Total Duration Of Hospitalization Research Articles

A Double-blind, Randomized, Placebo-controlled Trial of Lactobacillus acidophilus for the Treatment of Acute Watery Diarrhea in Vietnamese Children.

Probiotics are the most frequently prescribed treatment for children hospitalized with diarrhea in Vietnam. We were uncertain of the benefits of probiotics for the treatment of acute watery diarrhea in Vietnamese children. We conducted a double-blind, placebo-controlled, randomized trial of children hospitalized with acute watery diarrhea in Vietnam. Children meeting the inclusion criteria (acute watery diarrhea) were randomized to receive either 2 daily oral doses of 2 × 10 CFUs of a local probiotic containing Lactobacillus acidophilus or placebo for 5 days as an adjunct to standard of care. The primary end point was time from the first dose of study medication to the start of the first 24-hour period without diarrhea. Secondary outcomes included the total duration of diarrhea and hospitalization, daily stool frequency, treatment failure, daily fecal concentrations of rotavirus and norovirus, and Lactobacillus colonization. One hundred and fifty children were randomized into each study group. The median time from the first dose of study medication to the start of the first 24-hour diarrhea-free period was 43 hours (interquartile range, 15-66 hours) in the placebo group and 35 hours (interquartile range, 20-68 hours) in the probiotic group (acceleration factor 1.09 [95% confidence interval, 0.78-1.51]; P = 0.62). There was also no evidence that probiotic treatment was efficacious in any of the predefined subgroups nor significantly associated with any secondary end point. This was a large double-blind, placebo-controlled trial in which the probiotic underwent longitudinal quality control. We found under these conditions that L. acidophilus was not beneficial in treating children with acute watery diarrhea.

Validation of renal angina index to improve prediction of acute kidney injury in critically Ill children- A prospective observational cohort study

Background : Renal angina index (RAI) is a clinical guide that identifies patients at high risk for acute kidney injury (AKI) by integrating baseline, contextual and clinical evidence of renal injury. It may serve well to optimize biomarker utility. Methods : We performed a prospective observational study of 285 critically ill children aged 1 month to 18 years and followed them up for a minimum duration of 7 days to 28 days with daily documentation of fluid overload, creatinine values, need for renal replacement therapy(RRT), total duration of mechanical ventilation and hospital stay. RAI score of 8 or more was considered as fulfillment of renal angina. Results : Incidence rate for a Day 0 RAI of 8 or more was 49.4% and Day-3 AKI was 10.2%. Day-3 AKI rates were higher in patients with an RAI of 8 or more with the area under the curve of RAI for predicting Day-3 and Day-7 AKI of 0.815 and 0.727 respectively. An RAI under 8 had high negative predictive values (96.5%) for Day-3 AKI. RAI outperformed traditional markers of pediatric severity of illness (Pediatric Index of Mortality-II) for prediction of Day-3 AKI. Additionally, the RAI outperformed all Kidney diseases improving global outcomes (KDIGO) stages for prediction of Day-3 AKI. Conclusion : Renal angina index can predict development of subsequent severe AKI. Fulfillment of renal angina was associated with longer hospital stay, higher mortality, longer duration of mechanical ventilation and higher need for renal replacement therapy.

Investigation of the Satisfaction and Affecting Factors of the Parents Attending to the General Pediatrics Outpatient Clinic

Objection: Patients satisfaction with the healthcare services they receive has been one of the important criteria for evaluating the quality of the services provided. In our study, it was aimed to determine the satisfaction level of the parents and the factors affecting the parents’ satisfaction in accordance with the information obtained from the parents of the patients who applied to the General Pediatric Outpatient Clinic. Material and Methods: This prospective and descriptive study was carried out on 500 parents who applied to the General Pediatric Outpatient Clinic, who had no communication and language problems, and approved the informed consent form. The demographic characteristics of the parents, social security coverage, number and reasons of referral, termination status, effects of waiting for doctor examination and total duration of hospital stay on general satisfaction were examined. Results: The study participants were mothers (51%), fathers (30.4%), and other relatives (18.6%) of the patients with a mean age of 34.1±8.9 years. Pediatric patients were less than 1 year (30.2%), 1-5 years (27%), and more than 5 years of age (42.8%). The parents were primary school (43.6%), middle school (36.6%), and high school graduates (15%). Overall satisfaction rate of the parents was as 72.4 percent. The effect of medical personnel behavior, information, cleanliness and comfort on overall satisfaction was statistically significant. Conclusion: With such studies, it can be ensured that hospitals effectively increase service quality and respond to community expectations. 

Potential Role of Ketamine in the treatment of Schizoaffective Disorder, Depressive Type

Ketamine use for patients with severe treatment-resistant depression continues to be an area of interest due to the relatively limited number of treatment options for those patients. Although its use as a treatment option for patients with schizophrenia and schizoaffective disorder may seem counterintuitive, in this case report, we explore the efficacy of ketamine for depressive episodes in schizoaffective disorder. This patient who carried a diagnosis of schizoaffective disorder was given 300 mg of intramuscular ketamine for agitation. However, over the course of four days of inpatient stay, her depression drastically improved. She met criteria for remission with the Hamilton Rating Scale for Depression (HAM-D) score of 4, down from an initial score of 21. We advocate for a better understanding of the pros and cons of using ketamine for depression in schizoaffective disorders considering the controversy over the diagnosis of schizoaffective disorder, especially in African American population. At the urging of reducing the risk of suicide among this group and improving their quality of life as well as reducing financial burden by shortening total duration of hospitalization, it may be worthwhile to explore the feasibility of ketamine as a treatment option for severe depression in these patients, possibly as a last resort.

Role of single and mixed probiotics in acute diarrheal diseases in pediatric population

Background: The objective of present study was to analyse the effect of probiotics on various parameters of acute diarrhoeal disease and to compare single and mixed probiotic preparations in context to their role in acute diarrhoeal disease in paediatric population.Methods: A double blind controlled trial was conducted in children suffering from acute diarrhoeal disease at department of paediatrics jointly with department of pharmacology, G. S. V. M. Medical college, Kanpur, U.P., India. All enrolled children were divided into three groups having similar baseline characteristics. One group was given single probiotic preparation another mixed probiotic preparation and the third one (i.e. control group) placebo plus Zinc/ORS to all three groups. Various parameters such as frequency and consistency of stool, duration of diarrhoea were measured after doing intervention over a period of one week.Results: In our study duration of diarrhoea, stool frequency and total duration of hospital stay was found significantly less in probiotic groups compared to control group. However no significant difference was found between single and mixed probiotics in curtailing the acute diarrhoeal illness.Conclusions: Probiotics should be used judiciously in acute diarrhoeal diseases. There is no additional benefit of mixed probiotics in acute diarrhoeal diseases rather than increasing the cost of treatment.

Efficiency of spinal anesthesia versus general anesthesia for lumbar spinal surgery: a retrospective analysis of 544 patients.

BackgroundPrevious studies have shown varying results in selected outcomes when directly comparing spinal anesthesia to general in lumbar surgery. Some studies have shown reduced surgical time, postoperative pain, time in the postanesthesia care unit (PACU), incidence of urinary retention, postoperative nausea, and more favorable cost-effectiveness with spinal anesthesia. Despite these results, the current literature has also shown contradictory results in between-group comparisons.Materials and methodsA retrospective analysis was performed by querying the electronic medical record database for surgeries performed by a single surgeon between 2007 and 2011 using procedural codes 63030 for diskectomy and 63047 for laminectomy: 544 lumbar laminectomy and diskectomy surgeries were identified, with 183 undergoing general anesthesia and 361 undergoing spinal anesthesia (SA). Linear and multivariate regression analyses were performed to identify differences in blood loss, operative time, time from entering the operating room (OR) until incision, time from bandage placement to exiting the OR, total anesthesia time, PACU time, and total hospital stay. Secondary outcomes of interest included incidence of postoperative spinal hematoma and death, incidence of paraparesis, plegia, post-dural puncture headache, and paresthesia, among the SA patients.ResultsSA was associated with significantly lower operative time, blood loss, total anesthesia time, time from entering the OR until incision, time from bandage placement until exiting the OR, and total duration of hospital stay, but a longer stay in the PACU. The SA group experienced one spinal hematoma, which was evacuated without any long-term neurological deficits, and neither group experienced a death. The SA group had no episodes of paraparesis or plegia, post-dural puncture headaches, or episodes of persistent postoperative paresthesia or weakness.ConclusionSA is effective for use in patients undergoing elective lumbar laminectomy and/or diskectomy spinal surgery, and was shown to be the more expedient anesthetic choice in the perioperative setting.

A prospective study of cases with necrotising fasciitis: our experience at a tertiary care teaching hospital

Background: Necrotising fascitis is a life-threatening infection involving fascia and necrosis of subcutaneous tissue. The portal of entry usually is trivial trauma. It requires immediate diagnosis and intervention to reduce mortality. The objective of this study was to study clinical profile, predisposing risk factors and to formulate a protocol for management of necrotising fasciitis.Methods: The study was conducted at tertiary care teaching hospital in Punjab, India catering to a semi-urban and rural (agricultural based) population over a period of three years between January 2014 to January 2017. All the consecutive patients who came to the emergency department (ER) of the institute presenting early with clinical features suggestive of NF were included in the study. The study included total 50 cases. The cases were studied in detail according to study plan that included age, sex, clinical features, results of blood and wound cultures, the number of surgical interventions, total duration of hospitalization and the mortality rate.Results: The most common age group was between 40-60yrs and there were 48 males. There was history of trivial trauma or insect bite in majority of cases. Mostly patients presented with bullae formation, induration, edema. Diabetes was the commonest comorbid condition associated. All the patients were thoroughly investigated, swab cultures were taken. Debridements were done followed by grafting. In 10 patients, we could not salvage the limb and 10 patients expired after debridement.Conclusions: Necrotising fasciitis is more common in middle aged males with diabetes. Early diagnosis and aggressive treatment is required to reduce the mortality.

Research on the effectiveness between high flow nasal oxygen cannula and non-rebreather oxygen face mask in post-extubation patients

Objective To compare the clinical effects of high flow nasal cannula (HFNC) and non-rebreathing oxygen face mask(NRB) in post-extubation patients. Methods 88 critically ill patients with machinery ventilations were divided into HFNC group and NRB group randomly. Blood gas analysis and hemodynamic parameters were assessed 1 hour prior to extubation and 6 hours after extubation. The primary clinical outcomes measured were ventilation-free days, re-intubation patient numbers, length of stay in ICU(Intensive Care Unite) , total duration of hospitalization and mortality. The scant of breath degree and comfortableness of patient were recorded according to the Visual analogue scale. The measurement data were described by mean±standard deviation (±s) and analyzed with t test, enumeration data were described by number of cases and composition ratio and analyzed with χ2test, P<0.05 was considered to have statistical difference. Results There was no significant difference in clinical features between the two groups, The oxygenation index of HFNC group is significantly higher than that of NRB group after extubation [(251.4±43.9) vs.(201.7±60.7), P=0.037)]. There were more ventilator-free days in the HFNC group than NRB group [(4.2± 2.1) vs.(3.4±2.8), P=0.037)] and fewer patients required re-intubation(P=0.028). The rate of ventilator associated pneumonia is also lower than NRB group(P=0.024). The patients’ scant of breath feeling were obviously allevated comparing with the NRB group [(2.9±1.1) vs.(3.7±1.8), P=0.042)]. The oxygenation index of NRB group significantly decreased after extubation[(242.9±68.4vs.201.7±60.7 P=0.048)]. The two groups demonstrated similar hemodynamic patterns before and after extubation. And there were no statistically significant clinical differences in PaCO2, length of ICU stay, total duration of hospitalization or mortality. Conclusions Compared with NRB, HFNC is a more safe and effective clinical tool in the prevention and treatment of critical adult patients with extubation failure. Key words: High flow nasal cannula (HFNC); Non-rebreathing oxygen face mask (NRB); Post-extubation respiratory failure; Mechanical ventilation; Extubation; Curative effect

Does having a gastrectomy delay time to feeding and prolong hospital stay in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy?

Aim: Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is routinely used to treat selected patients with peritoneal carcinomatosis, but can be associated with prolonged hospital stay, significant morbidity and mortality. Our objective was to assess whether patients undergoing gastrectomy as part of CRS/HIPEC were at increased risk of delayed feeding time and prolonged hospital stay.Methods: Two hundred and fourteen consecutive patients with peritoneal carcinomatosis treated with CRS/HIPEC between 2001 and 2016 were stratified by whether CRS included gastrectomy (n = 19, 9%) and compared. Primary outcomes were time to full feeds and rate of serious morbidity (Clavien–Dindo grades III–V). Secondary outcomes were durations of ICU and hospital stays.Results: Of 214 patients undergoing CRS/HIPEC, those undergoing gastrectomy (19, 8.9%) had increased time to full feeds (8 vs. 5 days, p < 0.01), and duration of ICU (2 vs. 1 days, p < 0.01) and total hospital stays (16 vs. 14 days, p = 0.013). There was no significant increase in serious complications, although increased risk of pneumonia was noted (21% vs. 4.1%, p = 0.011). Undergoing gastrectomy was not independently prognostic in multivariable analysis including high peritoneal tumour load (PCI >12), multiple CRS procedures (number >2) and operation duration (>480 min) in which operative duration remained independently prognostic (p < 0.01).Conclusions: After surgery, early oral refeeding may be beneficial in the majority of patients undergoing CRS/HIPEC. However, patients found to have high peritoneal tumour load with extended surgery and those who underwent gastrectomy should be considered for early post-operative TPN due to the significant risk of delayed time to full feeds.

Neurodevelopmental Outcome in Children after Fetal Cardiac Intervention for Aortic Stenosis with Evolving Hypoplastic Left Heart Syndrome

To characterize neurodevelopmental outcomes after fetal aortic valvuloplasty for evolving hypoplastic left heart syndrome and determine the risk factors for adverse neurodevelopment. Questionnaires were mailed to families of children who underwent fetal aortic valvuloplasty from 2000 to 2012, and medical records were reviewed retrospectively. The primary outcome was the General Adaptive Composite score of the Adaptive Behavior Assessment System Questionnaire-Second Edition. Other questionnaires included the Behavior Assessment System for Children, Behavior Rating Inventory of Executive Function, Ages and Stages, and Pediatric Quality of Life Inventory. Among 69 eligible subjects, 52 (75%) completed questionnaires at median age of 5.5 (range 1.3-12) years; 30 (58%) had biventricular status circulation. The General Adaptive Composite mean score (92 ± 17) was lower than population norms (P < .001) and similar to published reports in patients with hypoplastic left heart syndrome without fetal intervention; scores in the single ventricular versus biventricular group were 97 ± 19 vs 89 ± 14, respectively (P = .10). On multivariable analysis, independent predictors of a lower General Adaptive Composite score were total hospital duration of stay in the first year of life (P = .001) and, when forced into the model, biventricular status (P = .02). For all other neurodevelopmental questionnaires (Behavior Assessment System for Children, Behavior Rating Inventory of Executive Function, Ages and Stages, Pediatric Quality of Life Inventory), most subscale scores for patients with biventricular and single ventricular status were similar. Children who underwent fetal aortic valvuloplasty have neurodevelopmental delay, similar to patients with hypoplastic left heart syndrome without fetal intervention. Achievement of biventricular circulation was not associated with better outcomes. We infer that innate patient factors and morbidity during infancy have the greatest effect on neurodevelopmental outcomes.

Clinical and Sociodemographic Characteristics that Affect the Recommendation for Assignment of a Legal Representative in Patients with Bipolar Disorder

In this study, we aimed to evaluate the clinical and sociodemographic characteristics of patients with bipolar disorder who had been sent to the Forensic Psychiatry Unit by the court in order to determine factors that affected the decision to appoint a legal representative. The reports of health council, follow-up outpatient, and hospitalization files of a total of 78 patients with bipolar disorder who had been sent to the Department of Forensic Psychiatry Outpatient Clinic of Bakirköy Mental Health and Neurological Diseases Education and Research Hospital between 1st June 2009-31st December 2011 were examined. Patients had been sent by the court in order to determine whether a legal representative was required. Seventy patients meeting enough to sociodemographic and clinical form were separated as appointment group of legal representative or not and decision variables were compared statistically. Forty-six patients (66%) were recommended assignment of a legal representative. In the patients with bipolar disorder for whom a legal representative was recommended, the presence of other first axis comorbidity, the presence of psychotic episodes, delusions of persecution and reference, hallucinations, the total number of manic and mixed episodes, incidence of alcohol and substance abuse, lifetime total number of attacks, and the total number and duration of hospitalizations were found to be significantly higher. The probability of assignment of a legal representative was increased 11-fold by the presence of first axis comorbidity, 1.3-fold by the number of manic episodes, and 2.2-fold by the number of mixed episodes were specified. In the practice of forensic psychiatry, clinicians should focus on the course of the disease, especially the number and frequency of manic or mixed episodes, total number of episodes and hospitalizations, duration of hospitalizations, alcohol and substance use, the presence of episodes accompanied by psychosis with paranoid delusions and hallucinations, and the presence of the other first axis comorbidity in the patient with bipolar disorder for assessment of the decision to appoint a legal representative.

Випадок успішного лікування новонародженого з обширним опіком шкіри ііі ступеня

A case of successful treatment in the neonatal intensive care department of Odessa Regional Clinical Children’s Hospital from 29.05.17 to 01.08.17 of a newborn with extensive thermal skin burn of the body and extremities is described in this article. The baby was admitted to the hospital on the first day of life with thermal burns of the back, buttocks and extremities І-IIА-ІІB – III grades 40% (32%) of body surface with the severe burning shock. The child passed through all stages of burning disease. The baby underwent 6 operations. The overall period of treatment at the intensive care department was 56 bed-days, during 33 days out of them artificial lung ventilation was provided; total duration of hospital stay was 65 bed-days. The child was discharged from the hospital in good condition.

Ketamine Role in Schizoaffective Disorder Depressive Type

Ketamine use for patients with severe treatment-resistant depression continues to be an area of interest due to the relatively limited number of treatment options for those patients. Although its use as a treatment option for patients with schizophrenia and schizoaffective disorder may seem counterintuitive, in this case report, we explore the efficacy of ketamine for depressive episodes in schizoaffective disorder. This patient who carried a diagnosis of schizoaffective disorder was given 300 mg of intramuscular ketamine for agitation. However, over the course of four days of inpatient stay, her depression drastically improved. She met criteria for remission with the Hamilton Rating Scale for Depression (HAM-D) score of 4, down from an initial score of 21. We advocate for a better understanding of the pros and cons of using ketamine for depression in schizoaffective disorders considering the controversy over the diagnosis of schizoaffective disorder, especially in African American population. At the urging of reducing the risk of suicide among this group and improving their quality of life as well as reducing financial burden by shortening total duration of hospitalization, it may be worthwhile to explore the feasibility of ketamine as a treatment option for severe depression in these patients, possibly as a last resort.

Prothrombin Complex Concentrate Versus Fresh Frozen Plasma for Vitamin K Antagonist Reversal in Acutely Bleeding Patients: A Retrospective Study

▪IntroductionVitamin K antagonist (VKA) drugs require immediate reversal in VKA-treated patients with major bleeding or requiring urgent surgery. 4-factor prothrombin complex concentrates (PCCs)are approved for urgent VKA reversalbecause they reverse the international normalized ratio (INR) more rapidly than fresh frozen plasma (FFP). Studies comparing the clinical benefits of PCC and FFP have focused on VKA reversal prior to urgent surgery. Few data comparing laboratory and clinical outcomes of patients receiving PCC or FFP for major hemorrhage have been published, and these pertain to intracranial hemorrhage (ICH) only. Given the complexity of performing randomized studies in this setting, observational studies are relevant to inform on this issue.AIMSTo compare the effects of PCC versus FFP on patient outcomes in VKA-associated major hemorrhage. The primary outcomes were the rate of INR reversal and blood product utilization. The secondary outcome was duration of intensive care and total hospital admission.MethodsWe performed a retrospective, single-center study of consecutive unselected patients receiving a 4-factor PCC for VKA reversal because of hemorrhage between January 2012 and April 2015 compared to consecutive unselected patients treated with FFP for the same indication from January 2010-December 2011, a period prior to introduction of PCC at the Meir Medical Center. Patients were identified by review of clinical and blood bank electronic medical records. We analyzed patient demographics, indication for VKA, underlying illnesses, aspirin use, site and severity of hemorrhage, INR pre- and post reversal, rate of INR reversal, transfusion requirements and duration of hospitalization, treatment.Results56 patients received PCC and were compared to 56 patients treated with FFP. In the PCC group 17 patients had ICH and 25 had gastrointestinal hemorrhage compared to 17 and 31 patients respectively in the FFP group. Patients were adjusted for age, sex, presence of renal failure, active cancer, aspirin use, site of hemorrhage, pre-treatment INR and hemoglobin concentration and hemorrhagic shock at presentation. Outcomes: Median time to INR of ≤1.3 was 0.5 (range 0.5-1.5) vs 15.5 (range 5-96) hours for PCC vs FFP respectively, P<0.001). Packed red cell transfusion did not differ between the groups: median =1(range 0-13) in the PCC group and median= 2(range=2-10) in the FFP group (P=0.3), but more FFP was transfused in the FFP vs PCC group median =0(range 0-8) in the PCC group and median= 4(range=2-8) in the FFP group (P<0.001). Duration of hospital admission was longer in the FFP (median=7 days, range 1-93) vs PCC patients (median =6 days, range=1-35) (P=0.04).ConclusionThis is the first observational study comparing PCC and FFP for VKA-related hemorrhage to our knowledge and the first study of PCC versus FFP for extracranial VKA-related hemorrhage. PCC was more effective than FFP in for reversal of the INR and was associated with less overall FFP use but not packed red cell transfusion. Similarly hospital admission duration was shorter among the PCC patients. Larger studies are required to determine whether PCC confers other clinical benefits over FFP for VKA reversal in acutely bleeding patients. DisclosuresEllis:Boehringer Ingelheim: Speakers Bureau; Bayer: Speakers Bureau; Pfizer: Speakers Bureau.

Management of stable intertrochanteric fractures with minimally invasive dynamic hip screw

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Trochanteric fracture is the commonest fracture which accounts to 90 % of the fractures in patients over 50 years. The aim of the treatment is to prevent malunion and early mobilization with ambulation which is accomplished by dynamic hip screw and sliding plate. Minimal invasive technique has advantages of less blood loss, minimal soft tissue dissection, early mobilization and shorter hospital stay&lt;span lang="EN-IN"&gt;.&lt;/span&gt;The study was done to evaluate the amount of intraoperative blood loss, reduction of postoperative haemoglobin, requirement of postoperative analgesics and duration of postoperative hospital stay in the patients with stable intertrochanteric fracture treated with minimal invasive dynamic hip screw (MIDHS).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Twenty five patients with stable intertrochanteric fractures were treated with minimal invasive Dynamic hip screw fixation. Average intra operative blood loss, reduction of postoperative haemoglobin, requirement of post-operative analgesics and total duration of postoperative hospital stay were evaluated. All the patients were followed up periodically at 6 weeks, 3 months, 6 months, 1 year. All the patients were evaluated radiologically in the follow up period. The functional assessment was done with Harris hip score.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Mean intraoperative blood loss was found to be 75 ml. The mean duration of surgery was found to be 44.3 minutes. All the patients were mobilized 24 hours of surgery with non-weight bearing walking with walker support. The average time for union was found to be 4 months. No complications like postoperative infection, malunion, coxa vara, limb length discrepancy were seen. The final functional Harris hip score was found to be excellent in 14, good in 4, fair in 2&lt;span lang="EN-IN"&gt;. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; MIDHS is a safe technique having advantages of less blood loss, minimal soft tissue dissection and shorter hospital stay, early rehabilitation in treating stable intertrochanteric fractures compared to conventional DHS&lt;span lang="EN-IN"&gt;.&lt;/span&gt;&lt;/p&gt;

Comparative Study Between Nasogastric (Ryle) Feeding and Oral Feeding Post- Cleft Palate Repair

Background: feeding after surgical correction of cleft palate is an important topic; the method of feeding usually affects the surgery outcome and stress of operation in infants. However, no consensus on the method of feeding for children with cleft palate either pre-or post-operative correction. Aim of the work: to investigate the effect of nasogastric tube (NGT) feeding compared with oral feeding on children in the first 48 hours after primary cleft palate repair. Patients and methods: The study was carried out at Al-Azhar University Hospital (Pediatric Surgery Unit);Damietta and specialized kids hospital during the period from January 2015 to Jun 2016. It included 36 children presented for primary repair of cleft palate. All were undergoing full history taking, clinical examination and laboratory investigations to prepare them for surgical intervention. Those patients were divided into 2 equal groups, each group had 18 patients.Then, after intervention, they followed up to examine the effect of method of feeding either by (NGT) (group 1) or oral route (group 2) on the outcome of surgery and postoperative analgesia requirements. Results: both groups were comparable asregard to demographic characteristics, amount of intraoperative fluids and required analgesia and for postoperative surgical outcome and complications. However, there was statistically significant decrease of Postoperative morphine, paracetamol and Ibuprofen in NG feeding group when compared to oral feeding group (0.13±0.08, 32.50±15.55, 14.44±8.72 vs 0.23±0.13, 51.66±28.43, and 26.38±14.43 respectively). Also, there was significant decrease of number of pain episodes in NGT feeding group when compared to oral feeding group (3.17±2.03 vs 4.77±2.86). On the other hand, there was statistically significant increase of the amount of postoperative feeding in NGT feeding when compared to oral feeding group (137.22±13.52 vs 59.72±18.74). Finally, the total duration of hospital stay was significantly shortened in NGT feeding group when compared to oral feeding group (47.55±15.33 vs 78.66±18.04 hours).Conclusion: NGT feeding is effective when compared to oral feeding post-palatoplasty as it increases consumption of foods and reduce postoperative analgesia requirements.

Early initiation of continuous renal replacement therapy improves survival of elderly patients with acute kidney injury: a multicenter prospective cohort study

BackgroundContinuous renal replacement therapy (CRRT) is essential in the management of critically ill patients with acute kidney injury (AKI). However, the optimal timing for initiating CRRT remains controversial, especially in elderly patients. Therefore, we investigated the outcomes of early CRRT initiation in elderly patients with AKI.MethodsA total of 607 patients ≥65 years of age who started CRRT due to AKI between August 2009 and December 2013 were prospectively enrolled. They were divided into two groups based on the median 6-hour urine output immediately before CRRT initiation. Propensity score matching was used to compare the overall survival rate, CRRT duration, and hospitalization duration.ResultsThe median age of both groups was 73.0 years, and 60 % of the patients were male. The most common cause of AKI was sepsis. In the early CRRT group, the mean arterial pressure was higher, but the prothrombin time and total bilirubin, aspartate aminotransferase, and alanine aminotransferase levels were lower. The overall cumulative survival rate was higher in the early CRRT group (log-rank P < 0.01). Late CRRT initiation was associated with a higher mortality rate than early initiation after adjusting for age, sex, the Charlson comorbidity index, systolic arterial pressure, prothrombin time, the total bilirubin, aspartate aminotransferase, and alanine aminotransferase levels, cumulative fluid balance and diuretic use (hazard ratio, 1.35; 95 % confidence interval 1.06, 1.71, P = 0.02). Following propensity score matching, patient survival was significantly better in the early CRRT group than in the late CRRT group (P < 0.01). The total duration of hospitalization from the start of CRRT was shorter among the survivors when CRRT was started earlier (26.7 versus 39.1 days, P = 0.04).ConclusionA better prognosis can be expected if CRRT is applied early in the course of AKI in critically ill, elderly patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1437-8) contains supplementary material, which is available to authorized users.

Comparison of duration of maternal hospital stay in conservative &amp; aggressive management of Preterm prelabor rupture of membranes(PPROM) in Indian women at 34-36 weeks gestation.

Aim:To compare the conservative and aggressive management of Preterm prelabor rupture of membranes (PPROM) in Indian women at 34-36 weeks gestation in terms of duration of their hospital stay. Materials & Method:194 pregnant women with PPROM at gestational age 34-36 weeks admitted in labour ward were included in the study conducted from 2009 -2010 in department of Obstetrics & Gynaecology, SMS Medical College, India. Random allocation to conservative & aggressive management group was done by offering Chit Box Method assigning 97 cases in each group. In conservative management cases were hospitalized& provided bed rest, Daily fetal monitoring, maternal vitals monitoring, Oral tab erythromycin 500 mg t.d.s for 7 days, Daily WBC count and C reactive protein estimation. Expectant management was abandoned if there was clinical evidence of labour, infection or fetal distress. In aggressive management induction of labour was done by Tab Misoprostol 25 g orally, at 4-6 hour intervals, for a maximum of 5 doses. Caesarean delivery was performed for standard obstetrical indication and for failed induction. After delivery neonatal care was provided by neonatologist Results:Out of total 97 cases, in aggressive management, majority 73 (75.26%) cases had duration  5 days, 19 (19.59%) up to 6-10 days and 5 (5.15%) cases up to 11+ days. Similarly out of total 97 cases in conservative management, majority 46 (47.42%) cases had duration  5 days, 33 (34.02%) up to 6-10 days and 18 (18.56%) cases up to 11+ days. The mean duration of hospital stay of mother in aggressive management were 4.10  3.10 days and in conservative management it is 7.21  3.36 days. Conclusion:Majority of cases in both aggressive and conservative management group had duration of hospital stay of  5 days. But the total duration of hospital stay of mother were much higher in conservative management group in present study. Thus mean duration of hospital stay of mother were much higher in conservative management group as compared to aggressive management. Keywords-PPROM, conservative, aggressive, hospital stay.

Minocycline trial in japanese encephalitis: a double blind, randomized placebo study

Objective: To evaluate the effect of minocycline in Japanese Encephalitis (JE ) patient on reduction in mortality, neurological deficit and behavioral outcome. Design: Double blind randomized placebo control trial. Setting: Tertiary level hospital. Inclusion criteria: Only JE patients who were IgM positive for JE Virus (JEV) in cerebrospinal fluid and/or serum were included. Exclusion criteria: Those clinically suspected JE patients who were IgM negative for JE Virus (JEV) in cerebrospinal fluid and serum were excluded. Patients were selected randomly. Intervention: A total of 44 patients of JE of the age range between 1-13yr were divided equally in two groups A and B. Group A received drug under study, that is minocycline, and Group B received placebo. Outcome measures: The present study was designed to: compare the clinical course during hospitalization and after discharge in terms of duration of symptoms, death and disability at the time of discharge, outcome of the intervention on clinical recovery, behavioral problems and neurological deficit after 12 month of follow up. Results: Duration of fever, unconsciousness and total duration of hospital stay were significantly reduced in Group A (minocycline) patients. Conclusion: Minocycline has significant beneficial effect in JE patients in duration of major symptoms and duration of hospital stay. However, the mortality rate and prevalence of neurological deficits and behavioral problems on a 12 months follow up remain unchanged.

Single dose oral zinc as adjuvant therapy in children admitted with severe pneumonia: A randomized, placebo-controlled study

Background: Childhood pneumonia is one of the major causes of under-five mortality in developing countries. Any interventions which can reduce the mortality and morbidity of pneumonia are of great importance. Adjuvant zinc therapy is one such intervention studied in various parts of the world with inconclusive results. Objective: We aim to study the impact of a single dose of zinc therapy on the outcome of childhood severe pneumonia. Material and Methods: Randomized, placebo-controlled study of young children between2 and 24 months was conducted to study the impact of single dose zinc administration on time to resolution of severe pneumonia. The subjects were assigned two groups, zinc group and non-zinc group, by stratified randomization. The zinc group received unlabeled oral zinc syrup 20 mg of elemental zinc as single dose for children &gt;6 months of age and 10 mg of elemental zinc as single dose for children &lt;6 months. The non-zinc group children were administered unlabeled non-zinc containing placebo as single dose. Results: From April2011 to December 2011, 1284 children screened for pneumonia as per Integrated Management of Neonatal and Childhood Illnesses guidelines and 126 children were included in the study. Of these 126 children, 63 were randomized to receive zinc and 63 to receive placebo. The mean duration of respiratory distress before hospitalization was 1.4±0.5 days in zinc group as compared to 1.1±0.5 days in non-zinc group (p=0.001). The mean duration of resolution of distress was 52.47±33.99 h in zinc group as compared to 74.17±37.76 h inthe non-zinc group (p=0.05). Similarly, the mean duration for resolution of symptoms was 65.52±36.03 h in zinc group as compared to 88.00±37.97 in non-zinc group (p=0.05). The 23% of the children in non-zinc group had treatment failure (p=0.03). Conclusion: Single dose of adjuvant oral zinc therapy in severe pneumonia, reduces the duration of respiratory distress, resolves the symptoms early and decreases the incidence of treatment failure. However, the total duration of hospitalization was not affected by zinc therapy.