A Study on the Incidence and Impact of Dysglycemia in Non-diabetic Sepsis Patients.

Context Dysglycemia is common in severe sepsis and is associated with a poor prognosis. There is a limited amount of research on stress-induced dysglycemia in non-diabetic sepsis patients. Aim This study aims to estimate the incidence of dysglycemia among non-diabetic patients presenting with sepsis at the Emergency Department and to determine its correlation with gender, age, APACHE II (Acute Physiology and Chronic Health Evaluation) scores, diagnosis, and duration of hospital stay. Materials and methods The study was conducted at a medical college hospital in Kochi from January 1, 2023, to December 31, 2023. A minimum sample size of 77 was derived after a pilot study, with a 95% confidence interval and 10% allowable error. A total of 100 non-diabetic sepsis patients meeting the inclusion and exclusion criteria were analyzed with regard to gender, age, diagnosis, glycemic status (hypo/hyper/normoglycemic), APACHE II scores, and hospital stay duration. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 20 (Released 2011; IBM Corp., Armonk, New York) software. Categorical variables were expressed as frequency and percentage. Continuous variables were presented as mean ± SD (standard deviation) and median (Q1-Q3). To test the statistical significance of the association between the presence of various factors (gender, age, diagnosis) and dysglycemia, the chi-square test was used. To test the statistical significance of the difference in the mean age and APACHE II score values with dysglycemia, an independent sample t-test was used. To test the statistical significance of the difference in the median hospital stay with dysglycemia, the Whitney U test was used. Data were represented as mean ± SD, and a p-value of <0.05 was considered to be statistically significant. Results The incidence of dysglycemia in the inclusion group was 49% (hypoglycemia in 16% and hyperglycemia in 33% of cases), and it increased with age (p=0.002). The majority of the dysglycemic patients fell into the age group >40 years. Dysglycemia was 54.8% in pneumonia and 66.7% in gastrointestinal sepsis ( p=0.138). Dysglycemia increased with an increase in APACHE II scores (p=0.017). The median hospital stay was almost the same in both normoglycemics and dysglycemics. Conclusion Dysglycemia is a frequent complication in non-diabetic patients with sepsis. It increased with age and APACHE II score, but it does not prolong the duration of hospital stay, nor is it associated with the diagnosis.

Improving Cardiopulmonary Resuscitation Quality and Resuscitation Training by Using Real-Time Audiovisual-Assisted Devices.

Context Cardiac arrest occurring outside of a medical facility is a significant cause of death and disability worldwide. In developing nations, it accounts for a notable portion of total mortality, with only a small percentage of those affected surviving beyond the initial emergency department intervention. Despite the critical importance of high-quality cardiopulmonary resuscitation (CPR) in these situations, there has been limited research on the effectiveness of audiovisual feedback devices in improving CPR performance among laypersons or non-medical caregivers. These caregivers, often untrained in advanced medical procedures, play a crucial role in the immediate response to cardiac arrest before professional help arrives. This study aims to address this gap by evaluating the impact of such devices on CPR quality delivered by non-medical individuals. Aim This study aimed to determine whether the use of audiovisual devices would improve cardiopulmonary resuscitation performance among non-medical care providers. Materials and methods Using a multiple-choice questionnaire, an audiovisual aid-based prospective observational study (non-interventional observation study) was conducted at a medical college hospital in Kochi from June 2022 to February 2024. A minimum sample size of 66 was derived from pilot studies, with 95% confidence and 90% power. A total of 146 participants met the inclusion criteria (non-medical personnel of 18-50 years of age). After the exclusion of pregnant women and non-interested participants, the study participants were analyzed for the quality of cardiopulmonary resuscitation in a mannequin with the help of audiovisual devices. Statistical analysis was conducted using IBM SPSS Statistics for Windows, Version 20 (IBM Corp., Armonk, New York, released in 2011). Categorical variables were expressed as frequency and percentage. McNemar's Chi-square test was applied to compare the CPR compression rates with and without the visual feedback device, and the kappa statistic was used to assess how consistently participants performed within the same compression rate category (less than 100, 100-120, or more than 120 compressions per minute) with and without the feedback device. Results The improvement in CPR quality, which was visualized as a green color in the CPR feedback device, was significant, with 109 participants (74.7%) showing good outcomes. The chest compression rate also significantly improved from 95 to 117 with the use of feedback devices (p -0.011, Kappa - 0.167) among non-medical care providers. While the kappa value suggests that some variability exists in compression rates when switching between with and without feedback, the overall improvement is still noteworthy. Conclusion The majority of participants (74.7%) were able to consistently maintain green light in the visual feedback watch, which means their chest compression rate was within optimal range (100-120/min) when using the audiovisual feedback device. This indicated that use of audiovisual devices significantly improved compression rates among non-medical care providers and effectively helped them perform high-quality CPR.

Silent Dyspnea: Spontaneous Pneumomediastinum in a Heroin User.

Spontaneous pneumomediastinum (SPM) is a relatively rare presentation that often follows a benign clinical course. It is mainly triggered by underlying bronchial asthma, respiratory tract infections, strenuous activities, or illicit drug use. We present a case of an isolated primary pneumomediastinum where the patient was a 24-year-old man with underlying bronchial asthma who presented with acute onset of shortness of breath and pleuritic chest pain following snorting of an opioid-heroin. Although the clinical exam and chest radiograph were both unremarkable, the multi-detector computed tomography of the chest revealed an isolated pneumomediastinum. The patient was managed conservatively in accordance with existing evidence as SPM is known for its spontaneous recovery.

The bane of coastal marine environment: A fatal case of Vibrio vulnificus associated cellulitis and septicaemia.

Vibrio vulnificus is a Gram negative motile bacterium known to cause fatal septicaemia and wound infection. It is commonly associated with the consumption of under-cooked seafood or exposure to marine environment. We report a case of a 55 year old male patient, who was presented with right lower limb cellulitis and septicaemia due to V. vulnificus. V. vulnificus infection in India are rare. However, increasing reports of V. vulnificus from India recommends considering the pathogen while dealing necrotising fasciitis especially in the proximity of marine environment.

Clinical Profile of Patients Admitted with Swine-Origin Influenza A (H1N1) Virus Infection: An Experience from A Tertiary Care Hospital.

BACKGROUND: Pandemic influenza A (H1N1) 2009 has posed a serious public health challenge world-wide. H1N1 critical illness mostly affects young patients and is often fatal. OBJECTIVE: Primary objective was to study clinical profile of the patients admitted with confirmed H1N1 swine flu infection. Secondary objective was to observe the risk factors associated with complications like need of mechanical ventilation and or death among H1N1 infected patients. MATERIAL AND METHODS: A prospective observational study was conducted in a tertiary care teaching hospital from June 2009, to December, 2011. H1N1 infection was confirmed by reverse transcriptase PCR. Statistical analysis was done by SPSS, version 11. Binary logistic regression was used to find out independent risk factors for morbidity. RESULTS: Total 495 patients were tested for H1N1 infection. Among them, 115 (23%) were positive and 88(76%) required admission. Median age of cohort was 29 years and 87% of the patients were below 54 years of age. Most common presenting symptoms were fever (98%), followed by cough (86%) and sore throat (54%). Out of 88 patients, 14 (16%) required mechanical ventilation and 6(6.8%) died. Lymphopaenia (Lymphocytes <10%) and presence of patchy infiltrates on chest X-ray (CXR) the time of presentation were independent risk factors associated with need of mechanical ventilation or death in H1N1 infected patients by multivariate analysis. CONCLUSION: Present study showed that H1N1 swine flu mainly affected people who were < 54 years of age. Majority of patients improved with antiviral treatment. Lymphopaenia and CXR which showed bilateral pneumonia at time of presentation were found to be independent risk factors associated with requirement of mechanical ventilation and/or death in H1N1 infection. Pregnant females with flu constituted 33% of total mortality. High priority should be given to such patients. Further community based studies are required to analyze the actual impact of H1N1 infection in the community.