scholarly journals Snake bite, a neglected menace: a prospective observational study in a tertiary care pediatric intensive care unit

2020 ◽  
Vol 7 (5) ◽  
pp. 1096
Author(s):  
Shatabdi Giri ◽  
Swarup Kumar Bisoi ◽  
Dillip Kumar Dash ◽  
M. D. Mohanty ◽  
S. K. Parida
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Prospective Observational Study ◽  
Tertiary Care ◽  
First Aid ◽  
Snake Bite ◽  
Morbidity And Mortality ◽  
Snake Envenomation ◽  
Snake Bites ◽  
Atypical Presentations

Background: Snake bite is a neglected and underestimated public health problem in tropical and subtropical region. Snake envenomation is a well-known cause of morbidity and mortality in India. In 2009, WHO declared snake bite a neglected disease. Ophitoxaemia is an exotic term characterising the clinical spectrum of snake bite. Objective of this study was to know the outcome in paediatric snake bite cases in a tertiary care PICU (Paediatric Intensive Care Unit) with special reference to envenomation time and also to evaluate and analyse few atypical presentations of snake envenomation by proper history taking, physical examination and help start early intervention to prevent morbidity and mortality.Methods: A prospective observational study was done in Paediatric Intensive care unit of the hospital from June 2017 to June 2019.Results: Around 56.8% of 109 cases were non-poisonous snake-bites. Out of 47 cases admitted to PICU, 68.08% developed cellulitis at the site of bite with Staphylococcus aureus being the commonest organism isolated (56.25%). Anaerobes (bacteroides and clostridium) were also isolated in few cases. Edema at site of bite (hematotoxic) and ptosis(neurotoxic) were most common initial presentation. 36.17% of patients received ASV (Anti- Snake Venom) and first aid within 6 hours of snake bite. The morbidity and mortality were significantly less (p<0.05) as compared to those who didn't receive ASV. 12.76% of cases with normal CRT (Clot Retraction Time) presented with features of coagulopathy. DIC (58.33% of hematotoxic bites) and respiratory paralysis 68 (75% of neurotoxic bites) were the commonest complications. Renal replacement therapy was required in 6.38%, transfusion in 10.63% cases and case-fatality-rate was 12.7%. There were a few atypical presentations of snake bite mimicking Gullain-Barre syndrome, acute onset encephalitis with absent brainstem and pupillary reflexes, intracerebral hemorrhage and cortical blindness.Conclusions: Most snake bites are non-poisonous. Early first aid and ASV administration has better outcome. Fibrinogen levels are more reliable than CRT to diagnose coagulopathy. Acute presentations i.e, altered sensorium, paralysis, blindness and stroke like features should always be evaluated for snake envenomation in suspected cases to prevent morbidity and mortality.

scholarly journals Study of coagulation disorder following haemotoxic snake envenomation in a tertiary care centre

2021 ◽  
Vol 9 (6) ◽  
pp. 1641
Author(s):  
Mubarak R. ◽  
B. N. Mohapatra
Keyword(s):  
Prospective Observational Study ◽  
Tertiary Care ◽  
Coagulation Disorder ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Snake Envenomation ◽  
Clinical Syndromes ◽  
Snake Bites ◽  
Group B ◽  
Common Manifestation

Background: Coagulopathy is the most common manifestation in cases of haemotoxic snake bites. The most common coagulopathy associated with snake envenoming worldwide is venom-induced consumption coagulopathy (VICC). The existence of overlapping clinical syndromes of VICC and thrombotic microangiopathy (TMA) in snake envenoming is the likely reason for the mistaken idea that snake bite causes disseminated intravascular coagulation (DIC). This study aims to look into the exact type coagulopathy in haemotoxic snake envenomation.Methods: Prospective observational study was conducted from January 2017 to January 2018 at a tertiary care centre in Odisha.Results: Out of 54, 23 (42.6%) cases were having DIC and 31 (57.4%) cases were not confirmed to be having DIC. In DIC group there was significantly delayed hospitalization (46.3±28.5 hours) when compared to group B (13.5±11.1 hours, p<0.05). Mean anti-snake venom (ASV) requirement in DIC group was significantly higher (28.3±14) than in those DIC is not confirmed (11.13±3.1, p<0.05). 21.7% cases in DIC group had kdigo stage III AKI compared to 3.3%cases of group B. 13% cases of DIC group required hemodialysis when compared to 3.2% cases of group B.Conclusions: Early hospitalisation (preferably <12 hours and not >24 hours), early ASV administration are important to prevent full blown DIC and more serious complications. Most of the non DIC cases appears to be DIC in evolution but not confirmed to diagnosis by DIC scoring system as they reached hospital early before the development of frank DIC. TMA has not been found in this study. However further studies are needed to ascertain the exact cause of coagulopathy in non DIC group.

A PROSPECTIVE DESCRIPTIVE STUDY OF REFERRED NEONATES ADMITTED TO A TERTIARY CARE CENTER OF NORTH INDIA

2021 ◽  
pp. 219-221
Author(s):  
Divya Mishra ◽  
Arun Kumar Thakur ◽  
Rashmi Kispotta ◽  
Neeraj Neeraj
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Prospective Observational Study ◽  
Care Center ◽  
Tertiary Care ◽  
Birth Asphyxia ◽  
North India ◽  
Tertiary Care Centre ◽  
Neonatal Transport ◽  
One Year

Objectives: The Study was conducted with an objective to analyze the important contributors of neonatal mortality and outcome of referred neonates admitted to intensive care unit of a tertiary care centre. Methods: In this prospective observational study conducted over one year period included extramural neonates only. Respiratory and hemodynamic status of all neonates at admission was assessed and outcome was evaluated. Results: At admission 80 % of neonates were hypothermic, hypoxic – 37 %, prolonged capillary lling time (CFT)- 85% and hypoglycemic – 28 %. Sepsis was the most common nal diagnosis followed by birth asphyxia and neonatal jaundice. 39% of neonates had poor outcome whereas 61% had good outcome. Culture positivity was 40 % for at risk neonates for sepsis. Among these, most common organism was klebsiella pneumoniae followed by Staph aureus. Conclusion: This prospective study reveals the need of better neonatal transport facility from labor room to intensive care unit and from periphery to tertiary centers.

scholarly journals Epidemiological and clinical profile of paediatric snake bite patients at a tertiary care centre of Himachal Pradesh, India

2020 ◽  
Vol 7 (6) ◽  
pp. 1331
Author(s):  
Arvind Sood ◽  
Aman Rana ◽  
Pancham Kumar
Keyword(s):  
Tertiary Care ◽  
Epidemiologic Study ◽  
Case Fatality ◽  
First Aid ◽  
Himachal Pradesh ◽  
Snake Bite ◽  
Clinical Profile ◽  
Medical Emergency ◽  
Peak Time ◽  
Snake Bites

Background: Pediatric snake bite cases are frequently encountered at health care centers of Himachal Pradesh. It is a medical emergency which require early hospitalisation and immediate medical intervention. This study determines the epidemiological and envenomation details along with clinical profile and management of pediatric snake bite patients in Himachal Pradesh, India.Methods: This prospective clinico-epidemiologic study included 30 paediatric snake bite cases reported at Department of Paediatrics, IGMC, Shimla. Demography, envenomation details, first aid and treatment, antivenom administration and outcome were recorded for all patients.Results: Of the total 30 cases, 56.6% were males and 43.3% were females. All patients were resident of rural areas and most of them belonged to middle socioeconomic status. Most (56.7%) snake bites occurred between 6pm to 12am and peak time was during rainy season. More cases of hemotoxic envenomation were observed as compared to neuroparalytic envenomation. Most common hematologic abnormalities were hematuria (4.8%) and epistaxis (4.8%). Respiratory paralysis, ptosis and opthalmoplegia were the most common presentation in patients with neuroparalytic envenomation. Clinical profile of patients showed thrombocytopenia (26.7%), prolonged PT/INR (76.6%) and 36.7% had prolonged activated partial thromboplastin time. All symptomatic patients were given ASV as primary treatment out of which 79.2% patients required more than 10 vials of ASV. Most common complication observed in neuroparalytic envenomation was respiratory failure (33.3%) and in hemotoxic envenomation was coagulation failure (66.7%). Only 3.3% case fatality was observed in this study.Conclusions: Snake bite in children is a medical emergency in hilly state of Himachal Pradesh where people still follow traditional first aid methods and treatment protocol. A widespread awareness programme is needed to propagate the newly advised first aid methods to prevent mortality by early hospitalization and administration of ASV.

scholarly journals Etiology & Outcome of Acute kidney Injury in Intensive Care Unit Settings of a Tertiary Care Hospital

2020 ◽  
Vol 4 (2) ◽  
pp. 01-05
Author(s):  
Hassan Mumtaz
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Risk Factor ◽  
Intensive Care ◽  
Tertiary Care ◽  
Hospital Setting ◽  
Kidney Injury ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Care Hospital

Introduction: Acute kidney injury (AKI) is defined as a rapid loss of kidney function occurring over few hours or days. In intensive care unit settings, acute kidney injury (AKI) is a very prevalent condition as most of the patients who are admitted in intensive care units are critically ill. The incidence of acute kidney injury is increasing throughout the world mainly because of aging population and co morbidities which are associated with aging. In intensive care unit settings, the incidence of AKI may reach up to 67%. Though AKI effects depend on clinical situation yet associated with high morbidity and mortality. The rationale of this study is that, as acute kidney is one of major factors contributing in mortality and morbidity of ICU patients, this study will be helpful in identifying important risk factor for development of acute kidney injury in ICU settings, leading to its early detection and thus decreasing associated morbidity and mortality. Objective: To determine the frequency of etiology and outcome of acute kidney injury in medical intensive care unit of KRL Hospital. Setting: Medical ICU, KRL Hospital, Islamabad. Duration: six months from 17th May 2017 to 17th November 2017. Study design: Descriptive case series. Material and method: In this study 118 patients were observed. After screening and application of exclusion criteria, a total of 118 patients who were fulfilling the inclusion criteria were selected as the study sample and were included in the final analysis regarding prevalence of risk factors associated with AKI and the outcome associated with AKI. AKI was further classified using acute kidney injury network (AKIN) classification system. Patient age, gender, serum creatinine, etiology and outcome in form of recovery or mortality was recorded. Results: Overall incidence of AKI in ICU settings in this study was 37.8% (n=118). Out of 118 patients who had AKI, 59.3% (n=70) were male, whereas 40.7% (n=48) were females. Most common risk factor associated with development of AKI was sepsis secondary to infectious illnesses and 39% (n=46) of the patients who developed AKI were suffering from infectious illnesses. Gastrointestinal, drugs and cardiac causes constitutes the 32.2 % (n=38), 18.6% (n=22) and 10.2% (n=12) respectively of the AKI in ICU settings. In terms of outcome, mortality rate in patients with AKI was significantly higher as compared to patients without AKI(P =<0.001) and 56.8%(n=67) of the patients who had AKI died during their ICU stay as compared to 30.4%(n=59) in patients without AKI. Conclusion: Our study concludes that the frequency of etiology including infectious causes was 39%, cardiac pathology 10%, GI causes 32%, drugs was 19% and mortality was 56.8% in patients with acute kidney injury.

scholarly journals Study of Morbidity and Mortality Pattern of Children Admitted in Paediatric Intensive Care Unit of Tertiary Care Children’s Hospital

2020 ◽  
Vol 40 (3) ◽  
pp. 232-240
Author(s):  
Prakash Joshi ◽  
Sumit Agrawal ◽  
Umesh Prasad Sah
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Infectious Diseases ◽  
Paediatric Intensive Care Unit ◽  
Tertiary Care ◽  
Paediatric Intensive Care ◽  
Morbidity And Mortality ◽  
Female Ratio ◽  
Children's Hospital ◽  
Children’S Hospital

Introduction: Intensive care is predominantly concerned with the management of patients with acute life threatening conditions in a specialised unit. The objective of this study was to describe the morbidity and mortality patterns as well as outcome of patients admitted in the Paediatric Intensive Care Unit (PICU) of a tertiary care government paediatric hospital in Nepal. Methods: A cross-sectional study of 652 children admitted to the PICU of Kanti Children’s Hospital was undertaken from 1st January 2018 to 31st December 2018. The data were retrieved retrospectively from the record files of PICU regarding patient’s age, sex, inhabitant, admitting and final diagnosis, length of stay in the ICU and final outcome. Data were entered into MS Excel and analysed using Pearson’s Chi Square Test. Results: Among 652 admitted children between 1 month to 14 years of age, 397 (61%) were males and 255 (39%) females with male to female ratio 1.55:1. Majority 352 (54%) of them were in the age group of one month to 12 months of age. Pneumonia (216, 33.1%) was the major disease seen followed by septicemia (123, 18.9%), bronchiolitis (44, 6.7%), Other infectious diseases (38, 5.8%) and so on. Out of total admission, 484 (74.23%) cases improved, 46 (7.05%) left against medical advice (LAMA) and 120 cases died with mortality rate of 18.46%. More than half of the deaths (n = 87/120, 72.5%) were due to infections (Septicemia, acute gastroenteritis, pneumonia and meningitis and other infectious diseases). Conclusions: Pneumonia with respiratory distress was the major cause of PICU admission while fatality was highest for acute leukemia. Therefore it seems justifiable to improve primary and secondary health care facilities for timely and reliable delivery of current standardised therapeutic practice as well as to increase ICU facilities in those areas.

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