scholarly journals A study on the role of paediatric assessment triangle, clinical scoring and serum lactate in the management of septic shock in children

2019 ◽  
Vol 6 (5) ◽  
pp. 2037
Author(s):  
Sai Shiva G. ◽  
V. Suresh Kumar ◽  
P. Ram Kumar ◽  
S. Bala Subramanian
Keyword(s):  
Septic Shock ◽  
Tertiary Care ◽  
Clinical Score ◽  
Serum Lactate ◽  
Care Hospital ◽  
Median Serum ◽  
Significant Difference ◽  
Clinical Scoring ◽  
Lactate Levels

Background: There is dearth of studies in India on the management of paediatric septic shock. So it is prudent to do a study on paediatric septic shock management. The objective of the study is to determine the correlation between Paediatric Assessment Triangle and serum lactate levels., to determine the role Paediatric Assessment Triangle in predicting mortality in septic shock and to the determine the role of elevated lactate levels in predicting mortality in septic shock.Methods: Descriptive study of 100 children from 31 days to 12 years of age who are admitted with septic shock in a tertiary care hospital are assessed with paediatric assessment triangle and clinical score and serum lactate was tested along with other standard tests and the children are managed as per the standard protocols. Outcome is analysed.Results: In this study, septic shock children with total clinical score >22 are having statistically significant low levels of diastolic blood pressure and low mean arterial pressure. There was a significant difference in median serum lactate levels between the survivors (28.08 mg/dl) and non-survivors (40.92 mg/dl).Conclusions: Paediatric assessment triangle and clinical scoring based on it more than 22 and serum lactate levels of more than 2mmol/L or 18mg/dl predict the mortality.

scholarly journals LDH LEVEL IN ACUTE ORGANOPHOSPHORUS POISONING AND ITS RELATION WITH SEVERITY AND MORTALITY: A TERTIARY CARE HOSPITAL EXPERIENCE

2021 ◽  
Vol 5 (4) ◽  
Author(s):  
Suresh Kumar Nagar ◽  
Maniram Kumhar ◽  
V. B. Singh ◽  
Mayank Srivastav
Keyword(s):  
Organophosphorus Compounds ◽  
Tertiary Care ◽  
Crop Protection ◽  
Serum Lactate ◽  
Spectrophotometric Analysis ◽  
Serum Lactate Dehydrogenase ◽  
Care Hospital ◽  
Significant Difference ◽  
Organophosphorus Poisoning ◽  
Acute Organophosphorus Poisoning

Background: Organophosphorus compounds have been widely used for a few decades in agriculture for crop protection and pest control. In India Organophosphorus poisoning is the most common. The objective of our study was to measure the  LDH Level in acute organophosphorus poisoning Methods: This study was conducted among minimum 100 patients acute organophosphorus poisoning admitted in Casualty ward, MICU and attending medical ward of JLN hospital, Ajmer during Aug 2018 to July 2020. Serum lactate dehydrogenase estimation by spectrophotometric analysis using Beckman Coalter AU 680 Results: These were significantly higher among deaths on day 1 and 3(810±372.99 and 1027.09±458.26, respectively) in comparison to survivors on day 1 and 3 (538.18±300.42 and 365.19±175.49, respectively). Significant difference was found between mean values of different levels of severity of LDH on day 1 and 3. Conclusion: In conclusion, this study found that Serum LDH can be used as biomarker in diagnosis or stratifying severity of acute OP poisoning, as it is cheap and easily available, especially in developing countries. Serial measurements of serum LDH levels in acute OP poisoning can predict the prognosis. Keywords: LDH, OP poisoning, Severity

scholarly journals Italian observational study on HPV infection, E6, and p16 expression in men with penile cancer

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Narcisa Muresu ◽  
Giovanni Sotgiu ◽  
Laura Saderi ◽  
Illari Sechi ◽  
Antonio Cossu ◽  
...  
Keyword(s):  
Penile Cancer ◽  
Tertiary Care ◽  
Hpv Infection ◽  
Molecular Techniques ◽  
Care Hospital ◽  
Hpv 16 ◽  
Hpv Dna ◽  
Diagnosis And Prognosis ◽  
Significant Difference

Abstract Background Human Papillomavirus (HPV) infection is one of the most important causes of cancer. It can play a role in cervical and extra-cervical cancers. Penile cancer is rare, even if an increasing trend was recently reported. Aim of the present study was to assess the prevalence and distribution of HPV genotypes in cases of penile cancer diagnosed in Sardinia, Italy. Surrogate markers of HPV infection (i.e., E6 and p16 genes) were also evaluated in all cases. Methods An observational, retrospective study which recruited all cases of penile cancer diagnosed between 2002 and 2019 at a tertiary care hospital in Sardinia, Italy, was carried out. HPV-DNA detection and genotyping were performed by Real-time PCR. Specimens were tested for oncogene E6 mRNA and for p16(INK4a) expression. Results HPV prevalence was 28.1% (9/32); HPV-16 was the most prevalent genotype (7/9, 77.8%). p16INK4a positivity was found in 66.7% of the samples with a statistically significant difference between HPV-positive and -negative groups. E6-transcript was detected in 71% of the HPV-16 positive samples. The overall survival was not statistically different between HPV-positives and -negatives. Discussion The present study confirms the etiologic role of HPV in penile cancer and supports the adoption of vaccination strategies in men and women. Further studies should clarify the diagnostic and prognostic role of E6 and p16 proteins. Conclusion HPV infection can favor the occurrence of penile cancer, whose diagnosis and prognosis could be improved with the implementation of validated molecular techniques.

scholarly journals Distribution of HPV Genotypes in Patients with a Diagnosis of Anal Cancer in an Italian Region

2020 ◽  
Vol 17 (12) ◽  
pp. 4516 ◽  
Author(s):  
Narcisa Muresu ◽  
Giovanni Sotgiu ◽  
Laura Saderi ◽  
Illari Sechi ◽  
Antonio Cossu ◽  
...  
Keyword(s):  
Anal Cancer ◽  
Tertiary Care ◽  
Scale Up ◽  
Anal Carcinoma ◽  
Detection Methods ◽  
P Value ◽  
Care Hospital ◽  
Significant Difference ◽  
Hpv Genotypes

Objectives: Anal cancer is a rare disease. However, its incidence is increasing in some population groups. Infection caused by Human Papillomavirus (HPV) is strongly associated with the risk of anal cancer, whose variability depends on samples, histology, and HPV detection methods. The aim of the study was to assess prevalence and distribution of HPV genotypes in patients diagnosed with anal carcinoma. Methods: An observational, retrospective study was carried out in a tertiary care hospital in North Sardinia, Italy. Specimens of anal cancer diagnosed from 2002–2018 were selected. Demographic, epidemiological, and clinical variables were collected to assess their relationship with the occurrence of anal cancer. Results: The overall HPV positivity was 70.0% (21/30), with HPV-16 being the predominant genotype (~85%). The highest prevalence of anal cancer was in patients aged ≥55 years. HPV positivity was higher in women (p-value > 0.05) and in moderately differentiated samples (G2) (p-value < 0.05). p16INK4a and E6-transcript positivity were found in 57% and 24% of the HPV positive samples, respectively. The OS (overall survival) showed a not statistically significant difference in prognosis between HPV positive sand negatives (10, 47.6%, vs. 4, 44.4%; p-value = 0.25). Conclusions: HPV-DNA and p16INK4a positivity confirmed the role of HPV in anal carcinoma. Our findings could support the implementation and scale-up of HPV vaccination in males and females to decrease the incidence of HPV-associated cancers. Further studies are needed to better clarify the prognostic role of HPV/p16 status.

scholarly journals Outcome of post cardiac surgery acute myocardial infarction and role of emergency percutaneous coronary interventions

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
M Laimoud ◽  
R Qureshi
Keyword(s):  
Coronary Angiography ◽  
Hospital Mortality ◽  
Troponin I ◽  
Tertiary Care ◽  
Adult Patients ◽  
Care Hospital ◽  
Factors Associated ◽  
Diagnosis And Management ◽  
Lactate Levels

Abstract Funding Acknowledgements Type of funding sources: None. Background The rapid haemodynamics deterioration and  presence of myocardial ischemia  early  after cardiac surgical operations is a complex life threatening condition  where rapid diagnosis and management is of fundamental importance. Objective: to  analyse the factors associated with mortality of patients with post cardiotomy MI  and  to study the role of emergency coronary angiography in management and outcome . Methods: we retrospectively enrolled  adult patients  diagnosed to have post cardiotomy MI and underwent emergency coronary angiography  at our tertiary care hospital  between January 2016 and August 2019. Results: Sixty one patients from consecutive  1869 adult patients who underwent cardiac surgeries were enrolled in our study.  The studied patients had a mean age of 49 ±16.2 years with a mean BMI of 29.5 ± 6.6 and 65.6% of them were males. As compared to the survivors group, the non-survivors of perioperative MI had significant preoperative CKD , postoperative AKI , longer CPB time , frequent  histories of  previous PCI , previous cardiotomies , pre and postoperative ECMO use , higher median troponin I levels , higher peak and 24 hours mean lactate levels. Regression analysis revealed that re-operation for revascularization  (OR:23 ; 95% CI: 8.27-217.06; p = 0.034) and hyperlactataemia  (OR: 3.21 ; 95% CI:1.14-9.04 ; p = 0.027) were independent factors associated with hospital mortality after perioperative MI . Hospital mortality occurred in ( 25.7% vs 86.7% ,p &lt; 0.001 ) , AKI occurred in ( 37.1% vs 93.3 %,p &lt; 0.001 ) , haemodialysis was used in (28.6 % vs 80%. P = 0.002), mediastinal exploration for bleeding done in (31.4% vs 80%, p = 0.006 ) in PCI and re-operation groups respectively while there were no significant differences regarding gastrointestinal bleeding , cerebral strokes nor intracerebral bleeding . Absence of significant angiographic findings occurred in 18% of patients. Conclusions: Perioperative MI is associated with significant morbidities and hospital mortality . Re-operation for revascularization  and progressive hyperlactataemia are independent predictors of hospital mortality. Emergency coronary angiography is helpful in diagnosis and management of perioperative MI. Predictors of hospital mortality.Significant variablesP valueOR95% CIPost-op ECMO0.1360.0390.001 -2.775Troponin0.6611.0000.998 -1.001Lactate peak0.0273.2121.141 - 9.042Re-operation0.03423.0058.27 - 217.06Abstract Figure. Hospital outcomes of PCI and Reoperation

scholarly journals Clinical Scoring for Diagnosis of Acute Lower Abdominal Pain in Female of Reproductive Age

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Kijja Jearwattanakanok ◽  
Sirikan Yamada ◽  
Watcharin Suntornlimsiri ◽  
Waratsuda Smuthtai ◽  
Jayanton Patumanond
Keyword(s):  
Abdominal Pain ◽  
Young Adult ◽  
Correct Diagnosis ◽  
Tertiary Care ◽  
Lower Abdominal Pain ◽  
Clinical Score ◽  
Reproductive Age ◽  
Care Hospital ◽  
Adult Females ◽  
Clinical Scoring

Background. Obstetrics and gynecological conditions (OB-GYNc) are difficult to be differentiated from appendicitis in young adult females presenting with acute lower abdominal pain. Timely and correct diagnosis is clinically challenging.Method. A retrospective data analysis was performed on 542 female patients who were admitted to a tertiary care hospital with a chief complaint of acute lower abdominal pain. Diagnostic indicators of appendicitis and OB-GYNc were identified by stepwise multivariable polytomous logistic regression. Diagnostic performances of the scores were tested.Result. The developed clinical score is comprised of (1) guarding or rebound tenderness, (2) pregnancy, (3) sites of abdominal tenderness, (4) leukocytosis, (5) peripheral neutrophils ≥75%, and (6) presence of diarrhea. For diagnosis of appendicitis, the area under the ROC curve was 0.8696, and the sensitivity and specificity were 89.25% and 70.00%. For OB-GYNc, the corresponding values were 0.8450, 66.67%, and 94.85%, respectively.Conclusion. The clinical scoring system can differentiate the diagnosis of acute lower abdominal pain in young adult females. Time spent for diagnosis at the emergency room may be shortened, and the patients would be admitted to the appropriate departments in less time.

scholarly journals Role of isosorbide mononitrate in induction of labour: A single arm clinical trial at a tertiary care hospital

Biomedicine ◽  
2021 ◽  
Vol 41 (2) ◽  
pp. 301-305
Author(s):  
Sinha Archana ◽  
Kiran Sneh ◽  
Sharma Sushant ◽  
Prasad Dipali ◽  
Parween Sadia
Keyword(s):  
Tertiary Care ◽  
Induction Of Labour ◽  
Nitric Oxide Donor ◽  
Isosorbide Mononitrate ◽  
Care Hospital ◽  
Bishop Score ◽  
Significant Difference ◽  
Successful Group ◽  
Group A

Introduction and Aim:Isosorbide mononitrate, a nitric oxide donor, induces the enzyme cyclo-oxygenase-2, leading to production of local prostaglandins in human cervix and leads to structural rearrangement of the collagen network and thereby the cervix ripens.The aim of this study was to determine the role of Isosorbide mononitrate in induction of labour, determine induction delivery interval and obstetric and neonatal outcome.   Materials and Methods:This study was an interventional study on 40 pregnant women conducted for a period of one year. Women requiring induction of labour, who met the inclusion criteria, were enrolled. Isosorbide mononitrate (40 milligrams) was inserted in the posterior fornix. If Bishop's score did not change after 24 hours of the initial dose, failure of induction of labour was considered.Those patients in whom labour pains started after isosorbide mononitrate alone were considered to be in successful group(A) while those who required additional drugs like prostaglandins were considered to be in the failed group(F).   Results:The mean (SD) Bishop score after 1dose of isosorbide mononitrate in the successful group (A) was 6.04 (2.16) and in the failed group (F) was 3.81 (0.83). There was a significant difference in terms of Bishop Score after 1st Dose of IMN (W = 310.000, p = 0.001) and in terms of induction-delivery time in hours (t = -2.386, p = 0.023).   Conclusion:This study concludes that Isosorbide mononitrate has significant role for induction of labor in terms of Bishop score changes and induction delivery interval.

TO DETERMINE THE ROLE OF CA125 IN THE DIAGNOSIS OF ACUTE APPENDICITIS

2020 ◽  
Vol 4 (7) ◽  
Author(s):  
Vinod Kumar ◽  
Bhupen Songra ◽  
Richa Jain ◽  
Deeksha Mehta
Keyword(s):  
Acute Appendicitis ◽  
Clinical Diagnosis ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Ca 125 ◽  
Care Hospital ◽  
Serum Samples ◽  
Roc Curve Analysis ◽  
Surgery Department

Background: the present study was under taken to determine the role of CA-125 in the diagnosis of acute appendicitis (AA), to prevent its complications and also in preventing negative appendicectomies in tertiary care hospital. Methods: The study was conducted at a tertiary care and research center between 01/03/2018 to 30/06/2019. Patients admitted to the surgery department with diagnosis of AA were considered for the study. After informed consent, a, standardized history was obtained as a case Performa. Serum samples from all the cases with clinical diagnosis of AA were obtained and stored. Only the cases with histopathologically approved AA were included in the study. Cases operated for clinical diagnosis of AA, but not histopathologically proven AA was not included in the study. CA125 levels in cases with definitive diagnosis of AA were measured. Results: In present study, ROC curve analysis revealed the sensitivity of 87.27 % and specificity of 90.91 % when the CA 125 cut-off value of > 16.8 was taken to diagnose acute appendicitis. AUC was 0.911 with a standard error of 0.0292. Conclusion: In this study we have observed that CA125 showed a positive correlation with acute appendicitis, that was statistically not significant (P>0.05). We didn’t evaluate the correlation with the disease severity. We consider that CA125 can be used as a marker in acute appendicitis cases although further research is still needed. Keywords: CA125, Acute Appendicitis, Surgery.

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