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Association between baseline insulin resistance and hospital mortality in moderate-to-severe coronavirus disease 2019 patients without diabetes mellitus: An observational study. 中重度冠状病毒病 2019 年无糖尿病患者基线胰岛素抵抗与住院死亡率之间的关系:一项观察性研究。
Q3 Medicine Pub Date : 2024-01-01 Epub Date: 2024-03-27 DOI: 10.4103/ijciis.ijciis_41_23
Tazeen Khan, Shilpa Naagar, Parvathy R Nair, Damarla Haritha, Preeti Yadav, Sudip Kumar Datta, Sulagna Bhattacharjee, Yashdeep Gupta, Dalim Kumar Baidya, Rahul Kumar Anand, Bikash Ranjan Ray, Shiba Ansari, Rajeshwari Subramaniam, Souvik Maitra

Background: Insulin resistance is often implicated as a risk factor of cell-mediated immune dysfunction in sepsis patients and results in poor clinical outcome. However, it is unclear whether early insulin resistance is contributory to T-cell dysfunction and poor clinical outcome in coronavirus disease 2019 (COVID-19) patients.

Methods: Adult patients with moderate-to-severe or critically ill COVID-19 infection were included in this study. Serum samples were collected at the time of diagnosis for fasting plasma glucose, serum insulin, serum cortisol, and serum glucagon measurements, and the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) score was calculated.

Results: One hundred and twenty-six subjects with a mean (standard deviation) age of 49.6 (16.3) years were recruited in this study, and 62.4% (78 of 125 patients) were male. HOMA-IR was a predictor of inhospital mortality with the area under the receiver operating characteristics curve (AUROC) (95% confidence interval [CI] of 0.61 [0.49-0.73]). With a cutoff value of 1.91, sensitivity was 75.5% and specificity was 45.2%. Higher serum insulin was associated with higher survival with AUROC (95% CI) of 0.65 (0.53-0.76), and the best cutoff was 7.15, with a sensitivity and specificity of 62.1% and 64.5%. Serum cortisol was also a predictor of inhospital mortality with an AUROC (95% CI) of 0.67 (0.56-0.77).

Conclusion: An independent association between baseline serum cortisol and poor outcome in moderate-to-severe COVID-19 patients was observed. Hyperglycemia and HOMA-IR can also predict poor outcome in these patients with some accuracy.

背景:胰岛素抵抗通常被认为是败血症患者细胞介导的免疫功能障碍的危险因素,并导致不良的临床预后。然而,冠状病毒病 2019(COVID-19)患者的早期胰岛素抵抗是否会导致 T 细胞功能障碍和不良临床预后,目前尚不清楚:本研究纳入了感染COVID-19的中重度或重症成人患者。在确诊时采集血清样本,测量空腹血浆葡萄糖、血清胰岛素、血清皮质醇和血清胰高血糖素,并计算胰岛素抵抗的稳态模型评估(HOMA-IR)得分:本研究共招募了 126 名受试者,平均(标准差)年龄为 49.6(16.3)岁,其中 62.4% (125 名患者中的 78 名)为男性。HOMA-IR 是预测住院死亡率的指标,其接收者操作特征曲线下面积 (AUROC) 为 0.61 [0.49-0.73] (95% 置信区间 [CI])。截断值为 1.91 时,敏感性为 75.5%,特异性为 45.2%。血清胰岛素越高,存活率越高,其AUROC(95% CI)为0.65(0.53-0.76),最佳临界值为7.15,灵敏度和特异度分别为62.1%和64.5%。血清皮质醇也是院内死亡率的预测因子,其AUROC(95% CI)为0.67(0.56-0.77):结论:基线血清皮质醇与中重度 COVID-19 患者的不良预后之间存在独立关联。高血糖和 HOMA-IR 也能在一定程度上准确预测这些患者的不良预后。
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引用次数: 0
Predictor of mitral valve regurgitation severity and left ventricular dilatation using amino-terminal pro-brain natriuretic peptide marker in pediatric rheumatic heart disease. 利用氨基末端前脑钠肽标记物预测小儿风湿性心脏病二尖瓣反流严重程度和左心室扩张程度
Q3 Medicine Pub Date : 2024-01-01 Epub Date: 2024-03-27 DOI: 10.4103/ijciis.ijciis_54_23
Dyahris Koentartiwi, Kurniawan Taufiq Kadafi, Fiqi Isnaini Nurul Hikmah, Takhta Khalasha, Ardhanis Ramadhanti, Renny Suwarniaty

Background: Early rheumatic heart disease (RHD) is characterized by valve regurgitation, leading to ventricular distention and possible elaboration of amino-terminal pro-brain natriuretic peptide (NT-proBNP).

Methods: Thirty-one children with RHD were entered in the study. Transthoracic echocardiography was performed in all patients to assess the severity of the valve disease and cardiac function, thus will be classified into three groups: mild, moderate, and severe mitral valve regurgitation (MR), with and without left ventricular (LV) dilatation. At the time of echo, venous blood samples were drawn; thus, NT-proBNP levels were measured using sandwich immunoassay.

Results: The median NT-proBNP levels in mild, moderate, and severe MR were 32.34, 120.75, and 7094 pg/ml, respectively. The median NT-proBNP levels in patients with and without LV dilatation were 3045 and 30.82 pg/ml. There was a significant correlation between the severity of MR and NT-proBNP levels (P < 0.001), thus a significant correlation between LV dilatation and NT-proBNP levels (P = 0.013). A cutoff value of 2598.50 pg/ml was obtained with a sensitivity value of 90% and a specificity of 90.5% for NT-proBNP levels against severe MR. A cutoff value of 199.35 pg/ml was obtained with a sensitivity value of 73.3% and a specificity of 75% for NT-proBNP levels on LV dilatation. A cutoff value of 2598.50 pg/ml was obtained with a sensitivity value of 85.7% and a specificity of 79.2% for NT-proBNP levels against severe MR with LV dilatation.

Conclusion: There was a significant relationship between NT-proBNP levels and the severity of MR and LV dilatation in children with RHD.

背景:早期风湿性心脏病(RHD)的特点是瓣膜反流,导致心室胀大,并可能产生氨基末端前脑钠尿肽(NT-proBNP):方法:31 名患有 RHD 的儿童参加了研究。所有患者均接受了经胸超声心动图检查,以评估瓣膜疾病的严重程度和心脏功能,并因此分为三组:轻度、中度和重度二尖瓣反流(MR),伴有或不伴有左心室(LV)扩张。在进行回声检查时,抽取静脉血样本,然后使用夹心免疫测定法测定 NT-proBNP 水平:结果:轻度、中度和重度 MR 的 NT-proBNP 水平中位数分别为 32.34、120.75 和 7094 pg/ml。有左心室扩张和无左心室扩张患者的中位 NT-proBNP 水平分别为 3045 和 30.82 pg/ml。MR 的严重程度与 NT-proBNP 水平之间存在明显的相关性(P < 0.001),因此左心室扩张与 NT-proBNP 水平之间也存在明显的相关性(P = 0.013)。以 2598.50 pg/ml 为临界值,NT-proBNP 水平对重度 MR 的敏感性为 90%,特异性为 90.5%。NT-proBNP 水平的临界值为 199.35 pg/ml,对左心室扩张的敏感性为 73.3%,特异性为 75%。NT-proBNP水平的临界值为2598.50 pg/ml,对左心室扩张的重度MR的敏感性为85.7%,特异性为79.2%:结论:NT-proBNP水平与RHD患儿MR和左心室扩张的严重程度有明显关系。
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引用次数: 0
Tracheostomy timing and outcomes in patients with coronavirus disease 2019-associated acute respiratory distress syndrome: A retrospective observational study. 2019年冠状病毒病相关急性呼吸窘迫综合征患者的气管切开时机和预后:一项回顾性观察研究。
Q3 Medicine Pub Date : 2024-01-01 Epub Date: 2024-03-27 DOI: 10.4103/ijciis.ijciis_39_23
Sachin Pralhad Sasane, Madhavi Mahesh Telang, Zeyad Faroor Alrais, Wasim Shabbir Shaikh, Ghaya Zeyad Alrais, Khalid Ismail Khatib

Background: Patients with coronavirus disease 2019 (COVID-19) pneumonitis may progress to acute respiratory distress syndrome (ARDS) requiring endotracheal intubation and prolonged mechanical ventilation (MV). There are limited data on the optimum time of tracheostomy in COVID-19 patients progressing to ARDS.

Methods: This was a retrospective observational study of all patients diagnosed with COVID-19 who progressed to ARDS requiring MV and undergone tracheostomy. We aimed to conduct a study to observe the impact of tracheostomy on the mortality of these patients and the impact of timing of tracheostomy on outcomes in these patients.

Results: Of the total 162 patients, 128 (79%) were male and 34 (21%) were female. Early group (≤14 days) comprised 37 patients, while 125 patients were included in late group (>14 days). A total of 91 (56%) patients died at the end of this period. Among the patients who died, 21were included in the early group, while the late group comprised the remaining 70 patients. On comparing the patients who died, the duration of stay in the intensive care unit (ICU) was significantly different in the two groups (median [Q1-Q3]: 12 [11-13] vs. 23 [19-28] days, P < 0.001). The number of days to death also differed significantly between the two groups (median [Q1-Q3]: 28 [21-38] vs. 24 [14-30] days, P = 0.009).

Conclusion: Early tracheostomy is associated with significantly shorter length of ICU stay in COVID-19 patients that have progressed to ARDS. However, the timing of tracheostomy had no influence on the overall mortality rate in these patients.

背景:2019年冠状病毒病(COVID-19)肺炎患者可能发展为急性呼吸窘迫综合征(ARDS),需要气管插管和长时间机械通气(MV)。目前关于COVID-19患者进展为ARDS时气管插管的最佳时间的数据有限:这是一项回顾性观察研究,研究对象是所有确诊为 COVID-19 的患者,这些患者均进展为需要 MV 的 ARDS 并接受了气管切开术。我们的目的是观察气管切开术对这些患者死亡率的影响,以及气管切开术的时机对这些患者预后的影响:在 162 名患者中,128 名(79%)为男性,34 名(21%)为女性。早期组(≤14 天)有 37 名患者,晚期组(>14 天)有 125 名患者。共有 91 名(56%)患者在此期间死亡。在死亡的患者中,21 人属于早期组,其余 70 人属于晚期组。对比死亡患者,两组患者在重症监护室(ICU)的住院时间明显不同(中位数[Q1-Q3]:12 [11-13] 对 23 [19-28] 天,P < 0.001)。两组患者的死亡天数也有显著差异(中位数[Q1-Q3]:28 [21-38] vs. 24 [14-30]天,P = 0.009):结论:对于已发展为 ARDS 的 COVID-19 患者,尽早进行气管切开术可明显缩短 ICU 的住院时间。然而,气管切开术的时机对这些患者的总体死亡率没有影响。
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引用次数: 0
What is new in critical illness and injury science? Patient falls in the intensive care unit. 重症与损伤科学有哪些新进展?重症监护室病人跌倒。
Q3 Medicine Pub Date : 2024-01-01 Epub Date: 2024-03-27 DOI: 10.4103/ijciis.ijciis_21_24
Andrew C Miller
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引用次数: 0
Influence of medications on fall risk assessment in maintenance hemodialysis patients: A cross-sectional study. 药物对维持性血液透析患者跌倒风险评估的影响:横断面研究
Q3 Medicine Pub Date : 2024-01-01 Epub Date: 2024-03-27 DOI: 10.4103/ijciis.ijciis_57_23
Raghad M Ismail, Dixon Thomas, Rajaram Jagdale

Background: Multiple factors influence the fall risk in end-stage kidney disease. This study aims to investigate how medication factors influence the interpretation of fall risk due to age, gender, and years of dialysis treatment among patients undergoing hemodialysis (HD).

Methods: A cross-sectional study was carried out in 2023 using the Johns Hopkins Fall Risk Assessment tool. Participants were recruited from the HD unit at a tertiary care academic medical center in Ajman, UAE. Data were analyzed between different ages, genders, and years on HD categories with or without medication factors.

Results: Data were collected and analyzed for 44 patients. The fall risk of the study population assessed with the Kruskal-Wallis test showed no difference between different age groups (P = 0.43) but did show a significant difference when the score of medication factor was removed from the fall risk estimation (P = 0.002). A pairwise analysis showed fall risk score of the age group 46-60 years was differing from the age cohort >60 (P < 0.001). A positive moderate correlation (Spearman's correlation coefficient 0.514 was found, with a P < 0.001) was seen with an increase in age and fall risk only when the medication factor was removed from the fall risk estimation. Results on gender or duration of dialysis were insignificant.

Conclusion: Medication factors being a significant contributor to fall risk among the study population was found to mask the fall risk difference between age groups 46-60 years and >60 years. Such influence was not found for gender or duration of dialysis.

背景:多种因素影响终末期肾病患者的跌倒风险。本研究旨在调查药物因素如何影响血液透析(HD)患者因年龄、性别和透析治疗年限而导致的跌倒风险:这项横断面研究于 2023 年进行,使用的是约翰-霍普金斯跌倒风险评估工具。参与者来自阿联酋阿治曼一家三级医疗学术医疗中心的血液透析室。分析了不同年龄、性别、服用或不服用药物的血液透析患者的数据:收集并分析了 44 名患者的数据。用 Kruskal-Wallis 检验法对研究人群的跌倒风险进行了评估,结果显示不同年龄组之间没有差异(P = 0.43),但如果从跌倒风险评估中剔除药物因素得分,则显示出显著差异(P = 0.002)。配对分析表明,46-60 岁年龄组与大于 60 岁年龄组的跌倒风险得分存在差异(P < 0.001)。只有当从跌倒风险评估中剔除药物因素时,才会发现年龄的增加与跌倒风险呈中度正相关(斯皮尔曼相关系数为 0.514,P < 0.001)。结论:药物因素是导致跌倒风险的重要因素:结论:研究发现,药物因素是导致研究人群跌倒风险的重要因素,它掩盖了 46-60 岁年龄组和 60 岁以上年龄组之间的跌倒风险差异。性别和透析时间的影响则不明显。
{"title":"Influence of medications on fall risk assessment in maintenance hemodialysis patients: A cross-sectional study.","authors":"Raghad M Ismail, Dixon Thomas, Rajaram Jagdale","doi":"10.4103/ijciis.ijciis_57_23","DOIUrl":"10.4103/ijciis.ijciis_57_23","url":null,"abstract":"<p><strong>Background: </strong>Multiple factors influence the fall risk in end-stage kidney disease. This study aims to investigate how medication factors influence the interpretation of fall risk due to age, gender, and years of dialysis treatment among patients undergoing hemodialysis (HD).</p><p><strong>Methods: </strong>A cross-sectional study was carried out in 2023 using the Johns Hopkins Fall Risk Assessment tool. Participants were recruited from the HD unit at a tertiary care academic medical center in Ajman, UAE. Data were analyzed between different ages, genders, and years on HD categories with or without medication factors.</p><p><strong>Results: </strong>Data were collected and analyzed for 44 patients. The fall risk of the study population assessed with the Kruskal-Wallis test showed no difference between different age groups (<i>P</i> = 0.43) but did show a significant difference when the score of medication factor was removed from the fall risk estimation (<i>P</i> = 0.002). A pairwise analysis showed fall risk score of the age group 46-60 years was differing from the age cohort >60 (<i>P</i> < 0.001). A positive moderate correlation (Spearman's correlation coefficient 0.514 was found, with a <i>P</i> < 0.001) was seen with an increase in age and fall risk only when the medication factor was removed from the fall risk estimation. Results on gender or duration of dialysis were insignificant.</p><p><strong>Conclusion: </strong>Medication factors being a significant contributor to fall risk among the study population was found to mask the fall risk difference between age groups 46-60 years and >60 years. Such influence was not found for gender or duration of dialysis.</p>","PeriodicalId":13938,"journal":{"name":"International Journal of Critical Illness and Injury Science","volume":"14 1","pages":"32-36"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11073637/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140876397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Acute presentation of Wunderlich syndrome in a pregnant woman treated with supra-selective cannulation of renal segmental arteries and nephrectomy: A case report. 一名孕妇急性 Wunderlich 综合征,经超选择性肾段动脉插管和肾切除术治疗:病例报告。
Q3 Medicine Pub Date : 2024-01-01 Epub Date: 2024-03-27 DOI: 10.4103/ijciis.ijciis_45_23
Oscar Orlando Sanabria-Rodríguez, Carlos Fernando Grillo-Ardila, Daniela Mojica-Méndez, Santiago Bottia-Córdoba

Wunderlich syndrome is characterized by the presence of abdominal pain, hematuria, and hypovolemic shock. We report a rare case of a 25-year-old pregnant woman, who came to the emergency department due to the sudden onset of low back pain and diaphoresis. The patient, during medical evaluation, experienced an altered state of consciousness. Diagnosed with hypovolemic shock, she was admitted to the operating room, where examination of the abdominal cavity revealed a left retroperitoneal hematoma. Damage control surgery was performed, but given the postoperative clinical deterioration, computerized tomography angiography of the abdomen was performed, showing a mass-like lesion arising from the upper pole of the left kidney, consistent with Wunderlich syndrome. Left nephrectomy was the definitive treatment for the 10-cm renal angiomyolipoma. Since Wunderlich syndrome is a potentially lethal entity, CT is usually the preferred diagnostic approach, and supra-selective vascular embolization is the first-line treatment.

Wunderlich 综合征的特征是腹痛、血尿和低血容量性休克。我们报告了一例罕见病例,患者是一名 25 岁的孕妇,因突然出现腰背痛和全身乏力而到急诊科就诊。在医疗评估期间,患者出现了意识改变。她被诊断为低血容量性休克,被送入手术室,腹腔检查发现左后腹膜血肿。虽然进行了损伤控制手术,但鉴于术后临床症状恶化,又进行了腹部计算机断层扫描血管造影,结果显示左肾上端出现肿块样病变,与 Wunderlich 综合征一致。左肾切除术是治疗 10 厘米肾血管肌脂肪瘤的最终方法。由于 Wunderlich 综合征是一种潜在的致死性疾病,CT 通常是首选的诊断方法,超选择性血管栓塞是一线治疗方法。
{"title":"Acute presentation of Wunderlich syndrome in a pregnant woman treated with supra-selective cannulation of renal segmental arteries and nephrectomy: A case report.","authors":"Oscar Orlando Sanabria-Rodríguez, Carlos Fernando Grillo-Ardila, Daniela Mojica-Méndez, Santiago Bottia-Córdoba","doi":"10.4103/ijciis.ijciis_45_23","DOIUrl":"10.4103/ijciis.ijciis_45_23","url":null,"abstract":"<p><p>Wunderlich syndrome is characterized by the presence of abdominal pain, hematuria, and hypovolemic shock. We report a rare case of a 25-year-old pregnant woman, who came to the emergency department due to the sudden onset of low back pain and diaphoresis. The patient, during medical evaluation, experienced an altered state of consciousness. Diagnosed with hypovolemic shock, she was admitted to the operating room, where examination of the abdominal cavity revealed a left retroperitoneal hematoma. Damage control surgery was performed, but given the postoperative clinical deterioration, computerized tomography angiography of the abdomen was performed, showing a mass-like lesion arising from the upper pole of the left kidney, consistent with Wunderlich syndrome. Left nephrectomy was the definitive treatment for the 10-cm renal angiomyolipoma. Since Wunderlich syndrome is a potentially lethal entity, CT is usually the preferred diagnostic approach, and supra-selective vascular embolization is the first-line treatment.</p>","PeriodicalId":13938,"journal":{"name":"International Journal of Critical Illness and Injury Science","volume":"14 1","pages":"62-65"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11073645/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140878400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A comparative study of perioperative pain, blood loss, and hospital stay in an Indian population undergoing mini-open oblique lumbar interbody fusion versus open transforaminal lumbar interbody fusion. 一项关于印度人接受小开腹斜行腰椎椎间融合术与开腹经椎间孔腰椎椎间融合术的围手术期疼痛、失血量和住院时间的比较研究。
Q3 Medicine Pub Date : 2024-01-01 Epub Date: 2024-03-27 DOI: 10.4103/ijciis.ijciis_59_23
Suma Rabab Ahmad, Mantu Jain, Auroshish Sahoo, Narayan Prasad Mishra, Neha Singh, Sumanta Kumar Dansana

Background: There are several approaches for lumbar fusion, although there is yet to be a consensus on which approach is the best. This study aimed to evaluate the intraoperative blood loss and acute postoperative pain in single-level mini-open oblique lumbar interbody fusion (OLIF) versus open transforaminal lumbar interbody fusion (TLIF) surgeries for the degenerative spine.

Methods: Thirty-two patients were assigned by the surgeon to OLIF or TLIF groups - 16 in mini-open OLIF and 16 in open TLIF groups. The intraoperative blood loss and postoperative hemoglobin, numerical rating scale (NRS) at proposed time intervals for 24 h postoperative, and rescue analgesics used were compared among the groups. The operative duration and hospital stay in both groups were also compared.

Results: The OLIF group showed significantly higher postoperative hemoglobin (11.5 vs. 10.5 g %, P = 0.04), lower 24-h postoperative pain scores on movement, (NRS 4 vs. 5.5, P = 0.0001), and shorter hospital stay (4.5 vs. 7 days, P = 0.003) than TLIF group. However, the surgery duration was significantly longer in OLIF than in TLIF (190 vs. 150 min, P = 0.005). Intraoperative hemodynamics, other postoperative pain scores at variable time points, and rescue analgesics given were comparable among groups (P > 0.05). Intraoperative blood loss was lower in OLIF than TLIF (275 vs. 500 mL) but was not statistically significant (P > 0.05).

Conclusion: Mini-open OLIF has favorable perioperative outcomes compared to open TLIF. Patients have higher postoperative hemoglobin and lesser pain on movement on the first postoperative day, leading to earlier mobilization and a shorter hospital stay.

背景:腰椎融合术有多种方法,但哪种方法最好尚未达成共识。本研究旨在评估单水平小开腹斜行腰椎椎体间融合术(OLIF)与开腹经椎间孔腰椎椎体间融合术(TLIF)治疗退行性脊柱手术的术中失血量和术后急性疼痛情况:32名患者被外科医生分配到OLIF或TLIF组,其中16名患者为小开放式OLIF组,16名患者为开放式TLIF组。比较了各组患者的术中失血量、术后血红蛋白、术后 24 小时拟议时间间隔的数字评分量表(NRS)以及所用的镇痛药。两组的手术时间和住院时间也进行了比较:结果:与 TLIF 组相比,OLIF 组的术后血红蛋白明显更高(11.5 vs. 10.5 g %,P = 0.04),术后 24 小时活动疼痛评分更低(NRS 4 vs. 5.5,P = 0.0001),住院时间更短(4.5 vs. 7 天,P = 0.003)。不过,OLIF 组的手术时间明显长于 TLIF 组(190 分钟对 150 分钟,P = 0.005)。各组的术中血流动力学、不同时间点的其他术后疼痛评分和所使用的镇痛药相当(P > 0.05)。OLIF的术中失血量低于TLIF(275毫升对500毫升),但无统计学意义(P > 0.05):结论:与开放式TLIF相比,小开腹OLIF的围手术期疗效更佳。患者术后血红蛋白较高,术后第一天活动时疼痛较轻,因此可以更早地活动,住院时间也更短。
{"title":"A comparative study of perioperative pain, blood loss, and hospital stay in an Indian population undergoing mini-open oblique lumbar interbody fusion versus open transforaminal lumbar interbody fusion.","authors":"Suma Rabab Ahmad, Mantu Jain, Auroshish Sahoo, Narayan Prasad Mishra, Neha Singh, Sumanta Kumar Dansana","doi":"10.4103/ijciis.ijciis_59_23","DOIUrl":"10.4103/ijciis.ijciis_59_23","url":null,"abstract":"<p><strong>Background: </strong>There are several approaches for lumbar fusion, although there is yet to be a consensus on which approach is the best. This study aimed to evaluate the intraoperative blood loss and acute postoperative pain in single-level mini-open oblique lumbar interbody fusion (OLIF) versus open transforaminal lumbar interbody fusion (TLIF) surgeries for the degenerative spine.</p><p><strong>Methods: </strong>Thirty-two patients were assigned by the surgeon to OLIF or TLIF groups - 16 in mini-open OLIF and 16 in open TLIF groups. The intraoperative blood loss and postoperative hemoglobin, numerical rating scale (NRS) at proposed time intervals for 24 h postoperative, and rescue analgesics used were compared among the groups. The operative duration and hospital stay in both groups were also compared.</p><p><strong>Results: </strong>The OLIF group showed significantly higher postoperative hemoglobin (11.5 vs. 10.5 g %, <i>P</i> = 0.04), lower 24-h postoperative pain scores on movement, (NRS 4 vs. 5.5, <i>P</i> = 0.0001), and shorter hospital stay (4.5 vs. 7 days, <i>P</i> = 0.003) than TLIF group. However, the surgery duration was significantly longer in OLIF than in TLIF (190 vs. 150 min, <i>P</i> = 0.005). Intraoperative hemodynamics, other postoperative pain scores at variable time points, and rescue analgesics given were comparable among groups (<i>P</i> > 0.05). Intraoperative blood loss was lower in OLIF than TLIF (275 vs. 500 mL) but was not statistically significant (<i>P</i> > 0.05).</p><p><strong>Conclusion: </strong>Mini-open OLIF has favorable perioperative outcomes compared to open TLIF. Patients have higher postoperative hemoglobin and lesser pain on movement on the first postoperative day, leading to earlier mobilization and a shorter hospital stay.</p>","PeriodicalId":13938,"journal":{"name":"International Journal of Critical Illness and Injury Science","volume":"14 1","pages":"37-42"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11073639/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140876391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A prospective cohort study evaluating the TRISS and TRISS-SpO2 scoring systems for assessing mortality risk in trauma study participants in India. 一项前瞻性队列研究评估了 TRISS 和 TRISS-SpO2 评分系统,用于评估印度创伤研究参与者的死亡风险。
Q3 Medicine Pub Date : 2024-01-01 Epub Date: 2024-03-27 DOI: 10.4103/ijciis.ijciis_38_23
Rishwanth Vetri, Dhanabalan Piramanayagam, Preethy Ravi

Background: Globally, trauma cases have significant morbidity and mortality. Hence, various scoring systems have been designed to improve the prognosis in trauma cases. Trauma and Injury Severity Score (TRISS) is one of the widely used models to predict mortality; however, it has certain limitation. We have aimed to evaluate the survival prediction of new model TRISS-oxygen saturation (SpO2) and to compare with original TRISS score in trauma study participants.

Methods: This was a prospective cohort study conducted on 380 trauma study participants admitted to the surgery department from January 20, 2021, to November 28, 2021. The proposed model includes TRISS-SpO2 which replaces pulse SpO2 instead of revised trauma score in the original TRISS score. Probability of survival (Ps) was calculated for both models using coefficients derived from Walker-Duncan regression analysis analyzed from the Major Trauma Outcome Study. Receiver operating characteristic curve analysis was used to predict model performance and the accuracy was calculated.

Results: The mortality rate in the present study was 30 (7.9%). The predictive accuracy of original TRISS score which calculated Ps based on respiratory rate was 97.11%, and for the proposed model of TRISS score which calculated Ps based on SpO2 was found 97.11%, and thus there is no significant difference in the performance.

Conclusions: The new proposed model TRISS-SpO2 showed a good accuracy which is similar to original TRISS score. However, the new tool TRISS-SpO2 might be easier to use for robust performance in the clinical setting.

背景:在全球范围内,创伤病例的发病率和死亡率都很高。因此,人们设计了各种评分系统来改善创伤病例的预后。创伤和损伤严重程度评分(Trauma and Injury Severity Score,TRISS)是广泛使用的死亡率预测模型之一,但它有一定的局限性。我们的目的是评估新模型 TRISS-血氧饱和度(SpO2)的生存预测能力,并与创伤研究参与者的原始 TRISS 评分进行比较:这是一项前瞻性队列研究,研究对象是 2021 年 1 月 20 日至 2021 年 11 月 28 日期间入住外科的 380 名创伤研究参与者。所提议的模型包括 TRISS-SpO2,它取代了原始 TRISS 评分中的脉搏 SpO2 而不是修订后的创伤评分。两个模型的存活概率(Ps)都是使用从重大创伤结果研究(Major Trauma Outcome Study)中分析得出的沃克-邓肯(Walker-Duncan)回归分析系数计算得出的。使用接收者操作特征曲线分析预测模型的性能,并计算其准确性:本研究中的死亡率为 30(7.9%)。根据呼吸频率计算Ps的原始TRISS评分的预测准确率为97.11%,而根据SpO2计算Ps的TRISS评分模型的预测准确率为97.11%,因此两者在性能上没有显著差异:结论:新提出的 TRISS-SpO2 模型显示出与原始 TRISS 评分相似的良好准确性。然而,新的 TRISS-SpO2 工具可能更易于在临床环境中使用,以获得更好的性能。
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引用次数: 0
Indoxacarb poisoning presenting as methemoglobinemia: A case report. 表现为高铁血红蛋白血症的茚虫威中毒:病例报告。
Q3 Medicine Pub Date : 2024-01-01 Epub Date: 2024-03-27 DOI: 10.4103/ijciis.ijciis_37_23
Abdelhakim Osman Hassan Mohammed, Malik Muhammed Akbar Saeed, Akhwand Shakeel Ahmad, Mansoor C Abdulla

A 34-year-old Sri Lankan man presented with multiple episodes of vomiting following accidental ingestion of 100 ml of indoxacarb (Avaunt). He had a significant saturation gap (discrepancy between oxygen saturation [98%] in blood gas analysis and saturation on pulse oximetry [70%] in finger pulse oximetry), the color of the blood was muddy brown, and the methemoglobin level (60%) was high in the blood gas analysis. A diagnosis of methemoglobinemia secondary to indoxacarb poisoning was made, and he was treated with methylene blue with a favorable outcome. Methemoglobinemia secondary to indoxacarb poisoning is extremely rare, and clinicians should be aware of this important complication. Methemoglobinemia secondary to indoxacarb poisoning has a favorable outcome if recognized and treated promptly.

一名 34 岁的斯里兰卡男子在误服 100 毫升茚虫威(Avaunt)后出现多次呕吐。他的血氧饱和度有明显差距(血气分析中的血氧饱和度[98%]与指脉搏血氧饱和度[70%]之间存在差异),血液颜色呈泥褐色,血气分析中高铁血红蛋白水平较高(60%)。诊断结果为继发于茚虫威中毒的高铁血红蛋白血症,他接受了亚甲蓝治疗,结果良好。茚虫威中毒继发高铁血红蛋白血症极为罕见,临床医生应注意这一重要并发症。继发于茚虫威中毒的高铁血红蛋白血症如果得到及时发现和治疗,预后良好。
{"title":"Indoxacarb poisoning presenting as methemoglobinemia: A case report.","authors":"Abdelhakim Osman Hassan Mohammed, Malik Muhammed Akbar Saeed, Akhwand Shakeel Ahmad, Mansoor C Abdulla","doi":"10.4103/ijciis.ijciis_37_23","DOIUrl":"10.4103/ijciis.ijciis_37_23","url":null,"abstract":"<p><p>A 34-year-old Sri Lankan man presented with multiple episodes of vomiting following accidental ingestion of 100 ml of indoxacarb (Avaunt). He had a significant saturation gap (discrepancy between oxygen saturation [98%] in blood gas analysis and saturation on pulse oximetry [70%] in finger pulse oximetry), the color of the blood was muddy brown, and the methemoglobin level (60%) was high in the blood gas analysis. A diagnosis of methemoglobinemia secondary to indoxacarb poisoning was made, and he was treated with methylene blue with a favorable outcome. Methemoglobinemia secondary to indoxacarb poisoning is extremely rare, and clinicians should be aware of this important complication. Methemoglobinemia secondary to indoxacarb poisoning has a favorable outcome if recognized and treated promptly.</p>","PeriodicalId":13938,"journal":{"name":"International Journal of Critical Illness and Injury Science","volume":"14 1","pages":"59-61"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11073642/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140876396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Metformin toxicity in the intensive care unit: A case series and review of the literature. 重症监护室中的二甲双胍毒性:系列病例和文献综述。
Q3 Medicine Pub Date : 2024-01-01 Epub Date: 2024-03-27 DOI: 10.4103/ijciis.ijciis_46_23
Katherine Nicole Peake, Steven Tessier, Santo Longo, Deborah M Stahlnecker, Osamudiamen Idahosa, Thomas Zanders, Firas Ido

Metformin toxicity is a life-threatening condition with high morbidity and mortality. Toxicity predominantly occurs in the setting of acute renal dysfunction, as the drug is solely eliminated by the kidneys. While this risk is widely known to clinicians, diagnosing metformin toxicity is challenging because commercially available serum metformin levels require days to weeks to result. Therefore, the intensivist must rely on medical history, clinical presentation, and routine laboratory findings to make the preliminary diagnosis. Treatment of metformin toxicity includes supportive fluid hydration, vasopressors, and emergent hemodialysis (HD). We report three critically ill patients who had near-fatal severe metformin-induced lactic acidosis. Their metformin levels were markedly higher than the toxicity threshold reported by the Federal Drug Agency. These patients made a prompt and complete recovery after the initiation of HD. We also review the pathophysiology, clinical presentation, diagnosis, and treatment of metformin toxicity.

二甲双胍中毒是一种危及生命的疾病,发病率和死亡率都很高。由于二甲双胍仅由肾脏排出,因此毒性主要发生在急性肾功能障碍的情况下。虽然临床医生都知道这种风险,但诊断二甲双胍中毒却很困难,因为市售的二甲双胍血清水平需要数天至数周才能得出结果。因此,重症监护医生必须依靠病史、临床表现和常规实验室检查结果来做出初步诊断。二甲双胍中毒的治疗包括支持性液体补液、血管加压和紧急血液透析(HD)。我们报告了三名重症患者因二甲双胍诱发乳酸酸中毒而濒临死亡。他们的二甲双胍水平明显高于联邦药品管理局报告的毒性阈值。这些患者在开始接受 HD 治疗后迅速完全康复。我们还回顾了二甲双胍中毒的病理生理学、临床表现、诊断和治疗。
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International Journal of Critical Illness and Injury Science
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