Nutrition Characteristics and Delivery in Relation to 28-day Mortality in Critically Ill Patients

@#Introduction: The limited data regarding nutrition characteristics and the delivery of critically ill patients in South Asia is intriguing. This study was conducted to investigate the nutrition characteristics and delivery in relation to 28- day mortality in mechanically ventilated patients. Methods: This prospective observational study was conducted in the intensive care unit (ICU) of the Maldives government referral hospital. Data about nutrition characteristics and delivery were collected from the ICU charts, and each patient was followed for a maximum of 28 days. Results: We recruited a total of 115 patients (mean age: 61.57±17.26 years, 52% females, mean BMI: 25.5±6.19kg/m2), of which 61 (53%) of them died within 28 days of ICU admission. Mean energy intake was 681.15±395.37 kcal per day, and mean protein intake was 30.32±18.97g per day. In the univariate logistic regression analysis, length of stay in ICU (OR = 0.950, 95% CI: 0.908 – 0.994, p = 0.027), and received intervention by a dietitian (OR = 0.250, 95% CI: 0.066 – 0.940, p = 0.040) were associated with 28-day mortality. None of the factors in the multivariate regression analysis remains significant when adjusted for sex, SOFA total score, daily energy and protein dosage. Conclusion: 28-day mortality was much higher in this study than in similar studies in South Asia, Asia and around the globe. None of the variables was significantly associated with 28-day mortality in the multivariate logistic model. However, there was a trend towards higher mortality for patients with shorter length of stay in the ICU, larger mean gastric residual volume, and no intervention by a dietitian.

Epidemiological evaluation and outcome of pure abdominal trauma victims who underwent surgical exploratory laparotomy

Objective: The aim of this study was to evaluate the epidemiological profile, surgical treatment, andoutcome of patients suffering from pure abdominal injuries who underwent exploratory laparotomy in the emergency department of Aswan University Hospital, Egypt

Patients and methods: This was an evaluation and assessment of observational and descriptive study with prospective approach through interviews of 80 patients with pure abdominal trauma who were subjected to surgical treatment in the form of exploratory laparotomy and evaluation of their medical records

Results: The most affected individuals were male patients younger than 49 years, most of them withlow educational level and single. There was a predominance of trauma in the rural areasthat mostly occurred at night time and evening. Blunt trauma was the most common type of abdominal trauma, and road traffic accidents were the most frequent mechanism of trauma.The upper abdomen was the most affected region. Pain was the most common presenting symptom, and the spleen was the most affected organ. The hospital stay ranged from 1 to11 days. Most patients were discharged with permanent sequelae; there were six deaths

Conclusion: Blunt trauma was the most common type of abdominal injury. Road traffic accidents were themost common mechanism of blunt trauma, and stab wounds were the most common type of penetrating injuries. A number of risk factors were identified in this study, which include the type of abdominal trauma, presence of chronic diseases, delay in early transport from the siteof trauma to the emergency department, and age of patient. Despite the magnitude of traumas,the outcome was satisfactory

Prognostic indicators in patients with relapsing remitting multiple sclerosis

Background: Multiple sclerosis inflammation demyelinating disease of the central nervous system affecting nearly 2 million people worldwide. Multiple sclerosis typically begins in early adulthood and has a variable prognosis

Objective: To determine the factors that affects the prognosis in Iraqi patients with relapsing remitting multiple sclerosis

Patients and Methods: This study includes fifty patients with relapsing remitting MS and was conducted from March 2007 to July 2008in Baghdad Teaching Hospital MS clinic. A study protocol sheet was done and filled from the patient's database in the MS clinic. The Prognostic indicators of residual disabillity depends on the [EDSS]

Results: The mean age for the study sample was 45-58 years, with 27 male and 23 female. High percentage of patients represented as monosymptomatic [70%], most of symptoms was spinal [48%]. The mean value for relapses was 2.3 with maximum number of 6. The study shows that there is no significant effect of gender as a prognostic indicators on the residual disabillity of patient with relapsing remitting multiple sclerosis. There is significant correlation between the age at CDMS and the EDSS in the first visit [SDSSI]

Conclusion: we concluded that the older age at onset, pyramidal and sphincteric involvement at the beginning of the illness and more relapses in the first 2 years of the illness all are associated with poor prognosis.

Epicardial fat thickness obese patients an observational echocardiographic study

Obesity currently affects nearly one-third of the population in the industrialized world. Traditionally, anthropometric measures such as body mass index [BMI] or waist circumference have been used to quantify overall adiposity; however, regional fat depots may be of greater importance than overall adiposity. Several studies have highlighted pericardial fat and abdominal visceral adipose tissue [VAT] as unique, pathogenic fat depot. Recognize the relation of obesity to increase epicardial fat pad thickness in Iraqi patients. Epicardial fat thickness was measured in 62 consecutive subjects [28 women 45%, 34 men 55%] mean age of 47.77 years [SD 8.03], using routine transthoracic echocardiogram. Epicardial fat was identified as the echo-free space between the outer wall of the myocardium and the visceral layer of the pericardium, and its thickness was measured perpendicularly on the free wall of the right ventricle at end-systole. The results show progressive increase of epicardial fat with increasing BMI which was very significant statistically. High mean epicardial fat is significantly associate with increasing waist circumference. No difference in those below and above 45 years of age in mean epicardial fat and there is gender difference in epicardial fat, where males had more epicardial fat than females. There is increase in the epicardial fat pad thickness in overweight and obese [BMI >/= 25] patients if compared to normal persons epicardial fat increase with increasing waist circumference more likely in male obese and independent on age.

Whether selective or routine episiotomy is more useful to protect anal sphincter in primiparous women

Perineal trauma is a common event, affecting up to 90% of first time mothers. It is a cause for concern for many women and in some countries has led to a large increase in the numbers of women requesting elective caesarean section. To highlight when episiotomy can be useful in preventing anal sphincter injury in primiparous women. This study is a prospective interventional clinical study conducted at AL-Elwiya Maternity Teaching Hospital in Baghdad throughout the period between Jan. 2009-Dec. 2009. Three hundred term primiparous ladies at time of their delivery with cephalic presentation were collected and subdivided into 3 equal groups randomly. The first group, women who were subjected to routine mediolateral episiotomy, while the second group of the participants were delivered without doing episiotomy, and the third group, a mediolateral episiotomy was done selectively to them when we found it is necessary [selective episiotomy]. State of the perineum, length of 2[nd] stage, weight of the baby, fetal head position and the occurrence of anal sphincter injury were all notified and carefully recorded on special form designed for the study. Selective episiotomy was found to be more useful than routine episiotomy in preventing anal sphincter injury [the incidence of anal sphincter injury was 2% for those in whom episiotomy was performed selectively, while it is 8% for those with routine episiotomy and 7% for those delivered without episiotomy], and the difference is statistically significant [P value 0.045]. There was a significant effect of the length of second stage of labour on the incidence of anal sphincter injury [P value 0.017], similarly for the weight of baby [P value 0.017]. Selective episiotomy is more useful intervention than routine episiotomy in protecting the anal sphincter when delivering a primiparous lady

Whether selective or routine episiotomy is more useful to protect anal sphincter in primiparous women

Perineal trauma is a common event, affecting up to 90% of first time mothers. It is a cause for concern for many women and in some countries has led to a large increase in the numbers of women requesting elective caesarean section. To highlight when episiotomy can be useful in preventing anal sphincter injury in primiparous women. This study is a prospective interventional clinical study conducted at AL Elwiya Maternity Teaching Hospital in Baghdad throughout the period between Jan. 2009-Dec. 2009. Three hundred term primiparous ladies at time of their delivery with cephalic presentation were collected and subdivided into 3 equal groups randomly. The first group, women who were subjected to routine mediolateral episiotomy, while the second group of the participants were delivered without doing episiotomy, and the third group, a mediolateral episiotomy was done selectively to them when we found it is necessary [selective episiotomy]. State of the perineum, length of 2[nd] stage, weight of the baby, fetal head position and the occurrence of anal sphincter injury were all notified and carefully recorded on special form designed for the study. Selective episiotomy was found to be more useful than routine episiotomy in preventing anal sphincter injury [the incidence of anal sphincter injury was 2% for those in whom episiotomy was performed selectively, while it is 8% for those with routine episiotomy and 7% for those delivered without episiotomy], and the difference is statistically significant [P value 0.045]. There was a significant effect of the length of second stage of labour on the incidence of anal sphincter injury [P value 0.017], similarly for the weight of baby [P value 0.017]. Selective episiotomy is more useful intervention than routine episiotomy in protecting the anal sphincter when delivering a primiparous lady

Evaluation of different teaching methods on the student's skill performance in measuring blood pressure for 2[nd] year nursing students at King Abdul Aziz University

Blood pressure measurement is an important clinical nursing skill however, errors in measuring blood pressure occur often. The aim of this study was to evaluate different teaching methods on blood pressure measurement skill performance and to identify the effect of different teaching methods on the acquired skills after 3 months period. The study conducted at King Abdul Aziz University. Faculty of Applied Medical Science, Nursing Department. The students were divided into 3 groups three different methods of teaching were used. Video were used in group [A] Demonstration were used in group B and both of this methods were used for group C. The results of this study revealed that in the first assessment, after immediate evaluation there was a significant difference between group A and B and between A and C. During late evaluation it showed that demonstration was the best between the three groups. This study recommended that demonstration learning during clinical placement is still considered the best method for teaching the undergraduate students

Complications of pre-term infants in the neonatal unit

To assess the complications of preterm infants in neonatal intensive care unit and compare that with those faced by preterm infants in western neonatal intensive care unit. A prospective comparative study. This study was conducted at Paediatrics Department, Shaikh Zayed Hospital Lahorefrom 1[st] December 1997 to 30[th] November 1998. All neonates delivered before 37 weeks and admitted to the neonatal Intensive care unit [NICU, SZH] were included in the study. It was a prospective study conducted over a period of one year from 1[st] December 1997 to 30[th] November 1998. The study population included 170 preterm neonates. For the purpose of study, these infants were divided into three gestational age groups i.e. < 30 weeks gestational age, 30 to 35 weeks gestational age, and > 35 weeks gestational age. These neonates were then prospectively followed till discharge from NICU. Out of the 170 preterm infants admitted to NICU, 128 infants survived and were discharged under stable conditions, while 42 infants expired. Maximum number of complications and highest mortality i.e. 87% was seen among the most premature group, i.e. below 30 weeks gestational age. Mortality in the gestational age group 30 to 35 weeks was 43%, while it was 9% in the gestational group >35 weeks

Rhinological manifestations of Wegener's granulomatosis in Pakistani patients

To assess the rhinological manifestations in Pakistani patients and early diagnosis of Wegener's Granulomatosis. Case Series. This study was conducted at ENT Department of CMH Rawalpindi in collaboration with Rheumatology Department of Military Hospital Rawalpindi, Pakistan Institute of Medical Sciences Islamabad and Fauji Foundation Hospital from March 2005 to January 2009. In this study 20 adult patients reporting to these hospitals were included according to inclusion criteria. All were c-ANCA positive. Both males and female were included. The condition was more common in males than females 3:2]. All the patients were followed regularly and c-ANCA titres were used to monitor disease activity in these patients. The age range at presentation was between 20 to 65 years. Rhinological features were present in 16 [80%] of our patients. These patients presented with the symptoms of epistaxis, nasal discharge, nasal obstruction, postnasal drip, anosmia and septal perforation. There [15%] patients had chronic supporative otitis media. They were initially treated by ENT specialists and an alternative diagnosis was suspected only when they failed to respond to conventional treatment or developed other complaints like haemoptysis, and renal impairment. Nasal biopsy was done in 7 patients. It showed necrotizing vasculitis with evidence of granuloma formation in 4 cases while the rest of cases showed chronic non specific inflammation. Evaluation of rhinological features have significant role in the early diagnosis of Wegener's Granulomatosis

Tuberculosis of the tongue clinically masquerading as a neoplasm: a case report and literature review

Tuberculosis of the tongue is a very rare event even in areas and countries in which tuberculosis is endemic. The disease can present itself in a variety of clinical appearances, most of which may mimic malignant lingual neoplasms clinically. In this case, we present a patient who initially complained of an ulcerated lingual swelling, which was suspected to be a squamous cell carcinoma on clinical examination. In addition, the diagnosis was missed on the first and initial biopsy as it was not representative of the lesion. The diagnosis of lingual tuberculosis was made by histopathology on a second biopsy. In this article, we described the clinicopathological features of tuberculous glossitis with a comparison between our case and other similar reported cases in addition to a literature review

Compliance issue in type ii diabetes: does it reduce the prevalence of cardiovascular risk factors?

Type 2 diabetes, which is the most common form of diabetes, has an alarming increasing rate. It is a recognized risk factor for cardiovascular disease [CVD]. Non-compliance with healthy life styles, anti-diabetic drugs and diet are the central issues in patient's management as it might synergist other CVD risk factors. The aims of this study were to find out the compliance, prevalence of CVD risk factors, and any association between them in type 2 diabetic patients. A cross-sectional design and a convenient sample of 820 diabetic patients were used in conducting this study for the period from the 1st October, 2006 to 31st December, 2008. A Structured questionnaire was used to collect demographic information from the patients. 10 questions were used to determine the patient's compliance. The classic risk factors; obesity, hyperglycemia [HG], hypertension [HT], and hypercholesterolemia [HC], have been studied for each patient and compared with his/her compliance to find any association. The results of this study revealed that there were only 187 out of 820 [22.80%] with good compliance and 297 [36.22%], 336 [40.98%] patients with fair and poor compliance respectively. The prevalence of obesity, over weight, uncontrolled HG, HT [systolic, diastolic or both] and presence of HC in our diabetic patients were 27.32%, 36.83%, 51.95%, 40.73 and 30.37 respectively. Good compliance was associated significantly with normal body weight, controlled HG, absence of HT, and absence of HC. The study concluded that less than one third of our diabetic patients had good compliance. CVD risk factors are prevalent among them, and this prevalence is associated significantly with the level of compliance. Understanding the reasons behind these forms of non-compliance is an important key to the successful development of potential program to decrease the CVD risk factors and associated complications

Frequency of HCV seropositivity and its association to risk factors among healthy blood donors reporting to blood bank at Bahawal Victoria hospital-Bahawalpur

The study was carried out to assess the frequency of HCV sero-positivity and to see the risk factors associated with it. This is a cross-sectional descriptive study, conducted at Blood Bank in Bahawal Victoria Hospital. Bahawalpur. The study was done from July to December 2008. One hundred [100] healthy blood donors of either sex, age between 18 and 50 years, who reported for blood donation were enrolled for this study through convenience sampling method [non-probable technique]. Persons with high blood pressure and H/O previous major surgeries were excluded. The anti-H.C.V. one step Hepatitis "C" Antigen Test Device, a rapid chromatographic immunoassay for the qualitative detection of Hepatitis "C" Antigen in serum or plasma-was used. Data were recorded in the structured Performa for further processing of data. Results were compiled by using SPSS [version 12.0] and Microsoft office to process the data. Most [94%] of the healthy, volunteer blood donors were male. Out of 100 subjects, eight [8%] were found to be HCV sero-positive. The independent risk factors associated with HCV sero-positive cases were post-transfusion history of jaundice, history of surgery, dental procedures, needle prick accidents, sexual promiscuity, tattooing, intravenous drug use and razor and scissors sharing. The frequency of HCV sero-positivity among the healthy blood donors is 8% which is quite high and alarming. Most of the risk factors associated with it involve parenteral route of viral transmission

Mothers knowledge, attitude and practice toward immunization against poliomyelitis among children up to 5 years age in Dar Saad District. Aden 2005

This work was conducted with the principal objective of contributing to the study of the accomplishment of the immunization coverage against poliomyelitis in Dar Sad district, Aden Governorate, the knowledge, attitude and practice related to this problem and the socioeconomic factors influencing it. A sample of 180 children under the age of five years was studied using stratified, cluster and random sampling methods. A closed type questionnaire was used and filled by the researcher during the interview of the mother of each selected child. An over all evaluation of the accomplishment of the immunization programs in Dar Sad district was made. The results showed a coverage level of 85% receiving complete vaccination, 12% receiving incomplete vaccination and 3% without vaccination. The drop out rate was 12.6% .The main causes for discontinuation and not doing the vaccination, and related factors to these problems were identified. Some factors were determined as strong as relationship between the educational level of both the mother and the father and the immunization coverage of children. Other influencing factors were; giving credit to rumors, no faith in immunization and ignorance of the importance of returning for the second and the third dose, prevalence of false contraindication to vaccinations among some mothers. Recommendations for increasing the rate of vaccination coverage and decreasing the drop out rate were proposed in order to improve the immunization against poliomyelitis and other types of vaccines in the future and meet the goals stated by the World Health Organization

Attitude of male toward contraceptive methods in Aden governorate, 2004

Family planning has direct relation with women's and children's health in developing countries, though important efforts have been done since the 1970's establishing MCH centers in urban and rural areas to achieve the objectives of the family planning program in accordance with the global goal of [Health for all by the year 2000]. Still the family planning services are neither sufficient nor adequately accessible. The performance of family planning program in Aden governorate and some related social factors are evaluated through this study of Knowledge, Attitude and Practice of contraception among male living in Aden. The interview of a random sample of 1080 men in all directorate of Aden governorate is made with a confidence of 95% and 3% allowable error, considering [p.q]:= [0.5 x 0.5] as the highest possible variability. The results showed that 33.3% [353 from 1060] of men were not using contraceptive method, higher in Seera 44.7, in non workers, and decrease by level of education, the main reasons for not use is because they want more children, although the percentage of men who consider not use because religion prohibition is high, and the preferable method was considered the pills, followed by breastfeeding. The conclusion is that the attitude toward contraception is considered favorable

role of hyperlipidemia on nerve conduction

Previous reports suggested a relationship between hyperlipidemia and neuropathy as a cause of focal neuropathy or generalized poly-neuropathy. Only few cases were reported and they are often involved individuals with other illnesses which cause neuropathy, such as diabetes mellitus, hypertension, hyperuricemia and fatty liver. To study the association of peripheral neuropathy with hyperlipidemia and to detect the type of peripheral neuropathy and its distribution. Prospective study. Neurophysiology unit in Basra teaching hospital and the department of physiological chemistry, College of Medicine, University of Baghdad. Sixty-eight patients [38 males and 30 females] aged 25-77 years with a mean age of [48.9 +/- 13.5] years. Forty-two healthy subjects [24 males and 18 females] of matching age were enrolled as control. Biochemical investigations included lipid profile, post parandial blood glucose, blood urea, serum creatinin and uric acid. Electrophysiological investigations included: 1. Sensory nerve conduction study: measurement of sensory latency, amplitude and conduction velocity of median, ulnar, common peroneal and posterior tibial nerves bilaterally. 2. Motor nerve conduction study: measurement of latency amplitude and conduction velocity of the CMAP of median, ulnar, common peroneal and posterior tibial bilaterally. 3. F-wave conduction study: measurement of minimal f-wave latency and conduction velocity of median and common peroneal nerves bilaterally. The result of the sensory nerve conduction study revealed variable levels of significance between measured parameters of the same nerve and between different nerves. As for the motor nerve conduction study and f-wave conduction study, they were all normal and with no abnormality that could be elicited. Hyperlipidemia could be associated with subclinical peripheral neuropathy which may occur more frequently in patients with very high levels of TG, TC and LDL. The type of peripheral neuropathy that occurs is mainly a sensory type, although motor neuropathy cannot be excluded

Compliance behavior of type II diabetic patients attending the specialized center of endocrinology and diabetes in Baghdad

Diabetes mellitus [DM] is a chronic illness that requires continuous medical care to prevent acute and long-term complications. It is an emerging clinical and public health problem. It has been reported that 10.4% of the Iraqi population has been diagnosed as having diabetes. Non-compliance with anti-diabetic drugs and diet are the central issues in patient's management, as it reduces the efficacy of treatment. It also adds considerably to the long term complications of the disease. The aim of this study was to find out the compliance of diabetic patients attending the Specialized Center for Endocrinology and Diabetes [SCED] in Baghdad and assess any association between the compliance and different clinico-epidemiological variables of the patients. A cross-sectional design and a convenient sample was used in conducting this study for the period from the 1[st] October 2006 to the 31[st] July 2007. Three-hundred forty diabetic patients [type II DM] attended the SCED were studied [who had registered in the Center at least one year earlier]. A structured questionnaire was used to collect information from the patients and their files. Modified criteria and scale was used to determine the patient's compliance and its association with different variables. The results of this study revealed that there were only 22 out of 340 [6.47%] patients with excellent compliance, 62 [18.24%] patients with good compliance and 256 [75.29%] patients with fair and poor compliance. There was a statistically significant association of compliance with age, gender, marital status, number of children, level of education, body mass index, smoking, duration of the disease, and the presence of complications. There was no significant association of compliance with occupation and owning a house. The study concluded that most of the diabetic patients [75.29%] had fair and poor compliance which is a high and alarming proportion that may lead to more complications among our patients and hence more burdens on the health system

Deliberate self harm and the surgeon: report of two cases

Deliberate Self Harm [DSH], formerly known as parasuicide, is commonly diagnosed in hospital emergency rooms, typically presenting with self poisoning and less often with self induced lacerations mostly of the wrists and forearms. We report two cases of atypical presentation that posed a diagnostic challenge for the surgeons in our hospital and discuss the epidemiology, psychopathology and treatment options