ASSESSMENT OF METERED DOSE INHALER TECHNIQUE IN PATIENTS WITH CHRONIC LUNG DISEASE AT TERTIARY HEALTH CARE CENTRE

Introduction: Bronchial asthma and chronic obstructive airway disease are the two most common chronic lung diseases encountered at C.U.Shah Medical College. The treatment usually includes the use of bronchodilators and steroids, which are best, delivered through the inhalational route. Metered-dose inhalers are routinely prescribed for this purpose. Metered dose inhalers (MDIs) are an affective modality of treatment for fast relief from asthma flare-ups and other symptoms, and are often used by asthmatic athletes. It has got lots of benefits and some drawbacks depending on usage technique. With proper technique and training drawbacks can be minimized. The aim of this study was to assess the metered dose inhaler technique in patients with chronic lung disease at our hospitals. Method: A cross sectional study was conducted at a Tertiary Health care centre. The inhalation technique was assessed in six steps. Result: Clear evidence showed that only 28% patient could perform all the steps correctly. Percentages of people that followed individual steps properly were: preparation (90%), exhalation (55%), lip closure (70%), inhalation (58%), breath-holding (30%) and puff interval (38%). Conclusion: This study showed that a number of patients in our hospitals were unable to use metered-dose-inhaler properly and therefore indicates the need to make people aware of this technique either by counseling or arranging seminars

Outcomes of cardiac arrest hospitalizations in patients with obesity with versus without prior bariatric surgery status:A nationwide propensity-matched analysis

Introduction: Prior bariatric surgery (PBS) status in obese patients is thought to curtail the risk of cardiovascular events, but its role in change of outcomes of patients with obesity developing new acute cardiac events such as cardiac arrests (CA) remains largely unknown. Methods: Hospitalizations among adult patients with obesity and CA were identified retrospectively using the National Inpatient Sample (2015 October-2017 December). Propensity-matched analysis (1:1) was performed for sociodemographic/hospital characteristics to identify two cohorts, with (PBS+) or without (PBS-) status. The primary endpoint was in-hospital mortality, and the secondary endpoint was healthcare resource utilization. Results: Both cohorts (n = 1275 each), had patients with comparable age (mean 58 years), with a higher frequency of white (>70 %), females (>60 %), and Medicare enrollees (>40 %). PBS + cohort had lower rates of diabetes (27.8 % vs 36.1 %), hyperlipidemia (33.7 % vs 48.6 %), renal failure (17.3 % vs 22.0 %), chronic pulmonary disease (11.8 % vs 21.2 %) and higher rates of anemias (18.4 % vs 12.2 %), liver disease (5.1 % vs 2.4 %) and alcohol abuse (6.7 % vs 2.4 %) than PBS- cohort (p < 0.05). All-cause mortality (46.3 % vs 45.1 %, p = 0.551) was comparable between the two cohorts. The PBS + cohort was less often transferred routinely (p<0.001) but had a shorter hospital stay (p<0.001) with equivalent hospital charges compared to the PBS- cohort. Conclusions: The PBS status (regardless of chronology) did not increase survival in CA admissions among patients with obesity. Preventive measures are necessary to manage enduring cardiovascular disease risk factors that may limit the advantages of surgery for patients with obesity and aggravate the worse outcomes of future cardiac events

Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic

Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality