The effect of caring for critically ill patients with COVID-19 acute respiratory distress syndrome in undesignated intensive care unit wardson mortality and length of hospital stay.

INTRODUCTION: COVID-19 has caused 4 million deaths as of 24 August 2021. A significant number of patients were admitted to undesignated ICU areas before transfer to a desig-nated ICU owing to the unavailability of ICU beds. We aim to compare the mortality and length of stay of patients in these 2 areas. MATERIAL AND METHODS: We retrospectively studied all critically ill patients with COVID-19 pneumonia who were admitted to Dubai hospital between 1 January 2020 and 30 June 2020. Patients who transferred to wards other than designated ICU constitute cases, while those who were admitted directly to designated ICUs constitute controls. The demographics, clinical parameters, and treatment profile of these patients were recorded and compared. Mortality and length of stay were calculated. RESULTS: The sample includes 239 subjects (admitted to an undesignated ICU ward [n = 107] and directly admitted to a designated ICU ward [n = 132]). Patients admitted to an undesignated ICU had extra transfers between wards and had more days on MV (median [IQR] 18 (19) vs. 11 (14); P = 0.001), greater length of stay in the ICU (median [IQR]) 21.5 (19) vs. 15 (14); P = 0.001), and greater length of stay in hospital (median [IQR] 32 (28) vs. 21 (26); P = 0.001). Multiple logistic regression analysis showed that patients treated at an undesignated ICU have better survival (odds of death for patients cared for at an undesignated ICU was 0.347 with CI 0.178-0.676; P = 0.002). Multiple linear regression analysis also showed that patients treated at an undesignated ICU had longer stay - 4.2 days, CI 1.3-7.13, P = 0.004). CONCLUSIONS: Admission to an undesignated ICU impacts mortality and length of ICU and hospital stay.

Evaluation of random plasma glucose for assessment of glycaemic control in type 2 diabetes mellitus.

OBJECTIVE: To evaluate the accuracy of random plasma glucose in outpatients with type 2 diabetes mellitus for assessing glycaemic control. METHODS: This comparative, cross-sectional study was conducted at the chemical pathology department of PNS Shifa Hospital, Karachi, from August 2015 to March 2016, and comprised data of subjects with type 2 diabetes mellitus who reported for evaluation of glycaemic control in non-fasting state. All blood samples were analysed for random plasma glucose and glycated haemoglobin. Random plasma glucose was compared as an index test with glycated haemoglobin considering it as reference standard at a value of less than 7% for good glycaemic control. SPSS 20 was used for data analysis. RESULTS: Of the 222 subjects, 93(42%) had good glycaemic control. Random plasma glucose showed strong positive correlation with glycated haemoglobin (p=0.000).Area under curve for random plasma glucose as determined by plotting receiver operating characteristic curve against glycated haemoglobin value of 7% was 0.89 (95% confidence interval: 0.849-0.930). Random plasma glucose at cut-off value of 150 mg/dl was most efficient for ruling out poor glycaemic control among patients with type 2 diabetes mellitus with 90.7% sensitivity and69.9% specificity and Youden's index of 0.606. CONCLUSIONS: Random plasma glucose may be used to reflect glycaemic control in adults with type 2 diabetes mellitus in areas where glycated haemoglobin is not feasible.

Decreased Serum 25-Hydroxycalciferol Levels in Pre-diabetic Adults.

OBJECTIVE: To determine the serum 25-hydroxycalciferol levels [25(OH)D] in adults with pre-diabetes and normoglycaemia to examine a possible association of vitamin D deficiency with pre-diabetes. STUDY DESIGN: Case control study. PLACE AND DURATION OF STUDY: Armed Forces Institute of Pathology, Rawalpindi, from November 2012 to July 2013. METHODOLOGY: Atotal of 272 adults including 136 pre-diabetics and 136 normoglycaemics of either gender aged 20 years and above were consecutively inducted. Patients with diabetes mellitus, pregnancy, rickets and osteomalacia, ischemic heart disease, chronic kidney disease and chronic liver disease were excluded. Fasting Plasma Glucose (FPG) was estimated with hexokinase method on Modular p800 Roche chemistry analyzer while serum 25(OH)D was measured on Diasorin Liaison immunoassay analyzer using the chemiluminescent technique. Mean 25(OH)D levels in pre-diabetic and normoglycaemic groups were compared using Mann-Whitney U test. Spearman's correlation coefficient 'rs' was determined between serum 25(OH)D and FPG. Odds ratio for vitamin D deficiency was also calculated. RESULTS: Mean serum 25(OH)D level was low in pre-diabetics (23.2 nmol/L) as compared to normoglycaemics (29 nmol/L; p=0.001). Serum 25(OH)D level had inverse correlation with FPG (rs= -0.448, p=0.000). There was also significant association of vitamin D deficiency with pre-diabetes compared with normoglycaemia (OR: 2.21, p= 0.016; 95% CI: 1.15-4.27). CONCLUSION: Vitamin D deficiency with pre-diabetes suggested that vitamin D may have an important role in pathogenesis of pre-diabetes.

Effect of near-total thyroidectomy on thyroid orbitopathy due to toxic goiter.

BACKGROUND: The relative merit of surgery in the treatment of Graves' ophthalmopathy as well as the extent of surgical resection are still matters of debate. This study aimed at reporting an assessment of the impact of near-total thyroidectomy on the course of ophthalmopathy including exophthalmos. METHODS: A total of 20 patients with thyrotoxic goiters who were suffering from mild to moderate exophthalmos were enrolled in this prospective study. Preoperative evaluation of ophthalmopathy was accomplished through the NOSPECS classification, magnetic resonance imaging (MRI) for measuring the extraocular muscle diameters, and measurement of the exophthalmos using Hertel's exophthalmometer. Ophthalmopathy including exophthalmos was reevaluated 6 months after operation using the same parameters. RESULTS: Clinical activity evaluation, exophthalmometry, and extraocular muscles measurement by MRI revealed that most of the patients experienced improvement of their ophthalmopathy (65%). This improvement was statistically significant. In addition, no major postoperative complications were observed. However, the study, unlike a number of reported retrospective ones, failed to specify any statistically significant prognostic factors affecting the course of ophthalmopathy; this may have been due to the limited number of patients. In addition, all of the patients were of relatively young age and thyrotoxic, and most were female and nonsmoking. CONCLUSIONS: In addition to the fact that near-total thyroidectomy adds the advantages of total thyroidectomy (no recurrence) to those of subtotal thyroidectomy (low incidence of temporary and permanent hypoparathyroidism), it has a significant positive impact on thyroid-associated orbitopathy.

Thyroid surgery: use of the LigaSure Vessel Sealing System versus conventional knot tying.

BACKGROUND: The aim of this work is to compare the use of conventional knot tying vs. LigaSuretrade mark Vessel Sealing System (Valley Lab, Boulder, CO) in patients undergoing thyroid surgery. We hypothesized that use of the LigaSure would reduce operating time while resulting in a similar rate of complications. METHODS: This study was conducted in Endocrine Surgery Unit, Mansoura University Hospital on patients who underwent thyroid surgery from January 1, 2006 to December 31, 2006. One hundred and ten patients were operated upon by the same team of surgeons using conventional knot tying in 55 and the LigaSure in 55 patients for hemostasis. The medical records of the patients enrolled were reviewed and compared regarding age, sex, histopathological diagnosis, type of operation performed (lobectomy vs. subtotal thyroidectomy vs. total thyroidectomy), operating time, estimated intraoperative blood loss, postoperative complications, length of incision, hospital stay and cost, postoperative pain and outcome evaluation. RESULTS: The two groups had similar demographics, thyroid pathology, types of operations and complication rates. The LigaSure group had lower operating times, lower intraoperative blood loss, less postoperative pain and early pain-free return to normal activity and return to work. CONCLUSION: The LigaSure Vessel Sealing System was as safe as conventional knot tying for thyroidectomy, with the benefit of reduced operating time, postoperative pain severity and early pain-free return to normal activity and return to work.