Journal of Acute Disease
Issue 2,2023 Table of Contents
Maryam Ziaei
,
Hojjat Rastegari Najafabadi
,
Mahjoubeh Keykha
,
Mehdi Galavi
,
Ali Abdolrazaghnejad
,
Alireza Bahmani
2023(2):45-50.
DOI: 10.4103/2221-6189.374309
Abstract:
Objective: To investigate the therapeutic effects of supplemental oxygen on patients with myocardial infarction.
Methods: This study was a randomized, double-blind clinical trial. The study population included all patients who were admitted to the emergency room of Ali-ibn-Abitaleb and Khatam-al-Anbia hospitals in Zahedan within six hours of the onset of classic symptoms of myocardial infarction. The patients (n=47) were divided into two groups: the case group (with oxygen therapy) and the control group (without oxygen therapy). The initial follow-up was evaluated after one month and the second follow-up was evaluated after three months in the target population in terms of mortality caused by acute myocardial infarction, mortality caused by any other cause, and re-hospitalization caused by acute myocardial infarction.
Results: Out of the 47 patients, 27 were male (57.4%). The average age of the patients was (60.9±8.1) years. One month after admission, 2 patients (8.7%) in the case group and 2 patients (8.3%) in the control group died due to acute myocardial infarction. A total of 7 patients (14.9%) died three months after admission. There was no significant difference between the control and case groups in terms of mortality caused by acute ischemia within one and three months. After one month, 2 patients (8.7%) in the case group and 1 patient (4.2%) in the control group died of other causes. After three months, 4 patients (8.5%) in total died for other causes. There was no significant difference between the control and case groups in terms of mortality due to other causes within one and three months. One month after admission, 5 patients (21.7%) of the case group and 4 patients (16.7%) of the control group were re-hospitalized due to acute myocardial ischemia. During the next three months, 3 patients (13.0%) of the case group and 5 patients (20.8%) of the control group were re-hospitalized. There was no significant difference between the control and case groups regarding the rate of re-hospitalization caused by acute myocardial infarction within one and three months after admission.
Conclusions: There is no significant relationship between oxygen therapy and death by acute myocardial ischemia, or any other causes. The relationship between oxygen therapy and the rate of re-hospitalization caused by acute myocardial ischemia is not found within one and three months after admission. The results show that oxygen therapy does not affect patients with acute myocardial ischemia within three months after admission.
Objective: To investigate the therapeutic effects of supplemental oxygen on patients with myocardial infarction.
Methods: This study was a randomized, double-blind clinical trial. The study population included all patients who were admitted to the emergency room of Ali-ibn-Abitaleb and Khatam-al-Anbia hospitals in Zahedan within six hours of the onset of classic symptoms of myocardial infarction. The patients (n=47) were divided into two groups: the case group (with oxygen therapy) and the control group (without oxygen therapy). The initial follow-up was evaluated after one month and the second follow-up was evaluated after three months in the target population in terms of mortality caused by acute myocardial infarction, mortality caused by any other cause, and re-hospitalization caused by acute myocardial infarction.
Results: Out of the 47 patients, 27 were male (57.4%). The average age of the patients was (60.9±8.1) years. One month after admission, 2 patients (8.7%) in the case group and 2 patients (8.3%) in the control group died due to acute myocardial infarction. A total of 7 patients (14.9%) died three months after admission. There was no significant difference between the control and case groups in terms of mortality caused by acute ischemia within one and three months. After one month, 2 patients (8.7%) in the case group and 1 patient (4.2%) in the control group died of other causes. After three months, 4 patients (8.5%) in total died for other causes. There was no significant difference between the control and case groups in terms of mortality due to other causes within one and three months. One month after admission, 5 patients (21.7%) of the case group and 4 patients (16.7%) of the control group were re-hospitalized due to acute myocardial ischemia. During the next three months, 3 patients (13.0%) of the case group and 5 patients (20.8%) of the control group were re-hospitalized. There was no significant difference between the control and case groups regarding the rate of re-hospitalization caused by acute myocardial infarction within one and three months after admission.
Conclusions: There is no significant relationship between oxygen therapy and death by acute myocardial ischemia, or any other causes. The relationship between oxygen therapy and the rate of re-hospitalization caused by acute myocardial ischemia is not found within one and three months after admission. The results show that oxygen therapy does not affect patients with acute myocardial ischemia within three months after admission.
Thirumurugan E
,
Gomathi K
,
Swathy P
,
Afrin Syed Ali
,
Alekhya Ponduri Lakshmi
,
Jishnu B
,
Banashree Das
2023(2):51-56.
DOI: 10.4103/2221-6189.374310
Abstract:
Objective: To investigate the golden-time-awareness of and the necessary actions in response to acute myocardial infarction among the general public.
Methods: This study was conducted with the use of a descriptive research design and convenience sampling. A sample of 800 subjects, using self-structured knowledge questionnaires, was selected for data collection and analysis. The study was conducted at Dr. M.G.R. Educational and Research Institute, India, from February to November 2022. Awareness of myocardial infarction symptoms and intervention timeline (the golden time) was investigated. A multivariate logistic regression analysis was performed to identify the demographic factors affecting the recognition of the golden time of acute myocardial infarction.
Results: A total of 800 subjects were included. Among the subjects, 367 (45.8%) were male, 433 (54.2%) were female, and 443 (55.3%) participants failed to recognize the golden time. Our multivariate logistic regression analysis showed that people with a bachelor’s degree (OR=0.41, 95% CI: 0.23-0.74, P=0.03) and a high school level diploma (OR=0.55, 95% CI: 0.31-0.97, P=0.03) are more likely to know about myocardial infarction (golden time) than illiterate people. Additionally, people who are employed (OR=0.59, 95% CI: 0.41-0.85, P=0.05) are more likely to know about myocardial infarction (golden time) than those who are not.
Conclusions: The majority of people in the awareness group realize that taking myocardial infarction patients to the hospital would be the best course of action. The unawareness of the ideal treatment window for myocardial infarction may cause a delay in seeking medical attention, which can lead to an increase in mortality and morbidity.
Objective: To investigate the golden-time-awareness of and the necessary actions in response to acute myocardial infarction among the general public.
Methods: This study was conducted with the use of a descriptive research design and convenience sampling. A sample of 800 subjects, using self-structured knowledge questionnaires, was selected for data collection and analysis. The study was conducted at Dr. M.G.R. Educational and Research Institute, India, from February to November 2022. Awareness of myocardial infarction symptoms and intervention timeline (the golden time) was investigated. A multivariate logistic regression analysis was performed to identify the demographic factors affecting the recognition of the golden time of acute myocardial infarction.
Results: A total of 800 subjects were included. Among the subjects, 367 (45.8%) were male, 433 (54.2%) were female, and 443 (55.3%) participants failed to recognize the golden time. Our multivariate logistic regression analysis showed that people with a bachelor’s degree (OR=0.41, 95% CI: 0.23-0.74, P=0.03) and a high school level diploma (OR=0.55, 95% CI: 0.31-0.97, P=0.03) are more likely to know about myocardial infarction (golden time) than illiterate people. Additionally, people who are employed (OR=0.59, 95% CI: 0.41-0.85, P=0.05) are more likely to know about myocardial infarction (golden time) than those who are not.
Conclusions: The majority of people in the awareness group realize that taking myocardial infarction patients to the hospital would be the best course of action. The unawareness of the ideal treatment window for myocardial infarction may cause a delay in seeking medical attention, which can lead to an increase in mortality and morbidity.
2023(2):57-60.
DOI: 10.4103/2221-6189.374311
Abstract:
Objective: To study epidemiology, clinical manifestations, and laboratory parameters of scrub typhus in Hadoti region of Rajasthan, India.
Methods: A cross-sectional study was conducted on 50 patients with scrub typhus between August 2022 and November 2022. Scrub typhus was diagnosed by ELISA IgM scrub typhus antibody. The data about demography, vital parameters, and lab investigations were collected and analyzed.
Results: Ninety-two percent of the patients were from a rural background (92%), 86% were farmers and the majority were females. Most patients were 40-60 years old. The major complaints were fever (100%), myalgia (100%), headache (82%), and body swelling (80%). Major complications were pneumonia (68%), multiple organ dysfunction syndrome (62%), hepatitis (44%), and acute kidney injury (42%). Triglyceride levels were >200 mg/dL in 80% of patients, albumin <3.5 g/dL in 98% and eschar mark was present in 24% of patients.
Conclusions: Scrub typhus is a serious acute febrile illness that can lead to multi-organ dysfunction and is associated with significant mortality. Increasing awareness regarding disease in endemic regions, early screening of patients, and treatment as early as possible could help prevent the patient from severe life-threatening complications.
Objective: To study epidemiology, clinical manifestations, and laboratory parameters of scrub typhus in Hadoti region of Rajasthan, India.
Methods: A cross-sectional study was conducted on 50 patients with scrub typhus between August 2022 and November 2022. Scrub typhus was diagnosed by ELISA IgM scrub typhus antibody. The data about demography, vital parameters, and lab investigations were collected and analyzed.
Results: Ninety-two percent of the patients were from a rural background (92%), 86% were farmers and the majority were females. Most patients were 40-60 years old. The major complaints were fever (100%), myalgia (100%), headache (82%), and body swelling (80%). Major complications were pneumonia (68%), multiple organ dysfunction syndrome (62%), hepatitis (44%), and acute kidney injury (42%). Triglyceride levels were >200 mg/dL in 80% of patients, albumin <3.5 g/dL in 98% and eschar mark was present in 24% of patients.
Conclusions: Scrub typhus is a serious acute febrile illness that can lead to multi-organ dysfunction and is associated with significant mortality. Increasing awareness regarding disease in endemic regions, early screening of patients, and treatment as early as possible could help prevent the patient from severe life-threatening complications.
4 Invasive versus non-invasive ventilation in patients with COVID-19 pneumonia: A retrospective study
2023(2):61-66.
DOI: 10.4103/2221-6189.374312
Abstract:
Objective: To compare the survival and length of stay of invasive ventilation (IV) with those of non-invasive ventilation (NIV) in patients with COVID-19 acute respiratory distress syndrome in a single hospital from May 2020 to March 2021.
Methods: After obtaining approval from the Hospital Director, the data of COVID-19 patients including demographics, type of respiratory support (non-invasive ventilation or invasive ventilation), duration of ventilation, length of stay, discharge, and death were collected and analyzed.
Results: Out of the 152 patients identified, 134 patients were analyzed. The median intubation days were 10.0 (Q1: 3.5, Q3: 13.5) in the IV group and 0.0 (Q1: 0.0, Q3: 0.0) days in the NIV-only group. Out of the 101 patients who received NIV, 43 patients were subsequently intubated due to failure of NIV. Of the 63 patients (47.01%) who died, 22 (66.66%) were from the IV group and 40 (92.02%) were from the NIV-followed-by-intubation group, and 1 (1.72%) were from the NIV-only group. Multivariate analysis showed that the presence of a respiratory comorbidity (OR=16.56, 95% CI=1.56-175.48, P=0.02) was an independent predictor of survival.
Conclusions: Respiratory co-morbidity is a significant adverse predictor of survival outcome. The decision on the type of respiratory support should be made on a patient-to-patient basis.
Objective: To compare the survival and length of stay of invasive ventilation (IV) with those of non-invasive ventilation (NIV) in patients with COVID-19 acute respiratory distress syndrome in a single hospital from May 2020 to March 2021.
Methods: After obtaining approval from the Hospital Director, the data of COVID-19 patients including demographics, type of respiratory support (non-invasive ventilation or invasive ventilation), duration of ventilation, length of stay, discharge, and death were collected and analyzed.
Results: Out of the 152 patients identified, 134 patients were analyzed. The median intubation days were 10.0 (Q1: 3.5, Q3: 13.5) in the IV group and 0.0 (Q1: 0.0, Q3: 0.0) days in the NIV-only group. Out of the 101 patients who received NIV, 43 patients were subsequently intubated due to failure of NIV. Of the 63 patients (47.01%) who died, 22 (66.66%) were from the IV group and 40 (92.02%) were from the NIV-followed-by-intubation group, and 1 (1.72%) were from the NIV-only group. Multivariate analysis showed that the presence of a respiratory comorbidity (OR=16.56, 95% CI=1.56-175.48, P=0.02) was an independent predictor of survival.
Conclusions: Respiratory co-morbidity is a significant adverse predictor of survival outcome. The decision on the type of respiratory support should be made on a patient-to-patient basis.
2023(2):67-72.
DOI: 10.4103/2221-6189.374313
Abstract:
Objective: To assess perceived stress and coping capacity of frontline health workers from AIIMS during COVID-19 pandemic.
Methods: This cross-sectional study conducted from May to July 2021 enrolled 694 participants. An online questionnaire based on Google Forms was developed to collect the data. Participants were assessed using the validated Perceived Stress Scale and the Coping Resources Inventory Scale.
Results: The age of participants were 27 (23-52) years old. The majority of respondents (73.5%) felt moderately stressed. Of the 694 participants, 83.0% of the 576 participants had average stress management skills. Sex, marital status, and profession were significantly associated with perceived stress. In addition, marital status and profession were significantly associated with coping capacity.
Conclusions: The majority of participants have moderate stress levels and average coping skills. Frontline healthcare workers have to maintain mental and physical health. Achieving this requires early screening and stress management for healthcare workers.
Objective: To assess perceived stress and coping capacity of frontline health workers from AIIMS during COVID-19 pandemic.
Methods: This cross-sectional study conducted from May to July 2021 enrolled 694 participants. An online questionnaire based on Google Forms was developed to collect the data. Participants were assessed using the validated Perceived Stress Scale and the Coping Resources Inventory Scale.
Results: The age of participants were 27 (23-52) years old. The majority of respondents (73.5%) felt moderately stressed. Of the 694 participants, 83.0% of the 576 participants had average stress management skills. Sex, marital status, and profession were significantly associated with perceived stress. In addition, marital status and profession were significantly associated with coping capacity.
Conclusions: The majority of participants have moderate stress levels and average coping skills. Frontline healthcare workers have to maintain mental and physical health. Achieving this requires early screening and stress management for healthcare workers.
2023(2):73-79.
DOI: 10.4103/2221-6189.374314
Abstract:
Objective: To investigate the stress perceptions of nurses serving in home healthcare services during COVID-19.
Methods: This study was qualitative research with a phenomenological design. Data were collected and recorded through in-depth interviews with 6 nurses working in Mus State Hospital, Home Healthcare Services Unit using a form consisting of 12 questions on an online platform between May 2021 and July 2021. The audio recordings were transcribed by the researcher and content analysis was performed by creating codes, categories, and themes.
Results: The interviews yielded 10 categories and 59 sub-codes. These codes were addressed under the theme of "COVID-19 pandemic". Under this main theme, nurses expressed the problems they experienced in issues such as stress, support mechanisms, and family and social problems during COVID-19. They mentioned that they experienced high stress in this process, as well as social isolation and negative thoughts of society about them and that they could not spare time for themselves and their families.
Conclusions: Nurses working in home healthcare services frequently express negativities such as high stress, isolation from society, and increased workload. Therefore, actions should be taken to raise awareness of society on these issues, increase the number of personnel, conduct more research, and share the results with the public.
Objective: To investigate the stress perceptions of nurses serving in home healthcare services during COVID-19.
Methods: This study was qualitative research with a phenomenological design. Data were collected and recorded through in-depth interviews with 6 nurses working in Mus State Hospital, Home Healthcare Services Unit using a form consisting of 12 questions on an online platform between May 2021 and July 2021. The audio recordings were transcribed by the researcher and content analysis was performed by creating codes, categories, and themes.
Results: The interviews yielded 10 categories and 59 sub-codes. These codes were addressed under the theme of "COVID-19 pandemic". Under this main theme, nurses expressed the problems they experienced in issues such as stress, support mechanisms, and family and social problems during COVID-19. They mentioned that they experienced high stress in this process, as well as social isolation and negative thoughts of society about them and that they could not spare time for themselves and their families.
Conclusions: Nurses working in home healthcare services frequently express negativities such as high stress, isolation from society, and increased workload. Therefore, actions should be taken to raise awareness of society on these issues, increase the number of personnel, conduct more research, and share the results with the public.
Eduardo Esteban-Zubero
,
Cristina García-Muro
,
Moisés Alejandro Alatorre-Jiménez
,
Carlos Arturo López-García
,
Alejandro Marín-Medina
2023(2):80-82.
DOI: 10.4103/2221-6189.374315
Abstract:
Rationale: Thrombosis of the internal jugular vein is an infrequent and underdiagnosed pathology due to the absence of symptoms. If present, the symptoms are frequently manifested as a sensation of pain and cervical tension. Its etiology is variable, including trauma, central catheterization, and hypercoagulable states, among others.
Patient’s Concern: A 41-year-old female, previously healthy, was admitted to the emergency room for worsening pain in the left cervical area of 5 d. Previously, she was treated for suspected acute pharyngotonsillitis yet without improvement.
Diagnosis: Physical examination revealed a 2 cm in length cervical mass of hard consistency that was painful on palpation and non-fluctuating. Ultrasound study showed thrombosis of the left internal jugular vein. A computed tomography scan revealed that the thrombosis occurred at the cervical portion of the left internal jugular vein as well as the left transverse sinus.
Interventions: Hospital admission and treatment with low molecular weight heparin at a dose of 1.5 mg/kg every 24 h.
Outcomes: The patient was discharged after 3 d of treatment with vitamin K antagonists.
Lessons: Venous thrombosis at the level of the internal jugular vein is an infrequent entity. Clinical suspicion is necessary for the diagnosis given the possibility of absence of symptoms.
Rationale: Thrombosis of the internal jugular vein is an infrequent and underdiagnosed pathology due to the absence of symptoms. If present, the symptoms are frequently manifested as a sensation of pain and cervical tension. Its etiology is variable, including trauma, central catheterization, and hypercoagulable states, among others.
Patient’s Concern: A 41-year-old female, previously healthy, was admitted to the emergency room for worsening pain in the left cervical area of 5 d. Previously, she was treated for suspected acute pharyngotonsillitis yet without improvement.
Diagnosis: Physical examination revealed a 2 cm in length cervical mass of hard consistency that was painful on palpation and non-fluctuating. Ultrasound study showed thrombosis of the left internal jugular vein. A computed tomography scan revealed that the thrombosis occurred at the cervical portion of the left internal jugular vein as well as the left transverse sinus.
Interventions: Hospital admission and treatment with low molecular weight heparin at a dose of 1.5 mg/kg every 24 h.
Outcomes: The patient was discharged after 3 d of treatment with vitamin K antagonists.
Lessons: Venous thrombosis at the level of the internal jugular vein is an infrequent entity. Clinical suspicion is necessary for the diagnosis given the possibility of absence of symptoms.
2023(2):83-86.
DOI: 10.4103/2221-6189.374316
Abstract:
Rationale: Post-COVID symptoms need aggressive evaluation.
Patient’s Concern: A 29-year-old male patient who had suffered from COVID-19 eight weeks earlier, presented with an acute onset of breathlessness and right-sided chest pain due to pneumothorax. Emergency tube thoracostomy was performed. However, it failed to improve hypoxia.
Diagnosis: High-resolution computed tomography of the thorax with computed tomography pulmonary angiography revealed pulmonary arterial thrombosis, ground-glass opacities, and bilateral pneumatoceles.
Interventions: Hospital admission and treatment with low molecular weight heparin at a dose of 1.5 mg/kg every 24 h.
Outcomes: The large pneumatocele showed significant resolution after three months of follow-ups.
Lessons: Being increasingly reported after having a SARS-CoV-2 infection, pneumatocele formation, due to post-COVID lung scarring and late vascular thrombotic events, is a peculiar sequela and can present as acute dyspnoea. Long-term preventive anticoagulants after recovery from COVID-19 are necessary. Breathing exercises during recovery should be done with caution.
Rationale: Post-COVID symptoms need aggressive evaluation.
Patient’s Concern: A 29-year-old male patient who had suffered from COVID-19 eight weeks earlier, presented with an acute onset of breathlessness and right-sided chest pain due to pneumothorax. Emergency tube thoracostomy was performed. However, it failed to improve hypoxia.
Diagnosis: High-resolution computed tomography of the thorax with computed tomography pulmonary angiography revealed pulmonary arterial thrombosis, ground-glass opacities, and bilateral pneumatoceles.
Interventions: Hospital admission and treatment with low molecular weight heparin at a dose of 1.5 mg/kg every 24 h.
Outcomes: The large pneumatocele showed significant resolution after three months of follow-ups.
Lessons: Being increasingly reported after having a SARS-CoV-2 infection, pneumatocele formation, due to post-COVID lung scarring and late vascular thrombotic events, is a peculiar sequela and can present as acute dyspnoea. Long-term preventive anticoagulants after recovery from COVID-19 are necessary. Breathing exercises during recovery should be done with caution.
2023(2):87-88.
DOI: 10.4103/2221-6189.374317
Abstract:
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