Dissertations

Analysing association between fluid balance and extubation success

Sat, 01 Jan 2022 00:00:00 GMT

Analysing association between fluid balance and extubation success Vivek mathew eapen Introduction: Water constitutes approximately 45–75% of total body weight and is essential for physiological functions including metabolism, temperature regulation, and tissue maintenance. In critically ill, mechanically ventilated patients, fluid homeostasis is disrupted due to reliance on intravenous fluids and impaired physiological responses. Improper fluid management may lead to pulmonary complications such as edema, which can negatively impact extubation outcomes and overall prognosis. Evidence increasingly suggests that maintaining an optimal fluid balance may improve extubation success and reduce morbidity. Objectives: Primary Objective: To examine the relationship between fluid balance from the day of intubation and extubation outcomes in patients mechanically ventilated for more than 24 hours who underwent successful spontaneous breathing trials (SBTs). Secondary Objective: To derive an optimal input/output (I/O) ratio to guide fluid administration in critically ill patients. Materials and Method: A prospective observational study was conducted over 12 months at BLDE, Shri B.M Patil Medical College Hospital and Research Centre, Vijayapura. The study included adult patients admitted to the ICCU and CCU who were intubated for medical reasons and mechanically ventilated for over 24 hours. Patients who completed an SBT using a T-piece or CPAP mode and underwent their first (index) extubation were included. Patients intubated before admission, post-operative or trauma cases, those extubated within 24 hours, or who underwent tracheostomy were excluded. Data were analyzed using JMP Pro 16 and SPSS v20. Statistical tests included the independent t vii Docusign Envelope ID: EFEB1A7B-4878-456C-83FB-4F7C23FAF536 test, Mann-Whitney U test, chi-square test, and ROC curve analysis. A p-value <0.05 was considered statistically significant. Results: Among categorical variables such as gender, primary diagnosis, type of SBT, diuretic use, and dialysis, no significant associations were found with extubation outcomes. However, cumulative fluid balance showed a statistically significant difference between extubation success and failure groups. Other continuous variables like age, individual fluid input/output volumes, and duration of mechanical ventilation did not predict extubation outcomes. ROC analysis for the I/O ratio yielded an AUC of 0.558 with a non-significant p value (0.140), indicating only marginal discriminative ability. A cut-off ratio of 1.129 offered moderate sensitivity and specificity but lacked predictive reliability as a standalone marker. Conclusion: Cumulative fluid balance emerged as a potential key factor in predicting extubation outcomes, whereas the fluid input/output ratio alone did not serve as a reliable predictor. These findings underscore the complexity of fluid management in critically ill patients and support the integration of fluid balance metrics into broader, multivariate predictive models. Future studies should focus on refining these models to improve extubation success rates and patient outcomes.

Effectiveness of serum glucose/potassium ratio as a tool for predictor of intermediate syndrome

Sat, 01 Jan 2022 00:00:00 GMT

Effectiveness of serum glucose/potassium ratio as a tool for predictor of intermediate syndrome Vishnu j nair Introduction: Intermediate syndrome (IMS) is a delayed neuromuscular complication of organophosphate (OP) poisoning, developing 24–96 hours after acute cholinergic crisis. It manifests as muscle weakness, particularly affecting the proximal muscles, neck flexors, and respiratory muscles, leading to potential respiratory failure. The precise pathophysiology remains unclear, but persistent acetylcholinesterase inhibition and neuromuscular dysfunction are key contributors. Objective: The study will evaluate the value of the predictive potential of serum glucose/potassium ratio among patients with at-risk potential of IMS development after OP poisoning. Materials and Methods: Prospective observational study was performed at Shri B M Patil Medical College with an enrollment of 228 patients of acute OP poisoning. The patients were clinically and biochemically evaluated, and serum glucose and potassium were measured at admission. G/K ratio was performed, and how its creation takes place regarding IMS was related by statistical correlation using ROC curve analysis. Results: Out of 228 patients, IMS was found in 21 (9.2%). G/K ratio was significantly higher in IMS-positive patients (82.5 ± 29.8) than in IMS-negative patients (24.7 ± 12.6) (p<0.0001). ROC analysis provided AUC as 0.910 with cutoff as 53.2 with high sensitivity (94.3%) and specificity (93.1%) for the prediction of IMS. Conclusion: Serum G/K ratio is a good and valid predictor of IMS in OP poisoning that facilitates early identification of high-risk patients. Its implementation into clinical routines can enhance monitoring and intervention methods and minimize the risk of critical complications.

Comparison of glasgow blatchford score, pre-endoscopic rockall score and aims65 score in predicting mortality and six-month hospital readmission in patients with upper gastrointestinal bleeding

Sat, 01 Jan 2022 00:00:00 GMT

Comparison of glasgow blatchford score, pre-endoscopic rockall score and aims65 score in predicting mortality and six-month hospital readmission in patients with upper gastrointestinal bleeding Teena kishor nikhar Introduction: Upper gastrointestinal bleeding (UGIB) is a common emergency with significant morbidity and mortality. Risk stratification scores such as Glasgow Blatchford Score (GBS), pre-endoscopic Rockall Score, and AIMS65 are used to predict adverse outcomes and guide clinical management. However, their comparative effectiveness in predicting both in-hospital mortality and six-month readmission remains underexplored in the Indian setting. Objective: This study aimed to compare the effectiveness of GBS, pre-endoscopic Rockall, and AIMS65 scores in predicting in-hospital mortality and six-month hospital readmission in patients presenting with UGIB. Materials and Methods: This cross-sectional observational study included 78 patients presenting to the emergency department with UGIB between May 2023 and January 2024. Scores were calculated based on clinical presentation and laboratory parameters. Patients were followed for mortality during admission and readmission up to six months post-discharge. Data were analyzed using chi-square, Mann-Whitney U tests, and ROC curves to assess predictive performance. Results: The Rockall score showed the strongest correlation with mortality, rising from 0% at score 0 to 100% at score 6. AIMS65 and GBS also predicted mortality but less consistently. Conversely, lower scores across all tools were associated with higher six-month readmission rates. For instance, AIMS65 scores of 0–2 showed >90% readmission, while scores of 5 had 0% readmission. This inverse trend likely reflects survival bias, where high-risk patients do not survive to be readmitted. Conclusion: The Rockall score was the most reliable for predicting both mortality and readmission trends. It remains a robust tool for UGIB risk stratification in emergency settings.

Correlation of hematological markers in psoriasis with the severity of the disease

Sat, 01 Jan 2022 00:00:00 GMT

Correlation of hematological markers in psoriasis with the severity of the disease Vishnavi pran kanath Background: Psoriasis is atchronic and recurrent disease that affects the skin, joints, and nails, characterised as an immune-mediated disorder with systemic involvement.tThis can lead to changes in the haemotological parameters as well. The tpsoriasis area and severity index (PASI) is a tool that assesses the severity of psoriasis lesions and the therapeutic response of the patients.tVarious studies have shown correlation between the PASI and haematological parameters. Aim: To assess the haematological parameters- platelet-lymphocyte ratio (PLR), platelet distribution width (PDW), neutrophil-lymphocyte ratio (NLR), red cell distribution width (RDW), mean platelet volume (MPV) and plataelet count (PLT) in psoriasis patients. These values will also be correlated with the disease severity. Materials and methods: A cross-sectional case-control study was conducted from May 2023 to January 2025 on 260 psoriasis patients and controls. The study was done at thetDepartment of Dermatology, Shri BM Patil Medical College Hospital and Research Center, Vijayapura.tComplete hemogram was done for all the study participants and the parameters were correlated with PASI in the cases. Additionally, the parameters were compared with that of controls. Results: PLT and NLR (p =0.045 and p =0.002 respectively) had a“statistically significant positive correlation”with PASI. On comparison of cases to controls, a statistically significant elevation was seen in the MPV (p =0.012 ) and NLR (p =0.012) in cases. Conclusion: NLR, PLT and MPV can be used as cost-effective and affordable laboratory markers in the assessment of disease severity in psoriasis, in conjunction with PASI (NLR, PLT).