scholarly journals Role of BAP 65 (Blood Urea Nitrogen, Altered Mental Status, Pulse, Age 65 Years) Scoring System in Risk Stratification of Patients with Acute Exacerbation of Chronic Obstructive Lung Disease in Tertiary Care Hospital

2019 ◽  
Vol 2 (2) ◽  
pp. 5-10
Author(s):  
Ashish Thapa
Keyword(s):  
Mechanical Ventilation ◽  
Acute Exacerbation ◽  
Severe Disease ◽  
Tertiary Care ◽  
Chronic Obstructive Lung Disease ◽  
Institutional Review Boards ◽  
Mortality Data ◽  
Chronic Obstructive ◽  
P Value ◽  
Care Hospital

Introduction: Exacerbations are important events in the management of COPD because they negatively impact health status, rates of hospitalization and readmission, and disease progression. COPD AE is one of the commonest case presenting to the TUTH Emergency, average being 5 patients a day. The aim of the study was to co-relate the BAP 65 score, mortality and mechanical ventilation in patients with acute exacerbation of COPD. Methods: It was an observational study, 648 patients from emergency of TUTH were screened for the study from Magh 2073 to Asar 2074 after getting approval from the institutional review boards, among them 114 were included after applying inclusion and exclusion criteria and BAP 65 score was calculated. The patients were followed till discharge, mechanical ventilation or mortality. Data entry was done in MS EXCEL and statistical analysis was done using SPSS version 24. Results: Total of 114 patients enrolled for the study from the emergency of TUTH. There were total 16 mortality and 12 patients were mechanically ventilated. Most of the mortality and mechanical ventilation were from severe group ie BAP class IV and V. We used Pearson Chi-squared test to compare between BAP 65 class and Mortality, and found that mortality rate increased with increasing BAP 65 class with a p value of < 0.0001. The need of Mechanical Ventilation increased as well, as the BAP 65 Class increased, less than 1% of the patients with BAP class I needed MV, the cause being Type II Respiratory Failure, while around 50% of the patients with BAP class V needed MV. Conclusions: BAP 65 score is an effective and simple tool to classify the patients presenting with AECOPD, it correlated well with both the need of mechanical ventilation and mortality. Higher the score higher the chances of severe disease.

scholarly journals Prognostic factors and outcome of Post-Neonatal Tetanus in an intensive care unit of a Tertiary Care Hospital

2019 ◽  
Vol 35 (5) ◽  
Author(s):  
Nighat Sultana ◽  
Attia Bari ◽  
Mehwish Faizan ◽  
Muhammad Sarwar
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Prognostic Factors ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Neonatal Tetanus ◽  
P Value ◽  
Care Hospital

Objective: To determine the prognostic factors and outcome of tetanus in children of post-neonatal age admitted in the intensive care unit (ICU) of a tertiary care hospital. Methods: This prospective cross sectional study, carried out in the Pediatric ICU of The Children’s Hospital Lahore from Jan 2013 to March 2017. Children of both genders with age range of two months to 16 years diagnosed clinically as tetanus were included. All 132 patients were scrutinized for all possible risk factors, need for mechanical ventilation and outcome. Data was analyzed by SPSS version 20. Results: Mean age of children was 7.5±3.4 years with male predominance (70.5%). Only (38.6%) received three doses of vaccination but none had booster dose. Trauma (43.2%) encompassed maximum predisposing factor followed by ear or nose prick and ear discharge. Mean duration of ICU stay was 20±13.3 days. Mortality rate was (17.4%). Ventilator support was given to (78.8%). Neurological outcome was normal in (82.6%). Trauma, ear or nose prick in girls and ear discharge were significantly associated with poor outcome and death with p-value of <0.001, 0.011 and <0.001 respectively. Other factors associated with poor outcome were need for mechanical ventilation and neurological impairment with p-value of 0.001 and <0.001 respectively. Conclusion: Tetanus is causing our children to suffer from devastating disease. Vaccination status is not satisfactory and along with trauma, ear discharge and ear or nose prick are identifiable risk factors. To combat these issues large scale vaccination and booster doses remains promising option. doi: https://doi.org/10.12669/pjms.35.5.656 How to cite this:Sultana N, Bari A, Faizan M, Sarwar M. Prognostic factors and outcome of Post-Neonatal Tetanus in an intensive care unit of a Tertiary Care Hospital. Pak J Med Sci. 2019;35(5):---------. doi: https://doi.org/10.12669/pjms.35.5.656 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Clinical characteristics and factors influencing the outcome of hospitalised COVID-19 patients in a semi-urban primary healthcare center

2021 ◽  
Vol 14 (2) ◽  
pp. 42-54
Author(s):  
Wasim Md Mohosin Ul Haque ◽  
Chinmay Saha Podder ◽  
Nandini Chowdhury ◽  
Md Mohim Ibne Sina ◽  
SKM Shameem Kawser ◽  
...  
Keyword(s):  
Risk Factors ◽  
Adverse Outcome ◽  
Severe Disease ◽  
Tertiary Care ◽  
Chronic Obstructive ◽  
Care Hospital ◽  
Rt Pcr ◽  
District Health ◽  
Factors Associated ◽  
Negative Outcome

Background and objectives: Various new manifestations and risk factors for COVID-19 have been unveiled in the course of the current pandemic. Understanding the clinical spectrums as well as the risk factors associated with the adverse outcome of the disease is critical to combat this pandemic. This study was conducted to identify the clinical features, overall outcome and the factors associated with adverse outcome of the hospitalised COVID-19 patients in a semi-urban healthcare setting. Methods: This study was conducted at Debidwar Upazila (sub-district) Health Complex under the Cumilla district from April 2020 to October 2020. Reverse transcriptase-polymerase chain reaction (RT-PCR) positive COVID-19 patients, aged 18 years and above, admitted at the Health Complex were enrolled in the study. All patients were followed till their recovery, referral or death. The data were collected in a pre-designed semi-structured questionnaire that included demographic, epidemiological, clinical and laboratory parameters. Result: Out of 50 RT-PCR positiveCOVID-19 adult participants, 30 (60%) were males and 20 (40%) were females. Twenty-four percent, 36%, and 40% of the patients had mild, moderate and severe disease respectively. The most common clinical symptom was fever (96%), followed by cough (86%) and shortness of breath (60%). Hypertension (54%), diabetes mellitus (40%), bronchial asthma (20%) and chronic obstructive pulmonary disease (COPD, 14%) were the major co-morbid conditions. Of the total cases, 2 (4%) died and 8 (16%) required referral to tertiary care hospital while 40 (80%) recovered. COPD was associated with poor outcome (OR 19; 95% CI: 2.88, 125.31; p < 0.05). Smokers were 7 times more likely to exhibit the negative outcome than non-smokers (95% CI: 1.52, 32.33; p < 0.05). Conclusion: In this study, COPD was associated with a negative outcome. Further study with larger sample should be carried out to determine the spectrum of risk factors. Ibrahim Med. Coll. J. 2020; 14(2): 42-54

Microbiological Etiology of Chronic Cough Associated with Acute Exacerbation of Chronic Obstructive Pulmonary Disease (COPD): A Study from Karachi, Pakistan

2020 ◽  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Acute Exacerbation ◽  
Tertiary Care ◽  
Environmental Pollutants ◽  
Sputum Culture ◽  
Chronic Obstructive ◽  
Care Hospital ◽  
Cross Sectional ◽  
Obstructive Pulmonary Disease

Background: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) worsens the respiratory symptoms that are usually triggered by infection with bacteria or viruses or by environmental pollutants. Therefore, the aim of this study was to determine the bacterial etiology from sputum culture in patients suffering from acute exacerbation of COPD, admitted in hospital. Methods: The study was cross sectional observational, where sputum bacterial cultures were analyzed from the patients with Acute exacerbation COPD treated in the ICU of a tertiary care hospital for pulmonary disease from January 2019 to December 2019. Two sputum samples were collected from each patient for bacterial examination. The results of sputum bacterial culture findings were expressed as frequency and percentage by using SPSS. Results: In the present study, there were 1296 patients, both males 749 (57.8%) and females 547 (42.2%). The mean age of patients was 57.39±19.74years. 470 (36.3%) showed negative culture reports. 440 (34.0%) patients had Moraxella infection, which was most common organism in all patients, and 149 (11.5%) patients had Pseudomonas infection, 157(12.1%) patients had Yeast Albicans and in only 1 (0.1%) patient Enterobacter infection were found. Other pathogens in low frequency identified were Haemophilus parainfluenzae, Streptococcus pneumoniae, Escherichia coli and Haemophilus influenzae. It was observed that the frequency of infections was linked with increasing age. Conclusion: With increasing age, people are prone to acquire pulmonary infections specifically COPD. It is therefore very important to perform sputum culture to identify the causative agents and treat the patients with appropriate antibiotic to reduce the episodes of AECOPD. Keywords: Bacteria; Sputum Culture; COPD; Antibiotic; Cough.

scholarly journals Cardiac troponin I as mortality predictor in acute exacerbation of chronic obstructive pulmonary disease

2017 ◽  
Vol 5 (6) ◽  
pp. 2669
Author(s):  
Seema Gupta ◽  
Varinder Saini ◽  
Jasbinder Kaur ◽  
Shivani Jaswal ◽  
Harjeet Kaur ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Acute Exacerbation ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Tertiary Care ◽  
Cardiac Troponin I ◽  
Chronic Obstructive ◽  
Care Hospital ◽  
Obstructive Pulmonary Disease

Background: Comorbidities are important determinants of outcome and quality of life of patients with chronic obstructive pulmonary disease (COPD). The risk of cardiovascular events in COPD patients is three to five-fold high. COPD is often associated with right ventricular hypertrophy and pulmonary hypertension. Various studies have associated levels of cardiac troponin I (cTnI) with severity and duration of acute exacerbation of COPD (AECOPD). The objective of the present study was to assess the usefulness of serum cTnI as mortality predictor in AECOPD patients.Methods: An observational, prospective and non interventional study was conducted in 50 patients with AECOPD admitted in the pulmonary medicine emergency or ward of a tertiary care hospital of Northern India. AECOPD was diagnosed according to Global Initiative for chronic obstructive lung disease guidelines. cTnI levels were estimated within 24 hours of admission by method based on chemiluminiscence along with routine investigations. Levels ≥ 0.01ng/ml were taken as positive. The patients were followed up for 30days for outcome in terms of mortality and morbidity. Data was entered and analyzed by SPSS package and two sided p values<0.05 were considered statistically significant.Results: The serum cTnI was found to be positive in 34% of patients with AECOPD. The in- hospital mortality was significantly low in patients having cTnI <0.01ng/ml as compared to patients with cTnI ≥0.01ng/ml. The patients with cTnI levels ≥0.01ng/ml had significantly higher mean PaCO2 levels and higher requirement for invasive or noninvasive ventilation during hospital stay as compared to patients having cTnI <0.01ng/ml (p=0.04 and 0.016 respectively).Conclusions: Levels of cTnI≥0.01ng/ml may be considered as a biomarker to predict mortality in AECOPD patients.

scholarly journals ROLE OF INTERLUEKIN – 6 AS A PROGNOSTIC MARKER IN COVID-19 PATIENTS IN A TERTIARY CARE CENTRE IN INDORE DISTRICT, STATE M.P.

2021 ◽  
Vol 5 (8) ◽  
Author(s):  
Sakar Saxena ◽  
Sanjeev Narang ◽  
V.K. Jain ◽  
Romi Srivastava ◽  
Rahul Karode
Keyword(s):  
Mechanical Ventilation ◽  
Hospital Stay ◽  
Interleukin 6 ◽  
Early Stage ◽  
Severe Disease ◽  
Tertiary Care ◽  
Chronic Obstructive ◽  
Tertiary Care Centre ◽  
Markers Of Inflammation ◽  
The World

Background: Coronavirus disease 2019 (COVID-19) has spread rapidly around the world since its emergence and has wreaked havoc globally. As hospitals around the world are being overwhelmed due  to the COVID-19 pandemic, it is of utmost urgency to identify biomarkers which would accurately predict patient outcome at an early stage. Many studies suggested that numerous markers of inflammation like CRP, ESR, LDH, D-Dimer, Serum Ferritin and Interleukin -6 were found to be significantly elevated in patients with severe disease relative to patients with milder conditions. Amongst which IL-6 appears to be the most important driver of immune dysregulation and ARDS in Covid-19.  According to known evidence, IL-6 is superior to CRP and other markers of inflammation in predicting respiratory failure in Covid-19 (1, 2]. Method: All patients had a positive covid-19 Reverse Transcriptase Polymerase Chain Reaction (PCR) test results.  Patients with the history of comorbidities such as Hypertension (HTN), Diabetes Mellitus (DM), Chronic Obstructive Pulmonary Disease (COPD), Asthama, Heart failure, Chronic renal Failure (CRF) were included. The clinical and laboratory findings including Haemoglobin, WBC counts, Differential Counts, Liver Function Tests, C-Reactive Protein (CRP), Ferritin and Interleukin -6 (IL-6) were obtained from the database. Results: A total of 50 patients were included in the study. The median age of study population was found to be 52.5 years. It was observed that there were significantly increased serum IL-6 levels as the age increased. The serum levels of both IL-6 and CRP were markedly increased in morbid patients. Higher plasma IL-6 levels translated to more severity (determined by of days of hospital stay, mechanical ventilation and mortality). Conclusion: This study proves that serum IL-6 level is an accurate and a reliable indicator in predicting the prognosis of the patients in terms of longer hospital stay ,greater need of mechanical ventilation, and/ or increased  mortality. Keywords: IL-6& Covid-Biomarkers.

scholarly journals Study of pulmonary function test in asymptomatic smokers and non-smokers between 30-50 years of age in a tertiary care hospital

2017 ◽  
Vol 4 (4) ◽  
pp. 959
Author(s):  
Kekhrielhouto Sophie ◽  
Neelima Singh ◽  
Avinash John Dharvey
Keyword(s):  
Pulmonary Function ◽  
Pulmonary Function Test ◽  
Tertiary Care ◽  
Significant Risk ◽  
Uncontrolled Hypertension ◽  
Chronic Obstructive ◽  
P Value ◽  
Care Hospital ◽  
Age Group ◽  
Function Test

Background: Tobacco smoking is widely prevalent all over the world and it continues to rise in developing countries. Smoking has a deleterious effect on pulmonary functions. Smoking is the single most significant risk factor contributing to the development of Chronic obstructive airway diseases (COPD). Spirometry by a trained health professional gives an indication of lung health by measuring airway abnormality. Objectives were to study pulmonary function test (PFT) in smokers and non-smokers between 30-50 years and to study the correlation of PFT with pack years.Methods: Apparently healthy subjects, 50 smokers and 50 non-smokers between 30-50 years without any symptoms were included as subjects. Patients with uncontrolled hypertension, recent myocardial infarction and pulmonary TB were excluded. Ex-smokers were excluded from the study. Patients with acute respiratory illness, severe systemic illness, chest trauma and dementia were also excluded. After proper history taking and clinical examination, measuring height and weight (vitals, pulse rate, respiratory rate, blood pressure) the selected individual was subjected to spirometry using ATS criteria (American Thoracic Society criteria). Spirometry was performed using UNI-EM spirometer. Collected data was analyzed using Statistical Package for the Social Service (SPSS) software version 17.Results: In this study 94 males and 6 females were enrolled as subjects. Maximum number of the patient 49 cases (49%) presented in the age group of 30-35 years, followed by 23 cases (23%) in 36-40 years age group. Of these 49 cases,15 were smokers while the rest 34 were non-smokers (P=0.0007). In 100 cases studied, 39% showed normal PFT and 61% shows abnormal PFT. Among smokers (out of total 50 cases) pulmonary function test (PFT) was abnormal in 36 cases (72%) while in non-smokers, 25 (50%) had abnormal PFT (P-value-0.024). This data indicates that smoking is highly associated with an abnormal PFT pattern. Out of 100 cases both smokers and non-smokers, 11 (73.33%) underweight cases with (BMI<18.4) showed abnormal PFT. In 50 smokers, maximum cases 29 (58%) had normal BMI (18.5-22.9) (P value 0.0002). Abnormal PFT was observed in 25 (50%) non-smokers (P=0.001). Abnormal PFT was seen in 30 (69.77%) smokers with pack years <15 and 6 smokers (85.6%) with pack years >15 (P-value 0.383).Conclusions: Smoking is common in males between 30-35 years age group. Smoking is highly associated with an abnormal PFT. Cessation of smoking should be encouraged and PFTs from time to time in asymptomatic adults both smokers and non-smokers will be useful for early identification of abnormalities.

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