Hospital-based Prospective Observational Study Research Articles

TOPRSS: a simple clinical score to predict outcome and mortality in paediatric emergency department

Background: To validate the clinical scoring system TOPRSS for the severity of the illness to prioritize care and predict outcomes in the emergency department.Methods: This prospective hospital-based observational study in 100 children for three months carried out. Cases<1-month age or>14 years excluded. Demographics data, provisional diagnosis, hemodynamics, seizures, and other clinical parameters were recorded on predesigned proforma at the time of admission. Final outcome of the patient, either discharge or death, was considered as the primary variable.Results: Out of 100 children, 92 were discharged and 8 deaths were recorded. Of the six variables, oxygen saturation and sensorium were found to be significantly associated with mortality. Logistic regression found that variables such as oxygen saturation and sensorium were strongly associated with mortality with a highly significant p value of 1% and variables such as pulse rate and seizures were also associated with mortality with a significant P value of 5%.Conclusions: For triage in pediatric emergency, a patient with two or more abnormal variables should be evaluated to facilitate admission as they have a potential risk of death. TOPRSS score being a simple clinical scoring system which does not require any expertise can applied at all levels of health care to identify critically ill patient referral to higher centre especially in regions of resource poor environment.

Evaluation of Risk Factors for Exchange Range Hyperbilirubinemia in Neonates from Eastern Part of Nepal


 
 
 
 Introduction: Neonatal hyperbilirubinemia continues to be the commonest cause of nursery and NICU admissions and readmissions in the neonatal period worldwide. Although most cases are physiological, toxic levels of un-conjugated bilirubin can lead to acute and chronic bilirubin encephalopathy. Hence, this study aimed to study the risk factors for exchange range hyperbilirubinemia in neonates.
 Methods: This was a hospital-based prospective observational study conducted in a teaching and referral NICU over a period of one year from July 2019 to August 2020. All neonates with diagnosis of hyperbilirubinemia requiring double volume exchange transfusion were included in the study. Risk factors for significant hyperbilirubinemia were analysed with descriptive statistics. P-value of < 0.05 was considered significant wherever applicable.
 Results: The mean gestational age and birth weight were 38.06 ± 2.13wks and 2611.72 ± 389.39 gm respectively. Fifteen percent of the babies (162) developed hyperbilirubinemia and 28 (17.3%) required double volume exchange transfusion. Among neonates requiring exchange transfusion, 17 were females and 11 were males. Among 28 babies who required DVET, 20 (71.4%) were SGA. ABO incompatibility was present in 14 (50.0%) neonates and Rh incompatibility in 13 (46.4%) neonates. ABO along with Rh incompatibility was present in eight (28.6%) neonates. DCT was positive in six neonates with ABO incompatibility and nine neonates in Rh incompatibility. G6PD deficiency was present in four (14.3%) neonates.
 Conclusions: The most important risk factors identified were small for gestational age, ABO and Rh incompatibility followed by oxytocin use and sibling treated for jaundice.
 
 
 

Correlation of ABO Rh and Cholelithiasis: A Prospective Observational Study in a Zonal Hospital, North India

Background: Karl Landsteiner discovered the ABO blood group system in 1901 and Rh factor in 1940, since then, scientists searched for an association between different pathologies and the ABO blood group system of patients. ABO blood groups have been shown to be associated not only with various diseases but also with metabolic process. Objective: This study was done to determine if there is any significant correlation between ABO-Rh and cholelithiasis. Materials and Methods: This is hospital-based prospective observational study in which 360 patients with ultrasonography proven symptomatic cholelithiasis, belonging to different socioeconomic conditions and various geographical locations of India, underwent laparoscopic cholecystectomy formed the study population. The ABO Rh of the 360 patients was done by standard agglutination technique in blood bank of department of pathology. For statistical analysis data were enter into the MS Excel sheet. Results: Cholelithiasis was predominant in females (85%) than males. Age group of 51–60 years has the maximum number of patients. Blood group “O” has maximum number of cholelithiasis patients (69.6%) followed blood group “B” (37.2%). Among blood group “O” Rh positive had numerous stone of cholesterol type, followed by blood group “B” Rh positive. Conclusion: In this study, incidence of cholelithiasis was maximum in the blood group “O” Rh positive with the cholesterol stones as the predominant type of stone. These results has not corroborated with the existing literature, suggesting variability. A large prospective study could potentially reveal if any correlation exists and this could open the doorway to future research on the etiologies of gall stone diseases.

CLINICAL PROFILE, PRESCRIPTION PATTERNS, AND ADVERSE DRUG REACTIONS IN PATIENTS WITH VITILIGO: A PROSPECTIVE STUDY

Objectives: The objectives of the study were to assess clinical profile (age of onset, age of presentation, gender, site of involvement, severity (stage), type of vitiligo, triggering factors, and associated diseases), prescription patterns (monotherapy, combination therapy, oral, topical, and therapeutic categories of drugs prescribed) and to monitor and report adverse drug reactions (based on World Health Organization [WHO] causality assessment scale) in vitiligo patients.
 Methods: A hospital-based prospective observational study was carried out by evaluating and assessing the clinical profile and prescription patterns of 85 patients who attended dermatology venereology and leprosy (DVL) outpatient department at Sri Padmavathi Medical College for Women, SVIMS, Tirupati, over a period of 6 months from June 2019 to December 2019.
 Results: In our study, forty four (51.77%) patients were female, vitiligo vulgaris is the most common morphological type observed in twenty seven (31.76%) patients. 31–50 years was the predominant age group. The mean age of onset and presentation was 38.35 (standard deviation of 18.37) and 43.27 (standard deviation of 17.96) years, respectively. Forty-one (48.23%) patients were having Stage 1 vitiligo. Fifty (58.85%) patients were having vitiligo at more than 1 site. Twelve (14.11%) patients were having a positive family history of vitiligo. Thirty-seven (43.53%) patients had triggering factors. Associated diseases were found in thirty (35%) patients. Combination therapy was given to sixty one (71.77%) patients. Topical medications were given to fifty two (61.18%) patients. During the study, we did not have a single patient complaining of any adverse drug reaction.
 Conclusion: Longer the time after appearance of vitiligo, lesser the number of patients attending follow-up. If vitiligo is diagnosed at the earliest stage, more are the chances for complete repigmentation. Patients with a poor economic background are less bothered about their skin condition and are not using medications properly.

English

BACKGROUND Phacoemulsification is a common surgery for cataract. The endothelium comprises of hexagonal cells which in single layer is essential for maintaining the transparency of the cornea. We wanted to compare endothelial cell density (ECD), central corneal thickness (CCT), coefficient of variability, and hexagonality of endothelial cells before and after phacoemulsification surgery. we also wanted to evaluate the endothelial cell loss after phacoemulsification surgery. METHODS A rural hospital-based prospective observational study with 120 patients was conducted in a hospital based setting utilising the data of patient’s eye by considering inclusion and exclusion criteria, before and after phacoemulsification surgery by using noncontact specular microscope. RESULTS The mean endothelial cell density significantly decreased postoperatively at day one, 4th week, 12th week. The mean central corneal thickness increased significantly at postoperative day one, then subsequently decreased at postoperative 4th week and 12th week (P value = 0.0001), but never reached the preoperative value. There was a significant change in coefficient of variation and hexagonality postoperatively (P value = 0.0001). CONCLUSIONS The primary result is the change in corneal endothelial cell density (cells per square millimetre of the corneal surface) which is decreased, and the central corneal thickness calculated in micro meter is increased. As endothelial cells do not replicate, to reimburse cell loss there are changes in coefficient of variation and hexagonality after phacoemulsification surgery. KEY WORDS Corneal Endothelial Cell Density, Central Corneal Thickness, Coefficient of Variation, Hexagonality, Phacoemulsification, Specular Microscope

High inter-rater reliability of Japanese bedriddenness ranks and cognitive function scores: a hospital-based prospective observational study

BackgroundThe statistical validities of the official Japanese classifications of activities of daily living (ADLs), including bedriddenness ranks (BR) and cognitive function scores (CFS), have yet to be assessed. To this aim, we evaluated the ability of BR and CFS to assess ADLs using inter-rater reliability and criterion-related validity.MethodsNew inpatients aged ≥75 years were enrolled in this hospital-based prospective observational study. BR and CFS were assessed once by an attending nurse, and then by a social worker/medical clerk. We evaluated inter-rater reliability between different professions by calculating the concordance rate, kappa coefficient, Cronbach’s α, and intraclass correlation coefficient. We also estimated the relationship of the Barthel Index and Katz Index with the BR and CFS using Spearman’s correlation coefficients.ResultsFor the 271 patients enrolled, BR at the first assessment revealed 66 normal, 10 of J1, 15 of J2, 18 of A1, 31 of A2, 37 of B1, 35 of B2, 22 of C1, and 32 of C2. The concordance rate between the two BR assessments was 68.6%, with a kappa coefficient of 0.61, Cronbach’s α of 0.91, and an intraclass correlation coefficient of 0.83, thus showing good inter-rater reliability. BR was negatively correlated with the Barthel Index (r = − 0.848, p < 0.001) and Katz Index (r = − 0.820, p < 0.001), showing justifiable criterion-related validity.Meanwhile, CFS at the first assessment revealed 92 normal, 47 of 1, 19 of 2a, 30 of 2b, 60 of 3a, 8 of 3b, 8 of 4, and 0 of M. The concordance rate between the two CFS assessments was 70.1%, with a kappa coefficient of 0.62, Cronbach’s α of 0.87, and an intraclass correlation coefficient 0.78, thus also showing good inter-rater reliability. CFS was negatively correlated with the Barthel Index (r = − 0.667, p < 0.001) and Katz Index (r = − 0.661, p < 0.001), showing justifiable criterion-related validity.ConclusionsBR and CFS could be reliable and easy-to-use grading scales of ADLs in acute clinical practice or large-scale screening, with high inter-rater reliabilities among different professions and significant correlations with well-established, though complicated to use, instruments to assess ADLs.Trial registrationUMIN000041051 (2020/7/10).

Antibiotic Susceptibility Patterns of Bacterial Isolates from Routine Clinical Specimens from Referral Hospitals in Tanzania: A Prospective Hospital-Based Observational Study.

IntroductionAntimicrobial resistance is one of the biggest threats of modern public health. Although sub-Saharan Africa is highly burdened with infectious diseases, current data on antimicrobial resistance are sparse.MethodsA prospective study was conducted between October 2018 and September 2019 to assess the antibiotic susceptibility patterns of clinical bacterial isolates obtained from four referral hospitals in Tanzania. We used standard media and Kirby-Bauer disc diffusion methods as per Clinical and Laboratory Standards Institute (CLSI) standards.ResultsWe processed a total of 2620 specimens of which 388 (14.8%) were culture-positive from patients with a median (IQR) age of 28 (12–44) years. Of the positive cultures, 52.3% (203) were from females. Most collected specimens were ear pus 28.6% (111), urine 24.0% (93), wound pus 20.6% (80), stool 14.9% (58), and blood 8.3% (32). Predominant isolates were S. aureus 28.4% (110), E. coli 15.2% (59), P. aeruginosa 10.6% (41), P. mirabilis 7.0% (27), V. cholerae 01 Ogawa 6.2% (24), Klebsiella spp. 5.2% (20) and Streptococcus spp. 4.6% (18). Generally, the isolates exhibited a high level of resistance to commonly used antibiotics such as Ampicillin, Amoxicillin-Clavulanic acid, Erythromycin, Gentamicin, Tetracycline, Trimethoprim, third-generation Cephalosporins (Ceftriaxone and Ceftazidime), and reserved drugs (Clindamycin and Meropenem). S. aureus isolates were resistant to most of the antibiotics tested; 66.7% were classified as MRSA infections.ConclusionAntibiotic resistance to commonly prescribed antibiotics was alarmingly high. Our findings emphasize the need for comprehensive national control programs to combat antibiotic resistance.

Zika virus infection in pregnant travellers and impact on childhood neurodevelopment in the first two years of life: A prospective observational study

BackgroundThe emergence of Zika virus (ZIKV) represents a threat with consequences on maternal and children's health. We aimed to assess the clinical and epidemiological characteristics of pregnant women returning from ZIKV affected areas, and the effects of maternal ZIKV infection on birth outcomes and children's health. MethodsThis was a hospital-based prospective observational study conducted at the Hospital Clínic of Barcelona and Hospital Sant Joan de Déu, Barcelona, Spain, from January 2016 to February 2020. ResultsOne hundred and ninety-five pregnant women who had travelled to ZIKV affected areas during pregnancy were recruited. Four women (2.1%) had a confirmed ZIKV infection, 40 women (20.5%) a probable infection, and 151 (77.4%) were negative for ZIKV. Among the ZIKV confirmed cases, a pregnant woman suffered a miscarriage, highly plausible to be associated with ZIKV infection. Brain cysts and microcalcifications were detected in 7% of fetuses or infants from women with confirmed or probable ZIKV infection. Neurodevelopmental delay in the language function was found in 33.3% out of the 21 children evaluated. ConclusionsThese findings contribute to the understanding of ZIKV prevalence estimates, and the impact of maternal ZIKV infection on pregnancy outcomes and children's health. Results highlight the importance of long-term surveillance in pregnant travellers and their children.

Rotavirus Diarrhea and its Determinants Among Under-Five Children Admitted in a Tertiary Care Hospital of Southern Haryana, India.

To estimate the prevalence of rotavirus diarrhea and its demographic, social, and clinical characteristics among children less than five years of age admitted in a rural tertiary care institute. This prospective hospital-based observational study was carried out during February 2016 to June 2019. Diarrheal admissions of children aged 0-59 mo were screened and those who met the inclusion criteria were included in the study. Sociodemographic and clinical information was collected using a case report form. Stool samples were collected within 48h of admission and transported in cold chain every month to the referral laboratory situated at Christian Medical College for testing. Among the children admitted with acute diarrhea, 148 (11.02%) were positive for rotavirus in the study. As per Vesikari scoring system, around three fourth (76.2%) of children were having severe or very severe diarrhea. Severity of diarrhea was more among rotavirus positive cases as assessed by the Vesikari scoring system. The rotavirus diarrhea showed a peak during November to February. Rotavirus diarrhea is an issue of public health importance, particularly due to its association with the severe diarrhea. As evidenced from similar settings in the world, rotavirus vaccine introduction and increased coverage is the most important strategy towards prevention and control of rotavirus diarrhea.

Comparative study of postoperative astigmatism following phacoemulsification with scleral incision and posterior chamber foldable and rigid (nonfoldable) intraocular lens implantation

Purpose: To study and compare the postoperative astigmatism following phacoemulsification with scleral incision and posterior chamber foldable and rigid (nonfoldable) intraocular lens (IOL) implantation. Materials and Methods: It was a hospital-based prospective observational study which included 200 eyes with presenile and senile cataract and were divided into two groups. Group I; included hundred cases with superior scleral incision (3.2 mm) phacoemulsification and foldable posterior chamber IOL (PCIOL) implantation. Group II; included 100 cases with superior scleral incision (5.5 mm) phacoemulsification and rigid (nonfoldable) PCIOL implantation. The data were analyzed by Chi-square test and P < 0.05 was considered statistically significant. The surgically induced astigmatism (SIA) at 6 weeks was compared between the two groups. SIA was calculated by the vector analysis. Results: The mean SIA in Group I was 0.67 ± 0.46 D, whereas in Group II was 1.17 ± 0.44 D. There was statistically significant difference between the two groups P < 0.05. Group II showed higher mean SIA than Group I at 6 weeks. Postoperatively, majority of patients developed against the rule astigmatism, 62% in Group I and 76% in Group II. Conclusion: SIA is less in 3.2 mm incision as compared to 5.5 mm incision with increase in against the rule astigmatism postoperatively.

Outdoor activity and myopia progression in children: A follow-up study using mixed-effects model.

Purpose:The purpose of this study was to determine the influence of outdoor activity on myopia progression.Methods:It was a hospital-based longitudinal prospective observational study. Children between 7 and 14 years of age with a myopia of − 0.5 D or worse were included. Myopia progression was evaluated by cycloplegic refraction, every 6 months for 18 months. Parents were asked to record the daily outdoor activity of the child in hours per day at school and at home during weekdays and at weekends separately, based on which the daily outdoor activity score was calculated. The independent variables measured included age and gender of the participant, degree of myopia, and the daily outdoor activity score. Progression of myopia was defined as an increase in the spherical equivalent (SE) over 18 months. The magnitude of the association was determined by two mixed-effects models.Results:A total of 495 participants (250 males and 245 females) completed three visits during the study period. On taking age groups and paired observations as a random effect and adding SE at the last visit as the random slope in Model 1, each unit increase in outdoor activity had a negative effect on change in SE of − 0.01 (−0.02 to 0.00; P = 0.045). The same inverse relationship between outdoor activity and absolute SE as − 0.06 (−0.07 to − 0.03; P < 0.001) is estimated in Model 2.Conclusion:The study demonstrates a statistically significant inverse relationship between outdoor activity and myopia.

A study on the status of serum High Sensitive C - Reactive Protein and Fasting Blood Sugar in Patients with Hyperlipidemia attending a Super Specialty Teaching Hospital in North Kerala

This study was aimed to analyses the serum Hs-CRP level and fasting Blood Sugar level in patients with Hyperlipidemia in a Super Specialty Teaching Hospital in north Kerala. This was a hospital-based prospective observational study which was conducted to study the status of Hs-CRP and Fasting Blood sugar level on lipid profile status of newly diagnosed Hyperlipidemia patients which was compared with Normal Lipid Profile people. Healthy subjects were recruited as a control group and newly Diagnosed Hyperlipidemia patients were recruited as Test group. Study subjects of both gender in an age group of 30 to 70 were selected for the study. Serum Hs CRP, Fasting Blood sugar and serum lipid profile were estimated after overnight fasting condition. After the biochemical estimation, values were entered in an Excel sheet and level of test and control group was statistically analyzed by using Student's t-test using SPSS software. The values were expressed in Mean ± Standard Deviation (SD) and The status of serum Hs CRP, fasting Blood Sugar and Lipid Profile Parameters were shown a statistically significant difference (p&lt;0.01) between Control and Test groups. The result of the study points out that the elevated level serum Hs-CRP and Fasting Blood Sugar can be used as predictive markers of Hyperlipidemia.

A prospective observational study on acute exacerbation of chronic obstructive pulmonary disease in pulmonology department of tertiary care hospital

BackgroundChronic obstructive pulmonary disease (COPD) is a common, preventable, and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gasses. An acute exacerbation of COPD refers to a flare up or episode where a person breathing becomes worse than normal. An acute exacerbation of COPD refers to a flare up or episode where a person breathing becomes worse than normal. Acute exacerbation in COPD (AECOPD) is frequent in the course of the illness and is the most common reason for medical visits, hospital admissions, and mortality among these patients. Exacerbations of COPD are associated with increased morbidity and mortality. To assess the exposure and severity of acute exacerbations of COPD with COPD Assessment Test (CAT Scale) and mMRC (modified Medical Research Council) Dyspnea scale. Study design was a hospital-based prospective observational study. Study site was conducted at Pulmonology Department of Government General Hospital, Vijayawada.ResultsThe total patients were 197. Out of which, 119 were from In-patient Department (IPD) and 78 were from Out-patient Department (OPD). In this study, males were 167 (85%), among which, IPD were 97 (49%), OPD were 70 (36%), and females were 30 (15%), among which, IPD were 22 (11%), OPD were 8 (4%).ConclusionThe morbidity and mortality of COPD have been increased in recent years. This study concludes that there is a relation between risk of acute exacerbations in COPD with habitual history and occupational history. Increase in exposure to occupational hazards, smoking habit leads to an increase in risk of acute exacerbations in COPD patients. The level of severity was more in smokers and the patients who had biomass, organic dust, and mineral exposure. When severity was observed, group D severity is more observed in population according to CAT scale and mMRC dyspnea scale.

Drug-Therapy Problems and Predictors among Hospitalized Heart-Failure Patients: A Prospective Observational Study.

BackgroundHeart-failure patients are at high risk of experiencing drug-therapy problems, owing to polypharmacy, comorbidities, and usually advanced age. Drug-therapy problems can lead to poor clinical outcomes, increased health-care costs and decreased quality of life, and thus strategies for identifying, resolving, and preventing them are urgently needed. Therefore, this study aimed at investigating the incidence and predictors of drug-therapy problems among hospitalized heart-failure patients.MethodsThis hospital-based prospective observational study was conducted from February 1 to May 31, 2014 at Jimma University Specialized Hospital. Patients of either sex aged 18 years and above with chronic heart failure and complete medical records were enrolled. Patients with high-output heart failure, <1 day of hospital stay, unwilling to give written informed consent, and unconscious without caregivers were excluded. Data were collected from medication charts, laboratory reports, patients/caregivers, morning multidisciplinary meetings, and ward rounds. Multivariate binary logistic regression analysis was done to identify independent predictors of drug-therapy problems.ResultsA total of 104 heart-failure patients (mean age 51.20±15.66 years, females 51.9%) were consecutively enrolled, and 95 (91.3%) had experienced at least one drug-therapy problem (total 268, mean 2.82±1.39 encounters per patient). Of these problems, 45.5% were the need for additional drugs, followed by noncompliance (22.0%), inappropriate dosing (9.3%), unnecessary drugs (9.0%), ineffective drugs (8.2%), and adverse drug reactions (6.0%). None of the independent variables was found to be an independent predictor of having at least one drug-therapy problem. However, the number of clinical/pharmacological risk factors (AOR 7.93), female sex (AOR 3.24), and length of hospital stay (AOR 12.98) were predictors of noncompliance.ConclusionPatients suffered from a large number of drug-therapy problems. Drugs with survival benefit were underused. Noncompliance and the need for additional drug therapy were the most frequently identified drug-therapy problems. Numbers of clinical/pharmacological risk factors, length of hospital stay, and female sex were identified as predictors for noncompliance.

Study of clinical profile and associated risk factors for congenital malformations in neonates: a hospital based prospective study

Background: Congenital malformations are major cause of neonatal morbidity and mortality and account for 8-10% of all peri-natal deaths especially in developing countries. Incidence of congenital malformation is increasing owing to reduction in other causes of neonatal deaths due to improvement in perinatal care worldwide. This study was aimed to evaluate the incidence, perinatal variables and contributing risk factors associated with birth defects that will help to plan future strategies for prevention, early diagnosis and timely management. Methods: This is a hospital-based prospective observational study conducted in department of pediatrics of a tertiary care centre of western India over period of two year. All new-borns with anatomical congenital malformations detected antenatal or postnatal (prior to discharge) period were included in this study. Detailed and careful clinical examination was carried out for all new-born.Results: The incidence of congenital malformation in the present study is 1.27%. Prematurity (76.1%), low birth weight (68%) and male neonates (67%) were associated with increased risk of congenital malformation. Most common system involved in this study was cranio-spinal system (47.3%). Overall, most common congenital anomaly was Hydrocephalus with meningomyelocele (8%). Among maternal variables, malnutrition (90%), consanguinity (40%) and abortions (40%) are strongly associated with malformations. Conclusions: Congenital malformations are important cause of neonatal death. Strategies to diagnose, prevent, treat and rehabilitate the neonate are utmost necessary. Early screening to identify high risk pregnancies and timely management is strongly recommended.

Abstract 318: Association Carbon Dioxide Level During Cardiopulmonary Resuscitation with Neurological Outcome After Out-of-hospital Cardiac Arrests

Background: Little evidence exists to guide appropriate ventilation strategies during CPR. We aimed to investigate the association between carbon dioxide (CO2) pressure measured on hospital arrival from those who were receiving ongoing resuscitation and neurological outcome after out-of-hospital cardiac arrest (OHCA). Method: This nationwide hospital-based prospective observational study (The JAAM-OHCA registry) carried out between June, 2014 and December, 2017 in Japan. From this registry, we included adult OHCA patients aged ≥18 years with blood gas sampled on hospital arrival during CPR. The main exposure was CO2 level in blood gas analysis during CPR. Based on the CO2 level on hospital arrival, included patients were classified into four quartiles (Q1-Q4) defined as Q1 (&lt;66.0 mmHg), Q2 (66.1-87.2 mmHg), Q3 (87.3-113.5 mmHg), and Q4 (≥113.6 mmHg). The primary outcome of this study was one-month survival with favorable neurological outcome defined by cerebral performance category 1 or 2. We adjusted for potential confounders with multivariable logistic regression analysis. Results: During the study period, a total of 21,137 patients were included in our analysis. The overall proportion of favorable neurological outcome was 1.0% (207/21137). The highest proportion of favorable neurological outcome was observed in the Q1 group (2.4% [140/5244]), followed by Q2 (0.7% [37/5284]), Q3 (0.4% [21/5296]), and Q4 (0.2% [9/5313]). In the multivariable logistic regression analysis, we found that the Q4 group had the significantly lower proportion of favorable neurological outcome than the Q1 group (adjusted odds ratio 0.25; 95% confidence interval 0.16-0.55). The adjusted probability of favorable neurological outcome decreased in a stepwise fashion across increasing quartiles (P&lt;0.001). Conclusion: This study observed the association between lower CO2 level on hospital arrival and favorable neurological outcome after OHCA in a dose-dependent manner.

Adverse Drug Reaction due to Antidepressants among Patients with Depression in a Private Psychiatric Hospital of Nepal.

Background Adverse drug reactions (ADRs) are the known cause of morbidity and mortality, resulting in increased hospitalization, healthcare costs, complications, and decreased adherence in patients with depression. This study is aimed at evaluating adverse drug reactions due to antidepressants among patients with depression in the psychiatric hospital of Nepal. Methods A hospital-based prospective observational study was conducted among 47 patients using purposive sampling techniques among patients with depression visiting a private psychiatric hospital. The causality, severity, and preventability assessment of reported ADRs was performed using the Naranjo scale, modified Hartwig Siegel's Severity Assessment Scale, and Schumock and Thornton scale, respectively. The data collected were entered into and analyzed using IBM-SPSS 20.0. Results The incidence rate of ADR was found to be 4.54%, with females having a higher incidence rate of 5.56%. A total of 54 ADRs were reported. The majority of them were probable (30, 55.55%), moderate (36, 66.66%) and probably preventable (24, 44.44%). Most of the ADRs were managed either by stopping (19, 35.18%) or substituting (19, 35.18%) the suspected drug and 66.66% of the ADRs were recovered. Selective serotonin reuptake inhibitors (SSRIs) were associated with a higher number of ADRs i.e. 34. Conclusion The findings highlight the need for regular intensive monitoring of ADRs in psychiatric outpatients by clinical pharmacists for early detection and reduction of risk caused by ADRs associated with antidepressants.

Prognosis of Neurological Improvement in Inpatient Acute Ischemic Stroke Survivors: A Propensity Score Matching Analysis

ObjectivesStroke has become a national concern in China. Early prediction of stroke benefits patients and aids medical professionals in clinical decision making and rehabilitation plans to improve successful outcomes. To identify prediction factors influencing short-term outcomes in patients with acute ischemic stroke (AIS). Materials and MethodsThis was a hospital-based prospective observational study. Recovery of neurological improvement was represented by a percent reduction in the National Institutes of Health Stroke Scale (NIHSS) at discharge. We performed propensity score matching (PSM) to balance the NIHSS at admission and compared NIHSS scores before and after matching with PSM criteria. Finally, we assessed the prognosis of neurological improvement and patient-related variables. ResultsIn the matched cohort, 92 pairs were matched by NIHSS admission after PSM. Modified Barthel Index, modified Rankin scale, NIHSS on admission, hypertension, sleep time, and Montreal Cognitive Assessment (MoCA) were statistically different between the two groups (P<0.05) before matching. Multivariable analysis identified two factors independently associated with neurological improvement: diabetes (P=0.030; adjusted odds ratio, 2.129; 95% confidence interval [CI] 1.078–4.026) and MoCA (P<0.001; adjusted odds ratio, 5.385; 95% CI 2.278–12.730). ConclusionConsistent with previous studies, diabetes affected the short-term outcomes of AIS, while cognitive impairment had a negative effect on long-term AIS prognosis.Diabetes and early cognitive impairment have adverse effects on short-term prognosis after AIS.

Association of High Sensitivity C-Reactive Protein with In-Hospital Mortality in Patients with Acute St-Segment Elevation Myocardial Infarction

Background and Aims: Among the various biomarkers, high sensitivity C-Reactive Protein (hs-CRP) has been widely studied and is easy to use in the prognostication of patients with acute ST elevation myocardial infarction (STEMI). This study aimed to associate serum level of hs-CRP with in-hospital mortality in patients presented with acute STEMI.&#x0D; Methods: This was a hospital-based prospective observational study conducted in Shahid Gangalal National Heart Centre among patients presented to the emergency department with chest pain of less than 24 hours duration, who were diagnosed subsequently to have STEMI. Patients who had known chronic inflammatory diseases, septic foci and chest pain of over 24 hours were excluded from the study. Blood sample for Hs-CRP was sent from the emergency department and was measured with Finecare TM FIA system; Model number: FS-112. The study was conducted from April 2019 to March 2020. Patient outcomes were stratified as per the four groups of serum level of hs-CRP and among them the relationship between mortality and hs-CRP level was tested with chi-square test. The p-value across the groups was again tested for inter-group significance using the Bonferroni adjusted significance level.&#x0D; Results: 140 patients (112 males and 28 females) with mean age of 58.1±14.86 years were enrolled in the study. There was no increased in-hospital mortality in acute STEMI patients who had serum level of hs-CRP below 3 mg/l. In-hospital mortality showed an increasing trend above this level but it reached statistical significance beyond 10 mg/l only. Thirty five percent of our patients of acute STEMI were found to have serum level of hs-CRP above this threshold. The total in-hospital mortality was 13 (9.28%).&#x0D; Conclusion: The increased serum level of hs-CRP was associated with increased in-hospital mortality in patients with acute STEMI.

Postcontrast Fluid-Attenuated Inversion Recovery (FLAIR) Sequence MR Imaging in Detecting Intracranial Pathology.

Background Imaging sequences for detection of meningeal and parenchymal lesions are critical in intracranial pathology. Our study analysed FLAIR MRI sequence for evaluating postcontrast enhancement. Objectives FLAIR imaging sequences have been used in evaluation of enhancement in the brain. We conducted a study of FLAIR imaging sequences to better delineate postcontrast enhancement. Materials and Methods In this prospective hospital-based observational study, postcontrast T1 MTC and delayed postcontrast T2 FLAIR and T1 FLAIR images of 66 patients with intracranial pathology were assessed by experienced radiologists from November 2017 to November 2019. Results 28 cases of meningeal enhancement were identified in delayed postcontrast T2 FLAIR images. Low-grade gliomas included in the study showed postcontrast enhancement on postcontrast T1 MTC images. Multiple sclerosis lesions were better seen on postcontrast T1 FLAIR. In extraaxial lesions of 11 cases of meningioma, brighter enhancement was seen on delayed postcontrast T2 FLAIR images. Conclusion We found that delayed postcontrast T2 FLAIR was better in detection of meningeal enhancement in infectious meningitis and in meningitis carcinomatosis than T1 MTC images. In delayed postcontrast T2 FLAIR images, intra-axial parenchyma lesions appeared more conspicuous or similar to T1 MTC images. Delayed postcontrast T1 FLAIR images provided better anatomic delineation of intra-axial lesions.