Till Discharge Research Articles

Overnight removal of urinary indwelling catheter following vaginal prolapse surgery (OVERACT)

ObjectivePelvic organ prolapse is a common condition in women. Adequate timing of urinary catheter removal after vaginal prolapse surgery is essential to reduce post-operative morbidity. We compared midnight removal of the indwelling urinary catheter to removal next morning. MethodsWe performed a retrospective cohort study among 266 women undergoing vaginal prolapse surgery, of whom 132 women had urinary catheter removal at midnight and 134 women morning after surgery. We compared the occurrence of urinary retention, time till first micturition, need for clean intermittent catherization and duration of hospital admission. Also, we assessed risk factors for the occurrence of retention. ResultsRetention occurred less after midnight removal of the urinary catheter, compared to removal next morning (6.1 % versus 23.9 %, p < 0.001). Furthermore, the time till catheter removal and discharge from hospital were shorter and the need for clean intermittent catheterization during hospital admission was lower after midnight compared to next morning removal of the urinary catheter. We identified anterior colporrhaphy as a risk factor for retention. ConclusionOur results suggest that early removal of the indwelling urinary catheter after vaginal prolapse surgery seems save with respect to urinary retention and leads to earlier mobilization and shorter hospital admission.

P147 Fungal osteomyelitis in patients with chronic granulomatous disease: a case series from a tertiary care medical centre.

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM ObjectivesTo present details of a case series of fungal osteomyelitis initially misdiagnosed as disseminated tuberculosis, in pediatric patients with chronic granulomatous disease.MethodInformed consent was obtained from the parents of three children (known cases of chronic granulomatous disease) with clinical features suggestive of chronic osteomyelitis. Clinical history was collected by interview and chart review. Samples were sent to the mycology laboratory for direct microscopy and fungal culture. Following a diagnosis of fungal osteomyelitis, antifungal therapy was administered and patients were monitored till discharge.ResultsFirst case:The first patient presented with fever, cough and progressive painful swelling over the left lower chest, and a past history of recurrent pneumonia and cervical lymphadenopathy, which were previously empirically treated with anti-tubercular therapy (ATT) and broad-spectrum antibiotics. Imaging revealed a soft tissue abscess with underlying rib osteomyelitis and pulmonary consolidation. Pus samples showed hyaline septate hyphae in direct microscopy and growth of Aspergillus nidulans in culture. The patient was successfully treated with intravenous voriconazole, which was switched to oral formulation on discharge.Second case:The second patient presented with fever and post-auricular swelling with multiple discharging sinuses, and a past history of fever and hilar lymphadenopathy, which were previously empirically treated with ATT and broad-spectrum antibiotics. Imaging revealed osteomyelitis involving mandible, temporal bone and skull base, with underlying sigmoid sinus thrombosis. Pus and tissue samples showed hyaline septate hyphae in direct microscopy and growth of Aspergillus fumigatus in culture. The patient was successfully treated with a combination of intravenous voriconazole and liposomal amphotericin B, and discharged on oral posaconazole.Third case:The third patient presented with progressive painful swelling over the right upper chest, and a past history of pneumonia, hemoptysis, and mediastinal lymphadenopathy, which were previously empirically treated with ATT and broad-spectrum antibiotics. During a previous hospitalization, imaging showed features suggestive of fungal pneumonia; BAL showed hyaline septate hyphae in direct microscopy and growth of Aspergillus fumigatus and Aspergillus flavus in culture, providing a diagnosis of fungal pneumonia which was treated with voriconazole and liposomal amphotericin B. During the present admission, imaging of the chest lesion revealed pus collection with underlying rib osteomyelitis, communicating with a cavity in the middle lobe of the right lung. FNAC from the lesion showed hyaline septate hyphae in direct microscopy but no growth in culture (probably due to previous antifungal therapy). The patient was successfully treated with a combination of intravenous voriconazole and liposomal amphotericin B, and discharged on oral posaconazole.ConclusionsFungal pneumonia and fungal osteomyelitis are often misdiagnosed as tuberculosis or bacterial infections, leading to unnecessary and ineffective ATT or broad-spectrum antibiotics. A high index of suspicion for fungal osteomyelitis is required in pediatric patients with a history of recurrent/chronic soft tissue infections, preceded by febrile episodes and/or pneumonia, especially if a diagnosis of chronic granulomatous disease (CGD) has already been established; if not, this characteristic clinical picture should in fact warrant evaluation for CGD.

CORRELATION OF ANTENATAL UMBILICAL ARTERY COILING INDEX AT SECOND TRIMESTER ULTRASOUND SCAN WITH PERINATAL FETAL OUTCOME

Aims and Objectives: To evaluate the perinatal fetal outcome in correspondence with the second-trimester scan umbilical artery coiling index in uncomplicated singleton pregnancies. Participants were recruited in the ultra Methods: sound unit at the Vani-Vilas hospital, Bangalore medical college &amp; research institute All ultrasound examinations were performed using a 6-MHz transabdominal transducer, with multihertz and harmonic capability.The evaluation of the umbilical cord mid-segment (free loop) that included recording of longitudinal cord images for the assessment of cord coiling. The antenatal UCI was calculated as the reciprocal of the distance between a pair of coils.After calculating the UCI, perinatal factors like meconium staining, fetal weight and Apgar score were followed till discharge. For the classication of newborns as SGA, gestational age-specic centiles were used. The sensitivity, specicity, posit Results: ive predictive value (PPV), and negative predictive value (NPV) of abnormal coiling for predicting SGA were 20%, 75%, 9.8%, and 87.4%, respectively.The odds ratio (OR) for the association between abnormal coiling index versus SGA at birth was 0.7 (95% CI: 0.3–1.6, P = 0.445. There was no signicant change in the above estimate with an OR of 0.6 (95% CI: 0.32–1.4, P = 0.26). Total of 19 cases which had meconium liqour, 3 (20.0%) had normocoiling, 14 (74%) had hypocoiling, 2 (4%) had hypercoiling. 135(88.0%) cases did not have meconium stained liquor. Out of them 116(95.4%) had normocoiling, 7 (26%) had hypocoiling and 12 (96.0%) had hypercoiling, which was statistically strongly signicant with P value being &lt;0.001 (P &lt;0.01) is strongly signicant. Meconium staining was more in the hypocoiled group. Apgar score at 1 minute and 5 minutes of &lt; 7 was found with UCI which was &lt; 10th percentile. Conclusion: The abnormal umbilical coiling index is associated with adverse perinatal outcomes. UCI which is &lt; 10th percentile is termed as hypocoiling and it is associated with meconium staining and low Apgar scores. Therefore, an antenatal detection of the coiling index can identify fetuses who are at risk and thus help in further management.

Symptoms to Balloon time Dependent St-Segment Resolution Post Primary Percutaneous Coronary Intervention and its Impact on Mortality

Background: The ST-segment elevation myocardial infarction (STEMI) is an emergency manifestation of coronary artery disease (CAD) that occurs when one epicardial coronary artery is completely blocked. Study aims to test whether symptom-onset-to-balloon time correlates with in-hospital outcomes after primary percutaneous coronary intervention (PPCI) among patients with STEMI. Methodology: under the Hospital Ethical and Research Committee's approval, NICVD's Department of Interventional Cardiology conducted a prospective cohort study that lasted for 6 months. Patients fulfilling the criteria of ST elevation, i.e., ≥ 1 mm in limb leads and ≥ 2 mm in precordial leads, aged &gt; 18 and &lt; 80 years, were included. ST segment elevations and time of symptoms onset were interpreted from the patient's ECG, performed for 30 to 60 minutes. Based on the symptom onset to balloon time, the patients were divided into 2 groups, i.e., &lt; 6 and &gt; 6 hours with follow-up till discharge and 30 days after discharge. An analysis of multivariate logistic regression was conducted to determine if ST-segment resolution and in-hospital mortality were influenced by the time from symptom onset to balloon time. Results: The results showed that Patients with double or triple vessel disease had longer symptom onset to balloon time (p=0.041). Symptom onset to balloon time delayed increased ST-segment resolution by &lt;50% (p=0.000). Symptom onset to balloon time was an important prognosticator of ST-Segment Resolution (&lt; 50% Resolution) but not for mortality. Conclusion: The current study concluded that the association between ST-segment resolution and symptom onset to balloon time shows the significance of symptom onset to balloon time among STEMI patients after PPCI. Keywords: Symptoms to Balloon Time, ST Segment Resolution, Primary percutaneous Coronary Intervention

Study of variables affecting mortality among extramural very low birth weight neonates in tertiary care centre: a prospective observational study

Background: Over the past few decades, the burden of extramural very low birth weight (VLBW) neonates is increasing due to advances in obstetrics services. Objective of present study was to know variables affecting mortality in these neonates. Methods: A prospective observational study was conducted at department of paediatrics, government medical college and hospital, Nagpur, India over a period of 2 years. Out-born neonates admitted in this tertiary care centre with birth weight between 1000-1499 gm were included in the study. Proper antenatal, natal history were taken and data was collected using data collection sheet. All subjects were followed up till discharge or death whichever was earlier. Results: Significant demographic factors associated with neonatal mortality were found out to be place of birth, birth attendant, distance travelled and transport time. Neonatal factors which significantly associated with mortality were found out to be hypothermia and SpO2 less than 90%.Conclusions: Univariate analysis concluded that age at presentation (&gt;24 hours), place of birth, birth attendant, distance travelled, mode of transport, transport time, hypothermia, SpO2&lt;90% were found to be significant factors for predicting risk of mortality in VLBW neonates. However, multivariate analysis concluded only 4 predictors that is age more than 24 hours, transportation time, SpO2 on admission and hypothermia were found to retain their significance. VLBW babies are vulnerable, but with small improvements in infrastructure and personnel training, significance difference in prevention of morbidity and mortality can be seen.

Whole body massage for newborns: A report on non-invasive methodology for neonatal opioid withdrawal syndrome.

Infants with in-utero exposure to opioids are at risk Neonatal Opioid Withdrawal Syndrome (NOWS) and non-pharmacological methods of care, like swaddling, quiet ambient environment are routinely recommended but are not systematically studied. We hypothesized that opioid exposed infants can tolerate whole body massage while hospitalized. This is a prospective observational study (August 2017 to January 2019) and infants of mothers having a history of opioids use (OUD) were included. Infants received whole body massage for 30 minutes from birth till discharge home. Infants heart rate (HR), respiratory rate (RR), systolic (sBP) and diastolic blood pressure (dBP) were recorded prior to and at the end of massage session. The pilot study enrolled 30 infants. The mean birth weight and gestational age were 38±1 weeks and 2868±523 grams, respectively. All massage sessions were well tolerated. There was marked decrease in HR, systolic and diastolic BP and RR, (p < 0.01) in all study infants post massage, more profound among infants with NOWS (p < 0.01) than without NOWS. Whole body massage is very well tolerated by infants with in-utero opioid exposure. Infants with NOWS had marked decrease in their HR and BP from their baseline after massage.

Novel Scoring Systems to Predict the Need for Oxygenation and ICU Care, and Mortality in Hospitalized COVID-19 Patients: A Risk Stratification Tool.

Introduction: A rapid surge in cases during the COVID-19 pandemic can overwhelm any healthcare system. It is imperative to triage patients who would require oxygen and ICU care, and predict mortality. Specific parameters at admission may help in identifying them.Methodology: A prospective observational study was undertaken in a COVID-19 ward of a tertiary care center. All baseline clinical and laboratory data were captured. Patients were followed till death or discharge. Univariable and multivariable logistic regression was used to find predictors of the need for oxygen, need for ICU care, and mortality. Objective scoring systems were developed for the same using the predictors.Results: The study included 209 patients. Disease severity was mild, moderate, and severe in 98 (46.9%), 74 (35.4%), and 37 (17.7%) patients, respectively. The neutrophil-to-lymphocyte ratio (NLR) >4 was a common independent predictor of the need for oxygen (p<0.001), need for ICU transfer (p=0.04), and mortality (p=0.06). Clinical risk scores were developed (10*c-reactive protein (CRP) + 14.8*NLR + 12*urea), (10*aspartate transaminase (AST) + 15.7*NLR + 14.28*CRP), (10*NLR + 10.1*creatinine) which, if ≥14.8, ≥25.7, ≥10.1 predicted need for oxygenation, need for ICU transfer and mortality with a sensitivity and specificity (81.6%, 70%), (73.3%, 75.7%), (61.1%, 75%), respectively. Conclusion: The NLR, CRP, urea, creatinine, and AST are independent predictors in identifying patients with poor outcomes. An objective scoring system can be used at the bedside for appropriate triaging of patients and utilization of resources.

Pattern of pressure ulcers in a tertiary hospital in south-south Nigeria

Background: Pressure ulcers are a common cause of increased morbidity in patients who are bedridden or wheelchair-bound. Objectives: This is to look at the pattern of pressure ulcers in our facility with the objectives to determine the demographic distribution such as age and sex, sites and stage of the ulcers, co-morbidities and duration of immobilisation prior to onset of ulcer. Methods: This is a prospective study of patients seen within 12 months in the ward or in the surgical outpatient and followed up till discharge or death. Patients were enlisted into the study as they presented. Those with previous surgical treatment of pressure ulcers at the same site were excluded. Results: AGE: range from 15 to 91 years with a mean age of 63.7 years, modal age of 70 years and peak age group 65-79 years (&gt;45 years of age). One patient (10%) was a 15 year old. M: F= 1.2:1. The duration of immobilization prior to development of ulcer ranged from 2 weeks to 20 years. Most of our patients had cerebrovascular disease, 25.8%, as the co-morbidity causing immobilization. Sacral ulcers (61%) were most common site followed by trochanteric (22%). Stage 2 pressure ulcers were the commonest stage.

Frequency of elevated systolic blood pressure and early mortality in patients with Intracerebral hemorrhage.

Objective: To determine the frequency of elevated systolic blood pressure and early mortality in patients with Intracerebral hemorrhage. Study Design: Descriptive Case Series study. Setting: Department of Medicine, Unit IV of Jinnah Hospital Lahore. Period: 6th April 2018 to 7th October 2018. Material &amp; Methods: Total 335 patients of intracerebral hemorrhage, fulfilling inclusion criteria were recruited for the study. Blood pressure levels was measured by researcher using random-zero sphygmomanometers with the subject lying quietly. Two readings of blood pressure 5 minutes apart were taken and average of the two readings was noted in the proforma. CT scan brain was done and analyzed by consultant radiologist. These study cases were followed till discharge to note outcome (mortality). Data was entered and analyzed in SPSS version 20. Frequency and percentages were used for expressing qualitative variables while quantitative variables were expressed in the form of mean and standard deviation. Results: The mean age of the study participants was 64.39 + 8.50 years. Majority of the cases were males with the frequency of 285(85.1%). Early mortality was noted in 132(39%) of cases. Diabetes Mellitus was noted in 144(43%) of cases. There was significant difference noted with p-value&lt;0.05 for early mortality in elevated versus normal blood pressure people. Conclusion: Significant proportion of patients with intracerebral hemorrhage patients have elevated blood pressure and suffer from early mortality.

Outcome among mechanically ventilated children in a tertiary care hospital.

Objective: To determine the frequency of outcomes among children who are mechanically ventilated in PICU. Study Design: Prospective Observational study. Setting: National Institute of Child Health (NICH). Period: January 2020 to June 2020. Material &amp; Methods: All children who fulfill the sample inclusion criteria were registered for research and prior consent was taken from parents or guardian by primary researcher. The primary investigator followed the patient till discharge from PICU. The patient information was obtained through medical record, patients’ charts, and directly by following the patients prospectively. Data was analyzed by employing SPSS version 25. In the test, significance was determined by P value of less than 0.05. Results: Mean age of patients was 6.73±3.90 years. There was 55.7% male and 44.3% female patients. Mean weight, duration of stay in PICU, mechanical ventilation days, PEEP, PIP, Pressure Support and FIO2 was 21.92±10.29 kg, 6.73±5.46 days, 5.78±4.43 days, 5.36±0.55, 16.87±1.03, 9.63±0.78 and 55.05±19.47 respectively. In our study, mortality rate was 37%. We found significant association of age group, cardiogenic shock and Sepsis with outcome. Conclusion: Mortality rate among mechanically ventilated patients was 37% while outcome was significantly associated with age group, cardiogenic shock and sepsis.

Study of thrombocytopenia in patients of acute febrile illness

Introduction: Many viral and bacterial infections result in thrombocytopenia and are most common non-iatrogenic cause of thrombocytopenia. Infections can affect both platelet production and platelet survival. In addition, immune mechanisms can also be a cause, as in immune-mediated thrombocytopenia (ITP) in children following viral infection. In our setup, tropical infections like malaria, dengue and leptospirosis formed the most common and important causes of thrombocytopenia. Objectives: To correlate the bleeding manifestations of thrombocytopenia with platelet count in patients with acute febrile illness and to document the incidence of thrombocytopenia and most common cause of thrombocytopenia among patients with acute febrile illnesses. Methodology: A minimum of 200 patients admitted to tertiary care center with documented fever of &gt;37.50C and platelet count &lt;1,50,000/µL were selected using purposive sampling techniques. They were followed from admission till recovery, discharge or death. Correlation of bleeding manifestations like petechiae, gum bleeding, hematuria, menorrhagia, epistaxis in relation with lowest platelet count was done along with categorization of patients according to different platelet count ranges. Results: Out of total 200 patients 65% were male and 35% were female.

Correlation of hs-CRP with in-hospital Outcome of Patients with Acute Coronary Syndrome (ACS)

Background and Objectives: Coronary artery disease (CAD) is a worldwide health epidemic. Acute coronary syndrome (ACS) is a potentially life-threatening condition of CAD. Serum high-sensitivity C Reactive Protein (hs- CRP) is being increasingly used as a marker for cardiac risk assessment and as a prognostic tool in acute coronary syndrome. The objective of this study was to evaluate the prognostic value of hs-CRP in predicting cardiovascular outcome in patients presenting with acute coronary syndromes. Methods: This prospective observational study was carried out in the department of cardiology of Chittagong Medical College Hospital (CMCH), Chittagong, from April 2013 to March 2014. Total 100 patients presenting with acute coronary syndromes who fulfilled the selection criteria were included in the study. Serum hs-CRP of all patients was assayed on admission and study population divided into 4 groups according to hs-CRP quartiles. All four groups were followed-up till discharge and occurrence of any cardiovascular events were sought. Results: Mean hs-CRP was 18±2.9mg/L (mean±SD), ranged from 1.6 mg/L to 71.2 mg/L /L. The mortality was significantly higher in quartile-4 (7%, p-0.001) and quartile- 3 (4%, 0.005) as compared to quartile-1 and 2 (0% and 2% respectively). 12% patients developed heart failure in quartile-4 vs 2% in quartile-1 (p-0.045). Similarly other cardiac complications like cardiogenic shock, arrhythmias and heart blocks occurred in increasing frequency among patients of higher quartiles. Conclusions: Elevated hs-CRP is a predictor of adverse outcome in patients with acute coronary syndromes and helps in identifying patients who may be at risk of cardiovascular complications. Bangladesh Heart Journal 2022; 37(1): 34-39

Impact of PCO2 gap protocol application on early postoperative mortality and organ failure in high risk surgical patients undergoing major abdominal surgeries

Background: high risk surgical patients undergoing major abdominal surgeries still have higher rate of mortality and organ failure rates in the early postoperative period. Objective: We aimed to assess PCO2 gap protocol application in the intraoperative and early post-operative (first 12 hours) on postoperative mortality and organ failure in high risk surgical patients undergoing major abdominal surgeries compared to a classical goal directed therapy protocol (GDT) targeting mean arterial blood pressure (MAP), mixed venous oxygen saturation (SvO2), central venous pressure (CVP), Haematocrite value (Hct) and urine output (UOP). Patients and Methods: Guided by Shoemacker et al score 80 high risk surgical patients undergoing major abdominal surgeries were divided into two groups group A PCO2 gap algorithm was applied intraoperative and 12 h postoperative end point PCO2 gap 2-6mm Hg ,group B goal directed therapy protocol targeting MAP &gt; 65mmHg, CVP between 8-12cmH2O , Haematocrite value more than 30, Svo2 &gt;75% and urine output more than &gt;0.5 ml/kg/hr an applied intraoperative and 12 postoperative end point . Postoperative organs dysfuctions were assessed using the Sequential Organ Failure Assessment (SOFA) score recorded daily ICU discharge then every three days till discharge home.

Gestational Age-Specific Nomogram of Transcutaneous Bilirubin in First 120 h of Life for Term and Late Preterm Indian Neonates

To create a nomogram based on transcutaneous bilirubin values (TCB) in first week of life for term and late preterm (>34 weeks) neonates. Prospective longitudinal study. Four tertiary-care teaching hospitals (one each in eastern and southern India, two in northern India) between February 2019 and March 2020. A total of 2492 term and late preterm (>34 weeks) neonates. Bilirubin was measured by transcutaneous bilirubinometer (Drager JM-105, Germany) in all neonates in pre-specified times of the day, 12 hourly every day since birth till discharge between 48 and 72 h, and data were recorded in epochs of 6 hourly intervals. Post-discharge, all neonates were called for review in next 48 h. Primary-TCB in first week of life. Secondary-factors having significant association with significant hyperbilirubinaemia requiring phototherapy. Total of 2492 neonates (males 1303 and female 1189), with a total of 14162 TCB recordings were analysed and mean hourly bilirubin (TCB) at hourly intervals till 120 h and then daily bilirubin values on Days 6 and 7 were tabulated. We have constructed hour-specific bilirubin nomogram with percentiles as per gestational age in term and near-term Indian neonates till 120 h of life. Amongst the known risk factors, delayed cord clamping, primipara and breastfeeding jaundice had significant association for hyperbilirubinaemia needing phototherapy. We have created gestation-specific nomogram of TCB levels in 6 hourly intervals for the first 120 postnatal hours, obtained from a large predominantly breast fed healthy, term and near-term Indian neonates.

Performance of maternal abdominal subcutaneous fat thickness in predicting cesarean section

Introduction: Overweight and obesity during pregnancy is associated with increased risk for cesarean delivery. BMI is the most frequently used parameters to define and to assess risk of pregnancy related complications. Maternal abdominal subcutaneous fat thickness (SCFT) can be used as a measure of obesity. The present study was done to find association of maternal SCFT with risk of cesarean section. Methods: 200 women with singleton live pregnancy at 16-18 weeks were included in the study after obtaining written informed consent. Ultrasonography was done to assess foetal wellbeing and rule out congenital malformation. Maternal abdominal subcutaneous thickness was measured. All women were followed during labour till discharge. ROC curve analysis was done to predict the risk of cesarean section. Odd ratio for SCFT mediated risk of cesarean section was calculated. Results: 32.5% women had cesarean delivery. Mean SCFT was also significantly more in women delivered by cesarean than who delivered vaginally (p &lt;0.001). ROC curve analysis for SCFT showed that SCFT above 11.5 mm (AUC=0.735) predicted LSCS with a sensitivity of 86.2% and specificity of 47.4% and Youden index of 0.34. Increased abdominal SCFT was significantly associated with increased risk of LSCS. . Using 11.5 mm cut -off value (by ROC curve) for SCFT, the odd ratio of LSCS was 7.5 (95% CI 3.4056 – 16.5837, p &lt;0.0001). Stitch line infection was seen in 15.38% women. Conclusion: This study observed that measurement of SCFT by ultrasonography at 16-18 weeks pregnancy is a significant predictor of cesarean section.

Validity of Clinical Risk Index for Babies (CRIB) Score in Predicting the Neonatal Mortality

Objective: To determine the validity of Clinical Risk Index for Babies (CRIB) score in predicting the neonatal mortality in very preterm neonates. Methodology: The 145 patients enrolled in this study were registered from NICU of Children Hosp, Lahore, they were preterm neonates with gestational age of ≤ 32 weeks. We determined six parameters of CRIB score; gestational age, birth weight, any congenital malformation, minimum and maximum FiO2 requirementduring 1st 12 hours of life and maximum base excess during 1st 12 hours of life. All parameters were recorded and assigned an individual score base upon CRIB scoring chart. Total CRIB score was determined by adding individual score of each parameter. We reviewed thebabiesdaily in NICU till discharge or death. Results: Out of 145 patients, 52.4%(n=76)male and female were 47.59%(n=69). Congenital malformations were present in 6.21% (n=9), mortality in 36.55%(n=53). Mean gestational age was 29.90±1.70weeks, mean birth weight1147.52±190.21grams, mean maximum base excess during first 12h of life-8.04±3.92mmol/L, mean minimum appropriate FiO2 in first 12h34.38±13.02 %, mean maximum appropriate FiO2 in first 12h69.17±21.11 % and mean CRIB Score was 4.63±3.67. AUR curve was 0.816 and std. error was recorded as =0.039;p=0.000. Conclusion: Mortality in very preterm neonates can be accurately predicted by using CRIB score. Keywords: Very Preterm Babies, Neonatal Mortality, CRIB Score, Validity

Optimal temperature in targeted temperature management without automated devices using a feedback system: A multicenter study

PurposeTargeted temperature management (TTM) at 32 °C–36 °C improves patient outcomes following out-of-hospital cardiac arrest (OHCA). TTM using automated temperature management devices with feedback systems (TFDs) is recommended, but the equipment is often unavailable. This study aimed to investigate therapeutic relations between targeted temperatures and TFDs on the outcomes of OHCA patients with TTM. MethodsThis multicenter study analyzed nontraumatic OHCA registry data between October 2015 and June 2020 from 29 institutions. Patients were classified into four groups based on targeted temperatures and TFD implementation: TTM at 33 °C with TFD (33TFD), TTM at 36 °C with TFD (36TFD), TTM at 33 °C without TFD (33NTFD), and TTM at 36 °C without TFD (36NTFD). Clinical outcomes were survival till hospital discharge and neurological status at discharge. ResultsA total of 938 patients were included in the analysis. There was an independent association between the 33NTFD patients with the least survival and the worst neurological outcomes among the four groups after adjustment for covariates. However, no significant differences were observed in survival and neurological outcomes among the 33TFD, 36TFD, and 36NTFD groups after adjusting for covariates. Compared to 33NTFD, 36NTFD patients exhibited significantly higher adjusted ORs for survival and favorable neurological status at hospital discharge. ConclusionIn OHCA patients receiving TTM without TFDs, the adjusted predicted probability of survival and good neurological outcomes at hospital discharge was greater for TTM at 36 °C than that at 33 °C. This suggests that a TTM of 36 °C rather than 33 °C is associated with more favorable clinical outcomes if TFDs are unavailable.

Impact of admission serum osmolarity on decongestion rate and clinical outcomes in patients with acute heart failure

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Statutory grant for Department of Heart Diseases, Wroclaw Medical University, Poland. Background/Introduction Serum osmolarity seems to be an important factor regulating the control of volume status and diuretic response in patients with Acute Heart Failure (AHF). Nevertheless, data on it’s clinical significance in this population is limited. Purpose We aim to evaluate serum osmolarity associations with decongestion rate and clinical outcomes in patients with AHF. Methods Serum osmolarity was determined in Arterial Blood Gases at admission in patients with AHF hospitalized in a single cardiology center. The endpoints of the study are: decongestion rate and one-year mortality. Decongestion rate was defined as body weight change between admission and discharge (kg) divided by number of days of hospital stay. Study group was divided into tertiles according to serum osmolarity – A: &amp;lt;277 mmol/kg; B: 277-285 mmol/kg; C: &amp;gt;285 mmol/kg. Results Study group consisted of 319 patients, average age 68±13 years, 240 (75%) men. Mean left ventricle ejection fraction (LVEF) was 34±14%. Patients with lowest osmolarity (tertile A) were younger and had lower EF when compared to the other tertiles (B and C) (65±15 vs. 70±13 vs. 71±12 years, respectively, p=0.028) and (30±14 vs. 36±14 vs. 36±13; p=0.001), respectively. Patients with higher osmolarity had greater baseline systolic and diastolic blood pressure values (114±24/71±13 vs 133±26/78±14 vs 140±35/121±16 mmHg; p&amp;lt;0.001/p&amp;lt;0.001). There was U-shape relationship between serum lactate concentration at admission and osmolarity tertiles: (2.0 [1.6-2.7] vs 1.6 [1.4-2.2] vs 2.1 [1.6-2.7] mmol/l, respectively; p&amp;lt;0.001). NT-proBNP at discharge was higher in group A (4082 [2405-8324] vs 2827 [1519-5271] vs 2392 [1386-5631] pg/ml, p=0.001). During hospitalization tertile A more often required inotropic support vs tertile B and C (29% vs 4% vs 4%; p&amp;lt;0.001). There was a difference of body weight change from admission till discharge between the tertiles, with tertile B having the highest weight loss when compared to the other tertiles: (3 [1-5] vs. 4 [2-6] vs. 2 [0-4] kg; p=0.004). Tertile A was characterized by the longest hospital stay in comparison the rest of the population (7 [6-13] vs. 7 [5-9] vs. 7 [5-8] days; p=0.043). There was a U-shape relation between serum osmolarity and decongestion rate. The rate of decongestion were significantly slower in patients with the lowest and the highest osmolarity (tertile A and C): (0.26 [0.08-0.50] vs 0.57 [0.17-1.0] vs 0.25 [0.04-0.53] kg/day; p=0.002), respectively. The tertile A had the highest one-year mortality, when compared to the other groups (53% vs. 33% vs. 28%; p&amp;lt;0.001). Moreover, the serum osmolarity itself as a continuous value had prognostic significance HR (95% confidence interval): 0.96 (0.94-0.97), p&amp;lt;0.001. Conclusions Serum osmolarity assessed at admission to the hospital is associate with the decongestion rate and one-year mortality in AHF patients and thus may help identify high risk population.

Immediate Outcome of Mechanically Ventilated Neonate : One Year Experience in Neonatal Intensive Care Unit of Combined Military Hospital Dhaka

Background: A large number of neonates in intensive care unit require mechanical ventilation due to various disease conditions. There has been a dramatic fall in neonatal mortality in developed countries with the advent of mechanical ventilation. This study was carried out to see the immediate outcome of neonates who required mechanical ventilation.&#x0D; Materials and methods: This prospective observational study was carried out in Neonatal Intensive Care Unit, CMH Dhaka from January 2016 to December 2016. Neonates who required mechanical ventilation during the study period were enrolled in this study. During the time of mechanical ventilation neonates were followed up for any complication till discharge or death.&#x0D; Results: Total 30 neonates were enrolled in the study. Among them 22(73.3%) of the neonates were preterm and 8(26.7%) were term, 25(83.3%) having birth weight &lt;2500 gm. Respiratory Distress Syndrome was the most common reason for mechanical ventilation accounting for 11(36.7%),other indications were Perinatal Asphyxia 7(23.3%), Septicemia 6(20.0%), Congenital Pneumonia 5(16.7%) and Meconium Aspiration Syndrome 1(3.3%). Common complications during the period of ventilation were Septicemia (40.0%), Acute Renal Failure (16.7%), Pneumonia (16.7%), Pulmonary Hemorrhage (10.0%), Intraventricular Hemorrhage (6.7%), Pneumothorax(10.0%) and Heart Failure (6.7%). 17(56.7%) neonates survived and 13(43.3%) were died. Most of the neonate died of Perinatal Asphyxia 4(57.1%), Septicemia 3(50.0%), RDS 5(45.5%) and Congenital Pneumonia 1(20.0%).&#x0D; Conclusion: The survival rate of ventilated neonates was 56.7%. The higher gestational age and birth weight was significantly associated with better outcome. Septicemia and Pneumonia (PNA) was the leading cause of death in this study. Effective measures for prevention and management of sepsis could improve the outcome of neonates in NICU.&#x0D; IAHS Medical Journal Vol 4(2), June 2021; 27-32

Complications affecting outcome in COVID 19 patients admitted in high dependency unit Sir Ganga Ram Hospital, Lahore

Background: Covid 19 is a highly contagious viral infection resulting in severe acute respiratory syndrome Coronavirus (SARS-CoV-2). The objective of this study was to determine the potential complications affecting the outcome of moderate to severe COVID 19 patients admitted in HDU of Sir Ganga Ram Hospital, Lahore.Subjects and methods: It was a prospective cohort study. The study was conducted on 108 patients admitted in the COVID HDU of Sir Ganga Ram Hospital, Lahore with positive PCR for COVID-19 having moderate to severe disease. After written consent, all the demographic data and complications like ARDS, respiratory failure, cardiac injury and liver dysfunction, acute kidney injury and sepsis/DIC were obtained through specially designed proformas data was collected through specially designed proformas and data was analysed through SPSS version 22. During hospital stay, we observed the patients for the development of complications as mentioned above. All Patients were followed up till discharge and outcome were noted in terms of discharge or death.Results: Out of 108 admitted patients in COVID HDU, 68 were discharged, 26 were died and14 got left against medical advice. The mean age was 53.6 + 15.94 years with 53.7% males (n=58), the most common complication during hospital stay was sepsis (31 affected with 16 deaths, 14 survived and p-value=0.000), acute kidney injury (27 affected, 13 died, 13 survived, p-value=0.002), ARDS (seen in 19 patients with 16 deaths, 3 survived and acute cardiac injury (17 affected, 9 died, 8 survived, p-value=0.005).Conclusion: The complications like adult respiratory distress syndrome, respiratory failure, acute cardiac injury, acute kidney injury, and secondary infection had poor outcomes. This study could help clinicians to take early measures to prevent the development of complications in patients admitted in HDU.