Morbid Conditions Research Articles

Comparison of Clinical Outcomes Following Head and Neck Surgery Among Patients Who Contract to Abstain From Alcohol vs Patients Who Abuse Alcohol

<h3>Importance</h3> Alcohol abuse is highly prevalent in the population of patients with head and neck cancer, and active abuse at the time of surgery results in poor postoperative outcomes. <h3>Objective</h3> To determine the association of alcohol abstinence with postoperative outcome in alcohol misusers undergoing major surgical procedures of the head and neck. <h3>Design, Setting, and Participants</h3> As a case-control study, from July 2013 to August 2015, outcomes were collected in patients at an academic tertiary referral center requiring free flap reconstruction who had undergone an abstinence contract (n = 15) and compared with those who were abusers of alcohol prior to the inception of the protocol (n = 30). <h3>Interventions</h3> Our institution developed a clinical protocol in which patients who are misusers of alcohol are educated and voluntarily asked to sign an alcohol abstinence contract agreeing to be abstinent of alcohol a minimum of 7 days prior to surgery. <h3>Main Outcomes and Measures</h3> Rate of alcohol withdrawal, length of stay, return to operating room, and readmission within 30 days were determined from medical record review. <h3>Results</h3> In the contracted group (15 patients), the mean age was 62 years, and 12 were male; in the control group (30 patients), the mean age was 58 years, and 26 were male. In both cohorts, no statistically significant difference was found between initial staging, surgery performed, and preoperative morbid conditions. The alcohol abstinence contracted group had an average of 14.8 days of abstinence prior to surgery. Abstinence was achieved at home for 11 patients, in a detoxification facility for 2 patients, and with preoperative admission for 2 patients. In direct comparisons between the groups, the rates of alcohol withdrawal (63% vs 0%; difference, 0.63; 95% CI, 0.33-0.85), delirium (73% vs 0%; difference, 0.73; 95% CI, 0.45-0.92), cellulitis (43% vs 7%; difference, 0.37; 95% CI, 0.04-0.64), and wound dehiscence (67% vs 13%; difference, 0.53; 95% CI, 0.22-0.79) were higher in the noncontracted group vs the contracted group. Furthermore, hospital stay (median 13 days vs 9 days; difference, 5 days; 95% CI, 3-7 days) and time lapse to starting adjuvant radiation therapy (median, 60.0 days vs 42.5 days; difference, 15 days; 95% CI, 5.0-25 days) were statistically and clinically significantly longer in the noncontracted group vs the contracted group. <h3>Conclusions and Relevance</h3> An alcohol abstinence program for surgically treated patients is safe and seems to be effective in reducing morbidity and improve outcomes.

Sialendoscopic management of autoimmune sialadenitis: a review of literature.

SUMMARYAutoimmune diseases of major salivary glands include Sjögren's syndrome and a complex of disorders classified as immunoglobulin G4-related diseases. These pathologies are characterised by an autoimmune reaction mediated by T-helper lymphocytes that targets the ducts of exocrine glands in Sjögren's syndrome and glandular parenchyma in immunoglobulin G4-related diseases. Immunoglobulin G4-related diseases represent recently introduced multi-organ diseases that also involve the salivary glands. However, the morbid conditions once known as Mikulicz's disease and Kuttner's tumour were recently considered as two variants of immunoglobulin G4-related diseases affecting the major salivary glands ( immunoglobulin G4-related sialadenitis). This review briefly summarises the pathogenesis and clinical features of autoimmune diseases of the major salivary glands, focusing on the diagnostic and therapeutic role of sialendoscopy.

Social determinants of morbidity during infancy: Results from a cross-sectional study in rural areas of Assam, India

Background: Assam, one of the seven North Eastern states of India has achieved the highest decline in maternal and child mortality compared to other states, still neonatal mortality and infant mortality rates are very high. Apart from other causes, certain social factors unique to Indian subcontinent are also responsible for high mortality and morbidity among children here. Objectives: To know the prevailing morbidity conditions among the infants and to assess the social determinants of morbidity of infants in rural areas of Assam. Materials and Methods: It was a cross-sectional study conducted among 250 rural families having an infant in each family. The primary caregiver was interviewed using pre-tested semi-structured interview schedules and investigators also clinically evaluate the index child for any morbidity. Data collected regarding various sociodemographic variables of the family, morbidity status of the infant and also the environmental variables relevant to the study were analyzed tabulated and percentages, and proportions were calculated. Chi-square test was done to see the relationship between the factors. Results: The study observed that prevalence of teenage mothers was high (32.4%). Most of the mothers were primipara (41.2%), and were belonging to nuclear families of lower socioeconomic strata (57%). In our study, acute respiratory infections (33.3%), fever (24.6%), and diarrhea (21.7%) were found to be the most common morbidities among infants. Statistically significant association was also found between morbidity of infants and male gender (p=0.003) and numbers of siblings (p=0.005), use of sanitary water source (p=0.001), and excreta disposal (p=0.001). Conclusion: This study observed that social factors which influence infant morbidity included male gender and numbers of siblings, use of sanitary water source and excreta disposal, less education of mothers, less family income, and lower social class of the family.

Prevalence, Aetiology, and Antimicrobial Susceptibility Patterns of Urinary Tract Infection Amongst Children Admitted at Kilimanjaro Christian Medical Centre, Moshi, Tanzania.

Background:Urinary tract infections (UTIs) in the paediatric population are well recognised as a cause of acute morbidity and chronic medical conditions, such as hypertension and renal insufficiency later in adulthood. Although antimicrobial treatment of UTIs is simple, the disease is still largely misdiagnosed and mismanaged. Moreover, increasing resistance to conventional antimicrobials is eroding the success of empiric therapy.ObjectiveTo determine prevalence, aetiological agents, and antimicrobial sensitivity patterns of UTIs amongst children admitted at Kilimanjaro Christian Medical Centre (KCMC).Methodology:A cross-sectional, hospital-based study was conducted at the KCMC Department of Paediatrics and Child Health between December 2013 and April 2014. All children ages 2 months to 14 years who were admitted in the paediatric ward during the study period and fulfilled study criteria were enrolled. Data were collected by structured questionnaires. A urine dipstick test was done to detect the presence of nitrites and leucocytes, and to perform microscopic analysis of leucocytes and bacteria. All positive cases with the urine dipstick were cultured to determine bacterial species and antimicrobial susceptibility. Urine culture is considered the gold standard to confirm UTI.Results:A total of 343 children enrolled in the study. Of these, 208 (60.6%) were male and 135 (39.4%) were female. The urine dipstick test was positive for leucocyte esterase and nitrate in 87 (25.4%) and 33 (9.6%), respectively, and urine microscopy showed leucocytes and bacteria by microscope in 38 (11.1%) and 24 (7.0%) samples, respectively. UTI was confirmed by culture in 11.4% (39/343) of the samples. Female children and children less than 24 months old had a higher prevalence of UTI (17% and 15.8%, respectively). Female sex (odds ratio [OR] 2.46, 95% confidence interval [CI], 1.25–4.86), presence of leucocytes esterase (OR 32.20, 95% CI, 12.03–86.19), and nitrate in urine dipstick (OR 5.87, 95% CI, 3.44–3.65) were associated with UTI. Leucocyte esterase, nitrite, microscopic leucocyte, and bacteria were positive in 34 (87.2%), 24 (61.5%), 30 (78.9%), and 23 (59%) samples, respectively, using culture as a gold standard. Antimicrobial sensitivity of nitrites, leucocyte esterase, microscopic leucocyte, and bacteria was 38.1%, 87.2%, 97.4%, and 59.0%, respectively, and specificity was 94.1%, 82.6%, 82.2%, and 99.7%. The most common bacterial species isolated were Escherichia coli 46.2% (18/39) and Klebsiella pneumoniae 30.8% (12/39); both exhibited low susceptibility to ampicillin, co-trimoxazole, and clindamycin, but they were susceptible to ciprofloxacin, nalidixic acid, and ceftazidime.ConclusionsUTIs are common conditions affecting children admitted at KCMC. The prevalence is higher in infants and children younger than 24 months. E coli and K pneumoniae were the most common isolated organisms with low susceptibility in commonly used antibiotics. Antimicrobials, such as ciprofloxacin, ceftriaxone, and gentamicin, are more likely to be successful for empirical treatment of UTIs.

Prevalence, Aetiology, and Antimicrobial Susceptibility Patterns of Urinary Tract Infection Amongst Children Admitted at Kilimanjaro Christian Medical Centre, Moshi, Tanzania

Background: Urinary tract infections (UTIs) in the paediatric population are well recognised as a cause of acute morbidity and chronic medical conditions, such as hypertension and renal insufficiency later in adulthood. Although antimicrobial treatment of UTIs is simple, the disease is still largely misdiagnosed and mismanaged. Moreover, increasing resistance to conventional antimicrobials is eroding the success of empiric therapy. Objective: To determine prevalence, aetiological agents, and antimicrobial sensitivity patterns of UTIs amongst children admitted at Kilimanjaro Christian Medical Centre (KCMC). Methodology: A cross-sectional, hospital-based study was conducted at the KCMC Department of Paediatrics and Child Health between December 2013 and April 2014. All children ages 2 months to 14 years who were admitted in the paediatric ward during the study period and fulfilled study criteria were enrolled. Data were collected by structured questionnaires. A urine dipstick test was done to detect the presence of nitrites and leucocytes, and to perform microscopic analysis of leucocytes and bacteria. All positive cases with the urine dipstick were cultured to determine bacterial species and antimicrobial susceptibility. Urine culture is considered the gold standard to confirm UTI. Results: A total of 343 children enrolled in the study. Of these, 208 (60.6%) were male and 135 (39.4%) were female. The urine dipstick test was positive for leucocyte esterase and nitrate in 87 (25.4%) and 33 (9.6%), respectively, and urine microscopy showed leucocytes and bacteria by microscope in 38 (11.1%) and 24 (7.0%) samples, respectively. UTI was confirmed by culture in 11.4% (39/343) of the samples. Female children and children less than 24 months old had a higher prevalence of UTI (17% and 15.8%, respectively). Female sex (odds ratio [OR] 2.46, 95% confidence interval [CI], 1.25–4.86), presence of leucocytes esterase (OR 32.20, 95% CI, 12.03–86.19), and nitrate in urine dipstick (OR 5.87, 95% CI, 3.44–3.65) were associated with UTI. Leucocyte esterase, nitrite, microscopic leucocyte, and bacteria were positive in 34 (87.2%), 24 (61.5%), 30 (78.9%), and 23 (59%) samples, respectively, using culture as a gold standard. Antimicrobial sensitivity of nitrites, leucocyte esterase, microscopic leucocyte, and bacteria was 38.1%, 87.2%, 97.4%, and 59.0%, respectively, and specificity was 94.1%, 82.6%, 82.2%, and 99.7%. The most common bacterial species isolated were Escherichia coli 46.2% (18/39) and Klebsiella pneumoniae 30.8% (12/39); both exhibited low susceptibility to ampicillin, co-trimoxazole, and clindamycin, but they were susceptible to ciprofloxacin, nalidixic acid, and ceftazidime. Conclusions: UTIs are common conditions affecting children admitted at KCMC. The prevalence is higher in infants and children younger than 24 months. E coli and K pneumoniae were the most common isolated organisms with low susceptibility in commonly used antibiotics. Antimicrobials, such as ciprofloxacin, ceftriaxone, and gentamicin, are more likely to be successful for empirical treatment of UTIs.

An Evaluation of a State-Funded Healthy Homes Intervention on Asthma Outcomes in Adults and Children.

Reducing exposure to environmental triggers is a critical part of asthma management. To evaluate the impact of a healthy homes intervention on asthma outcomes and assess the impact of different targeting strategies. The New York State (NYS) Healthy Neighborhoods Program (HNP) operates in select communities with a higher burden of housing-related illness and associated risk factors. Residents with asthma were recruited through 3 mechanisms: door-to-door canvassing (CANVASSED), 752 residents in 457 dwellings; referrals from community partners (REFERRED), 573 residents in 307 dwellings; referrals of Medicaid enrollees with poorly controlled asthma (TARGETED), 140 residents in 140 dwellings. The NYS HNP provides visual assessments and low-cost interventions to identify and address asthma triggers and trigger-promoting conditions in the home environment. Conditions are reassessed during a revisit conducted 3 to 6 months after the initial visit. The analysis compares improvements across the 3 groups for measures of asthma self-management, health care access, morbidity, and environmental conditions. An asthma trigger score characterizing the extent of multiple triggers in a dwelling was also calculated. Among 1465 adults and children, there were significant improvements in environmental conditions and self-reported self-management, health care access, and asthma morbidity outcomes for each group. The improvement was greatest in the TARGETED group for most outcomes, but selected measures of self-management and health care access were greater in the other groups. The mean improvement was significantly greater in the TARGETED group. Targeting the intervention to people with poorly controlled asthma maximizes improvements in trigger avoidance and asthma morbidity; however, other recruitment strategies are effective for impacting endpoints related to health care access and self-management. This evaluation demonstrates that a low-intensity home-based environmental intervention is effective as well as practical and feasible. Health care payers, state and local health departments, and others should consider investing in these home-based services as part of a comprehensive asthma care package.

Biological role of adipokines and their association with morbid conditions

Adipose tissue is the source of adipokines (leptine, adiponectine, resistine, interleukin-1, 6, 7, 8, 15, visfatine, PPAR-γ, tumor necrosis factor-α, vaspine, chemerine, progranuline, endocannabinoids, lipocaline-2, apleine, omentine, nesfatine-1) - biological active molecules of adipose tissue that have local and systematic effect on body. Changing of their level in the body is associated with insulin resistance, endothelium dysfunction, arterial hypertension, bronchial asthma and obesity progressing. Adipokines are heterogenous group of molecules, one part of them is produced directly by abdominal adipose tissue; another part of them is produced in other tissues but they indirectly affect development and functioning of adipose tissue. The study of adipokines lets us observe the pathogenesis of obesity, associated cardiovascular diseases and diabetes mellitus type 2 with another way. It will give us an opportunity to compose scientific base for recognizing, preventing and treatment of such diseases. It is necessary to realize that obesity with diabetes mellitus type 2 and atherosclerosis are inflammatory diseases, that's why we need to study pro- and anti-inflammatory factors of adipokines. The production of majority of inflammatory mediators is increased in case of obesity and contributes progressing of obesity and metabolic diseases. It is actual to observe adipokines as biomarkers of pathological processes, in future it will be available to prevent pathological processes, to establish prophylaxis of disease and to support positive treatment.

A clinical study on the management of sigmoid volvulus

Background: Sigmoid volvulus is a surgical emergency and significant cause of large bowel obstruction with high mortality and morbidity. The disease is more prevalent in India, especially rural population. It constitutes 15% of total bowel obstructions. This study analyzes various management options in our institute which caters mainly to patients from the surrounding rural areas.Methods: The present work is study of 36 cases, carried out as regards to the etiological factors which predispose to the sigmoid volvulus, the clinical features, modes of treatment and the outcome. Particular stress has been laid on the various treatments. The duration study was 2 years between November 2014 and October 2016 at Government Chengalpattu medical college, Tamil Nadu, India.Results: The mean age of sigmoid volvulus was 49 years (range 19-75) and male to female ratio was 2:1. Comparatively less frequent in less than 20 years and above 70 years. Distention of abdomen (100%), followed by constipation in 88% were common mode of presentation. Sigmoidopexy done in 22% patients with nil mortality and, for primary resection and anastomosis, it was 17%. Common post-operative complication found to be wound infections.Conclusions: Primary resection anastamosis is found to be definitive safe procedure if the colon is viable. Hartman’s procedure is suitable only if the bowel is gangrenous. Absence of co morbid conditions a notable feature. Pre operative X-RAY helpful in diagnosis. Mortality found to be 17.5% in our study.

Multimorbidity and the Risk of All-Cause 30-Day Readmission in the Setting of Multidisciplinary Management of Chronic Heart Failure: A Retrospective Analysis of 830 Hospitalized Patients in Australia.

Multimorbidity has an adverse effect on health outcomes in hospitalized individuals with chronic heart failure (CHF), but the modulating effect of multidisciplinary management is unknown. The aim of this study was to test the hypothesis that increasing morbidity would independently predict an increasing risk of 30-day readmission despite multidisciplinary management of CHF. We studied patients hospitalized for any reason with heart failure receiving nurse-led, postdischarge multidisciplinary management. We profiled a matrix of expected comorbidities involving the most common coexisting conditions associated with CHF and examined the relationship between multimorbidity and 30-day all-cause readmission. A total of 830 patients (mean age 73 ± 13 years and 65% men) were assessed. Multimorbidity was common, with an average of 6.6 ± 2.4 comorbid conditions with sex-based differences in prevalence of 4 of 10 conditions. Within 30 days of initial hospitalization, 216 of 830 (26%) patients were readmitted for any reason. Greater multimorbidity was associated with increasing readmission (4%-44% for those with 0-1 to 8-9 morbid conditions; adjusted odds ratio, 1.25; 95% confidence interval, 1.13-1.38) for each additional condition. Three distinct classes of patient emerged: class 1-diabetes, metabolic, and mood disorders; class 2-renal impairment; and class 3-low with relatively fewer comorbid conditions. Classes 1 and 2 had higher 30-day readmission than class 3 did (adjusted P < .01 for both comparisons). These data affirm that multimorbidity is common in adult CHF inpatients and in potentially distinct patterns linked to outcome. Overall, greater multimorbidity is associated with a higher risk of 30-day all-cause readmission despite high-quality multidisciplinary management. More innovative approaches to target-specific clusters of multimorbidity are required to improve health outcomes in affected individuals.

Clinical and genetic characterization of adult patients presenting with non-syndromic vascular aneurysms and dissections.

Genetic disorders affecting the arterial tree in the form of aneurysms and dissections are highly morbid conditions that strike younger persons leading to bleeding, infarction, or even death. Although clinically recognizable syndromes, notably Marfan, Ehlers Danlos, and Loeys-Dietz syndromes encompass the principal diagnosable phenotypes along the genetic vascular disorder spectrum, a substantial subset of patients cannot be adequately classified under a known diagnosis through clinical or molecular diagnostic methods. Here we describe patients presenting with multiple-aneurysms and/or pseudoaneurysm syndromes (MAPS), and clinically characterize this novel phenotype, present data on natural history and prognosis, and propose management guidelines. Thirty-two patients with MAPS were identified from February 2006 to October 2015 through the University of Colorado Adult Medical Genetics Clinic. A subset of patients underwent clinical genetic testing utilizing the Marfan/TAAD/Related disorders panel, and another subset was enrolled for research-based exome-sequencing. Thirty-two patients (10 men, 22 women) were classified as MAPS patients with an average age of diagnosis at 39.5 (±13.3) and 35.4 (±12.8) years, respectively. Symptom presentation and progression are presented based on vascular territory, notably of the heart, head, and neck, which could manifest with fatal complications. Secondary arterial events occurred at an average of 6.7±6.0 years after the initial MAPS episode. Genetic analysis revealed 9 gene variants that are likely pathogenic and implicated in MAPS. These data more broadly illuminate a phenotype of aneurysms, dissections, and/or pseudoaneurysms that do not classify under a recognizable genetic vascular diagnosis. Our data should provide useful clinical information for providers managing patients with MAPS.

Clinical outcome of metformin treatment in patients of acanthosis nigricans with insulin resistance

Background: Acanthosis nigricans (AN) is known to be associated with obesity, insulin resistance (IR) and other systemic morbid conditions. Proper treatment modalities of AN has not been established yet. Metformin may have some therapeutic effects on AN by reducing IR. Objective of the study was to examine the effect of metformin on AN in insulin resistant cases.Methodology and Results: This prospective, controlled trial was conducted in Dermatology OPD of BIRDEM General Hospital, Dhaka from September 2012 to August 2013. All the participants of the study had clinical presentation of AN on different anatomic locations such as neck, axilla, elbow, knuckle and knee and biochemical evidence of IR. Participants were of either sex with age ranging from 18 to 80 years. Any case who had contraindications to metformin therapy were excluded. Severity of AN was examined and assessed by a quantitative scale for measuring acanthosis nigricans. After detecting IR by Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), cases and controls were selected by random sampling method. Randomization was done for metformin in ratio of 2:1. Every third patient was a control. Forty study participants were assigned to receive tablet metformin 500mg thrice daily after meal for three months and twenty control participants were continued on their existing therapy. To maintain a static metabolic status, patients were allowed to remain with their previous diet and lifestyle habit. After 3 months of metformin therapy, improvement was assessed and was compared with control group.Mean age of the participants in case of male: 19.75±2.36 and in case of female: 26.58±9.38, M:F= 1:14, BMI of male: 32.15±4.15 and female: 33.18± 8.05. Mean baseline neck severity score of AN: 3.57 ± 0.78 and after metformin therapy: 2.65 ± 1.02, t-test value: 4.53. Baseline neck texture score of AN: 1.87±0.80, after metformin therapy: 1.25 ± 0.86, ttest value: 3.30. Baseline AN on axilla: 3.05 ± 0.94, after metformin therapy: 2.10 ± 0.98, ttest value: 4.56. Significant improvement of AN was observed clinically on neck and axilla (P&lt;0.005) when compared with control. However, in case of AN on knuckle, elbow and knee, improvement rates were not statistically significant. No side-effect except nausea in 4 patients was reported during study period.Conclusion: Metformin therapy for AN with IR had a significant beneficial effect clinically and was safe and well-tolerated. The effect was more pronounced in neck and axilla.IMC J Med Sci 2016; 10(1): 18-23

Artificial Neural Network (ANN) Model to Predict Depression among Geriatric Population at a Slum in Kolkata, India.

Depression is one of the most important causes of mortality and morbidity among the geriatric population. Although, the aging brain is more vulnerable to depression, it cannot be considered as physiological and an inevitable part of ageing. Various sociodemographic and morbidity factors are responsible for the depression among them. Using Artificial Neural Network (ANN) model depression can be predicted from various sociodemographic variables and co morbid conditions even at community level by the grass root level health care workers. To predict depression among geriatric population from sociodemographic and morbidity attributes using ANN. An observational descriptive study with cross-sectional design was carried out at a slum under the service area of Bagbazar Urban Health and Training Centre (UHTC) in Kolkata. Among 126 elderlies under Bagbazar UHTC, 105 were interviewed using predesigned and pretested schedule. Depression status was assessed using 30 item Geriatric Depression Scale. WEKA 3.8.0 was used to develop the ANN model and test its performance. Prevalence of depression among the study population was 45.7%. Various sociodemographic variables like age, gender, literacy, living spouse, working status, personal income, family type, substance abuse and co morbid conditions like visual problem, mobility problem, hearing problem and sleeping problem were taken into consideration to develop the model. Prediction accuracy of this ANN model was 97.2%. Depression among geriatric population can be predicted accurately using ANN model from sociodemographic and morbidity attributes.

The Vitamin D Status in 6-14 Year Old Children Attending Tertiary Care Teaching Hospital in South India

Introduction: Vitamin D insufficiency among healthy children and adolescents is reported to be highly prevalent in the different parts of world. Objective: To assess the Vitamin D status in children in the age group of 6-14 years attending a tertiary care teaching institute of South India and to analyze the factors which can contribute to Vitamin D deficiency in these children. Methods: Cross-sectional study. 6 – 14 year old children attending the outpatient department were included in the study. Children with co – morbid conditions that affect Vitamin D metabolism and those children on chronic drug treatment and on Vitamin D supplementation were excluded from the study. Results: Average age of study population was 8.93± 2.02. In the study 48 (52.2%) children among a total of 92 had a normal Vitamin D status while the rest 44 children (47.9%) had insufficient Vitamin D status (25 hydroxy vitamin D < 30 ng/ml). Among these children 21 (22.8%) had sub-optimal vitamin D levels, 19 (20.7%) were deficient, 3 (3.3%) had severe and 1 (1.1%) had very severe deficiency of Vitamin D. The average Vitamin D level among the study population was 31±14.13 ng/ml. There was significant statistical association between Vitamin D deficiency and stunting (p=0.003). No statistically significant association was found between outdoor activity, clothing and skin colour with Vitamin D deficiency in this study. Conclusions: Vitamin D insufficiency was documented in 47.9% of 6 – 14 year old children and there is a significant association between stunting and Vitamin D deficiency.

Clinical factors associated with postoperative length of time on ventilator among coronary artery graft surgery patients

Background: Very little is known about the optimum required length of time on ventilator after CABG surgery. Further there are inconsistencies in the practice of ventilator weaning criteria after CABG surgery. Identification of factors associated with ventilator weaning recovery may help to promote patient safety and quality care after CABG surgery. Objectives: The purposes of this secondary analysis were to identify the factors associated with the length of time on ventilator and to determine the factors associated with the prolonged mechanical ventilator more than 8 hours. Materials and Methods: Secondary analysis of a case control primary study data Results: The results of this secondary analysis revealed the factors associated with the length of time on the ventilator including Age, Sex, COPD, and CHF. Among patients with a history of COPD, 29.1% remained > 8 hours on the ventilator compared to 67.7% among those without COPD (COPD: p 8 hours compared to 31% among those without CHF ( p = 0.01 and Cramer’s V = 0.21). Conclusion: These associations remained significant after adjusting for age, sex, number of grafts and body surface area. Based on the above findings, this analysis concludes that ventilator weaning outcomes should be closely monitored, while implementing weaning protocols for patients with diagnosis of COPD, and CHF co morbid conditions after CABG surgery. Key Words: Ventilator Weaning, CABG surgery, Postoperative Ventilator Time, Clinical factors

Central-line associated bloodstream infections at a tertiary care hospital

Introduction: The Central line associated bloodstream infections (CLABSI) are the bloodstream infections where central line was in situ for more than 48 hours from the time of event and the line was in place on the date of event or before that and are confirmed by lab investigation. CLABSI are becoming common hospital acquired infections in indoor patients. Materials and Methods: This was a prospective one-year study to assess the occurrence of CLABSI at a tertiary care hospital in Gujarat. The study involved all hospitalized patients having a central line access during August 2015 to July 2016. CLABSI were identified according to the ‘Center for Disease Control and Prevention’ definitions. Microsoft excel was used for calculation of CLABSI rates and other statistical analysis. Results: There was 3.69 per 1000 central line days of CLABSI. More CLABSI was seen with underlying medical co morbid conditions. In this study, there were five infections caused by ESBL producing organisms and one carbapenemase producing K. pneumoniae. This study shows multi drug resistant pathogens as causative agent of CLABSI. A higher rate of CLABSI in this study might be due to underlying co-morbid conditions. Conclusion: CLABSI is a common entity especially in ICU setting. It is more commonly seen in patients with comorbid conditions. K. pneumoniae, S. aureus and CoNS are the common pathogens isolsted in CLABSI.

Scientific basis of surveillance and control of hepatitis E in the temperate climate

Purpose of the study. Epidemiological characteristics of hepatitis E in the territory of the Central European region of Russia (on the example of the Nizhny Novgorod region) for the scientific justification of the system of epidemiological monitoring and surveillance of this infection. Materials and methods. Samples of blood sera from patients with a diagnosis of hepatitis (n=860); «сonditionally healthy» population, livestock keepers (n=3108); migrants from the republics of Central Asia (n=160). Twelve years of dynamic monitoring of the prevalence of antibodies to the hepatitis E virus among an adult «conditionally healthy» population (n=1359). To resolve the issue of the prescription period for infection, the avidity of IgG antibodies to the hepatitis E virus (n=37) was determined by an experimental series of the test system produced by «Diagnostic Systems». Serological markers of hepatitis E virus infection was determined by ELISA using commercial test kits. For the detection of HEV RNA in faeces samples of pigs analyzed by PCR using an experimental set of «Interlabservice». Results. Manifestations of the epidemic process the hepatitis E in Russia Central European region are characterized by: substantially higher than the conventional parameters, the intensity of the manifest (from 0,9±0,20 /0000 to 6,9±1,70 /0000), and the latent components (from (1,03±1,0% to 9,3±2,2%); a high proportion of the hepatitis E (from 8,3±2,3% to 13,0±2,9%) in the etiological structure of acute viral hepatitis; low manifestation; active involvement of the epidemic process in persons aged 30-49 years, workers of livestock farms (from 6,4±1,3% to 31,1±0,4%) and enterprises in the meat industry (from 9,1±3,8% to 19,1±2,9%) and migrants from regions with high activity of epidemic process (31,9±3,7%). Workers of cattle-breeding complexes and the enterprises of meat processing industry in areas of temperate climate are at high risk of hepatitis E infection. A significant prevalence of hepatitis E in the human population non-endemic regions may be due not only to importation of infection from endemic areas, but also by contact with animals and/or possible ingestion of insufficiently cooked meat that in the conditions of sporadic morbidity is indicative of mainly zoonotic nature of hepatitis E in the framework of realization of fecal-oral mechanism of transmission. Conclusion. The conducted research allowed to characterize the epidemiological features of hepatitis E in the territory of the Central European region of Russia and served as the basis for developing a system of epidemiological supervision and control for this differentiated nosology.

Practices, Challenges, and Opportunities to Improving Pneumococcal Immunization in Working-Age, At-Risk Adults Through Community Pharmacies

Background Pneumococcal vaccination is an effective preventative measure. However, adult coverage rates remain very low, especially for working-age adults with chronic morbid conditions. Community pharmacists have the potential to improve such vaccination rates, but very little is known about their practices or perspectives. Methods Semistructured interviews were conducted with pharmacists at 12 independently owned community pharmacies purposefully selected from across Alabama. Transcript data were analyzed to identify community pharmacists' knowledge, practices, and perspectives on pneumococcal vaccination for at-risk working-age adults. Results Six major themes were identified regarding community pharmacists' knowledge and practice patterns. Multiple challenges and opportunities to improving vaccination coverage levels were also identified. Several knowledge gaps were noted, and very few pharmacists had provided pneumococcal vaccinations to at-risk adults aged 19 to 64. Most did not fully utilize patient data to identify vaccine candidates, and seldom adopted proactive approaches to promote pneumococcal vaccination. The vaccine was rarely recommended outside of flu season despite year-round vaccine availability. Challenges to increasing vaccination included pharmacy-specific barriers, advocacy, public misperceptions, limited collaboration with area physicians, and resource constraints. Opportunities included capitalizing on the growing acceptance of pharmacy-based immunization, the business case for pneumococcal vaccination, and pharmacists' interest in receiving continuing education. Improving record-keeping systems, pharmacist-patient communication, advocacy, and outreach, and building stronger collaborations with community stakeholders to facilitate the pharmacists' role as immunization advocates were additional areas for improvement. Conclusions Multiple challenges impede increased involvement by community pharmacists in pneumococcal vaccination services; however, opportunities can be exploited to affect such change.

Classification of Asthma Severity and Medication Using TensorFlow and Multilevel Databases

Escalating cost of treating chronic diseases demand that they be, to the extent possible, self-managed by the patients. In self-management of disease an imperative is to predict, the possible future state of morbidity (at time, T¹), given the present precursor conditions (at time, Tº) and expected precursor condition (at time, T¹).This paper reports the results of a study to evaluate the potential use of using TensorFlow and Inpatient Databases at national level and hospital level for predicting the asthma severity. Methods of Deep Neural Networks (DNN) have been deployed in classification of morbidity conditions, as well as treatment options. The results indicate that training a DNN to predict asthma severity level or the imminence of an asthma attack is possible.

A study to assess the physical health status of children aged between 6-12 years in selected orphanages of Udupi district during 2008 to 2010

Children are placed in orphanages due to poverty, abandonment, illness, death of parents, severe familial dysfunction and so on. Any of those conditions can result in a multitude of health problems in a child. The main Objectives of the study were to assess the physical health status of children aged between 6-12 years in selected orphanages of Udupi district and to find out association between the physical health status and selected demographic variables. Descriptive research design was adopted for the study. An observational checklist on physical health status was developed to collect the data by using purposive sampling technique. The findings of the results showed that the majority (65%) of the children had poor physical health status whereas 35% of the children had good physical health status. The major prevalent morbid conditions among children were Bitot’s spot (65%), pale conjunctiva (65%), acute respiratory tract infection (81.7%), dental caries (88.3%), inflammation of tonsils (73.3%), lice in the head (53.3%), scabies (65%), ring worm infection (46.7%), pyoderma (23.3%). The assessment of nutritional status revealed that majority (60%) of the children had malnutrition.

Exploring the Potential for Family Carers to Support People With Mental Illness to Stop Smoking

ABSTRACTCigarette smoking poses significant health burdens for people with mental illness. They die sooner than they should, and smoking is a major contributor to their high rates of morbid chronic physical health conditions and early mortality, compared to the general population. Family carers provide important support to people with mental illness. However, family carers' perspectives of smoking by their family members with mental illness are largely absent from the research literature and from practice, despite smoking rates remaining high and quit rates remaining low for this population. We know little about how family carers are or could be involved in supporting people with mental illness who smoke to stop smoking. This paper aims to provide a discussion of the opportunities for family carers to support their family member's smoking cessation and a discussion of our preliminary research on this topic. From the available literature, it appears that family carers are well placed to support smoking cessation for this population; however, they struggled physically, philosophically, and emotionally with perceived responsibilities involving their family member's smoking and the caring role. They felt isolated and asserted that there was limited support from service providers to assist them. We concluded that family carers are important agents within the person's immediate environment who could help them to improve their smoking cessation success. This suggests also that mental health services and other health service providers could benefit from including family carers in their efforts to support smoking cessation for people with mental illness who smoke.