To Access Knowledge Regarding Organ Donation among Healthcare Workers and Their Willingness toward Organ Donation.

BACKGROUND: In India, critical shortage of organ donations, particularly deceased donations, has led to a dire situation in India, with thousands of patients waiting for transplants and a significant number of them succumbing. One of the reasons for the shortage of organs for transplantation is unawareness and prejudiced information about organ donation. Being direct or indirect stakeholders, the knowledge regarding organ donation among healthcare workers may play an important role in the donation process. AIM: To assess the knowledge regarding cadaver organ donation among healthcare workers and their willingness toward organ donation. MATERIALS AND METHODS: It is a cross-sectional offline self-administered questionnaire-based survey conducted among healthcare professionals at tertiary care teaching institutes. Survey was carried out between the months of August to December 2019. A structured questionnaire was used to assess knowledge and willingness toward organ donation. Statistical analyzed was done by using statistical package for social sciences (SPSS) 20.0. All p-values were considered significant at <0.05. RESULTS: A total of 1,039 healthcare professionals participated in the survey. Out of them, 362 (34.8%) were males and 675 (65%) were females. Average age of the healthcare workers participating in survey was 30.81 years, and age ranged from 18 to 60 years. Awareness regarding corneal donation after brain death was found to be maximum (89.7%) and was comparable to that of kidney (86.6%) and heart (83.7%). Participants were unlearned of donation of lungs, pancreas, hands and unaware of heart valve donation. About 45% respondents considered that age affected the donors. About 40% respondents considered younger patients as ideal recipients, while 18.7% respondents considered waiting list patients as ideal recipients. Doctors had highest willingness (78. 3%) for organ donation, followed by nurses (69.9%) and support staff (59.3%) (p < 0.001). Only 119 (11.5%) participants received organ donation cards as against 68.7% willingness toward organ donation (p < 0.01). CONCLUSION: We have observed fair awareness regarding overall cadaver organ donation concept among healthcare workers. There is a need to improve knowledge of extended age criteria and which organs can be retrieved from deceased donor. Authorities have to work hard on delivery of organ donation pledging card to promote donation program.

Utility of Bedside Ultrasound Measurement of Optic Nerve Sheath Diameter as a Screening Tool for raised Intracranial Pressure in Neurocritical Care Prospective Observational Study.

Intracranial pressure (ICP) needs to be monitored in neurocritical patients. There is a need for portable bedside optic nerve ultrasound (ONUS) for early diagnosis to initiate the measures to reduce ICP Objective: To find the utility of bedside ONUS to diagnose raised ICP in neurocritical care. Materials and methods: After approval from the ethical committee, a prospective observational study was conducted. Optic nerve sheath diameter (ONSD) was measured in two groups: control group patients with neurological symptoms but computed tomography (CT)/magnetic resonance imaging (MRI) not suggestive of raised ICP, and second was study group patients with neurological symptoms and CT/MRI suggestive of elevated ICP Result: In patients with normal ICP, the mean ONSD in females was 4.47mm, and in males was 4.66mm. In patients with raised ICP, the mean ONSD in females was 6.45 ± 0.78 mm, and in males was 6.33 ± 0.70 mm. Regarding the correlation between Glasgow coma scale (GCS) and mean ONSD parameters, the coefficient of correlation (R) is 0.14; thus, there is a weak negative correlation. In our study, no difference was observed in raised mean ONSD in patients with different diagnoses. At a cut-off value of >4.8 mm, the sensitivity and specificity are 100% to diagnose raised ICP. Conclusion: Optic nerve sheath diameter (ONSD) is a reliable, rapid bedside screening tool in the Emergency Department/Critical Care/Operation Theatre to diagnose raised ICP. In order to keep a record of trends in ICP, we need to measure ONSD frequently. There was no correlation between GCS and ONSD measurement.

A Retrospective Analysis of Risk Factors of COVID-19 Associated Mucormycosis and Mortality Predictors: A Single-Center Study.

Background Mucormycosis has been identified with increasing frequency in patients with coronavirus disease 2019 (COVID-19). Aims We aimed to determine the in-hospital outcome of patients with COVID-19 associated mucormycosis (CAM). Materials and methods This was a single-center, retrospective, observational study. We included patients diagnosed with CAM from a tertiary care hospital in Pune, India. Clinical, laboratory, and in-hospital outcomes were noted. We analyzed factors associated with in-hospital mortality. Results Between February 2021 and June 2021, we identified 84 patients of CAM. The mean age was 49.3 ± 12.1 years. Of the included patients, 64.3% had diabetes mellitus, and 83.3% had received steroids. Mucormycosis was diagnosed after a median of 11 days from the COVID-19 diagnosis. Orbital and central nervous system (CNS) involvement was seen in 29.8% and 23.8% of patients, respectively. During a mean hospital stay of 12.5 ± 8.5 days, 15.5% of patients died. Compared to survivors, the presence of chronic kidney disease (CKD) (p<0.0001), orbital involvement (p=0.039), use of tocilizumab (p<0.0001), and development of renal dysfunction during hospitalization (p<0.0001) were seen in a significantly higher proportion of nonsurvivors. The proportion of patients with diabetes, those receiving steroids, and mean glycosylated hemoglobin (HbA1c) levels did not differ significantly in survivors and nonsurvivors. Conclusion In-hospital mortality in CAM is relatively lower in our institution. CKD, orbital involvement, use of tocilizumab, and renal dysfunction during hospital stay were found to be strong predictors of mortality.

Increase in Cadaver Organ Donation Rate at a Tertiary Care Hospital: 23 Years of Experience.

BACKGROUND: Transplantation of Human Organ Act was passed in India in 1994 to streamline organ donation and transplantation activities. It is time to retrospect ourselves and analyze the method to increase organ donation. TYPE OF STUDY: Retrospective observational analysis. OBJECTIVES: To evaluate the change in organ donation rate and reasons for changes in rates. SUBJECTS: Brainstem dead declared patients whose family consented for organ donations in the last 23 years (1997-2019) at Ruby Hall Clinic, Pune, India. MATERIALS AND METHODS: Retrospectively demographic data of the brainstem dead declared donors, the primary diagnoses, comorbidities, and the complete data of their management till organ retrieval was assessed. RESULTS: One hundred cases in the age group 15-75 years (mean 41.6 ± 15.3 years) of brainstem death consented for organ donation were retrospectively studied. The period was divided into two groups, group I and group II included study duration from 1997 to 2013 and from 2013 to 2019 respectively. During the entire period, though the major cause of donor death remained road traffic accidents (RTA) in both the groups (84.21% till 2013 vs 48.15% after 2013), the proportion of donors declared brain dead due to RTA dipped significantly after 2013 (p = 0.004) and the non-RTA causes of brain dead contributed more than RTA causes (51.85% non-RTA vs 48.15% RTA). The major contributor among non-RTA causes was intracranial bleeds (5.26% before 2013 vs 33.33% after 2013, p = 0.014). Compared to the previous 17 years (from 1997) there were more than fourfold rise in the rate of transplantation in the last 6 years (2014-2019) at our institute. Kidneys were retrieved from 90% donors followed by cornea 84%, liver 65%, heart 22%, skin 7%, lungs 6%, and pancreas 5%. CONCLUSION: We have observed that the cadaveric organ donation rate significantly improved after 2013. Reasons might be widening of the donor pool by the selection of more of non-RTA brain death donors over RTA, acceptability of elderly population donor (>60 years) by our transplant teams, early identification of potential organ donor, and better protocol-based management of the cadaver organ donor. HOW TO CITE THIS ARTICLE: Zirpe KG, Suryawanshi P, Gurav S, Deshmukh A, Pote P, Tungenwar A, et al. Increase in Cadaver Organ Donation Rate at a Tertiary Care Hospital: 23 Years of Experience. Indian J Crit Care Med 2020;24(9):804-808.

Impact of "Stroke Code"-Rapid Response Team: An Attempt to Improve Intravenous Thrombolysis Rate and to Shorten Door-to-Needle Time in Acute Ischemic Stroke.

OBJECTIVE: "Stroke code" (SC) implementation in hospitals can improve the rate of thrombolysis and the timeline in care of stroke patient. MATERIALS AND METHODS: A prospective data of patients treated for acute ischemic stroke (AIS) after implementation of "SC" (post-SC era) were analyzed (2015-2016) and compared with the retrospective data of patients treated in the "pre-SC era." Parameters such as symptom-to-door, door-to-physician, door-to-imaging, door-to-needle (DTN), and symptom-to-needle time were calculated. The severity of stroke was calculated using the National Institutes of Health Stroke Score (NIHSS) before and after treatment. RESULTS: Patients presented with stroke symptoms in pre- and post-SC era (695 vs. 610) and, out of these, patients who came in window period constituted 148 (21%) and 210 (34%), respectively. Patients thrombolyzed in pre- and post-SC era were 44 (29.7%) and 65 (44.52%), respectively. Average DTN time was 104.95 min in pre-SC era and reduced to 67.28 min (P < 0.001) post-SC implementation. Percentage of patients thrombolyzed within DTN time ≤60 min in pre-SC era and SC era was 15.90% and 55.38%, respectively. CONCLUSION: Implementation of SC helped us to increase thrombolysis rate in AIS and decrease DTN time.