Pub Date : 2024-07-16DOI: 10.18203/2349-3933.ijam20241967
Suhaib Alghawanmeh, Hayel Aladwan, Wael Alshobaki, Deema Aladwan, Ashraf F. Mohd, Nisrein M. Al-Aqqad
Background: Objective of the study was to identify differences in preoperative, intraoperative, and postoperative parameters between female and male cardiac surgical patients. Methods: This is a prospective observational analysis of adult cardiac surgical patients presenting for cardiac surgery at Queen Alia Heart Institute in the period between September 2023 and January 2024. Patients’ demographics, type of surgery (cardiac pathology), comorbidities, and perioperative, parameters were recorded and analysed. Males and females were compared according to their age at time of surgery, operative time, intensive care unit (ICU) stay, hospitalisation time and mortality. Male and female patients undergoing coronary surgery were compared. Results: Data from 166 adult cardiac surgical patients was analysed. They constituted 135 males and 31 females. Male to female ratio was 4.4:1. When considering all types of cardiac surgery, female patients had longer duration of hospitalisation (13.1 days) than males (11.5 days). Moreover, mortality was higher in the female subpopulation (12.9%) than the male subpopulation (8.1%). Only 14% of coronary artery bypass grafting (CABG) patients were females and they had higher in-hospital mortality (20%) versus 7.4% in males. Conclusions: Female patients present for CABG less commonly than males and at more advanced age. Mortality rates are higher in females and hospitalisation time is longer.
{"title":"Impact of gender on outcome of adult cardiac surgery","authors":"Suhaib Alghawanmeh, Hayel Aladwan, Wael Alshobaki, Deema Aladwan, Ashraf F. Mohd, Nisrein M. Al-Aqqad","doi":"10.18203/2349-3933.ijam20241967","DOIUrl":"https://doi.org/10.18203/2349-3933.ijam20241967","url":null,"abstract":"Background: Objective of the study was to identify differences in preoperative, intraoperative, and postoperative parameters between female and male cardiac surgical patients.\u0000Methods: This is a prospective observational analysis of adult cardiac surgical patients presenting for cardiac surgery at Queen Alia Heart Institute in the period between September 2023 and January 2024. Patients’ demographics, type of surgery (cardiac pathology), comorbidities, and perioperative, parameters were recorded and analysed. Males and females were compared according to their age at time of surgery, operative time, intensive care unit (ICU) stay, hospitalisation time and mortality. Male and female patients undergoing coronary surgery were compared.\u0000Results: Data from 166 adult cardiac surgical patients was analysed. They constituted 135 males and 31 females. Male to female ratio was 4.4:1. When considering all types of cardiac surgery, female patients had longer duration of hospitalisation (13.1 days) than males (11.5 days). Moreover, mortality was higher in the female subpopulation (12.9%) than the male subpopulation (8.1%). Only 14% of coronary artery bypass grafting (CABG) patients were females and they had higher in-hospital mortality (20%) versus 7.4% in males.\u0000Conclusions: Female patients present for CABG less commonly than males and at more advanced age. Mortality rates are higher in females and hospitalisation time is longer.","PeriodicalId":13827,"journal":{"name":"International Journal of Advances in Medicine","volume":" 26","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141832061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-09DOI: 10.18203/2349-3933.ijam20241953
Mohannad K. Bawaneh, Wael Alshobaki, Moath R. Alzboon, Murad Hamiedah, Hussien Alnawaiseh, Basel Albtoush, Ibrahim Al Foqahaa
Acute appendicitis is commonly associated with right lower quadrant abdominal pain and is a leading cause of emergent abdominal surgeries, carrying a significant morbidity risk. The rarity of anatomical deviations, such as appendix agenesis, complicates diagnosis and can exacerbate clinical outcomes due to diagnostic delays or mismanagement. We report the case of a 21-year-old male, who was surgically explored at prince Ali military hospital for suspected acute appendicitis based on clinical symptoms and an Alvarado score of 7. Despite strong clinical indications, imaging studies, including ultrasound and computed tomography, failed to visualize the appendix. Intraoperatively, appendix agenesis was confirmed, a finding seldom reported in medical literature. This case underscores the challenges of diagnosing congenital appendix absence and highlights the need for heightened awareness among clinicians to prevent unnecessary surgical interventions. Such awareness could potentially improve patient outcomes by sparing them from unnecessary surgical risks and complications.
{"title":"Congenital absence of the appendix in a 21-year-old male with clinical presentation of acute appendicitis: a diagnostic challenge at Prince Ali Military Hospital","authors":"Mohannad K. Bawaneh, Wael Alshobaki, Moath R. Alzboon, Murad Hamiedah, Hussien Alnawaiseh, Basel Albtoush, Ibrahim Al Foqahaa","doi":"10.18203/2349-3933.ijam20241953","DOIUrl":"https://doi.org/10.18203/2349-3933.ijam20241953","url":null,"abstract":"Acute appendicitis is commonly associated with right lower quadrant abdominal pain and is a leading cause of emergent abdominal surgeries, carrying a significant morbidity risk. The rarity of anatomical deviations, such as appendix agenesis, complicates diagnosis and can exacerbate clinical outcomes due to diagnostic delays or mismanagement. We report the case of a 21-year-old male, who was surgically explored at prince Ali military hospital for suspected acute appendicitis based on clinical symptoms and an Alvarado score of 7. Despite strong clinical indications, imaging studies, including ultrasound and computed tomography, failed to visualize the appendix. Intraoperatively, appendix agenesis was confirmed, a finding seldom reported in medical literature. This case underscores the challenges of diagnosing congenital appendix absence and highlights the need for heightened awareness among clinicians to prevent unnecessary surgical interventions. Such awareness could potentially improve patient outcomes by sparing them from unnecessary surgical risks and complications.","PeriodicalId":13827,"journal":{"name":"International Journal of Advances in Medicine","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141665374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-05DOI: 10.18203/2349-3933.ijam20241597
A. H. Qabaha, S. Al-Fawares, AbdaAllah Ibrahim Alqaisi, Wael Alshobaki, Rawand Hayel Al-Adwan, A. F. Mohd, Nisrein Mousa Al-Aqqad
Background: The objectives of study were to determine the incidence of overweight and obesity in adult cardiac surgical patients, and to evaluate the impact of BMI on outcome from cardiac surgery. Methods: Retrospective observational analysis of data of adult cardiac surgery at Queen Alia heart institute (QAHI) in the period of time between September 2023 and February 2024. Patients’ data were recorded and analysed. Patients were divided in categories according to the world health organisation (WHO) body mass index (BMI) classification. The WHO BMI categories were compared regarding their pre-operative, intra-operative and post-operative characteristics. Recovery parameters such as extubation time, length of ICU stay, length of hospitalisation and mortality were also compared between normal weight, overweight and obesity categories. Ethical committee approval obtained. Results: Data from 141adult cardiac surgical patients was analysed. Male patients were 115 (81.56%) and female patients were 26 (18.44%) with a male to female ratio of 4.4. Mean age of patients was 56.66 (SD 10.26). Majority of patients were obese (39%) and overweight (34%). The Incidence of diabetes in the normal weight category was 41.7%; while in the overweight category it increased to 58.4% and reached 60% in the obese category. The incidence of hypertension (75% in the overweight and 76.4% in the obese categories) increased with the increase of the BMI. Obese category had prolonged mean duration of hospitalisation (13 days); however, lower rates of re-opening and mortality. Conclusions: Most of the adult cardiac surgical patients in this study are obese and overweight. The overweight and obese patients had higher rates of hypertension, diabetes and ischaemic heart disease. Longer hospitalisation and lower mortality rates were noted in patients with higher BMI.
{"title":"Impact of body mass index on outcome of adult cardiac surgery","authors":"A. H. Qabaha, S. Al-Fawares, AbdaAllah Ibrahim Alqaisi, Wael Alshobaki, Rawand Hayel Al-Adwan, A. F. Mohd, Nisrein Mousa Al-Aqqad","doi":"10.18203/2349-3933.ijam20241597","DOIUrl":"https://doi.org/10.18203/2349-3933.ijam20241597","url":null,"abstract":"Background: The objectives of study were to determine the incidence of overweight and obesity in adult cardiac surgical patients, and to evaluate the impact of BMI on outcome from cardiac surgery.\u0000Methods: Retrospective observational analysis of data of adult cardiac surgery at Queen Alia heart institute (QAHI) in the period of time between September 2023 and February 2024. Patients’ data were recorded and analysed. Patients were divided in categories according to the world health organisation (WHO) body mass index (BMI) classification. The WHO BMI categories were compared regarding their pre-operative, intra-operative and post-operative characteristics. Recovery parameters such as extubation time, length of ICU stay, length of hospitalisation and mortality were also compared between normal weight, overweight and obesity categories. Ethical committee approval obtained.\u0000Results: Data from 141adult cardiac surgical patients was analysed. Male patients were 115 (81.56%) and female patients were 26 (18.44%) with a male to female ratio of 4.4. Mean age of patients was 56.66 (SD 10.26). Majority of patients were obese (39%) and overweight (34%). The Incidence of diabetes in the normal weight category was 41.7%; while in the overweight category it increased to 58.4% and reached 60% in the obese category. The incidence of hypertension (75% in the overweight and 76.4% in the obese categories) increased with the increase of the BMI. Obese category had prolonged mean duration of hospitalisation (13 days); however, lower rates of re-opening and mortality.\u0000Conclusions: Most of the adult cardiac surgical patients in this study are obese and overweight. The overweight and obese patients had higher rates of hypertension, diabetes and ischaemic heart disease. Longer hospitalisation and lower mortality rates were noted in patients with higher BMI.","PeriodicalId":13827,"journal":{"name":"International Journal of Advances in Medicine","volume":"12 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141383537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-05DOI: 10.18203/2349-3933.ijam20241596
Desak Putu Sukasanti Adi Kunti, K. Suryana
Central nervous system (CNS) disorders are estimated to occur in approximately 10-20% of people living with human immunodeficiency virus (HIV). Neurological manifestations in HIV-infected patients can be caused directly by HIV or by opportunistic infections. Here we present a case report of a 47-year-old male initially diagnosed with decreased of consciousness in HIV-infected patients on ARV. Differential diagnosis of HIV-infected patients with decreased consciousness must be made. We can consider causes of opportunistic infections such as toxoplasma encephalitis, HIV encephalitis, or both.
据估计，大约 10-20% 的人类免疫缺陷病毒（HIV）感染者会出现中枢神经系统（CNS）紊乱。艾滋病病毒感染者的神经系统表现可能由艾滋病病毒直接引起，也可能由机会性感染引起。本文报告了一例 47 岁男性患者的病例，他最初被诊断为使用抗逆转录病毒药物的 HIV 感染者意识减退。必须对意识减退的艾滋病病毒感染者进行鉴别诊断。我们可以考虑机会性感染的原因，如弓形虫脑炎、艾滋病脑炎或两者兼而有之。
{"title":"Human immunodeficiency virus infected patient with decreased of consciousness, what do we think?","authors":"Desak Putu Sukasanti Adi Kunti, K. Suryana","doi":"10.18203/2349-3933.ijam20241596","DOIUrl":"https://doi.org/10.18203/2349-3933.ijam20241596","url":null,"abstract":"Central nervous system (CNS) disorders are estimated to occur in approximately 10-20% of people living with human immunodeficiency virus (HIV). Neurological manifestations in HIV-infected patients can be caused directly by HIV or by opportunistic infections. Here we present a case report of a 47-year-old male initially diagnosed with decreased of consciousness in HIV-infected patients on ARV. Differential diagnosis of HIV-infected patients with decreased consciousness must be made. We can consider causes of opportunistic infections such as toxoplasma encephalitis, HIV encephalitis, or both.","PeriodicalId":13827,"journal":{"name":"International Journal of Advances in Medicine","volume":"29 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141382186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-03DOI: 10.18203/2349-3933.ijam20241593
Bilal Al-Bdour, Wael Alshoubaki, Rawan M. Ayyad, Murad M. Hamiedeh, Moath R. Alzboon, Mohammad S. Khlifat, Ahmad J. Saádeh, Ahmad T. Alhabashneh, Maysaa M. Al-lassasmeh
Background: This study at Prince Ali military hospital in Al Karak, Jordan, investigates seasonal variations in appendicitis incidence and outcomes, assessing diagnostic and treatment strategies across different seasons. The aim is to understand how seasonal changes influence appendicitis rates and to evaluate the effectiveness of diagnostic methods and treatment approaches. Methods: A retrospective observational study was conducted on 321 confirmed cases of inflamed or perforated appendicitis from March 2021 to February 2024. Patient demographics, dates of surgery, surgical interventions, and postoperative complications were analyzed, with a focus on seasonal trends. Results: Out of 394 reviewed cases, 321 (81.47%) met the inclusion criteria, showing significant seasonal variations in appendicitis incidence. Autumn saw the highest rate of appendicitis cases at 32.09% while the lowest was in Winter (22.12%). Regarding normal appendix, the highest rate was in winter (21.98%), and the lowest was in summer (13.09%). The mean patient age was 25.20 years, with a majority being male (66.36%). Open surgeries were the most common, comprising 91.9% of cases, compared to 8.1% for laparoscopic procedures. Diagnostic analysis revealed a very strong correlation between CT findings and histopathological outcomes (p=3.23×10^-11) and a significant but less strong correlation for ultrasound findings (p=0.000446). These results suggest that both diagnostic methods are effective, with CT scans showing a stronger correlation. The distribution of cases across seasons was 32.087% in autumn, 23.05% in spring, 22.741% in summer, and 22.118% in winter. Conclusions: Significant seasonal peaks in appendicitis are evident, particularly in autumn, driven by changes in diet and viral infections. The superior effectiveness of CT scans during winter highlights the need for adaptive diagnostic strategies across seasons. These findings advocate for healthcare systems to seasonally adjust resources and diagnostics to optimize appendicitis management, with further research needed to expand these insights globally.
{"title":"Exploring the seasonal impact on appendectomy: incidence, patterns, predictors, and healthcare implication of appendectomy at Prince Ali military hospital","authors":"Bilal Al-Bdour, Wael Alshoubaki, Rawan M. Ayyad, Murad M. Hamiedeh, Moath R. Alzboon, Mohammad S. Khlifat, Ahmad J. Saádeh, Ahmad T. Alhabashneh, Maysaa M. Al-lassasmeh","doi":"10.18203/2349-3933.ijam20241593","DOIUrl":"https://doi.org/10.18203/2349-3933.ijam20241593","url":null,"abstract":"Background: This study at Prince Ali military hospital in Al Karak, Jordan, investigates seasonal variations in appendicitis incidence and outcomes, assessing diagnostic and treatment strategies across different seasons. The aim is to understand how seasonal changes influence appendicitis rates and to evaluate the effectiveness of diagnostic methods and treatment approaches.\u0000Methods: A retrospective observational study was conducted on 321 confirmed cases of inflamed or perforated appendicitis from March 2021 to February 2024. Patient demographics, dates of surgery, surgical interventions, and postoperative complications were analyzed, with a focus on seasonal trends.\u0000Results: Out of 394 reviewed cases, 321 (81.47%) met the inclusion criteria, showing significant seasonal variations in appendicitis incidence. Autumn saw the highest rate of appendicitis cases at 32.09% while the lowest was in Winter (22.12%). Regarding normal appendix, the highest rate was in winter (21.98%), and the lowest was in summer (13.09%). The mean patient age was 25.20 years, with a majority being male (66.36%). Open surgeries were the most common, comprising 91.9% of cases, compared to 8.1% for laparoscopic procedures. Diagnostic analysis revealed a very strong correlation between CT findings and histopathological outcomes (p=3.23×10^-11) and a significant but less strong correlation for ultrasound findings (p=0.000446). These results suggest that both diagnostic methods are effective, with CT scans showing a stronger correlation. The distribution of cases across seasons was 32.087% in autumn, 23.05% in spring, 22.741% in summer, and 22.118% in winter.\u0000Conclusions: Significant seasonal peaks in appendicitis are evident, particularly in autumn, driven by changes in diet and viral infections. The superior effectiveness of CT scans during winter highlights the need for adaptive diagnostic strategies across seasons. These findings advocate for healthcare systems to seasonally adjust resources and diagnostics to optimize appendicitis management, with further research needed to expand these insights globally.","PeriodicalId":13827,"journal":{"name":"International Journal of Advances in Medicine","volume":"34 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141270694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-18DOI: 10.18203/2349-3933.ijam20241309
Ammar Mohammad Alomari, Youssef Jamal Zureiqat, Issa Hijazi, Safwan Al-Fawares, Monir Al-Dogum, A. F. Mohd
Background: Aim of the study was to evaluate the benefits and predictors of success of fast-track and ultra-fast track paediatric and congenital cardiac surgery. Methods: Retrospective observational study of paediatric and adult congenital cardiac surgical patients presented for surgery in period between October 2023 and April 2024 at Queen Alia heart institute (QAHI). Patients’ demographic, clinical and perioperative date were collected and analysed. Patients were divided into groups according to their extubation time: UFTE (Ultra-fast track extubation group, FTE (Fast-track extubation) group, CE (Conventional extubation) group and DE (Delayed extubation) group. All groups were compared in reference to their age, weight, CPB time, AXC time, length of ICU stay and hospitalisation time. Statistical analysis was done to determine the benefits of early extubation after paediatric and congenital cardiac surgery. Predictors of early and DE were studied. Results: Data of 73 paediatric and adult congenital cardiac surgical patients was reviewed and analysed. Patients were 37 males and 36 females. Average age of patients was 11.1 years (ranged from 5 days to 57 years). Average weight of patients was 29.3 kg (ranged from 2.4 to 109 kg) and average height was 104.8 cm. Average time of tracheal extubation was 13.1 hours (ranged from 0 to 168 hours). UFTE was accomplished in 11 patients (15.1%). FTE was done in 19 patients (26%). CE (between was 6 and 24 hours) was carried out in 38 patients (52.1%) and DE (after more than 24 hours) was noted in 5 patients (6.8%). The average ICU stay was 3 days (ranged from 1 to 15 days). Patients from the UFTE group had the shortest average ICU stay of 1.2 days, while patients from the FTE group had an average ICU stay of 1.9 days. Patients from the CE and the DE groups had an average ICU stay of 4 days and 9.4 days, respectively. Length of hospitalisation was shortest in the UFTE group with an average of 6 days. The hospitalisation time doubled in the DE group to 12 days. The shorter the CPB and AXC times the more likely patients were to have UFTE and FTE. Neonates were less likely to have UFTE and FTE. Conclusions: UFTE and FTE were associated with shorter ICU stay and hospitalisation time. Predictors of UFTE and FTE were simple cardiac procedures, shorter CPB and AXC durations. Neonatal age and low body weight paediatric cardiac surgical patients were predictors for conventional or DE.
{"title":"Fast-track paediatric and adult congenital cardiac surgery","authors":"Ammar Mohammad Alomari, Youssef Jamal Zureiqat, Issa Hijazi, Safwan Al-Fawares, Monir Al-Dogum, A. F. Mohd","doi":"10.18203/2349-3933.ijam20241309","DOIUrl":"https://doi.org/10.18203/2349-3933.ijam20241309","url":null,"abstract":"Background: Aim of the study was to evaluate the benefits and predictors of success of fast-track and ultra-fast track paediatric and congenital cardiac surgery.\u0000Methods: Retrospective observational study of paediatric and adult congenital cardiac surgical patients presented for surgery in period between October 2023 and April 2024 at Queen Alia heart institute (QAHI). Patients’ demographic, clinical and perioperative date were collected and analysed. Patients were divided into groups according to their extubation time: UFTE (Ultra-fast track extubation group, FTE (Fast-track extubation) group, CE (Conventional extubation) group and DE (Delayed extubation) group. All groups were compared in reference to their age, weight, CPB time, AXC time, length of ICU stay and hospitalisation time. Statistical analysis was done to determine the benefits of early extubation after paediatric and congenital cardiac surgery. Predictors of early and DE were studied.\u0000Results: Data of 73 paediatric and adult congenital cardiac surgical patients was reviewed and analysed. Patients were 37 males and 36 females. Average age of patients was 11.1 years (ranged from 5 days to 57 years). Average weight of patients was 29.3 kg (ranged from 2.4 to 109 kg) and average height was 104.8 cm. Average time of tracheal extubation was 13.1 hours (ranged from 0 to 168 hours). UFTE was accomplished in 11 patients (15.1%). FTE was done in 19 patients (26%). CE (between was 6 and 24 hours) was carried out in 38 patients (52.1%) and DE (after more than 24 hours) was noted in 5 patients (6.8%). The average ICU stay was 3 days (ranged from 1 to 15 days). Patients from the UFTE group had the shortest average ICU stay of 1.2 days, while patients from the FTE group had an average ICU stay of 1.9 days. Patients from the CE and the DE groups had an average ICU stay of 4 days and 9.4 days, respectively. Length of hospitalisation was shortest in the UFTE group with an average of 6 days. The hospitalisation time doubled in the DE group to 12 days. The shorter the CPB and AXC times the more likely patients were to have UFTE and FTE. Neonates were less likely to have UFTE and FTE.\u0000Conclusions: UFTE and FTE were associated with shorter ICU stay and hospitalisation time. Predictors of UFTE and FTE were simple cardiac procedures, shorter CPB and AXC durations. Neonatal age and low body weight paediatric cardiac surgical patients were predictors for conventional or DE.\u0000 ","PeriodicalId":13827,"journal":{"name":"International Journal of Advances in Medicine","volume":"123 18","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141125274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-09DOI: 10.18203/2349-3933.ijam20241296
Kadek Mien Dwi Cahyani, N. W. Candrawati, N. L. E. Arisanti, K. Suryana, I. Kusumawardani, I. G. N. Artana, Ida Bagus Ngurah Rai
Background: Septic shock is one of severe community-acquired pneumonia (CAP) complication with high mortality. Various laboratory parameters had been associated with poor outcome including neutrophil-to-lymphocyte ratio (NLR), red cell distribution width (RDW), procalcitonin, neutrophil to albumin ratio (NAR), and bun to albumin ratio (BAR). This study aimed to know the relationship between inflammatory markers with mortality of severe CAP patients with septic shock. Methods: This study is an observational analytic study using a cohort retrospective design conducted in Prof. I.G.N.G. Ngoerah General Hospital over a 3 years’ period (January 2020 to July 2023). The relative risk (RR) values showed relative risk of each parameter to mortality. Results: Of total 73 subjects, mortality was found in 68.5%. Male predominance was found (65.8%). Comorbid disease was reported in 69 subjects (94.5%), most found was cardiovascular disease (63%). Majority of the subjects did not have history of prior antibiotics use (86.3%). In multivariate analysis, it was found that NLR with cutoff ≥16.5 (p value 0.044; 95% CI 1.039-14.011; RR 3.816), procalcitonin ≥1.82 (p value 0.029; 95% CI 1.148-13.560; RR 3.945), and BAR ≥8.13 (p value 0.003; 95% CI 1.961-21.912; RR 7.399) are associated with mortality. There was no relationship between RDW ≥14.65 (p value 0.159; 95% CI 0.658-12.877) and NAR ≥4.5 (p value 0.436; 95% CI 0.429-7.106) with mortality in this study. Conclusions: Mortality of severe CAP patients with septic shock in this study is high. Higher NLR, procalcitonin, and BAR values have a significant relationship with mortality of severe CAP patients with septic shock.
背景：脓毒性休克是严重的社区获得性肺炎（CAP）并发症之一，死亡率很高。各种实验室指标都与不良预后有关，包括中性粒细胞与淋巴细胞比值（NLR）、红细胞分布宽度（RDW）、降钙素原、中性粒细胞与白蛋白比值（NAR）和馒头与白蛋白比值（BAR）。本研究旨在了解炎症指标与重症 CAP 败血症休克患者死亡率之间的关系：本研究是一项观察性分析研究，采用队列回顾设计，在 I.G.N.G. Ngoerah 教授综合医院进行，为期 3 年（2020 年 1 月至 2023 年 7 月）。相对风险（RR）值显示了各参数与死亡率的相对风险：结果：在总共 73 名受试者中，68.5% 的人死亡。男性占多数（65.8%）。69名受试者（94.5%）患有合并症，其中心血管疾病最多（63%）。大多数受试者以前没有使用过抗生素（86.3%）。多变量分析发现，NLR 临界值≥16.5（P 值 0.044；95% CI 1.039-14.011；RR 3.816）、降钙素原≥1.82（P 值 0.029；95% CI 1.148-13.560；RR 3.945）和 BAR ≥8.13（P 值 0.003；95% CI 1.961-21.912；RR 7.399）与死亡率相关。在本研究中，RDW≥14.65（P值0.159；95% CI 0.658-12.877）和NAR≥4.5（P值0.436；95% CI 0.429-7.106）与死亡率没有关系：结论：本研究中重症CAP脓毒性休克患者的死亡率较高。结论：本研究中严重 CAP 败血症休克患者的死亡率较高，较高的 NLR、降钙素原和 BAR 值与严重 CAP 败血症休克患者的死亡率有显著关系。
{"title":"Relationship between neutrophil to lymphocytes ratio, red cell distribution width, procalcitonin, neutrophil to albumin ratio, and bun to albumin ratio with mortality of severe cap patients with septic shock","authors":"Kadek Mien Dwi Cahyani, N. W. Candrawati, N. L. E. Arisanti, K. Suryana, I. Kusumawardani, I. G. N. Artana, Ida Bagus Ngurah Rai","doi":"10.18203/2349-3933.ijam20241296","DOIUrl":"https://doi.org/10.18203/2349-3933.ijam20241296","url":null,"abstract":"Background: Septic shock is one of severe community-acquired pneumonia (CAP) complication with high mortality. Various laboratory parameters had been associated with poor outcome including neutrophil-to-lymphocyte ratio (NLR), red cell distribution width (RDW), procalcitonin, neutrophil to albumin ratio (NAR), and bun to albumin ratio (BAR). This study aimed to know the relationship between inflammatory markers with mortality of severe CAP patients with septic shock.\u0000Methods: This study is an observational analytic study using a cohort retrospective design conducted in Prof. I.G.N.G. Ngoerah General Hospital over a 3 years’ period (January 2020 to July 2023). The relative risk (RR) values showed relative risk of each parameter to mortality.\u0000Results: Of total 73 subjects, mortality was found in 68.5%. Male predominance was found (65.8%). Comorbid disease was reported in 69 subjects (94.5%), most found was cardiovascular disease (63%). Majority of the subjects did not have history of prior antibiotics use (86.3%). In multivariate analysis, it was found that NLR with cutoff ≥16.5 (p value 0.044; 95% CI 1.039-14.011; RR 3.816), procalcitonin ≥1.82 (p value 0.029; 95% CI 1.148-13.560; RR 3.945), and BAR ≥8.13 (p value 0.003; 95% CI 1.961-21.912; RR 7.399) are associated with mortality. There was no relationship between RDW ≥14.65 (p value 0.159; 95% CI 0.658-12.877) and NAR ≥4.5 (p value 0.436; 95% CI 0.429-7.106) with mortality in this study.\u0000Conclusions: Mortality of severe CAP patients with septic shock in this study is high. Higher NLR, procalcitonin, and BAR values have a significant relationship with mortality of severe CAP patients with septic shock.","PeriodicalId":13827,"journal":{"name":"International Journal of Advances in Medicine","volume":" 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140994988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-07DOI: 10.18203/2349-3933.ijam20241287
Gargee M. Pore, Brig S. P. Gorthi
Spinal dural arteriovenous fistula is an abnormal connection between radicular arteries and spinal venous plexus. This condition is relatively rare with annual incidence of five-ten cases per million. We present a case of a 62-year-old male with complaints of tingling in feet since six months and weakness in legs since 1 hour. Lower limb weakness progressed over a day to complete paralysis and bladder incontinence. Magnetic resonance imaging (MRI) spine showed a dural hypointensity over D6-D11 with abnormal vessels around spinal cord. Patient underwent spinal angiography which showed an intramedullary arteriovenous malformation causing compression. Arterial embolization was done within 24 hours from symptom onset and he ambulated within a week. AV malformations are a rare cause of compressive myelopathy presenting with acute paraplegia. Advances in endovascular techniques have made it possible to treat them early and prevent irreversible damage.
{"title":"Spinal dural arteriovenous fistula: a case-based review","authors":"Gargee M. Pore, Brig S. P. Gorthi","doi":"10.18203/2349-3933.ijam20241287","DOIUrl":"https://doi.org/10.18203/2349-3933.ijam20241287","url":null,"abstract":"Spinal dural arteriovenous fistula is an abnormal connection between radicular arteries and spinal venous plexus. This condition is relatively rare with annual incidence of five-ten cases per million. We present a case of a 62-year-old male with complaints of tingling in feet since six months and weakness in legs since 1 hour. Lower limb weakness progressed over a day to complete paralysis and bladder incontinence. Magnetic resonance imaging (MRI) spine showed a dural hypointensity over D6-D11 with abnormal vessels around spinal cord. Patient underwent spinal angiography which showed an intramedullary arteriovenous malformation causing compression. Arterial embolization was done within 24 hours from symptom onset and he ambulated within a week. AV malformations are a rare cause of compressive myelopathy presenting with acute paraplegia. Advances in endovascular techniques have made it possible to treat them early and prevent irreversible damage.","PeriodicalId":13827,"journal":{"name":"International Journal of Advances in Medicine","volume":"65 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141003146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-16DOI: 10.18203/2349-3933.ijam20240682
Ramesh Roop Rai, P. Bose
Disturbed function of the pancreas, especially exocrine pancreatic insufficiency (EPI) results in inadequate synthesis or delivery of the pancreatic enzyme leading to maldigestion. Due to the lack of specific symptoms and overlapping manifestations of EPI, it often goes undiagnosed and untreated. Dyspepsia is another common condition characterized by upper gastrointestinal symptoms caused by a heterogeneous group of disorders. This consensus aims at providing a comprehensive overview of the diagnosis and management of disturbed function of the pancreas and dyspepsia. A total of 95 gastroenterologists participated in expert group meetings organized via virtual focus group discussions. Recent evidence elaborating various aspects like diagnosis and management of EPI and dyspepsia, including the use of pancreatic enzyme replacement therapy (PERT) and issues with compliance were discussed. The experts emphasized that clinical symptoms of maldigestion should not be ignored, and physicians should not wait to diagnose EPI until steatorrhea occurs. Fecal elastase (FE) test and imaging should be performed to confirm diagnosis. If EPI is diagnosed or the patient experiences weight loss or steatorrhea, PERT should be initiated while ensuring compliance. Reducing pill burden, active education, monitoring, and support from healthcare programs may help ensure compliance. EPI is also a cause of dyspepsia. Further, consuming lipid-rich foods worsens symptoms of dyspepsia. First-line treatment includes dietary changes and lifestyle modifications. Digestive enzyme supplements play a significant role in alleviating symptoms of indigestion. Routine enzyme supplementation is beneficial in managing dyspepsia caused by EPI, such as, in patients with EPI due to pancreatitis or diabetes.
{"title":"Emerging trends in disturbed function of the pancreas and dyspepsia: an Indian perspective","authors":"Ramesh Roop Rai, P. Bose","doi":"10.18203/2349-3933.ijam20240682","DOIUrl":"https://doi.org/10.18203/2349-3933.ijam20240682","url":null,"abstract":"Disturbed function of the pancreas, especially exocrine pancreatic insufficiency (EPI) results in inadequate synthesis or delivery of the pancreatic enzyme leading to maldigestion. Due to the lack of specific symptoms and overlapping manifestations of EPI, it often goes undiagnosed and untreated. Dyspepsia is another common condition characterized by upper gastrointestinal symptoms caused by a heterogeneous group of disorders. This consensus aims at providing a comprehensive overview of the diagnosis and management of disturbed function of the pancreas and dyspepsia. A total of 95 gastroenterologists participated in expert group meetings organized via virtual focus group discussions. Recent evidence elaborating various aspects like diagnosis and management of EPI and dyspepsia, including the use of pancreatic enzyme replacement therapy (PERT) and issues with compliance were discussed. The experts emphasized that clinical symptoms of maldigestion should not be ignored, and physicians should not wait to diagnose EPI until steatorrhea occurs. Fecal elastase (FE) test and imaging should be performed to confirm diagnosis. If EPI is diagnosed or the patient experiences weight loss or steatorrhea, PERT should be initiated while ensuring compliance. Reducing pill burden, active education, monitoring, and support from healthcare programs may help ensure compliance. EPI is also a cause of dyspepsia. Further, consuming lipid-rich foods worsens symptoms of dyspepsia. First-line treatment includes dietary changes and lifestyle modifications. Digestive enzyme supplements play a significant role in alleviating symptoms of indigestion. Routine enzyme supplementation is beneficial in managing dyspepsia caused by EPI, such as, in patients with EPI due to pancreatitis or diabetes.","PeriodicalId":13827,"journal":{"name":"International Journal of Advances in Medicine","volume":"78 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140236050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-22DOI: 10.18203/2349-3933.ijam20240359
Hardik More, Dilip Patil, Chahat Singh
Background: The present study was conducted to assess the clinical profile of type 2 diabetes patients presenting with diabetic ketoacidosis and review their biochemical parameters at the time of presentation. Methods: The present study was an analytical, cross-sectional study conducted over the period of two years. All the type 2 diabetes patients with diabetic ketoacidosis admitted during the study period constituted the study population, after being subjected to prefixed selection criteria. All the participants were subjected to detailed clinical examination and biochemical analysis during hospitalization and parameters were monitored. Results: Out of the total 60 type 2 DM patients with DKA studied, 53.3% patients belonged to 51 to 60 years age group and 55% were males. One patient died and 59 survived (mortality rate-1.6%). Comparatively higher mean RBS, higher mean serum osmolality and lower pH were observed in the death case in comparison with those who survived. The patient who died had no statistically significant difference in serum sodium, potassium, calcium and magnesium but had lower serum HCO3- than alive patients on admission. Conclusions: DKA is a serious metabolic complication even in cases of type 2 diabetes and higher RBS, higher Sr Osmolality and lower pH at the time of presentation correlate directly with poorer outcomes.
{"title":"Biochemical profile of diabetic ketoacidosis in type 2 diabetes patients: an observational study","authors":"Hardik More, Dilip Patil, Chahat Singh","doi":"10.18203/2349-3933.ijam20240359","DOIUrl":"https://doi.org/10.18203/2349-3933.ijam20240359","url":null,"abstract":"Background: The present study was conducted to assess the clinical profile of type 2 diabetes patients presenting with diabetic ketoacidosis and review their biochemical parameters at the time of presentation.\u0000Methods: The present study was an analytical, cross-sectional study conducted over the period of two years. All the type 2 diabetes patients with diabetic ketoacidosis admitted during the study period constituted the study population, after being subjected to prefixed selection criteria. All the participants were subjected to detailed clinical examination and biochemical analysis during hospitalization and parameters were monitored.\u0000Results: Out of the total 60 type 2 DM patients with DKA studied, 53.3% patients belonged to 51 to 60 years age group and 55% were males. One patient died and 59 survived (mortality rate-1.6%). Comparatively higher mean RBS, higher mean serum osmolality and lower pH were observed in the death case in comparison with those who survived. The patient who died had no statistically significant difference in serum sodium, potassium, calcium and magnesium but had lower serum HCO3- than alive patients on admission.\u0000Conclusions: DKA is a serious metabolic complication even in cases of type 2 diabetes and higher RBS, higher Sr Osmolality and lower pH at the time of presentation correlate directly with poorer outcomes.","PeriodicalId":13827,"journal":{"name":"International Journal of Advances in Medicine","volume":"11 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140438757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：