Browsing by Author "Ansari, Istiyaque"
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Publication A Prospective Observational Study on Use of Acute Physiology and Chronic Health Evaluation-II and Sequential Organ Failure Assessment Score to Predict Outcome(Nepal Health Research Council, 2025) Keyal, Niraj Kumar; Jha, Sudhakar; Parween, Shahnaj; Haque, Ishfa Banu; Ansari, Tauqueer; Ansari, IstiyaqueBackground: Acute physiology and chronic health evaluation –II (APACHE-II) and Sequential organ failure assessment (SOFA) is used to predict overall mortality and sepsis outcome in the intensive care unit (ICU) respectively. There are limited studies that have shown that both score can be used to predict mortality in surgical and medical patients admitted in the intensive care unit. Methods: It was a prospective, observational study in a level three intensive care unit of National Medical College, Birgunj. This study was conducted in 542 patients admitted in the mixed intensive care unit of medical; college. Demographic data was gathered from each patient in the preformed sheet at the time of presentation to the intensive care unit. Outcome of patients was recorded in terms of mortality, discharge toward and leave against medical advice. The descriptive data are presented as the number and percentage for categorical data and mean ± standard deviation for continuous data according to their distribution Results: Five hundred forty two patients were included in this study. 340(62.7%) were males and 202(37.3%) were females. 440(81%) patients survived and went home, 65(12%) expired, 26(5%) left the hospital against medical advice (LAMA) and 11(2%) gave do not resuscitate orders (DNR). The discrimination power was similar for APACHE II and SOFA scores (AUC=0.732 versus 0.771, respectively, p>0.05). APACHE II score>8.5 and SOFA >3.5 was cut off to predict mortality. Conclusions: SOFA and APACHE II has similar discriminating power to predict mortality in all group of patients in a mixed intensive care unit. Keywords: APACHE II; intensive care units; SOFA.Publication Clinical Profile and Outcome of Delirium in Patients in The Semi-Closed Intensive Care Unit(Nepal Health Research Council, 2024) Keyal, Niraj Kumar; Sherpa, Aang Dali; Kumar, Romi; Ansari, IstiyaqueBackground: Delirium is an underdiagnosed condition in the intensive care unit. This study was conducted to know clinical profile and outcome of delirium in patients in the mixed semi-closed intensive care unit of medical college. Methods: This prospective observational study was done in 284 patients of age?18 years admitted for more than 24 hours in level three intensive care unit of tertiary care hospital for one year. The Confusion Assessment Method-ICU and Richmond Agitation Sedation Scale were used to diagnose and motor subtype delirium, respectively, Hyperactive delirium was defined as a persistent rating of +1 to +4 during all assessments. Hypoactive delirium was defined as a persistent rating of 0 to ?3 during all assessments and mixed subtype was defined as present when the patients have rating of both hyperactive and hypoactive values. There was a checklist to assess risk factors. All data was transferred to the excel sheet and transferred to a statistical package for the social sciences-16. Chi-square test and Fisher’s exact probability test were used to detect the difference between groups in the univariate analysis, as appropriate. Results: Of the 284 ICU admissions 109(38.4%) patients developed delirium. Mixed delirium was the most common motor subtype 39(35.7%) in this study. The mean duration of delirium was 3.69±4.06 days. APACHE II score, SOFA score, presence of co-morbidities, history of alcohol intake, presence of hypoxemia, presence of metabolic acidosis, and use of mechanical ventilation were identified as risk factors for delirium. Delirious patients had longer length of ICU stay (5.8 ±5.4 vs 4.2±4.3 days) and higher reintubation rate. Conclusions: APACHE II score, SOFA score, presence of co-morbidities, history of alcohol intake, presence of hypoxemia, presence of metabolic acidosis, and use of mechanical ventilation were identified as risk factors for delirium in the intensive care unit patients that should be identified early to prevent complication such as longer length of ICU stay and higher reintubation rate. Keywords: Delirium; intensive care units; mortality.