moderate CD, defined as CDAI #300 at Wk 4, were analysed. A Cox model was applied to analyse the association between Wk-4 CRP concentration and the probability of having a CD-related hospitalisation during the 52-wk double-blind period. Wk-4 CDAI score, Wk-4 steroid use, age, sex, weight, body mass index, and prior antietumour necrosis factor use were also adjusted in the model. Patients were censored if they switched to open-label adalimumab or dropped out. A receiver operating characteristic (ROC) curve was used to identify the optimal CRP cut-off point to best predict the 52-wk CD-related hospitalisation rate.Results The analysis population included 214 patients randomised to placebo with Wk-4 CDAI #300. An elevated Wk-4 CRP concentration was associated with a greater chance of CD-related hospitalisation (HR¼1.24; p¼0.002). The ROC curve identified a CRP concentration ¼1.41 mg/dl as the dichotomising point (area under the curve¼0.68; sensitivity¼0.58; specificity¼0.80). Risk of CD-related hospitalisation during the double-blind period was 3.4 times greater for patients with CRP concentrations $1.41 mg/dl at Wk 4 vs patients with CRP concentrations <1.41 mg/dl (p¼0.015), with control for CDAI and other covariates. Conclusion Early CRP concentration represents a moderate to good marker to predict CD-related hospitalisation for patients with moderately active CD given the same CDAI score. CRP concentration of 1.41 mg/dl was the optimal cut-off point for predicting long-term CD-related hospitalisation. Introduction Acute severe ulcerative colitis (UC) is a serious illness that requires prompt hospitalisation and is associated with significant morbidity. It requires intensive monitoring, specialist intervention and a multidisciplinary approach throughout the duration of the illness with timely and appropriate medical and surgical interventions to avoid complications. Our aim was to evaluate the Foundation Year 1 (FY1) doctor's knowledge and understanding of this potentially life threatening emergency. Methods We approached FY1 doctors with an example case of acute severe UC and a questionnaire asking several questions regarding the diagnosis and management of acute severe UC 5 months into their training in 2011. Results 48 FY1 doctors completed the questionnaire during a medical teaching session. Only 25% had heard of the Truelove and Witts criteria as a tool for assessing the severity of UC. When asked regarding the criteria, 77.08% recognised stool frequency as one, 72.91% heart rate, 62.5% temperature, 41.67% haemoglobin and 35.42% erythrocyte sedimentation rate (ESR) as part of it. 58.33% of those asked diagnosed the example case as an acute severe UC, however only 43.75% stated that they would request daily
Background: Pulmonary hypertension (PH) is common among patients with end stage renal disease (ESRD) who are on dialysis and PH is associated with higher mortality rates among these patients. The impact of kidney transplantation on pulmonary hypertension is unknown. The purpose of this study is to evaluate the impact of successful kidney transplantation on pulmonary arterial hypertension in these patients on dialysis.Methods: The study was conducted on patients who underwent kidney transplantation in Department of Nephrology PSGIMSR. Patients with pulmonary hypertension pre transplant were taken up for the study after the application of inclusion and exclusion criteria and after obtaining consent. Demographic, clinical information and laboratory results were collected. The assessment of PH was done by Doppler echocardiography pre transplant and 3 and 6 months after transplant during follow up.Results: The prevalence of PH was 40%. The mean age of study population was 42 ± 8.7 years. The mean dialysis duration of study population was 32±8 months. 54.5% were male. 45.5% were female. Out of the 55 transplant recipients, 22 patients had elevated PASP on preoperative echocardiography examination. Compared to pre-transplant values, a significant decrease was observed in mean SPAP values and the severity of pulmonary hypertension 3 and6 months postoperative follow up (p<0.003).Conclusions: The prevalence of pre-operative PH among dialysis patient was high. Kidney transplantation leads to considerable improvement in pulmonary arterial hypertension in patients on dialysis.
Cardiac arrest, (is also known as circulatory arrest) is the cessation of normal circulation of the blood due to failure of the heart to contract effectively. Arrested blood circulation prevents delivery of oxygen to the body. Lack of oxygen to the brain causes loss of consciousness, which then result in abnormal or absent breathing. When unexpected cardiac arrest leads to death this is called sudden cardiac death. The treatment for cardiac arrest is cardiopulmonary resuscitation (CPR) to provide circulatory support. The aim of this narrative review is to find information on the effectiveness of simulation in terms of knowledge and skill regarding basic life support among non-medical faculty (participants). Intervention-Simulation on Basic life support method was used in the study. Quasi experimental study with skill lab of College was used in the study. This narrative review result has appeared that simulation will be effective for acquiring knowledge and skills on basic life support.
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