Perioperative glycemic control and its outcome in patients following open heart surgery

Background: Diabetes is not uncommon in patients requiring cardiac surgery. These patients have a higher incidence of morbidity and mortality. Subsequently, diabetes represents a major medico-economic problem in both developed and developing countries. This study was designed to observe the association between glycemic control and outcome of patients after open heart surgery in adult population. Materials and Methods: Data was collected retrospectively in all patients who underwent open cardiac surgery (coronary artery bypass grafting, valve, or bypass grafting with valve surgery) and survived 72 hours postoperatively and had diabetes. The study was conducted from January 2015 to December 2016. Results: Of the 129 patients included in the study, male dominated 101 (78.3%). Most frequent surgery was coronary artery bypass grafting (CABG) 123 (95.3%), CABG plus aortic valve replacement 4 (3.1%), and CABG plus mitral valve replacement 2 (1.6%). Considering diabetes, only 3 (2.3%) were on diet control, 112 (86.8%) on oral hypoglycemic agents (OHA), whereas 9 (7%) had control on both insulin and OHA. Only 5 (3.9%) had type I diabetes. The mean fasting blood sugar (FBS) was 154.58 g/dl, and the mean duration of diabetic mellitus was observed 12.32 years. Microvascular and macrovascular complications were 26/129 (20.16%) and 17/129 (13.17%), respectively. Total 75 (58.1%) patients did not require insulin and 54 (41.9%) were treated with insulin intraoperatively to keep the blood glucose level less than 200 g/dl. Cardiac arrhythmias were frequent in the insulin group (P < 0.05), which was also associated with increased stay in the cardiac intensive care unit. Conclusion: Inadequate glycemic control during open cardiac surgery can possibly lead to increased perioperative morbidity and mortality and with decreased long-term survival and recurrent ischemic events. Therefore, aiming for blood glucose levels around 140 mg/dl appears reasonable. Further studies are required to define specific glucose ranges for a clearer definition of recommended blood glucose goals in postoperative cardiac patients for the best outcomes in patients with diabetes mellitus.

Nutritional Status of Children Living in an Orphanage in Dhaka city, Bangladesh

Introduction: Children living in orphanages tend to be neglected and may be malnourished. This study assessed the socio-economic background and nutritional status of children living in an orphanage in Dhaka city, Bangladesh. Methods: A cross-sectional study was conducted among the children in Sir Salimullah Muslim Orphanage, Dhaka from January to November 2014. Systematic sampling was adopted to collect data from 232 children using a semi-structured questionnaire. Anthropometric measurements of the children were taken and the WHO reference growth chart was used to determine the children’s nutritional status. Weight-for-age was categorised by mild, moderate and severe malnutrition. The Pearson Chi-square test was performed to determine the association between the extent of malnutrition and socio-demographic characteristics of the children. Results: The majority of the children (60.3%) in the orphanage were malnourished, with mild, moderate and severe malnourished being 43.1%, 16.8% and 0.4%, respectively. Malnutrition was higher among the boys than girls in the age group of 15-18 years. The orphans suffered significantly (P<0.05) from malnutrition compared to those, who had at least one parent alive. Conclusion: Malnutrition is highly prevalent among children and adolescents under residential care and needs to be addressed. In particular, early identification and intervention can improve the quality of nutritional status of the urban orphanage population. An investigation with a large sample is highly desirable to explore the severity of the problem in the national context.

Severe pneumonia requiring ICU admission: revisited

To describe the aetiology, outcome and management approach for patients with community acquired pneumonia [CAP] and hospital-acquired pneumonia [HAP] who required ICU admission and to determine the predictors of mortality. A prospective observational study of 119 consecutive patients who were admitted to the ICU with diagnoses of CAP [n = 89] or HAP [n = 30] from May 2011 until December 2012. The overall ICU and hospital mortality rates for CAP and HAP were 24.4% and 30.3%, respectively. There were no significant differences between the patients with CAP and HAP in terms of ICU mortality or the average length of hospital stay. The most commonly isolated pathogens were H1N1 [23%] and Streptococcus pneumonia [17%] in the patients with CAP and Acinetobacter baumannii [37%] in the patients with HAP. Multidrug resistant [MDR] organisms were detected in 32 [38.6%] isolates. The median time for receiving antibiotics was 2 h. Most of the patients [82%] received double antibiotic coverage. Multiple regression analysis identified septic shock [beta = 0.43, p < 0.001], acute respiratory distress syndrome [ARDS] [beta = 0.34, p = 0.003], and the pneumonia severity index [PSI] [beta = -0.36, p < 0.024] as significant predictors of mortality. The outcomes of patients with severe pneumonia who were admitted to the ICU were better than those of previous reports. Early administration of combination antibiotics was practiced with vigilance. MDR organisms and respiratory viruses were the commonly isolated pathogens. The presence of septic shock, ARDS and high PSI were independent predictors of mortality

Risk factors for developing congenital nasolacrimal duct obstruction

To identify potential risk factors for developing congenital nasolacrimal duct obstruction [CNLDO]. A cross-sectional study. A quantitative questionnaire was distributed to a sample of mothers attending the Pediatrics Clinic at King Khalid University Hospital, Riyadh, Saudi Arabia. A total of 756 mothers responded to our questionnaire. Of the 756 filled questionnaires, 389 [51.67%] were male children. 5.3% of the mothers lived in non-urban settings. CNLDO was reported in the children attending the clinic by 17.1% [129/756] of their mothers. Average age [ +/- SD] of infants when persistent tearing was noticed was 3.2 +/- 2.7 months, while average age [ +/- SD] of resolution was 9.6 +/- 3.7 months. Of the children with CNLDO, 37.2% [48/129] still have persistent tearing at the time of distributing the questionnaire. Among the group with CNLDO, 17% [22/129] of their mothers have experienced an infection during pregnancy [p = 0.022]. Within the same group, 14.7% [19/129] of the affected children were reported by their mothers to have other children with CNLDO which was statistically significant [p = <0.001]. CNLDO could have a genetic predisposition and maternal infection is a possible risk factor for developing CNLDO. Surgical management awareness should be emphasized to relieve children from this relatively common and benign condition

comparative study of 20 / silver nitrate and galvanic cautry for the treatment of allergic rhinitis

To compare the results of 20% silver nitrate and galvanic cautry for the treatment of allergic rhinitis. SETTING: ENT department Mayo Hospital, Lahore: DESIGN: Retrospective study. PATIENTS AND METHODS: This study was conducted on 100 patients of allergic rhinitis with age range of 16 years to 50 years from Oct 1992 to Oct 1995. Taking into consideration the morbidity and beneficial effects of using 20% silver nitrate cautry and galvanic cautry for the treatment of allergic rhinitis detailed results are studied. 20% silver nitrate cautry is far superior than galvanic cautry for the treatment of allergic rhinitis

Role of HLA-B27 in high grade atrioventricular block and sick sinus syndrome

There has been an association between HLA-B27 and cardiovascular affection. Furthermore, a significantly increased prevalence of HLA-B27 was found in men with pacemakers who had no clinical or radiological signs of HLA-B27 associated disease. This study was planned to obtain more insight into the association between HLA-B27 and high grade AV block [HG-AVB] and sick sinus syndrome [SSS], and the possible role of HLA-B27 in causing this block. HLA tissue typing was preformed on 200 normal Egyptians [control] and 75 Egyptian pts who had permanent pacemakers implanted for HG-AVB and SSS who had no clinical or radiological signs of HLA-B27 associated disease. The pacemaker pts were classified into 3 groups according to the aetiology of AVB and SSS, group 1 included 5 pts with acquired HG-AVB, group II included 10 pts with congenital complete heart block and group III included 60 pts with idiopathic HG-AVB or SSS. HLA-B27 was present in 5/200 [2.5%] normal healthy Egyptians, in 6/60 [10%] pts with idiopathic HG-AVB and SSS [group III]. However, HLA-B27 was negative in both groups I and II. There was a statistically significant higher prevalence of HLA-B27 in pts with idiopathic HG-AVB/SSS than in both normal Egyptians and pts with acquired or congenital AVB [p < 0.05]. HLA-B27 might have a role in the aetiology of idiopathic AVB however, further research is needed to obtain more insight into its role and the role of other factors in idiopathic AVB

Special properties associated with virulence of urinary Escherichia coli.

Escherichia coli (E. coli) isolated from 53 urine and 26 stool samples of patients with urinary tract infection (UTI) and 50 stool samples of normal individuals were studied to see their hemolytic, hemagglutinating and 'O' antigenic properties which might be related to virulence of the organism. Significantly higher number of E. coli isolated from urine of UTI patients were found to possess hemolytic, hemagglutinating properties and more frequently belonged to certain "O" antigenic groups either singly or in combination as compared to those isolated from stool of both UTI patients and normal individuals. Hemagglutinating property appeared to be most frequently associated with UTI.