Cancer Patients Missing Pain Score Information:- Application with Imputation Techniques

Background: Methods for handling missing data in clinical research have been getting more attentions over last few years. Contemplation of missing data in any study is vital as they may lead to considerable biases and can have an impact on the power of the study. Objective: This manuscript is dedicated to present different techniques to handle missing observations obtained from repeatedly measured pain score data on palliative cancer. Methods: This problem caused by subjects drop out before completion of the study. The reason for dropout or withdrawal may be related to study (e.g., adverse event, death, unpleasant study procedures, lack of improvement) or unrelated to the study (e.g., moving away, unrelated disease). The dropout might be very common on studies on palliative cancer patients. The Palliative treatment is designed to relieve symptoms, and improve the quality of life and can be used at any stage of an illness if there are troubling symptoms, such as pain or sickness. Results: The mean(SD) of observed pain score was 3.638(3.156) whereas the imputed mean values were 3.615(2.980), 3.618(2.954), 3.577(2.892), 3.560(2.999) and 3.627(2.949) respectively for the imputation methods regression, predictive mean matching, propensity score, EM algorithm and MCMC methods for pain score values at visit3.  Interpretation and Conclusion: The EM algorithm shows the least percentage change from observed values in both visits followed by predictive mean matching method and MCMC methods. The multiple imputation techniques have few advantages; the imputed values are drawsfrom a distribution, so they inherently contain some variation by introducing an additional form of error in the parameter estimates across the imputation &nbsp

Study of prevalence of maternal anaemia and its fetal outcome at rural tertiary care centre

Background: Anaemia is a major public health problem especially among low socioeconomic class of the population in developing countries. Prevalence of anaemia among pregnant women in developing countries is 51%. Anaemia is defined by the WHO as haemoglobin levels of less than 11 gm. %   in pregnancy. The present study was aimed to find out prevalence of anaemia in rural tertiary care centre to see the foetal outcome in anaemic women.Methods: This is a retrospective observational study done in the Department of Obstetrics and Gynaecology, University of medical sciences Saifai, Etawah from June 2017 to November 2017. All the women admitted to labour room in third trimester and delivered here were included in the study excluding the patients with pre-eclampsia, eclampsia, gestational diabetes mellitus, heart disease, patients with other medical disorders and patients with twin pregnancy, antepartum haemorrhage and the patients who did not deliver here.Results: Prevalence of anaemia was 87.3 %. severe anaemia was found in 3.5 % women. The percentage of preterm births was more in anaemic women that is 16.9 %.Conclusions: Anaemia in pregnancy is a major public health problem in India. The number of IUGR and LBW babies were more in anaemic women. Anaemia is related to serious consequences in mother and baby if not diagnosed and treated timely. It can be prevented by increasing the awareness regarding need of iron intake during pregnancy

Time-to-death approach in revealing chronicity and severity of COVID-19 across the world

Background The outbreak of coronavirus disease, 2019 (COVID-19), which started from Wuhan, China,in late 2019, have spread worldwide. A total of 5,91,971 cases and 2,70,90 deaths were registered till 28th March, 2020. We aimed to predict the impact of duration of exposure to COVID-19 on the mortality rates increment. Methods In the present study, data on COVID-19 infected top seven countries viz., Germany, China, France, United Kingdom, Iran, Italy and Spain, and World as a whole, were used for modeling. The analytical procedure of generalized linear model followed by Gompertz link function was used to predict the impact lethal duration of exposure on the mortality rates. Findings Of the selected countries and World as whole, the projection based on 21st March, 2020 cases, suggest that a total (95% Cl) of 76 (65–151) days of exposure in Germany, mortality rate will increase by 5 times to 1%. In countries like France and United Kingdom, our projection suggests that additional exposure of 48 days and 7 days, respectively, will raise the mortality rates to 10%. Regarding Iran, Italy and Spain, mortality rate will rise to 10% with an additional 3–10 days of exposure. World’s mortality rates will continue increase by 1% in every three weeks. The predicted interval of lethal duration corresponding to each country has found to be consistent with the mortality rates observed on 28th March, 2020. Conclusion The prediction of lethal duration was found to have apparently effective in predicting mortality, and shows concordance with prevailing rates. In absence of any vaccine against COVID-19 infection, the present study adds information about the quantum of the severity and time elapsed to death will help the Government to take necessary and appropriate steps to control this pandemic

Prevalence and determinants of caesarean section in south and south-east Asian women

Background: Caesarean section is considered a relatively preferable and safe method of delivery as compared to normal delivery. Since the last decade, its prevalence has increased in both developed and developing countries. In the context of developing countries viz., South Asia (the highest populated region) and South-East Asia (the third-highest populated region), where a significant proportion of home deliveries were reported,however, the preference for, caesarean delivery and its associated factors are not well understood. Objective: To study the caesarean delivery in the South and South-East Asian countries and to determine the factors associated with the preference for caesarean delivery. Methodology: Demographic and Health Survey Data on from ever-married women of nine developing countries of South and South-East Asia viz., Vietnam, India, Maldives, Timor-Leste, Nepal, Indonesia, Pakistan, Bangladesh, and Cambodia have been considered. Both bivariate and binary logistic regression models were used to estimate the propensity of a woman undergoing for caesarean delivery and to assess the influence of maternal socioeconomic characteristics towards the preference for caesarean delivery. Results:Obtained results have shown an inclination of caesarean delivery among urban than rural women and are quite conspicuous, but is found to be underestimated mostly among rural women. Caesarean delivery in general is mostly predisposed among women whose baby sizes are either very large or smaller than average, have a higher level of education and place of delivery is private medical institutions. The logistic regression also revealed the influence of maternal socioeconomic characteristics towards the preference for caesarean delivery. Based on nine South and South-East Asian countries an overall C-section prevalence of 13%, but based on institutional births its increase to 19%. The forest plot demonstrated that a significant inclination of C-section among urban than rural regions. In Meta-Analysis, very high and significant heterogeneity among countries is observed, but confirms that in terms of prevalence of C-section all of the countries follow independent pattern. Conclusion: Study of seven urban and four rural regions of nine South and South- East Asian countries showed, a significant inclination towards the caesarean delivery above the more recent outdated WHO recommended an optimal range of 10-15%and are associated maternal socioeconomic characteristics. In order to control unwanted caesarean delivery, the government needs to develop better healthcare infrastructure and along with more antenatal care related schemes to reduce the risks associated with increased caesarean delivery

Global lockdown: An effective safeguard in responding to the threat of COVID-19

Rationale, aims, and objectives: The recent outbreak of coronavirus (COVID-19) has infected around 1,560,000 individuals till 10th April 2020, which has resulted in 95,000 deaths globally. While no vaccine or anti-viral drugs for COVID-19 are available, lockdown acts as a protective public health measures to reduce human interaction and lower transmission. The study aims to explore the impact of delayed planning or lack of planning for the lockdown and inadequate implementation of the lockdown, on the transmission rate of COVID-19. Method: Epidemiological data on the incidence and mortality of COVID-19 cases as reported by public health authorities were accessed from six countries based on total number of infected cases, viz., (United States of America (USA) and Italy (more than 100,000 cases); United Kingdom (UK), and France (50,000 to 100,000 cases), and India and Russia (6,000 to 10,000 cases).The Bayesian inferential technique was used to observe the changes (three points) in pattern of number of cases on different duration of exposure (in days)in these selected countries one month after WHO declaration about COVID-19 as a global pandemic. Results: On comparing the pattern of transmission rates observed in these six countries at posterior estimated change points, it is found that partial implementation of lockdown (in the USA), delayed planning in lockdown (Russia, UK and France), and inadequate implementation of the lockdown (in India and Italy) were responsible to the spread of infections. Conclusions: In order to control the spreading of COVID-19, like other national and international laws, lockdown must be implemented and enforced. It is suggested that on-time or adequate implementation of lockdown is a step towards social distancing and to control the spread of this pandemic

Ketamine-based sedation use in mechanically ventilated critically ill patients with COVID-19: A multicenter cohort study

Backgrounds: Ketamine possesses analgesia, anti-inflammation, anticonvulsant, and neuroprotection properties. However, the evidence that supports its use in mechanically ventilated critically ill patients with COVID-19 is insufficient. The study's goal was to assess ketamine's effectiveness and safety in critically ill, mechanically ventilated (MV) patients with COVID-19. Methods: Adult critically ill patients with COVID-19 were included in a multicenter retrospective-prospective cohort study. Patients admitted between March 1, 2020, and July 31, 2021, to five ICUs in Saudi Arabia were included. Eligible patients who required MV within 24 hours of ICU admission were divided into two sub-cohort groups based on their use of ketamine (Control vs. Ketamine). The primary outcome was the length of stay (LOS) in the hospital. P/F ratio differences, lactic acid normalization, MV duration, and mortality were considered secondary outcomes. Propensity score (PS) matching was used (1:2 ratio) based on the selected criteria. Results: In total, 1,130 patients met the eligibility criteria. Among these, 1036 patients (91.7 %) were in the control group, whereas 94 patients (8.3 %) received ketamine. The total number of patients after PS matching, was 264 patients, including 88 patients (33.3 %) who received ketamine. The ketamine group's LOS was significantly lower (beta coefficient (95 % CI): −0.26 (−0.45, −0.07), P = 0.008). Furthermore, the PaO2/FiO2 ratio significantly improved 24 hours after the start of ketamine treatment compared to the pre-treatment period (6 hours) (124.9 (92.1, 184.5) vs. 106 (73.1, 129.3; P = 0.002). Additionally, the ketamine group had a substantially shorter mean time for lactic acid normalization (beta coefficient (95 % CI): −1.55 (−2.42, −0.69), P 0.01). However, there were no significant differences in the duration of MV or mortality. Conclusions: Ketamine-based sedation was associated with lower hospital LOS and faster lactic acid normalization but no mortality benefits in critically ill patients with COVID-19. Thus, larger prospective studies are recommended to assess the safety and effectiveness of ketamine as a sedative in critically ill adult patients

Evaluation of inhaled nitric oxide (iNO) treatment for moderate-to-severe ARDS in critically ill patients with COVID-19: A multicenter cohort study

Background: Inhaled nitric oxide (iNO) is used as rescue therapy in patients with refractory hypoxemia due to severe COVID-19 acute respiratory distress syndrome (ARDS) despite the recommendation against the use of this treatment. To date, the effect of iNO on the clinical outcomes of critically ill COVID-19 patients with moderate-to-severe ARDS remains arguable. Therefore, this study aimed to evaluate the use of iNO in critically ill COVID-19 patients with moderate-to-severe ARDS. Methods: This multicenter, retrospective cohort study included critically ill adult patients with confirmed COVID-19 treated from March 01, 2020, until July 31, 2021. Eligible patients with moderate-to-severe ARDS were subsequently categorized into two groups based on inhaled nitric oxide (iNO) use throughout their ICU stay. The primary endpoint was the improvement in oxygenation parameters 24 h after iNO use. Other outcomes were considered secondary. Propensity score matching (1:2) was used based on the predefined criteria. Results: A total of 1598 patients were screened, and 815 were included based on the eligibility criteria. Among them, 210 patients were matched based on predefined criteria. Oxygenation parameters (PaO2, FiO2 requirement, P/F ratio, oxygenation index) were significantly improved 24 h after iNO administration within a median of six days of ICU admission. However, the risk of 30-day and in-hospital mortality were found to be similar between the two groups (HR: 1.18; 95% CI: 0.77, 1.82; p = 0.45 and HR: 1.40; 95% CI: 0.94, 2.11; p= 0.10, respectively). On the other hand, ventilator-free days (VFDs) were significantly fewer, and ICU and hospital LOS were significantly longer in the iNO group. In addition, patients who received iNO had higher odds of acute kidney injury (AKI) (OR (95% CI): 2.35 (1.30, 4.26), p value = 0.005) and hospital/ventilator-acquired pneumonia (OR (95% CI): 3.2 (1.76, 5.83), p value = 0.001). Conclusion: In critically ill COVID-19 patients with moderate-to-severe ARDS, iNO rescue therapy is associated with improved oxygenation parameters but no mortality benefits. Moreover, iNO use is associated with higher odds of AKI, pneumonia, longer LOS, and fewer VFDs

Survival implications vs. complications: unraveling the impact of vitamin D adjunctive use in critically ill patients with COVID-19—A multicenter cohort study

BackgroundDespite insufficient evidence, vitamin D has been used as adjunctive therapy in critically ill patients with COVID-19. This study evaluates the effectiveness and safety of vitamin D as an adjunctive therapy in critically ill COVID-19 patients.MethodsA multicenter retrospective cohort study that included all adult COVID-19 patients admitted to the intensive care units (ICUs) between March 2020 and July 2021. Patients were categorized into two groups based on their vitamin D use throughout their ICU stay (control vs. vitamin D). The primary endpoint was in-hospital mortality. Secondary outcomes were the length of stay (LOS), mechanical ventilation (MV) duration, and ICU-acquired complications. Propensity score (PS) matching (1:1) was used based on the predefined criteria. Multivariable logistic, Cox proportional hazards, and negative binomial regression analyses were employed as appropriate.ResultsA total of 1,435 patients were included in the study. Vitamin D was initiated in 177 patients (12.3%), whereas 1,258 patients did not receive it. A total of 288 patients were matched (1:1) using PS. The in-hospital mortality showed no difference between patients who received vitamin D and the control group (HR 1.22, 95% CI 0.87–1.71; p = 0.26). However, MV duration and ICU LOS were longer in the vitamin D group (beta coefficient 0.24 (95% CI 0.00–0.47), p = 0.05 and beta coefficient 0.16 (95% CI −0.01 to 0.33), p = 0.07, respectively). As an exploratory outcome, patients who received vitamin D were more likely to develop major bleeding than those who did not [OR 3.48 (95% CI 1.10, 10.94), p = 0.03].ConclusionThe use of vitamin D as adjunctive therapy in COVID-19 critically ill patients was not associated with survival benefits but was linked with longer MV duration, ICU LOS, and higher odds of major bleeding

The Clinical Efficacy and Safety of Acepromazine and Propofol Anesthesia for the Cesarean Section in the Cat

A 3-year-old crossbred cat was presented at the clinics. History revealed that the cat had sustained frequent straining for the last 12 hrs. One kitten was found stuck in the birth canal. The cat was premedicated with atropine sulphate @ 0.04 mg/kg b.wt and tranquilized with acepromazine maleate @ 0.1mg/kg b.wt. I/M, and anesthetized with propofol @ 4 mg/kg b.wt. I/V. via the cephalic vein. The abdominal region was aseptically prepared from the umbilicus to the pubis region. A ventral mid line incision of approximately 3.5 cm was made in linea alba between the umbilicus and pubis, caudally. The gravid uterus was exposed through the surgical wound. A longitudinal incision was placed on the uterine body and kittens were taken out slowly one by one. One of the kittens, which was stuck in the vaginal orifice, was taken out slowly by gently manipulating its presentation. A total of four kittens were born. The use of acepromazine and propofol anesthesia for the cesarean section in the cat proved to be an easy and excellent method without any complications. [Arch Clin Exp Surg 2012; 1(4.000): 258-260