Uncompleted Data Research Articles

Gender differences in KAsH score in acute myocardial infarction

Abstract Funding Acknowledgements None. Introduction Risk stratification at admission in patients with myocardial infarction (MI) is crucial in the prognosis assessment. KAsH score is a useful and simple tool to predict in-hospital mortality. Objective To evaluate KAsH score predictive power according to gender in patients (P) who suffered MI (either STEMI or NSTEMI) Methods Based on a single-center retrospective study, data collected from P admitted in the Cardiology department with MI between 2016 and 2019. P without or uncompleted data were excluded. We compared 2 groups: Group 1 (G1) – male patients; Group 2 (G2) – female patients. Major adverse cardiac events (MACE) were defined as the composite of nonfatal stroke, nonfatal myocardial infarction and cardiovascular death. Statistical analysis used T test, chi-square, logistic regression and ROC curve analysis. Results Among the 611 P admitted with MI mean age was 66.6±12.7 years old and 64.8% were male. G1 was younger (64.7 ±12.8 years vs 64.7±12.8, p<0.001). The groups were similar regarding the other variables that compose the KAsH score, namely Killip-Kimbal class (p=0.668), systolic blood pressure (p=0.378), and heart rate (p=0.265). The mean KAsH categorization was 1.48 for G1 and 1.54 for G2 (p=0.05). The groups were also similar regarding other (CV) factors namely arterial hypertension, diabetes mellitus, dyslipidaemia, smoking and previous MI. In general, KAsH score was able to predict in-hospital mortality in our sample p=0.03, OR 2.45, CI 1.09-5.55 but with poor accuracy (AUC 0.355). However, the score did not predict 1 year mortality (p=0.337) or 1 year readmission (p=0.943). Regarding the groups, KAsH score did not predict in-hospital mortality for G1 (p=0.465) but it did predict the occurrence of MACE events, p=0.01, OR 2.20, CI 1.20-4.09, AUC 0.634. Considering G2 KAsH score predicted in-hospital mortality p=0.02, OR 4.10, CI 1.24-13.87 but with poor accuracy (AUC 0.211). It also predicted the occurrence of MACE events p=0.001, OR 4.61, CI 1.83-11.63 with fair accuracy (AUC 0.77). Such as in G1 the score did not predict 1 year mortality or readmission (p=0.178) Conclusion In our center, KAsH score performed better in female patients in predicting in-hospital mortality and MACE events. The score also predicted MACE events in male patients, but did not predict in-hospital mortality. More studies are needed to validate additional variables to the score and to validate KAsH score as a long-term prognostic tool.

Review: Medication Error in Prescribing and Dispensing Phases on Outpatient

Background: A medication error is defined as "any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional, patient, or consumer." A medication error might occur at any point during the medication-use process, such as when prescribing the medicines, during dispensing, and when the drug is taken by the patient. Objectives: This review focusing on the types of medication errors (MEs) which commonly occurs during prescribing and dispensing phase on the outpatient in Indonesia. Material and Methods: Articles related to MEs during prescribing and dispensing phase were collected from DOAJ (Directory of Open Access Journals) and google scholar. The articles were reviewed and analyze to draw conclusions about the common type of MEs mostly occured on the outpatients. There were 10 articles (2003-2020) that have been reviewed, covering the types of MEs, MEs incidents and how to reduce the number of MEs incident. Results: Based on the reviewed articles, MEs commonly occured in the prescribing phase were incomplete data of patient's on the prescription include address, born date, weight and gender; unclear information on the prescription including, dosage, route of adminstration, illegible writing; uncomplete data on the doctor's information such as the practise license number wasn't listed, and there were no information on medicine interactions. MEs occured during dispensing phase were uncomplete data on the information about how to use, time of using, indication, the amount of the drug given, the side effects, the storage instruction, the strength or the doses of medicine, error in writing etiquette, error in compounding as well as there was no information related what to do if the patient forgot to take the medicines.

In-hospital outcomes of sustained ventricular tachycardia in the setting of Acute Coronary Syndrome

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf on behalf of the Investigators of " Portuguese Registry of ACS " Introduction Sustained ventricular tachycardia (SVT) complicates up to 20% of acute coronary syndromes (ACS) and it is, therefore, important to access its impact on prognosis and identify patients with higher risk of SVT. Objective To evaluate predictors of early onset (<48h) and late onset (≥48h) SVT. Methods Based on a multicenter retrospective study, data collected from admissions between 1/10/2010 and 4/09/2019. Patients (pts) were divided in two groups (G): A – pts that presented early onset SVT (ESVT), and B – pts that presented late onset SVT (LSVT). Pts without data on previous cardiovascular history or uncompleted clinical data were excluded. Logistic regression was performed to assess predictors of SVT in ACS. Results Between 29851 pts with ACS, 364 (1.2%) presented SVT. ESVT – 251 pts (69%); LSVT – 91 pts (25%). LSVT G was older (74 ± 13 vs 68 ± 14, p = 0.003), was admitted directly to cat lab less frequently (10.1% vs 24.8%, p = 0.003), had longer times from first symptoms to admission (440min vs 261 min, p < 0.001) and had higher rates of previous stroke (14.4% vs 6.8%, p = 0.028). LSVT G had higher rates of non-ST-elevation myocardial infarction (MI) (35.2% vs 23.1%, p = 0.025) and lower rates of ST-elevation MI (53.8% vs 71.7%, p = 0.002), although both G were similar regarding MI location (anterior – p = 0.135, inferior – p = 0.097). LSVT G had higher systolic blood pression (130 ± 33 vs 122 ± 33, p = 0.050), presented more frequently in Killip-Kimball class ≥2 (52.5% vs 35.5%, p = 0.005) and with atrial fibrillation (21.2% vs 12.4%, p = 0.045), and had higher brain-natriuretic peptide (1075 vs 329, p < 0.001). LSVT G was treated more frequently with diuretics (80.0% vs 47.8%, p < 0.001), amiodarone (62.2% vs 48.8%, p = 0.029), digoxin (8.9% vs 2.4%, p = 0.013) and levosimendan (11.1% vs 2.8%, p = 0.004). ESVT G had higher rates of performed coronarography (88.4% vs 79.1%, p = 0.028) but lower rate of 3 vessels disease (58.5% vs 70.8%, p = 0.017). LSVT G had higher rates of severe (<30%) left ventricle dysfunction (32.9% vs 15.4%, p < 0.001) and need to non-invasive ventilation (23.1% vs 6.8%, p < 0.001). Regarding in-hospital complications, ESVT G had higher rates of heart failure (34.7% vs 19.1%, p = 0.006), atrioventricular block (15.7% vs 1.1%, p < 0.001), atrial fibrillation (20.4% vs 7.7%, p = 0.006) and major haemorrhage (5.2% vs 0.0%, p = 0.024). LSVT G had higher rates of in-hospital death (44.4% vs 20.9%, p < 0.001) and in-hospital stay (14 days vs 7 days, p < 0.001). The G were similar regarding re-infarction (p = 0.216), shock (p = 0.179), mechanical complications (p = 1.00), cardiac arrest (p = 0.097) and stroke (0.348) rates. Logistic regression confirmed ESVT was predictive in-hospital heart failure (p = 0.010, OR 2.67) and de novo AF (p = 0.001, OR 5.56), whether LSVT was predictive of in-hospital death (p = 0.002, OR 2.70). Conclusion LSVT was associated with higher rates of in-hospital complications, but ESVT was associated with higher in-hospital mortality.

Cardiac arrest in Acute Coronary Syndrome: predictors and prognosis

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf on behalf of the Investigators of " Portuguese Registry of ACS " Introduction Cardiac arrest (CA) is a potential complication of acute coronary syndromes (ACS) and it is, therefore, important to access its impact on prognosis and identify patients with higher risk of CA in the setting of ACS. Objective To evaluate predictors and prognosis of CA in the setting of ACS. Methods Based on a multicenter retrospective study, data collected between 1/10/2010 and 4/09/2019. Patients (pts) without data on previous cardiovascular history or uncompleted clinical data were excluded. Pts were divided in 2 groups (G): GA – pts without CA; GB - pts with CA during hospitalization. Logistic regression and survival analysis was performed. Results Between 25718 pts with ACS, CA occurred in 651 (2.5%). GB was younger (65 ± 15 vs 67 ± 14, p < 0.001), had higher rates of smoking (35.8% vs 26.4%, p < 0.001), and lower rates of hypertension (62.3% vs 70.9%, p < 0.001), diabetes (25.7% vs 31.7%, p < 0.001), dyslipidaemia (53.8% vs 61.7%, p < 0.001), previous ACS (17.2% vs 20.6%, p = 0.037) and coronary artery bypass grafting (CABG) (1.9% vs 5.1%, p < 0.001). Both groups were similar regarding previous heart failure (p = 0.450) and chronic kidney disease (p = 0.560). GB had shorter times from first symptoms to admission (158min vs 243min, p < 0.001). GA had higher rate of non-ST-elevation myocardial infarction (MI) (78.6% vs 41.4%, p < 0.001), whether GB had higher rates of ST-elevation myocardial infarction (STEMI) (46.7% vs 18.1%, p < 0.001), namely anterior (54.9% vs 46.9%, p < 0.001). GB had lower blood pressure (BP) (122 ± 33 vs 139 ± 28, p < 0.001), higher heart rate (HR) (83 ± 23 vs 77 ± 19, p < 0.001), presented more frequently in Killip-Kimball class (KKC) ≥2 (37.6% vs 14.6%, p < 0.001), in atrial fibrillation (AF) (13.9% vs 7.0%, p < 0.001) and with right bundle block (10.6% vs 5.3%, p < 0.001). GB had higher rates of common trunk culprit lesion (CL) (3.9% vs 1.6%, p < 0.001), anterior descending coronary CL (49% vs 37%, p < 0.001), 1 vessel lesion (53.4% vs 38.5%, p < 0.001), lower CABG rates (4.3% vs 6.3%, p = 0.042), more left ventricle dysfunction (57.7% vs 38.7%, p < 0.001) and needed more frequently mechanical ventilation (35.3% vs 1.1%, p < 0.001), non-invasive ventilation (6.8% vs 1.6%, p < 0.001) and provisory pacemaker (9.4% vs 1.3%, p < 0.001). Logistic regression confirmed that older age (p < 0.001, OR 1.89, CI 1.35-2.64), higher HR (p < 0.029, OR 1.33, CI 1.03-1.71), lower BP (P < 0.001, OR 2.67, CI 1.94-3.68), KKC ≥2 (p < 0.001, OR 2.35, CI 1.84-3.00), AF at admission (p < 0.001, OR 1.84, CI 1.34-2.51), STEMI (p < 0.001, OR 4.08, CI 3.66-6.77), lower left ventricle function (p = 0.009, OR 1.38, CI 1.08-1.75) were predictors of CA. Event-free survival was higher in GA than GB (92.8% vs 83.3%, OR 1.68, p = 0.008, CI 1.41-2.47). Conclusion As expected, CA in the setting of ACS is associated with poorer prognosis. Several characteristics of the pts may help to predict the development of CA during hospitalization, allowing earlier identification and prompt treatment.

Acute heart failure: is ACTION-ICU useful?

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Patients (pts) with acute heart failure (AHF) are a heterogeneous population. Risk stratification at admission may help predict in-hospital complications and needs. ACTION ICU score is validated to estimate the risk of complications requiring ICU care in non-ST elevation acute coronary syndromes. Objective To validate ACTION-ICU score in AHF as predictor of in-hospital M (IHM), post discharge early M [1-month mortality (1mM)] and 1-month readmission (1mRA), in our center population, using real-life data. Methods Based on a single-center retrospective study, data collected from pts admitted in the Cardiology department with AHF between 2010 and 2017. Pts without data on previous cardiovascular history or uncompleted clinical data were excluded. Statistical analysis used non-parametric tests, logistic regression analysis and ROC curve analysis. Results We included 300 pts admitted with AHF. Mean age was 67.4 ± 12.6 years old and 72.7% were male. 37.7% had previous history of revascularization procedures, 66.9% had hypertension, 41% were diabetic and 38% had dyslipidaemia. Mean heart rate was 95.5 ± 27.5bpm, mean systolic blood pressure (SBP) was 131.2 ± 37.0mmHg, mean urea level at admission was 68.8 ± 40.7mg/dL, mean sodium was 137.6 ± 4.7mmol/L, mean glomerular filtration rate (GFR) was 57.1 ± 23.5ml/min. 35.3% were admitted in Killip-Kimball class (KKC) 4. Mean ACTION-ICU score was 10.4 ± 2.3. Inotropes’ usage was necessary in 32.7% of the pts, 11.3% of the pts needed non-invasive ventilation (NIV), 8% needed invasive ventilation (IV). IHM rate was 5% and 1mM was 8%. 6.3% of the pts were readmitted 1 month after discharge. Older age (p < 0.001), lower SBP (p = 0,035), presenting in KKC 4 (p < 0.001, OR 8.13) and need of inotropes (p < 0.001) were predictors of IHM in our population. Older age (OR 1.06, p = 0.002, CI 1.02-1.10), lower SBP (OR 1.01, p = 0.05, CI 1.00-1.02) and lower left ventricle ejection fraction (LVEF) (OR 1.06, p < 0.001, CI 1.03-1.09) were predictors of need of NIV. None of the studied variables were predictive of need of IV. LVEF (OR 0.924, p < 0.001, CI 0.899-0.949), lower SBP (OR 0.80, p < 0.001, CI 0.971-0.988), higher urea (OR 1.01, p < 0.001, CI 1.005-1.018) and lower sodium (OR 0.92, p = 0.002, CI 0.873-0.971) were predictors inotropes’ usage. ACTION-ICU was able to predict IHM (OR 1.51, p = 0.02, CI 1.158-1.977), 1mM (OR 1.45, p = 0.002, CI 1.15-1.81) and inotropes’ usage (OR 1.22, p = 0.002, CI 1.08-1.39), but not 1mRA, the need of IV or NIV. ROC curve analysis revealed ACTION-ICU performs well when predicting IHM (Area under curve (AUC) 0.729, confidence interval (CI) 0.59-0.87), inotropes’ usage (AUC 0.619, CI 0.54-0.70) and 1mM (AUC 0.705, CI 0.58-0.84). Conclusion In our population, ACTION-ICU score was able to predict IHM, 1mM and inotropes’s usage.

Heart failure in Acute Coronary Syndrome: predictors and prognosis

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf on behalf of the Investigators of " Portuguese Registry of ACS " Introduction Heart failure (HF) is a frequent complication of acute coronary syndromes (ACS). Therefore, it is important to access its impact on prognosis and identify patients (pts) with higher risk of HF. Objective To evaluate predictors and prognosis of HF in the setting of ACS. Methods Based on a multicenter retrospective study, data collected from admissions between 1/10/2010 and 4/09/2019. Pts without data on cardiovascular history or uncompleted clinical data were excluded. Pts were divided in 2 groups (G): GA – pts without HF; GB - pts with HF during hospitalization. Results HF occurred in 4003 (15.6%) out of 25718 pts with ACS. GB was older (74 ± 12 vs 65 ± 13, p < 0.001), had more females (36.3% vs 26.2%, p < 0.001), had higher rates of arterial hypertension (78.4% vs 69.3%, p < 0.001), dyslipidaemia (64.4% vs 61.1%. p < 0.001), previous ACS (25.6% vs 19.7%, p < 0.001,), previous HF (16.4% vs 4.1%, p < 0.001), previous stroke (11.9% vs 6.4%, p < 0.001), chronic kidney disease (CKD) (17.1% vs 5.5%, p < 0.001), chronic obstructive pulmonary disease (COPD) (7.8% vs 3.8%, p < 0.001) and longer times from first symptoms to admission (268min vs 238min, p < 0.001). GA had higher rate of smokers (28.4% vs 16.2%, p < 0.001) and higher rate of non-ST-elevation myocardial infarction (MI) (46.5% vs 43.0%, p < 0.001). GB had higher rates of ST-elevation MI (STEMI) (49.2% vs 41.1%, p < 0.001), namely anterior STEMI (58.1% vs 44.9%, p < 0.001). GB had lower blood pressure (130 ± 32 vs 140 ± 28, p < 0.001), higher heart rate (86 ± 23 vs 76 ± 18, p < 0.001), Killip-Kimball class (KKC) ≥2 (63.2% vs 6.7%, p < 0.001), atrial fibrillation (AF) (15.4% vs 5.7%, p < 0.001), left bundle branch block (7.5% vs 3.1%, p < 0.001) and were previously treated with diuretics (39.1% vs 22.1%, p < 0.001), amiodarone (2.2% vs 1.4%, p < 0.001) and digoxin (2.8% vs 0.7%, p < 0.001). GB had higher rates of multivessel disease (66.0% vs 49.5%, p < 0.001) and planned coronary artery bypass grafting (7.3% vs 6.0%, p < 0.001), reduced left ventricle function (72.3% vs 33.4%, p < 0.001) and needed more frequently mechanical ventilation (8.2% vs 0.9%, p < 0.001), non-invasive ventilation (8.7% vs 0.5%, p < 0.001) and provisory pacemaker (4.5% vs 1.0%, p < 0.001). Logistic regression confirmed females (p < 0.001, OR 1.42, CI 1.29-1.58), diabetes (p < 0.001, OR 1.43, CI 1.30-1.58), previous ACS (p < 0.001, OR 1.27, CI 1.10-1.47), previous stroke (p < 0.001, OR 1.35, CI 1.16-1.57), CKD (p < 0.001, OR 1.76, CI 1.50-2.05), COPD (p < 0.001, OR 2.15, CI 1.82-2.54), previous usage of amiodarone (p = 0.041, OR 1.35, CI 1.01-1.81) and digoxin (p < 0.001, OR 2.30, CI 1.70-3.16), and multivessel disease (p < 0.001, OR 1.64, CI 1.67-2.32) were predictors of HF in the setting of ACS. Event-free survival was higher in GA than GB (79.5% vs 58.1%, OR 2.3, p < 0.001, CI 2.09-2.56). Conclusion As expected, HF in the setting of ACS is associated with poorer prognosis. Several features may help predict the HF occurrence during hospitalizations, allowing an earlier treatment.

Acute Coronary Syndrome - reinfarction predictors and outcomes

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf on behalf of the Investigators of " Portuguese Registry of ACS " Introduction Reinfarction (RI) is a potential complication of acute coronary syndromes (ACS) and it is, therefore, important to access its impact on prognosis and identify patients with higher risk of RI in the setting of ACS. Objective To evaluate predictors and prognosis of RI in the setting of ACS. Methods Based on a multicenter retrospective study, data collected from admissions between 1/10/2010 and 4/09/2019. Patients (pts) without data on previous cardiovascular history or uncompleted clinical data were excluded. Pts were divided in 2 groups (G): GA – pts without RI; GB - pts with RI during hospitalization. Logistic regression and survival analysis were performed. Results Between 25718 pts with ACS, RI occurred in 223 (0.87%). Regarding epidemiological factors and past history, GB was older (70 ± 12 vs 67 ± 14, p < 0.001), had higher rates of hypertension (77.4% vs 70.6%, p = 0.028), previous stroke (12.1% vs 7.2%, p = 0.005), peripheric arterial disease (10.0% vs 5.5%, p = 0.004) and chronic obstructive pulmonary disease (8.6% vs 4.4%, p = 0.003). GB had higher rates of non-ST-elevation myocardial infarction (MI) (54.3% vs 45.9%, p = 0.012) and GA had higher rates of ST-elevation MI (42.4% vs 35.9%, p = 0.049). The groups were similar regarding blood pressure (p = 0.285), heart rate (p = 0.796) and Killip-Kimball class at admission, but GB had higher levels of brain natriuretic peptide (392 vs 180, p = 0.005). GB had higher rates of multivessel disease (62.8% vs 51.6%, p = 0.002), left ventricle dysfunction (50.0% vs 39.1%, p = 0.002), higher needs of mechanical ventilation (6.3% and vs 1.9%, p < 0.001) non-invasive ventilation (5.4% vs 1.7%, p < 0.001). Logistic regression confirmed that peripheric arterial disease (p = 0.011, OR 1.93, CI 1.17-3.19), multivessel disease (p = 0.003, OR 1.69, CI 1.20-2.39) and lower left ventricle function (p < 0.001, OR 2.42, CI 1.69-3.47) were predictors of RI in the setting of ACS. Event-free survival was similar between groups (p = 0.399). Conclusion RI in the setting of ACS was associated multivessel disease and left ventricle disfunction, however, 1-year prognosis was similar to pts who didn’t suffer RI.

Acute heart failure: predicting early in-hospital outcomes

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Patients (P) with acute heart failure (AHF) are a heterogeneous population. Risk stratification at admission may help predict in-hospital complications and needs. The Get With The Guidelines Heart Failure score (GWTG-HF) predicts in-hospital mortality (M) of P admitted with AHF. ACTION ICU score is validated to estimate the risk of complications requiring ICU care in non-ST elevation acute coronary syndromes. Objective To validate ACTION-ICU score in AHF and to compare ACTION-ICU to GWTG-HF as predictors of in-hospital M (IHM), early M [1-month mortality (1mM)] and 1-month readmission (1mRA), using real-life data. Methods Based on a single-center retrospective study, data collected from P admitted in the Cardiology department with AHF between 2010 and 2017. P without data on previous cardiovascular history or uncompleted clinical data were excluded. Statistical analysis used chi-square, non-parametric tests, logistic regression analysis and ROC curve analysis. Results Among the 300 P admitted with AHF included, mean age was 67.4 ± 12.6 years old and 72.7% were male. Systolic blood pressure (SBP) was 131.2 ± 37.0mmHg, glomerular filtration rate (GFR) was 57.1 ± 23.5ml/min. 35.3% were admitted in Killip-Kimball class (KKC) 4. ACTION-ICU score was 10.4 ± 2.3 and GWTG-HF was 41.7 ± 9.6. Inotropes’ usage was necessary in 32.7% of the P, 11.3% of the P needed non-invasive ventilation (NIV), 8% needed invasive ventilation (IV). IHM rate was 5% and 1mM was 8%. 6.3% of the P were readmitted 1 month after discharge. Older age (p < 0.001), lower SBP (p = 0,035) and need of inotropes (p < 0.001) were predictors of IHM in our population. As expected, patients presenting in KKC 4 had higher IHM (OR 8.13, p < 0.001). Older age (OR 1.06, p = 0.002, CI 1.02-1.10), lower SBP (OR 1.01, p = 0.05, CI 1.00-1.02) and lower left ventricle ejection fraction (LVEF) (OR 1.06, p < 0.001, CI 1.03-1.09) were predictors of need of NIV. None of the variables were predictive of IV. LVEF (OR 0.924, p < 0.001, CI 0.899-0.949), lower SBP (OR 0.80, p < 0.001, CI 0.971-0.988), higher urea (OR 1.01, p < 0.001, CI 1.005-1.018) and lower sodium (OR 0.92, p = 0.002, CI 0.873-0.971) were predictors of inotropes’ usage. Logistic regression showed that GWTG-HF predicted IHM (OR 1.12, p < 0.001, CI 1.05-1.19), 1mM (OR 1.10, p = 1.10, CI 1.04-1.16) and inotropes’s usage (OR 1.06, p < 0.001, CI 1.03-1.10), however it was not predictive of 1mRA, need of IV or NIV. Similarly, ACTION-ICU predicted IHM (OR 1.51, p = 0.02, CI 1.158-1.977), 1mM (OR 1.45, p = 0.002, CI 1.15-1.81) and inotropes’ usage (OR 1.22, p = 0.002, CI 1.08-1.39), but not 1mRA, the need of IV or NIV. ROC curve analysis revealed that GWTG-HF score performed better than ACTION-ICU regarding IHM (AUC 0.774, CI 0.46-0-90 vs AUC 0.731, CI 0.59-0.88) and 1mM (AUC 0.727, CI 0.60-0.85 vs AUC 0.707, CI 0.58-0.84). Conclusion In our population, both scores were able to predict IHM, 1mM and inotropes’s usage.

The characteristics of neonatal sepsis in Low Birth Weight (LBW) infants at Sanglah General Hospital, Bali, Indonesia in 2018

Background: Sepsis is one of the most common causes of mortality and long terms morbidity among infants. It is known to be related to Low Birth Weight (LBW) due to the lack of immunity function to resist the infection. This study aims to identify the characteristics of neonatal sepsis in LBW infants in Sanglah General Hospital.Method: A retrospective cross-sectional study was conducted in the Neonatal Care Unit, Sanglah General Hospital, during January-December 2018 period among 135 neonates. Samples were taken using total sampling for neonates who had LBW and diagnosed with sepsis. Uncompleted data and voluntarily discharge patients were excluded from the study. Data regarding baseline characteristics of respondents, major and minor risk factors, laboratory results of sepsis, as well as blood culture, were analyzed using SPSS version 23 for Windows.Result: Most of respondents were male (54.1%), followed by bodyweight 1,500-2,499 grams (58.5%), and preterm labor (<32 weeks) (86.7%). The average length of stay was 21.30±19.28 days. The vast majority of infants diagnosed as Early Onset Sepsis (EONS) (89.6%). Most of the patients had normal leukocyte count (93.3%), neutrophilia (95.6%), low I/T ratio (70.4%), normal platelets (67.4%), and high procalcitonin (98.5%). The blood culture showed the most microorganism was Enterococcus faecalis (6.00%) in gram-positive bacteria.Conclusion: This study found that most of the respondents were male, followed by preterm labor, EONS, normal leukocyte count, low I/T ratio, high procalcitonin, as well as Enterococcus faecalis as the most common gram-positive bacteria.Â

Simple water quality observations in Cikapundung River from upstream to downstream to determine the quality

Cikapundung River is located through Bandung City, it’s one of stream which flow to Citarum Watershed. Several studies on conservation modelling and planning have been carried out, but there are uncompleted data about water quality of Cikapundung River, therefore study on water quality assessment is required. Data was collected in 26 points starting from upstream in Maribaya and ends in the downstream in Bojongsoang, Bandung City. Parameters that recorded are pH, temperature, conductivity and dissolved oxygen (DO). Result showed that DO levels begin to drop under 5 mg/L in 17000 meters or 17 kilometers from a upstream, the increasing of human activity of this point influenced the level of dissolved oxygen in the surface water, pH ranged from 6.7 to 9.67, while conductivity range about 66 to 410 µS/cm. Sampling locations and land use was determining factors that influenced dissolved oxygen concentration, pH and conductivity values, while climate affects temperatures around the sampling point.

Dissipative Fuzzy Filtering for Nonlinear Networked Systems With Limited Communication Links

This paper aims to design a dissipative fuzzy filter for a class of discrete-time nonlinear networked systems. In order to adopt the limited communication links, we employ an event-triggered scheme to reduce the number of transmitted data in the network by preventing the unnecessary ones from releasing. Due to the digital channel, the data to be transmitted should be quantized and a logarithmic quantizer is employed. Then, when the part of released data is transmitted in the network, data losses is captured by a Bernoulli process. Consequently, the uncomplete data sequence is compensated by the buffer and then send to the filter. During this process, a new random series is developed to help constructing the filtering systems. Thus, a novel method is presented to guarantee the filter error system to be dissipative based on the T–S fuzzy model approach. Finally, an example concerned with Henon mapping system is provided to verify the validity of the proposed design method.

El asociacionismo católico español en 1900: un intento de aproximación

Las investigaciones sobre las formas y ámbitos de sociabilidad, situadas a caballo de la antropología y la sociología, resultan una de las líneas de investigación histórica más fecundas hoy en día. En el caso de la sociedad española del último cuarto del siglo XIX el asociacionismo católico, punta de lanza del resurgir que experimentó la Iglesia durante la Restauración, es un fenómeno todavía no suficientemente valorado y necesitado de una mayor profundización. Se requieren en primer lugar monografías concretas que sean elaboradas a partir de los datos fragmentarios disponibles para reconstruir a continuación el mapa asociativo del catolicismo español. A partir de su realización podremos afrontar con más garantías una interpretación de conjunto sobre la intensidad, carácter y diversidad de las redes asociativas de la Iglesia en aquella sociedad. El estudio aquí reflejado intenta dar una aproximación al mundo asociativo católico español en el entorno del cambio de siglo a partir de la contrastación de los datos existentes con el análisis de estadísticas que apenas han sido utilizadas, y enmarcar todo este fenómeno dentro de los conflictos anticlericales de fines de siglo. Se pretende con ello despertar un mayor interés por este tema y abrir el camino de ulteriores investigaciones.

Prediction of mortality rate of trauma patients in emergency room at Cipto Mangunkusumo Hospital by several scoring systems

Background: Trauma management is well recognized as one of the main challenges in modern health care. Easy-to-use trauma scoring systems inform physicians of the severity of trauma and help them to decide the course of trauma management. The aim of this study was to find the most applicable trauma scoring system which can be used by physicians by comparing prediction of the mortality rate using: 1)triage-revised trauma score (T-RTS); 2) mechanism, Glasgow coma scale (GCS), age, and arterial pressure (MGAP); and GCS, age, and systolic blood pressure (GAP) scoring system on trauma patients in emergency room (ER) at Cipto Mangunkusumo Hospital. Methods: The data were collected retrospectively from medical records of trauma patients who came to the resuscitation area in ER at Cipto Mangunkusumo Hospital throughout 2011. As many as 185 patients were managed. The inclusion criteria were all trauma patients who came to the resuscitation area in ER. All referred patients, patients under eighteen, and uncompleted data were excluded. The data were calculated based on each scoring system. The outcome (death or alive) was collected on first 24 hours following admission. Results: There were 124 cases analyzed, with mean of age of 32.4 years and total mortality rate up to 23 cases (18.5%). The mortality rate of low risk group on T-RTS, MGAP, and GAP was 5%, 1.3%, and 1.4% respectively (p = 1.000). The mortality rate of intermediate risk group on T-RTS, MGAP, and GAP was 39.4%, 32.1%, and 36.3%, respectively (p = 0.841). Mortality rate of high risk group on T-RTS, MGAP, and GAP was 100%, 72.2%, and 85.7% respectively (p = 0.782). Conclusion: There was no difference on T-RTS, MGAP, and GAP scoring system in predicting mortality rate. T-RTS is the most applicable trauma scoring system since it does not differ the age and mechanism of trauma. (Med J Indones. 2013;22:227-31. doi: 10.13181/mji.v22i4.603) Keywords: GAP, MGAP, T-RTS, Trauma scoring system

Facoemulsificação sob anestesia tópica: série de casos

PURPOSE: To evaluate the outcome and safety of phacoemulsification performed under topical anesthesiain cases with several complexities. METHODS: Cases performed under topical anesthesia from january 2009 to april 2011 were analyzed. Variables analyzed included patients age, sex, race, systemic diseases, eyes comorbidities, type of cataract, visual acuity before and after the surgery, complications, number of conversions to peribulbar anesthesia and IOL power. Patients with uncompleted data were excluded from analysis. RESULTS: A total of 111 eyes were analyzed; only cases [...]

Foreign Direct Investment as an Instrument for promoting Economic Development in Bangladesh

A healthy financial sector is very much crucial for economic growth, especially for economies like Bangladesh. Because, growth in Bangladesh must come largely from exports and its enterprises must, therefore, be internationally competitive. But unfortunately, Bangladesh has a financial system in which borrowers fail to repay loans, foreclosure is almost unheard of, and the government has to bail out banks. However, the Foreign Direct Investment (FDI), the most powerful weapon for accelerating economic development in Bangladesh. To attain an economic growth rate in the seven to eight percent range, investment has to be increased significantly, Because of declining levels of official development assistance in recent years and inadequate domestic savings, FDI presents opportunities for overcoming domestic resource constraints. The Board of investment (BOI) was created as market mechanism where investors can cut through red-tape associated with foreign trade and business start-ups. FDI basically helps to fill-up the capital gap and shortage of a country. Foreign Direct Investment is one of the vital forces to boost up the economy. In this study paper I would like to draw a current scenario of Foreign Direct Investment in Bangladesh. In this regard I present the most updated data, avoid the uncompleted data and use the best judgment at the time of presenting the data to better knowing the current trend about the Foreign Direct Investment in Bangladesh. The benefits of FDI in terms of physical capital formation, transfer of technology, and know-how are sufficient to justify sustaining these flows. Capital controls are not the answer to a rising flow of FDI. Foreign Direct Investment (FDI) will help the country in further developing infrastructures, creating more employment, developing capacity, enhancing skills of the labour force of the host country through transferring technological knowledge and managerial capability. To ensure that resulting payments liabilities remain within the country’s debt-servicing capacity, it is essential to develop an effective non-intrusive reporting and monitoring system the main ingredients of which are presented in the study. JEL Classification Code: G11, O24

PP050. Distribution of ABO and Rhesus blood groups in patients withpre-eclampsia

The ABO-system of antigens and the Rh-system (D-antigen) is genetically determined and remains the most important blood group systems clinically. Several studies have examined the association between ABO and Rhesus blood group systems and pre-eclampsia. At present there is no consensus to define this association, especially not in a Brazilian population. The purpose of the present study was to evaluate the association between pre-eclampsia versus ABO and Rhesus blood group systems in pregnant women hospitalized in a University Hospital in Porto Alegre, Brazil -Hospital São Lucas (HSL). Pre-eclampsia/eclampsia (PE/E) was diagnosed by the National High Blood Pressure Education Program Working Group Report on High Blood Pressure in Pregnancy guidelines. This study consisted of 14,894 pregnant women admitted to the Maternity Department between 2005 and 2010. The patients were reviewed retrospectively for inclusion. Complications in pregnancy not related to pre-eclampsia/eclampsia (PE/E) and those with uncompleted data were excluded. Medical records of 410 women were used to diagnose PE/E. The control group consisted of 8781 women. Each group was subdivided according to their blood groups. In comparison to the PE/E women and controls, no specific relation in blood groups was observed. With respect to ABO and Rh groups, no differences between PE/E and controls were observed (P=0.479 and P=0.169 respectively). When analyzed with both Rh and ABO Pearson Chi-Square also showed no differences (P=0.569). This study aimed to demonstrate some association between blood groups and PE/E using a large sample from the south of Brazil, a population not investigated before. In our study, no specific differences were observed between PE/E and controls in the distribution of the blood groups. In conclusion, the results of this study suggest no association between ABO and Rhesus blood group systems and PE/E in our population. CAPES Foundation-Ministry of Education of Brazil.

Simulation and Validation of Non-point Source Nitrogen and Phosphorus Loads under Different Land Uses in Sihu Basin, Hubei Province, China

Abstract Many water quality models have been extensively used to evaluate non-point source pollution, such as SWMM (Storm Water Management Model), AnnAGNPS (Annualized Agricultural Non-point Source), HSPF (Hydrological Simulation Program– Fortran), SWAT (Soil and Water Assessment Tool) and so on. However, these models’ construction tended to be complex, only used well in the condition of many parameters and normative data can be obtained. There were much problem to use these models in tidal plain, where topography were flat, stream network were complex and controlled by many water conservancy systems. The L-THIA (Long-Term Hydrologic Impact Assessment) model can be used in the areas with uncompleted data, evaluate the effects of land use on non-point source pollution, because it only needs land use, soil types and some rainfall data. But the output results of L-THIA model are the annual average runoff volume and pollution load, which cannot be obtained easily in in-site observation. In this paper, one of typical tidal plain, Sihu basin in Hubei province of China, was studied. The annual average runoff volume and the non-point source nitrogen and phosphorus load of each grid (16m*16m) and the spatial distribution were estimated by L-THIA model. The average load of non-point source nitrogen and phosphorus at each exit of the units were calculated based on the suppose that the pollution load is inverse to the distance of water flow. Model validation was executed by comparing calculated results and observed water quality data for study area. The results demonstrated that there were highly significant linear correlation between the calculated average load of non-point source nitrogen and phosphorus and the measured concentrations of TP and TN (TN: R=0.828; TP: R=0.957). These suggested that the average load of non-point source nitrogen and phosphorus were reliable to evaluate non-point source pollution. Moreover, the simulation results illustrated that the non-point source nitrogen and phosphorus loads under different land uses were quite different. The impact of dry lands on the non-point source nitrogen and phosphorus was the highest; that of paddy fields and residential areas were secondary; and the impact of woodlands to non-point source nitrogen and phosphorus was the minimum.

La discapacidad como barrera a la adherencia terapéutica en pacientes pluripatológicos: papel del cuidador principal

Objectives To determine which social and individual factors may predict adherence to medication in patients with more than two chronic symptomatic diseases (polypathological patients) under polypharmacy. Methods Cross-sectional observational study. In a primary care area assigned to our teaching hospital 265 patients with multiple chronic diseases and polypharmacy were recruited over a 6 month period. 84 patients with uncompleted data or died before finishing our study were excluded. An structured interview performed by a investigator different from responsible physicians was used. Drug adherence was assessed by a subjective method. Results Disability measured by Barthel index was was the main predictor of drug adherence. Patients without carer support and Barthel Index lower than 100 showed the poorer drug adherence. In the later group number of drugs also affected adherence. However, in patients with carer available, medication adherence was better, mostly in more disabled ones, and unaffected by other factors. Conclusions In patients with multiple chronic diseases, social support by a carer may allow disabled patients to overcome the barrier of disability leading to a better drug adherence, even than non-disabled ones. These findings may help to design future prospective studies on medication adherence performed in this peculiar frail population.

Causes of postreperfusion syndrome in living or cadaveric donor liver transplantations

ObjectiveThe postreperfusion syndrome (PRS) occurence was evaluated in patients undergoing liver transplantation in our institution to determine the relationship between PRS and associated variables. MethodOf the 185 consecutive liver transplants, pediatric patients, patients with uncompleted data or retransplantations were excluded. The remaining 145 adult patients having 77 cadaveric and 68 living donor right lobe liver transplantations were studied. PRS was defined as a decrease in mean arterial pressure >30% below the baseline value. Logistic regression was used for statistical analyses. A P value <.05 was considered as significant. ResultsTotal rate of PRS occurence was 48.9% (71 patients) for the 145 patients. Logistic regression analyses revealed a significant relationship between the PRS and four of the variables: shorter duration of the anhepatic period, higher mean calcium requirement, higher mean heart rate difference from anhepatic to reperfusion period and lower central venous pressure at the dissection period during operations (P < .05). We could not demonstrate any significant effect of the operation type-surgical technique and duration of operations, blood and fresh frozen plasma volume transfused, demographic variables of the recipients, donor liver factors, other haemodynamic and metabolic variables at specific time periods (P > .05). ConclusionIn conclusion, it is important that PRS does not seem to occur in a predictable manner in this study except for the increased calcium requirements during the operations in PRS experienced patients. The clinical parameters as graft ischemia time, the type of the operation, demographic variables of the recipient, hemodynamic or metabolic variables and transfusion needs during the operations seemed to have no contribution to PRS occurrence.

PREDIKSI PENINGKATAN KADAR HB PADA ANAK BAWAH TIGA TAHUN ANEMIA SETELAH MENDAPAT INTERVENSI ZAT BESI DI DESA PAGELARAN, CIOMAS, BOGOR

PREDICTION OF HAEMOGLOBIN ELEVATION IN ANEMIA CHILDREN UNDER THREE YEARS AFTER IRON-INTERVENTION A STUDY FROM VILLAGE OF PAGELARAN SUB DISTRICT OF CIOMAS BOGOR. Background: Anenia is one of four nutrition problems in Indonesia. Impact of anemia in children 6-36 months (underthree children) related to their growth and development Program to combat the problem has been made, however data on the effect of such program on haemoglobin improvement are scarce. Objective: To elaborate the effects of oral iron 70 mg given weekly for four months intervention to children 6-36 months old whom suffers from anemia on changes of haemoglobin (Hb). Method: A four months follow up study on iron intervention to anemic children underthree years old had been carried out in the village of Pagelaran, Subdistrict of Ciomas, Bogor in 1999. The anemic children (<10 g%) screened from monthly weighing activity (POSYANDU). The parents consented to participate in tns study and allowed the author taken blood from finger tip of the children. A number of 58 out of 67 records had been performed. The rest dropped due to the uncompleted data; six children were believed not taken the all given iron and three children moved out the village. All children received 70 mg iron powder mixed with 40 mg Vitamin C and 40 mg Folic Acid weekly. Execution of this scheme was supervised every two weeks. Conclusions: There was improvement in haemoglobin level of the children 7-35 months of age after oral iron supplementation weekly for four months. Recommendations: To combat anemia in children 7-35 months of age, a weekly supplementation of iron as much as 70 mg together with 40 mg vitamin C and 40 mg folic acid is recommended as one of the alternative intervention. Key Words: haemoglobin, anemia, iron-intervention, underthree-years children