A short cut review was carried out to establish whether negative dipstick urine analysis is sensitive enough to rule out urinary tract infection (UTI) in adults with urinary symptoms. Altogether 75 papers were found using the reported search, of which two presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.
Objective: To assess the fluid responsiveness with end tidal carbon dioxide using a simplified leg-raising maneuver in noncardiac patients admitted in medical Intensive Care Unit (ICU). Study Design: Cross sectional analytical study. Place and Duration of Study: Intensive Care Unit, Pak Emirates Military Hospital Rawalpindi, form Jun to Nov 2019. Methodology: A total of 80 cases were included in this study who were admitted in medical ICU and were on ventilator support. A standard 5-minute leg-raising maneuver was applied on all the patients. An increase in cardiac index >15% after passive leg rise was taken as criteria for responders. All echocardiographic evaluations were performed by experienced sonographers. Results: Mean age of study participants was 47.4 ± 4.421 years, 65 (81.3%) were males while 15 (18.7%) were female patients. Sixty (75%) patients responded to the simplified leg raising maneuver while 20 (25%) did not respond. Mean arterial pressure of the respondents was 92.3 ± 3.26 mmHg while mean arterial pressure of the non-respondents was 83.2 ± 4.57 mmHg. High body mass index and low mean arterial pressure had statistically significant relationship with no response to the maneuver in our study. Conclusion: Simplified leg raising emerged as an effective maneuver to stabilize the non-cardiac patients hemodynamically inside the setting of critical care unit. Patients with low baseline mean arterial pressure or high body mass index may be considered as high risk for non-response to this maneuver.
Objective: To determine the frequency of acute pancreatitis among the patients diagnosed with diabetic ketoacidosis at our tertiary care hospital. Study Design: Co-relational study. Place and Duration of Study: Medicine department, Pak Emirates Military Hospital Rawalpindi, from Jun to Dec 2019. Methodology: A total of 40 cases presenting with diabetic ketoacidosis were included in our study. Diabetic ketoacidosis was diagnosed by consultant medical specialist. All patients underwent baseline investigations including serum amylase, lipid profile and CT scan abdomen in order to diagnose acute pancreatitis. Relationship of age, gender, duration of diabetes mellitus and triglyceride levels was assessed with the presence of acute pancreatitis among the patients of diabetic ketoacidosis. Results: A total of forty patients were managed as diabetic ketoacidosis in our hospital during the study period. Out of them 8 (20%) had acute pancreatitis while 32 (80%) were not diagnosed with acute pancreatitis. Confusion (55%) was the commonest presenting complaint followed by abdominal pain (25%). With binary logistic regression analysis, we found that female gender and raised triglyceride levels had a statistically significant relationship with presence of acute pancreatitis among the patients of diabetic ketoacidosis included in this study. Conclusion: Considerable number of patients were diagnosed with acute pancreatitis who presented with diabetic ketoacidosis. Special attention should be paid towards female patients and those with raised triglyceride levels to look for the sign and symptoms of acute pancreatitis in order to diagnose and manage this condition.
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