Valproic Acid After Neurosurgery Induces Elevated Risk of Liver Injury: A Prospective Nested Case-Control Study

Background Valproic acid (VPA) has been widely used to prevent epileptic seizures after neurosurgery in China. We have found that the incidence of liver injury (LI) in patients using VPA after neurosurgery is higher than that in other patients. Objective The objective of this study was to investigate the risk factors of LI in patients using VPA after neurosurgery. Methods A nested case-control study was conducted in patients using VPA after neurosurgery between September 2019 and March 2021. Cases of LI were matched to controls by age and body mass index (BMI). Conditional logistic regression was used to estimate matched odds ratios representing the odds of LI. A receiver operating characteristic curve was used to analyze the optimal cutoff condition. Results A total of 248 people (62 LI and 186 control) were enrolled. Among patients with vs without LI, the matched odds ratio for trough concentration of VPA was significant (matched odds ratio [OR], 1.09; 95% confidence interval [CI]: 1.01-1.19). The course of treatment (OR: 1.17, 95% CI: 1.02-1.33), Glasgow score (OR: 0.26, 95% CI: 0.10-0.67), gene polymorphisms of CYP2C19 (OR: 2.09, 95% CI: 1.03-146.93), and UGT1A6 (OR: 34.61, 95% CI: 1.19-1003.23) were all related to the outcome. The optimal cutoff of the course of treatment was 10 days, while the trough concentration of VPA was determined to be 66.16 mg/L. Conclusion Length of treatment, VPA trough concentration, and Glasgow score were associated with LI in patients after neurosurgery. A gene test may be necessary for people who are prescribed VPA for a long time.

129 Recording of the Glasgow Scores in patients admitted to The Great Western Hospital (GWH) with Pancreatitis

Introduction Pancreatitis represents a significant pathology in terms of morbidity and mortality and therefore it is important to be able to differentiate between mild and severe episodes. The objective nature of the Glasgow score and ability to predict severity make it a useful guide, however its use within GWH varies greatly. Method Both cycles of data collection occurred over one-month periods. Data was collected retrospectively of prospectively recorded data. Intervention implemented following the first audit cycle was a standardised proforma and the biochemistry lab instigated automated analysis of lactate dehydrogenase and calcium. Following this an identical audit was performed. In addition, the presence of CXR on admission and USS within 24hrs of admission was recorded. Results During the first audit cycle 44% of patients had a Glasgow score documented on admission, which improved to 63% after the second audit. There was a 17% improvement in USS scanning within 24 hours and a 50% increase in CXR being performed on admission following the second audit. Conclusions The changes implemented during the study have increased both the quantity and quality of the data recorded in patients admitted to GWH with pancreatitis. This should function to improve differentiation of those with mild episodes from those with severe.

Accuracy of conventional and novel scoring systems in predicting severity and outcomes of acute pancreatitis: a retrospective study

Background Recently, several novel scoring systems have been developed to evaluate the severity and outcomes of acute pancreatitis. This study aimed to compare the effectiveness of novel and conventional scoring systems in predicting the severity and outcomes of acute pancreatitis. Methods Patients treated between January 2003 and August 2020 were reviewed. The Ranson score (RS), Glasgow score (GS), bedside index of severity in acute pancreatitis (BISAP), pancreatic activity scoring system (PASS), and Chinese simple scoring system (CSSS) were determined within 48 h after admission. Multivariate logistic regression was used for severity, mortality, and organ failure prediction. Optimum cutoffs were identified using receiver operating characteristic curve analysis. Results A total of 1848 patients were included. The areas under the curve (AUCs) of RS, GS, BISAP, PASS, and CSSS for severity prediction were 0.861, 0.865, 0.829, 0.778, and 0.816, respectively. The corresponding AUCs for mortality prediction were 0.693, 0.736, 0.789, 0.858, and 0.759. The corresponding AUCs for acute respiratory distress syndrome prediction were 0.745, 0.784, 0.834, 0.936, and 0.820. Finally, the corresponding AUCs for acute renal failure prediction were 0.707, 0.734, 0.781, 0.868, and 0.816. Conclusions RS and GS predicted severity better than they predicted mortality and organ failure, while PASS predicted mortality and organ failure better. BISAP and CSSS performed equally well in severity and outcome predictions.

Accuracy of Conventional and Novel Scoring Systems in Predicting Severity and Outcomes in Acute Pancreatitis: A Retrospective Study

Backgroud: Recently there are several novel scoring systems to evaluate the severity and outcomes of acute pancreatitis. This study is to compare the effectiveness of novel and traditional scoring systems for predicting severity and outcomes in acute pancreatitis.Methods: Patients between January 2003 and August 2020 were reviewed. Ranson score (RS), Glasgow score (GS), beside index of severity in acute pancreatitis (BISAP), pancreatic activity scoring system (PASS), and Chinese simple scoring system (CSSS) were determined within 48h after admission. Multivariate logistic regression was used for severity, mortality, and organ failure prediction. Optimum cutoffs were identified using ROC analysis.Results: A total of 1848 patients were included. AUCs of RS, GS, BISAP, PASS, and CSSS for severity prediction were 0.861, 0.865, 0.829, 0.778, and 0.816, respectively. AUCs for mortality prediction were 0.693, 0.736, 0.789, 0.858, and 0.759. AUCs for ARDS prediction were 0.745, 0.784, 0.834, 0.936, and 0.820. AUCs for ARF prediction were 0.707, 0.734, 0.781, 0.868, and 0.816.Conclusions: RS, and GS predict severity superior to mortality and organ failure while PASS predicts mortality and organ failure better. BISAP and CSSS shared steady capacity in severity and outcomes prediction.

Determination of severity of acute pancreatitis

Background: Acute pancreatitis is an inflammatory process with a highly variable clinical course. The present study was conducted to assess severity of acute pancreatitis.Methods: The present study was conducted on 53 patients of acute pancreatitis of both genders. A thorough clinical examination was performed. Ranson’s score (RS), Glasgow score (GS), acute physiology and chronic health evaluation (APACHE-II) score, APACHE-O score and Balthazar’s computed tomography severity index (CTSI) score was recorded.Results: Out of 53 patients, males were 47 and females were 6. Patients were divided into acute pancreatitis (32) and severe pancreatitis (21). Results of the bivariate analysis of Ranson scoring system in mild periodontitis was 0.84 in severe was 2.95, Glasgow score was 0.66 in mild and 2.48 in severe, APACHE-II had 6.94 in mild and 10.33 in severe, APACHE-O had 7.34 in mild and 11 in severe and CTSI had 1.9 in mild and 6.15 in severe.Conclusions: Authors found that all the scoring systems are useful in assessing the severity of acute pancreatitis.

P1528EPIDEMIOLOGICAL SURVEY OF A POPULATION UNDERGOING URGENT HEMODIALYSIS

Background and Aims Urgent hemodialysis is a very common situation in nephrology and is burdened with high morbidity and mortality. The aim of this work is to study the epidemiological, etiological, clinico-biological and indications of dialysis emergencies, the parameters of the session and the potential complications. Method This is a descriptive study conducted over a period of 12 months (January – December 2017), including all patients who have been admitted to the nephrology department for urgent management in hemodialysis. Results Our study collected a total of 318 patients (sex ratio =1.52), the mean age 60.54 ± [18-95 years]. Patients came mainly from the emergency department (69.8%). 40.9 % of the patients were diabetic and 66,4 % hypertensive, 15.1% had coronary artery disease. Among patients, 80.9% had chronic renal insufficiency, of which 29.6% were end-stage (28% hemodialysis and 1.6% peritoneal dialysis). Urgent hemodialysis was undertaken for threatening hyperkalemia in 58.2% of cases, a poorly tolerated uremic syndrome in 50.8% acute pulmonary edema (APO) in 36.5% of cases, and anuria greater than 12h were the indication in 44.4% of cases and a severe metabolic acidosis in 11.3% of cases. The average duration of the session was 3 hours. Ultrafiltration was necessary in 63.7% of the cases. The blood access was a femoral catheter in 80.6% of the cases. Blood transfusion was indicated in 13.8% of cases. Main complications were dominated by symptomatic arterial hypotension in 12.9% requiring stopping the session in half of cases hypoglycemia in 6.9%, neurological disorder in 6.6% chest pain in 3.5 %. After a year of follow up care, overall mortality was 40% in this population. On multivariate analysis, age (p=0.006) and neurological state according to the glasgow score (p=0.01) were retained as independent factors of mortality in this population. Conclusion A greater prevalence of urgent hemodialysis is observed in our country testifying to the accessibility of this method of extrarenal replacement. Hyperkalemia, uremic syndrom and PAO are the main indications for urgent hemodialysis. Early diagnosis, prompt and relevant management of these patients will determine their prognoses in the short and medium term.

Sodium brain trauma Prognostic value of the sodium alterations during the first seven days in adults patients with severe brain trauma of the autonomous institute university hospital of Los Andes Merida between June 2017 - June 2018

Objectives To establish the prognostic role of serum sodium alterations during the first seven days in patients diagnosed with severe brain trauma admitted to the adult emergency area of ​​the autonomous university hospital of the Mérida Andes, from June 2017 to June 2018 Materials and Methods: Prospective, field and longitudinal sectional study. Patients older than 18 years with a diagnosis of head brain injury were selected, diabetes insipidus, inappropriate antidiuretic secretion and salt loser brain were evaluated in each patient of the sample. Results: 103 patients, 90.6% men and 9.4% women, the mean age was 25.8 years, the largest age group corresponded to those under 30 years, 79 (76.9%), accidents of Transients were the main cause of brain trauma 79 (76%), brain edema was the main tomographic finding, all tomographic findings showed statistical significance. The 3 types of neuroendocrine disorders related to sodium were presented, being diabetes insipidus the most frequent. total mortality was 22 (22.63%) patients of 103. Neurosurgical interventions were performed in 10 patients with a mortality of 8 (80%), (p <0.001). The Glasgow score in the live group was 9.7 compared to 6.3 points in the deceased subgroup (p <0.001). Conclusions: There is a higher mortality associated with sodium alterations, the greatest association corresponded to diabetes insipidus (p0,026), so it is vital to adequately manage these alterations.

DIAGNOSTICOS E CUIDADOS DE ENFERMAGEM COM CRIANÇAS HOSPITALIZADAS

Introdução: O processo de hospitalização torna a criança e sua família vulnerável, pois, estão em um ambiente novo, no qual recebem cuidados de vários profissionais e precisam se habituar a rotina da instituição, além da alteração do estado de saúde do filho, muitas vezes podendo gerar medo e ansiedade entre o doente e seus familiares (GOULART, et al 2018). Objetivo: Traçar um plano de cuidados embasado nos diagnósticos da Nanda. Metodologia: Trata-se de um estudo de caso, abordando aspectos relacionados ao plano de cuidados de uma criança do sexo feminino, de um mês, que se encontrava hospitalizada com o diagnóstico de Anemia e Leucopenia. Estudo desenvolvido em um hospital geral, no setor de pediatria no dia 27/02/2019 até o dia 02/04/2019. Foram utilizadas as escalas Branden, Glasgow, Dini e EVA, padronizadas na pediatria. Resultados e Discussão: Depois de aplicar as escalas, conforme o protocolo de pediatria da instituição, foram obtidos os seguintes resultados: Braden 16 pontos, EVA score 2, Glasgow score 7 e Dini 18 pontos, encontrados seis diagnósticos de enfermagem no livro da Nanda. Um diagnóstico de enfermagem é um julgamento clínico sobre uma resposta humana a condições de saúde/processos da vida, ou uma vulnerabilidade a tal resposta, de um indivíduo, uma família, um grupo ou uma comunidade (HERDMAN, KAMITSURU 2018). Com enfoque nos diagnósticos da Nanda, segue abaixo os diagnósticos detectados, características definidoras e os fatores relacionados à saúde da criança, e por fim o plano de cuidados. 1 Produção insuficiente de leite materno, 2 Amamentação ineficaz, 3 Amamentação interrompida, 4 Desobstrução ineficaz das vias aéreas, 5 Risco de lesão por pressão, 6 Risco de quedas. Conclusão: O enfermeiro é o profissional que coordena e gerencia todo o processo de assistência a ser desenvolvido em relação ao paciente e tudo o que o envolve no contexto da instituição hospitalar, sendo assim, é de suma importância que o mesmo elabore um plano terapêutico para detecção precoce dos riscos que podem afetar/ ou prejudicar a boa recuperação do paciente internado.

TÍTULO: AMIGDALITE EM CRIANÇA: UM ESTUDO DE CASO EM PEDIATRIA

Resumo: Introdução: Em crianças de até quatro anos de idade, quase todas as amigdalites agudas são causadas por vírus, principalmente por adenovírus. As infecções bacterianas apesar de pouco comum também podem ocorrer. Entre as causas bacterianas, o principal agente etiológico é o Streptococcus pyogenes ou estreptococo beta-hemolítico do grupo A, que pode causar complicações não supurativas, como glomerulonefrite aguda e febre reumática, e supurativas, como otite média aguda, abscesso peritonsilar e rinossinusite aguda. (OLIVEIRA, 2012) Objetivo: Este trabalho teve como objetivo identificar as necessidades e traçar um plano de cuidados para uma criança hospitalizada no setor de pediatria de um hospital geral. Metodologia: Esse caso clínico foi realizado com um paciente do sexo masculino, de 11 meses, que se encontrava hospitalizado com o diagnóstico de amigdalite. Foram coletados dados do prontuário, e realizado exame físico, histórico de enfermagem, projeto terapêutico e aplicadas as escalas DINI, Glasgow, Braden e EVA. Resultados: Depois de aplicar as escalas conforme o protocolo da instituição foi obtido os seguintes resultados: Braden 26 pontos, EVA score 2, Glasgow score 9 e Dini 19 pontos. Com base nos diagnósticos da Nanda, os diagnósticos detectados foram: 1 Infeção, 2 Integridade da membrana mucosa oral prejudicada, 3 Hipertermia, 4 Deglutição prejudicada e 5 Fadiga. Levando em consideração os diagnósticos encontrados foi traçado o seguinte plano de cuidado: Monitorar curva térmica de 4 em 4 horas, ficar atento aos sinais e sintomas de infecção, monitorar exames laboratoriais, administrar medicações prescritas pelo médico, remover excesso de roupa, recomendar banho morno caso haja febre, monitorar ingestão e eliminação de líquidos, orientar acompanhante sobre a importância de insistir/incentivar a alimentação e sobre as atividades recreativas no leito e na brinquedoteca da unidade, comunicar acompanhante sobre procedimentos realizado e evoluir em prontuário. Conclusão: Conclui-se então a importância do enfermeiro realizar uma anamnese e um exame físico criterioso, com base em seus conhecimentos técnicos e científicos, e que o mesmo fique atento as queixas e a evolução do quadro do paciente, afim de promover o conforto e um tratamento clínico eficiente.Descritores: Pediatria; Estudo de Caso; Cuidados de Enfermagem;Área Temática: Processo de Cuidar em Enfermagem na Saúde da Criança e do Adolescente.Tipo de Estudo: Estudo de CasoDiscente do curso de Enfermagem da Universidade do Estado de Minas Gerais (UEMG -Unidade de Passos-MG). E-mail: [email protected] Doutora da Universidade do Estado de Minas Gerais (UEMG -Unidade de Passos, MG). E-mail: [email protected]