Number Of Patients In Group Research Articles

Comparison of Nebulized Glycopyrronium with a Combination of Salbutamol and Ipratropium on Ventilatory Parameters in Critically Ill Mechanically Ventilated Patients of Chronic Obstructive Pulmonary Disease: An Observational Study.

The present study examined the duration of bronchodilation induced by nebulized glycopyrronium bromide (GB) and compared its effectiveness and incidence of any side effects with the combination of salbutamol and ipratropium bromide (SI) in critically ill mechanically ventilated chronic obstructive pulmonary disease (COPD) patients. This prospective, observational study was conducted in mechanically ventilated adult patients of COPD (18-75 years). Data of two groups of patients were collected for 12 hours each for three consecutive days after the nebulization - Group I: those who received 25 µg of GB, and Group II: those who received 1.25 mg of levo-salbutamol and 500 µg of ipratropium by nebulization. A significantly higher number of patients in group II had copious secretions. The mean static compliance was comparable at all time intervals, whereas the mean airway pressure was significantly lower in group II from 15 minutes to 4 hours post-nebulization. In group I, the onset of bronchodilation was 30 minutes on days 1 and 3, and 60 minutes on day 2, whereas, in group II, it was 60 minutes on days 1 and 2 and 30 minutes on day 3. In group I, bronchodilation was 10 hours on day 1 and 12 hours each on days 2 and 3, whereas in group II, bronchodilation was 4 hours on day 1 and 6 hours each on day 2 and 3. Compared with SI, GB nebulization resulted in lesser respiratory secretions, a longer duration of action in terms of lowered airway resistance, and no adverse effects like hypertension, tachycardia, or desiccation of respiratory secretions. Priya P, Nath SS, Kumar V, Kumar S. Comparison of Nebulized Glycopyrronium with a Combination of Salbutamol and Ipratropium on Ventilatory Parameters in Critically Ill Mechanically Ventilated Patients of Chronic Obstructive Pulmonary Disease: An Observational Study. Indian J Crit Care Med 2024;28(10):963-969.

The role of vitamin D in amelioration of oral lichen planus and its effect on salivary and tissue IFN-γ level: a randomized clinical trial

Background and objectivesOral lichen planus (OLP) is a common, prevalent, immune-mediated, inflammatory disease affecting both the skin and oral mucosa and is considered one of the potentially malignant diseases. Since OLP is regarded as an immunologically mediated disease, some studies suggest the use of vitamin D (VD) for its management as it exhibits immune-modulatory, anti-inflammatory, and antimicrobial properties, as well as anti-proliferative, pro-differentiative, and anti-angiogenic effects. VD has demonstrated a suppressive effect on TH1 pro-inflammatory cytokines, including IFN-γ while augmenting the secretion of anti-inflammatory cytokines. At the same time, VD deficiency is a prevalent public issue. Therefore, the present study aimed to investigate the role of VD as an adjunct to steroids in the management of VD-deficient OLP patients as well as its inhibitory effect on IFN-γ through measurement of salivary and tissue IFN-γ levels in OLP patients.MethodsA total of 40 patients with ulcerative or erythematous OLP, diagnosed according to the World Health Organization’s (WHO) modified criteria for OLP, were randomly allocated into one of the two study groups to receive either systemic steroids in addition to VD supplements (Group A) or systemic steroids only (Group B). Blood samples were collected for the measurement of serum VD level (SVDL) using the enzyme-linked immunosorbent assay (ELISA) to involve only patients with VD deficiency or insufficiency (≤ 30 ng/ml). Clinical evaluation of the lesion involved objective signs and subjective symptoms. Also, changes in salivary and tissue INF-γ levels (in pg/mL and pg/mg, respectively) were determined using the ELISA technique. All parameters were measured at baseline and after 4 weeks of treatment. The clinical pharmacy team devised a checklist to record all team interventions. The interventions were categorized into six domains, including drug interactions and/or adverse reactions, medication dose issues, drug selection issues, support with medication history, patient-related concerns, and suggestions for dental medication.ResultsAfter one month of treatment, a significantly greater number of patients in group A showed complete pain relief and resolution of clinical lesions, as well as a greater number of patients showing a reduction in the clinical severity of lesions than in group B (P = 0.005). Also, there was a statistically significant reduction in average VAS pain scores and clinical scores in group A compared to group B after 1 month of treatment (P = 0.001 and 0.002, respectively). Furthermore, there was a statistically significant greater reduction in salivary and tissue IFN-γ levels in group A than in group B (P ≤ 0.001 and 0.029, respectively) after 1 month of treatment.ConclusionCurrent evidence suggests a significant preventive and therapeutic role for VD as an adjunct to standard therapies indicated for OLP lesions. These protective and therapeutic functions are achieved through the suppressive effect of VD on pro-inflammatory cytokines, particularly IFN-γ. Also, salivary IFN-γ appears to be a valuable prognostic marker for monitoring the progression of OLP. In addition, the inter-professional collaboration between dentists and clinical pharmacists helped to deliver complete, patient-centered primary care and ensured the quality of the medications included in patient kits, thus improving patient treatment and management. Nevertheless, further studies with larger sample sizes, longer follow-ups, and standardized designs may still be needed.

Validation of the “TWO-ROP” Algorithm at a Multi-Neonatal Intensive Care Unit Tertiary Referral Center

PurposeWe aim to validate the previously published TWO-ROP algorithm on an external dataset. DesignRetrospective consecutive study. SubjectsInfants screened for retinopathy of prematurity (ROP) between January 2013 and August 2023 at a tertiary referral multi-site. MethodsInfants with higher birth weight (BW) and longer gestational age (GA) were included and stratified into three groups as follows: group 1 (BW<1500 g, GA≥30 weeks), group 2 (BW≥1500g, GA< 30 weeks), and group 3 (BW≥1500g, GA≥30 weeks). Main Outcome MeasuresThe rate of ROP, treatment-warranted ROP (TW-ROP), and number of inpatient examinations were evaluated in the three groups. Results1,095 (33.8%) patients met the inclusion criteria. The number of patients in groups 1, 2, and 3 were 837 (76.4%), 72 (6.6%), and 186 (17.0%), respectively. ROP was detected in 120 (11.0%) patients; the rate was 9.8% in group 1, 20.8% in group 2, and 12.4% in group 3 (p=0.013). The overall mean number of inpatient examinations for patients undergoing traditional, TWO-ROP 36-week, and TWO-ROP 40-week screening systems were 1.95, 1.43, and 0.99, respectively (p<0.001). Stage 3 was found in 9 eyes of 5 patients (0.5%, all zone II). Three eyes of 2 patients (0.2%) had plus disease. Two patients had bilateral laser treatment at 44 and 39.4 weeks postconceptional age; 3 out of 4 of these eyes met Type 1 treatment criteria. Overall, the ROP screening burden saved was 9.0% and 16.7% for the TWO-ROP 36-week and 40-week systems, respectively. The sensitivity for TW-ROP was 100% for TWO-ROP 36-week system and 99.4% for TWO-ROP 40-week system. ConclusionThe TWO-ROP algorithm can reduce the number of inpatient examinations while maintaining safety. To ensure timely management, we recommend that the single first ROP examination occurs at 38-39 weeks postconceptional age.

The Effect of Combined Spinal Epidural Anesthesia on Shoulder Pain in Laparoscopic Extraperitoneal Hernia Surgery.

Shoulder pain is a condition that seriously discomforts patients and develops caused by a peritoneal tear in laparoscopic extraperitoneal hernia repair (TEP) surgeries. Although surgeons generally prefer general anesthesia for the TEP technique, many studies have been carried out on the use of regional anesthesia in recent years. In our study, we aimed to investigate the efficacy and safety of the combined spinal/epidural anesthesia (CSEA) method to prevent shoulder pain in the TEP technique. The patients who operated with the TEP procedure were divided into 2 groups; SA (group 1) and CSEA (group 2). The 2 patient groups were compared in terms of sex, age, body mass index, duration of surgery, total operation time, patient satisfaction, pain scores, length of hospital stay, adverse effects, intraoperative, and postoperative complications. The number of patients in group 1 was 42 and group 2 was 40. The mean operation time was recorded as 55.9 and 80.2 minutes in groups 1 and 2, respectively, which was statistically significantly shorter in group 1 ( P <0.001). Postoperative pain was significantly less in group 2 for the 4th hour ( P <0.0001) and the 12th hour ( P =0.047). There was no difference between the 2 groups in terms of peritoneal tear ( P =0.860). Intraoperative and postoperative shoulder pain was significantly less in group 2 ( P =0.038, P =0015, respectively). CSEA is an effective and safe anesthesia method for preventing shoulder pain that develops after TEP surgeries.

Comparative Evaluation of Ease of Nasotracheal Intubation Using C-MAC versus TuoRen Video Laryngoscope in Adult Surgical Patients: A Randomized Study

Background and Aims: Laryngeal visualization and ease of intubation vary with the use of different video laryngoscopes. We compared the number of attempts taken for successful first-attempt nasotracheal intubation using C-MAC video laryngoscope versus TuoRen video laryngoscope. Ease of intubation and time taken, glottic view, and hemodynamic responses were also compared. Materials and Methods: It was a randomized, single-blinded trial conducted in eighty adult surgical patients with normal airways requiring nasotracheal intubation. In all patients, the protocols for induction and intubation were similar. In Group C, C-MAC video laryngoscope and in Group T, TuoRen video laryngoscope were used. Statistical analysis was done using independent samples t-test and Chi-squared test as applicable. Results: Successful first-attempt intubation was significantly higher in Group C compared to Group T (87.5% vs. 60%). Incidence of fogging was significantly lower in Group C compared to Group T (10% vs. 30%). Time taken for intubation was significantly higher in Group T (34.64 ± 4.38 s vs. 86.25 ± 8.56 s). The view of the glottis obtained was similar in both groups. A significantly higher number of patients in Group C had easy intubation (87.5% vs. 60%). Mean heart rate and mean arterial pressure were significantly higher in Group T after intubation. Conclusion: Successful first-attempt nasotracheal intubation was significantly higher with the use of C-MAC which required lesser attempts and time compared to TuoRen video laryngoscope. The glottic views obtained with both devices were comparable, but the ease of intubation was better and fogging was lesser with C-MAC. The use of TuoRen videoscope was associated with significantly higher hemodynamic responses.

Findings from the Use of Spinal Anesthesia in the Laparoscopic Treatment of Extrauterine Pregnancy: Could It Represent an Alternative to General Anesthesia?

Introduction: Minimally invasive procedures performed in laparoscopy, such as salpingectomy for ectopic pregnancy, can be combined with a minimally invasive anesthesia. The aim of this study was to assess the feasibility and the intraoperative and postoperative outcomes of laparoscopic surgery for ectopic pregnancy under spinal anesthesia (SA) compared to general anesthesia (GA) from the point of view of the surgeon, anesthesiologist, and patient. Methods: A retrospective cohort study was performed at DAI Materno Infantile of AOU Federico II of Naples, analyzing all medical records of women who met the inclusion criteria between April 2020 and April 2023. Eighty-two women (35 under SA in group A and 47 under GA in group B) undergone elective or emergency laparoscopic salpingectomy for ectopic tubal or ovarian pregnancy were included. Results: Patients in group A reported less pain at 0 h (adjusted mean difference: −1.5; 95% CI: −2.3 to −0.7; p < 0.001) and after 6 h (adjusted mean difference: −1.1; 95% CI: −2.0 to −0.3; p = 0.01) while no statistically significant differences between the two groups at 12 and 24 h after surgery. No differences were observed among the type of analgesic and during the postoperative observation time, except for paracetamol at 0 h in group B. A faster resumption of bowel motility, patient’s mobilization, and a shorter hospital stay were observed in group A compared to group B. Also greater odds of returning faster to daily activities emerged in group A (adjusted OR: 5.39; 95% CI: 1.77–16.37). A greater number of patients in group A were satisfied with the entire procedure compared to those of group B (33 [94.3%] vs. 37 [78.7%]). The general surgeon satisfaction was always very good or excellent in group A. Finally, all surgical steps were well tolerated in group A. Conclusion: In specific settings, SA is a feasible and safe procedure for the laparoscopic treatment of ectopic pregnancy.

#281 : IVF Outcome of Good Prognosis Patients Based on Sperm Morphology Grading Using Intracytoplasmic Morphologically Selected Sperm Injection (IMSI) Technique

Background and Aims: Spermatozoa morphology is one of the factors that can influence the success of IVF. IMSI is a technique that provides various selection criteria of sperm head’s morphology and the presence of vacuoles with a total magnification of over 6,000. The purpose of this study was to compare the embryo development of good prognosis patients based on sperm morphology grading using IMSI technique. Method: This study was a retrospective analysis performed at Morula IVF Jakarta from 2019 to 2022 based on good prognosis patients (age [Formula: see text] 38 years, AFC [Formula: see text] 7, AMH [Formula: see text] 1.1). There were two groups in this study, (A) sperm grade I and II, (B) sperm grade III and IV, based on Vanderzwalden et al. (2008). The number of patients in group (A) was 1035 patients, and group (B) was 345 patients. The parameters observed in this study were fertilization rate (FR), top embryo quality rate on day 3 (D3) and day 5 (D5), blastocyst rate (BR). Results: The result study showed that (FR) were significantly increased (P=0.000) in group (A) compared to group (B), which was 77.28% and 72.90%. In addition, group (A) had significantly (D3), which was 51.37% (P=0.012) compared to group (B) 46.92%. On the other hand (D5) and (BR) were significantly increased (P=0.000) in group (A), by about 42.58% and 48.01%, contrasted to group (B), which was only 36.11% and 39.21%. Conclusion: Grade I and II sperm of IMSI technique significantly increased IVF outcome in good prognosis patient.

Correlation of axial length with minimal effective volume of peribulbar block

Cataract remains the most common cause of blindness worldwide and surgery is the only option to get rid of a cataract. Good anaesthesia is an essential requirement for performing safe cataract surgery. Peribulbar block using regional anaesthetic is the most common technique of administrating anaesthesia for cataract extraction. The study aimed to know the relationship between the axial length and the minimal effective volume of the peribulbar block. The study was done in a hospital based in the rural area of Panipat. It was a cross-sectional study done on patients who underwent cataract surgery and met the inclusion and exclusion criteria of the study. The patients were divided into two groups based on axial length and were given peribulbar block using 2% lignocaine with 1500 IU of hyaluronidase of 6 ml and 8 ml. The subsequent doses of the block were given in those in which adequate response was not present. The study includes 100 patients divided into two groups. The patients in group 1 had axial lengths between 21-23.99 mm and the second group included patients with axial lengths of 24-26.99 mm. In group 1 the volume of peribulbar block given was higher than that in group 2. The maximum number of patients in group 1 (34) were given an 8 ml block and those in group 2 were given a 6 ml of block. The study had a p-value of 0.02. In our study, we found that axial length has a negative correlation with the volume of the peribulbar block. It was also seen that there was an increase in IOP with more amount of local anaesthetic used in the peribulbar block.

Ways to reduce the incidence of cesarean sections according to the Robson classification

Introduction and Aim: Cesarean sections (CS) are a medically indicated and effective method for reducing maternal and perinatal mortality. The incidence of CS has increased in developed as well as developing countries over the past few decades. The objective of this study is to analyze the distribution of births according to the Robson classification and to assess ways to reduce the frequency of CS. Methods: This is a retrospective study based on records of the delivery histories of 18,125 female patients in the maternity department of the Kyrgyz Research Center for Human Reproduction, conducted using Robson classification. Results: However, the parameters also showed a statistically significant decrease in the highest number of patients in group 3 by -18.9% (from 40.6% to 32.9%) and group 1 by -9.9% (from 29.2% to 26.3%) in 2022 compared to 2016, p&lt;0.001. Despite their low specific weights, the 6, 7, 8, 9, and 10 groups showed a significant increase despite their small numbers. Conclusion: Despite their low proportion but massive increase in indicators, the small number of groups 6, 7, 8, 9, and 10 may contribute to perinatal mortality and morbidity, highlighting the need for rigorous monitoring and control of pregnant women in these groups.

Influence of Different Types of β-Blockers on Mortality in Patients on Hemodialysis.

Previous results regarding the association between types of β-blockers and outcomes in patients on hemodialysis (HD) were inconsistent. Our study aimed to evaluate patient survival according to the type of β-blockers administered using a large sample of patients with maintenance HD. Our study included patients on maintenance HD patients from a national HD quality assessment program (n = 54,132). We divided included patients into four groups based on their use and type; Group 1 included patients without a prescription of β-blockers, Group 2 included patients with a prescription of dialyzable and cardioselective β-blockers, Group 3 included patients with a prescription of non-dialyzable and non-cardioselective β-blockers, and Group 4 included patients with prescription of non-dialyzable and cardioselective β-blockers. The number of patients in Groups 1, 2, 3, and 4 were 34,514, 2789, 15,808, and 1021, respectively. The 5-year survival rates in Groups 1, 2, 3, and 4 were 69.3%, 66.0%, 68.8%, and 69.2%, respectively. Univariate Cox regression analyses showed the hazard ratios to be 1.10 (95% CI, 1.04-1.17) in Group 2 and 1.05 (95% CI, 1.02-1.09) in Group 3 compared to Group 1. However, multivariate Cox regression analyses did not show statistical significance among the four groups. Our study showed that there was no significant difference in patient survival based on the use or types of β-blockers.

Effect of operation table height on ease of mask ventilation, laryngeal view, and endotracheal intubation success.

Optimal patient positioning and operating table height are essential for an ergonomic posture of an anesthesiologist in which there is minimal or no strain on thewrist during mask ventilation. It also avoids flexion of the neck, lower back, and knee bending at the time of laryngoscopy and intubation. One hundred eighty patients were randomly allocated to three groups based on different table heights. The height of the table is kept at the mid-sternum level of an anesthesiologist in group 1, at the xiphoid process in group 2, and at the level of umbilicus in group 3. Laryngoscopic view with or without postural changes (exertion at wrist joint, flexion of the neck, lower back, or knee bending) was graded as per Cormack Lehane's (CL) grading. The degree of discomfort experienced by the anesthesiologist during mask ventilation or tracheal intubation was graded subjectively (1 = no discomfort, 2 = mild discomfort, 3 = moderate discomfort, and 4 = severe discomfort) at different table heights. Postural changes required to obtain the best glottic view and quality of endotracheal (ET) intubation (intubation time and attempts required) were also noted. For analysis, quantitative variables were expressed as mean ± SD and compared using unpaired t or analysis of variance test. Qualitative variables were expressed as frequencies/percentages and compared using the Chi-square test. Results with P value <0.05 were considered significant statistically. Moderate discomfort (strain at wrist joint) during bag-mask ventilation was experienced by the anesthesiologist in a maximum number of patients in group 1 (81.7%). Significant improvement was seen in CL grade after the use of postural modifications in groups 1 and 2 (P value ≤0.05). Greater postural modifications were required during ET intubation at lower table heights (group 3). It is advisable to adopt higher table positioning in relation to anesthesiologist performing the laryngoscopy for smooth and single-attempt ET intubation since the best laryngoscopic view and intubation with minimal postural modifications was seen at higher table heights (at the mid-sternum level of an anesthesiologist).

Proper position of single and large (≥5 cm) hepatocellular carcinoma in Barcelona Clinic Liver Cancer classification.

The purpose of this study was to evaluate the proper position of single large hepatocellular carcinoma (HCC) in the Barcelona Clinic Liver Cancer (BCLC) staging system. The data were collected from the nationwide multicentre database of the Korean Liver Cancer Association. Patients with single large (≥5 cm) HCC were separated from BCLC stage A patients and designated as Group X. The remaining BCLC stage A and stage B patients were classified as Group A and Group B, respectively. The survival outcomes of propensity score-matched groups were compared. Among the 3965 randomly selected patients, the number of patients in Group X, Group A, and Group B was 414, 2787, and 760, respectively. TriMatch analysis allowed us to obtain 116 well-balanced triplets. The 1-, 3-, and 5-year overall survival rates in Group X were worse than in Group A (91%, 71%, and 48% vs 90%, 78%, and 64%, respectively; P < .000). However, the rates were not different compared with those in Group B (91%, 71%, and 48% vs 90%, 69%, and 48%, respectively; P < .09). In multivariate analysis, Group X, Group B, age over 60 years, prothrombin time-international normalized ratio, and creatinine level were independent predictors of worse overall survival. Our findings suggest that Group X should be relocated to BCLC stage B rather than BCLC stage A.

Impact of forced diuresis at two different time points on pelvic imaging in prostatic carcinoma with 68Ga-PSMA PET/CT.

We compared diagnostic quality of 68Ga-PSMA PET/CT imaging focused on the pelvic structures using two furosemide protocols in two different groups of patients. A total of 55 patients with prostate cancer were retrospectively enrolled in the study. Out of 55, 31 patients were in group 1 (median age: 66 years, Range 44-78 years) in which furosemide injection was given after completion of whole-body 68Ga-PSMA PET/CT scan and 24 patients were in group 2 (median age: 63.5 years, range: 50-82 years) in which it was given along with the 68Ga-PSMA injection. In both groups, an initial time point scan (T0 scan) and a delayed time point scan (T1scan) were done. The images were analyzed qualitatively as well as quantitatively. Quantitatively there was no statistically significant difference between the SUVmax and T:B of prostatic lesion and seminal vesicle invasion (SVI) in both the groups at two time points (P > 0.05). Early furosemide injection caused a washout of the urinary bladder radiotracer concentration in significantly higher number of patients in group 2 (62.5% vs. 6.45% patients, P < 0.001). There was significant clearance of radiotracer activity from the ureters in group 2 (SUVmax: 9.28 vs. 3.09, P = 0.002). The simultaneous furosemide and 68Ga-PSMA injection can reduce the urinary excretion of the tracer and improve the diagnostic confidence of prostatic lesion, SVI and lymph nodal metastasis, along with reducing the scanning time and radiation burden, making this protocol an effective alternative to the present protocol of delayed furosemide injection.

Rehabilitation effect of intelligent rehabilitation training system on hemiplegic limb spasms after stroke.

This article aimed to explore the rehabilitation efficacy of intelligent rehabilitation training systems in hemiplegic limb spasms after stroke and provided more theoretical basis for the application of intelligent rehabilitation systems in the rehabilitation of hemiplegic limb spasms after stroke. To explore the rehabilitation efficacy of intelligent rehabilitation training system (RTS for short here) in post-stroke hemiplegic limb spasms, this study selected 99 patients with post-stroke hemiplegic limb spasms admitted to a local tertiary hospital from March 2021 to March 2023 as the research subjects. This article used blind selection to randomly divide them into three groups: control group 1, control group 2, and study group, with 33 patients in each group. Control group 1 used a conventional RTS, group 2 used the brain-computer interface RTS from reference 9, and research group used the intelligent RTS from this article. This article compared the degree of spasticity, balance ability score, motor function score, and daily living activity score of three groups of patients after 10 weeks of treatment. After 10 weeks of treatment, the number of patients in the study group with no spasms at level 0 (24) was significantly higher than the number of patients in group 1 (7) and group 2 (10), with a statistically significant difference (P < 0.05); In the comparison of Barthel index scores, after ten weeks of treatment, the total number of people in the study group with scores starting at 71-80 and 81-100 was 23. The total number of people in the score range of 71-80 and 81-100 in group 1 was 5, while in group 2, the total number of people in this score range was 8. The study group scored considerably higher than the control group and the difference was found to be statistically relevant (P < 0.05). In the Berg balance assessment scale and motor function assessment scale, after 10 weeks of treatment, the scores of the study group patients on both scales were significantly higher than those of group 1 and group 2 (P < 0.05). The intelligent RTS is beneficial for promoting the improvement of spasticity in stroke patients with hemiplegic limb spasms, as well as improving their balance ability, motor ability, and daily life activities. Its rehabilitation effect is good.

Psychiatric comorbidities, quality of life, and cardiovascular risk factors in patients with heart failure

Background: Heart failure (HF) leads to various changes including physiological (neurohormonal) changes and an increase in stress level, which can become a risk factor for the development of various psychiatric disorders, further worsening quality of life (QOL). Methods: Patients of HF between 18 and 60 years of age attending the outpatient department of the Department of Cardiology were enrolled. Patients were screened for psychiatric illness by applying Mini International Neuropsychiatric Interview 7.0.2. The diagnosis was made through the Diagnostic and Statistical Manual of Mental Disorders-5. The severity of anxiety and depression was assessed by applying the Hamilton Depression Rating Scale and Hamilton Anxiety Rating Scale. Sleep quality was measured by applying the Pittsburgh Sleep Quality Index. Subsyndromal symptoms were assessed via SADS-CB. QOL was measured by the World Health Organization QOL-BREF. Data were statistically analyzed. Results: Out of 70 enrolled patients, 32 patients did not have any psychiatric illness (Group A), 20 patients were in the subsyndromal group (Group B), and 18 patients had psychiatric disorders (Group C). Tobacco use and the number of risk factors of HF present were significantly higher in Group C. A significantly higher number of patients in Group C were lying in the New York Heart Association (NYHA) II class (patients lying in NYHA III and NYHA IV classes were excluded) than in other groups. In addition, sleep and QOL (especially among patients under NYHA I class) were significantly impaired in Group C. Conclusion: Psychiatric illness is common in patients with HF. Despite guidelines to screen for them, clinicians either do not screen for them or otherwise miss the psychiatric illness. These psychiatric illnesses may further impair the outcome of heart diseases and worsen QOL.

FTP6.4 Management and Outcomes of Acute Diverticulitis in Immunosuppressed Patients

Abstract Aims Previous studies have suggested that immunosuppressed patients with acute diverticulitis are at high risk of failing conservative management and many will require urgent surgical intervention. Some series have shown mortality rates as high as 39% and 56% with medical and surgical management respectively. The aim of this study was to analyse the management and outcomes of immunosuppressed patients presenting with acute diverticulitis. Methods Data were collected on patients admitted as an emergency with acute diverticulitis over a 2-year period (1st January 2018 to 31st December 2019). Immunosuppressed patients were identified and divided into 5 groups according to the cause: group 1, chronic corticosteroid use; group 2, transplant patients; group 3, malignant neoplasm; group 4 chronic kidney disease; group 5, other immunosuppressant treatments. Outcomes were recorded. Results Sixty-one patients with immunosuppression were admitted with acute diverticulitis. The number of patients in groups 1-5 were 23, 2, 11, 16 and 9 respectively. Fifty-one patients (83.6%) had a CT during their admission and thirteen (21.3%) presented with complicated diverticulitis. Two patients (3.3%) underwent emergency surgery, both of whom were on chronic corticosteroid therapy and were alive at 1-year post-op. All fifty-nine patients (96.7%) managed conservatively survived admission. Conclusions This study has shown a lower rate of emergency surgery than previously observed and lower mortality with both medical and surgical management. Conservative management appears to be safe for the majority of immunosuppressed patients with acute diverticulitis.

Effects of Proton Pump Inhibitors on Patient Survival in Patients Undergoing Maintenance Hemodialysis.

Data to draw definite conclusions regarding the association between proton pump inhibitor (PPI) and all-cause mortality in patients undergoing hemodialysis (HD) remain insufficient. The object of this retrospective study was to assess the impact of PPIs on patient survival within a substantial cohort of individuals receiving maintenance HD. To achieve this, the study employed laboratory and clinical data sourced from the 4th, 5th, and 6th National HD Quality Assessment Programs. The programs included patients undergoing maintenance HD (n = 54,903). Based on the PPI prescription data collected over the 6-month HD quality assessment, the patients were categorized into three groups: Group 1, comprising individuals with not prescription; Group 2, consisting of patients prescribed PPIs for less than 90 days; and Group 3, comprising patients prescribed PPIs for 90 days or more. The respective number of patients in Groups 1, 2, and 3 was 43,059 (78.4%), 5065 (9.2%), and 6779 (12.3%), respectively. Among the study groups, the 5-year survival rates were as follows: Group 1-70.0%, Group 2-68.4%, and Group 3-63.0%. The hazard ratio for Group 3 was 1.09 (95% CI, 1.04 to 1.15; p < 0.001) and 1.10 (95% CI, 1.03 to 1.18; p = 0.007) compared to Groups 1 or 2 based on multivariable analysis. Multivariable analyses revealed a lower rate of patient survival in Group 3 compared to the other groups, while Groups 1 and 2 exhibited similar patient survival rates. Our study revealed a significant association between long-term PPI usage and increased mortality among patients undergoing HD. However, distinct trends were observed in subgroup analyses. The association between long-term PPI usage and mortality was prominent in patients who did not have a high gastrointestinal burden or comorbidities. Meanwhile, this association was not observed in patients who did have a high gastrointestinal burden or comorbidities.

Long-term efficacy and safety of different corticosteroid courses plus mycophenolate mofetil for autoimmune encephalitis with neuronal surface antibodies without tumor.

To compare the efficacy and safety of different-course corticosteroids plus mycophenolate mofetil (MMF) as maintenance therapy in autoimmune encephalitis (AE) with neuronal surface antibodies (NSAbs) without tumor and explore the optimal course of corticosteroids. Fifty-five patients with definite AE without tumor were enrolled consecutively between June 2015 and November 2020 and retrospectively divided three groups according to the course of treatment with corticosteroid, i.e., a group of patients with a course of 3-6 months (Group 3-6mo), 6-12 months (Group 6-12mo), and >12 months (Group >12mo). Demographic data, clinical manifestation and ancillary tests results were recorded. The dosage and courses of corticosteroid treatment, the recovery of neurological function, the occurrence of adverse effects, and relapses were followed up. A total of 55 patients were included in the final analysis. The numbers of patients in Group 3-6 mo, Group 6-12 mo, and Group >12 mo was 14, 17, and 24, respectively. A significantly higher proportion of patients in Group >12 mo showed a decreased level of consciousness at the onset (12, 50%) than in Group 3-6 mo and Group 6-12 mo (2,14.3%; 3, 17.6%) (p = 0.033). The incidence of MRI abnormalities was significantly higher in Group 6-12 mo and Group >12 mo (10, 58.8%; 16, 66.7%) than in Group 3-6 mo (3, 21.4%) (P=0.023). Ordinal regression analysis indicated that decreased level of consciousness was associated with the course of corticosteroid (OR=3.838, 95% CI: 1.103-13.323, P=0.035). No significant difference was observed between the three groups regarding the cumulative dose of corticosteroids administered during the first three months of long-term treatment (P>0.05). Additionally, no significant difference in the cumulative dosage of corticosteroids was found between patients in Group 6-12 months and Group >12 months during the first 6 months after beginning long-term treatment. The mRS scores of the three groups were not statistically significant before and after first-line treatment or at the last follow-up. Bonferroni multiple comparison test indicated that the mRS scores of patients in Group 6-12 months and Group >12 months were not statistically significant at 3 months and 12 months after the start of long-term treatment. During the follow-up, 50 (90.9%) patients achieved satisfactory neurological function (mRS score ≤2). Five patients (9.1%) experienced a first relapse and 2 of them were overlapped with both anti-NMDA receptor and glial antibodies. The incidence of adverse effects was significantly higher in Group >12 mo (17, 70.8%) than in Group 3-6 mo (3, 21.4%) and Group 6-12 mo (5, 29.4%) (P=0.003). The beneficial effects of oral corticosteroid treatment may do not persist beyond 12 months and may even contribute to an increased incidence of adverse effects. In order to optimize the effectiveness and safety of treatment, we recommend a corticosteroid course of 3-12 months. Patients with reduced levels of consciousness may be more inclined to choose longer courses of corticosteroids for long-term treatment. Patients with an "overlapping syndrome" may require more intense immunotherapy to prevent relapse.

Evaluation of comparative efficacy of Dietary supplement acquired from Kitchen Garden (Parasbag) and Gudharitaki Awaleha in Pandu Roga (Iron Deficiency Anemia)

Backround-Panduroga is a Raktapradoshaja vyadhi having pitta dominance. Due to similarity of symptoms it can be correlated with Iron deficiency Anemia. Iron deficiency anemia secondary to inadequate dietary iron intake is caused by consuming a diet low in iron-rich foods. The richest sources of minerals and vitamins are fruits and green leafy vegetables. Growing a variety of crops in the kitchen garden is one of the simplest methods to make sure that everyone has access to a balanced meal that contains enough micronutrients. Aim and objectives-The objective of this study, which is being conducted in association with Mission Samriddhi (MS), is to compare the effectiveness of dietary supplements from Kitchen Garden (Parasbag) and Gudaharitaki Awaleha. Methodology- Total 60 patients were selected and divided in two equal groups. Group A patients were treated with nutritional supplement obtained from (Parasbag) Kitchen Garden along with Gudaharitaki Awaleha whereas group B patients were treated with Gudaharitaki Awaleha for 90 days. Assessment of subjective and objective criteria was done before and after treatment. Result and Discussion- Significant improvement was observed in subjective and objective parameters in both groups. But improvement was observed in more number of patients in group A than group B. Conclusion- Nutritional supplement obtained from (Parasbag) Kitchen Garden and Gudharitaki Awaleha improve Haemoglobin percentage because organically grown vegetables and fruits are rich in nutrients which help in prevention of nutritional deficiencies.

THE EFFECT OF SEDATION STRATEGY ON THE FREQUENCY OF POSTOPERATIVE ARRHYTHMIAS AFTER CARDIAC SURGERIES WITH BYPASS

Introduction: Postoperative arrhythmias are a frequent problem after surgical interventions, both noncardiac and cardiac surgeries. A 20% higher frequency of rhythm disturbances occurs in patients after cardiac surgery. Postoperative arrhythmia has many variations. Such arrhythmias include atrial fibrillation, atrial flutter, ventricular arrhythmias, and bradyarrhythmias. There are many conflicting facts about the effect of sedative drugs, which are most often used at the moment: propofol, dexmedetomidine, on reducing the frequency of postoperative arrhythmias. Purpose: To analyze whether there is a difference in the frequency of postoperative arrhythmia in patients in different groups sedated with propofol, dexmedetomidine and their combination. Materials and methods: This is a randomized controlled parallel study. The study included 356 patients over 18 years of age who underwent cardiac surgeries operative treatment. 194 patients were analyzed. Statistical data processing was carried out on the basis of GraphPad Prism 9.0 software. Results: Of the total number of patients in the propofol sedation group without prior rhythm disturbance, in whom arrhythmia was detected in the postoperative period, n=13 patients were registered. In the dexmedetomidine sedation group, postoperative arrhythmia was observed in 8 patients, which is also 50 % of the total number of patients in this group. Among 8 patients in whom postoperative arrhythmia was registered, 5 patients did not have rhythm problems before surgery. Of the total number of patients in the group of sedation with a combination of drugs without previous rhythm disturbance, postoperative arrhythmia was detected in 19 patients. When analyzing the frequency of postoperative arrhythmias, no difference in the frequency of postoperative arrhythmias has been detected in all three sedation strategies (p=0.1107). Conclusions: According to the data we obtained, no difference was found in the frequency of postoperative arrhythmias in patients after cardiac surgery in any of the sedation groups (p=0.1107).