Lipid Levels in Acute Coronary Syndromes Admitted in Medical Intensive Care Unit in a Tertiary Care Hospital.

Coronary artery disease (CAD) is the leading cause of mortality in men and women. Acute coronary syndrome (ACS), is a major reason for hospitalisation in our country. Dyslipidemia has been identified as one of the most important modifiable risk factors for CAD. The aim of the study was to determine the prevalence and pattern of dyslipidaemia and its relation to other modifiable risk factors.METHODS100 cases were studied in a Krishna Institutes of Medical Sciences, Karad, over a period of 12 months from 1st August 2015 to 31st July 2016. This is a prospective observational study. All adults >18 years of age admitted for acute coronary syndrome were eligible for this study. The ACS group was studied as STEMI, NSTEMI, and Unstable Angina.RESULTSMajority of patients (33) was in the age group 51-60 years followed by 29 patients in the age group 61-70 years. Out of 100 ACS patients, 62 were STEMI, 20 were NSTEMI, and 18 were unstable angina. The prevalence of ACS was higher in males than females. Hypertension is the most common risk factor of ACS (41%) followed by diabetes mellitus (33%). We found that high levels of TC (more than 200 mg/dl) were found in 31% patients [mean ± SD (167.79 mg/dl ± 45.28)]. High levels of LDL (more than 130 mg/dl) were found in 23% patients [mean ± SD (97.47 mg/dl ± 38.24)]. Low levels of HDL (less than 40 mg/dl) were found in 52% patients [mean ± SD (40.69 mg/dl ± 11.84)]. High levels of TG (more than 150 mg/dl) were found in 37 % patients [mean ± SD (145.28 mg/dl ± 65.78)].CONCLUSIONSDyslipidemia is one of the major risk factors which is widely prevalent in patients with ACS and is more prevalent in males than in females. We recommend paying more attention to serum lipids and other modifiable risk factors for prevention of ACS

To study the prescription pattern of antibiotics in medicine intensive care unit at tertiary care hospital

Background: Drug utilization studies are crucial and create a positive awareness about proper use of drugs. Analysing the pattern of prescriptions is important in the settings of intensive care units where patients receive multiple antibiotics. The objective of this study was to analyse the use of antibiotics in a Medicine Intensive Care Unit (MICU) of Government Medical College and Hospital, Aurangabad, Maharashtra, India, a tertiary health care centre.Methods: Total 988 number of patients admitted in MICU from January 2017 to June 2018 were enrolled in the study and fulfilling inclusion criteria. Demographic details, disease state and prescription of antibiotic was recorded.Results: Out of 988, n=700 patients received antibiotics. Most common diseases for which patients were admitted in MICU included OP poisoning (24.86%), snake bite (15.14%), bilateral pneumonitis (12.71%), HELLP syndrome (12.14%), and the least common conditions were chronic obstructive pulmonary disease (COPD), meningitis, sepsis with multiple organ dysfunction syndrome (MODS), Guillen barre syndrome (GBS), lung abscess etc., Most common single antibiotic used in the studied cases was ceftriaxone (21.42%) followed by either alone or in combination piperacillin and tazobactam (12.04%), metronidazole (11.85%) etc.Conclusions: Total 700 patients received systemic antibiotics in present study bringing the incidence of systemic antibiotics use in MICU to be 70.85%. Ceftriaxone and combination of piperacillin and tazobactam are most commonly used antibiotics in MICU of the hospital. All patients admitted in this MICU received antibiotics as per the standard protocols of the hospital.

A Comparison of Vancomycin and Metronidazole for the Treatment of Clostridium difficile-associated Diarrhea (CDAD) in Medical Intensive Care Unit (MICU)

BACKGROUND: Clostridium difficile associated diarrhea (CDAD) is a leading cause of hospital-associated gastrointestinal illness. Risk factors for CDAD include advanced age, long-term admission, antibiotics, proton-pump inhibitor or H₂ blocker use and immunosuppression. The practice guideline of American Journal of Gastroenterology (2013) suggests metronidazole for the first-line therapy of mild-moderate CDAD as well as vancomycin for severe CDAD. MICU inpatients receiving stress ulcer prophylaxis and antibiotics are susceptible to nosocomial CDAD. Therefore, this study aimed to evaluate occurrence and treatment of CDAD in MICU. METHODS: Patients who were admitted to the MICU and had CDAD from August 2012 to August 2015 were analyzed retrospectively. RESULTS: Of the 90 patients with CDAD, 20 patients (2.22%) had mild-moderate CDAD (16 received metronidazole and 4 received vancomycin therapy) and 70 patients (77.8%) had severe CDAD(54 received metronidazole and 16 received vancomycin therapy). Among the patients with mild-moderate CDAD, treatment with metronidazole or vancomycin resulted in same clinical cure in 50% of the patients (p=1.00). Among the patients with severe CDAD, treatment with metronidazole or vancomycin resulted in clinical cure in 40.7% and 50.0% of the patients, respectively (p=0.511). Clinical symptoms recurred in 7.4% of the severe CDAD patients treated with metronidazole and 6.3% of those treated with vancomycin (p=0.875). CONCLUSION: Our findings suggest that metronidazole and vancomycin are equally effective for the treatment of mild-moderate CDAD; however, vancomycin demonstrated higher clinical cure rate and lower recurrence rate for severe CDAD, although the difference was not statistically significant. For better clinical outcomes, appropriate medication use by disease severity is needed.

The risk factors analysis of incontinent-associated dermatitis in MICU / 现代临床护理

Objective To explore the risk factors of incontinent-associated dermatitis (IAD) in MICU. Methods A retrospective analysis of 141 cases of MICU incontinence in our hospital was done in IAD. The risk factors of IAD were analyzed by single factor and logistic regression analysis. Results The incidence of IAD in MICU fecal incontinence was 43.97%.The risk factors of IAD in MICU incontinence included the amount of defecate,age,body temperature (all P＜0.05). Conclusion The incidence of IAD in patients with MICU incontinence is higher.The risk factor for IAD in patients with ICU incontinence are the amount of defecate, age and body temperature.These high-risk factors should be well-considered and relative measures should be done.

A clinical study of percutaneous tracheostomy in medical ICU by non surgical doctors.

Introduction: Tracheostomy is one of the oldest surgical procedures to access the airway. The majority of cases who require tracheostomy are in ICUs. The ICUs are monitored by intensivists who are mostly Anesthesiologists or Physicians (non-surgical personnel). While doing surgical tracheostomy, there is dependency on other departments like surgeons of ENT department. In most cases, critically ill patients are made to shift to operating room, where we may have to wait for the availability of operating table. Method: This clinical study was carried out to access the airway when required by nonsurgical doctors like anesthesiologists or physicians at bed side and to save cost and operation theatre time. Result: Sixteen male & twelve female patients with an average age of 28 Years (range, 19 to 40Years) underwent PCT from Oct. 2008 to Oct.2011. Fourteen patients were of snake bite, 10 were of organo-phosphorus poisoning & 4 were of G.B. Syndrome. Conclusion: Percutaneous tracheostomy has replaced the surgical route in several intensive care units and it is indeed the procedure of choice in the majority of cases. [Rajan N NJIRM 2014; 5(1):6-9] Key Words: Percutaneous Tracheostomy (PCT), Surgical Tracheostomy (ST), Medical intensive care unit (MICU), critically ill, complications, tracheal injury, bleeding.

Ephemeroptera (Insecta) ocorrentes no leste do Estado do Mato Grosso, Brasil / Ephemeroptera (Insecta) from east of Mato Grosso State, Brazil

Com o objetivo de apresentar um levantamento da fauna de Ephemeroptera no Estado do Mato Grosso, investigamos as ninfas de Ephemeroptera, principalmente de duas bacias hidrográficas do leste do estado. Sessenta e sete espécies/morfoespécies em 41 gêneros e oito famílias foram encontradas. Quatro espécies (Cloeodes redactus Waltz & McCafferty, 1987 e Waltzoyphius roberti Thomas & Peru, 2002 [Baetidae], Tricorytopsis chiriguano Molineri, 2001 [Leptohyphidae] e Microphlebia surinamensis Savage & Peters, 1983 [Leptophlebiidae]) foram registradas pela primeira vez no Brasil. As famílias Euthyplociidae, Polymitarcyidae e Coryphoridae foram registradas pela primeira vez para o Mato Grosso, assim como 19 gêneros e 18 espécies. Vinte e cinco espécies não foram identificadas devido à falta de informação envolvendo o estágio ninfal de seus respectivos gêneros. Assim como demonstrado em outros trabalhos com o grupo, a ordem se mostrou mais diversa do que se conhece atualmente, especialmente se considerarmos as várias fisionomias e bacias hidrográficas do estado que se mantêm desconhecidas.

Aiming to present a survey of Ephemeroptera fauna of Ephemeroptera from Mato Grosso State we investigated mayfly nymphs mainly from two hydrographic basins located in the eastern area of the state. Sixty-seven species/morphospecies in 41 genera and eight families were encountered. Four species (Cloeodes redactus Waltz & McCafferty, 1987 and Waltzoyphius roberti Thomas & Peru, 2002 [Baetidae], Tricorytopsis chiriguano Molineri, 2001 [Leptohyphidae] and Microphlebia surinamensis Savage & Peters, 1983 [Leptophlebiidae]) are recorded for the first time from Brazil. The families Euthyplociidae, Polymitarcyidae and Coryphoridae are recorded for the first time from Mato Grosso, as well as 19 genera and 18 species. Twenty-five species could not be identified due to the lack of knowledge regarding the nymphal stage of their respective genera. As demonstrated in others surveys of mayflies in Brazil, the order is much more diverse than currently recognized, especially if we consider that several physiognomies and hydrographic basins of the state remain undocumented.

Analysis of the Nursing Interventions done by MICU and SICU nurses using NIC / 간호학회지

The purpose of this research was to identify nursing interventions performed by MICU and SICU nurses. For data collection this study used the taxonomy of the Nursing Interventions Classification(NIC: 433 nursing interventions) which was modified by McCloskey and Bulecheck(1996). Each of the 433 interventions were identified as used by MICU and SICU nurses. More than 50% of the ICU nurses performed 280 nursing interventions at least monthly. Rarely used interventions included 26 nursing interventions in the childbearing care class. Overall, both MICU and SICU nurses used interventions in the Physicological : Complex domain most often on a daily basis and the interventions in the Family domain least often. The most frequently reported interventions as being used daily in the MICU were chest physioterapy, airway suctioning and coughing enhancement and, in the SICU, documentation and airway suctioning. There were significant differences between MICU and SICU nurses differences interventions childbearing care, cognitive therapy, communication enhancement, coping assistance, elimination management, lifespan care, health system mediation, immobility management, medication management, neurologic management, patient education psychological comfort promotion, physical comfort program, respiratory management, risk management and information management. The SICU nurses performed there interventions more frequently than the MICU nurses. These findings will help in building of a standardized language for the MICU and SICU and enhance the quality of nursing care.