence of UTI was lacking in 61/103, 33/54 and 31/42 cases respectively. The ED diagnosis was concordant with the main reason for admission in less than 40% of patients with UTI syndromes, and antibiotics were stopped within 72 h in 37/161 patients.ConclusionsClinical/microbiological evidence of UTI was lacking in 60–70% of patients, suggesting scope to revise empirical prescribing decisions for UTI syndromes in light of microbial culture and clinical progression.

Impact of Iron Deficiency Anemia in Patients with Pulmonary Arterial Hypertension

The impact of iron deficiency anemia on hospital length of stay and in hospitalization mortality has not been investigated in patients whose main reason for admission is pulmonary arterial hypertension. We sought to compare the outcomes in hospitalization in patients with pulmonary arterial hypertension (PAH) with a diagnosis of iron deficiency anemia (IDA) versus those without from a large sample database. The National Inpatient Sample (NIS) was used to identify all patients hospitalized 18 years of age and older in 2016 with a primary or secondary diagnosis of PAH by ICD-10 code I270. Within each hospitalization, the diagnosis of IDA was further identified using ICD-10 code D50.xx. We then examined the relative risk profile, and outcomes of interests including length of stay (LOS), total charges, number of diagnoses, Elixhauser[EC1] mortality, readmission score and in hospital mortality of each group. Categorical variables were analyzed with logistic regression models while continuous variables were assessed using two sample t-tests. All analyses were conducted using SAS v 9.4 and accounted for the NIS sampling design and updated hospital trend weights. A total of 10,300 patients with a primary or secondary diagnosis of PAH were identified, and of those, 8.45% had a diagnosis of IDA[EC2] . The cohort with IDA had a majority of women (80% vs 68%, p=<0.0001[EC3]), and were more likely to be black (24.5% vs 18.4%, p<0.0001). The number of hospital diagnoses in the IDA group was higher as well (17.0 vs 19.24, p=<0.0001). The IDA cohort were more likely to obese (28.74% vs 23.12%, p = 0.0061), have heart failure (52.30% vs 46.24%, p=0.0350), and have high risk features such as a pericardial effusion (6.32% vs 2.97%, p=0.0015). The IDA cohort were also more likely to be readmitted (mean readmission scores 35.19, p<0.0001), but there was no significant difference in length of stay, in hospital mortality, or hospital charges. Patients with primary pulmonary hypertension and IDA are more likely to be female and non-Caucasian, obese, have heart failure, or pericardial effusion, higher number of co-morbidities, and are more likely to be readmitted that those without IDA.

Clinical relevance and impact of Corynebacterium isolation in lower respiratory tract of critically ill patients requiring mechanical ventilation.

PurposeCorynebacterium spp. (C. spp.) is commonly considered as a contaminant in respiratory specimens. No study has ever focused on its clinical relevance in the lower respiratory tract of patients admitted to the intensive care unit (ICU) and requiring mechanical ventilation. The aims were to describe the characteristics of ICU patients with a C. spp. positive deep respiratory specimen, to investigate the impact of C. spp. on the occurrence of pneumonia, and to evaluate the outcomes of these pneumonia.MethodsWe retrospectively included all adult patients admitted to ICU in a 1000-bed University Hospital (2007–2017) who had a C. spp. positive lower respiratory tract specimen at a significant quantitative level. We used clinical, radiological, and microbiological criteria to classify the likelihood of such pneumonia.ResultsAmong the 31 patients included, acute respiratory failure and postoperative care after major surgery were the main reasons of admission. SAPS II was 47 [34–60]. C. spp. pneumonia was considered as probable, possible and unlikely in 10, 14, and 7 patients, respectively. Fifty-two and 94% of C. spp. strains were sensitive to amoxicillin, and vancomycin/linezolid, respectively. Seventeen patients had a complete course of antibiotic against C. spp. The overall ICU mortality was 58%.ConclusionCorynebacterium spp seems to be responsible for authentic pneumonia in mechanically ventilated patients. It should be considered as clinically relevant when predominantly present in respiratory specimen from patients suspected with pneumonia in ICU, and empirically treated.

High prevalence of malnutrition in Internal Medicine wards – a multicentre ANUMEDI study

BackgroundDisease-related malnutrition is a significant problem in hospitalized patients, with high prevalence rates depending on the studied population. Internal Medicine wards are the backbone of the hospital setting. However, prevalence and determinants of malnutrition in these patients remain unclear. We aimed to determine the prevalence of malnutrition in Internal Medicine wards and to identify and characterize malnourished patients. MethodsA cross-sectional observational multicentre study was performed in Internal Medicine wards of 24 Portuguese hospitals during 2017. Demographics, hospital admissions during the previous year, type of admission, primary diagnosis, Charlson comorbidity index, and education level were registered. Malnutrition at admission was assessed using Patient-Generated Subjective Global Assessment (PG-SGA). Demographic characteristics were compared between well-nourished and malnourished patients. Logistic regression analysis was used to identify determinants of malnutrition. Results729 participants were included (mean age 74 years, 51% male). Main reason for admission was respiratory disease (32%). Mean Charlson comorbidity index was 5.8 ± 2.8. Prevalence of malnutrition was 73% (56% moderate/suspected malnutrition and 17% severe malnutrition), and 54% had a critical need for multidisciplinary intervention (PG-SGA score ≥9). No education (odds ratio [OR] 1.88, 95% confidence interval [CI]: 1.16–3.04), hospital admissions during previous year (OR 1.53, 95%CI: 1.05–2.26), and multiple comorbidities (OR 1.22, 95%CI: 1.14–1.32) significantly increased the odds of being malnourished. ConclusionsPrevalence of malnutrition in the Internal Medicine population is very high, with the majority of patients having critical need for multidisciplinary intervention. Low education level, admissions during previous year, and multiple comorbidities increase the odds of being malnourished.

EFFECTIVE DOSE FOR RADIOLOGICAL PROCEDURES IN AN EMERGENCY DEPARTMENT: A CROSS-SECTIONAL STUDY.

The extent of radiation exposure in emergency settings is not well documented; here, the corresponding effective dose (ED) is provided. In 500 patients admitted in row to the emergency department, ED was compared in patients according to complaints and their visiting physicians. Out of all, 220 patients aged 43.5±22.2years (admission: 2.0±1.6days) had at least an imaging. The main reasons for admission were trauma (10.5%) and then orthopedic problems (8.6%). EDs from CT and radiography were 1.66±3.59 and 0.71±1.67mSv, respectively (from all 2.29±4.12). Patients with abdominal (5.8±5.2mSv; p<0.002) and pelvic (12.0±6.3mSv; p<0.007) complaints received higher ED from CT and radiography and, also, patients visited by surgeons (7.94±6.9mSv). CT scan was the main source for ED to patients. Irrespective of the final diagnosis, patients with abdominopelvic complaints and those visited by surgeons are at higher exposure risk.

Delayed versus classic orthostatic hypotension: clinical and prognostic implications

Purpose: Orthostatic hypotension (OH) is a common disorder, especially among hospitalised patients. Classic OH is defined as occurring 3 or less minutes of orthostatic stress, and delayed OH as occurring after 3 min of stress. We aimed to compare clinical characteristics and prognosis between inpatients with classic vs. delayed OH.Methods: We performed a retrospective analysis of data from 358 inpatients, aged ≥60 years, who were evaluated for the occurrence of OH at the initial phase of ambulation in four previous prospective studies in our department. Demographic, clinical and prognostic data were compared between patients with (n = 191) vs. without (n = 167) OH, classic (n = 138) vs. delayed (n = 53) OH and seated (n = 115) vs. standing (n = 76) OH.Results: Demographic characteristics, duration of bed rest, the main reasons for admission and the use of offending medications were comparable between the delayed and classic OH groups. Mean maximal postural diastolic (p < .001) and systolic (p = .063) blood pressure falls were higher among patients with classic v. delayed OH. No statistically significant difference between the patients with classic and delayed OH were observed in the occurrence of OH-related symptoms (62.3 vs. 69.8%, p = .42). During a median follow-up of 5.5 years, no statistically significant differences in survival were observed between patients with vs. without OH (p = .14), classic vs. delayed OH (p = .68) and seated vs. standing OH (p = .067). On multivariate analysis, these variables remained not significantly associated with decreased survival.Conclusions: Among inpatients, delayed OH is associated with a lesser magnitude of orthostatic blood pressure fall than classic OH. However, rates of symptomatic OH and long-term mortality were comparable between the groups. Thus, among hospitalised patients, delayed OH should be considered as posing the same severity as classic OH.

SAT-140 PREVALENCE AND ASSOCIATED FACTORS OF KIDNEY FAILURE IN HIV INFECTED PATIENTS ADMITTED FOR NON-RENAL CONDITIONS IN GENERAL MEDICAL WARDS OF SECONDARY HOSPITALS IN CAMEROON

The prevalence of renal failure or renal dysfunction among HIV positive patients varies from 6% to 48.5% in most sub-Saharan African countries. However, most of those studies were conducted in tertiary health facilities with nephrology services. The burden among HIV positive patients admitted into general medical ward in district hospitals without nephrology services is unknown. Objective: Evaluate renal function in HIV positive patients admitted for non-renal conditions in a general medical ward of district hospitals in Yaounde, Cameroon. We conducted a cross sectional study over 3 months (January to April 2018) in the general medical wards of the five main secondary hospitals of Yaounde (political Capital of Cameroon). We excluded patients receiving high doses of cotrimoxazole (≥ 2880g/day), major limb amputees and patients with transurethral catheter. HIV infection was classified according to the OMS classification. Glomerular filtration rate was estimated using the MDRD equation. Kidney failure (KF) was defined as an eGFR < 60 ml/min/1.73m2 and classified as mild (60 < eGFR ≤ 30), severe (30 < eGFR ≤ 15) and very severe (eGFR < 15). We included 102 patients with 53% (n=52%) females. Mean age was 44.1 ± 12.2 years and 70 (67%) reported complimentary and alternate medicine (CAM) use. Hypertension (9%), diabetes (8%) and hepatitis B (10%) or Hepatitis C (4%) were infrequent. In all 84.5% (n=86) of patients were in OMS stage 3 and 4, and 71.5% (n=73) were on combined antiretroviral therapy (c-ART) with about two-thirds receiving tenofovir (n=61). Main reasons for admission were tuberculosis (31.5%), gastro-enteritis (18.6%) and malaria (17%). In all 26.5% (n=27) had proteinuria and the median eGFR was 88 [25th-75th IQ 45-122] ml/min/1.73m2 A total of 37.2% (n= 38) had kidney failure with mild KF in 53% (n=20), severe KF in 29% (n=11) and very severe KF in 18% (n=7). CAM use (82.5% Vs 62.5%, p=0.02) and proteinuria (55% Vs 9%, p<0.001) were more common in KF patients. Only proteinuria was associated with KF [adjusted OR =9.14 CI (3.16-28.13); p<0.001]. Kidney failure is very frequent among HIV positive patients admitted for non-renal condition in general medical ward. Evaluation of renal function needs to be systematic especially in patients using CAM and with proteinuria.

Characteristics and short-term outcomes of patients with esophageal cancer with unplanned intensive care unit admissions: a retrospective cohort study.

ObjectiveTo depict the clinical presentation and outcomes of a cohort of critically ill patients with esophageal cancer.MethodsWe carried out a multicenter retrospective study that included patients with esophageal cancer admitted to intensive care units with acute illness between September 2009 and December 2017. We collected the demographic and clinical characteristics of all included patients, as well as organ-support measures and hospital outcomes. We performed logistic regression analysis to identify independent factors associated with in-hospital mortality.ResultsOf 226 patients included in the study, 131 (58.0%) patients died before hospital discharge. Squamous cell carcinoma was more frequent than adenocarcinoma, and 124 (54.9%) patients had metastatic cancer. The main reasons for admission were sepsis/septic shock and acute respiratory failure. Mechanical ventilation (OR = 6.18; 95%CI 2.86 - 13.35) and metastatic disease (OR = 7.10; 95%CI 3.35 - 15.05) were independently associated with in-hospital mortality.ConclusionIn this cohort of patients with esophageal cancer admitted to intensive care units with acute illness, the in-hospital mortality rate was very high. The requirement for invasive mechanical ventilation and metastatic disease were independent prognostic factors and should be considered in discussions about the short-term outcomes of these patients.

Clinical Characteristics and Outcomes of Mothers and Newborn Babies at an Integrated Perinatal Center for High-risk Pregnancy and Neonatal Care

Objective: The appropriate perinatal care and safe delivery of high-risk pregnant women have a significant impact on the prognosis of newborn. The purpose of this study is to analyze the characteristics and outcomes of high-risk pregnant women and their babies in a single integrated care center for high risk pregnancy and neonate care. Methods: The subjects were babies born in Chungnam national university hospital, their mothers and transferred babies between January 1, 2018 and December 31, 2018. We analyzed the time of transfer, interval between transfer and delivery, clinical features in pregnant women and their babies. The clinical characteristics and outcomes of the babies were compared to those of outborn babies and analyzed according to the timing of the transfer and duration between time of the mother's transfer and delivery. Results: Mean gestational age at first visit was 26.4 weeks. The average time to delivery after the first visit was 73.1 days. The main reasons for the mother's transfer were fetal problems (17.0%), obstetric and other underlying diseases of mothers (18.9%) and various problems related to pregnancy (52.4%). Babies born in hospital had lower gestational age and birth weight than transferred babies and their main reason for admission was prematurity (65.5%). The earlier transfer of mothers and longer interval between transfer and delivery were related to lower rate of emergency cesarean section in mothers, lower admission rate and larger gestational age and birth weight in babies. Conclusions: The early transfer of high-risk pregnant women and their appropriate management can optimize the outcomes of babies as well as mothers.

Demographic and clinical profiles of admitted psychiatric patients of the East London Mental Health Unit in the Eastern Cape, South Africa.

Integration of psychiatric care at the Primary Health Care (PHC) could be an important strategy towards addressing the shortages of in-patient mental health care services in South Africa. This study describes the profiles of admitted psychiatric patients at the East London Mental Health Unit (ELMHU) of the Eastern Cape from January 2016 to December 2016.In this retrospective cross-sectional study, an audit of medical records of all psychiatric in-patients managed at the ELMHU during the study period was undertaken. Simple descriptive and inferential statistics were used to describe the profiles and examine the associations with the common psychiatric conditions.Of the participants with complete data (n = 186), the majority were males (n = 108); single (72.6%) and had secondary education (45.7%). The majority of in-patients were psychotic (38%), violent (31%), manic (16%) or suicidal (9.2%) at the time of admission. Patients who were 35 years and above, resided in urban areas, and presented with suicidal and depressive symptoms were more likely to be admitted voluntarily. Schizophrenia (31.6%), cannabis-related psychiatric disorders (31.6%), bipolar Type-1 disorder (21.9%) and alcohol related disorders (15.5%) were the main reasons for admission. There was a significant association between demographic characteristics and the common psychiatric disorders of the patients.Schizophrenia, bipolar 1 disorder, cannabis-related disorders and alcohol-related disorders are the predominant disorders leading to in- patient mental health care services being utilized in the study setting. Findings might inform training of health care workers at the PHCs with a view to integrating mental health care services in the Eastern Cape.

Pattern of Admission and Outcome in a Neonatal Intensive Care Unit (NICU) of a Tertiary Care Hospital in Dhaka, Bangladesh

Background: The neonatal period is a highly vulnerable time for an infant completing many of the physiologic adjustments required for life outside the uterus. As a result, there are high rates of morbidity and mortality. To reduce morbidity and mortality it is essential to know the neonatal disease pattern. Neonatal disease pattern changes from time to time and place. Analyzing the neonatal admission pattern helps the policy makers to make the better strategies and health care givers to serve better.&#x0D; Objectives: This study aimed to determine the disease patterns and outcome of patients admitted to the Neonatal Intensive Care Unit (NICU) of Anwer khan Modern Medical College Hospital, a tertiary care hospital in Dhaka, between January 2017 to December 2018.&#x0D; Methods: Retrospective data from the medical records of all neonates admitted during the study period were reviewed and analyzed for age, weight, sex, reason for admission, duration of hospital stay, diagnosis and final outcome.&#x0D; Results: The total number of neonates admitted during the study period was 262; 164 were male (62.6%), and 98 were female (37.4%). A total of 223 patients (85.12%) wereborn in the hospital while 39 (12.88%) were born at home. The majority were admitted during the first 48 hours of life (72.2%). A total of 5 patients (2%) weighed &lt;1000 gm; 53(20.2%) weighed 1000-1500 gm, and 89 (34%) between 1600-2499 gm. Prematurity and infection were the main reasons for admission (52.7% and 20%, respectively), followed by birth asphyxia (12%) and neonatal jaundice (6.8%). A total of 206 patients (78.6%) were improved and discharged, 43 left against medical advice (16.4%), 3 were referred for urgent cardiac intervention (1.1%) and 10 (3.9%) died.&#x0D; Conclusion: Prematurity, neonatal infection and birth asphyxia were the major causes of neonatal morbidity and mortality.&#x0D; Anwer Khan Modern Medical College Journal Vol. 10, No. 2: July 2019, P 150-158