The Epidemiology of Intensive Care Unit Readmissions and Proposed Discharge Protocol for a Tertiary Care Hospital

Background: Intensive Care Unit (ICU) readmissions during the same hospitalization are associated with increased hospital stays, morbidity and mortality. Whereas mortality rates in patients admitted to the ICU for the first time may range from 10 to 20% depending on various factors, readmission mortality rates can be up to 50 to 70%. Factors leading to readmission in ICU in Indian Armed Forces Hospitals have not been well studied till date. Methods: This was a record based cross sectional descriptive study conducted at the ICU of a tertiary care Armed Forces hospital. Demographic and clinical data of ICU patients were analysed. ICU admission and discharge data for the duration of last three years were acquired from admission and discharge registers and Hospital Informatics system (HIS) software. The primary outcome was readmission rates to ICU during the same hospitalization. Secondary outcomes included diagnosis at time of index admission (first time admission) to ICU and at readmission, multiple readmissions to ICU and mortality rates in readmitted patients. Results: There were 3021 admissions to the ICU during the study period. 422 patients succumbed to illness during initial admission resulting in a mortality rate of 14%. 198 patients were readmitted to the ICU. The readmission rate to the ICU was 7.8%. The mortality rate in readmitted patients was 31% as compared to the ICU mortality rate of 14%. The triggering factors for readmission were usually respiratory or cardiac decompensations. Conclusion: Readmission to ICU occurred in about 7.8 % of all ICU patients in our study. ICU readmissions increase the risk of adverse outcomes. Objective measures in the form of a discharge protocol incorporating the stability and work index for transfer (SWIFT Score) may help minimizing readmission to ICU. Such protocols must be in place while shifting any patients from ICU so as to improve outcomes in patients of tertiary care hospitals.

Bilateral Brenner tumor of ovary with associated unilateral mucinous cystadenoma: a case report

Brenner tumors are rare ovarian tumors, which are a subgroup of transitional cell tumors of ovary. Most of these tumors are benign presenting as incidental unilateral masses in postmenopausal age group. Only 5-7% cases are bilateral. These tumors are mostly small, solid and asymptomatic, seen commonly in association with mucinous cystadenomas of ovary. In such cases they may attain a massive size. Specific diagnosis of Brenner tumor is difficult using imaging studies and can be definitely diagnosed only on pathological examination. Surgical removal is usually curative for benign tumors. We present a rare case of bilateral Brenner tumor of ovary with associated unilateral mucinous cystadenoma in which bilateral Brenner tumor was a rare incidental finding on pathological examinatio

Hemoglobin E genotypes and fertility: a study among the Ahom of Upper Assam, India.

Background: Differential fertility is reported in areas where prevalence of hemoglobin E (Hb E) is high. At this backdrop a representative Ahom sample from Upper Assam is studied to examine if differential fertility exist between Hb E and normal Hb A mothers and whether there is significant difference between them with regard to the hemoglobin (Hb) concentration. Methods: Detailed reproductive histories are collected from 119 Ahom couples followed by Hb typing by ‘Cellulose Acetate Gel’ electrophoresis (pH 8.9) and fetal hemoglobin (Hb F) determined by Acid Elution technique. Hb concentration (in g/dl) is measured by Sahley’s method. Results: The calculated Hb E allele frequencies for the Ahom male and the female subjects are 0.424 and 0.403 respectively. β-carrier frequency in the total sample is found to be 0.42%. There is no differential fertility observed between Hb A/Hb A (AA), Hb A/Hb E (AE) and Hb E/Hb E (EE) mothers. Reproductive performance of the couples revealed that the mothers with an Hb E complement either heterozygous or homozygous are more likely to have a spontaneous abortion or an infant mortality. Conclusions: It may be concluded that Hb E induced anemia may increase spontaneous abortion and infant mortality in AE and EE mothers.

Arsenic contamination in groundwater: a global perspective with emphasis on the Asian scenario.

The incidence of high concentrations of arsenic in drinking-water has emerged as a major public-health problem. With newer-affected sites discovered during the last decade, a significant change has been observed in the global scenario of arsenic contamination, especially in Asian countries. This communication presents an overview of the current scenario of arsenic contamination in countries across the globe with an emphasis on Asia. Along with the present situation in severely-affected countries in Asia, such as Bangladesh, India, and China, recent instances from Pakistan, Myanmar, Afghanistan, Cambodia, etc. are presented.

An eight-year study report on arsenic contamination in groundwater and health effects in Eruani village, Bangladesh and an approach for its mitigation.

Based on several surveys during 1997-2005 and visits of a medical team to Eruani village, Laksham upazila, Comilla district, Bangladesh, the arsenic contamination situation and consequent clinical manifestations of arsenicosis among the villagers, including dermatology, neuropathy, and obstetric outcome, are reported here. Analysis of biological samples from patients and non-patients showed high body burden of arsenic. Even after eight years of known exposure, village children were still drinking arsenic-contaminated water, and many of them had arsenical skin lesions. There were social problems due to the symptoms of arsenicosis. The last survey established that there is a lack of proper awareness among villagers about different aspects of arsenic toxicity. The viability of different options of safe water, such as dugwells, deep tubewells, rainwater harvesting, and surface water with watershed management in the village, was studied. Finally, based on 19 years of field experience, it was felt that, for any successful mitigation programme, emphasis should be given to creating awareness among villagers about the arsenic problem, role of arsenic-free water, better nutrition from local fruits and vegetables, and, above all, active participation of women along with others in the struggle against the arsenic menace.