Burden and outcome of community-acquired pneumonia in adult patients admitted to National Referral Hospital, Bhutan

ABSTRACT Introduction: Community acquired pneumonia is one of the leading causes of morbidity and mortality globally with the highest burden being reported from Asia. In Bhutan, community acquired pneumonia was reported to be one of the top five causes of mortality and one of the top ten causes of morbidity. Methods: This was an observational study done in a cohort of adult patients with community acquired pneumonia who were admitted to National Referral Hospital of Bhutan from February 2020 – February 2021 using purposive sampling. The Research Ethics Board of Health, Bhutan, gave ethical approval. We evaluated the burden and outcome of the community acquired pneumonia, and assessed the predictive capability of CURB-65 score to predict mortality as an outcome in these patients. Results: The inpatient burden of community acquired pneumonia was found to be 4.7% among patients admitted to medical wards. The mortality was 7.8%. 15.7 % of patients were managed in the intensive care unit out of which 5.9% patients needed mechanical ventilation. The mean hospital length of stay of these patients was 13 days. The sensitivity, specificity, PPV and NPV of CURB-65 score to predict death as an outcome in these patients were 87.5%, 43.6%, 11.7% and 97.6% respectively. Conclusion: The inpatient burden of Community Acquired Pneumonia in the National Referral Hospital is of concern. The CURB-65 score can be used a supplement to clinical judgement to assess the severity of the disease and make appropriate management decisions.

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Effects of statins on clinical outcomes in hospitalized patients with community-acquired pneumonia

Journal of International Medical Research ◽

10.1177/0300060520938586 ◽

2020 ◽

Vol 48 (8) ◽

pp. 030006052093858

Author(s):

Rony M. Zeenny ◽

Hanine Mansour ◽

Wissam K Kabbara ◽

Nibal Chamoun ◽

Myriam Audi ◽

...

Keyword(s):

Retrospective Study ◽

Length Of Stay ◽

Hospital Length ◽

Community Acquired Pneumonia ◽

Hospital Length Of Stay ◽

Comorbid Conditions ◽

C Reactive Protein ◽

Reactive Protein ◽

Significant Difference ◽

Chronic Use

Objective We evaluated the effect of chronic use of statins based on C-reactive protein (CRP) levels and hospital length of stay (LOS) in patients admitted with community-acquired pneumonia (CAP). Methods We conducted a retrospective study over 12 months at a teaching hospital in Lebanon comparing patients with CAP taking chronic statins with patients not taking statins. Included patients with CAP were older than age 18 years and had two CRP level measures during hospitalization. CURB-65 criteria were used to assess the severity of pneumonia. A decrease in CRP levels on days 1 and 3, LOS, and normalization of fever were used to assess the response to antibiotics. Results Sixty-one patients were taking statins and 90 patients were not taking statins. Patients on statins had significantly more comorbid conditions; both groups had comparable CURB-65 scores. In both groups, no statistically significant difference was seen for the decrease in CRP level on days 1 and 3 and LOS. No difference in days to normalization of fever was detected in either group. Conclusion No association was found between the chronic use of statins and CRP levels, LOS, or days to fever normalization in patients with CAP.

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Pterygium and associated factors among adults: a hospital-based prospective study

Bhutan Health Journal ◽

10.47811/bhj.97 ◽

2020 ◽

Vol 6 (1) ◽

pp. 32-37

Author(s):

Chhimi Wangmo ◽

Nor Tshering Lepcha

Keyword(s):

Associated Factors ◽

Cross Sectional Study ◽

Referral Hospital ◽

Adult Patients ◽

Age Group ◽

Cross Sectional ◽

Systematic Random Sampling ◽

High Prevalence ◽

Grade 3 ◽

National Referral Hospital

Introduction: The aim of this hospital-based study was to assess the prevalence and associated factors of pterygium among adult patients visiting the Ophthalmology Outpatient Department (OPD) in the Jigme Dorji Wangchuck National Referral Hospital (JDWNRH), Thimphu. Methods: A cross sectional study was carried out in the ophthalmology OPD in the national referral hospital, Thimphu from 1st January, 2018 to 31st December, 2018, during which 1599 adult patients were selected through systematic random sampling. Results: The prevalence of pterygium was 12.8% (95% CI: 11.2 -14.5). Among 271 eyes with pterygium, the distribution of grade 1, grade 2 and grade 3 pterygium was 34.7%, 56.1% and 9.2% respectively. Pterygium wasmost common in the age group of 36-55 years. The significant factors associated with pterygium were age group, occupation and usage of sunglasses. Individuals who were 36-55 years (adjusted OR 2.70, 95% CI 1.82-4.0) and >55 years (adjusted OR 2.17, 95% CI 1.34-3.50) had significantly higher risk than 18-35 years (p< 0.002), and not using sunglasses (adjusted OR 1.97, 95% CI1.17-3.33, p = 0.007) significantly increased the risk of pterygium. Indoor occupation, particularly being a student was protective against pterygium (OR 0.08, 95% CI 10.02-0.33, p< 0.001). Only 14.1% used sunglasses and among them, 27.6% were aware that sunglasses can protect from ultraviolet radiation. Conclusion: This study found a high prevalence of pterygium among adults aged 18 years and above. Those aged 36-55 years and an occupation involving outdoor activities were affected more. Encouraging usage of sunglasses may reduce pterygium

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Bacteriology of community acquired pneumonia in adult patients at Felege Hiwot Referral Hospital, Northwest Ethiopia: a cross-sectional study

Antimicrobial Resistance and Infection Control ◽

10.1186/s13756-019-0560-0 ◽

2019 ◽

Vol 8 (1) ◽

Cited By ~ 3

Author(s):

Dinbere Temesgen ◽

Fetlewok Bereded ◽

Awoke Derbie ◽

Fantahun Biadglegne

Keyword(s):

Cross Sectional Study ◽

Northwest Ethiopia ◽

Community Acquired Pneumonia ◽

Referral Hospital ◽

Adult Patients ◽

Sectional Study ◽

Cross Sectional ◽

Felege Hiwot Referral Hospital

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Statin Use and Hospital Length of Stay Among Adults Hospitalized With Community-acquired Pneumonia

Clinical Infectious Diseases ◽

10.1093/cid/ciw174 ◽

2016 ◽

Vol 62 (12) ◽

pp. 1471-1478 ◽

Cited By ~ 19

Author(s):

Fiona Havers ◽

Anna M. Bramley ◽

Lyn Finelli ◽

Carrie Reed ◽

Wesley H. Self ◽

...

Keyword(s):

Length Of Stay ◽

Hospital Length ◽

Community Acquired Pneumonia ◽

Hospital Length Of Stay ◽

Statin Use

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Assessment of the HScore as a predictor of disease outcome in patients with COVID-19

BMC Pulmonary Medicine ◽

10.1186/s12890-021-01706-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Mohammadreza Bordbar ◽

Anahita Sanaei Dashti ◽

Ali Amanati ◽

Eslam Shorafa ◽

Yasaman Mansoori ◽

...

Keyword(s):

Disease Severity ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Multivariable Logistic Regression Analysis ◽

Hospitalized Children ◽

Icu Admission ◽

Risk Of Death ◽

Low Levels ◽

Medical Wards ◽

Secondary Hemophagocytic Lymphohistiocytosis

AbstractSevere coronavirus disease 2019 (COVID-19) accompanies hypercytokinemia, similar to secondary hemophagocytic lymphohistiocytosis (sHLH). We aimed to find if HScore could predict disease severity in COVID-19. HScore was calculated in hospitalized children and adult patients with a proven diagnosis of COVID-19. The need for intensive care unit (ICU), hospital length of stay (LOS), and in-hospital mortality were recorded. The median HScore was 43.0 (IQR 0.0–63.0), which was higher in those who needed ICU care (59.7, 95% CI 46.4–72.7) compared to those admitted to non-ICU medical wards (38.8, 95% CI 32.2–45.4; P = 0.003). It was also significantly higher in patients who died of COVID-19 (105.1, 95% CI 53.7–156.5) than individuals who survived (41.5, 95% CI 35.8–47.1; P = 0.005). Multivariable logistic regression analysis revealed that higher HScore was associated with a higher risk of ICU admission (adjusted OR = 4.93, 95% CI 1.5–16.17, P = 0.008). The risk of death increased by 20% for every ten units increase in HScore (adjusted OR 1.02, 95% CI 1.00–1.04, P = 0.009). Time to discharge was statistically longer in high HScore levels than low levels (HR = 0.41, 95% CI 0.24–0.69). HScore is much lower in patients with severe COVID-19 than sHLH. Higher HScore is associated with more ICU admission, more extended hospitalization, and a higher mortality rate. A modified HScore with a new cut-off seems more practical in predicting disease severity in patients with severe COVID-19.

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Perioperative Risk Factors for Intraoperative Hypothermia in Adult Patients Undergoing Elective Surgery at a National Referral Hospital in Bhutan: A Prospective Observational Study

Journal of Health Science and Medical Research ◽

10.31584/jhsmr.201966 ◽

2019 ◽

Author(s):

Kinley Zangmo ◽

Sunisa Chatmongkolchart ◽

Pasuree Sangsupawanich

Keyword(s):

Risk Factors ◽

Heart Rate ◽

Observational Study ◽

Prospective Observational Study ◽

Elective Surgery ◽

Perioperative Risk ◽

Referral Hospital ◽

Adult Patients ◽

Intraoperative Hypothermia ◽

National Referral Hospital

Objective: Intraoperative hypothermia is commonly encountered in anesthetic practice. It is related to several risk factors and can lead to various adverse events. It is important to detect it early and prevent the complications related to it. This study was done to identify incidence and perioperative risk factors of intraoperative hypothermia at a national referral hospital in Bhutan.Material and Methods: A prospective observational study was conducted in adult patients who underwent elective surgery lasting more than 30 minutes. Patient characteristics, incidence of hypothermia, and any interventions for treatment of hypothermia during the operation were recorded. Intraoperative hypothermia was defined as a core body temperature less than 36 °C measured with an esophageal probe.Results: Data were obtained from 91 patients with a mean (±standard deviation; S.D.) age of 42.3 (17.2) and American Society of Anesthesiologists (ASA) scores of 1 and 2 in 62.6% and 37.4% of the patients, respectively The patients underwent elective surgery with a mean (S.D.) duration of 73.24 (48.1) minutes and a mean (S.D.) duration of anaesthesia of 80.9 (49.2) minutes. The incidence of intraoperative hypothermia was 61.5% (56/91). Preoperative heart rate more than 80 beats per minute [hazard ratio (HR) 0.45, 95% confidence interval (CI), 0.26-0.77] was a protective factor and duration of anesthesia more than 60 minutes (HR 1.82, 95% CI, 0.98–3.38) was a risk factor for intraoperative hypothermia.Conclusion: Patients with a preoperative heart rate less than 80 beats per minute and undergoing duration of anesthesia more than 60 minutes should be assessed from the preoperative period and continuously monitored throughout the intraoperative period.

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Clinical profile of home-based care patients in a Brazilian cohort

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.546 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

A P P P Botelho ◽

F C B Netto ◽

R M Silva ◽

C G Filho ◽

D Chiesa ◽

...

Keyword(s):

Invasive Mechanical Ventilation ◽

Hospital Length ◽

Adult Patients ◽

Hospital Length Of Stay ◽

Main Diagnosis ◽

Care Services ◽

Home Based ◽

Care Models ◽

Adequate Provision ◽

Home Based Care

Abstract Background The concern with increasing healthcare expenditures and the quality of life of chronically dependent of invasive mechanical ventilation (IMV) patients, led to the emergence of home-based care services (HBCS), which aims the humanization of health services and the reduction of hospital length of stay. Knowledge about the models used in HBCS and the results achieved is essential to identify, plan and execute actions that minimize obstacles to the adequate provision of this service. Methods Descriptive, longitudinal and retrospective study, in a HBCS provided by a private hospital in Fortaleza, Brazil. The medical records of 98 adult patients from the HBCS in need of IMV were analyzed. Results In 2019, 156 patients went through the HBCS. Of these, 58 were under 18 years-old and not included in the sample. Of the adult patients, 42 (42,8%) were male and 56 (57,1%) female. The age range varied from 28 to 102 years-old and the median age was 85 years. 57 (58,2%) patients were admitted throughout 2019, and 16 (28,1%) of them had, at least, 1 hospital readmission in 2019. 41 (41,8%) patients had been admitted before 2019, and 6 (14,6%) of them had, at least, 1 readmission in 2019. These facts may suggest that the need of hospitalization tend to happen more at the beginning of home-based care. In 2019, 13 (13,3%) patients died. 8 (61,5%) of these were admitted in 2019, and 5 (38,4%) were already in the HBCS before that year. The main diagnosis were: Dementia (21,4%), Chronic Encephalopathy (9,1%) and Multiple Sclerosis (8,2%). Conclusions The study shows that, even in an elderly and dependent cohort, the need of re-hospitalization and mortality rates are low, which points to the need of further studies of HBCS in order to reduce hospital stay and expenditures. Key messages It is important to deepen studies related to home-based care models, in association with payment expenses inquiries, as this type of assistance seems to develop humanized and safe care. The mortality rate of the HBCS studied was 13% and the overall re-hospitalization rate was 22,4%, which points this as a promising model for IMV dependent patients.

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