Managing dyspnea in pregnancy-an errand uphill: an experience from the critical care obstetric unit of a tertiary care facility in India

Background: The occurrence of dyspnea in a gravid woman induces the query in the treating obstetrician regarding its root cause being either underlying or new cardiac or pulmonary disease, or due to the pregnancy itself. Attainment to this conclusion requires grasp of the cardiopulmonary changes befalling during normal pregnancy, as well as detection of the ailment of dyspnea during antenatal period. Objective of present study was to find out the incidence and feto-maternal outcome of patients presenting with dyspnea in pregnancy and puerperium.Methods: This study was conducted in Department of Obstetrics and Gynaecology in Vardhaman Mahavir Medical College and Safdarjung hospital over a period of one year, wherein review of all women who had presented with a diagnosis of dyspnea in pregnancy and puerperium, and admitted and treated in the Critical care obstetric unit of the department was done. Thorough evaluation was done and case files were exhaustively reviewed, data was anonymously extracted, and outcomes analyzed. All causes of mortality were also recorded. The primary outcome was incidence of dyspnea in pregnancy. Secondary outcomes measured were socio-demographic variables, timing of presentation-antepartum=first trimester, second trimester, third trimester/postpartum<48 hours, 3-7 days,>7 days, causative factors for dyspnea, any other obstetric complications, mode of delivery, fetal outcome (fetus weight, Apgar score, need for NICU admission), need for ICU/HDU admission, duration and course in the hospital, mortality, and cause of death in case of mortality. Data recording was done on a predesigned proforma and deciphered at the end of study and analyzed.Results: Incidence of dyspnea was 1.97% of all admissions. Pulmonary edema following hypertensive disorders of pregnancy, was the leading cause. 28.5 % women succumbed to their illness. Majority were preterm births (88/112), requiring NICU admission.Conclusions: The clinician should be able to determine the underlying cause of dyspnea, differentiating it from physiologic progesterone-induced hyperventilation. Strategy of expeditious delivery during the third trimester is often warranted after weighing fetal outcome and maternal risk in such women.

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Fever in pregnancy and its maternal and fetal outcomes

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20175273 ◽

2017 ◽

Vol 6 (12) ◽

pp. 5523

Author(s):

Vibha S. More

Keyword(s):

Tract Infection ◽

Cohort Analysis ◽

Tertiary Care ◽

Fetal Distress ◽

First Trimester ◽

Fetal Outcome ◽

Third Trimester ◽

Tertiary Care Centre ◽

Fetal Outcomes ◽

In Pregnancy

Background: Contemporary obstetrics has witnessed improved maternal and fetal outcomes, owing to several advances. Any source of maternal hyperthermia that results in significant core temperature increase (>38.9°C), could potentially affect the fetus. Hence a study was planned to know the effect of fever on maternal and fetal outcome.Methods: This was a retrospective cohort analysis of case-records, of patients admitted in the Department of Obstetrics and Gynecology at tertiary care centre, Mumbai, between May 2007 and October 2009. The main parameters of assessment included incidence of fever in pregnancy, causes of fever, effect of episode(s) of fever on maternal and fetal outcomes, effect of specific infection on maternal and fetal outcomes, impact of fever on antepartum, intrapartum and postpartum phasesResults: The incidence of fever was 10.5%. the common cause of fever was malaria (15%), urinary tract infection (14%), viral (14%), respiratory tract infection (18%), and typhoid (7%). Seventy eight percent had fever in third trimester. The most common antenatal complication observed was preterm (13%), premature rupture of membrane (12%), oligohydramnios (8%), intrauterine growth retardation (26%). The rate of LSCS was 13% in study group and the most common indication was fetal distress and meconium stained amniotic fluid.Conclusions: In the present study on fever during pregnancy and its maternal and fetal outcomes, fever was associated with a definite impact on maternal and fetal outcomes. Preterm and IUGR were the most common fetal complications. Duration of fever was linearly associated with poor outcomes. Different causes of fever also had different impact on maternal and fetal outcome. Preterm IUGR, MSAF were more common with malaria and tuberculosis. Abortion was more commonly seen in first trimester fever, whereas preterm, PROM in the third trimester fever. Hence it is suggested that fever during pregnancy needs to be promptly investigated and treated to have a better outcome.

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P152590 DAY MORTALITY DATA OF PATIENTS INITIATING MAINTENANCE HEMODIALYSIS AT A TERTIARY CARE FACILITY IN PAKISTAN

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1525 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Sonia Asif ◽

Mohammad Saleem ◽

Ahad Qayyum

Keyword(s):

Mortality Rate ◽

Vascular Access ◽

Tertiary Care ◽

Care Facility ◽

High Rate ◽

Maintenance Hemodialysis ◽

Mortality Data ◽

Tertiary Care Facility ◽

Town Hospital ◽

Dialysis Vintage

Abstract Background and Aims Mortality of end stage renal disease patients is 10 to 30 times higher than that of the general population. Timing of death related to dialysis vintage remains unclear. Mortality risk among hemodialysis patients may be highest soon after initiation of hemodialysis, the reason for which remains elusive. Additionally mortality on initiating hemodialysis is related to arteriovenous vascular access. Poor planning for dialysis initiation may contribute to hemodialysis catheter use and the associated high rate of infections. This study was carried out to determine the 90-day mortality in patients starting maintenance hemodialysis at a tertiary care facility in Pakistan. Method This is a cross sectional study which included all consecutive patients who initiated maintenance hemodialysis at Bahria Town Hospital Lahore. A total of 485 participants were included and the collected data was entered into the SPSS software and their mortality rate was calculated within 90 days after initiation of maintenance hemodialysis. Additionally 90-day mortality based on type of vascular access at initiation was also noted. Results The mean age of the participants included in the study was 44 with 50% of the patients were male. The 90-day mortality of patients initiating maintenance hemodialysis at our centre was found to be 37%. 90% of the patients initiating maintenance hemodialysis started through a double lumen temporary dialysis catheter. Amongst these patients the mortality rate was 39%. 10% of the patients initiating maintenance hemodialysis started through an arteriovenous fistula. Amongst these the mortality rate was 19%. Conclusion Our study showed that the mortality rate is high in patients undergoing hemodialysis with in first 90 days. Early planning for permanent vascular access may result in a reduction of mortality.

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Mortality in Patients with Primary Unipolar Depression, Secondary Unipolar Depression, and Bipolar Affective Disorder: A Comparison with General Population Mortality

The International Journal of Psychiatry in Medicine ◽

10.2190/vl1b-7yee-91j5-mwra ◽

1988 ◽

Vol 17 (4) ◽

pp. 351-360 ◽

Cited By ~ 14

Author(s):

Donald W. Black ◽

George Winokur ◽

Amelia Nasrallah

Keyword(s):

Affective Disorder ◽

Bipolar Affective Disorder ◽

Tertiary Care ◽

Geographical Area ◽

Care Facility ◽

Unipolar Depression ◽

Mortality Data ◽

Initial Portion ◽

Tertiary Care Facility

Mortality data are presented from a two to fourteen year follow-up of 705 primary unipolar depressives, 302 secondary unipolar depressives, and 586 patients with bipolar affective disorder (BAD) hospitalized at a tertiary care facility. Death ascertainment was made through a record-linkage process. Using sex- and age-standardized mortality ratios (SMRs), the mortality experience of the study population was compared with that of Iowa, the geographical area served by the admitting medical facility for this study group. Results show that risk for all-cause mortality was most pronounced during the first two years following hospital discharge, although secondary unipolar depressives continued to show a significant excess of deaths throughout the entire follow-up period. Deaths occurring from natural causes were significantly excessive only during the initial portion of the follow-up. Deaths from unnatural causes were significantly excessive throughout follow-up except for patients with bipolar affective disorder.

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Facility based retrospective infant death study in a tertiary care hospital of Tripura

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20202979 ◽

2020 ◽

Vol 7 (7) ◽

pp. 2574

Author(s):

Subrata Baidya ◽

Sanjib Debbarma ◽

Debosmita Paul ◽

Purvita Chowdhury ◽

Biraj Kumar Kalita ◽

...

Keyword(s):

Neonatal Mortality ◽

Perinatal Asphyxia ◽

Tertiary Care ◽

Care Facility ◽

Preterm Births ◽

Healthcare Facility ◽

Healthcare Services ◽

Mortality Data ◽

Care Hospital ◽

Tertiary Care Facility

Background: Infant and neonatal mortality are important indicators of the overall physical health of a community. An increase is generally indicative of unmet human needs in healthcare, sanitation, nutrition and education. Objective: To estimate the different causes of death along with the geographic distribution of the reported death cases during the study period.Methods: Analysis of the retrospective mortality data of infant and neonates in the Pediatric Department of Agartala Government Medical College and Hospital, from 2014-2018, was conducted.Results: A total of 1525 infant deaths were recorded in the study facility, of which 878 (57.57%) were early-neonates, 120 (7.87%) late neonates and 527 (34.56%) post-neonatal infants. The most reported causes of neonatal mortality in Tripura were found to be preterm/low birth weight and perinatal asphyxia with OR of 1.45 (CI=1.137-1.857) and 1.41 (CI=1.10-1.81) respectively.Conclusions: The increasing burden of preterm births and neonatal sepsis needs attention towards ante-natal care along with holistic healthcare services. The need for intensive actions from both administration and healthcare facility to promote identification of red-flags at primary level, followed by proper referral from the periphery to tertiary care facility has been reiterated in this study.

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Mortality and Resource Utilization After Critical Care Transport of Patients With Hypoxemic Respiratory Failure

Journal of Intensive Care Medicine ◽

10.1177/0885066615623202 ◽

2015 ◽

Vol 33 (3) ◽

pp. 182-188 ◽

Cited By ~ 5

Author(s):

Susan R. Wilcox ◽

Jeremy B. Richards ◽

Alissa Genthon ◽

Mark S. Saia ◽

Heather Waden ◽

...

Keyword(s):

Critical Care ◽

Respiratory Failure ◽

Mortality Rate ◽

Hospital Discharge ◽

Tertiary Care ◽

Care Facility ◽

Apache Ii ◽

Apache Ii Score ◽

Hypoxemic Respiratory Failure ◽

Tertiary Care Facility

Introduction: We performed this study to quantify resources required by mechanically ventilated patients with hypoxemia after critical care transport (CCT) and to assess short-term clinical outcomes. Methods: We performed a retrospective review of transports of patients with severe hypoxemic respiratory failure from referring hospitals to 3 tertiary care hospitals to assess the outcomes including in-hospital mortality, ventilator days, intensive care unit length of stay (LOS), hospital LOS, disposition, and reported neurologic status on hospital discharge as well as medical interventions specific to acute respiratory failure and critical care. Results: Of 230 patients transported with hypoxemic respiratory failure, 152 survived to hospital discharge, for a mortality rate of 34.5%, despite a predicted mortality of 64% by Acute Physiology and Chronic Health Evaluation II (APACHE II) score. Twenty-five percent of patients were treated with neuromuscular blockade, 10.1% received inhaled pulmonary vasodilators, and extracorporeal membrane oxygenation was initiated in 2.6%. Conclusions: In this cohort with hypoxemic respiratory failure transported to tertiary care facilities, patients had a mortality rate comparable to patients with acute respiratory distress syndrome treated with best practices and a mortality rate lower than predicted based on APACHE-II score. The risks of CCT are outweighed by the benefits of transfer to a tertiary care facility, and pretransport hypoxemia should not be used as an absolute contraindication to transport.

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Critical Care Echocardiography as a Routine Procedure for the Detection and Early Treatment of Cardiac Pathologies

Diagnostics ◽

10.3390/diagnostics10090671 ◽

2020 ◽

Vol 10 (9) ◽

pp. 671

Author(s):

Stefan Schmidt ◽

Jana-Katharina Dieks ◽

Michael Quintel ◽

Onnen Moerer

Keyword(s):

Critical Care ◽

Tertiary Care ◽

Care Facility ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Icu Patients ◽

Ventricular Ejection Fraction ◽

Critical Care Echocardiography ◽

Tertiary Care Facility ◽

Significant Survival

Transthoracic and transesophageal echocardiography are important investigations in the intensive care unit (ICU) to diagnose acute cardiac pathologies and assess the haemodynamic status. Recommendations for critical care echocardiography (CCE) have been published recently, but these still lack an evidence-based foundation. It is not known if performing transthoracic echocardiography (TTE) on a routine basis instead of only when required in acute cases is feasible or clinically useful. In this single-centre prospective observational study, we routinely performed TTE on 111 consecutive non-cardiological, non-cardiothoracic surgical ICU patients in two surgical ICUs in a tertiary care facility. Significant cardiac pathologies were detected in 82 (76.6%) and critical cardiac pathologies in 33 (30.8%) of the 107 patients. The most common critical cardiac pathologies were sPAP > 50 mmHg (19.63%), tricuspid annular plane systolic excursion ≤ 13 mm (9.4%), grade III diastolic dysfunction (8.4%), severe tricuspid valve insufficiency (5.6%) and left ventricular ejection fraction (LV-EF) ˂ 30% (4.7%). Some of the most commonly found cardiac pathologies are not well emphasised in current recommendations and training programs. We observed a progression of the cardiac pathologies previously described in 41 of the patients (91.1%). Patients with echocardiographic abnormalities had a significant survival disadvantage in the ICU. By performing CCE routinely, we observed the range and prevalence of cardiac pathologies that can be detected by echocardiography in critically ill patients. We recommend routine transthoracic CCE in ICU patients for early detection of cardiac pathologies and to help inform early intervention regimens, since cardiac conditions carry a significant survival disadvantage for the ICU patient.

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Assessing Acute St-Elevation Myocardial Infarction With Prognostic Significance Of The Hyponatramia

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v11i3.2445 ◽

2020 ◽

Vol 11 (3) ◽

pp. 3251-3260

Author(s):

Makrand B Mane

Keyword(s):

Myocardial Infarction ◽

Ejection Fraction ◽

Tertiary Care ◽

Prognostic Significance ◽

Care Facility ◽

Early Death ◽

Public Health Issue ◽

Care Hospital ◽

Tertiary Care Facility ◽

Significant Public Health

Acute Myocardial Infarction (AMI) has become a significant public health issue in developed and developing nations, following extensive diagnostic and management research over recent decades. The study intended to research the prognostic values of inexplicable Hyponatremia in patients with severe STelevation of myocardial infarction, in 100 consecutive patients admitted to Tertiary care hospital. In the analysis, identified patients on admission were diagnosed with or produced Hyponatremia within 72 hours—a lower ejection fraction than those with usual amounts of sodium. The research aimed to evaluate the prognosis significance of Hyponatremia for the estimation of early death in acute ST-elevated myocardial infarction. One hundred straight patients admitted in the Coronary Centre Tertiary Care Facility with severe STelevated myocardial infarction were studied. The data of the study on various risk factors in association with the development of Hyponatremia like as age, sex, use of tobacco, diabetes, hypertension, ejection fraction etc. were analyzed. Thus, the researchers reported that in patients diagnosed with severe ST section escalation, Hyponatremia showed the initial emergence of hyponatremia myocardial infarctions. This condition correlates with the severity of LV dysfunction (in term of LVEF) and can be considered as an individual early death indicator as well as a prediction exacerbates with hyponatremia frequency.

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Clinical features and outcomes of infective endocarditis in Egypt: an 11-year experience at a tertiary care facility

The Egyptian Heart Journal ◽

10.1186/s43044-019-0018-y ◽

2019 ◽

Vol 71 (1) ◽

Cited By ~ 1

Author(s):

Hussein Hassan Rizk ◽

Ahmed Adel Elamragy ◽

Ghada Sayed Youssef ◽

Marwa Sayed Meshaal ◽

Ahmad Samir ◽

...

Keyword(s):

Infective Endocarditis ◽

Hospital Mortality ◽

Tertiary Care ◽

Care Facility ◽

Period 2 ◽

Peripheral Embolization ◽

Tertiary Care Facility ◽

Few Data ◽

Healthcare Associated ◽

Complications And Mortality

Abstract Background Few data are available on the characteristics of infective endocarditis (IE) cases in Egypt. The aim of this work is to describe the characteristics and outcomes of IE patients and evaluate the temporal changes in IE diagnostic and therapeutic aspects over 11 years. Results The IE registry included 398 patients referred to the Endocarditis Unit of a tertiary care facility with the diagnosis of possible or definite IE. Patients were recruited over two periods; period 1 (n = 237, 59.5%) from February 2005 to December 2011 and period 2 (n = 161, 40.5%) from January 2012 to September 2016. An electronic database was constructed to include information on patients’ clinical and microbiological characteristics as well as complications and mortality. The median age was 30 years and rheumatic valvular heart disease was the commonest underlying cardiac disease (34.7%). Healthcare-associated IE affected 185 patients (46.5%) and 275 patients (69.1%) had negative blood cultures. The most common complications were heart failure (n = 148, 37.2%), peripheral embolization (n = 133, 33.4%), and severe sepsis (n = 100, 25.1%). In-hospital mortality occurred in 108 patients (27.1%). Period 2 was characterized by a higher prevalence of injection drug use-associated IE (15.5% vs. 7.2%, p = 0.008), a higher staphylococcal IE (50.0% vs. 35.7%, p = 0.038), lower complications (31.1% vs. 45.1%, p = 0.005), and a lower in-hospital mortality (19.9% vs. 32.1%, p = 0.007). Conclusion This Egyptian registry showed high rates of culture-negative IE, complications, and in-hospital mortality in a largely young population of patients. Improvements were noted in the rates of complications and mortality in the second half of the reporting period.

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Characteristics of Critically Ill Patients with COVID-19 Compared to Patients with Influenza—A Single Center Experience

Journal of Clinical Medicine ◽

10.3390/jcm10102056 ◽

2021 ◽

Vol 10 (10) ◽

pp. 2056

Author(s):

Frank Herbstreit ◽

Marvin Overbeck ◽

Marc Moritz Berger ◽

Annabell Skarabis ◽

Thorsten Brenner ◽

...

Keyword(s):

Influenza A ◽

Health Care Systems ◽

Severe Disease ◽

Tertiary Care ◽

Care Facility ◽

High Volume ◽

Single Center Experience ◽

Severe Influenza ◽

Tertiary Care Facility ◽

Care Systems

Infections with SARS-CoV-2 spread worldwide early in 2020. In previous winters, we had been treating patients with seasonal influenza. While creating a larger impact on the health care systems, comparisons regarding the intensive care unit (ICU) courses of both diseases are lacking. We compared patients with influenza and SARS-CoV-2 infections treated at a tertiary care facility offering treatment for acute respiratory distress syndrome (ARDS) and being a high-volume facility for extracorporeal membrane oxygenation (ECMO). Patients with COVID-19 during the first wave of the pandemic (n = 64) were compared to 64 patients with severe influenza from 2016 to 2020 at our ICU. All patients were treated using a standardized protocol. ECMO was used in cases of severe ARDS. Both groups had similar comorbidities. Time in ICU and mortality were not significantly different, yet mortality with ECMO was high amongst COVID-19 patients with approximately two-thirds not surviving. This is in contrast to a mortality of less than 40% in influenza patients with ECMO. Mortality was higher than estimated by SAPSII score on admission in both groups. Patients with COVID-19 were more likely to be male and non-smokers than those with influenza. The outcomes for patients with severe disease were similar. The study helps to understand similarities and differences between patients treated for severe influenza infections and COVID-19.

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