scholarly journals Etiological analysis, morbidities and mortality that affect the young and middle aged admitted with altered mental status in a general hospital

2018 ◽  
Vol 5 (5) ◽  
pp. 1295
Author(s):  
Henna Naqash ◽  
Parvaiz Ahmad Shah ◽  
Mohammad Hayat Bhat ◽  
Ishrat Hussain Dar ◽  
Muzaffar Maqbool
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Mental Status ◽  
Distress Syndrome ◽  
Middle Age ◽  
Altered Mental Status ◽  
Age Group ◽  
Common Cause ◽  
Group A ◽  
Group B

Background: Authors conducted this study to find the profile of causes and diseases that affect patients of younger age group in altered sensorium admitted in a general hospital associated with Government Medical College Srinagar, in India.Methods: Authors conducted present study over a period of eight months. The patients of young and middle age who were admitted in their hospital ward with altered mental status were included. The study subjects were divided into two groups: group A included patients of age upto 30 years, and group B with patients in age group 31-50 years. The patients were studied for their diagnoses, comorbidities, gender distribution, duration of stay in hospital and mortality patterns.Results: Authors had a total of 112 patients of young and middle age admitted in their hospital ward with altered mental status during the study period. In group A, there were 42 patients or 37.5% (20 males and 22 females). In group B, there were 70 patients or 62.5% (30 males and 40 females). The most common cause of admission in these patients was infection (29.46%) followed by seizures (17.85%) and cardioembolic strokes (11.60%).The most common comorbidities in studied patients were underlying seizure disorder, psychiatric disease in the form of bipolar affective disorder or schizophrenia, hypertension, type 2 diabetes and chronic kidney disease.There were 14 deaths in group A and 30 deaths in group B. The most common cause of death was infections followed by seizures, Acute respiratory distress syndrome (ARDS) and severe diabetic ketoacidosis (DKA).Conclusions: The most common cause of admission in young and middle-aged patients in authors’ hospital was infection followed by seizures and cardioembolic strokes. The most common cause of death was again infections followed by seizures, acute respiratory distress syndrome and severe diabetic ketoacidosis.

scholarly journals Identification of Three Endotypes in Pediatric Acute Respiratory Distress Syndrome by Nasal Transcriptomic Profiling

2020 ◽  
Author(s):  
James Garrett Williams ◽  
Rashika Joshi ◽  
Rhonda Jones ◽  
Toni Yunger ◽  
Erin Stoneman ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Prospective Trial ◽  
Inferior Turbinate ◽  
Transcriptomic Profiling ◽  
Low Input ◽  
Group A ◽  
Group B

1ABSTRACTAcute respiratory distress syndrome (ARDS) and pediatric ARDS (PARDS) can be triggered by multiple pulmonary and non-pulmonary insults and are the source of substantial morbidity and mortality. The nasal epithelium is similar to that of the lower conducting airways and nasal transcriptomic profiling identifies disease and endotypes in lung cancer, COPD, and asthma. We conducted a prospective trial of testing whether this technique could identify PARDS endotypes in 26 control and 25 PARDS subjects <18 admitted to the PICU extracting RNA from inferior turbinate brushings on days 1, 3, 7, and 14. Standard RNA processing and mRNA-seq yielded ~25% usable specimens and a modified, low-input RNA protocol yielded 95% usable specimens. Sixty-four low-input specimens from 10 control and 15 PARDS subjects were used for initial analysis. Control and some PARDS subjects clustered together in both by-day and combined analysis into Groups A while some day 1, 3, and 7 specimens from the same subjects clustered into Groups B and C with specimens from these subjects moving to Group A with PARDS resolution. In multivariate analysis, the only clinical variables predictive of Group B or C status was severity of lung injury or viral PARDS trigger. Compared to Group A, Group B had upregulation of innate immune processes and group C had upregulation of cilia-associated processes. Analysis of the 15 specimens processed and analyzed by standard techniques identified the same processes as differentiating Groups A, B, and C. Mortality appeared to be higher in group B (25%) and C subjects (28.6%) compared to A subject (5%, p=0.1). Our findings demonstrate three distinct PARDS endotypes which may be useful for prognostic and therapeutic enrichment. ClinicalTrials.gov Identifier NCT03539783

scholarly journals Therapeutic Evaluation of Computed Tomography Findings for Efficacy of Prone Ventilation in Acute Respiratory Distress Syndrome Patients with Abdominal Surgery

2020 ◽  
Vol 6 (1) ◽  
pp. 32-40 ◽  
Author(s):  
Masayuki Akatsuka ◽  
Hiroomi Tatsumi ◽  
Naoya Yama ◽  
Yoshiki Masuda
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Abdominal Surgery ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Ct Scan ◽  
Distress Syndrome ◽  
Ground Glass Opacity ◽  
Ct Scanning ◽  
Group A ◽  
Group B

AbstractIntroductionIn Acute Respiratory Distress Syndrome (ARDS), the heterogeneity of lung lesions results in a mis-match between ventilation and perfusion, leading to the development of hypoxia. The study aimed to examine the association between computed tomographic (CT scan) lung findings in patients with ARDS after abdominal surgery and improved hypoxia and mortality after prone ventilation.Material and MethodsA single site, retrospective observational study was performed at the Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan, between 1st January 2004 and 31st October 2018. Patients were allocated to one of two groups after CT scanning according to the presence of ground-glass opacity (GGO) or alveolar shadow with predominantly dorsal lung atelectasis (DLA) on lung CT scan images. Also, Patients were divided into a prone ventilation group and a supine ventilation group when the treatment for ARDS was started.ResultsWe analyzed data for fifty-one patients with ARDS following abdominal surgery. CT scans confirmed GGO in five patients in the Group A and in nine patients in the Group B, and DLA in 17 patients in the Group A and nine patients in the Group B. Both GGO and DLA were present in two patients in the Group A and nine patients in the Group B. Prone ventilation significantly improved patients’ impaired ratio of arterial partial pressure of oxygen to fraction of inspired oxygen from 12 h after prone positioning compared with that in the supine position. Weaning from mechanical ventilation occurred significantly earlier in the Group A with DLA vs the Group B with DLA (P < 0.001). Twenty-eight-day mortality was significantly lower for the Group A with DLA vs the Group B with DLA (P = 0.035).ConclusionsThese results suggest that prone ventilation could be effective for treating patients with ARDS as showing the DLA.

scholarly journals Early veno-venous Extra Corporeal Membrane Oxygenation with prone positioning in the treatment of severe Acute Respiratory Distress syndrome in a pediatric patient: a case report

2019 ◽  
Vol 6 (4) ◽  
pp. 1743
Author(s):  
Md Nawad Azam ◽  
Senthil Kumar S. P.
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Adult Population ◽  
Age Group ◽  
Prone Positioning ◽  
Extra Corporeal Membrane Oxygenation ◽  
Membrane Oxygenation ◽  
Vv Ecmo

Aim of the study was to discuss effectiveness and outcome of Extra Corporeal Membrane Oxygenation (ECMO) therapy with prone positioning while on ECMO in a child with severe Acute Respiratory Distress Syndrome (ARDS). Veno-venous ECMO (VV-ECMO) and prone position on ECMO are relatively newer modalities of treatment in severe ARDS in pediatric age group and to our experience very few cases has been reported in paediatric age group. A 5 year old male child presented with fever with respiratory distress. He deteriorated in next 48 hrs leading to severe hypoxemia with ARDS following which he was put on conventional ventilation. In view of worsening critical lung parameters, veno-venous ECMO was initiated. Child had persistent hypoxemia inspite on high positive end expiaratory pressure (PEEP), adequate flow and adequate Post oxygenator PO2. Recirculation and other possible causes were excluded. Prone positioning (PP) was done for 8 hrs a day with chest physiotherapy while on ECMO. Patient showed considerable improvement in next few days and ECMO was weaned on day 7 and child was discharged on day 16 with good lung recovery. Although studies on VV-ECMO with PP has proven effectiveness in severe ARDS in adult population, overall studies in paediatric ARDS are very limited. Prone positioning on ECMO may decrease duration of ECMO support. Prone positioning on VV ECMO is safe and can be considered in Persistent hypoxemia with poor respiratory compliance.

scholarly journals Acute viral bronchiolitis as a cause of pediatric acute respiratory distress syndrome

2020 ◽  
Author(s):  
Marwa M. H. Ghazaly ◽  
Nagla H. Abu Faddan ◽  
Duaa M. Raafat ◽  
Nagwa A. Mohammed ◽  
Simon Nadel
Keyword(s):  
Risk Factor ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Demographic Data ◽  
Significant Risk ◽  
Common Cause ◽  
Syncytial Virus ◽  
Acute Viral Bronchiolitis

Abstract The Pediatric Acute Lung Injury Consensus Conference (PALICC) published pediatric-specific guidelines for the definition, management, and research in pediatric acute respiratory distress syndrome (PARDS). Acute viral bronchiolitis (AVB) remains one of the leading causes of admission to PICU. Respiratory syncytial virus (RSV) is the most common cause of AVB. We aimed to evaluate the incidence of PARDS in AVB and identify the risk of RSV as a trigger pathogen for PARDS. This study is a retrospective single-center observational cohort study including children < 2 years of age admitted to the pediatric intensive care unit at St Mary’s Hospital, London, and presented with AVB in 3 years (2016–2018). Clinical and demographic data was collected; PALICC criteria were applied to define PARDS. Data was expressed as median (IQR range); non-parametric tests were used. In this study, 144 infants with acute viral bronchiolitis were admitted to PICU in the study period. Thirty-nine infants fulfilled criteria of PARDS with RSV as the most common virus identified. Bacterial infection was identified as a risk factor for development of PARDS in infants with AVB. Conclusion: AVB is an important cause of PARDS in infants. RSV is associated with a higher risk of PARDS in AVB. Bacterial co-infection is a significant risk factor for development of PARDS in AVB. What is Known:• Bronchiolitis is a common cause of respiratory failure in children under 2 years.• ARDS is a common cause of PICU admission. What is New:• Evaluation of bronchiolitis as a cause of PARDS according to the PALLIC criteria.• Evaluation of different viruses’ outcome in PARDS especially RSV as a commonest cause of AVB.

scholarly journals Acute respiratory distress syndrome, metabolic acidosis, and respiratory acidosis associated with citalopram overdose

2013 ◽  
Vol 2 (5) ◽  
pp. 24
Author(s):  
Hawa Edriss ◽  
Marie Pfarr
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Metabolic Acidosis ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Respiratory Acidosis ◽  
Altered Mental Status ◽  
Cardiac Biomarkers ◽  
X Ray ◽  
Chest X Ray

We report a 53-year-old man who ingested 2400 mg of citalopram and presented to the emergency department three hours post-ingestion with altered mental status, somnolence, and a blood pressure of 67/45 mmHg. He failed to respond to three boluses of normal saline (1000 ml each) and required vasopressors. The patient developed serotonin syndrome with hyper-reflexia, rigidity, and ankle myoclonus. He had a tonic-clonic seizure in the ER requiring intravenous lorazepam and phenytoin. An ECG showed QT prolongation. Chest x-ray on presentation was normal. Within 32 hours the patient developed acute respiratory distress, hypoxemia, a wide A-a gradient, PaO2/FiO2< 200, and chest x-ray changes compatible with acute respiratory distress syndrome (ARDS). He had normal central venous pressures, normal cardiac biomarkers, normal systolic and diastolic functions on echocardiography, and no acute ST/T wave changes. His ABG showed a metabolic acidosis and a respiratory acidosis. The patient required intubation and ventilation. Citalopram has been associated with seizures and ECG abnormalities after overdoses. The respiratory complications and metabolic acidosis have been reported only a few times in the literature.  We are reporting the second case of ARDS and the fifth case of metabolic acidosis due to citalopram overdose and suggest that the metabolic acidemia is explained by propionic acid. The respiratory acidosis seen in this patient has not been reported previously.

scholarly journals Anaphylaxis to Ceftriaxone – Evaluation of Two Cases

2018 ◽  
Vol 11 (02) ◽  
pp. 82-84
Author(s):  
Rozeeta Hirachan ◽  
PH Gopi ◽  
R Bibek ◽  
Hari KC ◽  
G Tumaya ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Adverse Drug Reactions ◽  
Distress Syndrome ◽  
Allergic Reactions ◽  
Beta Lactamase ◽  
Drug Reactions ◽  
Immunological Mechanism ◽  
Common Cause

Allergic reactions to beta-lactamase antibiotics are the most common cause of adverse drug reactions mediated by specific immunological mechanism. Anaphylaxis is diagnosed clinically. In two of our cases, patients developed acute respiratory distress syndrome (ARDS) secondary to anaphylaxis, which was however managed successfully without residual deficits.

Evaluation of interferon-alfa 2b in a model of acute respiratory distress syndrome and pulmonary fibrosis induced by intratraqueal bleomycin in Wistar rats

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 2566-2566
Author(s):  
A. F. Ferreira Filho ◽  
J. R. Rossari ◽  
V. D. Silva ◽  
D. L. Da Silva ◽  
J. C. Prolla
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Pulmonary Fibrosis ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Wistar Rats ◽  
Distress Syndrome ◽  
Histological Evaluation ◽  
Interferon Α ◽  
Tnf Α ◽  
Group B

2566 Background: The acute respiratory distress syndrome (ARDS) is a common clinical entity, characterized by severe and acute pulmonary dysfunction, caused by a non-cardiogenic pulmonary edema, secondary to an increased permeability in the alveolar-capillary barrier due to a local or systemic inflammatory reaction initiated and amplified by pro-inflammatory cytokines, mostly interleukin (IL) 1, 6 and 8, and TNF-α. Despite recent advances in intensive care, the mortality associated to this syndrome remains around 40–50%. Interferons are natural proteins with antiviral, antiproliferative, antiangiogenic and immunomodulatory properties. Interferon-α reduces the synthesis and deposition of collagen I and III in hepatic tissue in experimental models of hepatic fibrosis. Interferon-α also modulates inflammation by inhibiting the action of TNF-α. The objective of this study was to evaluate the effect of interferon-α 2b in an experimental model of bleomycin-induced pulmonary fibrosis in Wistar rats. Methods: We evaluated 34 Wistar rats that were anesthetized with ketamine 100 mg/kg by the intraperitoneal route and divided in two groups of 17 animals each. Both groups received an intratracheal instillation of 1,5U of bleomycin and 0,2ml of saline solution in the first day (D1). Starting on D1, Group B received subcutaneous interferon-α 2b in a dose of 100,000 U/Kg/day for 14 days. In the fifteenth day (D15), all rats in both groups were anesthetized with thiopental and sacrificed. Their right lungs medium lobes were prepared for histological evaluation. Hematoxylin eosin and picrosirius stains were performed on 4 μm cuts of each specimen under carefully controlled conditions. The areas of collagen in their lungs were quantified in (μm2) by digital image analysis with the Image Pro for Windows software. All statistical tests were two-sided, and P < .05 was used to indicate statistical significance. Results: The mean pulmonary fibrosis area in the group A was 28,432 μm2 versus 8,866 μm2 in group B who used interferon-α 2b (P = 0,037). Conclusions: These results shows that the use of interferon-α 2b, in this animal model of ARDS, reduced the development of pulmonary fibrosis. No significant financial relationships to disclose.

scholarly journals Profile of invasive group A and group B Streptococcal infections in patients hospitalized at the University Hospital for Infectious Diseases „Dr. Fran Mihaljević“ during the period from 2011 to 2018

2020 ◽  
Vol 40 (1) ◽  
pp. 11-14
Author(s):  
Lana Šepec Rožmarić ◽  
Suzana Bukovski
Keyword(s):  
Infectious Diseases ◽  
Invasive Disease ◽  
University Hospital ◽  
Age Group ◽  
Streptococcal Infections ◽  
Invasive Group ◽  
Common Cause ◽  
Group A ◽  
Group B ◽  
The University

Aim: Beta-haemolytic streptococci (BHS) rarely cause invasive disease (ID). Usually the most common cause of ID is group B BHS (BHS-B). However, in our recent routine work higher number of group A BHS (BHS-A) isolates from blood was noted. The aim of this study was to report trends and findings by group BHS-A and BHS-B causing laboratory confirmed disease from 2011 to 2018 at the University Hospital for Infectious Diseases „Dr. Fran Mihaljević”. Methods: Data on patients from the electronic database of microbiological laboratory at UHID for the period 2011-2018 was collected and analysed. Results: During the period 2011-2018, 151 BHS A and B were identified from normally sterile body sites. Most isolates were from blood cultures (96.7%). BHS-A and BHS-B were isolated almost equally. The highest number of isolates was recorded in 2012 and 2017. The number of BHS A isolates peaked in 2012, 54% more than BHS-B, and 50% more in 2016. Children presented 19.9% of patients, and were mostly isolated with BHS-A. 80.1% patients were adults. Adults predominated in the age group &gt;65 years. 12 children and 18 adults were hospitalised in intensive care unit. Conclusion: Invasive group A and group B streptococcal infections predominantly affect most vulnerable age groups, children and elderly. In this study invasive BHS disease is most common among adults above 65 years of age. BHS-A was most common cause of invasive disease among paediatric patients as well as in the age group above 65 years. Typing and characterization of BHS-A isolates due to its characteristics should be foreseen as important diagnostic tool, especially to monitor changes in virulence and to prevent potential outbreaks.

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