Accuracy of delirium risk factors in adult intensive care unit patients

Objective: To assess the accuracy measurements for predisposing and precipitating Risk Factors for delirium in an adult Intensive Care Unit. Method: Cohort, prospective study with patients over 18 who had been hospitalized for over 24 hours and were able to communicate. The patients were assessed once a day until the onset of delirium or permanence in the Intensive Care Unit. Instruments were employed to track delirium, characterize the sample, and identify the risk factors. Descriptive statistics was employed for sample characterization and accuracy tests for risk factors. Results: The included patients amounted to 102, 31 of which presented delirium. The predisposing predictive risk factors were hypoalbuminemia, American Society of Anesthesiology over three, severity, altered tissue perfusion, dehydration, and being a male, whereas precipitating predictive factors were physical restraint, infection, pharmacological agent, polypharmacy, anemia, altered renal function, dehydration, invasive devices, altered tissue perfusion and altered quality and quantity of sleep. Conclusion: An accurate identification of predisposing and precipitating risk factors may contribute to planning preventive measures against delirium.

D-dimer/Fibrinogen ratio and recurrent exacerbations might have a potential impact to predict 90-day mortality in patients with COPD exacerbation

BackgroundAccording to the World Health Organisation reports (WHO), COPD is the third leading cause of overall in the World by 2020. AimWe aimed to determine the prognostic predictors of 90-day mortality after an initial exacerbation in patients with acute exacerbation of COPD (AECOPD). Results Increased Charlson Comorbidity Score(CCS) (HR:1.47; p<0.05), readmission after initial exacerbation (HR:1.47; p<0.05) were predictive risk factors for 30-day mortality in multivariable regression model. The 90-day mortality rate was %11.8. Hypertension, increased median age, nutrition risk score (NRS), CCS, CAT score, and mMRC 4th level were possible risk factors for 90-day mortality. There was a significant difference in the mortality of patients with D-dimer/Fibrinogen ratios>0.11 and ≤0.11 (HR:2.47; p<0.05). Recurrent exacerbations after discharge were predictive risk factors for 90-day mortality in the multivariable regression model (HR:2.25; p<0.001) with the increased mortality risk 4.73 times (HR:4.73; p=0.002). Furthermore, a 1-unit increment of acute exacerbation increased the mortality risk 3.39 times (HR:3.39; p<0.001). ConclusionOur study showed that D-dimer/Fibrinogen ratio but not D-dimer and recurrent exacerbations after discharge might have a critical impact on 90-day mortality

Prevalence and predictive risk factors of hypertension in patients hospitalized in Kamenge Military hospital and Kamenge University teaching hospital in 2019: A fixed effect modelling study in Burundi

Introduction Hypertension is a major threat to public health globally. Especially in sub-Saharan African countries, this coexists with high burden of other infectious diseases, creating a complex public health situation which is difficult to address. Tackling this will require targeted public health intervention based on evidence that well defines the at risk population. In this study, using retrospective data from two referral hospitals in Burundi, we model the risk factors of hypertension in Burundi. Materials and methods Retrospective data of a sample of 353 randomly selected from a population of 4,380 patients admitted in 2019 in two referral hospitals in Burundi: Military and University teaching hospital of Kamenge. The predictive risk factors were carried out by fixed effect logistic regression. Model performance was assessed with Area under Curve (AUC) method. Model was internally validated using bootstrapping method with 2000 replications. Both data processing and data analysis were done using R software. Results Overall, 16.7% of the patients were found to be hypertensive. This study didn’t showed any significant difference of hypertension’s prevalences among women (16%) and men (17.7%). After adjustment of the model for cofounding covariates, associated risk factors found were advanced age (40–59 years) and above 60 years, high education level, chronic kidney failure, high body mass index, familial history of hypertension. In absence of these highlighted risk factors, the risk of hypertension occurrence was about 2 per 1000 persons. This probability is more than 90% in patients with more than three risk factors. Conclusion The relatively high prevalence and associated risk factors of hypertension in Burundi raises a call for concern especially in this context where there exist an equally high burden of infectious diseases, other chronic diseases including chronic malnutrition. Targeting interventions based on these identified risk factors will allow judicious channel of resources and effective public health planning.

A Case Report of Genetic Cascade Screening in Dilated Cardio-myopathy: A Perspective for Preventive Cardiology

Cardiomyopathies are heterogeneous and critical disorders of cardiovascular diseases. One of the most common inherited cardiomyopathies is DCM (dilated cardiomyopathy). Genetic disorders are found in approximately 50% of DCM cases. We aimed to describe a case of DCM in a 42-year-old woman in 2018 at Farhud Genetic Clinic, Tehran, Iran. To detect genetic involvement, Next-generation sequencing (NGS) was performed and the data were evaluated carefully. Variations in different genes coding crucial proteins in cardiac muscle structure (i.e. Titin, Obscurin, MYH6, and LAMA4) and proteins involved in channels (i.e. CAVNA1C, SCN1B and SCN5A) were detected by whole-exome sequencing (WES). In agreement with the clinical manifestations and molecular analysis, DCM was confirmed. This study provides further evidence on the diagnostic role of NGS in borderline DCM cases. It also shows the recently developed high throughput sequencing can provide clinicians with this approach to diagnosis, treatment, and prevention of such hard-to-diagnose disorders. Furthermore, this study highlights the basis of personalized medicine, namely detection of high-risk individuals by revealing some genetic variants as predictive risk factors, and initial prevention of DCM.

O-P06 Early postoperative differentiation between biochemical leak and clinically-relevant pancreatic fistula after pancreaticoduodenectomy: development of a predictive risk score

Background Several risk scores are available which predict pancreatic fistula after pancreaticoduodenectomy (PD), but do not differentiate between biochemical leak (BL) and clinically relevant pancreatic fistula (CR-POPF). The aim of this study was to identify factors that differentiate between BL and CR-POPF in the early postoperative period. Methods Consecutive patients diagnosed with BL and CR-POPF after PD were identified from a prospectively maintained database (2009-2019). Data were collected for demographics, intraoperative and laboratory parameters on the first five postoperative days (PODs), including drain fluid amylase (DFA), C-reactive protein (CRP) and albumin. Independent predictors of CR-POPF were identified using a multivariable binary logistic regression model, which was subsequently converted to a risk score Results 187 patients consisted of 99 BL and 88 CR-POPF. In those with CR-POPF, the leak became clinically relevant a median of 9 days after surgery; these patients had a significantly higher length of hospital stay than those with BL (median: 24 vs. 10 days, p &lt; 0.001). On multivariable analysis, male gender (p = 0.002), higher DFA (p &lt; 0.001) or CRP (p &lt; 0.001) on POD3, lower albumin (p = 0.028) on POD3 were all found to be independent predictors of CR-POPF. A risk score based on these factors returned an area under the ROC curve of 0.78. Conclusions In patients with a confirmed pancreatic fistula it may be possible to differentiate between BL and CR-POPF using early postoperative variables, particularly DFA, serum albumin and CRP. Early identification of CR-POPF may allow earlier intervention to improve clinical outcomes.

Serious Suicide Attempt by Hunting Gun with Severely Infectious Wounds and Facial Deformity during COVID-19 Arena; A Case Report

The etiology of suicide among students around the world revolves issues such as communication, education, family problems and parents’ relationship. We intend to report a case with serious recurrent suicide attempt by gun shot during COVID-19 period. We also present psychiatric and clinical evaluation, cosmetic surgery consultation, as well as microbial assessments in this survey. The seventeen-year-old single male student from southwest of Iran with asymmetric deformed face was observed with the loss of parts of the mouse, nose, chin and mandible region .He had experienced a serious suicide attempt by a threatening plan following rejection. The patient had blurred, hypo phonic and hypotonic speech. Following the shooting, the soft and hard palate, facial, frontal bone and sinus had been destroyed and a foreign body was seen in the frontal sinus. After suicide risk as assessment, It was detected multiple predictive risk factors for recent suicide attempt and the possibility of recurrent suicide in future. Finally, reconstructive surgery was performed. We assessed him via face to face interview in order to identify psychiatric disorders. Also, he was evaluated as probability of committing recurrent suicide. It is emphasized that in families which young children are prone to psychiatric disorders or emotional problems, availability of a dangerous device such as a gun can be harmful and it should be removed as soon as possible. We suggest the need for psychiatric evaluation especially suicide phenomenon in adolescents and their families as various conflicts in family context.