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  1. Article: Risk factors and outcomes of upper gastrointestinal bleeding in hospitalized patients in a tertiary care hospital.

    Sohail Essani, Zahabia Muhammad / Naeem, Filza / Parkash, Om

    JPMA. The Journal of the Pakistan Medical Association

    2024  Volume 74, Issue 2, Page(s) 224–228

    Abstract: Objective: To determine different aetiologies and outcomes of upper gastrointestinal bleeding in hospitalised patients.: Methods: The retrospective cohort study was conducted at the Aga Khan University Hospital, Karachi, and comprised data from ... ...

    Abstract Objective: To determine different aetiologies and outcomes of upper gastrointestinal bleeding in hospitalised patients.
    Methods: The retrospective cohort study was conducted at the Aga Khan University Hospital, Karachi, and comprised data from December 2019 to April 2021 related to adult patients of either gender with nongastrointestinal illnesses who developed bleeding at least 24 hours after admission. Data was reviewed for clinical characteristics, cause of bleeding and clinical outcome. Data was analysed using SPSS 23.
    Results: Among 47,337 hospitalised patients, upper gastrointestinal bleeding was identified in 147(0.3%); 98 (66.7%) males and 49 (33.3%) females. The overall mean age was 62.73±14.81 years (range 20-95 years). Of the total, 125(85%) presented with overt bleeding and 22(15%) with a drop in haemoglobin level. There were 34(23%) patients on aspirin, 36(24%) on dual anti-platelets, 41(28%) on therapeutic anticoagulation, and 81(55%) on prophylactic anticoagulation. There were 7(5%) patients having a history of non-steroidal anti-inflammatory drugs (NSAIDs), and 12(8%) were on steroids. In terms of associated medical conditions, pneumonia, stroke, and acute coronary syndrome were commonly seen with frequency of 29.9%, 8.1% and 7.4% respectively. Overall, 36(24.4%) patients underwent endoscopy, 8(5.4%) had therapeutic measures to control bleeding, 14(9.5%) had bleeding for >48 hours, 89(60.5%) were stepped up to special care. Mortality was seen in 36(24.5%) cases.
    Conclusions: Hospital acquired gastrointestinal bleeding was found to be uncommon, and there were several risk factors for such bleeding events.
    MeSH term(s) Adult ; Male ; Female ; Humans ; Young Adult ; Middle Aged ; Aged ; Aged, 80 and over ; Retrospective Studies ; Tertiary Care Centers ; Gastrointestinal Hemorrhage/epidemiology ; Gastrointestinal Hemorrhage/etiology ; Gastrointestinal Hemorrhage/therapy ; Risk Factors ; Endoscopy, Gastrointestinal/adverse effects ; Anticoagulants/adverse effects ; Anti-Inflammatory Agents, Non-Steroidal/adverse effects
    Chemical Substances Anticoagulants ; Anti-Inflammatory Agents, Non-Steroidal
    Language English
    Publishing date 2024-02-28
    Publishing country Pakistan
    Document type Journal Article
    ZDB-ID 603873-6
    ISSN 0030-9982
    ISSN 0030-9982
    DOI 10.47391/JPMA.7141
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Comparison of five different disseminated intravascular coagulation criteria in predicting mortality in patients with sepsis.

    Zafar, Amara / Naeem, Filza / Khalid, Muhammad Zain / Awan, Safia / Riaz, Muhammad Mehmood / Mahmood, Saad Bin Zafar

    PloS one

    2024  Volume 19, Issue 3, Page(s) e0295050

    Abstract: Objective: Even though patients with sepsis and DIC have a higher mortality rate compared to those without DIC, screening for DIC is not currently part of sepsis management protocols. This may be due to a lack of literature on the frequency of DIC ... ...

    Abstract Objective: Even though patients with sepsis and DIC have a higher mortality rate compared to those without DIC, screening for DIC is not currently part of sepsis management protocols. This may be due to a lack of literature on the frequency of DIC occurrence in sepsis patients, as well as the absence of evidence on the optimal DIC criteria to use for identifying DIC and predicting mortality among the five criteria available. To address this gap, this study investigates the predictive value of five different criteria for diagnosing DIC and its relationship to patient outcomes in our population of sepsis patients.
    Methods: In the Medicine department of Aga Khan University Hospital, a retrospective observational study was conducted, enrolling all adult patients with International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) coding of sepsis and clinical suspicion of DIC between January 2018 and December 2020. To diagnose DIC, five different criteria were utilized, namely the International Society of Thrombosis and Hemostasis (ISTH), the Korean Society on Thrombosis and Hemostasis (KSTH), the Japanese Association for Acute Medicine (JAAM), the revised-JAAM (RJAAM), and the Japanese Ministry of Health and Welfare (JMHW). The study analyzed the sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of these five criteria, as well as the overall prediction of mortality.
    Results: Of 222 septic patients included in this study with clinical suspicion of DIC, 94.6% of patient had DIC according to KSTH criteria, followed by JAAM (69.4%), ISTH (64.0%), JMHW (53.2%) and lastly R-JAAM (48.6%). KSTH had sensitivity of 95.4% in diagnosing DIC and predicting mortality with a positive predictive value of 70% but specificity of 7.3% only. JAAM had sensitivity of 75.9%, positive predictive value of 75.9% with a specificity of 45.5%. ISTH had sensitivity of 69.4%, positive predictive value 75.3% and specificity of 48.5%.
    Conclusion: DIC can impose a significant burden on septic patients and its presence can lead to higher mortality rates. Early detection through screening for DIC in septic patients can potentially reduce mortality. However, it is necessary to identify the most appropriate diagnostic criteria for each population, as various criteria have demonstrated different performance in different populations. Establishing a gold standard for each population can aid in accurate diagnosis of DIC.
    MeSH term(s) Adult ; Humans ; Disseminated Intravascular Coagulation ; Hemostasis ; Thrombosis ; Predictive Value of Tests ; Sepsis
    Language English
    Publishing date 2024-03-07
    Publishing country United States
    Document type Observational Study ; Journal Article
    ZDB-ID 2267670-3
    ISSN 1932-6203 ; 1932-6203
    ISSN (online) 1932-6203
    ISSN 1932-6203
    DOI 10.1371/journal.pone.0295050
    Database MEDical Literature Analysis and Retrieval System OnLINE

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