Introduction: Following cardiac surgery, complications such as cardiac, pulmonary, renal, and neurological diseases, infections like pneumonia or sepsis, and extended stays in the intensive care unit (ICU) and hospital are signs of both the quality of care and the quality of life. Therefore, it's critical to pinpoint the complications that put patients at risk for substantial postoperative morbidity and extended lengths of hospital stay. Aims & Objectives: To study nature and incidence of perioperative complications in patients undergoing cardiac surgery under cardiopulmonary bypass. Material & Methods: This study included 151 patients, of any age, either sex, planned for cardiac surgery under cardiopulmonary bypass (like Valve replacement, valve repairs, CABG, myxoma excision, Congenital Heart Diseases like ASD, VSD, TOF). The data regarding demographic profile and postoperative complications were collected. RESULTS; There were total of 151 patients in our study including 66 males (43.7%) and 85 females (56.3%). Age of the subjects ranged from 1 to 70 years with a mean of 26.39 ± 18.67 years (Median of 25 years). Mean age of males was 26.27 ± 20.72 years and mean age of females was 26.49 ± 17.03 years. About 51 % patients in our study had at least one of the complications. The most common complication was rhythm disorder which was present in 34.4% of all patients. ARDS developed in 1.3% of patients. Infections were present in 27 patients (17.9%). Dyselectrolytemia was present in 11 patients (7.3%). Conclusion: Cardiac surgery under cardiopulmonary bypass is associated with as cardiac, pulmonary, renal, and neurological diseases, infections like pneumonia or sepsis. The most common complication was rhythm disorder which was present in 34.4% of all patients. ARDS developed in 1.3% of patients. Infections were present in 27 patients (17.9%). Dyselectrolytemia was present in 11 patients (7.3%). Keywords: Cardiopulmonary Bypass (CPB), Length of stay (LOS).
INTRODUCTION: After open heart surgery (OHS) using cardiopulmonary bypass (CPB), abnormalities in the circulating thyroid hormone levels are found in the absence of primary thyroid disease; this is collectively called the sick euthyroid syndrome (SES). AIMS ANDOBJECTIVES: To study thyroid function test in patients planned for cardiac surgery under cardiopulmonary bypass. MATERIALS AND METHODS: This study included a total of 150 patients, of any age, either sex, planned for cardiac surgery under cardiopulmonary bypass (like Valve replacement, CABG, myxoma excision, congenital Heart Diseases like ASD, VSD, TOF). To assess the levels of thyroid hormone, TSH, TT3 and TT4 were measured. The blood samples were collected at regular intervals: preoperatively, on 2nd postoperative day and on 7th postoperative day. CONCLUSION: In our study the levels of thyroid hormone (TT4 and TT3) decreased significantly after cardiopulmonary bypass. Keywords: Open Heart Surgery (OHS), Cardiopulmonary Bypass (CPB), Sick Euthyroid Syndrome (SES)
INTRODUCTION: Symptoms of hypothyroidism are often subtle and are easily overlooked specially in patients with a heart disease and symptoms are thought to be from the existing cardiac condition. There is a consensus that patients with known hypothyroidism should have thyroid screening before any major surgery including cardiac surgery and if indicated should be made euthyroid before surgery. AIMS AND OBJECTIVES: To study the correlation of thyroid function test status with postoperative course and outcome (total duration of hospital, duration of ICU stay, hours of mechanical ventilation and in hospital mortality). MATERIAL AND METHODS: This prospective study recruited 151 patients who underwent cardiac surgery under cardiopulmonary bypass, TSH was measured and compared with outcome in these patients. RESULTS: Hours of mechanical ventilation (35.20 ± 20.1 Vs 110.61 ± 71.9 hours), ICU stay (3.3 ± 2.30 vs 5.9 ± 5.56 days) and hospital stay (16.7±4.21 days vs 21.1 ± 6.95 days) was significantly less in euthyroid than patients whose TSH was raised before surgery , also postoperative in hospital mortality was more in patients with raised TSH preoperatively. CONCLUSION: We concluded that patients with Subclinical hypothyroidism (SCHT) and Overt Hypothyroidism (OH) planned for cardiac surgery on cardiopulmonary bypass should be treated and those on levothyroxine replacement should have fair control before undergoing surgery. Keywords: Subclinical Hypothyroidism [SCHT], Overt Hypothyroidism [OH], Cardiopulmonary Bypass, Atrial Fibrillation [AF].
NTRODUCTION: IWMI is associated with increased risk of death, shock, ventricular tachycardia or fibrillation and atrioventricular block (AVB), and a higher mortality rate for the first month post MI in patients with RVMI. AIMS & OBJECTIVES: To study the complications and in-hospital mortality in IWMI with RVMI. MATERIALS AND METHODS: A total of 100 patients of IWMI were recruited and screened for RVMI and complications and in-hospital mortality was recorded. RESULTS; It was observed that patients with IWMI had CHD, more commonly in RVI (7.14%) as compared with NRVI group (1.38%). Bradyarrhythmia was found in 7 cases (25%) in RVI group as compared to 3 (4.16%) in NRVI group which was statistically significant. (p= 0.002). A high mortality of 10.71% was observed in RVI group as compared to 2.77% in NRVI group (p= 0.05). DISCUSSION: In the present study, prevalence of CHB and second-degree AV block was found to be 4% and 3%, respectively, among patients with IWMI, which is lower than earlier studies. In the present study, 1 patient presented with cardiogenic shock, in each group of IWMI. In our study, total in-hospital mortality in IWMI was found to be 5%, which is less than reported prevalence. CONCLUSION: RVMI in IWMI is associated with some increased complications especially high degree AV block and CHB which harbour increased mortality. Keywords: Right Ventricular Myocardial Infarction (RVMI), Inferior Wall Myocardial Infarction (IWMI), Atrioventricular block (AVB), Complete Heart Block (CHB), Right Ventricular Infarction (RVI). Non Right Ventricular Infarction (NRVI).
INTRODUCTION: In CAP patients, the mortality rate within 90 days after discharge can be as high as 14% (this is in addition to the inpatient mortality referred to early) and considerably higher than in the general population or in those hospitalized for other reasons. However, the mortality & morbidity data in young patients of CAP (≤60 years) is sparse, this is the reason for undertaking this study. AIMS & OBJECTIVES: To study the 90 day mortality /morbidity and complications in young patients of CAP (≤60 years). MATERIALS & METHODS: 100 cases, 60 years old or younger, who were diagnosed as CAP (defined as pneumonia identified 48 hours or less from hospitalization) were studied for morbidity (complications and/or ≥10 days hospital admission and/or admission to ICU) and the 90-day mortality was calculated. RESULTS: Sepsis was significantly present in complicated hospitalisations (p value <.001). Also CCF (p value =.002) and shock (p value=.023) were significantly present in complicated group. Elevated CURB SCORE (≥2) and PSI (≥2) were significantly associated with 90 day mortality and present in complicated hospitalisation compared to uncomplicated ones. CONCLUSIONS: Young patients with CAP who had higher CURB/PSI score had higher mortality and morbidity. Also patients in complicated hospitalisation group had higher rate of associated complications and vice versa. Keywords: Community Acquired Pneumonia, CURB-65, Pneumonia severity Index (PSI).
Background: Although sepsis is one of the leading causes of mortality in hospitalized patients, information regarding early predictive factors for mortality and morbidity is limited. The main objective of this study was to identify the outcome of patients with sepsis and septic shock. Methods: A prospective observational study was done in a surgical ICU over a period of one year. We included all adult patients admitted to ICU with features of sepsis and septic shock. Data related to demography, co-existing illnesses, parameters to assess Sequential Organ Failure Assessment (SOFA) scores, other relevant laboratory data, source of infection, organ failures and supportive measures instituted were recorded. Patients were followed till discharge or death from the ICU. Results: 160 patients were included in this study. The mortality rate was significantly higher among females compared with males. The most common co-existing illnesses were hypertension and type II diabetes mellitus. The SOFA scores at admission were high among non-survivors. Older age, presence of anaemia (defined as haemoglobin less than 13 g/dL in males and 12 g/dL in females), renal dysfunction (creatinine level more than 1.3 g/dL), and acute respiratory distress syndrome (ARDS) were associated with higher mortality. Haematocrit, total leucocyte count, serum bilirubin and SOFA scores were significantly higher among non-survivors. Conclusion: Our findings suggest that septic shock occurs frequently in ICU patients and mortality remains high. Several critical scoring systems are useful for the early prediction of mortality. A sepsis mortality based on SOFA scores and haemoglobin has greater predictive power.
INTRODUCTION: Right ventricular myocardial infarction can lead to diminished right sided stroke volume with concomitant right ventricular dilatation and septal changes. The potential hemodynamic derangement associated with right ventricular infarction renders the patients unusually sensitive to diminished ventricular preload. These two circumstances can result in a severe decrease in right and, secondarily, left ventricular output resulting in a clinical triad of hypotension and jugular venous pressure distension in the presence of clear lung fields. AIMS & OBJECTIVES: To study the incidence of RVMI in IWMI, risk factors and clinical profile of IWMI. MATERIAL & METHODS: A total of 100 patients were taken. At the time of admission, a 16 lead ECG consisting of twelve conventional leads; and additional right precordial leads V3R, V4R, V5R, V6R were taken, risk factors and clinical features were noted. RESULTS: Maximum number of patients in our study were in the age group 51 to 60 years (35%). IWMI was more common in males. Chest pain was most common symptom in RVMI. Hypertension was present in 40% and diabetes in 24% patients. Smoking was common risk factor in both RVI and NRVI IWMI patients. Hypotension and kussmaul’s sign was present in about 28.5% and 10.7% patients of RVMI. CONCLUSION: Right ventricular involvement in IWMI make the hemodynamics in these patients unstable. This explains the importance of diagnosing RVI in these patients. Keywords: Right Ventricular Infarction (RVI), Non Right Ventricular Infarction (NRVI), Right Precordial Leads (RPL)
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