scholarly journals Delirium in Critically ill Patients in a Tertiary Care Centre in Western Region of Nepal

2015 ◽  
Vol 12 (2) ◽  
pp. 117-120
Author(s):  
P Thapa ◽  
PK Chakraborty ◽  
JB Khattri ◽  
K Ramesh ◽  
P Sharma
Keyword(s):  
Risk Factors ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Tertiary Care ◽  
Prognostic Significance ◽  
Significant Proportion ◽  
Adverse Outcomes ◽  
Tube Placement ◽  
Tertiary Care Centre ◽  
Cross Sectional

Background Delirium affects a significant proportion of critically ill patients admitted in hospital. It is associated with various adverse outcomes. Despite its enormous prognostic significance it tends to be underdiagnosed. There is a dearth of studies on risk factors of delirium in our setting.Objectives The main objectives of this study was to find out the prevalence, rate of non recognition and risk factors associated with delirium in hospitalized critically ill patients.Methods A hospital based cross-sectional study was carried out. Data was collected using a predesigned semi-structured proforma and Intensive care delirium screening checklist was used to screen for delirium in patients admitted in various wards of Manipal teaching hospital, Pokhara, Nepal.Results Ninety five cases were included in the analysis. The mean age of study group was 58.9 ± 19.1 years. Delirium was present in 15/95 cases and it was not recognized by treating physician in about one third of cases. Odds ratio (OR) was statistically significantly increased in patients with history of stroke (OR=4.484 95% CI=1.0896;18.459), alcohol use (OR=10.792 95% CI=2.906;40.072), smoking (OR= 4.836 95% CI= 1.411;16.576), use of restraint (OR=17.143 95% CI=4.401;66.766), nasogastric tube placement (OR= 7.731 95% CI=2.348;25.452) and use of Foley’s catheter (OR=12.000 95% CI= 3.072;46.877).Conclusion About 16% of critically ill patients were found to be delirious. In about one third of the cases delirium was not recognized. Both patient related and iatrogenic factors may increase the risk of delirium in hospitalized critically ill patients.Kathmandu University Medical Journal Vol.12(2) 2014: 117-120

scholarly journals A STUDY OF VENTILATOR-ASSOCIATED PNEUMONIA: INCIDENCE, OUTCOME, RISK FACTORS AND MEASURES TO BE TAKEN FOR PREVENTION

2019 ◽  
Vol 3 (10) ◽  
Author(s):  
Dr. Raghvendra Singh ◽  
Dr. Ramesh Kumar
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Tertiary Care ◽  
P Value ◽  
Mechanical Ventilator ◽  
Tertiary Care Centre ◽  
High Incidence ◽  
Time Of Admission

Background: Pneumonia is the second most common nosocomial infection among critically ill patients, affecting 27% of all critically ill patients. Methods: The study was conducted in an intensive care unit (ICU) of a tertiary care centre. A total of 100 patients who were kept on mechanical ventilator were randomly selected. Cases included were patients of both sexes who were kept on mechanical ventilator for more than 48 h, having the age of >15 years. Patients who died or developed pneumonia within 48 h or those who were admitted with pneumonia at the time of admission and patients of ARDS (Acute Respiratory Distress Syndrome) were excluded from the study. Results: The mean duration of mechanical ventilation was found to be 12.3±3.1 days for the non-VAP group and 19.1 ±4.2 days for the VAP group that those requiring prolonged ventilator support (>15 days) had a significantly higher incidence of VAP (P-value, 0.001). Supine position and stuporous, comatose patients were found to be risk factors, having a high incidence of VAP, and proved to be statistically significant. Conclusion: Incidence is directly proportional to duration of mechanical ventilation and re-intubation is a strong risk factor for development of VAP. Therefore, duration of ventilation has to be reduced to get rid of morbidity and mortality associated with mechanical ventilation, which can be achieved by administering a proper weaning protocol and titrating sedation regimens as per the need of the patients. Keywords: Incidence, Infection, ICU

scholarly journals Clinical and Etiological Profile of Mycotic Keratitis from a Tertiary Care Centre in South India

2021 ◽  
Vol 10 (27) ◽  
pp. 2001-2006
Author(s):  
John Britto Augustin ◽  
Sureshbaboo Variamkandi
Keyword(s):  
Risk Factors ◽  
Corneal Ulcer ◽  
Fusarium Species ◽  
Tertiary Care ◽  
Government Medical College ◽  
Tertiary Care Centre ◽  
Cross Sectional ◽  
Medical College ◽  
Corneal Ulcers ◽  
Prompt Treatment

BACKGROUND Corneal ulcer is the leading cause of ocular morbidity and monocular blindness worldwide. To effectively prevent blindness in patients with corneal ulcer, a proper understanding of the risk factors predisposing to ulceration, its clinical and microbiological characteristics are essential. Timely identification of aetiological agents causing corneal ulcers and their prompt treatment helps to save the vision. We wanted to detect aetiological agents of corneal ulcer with special references to fungal causes and characterize the fungal aetiological agents to species level. METHODS This is a cross sectional study, conducted in Government Medical college, Kozhikode, between January 2016 and June 2017. All patients who were clinically diagnosed as cases of infectious corneal ulcer in the Ophthalmology department, Government Medical College, Kozhikode were included in the study. Corneal scrapings collected from the infected eye were subjected to microbiological examination and culture. A total of 120 cases were analysed. Each patient was examined with the slit lamp bio microscope after staining with fluorescein. Scrapings from cornea at the site of corneal ulcer were collected by ophthalmologist after a detailed clinical history and examination of the affected eye. The laboratory procedures used in the diagnosis of infectious keratitis were based on direct visualization of organisms by subjecting corneal scrapings to Gram stain and KOH wet mount and inoculation of material on to blood agar and Sabouraud dextrose agar. RESULTS Among the 120 cases, a total of 49 cases were culture positive. Twenty-one [17.5 %] were bacterial, twenty-two [18.34 %] were fungal and six [5.0 %] were poly microbial [bacteria and fungus]. Among the fungal aetiology, fusarium species was most common [32.14 %], followed by aspergillus species - 25.0 %. Trauma was the major risk factor. Diabetes mellitus, exposure keratitis were the other comorbidities / risk factors. CONCLUSIONS This study shows majority of infected corneal ulcers are associated with risk factors and the aetiology are mainly fungi. Microscopy, culture, and clinical correlation helped in adequate management. Thus, prognosis and outcome of corneal ulcers rely on timely identification of their aetiology and prompt treatment. KEY WORDS Corneal ulcer, Fungal Keratitis

scholarly journals Clinical profile of pediatric patients with tuberculosis in a tertiary care centre in India

2020 ◽  
Vol 7 (9) ◽  
pp. 1906
Author(s):  
Ashna Kumar ◽  
Javid Ahmad ◽  
Pooja Bharti ◽  
Vasundhara Bakshi
Keyword(s):  
Pediatric Population ◽  
Tertiary Care ◽  
Significant Proportion ◽  
Abdominal Tuberculosis ◽  
Childhood Tuberculosis ◽  
Diagnostic Methods ◽  
North India ◽  
Tuberculous Lymphadenitis ◽  
Tertiary Care Centre ◽  
Cross Sectional

Background: India has one of the highest TB burden globally. Children contribute a significant proportion of TB burden, in whom the diagnosis can be challenging because many childhood diseases mimic TB. Therefore, a high index of suspicion is required for early diagnosis of childhood tuberculosis to prevent poor outcome. Objectives was to evaluate the prevalence and profile of childhood tuberculosis cases and to determine the risk factorsMethods: An observational cross-sectional study was conducted over a period of 6 months at a hospital in north India and the prevalence and profile of the children admitted with the clinical suspicion of tuberculosis was studied. Case specific diagnostic approach was used for diagnosis and the appropriate treatment was instituted.Results: The prevalence of childhood TB was 2.3% among hospitalized children. Of these, 66.5% were males and 33.49% were females. The majority of cases were more than 8 years. The history of contact was present only in 31.1%. Tuberculin skin test was positive in 53.11%. Pulmonary tuberculosis was the most common type of childhood tuberculosis (45.45%) followed by neurological tuberculosis (42.8%), abdominal tuberculosis (6.45%), tuberculous lymphadenitis (2.63%), others (2.61%). Malnutrition was a potent contributing factor present in 91.86%. The mortality rate observed in the study was 9.56%.Conclusions: Owing to the high burden of tuberculosis among pediatric population in India, there is an alarming need to develop more economical and advanced diagnostic methods for better patient management and above all there is urgent need of the hour to educate the masses about the transmission and risk factors for this disease.

scholarly journals Ectopic pregnancy: an observational study in a tertiary care centre of Southern Rajasthan, India

2020 ◽  
Vol 9 (2) ◽  
pp. 516
Author(s):  
Shrusti Parmar ◽  
Nalini Sharma ◽  
Vimla Dhakar
Keyword(s):  
Risk Factors ◽  
Ectopic Pregnancy ◽  
Tertiary Care ◽  
First Trimester ◽  
Treatment Modalities ◽  
Public Health Issue ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Cross Sectional ◽  
Early Presentation

Background: One among the three chief obstetric causes of bleeding in first trimester, ectopic pregnancy is the first thing to rule out as a gestation is suspected. The present study observes and analyses sociodemographic distribution, risk factors, presentation, diagnosis and treatment modalities in a tertiary care centre.Methods: An observational cross-sectional study, conducted among patients who were diagnosed and managed in department of obstetrics and gynaecology of a tertiary care centre. Data analyzed and explained as frequency, percentage, mean and standard deviation.Results: Age group between 21 to 30 years (69.9%) and multigravida (68.5%) are high risk for ectopic pregnancy (EP). Menstrual history was regular in 86.3%. Risk factors identified were previous abortion (30%) and history of pelvic inflammatory disease (30%). In 80.9% pain in abdomen was presenting complaints followed by bleeding per vaginum (60%), amenorrhoea (60%) and nausea and vomiting (32.9%). Right salpingectomy was most common in 43.8%, followed by left salpingectomy in 28.8%, methotrexate in 15.1%, left salpingo-ophorectomy in 5.5%, right salpingo-opherectomy in 5.5% and removal of tubal abortion in 1.3% patients. Laparoscopy was chosen route in majority 64.4% patients.Conclusions: Ectopic pregnancy - a gynecological catastrophe as well as a major challenge to the reproductive performance of women worldwide, should be considered a relevant public health issue. By providing adequate materials, manpower, well-equipped health facilities as well as a prompt and efficient referral system, good access roads and efficient transportation, will ensure early presentation in hospitals and prompt management of cases.

scholarly journals PREVALENCE AND RISK FACTORS OF DRY EYE AMONG PATIENTS OF A TERTIARY CARE CENTRE IN EASTERN INDIA

2021 ◽  
pp. 5-7
Author(s):  
Nilesh Mohan ◽  
Vandana Parasar ◽  
Ankita Singh ◽  
Rakhi Kusumesh
Keyword(s):  
Risk Factors ◽  
Dry Eye ◽  
Tertiary Care ◽  
Office Worker ◽  
Care Centre ◽  
Eastern India ◽  
Tertiary Care Centre ◽  
Cross Sectional ◽  
Female Ratio ◽  
Ocular Discomfort

AIM: To determine the prevalence and risk factors of dry eye among patients of a tertiary care centre in eastern India. Symptoms of dry eye are encountered as one of the most frequent complains among the patients attending the outpatient department in ophthalmology commonly presenting as ocular discomfort, burning sensation and foreign body sensation.Prevalence of this entity is still not known in our study population due to lack of specificity of symptoms and diagnostic criteria. MATERIALS AND METHODS: A prospective, observational, cross-sectional study was conducted among patients attending ophthalmology OPD in a tertiary care teaching hospital of Bihar. 4116 (16.64%) patients with dry eye symptoms were examined after taking informed consent. RESULTS: 1620 (6.55%) patients were found to have dry eye based on McMonnies questionnaire, Schirmer's test and tear film breakup time.There were 1180 female and 440 male with dry eye.Male to female ratio was 2.7:1.Non-tribals were affected more commonly than tribals. Students, outdoor workers and office worker with professional constituted over fifty percent of dry eye cases. CONCLUSION: Prevalence of dry eye was more in females and elderly as compared to male and younger population respectively.Burning sensation and ocular discomfort was the most common presenting complains.

scholarly journals A STUDY TO DOCUMENT LIFESTYLE ASSOCIATED RISK FACTORS FOR NON COMMUNICABLE DISEASES AMONG ADOLESCENTS

2020 ◽  
pp. 14-15
Author(s):  
Gunjan Jain ◽  
Jigisha Patadia ◽  
Praful Bambhroliya
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Low Income ◽  
Communicable Disease ◽  
Tertiary Care ◽  
Age Groups ◽  
Tertiary Care Centre ◽  
Cross Sectional ◽  
Primordial Prevention ◽  
Associated Risk Factors

The burden of morbidity and mortality from Non-Communicable disease has risen worldwide and is accelerating in low-income and middle-income countries. Lifestyle-associated risk factors among adolescent are rampantly increasing throughout the world. They place a tremendous demand on health care systems and social welfare, cause decreased productivity in the workplace, prolong disability and diminish resources within families. A life course approach to preventive efforts addressing NCDs and their risk factors and behaviors will improve child and adolescent health but also decrease lifetime health care costs. Nevertheless, those risk behaviors are initiated usually in the adolescent’s age groups which are continued to adult. Therefore, this group is important target for primordial prevention. This study is a cross-sectional study which aims to determine the prevalence of risk factors among adolescents attending the tertiary care centre in Surat, district of Gujarat, conducted in March 2019 to June 2019. A total of 498 adolescents were screened using a structured questionnaire. The study documented that improper diet is the major risk factor while habits like smoking and alcohol consumption is fairly uncommon. Study recommends creating awareness among adolescents and promoting healthier lifestyle habits.

scholarly journals Analysis of oral risk-factors for ventilator-associated pneumonia in critically ill patients

2020 ◽  
Author(s):  
Ademar Takahama ◽  
Vitoria Iaros de Sousa ◽  
Elisa Emi Tanaka ◽  
Evelise Ono ◽  
Fernanda Akemi Nakanishi Ito ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Logistic Regression ◽  
Physical Examination ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Cross Sectional Study ◽  
Ventilator Associated Pneumonia ◽  
Cross Sectional ◽  
Logistic Regression Models

Abstract Objective: This a cross-sectional study to evaluate the association between oral health findings and ventilator-associated pneumonia (VAP) among critically ill patients in intensive care units (ICU). Material and Methods: Data were collected from medical records, and a detailed oral physical examination was performed on 663 critically ill patients on mechanical ventilation. Data were statistically analysed using univariate and logistic regression models relating the development of VAP with the oral findings. Results: At oral physical examination, the most frequent findings were tooth loss (568 - 85.67%), coated tongue (422 - 63.65%) and oral bleeding (192 - 28.96%). Patients with a coated tongue or oral bleeding on the first day of ICU hospitalization developed more VAP than did patients without these conditions (20.14% vs 13.69%: p=0.02; 23.44% vs 15.50%: p=0.01, respectively). In the logistic regression, a coated tongue and oral bleeding were considered independent risk factors for VAP development [OR=1.60 (1.02-2.47) and OR=1.59 (1.05 – 2.44), respectively]. Conclusions: The presence of a coated tongue and oral bleeding in ICU admission could be considered markers for the development of VAP. Clinical relevance: The results of this paper reinforces the importance of proper maintenance of oral hygiene before intubation, which may lead to a decrease in the incidence of VAP in the ICU. This is particularly important in the COVID-19 current scenario, where more people are expected to need mechanical ventilation, consequently increasing cases of VAP.

scholarly journals Prevalence, Risk Factors and Outcomes of Platelet Transfusion Refractoriness in Critically Ill Patients:  A Retrospective Cohort Study

2020 ◽  
Author(s):  
Saeed Arabi ◽  
Abdullah O Almahayni ◽  
Abdulrahman Alomair ◽  
Emad M Masuadi ◽  
Moussab Damlaj ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Critically Ill ◽  
Retrospective Cohort Study ◽  
Critically Ill Patients ◽  
Retrospective Cohort ◽  
Platelet Transfusion ◽  
Tertiary Care ◽  
Interquartile Range ◽  
Surgical Icu

Abstract Background: Refractoriness to platelet transfusion is an understudied phenomenon in critically ill patients. Our objective was to evaluate the prevalence, risk factors and clinical outcomes of platelet refractoriness among patients in a tertiary-care intensive care unit (ICU).Methods: A retrospective cohort study included all patients (age >14 years) who were admitted to a tertiary-care medical-surgical ICU between 2011 and 2016 and received ≥2 platelet transfusions during their ICU stay. We calculated platelet increment (PI) and corrected count increment (CCI). Results: A total of 267 patients were enrolled in the study, collectively receiving 1357 transfusions with a median of 3 (interquartile range: 2-6) transfusions per patient. The median pretransfusion platelet count was 31.0 x109/L (interquartile range: 16.0, 50.0) with a median PI of 6 x109/L (interquartile range: -5, 24). The prevalence of platelet transfusion refractoriness was 54.8% based on PI and 57.0% based on CCI. The two methods had excellent concordance in diagnosing refractoriness (kappa coefficient: 0.939). Refractoriness was more common in patients admitted by Hepatology, Liver Transplant, and Hematology services (69.7%, 69.2%, and 55.6%, respectively). On multivariable logistic regression, younger age was the only significant predictor of refractoriness (odds ratio per year increment: 0.975, 95% CI: 0.951-0.999). Finally, refractoriness was associated with increased length of stay in the ICU (p=0.02), but not with mortality.Conclusions: We demonstrated excellent concordance between PI and CCI for the diagnosis of platelet transfusion refractoriness. Platelet transfusion refractoriness was highly (>50%) prevalent in critically ill patients. However, it was not associated with increased mortality.

scholarly journals Intravenous Fluid Prescription Practices in Critically Ill Children: A Shift in Focus from Natremia to Chloremia?

2019 ◽  
Vol 08 (04) ◽  
pp. 218-225
Author(s):  
Adrian F. Bulfon ◽  
Hakem L. Alomani ◽  
Natalie Anton ◽  
Brooke T. Comrie ◽  
Bram Rochwerg ◽  
...  
Keyword(s):  
Critically Ill ◽  
Tertiary Care ◽  
Significant Proportion ◽  
Daily Intake ◽  
Adverse Outcomes ◽  
Critically Ill Children ◽  
Salt Solutions ◽  
Eligibility Criteria ◽  
Maintenance Fluid ◽  
Increased Risk

AbstractOur objective is to evaluate intravenous (IV) fluid prescription practice patterns in critically ill children in the first 72 hours of pediatric intensive care unit (PICU) admission and to evaluate the incidence and predictors of hyperchloremic metabolic acidemia (HCMA) and the association between HCMA and adverse outcomes. This retrospective cohort study was conducted in two tertiary-care Canadian PICUs. Children aged 0 to 18 years admitted to the PICU between January 2015 and January 2016 who received at least 50% of their calculated maintenance fluid requirements parenterally during the first 24 hours of admission were included. Children with known preexisting conditions associated with HCMA, such as renal tubular acidosis and gastrointestinal bicarbonate losses, were excluded. Of the 771 children screened, 543 met eligibility criteria and were included. The commonest prescribed maintenance fluid was 0.9% NaCl (72.9%) followed by lactated Ringer's solution (19.6%) and hypotonic solutions (4.6%). Balanced salt solutions (i.e., lactated Ringer's and Plasma-Lyte) were as commonly administered as unbalanced solutions (0.9% NaCl) for volume expansion (49.6 vs. 48.5%, respectively). Medications contributed to a significant proportion of total daily intake, in excess of bolus fluids. The incidence of hyperchloremia and HCMA was 94.9% (95% confidence interval [CI]: 93.2–96.9; 470/495) and 38.9% (95% CI: 34.6–43.2; 196/504), respectively. Predictors of HCMA were increasing combined bolus and maintenance 0.9% NaCl intake (odds ratio: 1.13; 95% CI: 1.04–1.23) and increasing severity of illness. HCMA was not associated with an increased risk of acute kidney injury, feeding intolerance, or PICU-acquired weakness. Isotonic fluids, specifically 0.9% NaCl, were the most commonly administered maintenance IV fluid in critically ill children. Sources of chloride load are not isolated to resuscitation fluids as previously suggested. Maintenance fluids and fluids administered with medications and IV flushes (fluid creep) are under-recognized significant sources of fluid and electrolyte intake in critically ill children. HCMA is common, and further prospective research is required to determine whether HCMA is indeed harmful in children. However, all significant sources of fluid should be accounted for in the design of future trials comparing balanced and unbalanced salt solutions.

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