SAT Hospital Research Articles

Risk Factors for Cardiac Involvement in Children with Severe Acute Respiratory Syndrome Coronavirus 2-related Multisystem Inflammatory Syndrome in Children: A Prospective Observational Study

Introduction: Our study aims to investigate the association between cardiac involvement in multisystem inflammatory syndrome in children (MIS-C) and the patient’s epidemiological, clinical, and investigative profile. Identifying such associations could facilitate the early detection and management of cardiac complications, potentially leading to improved patient outcomes. Materials and Methods: The study was conducted as a prospective observational study at SAT Hospital, Government Medical College, Thiruvananthapuram. It included all children aged 0–12 years admitted during the study period who met the criteria for the diagnosis of MIS-C as per the guidelines provided by the World Health Organization. Exclusion criteria comprised children with a confirmed alternative diagnosis, preexisting heart disease, and those whose parents declined consent for participation. Despite aiming for a sample size of 55 based on previous studies, only 50 samples were obtained within the study period. Ethical considerations were met and no funding was involved in our study. A well-structured pro forma was used for data collection. Results: Our study included 50 children aged under 12 years, with a median age of 7 years, and an interquartile range of 4.6 years. Of these participants, 54% were male, and the remaining 46% were female. According to the operational definition utilized in our study, 62% of the children exhibited cardiac involvement, while 38% had a normal cardiac status. In our investigation, the median values for C-reactive protein and erythrocyte sedimentation rate were found to be 10 mg/dl and 60 mm/h, respectively. Furthermore, the median platelet count was observed to be 1.87 lakhs/mm3, while the median absolute lymphocyte count was recorded as 1472 cells/mm3. Serum albumin and NT-pro BNP were identified to have a statistically significant association with cardiac involvement, exhibiting significance at the 1% level. Conclusion: Our findings suggest that serum albumin and NT-pro BNP have a statistically significant association with cardiac involvement in MIS-C. Furthermore, hemodynamic instability in MIS-C may result primarily from vasculopathy rather than cardiac dysfunction.

The investigation of serum phenylalanine levels based on infant feeding method: a cross-sectional study of children less than two years old with phenylketonuria (PKU)

BackgroundClinical advice may suggest discontinuing breastfeeding after the diagnosis of phenylketonuria in infants as the only effective way to monitor the newborn's intake and accurate measurement of phenylalanine (Phe). This study aims to investigate the prevalence and duration of breastfeeding, as well as its effect on serum Phe levels in infants with phenylketonuria at Education and Therapy Medical Center, Be'sat Hospital, Iran.MethodsWe conducted a cross-sectional study of 34 children under two years old diagnosed with phenylketonuria between September 2018 and December 2022. Infants were categorized as breastfed and non-breastfed (bottle-fed) based on their feeding method after diagnosis. Data on age at diagnosis, medical records, demographic information, and anthropometric indices were collected, and infants with incomplete data or mixed feeding (formula + breast milk) were excluded from the study.ResultsOf 94 infants managed in our hospital, 34 had complete medical records. Among the all patients 13 (38%) continued to be breastfed combined with phenylalanine-free amino acid-based protein substitute, while 21 (62%) were did not receive breast milk. The mean duration of breastfeeding was 2.57 ± 0.59 (1–3) months. The mean age at diagnosis was 22.6 ± 18.4 days. Phenylalanine concentrations at diagnosis were mean 10, SD 5.44; range 4–24 mg/dL [0.22–1.33 μmol/L] in the breastfed group and mean 14.3, SD 10.2; range 5–37 mg/dL [0.27–2.05 μmol/L] in the non-breastfed group.Non-breastfed infants had lower serum Phe levels than breastfed infants: mean 3.76, SD 2.10; range 1–7 mg/dL [0.05–0.38 μmol/L] and mean 4.89, SD 3.68; range 2–19 mg/dL [0.11–1.05 μmol/L], respectively, although not statistically significant [(t (34) = 118.0, P = 0.51]. Also we found no significant associations in body measurements for weight, height, and head circumference at birth and final assessment.ConclusionsIn conclusion, during treatment, there were no statistically significant associations between breastfeeding and serum Phe levels with growth in children with phenylketonuria.

Clinical pattern and outcome of hematuria in children – A prospective follow-up study from South India

Background: Hematuria is defined by the presence of an increased number of red blood cells (RBCs) in the urine. It can be visible or apparent only on microscopic analysis of urine which many times is an incidental finding. The prevalence of microscopic hematuria is 4–5% in routine clinical practice in children of 6–12 years of age. The pediatrician is the first person who comes in contact with children having microscopic or gross hematuria. Updated knowledge of clinical patterns and their outcomes will help improve the management of children with hematuria. Aim and Objective: The aim and objectives are to study the outcome of hematuria in children attending SAT Hospital, Government Medical College, Thiruvananthapuram. Materials and Methods: This is a prospective follow-up study of 100 children admitted with hematuria in our hospital whose ages were between 1 month and 12 years. A preformed and piloted questionnaire was used. Clinical history and examinations were done. Relevant investigations and follow-up assessments were done for 1 year. Biopsy was done for 35 patients by an experienced pediatric nephrologist. Results: Among the 100 children presented with hematuria, 24 had prior renal disease whereas 76 children did not have any pre-existing renal disease. Both were followed up for 1 year. 80% (45) of those without prior renal involvement cleared of hematuria by 1 year and 20% had persistent renal impairment. In the other group with prior renal problems, 75% (15) showed persistent renal problems. School-going children (57%) were mostly affected with female preponderance (30%). The most common etiology was acute post-infectious glomerulonephritis (60%), and the next most common seems to be IgA nephropathy (23%) followed by SLE (17%) Conclusion: Eighty percent of hematuria was found to be resolved completely after 1 year. The remaining 20% has to be carefully evaluated including renal biopsy when indicated. This will help the clinician to provide better care for sick babies with hematuria.

Psycho-social Factors Affecting the use of Masks during the COVID-19 Pandemic in Be'sat Hospital in Hamadan: A Descriptive Study

Background and Objective: Despite the definite positive effect of wearing masks in preventing diseases, the level of adherence has been reported to be very low in some communities. This study was conducted to determine psycho-social factors affecting the use of masks during the COVID-19 pandemic at Be'sat Hospital in Hamadan, Iran. Materials and Methods: This descriptive cross-sectional study was conducted on 384 people referring to the Be'sat Medical Research and Training Hospital in Hamadan in 2022. The samples were selected using the availability sampling method. The data collection tool was a researcher-made questionnaire that included 51 questions to assess the participants' demographic, economic, social, cultural, and spiritual status and was completed by face-to-face interview method. The data were analyzed in SPSS 26 software using Chi-square, Monte Carlo, Mann-Whitney, and Student's t-tests were used to analyze the data. Results: The mean age of the participants was 36.76±11.71 years. More than half of the participants (54.7%) were men. The frequency of wearing a mask at the time of the interview was 48.4%. According to the findings, the frequency of using a mask was significantly lower in men than in women. A significant relationship was observed between wearing a mask and being single, being more educated, living in the city, and lacking a smoking history (P<0.001). Moreover, higher economic, cultural, and social status showed a significant relationship with using a mask (P<0.001). Conclusion: Economic, social, and cultural factors were identified as the influential factors in mask use; therefore, it is necessary to pay attention to preventive behaviors, social norms, and culturalization during epidemics.

Knowledge, Attitude and Practices Among Mothers of Infants Regarding Breastfeeding.

This study aims at understanding the level of knowledge, attitude, and practice of breastfeeding among mothers and the factors associated with good knowledge about breastfeeding. A cross-sectional study among 251 mothers of infants admitted in the pediatric wards of SAT Hospital, Thiruvananthapuram was conducted during November-December 2019. The mothers of infants born between 37 and 42 weeks of gestation and without major birth defects were included in the study. The data were entered into an MS Excel sheet and analyzed using Statistical Package of Social Sciences version 26.0. Significance of association was tested using Chi-square test and multivariate analysis was done using binary logistic regression test. The mean age of the participants was 26.25 (SD 4) years. On multivariable analysis, higher education and older age were found to be significantly associated with good knowledge. Independent sample T-Test results show that there was a statistically significant difference between the mean age of mothers with good knowledge (26.4(±4), 25.14(±3.7)), p-0.015 and statistically significant association was found between the mean attitude scores (34.07(5.58)) with current breastfeeding practices (p=0.002). Chi-square test shows that exclusive breastfeeding was significantly associated with the mother's age (p=0.006); 64.2% of women practicing exclusive breastfeeding were less than 25 years of age. This study also demonstrated a significant association between the initiation of breastfeeding within an hour and exclusive breastfeeding (p=0.003). This study shows that mothers with higher age and higher educational qualifications were significantly associated with good knowledge about breastfeeding. Even though mothers have good knowledge, nearly half the mothers only exclusively breastfeed their infants for six months. Improving the educational qualification of women and increasing awareness about the benefits of breastfeeding among young women will promote breastfeeding practices.

Comparison of clinical outcome of lumbar spinal stenosis surgery in patients with and without osteoporosis: a prospective cohort study

BackgroundOsteoporosis is one of the most important risk factors for failure of the spine instrumentation. Management of patients with osteoporosis who requires spinal surgery because of the difficulty in instrument placement and the potential complications is still a challenge. This study was designed to evaluate the clinical outcome of lumbar spinal canal stenosis after instrumentation in patients with and without osteoporosis.MethodsThis prospective cohort study was performed from June 2018 to December 2020, in Be'sat Hospital, Hamadan, Iran. The sample consisted of patients over 50 years old referred to Be'sat Hospital with a diagnosis of lumbar spinal canal stenosis who underwent instrumental surgery (n = 107). Based on bone densitometry, the sample was divided into two groups with osteoporosis (n = 34) and without osteoporosis (n = 73). To collect data, we used a three-part researcher-made questionnaire (demographic information, medical records information, and paraclinical parameters). Statistical analyzes were performed by the Fisher Exact, chi-square, independent t-test, Multiple ANCOVA, Mann–Whitney and the Rank Wilcoxson tests using Stata version 17 software.ResultsThe mean age (SD) of patients in the two groups with and without osteoporosis was 67.9 (7.0) and 59.1 (5.1) years, respectively (p = 0.001). The results indicated that a significant difference was observed between the two groups in sex (p = 0.032), educational status (p = 0.001), marital status (p = 0.023), employment status (p = 0.004), menopausal status (p = 0.018), taking corticosteroids (p = 0.028), and body mass index (p = 0.015). Also, there was a significant difference between two groups in the loosening of instrument (p = 0.039), the postoperative pain intensity (p = 0.007), fusion (p = 0.047), and neurogenic claudication (p = 0.003). Based on multiple ANCOVA test, there was not a significant difference between two groups in the clinical and paraclinical charatecristics (p > 0.05). The mean (SD) of T-Score in the osteoporosis group was 3.06 (0.37).ConclusionThis study provides evidence that there is no significant difference in the clinical outcomes of lumbar spine instrumentation due to spinal canal stenosis in patients with and without osteoporosis. Because of the high cost of specific instrumentation developed for patients with osteoporosis and their unavailability, it seems that the use of conventional instrumentation along with complete treatment of osteoporosis can help improve the clinical outcome of surgery in these patients.

Survival analysis of coagulation disorders: A retrospective study with a 5-year follow-up

ObjectiveRare bleeding disorders (RBDs) are the diseases in which patients experience a deficiency of coagulation factors. In the management of these disorders, surveillance is a significant challenge. This study aimed to assess the survival of patients with RBDs in a five-year follow-up. Materials and methodsThis descriptive cross-sectional study was conducted on 146 patients with RBDs who had referred to Be'sat Hospital of Hamadan, Iran from July 2017 to August 2022. A computerized record search was performed to identify the patients. The surveillance time for a five-year follow-up was assessed with the Kaplan–Meier curve. A log-rank test also served to compare the survival rates according to the type of factor. ResultsOut of 146 patients, 117 (80.2%) were males and 29 (19.8%) were females. They were in the range of 2–59 years of age with a mean of 23.11 ± 14.6. The most common disorder was FVIII deficiency (65.8%), and the rarest one was FXIII deficiency (4.8%). The rate of survival for any reason was 54.42 ± 1.3 months. The survival in combined FV and FVIII deficiencies was found to be longer than in the other deficiencies (55.9 ± 5.7), but there was no significant difference (P ≥ 0.05). In contrast, the survival in FXIII deficiency was observed to be lower than the other cases (44 ± 9.6); however, no significant difference was found in this regard (P ≥ 0.05). ConclusionThe results of this study show that patients with RBDs have different rates of survival, which suggests that identifying high-risk patients may be helpful for the improvement of their survival time through timely therapeutic interventions.

The Relationship of Integrated Geriatric Assessment and Effective Communication Towards Holistic Nursing Care With Caring Nurse Behavior as an Intervening Variable at Islamic Hospital Siti Khadijah Palembang City

In the world of health, Holistic Nursing Care is a standard with a multi-disciplinary approach through integrated and holistic assessment. Geriatric patients have complex needs that must be identified to address the needs that must be met by a hospital service to provide patient survival, quality of life and satisfaction. Holistic nursing care is influenced by several variables such as integrated geriatric assessment and effective communication. In addition to these two variables, there are other variables that can affect this relationship, one of which is the caring behavior of nurses. The purpose of this study was to analyze the relationship between Integrated Geriatric Assessment and Effective Communication of Holistic Nursing Care with Nurse Caring Behavior as Intervening Variables at Siti Khadijah Islamic Hospital, Palembang City. This research is explanatory research with a quantitative approach in the form of causality using 7 hypotheses with a sample of 80. The conclusion in this study is that there is a significant relationship between integrated geriatric assessment and effective communication on nurse caring behavior and holistic nursing care, besides that caring behavior turns out to be able to Intervene a significant relationship between integrated geriatric assessment and effective communication of holistic nursing care. Meanwhile, another significant relationship is between the caring behavior of nurses and holistic nursing care at Siti Khadijah Islamic Hospital, Palembang. The theoretical implications of this study will prove the effect of research variables and managerially will further improve the evaluation system for the quality of nursing care for geriatric services in hospitals and the overall management of geriatric patients for healthy old age.

Evaluating the Outcome of an Unnecessary Request for CT Scan in Be'sat Hospital of Hamadan.

This study aimed to investigate the frequency of unnecessary tests requested in Be'sat Hospital in Hamadan. This descriptive research was conducted in order to investigate the frequency of unnecessary requests for CT scan and radiography of patients referring to the imaging department of Be'sat Hospital in Hamadan in a 4- to 6-month period. Patient information, including gender, age, type of CT scan test, the reason for requesting the test, the expertise of the requesting physician, and the result of the radiologist's report on each test, was extracted and collected. A total of 1000 CT scans were evaluated. The mean age of these patients was about 36 years and most of them were men. The highest and lowest percentages of unnecessary cases were related to CT scans of the brain (42.3%) and facial bones (2.3%), respectively. The most and the least unnecessary CT scans based on the reason given for the request were related to multiple physical trauma (30.7%) and chronic kidney disease (1.5%), respectively. In all tests, over 74% of the reports were unnecessary and less than 26% were necessary. Therefore, it is necessary to reduce unnecessary requests to reduce the radiation dose of patients. Also, the knowledge of doctors should be increased in the field of appropriate evaluation of CT scan tests based on clinical guidelines.

Comparison of Tranexamic Acid and Dexmedetomidine on Bleeding in Endoscopic Sinus Surgery.

The quality of the surgical field during the surgery is impaired when bleeding occurs. This study compared the effect of tranexamic acid and dexmedetomidine on the rate of bleeding during endoscopic sinus surgery (ESS). In this one-blind clinical trial, 72 patients with chronic rhinosinusitis who were candidates for ESS at Be'sat Hospital in Hamedan were randomly assigned to two groups. Group A received dexmedetomidine at a dose of 1μg/kg, and group B received tranexamic acid at a dose of 10mg/kg immediately after induction of anesthesia intravenously within 15 minutes. The two groups were evaluated and compared regarding the quality of the surgery field with the Boezaart scale, volume of intraoperative bleeding, hemodynamic changes, and complications up to 90 minutes after the beginning of surgery. The mean volume of intraoperative bleeding in group A (181.67±86.66) was significantly higher than in group B (110.28±61.23) (P =0.000). At 15, 30, and 60 minutes, the quality of the surgical field in group B was better than group A (P =0.038), while at 90 minutes, there was no statistically significant difference (P =0.450). The mean arterial pressure in group A at 15 minutes was higher than in group B (P=0.003); at 60 and 90 minutes, it was lower, and the difference was statistically significant (P =0.01). On the other hand, in 30 minutes, the mean arterial pressure in group A was higher than in group B, without a significant difference (P =0.07). Moreover, there was no statistically significant difference between the average surgery time (P = 0.25) and the frequency of complications (P =0.405). Based on the results, tranexamic acid is preferable to injectable dexmedetomidine to control and reduce bleeding during ESS.

Paediatric Appendicitis: Has SARS-COV-2 Influenced the Clinical Profile and Management during the Pandemic Period?

Introduction: The Coronavirus Disease-2019 (COVID-19) had profound repercussions on routine medical practices all over the globe. There are fewer studies on the impact of the pandemic on childhood surgical conditions like Acute Appendicitis (AA), which is the most common paediatric surgical emergency. Aim: To analyse whether COVID-19 has influenced the clinical profile and management of paediatric appendicitis during the pandemic period. Materials and Methods: A retrospective study was carried out in the Department of Paediatric Surgery, SAT Hospital, Government Medical College, Thiruvananthapuram, Kerala, India, comparing AA cases during the pandemic period (group A=from February 2020 to January 2022) with AA cases during the prepandemic period (group B=from February 2018 to January 2020). Analysis of data regarding patient demographics (age, sex), duration of symptoms and hospital stay, type of appendicitis, total and differential leucocyte count, ultrasonographic findings, treatment modality and complications was done. Subgroup analysis of children in group A was done by comparing AA cases with active/recent COVID-19 infection (Subgroup A1) with the rest of AA in the group (Subgroup A2). Pearson’s Chi-square test was used for the analysis of categorical variables and independent t-test was used for numerical data. p-value<0.05 was considered significant. Results: There were 826 AA cases, with 375 children in group A and 451 in group B. A significant reduction in the number of AA cases was noted during the first year of the pandemic (n=167 vs n=242, p-value=0.009) and a significantly higher number of cases were managed conservatively during the pandemic period (n=48 vs n=10, p-value <0.0001). Children with active/ recent COVID-19 infection presented late (p-value=0.03), had a significantly higher incidence of complicated appendicitis (p-value=0.02), decreased total leucocyte count (p-value=0.01), decreased polymorph count (p-value=0.02) and higher incidence of the conservative modality of treatment (p-value<0.005). Conclusion: Overall, there were no significant differences in the clinical profile of AA during the pandemic period. But, children with AA who had active/recent COVID-19 infection had a longer duration of symptoms and a higher incidence of complicated appendicitis. The pandemic influenced the management protocols with an increase in the number of AA cases being managed conservatively when compared to the prepandemic period.

Epidemiological pattern of trauma patients based on the mechanisms of trauma: trends of a regional trauma center in Midwest of Iran

IntroductionTrauma is one of the important issues in public health because it is responsible for 90% of mortality in Low and Middle-Income Countries (LIMCs). The present study aimed to determine the epidemiological pattern of trauma patients in a regional trauma center in the Midwest of Iran from 2014 to 2020.MethodsThis study was a retrospective study that was performed on 29,804 trauma patients admitted to Be′sat Hospital in Hamadan from January 2014 to December 2020. Data was collected using Health Information Management (HIM) Center of the Be′sat Hospital. For investigating the relationship of the characteristics of trauma patients and the mechanisms of trauma, Multiple Multinomial Logistic Regression (MMNLR) model was used. All statistical analyses were performed using the IBM SPSS Statistics version 24.ResultsThe mean age of all patients was 35.4 (SD = 21.9) years. Most of them were men (71.7%). The most common mechanism of trauma was road traffic accidents (RTAs) (39.6%) followed by falls (30.2%), other (19.7%), violence (6.2%), and burn (4.4%). 1.5% of the trauma patients expired. The results of multiple multinomial logistic regression indicated that significant affected factor on odds referring because of RTAs compared to other mechanism were: season and hospital length of stay (LOS); in falls and violence: age, sex, season, and LOS; and in burn: age, sex, season, evening time, and LOS (p < 0.05).ConclusionBased on the investigation of 29,804 trauma patients, in Iran as a developing country, RTAs and falls were two common mechanisms of trauma. It seems that as a short-term plan, it is possible to focus on road safety, to improve the quality of vehicles, to hold training courses for drivers. Also, as a long-term goal, considering that the elderly population in Iran is increasing, it is necessary to pay attention to fall reduction programs.

Comparison of the effects of Date Syrup with Saffron-Honey Syrup on the Progress of Labor in Nulliparous Women: A Single Blind Randomized Clinical Trial.

Background:Assessing the progress of labor is a primary step in intrapartum care. This study was performed to assess comparison of the effects of date syrup with saffron–honey syrup on the progress of labor in nulliparous women.Materials and Methods:A randomized single-blind clinical trial study was conducted on 189 women who were referred to Bea'sat Hospital of Sanandaj from October 2019 to March 2020. Patients were randomly divided into three groups saffron–honey syrup, date syrup, and placebo syrup each including 63 cases. Each participant in the intervention and control groups received a maximum volume of 150 ml of saffron–honey syrup, date syrup, or placebo syrup. The syrups were given at the 4 cm dilation, and every 30–60 min until the end of the active phase of the first stage of labor. Data collection tools included a two-part questionnaire and a partograph form. The results were analyzed by Statistical Package for the Social Sciences (SPSS) 24 using Chi-squared test, analysis of variance, and last significant difference as a post hoc test, the significance level was set at 0.05.Results:The duration of the active phases of the first (F2 = 92.70, p < 0.01), second (F2 = 66.76, p < 0.01), and third (F2 = 12.34, p < 0.01) stages of labor was shorter in the date syrup and saffron–honey syrup groups than in the control group (p < 0.01). Additionally, both experimental groups exhibited no significant difference in terms of duration between the first (p = 0.312), second (p = 0.724), and third (p = 0.911) stages of labor.Conclusions:Date syrup and saffron–honey syrup can be used as one of the safe and available herbal methods to facilitate labor.

Factors Associated with Outcomes in Patients with Chronic Subdural Hematoma who Underwent 'Burr Hole Craniotomy'.

Chronic subdural hematomas (CSDH) is frequently encountered in neurosurgical practice. The aim of this study was to investigate the factors associated with the outcome of Burr Hole Craniotomy. This study was conducted on 116 patients with CSDH in Be'sat Hospital, an educational hospital, in Kurdistan province, Iran. We used Glasgow outcome scale (GOS) at times of discharge and 1 month after stitch removal as favorable outcome. Student t-test or corresponding nonparametric test (Mann-Whitney U test) and logistic regression were used to assess the relationship between investigated variables and favorable outcome. : The results indicated that the chance of success after surgery in patients with CSDH was different based on several variables. The chance of cure after surgery among CSDH male patients (OR = 12.5), patients who have no atrophy (OR = 25.0), patients with no cardiovascular diseases (OR = 7.14), patients who had no medical complications after surgery (OR = 2.08), and patients with higher GCS score at the time of hospitalization (OR = 1.31) was higher. Burr hole drainage technique is a simplified, efficient and reliable method of treating patients with CSDH. Our study highlights various factors including female gender, diffuse brain atrophy, postoperative medical complications, a previous history of cardiovascular disease, and lower GCS score at the time of admission can be related to patients' worse outcome.

Incidence and Risk Factors of Ventilator-Associated Pneumonia among Patients with Delirium in the Intensive Care Unit: A Prospective Observational Study.

Introduction The incidence and risk factors for ventilator-related pneumonia (VAP) in patients with delirium are deficient, and there is a lack of in-depth knowledge of the impact of VAP on outcomes in this population. We investigated the incidence, risk factors, and outcomes of VAP in patients with delirium. Materials and Methods This prospective observational study was performed in a surgical ICU at Be'sat Hospital in Hamadan, Iran, between 2018 and 2019. A total of 108 patients with delirium were identified using the Confusion Assessment Method (CAM) for the ICU and Intensive Care Delirium Screening Checklist (ICDSC) and enrolled in this study. The association between VAP and delirium, risk factors, and outcomes (ICU length of stay and ICU mortality) for VAP were investigated using the Cox proportional hazards model and logistic and simple linear regression analyses with a 95% confidence interval. Results Of 108 delirium patients, 86 patients (79.6%) underwent mechanical ventilation (MV) and 16 patients (18.6%) experienced VAP during ICU stay. The median onset of VAP was 6.5 (IQR 4.2–7.7) days after intubation. Delirium patients with VAP stayed longer in the ICU (21.68 ± 4.26 vs.12.93 ± 1.71, P < 0.001) and also had higher ICU mortality (31.25% vs. 0%, P < 0.001) than subjects without VAP. According to multivariate cox regression, the expected HR for VAP was 53.5% lower for patients with early-onset delirium than in patients with late-onset delirium (HR: 0.465, 95% CI: 0.241–0.894, P=0.022). However, the expected hazard for VAP was 1.854 times and 4.604 times higher in patients with longer ICU stay (HR: 1.854, 95% CI: 1.689–3.059, P=0.032) and in patients with a prolonged MV duration (HR: 4.604, 95%CI: 1.567–6.708, P=0.023). Conclusion According to the results, there seems to be an inverse relationship between early onset of delirium and VAP. This finding cannot be conclusively cited, and more studies in this filed should be conducted with a larger sample size. Furthermore, VAP in delirium patients is associated with increases in poor outcomes (higher ICU mortality) and the use of medical resources (longer stay in the ICU and MV duration).

A prospective and observational study on the variation in Hemoglobin A1c levels among asthmatic children using inhaled corticosteroids

Background: The studies in children regarding the effects of inhaled corticosteroids (ICS) on the carbohydrate metabolism are scant in India. This study was undertaken to determine if there is any effect of inhaled steroids on the glycemic control. Aims and Objectives: The aim of the study was to analyze the pattern of glycated hemoglobin (HbA1c) levels in children with persistent asthma, before and after using prophylactic doses of ICS and to evaluate and compare HbA1c levels separately in those taking budesonide and in those taking fluticasone or other steroids. Materials and Methods: It was a prospective and observational study, based on a study proforma. Children of 2–12 years of age, diagnosed with mild-to-moderate persistent asthma, attending the Asthma Clinic at Paediatrics Department of SAT Hospital, Government Medical College, Thiruvananthapuram were included in the study. The diagnosis of asthma and the severity was recorded according to Global Initiative for Asthma guidelines.5 The sample size was calculated to be 40. Type, dose, and frequency of administration of ICS and other coprescribed drugs were recorded on an asthma diary and entered into the study proforma. HbA1c levels were measured in children before they were started on ICS, on the same day of visit using high perfusion liquid chromatography technique and repeated after 6 months. Student’s t-test was used to compare mean values between two groups. Results: Mean age of patients is 5.75. About 62.5% of patients were males. About 72.5% of the patients had a diagnosis of moderate persistent asthma. The mean HbA1c before the treatment with ICS was 5.36 and after the treatment is 5.37 and the difference was not significant. Conclusions: There was no significant change in HbA1c levels with the use of ICS.

Causes and results of non-cardiac surgeries in newborns admitted to the NICU

Background and aims: Surgery is an important and life-saving health service that can treat many of the congenital anomalies. This study aimed to investigate the possible causes and outcomes of non-cardiac surgeries in newborns admitted to the neonatal invasive care unit (NICU) department of Be’sat Hospital in Hamadan during the period 2011 to 2017. Methods: This study included all neonates (482 newborns) who were admitted to the NICU department of Be’sat hospital during the period 2011-2017 due to non-cardiac surgery, and had hospital records. The required information was extracted from their hospital records and the surgical outcomes and complications were analyzed with respect to other variables such as the gender, type of delivery, gestational age, birth weight, and disease. Results: According to our study results, 80.5% of the newborns had the gastrointestinal disease which was the most common cause of surgery found in this study. Moreover, imperforated anus (20.8%) and esophageal atresia (17.1%) were among the most common disorders. Esophageal atresia (33.9%) was detected to be the most common disease among the newborns who died during the course of the study. The results from the study showed that the outcome of surgery had statistically significant relationship with gender (P=0.011), type of breastfeeding/feeding (P&lt;0.001), gestational age (P&lt;0.001), and birth weight (P&lt;0.001). Conclusion: Fetal examinations during pregnancy and neonatal care immediately after birth were recommended for early diagnosis of esophageal atresia, diaphragmatic hernia, and imperforated anus. Since gender (male), breastfeeding, normal gestational age, and normal birth weight had a significantly positive effect on surgery outcome, higher quality care was also recommended for infants lacking these characteristics.

VACTERL Association in Neonates Hospitalized with Esophageal Atresia and Imperforate Anus

Background: VACTERL association is a congenital abnormality involving several organs. The percentage of involvement of different organs in this illness varies and treatment success depends on the intensity of the accompanied anomalies. This study aimed to investigate the prevalence of VACTERL association in neonates Hospitalized in Be'sat Hospital in Hamadan, Iran. Materials and Methods: This retrospective study was conducted using the descriptive-analytic method and all the neonates who were hospitalized with esophageal atresia and imperforate anus abnormalities in Be'sat Hospital, Hamadan, Iran, from April 2009 to April 2018 were included in the study. Information on the neonates were extracted from the medical records and after being recorded in the checklist, they were analyzed using SPSS v.16 at a 95% confidence level. Results: 127 neonates were included in this study. 42 neonates (33.1%) had esophageal atresia, 78 (61.4%) had imperforate anus, and 7 neonates (5.5%) had both anomalies. 87 of these neonates (68.5%) suffered from congenital heart disease. Atrial septal defect (31%), simultaneous presence of atrial septal defect and patent ductus arteriosus‎ (24%), and patent ductus arteriosus (23%) were the most common congenital heart diseases, respectively. 32 neonates (25.2%) had VACTERL association. Heart, genitourinary, and spinal anomalies were present in 93.2%, 84.3%, and 9.3% of the neonates, respectively. VACTERL association was significantly observed in neonates with imperforate anus (P = 0.001) Conclusion: VACTERL association is common in neonates who suffer from esophageal atresia or imperforate anus. Considering the high prevalence of anomaly of other organs, in addition to complete physical examination, echocardiography, abdominal ultrasound, and radiography of the spine are recommended.

Clinical and Laboratory Profile of Children with Dengue Fever and Predictors of Severe Dengue

Objectives: To study the Clinical and Laboratory profile of children upto 12 years of age with Dengue fever and to study the predictors of Severe Dengue among these children. Methods: Design: Descriptive study over 1 year 9 months. Setting: SAT hospital, Thiruvananthapuram, a tertiary care center. Study Population: 204 children aged 1month to 12 years admitted with serologically confirmed dengue fever without any co-infections; consecutive sampling. Procedure: Relevant history, detailed physical examination and investigations were noted. Patients were classified for their severity based on DENGUE guidelines-WHO 2009. Children were followed up till discharge during hospital stay. Categorical values were expressed as proportions and quantitative variables in mean and standard deviation. Association between various study variables and severe dengue were statistically analysed. Results: Mild dengue was seen in 96 children(47.1%), moderate dengue in 78 children(38.2%) and severe dengue in 30 children(14.7%). Mean age of presentation was 6.4 years. Age distribution- infants were 4.4%, 38.7% were between 1 year and 5 years; 56.9% were between 6 and 12 years.51% of children were males. Common clinical presentation was fever (100%), vomiting(46.6%), abdominal pain(32.4%), lethargy(24.5%), myalgia(22%), headache(16.7%) and reduced appetite(15.7%). Mean fever duration was 5 days. Hypotension was noted in 13.2%, Tender hepatomegaly in 44%, signs of plasma leakage in 6%, hypoalbuminemia in 7.8%. Total number of death was 2(1%). Variables with significant association with severe dengue on univariate analysis were Lethargy (p-&lt;0.001, OR- 11.6), reduced appetite (p- &lt;0.001,OR- 17.14), mucosal bleed (p&lt;0.001, OR- 15.45), Fever spike &gt;39◦C (p- 0.001, OR- 4.3), tender hepatomegaly (p- 0.001, OR- 4.2), decreased urine output (p &lt;0.001, OR- 23.04), hypoalbuminemia (p &lt;0.001, OR-43.5), platelet count below 80,000 (p &lt;0.001, OR-4.43), SGOT above 85 (p &lt;0.001, OR-4.9). According to the maximum area under ROC curve, a cutoff of platelet count 80,000 had 75% sensitivity and 60% specificity for predicting severe dengue. Conclusion: Proportion of children developed severe dengue was 14.7%. Independent predictors of severe dengue after multiple logistic regression were Lethargy, Reduced appetite, Reduced urine output and Hypoalbuminemia. Keywords: severe dengue; urine output; shock; hypoalbuminemia.

POS-060 CHRONIC KIDNEY DISEASE IN PEDIATRIC ACUTE KIDNEY INJURY SURVIVORS FROM INTENSIVE CARE UNIT: PROSPECTIVE STUDY FROM A DEVELOPING COUNTRY

Acute kidney injury (AKI) is an independent risk factor for mortality in critically il. Incidence of AKI in PICU ranges from 8-30%. Despite advances in therapy, mortality is still high and survivors are at risk of CKD. A hospital based prospective cohort study was conducted on critically ill children and neonates with AKI admitted to SAT Hospital, a tertiary care teaching hospital in South India over a period of 1 year with the objective to assess the immediate and long term outcome and risk factor involved in adverse outcome. Adverse outcome is defined as mortality or development of CKD in survivors. AKI was defined by pRIFLE and nRIFLE criteria respectively in children and neonates. Those with pre-existing CKD or CAKUT were excluded. The demographic profile, etiology, organ dysfunction, inotrope support, mechanical ventilation, AKI severity, need for dialysis and condition at discharge were assessed. Survivors were followed up with assessment of blood pressure, proteinuria and e GFR by Schwartz formula at 3 months, 6 months and 1 year. GFR below 90 mL/min/1.73 m2 or a normal GFR with proteinuria and/or hypertension were used to identify CKD. Statistical analysis was done with SPSS 20.0 .Chi square test was used for discrete variables, t test and ANOVA for quantitative variables. Univariate analysis and binary logistic regression were done for assessment of factors affecting the outcome. 155 critically ill babies- 87 neonates and 68 children were diagnosed with AKI during the study period. Male to Female ratio was 4.1:1 for new-born and 1.8:1 for children. Out of the 87 neonates 25.3% (22) were at risk, 43.7 % (38) in injury and 31 % (27) had failure. Dehydration due to faulty feeding and lactation failure formed the major cause of neonatal AKI (50.6%) followed by septicaemia (28.7%). Of the 68 children 17.7% (12), 23.5 % (16) and 58.8% (40) were in risk, injury and failure respectively. Acute Glomerulonephritis was the major etiology (23.5%) followed by sepsis with MODS (19.1%). Significant association was found between mortality and severity of AKI in both neonates and children. (P 0.002, P 0.00). Significant risk factors of mortality are given in Table 1.View Large Image Figure ViewerDownload Hi-res image Download (PPT) 13 out of 87 neonates expired (14.9%). 83.7% had normal GFR at discharge. 8.6% (3/35) with Injury and 53% (9/17) with Failure had partial recovery. 74 survivors were followed up for 1 year. 12 were lost to follow up and 1 died at 3 months. 4/61 babies (6.5%) developed CKD - 11% with injury and 14.2% with failure. Of the 68 children, 15 expired (22%). Among 53 survivors, 27 (51%) – {33.3 % (5/15) with injury and 80.8 % (21/26)} had abnormal GFR at discharge. 48 children were followed up till 1 year. 22.9% (11) had CKD . Of this 20% (3/15) were with injury and 36% (8/22) with failure. Severity of AKI correlated with adverse outcome. Risk factors for CKD were anuric AKI, MODS, need for dialysis, component therapy, inotrope support, abnormal GFR and hypertension at discharge. Anuric AKI and need for dialysis were the independent risk factors by multivariate analysis for development of CKD (Table 2). 22.9% children and 6.5% neonates surviving an AKI episode had CKD at 1 year follow up. Regardless of the severity, all AKI survivors after critical illness should be monitored regularly for long-term kidney damage so that early intervention becomes possible to retard the progression.