Clinical profile of Guillain Barre syndrome in a tertiary care centre

Background:This study was done to know about the clinical profile of Guillain Barre syndrome in a tertiary care centre and to correlate certain clinical features with outcome at discharge and thereby to identify a poor outcome group in early stages.Methods:33 patients admitted in the medical wards were included in the study based on the diagnostic criteria modified by Asbury. Detailed history and physical examination as per a structured profroma was taken and necessary lab investigations were done including CSF study and electrodiagnostic study.Results:The factors affecting the outcome at discharge were 1. Requirement of mechanical ventilation 2. Features of axonopathy in electrodiagnostic studies 3. Decreased CMAP (<10% of lower limit of normal) 4. Presence of cranial nerve involvement 5. Presence of autonomic involvement.Conclusion: There is a high percentage of Miller Fisher variant of GBS this study. Older age is not found to have adverse effect on outcome at discharge in this study. Axonal variant of GBS is found to have a bad outcome. Requirement of mechanical ventilation was found to be a factor adversely affecting outcome. Cranial nerve involvement and autonomic involvement adversely affects the outcome at discharge.

Clinical profile of Dengue patients in a rural tertiary care centre of coastal Kerala

Background: Dengue epidemic is a major health problem in India. According to the directorate of National Vector Borne Disease Control Programme (NVBDCP) over 18,700 cases of dengue have been reported in India in 2017.Kerala has reported the highest number of dengue related deaths in the country. The aim of the present study is to find out the clinical profile of patients admitted with dengue fever during the epidemic in 2017 in a rural tertiary care centre in coastal Kerala.Methods: 341 patients who were admitted in the medicine department of a rural tertiary care centre in Kerala with Dengue were included in the study. W.H.O case definitions were used for the diagnosis. Complete blood counts, RBS, serum creatinine and liver function tests and E.C.G were carried out in all patients. Chest X ray, Echocardiogram, ultrasonogram, MRI and CSF study were done when indicated.Results: Males predominated. 317 were diagnosed as dengue fever, 12 as dengue hemorrhagic fever and 12 had dengue shock syndrome. Only four patients succumbed to death. Aminotransferases were elevated in 74.4%. In all cases AST was more than ALT. Head ache and myalgia were the common symptoms at the time of presentation. 72 patients had abnormal ECG, but all had normal ECG at the time of discharge, indicating a transient change during the episode.Conclusions: Careful monitoring of clinical and biochemical parameters is necessary during dengue epidemics. Atypical manifestations of dengue should also be considered in the differential diagnosis of various diseases in different organ systems

Ventilator Decision and Allocation Pathway for Surge Conditions

We created a deployment plan of the available ventilator fleet to be deployed during surge conditions. The plan includes appropriate allocation of acute care ventilators to manage complex respiratory patients, while a percentage of stable respiratory patients can be safely managed using a back-up ventilator

Organizing a System-Wide Effort on Ventilator Supply Management during COVID-19

We developed a concise definition of ventilators to accurately represent them in all reports across the enterprise, and a ventilator deployment plan

A STUDY ON STROKE-ASSOCIATED PNEUMONIA IN A TERTIARY CARE CENTER AND EFFECT OF SERUM ALBUMIN ON PATIENT OUTCOMES

Objectives: The objectives of this study were to determine if serum albumin level is an independent predictor of nosocomial pneumonia in stroke patients. Methods: Relevant medical data of 500 consecutive ischemic stroke patients admitted within 24 h of stroke onset during the study period were analyzed. Serum albumin level was measured within 36 h after stroke onset. Nosocomial pneumonia was foundin 10.5% of stroke patients. SPSS (Version 22.0) was used for analysis. Results: Patients with pneumonia had significantly lower serum albumin level than those without pneumonia (31.5 ± 7.3 g/l vs. 35.3 ± 6.4 g/l) and serum albumin level was associated with risk of pneumonia on multivariate analysis (OR: 0.95, 95% CI: 0.90–0.97). Conclusion: Our results show that serum albumin level is an independent predictor of nosocomial pneumonia in stroke patients

Long-Term Safety of Dupilumab in Patients With Moderate-to-Severe Asthma : TRAVERSE Continuation Study

Altres ajuts: Sanofi and Regeneron Pharmaceuticals, Inc (NCT02134028 and NCT03620747)Background: Previous clinical trials have demonstrated dupilumab efficacy and safety in adults and adolescents with moderate to severe asthma for up to 3 years. Objective: The TRAVERSE continuation study (NCT03620747), a single-arm, open-label study, assessed safety and tolerability of dupilumab 300 mg every 2 weeks up to an additional 144 weeks (∼3 years) in patients with moderate to severe asthma who previously completed TRAVERSE (NCT02134028). Methods: Primary end points were incidence and event rates per 100 patient-years of treatment-emergent adverse events (TEAEs). Secondary end points included adverse events (AEs) of special interest, serious AEs, and AEs leading to study discontinuation. Results: A total of 393 patients participated in the TRAVERSE continuation study (cumulative dupilumab exposure, 431.7 patient-years; median treatment duration, 309 days). A total of 29 patients (7.4%) received more than 958 days of treatment. A total of 214 (54.5%) patients reported at least 1 TEAE (event rate: 171.4); 37 (9.4%) experienced at least 1 treatment-related TEAE, none of which were considered severe; 2 patients reported 6 TEAEs of moderate intensity. A total of 22 (5.6%) patients reported serious AEs (event rate: 6.9). AEs of special interest were reported in 24 patients (6.1%; event rate: 6.0). Five (1.3%) deaths occurred (event rate: 1.2) following serious AEs of coronavirus disease 2019 (COVID-19)-related pneumonia (3 patients), pancreatitis (1 patient), and pulmonary embolism (1 patient). None of the TEAEs leading to death were considered treatment-related. Conclusions: Dupilumab treatment was well tolerated for up to an additional 3 years. Safety findings were consistent with the known safety profile of dupilumab. These findings further support the long-term use of dupilumab in patients with moderate to severe asthma

The Demographic Foundations of Rising Employment and Earnings among Single Mothers in Canada and the United States, 1980–2000

Female single parents, Employment rate, Earnings,