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Background
Several studies have been published in the western literature on the incidence, clinical course and outcome of patients with ARDS. However, there is limited data about ARDS in the tropics and moreover, the etiology and outcomes of ARDS in tropical countries are different from those of western nations. In tropical countries like India, resources are limited and costs of therapy play a major role in deciding treatment options. This prospective observational study was designed to analyze the clinical profile, outcomes and predictors of mortality of patients with ARDS in an urban tropical setting.Methods
75 patients ≥13 years, admitted in the medical intensive care unit of a teaching hospital in Kerala, India between March 2013 and February 2014, satisfying Berlin definition for ARDS were enrolled in the study. Lung protective ventilation strategy as laid by ARDS Network protocol was followed for every patient on mechanical ventilation. Due to scarcity of ventilators in our institution, invasive ventilation could not be provided for all ARDS patients. The criteria used for patient selection for non-invasive ventilation were hemodynamic stability, well compliant to the use of NIV mask and PaO2/FiO2 ratio >180 at the time of admission.Results
Out of the 75 patients, 51% were females and the mean age of the study population was 39.8 ± 3.3 years. Common aetiologies were leptospirosis (18.7%), bronchopneumonia (17.3%), scrub typhus and dengue (12% each). Lung injury score and sequential organ failure assessment score scores had statistically significant association with the severity of ARDS. Forty patients (53.3%) received invasive mechanical ventilation and 35 patients were managed with non-invasive ventilation at the time of admission. The mortality in our study was 45%. Altered sensorium (p-0.002), central cyanosis (p-0.024), elevated creatinine (p-0.036), acidosis (p < 0.001), hypotension (p < 0.001), multiorgan dysfunction (p-0.017), PEEP >12 cm H2O (p-0.036), days on ventilator <7 (p-0.014), PaO2/FiO2 Ratio <100 (p < 0.001), LIS>2.5 (p < 0.001) and SOFA score>11 (p < 0.001) were individual predictors of mortality.Conclusion
Tropical infections form a major etiological component of ARDS in a developing country like India. More studies are required for determining criteria for using NIV in mild ARDS patients which would be helpful in resource limited countries. Timely administration of effective antimicrobial therapy in patients in the rural tropics may help to reduce mortality and financial burden due to ARDS. 相似文献Materials and methods: Electronic search was performed in PubMed and REHABDATA for studies published between 2000 and 2017.
Results: Eighty-six articles met the inclusion criteria. Results revealed a profound need for rehabilitation among different user groups with non-communicable diseases and injuries across countries. However, this need considerably outstripped the provision of services, which left many people with substantial unmet needs for rehabilitation. The main reasons for the unmet needs for rehabilitation were the absence of or unequal geographical distribution of services within a country, lack of transportation, and unaffordability of the services.
Conclusions: There are substantial unmet needs for rehabilitation and numerous barriers to accessing services. Efforts need to focus on building the capacity for rehabilitation research predominantly in low- and middle-income countries. The comprehensive data that this review provides is useful for raising awareness for the need of rehabilitation at policy level.
- Implications for rehabilitation
There is a profound need for rehabilitation services due to the ageing population and growing prevalence of non-communicable diseases.
This scoping review shows that the need for rehabilitation considerably outstrips the provision of services.
There are substantial unmet needs for rehabilitation and numerous barriers to accessing services.
Concerted global action to scale up quality rehabilitation services is needed, especially in low- and middle-income countries.
Objective
High blood pressure is one of the most important risk factors, directly responsible for increasing the cardiovascular morbidity and mortality. The primary objective was to evaluate the efficacy of metoprolol XL/chlorthalidone against metoprolol XL/hydrochlorothiazide with respect to mean fall in systolic and diastolic blood pressure. The secondary objective was to compare the response rates and to evaluate the tolerability of study medications in patients with mild-tomoderate essential hypertension.Methods
Total 130 eligible patients (65: metoprolol XL 25 mg/chlorthalidone 6.25 mg; 65: metoprolol XL 25 mg/HCTZ 12.5 mg) were enrolled in this randomized, comparative, multicentric, 12-weeks study. Sixty-two patients from each group completed the study. After 4-weeks of treatment, non-responders from chlorthalidone 6.25 mg combination group were shifted to metoprolol XL 50 mg/chlorthalidone 12.5 mg and non-responders from HCTZ 12.5 mg combination group were escalated to metoprolol XL 50 mg/HCTZ 12.5 mg.Results
The study treatment groups were comparable with respect to demography and baseline disease characteristics. Both the starting therapies were comparable with respect to mean fall in SBP (p = 0.788) and DBP (p = 0.939), and response rates (p = 1.0) after 4-weeks of therapy. Also both the step-up therapies showed similar mean fall in SBP (p = 0.277) and DBP (p = 0.507) at the end of 12-weeks. However, significantly more number of patients from chlorthalidone 12.5 mg/metoprolol XL 50 mg group responded to therapy as compared to that from HCTZ 12.5 mg/metoprolol XL 50 mg group (p = 0.045). All the reported adverse events were of mild-to-moderate intensity. There were no clinically significant trends in electrolytes (Na+, K+, Cl-)and fasting blood sugar, evident across the treatment groups.Conclusion
Chlorthalidone in combination with metoprolol XL is as effective and well tolerated as widely used combination of metoprolol XL/HCTZ, thus providing an alternative therapeutic option. 相似文献Awad MatariaEmail: |