Time Of Admission Research Articles

INTERASPIRE a global cross-sectional survey of secondary prevention of cardiovascular disease (CVD) across six WHO regions

Abstract Introduction This survey of secondary prevention of CVD was conducted through National Societies of Cardiology across all WHO regions and included Kenya, Nigeria, Tanzania, Argentina, Colombia, Egypt, UAE, Poland, Portugal, Indonesia, China, Malaysia, Philippines and Singapore. Purpose The overall aim of INTERASPIRE was to assess the clinical implementation of risk reduction initiatives to reduce cardiovascular risk in line with lifestyle, risk factor and therapeutic targets defined in international and national guidelines on CVD prevention. Methods A consecutive sample of patients (> 18 and < 80 years) admitted to public hospitals in selected regions within each participating country with an acute ST elevation myocardial infarction (MI), Non-ST elevation MI, acute myocardial ischaemia or for elective revascularisation was identified retrospectively from medical record systems. Patients were invited to attend a clinical visit with trained research assistants at least 6 months but not more than 2 years after their event. The assessment included self-reported smoking status validated with an expired breath carbon monoxide measurement, self-reported participation in physical activity using the Godin validated questionnaire and standardised measurements of height, weight, blood pressure, blood lipids and blood glucose including an oral glucose tolerance test. Results 4548 (21.1% women) patients attended the clinical visit. 12.6% were smoking with wide variation across countries (1.9 – 27.3%). 48% of those who were smoking at the time of hospital admission had continued to smoke. 66.5% reported being sedentary with wide variation across countries (51.3 – 90.5%). 24% were obese and 40% centrally obese with a large difference between men (32.3%) and women (69.4%). 38% achieved a blood pressure target of < 130/80 mmHg, 19.2% achieved an LDL-C target of < 1.4 mmol/l and in patients with self-reported diabetes 56% achieved a target HbA1c of < 53 mmol/mol (7%). In those who did not report having diabetes, a further 9.8% had undetected diabetes and 26.9% impaired glucose tolerance. 48% were prescribed all four classes of cardioprotective drugs (antiplatelets, beta blockers, ACE/ARB, lipid lowering agents) with wide variation between countries (25% - 75%) and 88.3% were prescribed both antiplatelets and lipid lowering agents. Only 1219 (26.8%) were advised to attend cardiac rehabilitation with wide variation (4.5% to 58.9%) between countries. Overall only 9.0% (men 9.1%, women 9.1%) of all patients attended cardiac rehabilitation. Figure 1 shows the distribution of the INTERASPIRE Guideline Target Score. Conclusion There is substantial room for improvement in secondary prevention in patients with coronary disease globally. It is of concern that only 9% of patients received cardiac rehabilitation despite it being a Class 1 recommendation in all prevention guidelines with wide variation in advice and uptake between countries.Figure 1

The relationship between gender, body mass index, and length of hospital stay in patients with hypertension

Abstract Introduction Globally, hypertension impacts approximately 40-45% of the adult demographic. This condition serves as a changeable risk factor for cardiovascular diseases (CVD), and its escalation demonstrates a direct correlation with heightened mortality rates and the onset of additional medical issues, including myocardial infarction, heart failure, and cerebrovascular accidents. The financial burden of CVD management is substantial, marking it as a significant issue in public health worldwide. Influencing factors that contribute to the duration of a patient's hospital stay (LOS) encompass both suboptimal nutritional status and the coexistence of other health conditions. Purpose The aim of this study was to assess whether there are sex differences in the prognostic impact of BMI, as calculated on admission to the cardiology department, on the length of hospital stay in patients with hypertension (HT). Methods We performed a retrospective analysis of 486 medical records of patients who had been admitted to an University Hospital between January 2017 and June 2021. Linear regression was used to analyse the impact of selected variables on continuous outcomes. Regression parameters with 95% confidence intervals were shown. The significance level for all statistical tests was set to 0.05. R 4.3.0. was used for computations. Results Women accounted for 53% of the study group and were significantly older than men (64.7±12.8 vs. 60.5±11.8, p=0.466). The mean BMI in women was 28.49±5.39 and in men 29.14±4.88. In an unadjusted linear regression mode, underweight, overweight and obesity by BMI were not independent predictors of longer hospitalization in either sex. The same result was noted after adjusting the model for patient age. After adjusting the model for comorbidities for women, a significant independent predictor of prolonged hospitalization was a prior MI, which prolonged hospitalization by an average of 1,727 days (B=1,727, p=0.034). For men, none of the analyzed features was a statistically significant predictor of length of hospitalization. Conclusions The result of body mass index score assessed at the time of a patient's admission to the cardiology department is not a predictor of length of hospitalization in both men and women with hypertension.

Outcomes in Critically Ill Allogeneic Hematopoietic Stem-Cell Transplantation Recipients.

Rationale: Allogeneic hematopoietic stem-cell transplantation (Allo-HSCT) recipients are still believed to be poor candidates for ICU management. Methods: We investigated outcomes and determinants of mortality in a large multicenter retrospective cohort of Allo-HSCT patients admitted between January 1, 2015, and December 31, 2020, to 14 French ICUs. The primary endpoint was 90-day mortality. Measurements and Main Results: In total, 1,164 patients were admitted throughout the study period. At the time of ICU admission, 765 (66%) patients presented with multiple organ dysfunction, including acute respiratory failure in 40% (n = 461). The median sepsis-related organ failure assessment score was 6 (interquartile range, 4-8). Invasive mechanical ventilation, renal replacement therapy, and vasopressors were required in 438 (38%), 221 (19%), and 468 (41%) patients, respectively. ICU mortality was 26% (302 deaths). Ninety-day, 1-year, and 3-year mortality rates were 48%, 63%, and 70%, respectively. By multivariable analysis, age > 56 years (odds ratio [OR], 2.0 [95% confidence interval (CI), 1.53-2.60]; P < 0.001), time from Allo-HSCT to ICU admission between 30 and 90 days (OR, 1.68 [95% CI, 1.17-2.40]; P = 0.005), corticosteroid-refractory acute graft-versus-host disease (OR, 1.63 [95% CI, 1.38-1.93]; P < 0.001), need for vasopressors (OR, 1.9 [95% CI, 1.42-2.55]; P < 0.001), and mechanical ventilation (OR, 3.1 [95% CI, 2.29-4.18]; P < 0.001) were independently associated with 90-day mortality. In patients requiring mechanical ventilation, mortality rates ranged from 39% (no other risk factors for mortality) to 100% (four associated risk factors for mortality). Conclusions: Most critically ill Allo-HSCT recipients survive their ICU stays, including those requiring mechanical ventilation, with an overall 90-day survival rate reaching 51.8%. A careful assessment of goals of care is required in patients with two or more risk factors for mortality.

Risk Factors and Etiological Classification of Ischemic Stroke Subtypes in Southwest Iran

Precise categorization of the causes of ischemic stroke (IS) is crucial for optimizing stroke treatment and assessing the prognosis of patients. This cross-sectional study aimed to determine the risk factors and various subcategories of IS in Iranian patients. The study included all patients with IS referred to Golestan Hospital (Ahvaz, Iran) for one year. Their demographics and clinical data were collected. The etiology of IS was classified based on the TOAST (Trial of ORG 10172 in Acute Stroke Treatment) criteria. A total of 1100 patients with IS were evaluated, 658 were male and 442 were female. They had an average age of 66 years (ranging between 20 and 99 years). The majority of them were in the 61-80 age group. The prevalence of risk factors for IS included hypertension (HTN) (71.4%), diabetes (50.4%), smoking (42.4%), history of previous stroke (28%), dyslipidemia (15.4%), and cardiovascular disease (22.5%). Three months after admission, the mortality rate was 10.7% and the majority of patients exhibited a lower level of disability based on the modified Rankin Score (mRS) compared to the time of admission. The frequency of all risk factors, except for HTN, differed significantly between genders (P&lt;0.05). Furthermore, the prevalence of risk factors varied significantly among different stroke etiologic subgroups (P&lt;0.05). The most common etiological factors identified by TOAST classification were associated with large artery atherosclerosis (LAA) and small artery occlusion (SAO). Significant variations were observed in the prevalence of different etiologic subtypes of stroke among genders and across different age groups.

Silent while living, speaks when dead- A case report of manual strangulation

Victim of throttling in majority of the cases die instantaneously as the perpetrator continues to apply pressure till death ensues. In certain cases, victim may survive for some time if pressure is withdrawn due to any reason. In such cases, after the incident, he/she may not be conscious or able to speak for giving history; but the injuries produced by application of pressure by palms and fingers, if looked for them carefully, may speak by themselves about the incident. Presenting here, a case of 52 years old female, where the “made-up” history by the relatives misdirected the thinking process of the clinicians as the patient could not speak at all at the time of admission to the hospital until death. Autopsy conducted on 5 day of hospitalization revealed typical signs of the homicidal act the victim was subjected to, which could have been identified in the “fresh” stage at the time of admission and could have helped in some more detailed medico legal investigations if it could have been referred to Forensic Medicine experts of the institute. This case report stresses on the need of multi-disciplinary approach at the time of treatment of any patient with suspicious history, to have some different angle of view with regards to medico legal concerns and hence, it is discussed here.

Identifying Importation and Asymptomatic Spreaders of Multi-drug Resistant Organisms in Hospital Settings.

Healthcare-associated infections (HAIs) due to multi-drug resistant organisms (MDROs) are a significant burden to the healthcare system. Patients are sometimes already infected at the time of admission to the hospital (referred to as "importation"), and additional patients might get infected in the hospital through transmission ("nosocomial infection"). Since many of these importation and nosocomial infection cases may present no symptoms (i.e., "asymptomatic"), rapidly identifying them is difficult since testing is limited and incurs significant delays. Although there has been a lot of work on examining the utility of both mathematical models of transmission and machine learning for identifying patients at risk of MDRO infections in recent years, these methods have limited performance and suffer from different drawbacks: Transmission modeling-based methods do not make full use of rich data contained in electronic health records (EHR), while machine learning-based methods typically lack information about mechanistic processes. In this work, we propose NEURABM, a new framework which integrates both neural networks and agent-based models (ABM) to combine the advantages of both modeling-based and machine learning-based methods. NEURABM simultaneously learns a neural network model for patient-level prediction of importation, as well as the ABM model which is used for identifying infections. Our results demonstrate that NEURABM identifies importation and nosocomial infection cases more accurately than existing methods.

Interrelation of plasma haemostasis and heart rate variability in patients with chronic coronary syndrome in combination with COVID-19

The aim of the study was to identify the relationship between activated partial thromboplastin time, prothrombin time, fibrinogen, D-dimer and indicators of N-N interval deviations, heart rate, on the one hand, and to identify the relationship between parasympathetic and sympathetic heart rate activity and dynamic blood viscosity, on the other hand. The COVID-19 pathogen affects the functioning of the parasympathetic and sympathetic nervous systems, which also changes the heart rate. To study this process, a group of 10 patients with chronic coronary syndrome in combination with COVID-19 without comorbidities aged 35-48 years was observed in a hospital. To study this relationship, plasma haemostasis parameters (activated partial thromboplastin time, prothrombin time, fibrinogen, D-dimer) and heart rate variability were taken at the time of admission to the hospital and after discharge from the hospital. A direct correlation between the indicators was found: in patients 1 and 4, at the time of admission to the hospital, there was an increase in activated partial thromboplastin time, prothrombin time, D-dimer and a decrease in fibrinogen, which coincides with an increase in heart rate, 5-10 minute and long-term deviation of the N-N segments. That is, changes in blood plasma affect the rhythm of the heart already at the onset of COVID-19 in combination with chronic coronary syndrome. Patients 1 and 4 had an increase in D-dimer at the time of discharge from the hospital, which coincided with an increase in heart rate. Patients require further follow-up, as these are signs of a cautious prognosis. All other plasma haemostasis parameters are normal in all patients, with minor changes. It is necessary to monitor plasma haemostasis and heart rate variability to adjust treatment during hospitalization of patients with chronic coronary syndrome in combination with COVID-19 and after discharge from hospital

Prevalence and risk factors of deep venous thrombosis of hospitalizations in plateau: a cross-section analysis

BackgroundDeep venous thrombosis (DVT) is a serious public health issue that threatens human health and economic development. Presently, differences in the prevalence of DVT among individuals from different nationalities, residents of high-altitude areas, and those consuming any special diet are unknown. Therefore, we aimed to elucidate the prevalence of and the associated risk factors for DVT in hospitalized patients in the plateau areas.MethodsThe subjects were hospitalized patients in three grade III-a hospitals in the Qinghai Province, China, during January–October 2020. The demographic, clinical, and laboratory data were collected at admission, and ultrasonography of the bilateral lower extremities was performed. The hospital stay-duration was recorded at the time of discharge.ResultsA total of 3432 patients were enrolled, of which 159 (4.60%) were diagnosed with DVT. The age of > 50 years (OR = 2.434, 95% CI: 1.521–3.894252, P < 0.001), residence altitude of ≥ 3000 m (OR = 2.346, 95% CI: 1.239–4.440, P = 0.009), D-dimer level of ≥ 0.5 mg/L (OR = 2.211, 95% CI: 1.547–3.161, P < 0.001), presence of comorbidities (OR = 1.904, 95% CI: 1.386–2.705, P < 0.001), a history of varicose veins (OR = 1.990, 95% CI: 0.959–4.128, P = 0.045), and current medications (OR = 2.484, 95% CI: 1.778–3.471, P < 0.001) were identified as risk factors for DVT in these plateau areas.ConclusionThe prevalence of DVT in the hospitalized patients of the studied plateau areas was 4.60%. We recommend considering individualized risk stratification (age > 50 years, residence altitude ≥ 3000 m, a history of varicose veins, D-dimer level ≥ 0.5 mg/L, current medications, and comorbidities) for patients at the time of admission.

Peripartum Prediction of Fetal Weight in Gravidas With Obesity.

Estimated fetal weight (EFW) is an important metric at delivery as neonates with abnormal birthweight and their mothers are at higher risk of birth complications. Data regarding optimal EFW assessment in gravidas with obesity is inconsistent, and with the increasing incidence of obesity, clarification of this question is crucial. We aimed to compare accuracy of ultrasound (US)-derived EFW and clinical assessments of EFW in predicting neonatal birthweight among gravidas with obesity. This prospective cohort study enrolled gravidas with obesity and a singleton pregnancy admitted for delivery at term. EFW was determined using either US biometry or clinical assessment (Leopold's maneuvers, Johnson's formula, and Insler's formula) at time of admission. Our primary outcome was accurate EFW, defined as EFW within 500 g of birthweight. Secondary outcomes included ability to predict small-for-gestational age (SGA) and large-for-gestational age (LGA) birthweights. These outcomes were compared between all EFW methods. A total of 250 gravidas with a median body mass index of 36.4 kg/m2 were enrolled. Admission US outperformed Leopold's maneuvers in obtaining accurate EFW (81.6% versus 74.5%, P = .03). When comparing all methods, Johnson's and Insler's formulae performed the worst, accurately predicting EFW in only 27.4% and 14.3% of cases, respectively. Likewise, US-derived EFW outperformed Leopold's maneuvers and fundal height in the prediction of SGA and LGA neonates. US is more accurate than clinical assessment of EFW in gravidas with obesity both for estimation of actual birthweight and prediction of abnormal birthweight. Universal late third-trimester or peripartum US for EFW should be considered in gravidas with obesity.

Study of Levels of Creatine Phosphokinase and Lactate Dehydrogenase as Prognostic Markers in Acute Organophosphorus Poisoning

Objectives: Organophosphorus compound (OPC) poisoning is primarily a problem in developing countries. Its widespread use and easy availability have increased the likelihood of poisoning with these compounds. Serum cholinesterase levels are easier to estimate and usually depressed after organophosphorus (OP) poisoning. Peradeniya OP poisoning scale has not been studied much in the Indian scenario. It could be a simple and effective system to determine the need for ventilatory support early on in the course. Hence, this study was undertaken to assess the severity of OPC poisoning clinically using Peradeniya scoring and by estimating creatine phosphokinase (CPK) and lactate dehydrogenase (LDH) levels. Material and Methods: A prospective observational study was performed among 100 cases of OP poisoning from January 2021 to October 2022. On patient’s fulling, inclusion criteria were investigated with serum acetylcholinesterase at the time of admission, and periodic estimation of serum CPK and serum LDH was done on the day of admission and then on day three and day 5 of admission Results: The CPK and LDH levels were significantly elevated in patients who developed respiratory failure and thus strongly correlated with clinical severity Conclusion: Serum CPK and LDH show a strong degree of positive correlation with the severity of poisoning and can be used as a predictor of outcome in OP poisoning.

Clinical significance of PLT for diagnosis and treatment monitoring in imported malaria

To evaluate the clinical significance of PLT, MPV, and PDW in monitoring malaria treatment efficacy and predicting disease progression. A total of 31 patients with imported malaria were selected as the observation group, while 31 non-malaria patients with fever were selected as controls. The observation group was subdivided into a complication group and a non-complication group according to the occurrence of complications during treatment. Additionally, on the 1st day (within 24 h), the 3rd day, and the 5th day following admission, a comprehensive blood routine examination, Plasmodium microscopic examination, and colloidal gold assay were conducted. The blood routine examination results were compared before and after treatment among patients in the observation group and the control group. Moreover, the study involved dynamic monitoring and analysis of the levels and variations in PLT, MPV, and PDW within both the complication group and the non-complication group. The Plasmodium density was negatively correlated with PLT before treatment. There were significant differences were observed in PLT, MPV, and PDW (P < 0.05) within the observation group before and after treatment. Notably, there were no significant alterations in red blood cell (RBC), hemoglobin (Hb), and white blood cell (WBC) counts (P > 0.05) within the observation group before and after treatment. The PLT, MPV, and PDW levels in the complication group and the non-complication group exhibited an upward trend after treatment. Further, the PLT of patients in the complication group was significantly lower than that in the non-complication group. Additionally, the PLT, MPV, and PDW levels in the complication group and the non-complication group increased gradually from the time of admission to the 3rd and 5th day of treatment. Notably, the PLT in the complication group was consistently lower than that in the non-complication group. The continuous monitoring of PLT, MPV, and PDW changes plays a crucial role in assessing malaria treatment efficacy and prognosis in these individuals.

Using microfluidic shear to assess transfusion requirements in trauma patients

BackgroundViscoelastic assays have widely been used for evaluating coagulopathies but lack the addition of shear stress important to in vivo clot formation. Stasys technology subjects whole blood to shear forces...

Efficacy and safety of conservative treatment in patients with neurologically intact thoracolumbar burst fractures: a meta-analysis

Objective. To conduct a meta-analysis of studies focused on the conservative treatment of thoracolumbar burst fractures, and to determine the efficacy and safety of this method in the observed group of patients.Material and Methods. The study was performed following PRISMA guidelines. Inclusion criteria for meta-analysis were as follows: availability of full-text version of the article in English or Russian; A3 or A4 type fractures according to the AOSpine classification, or burst fractures of types IIA, IIB or IIC according to the Denis classification, or a direct indication of the presence of a burst fracture without its classification; absence of neurological deficit; age over 18 years; detailed description of treatment outcomes or complications; and a follow-up for at least one year.Results. The meta-analysis included 29 articles describing the results of treatment of 1107 patients. At the time of admission, the following radiographic parameters were calculated for patients: mean kyphotic angle, 13.6 (95 % CI, 10.8–16.5), degree of vertebral body compression, 39.9 % (95 % CI, 27.7–52.0), and the degree of compression of the spinal canal lumen, 41.7 % (95 % CI, 29.2–54.2). A follow-up examination revealed a significant increase in segmental kyphosis by 3%, in vertebral body compression by 3.7 %, and lysis of bone fragments with a decrease in the degree of spinal canal stenosis by 2 times. The incidence of neurological deficit and progression of thoracic and lumbar spine instability was 5.8 % (95 % CI, 4.1–8.1) and 6.5 % (95 % CI, 4.5–9.3), respectively. Recovery of work ability according to Denis scale was as follows: W1 and W2 – 74.7 % (95 % CI, 63.9–83.1); W3 – 14.1 % (95 % CI, 10.2–19.3); and W4 and W5 – 14.8 % (95 % CI, 8.8–23.9).Conclusion. Conservative treatment of neurologically intact thoracolumbar burst fractures can be an effective and safe option if the angular deformity does not exceed 16 degrees and the anterior vertebral body compression rate is up to 52 %. With conservative therapy, a twofold reduction in spinal canal stenosis was observed due to the lysis of bone fragments. The pooled prevalence of radiculopathy or myelopathy with conservative therapy was 5.8 %. Orthopedic intervention due to the progression of instability of the damaged segment may be required in 6.5 % of patients. More than 90 % of patients returned to full-time work following conservative therapy. Comparative studieson the effectiveness of conservative therapy versus surgical treatment should be continued to form clear recommendations for the choice of treatment tactics for patients with uncomplicated fractures of the thoracic and lumbar spine.

564 The Assessment and Management of Anaemia in Patients Who Underwent an Emergency Laparotomy

Abstract Aim Emergency Laparotomies (EmLap) carry a significant risk of morbidity and mortality. Peri and post-operative anaemia are associated with higher complication rates, delayed healing, and lethargy. This study aimed to assess the occurrence of anaemia in EmLap patients upon admission and discharge, as well as to evaluate its management. Method Data was collected from 260 participants undergoing EmLap from 2016 to 2019 that completed a follow up questionnaire in 2020, as part of PEEL 2 (Patients Experience of Emergency Laparotomy) in Cardiff, a retrospective cohort study. 34% of patients (n=90) had a Haemoglobin (Hb) level on admission and discharge and were included into the study. Information on transfusions and prescriptions of ferrous fumarate tablets during admission and on discharge were obtained from electronic records. Results 46.7% (n=42) were anaemic at time of admission and further 19 patients were anaemic after surgery. 61 patients (68%) were discharged with anaemia post EmLap. Of the 61 patients discharged with anaemia only 10 (16%) were given treatment; 7 (11%) were offered a blood transfusion, 2 (3%) were prescribed ferrous fumarate tablets and 1 (1.6%) received a combination of both. Discharge summaries did not highlight the issue and follow up advice was not given to GPs. Conclusions 2/3 of EmLap patients were discharged with anaemia and was not addressed. A greater understanding is needed to appreciate the impact of anaemia on EmLap patients’ such as fatigue levels. It can be avoided if a closer look at patients’ blood results is conducted and treated aligning with the NICE guidelines.

142 Understanding the Burden of Emergency Bariatric Surgery Admissions

Abstract Aim To quantify the incidence and resource use of bariatric surgical emergencies (BSE) in a tertiary hospital setting. Method Patients were identified prospectively for 17 weeks from the 1st March 2023. Inclusion criteria were a bariatric emergency with an admission duration exceeding 24 hours. Results Of the 471 emergency general surgery admissions, 21 (4.5%) were identified as BSE. From 63 elective bariatric procedures, 4 (6.3%) necessitated prolonged stays owing to post-operative complications. Most patients were female (23/25), with an average age of 48 years (IQR 34-55) and a pre-operative BMI averaging 39 (IQR 37-44). The typical hospital stay was 5 days (IQR 1-15), with no reported fatalities. In total 23 patients had CT scans, 7 required surgical or procedural interventions, and 5 were admitted to the ICU. Interestingly, 12 emergency admissions had no prior NHS history, and 10 had undergone their procedures in Turkey. The post-surgery admission time was notably shorter for the Turkey group [2 (1-7) weeks] compared to those treated under the NHS [86 (5-750) weeks, p=0.003]. Conclusions More than one patient per week is admitted for a BSE. These patients have substantial resource requirements and highlight the need for adequate training and preparedness to manage these emergencies.

Risk Factors and Stroke Subtyping in Young Adults: A Study From a Tertiary Care Hospital in South India.

This study aimed to determine the risk factors and stroke subtypes for young ischemic stroke patients and their outcomes at the time of discharge. This is a retrospective cross-sectional study of ischemic stroke patients (n = 264) between the age groups of 18 and 45. The study population was divided into two broad age groups: 18 to 35 years and 36 to 45 years; and compared based on demographics, risk factors, the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification, and outcomes. The outcomes were compared based on the National Institutes of Health Stroke Scale (NIHSS) and Modified Rankin Scale (MRS) systems at the time of admission and discharge. The mean age of patients was 37.84±6.19 years. The male-to-female ratio was 2.5:1. The most common vascular risk factors identified were diabetes (29.16%), hypertension (49.62%), dyslipidaemia (DLP, 44.4%), and smoking (10.9%). The most common TOAST subtype was large vessel disease (38.63%), followed by the undetermined category (35.6%). The elderly group showed a high proportion of strokes secondary to small vessel disease (14.13%; p = 0.03), while cardioembolic strokes were common in the female subgroup (p = 0.05). The majority of strokes were in the anterior circulation (66.6%) as compared to the posterior (25.75%), and nearly 50% of the patients had intracranial disease. Overall, there was a favourable MRS outcome at discharge. Conventional vascular risk factors are equally prevalent, even among young stroke patients. The benchmark for young stroke age is showing a downward shift as more stroke patients above the age of 35 are showing similar risk factor trends as those of their older counterparts. The majority of stroke burden still falls under the undermined category, which requires aggressive risk factor identification and management.

An Early and Routinely Collected Applied Cognitive Assessment Is Associated with Post-Acute Care Facility Discharge from the Hospital

Objective: Although patient cognition can have an impact on health services needs once discharged from the hospital, it is typically not evaluated as part of routine care. We aimed to investigate how routinely collected Activity Measure for Post-Acute Care Applied Cognitive Inpatient Short Form (AM-PAC ACISF) scores, a measure of applied cognition, are associated with discharge disposition. Methods: A retrospective analysis was conducted on 5,236 electronic medical records of adult patients admitted in Johns Hopkins Hospital (JHH) between July 1, 2020 to November 2, 2021. Data was evaluated on whether patients who have been admitted across hospital services required post-acute care based on their AM-PAC ACISF scores. A cut-off raw score of 21 or less was considered as having cognitive impairment. Results: The applied cognitive t-scale scores assessed near time of admission were 9.3 points lower in patients discharged to PAC compared to discharge home. Adjusted regression models showed the odds of PAC needs for patients with AM-PAC ACISF t-scale scores in the lowest tertile were 3.4 times greater than patients in the highest tertile (95% CI 2.8,4.0; p &lt;0.001). Patients with scores in the middle tertile have 1.9 times greater odds for PAC needs than those in the highest tertile (95% CI 1.6,2.2; p&lt;0.001). Bivariate and multivariate logistic regression models showed AM-PAC ACISF, living alone, male gender, prior residence outside of home, admission due to general surgery, neurology, or orthopedics services versus medicine service all increased the odds of discharge to PAC (OR 1.2–4.4, p=&lt;0.001). Conclusions: This study provides empirical evidence that a routinely collected cognitive assessment could be a care coordination strategy to help identify patients who are more likely to require PAC after discharge.

Acute kidney injury in critically ill obstetric patients: Incidence and role of neutrophil gelatinase-associated lipocalcin - A prospective observational cohort study.

Data focussing on acute kidney injury (AKI) in obstetric patients admitted to the intensive care unit (ICU) are scarce and even more so regarding the role of neutrophil gelatinase-associated lipocalcin (NGAL) in detecting AKI or predicting outcomes in these patients. Hence, we aim to evaluate the incidence of AKI in obstetric ICU patients and validate the role of urinary and serum NGAL in predicting the onset of AKI and mortality. This prospective observational cohort included 45 obstetric patients admitted in ICU, excluding those with prior renal dysfunction. Serum creatinine and urine output were monitored for the occurrence of AKI during the ICU stay. The outcome of the patient (survival or death) in the ICU and hospital was recorded, and serum and urinary NGAL were determined at the time of ICU admission. AKI occurred in 32 [71.1%; 95% confidence interval (CI): 55.4%, 86.8%] patients during their ICU stay. Serum NGAL showed an area under receiver operating characteristic curve (AUROCC) of 0.630 (95% CI: 0.417, 0.842) (P = 0.231) for AKI and 0.486 (95% CI: 0.295, 0.676) (P = 0.883) for ICU mortality. Urinary NGAL showed AUROC = 0.472 (95% CI: 0.285, 0.660) (P = 0.772) to predict AKI and 0.430 (95% CI: 0.268, 0.652) (P = 0.684) for ICU mortality. AKI is common amongst critically ill obstetric ICU patients. However, serum and urinary NGAL cannot be advocated to discriminate between patients with or without AKI or between survivors and non-survivors in critically ill obstetric patients.

Stress hyperglycemia as a prognostic indicator of the clinical outcome in patients with ischemic stroke

Background: Stroke is gaining worldwide importance as the focus now shifts to non-communicable diseases. According to the World Health Organization, over 15 million people, equating to one in every 400 people, suffer stroke worldwide per year. There are many factors which affect the outcome of stroke – artery involved, size of the infarct, associated co-morbidities, age of the patient, collateral blood supply, and many more. Among those one of the factors proposed is stress hyperglycemia (SH). Aims and Objectives: The aims and objectives of the study are to identify the occurrence of SH in patients admitted with ischemic stroke and to assess the relation of SH in clinical outcomes in patients with ischemic stroke. Materials and Methods: The prospective study was conducted on patients admitted to medical college hospitals affiliated with VIMS, Ballari. All patients age more than 18 years presenting with acute-onset ischemic stroke were taken into the study, and GRBS was done at presentation and at every 6th hourly for 48 h to identify hyperglycemia. Hemoglobin A1c was done to rule out overt diabetes and previously undiagnosed diabetes mellitus. Clinical outcome and functional recovery using the modified ranking scale (MRS) were done at the time of admission, at discharge, and at every month for 3 months. Results: Out of 150 patients, 63 (42%) of them had SH. The majority of patients belong to 60–69 years age group. The mean age of patients with SH was 60.2 years and that of patients without SH was 57.75 years. MRS score at the time of admission and during follow-up was higher in SH patients than no SH patients (P&lt;0.001). Patients with SH were more prone to urinary tract infection (n=19 [SH]; n=8 [no SH] P&lt;0.001), bed sores (n=10 [SH]; n=18 [no SH] P&lt;0.008), lower respiratory tract infection (n=30 [SH]; n=34 [no SH], P=0.000), and duration of hospital stay (P=0.000). Delay in presentation to a health facility after the onset of stroke symptoms was found to be a significant contributing factor in SH patients (P&lt;0.003). Conclusion: The prevalence of SH in ischemic stroke is high. Patients with SH had longer duration of hospital stay, high mortality rate, higher incidence of complications, and poor functional recovery.

Templer's death anxiety scale on the relationship between white coat hypertension and anxiety: A cross-sectional study.

The relationship between white coat hypertension (WCH) and anxiety remains not fully elucidated. This study aims to investigate the correlation between WCH and Templer's Death Anxiety Scale (T-DAS) questionnaire. Asymptomatic individuals with a familial history of sudden cardiac death or acute myocardial infarction within the last year, who presented at our cardiology outpatient clinic, were enrolled in this prospective, single-center, cross-sectional study. Among those with elevated blood pressure in the outpatient clinic setting, participants were categorized into normotensive and WCH groups through 24-hour ambulatory blood pressure monitoring. Demographic features, laboratory parameters, and T-DAS scores were documented. Logistic regression and sensitivity analyses were conducted to ascertain WCH occurrence. Among 324 consecutive participants, 90 were diagnosed with WCH. T-DAS scores were significantly elevated in the WCH subgroup, particularly among those seeking early medical attention following bereavement. Multivariable logistic regression highlighted gender, BMI, heart rate, T-DAS, and admission time as independent correlates of WCH. Significantly, T-DAS exhibited the third most substantial contribution to the regression analysis, following admission time and heart rate. The multivariable logistic regression analysis incorporating T-DAS exhibited high robustness, discrimination, fit, and calibration, with a Brier score of 0.106, adjusted R2 of 0.576, and C-statistic of 0.905 (95% CI: 0.871-0.940, p < 0.001). T-DAS, with a threshold of >8, demonstrated 48% sensitivity and 90% specificity in detecting WCH. Additionally, decision curve analysis verified that the model including T-DAS offers a net benefit in detecting WCH. This study unveils a potential association between WCH and death anxiety.