scholarly journals (P2-25) Evaluation of the Apache III Grading System in Predicting the Prognosis and Mortality of Patients Admitted to Emergency Room, in Need of Intensive Care Unit Admission

2011 ◽  
Vol 26 (S1) ◽  
pp. s143-s144
Author(s):  
H. Hatamabadi ◽  
P. Darbandsar ◽  
A. Abdalvand ◽  
H. Kariman ◽  
A. Arhamidolatabadi
Keyword(s):  
Mortality Rate ◽  
Scoring System ◽  
Mortality Rates ◽  
Cross Sectional ◽  
Lengths Of Stay ◽  
Apache Iii ◽  
Study Results ◽  
Significant Difference ◽  
Critical Patients ◽  
One Year

ObjectivesMany of critically ill patients are being cared for prolonged periods in ED just because of limited number of ICU beds and utilize of ED as the entry point to the health care system. The aim of this study is evaluation efficiency of APACHE III scoring system in predicting mortality rate of the mentioned patients.Materials and MethodsThis cross-sectional, observational, analytic study was performed in one year period. A hundred patients remaining in ED and necessitating ICU hospitalizing were enrolled by the convenience type of non-probability sampling. Then, the APACHE III scores, predicted and observed mortality rates were calculated using of information obtained from patients' files, interview with the patients' family and performing required physical exams and lab tests.ResultsIn the assessment of 100 patients, men group were 56% (56) and women group 44% (44). The age of patients and the ED lengths of stay were 66.07 ± 19.92 years and 5.11 ± 3.79 days respectively. The average (± SD) of APACHE III score of the enrolled patients was 58.89 ± 18.24 and the predicted mortality rate calculated 32.73%; while, the total of observed mortality rate was 55%. The average (± SD) of APACHE III score of survivors and non-survivors were 48.63 ± 16.35 and 67.63 ± 14.84 respectively. So, there was a significant deference (p < 0.001). Also, there was a significant deference in the ED lengths of stay between survivors and non-survivors (3.20 ± 1.34 and 6.57 ± 4.40 respectively, p < 0.001).ConclusionIn our study, APACHE III score and ED lengths of stay were higher versus other studies in Iran and other countries; which show more critical patients presenting to our hospital and limited ICU beds versus patients. This study results nevertheless there was significant difference between predicted and observed mortality rates, the APACHE III scoring system is applicable to evaluating care, treatment and prognosis of ED patients, as is used in ICU.

scholarly journals Evaluation of P- POSSUM Scoring System in Patients Undergoing Emergency Laparotomy

2017 ◽  
Vol 16 (2) ◽  
pp. 28-36
Author(s):  
Manoj Kumar Jha ◽  
Yahun Chandra Sibakoti ◽  
Harihar Devkota
Keyword(s):  
Risk Factors ◽  
Mortality Rate ◽  
Prospective Study ◽  
Scoring System ◽  
Emergency Laparotomy ◽  
Mortality And Morbidity ◽  
Operative Severity Score ◽  
Significant Difference ◽  
One Year ◽  
Operative Findings

Introduction: The Physiological and Operative Severity Score for the enumeration of Mortality and morbidity (POSSUM) and its modification the Portsmouth POSSUM (P-POSSUM), have been proposed as a method for standardizing patient data so that direct comparisons can be made despite differing patterns of referral and population. In this prospective study, the validity of P-POSSUM was tested in patients undergoing emergency laparotomy and the risk factors for low outcome were noted.Methods: This is the Prospective Study and was conducted in Department of surgery, of a tertiary level hospital. The study period was from April 2014- April 2015 for one year. Patients admitted under department of general surgery scheduled to undergo emergency laparotomy were included and scored according to their physiological and operative findings using a proforma sheet. Physiological scoring was performed just before surgery and operative scoring was carried out intra-operatively. Patients were followed-up for the first 30 days postoperative period. The observed mortality rate was compared with the P-POSSUM predicted mortality rate. Data analysis was done using SPSS 20.Results: A total of 60 patients who met the inclusion criteria were included in this study. On applying linear analysis, an observed to expected ratio of 1.18 was obtained, indicating a significant fit for predicting the post-operative adverse outcome. There was no significant difference between the observed and predicted mortality rates (x2 = 1.467, 4 df., P = 0.833). It was found to be comparable to other studies. In all the risk factors studied, a positive correlation was found between deaths and higher POSSUM scores.Conclusion: Portsmouth POSSUM scoring system serves as a good predictor of post-operative outcome in emergency laparotomy procedures.

scholarly journals COVID19 EN POBLACIÓN RESIDENTE DE ZONAS GEOGRÁFICAS A ALTURAS SUPERIORES A 2500 m.s.n.m.

SITUA ◽  
2020 ◽  
Vol 23 (1) ◽  
pp. 16
Author(s):  
Anahi Cardona Rivero ◽  
Manuel Montoya
Keyword(s):  
Mortality Rate ◽  
Sea Level ◽  
Descriptive Study ◽  
Mortality Rates ◽  
Wilcoxon Test ◽  
Cross Sectional ◽  
A Value ◽  
Significant Difference ◽  
The Difference ◽  
Population Numbers

RESUMEN. -El objetivo del estudio fue evaluar las tasas de mortalidad por COVID19 en las regiones a alturas superiores de 2500 m.s.n.m. en comparación a las tasas de mortalidad por COVID19 de los países respectivos. Para lo cual se realizó un estudio de tipo descriptivo transversal comparativo, se revisaron 20 regiones de 7 países con ciudades de más de 100 000 habitantes que se encuentran por encima de 2500 m.s.n.m. Se registraron los casos de fallecidos por COVID19, cantidad de población y las tasas de mortalidad al 30 de abril del 2020. Los resultados de las tasas de mortalidad fueron evaluados con pruebas de normalidad Kolmogorov y Smirnov y Shapiro Wilk. Para evaluar la diferencia entre las medias de las tasas de mortalidad se utilizó la prueba de Wilcoxon con signos para muestras relacionadas se trabajó a un nivel de confianza del 95%, obteniendo un valor de p= 0,015 < 0,05; que demuestra la diferencia estadísticamente significativa. Se concluye que el COVID19 presenta menores tasas de mortalidad en zonas geográficas con alturas superiores a 2500 m.s.n.m.Palabras clave: altura, 2500 m.s.n.m., COVID19, tasa de mortalidad.ABSTRACTThe objective of the study was to evaluate the mortality rates by COVID19 in the regions at altitudes higher than 2500 m.s.n.m., compared to the mortality rates by COVID19 of the respective countries. For this purpose, a comparative cross-sectional descriptive study was carried out, reviewing 20 regions of 7 countries with cities of more than 100,000 inhabitants that are above 2500 meters above sea level. Cases of deaths due to COVID19, population numbers and mortality rates as of April 30, 2020 were recorded. The results of the mortality rates were evaluated with Kolmogorov and Smirnov and Shapiro Wilk normality tests. To evaluate the difference between the means of mortality rates, the Wilcoxon test with signs for related samples was used at a 95% confidence level, obtaining a value of p= 0.015 < 0.05; which demonstrates the statistically significant difference. It is concluded that the COVID19 presents lower mortality rates in geographical areas with altitudes higher than 2500 meters above sea levelKeywords: altitude, 2500 m.s.n.m., COVID19, mortality rate

COMPARISION OF DENTAL SCORING SYSTEM WITH RADIOGRAPHIC SKELETAL SYSTEM IN AGE ESTIMATION

JKCD ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. 9-11
Author(s):  
Sadaf Ambreen
Keyword(s):  
Age Estimation ◽  
Scoring System ◽  
Skeletal Age ◽  
Chronological Age ◽  
Age Group ◽  
Dental Age ◽  
Scoring Method ◽  
Cross Sectional ◽  
Study Results ◽  
Male Subjects

Objectives: To compare Demirjian Dental scoring method with Greulich-Pyle (GP) Skeletal method of age estimation in pubertal children. Materials and Methods: Sample of the study included 267 male healthy subjects of 11-16 years of age group.. Demirjian Scoring system was utilized to evaluate the orthopantomograms to assess their Dental age and the Hand-Wrist radiographs were analyzed to calculate the skeletal age by utilizing GP atlas. Chronological age was obtained from the date of birth of the subject .Both methods were compared with one another and with the chronological age. It was a cross-sectional study and only healthy male subjects without any clinical abnormalities were included in the study. Results: A total of 267 male subjects of 11-16 years of age group were assessed by Demirjian and Greulich Pyle Methods. Both were compared with Chronological Age. Data obtained was statistically analyzed and the Student “t” test was applied in the study population. The mean difference between Chronolgical age and dental age was 0.69years and that of chronological age and skeletal age was 0.87 years. It was observed from dental age assessment that it does not differ much from the skeletal age. Conclusion: It was concluded that Demirjian method of Age Estimation is more precise than Greulich Pyle method of Age Estimation. Furthermore both methods can be used selectively in Medicolegal cases to access bone age which can be easily correlated to chronological age.

Renal Phosphate Handling in Antiretroviral-naïve HIV-infected Patients

2020 ◽  
Vol 20 ◽  
Author(s):  
Tewogbade Adeoye Adedeji ◽  
Simeon Adelani. Adebisi ◽  
Nife Olamide Adedeji ◽  
Olusola Akanni Jeje ◽  
Rotimi Samuel Owolabi
Keyword(s):  
Hiv Infection ◽  
Plasma Phosphate ◽  
Cross Sectional ◽  
Phosphate Retention ◽  
Significant Difference ◽  
Immunodeficiency Virus ◽  
Life Threatening ◽  
Moderate Chronic Kidney Disease ◽  
One Year ◽  
Sectional Analysis

Background: Human immunodeficiency virus (HIV) infection impairs renal function, thereby affecting renal phosphate metabolism. Objectives: We prospectively estimated the prevalence of phosphate abnormalities (mild, moderate to life-threatening hypophosphataemia, and hyperphosphataemia) before initiating antiretroviral therapy (ART). Methods: A cross-sectional analysis was performed on 170 consecutive newly diagnosed ART-naïve, HIV-infected patients attending our HIV/AIDS clinics over a period of one year. Fifty (50) screened HIV-negative blood donors were used for comparison (controls). Blood and urine were collected simultaneously for phosphate and creatinine assay to estimate fractional phosphate excretion (FEPi %) and glomerular filtration rate (eGFR). Results: eGFR showed significant difference between patients’ and controls’ medians (47.89ml/min/1.73m2 versus 60ml/min/1.73m2, p <0.001); which denotes a moderate chronic kidney disease in the patients. Of the 170 patients, 78 (45.9%) had normal plasma phosphate (0.6-1.4 mmol/L); 85 (50%) had hyperphosphataemia. Grades 1, 2 and 3 hypophosphataemia was observed in 3 (1.8%), 3 (1.8%), and 1(0.5%) patient(s) respectively. None had grade 4 hypophosphataemia. Overall, the patients had significantly higher median of plasma phosphate than the controls, 1.4 mmol/L (IQR: 1.0 – 2.2) versus 1.1 mmol/L (IQR: 0.3 – 1.6), p <0.001, implying hyperphosphataemia in the patients; significantly lower median urine phosphate than the controls, 1.5 mmol/L (IQR: 0.7 -2.1) versus 8.4 mmol/L (IQR: 3.4 – 16), p <0.001), justifying the hyperphosphataemia is from phosphate retention; but a non-significantly lower median FEPi% than the controls, 0.96 % (IQR: 0.3 -2.2) versus 1.4% (IQR: 1.2 -1.6), p > 0.05. Predictors of FEPi% were age (Odds ratio, OR 0.9, p = 0.009); weight (OR 2.0, p < 0.001); CD4+ cells count predicted urine phosphate among males (p = 0.029). Conclusion: HIV infection likely induces renal insufficiency with reduced renal phosphate clearance. Thus, hyperphosphataemia is highly prevalent, and there is mild to moderate hypophosphataemia but its life-threatening form (grade 4) is rare among ART-naïve HIV patients.

Impact of the period of the day on mortality and major cardiovascular complications after vascular surgeries

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
F.A.M Cardozo ◽  
T Artioli ◽  
B Caramelli ◽  
D Calderaro ◽  
P.C Yu ◽  
...  
Keyword(s):  
Multivariable Analysis ◽  
Total Mortality ◽  
Mortality Rates ◽  
Cardiovascular Complications ◽  
Cardiac Complications ◽  
Funding Source ◽  
Confounding Variables ◽  
Significant Difference ◽  
One Year ◽  
Night Period

Abstract Introduction Patients submitted to arterial vascular surgeries are at a high risk of postoperative cardiac and non-cardiac complications, therefore developing strategies to lower perioperative complications is essential to optimize outcomes for this subgroup. Recent studies have suggested that the period of the day in which surgeries are performed may influence postoperative major cardiovascular complications but there is still no evidence of this association in vascular surgeries. Purpose Our goal is to evaluate whether the period of the day in which surgeries are performed may influence mortality and cardiovascular outcomes in patients undergoing non-cardiac vascular procedures. Methods Patients who underwent non-cardiac vascular surgeries between 2012 and 2018 were prospectively included at our cohort. For this analysis, subjects were categorized into two groups: those who underwent surgery in the morning (7am - 12am) and those who underwent surgery in the afternoon/night (12:01pm - 6:59am). The primary endpoints were to compare the incidence of major adverse cardiac events (MACE - acute myocardial infarction, acute heart failure, arrhythmias, and cardiovascular death) and total mortality between morning and afternoon/night surgeries within 30 days and one year. The secondary endpoint was the incidence of perioperative myocardial injury (PMI) in both groups. PMI was defined as an absolute elevation of high-sensitivity cardiac troponin T (hs-cTnT) concentrations ≥14ng/L. Multivariable analysis using Cox proportional regression (with Hazard Ratio – HR and Confidence Interval – 95% CI) was performed to adjust for confounding variables, including emergency and urgent surgeries. Results Of 1267 patients included, 1002 (79.1%) underwent vascular surgery in the morning and 265 (20.9%) in the afternoon/night. After adjusting for confounding variables, the incidence of MACE at 30 days was higher among those who underwent surgery in the afternoon/night period (37.4% vs 20.4% – HR 1.43, 95% CI: 1.10–1.85; p=0.008). Mortality rates were also elevated in the afternoon/night group (21.5% vs 9.9%, HR 1.59, 95% CI: 1.10–2.29; p=0.013). After one-year of follow-up the worst outcomes persisted in patients operated in the afternoon/night: higher incidence of MACE (37.7% vs 21.2%, HR 1.37, 95% CI: 1.06–1.78; p=0.017) and mortality (35.8% vs 17.6%, HR 1.72, 95% CI 1.31–2.27; p&lt;0.001). There was no significant difference in the incidence of PMI between groups (p=0.8). Conclusions In this group of patients, being operated in the afternoon/night period was independently associated with increased mortality rates and incidence of MACE. Mortality and MACE at one year Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): FAPESP - Fundação de Amparo a Pesquisa do Estado de São Paulo

scholarly journals Evaluation of Patient Experience During Virtual and In-Person Urgent Care Visits: Time and Cost Analysis

2021 ◽  
Vol 8 ◽  
pp. 237437352098148
Author(s):  
Saif Khairat ◽  
Xi Lin ◽  
Songzi Liu ◽  
Zhaohui Man ◽  
Tanzila Zaman ◽  
...  
Keyword(s):  
Patient Experience ◽  
Care Delivery ◽  
Turnaround Time ◽  
Cross Sectional Study ◽  
Emergency Department Visits ◽  
Urgent Care ◽  
Cross Sectional ◽  
Significant Difference ◽  
Virtual Visits ◽  
One Year

Urgent care (UC) is one of the fastest growing venues of health care delivery for nonemergent conditions. This study compared the patient experience during virtual and in-person urgent care visits. We conducted a cross-sectional study of patients with the same diagnosis during Virtual Urgent Care (VUC) and in-person UC visits with the same diagnosis with regard to time and cost over a period of one year. We recorded and analyzed 16 685 urgent care visits: In-person UC (n = 14 734), VUC (n = 1262). Significant differences were found in the average total time for a visit in an in-person UC (70.89 minutes), and VUC (9.38 minutes). The average total cost of VUC ($49) and in-person UC ($142.657) differed significantly. Significant difference was found between UC turnaround time and VC turnaround time (Dependent variable (DV): 53.77, P < .01). We found significant differences in cost and time between in favor of virtual visits. Our findings suggest additional policy reform to expand the use of virtual care among target populations to improve access, reduce costs, meet the needs of patients, and reduce emergency department visits.

scholarly journals Severity and prognosis in intensive care: prospective application of the Apache II Index

1999 ◽  
Vol 117 (5) ◽  
pp. 205-214 ◽  
Author(s):  
Joel Isidoro Costa ◽  
José Luiz Gomes do Amaral ◽  
Masashi Munechika ◽  
Yara Juliano ◽  
José Gomes Bezerra Filho
Keyword(s):  
Intensive Care ◽  
Mortality Rate ◽  
Elective Surgery ◽  
Tertiary Care ◽  
Prognostic Index ◽  
Clinical Severity ◽  
Apache Ii ◽  
Sample Population ◽  
Significant Difference ◽  
Critical Patients

CONTEXT: The performance of each ICU needs to be assessed within the overall context of medical care, as well as by the institution which the ICU forms part of. Evaluation mechanisms in the field of intensive care have been developed that are recognized worldwide within the scientific literature. OBJECTIVE: To study outcomes from groups of critical patients and to compare their actual and estimated mortality rates. DESIGN: Prospective study of patients' outcomes. SETTING: A tertiary care unit for a period of 13 months (anesthesiology intensive care unit at the Escola Paulista de Medicina). PARTICIPANTS: 520 patients selected according to sex, age and nature of hospitalization. DIAGNOSTIC TEST: The modified APACHE II prognostic index was applied in order to assess clinical severity and anticipation of mortality in three groups who had non-surgical treatment, emergency surgery and elective surgery. MAIN MEASUREMENTS: The APACHE II index. RESULTS: The application of this index allowed patients to be stratified and expected death risks for both subgroups and the entire sample population to be calculated. The observed mortality rate was greater than the expected rate (28.5% versus 23.6%, respectively), with a statistically significant difference. The standardized mortality rate was 1.20. Patients who obtained scores above 25 presented a significant outcome towards death. The most severe and worst evolving cases were, in decreasing order: non-surgical, emergency surgical and scheduled surgical patients; the actual general mortality rate was higher than the expected one. CONCLUSIONS: The use of the APACHE II index made it possible to stratify critical patient groups according to the severity of their condition.

scholarly journals ULTRASOUND;

2012 ◽  
Vol 19 (02) ◽  
pp. 187-192
Author(s):  
EJAZ HUSSAIN SIDDIQUI ◽  
SAAD SIDDIQUI ◽  
NOREEN SHAH
Keyword(s):  
Pediatric Population ◽  
Adult Population ◽  
Age Groups ◽  
X Rays ◽  
Geriatric Population ◽  
Cross Sectional ◽  
Study Results ◽  
Significant Difference ◽  
Ultrasound Findings ◽  
Hepatobiliary Diseases

Objectives: To assess common presenting features and the role of Ultrasound in evaluation of Hepatobiliary diseases in ourpopulation. Design: Cross sectional study. Setting: Khyber X rays, Khyber Medical Centre, Peshawar. Period: August 2010 to December2010. Material and Methods: Data from patients presenting for evaluation of Hepatobiliary diseases was analyzed for presenting complaintsand ultrasound findings according to objectives of the study. Results: In total 197 cases were included in the study. The age wise categorizationincluded pediatric population (6.1%) adult population (87.3%) and geriatric population (6.6%). Upper abdominal pain was the most commonpresenting feature in all age groups as well as in both genders. Cholelithiasis with or without cholecystitis was the most common ultrasoundfinding in all age groups. No statistically significant difference was found between presenting features or ultrasound findings in different agegroups as well as across gender. Conclusions: Hepatobiliary diseases are among major illnesses in our region. Ultrasound is a sensitive anduseful tool for screening and evaluation of Hepatobiliary disorders.

scholarly journals Differences in Surgical Outcome in Near Total Thyroidectomy for Benign Nodular Goiter: A Comparison of LigaSure Vessel Sealer versus Conventional Clamp Knot Tie Technique

2021 ◽  
pp. 65-69
Author(s):  
Shiraz Shaikh ◽  
Champa Sushel ◽  
Ahsan Ali Laghari ◽  
Qamber Ali Laghari ◽  
Zameer Hussain Laghari ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Total Thyroidectomy ◽  
Calcium Level ◽  
Operative Time ◽  
Nodular Goiter ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Post Operative Pain ◽  
Significant Difference ◽  
One Year

Objective: To compare the efficacy of LigaSure Vessel Sealer in Near Total Thyroidectomy versus Conventional Clamp Knot Tie Technique in terms of bleeding, operative time and postoperative drainage. Methodology: This comparative cross sectional study was conducted at Department of Surgery, Liaquat University of Medical and Health Sciences, Jamshoro. Study duration was one year from November 2019 to October 2020. All patients of any age with benign multinodular goiter and either of gender were included. The study subjects were grouped into two categories by randomization (odd / even). The odd numbers were given to patients operated for ligasure and even numbers were given to patients operated with conventional clamp knot tie technique.  Outcomes were observed with respect to post-operative calcium level, intra-operative bleeding, operative time, post-operative pain & post-operative hospital stay. All the data was recorded via study proforma. Data was analyzed by using SPSS version 20. Results: Total 55 patients were observed. Mean age was 33.25±10.60 years in clamp knot tie procedure group and 35.16±07.96 years in ligasure technique group; without significant difference (p-0.448). Pre and post-operative calcium levels were statistically insignificant among both groups (p-0.358 and 0.163), while loss of blood, hospital stay, post-operative pain and operative duration were significantly greater in clamp knot tie technique group in comparison to ligasure technique group (p-<0.001). Conclusion: LigaSure Vessel Sealer is a feasible and reliable surgical technique and significantly more effective as compared to conventional clamp knot tie technique in terms of post-operative bleeding, operative time, post-operative pain and post-operative hospital stay. However, calcium level was statistically insignificant.

scholarly journals An analytical study of prevalence of ear disorders and their risk factors among children in a resettlement colony of Delhi

2021 ◽  
Vol 8 (3) ◽  
pp. 13-19
Author(s):  
Gupta Kalika ◽  
Gourav Kumar Goyal ◽  
Akshay Berad
Keyword(s):  
Risk Factors ◽  
Hearing Loss ◽  
Educational Status ◽  
School Age Children ◽  
Cross Sectional ◽  
Total Prevalence ◽  
Study Results ◽  
Group 5 ◽  
One Year ◽  
Associated Risk Factors

Background: The world has more than 360 million population (almost 5% of world’s population) with disabling hearing loss and among them, 32 million are children. It is estimated that over 166 million people in the developing world face a severe lack of intervention services for hearing loss. There is a need to estimate the magnitude of various ear morbidities in school age children as well as to identify the various risk factors that play a role in the emergence of these morbidities. Aim: To find prevalence of various ear disorders and their risk factors among children 5-11 years old. Methodology: It was a cross-sectional, community based study conducted at a resettlement colony named Gokulpuri, in East Delhi. Study was conducted for a period of one year, Jan 2017 – Dec 2017. Children in the age group 5 yrs. to 11 yrs. were included in the study. Results: Total prevalence of ear morbidities in children was found to be 15.8%. Wax impaction in the ears was found to be most prevalent morbidity 10.6%. Educational status of mother and head of the family, immunization status of child, history of slapping trauma and coryza were among the associated risk factors. Exclusive breast feeding was statistically insignificantly associated

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