Prevalence of Gestational Diabetes Mellitus and Pregnancy Outcomes in Women with Risk Factors Diagnosed by IADPSG Criteria at Bhumibol Adulyadej Hospital

Objective:To determine the prevalence and clinical outcomes of gestational diabetes mellitus (GDM), defined by IADPSG criteria, in pregnant women who are at risk of GDM.Study design: Descriptive study.Material and Method: We studied pregnant women who visited the antenatal clinics at Bhumibol Adulyadej Hospital between July 1, 2011 and December 31, 2012 and had risk factors of GDM. The diagnosis of GDM was defined using the IADPSG criteria. Primary outcome was the prevalence of GDM and the secondary outcomes were pregnancy related complications which included maternal and neonatal complications.Results: A total of 6,324 pregnancy women, 164 patients were diagnosed GDM. The prevalence of GDM was 2.6%. The most common clinical risk factor for GDM was age ≥30 years (75.4%). The most common maternal and neonatal complication were pregnancy induced hypertension (PIH) (12.7%) and hypoglycemia (47.6%). GDM women were significantly different from non-GDM women in PIH, primary cesarean section, hypoglycemia, Apgar <7, and NICU admission. Pregnancy outcomes between GDM A1 and A2 were significantly different. GDM A2 increased the rate of cesarean section, hypoglycemia, and NICU admission. Conclusion: Using the IADSP criteria, the prevalence of GDM was 2.6%. Compared to non-GDM regnant women, adversed pregnancy outcomes were significantly higher in GDM pregnant wome

The intensive care unit admission predicting the factors of late complications in trauma patients: A prospective cohort study

Background: Organ failure (OF) and sepsis are important causes of late death in trauma. Previous studies reported the methods that could predict OF at the time of patient arrival. However, most of the evidence is from high-income countries, where health-care systems were different from developing countries. This research aimed to identify the factors to predict late complications in trauma patients in surgical intensive care units (SICUs). Methods: This study was a secondary data analysis from the THAI-SICU study, which was a prospective cohort study in nine university-based-SICUs in Thailand. Late complications were defined as any OF or sepsis that occurred after 48 h of ICU admission. Multivariable logistic regression was conducted to identify the significant factors. Results: Three hundred and fourteen patients were eligible for the analysis. Late complications occurred in 60 patients (19). Patients who had complications had higher Acute Physiology and Chronic Health Enquiry (APACHE II) (15.8 vs. 12.4, P = 0.02) and Sequential OF Assessment (SOFA) scores on admission (6.7 vs. 3.8, P P = 0.04) and SOFA score on admission (OR = 1.2, 95% CI; 1.12-1.29, P P Conclusions: The incidence of late complications in trauma patients in the SICU was 19%. Current smoking and SOFA score might be valuable in future prediction of late complications during admission

One size does not fit all in severe infection: obesity alters outcome, susceptibility, treatment, and inflammatory response

Introduction: Obesity is an increasingly common comorbidity in critically ill patients. Whether obesity alters sepsis outcome, susceptibility, treatment, and response is not completely understood. Methods: We conducted a retrospective analysis comparing three group of septic shock patients based on the intervals of actual body mass index (BMI) in patients enrolled in the VASST (Vasopressin and Septic Shock Trial) cohort. Primary outcome measurement was 28-day mortality. We tested for differences in patterns of infection by comparing the primary site of infection and organism. We also compared the treatments (fluids and vasopressors) and inflammatory response, measuring adipose tissue-related cytokine concentrations (interleukin [IL]-6, monocyte chemotactic protein [MCP]-1, tumor necrosis factor [TNF]-α, and resistin) in plasma in a subset of 382 patients. Of the 778 patients in VASST, 730 patients who had body weight and height measurements were analyzed. Patients with BMI 30 kg/m2, n = 245) patients. Results: Obese patients had the lowest 28-day mortality followed by overweight patients while patients with BMI <25 kg/m2 had the highest mortality (p = 0.02). Compared to the patients with BMI <25 kg/m2, obese and overweight patients also had a different pattern of infection with less lung (obese 35%, overweight 45%, BMI<25 kg/m2 50%, p = 0.003) and fungal infection (obese 8.2%, overweight 11%, and BMI<25 kg/m2 15.6%, p = 0.03). Per kilogram, obese and overweight patients received less fluid during the first four days (p<0.05) and received less norepinephrine (obese 0.14, overweight 0.21, BMI <25 kg/m2 0.26 µg/kg/min, p<0.0001) and vasopressin (obese 0.28, overweight 0.36, BMI <25 kg/m2 0.43 µU/kg/min, p<0.0001) on day 1 compared to patients with BMI <25 kg/m2. Obese and overweight patients also had a lower plasma IL-6 concentration at baseline (obese 106 [IQR 34-686], overweight 190 [IQR 44-2339], BMI <25 kg/m2 235 [IQR 44-1793] pg/mL, p = 0.046). Conclusions: Overall obesity was associated with improved survival in septic shock and differences in pattern of infection, fluids, and vasopressors. Importantly, the magnitude of inflammatory IL-6 response is muted in the obese.Other UBCNon UBCReviewedFacult

Dynamic Measurement of Hemodynamic Parameters and Cardiac Preload in Adults with Dengue: A Prospective Observational Study.

Few previous studies have monitored hemodynamic parameters to determine the physiological process of dengue or examined inferior vena cava (IVC) parameters to assess cardiac preload during the clinical phase of dengue. From January 2013 to July 2015, we prospectively studied 162 hospitalized adults with confirmed dengue viral infection using non-invasive cardiac output monitoring and bedside ultrasonography to determine changes in hemodynamic and IVC parameters and identify the types of circulatory shock that occur in patients with dengue. Of 162 patients with dengue, 17 (10.5%) experienced dengue shock and 145 (89.5%) did not. In patients with shock, the mean arterial pressure was significantly lower on day 6 after fever onset (P = 0.045) and the pulse pressure was significantly lower between days 4 and 7 (P<0.05). The stroke volume index and cardiac index were significantly decreased between days 4 and 15 and between days 5 and 8 after fever onset (P<0.05), respectively. A significant proportion of patients with dengue shock had an IVC diameter <1.5 cm and IVC collapsibility index >50% between days 4 and 5 (P<0.05). Hypovolemic shock was observed in 9 (52.9%) patients and cardiogenic shock in 8 (47.1%), with a median (interquartile range) time to shock onset of 6.0 (5.0-6.5) days after fever onset, which was the median day of defervescence. Intravascular hypovolemia occurred before defervescence, whereas myocardial dysfunction occurred on the day of defervescence until 2 weeks after fever onset. Hypovolemic shock and cardiogenic shock each occurred in approximately half of the patients with dengue shock. Therefore, dynamic measures to estimate changes in hemodynamic parameters and preload should be monitored to ensure adequate fluid therapy among patients with dengue, particularly patients with dengue shock

Baseline characteristics, clinical parameters, laboratory parameters, and outcomes among 162 hospitalized adults with dengue, subdivided by patients with and without dengue shock.

<p>Baseline characteristics, clinical parameters, laboratory parameters, and outcomes among 162 hospitalized adults with dengue, subdivided by patients with and without dengue shock.</p

Daily cumulative fluid balance (mL) by day after fluid therapy among patients with and without dengue shock.

<p>Daily cumulative fluid balance (mL) by day after fluid therapy among patients with and without dengue shock.</p

Inferior vena cava parameters by day after fever onset among patients with and without dengue shock.

<p>(A) A Bland-Altman plot of data from the intraobserver reliability study. The mean IVCdmax (cm) of each patient was plotted against the difference in IVCd (cm) between two measurements (811 measurements each) obtained by the same observer. (B) A Bland-Altman plot of data from the intraobserver reliability study. The mean IVCdmin (cm) of each patient was plotted against the difference in IVCd (cm) between two measurements (811 measurements each) obtained by the same observer. (C) IVCd (cm) after fever onset among patients with and without dengue shock (D) IVCc (%) after fever onset among patients with and without dengue shock. IVCc = Inferior vena cava collapsibility index; IVCd = inferior vena cava diameter; IVCdmax = maximum inferior vena cava diameter; IVCdmin = minimum inferior vena cava diameter; LLA = lower limit of agreement; NA = not applicable; ULA = upper limit of agreement.</p

Hemodynamic parameters by day after fever onset among patients with and without dengue shock.

<p>(A) MAP (mmHg) after fever onset among patients with and without dengue shock. (B) PP (mmHg) after fever onset among patients with and without dengue shock. (C) HR (beats/min) after fever onset among patients with and without dengue shock. (D) CI (L/min/m²) after fever onset among patients with and without dengue shock. (E) TPRI (dynes∙sec/cm⁵/m²) after fever onset among patients with and without dengue shock. (F) SVI (mL/m²/beat) after fever onset among patients with and without dengue shock. CI = cardiac index; HR = heart rate; MAP = mean arterial pressure; NA = not applicable; PP = pulse pressure; SVI = stroke volume index; TPRI = total peripheral resistance index.</p

Change in hematocrit (Hct) from baseline (%) by day after fever onset among patients with and without dengue shock.

<p>Change in hematocrit (Hct) from baseline (%) by day after fever onset among patients with and without dengue shock.</p