scholarly journals A prospective observational study on assessment of types of shock in children and requirement of inotropes in treatment of shock in tertiary care hospital

2021 ◽  
Vol 8 (5) ◽  
pp. 835
Author(s):  
Jhansi Rani Kotha ◽  
Hari Krishna Kothapally ◽  
Sai Chand Pinnoju ◽  
Sudheer Kumar
Keyword(s):  
Septic Shock ◽  
Mortality Rate ◽  
Cardiogenic Shock ◽  
Early Recognition ◽  
Tertiary Care ◽  
Hypovolemic Shock ◽  
Oxygen Demand ◽  
Tissue Perfusion ◽  
Care Hospital ◽  
Demand And Supply

Background: Shock is a state of impaired tissue perfusion which result in an imbalance between oxygen demand and supply. This reduction in effective tissue perfusion causes insufficient or improper delivery and distribution of oxygen and nutrients. There is sparse date regarding epidemiology of shock in paediatrics. In this study we were aimed to assess the types of shock and treatment of shock with Inotropes.Methods: Children of age 1 month to 12 years with a clinical diagnosis of shock were included.Results: Out of 155 children admitted with shock 72.2% had septic shock, 25.8% had hypovolemic shock, 1.2% had cardiogenic shock, 0.6% had dengue shock. In this study the mortality rate was 8.39% of total patients. The mortality rate of septic shock, hypovolemic shock, cardiogenic shock was 84%, 7.69%, 7.69% respectively. 74.33% of patients were treated with two Inotropes, 5.3% were treated with more than two Inotropes, 11.5% were treated with single Inotropes and 0.88% was treated with no inotrope.Conclusions: In the present study, among all types of shock the prevalence and mortality rate was more with Septic shock. As shock has high mortality rate in children the early recognition and patient education is required.

scholarly journals Assessment of clinical parameters and immediate outcome of children with shock in a tertiary care hospital ASRAM, Eluru, Andhra Pradesh, India

2017 ◽  
Vol 4 (2) ◽  
pp. 586
Author(s):  
Arigela Vasundhara ◽  
Manas Ranjan Sahoo ◽  
Sai Silpa Chowdary
Keyword(s):  
Septic Shock ◽  
Cardiogenic Shock ◽  
Tertiary Care ◽  
Hypovolemic Shock ◽  
Oxygen Demand ◽  
Tissue Perfusion ◽  
Multiple Organ ◽  
Cellular Damage ◽  
Care Hospital ◽  
A Prospective Study

Background: Shock is a state of impaired tissue perfusion resulting in an imbalance between oxygen demand and supply. This widespread reduction in effective tissue perfusion causes insufficient or improper delivery and distribution of oxygen and nutrients, the end result of which is an altered cellular and sub cellular function leading to anaerobic metabolism and accumulation of lactic acid, and consequently cellular damage, multiple organ dysfunction and finally cardiovascular collapse.Methods: The present study was conducted in the department of Pediatrics at Alluri Sitarama Raju Academy of Medical Sciences hospital, Eluru, between December 2014 and June 2016. It is a prospective study. Children aged 1 month to 12 years with a clinical diagnosis of shock were included after written consent from parents.Results: Out of 75 children admitted with shock, 69.33% had septic shock, 25.33% had hypovolemic shock, 2.66% had distributive shock, 2.66% cardiogenic shock. Most common age group admitted with shock was 1 month-1 year 38.666%. Among 75 children with shock, 74.66% children survived and 25.33% children died. Mortality rate in cardiogenic shock was 100%, in septic shock 28.84%, in hypovolemic shock 10.52%.Conclusions: Septic shock was the most common type of shock. Most common cause for septic shock was pneumonia. Septic shock has got highest mortality in the present study.Need for inotropes and mechanical ventilaton indicates poor prognosis in shock.

scholarly journals Efficacy of Emergency Severity Index (ESI) in Early Identification of Patients with Sepsis and Septic Shock at Triage

2020 ◽  
Author(s):  
Emad Uddin Siddiqui ◽  
Noman Ali ◽  
Mirza Noor Ali Baig ◽  
Ahmed Raheem ◽  
Nazir Najeeb ◽  
...  
Keyword(s):  
Septic Shock ◽  
Tertiary Care Hospital ◽  
Early Recognition ◽  
Tertiary Care ◽  
Area Under The Curve ◽  
Severity Index ◽  
Care Hospital ◽  
Emergency Severity Index ◽  
Optimal Cutoff ◽  
Sepsis And Septic Shock

Abstract Objectives The objective of the study is to determine the efficacy of Emergency Severity Index (ESI) tool in early recognition of “sepsis” and “septic shock” at the triage of an emergency room at a tertiary care hospital in Pakistan.Results A total of 240 patients were included in this study. The area under the curve (AUC) for the ESI score I for septic shock was 0.943 [0.921–0.964] with the optimal cutoff value of 2.0 with sensitivity of 88.5% and specificity of 100%. Similarly, the sensitivity and specificity of ESI score II for the diagnosis of sepsis was found to be 100.00% (CI 97.63–100.00%) and 66.28% (CI 55.28% to76.12%) with accuracy of 87.92% (83.11–91.76%)

scholarly journals Enteroviruses in Respiratory Samples from Paediatric Patients of a Tertiary Care Hospital in Germany

Viruses ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 882
Author(s):  
Susanne Baertl ◽  
Corinna Pietsch ◽  
Melanie Maier ◽  
Mario Hönemann ◽  
Sandra Bergs ◽  
...  
Keyword(s):  
Genetic Diversity ◽  
Phylogenetic Analyses ◽  
Tertiary Care ◽  
Oxygen Demand ◽  
Care Hospital ◽  
Paediatric Patients ◽  
Enterovirus A71 ◽  
Coxsackievirus A6 ◽  
Enterovirus D68 ◽  
Tract Infections

Enteroviruses are associated with various diseases accompanied by rare but severe complications. In recent years, outbreaks of enterovirus D68 and enterovirus A71 associated with severe respiratory infections and neurological complications have been reported worldwide. Since information on molecular epidemiology in respiratory samples is still limited, the genetic diversity of enteroviruses was retrospectively analysed over a 4-year period (2013–2016) in respiratory samples from paediatric patients. Partial viral major capsid protein gene (VP1) sequences were determined for genotyping. Enteroviruses were detected in 255 (6.1%) of 4187 specimens. Phylogenetic analyses of 233 (91.4%) strains revealed 25 different genotypes distributed to Enterovirus A (39.1%), Enterovirus B (34.3%), and Enterovirus D (26.6%). The most frequently detected genotypes were enterovirus D68 (26.6%), coxsackievirus A6 (15.9%), and enterovirus A71 (7.3%). Enterovirus D68 detections were associated with lower respiratory tract infections and increased oxygen demand. Meningitis/encephalitis and other neurological symptoms were related to enterovirus A71, while coxsackievirus A6 was associated with upper respiratory diseases. Prematurity turned out as a potential risk factor for increased oxygen demand during enterovirus infections. The detailed analysis of epidemiological and clinical data contributes to the non-polio enterovirus surveillance in Europe and showed high and rapidly changing genetic diversity of circulating enteroviruses, including different enterovirus D68 variants.

Rising Economic Impact of Clostridium difficile-Associated Disease in Adult Hospitalized Patient Population

2008 ◽  
Vol 29 (9) ◽  
pp. 823-828 ◽  
Author(s):  
Xiaoyan Song ◽  
John G Bartlett ◽  
Kathleen Speck ◽  
April Naegeli ◽  
Karen Carroll ◽  
...  
Keyword(s):  
At Risk ◽  
Mortality Rate ◽  
Clostridium Difficile ◽  
Economic Burden ◽  
Excess Mortality ◽  
Tertiary Care ◽  
Severity Of Illness ◽  
Adult Patients ◽  
Care Hospital ◽  
Course Of Illness

Background.Clostridium difficile-associated disease (CDAD) is responsible for increased morbidity and a substantial economic burden. Incidences of CDAD, including those with a severe course of illness, have been increasing rapidly.Objective.To evaluate the excess mortality, increased length of stay (LOS) in the hospital, and additional costs associated with CDAD.Design.A retrospective matched cohort study.Patients.Adult patients admitted to a large tertiary care hospital between January 2000 and October 2005.Methods.Adult patients were tested with a C. difficile laboratory assay at admission or 72 hours after admission. Infected patients had lor more positive assay results and were individually matched to 1 uninfected patient who had negative assay results, by exposure time, age, ward, and at least 2 measurements for comorbidity and severity of illness.Results.The incidence rate of CDAD among adult patients increased from 0.57 cases per 1,000 patient-days at risk before 2004 to 0.88 cases per 1,000 patient-days at risk after 2004 (P < .001). The 630 infected patients had a mortality rate of 11.9%; the 630 uninfected patients had a mortality rate of 15.1% (P = .02). After adjustment in the multivariate analysis, we found that the LOS for infected patients was 4 days longer than that for uninfected patients (P < .001). If CDAD occurred after 2004, the additional LOS increased to 5.5 days. The direct cost associated with CDAD was $306 per case; after year 2004, it increased to $6,326 per case.Conclusions.There may be no excess mortality among patients with CDAD, compared with patients without it, but the economic burden of CDAD is increasing. By 2004, CDAD-associated medical expenditures approached $1,000,000 per year at our institution alone.

scholarly journals Epidemiology, species distribution, and outcome of nosocomial Candida spp. bloodstream infection in Shanghai: an 11-year retrospective analysis in a tertiary care hospital

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Yan-Jun Zheng ◽  
Ting Xie ◽  
Lin Wu ◽  
Xiao-Ying Liu ◽  
Ling Zhu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mortality Rate ◽  
Antifungal Therapy ◽  
Species Distribution ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Clinical Severity ◽  
Severe Neutropenia ◽  
Care Hospital ◽  
The Impact

Abstract Background The incidence of Candida bloodstream infections (BSIs), has increased over time. In this study, we aimed to describe the current epidemiology of Candida BSI in a large tertiary care hospital in Shanghai and to determine the risk factors of 28-day mortality and the impact of antifungal therapy on clinical outcomes. Methods All consecutive adult inpatients with Candida BSI at Ruijin Hospital between January 1, 2008, and December 31, 2018, were enrolled. Underlying diseases, clinical severity, species distribution, antifungal therapy, and their impact on the outcomes were analyzed. Results Among the 370 inpatients with 393 consecutive episodes of Candida BSI, the incidence of nosocomial Candida BSI was 0.39 episodes/1000 hospitalized patients. Of the 393 cases, 299 (76.1%) were treated with antifungal therapy (247 and 52 were treated with early appropriate and targeted antifungal therapy, respectively). The overall 28-day mortality rate was 28.5%, which was significantly lower in those who received early appropriate (25.5%) or targeted (23.1%) antifungal therapy than in those who did not (39.4%; P = 0.012 and P = 0.046, respectively). In multivariate Cox regression analysis, age, chronic renal failure, mechanical ventilation, and severe neutropenia were found to be independent risk factors of the 28-day mortality rate. Patients who received antifungal therapy had a lower mortality risk than did those who did not. Conclusions The incidence of Candida BSI has increased steadily in the past 11 years at our tertiary care hospital in Shanghai. Antifungal therapy influenced short-term survival, but no significant difference in mortality was observed between patients who received early appropriate and targeted antifungal therapy.

Recent Advances in the Management of Cardiogenic Shock

2021 ◽  
Author(s):  
Christine M. Gasperetti
Keyword(s):  
Mortality Rate ◽  
Cardiogenic Shock ◽  
Case Studies ◽  
Mechanical Circulatory Support ◽  
Early Recognition ◽  
Dynamic State ◽  
Circulatory Support ◽  
Mechanical Support ◽  
Recent Advances ◽  
Definition Of

For decades, the cardiogenic shock has remained one of the cardiac illnesses with the highest mortality, as high as 50%. Recent advances have lowered this mortality rate by use of early recognition of shock as well as an increased understanding of both advanced mechanical support and the hemodynamics of myocardial support. Included are the new definition of shock, results of a study of inotropic medications in shock, description, and case studies of mechanical circulatory support, all providing a framework for the overall goal in the management of cardiogenic shock as one to recognize shock, follow its dynamic state, and maximize support to patients toward recovery.

scholarly journals Two year review of maternal mortality at a tertiary care hospital of GMERS, Valsad, Gujarat, India

2018 ◽  
Vol 7 (6) ◽  
pp. 2283
Author(s):  
Darshna M. Patel ◽  
Mahesh M. Patel ◽  
Vandita K. Salat
Keyword(s):  
Mortality Rate ◽  
Maternal Mortality ◽  
Rural Areas ◽  
Tertiary Care ◽  
Maternal Mortality Ratio ◽  
Care Hospital ◽  
Maternal Deaths ◽  
Maternal Mortality Rate ◽  
Live Births ◽  
Mortality Ratio

Background: According to the WHO, 80 of maternal deaths in developing countries are due to direct maternal causes such as haemorrhage, hypertensive disorders and sepsis. These deaths are largely preventable. Maternal mortality ratio (MMR) in India is 167/100,000 live births.Methods: This retrospective observational study was conducted at GMERS, Valsad. Data regarding maternal deaths from January 2016 to December 2017 were collected and analyzed with respect to epidemiological parameters. The number of live births in the same period was obtained from the labour ward ragister. Maternal mortality rate and Mean maternal mortality ratio for the study period was calculated.Results: The mean Maternal mortality rate in the study period was 413.3/100,000 births. The maternal mortality ratio (MMR) in India is 167/100,000 live births. More than half of maternal deaths were reported in multiparous patients. More maternal deaths were observed in women from rural areas (67.3%), unbooked patients (73.3%) and illiterate women (65.3%). Thirty six (69.3%) maternal death occurred during postpartum period. Most common delay was first delay (60.0%) followed by second delay (40.0%). Postpartum haemorrhage (28.8%), preeclampsia (17.3%), sepsis (13.46%) were the major direct causes of maternal deaths. Indirect causes accounted for one third of maternal deaths in our study. Anemia, hepatitis and heart disease were responsible for 13.4%, 5.7%, and 1.9% of maternal deaths, respectively.Conclusions: Majority of maternal deaths are observed in patients from rural areas, unbooked, and illiterate patients. Hemorrhage, eclampsia and sepsis are leading causes of maternal deaths. Most of these maternal deaths are preventable if patients are given appropriate treatment at periphery and timely referred to higher centers.

scholarly journals Assessment of adverse drug reaction profile of the disease-modifying anti-rheumatic drugs at the department of orthopaedics in a tertiary care hospital, Silchar, Assam, India

2019 ◽  
Vol 8 (5) ◽  
pp. 1007
Author(s):  
Vijoy S. Kairi ◽  
Pinaki Chakravarty ◽  
Arun Kumar Sipani
Keyword(s):  
Prospective Observational Study ◽  
Tertiary Care Hospital ◽  
Early Recognition ◽  
Tertiary Care ◽  
P Value ◽  
Care Hospital ◽  
Case Record ◽  
Medical College ◽  
Disease Modifying ◽  
Reaction Profile

Background: The mainstay of treatment of Rheumatoid Arthritis (RA) is the use of the disease-modifying anti-rheumatic drugs (DMARDs). Methotrexate, sulfasalazine and hydroxychloroquine are some of the DMARDs which are used in combination for the treatment of RA. The current study was undertaken to assess the adverse drug reactions (ADRs) of DMARDs that are commonly encountered with the treatment of RA.Methods: The present study was designed as a prospective, observational study on newly diagnosed patients with RA. Patients diagnosed with RA above 18 years (excluding pregnant women) of either sex who were prescribed DMARDs in combination were included. ADRs reported spontaneously by the patients and also responses obtained in a questionnaire related to likely ADRs from the patients was recorded in the case record form. Statistical analysis was done using graph pad and p value <0.05 was considered to be statistically significant.Results: A total of 47 patients attending the Outpatient Department of Orthopaedics, Silchar Medical College and Hospital, Silchar, Assam, India were screened for the study. ADRs were monitored up to the last visit on 41 patients excluding the patients who were lost and who were not able to adhere to the treatment. A total of 27 ADRs were reported from 19 ADR forms. Gastrointestinal manifestations were the most common adverse effects of combination DMARDs seen in 10 patients (24.39%). Severity assessment done using modified Hartwig and Siegel scale that showed majority of the ADRs were mild (74.07%).Conclusions: Present study showed that DMARDs are well-tolerated and have an acceptable toxicity profile as majority of ADRs seen were mild. It was however difficult to prevent the occurrence of ADRs. Proper monitoring of therapy is needed for early recognition of ADRs.

scholarly journals A STUDY ON ADVERSE DRUG REACTIONS IN PATIENTS ON ANTIRETROVIRAL THERAPY IN A TERTIARY CARE HOSPITAL AT JAIPUR, RAJASTHAN

2021 ◽  
Vol 5 (8) ◽  
Author(s):  
Vishnu Gupta ◽  
Abhishek Agarwal
Keyword(s):  
Nervous System ◽  
Peripheral Nervous System ◽  
Early Recognition ◽  
Tertiary Care ◽  
Hiv Treatment ◽  
Research Review ◽  
Care Hospital ◽  
Medical College ◽  
The Status ◽  
Definition Of

Background: The present study was conducted to know the status of ADRs caused due to the first line ART in the ART center of SMS Hospital Jaipur, Rajasthan. This study would be beneficial to the HIV infected patients, with the ultimate goal of improving the tolerability and effectiveness of HIV treatment by promoting the early recognition of potentially serious adverse effects. Methods: Hospital based Prospective, Observational study conducted after approval by research review board and ethics committee SMS Medical College Jaipur (Rajasthan). WHO definition of ADR was used (any response to a medicine which is noxious and unintended and which occurs at doses normally used in man). The detail of ADRs collected including suspected drug involved, treatment given for ADRs and outcome. Results: Majority of ADRs were related to central and peripheral nervous system related 55 (47%) followed by gastro intestinal 28 (23.9%), dermatological 15 (12.8%), musculoskeletal 9 (7.7%) and metabolic 5 (4.3%). Conclusion: Majority of ADRs were related to central and peripheral nervous system related followed by gastro intestinal. Keywords: ADRs, HIV, WHO.

scholarly journals Predictors of Disseminated Intravascular Coagulation in Patients with Septic Shock

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Diana J. Kelm ◽  
Juan Carlos Valerio-Rojas ◽  
Javier Cabello-Garza ◽  
Ognjen Gajic ◽  
Rodrigo Cartin-Ceba
Keyword(s):  
Septic Shock ◽  
Antiplatelet Therapy ◽  
Disseminated Intravascular Coagulation ◽  
Tertiary Care ◽  
Multivariate Logistic Regression Model ◽  
Care Hospital ◽  
Clinical Predictors ◽  
Intravascular Coagulation ◽  
Early Goal Directed Therapy ◽  
Increased Risk

Purpose. The goal of this study was to identify potential clinical predictors for the development of disseminated intravascular coagulation (DIC) in patients with septic shock. Material and Methods. We performed a retrospective analysis of a cohort of adult (>18 years of age) patients with septic shock admitted to a medical ICU in a tertiary care hospital from July 2005 until September 2007. A multivariate logistic regression model was used to determine the association of risk factors with overt DIC. Results. In this study, a total of 390 patients with septic shock were analyzed, of whom 66 (17%) developed overt DIC. Hospital mortality was significantly greater in patients who developed overt DIC (68% versus 38%, P<0.001). A delay in the timing of antibiotics was associated with an increased risk of the development of overt DIC (P<0.001). Patients on antiplatelet therapy prior to hospital admission and who that received adequate early goal-directed therapy (EGDT) were associated with a decreased risk of overt DIC (P<0.001). Conclusions. In our cohort of patients with septic shock, there was a risk reduction for overt DIC in patients on antiplatelet therapy and adequate EGDT, while there was an increased risk of DIC with antibiotic delay.

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