Prevalence, Correlates and Management of Hyperglycemia in Diabetic Non-critically Ill Patients at a Tertiary Care Center in Lebanon

2019 ◽  
Vol 15 (2) ◽  
pp. 133-140 ◽  
Author(s):  
Ghada El Khoury ◽  
Hanine Mansour ◽  
Wissam K. Kabbara ◽  
Nibal Chamoun ◽  
Nadim Atallah ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Care Center ◽  
Descriptive Analysis ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
Diabetic Patients

Background: Diabetes Mellitus is a chronic metabolic disease that affects 387 million people around the world. Episodes of hyperglycemia in hospitalized diabetic patients are associated with poor clinical outcomes and increased morbidity and mortality. Therefore, prevention of hyperglycemia is critical to decrease the length of hospital stay and to reduce complications and readmissions. Objective: The study aims to examine the prevalence of hyperglycemia and assess the correlates and management of hyperglycemia in diabetic non-critically ill patients. Methods: The study was conducted on the medical wards of a tertiary care teaching hospital in Lebanon. A retrospective chart review was conducted from January 2014 until September 2015. Diabetic patients admitted to Internal Medicine floors were identified. Descriptive analysis was first carried out, followed by a multivariable analysis to study the correlates of hyperglycemia occurrence. Results: A total of 235 medical charts were reviewed. Seventy percent of participants suffered from hyperglycemia during their hospital stay. The identified significant positive correlates for inpatient hyperglycemia, were the use of insulin sliding scale alone (OR=16.438 ± 6.765-39.941, p=0.001) and the low frequency of glucose monitoring. Measuring glucose every 8 hours (OR= 3.583 ± 1.506-8.524, p=0.004) and/or every 12 hours (OR=7.647 ± 0.704-79.231, p=0.0095) was associated with hyperglycemia. The major factor perceived by nurses as a barrier to successful hyperglycemia management was the lack of knowledge about appropriate insulin use (87.5%). Conclusion: Considerable mismanagement of hyperglycemia in diabetic non-critically ill patients exists; indicating a compelling need for the development and implementation of protocol-driven insulin order forms a comprehensive education plan on the appropriate use of insulin.

A 10-Year Review of Necrotizing Fasciitis in the Pediatric Population: Delays to Diagnosis and Management

2016 ◽  
Vol 56 (7) ◽  
pp. 627-633 ◽  
Author(s):  
Heather VanderMeulen ◽  
Jeffrey M. Pernica ◽  
Madan Roy ◽  
April J. Kam
Keyword(s):  
Necrotizing Fasciitis ◽  
Chart Review ◽  
Pediatric Population ◽  
Care Center ◽  
Tertiary Care ◽  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
Causative Organism ◽  
Antibiotic Administration ◽  
Large Variability

Objective. To assess the promptness and appropriateness of management in pediatric cases of necrotizing fasciitis (NF). Methods. A retrospective chart review examined cases of pediatric NF treated at a pediatric tertiary care center over a 10-year period. Results. Twelve patients were identified over the 10-year period. The median (25th to 75th centile) times to appropriate antibiotic administration, infectious disease consults, surgical consults and debridement surgeries were 2.6 (2.1-3.2), 7.7 (3.4-24.4), 4.6 (1.7-21.0), and 22.1 (10.3-28.4) hours following assessment at triage. The initial antibiotic(s) administered covered the causative organism in 9 of 12 cases. The median (25th to 75th centile) length of hospital stay was 21 (14.0-35.5) days. Conclusions. The large variability in the care of these patients speaks to the range of their presenting symptomatology. The lack of a standardized approach to the pediatric patient with suspected NF results in delays in management and suboptimal antibiotic choice.

scholarly journals Outcomes of Barotrauma in Critically Ill COVID-19 Patients With Severe Pneumonia

2021 ◽  
pp. 088506662110233
Author(s):  
Victor P. Gazivoda ◽  
Mudathir Ibrahim ◽  
Aaron Kangas-Dick ◽  
Arony Sun ◽  
Michael Silver ◽  
...  
Keyword(s):  
New York ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
Severe Pneumonia ◽  
Care Hospital ◽  
Mechanically Ventilated ◽  
Design And Methods

Background: Pneumomediastinum and pneumothorax are complications which may be associated with barotrauma in mechanically ventilated patients. The current literature demonstrates unclear outcomes regarding barotrauma in critically ill patients with severe COVID-19. The purpose of this study was to examine the incidence of barotrauma in patients with severe COVID-19 pneumonia and its influence on survival. Study Design and Methods: A retrospective cohort study was performed from March 18, 2020 to May 5, 2020, with follow-up through June 18, 2020, encompassing critically ill intubated patients admitted for COVID-19 pneumonia at an academic tertiary care hospital in Brooklyn, New York. Critically ill patients with pneumomediastinum, pneumothorax, or both (n = 75) were compared to those without evidence of barotrauma (n = 206). Clinical characteristics and short-term patient outcomes were analyzed. Results: Barotrauma occurred in 75/281 (26.7%) of included patients. On multivariable analysis, factors associated with increased 30-day mortality were elevated age (HR 1.015 [95% CI 1.004-1.027], P = 0.006), barotrauma (1.417 [1.040-1.931], P = 0.027), and renal dysfunction (1.602 [1.055-2.432], P = 0.027). Protective factors were administration of remdesivir (0.479 [0.321-0.714], P < 0.001) and receipt of steroids (0.488 [0.370-0.643], P < 0.001). Conclusion: Barotrauma occurred at high rates in intubated critically ill patients with COVID-19 pneumonia and was found to be an independent risk factor for 30-day mortality.

scholarly journals Acute Stroke Care and Thrombolytic Therapy Use in a Tertiary Care Center in Lebanon

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Mazen J. El Sayed ◽  
Tharwat El Zahran ◽  
Hani Tamim
Keyword(s):  
Ischemic Stroke ◽  
Thrombolytic Therapy ◽  
Care Center ◽  
Descriptive Analysis ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Delayed Presentation ◽  
Tertiary Care Center ◽  
Acute Stroke Care ◽  
Symptomatic Intracerebral Hemorrhage

Background. Thrombolytic therapy (rt-PA) is approved for ischemic stroke presenting within 4.5 hours of symptoms onset. The rate of utilization of rt-PA is not well described in developing countries.Objectives. Our study examined patient characteristics and outcomes in addition to barriers to rt-PA utilization in a tertiary care center in Beirut, Lebanon.Methods. A retrospective chart review of all adult patients admitted to the emergency department during a one-year period (June 1st, 2009, to June 1st, 2010) with a final discharge diagnosis of ischemic stroke was completed. Descriptive analysis was done followed by a comparison of two groups (IV rt-PA and no IV rt-PA).Results. During the study period, 87 patients met the inclusion criteria and thus were included in the study. The mean age was found to be 71.9 years (SD = 11.8). Most patients arrived by private transport (85.1%). Weakness and loss of speech were the most common presenting signs (56.3%). Thirty-three patients (37.9%) presented within 4.5 hours of symptom onset. Nine patients (10.3%, 95% CI (5.5–18.5)) received rt-PA. The two groups (rt-PA versus non rt-PA) had similar outcomes (mortality, symptomatic intracerebral hemorrhage, modified Rankin scale scores, and residual deficit at hospital discharge).Conclusion. In our setting, rt-PA utilization was higher than expected. Delayed presentation was the main barrier to rt-PA administration. Public education regarding stroke is needed to decrease time from symptoms onset to ED presentation and potentially improve outcomes further.

scholarly journals Comparative Cost Analysis of Endoscopic versus Microscopic Endonasal Transsphenoidal Surgery for Pituitary Adenomas

2017 ◽  
Vol 79 (02) ◽  
pp. 131-138 ◽  
Author(s):  
Chikezie Eseonu ◽  
Karim ReFaey ◽  
Oscar Garcia ◽  
Roberto Salvatori ◽  
Alfredo Quinones-Hinojosa
Keyword(s):  
Operating Room ◽  
Transsphenoidal Surgery ◽  
Operative Time ◽  
Care Center ◽  
Tertiary Care ◽  
Hospital Costs ◽  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
Life Years ◽  
Endoscopic Group

Objective This study presents a comparative analysis of cost efficacy between the microscopic and endoscopic transsphenoidal approaches, evaluating neurological outcome, extent of resection (EOR), and inpatient hospital costs. Design This study was a retrospective chart review. Setting This study was conducted at a tertiary care center. Participants The study group consisted of 68 patients with transsphenoidal surgeries between January 2007 and January 2014. Main Outcome Measures Two-sample t-tests and Pearson's chi-square test evaluated inpatient costs, quality-adjusted life years (QALYs), volumetric EOR, and neurological outcomes. Results Total inpatient costs per patient was $22,853 in the microscopic group and less ($19,736) in the endoscopic group (p = 0.049). Operating room costs were $5,974 in the microscopic group and lower in the endoscopic group ($5,045; p = 0.038). Operative time was 203.6 minutes in the microscopic group and 166.3 minutes in the endoscopic group (p = 0.032). The QALY score, length of hospital stay, and postoperative outcomes were found to be similar between the two cohorts. Multivariate linear regression modeling suggested that length of stay (p < 0.001) and operative time (p = 0.008) were important factors that influenced total inpatient costs following transsphenoidal surgery. Conclusion This study shows that transsphenoidal surgery is more cost effective with the endoscopic approach than with the microscopic approach and depends on efficiency in the operating room as well as reduction in the length of hospitalization.

scholarly journals 1676. Incidence and Outcomes of Pulmonary Involvement in Patients with Scrub Typhus: A Clinical Study from India

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S614-S614
Author(s):  
Vivek Nangia ◽  
Amina Mobashir
Keyword(s):  
Hospital Stay ◽  
Scrub Typhus ◽  
Care Center ◽  
Invasive Mechanical Ventilation ◽  
Tertiary Care ◽  
Length Of Hospital Stay ◽  
Severity Of Illness ◽  
Pulmonary Involvement ◽  
Primary Objective ◽  
Presenting Symptoms

Abstract Background Scrub typhus is a tropical fever caused by orrientia tsutsugamushi and is probably the most under-recognized of all the febrile illnesses leading to hospitalization, especially in India. Although the most common presenting symptoms are fever, myalgia, lymphadenopathy and rash, a significant percentage of patients also present with respiratory complaints. Methods December 2018 at a tertiary care center, in Delhi, India. The primary objective was to determine the incidence of respiratory involvement in patients with scrub typhus on the basis of radiological findings. Secondary objective was to compare the length of hospital stay, clinical presentation, and severity of illness as indicated by transaminitis, thrombocytopenia, inotropic requirement, and lactate levels. Also compared was the difference in mortality between the two groups. Results Pulmonary involvement was seen in 28.9% (22/76) patients which included varied radiological pictures. 5 patients required mechanical and 2 noninvasive ventilation. Eschar was seen in 44.7% out of which 20 had pulmonary involvement. Patients with pulmonary involvement had a significantly greater length of hospital stay (5.82 days vs. 2.56, P < 0.001), more severe transaminitis (P < 0.001), thrombocytopenia (P < 0.001), hyperlactatemia (P < 0.001), higher ionotropic requirement (P < 0.001) and mortality (P = 0.006). Conclusion Pulmonary involvement was seen in almost one-third of the patients with scrub typhus and was associated with higher morbidity and mortality. These patients were sicker, often required intensive care admissions, inotropic support, noninvasive and invasive mechanical ventilation and a significantly prolonged hospitalization. Chest radiographs should be a part of routine evaluation of all patients suspected to have scrub typhus. With such high pulmonary involvement, scrub typhus forms an important differential diagnosis in patients with lung infection residing in endemic areas and in those with a history of travel to such areas Disclosures All authors: No reported disclosures.

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