scholarly journals The study of incidence of post operative delirium in geriatric patients who needed prolonged ICU stay after undergoing a major cardiac surgery in a tertiary care hospital

2018 ◽  
Vol 5 (2) ◽  
pp. 3504-3506
Author(s):  
Dr Aswin Rajeev ◽  
Dr George Paul ◽  
Dr Sunil K S ◽  
Dr Priya Vijayakumar
Keyword(s):  
Cardiac Surgery ◽  
Elderly Patients ◽  
Artery Bypass ◽  
Tertiary Care ◽  
P Value ◽  
Care Hospital ◽  
Icu Stay ◽  
Care Givers ◽  
Hospitalized Elderly ◽  
Prolonged Icu Stay

INTRODUCTION: Delirium, defined as an acute disorder of attention and global cognitive function  is a common, serious and potentially preventable source of morbidity and mortality in  hospitalized elderly patients.  Different studies have shown that prolonged post operative ICU stay contributes to occurrence of delirium OBJECTIVE: To assess the incidence of post operative delirium in elderly patients who needed prolonged ICU stay after  undergoing a major cardiac surgery (coronary artery bypass grafting). MATERIALS AND METHODS: Prospective cohort study, Study Period: 1 ½ years. Using a prepared questionnaire after obtaining fully informed written consent. 3 visits for each patient: 1) before surgery, 2) in the ICU: 48 hours after surgery and 3) In ward after shifting out from ICU. Prolonged ICU stay was defined as admission more than 3 days in ICU. The details from nursing staff and care givers were taken. RESULTS: Out of total 250 patients included in the study, 43 (17.2%) patients developed post operative delirium. 32 (26%) out of 19 patients who needed prolonged ICU stay developed post operative delirium compared to 11 (8.7%) out of 116 patients who spent less than 3 days in ICU in post operative period. (p Value: <0.001). Prolonged ICU stay contributes to post operative delirium and measures have to be instituted to shift out the patient from ICU at the earliest after stabilization.

Causes of Epilepsy in Elderly Patients Presenting in a Tertiary Care Hospital of Karachi

2020 ◽  
Keyword(s):  
Elderly Patients ◽  
Cerebrovascular Disease ◽  
Neurodegenerative Disorder ◽  
Tertiary Care ◽  
P Value ◽  
Care Hospital ◽  
Traumatic Head Injury ◽  
Keywords Epilepsy ◽  
College Hospital ◽  
Cross Sectional

Background: Epilepsy is fairly a frequent occurrence in the elderly. It is commonly diagnosed after the episode of two or more unprovoked seizures. Unprovoked seizures in elderly are recurrent rather than younger individuals. This study was designed to estimate the concrete burden of frequent causes of epilepsy. Methods: A descriptive cross-sectional study with a total of 153 patients diagnosed case of epilepsy were included in this study at Jinnah Medical College Hospital from February 2018-August 2018. Mean was calculated for age, duration of disease of the patients. Causes of epilepsy, gender, and education was calculated and presented as percentages. Electrolyte readings were taken i.e., Sodium, Calcium and Magnesium levels and imaging was planned to rule out stroke, primary neurodegenerative disorders and tumors. Post stratification Chi square test was applied and p-value less than or equal to 0.05 was considered significant. Results: The mean age of the patients was 63.91±5.68 years and mean duration of the disease was 4.61± 1.07 months. The common causes of epilepsy were found to be cerebrovascular disease 56.9%, cryptogenic 54.2%, neurodegenerative disorder 20.3%, traumatic head injury 11.8%, metabolic abnormalities or electrolyte disturbances 10.5% and brain tumor 7.8%. Conclusion: Elderly patients with first seizure should present to a facility designed in a way that neurologist, cardiologist, rehabilitation and geriatrics work together to identify and treat the condition in a better way. Keywords: Epilepsy; Seizures; Cerebrovascular Disease; Neurodegenerative Disorder.

scholarly journals Antimicrobial stewardship measures in cardiac surgery and its impact on surgical site infections

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Güzin Surat ◽  
Dominik Bernsen ◽  
Christoph Schimmer
Keyword(s):  
Cardiac Surgery ◽  
Antimicrobial Stewardship ◽  
Antimicrobial Prophylaxis ◽  
Tertiary Care ◽  
Surgical Site Infections ◽  
Antibiotic Use ◽  
P Value ◽  
Care Hospital ◽  
Surgical Antimicrobial Prophylaxis ◽  
Sternal Wound Infections

Abstract Objective The goal of this study was to monitor the compliance and impact on a protocol change of surgical antimicrobial prophylaxis in cardiac surgery favouring cefazolin instead cefuroxime, initiated by the hospital’s antimicrobial stewardship team. Methods This quality improvement study was performed in a tertiary care hospital in collaboration with the department of cardiothoracic surgery and the hospitals antimicrobial stewardship team following a revision of the standard for surgical antimicrobial prophylaxis including 1029 patients who underwent cardiac surgery. 582 patients receiving cefuroxime and 447 patients receiving cefazolin respectively were compared without altering any other preventative perioperative measures including its postoperative duration of less than 24 h. Adherence and surgical site infections were compiled and analysed. Results A complete adherence was achieved. Overall surgical site infections occurred in 37 (3.6%) of the cases, 20 (3.4%) in cefuroxime patients and 17 (3.8%) in cefazolin patients (p value = 0.754). No statistically significant differences could be found in any of the primary endpoints, but there was a trend towards less deep sternal wound infections in the cefazolin group. Conclusions The study supports the role of antimicrobial stewardship in cardiac surgery and mirrors the success of a multidisciplinary team aiming to minimize adverse events by optimizing antibiotic use.

scholarly journals Drug prescribing patterns in elderly patients in a tertiary level hospital

2017 ◽  
Vol 6 (4) ◽  
pp. 759
Author(s):  
Nachiket Bhaveshaikh ◽  
Sangita Sukumaran ◽  
Upal Vyas
Keyword(s):  
Elderly Patients ◽  
Tertiary Care ◽  
Prescribing Patterns ◽  
P Value ◽  
Pulmonary Medicine ◽  
Potentially Inappropriate Medications ◽  
Care Hospital ◽  
Prescribing Practices ◽  
Inappropriate Drugs ◽  
Utilization Patterns

Background: Elderly people have multiple co morbidities and are often prescribed potentially inappropriate medications (PIMs). As there is paucity of information about the prescribing practices in elderly this study was undertaken to assess drug utilization patterns in elderly patients.Methods: A prospective observational study was conducted in a tertiary care hospital. A total of 576 prescriptions of elderly patients were included in the study. Prescribing patterns among elderly patients attending OPD and admitted to wards of departments of Medicine, Psychiatry, Dermatology, Pulmonary Medicine, General Surgery, E.N.T., Ophthalmology, Orthopaedics, Obstetrics and Gynaecology were analysed using the prescribing indicators (WHO criteria). The PIMs were identified as per the Beers 2012 criteria.Results: The average number of drugs per patient was 3.91±1.93 for O.P.D and 7.37 ±2.22 for I.P.D. patients. 37.76% patients in I.P.D. and 26.87% patients in O.P.D. received a medication which was potentially inappropriate as per Beers 2012 criteria. 7.58% (234/3088) of total medications prescribed to patients in the study were potentially inappropriate. There was a significant increase in the number of PIMs (p value ˂0.05) as the total number of drugs prescribed increased.Conclusions: Educational programmes are needed to reinforce rational prescribing by physicians and precautions should be taken while prescribing potentially inappropriate drugs to elderly patients.

Seroprevalence of anti-SARS-CoV-2 IgG antibodies in hospitalized patients at a tertiary referral center in North India (Preprint)

2020 ◽  
Author(s):  
Dr. Animesh Ray ◽  
Dr. Komal Singh ◽  
Souvick Chattopadhyay ◽  
Farha Mehdi ◽  
Dr. Gaurav Batra ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Age Groups ◽  
Hospitalized Patients ◽  
North India ◽  
P Value ◽  
Care Hospital ◽  
Igg Antibodies ◽  
Igg Antibody ◽  
Increased Risk ◽  
Significant Difference

BACKGROUND Seroprevalence of IgG antibodies against SARS-CoV-2 is an important tool to estimate the true extent of infection in a population. However, seroprevalence studies have been scarce in South East Asia including India, which, as of now, carries the third largest burden of confirmed cases in the world. The present study aimed to estimate the seroprevalence of anti-SARS-CoV-2 IgG antibody among hospitalized patients at one of the largest government hospital in India OBJECTIVE The primary objective of this study is to estimate the seroprevalence of SARS-CoV-2 antibody among patients admitted to the Medicine ward and ICU METHODS This cross-sectional study, conducted at a tertiary care hospital in North India, recruited consecutive patients who were negative for SARS-CoV-2 by RT-PCR or CB-NAAT. Anti-SARS-CoV-2 IgG antibody levels targeting recombinant spike receptor-binding domain (RBD) protein of SARS CoV-2 were estimated in serum sample by the ELISA method RESULTS A total of 212 hospitalized patients were recruited in the study with mean age (±SD) of 41.2 (±15.4) years and 55% male population. Positive serology against SARS CoV-2 was detected in 19.8%patients(95% CI 14.7-25.8). Residency in Delhi conferred a higher frequency of seropositivity 26.5% (95% CI 19.3-34.7) as compared to that of other states 8% (95% CI 3.0-16.4) with p-value 0.001. No particular age groups or socio-economic strata showed a higher proportion of seropositivity CONCLUSIONS Around, one-fifth of hospitalized patients, who were not diagnosed with COVID-19 before, demonstrated seropositivity against SARS-CoV-2. While there was no significant difference in the different age groups and socio-economic classes; residence in Delhi was associated with increased risk (relative risk of 3.62, 95% CI 1.59-8.21)

scholarly journals Tracheostomy in Postoperative Pediatric Cardiac Surgical Patients—The Earlier, the Better

2021 ◽  
Author(s):  
Chalattil Bipin ◽  
Manoj K. Sahu ◽  
Sarvesh P. Singh ◽  
Velayoudam Devagourou ◽  
Palleti Rajashekar ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Hospital Stay ◽  
Pediatric Patients ◽  
Tertiary Care ◽  
Surgical Patients ◽  
Surgical Intensive Care Unit ◽  
Care Hospital ◽  
Surgical Intensive Care ◽  
Nutrition Supplementation

Abstract Objectives This study was aimed to assess the benefits of early tracheostomy (ET) compared with late tracheostomy (LT) on postoperative outcomes in pediatric cardiac surgical patients. Design Present one is a prospective, observational study. Setting The study was conducted at a cardiac surgical intensive care unit (ICU) of a tertiary care hospital. Participants All pediatric patients below 10 years of age, who underwent tracheostomy after cardiac surgery from January2019 to december2019, were subdivided into two groups according to the timing of tracheostomy: “early” if done before 7 days or “late” if done after 7 days postcardiac surgery. Interventions ET versus LT was measured in the study. Results Out of all 1,084 pediatric patients who underwent cardiac surgery over the study period, 41 (3.7%) received tracheostomy. Sixteen (39%) patients underwent ET and 25 (61%) underwent LT. ET had advantages by having reduced risk associations with the following variables: preoperative hospital stay (p = 0.0016), sepsis (p = 0.03), high risk surgery (p = 0.04), postoperative sepsis (p = 0.001), C-reactive protein (p = 0.04), ventilator-associated pneumonia (VAP; p = 0.006), antibiotic escalation (p = 0.006), and antifungal therapy (p = 0.01) requirement. Furthermore, ET was associated with lesser duration of mechanical ventilation (p = 0.0027), length of ICU stay (LOICUS; p = 0.01), length of hospital stay (LOHS; p = 0.001), lesser days of feed interruption (p = 0.0017), and tracheostomy tube change (p = 0.02). ET group of children, who had higher total ventilation-free days (p = 0.02), were decannulated earlier (p = 0.03) and discharged earlier (p = 0.0089). Conclusion ET had significant benefits in reduction of postoperative morbidities with overall shorter mechanical ventilation, LOICUS, and LOHS, better nutrition supplementation, lesser infection, etc. These benefits may promote faster patient convalescence and rehabilitation with reduced hospital costs.

scholarly journals Clinical characteristics and factors related to antibiotic-associated diarrhea in elderly patients with pneumonia: a retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yoko Takedani ◽  
Tsukasa Nakamura ◽  
Noriko Fukiwake ◽  
Toshihiro Imada ◽  
Junji Mashino ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Elderly Patients ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Tertiary Care ◽  
Multivariate Logistic Regression Model ◽  
Care Hospital ◽  
Antibiotic Associated Diarrhea ◽  
Elderly Inpatients

Abstract Background Antibiotic-associated diarrhea (AAD) is a common problem among elderly inpatients because many elderly patients are admitted for pneumonia or other conditions that necessitate antibiotic treatment. In the super aging population, more patients are suffering from pneumonia than before, but the incidence or risk factors for AAD among many elderly patients have not been well scrutinized. Methods We conducted a retrospective cohort study of elderly patients diagnosed with pneumonia from April 2014 to March 2019 who were admitted to the Department of General Medicine of a Tertiary Care Hospital in Japan. Patients (≥ 65 years of age) who were diagnosed with bacterial pneumonia or aspiration pneumonia and treated with antibiotics were included. We defined AAD by diarrhea with more than three loose or watery stools per day and included patients who had these symptoms for either one day or two or more consecutive days. We also assessed the length of hospital stay and in-hospital mortality. The potential risk factors for AAD included age, sex, body weight, body mass index, smoking, alcohol, activities of daily living (ADL),　comorbidities, vital signs, laboratories, the severity of pneumonia, antibiotic and other medication use. Results There were 1,067 patients, the mean age was 83 years, and men accounted for 59 %. β-Lactamase inhibitors were frequently prescribed antibiotics in 703 patients (66 %), and proton pump inhibitors (PPIs) were also commonly administered (48 %). AAD developed in 322 patients (30 %). The multivariate logistic regression model showed that β-lactamase inhibitors (OR 1.43, 95 % CI 1.05–1.95) and PPIs (OR 1.37, 95 % CI 1.03–1.83) were associated with AAD as well as age (OR 1.03 per year, 95 % CI 1.01–1.05). Conclusions AAD was common among elderly inpatients with pneumonia, and β-lactamase inhibitors and PPIs were associated with AAD. Strict use of such medication should be considered to decrease the risk of AAD.

scholarly journals Post-Operative Outcomes of Intravenous Lidocaine Infusion on Major Abdominal Surgery in Pediatric Patients: A Randomized Control Trial in a Tertiary Care Hospital

2018 ◽  
Vol 10 (1) ◽  
pp. 23-27
Author(s):  
Nirupama Saha ◽  
Nadiuzzaman Khan ◽  
Mirza Kamrul Zahid ◽  
Shah Alam Talukder ◽  
ASM Meftahuzzaman
Keyword(s):  
Abdominal Surgery ◽  
Tertiary Care ◽  
Major Abdominal Surgery ◽  
P Value ◽  
Care Hospital ◽  
Intravenous Lidocaine ◽  
Operative Outcomes ◽  
Group A ◽  
Randomized Control ◽  
Group B

Background: Post-operative outcomes of a major abdominal surgery depend on careful & effective post-operative management. But it is a critical job especially in children. Obtaining adequate analgesia after major surgery is a problematic issue and postoperative pain still imposes a major burden of suffering in surgical patients.Objectives: The principle objectives of the study is to evaluate the effects of intravenous lidocaine infusion in pain management of pediatric population undergone in major abdominal surgery; to reduce post-operative morbidity & enhance better surgical outcome in children.Methodology: This is a randomized control trial carried out from January 2015-June2015,in a tertiary care hospital among 60 cases of 4 to 14 years children with major abdominal surgery without having any pulmonary, cardiac, hepatic or renal insufficiency. Grouping of patients that is lidocaine infusion group (Group A) and control group (Group B) was made among admitted cases for elective abdominal surgery by simple random technique by means of lottery. For assessment of postoperative pain FLACC Scale was used in both groups. Clinical examination findings & specifically designed data collection sheet with a set questionnaire were used as research instruments. Formulated data was analyzed by SPSS version 17, taking p value <0.05 as significant.Results: It is noted that, after 24 hours of operation most of the patients 56.7% of group A had mild pain whereas 90% patients of group B had moderate pain (p<0.001)& during that time there was no patient with severe pain in group A whereas in group B 10% patients were with severe pain. At 48 hours, pain was absent in 13.3% children of group A and 6.7% in group B. In group A most of the children 76.7%had mild pain compared to moderate pain 18 (60%) in group B children at that hours (P<0.001). Again, regarding required amount of analgesics, patients received I/V lidocaine required less amount of analgesics than its counterpart. In present study, complications was noted only 3.3% patien in group A, where as in the opposite group it was found in 23.3% & p was <0.05. In group A, in 50% patients post operative bowel sound was returned within 72 hours, compared to 73.3% patients in group B. The p value was 0.001. About post-operative hospital stay, 83.3% children of the group A were released from hospital after 5th P.O.D whereas, in group B, only 50% children were released after 7th P.O.D of operation. The P value was 0.03 that is also significant.Conclusion: Intravenous lidocaine could improve immediate and late post-operative pain with early recovery after major abdominal surgery in children & it can contribute to rapid postoperative rehabilitation programs.J Shaheed Suhrawardy Med Coll, June 2018, Vol.10(1); 23-27

Medialization Laryngoplasty in the Elderly: Outcomes and Expectations

2017 ◽  
Vol 157 (4) ◽  
pp. 664-669 ◽  
Author(s):  
Andrew Jay Bowen ◽  
Tiffany L. Huang ◽  
Michael S. Benninger ◽  
Paul C. Bryson
Keyword(s):  
Elderly Patients ◽  
Vocal Cord ◽  
Vocal Cord Paralysis ◽  
Tertiary Care ◽  
Anticoagulation Therapy ◽  
Voice Handicap Index ◽  
Care Hospital ◽  
Disease Etiology ◽  
Chi Square Analysis ◽  
Medialization Laryngoplasty

Objective To describe the profile and outcomes of elderly patients undergoing medialization laryngoplasty for vocal cord paralysis. Study Design Case series with retrospective review. Setting Tertiary care hospital. Subjects and Methods Patients were included in the study if they were >65 years old at the time of medialization laryngoplasty between 2008 and 2015. Patient comorbidities, anticoagulation status, disease etiology, and physical examination findings were recorded with postoperative length of stay, complications, pre- and posttreatment voice outcomes with the Voice Handicap Index (at 6 weeks, 4 months, 8 months, and 1 year), and postprocedural interventions (revision injections, surgery, therapy). Results A total of 112 patients met the eligibility criteria. Iatrogenic injury to the recurrent laryngeal nerve (50%) was the most common etiology, followed by idiopathic (31%) causes. Sixty percent of patients were receiving long-term antiplatelet and/or anticoagulation therapy. All but 14 patients on aspirin therapy stopped their antiplatelet/anticoagulation therapy prior to surgery. Most patients were discharged on the day of surgery. Postprocedure Voice Handicap Index scores significantly improved ( P < .001) by 47%, 53%, 64%, and 57% at each of the 4 measured postprocedure dates, respectively. Two patients had major nonsurgical complications postoperatively requiring inpatient hospitalization. Chi-square analysis revealed no differences between intraoperative aspirin use, sex, or comorbidities and the incidence of complications ( P > .05). Conclusion The clinical profile and outcomes of our patients undergoing medialization laryngoplasty are comparable to those seen in younger cohorts. Medialization laryngoplasty is a safe and successful option for elderly patients with vocal cord paralysis and vocal handicap.

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