5 research outputs found
Deep vein thrombosis in a medical ward: Incidence and Risk factors
No full textINTRODUCTION:
A “Thrombus” is defined as a blood clot lodged in the blood vessel. When the pathologic processes overwhelm the regulatory mechanisms of hemostasis, there is excessive formation of thrombin, initiating thrombosis. The thrombus can cause vascular occlusion
Deep venous thrombosis is blood clot in the larger veins. They usually involve the veins of the lower limb. Ocasionally, the clot from the lower limb can dislodge and travel along the venous system, the heart and get occluded in the pulmonary vasculature. This is called pulmonary embolism.
Venous thromboembolism is a term that includes both, deep venous thrombosis and pulmonary embolism, which in itself, is a sequele of the former.
Deep venous thrombosis is defined as formation of a blood clot in the deep venous system. A deep venous thrombosis can occur either in the upper limbs or the lower limbs. In the lower limbs, the deep venous thrombosis is classified as either proximal, involving the femoral vein and distal involving the popliteal veins. The proximal lower limb deep venous thrombosis is usually associated with serious chronic diseases such as malignancies, biventricular failure and acute respiratory distress; whereas, distal lower limb deep venous thrombosis is associated with transient risk factors such as recent surgery, immobilization and travel.
OBJECTIVES:
Primary Objective: The incidence of deep vein thrombosis in patients admitted to a medical ward.
Secondary Objective:
1. To assess the risk factors for development of deep vein thrombosis in patients admitted to a medical ward
2. To assess the outcome of patients who developed deep vein thrombosis in a medical ward.
METHODS:
This is a prospective observational study with a cohort design which looked at the incidence of deep vein thrombosis in patients admitted in a medical ward under Medicine 2, CMC Vellore, over a period of 9 months. We included patients aged more than 18 years admitted in a medical ward of Medicine 2 from October 2014 to May 2015. We excluded patients who had a preexisting deep vein thrombosis or a pulmonary embolism and patients on therapeutic anticoagulation. A bedside ultrasound machine was used for screening for deep vein thrombosis. The principal investigator looked at the compressibility of internal jugular, axillary, femoral and popliteal veins. Non-compressibility of the vein comapred to the artery was suggestive of thrombosis.. The sample size was calculated to include 220 patients.
RESULTS:
Among the 43 patients included in the study, 3(6.98%) patients developed deep vein thrombosis. The incidence of deep vein thrombosis was 7.48 per 1000 patient days.
The most common site of deep vein thrombosis was the femoral vein. One patient developed a central venous catheter associated deep vein thrombosis. Multivariate analysis showed that duration of hospital stay more than 7 days was associated with higher risk of development of deep vein thrombosis.
CONCLUSIONS:
The incidence of depe vein thrombosis among patients admitted in a medical ward of a tertiary care hospital in South India was 7.48 per 1000 patient-days.
Hospital admission of more than 7 days was found to be a significant independent risk factor for development of deep vein thrombosis in our study.
Hence, deep vein thrombosis prophylaxis should be considered in patients whose hospital stay exceeds 7 days
Time to Platelet Recovery in Patients with Severe Dengue Post Transfusion with Fresh Frozen Plasma and Platelet-rich Concentrate versus Platelet-rich Concentrate Alone: An Observational Study
No full textBackground and Objective:
Life-threatening bleed in severe dengue may justify the need for product transfusion. Earlier, only platelet-rich concentrates were transfused but recently transfusion with fresh frozen plasma (FFP) followed by platelet rich concentrate is done as thrombocytopenia in dengue is thought to be due to a mismatch between von Willebrand factor and ADAMTS13. We aimed to see which of the above modes of transfusion hastened recovery of platelet count to more than 50,000/mm3.
Methods:
A retrospective observational study was done in 101 patients with dengue for10 years admitted under a single medicine unit in a tertiary center in South India.
Results:
The mean number of days for platelets to reach 50,000/mm3 from the day of the first transfusion was 2.5 days (n = 60) for those who received FFP and platelet-rich concentrate, whereas it was 2.4 days (n = 41) for those who received only platelet-rich concentrate alone.
Conclusion:
There was no significant difference in time to recovery of platelet levels between the two groups
Quantification of Organophosphorus Insecticide Removed by Gastric Lavage in Acutely Poisoned Patients: An Observational Study
No full textBackground: The effectiveness of gastric lavage in organophosphorus poisoning has not been established. We assessed the ability of gastric lavage to remove organophosphorus insecticides as a preliminary stage in assessing effectiveness.Methods: Organophosphorus poisoning patients presenting within Results: 42 patients underwent gastric lavage. 8 (19.0%) patients were excluded because of lack of analytical standard for ingested compounds. Insecticides were detectable in the lavage samples of 24/34 (70.6%) patients. Lipophilic organophosphorus compounds were detected in 23/24 patients while no hydrophilic organophosphorus compounds could be detected in six patients with reported ingestion of hydrophilic compounds. For chlorpyrifos poisoning (n=10), only 0.65 (S.D 1.2) mg of estimated ingested amount (n=5) of 8,600 (S.D 3,200) mg was recovered by gastric lavage. The mean proportion of compound removed by initial gastric aspirate was 79.4%and subsequent 3 cycles removed 11.5%, 6.6% and 2.7%. Conclusion: Lipophilic organophosphorus insecticides could be quantified in stomach contents of organophosphorus poisoning patients with the first aspiration or lavage being most effective. The amount removed was very low hence, routine use of gastric lavage for organophosphourus poisoning patients arriving within 6 hours is unlikely to be beneficial.<br/
Clinical presentation of type 1 and type 2 pyrethroid poisoning in humans
No full textIt is unclear if the clinical presentation of poisoning with type 1 and type 2 pyrethroid compounds is different. This study was undertaken to detail the clinical profile and outcome of patients presenting with pyrethroid poisoning and to quantify serum pyrethroid levels. In this prospective study, patients were categorised as poisoning with type 1 pyrethroids or type 2 pyrethroids. Blood samples were sent for compound identification and quantification. Clinical features and outcomes were compared between the two groups. Factors associated with moderate and severe toxicity were explored using univariate logistic regression analysis and presented as odds ratio (OR) and 95% confidence intervals (CI). Type 1 pyrethroids were implicated in 16 patients and type 2 in 43 patients. The incidence of nausea and vomiting (81.2% vs. 81.3%) and tremor (37.5% vs. 32.6%) were similar in type 1 and type 2 poisoning; paraesthesia (6.2% vs. 32.6%, p = 0.04), hypersalivation (0% vs. 20.9%, p = 0.04), seizures (0% vs. 7%, p = 0.29) and depressed sensorium (0% vs. 18.6%, p = 0.03.) were observed more frequently in type 2 pyrethroid poisoning. Pyrethroids were detected in the serum samples of 24 patients; quantification was possible in 22 patients in whom serum levels ranged from 1.1 to 453 μg/ml. The compounds were undetectable in 35 patients. Two patients (lambda-cyhalothrin poisoning and cypermethrin poisoning) required intubation for low sensorium and respiratory distress. The median (interquartile range) duration of hospitalization was 12 (12–24) hours. All patients survived. Factors associated with moderate and severe toxicity included ingestion of a type 2 pyrethroid, lambda-cyhalothrin (OR 7.81, 95%CI 1.55–39.37, p = 0.01) and volume ingested (OR 1.01, 95%CI 1.00–1.02, p = 0.02). Patients with pyrethroid poisoning present predominantly with mild to moderate symptoms. Paraesthesia and hypersalivation are more frequent in type 2 poisoning. A favourable outcome can be expected.</p
A multifaceted intervention to improve diagnosis and early management of hospitalised patients with suspected acute brain infections in Brazil, India, and Malawi: An international multicentre intervention study
No full textBackground
Brain infections pose substantial challenges in diagnosis and management and carry high mortality and morbidity, especially in low-income and middle-income countries. We aimed to improve the diagnosis and early management of patients admitted to hospital (adults aged 16 years and older and children aged >28 days) with suspected acute brain infections at 13 hospitals in Brazil, India, and Malawi.
Methods
With hospital stakeholders, policy makers, and patient and public representatives, we co-designed a multifaceted clinical and laboratory intervention, informed by an evaluation of routine practice. The intervention, tailored for each setting, included a diagnostic and management algorithm, a lumbar puncture pack, a testing panel, and staff training. We used multivariable logistic regression and interrupted time series analysis to compare the coprimary outcomes—the percentage of patients achieving a syndromic diagnosis and the percentage achieving a microbiological diagnosis before and after the intervention. The study was registered at ClinicalTrials.gov (NCT04190303) and is complete.
Findings
Between Jan 5, 2021, and Nov 30, 2022, we screened 10 462 patients and enrolled a total of 2233 patients at 13 hospital sites connected to the four study centres in Brazil, India, and Malawi. 1376 (62%) were recruited before the intervention and 857 (38%) were recruited after the intervention. 2154 patients (96%) had assessment of the primary outcome (1330 [62%] patients recruited pre-intervention and 824 [38%] recruited post-intervention). The median age across centres was 23 years (IQR 6–44), with 1276 (59%) being adults aged 16 years or older and 888 (41%) children aged between 29 days and 15 years; 1264 (59%) patients were male and 890 (41%) were female. Data on race and ethnicity were not recorded. 1020 (77%) of 1320 patients received a syndromic diagnosis before the intervention, rising to 701 (86%) of 813 after the intervention (adjusted odds ratio [aOR] 1·81 [95% CI 1·40–2·34]; p<0·0001). A microbiological diagnosis was made in 294 (22%) of 1330 patients pre-intervention, increasing to 250 (30%) of 824 patients post-intervention (aOR 1·46 [95% CI 1·18–1·79]; p=0·00040). Interrupted time series analysis confirmed that these increases exceeded a modest underlying trend of improvement over time. The percentage receiving a lumbar puncture, time to appropriate therapy, and functional outcome also improved.
Interpretation
Diagnosis and management of patients with suspected acute brain infections improved following introduction of a simple intervention package across a diverse range of hospitals on three continents. The intervention is now being implemented in other settings as part of the WHO Meningitis Roadmap and encephalitis control initiatives
