Triage and Ongoing Care for Critically Ill Patients in the Emergency Department: Results from a National Survey of Emergency Physicians

Introduction: We conducted a cross-sectional study at the Icahn School of Medicine at Mount Sinai to elicit emergency physician (EP) perceptions regarding intensive care unit (ICU) triage decisions and ongoing management for boarding of ICU patients in the emergency department (ED). We assessed factors influencing the disposition decision for critically ill patients in the ED to characterize EPs’ perceptions about ongoing critical care delivery in the ED while awaiting ICU admission.Methods: Through content expert review and pilot testing, we iteratively developed a 25-item written survey targeted to EPs, eliciting current ICU triage structure, opinions on factors influencing ICU admission decisions, and views on caring for critically ill patients “boarding” in the ED for >4-6 hours.Results: We approached 732 EPs at a large, national emergency medicine conference, achieving 93.6% response and completion rate, with 54% academic and 46% community participants. One-fifth reported having formal ICU admission criteria, although only 36.6% reported adherence. Common factors influencing EPs’ ICU triage decisions were illness severity (91.1%), ICU interventions needed (87.6%), and diagnosis (68.2%), while ICU bed availability (13.5%) and presence of other critically ill patients in ED (10.2%) were less or not important. While 72.1% reported frequently caring for ICU boarders, respondents identified high patient volume (61.3%) and inadequate support staffing (48.6%) as the most common challenges in caring for boarding ICU patients.Conclusion: Patient factors (eg, diagnosis, illness severity) were seen as more important than system factors (eg, bed availability) in triaging ED patients to the ICU. Boarding ICU patients is a common challenge for more than two-thirds of EPs, exacerbated by ED volume and staffing constraints

Review of Hussain Sagar Lake Pollution, Hyderabad, India

Hussain sagar lake, a historical lake which was built in 1562 by Hussain Shaw Wali is situated in the heart of Hyderabad city, India. Earlier up to 1930's, it was the major water source to meet drinking and irrigation requirements for both twin cities of Hyderabad and Secunderabad. Now this lake turned to virtual garbage bin with no adequate treatment for wastewater loads originated from point and non point sources. Therefore the lake loses the capability of self purification system which was an important factor that depends on the maximum uptake of oxygen from the atmosphere. Multiple projects were undertaken by the concerned authorities for the improvement of Hussain sagar lake and its catchment area. Recently With referring to the Lake health status, In 2006, HMDA, a governing body set up by Andhra Pradesh Government, initiated “Hussainsagar Lake and Catchment Area Improvement project” and set up STPs and wastewater interception and diversion structures. It also installed fountains to aerate the lake to improve its water quality as well as to add beauty. But these measures are lying ineffective to manage wastewater loads. This paper discusses that the Hussain Sagar lake water body over decades, has been polluted adversely from discharging of organic and inorganic pollutants through open drains as well as point and non point sources and also presents various measures had taken to rejuvenate Hussain Sagar Lake to its past glory

The prognostic significance of ploidy analysis in operable breast cancer

The nuclear DNA content of 98 operable breast cancers was determined by flow cytometric analysis using paraffin-embedded tissue. All patients were on follow-up and failure of treatment or recurrences were identified. DNA ploidy data in the form of ploidy status and DNA index (DI) has been correlated with various clinical and histopathologic factors. The only significant correlation using univariate analysis exists between the histologic grade and DI (P < 0.025), recurrence of the disease and ploidy status (P < 0.005), and recurrence of the disease and DI (P < 0.005). The absence of correlation of ploidy status with other tumor derived factors indicates the independent nature of ploidy as a prognostic factor. Multivariate analysis showed that in the whole-group ploidy (P < 0.01), tumor margin (P < 0.01), and menopausal status (P < 0.01) were significant factors in the order mentioned. DI with a cut of at 1.29 is not found to be a significant factor in the multivariate analysis. The maximum prognostic value of ploidy status was observed in the postmenopausal group (P < 0.0005). In the node-negative group ploidy status (P < 0.05) is the only independent significant factor predicting for early relapse. It is concluded that ploidy status is an independent prognostic factor predicting for recurrence of the disease. In the node-negative subgroup this could be used to identify the subset of patients who may benefit from adjuvant treatment

Analysis of Correlation between Anthropometry of Hand and Smartphone Overuse on Musculoskeletal Pain in Thumb/Wrist in Medical Students: A Cross Sectional Study at Tertiary Care Center of Central India

Introduction: As mobile technology has evolved and is used extensively by most of the population, there is an increase in incidences of pain associated with the overuse of mobile phones. Pain associated with smartphone use is because of prolonged periods of time engaging with digital devices. The use of smartphones can cause various types of physical discomforts, such as neck pain, shoulder pain, and thumb pain, collectively referred to as “smartphone-related musculoskeletal disorders” (SRMDs). These medical issues arise mainly due to poor posture, repetitive movements, and prolonged use of smartphones without breaks. The impact of SRMDs on an individual’s daily life can be significant, resulting in decreased productivity, reduced quality of life, and increased healthcare costs. It is important for individuals to be aware of the risks associated with smartphone use and take steps to minimize their risk of developing SRMDs. Methods: The proposed study was an observational, questionnaire-based non-invasive study. The study was conducted in AIIMS Bhopal. The study was conducted on 130 adult males and 70 adult females. Personal and demographic details along with anthropometric measurements like Palm length, Palm breadth, and middle finger length were recorded. The level of smartphone addiction of individuals was also documented. Results: Correlations among palm length, palm breadth, length of the middle finger, smartphone size and shape, addiction level, and musculoskeletal pain were calculated. Conclusion: Present study proposes some important remedies which may minimize the musculoskeletal pain associated with the overuse of mobile phones.Introducción: A medida que la tecnología móvil ha evolucionado y es ampliamente utilizada por la mayoría de la población, hay un aumento en la incidencia de dolor asociado con el uso excesivo de teléfonos móviles. El dolor asociado con el uso de teléfonos inteligentes se debe a los períodos prolongados de tiempo relacionados con los dispositivos digitales. El uso de teléfonos inteligentes puede causar varios tipos de molestias físicas, como dolor de cuello, hombro y pulgar, denominados colectivamente "trastornos musculoesqueléticos relacionados con teléfonos inteligentes" (SRMD). Estos problemas médicos surgen principalmente debido a malas posturas, movimientos repetitivos y uso prolongado de teléfonos inteligentes sin descanso. El impacto de los SRMD en la vida diaria de un individuo puede ser significativo, lo que resulta en una disminución de la productividad, una reducción de la calidad de vida y un aumento de los costos de atención médica. Es importante que las personas sean conscientes de los riesgos asociados con el uso de teléfonos inteligentes y tomen medidas para minimizar el riesgo de desarrollar SRMD. Métodos: El estudio propuesto fue un estudio observacional no invasivo basado en un cuestionario. El estudio se realizó en AIIMS Bhopal. El estudio se realizó en 130 hombres adultos y 70 mujeres adultas. Se registraron detalles personales y demográficos junto con medidas antropométricas como la longitud de la palma, el ancho de la palma y la longitud del dedo medio. También se documentó el nivel de adicción a los teléfonos inteligentes de las personas. Resultados: Se calcularon las correlaciones entre la longitud de la palma, el ancho de la palma, la longitud del dedo medio, el tamaño y la forma del teléfono inteligente, el nivel de adicción y el dolor musculoesquelético. Conclusión: El presente estudio propone algunos remedios importantes que pueden minimizar el dolor musculoesquelético asociado con el uso excesivo de teléfonos móviles

Prevalence and Correlation of Human Papilloma Virus and its Types with Prognostic Markers in Patients with Invasive Ductal Carcinoma of the Breast in Kuwait

Objectives: This study aimed to document the association of human papilloma virus (HPV) and its types in breast carcinoma tissues in Kuwaiti women, and correlate this with known prognostic markers. Methods: The clinicopathological data of archived tissue from 144 cases of invasive ductal breast carcinoma were studied (age, histological grade, size of tumour, lymph node metastases, oestrogen/progesterone receptors and human epidermal growth factor receptor 2 status). HPV frequency was documented using immunohistochemistry (IHC) and chromogenic in-situ hybridisation (CISH). HPV types were documented by CISH using HPV probes. CISH and IHC techniques were compared and HPV correlated with prognostic parameters. Results: The HPV prevalence as determined by CISH and IHC was 51 (35.4%) and 24 (16.7%) cases, respectively. The sensitivity of HPV by IHC was 37.3% and specificity was 94.6%. The sensitivity and specificity of HPV-CISH compared to HPVIHC was statistically significant (P <0.001). HPV-CISH was seen in 51 cases. A combination of HPV 6 and 11, and 16 and 18 was seen in 2 (3.9%) cases, and a combination of HPV 6, 11, 31 and 33 was seen in 7 (13.7%) cases. All three HPV probes: 6 and 11, 16 and 18, as well as 31 and 33 were present in 2 (3.9%) cases. The prevalence of HPVCISH in the Kuwaiti and non-Kuwaiti populations was 27 (52.9%) and 19 (37.2%), respectively. No correlation was observed with the prognostic parameters. Conclusion: The frequency of HPV in breast carcinoma cases in Kuwait was 35.4% (CISH). Of those, 52.9% were Kuwaitis in whom both low- and high-risk HPV types were detected

Phosphatidylethanolamine N-methyltransferase (PEMT) Knockout Mice Exhibit Worse Alcohol-Induced Liver Injury than Wildtype Mice

Phosphatidylethanolamine N-methyltransferase (PEMT) is an enzyme that catalyzes the successive transfer of 3 methyl groups from S-adenosylmethionine (SAM) to phosphatidylethanolamine (PE) to generate phosphatidylcholine (PC). PC is vital for exporting fat out of the liver, ultimately preventing hepatic steatosis. Alcohol also induces steatosis partly through damaging this pathway, so the purpose of this study was to investigate the relationship between alcohol and PEMT in the liver. PEMT -/- (KO) and wild-type (WT) mice were subjected to a chronic + binge alcohol treatment, and both serum and liver samples were analyzed. Triglyceride quantification, SAM and S-adenosylhomocysteine (SAH) levels, and histological analyses were performed on liver samples, while ALT levels were determined from serum samples. Our study showed that ethanol-fed PEMT KO mice exhibited worse liver injury compared to other treatment groups. Our results show increased triglyceride levels, increased ALT levels, decreased SAM:SAH ratio, and increased liver to body weight ratio. From these findings, we conclude that additional liver damage is observed with the combination of alcohol feeding and absence of the PEMT enzyme. The mechanism by which these two factors affect one another is a key area of future study.https://digitalcommons.unmc.edu/surp2021/1016/thumbnail.jp

EEE-INST-002/003 Revision

No abstract availabl

Endocrine Dysfunction Criteria in Critically Ill Children: The PODIUM Consensus Conference

CONTEXT Endocrine dysfunction is common in critically ill children and is manifested by abnormalities in glucose, thyroid hormone, and cortisol metabolism. OBJECTIVE To develop consensus criteria for endocrine dysfunction in critically ill children by assessing the association of various biomarkers with clinical and functional outcomes. DATA SOURCES PubMed and Embase were searched from January 1992 to January 2020. STUDY SELECTION We included studies in which researchers evaluated critically ill children with abnormalities in glucose homeostasis, thyroid function and adrenal function, performance characteristics of assessment and/or scoring tools to screen for endocrine dysfunction, and outcomes related to mortality, organ-specific status, and patient-centered outcomes. Studies of adults, premature infants or animals, reviews and/or commentaries, case series with sample size ≤10, and non-English-language studies were excluded. DATA EXTRACTION Data extraction and risk-of-bias assessment for each eligible study were performed by 2 independent reviewers. RESULTS The systematic review supports the following criteria for abnormal glucose homeostasis (blood glucose [BG] concentrations >150 mg/dL [>8.3 mmol/L] and BG concentrations <50 mg/dL [<2.8 mmol/L]), abnormal thyroid function (serum total thyroxine [T4] <4.2 μg/dL [<54 nmol/L]), and abnormal adrenal function (peak serum cortisol concentration <18 μg/dL [500 nmol/L]) and/or an increment in serum cortisol concentration of <9 μg/dL (250 nmol/L) after adrenocorticotropic hormone stimulation. LIMITATIONS These included variable sampling for BG measurements, limited reporting of free T4 levels, and inconsistent interpretation of adrenal axis testing. CONCLUSIONS We present consensus criteria for endocrine dysfunction in critically ill children that include specific measures of BG, T4, and adrenal axis testing

Sizes of induration and nutritional status in children with positive Mantoux test

Background: The immune status of children is always affected by nutrition. Sometime severe malnutrition is associated with falsenegative Mantoux test. There is a need to study to observe the effect of nutritional status on the size of indurations in Mantoux positivechildren. Study Design: Observational analytical cross-sectional study. Methods: The study population consisted of 310 patients,belonging to both sexes and age of 1-14 years, attending the outpatient department of UP Rural Institute of Medical Sciences andResearch, Saifai, Etawah. Only Mantoux positive cases were included in the study. Their sizes of indurations of skin reaction weremeasured and recorded in mm. The nutritional status was calculated as the weight for age and height for age standard (Z-score), usingthe NCHS charts of for males and females. Results: Out of 800 children screened for tuberculosis, 310 children had positive Mantouxtest and were recruited in the study. Mean induration (20 mm) was similar in all the groups. However, the size of indurations rangedfrom 10-40 mm, 11-33 mm, and 12-24 among normal weight, underweight, and overweight Z-score groups. Mean induration was same(20 mm) in two Z-score height for age groups (normal height, stunting), while it was 20.6 mm in the over-height group. Although, therange of Mantoux positivity ranges from 10-35 mm, 11-40 mm, and 18-22 mm among normal height, stunting, and over height Z-scoregroups. Conclusion: Although, nutritional status can affect the positivity of Mantoux test; in Mantoux positive children, the size ofindurations does not depend on their nutritional status