Cumulative fluid balance as a major predictor of clinical outcome in patients admitted to surgical intensive care unit

Objective: Fluid balance remains a highly controversial topic in the critical care field, and there is no consensus about the amount of fluid required by critically ill patients.In this study, the objective was to find the relationship between fluid balance and in hospital mortality in critically ill surgical patients.Our secondary objective was to identify the association between use of colloid and acute kidney injury and use of blood products and development of ARDS.Study Design: The medical records of adult patients admitted to a surgical intensive care unit (ICU) \u3e48 hours, from Aug 2014 toFeb 2016 (18 months) were reviewed retrospectively.Place and Duration of Study: The study was conducted in the surgical intensive care unit of a tertiary care hospital.Medical records of 18 months from Aug 2014 toFeb 2016 were reviewed.Material and Methods: Sampling technique was convenience sampling. A total of 100 patients met the inclusion criteria. Abstracted dataof patients admitted to surgical intensive care included body mass index, Acute physiology and chronic health evaluation (APACHE)-II scores, fluid balance during first 5 days of ICU stay, length of ICU stay andin hospitalmortality. All statistical analysis was performed using statistical packages for social science version 19 (SPSS Inc., Chicago, IL). Frequency and percentage werecomputed for qualitative observation and wereanalyze by chi-square test. Mean (±Standard deviation) andmedian (IQR) were presented for quantitative variables and analyze by independent sample t-test and Mann-Whitney test. Normality of quantitative data wasalso be checked by Kolmogorov-Smirnov test. Statistically significantresults had a p-value less than0.05.Results: A total of 100 patients fulfilled the inclusion criteria. The average age of patients was 44.08±18.14 (years), BMI (kg/m2) 27.84±5.56 and APACHE II Score 17.28±6.96. The in hospital mortality was 26%, median length of ICU and hospitalstay was 6.91 ±4.07 and 14.74 ±7.78 days. In non-survivors fluid balance was significantly positive on 2nd, 3rd, 4th and 5thday of SICU (p-value: 0.005, 0.0005 and 0.024), APACHE II score (pConclusion: Positive fluidbalance, high APACHE II score and acute kidney injury is significantly associated with hospital mortality of non-cardiac surgical ICU patients

Use of follicular output rate to predict intracytoplasmic sperm injection outcome

Background: The measurement of follicular output rate (FORT) has been proposed as a good indicator for evaluating follicular response to the exogenous recombinant folliclestimulating hormone (rFSH). This places FORT as a promising qualitative marker for ovarian function. The objective of the study was to determine FORT as a predictor of oocyte competence, embryo quality and clinical pregnancy after intracytoplasmic sperm injection (ICSI).Materials and Methods: This prospective study was carried out on a group of infer- tile females (n=282) at Islamabad Clinic Serving Infertile Couples, Islamabad, Pakistan, from June 2010 till August 2013. Downregulated females were stimulated in injection gonadotropins and on ovulation induction day, pre-ovulatory follicle count (PFC) was determined using transvaginal ultrasound scan (TVUS), and FORT was determined as a ratio of PFC to antral follicle count (AFC)*100. Group I consisted of females with a negative pregnancy test, while group II had a positive pregnancy test that was confirmed with the appearance of fetal cardiac activity. Linear regression analyses of categorical variables of clinical pregnancy along with other independent variables, including FORT, were performed using SPSS version 15.0.Results: Pregnancy occurred in 101/282 women who were tested, recording a clinical pregnancy rate of about 35.8%. FORT values were higher in group II as compared to group I females (P=0.0001). In multiple regression analysis, 97.7, 87.1, 78.2, and 83.4% variations were explained based on the number of retrieved oocytes per patients, number of metaphase II oocytes retrieved, number of fertilized oocytes, and number of cleaved embryos, respectively, indicating FORT as an independent predictor.Conclusion: FORT is a predictor of oocyte competence in terms of a number of retrieved, mature and fertilized oocytes. It also gives information about the number of cleaved embryos and clinical pregnancy rate

Incidence and risk factors of delirium in surgical intensive care unit

Background: To evaluate the incidence and modifiable risk factors of delirium in surgical intensive care unit (SICU) of tertiary care hospital in a low-income and middle-income country.Methods: We conducted a single cohort observational study in patients over 18 years of age who were admitted to the SICU for \u3e24 hours in Aga Khan University Hospital from January to December 2016. Patients who had pre-existing cognitive dysfunction were excluded. Intensive Care Delirium Screening Checklist was used to assess delirium. Incidence of delirium was computed, and univariate and multivariable analyses were performed to observe the relationship between outcome and associated factors.Results: The average patient age was 43.29±17.38 and body mass index was 26.25±3.57 kg/m2. Delirium was observed in 19 of 87 patients with an incidence rate of 21.8%. Multivariable analysis showed chronic obstructive pulmonary disease, pain score \u3e4 and hypernatremia were strong predictors of delirium. Midazolam (adjusted OR (aOR)=7.37; 95% CI 2.04 to 26.61) and propofol exposure (aOR=7.02; 95% CI 1.92 to 25.76) were the strongest independent predictors of delirium while analgesic exposures were not statistically significant to predict delirium in multivariable analysis.Conclusion: Delirium is a significant risk factor of poor outcome in SICU. There was an independent association between pain, sedation, COPD, hypernatremia and fever in developing delirium.Level of evidence: IV

Emergency Response of Indian Hajj Medical Mission to Heat Illness Among Indian Pilgrims in Tent-Clinics at Mina and Arafat During Hajj, 2016

Introduction: Extreme heat claims more lives than all other weather-related exposures combined. Hajj rituals at Mina, Arafat, and Muzdalifah involve a minimally-clothed, moving assemblage of 3.5 million pilgrims who are exposed to a harsh, hot, desert climate during physically challenging outdoor rituals and unsheltered night stays, rendering them prone to heat illness, dehydration, and sunburn. This cross-sectional study assessed the emergency response of the Indian Hajj Medical Mission to overwhelming heat illnesses in Mina and Arafat among Indian pilgrims during Hajj, 2016. Methods: In 2016, 88 patients affected by the heat were brought to central tent-clinics at 36 maktabs in Mina and Arafat that were established by the Indian Hajj Medical Mission. Patients were offered rapid external evaporative cooling (wet towels) and cold intravenous saline infusion on patient couches and wheelchairs. Results: The incidence of heat illness among Indian pilgrims in 2016 was 0.62/1000. The ratio of males to females was 1.8:1. Mean ages of males and females were 62.2 ± 7.43 and 52.6 ± 9.3, respectively. Pre-existing conditions, such as diabetes mellitus and hypertension, were present in 93.2% of the patients. The most common presentations included hyperthermia, fatigue, and restlessness. Heatstroke presented in five patients and resulted in one fatality. Twenty-eight patients were referred to Saudi hospitals, and 12 of them were institutionalized. Exertion related to the stoning of Satan ritual during late morning and afternoon hours was the leading cause of heat illness. Conclusion: The overwhelming incidence of heat illness among Indian pilgrims in the critical five-day period of the Hajj represents the tip of the iceberg as the Hajj attracts over 3.5 million pilgrims from 200 countries annually. Heat illness is difficult to manage in the presence of pre-existing comorbidities and mandates clientele education and outreach warning systems to enhance resilience capital amongst Hajj pilgrims, sportspersons, outdoor enthusiasts, and military personnel

How children perceive COVID-19? Kids drawings and perceptions of parents

COVID-19 affected many lives, number of children become stressful and socially isolated. School closure also has great impact on children’s social-emotional development and overall wellbeing. The aim of current study was to identify children’s reactions to COVID-19 and its impact on academic and social life. Qualitative participatory research design was used to assess children perception about COVID-19. Data were collected from parent’s interview and Children drawing. Three major themes include: Fear of the drastic changes, increased sense of responsibility, and gratitude for being at home with family was reported by the parents however children drawings revealed that most of the children felt unhappy and sad because of lock down they were missing things they were missing enjoyed earlier such as school, fiends and outdoor activities and games. This is astonished that most of the children drawn the COVID-19 virus and represented as giant and ugly. Few children also draw mask and other protective measures. Public awareness program on COVID-19 protection and mental health promotion of will be window of opportunity for children psychosocial wellbeing

ACORN (A Clinically-Oriented Antimicrobial Resistance Surveillance Network) II: protocol for case based antimicrobial resistance surveillance

Background: Antimicrobial resistance surveillance is essential for empiric antibiotic prescribing, infection prevention and control policies and to drive novel antibiotic discovery. However, most existing surveillance systems are isolate-based without supporting patient-based clinical data, and not widely implemented especially in low- and middle-income countries (LMICs). Methods: A Clinically-Oriented Antimicrobial Resistance Surveillance Network (ACORN) II is a large-scale multicentre protocol which builds on the WHO Global Antimicrobial Resistance and Use Surveillance System to estimate syndromic and pathogen outcomes along with associated health economic costs. ACORN-healthcare associated infection (ACORN-HAI) is an extension study which focuses on healthcare-associated bloodstream infections and ventilator-associated pneumonia. Our main aim is to implement an efficient clinically-oriented antimicrobial resistance surveillance system, which can be incorporated as part of routine workflow in hospitals in LMICs. These surveillance systems include hospitalised patients of any age with clinically compatible acute community-acquired or healthcare-associated bacterial infection syndromes, and who were prescribed parenteral antibiotics. Diagnostic stewardship activities will be implemented to optimise microbiology culture specimen collection practices. Basic patient characteristics, clinician diagnosis, empiric treatment, infection severity and risk factors for HAI are recorded on enrolment and during 28-day follow-up. An R Shiny application can be used offline and online for merging clinical and microbiology data, and generating collated reports to inform local antibiotic stewardship and infection control policies. Discussion: ACORN II is a comprehensive antimicrobial resistance surveillance activity which advocates pragmatic implementation and prioritises improving local diagnostic and antibiotic prescribing practices through patient-centred data collection. These data can be rapidly communicated to local physicians and infection prevention and control teams. Relative ease of data collection promotes sustainability and maximises participation and scalability. With ACORN-HAI as an example, ACORN II has the capacity to accommodate extensions to investigate further specific questions of interest

THE EVIDENTIARY VALUE OF MODERN ELECTRONIC DEVICES AND THEIR APPLICATION IN THE JUSTICE SYSTEM OF PAKISTAN

Abstract: Social interaction is facilitated by mental processes shifting from the real world to the virtual world. Computers, mobile phones, printers, digital cameras, and other information and communication technology equipment are crucial to the virtual world. Unl the virtual world provides several opportunities for crimes such as phishing, identity theft, child pornography, hacking, and so on. Electronic data is frequently relevant in demonstrating or disproving a truth or fact in question, established judiciary cultures around the world, employing modern Devices for evidential representation is permitted. Modern technology is also being used in Pakistan's courts and judicial system to present evidence in court, which aids in the formation of more informed decisions.The Qanun-e-Shahadat order1984, including its paragraphs and Articles, as well as the Electronic Certification Accreditation Council, established under Section 18 of the Electr Transaction Ordinance in 2002, clarified the use of contemporary technology to present evidence in courts with the viewpoints of the state and religion&nbsp

P018. Intensive care unit (SICU) of a tertiary care hospital effect of fluid balance on outcome of patients admitted to the surgical

Background: Fluid balance remains a highly controversial topic in the critical care field, and there is no consensus about the amount of fluid required by critically ill patients.Objectives: In this study, the objective was to find the relationship between fluid balance and in hospital mortality in critically ill surgical patients. Our secondary objective was to identify the association between use of colloid and acute kidney injury and use of blood products and development of ARDS.Methods: The medical records of adult patients admitted to a surgical intensive care unit (ICU) ≥ 48 hours, from August 2014 to February 2016 (18 months) were reviewed retrospectively. The study was conducted in the surgical intensive care unit of a tertiary care hospital .Medical records of 18 months from August 2014 to February 2016 were reviewed. Abstracted data of patients admitted to surgical intensive care included body mass index, Acute Physiology and Chronic Health Evaluation (APACHE) II scores, fluid balance during first 5 days of ICU stay, length of ICU stay and in hospital mortality. All statistical analysis was performed using statistical packages for social science version 19 (SPSS Inc., Chicago, IL). Frequency and percentage were computed for qualitative observation and were analyze by chi square test. Mean (± standard deviation) and median (IQR) were presented for quantitative variables and analyze by independent sample t test and Mann-Whitney test. Normality of quantitative data was also be checked by Kolmogorov-Smirnov test. Statistically significant results had a P-value less than 0.05.Results: A total of 100 patients fulfilled the inclusion criteria. The average age of patients was 44.08 ± 18.14 (years), BMI (kg m-2) 27.84 ± 5.56 and APACHE II Score 17.28 ± 6.96. The in hospital mortality was 26%, median length of ICU and hospital stay was 6.91 ± 4.07 and 14.74 ± 7.78 days. In non-survivors fluid balance was significantly positive on 2nd, 3rd, 4th and 5th day of SICU (P-value: 0.005, 0.0005 and 0.024), APACHE II score (P \u3c 0.02), incidence of acute kidney injury (P \u3c 0.004) and mechanical ventilation days were significantly more. There was association between the of use of colloid and acute kidney injury (P \u3c 0.014). Use of blood products was significantly associated (P \u3c 0.03) with development of ARDS.Conclusions: Positive fluid balance, high APACHE II score and acute kidney injury is significantly associated with hospital mortality of non-cardiac surgical ICU patients