ABSTRACT
Background: Chronic obstructive pulmonary disease (COPD) is not only a respiratory disease but is also a systemic disease associated with comorbidities such as diabetes mellitus (DM), hypertension, osteoporosis, etc. Diabetes being one of the comorbidities, COPD is thought to be a causative factor for developing insulin resistance. Similarly, poor glycemic control is associated with worsened COPD outcomes. Thus, this study has been taken up to analyze the effect of hyperglycemia on the duration of hospital stay and rate of mortality, and other outcomes in patients with COPD with exacerbation. Methods: It was an observational study conducted for 1 year in KLES Dr. Prabhakar Kore Hospital & Medical Research Centre, Belagavi, Karnataka, India. A total of 84 patients were enrolled and divided into two groups based on the mean random blood sugar (RBS) levels. Group I had 40 patients with mean RBS <250 mg/dL and group II had 44 patients with mean RBS ?250 mg/dL. Outcomes and variables of the patients with COPD were compared between both groups. Results: Patients in group II had poor outcomes compared to group I. The mean duration of hospital stays in groups I and group II were 5.43 and 7.34, respectively, with a significant p < 0.0001. The mean duration of intensive care unit (ICU) stay was 3.33 and 4.47 in groups I and II, respectively, which was statistically significant. The rate of mortality in groups I and II was 5.00 and 11.36%, respectively. Conclusion: Patients with hyperglycemia had an increased duration of hospital stay and rate of mortality. Optimal glycemic control plays a significant role in patients with COPD in reducing the severity of exacerbation and mortality.
ABSTRACT
Background: This study was conducted in GMC Jammu to evaluate ICU stay and cost effectiveness in patients with cervical spine trauma undergoing early fixation (within 24-72 hours after trauma) versus late fixation (delayed fixation after applying traction and waiting for return of cough reflex).Methods: Retrospective and prospective study was done by collecting data from admission register and patient follow-up during 2016-2019. 50 patients were admitted as cervical spine trauma, out of which 38 were operated upon and ten managed conservatively. 15 patients were operated within 72 hours of admission with absent cough reflex and 23 were put on cervical traction and operated upon after return of cough reflex.Results: Average ICU stay for 15 patients (4 females 11 males) immediately operated ranged from 10 to 15 days along with prolonged mechanical ventilation. Average ICU stay for 23 patients (16 males and 7 females) operated after returning of cough reflex ranged from 3-4 days with considerably decreased requirement of mechanical ventilation.Conclusions: Delayed fixation of cervical spine after returning of cough reflex shortens post-operative ICU stay and is considerably more cost effective than early fixation.
ABSTRACT
Aims and Objective: We tested the hypothesis that use of levosimendan would be associated with better perioperative hemodynamics and cardiac function during off-pump coronary artery bypass grafting (OPCAB) in patients with good left ventricular function. Materials and Methods: Thirty patients scheduled for OPCAB were randomized in a double-blind manner to receive either levosimendan 0.1 μg/kg/min or placebo after induction of general anesthesia. The hemodynamic variables were measured after induction of anesthesia, at 6 minute after application of tissue stabilizer for the anastomoses of left anterior descending artery, diagonal artery, left circumflex artery, and right coronary artery and at 6, 12, 18, and 24 hours after completion of surgery. Results: Compared with placebo group, cardiac index (CI) was significantly higher and systemic vascular resistance index (SVRI) was significantly lower at 6, 12, 18, and 24 hour after surgery in levosimendan group. Norepinephrine was infused in 60% of the patients in the levosimendan group compared to 6.7% in the control group ( P < 0.05). Lactate and mixed venous oxygen saturation were not significantly different between groups. Conclusions: Levosimendan significantly increased CI and decreased SVRI after OPCAB but it did not show any outcome benefit in terms of duration of ventilation and intensive care unit stay.