Management Protocol Research Articles

Management and monitoring of anesthesia during the perioperative period in a Tertiary Hospital in Bangladesh

Background: Anesthesia management is crucial for ensuring patient safety and optimal surgical outcomes during the perioperative period. In Bangladesh, the challenges faced in managing and monitoring anesthesia in tertiary care hospitals necessitate a comprehensive evaluation of current practices. This study aims to assess the anesthetic management protocols and monitoring strategies employed in a tertiary hospital in Bangladesh. Methods: This observational study was conducted in Islami Bank Medical College Hospital, Rajshahi, Bangladesh from July to December 2023. Data were collected from patients undergoing various surgical procedures requiring anesthesia. The anesthetic techniques used, intraoperative monitoring parameters, and any complications encountered were recorded. The study included a review of anesthesia charts, patient records, and interviews with anesthesia providers. Statistical analysis was performed to identify trends and correlations. Results: A total of 200 patients were included in the study. The most commonly used anesthetic technique was general anesthesia (65%), followed by regional anesthesia (30%) and local anesthesia (5%). Intraoperative monitoring parameters included heart rate, blood pressure, oxygen saturation, and end-tidal carbon dioxide levels, which were consistently documented in 95% of cases. Complications occurred in 10% of patients, primarily involving respiratory issues and cardiovascular instability. Proper adherence to monitoring protocols significantly reduced the incidence of complications. Conclusion: Effective management and monitoring of anesthesia during the perioperative period are vital for patient safety in a tertiary hospital setting. The study highlights the importance of standardized protocols and continuous monitoring to minimize complications. Recommendations for improving anesthetic practices include regular training for anesthesia providers and enhancing monitoring infrastructure to ensure optimal patient care.

Understanding the benefits of renin-angiotensin-aldosterone system inhibitors and influence of hyperkalaemia on their prescription: a UK survey of healthcare professionals' views and practice

Abstract Background Renin–angiotensin–aldosterone system inhibitors (RAASi) improve outcomes in heart failure with reduced ejection fraction (HFrEF) and they should be increased to the maximally tolerated dose. However, their use is often hindered by hyperkalaemia leading to discontinuation or down titration. Purpose Assess perceptions of primary and secondary healthcare professionals regarding benefits of RAASi according to indication and, in the context of developing hyperkalaemia, to identify barriers to optimal utilisation, and to explore options for improving management protocols, specifically in HFrEF. Methods An electronic survey was distributed in primary and secondary care setting in Hampshire, UK, to evaluate knowledge about benefits of RAASi, clinical response to varying level of potassium (K+), and decision-making using several clinical scenarios. Hyperkalaemia was graded into mild (serum K+ 5.5 – 5.9 mmol/L), moderate (serum K+ 6.0 – 6.4 mmol/L) or severe (serum K+ ≥ 6.5 mmol/L). Results Between November 2021 and January 2023, 300 questionnaires were completed by 274 (91%) physicians (varying grades of seniority), 22 (7%) non-medical prescribers, and 4 (1%) pharmacists. 80% were working in secondary care across different specialities (31 working in cardiology and 15 in nephrology). The majority were aware of prognostic benefit of angiotensin converting enzyme inhibitors (ACEi) in patients with HFrEF although this was lower for mineralocorticoid receptor antagonists (MRA) (Fig 1). Fewer than 2/3 of respondents were aware of impact of ACEi on symptoms. In the presence of mild hyperkalaemia, 75% and 88% of healthcare professionals would stop or reduce ACEi and MRA, respectively. In moderate or severe hyperkalaemia, this increased to 96% and 97%, respectively (Fig 2A-B). When considering the scenario of a patient with HFrEF who had ACEi stopped due to K+ 5.9 mmol/L, the potassium at which the responder would consider re-starting the ACEi ranged from 77% when potassium level < 5.5 mmol/L to 1% in moderate or severe hyperkalaemia (Fig 2C). 74% of healthcare professionals were familiar with local hyperkalaemia management protocol and 93% supported dedicated training on RAASi dose adjustment and hyperkalaemia management. Conclusion This survey, across a broad range of healthcare professionals, shows uncertainties around knowledge of benefits of RAASi in patients with HFrEF and there is sizeable variation in the prescribing response to degrees of hyperkalaemia. Given the voluntary nature of the survey, it is plausible that these data are biased towards individuals with greater understanding. Regardless, there is a need for continued education with a goal of improving patient-centred care.

Telemedicine through social media to enhance guideline-directed revascularization in STEMI: a five-year analysis in a developing nation

Abstract Background Timely reperfusion reduces mortality in ST segment Elevation Myocardial infarction (STEMI). Telemedicine and social media have been variably used to improve STEMI care in community settings. We established a new care system for STEMI in a public health setting serving a population of over 80 million, in a state with from a developing nation. Purpose To enhance guideline directed revascularisation (GDR) in STEMI by networking non-percutaneous coronary intervention (PCI) capable hospitals to PCI capable hospitals in a hub-and-spoke model and implementing telemedicine via social media platforms (Whatsapp) over five years(2019-2023). Methods Eighteen Government medical college hospitals were identified as hubs and were provided with cardiac catheterisation laboratories and empowered to provide either round the clock (Phase I hubs) or office hour primary PCI (Phase II hubs). They were linked to 188 Taluk or District-level, non-PCI capable Government hospitals identified as spokes to form 18 STEMI clusters. Separate social media groups on WhatsApp were created for each of the clusters, facilitating the sharing of de-identified ECGs and clinical data from spokes for guidance on diagnosis and management by hub hospital cardiologists. Transfer to hub hospitals for catheter based therapies were coordinated through prior intimation in the cluster WhatsApp group to ensure timely arrival and treatment. A customised uniform protocol for STEMI management was developed and health care personnel were trained accordingly. Human resource support was provided to collect and submit cumulative daily data on the number of STEMIs, the revascularisation provided and mortality through online free web forms. Annual cumulative data on STEMI volumes and GDR were analysed. Results 71,907 STEMI patients were treated from 2019 to 2023. We observed a 67% increase in STEMIs treated per year from over five years (11,363 in 2019 to 18565 in 2023). Use of pharmaco-invasive therapy increased from 7.9% to 31.7% (Figure-1). There was a marginal increase in use of primary PCI. The count of patients without GDR decreased by 20%. There was a 6.7 fold (672 in 2019 to 4,535 in 2023) rise in patients referred from spoke to hub hospitals for catheter-based revascularization. Over five years, there was an increase in the proportion of patients receiving GDR. This increase was more evident in Phase II hubs (52% in 2019 to 87.1% in 2023). Commensurate with the increase in GDR, phase II hubs demonstrated a tangible decrease in mortality (Figure-2). Conclusion We have shown that networking of non-PCI-capable hospitals with PCI-capable hospitals in a hub and spoke model using social media groups, facilitates telemedicine, leading to improved GDR in STEMI. This innovative approach not only enhances connectivity but also contributes to more efficient and timely cardiac care in resource-constrained settings.Figure 1. Revascularisation in STEMIFigure 2.Mortality Trends in STEMI (hubs)

The impact of garbage codes on the quality of death coding in Belgrade in 2010, 2015, and 2020

Abstract Background Accurate data on the causes of death (CoDs) is the foundation for analyzing the health situation and developing health policy in various countries. The percentage of garbage codes (GCs) indicates the quality of the CoDs data. Within the Western Balkan Strategic Partnership Project (Work Package 4: Use of Population Health Metrics for Improved Surveillance), we evaluated the impact of the four levels of GCs on the quality of mortality data of Belgrade. Methods In a retrospective study, we examined the underlying CoDs of Belgrade residents by age and sex and the change in GCs’ share in the CoDs in 2010, 2015, and 2020. We used anonymous individual mortality data and population age and sex annual data from the electronic databases of the City Institute of Public Health of Belgrade, as well as the list of GS levels 1-4 from the 2019 Global Burden of Disease Study. Results Over the observed years, the percentage of all GCs in underlying CoDs was approximately 20%. The GCs with profound policy implications level 1 accounted for 52% of all GCs in 2020, higher than those recorded in previous years - 46.3% in 2010 and 45.1% in 2015. The total number of GCs per 100,000 inhabitants in Belgrade was the highest in 2020, with a rate of 325.2/100,000 (males: 374.4, females: 301.3). This rate has increased by about one-third since 2010 (both sexes: 245.4, males: 269.2, females: 221.1) and by about two-fifths since 2015 (both sexes: 235.8, males: 262.7, females: 211.8). Conclusions This research has revealed a significant decline in the quality of data related to the causes of death in Belgrade. One-fifth of the recorded causes of death are inaccurate or unreliable. The study highlights the importance of maintaining strict protocols for data collection, analysis, and management to ensure the accuracy and reliability of CoDs data in developing effective public health policies. Key messages • The rate of total garbage codes per 100,000 inhabitants of Belgrade has increased by about two-fifths since 2015. • Failure in quality, accuracy, and reliability of causes of death can lead to suboptimal health policymaking.

Evaluating the Role of Hyperbaric Oxygen Therapy in Enhancing Skin Graft Outcomes: Mechanisms, Clinical Evidence, and Comparative Efficacy

Skin grafting is a critical procedure for treating skin defects from burns, trauma, and surgical interventions, yet complications such as ischemia, necrosis, and infection can limit graft success. Hyperbaric Oxygen Therapy (HBOT) has emerged as a promising adjunctive treatment that enhances skin graft viability through mechanisms including enhanced oxygenation, angiogenesis, reduced inflammation, and anti-infective effects. This review synthesizes findings from clinical studies, comparative analyses, and case reports to clarify HBOT’s efficacy in improving skin graft outcomes. Methods include a comprehensive analysis of HBOT’s impact on graft take rates, healing times, and complication rates. Results indicate that HBOT significantly improves graft survival by mitigating ischemia and infection, while comparative studies show a reduction in major amputations and improved healing in complex cases, such as diabetic foot ulcers and traumatic injuries. These findings suggest that HBOT can serve as a valuable adjunct to standard grafting procedures, offering a multifaceted approach to improve graft viability, especially in high-risk cases. This review highlights HBOT’s potential for integration into wound management protocols, providing a foundation for further exploration into its efficacy and applications in reconstructive surgery.

Numerical simulation and risk assessment of toluene tank leakage in petrochemical industries, China.

Large-capacity toluene storage tank leakage accidents can lead to severe casualties and environmental damage. In this study, numerical simulation of the toluene leakage accidents is performed using PHAST and ALOHA softwares across 16 scenarios. The present research focuses on the dispersion of toluene lethal and toxicity clouds, as well as the associated risks from vapor cloud explosions and pool fires resulting from the large-capacity toluene storage tank leakage. Meanwhile, the effects of influential factors such as leakage height, wind speed, ambient temperature, and atmospheric stability on toluene leakage accidents are also discussed, and then the worst-case scenario of the toluene leakage accident is obtained. The effects of wind speed, ambient temperature, leakage height, and atmospheric stability on outcomes such as toxic clouds, vapor dispersion, explosions, and pool fires are also analyzed. The result reveals that toxic cloud dispersion increases with ambient temperature, while the impact of vapor cloud explosions and pool fires decreases with the increase of leak heights. Wind speed significantly affects pool fire spread. The influential factors related to maximizing hazard range including low leak heights, low wind speeds, high temperatures, and stable conditions are obtained. Risk analysis indicates that vapor cloud explosions significantly impact outdoor potential loss of life (PLLoutdoor) compared with other incidents. Scenario 4 within a directional range from 33.8 to 56.3° shows the highest incident frequencies, highlighting its importance for risk monitoring. These findings are crucial for enhancing emergency response strategies and safety protocols in industrial safety management.

Recovery rate and predictors among children aged 6–59 months with severe acute malnutrition in Addis Ababa, Ethiopia: a retrospective follow-up study

IntroductionSevere acute malnutrition (SAM) is a critical public health concern in Ethiopia, contributing to high morbidity and mortality rates among children. Despite the improvement in hospital coverage and the development of standardized WHO treatment guidelines, recent reviews indicated a wide range in recovery rates (34%–88%) due to several context-specific factors. Understanding the factors influencing the recovery time can help inform targeted interventions and improve the overall management of SAM cases. Therefore, this study aimed to assess the time to recovery and predictors of children aged 6–59 months with severe acute malnutrition in Addis Ababa, Ethiopia, in 2023.MethodsAn institutional-based retrospective follow-up study was conducted among children aged 6–59 months who were admitted to Tirunesh Beijing Hospital (TBH), Addis Ababa, Ethiopia, from July 2019 to June 2023. The Kaplan–Meir estimate and survival curve were used to compare the time to recovery using a log-rank test among different characteristics. A Cox proportional hazard regression analysis model was used to identify significant predictors of time to recovery. Finally, a p-value of <0.05 was used to declare a significant association.ResultsThe median survival time to recovery was 17 (95% CI: 16.39–17.60) days, and the incidence rate of recovery from SAM was 37.8 per 1,000 child days. Moreover, exclusive breastfeeding [adjusted hazard ratio (aHR): 1.97, 95% CI: 1.45–2.68], amoxicillin provision (aHR = 1.62, 95% CI: 1.11–2.35), and deworming (aHR = 2.14, 95% CI: 1.48–3.09) were protective factors. However, complications at admission (aHR = 0.41, 95% CI: 0.23–0.73) and diarrhea during admission (aHR = 0.64, 95% CI: 0.45–0.91) were identified as risk factors of recovery from SAM.ConclusionThe time to recovery among the current study participants was low compared with the sphere standard. Besides, exclusive breastfeeding, complications at admission, diarrhea, amoxicillin provision, and deworming were independent predictors. Therefore, appropriate provision of routine medication and early management of medical comorbidity as per the national SAM management protocol can reduce the mortality of children with severe acute malnutrition significantly.

Dynamic change and risk factors of intense thirst in patients admitted to neuro-intensive care unit: An observational study.

Thirst is a clinical discomfort symptom reported by most patients admitted to intensive care unit (ICU). Little is known about the dynamic change and risk factors of intense thirst in neuro-intensive care unit (Neuro-ICU). The objective of this study was to explore the dynamic change and determine the risk factors of intense thirst in patients admitted to Neuro-ICU, providing reference for personalized interventions of intense thirst. The study design is a prospective observational study. Demographic and disease-related,treatment, physiological and biochemical data were collected for 230 patients from Neuro-ICU of a hospital from May 2023 to November 2023. We assessed thirst intensity on numeric rating scale (NRS) of 0-10 (10 = worst possible thirst) at eight time points: 7:00, 9:00, 11:00, 13:00, 15:00, 17:00, 19:00 and 21:00 and a self-designed general information questionnaire based on safety protocol for thirst management to analyse the risk factors of intense thirst in Neuro-ICU patients. If thirst scores were more than 7, we defined it as intense thirst. This study followed the STROBE checklist for cross-sectional studies. A total of 230 Neuro-ICU patients were observed. The dynamic analysis results showed an overall downward trend in thirst intensity, with the highest NRS thirst scores at 07:00 (6.13 ± 2.14) and the lowest at 21:00 (4.02 ± 2.72). The investigation of the current situation showedthat the incidence of intense thirst in Neuro-ICU patients was 47.4%. Intense thirst in Neuro-ICU patients was predicted by dysphagia (odds ratio [OR] = 1.436, 95% confidence interval [CI]:1.063-1.941), open mouth breathing (OR = 2.201, 95% CI:1.041-4.656), high glucose (OR = 2.584, 95% CI:1.097-6.087), xerostomia (OR = 3.049, 95% CI:1.950-4.767) (all p < .05). The intensity of thirst was dynamically changing and the incidence of intense thirst in Neuro-ICU patients was relatively high. Timely assessment of Neuro-ICU patients' thirst severity and identification of those at high risk can ensure the implementation of effective interventions based on patients' characteristics. Thirst is a pervasive distressing symptom often reported by critically ill patients. This study revealed that the clinical nurses need to enhance their focus on dynamic change of thirst, which is helpful for improving the efficiency of bundled thirst interventions at the suitable time.

Identification and assessment of the mudflat ecological vulnerability dominated by coastline evolution in Jiangsu

Coastlines have experienced profound alterations due to human disturbances and ocean dynamics against the backdrop of climate change and intensified anthropogenic activities. Significant modifications have occurred within the muddy coastal ecosystem, rendering it extremely susceptible to heightened levels of vulnerability. However, existing studies on coastal eco-environmental vulnerability have often overlooked crucial factors such as coastline erosion and siltation, particularly concerning coastline change. In this study, we assess coastline stability utilizing Landsat remote sensing imagery to investigate the vulnerability of coastal ecology alongside 24 economic and natural parameters, serving as indices for the Coastal Vulnerability Index (CVI) of the coastal eco-environment. Subsequently, we analyze the impact factors to vulnerability and predict trends in coastline change over the next 20 years to propose recommendations for sustainable development to safeguard the coastal eco-environment. Our findings reveal a trend towards coastline stabilization in Jiangsu, with significantly higher stability observed during 2010–2020 compared to 1985–2010. The overall CVI along the Jiangsu coast shows an downward trajectory over the past 15 years, primarily influenced by tidal action and coastal topography and geomorphology. Predictive modeling suggests Jiangsu coastline is bounded by the Sheyang estuary, with the coastline to the north dominated by stabilization and to the south dominated by siltation. Climate change, coupled with intensified human activities and future coastline alterations, may exacerbate vulnerability. Effective protection strategies for coastal ecosystems necessitate a comprehensive understanding of local natural conditions, resource availability, and socioeconomic dynamics. Governmental interventions should focus on reinforcing regulatory frameworks for coastal organism management, implementing coastal protection infrastructure, and enhancing supervision and management protocols for beachfront development, thereby fostering the sustainable management of muddy coastlines.

How long is long enough? An international survey exploring practice variations on the recommended duration of maintenance therapy with PARP inhibitors in patients with platinum sensitive recurrent ovarian cancer and long-term outcomes

ObjectiveThere are no data, and thus no consensus, on the optimal duration of poly(ADP-ribose) polymerase (PARP) inhibitor maintenance therapy for exceptional responders (here defined as progression-free for 5 years or...

Contribution of TB-LAM Urine Test to Tuberculosis Diagnosis in HIV-infected Adult Patients in Burkina Faso

Aims: With the aim of improving the diagnosis of tuberculosis in patients living with HIV, we set out to evaluate the contribution of the TB-LAM urine test to the diagnosis of tuberculosis in PLWHA in Burkina Faso, in real life. Methodology: The study was conducted in the Infectious Diseases Departments of the Yalgado OUEDRAOGO (CHU-YO), Souro SANOU (CHU-SS) and Bogodogo (CHU-B) University Hospitals. These 03 centers are among the most important reference centers in Burkina Faso. This was a descriptive and analytical cross-sectional study with prospective data collection over 12 months, from January 1, 2023 to December 31, 2023, and involved PLWH inpatients and outpatients. Data were collected using the KoBoCollect v1.30.1 application and analyzed using STATA 16 software. Binary uni and multivariate logistic regression with a statistical significance level of 0.05 was used to identify associated factors. Results: A total of 113 patients were included in the study. The mean age was 43 ± 1.35 years, with a sex ratio of 0.85. The TB-LAM urine test was positive in 76 patients, for a positivity rate of 67.26%. The diagnosis of tuberculosis was confirmed by bacteriology in accordance with the national tuberculosis management protocol in 18/113 (15.93%) patients. Bacilloscopy and the Xpert test performed on all biological fluids, combined with the TB-LAM urine test, enabled the diagnosis of 81/113 (71.68%) patients in the study. Patients already on antiretroviral therapy (ORa=0.06 [0.06-0.73], p=0.02) were less likely to test positive for urinary TB-LAM, and those with unexplained asthenia (ORa=15.76 [1.19-20.66], p=0.03) were more likely to test positive. Conclusion: The TB-LAM urine test, combined with other tuberculosis diagnostic tools, increases the diagnostic yield of tuberculosis in PLWHA.

PERFIL DOS ATENDIMENTOS POR EMERGÊNCIAS PSIQUIÁTRICAS EM UM PRONTO SOCORRO GERAL

Objective: This study investigates the occurrence and nature of psychiatric emergencies in a general emergency department. Location: Palmas General Hospital (HGPP), State of Tocantins, Brazil. Methods: From November 2022 to July 2023, through an observational analysis of patient records, the frequency of visits, demographic data and clinical assessments are evaluated to build an epidemiological profile, which will assist in the development of improved management protocols and the dissemination of knowledge. Results: In this sample of 24,697 emergency room visits over 9 months, 6.4% of the cases were psychiatric emergencies. These cases were more frequent among young adults and women. The most common situations involved suicide risk, psychotic symptoms and psychomotor agitation, and the most frequent diagnoses were psychotic disorders, substance use disorders and depressive disorder. The data was similar to other studies, with some differences. Conclusion: Future studies with larger and more detailed samples will not only be able to profile psychiatric emergencies but also predict the most frequent cases, which is essential for planning public policies and training health professionals.

Assessing the influence of thermal structure variation on Fe and P mobility in sediments cores using Yellow Spring Instrument, diffusive gradient technology, and HR Peeper for sustainable water quality management.

The freshwater ecological characteristics in terms of the daily inventory of thermal stratification, spatial variation of O2 distribution, and the mobility of potentially toxic elements (PTEs) at the water sediment interface (WSI) are prudent freshwater assessment indices for water quality management protocol. The study conducted daily observations within a monsoon-influenced region, utilizing high-resolution techniques such as HR Peeper, Yellow Spring Instrument (YSI), and ZrO-Chelex diffusive gradient technology (DGT) to analyze PTEs, specifically phosphorus (P) and iron (Fe),within the water-sediment interface (WSI) under different temperatures and oxygen conditions. The 66-day field study showed that high thermal structure contributed significantly to production Fe ions and P from sediment under reductive dissolution of FeOOH. The study also revealed that P and Fe exhibited comparable spatial distribution patterns at the WSI, indicating a linked relationship between these PTEs. This correlation was reinforced by high Pearson correlation coefficients ranging from 0.7 to 0.9 (bilateral, p < 0.05) indicating that the concentrations of labile P were predominantly influenced by the release of phosphorus bound to iron. The fluxes of the PTEs were positive with a range of Fe, 3.3-81.5 mg/m2 day and P, 0.03-0.5 mg/m2 day showing the sediments liberated the PTEs into the benthic water. Again, high positive fluxes (Fe≈60 mg/m2 day, P≈0.5 mg/m2 day) for PTEs were obtained when stratification was high (anoxic conditions) and low (Fe≈5 mg/m2 day, P≈0.08 mg/m2 day) when stratification did not exist. This depicts that Fe/P dynamics were hinged mainly on hypoxic conditions in the benthic water under the reductive dissolution of FeOOH. The findings showed that organic materials (both solid and dissolved) correlated (> 0.7) significantly with (positive high values) Fe. This indicates that their interaction contributed to the reservoir water deterioration. However, Ca2⁺ and Mg2⁺ had little impact on the liberation of Fe-DOC-P from sediments due to their inability to compete with Fe for binding to DOC and P, as shown by their low correlation values. The research provides in-depth insights into the dynamics of PTEs on a daily timescale and offers valuable information for water management practices in inland reservoirs, particularly concerning the cycling of phosphorus (P) and its effects on ecosystem health.

A personalized approach to the treatment of chronic tension-type headache: quality of life of patients

Objective: to evaluate the quality of life in a personalized approach to the treatment of chronic tension-type headache (CTTH) in comparison with a standard treatment protocol.Material and methods. The study involved 61 patients with CTTH. Patients were randomly divided into two groups. The first (main) group consisted of patients (n=30) who received a personalized approach with a psychotherapist contributing to the treatment. The comparison group consisted of patients (n=31) who were treated according to a standard protocol with counselling and observation by a neurologist. Pain intensity was assessed using the visual analogue pain scale (VAS). The SF-36 questionnaire was used to assess quality of life. Differences between the groups were analyzed by assessing individual changes in eight different domains of the SF-36 questionnaire for each patient.Results. In the main group, parameters characterizing the physical (pain intensity) and emotional experience of the pain (mental health, social functioning, life activity; p&lt;0.05) decreased after 6 months of treatment when a personalized approach to the treatment of CTTH was applied, compared to the control group (with a standard patient management protocol).Conclusion. The personalized approach showed an improvement of the quality of life of patients with CTTH compared with the standard protocol, allowing us to recommend it for a wider application in clinical practice.

Clinical Study of Eclampsia Patients in Early Age Group of Women Admitted into DMCh between July 2023 to December 2023

Background: Eclampsia, characterized by the onset of seizures in women with preeclampsia, is a significant cause of maternal and neonatal mortality, especially in low-resource settings like Bangladesh. Young women, particularly those in their teenage years, are especially vulnerable to this life-threatening condition due to socio-economic and health factors. Objective: This study aims to assess the clinical outcomes of eclampsia patients aged 15 to 20 years admitted to Dhaka Medical College Hospital (DMCh) between July 2023 and December 2023. Method: A cross-sectional study was conducted at DMCh, focusing on young women diagnosed with eclampsia. Patients admitted with symptoms of preeclampsia or eclampsia after 20 weeks of gestation were included. Detailed clinical evaluations and sociodemographic data were collected, including obstetric history and predisposing factors. Diagnostic tests were performed, and management protocols were followed, including the administration of magnesium sulfate. Maternal and neonatal outcomes were monitored, including mode of delivery and complications. Results: The majority of eclampsia patients (39.13%) were aged 17-18 years, followed by 35% aged 15-16 years, with a significant proportion being primigravida (55%). Most cases occurred between 36-38 weeks of gestation (35%). Antepartum eclampsia accounted for 90% of cases, and 80% of deliveries were via cesarean section. Maternal outcomes revealed a 77% improvement rate, while neonatal outcomes showed an 80% survival rate, despite a 15% stillbirth rate. Conclusion: The findings indicate that eclampsia predominantly affects young, primigravida women in late gestation, with significant implications for maternal and neonatal health. The high incidence of cesarean deliveries and notable stillbirth rates highlight the need for improved prenatal care and postnatal monitoring in this vulnerable population. Addressing these gaps could help reduce the burden of eclampsia in young women in Bangladesh.

High-energy blunt pelvic ring injuries and pre-hospital pelvic binder applications – A retrospective assessment based on a prospective registry

IntroductionApplication of a pelvic binder in the pre-hospital settings is a crucial step of high-energy blunt pelvic ring injury (PRI) management protocols. The aim of this retrospective cohort study was to evaluate the percentage of pre-hospital pelvic binder's applications in high-energy blunt type B or C PRI patients managed at a single level I trauma center, and to assess its impact on the medical resource requirements and patients' outcomes. MethodsThe institutional Severely Injured Patients’ Registry was screened for patients meeting the following inclusion criteria: (1) high-energy blunt PRI; (2) admission between 2014.01.01 and 2022.12.31; (3) age ≥16 years; and (4) available computed tomography of the pelvis. Exclusion criteria were: (1) death before admission; (2) low-energy injury; (3) penetrating, blast and electrical injuries; and (4) secondary transfers. Study variables, including pre-hospital application of a pelvic binder and demographic, clinical, management and outcome data were extracted from the registry. Additionally, AO/OTA classifications were determined. ResultsA consecutive series of 262 patients was included into the final analysis. Of these, 58.8 % received a pre-hospital pelvic binder (PPB), increasing from type A (45.1 %) to type B (57.8 %) and type C (73.7 %). Pre-hospital hemodynamic instability was a major factor triggering the use of PPB in high-energy blunt type B PRI patients with PPB in 76.9 % of the cases with hemodynamic instability vs. 51.3 % of the cases without hemodynamic instability (p = 0.009). This difference was not statistically significant for high-energy blunt type C PRI patients (82.8 % vs. 64.3 %, p = 0.200). The presence of a physician on the trauma site contributed to the increased percentage of PRI managed with PPB from 43.5 % to 67.3 % in type B PRI (p = 0.011), and from 50 % to 77.1 % in type C PRI (p = 0.257).This study showed an increased need for packed red blood cells (PRBC) transfusions in subgroups treated with PPB and no statistically significant differences in term of intensive care unit (ICU) and total hospital length of stay and complications between high-energy blunt type B or C PRI patients with or without PPB.Comparison of mortality rates in patients with and without PPB showed a trend towards lower mortality rates with PPB in patients with AIS extremity participating in at least 50 % of the total ISS. ConclusionIn the ideal pre-hospital scenario, every high-energy blunt type B or C PRI patient should be managed with a PPB. Continuous pre-hospital team training and information is crucial to achieve this goal. The preparation of Emergency Department and ICU who admit a patient with PPB should include a sufficient number of PRBC ready for transfusion. Mortality rates did not seem to be affected by PPB, except for a trend towards lower mortality rates in patients in whom their PRI was the major component of the global severity of their injury. This might point out the critical and positive effect of PPB in high-energy blunt PRI patients.

A Lightweight PUF-Based Protocol for Dynamic and Secure Group Key Management in IoT

A Lightweight PUF-Based Protocol for Dynamic and Secure Group Key Management in IoT

Short-term Outpatient Parenteral Antimicrobial Therapy Administration in the Pediatric Emergency Department: Feasibility, Safety, and Outcome.

The practice of administration of intravenous (IV) antimicrobial therapy in outpatient settings (OPAT) is a low-cost alternative to in-patient admission and treatment. There is, however, limited evidence supporting OPAT management protocols for children. The primary objective of this study was to describe the use of pediatric emergency-based OPAT, as well as the safety of this practice. The study was a prospective, observational study conducted in pediatric emergency department of a tertiary care hospital. Children younger than 14 years who required pediatric emergency department-based OPAT were included in the study. Three hundred and ninety-two children were included in the study. The mean duration of OPAT was 3.5 days. Ceftriaxone was the most frequently used antimicrobial. Chest infection was the commonest indication, followed by sickle cell disease with fever and soft tissue infections. There were no major intravenous line-related complications over course of treatment. Most of the patients (89.5%) completed the OPAT course successfully. Only 10.4% patients required subsequent hospital admission, with failure to improve on the OPAT protocol being the main reason patients for admission. None of the admitted patients required intensive care settings or faced unexpected morbidity. Our results affirm that pediatric emergency-based OPAT is a safe yet effective practice in children with good clinical outcome. We believe that a reduction in admissions translates to better hospital resource utilization.

Ketone Management in Pediatric Diabetes Centers in the USA: Current Practices and a Call for Improved Standardization

Introduction: Diabetic ketoacidosis (DKA) is the leading cause of mortality among youth with type 1 diabetes (T1D). Guidelines for DKA prevention exist; however, specific guidance about when to check ketones and how to manage youth using insulin pumps and automated insulin delivery (AID) systems is lacking. Methods: A 35-item online survey exploring clinical ketone management practices for youth with T1D in the USA was distributed to diabetes healthcare professionals (HCPs). Survey responses, including multiple-choice and Likert scale questions, were summarized and rates of agreement and disagreement (Likert scale 4, 5 vs. 1, 2, 3) are reported. Results: In total, 123 HCPs (51% physicians, 26% diabetes educators, 19% nurse practitioners) from 47 institutions completed the survey. Seventy percent worked at academic specialty centers. Ninety-seven percent reported >50% continuous glucose monitoring use in their clinic and 72% reported >50% insulin pump use. Although 79% reported having ketone management protocols, the level and duration of hyperglycemia at which ketone monitoring was advised ranged from >200 to 350 mg/dL and from 0 min to >6 h of duration. While 72% had distinct ketone management protocols for pump users, only 29% had specific protocols for AID. Sixty-two percent agreed that DKA due to infusion site failure was a significant problem in their practice, and 70% agreed there was a need to standardize ketone management guidelines. Conclusions: The preventable nature and high incidence of DKA highlight the need to build consensus for clinical ketone management and to develop tools to facilitate management, especially as the use of diabetes technologies continues to increase.

Evaluating the Impact of Enhanced Recovery After Surgery (ERAS) on Postoperative Outcomes in Pancreatic Cancer Patients: A Historical Control Study

Objective: This study evaluates the impact of the Enhanced Recovery After Surgery (ERAS) program on postoperative outcomes in patients undergoing pancreatic cancer surgery. It compares traditional perioperative care with ERAS-based interventions, focusing on key rehabilitation indicators such as postoperative intestinal function recovery, length of hospital stays, medical costs, and the incidence of complications. Methods: A total of 74 patients were studied, with 37 receiving traditional perioperative care and 37 managed under the ERAS protocol. Data collection included intraoperative indicators such as operation time, fluid input, blood loss, and postoperative recovery measures like first ambulation, pain scores, and complications. Results: The ERAS group demonstrated significantly faster recovery of gastrointestinal function, earlier mobilization, and reduced postoperative pain within the first 12 hours compared to the control group (p&lt;0.05). The incidence of postoperative complications was lower in the ERAS group (13.51% vs. 37.84%, p=0.0166). Furthermore, the ERAS protocol led to a shorter length of hospital stay and lower total medical costs (p&lt;0.0001). Conclusion: The implementation of the ERAS protocol for pancreatic cancer surgery significantly improves recovery outcomes, reduces complications, and lowers healthcare costs. These findings support the broader adoption of ERAS protocols in pancreatic cancer management to optimize clinical and economic outcomes.