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Novel approaches in Nursing Education and Health Care System

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A Retrospective Study Comparing Patients with Tuberculosis and HIV Co-infection in Relation to Mean CD4 Count in CART Era

Rajeev Shah

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Background:-Individuals with HIV infection are at increased risk for tuberculosis (TB) and other respiratory tract infections. Infection with TB enhances replication of HIV and may accelerate the progression of HIV to AIDS, with rapid fall in CD4 count, as both HIV/TB are individually known to decrease CD4 count. Aim: Emphasizing the pivotal role of cART and ATT in TB/HIV patients in maintaining their immune system effective (by maintaining CD4 count) and thus decreasing MDR/XDR, morbidity and mortality among these patients. Calculating average mean CD4 count for Indian scenario in cART era. Material and methods: All the 961 HIV infected patients early morning sputa were screened for AFB and few of the samples were even cultured on LJ medium. The samples were also examined for PMNLs in Gramâ??s staining. All patientsâ?? CD4 count were also evaluated by flow cytomerty method within one week of sputa collection. Seven other published work of HIV patients were analyzed for TB in relation to CD4 count. Moreover five published research work of CD4 in TB patients but HIV-negative were also discussed in this article. Results: Out of 961 patents with RTI , 308(32.06%) found positive for tuberculosis with mean CD4 count found to be 198.5 and 105.9 cells/μl for pulmonary TB and for extra-pulmonary TB respectively in present study. The average mean CD4 count from seven research studies from India were found to be 169.75 and 145.3 cells/μl for pulmonary and extra-pulmonary TB respectively, in TB/HIV co-infected patients on cART. In advanced TB (HIV-negative) patients mean CD4 count found to be 485+321 by other researchers. Conclusion: HAART and ATT both are equally important in maintaining immune system(maintaining CD4 count) of TB/HIV co-infected patients. In India, clinician should suspect more for TB at around mean CD4 count of 169.75 even if found negative by AFB staining but should be confirm by culture on LJ medium, PCR or any other advanced techniques for HIV-positive patients.

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Surgical Experience for Prosthetic Valve Infective Endocarditis

Shengli Jiang

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Background: To explore the diagnosis and treatment strategy of prosthetic valve endocarditis (PVE). Materials and methods: From December 2014 to January 2019, a total of 19 PVE patients came to our hospital for treatment. These articles review the clinical symptoms, diagnosis, treatment process and prognosis of these patients, and discuss the disease characteristics and treatment strategy of PVE. Results: 4 patients died before operation, 15 patients received surgical heart valve replacement, and 3 patients died of septic shock after operation. All 12 discharged patients were followed up and their cardiac functions were obviously improved at present. Conclusions: Hospital internal infection control can effectively reduce the occurrence of early-onset PVE. Joint consultation of physicians and surgeons is helpful for early diagnosis and formulation of optimal treatment strategies. Grasping surgical indications, thorough removal of infected tissues during surgery and reconstruction of cardiac morphology and structure are the keys to the success of surgical intervention. Keywords: Heart valve replacement; Infective endocarditis; Prothetic valve endocarditis; Mechanical valve; Biological valve

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Does Follow up Communication Decrease Readmissions of Patients Living with Heart Failure?

Rekha Aryal

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About 6.5 million adults in the United States have heart failure, a condition that was deemed a contributing cause of 1 in 8 deaths in 2017, costing the nation an estimated $30.7 billion in 2012 reflected in healthcare services, missed days of work, and on medications to treat heart failure. Patients with heart failure (HF) who are inappropriately discharged without the proper teaching and follow-up instructions end up being readmitted within 30 days. Research has shown that admissions back to the hospital or emergency department post-discharge for heart failure have been associated with worse outcomes, high costs, and more often than not represent poor quality of care. The goal of our systematic review was to determine if among heart failure patients does the addition of discharge education adjuncts following hospital discharge improve key compliance indicators. Consecutive 150 patients underwent discharge education and follow up between June 2018 to September 2018 at Moses Cone Hospital, North Carolina, USA. Vast majority of patients found lacking knowledge regarding their plan of care and treatment. Discharge education and follow up phone call/email regarding their medicine, diet, exercise, and future appointment with a doctor, has significantly reduced the hospital readmission of heart failure patients within a month. Conclusion: Evidence suggests that the results are relatively consistent that the nurse-driven educational interventions and follow-up to reduce the readmission rate and to decrease mortality among HF patients. This study showed a difference of 1.3% in readmission between the control and intervention group. Despite the outcome of the study, there were lessons learned by staff: Understanding the process of research and being able to conduct an actual research project. The outcome demonstrated there was a reduction in hospital readmission rates within one month from 17% to 14%.

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Fine-tuning of risk prediction in PE: GFR and sPESi combined - powerful predictor of survival in patients with pulmonary embolism

Zorica Dimitrijevic

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Background: The PESI score is an established prognostic score of the severity of the acute -pulmonary embolism (PE). Patients with sPESI class 0 represented a low-risk PE. However, several laboratory and echocardiographic parameters not included in sPESI score may represent the features of worse outcome in PE. Purpose: To investigate whether adding brain natriuretic peptide (BNP) and cardiac troponin (cTn) blood concentrations, echocardiographic parameters or glomerular filtration rate to sPESI can improve the prognostic value of acute PE. Methods: The study included 1201 consecutive patients with PE which was confirmed using MDCT. All patients underwent echocardiography examination on admission and blood samples were collected for troponin I (TnI), B-type natriuretic peptide (BNP), creatinine and other routine laboratory analyses. Results: Intra-hospital mortality rate was 11.5%. Using three levels sPESI model : sPESI 0, sPESI 1 and sPESI �?�2, patients were into three groups. There were statistically significant differences in death rate and values of BNP, TnI, eGFR and right ventricular dysfunction between groups based on sPESI score. Cox regression analysis revealed that the best predictor of 30-days all-cause mortality rate was eGFR ((HR 2.24 (CI 1.264-3.969); p =0.006) in all three sPESI groups. Neither TnI and BNP, nor RVD improved risk assessment in combination with a different stratification tool based on three levels sPESI model. Conclusion: Renal dysfunction on admission, in patients with acute PE, is strongly associated with high intrahospital mortality risk. Three levels model of sPESI score, can be used as a more accurate prognostic stratification tool in patients with acute pulmonary embolism. Established sPESI score may have greater discriminative power by using a simple calculation of GFR in prediction of survival of patients with PE and possible outpatient treatment. In spite of that, GFR calculation has still not become the clinical routine in PE. Key words: pulmonary embolism, sPESI score, prognosis

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Fever is not a symptom in covid-19 and none of the diseases require fever as its symptom

K. M. Yacob

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We have been hearing for centuries that â??fever is not a disease but a symptomâ??. Physicians say that fever is a symptom of diseases like flu to cancer. The conservative fever definition, diagnosis, and treatments are based on fever as a symptom .All the studies related to fever as a symptom of a disease have been done without knowing the Purpose of the temperature of fever is. Most of the diseases may not have a fever. Sometimes it disappears. Then, is fever a symptom of which disease. Symptom Definition is the only parameter necessary for a Symptom. As with any or all other definitions, symptom definition should describe the symptom scientifically. If it cannot describe clearly, there is no use of a symptom definition. A symptom is a departure from normal function or feeling which is noticed only by a patient, indicating the presence of disease or abnormality. One cannot be understood directly the temperature is elevated in the hypothalamus. A mechanical device is necessary to measure elevated temperature in the hypothalamus. In symptom definition, fever definition canâ??t be found. The elevation of body temperature is not included in symptom definition.

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Changes over Time in Hemoglobin A1c (HbA1C) Levels Predict Long-term Survival Following Acute Myocardial Infarction Among Patients with Diabetes Mellitus

Ygal Plakht

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Frequent fluctuations of hemoglobin A1c (HbA1C) values are independent predictors of diabetic complications and patient outcomes. However, data regarding prognosis depending on the long-term changes in HbA1C among patients after acute myocardial infarction (AMI) are scarce. We evaluated the prognostic significance of HbA1C levels and their changes among diabetic patients after non-fatal AMI. Patients with diabetes mellitus (DM) admitted with AMI (2002-2017) and survived >1year were evaluated. All the results of HbA1C values during the follow-up period (up to 10-years after discharge) were obtained and analyzed. The changes (â??) of HbA1C were calculated for all pairs of tests in each patient. The time interval of â??HbA1C values was classified as rapid (<1 year) and slow (â?¥1 year) change. The outcome was all-cause mortality. A total of 4,066 patients were analyzed, mean age 66.4±11.9 years, 36% females. A U-shaped association was observed between HbA1C and mortality: adjOR=1.887 and adjOR=1.302 for HbA1C <5.5% and â?¥8.0% respectively, as compared with 5.5-6.5% (p<0.001). A U-shaped independent association between â??HbA1C and mortality was found: adjOR=2.376 and adjOR=1.340 for the groups of <-2.5% and â?¥2.5% HbA1C changes, respectively (p<0.001 for each), as compared to the group of minimal â??HbA1C (±0.5%). A rapid increase in HbA1C (but not decrease) was associated with a greater risk for mortality. HbA1C values and their changes are significant independent prognostic markers for long-term mortality with a U-shaped association following AMI among DM patients. Thus, â??HbA1C and its timing, in addition to absolute HbA1C values, should be monitored among these patients.

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