scholarly journals Malaria Severity Score in Malaria Patients Admitted in Critical Care Wards

2021 ◽  
Author(s):  
Jitendra Dewjibhai Lakhani ◽  
Niraj Chavda ◽  
Chintan Shah ◽  
Mrugal Doshi ◽  
Rohit Chordiya ◽  
...  
Keyword(s):  
Intensive Care ◽  
Severity Score ◽  
Vivax Malaria ◽  
Scoring System ◽  
Intensive Care Treatment ◽  
Parasite Count ◽  
Survivor Group ◽  
Significant Difference ◽  
Disease Specific ◽  
Malaria Severity

Introduction: Prognostic scoring system in Intensive Care Unit (ICU) can be generic, which can be applied to any critical illness for which patients are admitted in critical wards or can be disease specific. Malaria Severity Score (MSS) is a disease specific prognostic scoring system. Aim: To study the role of MSS in patients having malaria who were critically ill having multi organ dysfunction and to correlate the score with risk of mortality. Materials and Methods: This longitudinal study was conducted at the Department of General Medicine, SBKSMI & RC, Sumandeep Vidyapeeth, Vadodara, Gujarat, India. Adult patients (>18 years) with falciparum as well as vivax malaria, who had positive peripheral smear malaria and were admitted in ICU/Casualty (Emergency) ward, were taken in the study. The score was calculated on day of admission, day 2 and day 7. The score was analysed between two groups: survivors and non-survivors. Appropriate statistical tests were applied (z-test for two population proportion and Chi-square test for categorical values). The p-value <0.05 was considered as significant. Results: Out of 60 patients, 41 survived and 19 died due to malaria. Mean age of survivors was 38.56±2.27 and of non-survivors 40.21±5.6 years (p=0.718). There were 27 patients of P.vivax, 30 of P. falciparum and three patients of mixed infection; mortality was in 09, 08, 02 patients, respectively. On admission, out of total 60 patients, 10 (16.67%) had 1+, 20 (33.33%) had 2+, 24 (40%) had 3+ and 6 (10%) had 4+ parasite count. There were no patients in 1+ parasite count group, two (10%) in 2+, eleven (45.8%) in 3+ and six (100%) in 4+ parasite count group. Mean MSS was not significantly different on day 0 and day 2 but was higher on day 7 in non-survivor group than in survivors group (p=0.005). Mortality prediction score cut-off was ≥9, which was obtained by plotting Receiver Operating Characteristic (ROC) curve. Mean MSS in non-survivor group was 7.37 on day 0, 6.58 on day 2 and 9.11 on day 7. Thus, MSS score of day 7 gave `prediction reaching cut-off value of ≥9. Conclusion: MSS was found to be a useful prognostic score in severe falciparum/vivax malaria who needs intensive care treatment as sequential score gives significant difference in survivors and non-survivors on seventh day.

Epidemiology and Outcomes of Acute Respiratory Syndrome in Aged Patients with Overlap Syndrome

2019 ◽  
Vol 4 (11) ◽  
Author(s):  
Hakan Celikhisar ◽  
Gulay Dasdemir Ilkhan
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Overlap Syndrome ◽  
Treatment Modalities ◽  
Chronic Obstructive ◽  
Intensive Care Treatment ◽  
Aged Patients ◽  
Obstructive Pulmonary Disease ◽  
Significant Difference

Objectives: The aim of this study was to determine the complication and prognostic criteria in patients with overlap syndrome developing respiratory failure due to chronic obstructive pulmonary disease. Materials and Methods: The files of 418 patients 358 (85.6%) male and 60 (14.4%) female aged 65 years and over who were treated in İzmir Eşrefpaşa Hospital and İstanbul Okmeydanı Training Hospital intensive care units between January 2016 and January 2019 were included in the study. In this study, we retrospectively evaluated treatment modalities, complications and prognosis in aged patients with overlap syndrome. Results: It was determined that 192 (78.04 %) of the cases with complications were exitus and that 62 (36.04 %) of the 172 cases without complications were exitus. There was a statistically significant difference between the two groups with regard to mortality (p< 0.05). Conclusion: In conclusion, it was considered that the complication rate is high in aged OSAS patients with respiratory syndrome due to COPD requiring intensive care treatment and that complication development increases mortality.

scholarly journals Comparison of the Effectiveness of Haloperidol Injection and Oral Quetiapine to Control Delirium in Patients in the Emergency Department and Intensive Care Unit – A Randomized Clinical Trial

2021 ◽  
Keyword(s):  
Clinical Trial ◽  
Intensive Care Unit ◽  
Emergency Department ◽  
Intensive Care ◽  
Randomized Clinical Trial ◽  
Severity Score ◽  
Severity Scores ◽  
Psychiatric Syndrome ◽  
Significant Difference ◽  
The Mean

Background: Delirium is a psychiatric syndrome observed among patients with critical psychiatric disorders. Haloperidol is now one of the first-line drugs for the treatment of delirium. However, quetiapine can be considered as an appropriate substitute in patients with a high risk of extrapyramidal symptoms or long QT syndrome. Objectives: This study aimed to compare the effectiveness of intramuscular haloperidol and oral quetiapine to control delirium in patients in the emergency department and intensive care unit. Methods: This randomized clinical trial was performed during 2017-2018 on patients with delirium who were referred to the emergency department and intensive care unit of Imam Reza Hospital (referral center), Mashhad, Iran. Patients were divided into two groups of 100 patients per group through a random allocation technique . In this study, 5 mg of intramuscular haloperidol every 12 hours and 25 mg of oral quetiapine were prescribed daily for the patients in the control and intervention groups, respectively. The delirium severity score of each patient was evaluated before and three days after the intervention through Delirium Rating Scale-Revised-98. Results: In this study, the mean±SD age of participants was 60.2±14.1 years. The findings indicated that no significant difference was observed between haloperidol (22.7±1.9) and quetiapine (22.7±2.2) groups in terms of the baseline delirium severity score (P=0.95). The mean delirium severity scores of patients in haloperidol and quetiapine groups were 25.6±2.1 and 25.2±2.5, respectively. Based on the obtained results, the difference between the delirium severity scores of both groups was not statistically significant (P=0.24). Conclusion: Based on the results, oral quetiapine has a similar effect as intramuscular haloperidol and can be used as a substitute to this medicine for controlling the symptoms of patients with delirium.

scholarly journals Evaluation of the effect of clinical characteristics and intensive care treatment methods on the mortality of covid-19 patients aged 80 years and older

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sibel Oba ◽  
Mustafa Altınay ◽  
Aysel Salkaya ◽  
Hacer Şebnem Türk
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Invasive Mechanical Ventilation ◽  
Albumin Level ◽  
Intensive Care Treatment ◽  
Plasma Therapy ◽  
Laboratory Findings ◽  
Mean Values ◽  
Survivor Group ◽  
Increased Risk

Abstract Background Older adults have an increased risk of mortality from Coronavirus disease 2019 (Covid-19). Despite the high number of publications on the topic of Covid-19 pandemic, few studies have focused on the intensive care treatments of Covid-19 patients aged 80 years and older. The goal of our study is to investigate the effect of the intensive care treatments on the mortality of Covid-19 patients aged 80 years and older based on their clinical features, laboratory findings and the intensive care treatments methods. Methods The data of 174 patients aged 80 years and older treated from Covid-19 in intensive care unit were assessed retrospectively. The patients were divided into two groups as survivor and non-survivor. The effects of age, gender, length of stay, comorbid diseases, laboratory values, thoracic computed tomography findings, having invasive mechanical ventilation (IMV), high flow nasal cannula (HFNC) and/or non-invasive mechanical ventilation (NIMV), hemodiafiltration (HDF), anti-cytokines and plasma therapy on mortality have been investigated. Results The mean age and mean values of CRP, PCT, Ferritin, LDH were statistically significantly high in the non-survivor group. The mortality rate of the patients who had IMV was also statistically significantly higher compared to patients who had HFNC and/or NIMV. Albumin level and the rate of treatment with HFNC and/or NIMV were statistically significantly low in non-survivor group compared to the Survivor group. Conclusion ICU treatments may be beneficial for the Covid-19 patients aged 80 years and older. Increased age, high levels of CRP, PCT, ferritin, and having IMV are detected as poor outcome markers.

scholarly journals Evaluation of prognostic predictors of mangled extremity severity scoring system on the outcome of traumatic extremities injuries at emergency department in Suez Canal University Hospitals

2016 ◽  
Vol 4 (1) ◽  
pp. 75 ◽  
Author(s):  
Ahmed A. Essa ◽  
Islam M. El-Shaboury ◽  
Yasmin E. El-Beltagy
Keyword(s):  
Emergency Department ◽  
Severity Score ◽  
Scoring System ◽  
Suez Canal ◽  
Lower Limbs ◽  
University Hospital ◽  
Severity Scoring ◽  
Mangled Extremity ◽  
Limb Injuries ◽  
Significant Difference

Background:Severe traumatic lower limbs injuries have been associated with high incidence of multiple systems involved (integument, nerve, bone, and vascular structures). That’s make difficulty and stress on surgeon’s decision making either to amputate or preserve the injured limbs. The Mangled Extremity Severity Score (MESS) was developed in Seattle (Johansen et al), based on both retrospective and prospective analysis of admission data of patients with severe limb injuries. The objective of this study was to evaluation of the prognostic predicting factors of outcome of traumatic extremities patients using Mangled Severity Scoring System at Emergency Department in Suez Canal University Hospital in order to help surgeon to make decision either to preserve or to amputate.Methods: This is a descriptive study (cross sectional), conducted on 60 patients with severe extremities injuries that met the criteria of the Mangled Extremity Severity Scoring attending to the Emergency Department (ED) at Suez Canal University Hospital.Results:This study showed that 83.33% of the patients had associated fractures, 8.33% of them had pneumothorax, 5% of them had abdominal collection and 3.33% of them had brain injuries. This study showed that 75% of the studied patients had MESS less than 7 while 25% of them had MESS > or = 7. The Mangled scoring system was a good predictor of amputation among the studied patients with sensitivity of 71.4%, specificity of 100% and 90% accuracy.Conclusions:Most of the patients had Mangled Extremity Severity Score less than 7. The MESS showed statistically significant difference between the amputated and the not amputated patients with 90% accuracy in prediction of amputation.

scholarly journals Efficacy of Possum in Surgical Audit of Patient Undergoing Emergency Surgery at Nepalgunj Medical College

2018 ◽  
Vol 14 (2) ◽  
pp. 2-7
Author(s):  
S V Bharti ◽  
S M Mishra ◽  
R R Ranjitkar ◽  
A O Chhetri
Keyword(s):  
Risk Factors ◽  
Emergency Surgery ◽  
Severity Score ◽  
Scoring System ◽  
College Teaching ◽  
Treatment Modalities ◽  
Mortality And Morbidity ◽  
Medical College ◽  
Operative Severity Score ◽  
Significant Difference

 Introduction: The Physiological and Operative Severity Score for the en Umeration of Mortality and morbidity (POSSUM) has been proposed as a method for standardizing patient data so that direct comparisons can be made in spite of differing patterns of referral and population.Aims and objectives: To evaluate the efficacy of a scoring system for predicting the incidence of postoperative complications and mortality in patient undergoing Emergency Surgeries based on the Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM).Material and Methods: This is a hospital based cross sectional study of all the cases that had undergone Emergency Surgery at Nepalgunj Medical College Teaching Hospital from the period of July 2014 to June 2015. The period of follow up was 30 days following the surgical procedure? A total of 100 emergency surgeries, as defined by the POSSUM scoring system criteria were studied. Predicted mortality and morbidity rates were calculated using the POSSUM equation by exponential analysis method. It was then compared with the actual outcomes. Observed: Expected Ratio (O:E) was calculated and difference detected by chi-square test. The risk factors as scored in the POSSUM criteria were noted.Results: Applying exponential analysis, an observed to expected ratio (O:E) for mortality of 0.44 was obtained, indicating significant 2 difference between the predicted and observed values (x =93.207, df 63, p=0.008). But, an observed to expected ratio (O:E) for 2 morbidity of 1.01 was obtained and there was no significant difference between the predicted and observed values (x =76.295, df 71, p=0.312). It was found to be comparable to other studies. In all the risk factors studied, a positive correlation was found between deaths and post-operative complications with higher POSSUM scores.Conclusion: POSSUM scoring system could accurately predict overall morbidity while it over predicted the overall mortality. POSSUM scoring system serves as a good predictor of post-operative outcome in major general surgical procedures and was applicable even in our setup and be used for comparing various treatment modalities and assessing the quality of care provided. JNGMC Vol. 14 No. 2 December 2016,   page: 2-7  

scholarly journals Feasibility of Non-Rebreather Masks and Nasal Cannula as a Substitute for High Flow Nasal Oxygen in Patients with Severe COVID-19 Infection

2021 ◽  
Author(s):  
mehmet kabak ◽  
Baris Cil
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
High Flow ◽  
Nasal Cannula ◽  
Intensive Care Treatment ◽  
Mechanical Ventilators ◽  
Non Invasive ◽  
Significant Difference

Abstract Objective: Severe pneumonia and respiratory failure may develop in patients with coronavirus infection, placing a very significant burden on healthcare systems due to the need for both emergency and intensive care treatment. Therefore, treatment of hypoxemia is a clinical priority in the treatment of such patients. In this regard, newer strategies such as High Flow Nasal Oxygen (HFNO) and non-invasive mechanical ventilators that can provide non-invasive high fraction of inspired oxygen are gaining clinical significance. Our objective was to compare oxygen supply by HFNO with Non-Rebreather Masks and Nasal Cannula (NRMs + NC) in terms of treatment costs and mortality in a group of COVID-19 patients requiring intensive care unit admission. Material and Methods: This was a retrospective and single-center study involving 54 patients who were admitted to an Intensive Care Unit with a diagnosis of COVID-19 infection between July 2020 and August 2020. Results: HFNO was compared with NMRs + NC in terms of mortality and duration of hospital stay. The two groups were comparable in age (p=0.45), gender (p=0.33), and mortality (p=0.43). Also, there was no significant difference in oxygen saturation at admission (p=0.63), duration of intensive care (p=0.35), total length of hospital stay (p=0.057), and need for invasive mechanical ventilator (p=0.39) between the study groups. The levels of WBC (p=0.36), platelets (p=0.12), lymphocytes (p=0.98), CRP (p=0.11), pro-calcitonin (p=0.20), D-dimer (p=0.74), ferritin (p=0.14), urea (p=0.74), and creatinine (p=0.35) were also similar between the two groups. Conclusion: Oxygen support by NRMs + NC was comparable to HFNO in terms of mortality, need for invasive mechanic ventilation, length of intensive care, and length of hospital stay. We believe that NRMs + NC may represent an inexpensive and easily accessible therapeutic substitute for HFNO, particularly when the risk of transmission and costs related with HFNO use are considered.

scholarly journals Detection of SARS-CoV-2 and Other Infectious Agents in Lower Respiratory Tract Samples Belonging to Patients Admitted to Intensive Care Units of a Tertiary-Care Hospital, Located in an Epidemic Area, during the Italian Lockdown

2021 ◽  
Vol 9 (1) ◽  
pp. 185
Author(s):  
Adriana Calderaro ◽  
Mirko Buttrini ◽  
Sara Montecchini ◽  
Giovanna Piccolo ◽  
Monica Martinelli ◽  
...  
Keyword(s):  
Intensive Care ◽  
Respiratory Tract ◽  
Intensive Care Units ◽  
Lower Respiratory Tract ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Infectious Agents ◽  
Epidemic Area ◽  
Significant Difference

The aim of this study was the detection of infectious agents from lower respiratory tract (LRT) samples in order to describe their distribution in patients with severe acute respiratory failure and hospitalized in intensive care units (ICU) in an Italian tertiary-care hospital. LRT samples from 154 patients admitted to ICU from 27 February to 10 May 2020 were prospectively examined for respiratory viruses, including SARS-CoV-2, bacteria and/or fungi. SARS-CoV-2 was revealed in 90 patients (58.4%, 72 males, mean age 65 years). No significant difference was observed between SARS-CoV-2 positives and SARS-CoV-2 negatives with regard to sex, age and bacterial and/or fungal infections. Nonetheless, fungi were more frequently detected among SARS-CoV-2 positives (44/54, 81.4%, p = 0.0053). Candida albicans was the overall most frequently isolated agent, followed by Enterococcus faecalis among SARS-CoV-2 positives and Staphylococcus aureus among SARS-CoV-2 negatives. Overall mortality rate was 40.4%, accounting for 53 deaths: 37 among SARS-CoV-2 positives (mean age 69 years) and 16 among SARS-CoV-2 negatives (mean age 63 years). This study highlights the different patterns of infectious agents between the two patient categories: fungi were prevalently involved among SARS-CoV-2-positive patients and bacteria among the SARS-CoV-2-negative patients. The different therapies and the length of the ICU stay could have influenced these different patterns of infectious agents.

scholarly journals Efficacy of chest X-ray in the diagnosis of COVID-19 pneumonia: comparison with computed tomography through a simplified scoring system designed for triage

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Akın Çinkooğlu ◽  
Selen Bayraktaroğlu ◽  
Naim Ceylan ◽  
Recep Savaş
Keyword(s):  
Computed Tomography ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Scoring System ◽  
Imaging Modality ◽  
Ground Glass Opacity ◽  
Initial Presentation ◽  
X Ray ◽  
Chest X Ray

Abstract Background There is no consensus on the imaging modality to be used in the diagnosis and management of Coronavirus disease 2019 (COVID-19) pneumonia. The purpose of this study was to make a comparison between computed tomography (CT) and chest X-ray (CXR) through a scoring system that can be beneficial to the clinicians in making the triage of patients diagnosed with COVID-19 pneumonia at their initial presentation to the hospital. Results Patients with a negative CXR (30.1%) had significantly lower computed tomography score (CTS) (p < 0.001). Among the lung zones where the only infiltration pattern was ground glass opacity (GGO) on CT images, the ratio of abnormality seen on CXRs was 21.6%. The cut-off value of X-ray score (XRS) to distinguish the patients who needed intensive care at follow-up (n = 12) was 6 (AUC = 0.933, 95% CI = 0.886–0.979, 100% sensitivity, 81% specificity). Conclusions Computed tomography is more effective in the diagnosis of COVID-19 pneumonia at the initial presentation due to the ease detection of GGOs. However, a baseline CXR taken after admission to the hospital can be valuable in predicting patients to be monitored in the intensive care units.

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