Reason For Admission Research Articles

Dual-Energy CT muscle fat fraction as a new imaging biomarker of body composition and survival predictor in critically ill patients

ObjectiveTo analyze changes in the muscular fat fraction (FF) during immobilization at the intensive care unit (ICU) using dual-energy CT (DECT) and evaluate the predictive value of the DECT FF as a new imaging biomarker for morbidity and survival.MethodsImmobilized ICU patients (n = 81, 43.2% female, 60.3 ± 12.7 years) were included, who received two dual-source DECT scans (CT1, CT2) within a minimum interval of 10 days between 11/2019 and 09/2022. The DECT FF was quantified for the posterior paraspinal muscle by two radiologists using material decomposition. The skeletal muscle index (SMI), muscle radiodensity attenuation (MRA), subcutaneous-/ visceral adipose tissue area (SAT, VAT), and waist circumference (WC) were assessed. Reasons for ICU admission, clinical scoring systems, therapeutic regimes, and in-hospital mortality were noted. Linear mixed models, Cox regression, and intraclass correlation coefficients were employed.ResultsBetween CT1 and CT2 (median 21 days), the DECT FF increased (from 20.9% ± 12.0 to 27.0% ± 12.0, p = 0.001). The SMI decreased (35.7 cm2/m2 ± 8.8 to 31.1 cm2/m2 ± 7.6, p < 0.001) as did the MRA (29 HU ± 10 to 26 HU ± 11, p = 0.009). WC, SAT, and VAT did not change. In-hospital mortality was 61.5%. In multivariable analyses, only the change in DECT FF was associated with in-hospital mortality (hazard ratio (HR) 9.20 [1.78–47.71], p = 0.008), renal replacement therapy (HR 48.67 [9.18–258.09], p < 0.001), and tracheotomy at ICU (HR 37.22 [5.66–245.02], p < 0.001). Inter-observer reproducibility of DECT FF measurements was excellent (CT1: 0.98 [0.97; 0.99], CT2: 0.99 [0.96–0.99]).ConclusionThe DECT FF appears to be suitable for detecting increasing myosteatosis. It seems to have predictive value as a new imaging biomarker for ICU patients.Clinical relevance statementThe dual-energy CT muscular fat fraction appears to be a robust imaging biomarker to detect and monitor myosteatosis. It has potential for prognosticating, risk stratifying, and thereby guiding therapeutic nutritional regimes and physiotherapy in critically ill patients.Key PointsThe dual-energy CT muscular fat fraction detects increasing myosteatosis caused by immobilization.Change in dual-energy CT muscular fat fraction was a predictor of in-hospital morbidity and mortality.Dual-energy CT muscular fat fraction had a predictive value superior to established CT body composition parameters.

Parenting styles and dental caries in Brazilian children and adolescents in foster care.

This study aimed to analyse parenting styles as a possible factor associated with caries in foster children and adolescents who had been victims of domestic violence. The study was carried out in nine foster shelters in Recife, Northeast Brazil, with a sample of 88 participants aged 8 to 17years old. Data were collected through intraoral examinations to verify deft/DMFT indices, applying the Demandingness and Responsiveness Scales to determine parenting styles. In turn, sociodemographic data were retrieved from records filed at the institutions. Descriptive analysis was performed, with the Mann-Whitney and Kruskal-Wallis tests being used to compare the categories of numerical variables. The mean deft/DMFT was of 3.78 in children (8 and 9years old) and 1.93 in adolescents (10years old and older). Overall, the index was of 2.31. Neglect was the main reason for the children's admission to foster care, while neglectful was the most prevalent parenting style. Children of indulgent parents had higher caries indices in both deciduous and permanent teeth, while children of authoritative (permanent teeth) and authoritarian parents (deciduous teeth) had the lowest caries indices. However, no significant associations were found between caries and parenting styles.

Clinical characteristics, complications and in-hospital mortality in patients in the coronary care unit requiring invasive mechanical ventilation

Abstract Funding Acknowledgements None. Introduction Mechanical ventilation (MV) is one of the most widely used life support techniques in critically ill patients and, due to the increasing number of coronary care units (CCU), adequate management of this technique is essential. Purpose The aim of our study was to describe the profile of patients requiring invasive MV (IMV) in our CCU, as well as the mode of ventilation, complications and in-hospital mortality. Methods Single-center retrospective observational study of a cohort of patients admitted to a CCU between January 2018 and March 2023 who required IMV. Baseline characteristics, reason for admission and intubation, as well as evolution and complications during admission were analyzed. Results A total of 157 patients were included, 113 (72%) men. The mean age was 66.9 years (SD 12.2). Table 1 summarizes the history and baseline characteristics of the patients. Image 1 summarizes the reasons for admission. Regarding the causes of oro-tracheal intubation, the most frequent was cardiopulmonary arrest (CPA) (49.7%), followed by respiratory failure (32.5%) and cardiogenic shock (CS) (16.6%). Regarding left ventricular ejection fraction (LVEF) on admission, 69.4% had LVEF&amp;lt;52%, with 32.5% of all patients having LVEF below 30%. The most used ventilation mode as initial mode was volume-controlled mode (VC/AC), used in 71.3% of patients. The mean stay in CCU was 11 (min 1-max 78, SD 12) and of orotracheal intubation was 5 days (min 1-max 64, SD 7). Mean days to weaning from VMI was 2 (min 0-max 8, SD 2). Failure on extubation occurred in 38 patients (19.1%), the most frequent reasons being need for reintubation (12.7%), need for noninvasive MV (8.9%) and self-extubation (2.5%). Only 7 patients (4.5%) required tracheostomy. Regarding complications, 49% developed sepsis, 61.1% had CS, and 7% required renal replacement therapy. In-hospital mortality was 38.2% (60 patients). Conclusions IMV is a technique that is increasingly used in our environment. Patients who require it are usually complex, with multiple comorbidities, with a high percentage of CPA and CS. These patients usually have prolonged stays in the CCU, with an average of more than 10 days, frequent complications and a high in-hospital mortality of almost 40%. It is essential to gather series as large as possible of these patients to improve our knowledge of their management and characteristics.

The lipid profile of the young patient with ischemic heart disease. Do these patients meet the goals?

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Hospital Universitario Virgen Macarena Introduction Ischemic heart disease is becoming increasingly common in young individuals, with dyslipidemia being an important risk factor for developing acute coronary syndrome (ACS). Recently, new analytical parameters of the lipid profile have been described, which are associated with a higher cardiovascular risk. Purpose The aim of the study was to analyse characteristics, lipid profile and, whether LDL goals are achieved in young patients with ACS admitted to our Coronary Care Unit (CCU). Methods Retrospective cohort of all patients with ACS minor than 45 years admitted to a CCU between January 2010 and February 2023. The LDL goals were established according to the European clinical practice guidelines (&amp;lt;70 mg/dL or &amp;lt;55 mg/dL after 2019). Results A total of 287 patients were included, with 82.6% being male and an average age of 41 years. 77% were smokers and 9% were ex-smokers. The prevalence of classic cardiovascular risk factors at admission was as follows: dyslipidemia 105 (37%), overweight 74 (26%), obesity 70 (25%), hypertension 87 (30%), and diabetes 29 (10%). Lipid profile’s results are showed in picture 1. Smoking, gender, as well as obesity or overweight were not significantly associated with a worse lipid profile. Significant differences were also not found based on the extent of coronary involvement (analyzing the number of affected vessels or the presence of coronary occlusion) or the reason for admission (NSTEMI vs. STEMI). As for secondary prevention, 70% of patients completed the cardiac rehabilitation program. The percentage of patients who achieved the LDL goal was 62.4% at 6 months (with an average of 61 mg/dL) and 52.4% at one year (with an average of 72 mg/dL). The majority of patients (74%) who did not meet the goals at 6 months still did not achieve them at one year. A higher initial LDL-C level was associated with a lower likelihood of achieving the goals at 6 months and one year, although it did not reach statistical significance at one year (p = 0.05 and 0.08, respectively). No other predictors of success were found, although participation in a Cardiac Rehabilitation Program was associated with a non-significant trend towards goal attainment, likely due to the small sample size (45% vs. 65%, p = 0.09). Conclusion Young patients with ACS have a good short-term and long-term prognosis, which is why secondary prevention becomes particularly important. However, a significant percentage of patients still do not achieve the recommended LDL-C goals, leaving room for improvement in reducing morbidity and mortality in this population. Larger patient series are needed to gain a better understanding of this population.Table 1.Lipid profile'sLDL and Lipoprotein (a) at admission

Characteristics, management and prognosis of patients with coronary artery disease undergoing coronary intervention and atrial fibrillation

Abstract Funding Acknowledgements None. Introduction The selection of antithrombotic treatment in patients with ischaemic heart disease (IHD) and atrial fibrillation (AF) represents a challenge when trying to balance ischaemic and haemorrhagic risk. However, there is little "real-life" data on the selected antithrombotic treatment and its short and long-term prognosis. Methods A Prospective multicentre study that includes patients with IHD [acute coronary syndrome (ACS) or chronic coronary syndrome (CCS)] and AF admitted to 13 Spanish centres. The objective is to describe the characteristics, antithrombotic treatment and prognosis of patients undergoing PCI and AF. Results 373 patients were included. The average age was 77.6 ± 9.8 years (28% women). Patients had a high ischaemic and haemorrhagic risk [CHA2DS2VASc 4 (2-5) and HASBLED 3 (2-4)], with 25.5% being frail according to the Clinical Frailty Scale. The main reason for admission was ACS (44.8% NSTEMI, 22.2% STEMI and 33% CCS ), and 49.8% of patients had multivessel disease. 70.3% of patients underwent revascularisation, mainly percutaneously (92.2%). Among those percutaneously revascularised, the most used antithrombotic treatment was triple therapy with double antiplatelet therapy (DAPT) + oral anticoagulant (OAC) (62.5%), followed by double therapy with monoantiplatelet therapy + OAC (29.2%). In revascularised patients over 80, the most selected antithrombotic therapy was similar: 60.5% and 28.9%, respectively. The most used OAC was apixaban (42.3%), followed by vitamin K antagonists (17.3%). One-year survival was 88.5%. 2.6% of patients presented an ischemic stroke, and 4.8% suffered a new ACS. At the same time, haemorrhagic events (BARC ≥2) were 8.9%. Conclusions A high ischaemic and haemorrhagic risk co-exists in patients with IHD and AF. In our setting, triple therapy, mainly with the use of DOACs over VKA, is the preferred therapy. The long-term mortality of this subgroup of patients with IHD is high (&amp;gt;10%), with a rate of haemorrhagic events (8.9%) higher than ischaemic events (4.8%).Characteristics of patients

Enhancing NICU Care and Communication: Perspectives of Moderately Preterm Infant Parents.

Moderately preterm infants (MPTI) comprise a large proportion of NICU admissions and are an understudied population. The unique experience of families with MPTIs has yet to be examined in the literature. Describing MPTI parent needs and preferences may inform interventions to improve care and outcomes for this population. Semistructured qualitative interviews were performed with English-speaking birth parents of infants born between 32 and 34 weeks gestation to describe their NICU experience and identify areas for improvement specifically surrounding care team inclusion, education, discharge, and communication. Interviews were recorded, transcribed, and analyzed using directed content analysis. Enrollment ceased when the data reached thematic saturation. Sixteen birth parents participated. Four themes emerged around parent-medical team connectedness, parental confusion, discharge readiness, and the desire for a use of a mix of in-person and electronic communication methods (e-mail, texting, apps, etc) for communication. MPTI parents valued a strong connection with the medical team; however, they described a lack of knowledge regarding the reasons for admission and ongoing management. Near discharge, parents desired more information regarding feeding, reflux, and breathing patterns. Parents preferred in-person discussions but described a role for electronic methods to improve their understanding of their infant and discharge readiness. From the MPTI parent perspective, clinicians can focus improvement efforts on communication, specifically around reasons for admission, discharge planning, and anticipatory guidance. These results may serve as a foundation for initiatives to improve the MPTI parent experience and potentially parent and MPTI outcomes.

Obstetric HDU: A Supply-Based Alternative for ICU Care in a Low-Income Setting: A Descriptive Study

Abstract Background: The demand of ICU care for obstetric patients is rising in low-income settings, where there is low ICU-bed capacity. Introduction of obstetric High-dependency unit (HDU) has been described as an effective strategy to bridge this gap in resource-restricted settings. Objective: To describe the clinical characteristic and maternal outcomes of obstetric patients admitted to the first obstetric HDU in Ethiopia. Study Design: This was a descriptive study on clinical characteristics and maternal outcomes of obstetric patients admitted to obstetric HDU over one year (October 2021 to September 2022) at St. Paul’s Hospital Millennium Medical College (Ethiopia). Data were collected retrospectively through reviewing patients’ medical records using a data extraction format with KOBO collect tool. Data were analyzed using SPSS version 23 and simple descriptive statistics were employed. Proportions and percentages were used to present the results. Results: After excluding 18 patients who did not meet the inclusion criteria, a total of 355 obstetric patients who were admitted to an obstetric HDU were included in the final analysis. Among these all-obstetric patients admitted to obstetric HDU, pre-eclampsia/ eclampsia (82/355, 23.1%) and postpartum hemorrhage (66/355, 18.6%) were the most frequent reasons for admission to the HDU whereas cardiac disease constituted 14.1% (50/355) of the indication for admissions to the unit. Majority (318/355, 89.6%) from the study participants were transferred to other wards with improvement, while 37(7.9%) deteriorated with 9(2.53%) of them died. Septic shock (6/9, 66.6%) and DIC (2/9, 22.2%) were the leading causes of death in the HDU. Conclusion: Findings of our study demonstrate that opening HDU in a low-income setting is feasible and results in favorable maternal outcomes. Introduction of obstetric HDU in low-income settings is an effective intervention to reduce severe maternal morbidity and mortality associated with low ICU-bed capacity in those settings.

Discharges Against Medical Advice in Pregnant Patients at a Canadian Tertiary Care Center: Does Lack of Access to Childcare Play a Role? [ID 2683591

INTRODUCTION: Discharges against medical advice (AMA) during pregnancy have been associated with poor maternal and fetal outcomes. Moreover, one of the documented reasons why female patients might leave the hospital AMA is lack of access to childcare. In recent years, lack of access to childcare has been identified as a potential risk factor for discharge AMA and maternal mortality at a tertiary care center in Edmonton, Alberta, Canada. The goal of this chart review project is to study the characteristics of pregnant women who leave AMA from this center, and to determine what proportion of these discharges is due to difficulties securing childcare. METHODS: Ethics approval was obtained through the University of Alberta’s Health Research Ethics Board. All patients who were discharged AMA from the triage and antepartum units at the study site between May 28, 2021, and May 27, 2022, were identified. Patients were included in the chart review as long as they remained undelivered at the time of discharge. Reasons for admission and discharge AMA were extracted from each patient’s chart whenever available. Patients' age, gravidity, parity, and gestational age at the time of discharge were also collected. RESULTS: During the study period, approximately 9.3% of recorded discharges from the triage and antepartum units were for patients who left AMA. In total, we included 89 individual patient visits that ended with a discharge AMA. For these patients, the most frequent reason for admission was threatened preterm labor (including short cervix). Although the reason motivating discharges AMA was not documented in the majority of charts reviewed (49/89), lack of access to childcare was the most frequently documented reason provided by patients for leaving AMA (15/40). CONCLUSION: Improving access to childcare for pregnant patients who are admitted to the study site might help to decrease discharges AMA, and therefore help reduce perinatal complications.

A study on Awareness and Knowledge of Surgical Site Infection among Dental Patients in a Nigerian Tertiary Hospital

Background: Risk of surgical site infection (SSI) can be reduced or eliminated if its awareness and knowledge is optimal among patients. Aim: The aim of this study was to assess the level of awareness and knowledge of SSI among dental patients in a Nigerian Tertiary Hospital. Materials and methods: This was a cross-sectional study design conducted in hospital setting on adult Nigerian population visiting a tertiary hospital between December, 2022 and February, 2023. The data was collected with a pretested 36-item, structured, close-ended, self-administered and interviewer -administered questionnaires. The data collected were socio demographic characteristics, past admission, days of hospitalization, reason for admission and history of SSI. Other collected data were awareness and knowledge of SSI. Both descriptive and inferential statistics were analyzed. The data was entered and analyzed using the statistical package for the social sciences (SPSS), version 26 (IBM, Armonk, NY, United States of America). A critical probability level (p-value) of &lt;0.05 was used as the cut-off level for statistical significance. Results: A total of 102 dental patients were interviewed in this study. The age range and the mean age were 20 -76 years and 45.3± 5.1 years respectively. There was slight (55.9%) preponderance of female gender. Only 24(23.5%) respondents had heard of SSI and this was mainly through medical personnel. The majority (76.5%) of the respondents had never seen anyone diagnosed of SSI. Few (6.9%) respondents claimed they were enlightened about SSI prior to surgery. Overall, half (50%) of the respondent had poor knowledge while only 13(12.7%) had good knowledge. Marital status, level of education and previous admission were significantly associated with poor knowledge (p&lt;0.05). Conclusions: The awareness and knowledge of surgical site infection among patients in this study were relatively poor. Therefore, awareness campaign among Nigerian population can help improved the level of knowledge for better wound care and quality care.

Adult Cancer Patients' Perceptions of Factors That Influence Hospital Admissions.

To explore cancer patients' perceptions of factors that influence hospital readmissions. A cross-sectional, prospective design was employed utilizing a 1-time survey and brief interviews to measure patients' perceptions and unplanned hospital admissions. The principal investigator collected data from medical record review, the Hospital Admission Survey, and interviews to measure patient characteristics and perceptions of influencing factors that contributed to an unplanned hospital admission upon admission. Data were analyzed using descriptive statistics to categorize patient perceptions of influencing factors of unplanned hospital admissions. The top reasons for admission were symptoms of uncontrolled gastrointestinal, pain, fever, and respiratory problems. The majority perceived the admission was unavoidable and wanted to avoid an admission. Perceived influencing factors were related to survey categories of 1) communication (ie, cannot reach physician anytime, cannot get a next-day appointment, medical problems are out of control, advised to go to the emergency department) and 2) home environment (ie, unable to adequately manage symptoms at home and hospital admission is the best place for care). Other survey categories of patient education and palliative care were not perceived as influencing or contributing factors. These findings highlight opportunities for clinical nurse specialists to target these vulnerable patients and provide expert consultation to address potential barriers and gaps in utilization of appropriate supportive services that may reduce unplanned hospital admissions.

Determinants of Mortality in Primigravida in Peoples Medical College Nawabshah.

Objective: To determine the determinants of maternal mortality in primigravida. Methodology: This cross-sectional, descriptive study was conducted from June 2023 to Dec 2023 at the department of Gynecology and Obstetrics of Peoples University of Medical &amp; Health Sciences for women, Nawabshah; a tertiary care center. We studied overall causes of death (direct and indirect) during pregnancy, delivery, and puerperium. Those patients who died after admission were included and analyzed on specially designed proforma. Information collected from hospital records/patient attendants. The reason for admission, status at arrival, cause of death, and potential variables answerable for death were recognized. Data including age, booking status, parity, gestational age, and relevant variables from the current pregnancy, along with the traveling distance from the clinic, was recorded on Performa, and analyses were done on SPSS adaptation 25. Results: During study period 43 maternal deaths occurred in their first pregnancy. The live birth rate was 10020. MMR counted to 429 per lac live birth. Most frequent death occurs at 19 years of age, from the rural population (62%), the majority un-booked (72%), history of domestic violence (48%) was not uncommon. Among these primigravida; 60% having no formal education, 65% were referral cases presented with obstetrical complication and in labor (34.9%). Almost all deaths were due to direct causes (99%). The highest contribution was by hemorrhage 39.5% (PPH=27.9%+ APH 11.6%), followed by sepsis (27.9%), pre-eclampsia/ eclampsia (18.6%), pulmonary embolism (7%), while 4.7% deaths due to unsafe abortion in early pregnancy complications. We found only 2.3% of deaths due to indirect causes. CONCLUSION: It is crucial to highlight that tackling maternal mortality requires a comprehensive strategy, which encompasses enhancing healthcare infrastructure, guaranteeing access to high-quality prenatal and obstetric care, advocating for education and awareness, and tackling social determinants of health. Recognizing and dealing with these factors can help decrease maternal mortality rates for all expectant mothers, including primigravidae. Key words: Primigravida, Maternal Mortality Rate, antenatal care, Obstetric emergency.

Uncontrolled hypertension and hypertensive urgency: One-year single-center emergency department experience.

The prevalence of uncontrolled hypertension remains a significant concern in public healthcare systems, including daily practices of emergency departments (ED). We aimed to characterize patients admitted to an ED for elevated blood pressure (BP) and to identify factors leading to hospitalization. This retrospective analysis included all patients admitted to an ED in a tertiary hospital in 2022 due to an acute BP rise without hypertensive emergencies. The studied group (n = 570) constituted 1.5% of all ED admissions in 2022. The median age was 67 years (Q1-Q3) (52-75), 68.9% were females. Systolic BP (200 mm Hg [180-212]) and diastolic BP (105 mm Hg [100-115]) at home were higher than during triage (173 mm Hg [160-190] and 95 mm Hg [84-103], respectively [P <0.0001]). Thirty-nine percent of the studied population had taken BP-lowering agents before ED admission (captopril in 91.8% of cases). In the ED, nitrendipine (54.2%), captopril (38.1%), furosemide (16.3%), urapidil (10.0%), and nitroglycerine (1.9%) were administered. Eventually, a median of 140/82 mm Hg BP was reached in the median time of 288 minutes (202-400). Hospitalization was necessary in 5.4% of patients. The need for furosemide or urapidil administration in the ED doubled the risk of hospitalization (OR, 2.0; P <0.01). Before ED admission, only 17.0% of patients received guidelines-recommended single-pill combination therapy, and 17.6% had already visited ED for uncontrolled hypertension (median of 388 days earlier). Elevated BP is a common reason for admission to the ED. Crucially, improvements in long-term hypertension treatment and education are needed to reduce the number of patients seeking ED care for elevated BP.

Evaluation of neuroimaging findings in children who admitted to pediatric emergency clinic with acute neurologic complaints

Aim: Acute neurological complaints are one of the reasons why children present to pediatric emergency departments. Neuro-imaging techniques gain more importance in children since physical examination and anamnesis do not provide sufficient information due to insufficient cooperation. We aimed to determine the distribution of patients who applied to the pediatric emergency department with non-traumatic acute neurological complaints and underwent neu-roimaging, and the clinical benefit of neuroimaging in these patients. Methods: The information and records of the patients who applied to the Konya City Hospital Pediatric Emergency Clinic between January 1 and October 1, 2022, due to acute neurological complaints and underwent neuroimaging were retrieved and analyzed retrospectively. Acute neurological complaints of the patients were classified according to the International Classifi-cation of Diseases-10 diagnostic coding. Results: This study included 180 (50.5% male) patients. The median age of the patients was 120 (interquartile range: 45-180) months. Afebrile convulsion was the most common reason for admission in 69 patients (38.3%). Cranial computed tomography (CCT) was performed in all 180 patients. Of the patients, 68 (37.8%) only underwent CCT scan, while 90 (50%) had diffusion magnetic resonance imaging (MRI), 20 (11.1%) had brain+diffusion MRI, and 2 (1.1%) had brain+diffusion+spinal MRI. Neuroimaging abnormalities were statistically higher in patients with abnormal physical examination findings than in patients with normal physical examination findings (p&lt;0.001). Conclusion: Neuroimaging results are mostly normal even in the presence of symptoms such as seizures, headaches, and impaired consciousness. Therefore, neuroimaging should be planned by considering not only the acute neurological complaint on admission but also the physical examination findings.

Evaluation of Seasonal Hazelnut Workers' Emergency Department Applications in Ordu Province: A Retrospective Study

Objective: In Turkey, agricultural worker migration occurs in order to maintain different regulations and management in different seasons. Seasonal agricultural workers (SAWs) may also cause problems such as not knowing the conditions of the region they go to, experiencing health problems due to seasonal conditions, and increased workload in local institutions brought about by population growth due to humidity. This study aimed to evaluate the emergency service applications of seasonal hazelnut workers during the hazelnut harvesting season and to find solutions to possible health problems. Method: It was a single-center, retrospective study and the applications of seasonal hazelnut workers who applied to the local tertiary emergency department between 01 August 2022 and 30 September 2022 were evaluated. The socio-demographic characteristics of non-pregnant patients aged 18 and over, their reasons for admission to the emergency department, and the treatments they received were recorded. Results: 400 patients with no missing data were included in the study. 60.2% of the patients included in the study were female and 19% were SAWs who were not registered in the population of Ordu province. It was determined that the most common causes of SAWs in emergency department admissions were allergic reactions with at 37.3% and trauma with at 26%. Conclusion: It is observed that SAWs increase the rates of emergency service admissions during the hazelnut harvesting season. We think that in this period, the employment of healthcare personnel should be increased, SAWs should be trained in terms of diseases that may occur due to environmental factors and working conditions, and the necessary health plans should be determined in advance.

Pattern of Disease Admissions and Their Outcome of Neonates Admitted In Neonatal Intensive Care Unit of A Tertiary Care Hospital in Quetta

Objective: to determine the admission pattern and outcomes of neonatal admissions to a neonatal intensive care unit (NICU) in a tertiary care hospital of Quetta Pakistan. Study Design: Prospective longitudinal study. Place and Duration of Study: Neonatal Intensive Care Unit, Combined Military Hospital (CMH), Quetta Pakistan, from Jan to Dec 2020. Methodology: All neonates admitted to the NICU Indoor or Outdoor Department during study duration were included. The disease pattern of the admission was noted, along with information regarding gender, gestational age, birth weight, diagnosis, duration of NICU stay, and outcome. Results: Of 424 neonates, respiratory-related disorders were predominantly higher (185,43.6%) followed by infection/sepsis-related disorders (105,24.8%), care of prematurity (81,19.1%), whereas 53(12.5%) had miscellaneous disorders. The overall mortality rate was observed in 34(8.0%) babies. A significant mean difference in gestational age (p: &lt;0.001), birth weight (p: &lt;0.001), and duration of stay (p: 0.003) was observed for reasons for admissions. Furthermore, a significant association of reasons for admission was observed with gender (p: 0.013), route of admission (p: &lt;0.001), and respiratory support (p: &lt;0.001). Conclusion: The pattern of the disease admission showed that respiratory-related disorders were predominantly higher, followed by infection/sepsis-related disorders and care of prematurity. Though the mortality rate was low, however, low birth weight, prematurity, and caesarean delivery are common risk factors.

An Assessment of the Prevalence and Risk Factors of Hypertensive Crisis in Patients Who Visited the Emergency Outpatient Department (EOPD) at Adama Hospital Medical College, Adama, Oromia, Ethiopia: A 6-Month Prospective Study.

Over 1 billion people worldwide suffer from the common chronic medical condition of hypertension. A hypertensive crisis occurs when blood pressure exceeds 180/110 mmHg. Depending on whether the target organ is harmed, the situation may be presented as a hypertensive emergency or urgency. To assess the prevalence and risk factors of patients with hypertensive crises who visited the Emergency Outpatient Department (EOPD) at Adama Hospital Medical College in Adama, Oromia, Ethiopia, between January 01 and August 31, 2021, G.C. Methodology. A cross-sectional, prospective study on the hypertensive crisis was conducted at Adama Hospital Medical College from January 01 to August 31, 2021, G.C. The data were collected using a standardized questionnaire, validated for completeness, and analyzed using SPSS. The findings were tabulated, and conclusions and recommendations were conveyed. Out of 9,082 patients who visited the EOPD during the six-month period, 444 individuals with hypertensive crises were identified, representing a prevalence of 4.9%. Of these, 56.8% were men, resulting in a M : F ratio of 1.31 : 1. Those between the ages of 66 and 75 were the most affected. At presentation, 91.0% of the study participants were known hypertensive patients. Among the known hypertensive patients, the majority (34.9%) were known to have been hypertensive for 5-10 years. Of the known hypertensive patients, 48.6% were found to be adherent. Hypertensive urgency was discovered to be far more common than hypertensive emergencies (63.5% vs. 36.5%). Headache was the most common presenting symptom, and most patients (36.5%) presented to the health setup in less than 24 hours. The main risk variables identified were drug discontinuation, family history of hypertension, salt consumption, and alcohol usage. The main excuse for the lack of adherence was the cost of the medications. More than half of the patients do not have any additional comorbidities, and of those who do, diabetes mellitus is the most prevalent. A stroke was identified as a major complication. Conclusions and Recommendations. Hypertensive crises are one of the most prevalent reasons for EOPD admission and are linked to significant consequences. At presentation, most of the study subjects were known hypertension patients. Diabetes mellitus was discovered to be a comorbid condition in one-quarter of them. Although more than half of the patients had improved, the death rate still remained high. Infrastructure and capacity building to provide hospitals with the requisite baseline investigations are among the government's recommendations. Health practitioners are expected to make improvements, such as by educating the public about the need for lifestyle changes and evaluating and managing any hypertension problems.

A quantitative and qualitative investigation into the management of carious primary molars by foundation dentists in primary care in the South East of England.

Introduction Dental caries is the most common reason for hospital admission of children aged 5-9 in the UK. Better management of caries in primary molars would reduce the number of children requiring treatment in hospitals; however, little research has been done into why primary care clinicians do not use an evidence-based approach to caries management for deciduous molars.Aims The aim of this paper is to identify the rationale behind caries management techniques used in primary care, as well as the choice of materials and long-term success of restorations placed.Materials and methods Use of a retrospective audit and a focus group with primary care clinicians to provide an insight into the management of carious primary molars and the barriers to achieving gold standard care.Results Glass ionomer cements (GICs) were the restoration of choice in primary care. Lack of time, equipment availability and clinician inexperience were cited as to why Hall crowns were not commonly placed.Conclusions The barriers to gold standard management of carious primary molars in practice are wide-ranging but tend to focus on the limitations of NHS care under the units of dental activity system. Lack of time and cost of materials encouraged clinicians to adopt a 'quick fix' approach in GIC.

Radiographic Evaluation of Neonatal Respiratory Distress: Cross-Sectional Study on Chest X-ray Findings in the Neonatal Intensive Care Unit

Introduction: Neonatal Respiratory distress (NRD) is a common reason for admission to the Neonatal Intensive Care Unit (NICU). While clinical diagnosis is essential, imaging evaluation can help confirm lung lesions, their extent, and associated abnormalities. However, radiation exposure from imaging modalities such as Computed Tomography (CT) and Chest X-ray (CXR) is a concern, particularly for neonates. This study aims to identify the various CXR findings in neonates with respiratory distress in the NICU. Methods: A quantitative cross-sectional study was conducted on 59 neonates with respiratory distress in the NICU from November 2019 to November 2020. Ethical clearance was obtained, and data were collected through portable CXR. The collected data were analyzed using Microsoft Excel 2016 and Statistical Package of Social Services (SPSS) IBM version 23. Results: CXR findings of 59 neonates with a mean age of 15.9 ± 7.4 days were evaluated. The majority were premature neonates, and the most common clinical diagnosis was respiratory distress syndrome (RDS). Hypoaeration was the most common finding in lung fields, followed by normal aeration. Parenchymal changes were observed in most cases, with reticulations/haziness being the most common, followed by consolidation. Pleural effusion was seen in a few cases, predominantly in preterm neonates with RDS. Conclusions: The study underscores the prevalence of hypoaeration, reticulations, and consolidations in NICU patients with RDS, emphasizing the importance of early diagnosis and future research in neonatal chest imaging for respiratory distress.

The effect of the SARS-CoV2 pandemic and lockdown on non-Covid ICU admissions: Experience from a South African tertiary hospital.

Future pandemic planning involves analysing past experiences. We compared intensive care unit (ICU) admissions during the SARS-CoV-2 pandemic (2020) with the preceding year. To assess the SARS-CoV-2 pandemic's effect on ICU admissions in a tertiary hospital, examining differences in patient characteristics, organ support requirements, reason for admission, mortality rates and length of ICU stay. This retrospective cohort study compared ICU patient data at a tertiary hospital during the SARS-CoV-2 pandemic (26 March 2020 to 20 September 2020) with the same period in 2019. Patient admissions (p=0.39) and severity of illness (p=0.27 adults; p=0.92 paediatrics) showed no differences across the study period. Similarly, no differences were observed for underlying chronic conditions between the two years. Adult trauma admissions significantly declined, specifically those related to road traffic accidents (RR 0.63). Admissions for acute infectious conditions, including respiratory infections, sepsis, urosepsis, septic arthritis and gastroenteritis significantly declined in both adults (RR 0.50) and paediatric admissions (RR 0.25). During the lockdown period, the length of stay (LOS) decreased for adults, but mortality rates remained unchanged across the study period. The paediatric mortality rate decreased during the lockdown period (p=0.004). There was no reduction in SARS-CoV-2-negative ICU admissions during the 2020 lockdown period compared with the preceding year, likely due to chronic resource limitations. We found a decrease in acute trauma and acute infectious illness admissions, while acute surgical emergency admissions increased. These findings suggest that lockdown orders may have affected admission patterns, aiding in future pandemic planning. The study highlights the chronic shortage of critical care resources in South Africa and aids with future pandemic preparedness and planning in a resource limited setting.

Noncardiac Surgery in Patients with Left Ventricular Assist Devices: A 11-Year Institutional Experience.

Limited options in the end-stage treatment of heart failure have led to increased use of left ventricular assist devices. For this reason, the rate of non-cardiac surgeries in patients with left ventricular assist devices is also increasing. Our study aims to analyze surgical rate, anesthesia management, and results by reviewing our 11-year experience with patients who underwent non-cardiac surgery receiving left ventricular assist devices support. We retrospectively evaluated 57 patients who underwent non-cardiac surgery and 67 non-cardiac surgical procedures among 274 patients who applied between January 2011 and December 2022 and underwent left ventricular assist devices implantation with end-stage heart failure. Fifty (74.6%) patients with left ventricular assist devices admitted to the hospital for non-cardiac surgery were emergency interventions. The most common reasons for admission were general surgery (52.2%), driveline wound revision (22.3%), and neurological surgery (14.9%). This patient group has the highest in-hospital mortality rate (12.8%) and the highest rate of neurological surgery (8.7%). While 70% of the patients who underwent neurosurgery were taken to surgery urgently, the International Normalized Ratio values of these patients were between 3.5 and 4.5 at the time of admission to the emergency department. With a perioperative multidisciplinary approach, higher morbidity and mortality risks can be reduced during emergencies and major surgical procedures.