ABSTRACT
Aims and Objectives: Patients with pulmonary thromboembolism (PTE) are commonly admitted to hospital and generally have a prolonged hospital stay in this part of the world. We aimed to determine different clinical and laboratory parameters that are associated with prolonged hospital stay in our set-up and to analyse effectiveness of Pulmonary Embolism Severity Index (PESI) score as a predictor of prolonged hospital stay in patients with PTE. Materials and Methods: It was a hospital based observational prospective study. Confirmed cases of PTE defined as patients with evidence of thrombus on CT pulmonary angiogram (CTPA) were included in this study. Depending on the length of hospital stay, patients were divided into two cohorts: Shorter Hospital stay (less than mean i.e., < 10 Days) and Prolonged Hospital stay (longer than mean i.e., ? 10 Days). Logistic regression analysis was done to identify predictors of prolonged hospital stay. Results: 150 patients were included in the study with 67 patients (44.67%) having shorter hospital stay (<10 days) and 83 patients (55.33%) having prolonged hospital stay (?10 days). On multivariate regression analysis, parameters that were found to be statistically significant were hypotension at presentation, decreased level of consciousness, pco2 < 30 mmHg, presence of S1Q3T3 pattern on electrocardiogram (ECG) and high risk PESI (class III-V). Conclusion: PESI class can be effectively used to predict prolonged hospital stay in patients with pulmonary embolism. Patients with hypotension at presentation, decreased level of consciousness, pco2 less than 30 mmHg, and S1Q3T3 on ECG are more likely to have prolonged hospital stay in our healthcare setup.
ABSTRACT
Background: The outbreak of coronavirus disease 2019 (COVID-19) caused by novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) began in China, in December 2019, and was declared a pandemic by WHO on March 11, 2020. The treatment is evolving and is mostly supportive in nature. Material and methods: This was a single-center retrospective study that included confirmed COVID-19 cases treated at our institute (a tertiary care hospital in Jammu and Kashmir, India), between March 2020 and December 2020. Patients with age more than 18 years were included in the study. Results: On evaluating the effect of various drug therapies used in management of COVID-19 patients of all severity, use of remdesivir and famotidine was associated with significantly higher odds of survival. In subgroup of patients with severe disease, use of systemic steroids was associated with significantly higher odds of survival in addition to remdesivir and famotidine. In patients with severe COVID-19 illness, likelihood of survival was significantly higher in those who received combination of systemic steroids plus remdesivir compared to steroids and remdesivir alone. Conclusion: Steroids were effective in severe COVID-19 illness and the combination of steroids and remdesivir was more effective in severe illness. There is a need to undertake more large scale prospective randomized trials to determine the most effective drug therapies to treat the sick patients and prevent worsening of mild cases.
ABSTRACT
COPD is a growing global threat considering its increasing prevalence, morbidity and mortality. The only modality of treatment that has been proven to alter the late course of this disease is the long term oxygen therapy (LTOT). Considering that an increasing number of COPD patients are getting a prescription of LTOT, this study was done to recognize the common barriers that prevent its adequate compliance.METHODSA pre-set questionnaire was administered to patients and their caregivers regarding LTOT prescription, compliance to LTOT and reasons for their poor compliance to LTOT.RESULTS58 COPD patients included in the study completed the questionnaire. Only 12 (21.4%) patients used the recommended oxygen for more than 15 hours per day to give them the therapeutic benefit. 21 (37.5%) patients received recommended advice for the duration of using supplemental oxygen each day from their treating physicians. None of the patients received education about the correct use of using oxygen therapy at home.CONCLUSIONSOxygen usage among patients who have been prescribed home oxygen therapy is far from optimal, and both patient and physician related factors are responsible for it. Thus, the knowledge of major factors responsible for poor compliance of LTOT stresses upon the need for proper education of the treating physician and proper advice and counselling for this treatment modality at the time of prescription, for the patient.