The six global nutrition targets (GNTs) related to low birthweight, exclusive breastfeeding, child growth (ie, wasting, stunting, and overweight), and anaemia among females of reproductive age were chosen by the World Health Assembly in 2012 as key indicators of maternal and child health, but there has yet to be a comprehensive report on progress for the period 2012 to 2021. We aimed to evaluate levels, trends, and observed-to-expected progress in prevalence and attributable burden from 2012 to 2021, with prevalence projections to 2050, in 204 countries and territories. The prevalence and attributable burden of each target indicator were estimated by age group, sex, and year in 204 countries and territories from 2012 to 2021 in the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, the most comprehensive assessment of causes of death, disability, and risk factors to date. Country-specific relative performance to date was evaluated with a Bayesian meta-regression model that compares prevalence to expected values based on Socio-demographic Index (SDI), a composite indicator of societal development status. Target progress was forecasted from 2021 up to 2050 by modelling past trends with meta-regression using a combination of key quantities and then extrapolating future projections of those quantities. In 2021, a few countries had already met some of the GNTs: five for exclusive breastfeeding, four for stunting, 96 for child wasting, and three for child overweight, and none met the target for low birthweight or anaemia in females of reproductive age. Since 2012, the annualised rates of change (ARC) in the prevalence of child overweight increased in 201 countries and territories and ARC in the prevalence of anaemia in females of reproductive age decreased considerably in 26 countries. Between 2012 and 2021, SDI was strongly associated with indicator prevalence, apart from exclusive breastfeeding (|r-|=0·46-0·86). Many countries in sub-Saharan Africa had a decrease in the prevalence of multiple indicators that was more rapid than expected on the basis of SDI (the differences between observed and expected ARCs for child stunting and wasting were -0·5% and -1·3%, respectively). The ARC in the attributable burden of low birthweight, child stunting, and child wasting decreased faster than the ARC of the prevalence for each in most low-income and middle-income countries. In 2030, we project that 94 countries will meet one of the six targets, 21 countries will meet two targets, and 89 countries will not meet any targets. We project that seven countries will meet the target for exclusive breastfeeding, 28 for child stunting, and 101 for child wasting, and no countries will meet the targets for low birthweight, child overweight, and anaemia. In 2050, we project that seven additional countries will meet the target for exclusive breastfeeding, five for low birthweight, 96 for child stunting, nine for child wasting, and one for child overweight, and no countries are projected to meet the anaemia target. Based on current levels and past trends, few GNTs will be met by 2030. Major reductions in attributable burden for exclusive breastfeeding and anthropometric indicators should be recognised as huge scientific and policy successes, but the comparative lack of progress in reducing the prevalence of each, along with stagnant anaemia in women of reproductive age and widespread increases in child overweight, suggests a tenuous status quo. Continued investment in preventive and treatment efforts for acute childhood illness is crucial to prevent backsliding. Parallel development of effective treatments, along with commitment to multisectoral, long-term policies to address the determinants and causes of suboptimal nutrition, are sorely needed to gain ground. Bill & Melinda Gates Foundation.
There are conflicting findings regarding the risk of acute kidney injury (AKI) and mortality with vancomycin/piperacillin-tazobactam combination (VPT) and vancomycin/meropenem (VM). The aim of this meta-analysis was to compare the risk of AKI and mortality between VPT and VM. Observational studies reporting the incidence of AKI and mortality in patients receiving VPT or VM between January 2017 and September 2024 were retrieved from PubMed, the Cochrane Library, and Web of Science. The primary outcome of the analysis was the risk of AKI, and the secondary outcomes were the mortality rate, need for renal replacement therapy (RRT), and hospital length of stay (LOS). This meta-analysis was conducted using a random-effects model to estimate the odds ratios (OR) and 95% confidence intervals (CI) for AKI, mortality, and RRT or mean difference and 95% CI for the LOS. Seventeen studies involving a total of 80,595 patients were included in the analysis. The odds of developing AKI were higher among patients who received the VPT versus those who received the VM combination (OR = 2.02; 95%CI 1.56-2.62). There were no differences between VPT and VM in the mortality and hospital length of stay; however, the odds of requiring RRT were higher among VPT group versus VM group (OR = 1.55; 95%CI 1.23-1.96). The findings suggest that the use of VPT is associated with a higher risk of AKI compared to VM and highlight the need for cautious antibiotic selection and monitoring of renal function in patients receiving these combinations.
One of the most vital forms of the affected patient safety is pressure ulcers (PUs), which can be a critical health problem that every day impacts sufferers and healthcare structures. This study aimed to explore the level of nurse's knowledge and perceived barriers regarding PUs prevention among critically ill patients. This cross-sectional study was conducted among 100 nurses who working in the critical care units (CCUs) at tertiary teaching hospitals in Baghdad City, the study extended from April to June 2024 to assess the nurses' knowledge level using the knowledge perceived barriers on the prevention of PUs questionnaire. The data were analyzed using descriptive and inferential statistics (SPSS version 26). The age of the participants included in this study ranged between 18 and 27 years with a mean age of (28.61 ± 6.603) years and females accounted 55% of total study participants. The highest group of the study population has finished their bachelor's degree (74%). Moreover, less than half of the study population (43%) had <5 years of experience in CCU. Nurses' knowledge on the prevention of PU in CCUs is satisfactory in this study and moderately has a high level of perceived barriers toward PU prevention. Several barriers perceived to affect patients' quality of care regarding proper prevention of PUs were identified by Iraqi CCUs. The findings of this study suggest that several barriers need to be resolved if proper prevention of PUs is to be guaranteed in CCUs.
Acute kidney injury (AKI) is associated with significant short-term morbidity and mortality. However, its long-term outcomes, particularly in resource-limited settings, remain poorly understood. This study aimed to evaluate 2-year major adverse kidney events (MAKE) in patients with severe AKI. We analyzed data from the India and Southeast Asia Renal Replacement Therapy (InSEA-RRT) registry, a multicenter cohort study conducted between April 2019 and December 2023 across 24 hospitals in Southeast Asia and India. Critically ill patients with AKI stage 3, as defined by the Kidney Disease Improving Global Outcomes (KDIGO) criteria, were enrolled. The primary outcome was 2-year MAKE, defined as a composite of persistent kidney dysfunction, long-term dialysis, and all-cause mortality at 2 years post-enrollment. A total of 2,315 patients were enrolled, of whom 1,033 (47%) died during hospitalization. Among surviving patients, the incidence of 2-year MAKE was 46.6 per 100 person-years (95% CI 42.7-50.6). Notably, mortality (32%) was the dominant component of MAKE. The incidence of new chronic kidney disease (CKD) and CKD progression at 2 years post-AKI was 58.6 and 35.4 per 100 person-year (95% CI 51.0-67.0 and 26.0-47.0), respectively. Multivariable-adjusted models identified older age, male sex, preexisting CKD, malignancy, cardiac-associated AKI, and non-recovery of kidney function after AKI as independent risk factors for 2-year MAKE. Patients with severe AKI face a high incidence of 2-year MAKE and poor long-term clinical outcomes. Early recognition and close follow-up of these patients are crucial. Further research is needed to identify effective strategies to improve long-term outcomes in this high-risk population.
Acute pancreatitis (AP) is frequently complicated by acute kidney injury (AKI), contributing to increased morbidity and mortality. Thoracic epidural analgesia (TEA) may improve splanchnic perfusion, attenuate inflammation, and reduce renal dysfunction. In this prospective randomized controlled trial, 88 adults with AP were enrolled; 8 were lost to follow-up. Eighty patients were analyzed and randomized to a TEA group (n = 40) or a control group (n = 40). The TEA group received epidural analgesia in addition to standard care. Renal and metabolic parameters, including urine output, serum urea, creatinine, electrolytes, lactate, bicarbonate, and base excess, were monitored. AKI was defined and staged using KDIGO criteria. Statistical analysis was performed using independent t-tests and Chi-square tests, with P < 0.05 considered significant. Baseline characteristics were comparable between groups. Transient hypotension occurred in nine TEA patients and was managed conservatively; no major complications were observed. Postintervention urine output was significantly higher (P = 0.034) and serum urea significantly lower (P = 0.016) in the TEA group. Lactate levels were lower (P = 0.011), bicarbonate levels higher (P = 0.026), and base excess less negative (P = 0.033), indicating improved perfusion and metabolic status. AKI occurred in 7/40 patients in the TEA group and 12/40 in controls, a nonsignificant difference (P = 0.14). However, AKI severity was lower in the TEA group. TEA was associated with improved renal and metabolic parameters and a trend toward reduced AKI incidence and severity in AP, without major adverse effects. Larger multicenter studies are needed for confirmation.
Severe and nonsevere forms of repeated malaria can cause numerous cognitive impairments, usually in the aspects of problem-solving, executive function, memory, and attention. Several studies have suggested that rehabilitation treatment interventions can be effective in treating cognitive symptoms of cerebral malaria (CM). Virtual reality (VR) technology potentiates as a useful tool for the assessment and rehabilitation of cognitive processes. The aim of the present systematic review is to examine neuropsychological and behavioral benefits of virtual cognitive rehabilitation training among children with Malaria. Cumulative Index to Nursing and Allied Health Literature, Physiotherapy Evidence Database (PEDro), Excerpta Medica Database, Medical Literature Analysis and Retrieval System Online, PubMed, Web of Science, Google Scholar, ClinicalTrials.gov., and Global Health databases were searched for studies that investigated the effect of VR on cognitive functions post-CM. The methodological quality was evaluated using PEDro scale. Six studies were included for qualitative analyses, with five being randomized controlled trials and one was parallel-group randomized trial. The scores on the PEDro scale ranged from 5 to 7 with a mean score of 6. The results showed improvement in various aspects of cognitive functions such as: memory, executive function, and attention in CM survivors. Using computerized cognitive rehabilitation training with the treatment protocol of 16-24 sessions, each of 45-60 min in duration, with 2-3 sessions per week, may improve neuropsychological performance and behavior in terms of executive functions, working memory, and attention in severe malaria survivors.
Respiratory tract (RT) colonization with Candida spp. is common in ventilated patients. We aimed to investigate the epidemiology of candidal colonization of the RT in patients with malignancies and to assess its prognostic impact. A retrospective study was conducted in two intensive care units (ICUs). All adult patients with proven malignancies requiring invasive mechanical ventilation ≥48 h were included. Two groups were compared (Candida+ and Candida-). One hundred and sixty-one patients were included. Twenty-one (13%) patients grew Candida species in their endotracheal cultures. Candida albicans represented 47.6% of the isolates. In a multivariate analysis, only candiduria was associated with candidal colonization of the RT (odds ratio = 3.86; 95% confidence interval: 1.47-10.13; P = 0.006). The incidence of ventilator-acquired pneumonia was similar between Candida+ and Candida- groups (38.1% and 32.1%, respectively; P = 0.588). The 28-day mortality rate was 55.9% with no significant difference between Candida+ and Candida- groups (66.7% and 54.3%, respectively; P = 0.287). However, Candida+ patients had a longer duration of mechanical ventilation (16 [9.5-29] vs. 6 [2-16] days; P = 0.002) and length of ICU stay (LOS; 20 [11.1-26.5] vs. 9 [3-19] days; P = 0.004). Candidal colonization of the RT has no impact on 28-day mortality. However, it significantly increases the duration of mechanical ventilation and the LOS.
Sepsis, a major global health concern, leads to millions of deaths annually, hence the need for early and reliable prognostic tools to assess patient risk and guide clinical decision making becomes crucial. This cross-sectional study evaluated the prognostic accuracy of integrating blood lactate and serum procalcitonin (PCT) levels with the National Early Warning Score (NEWS) for predicting mortality in sepsis patients. The objective was to assess whether this lactate and procalcitonin integrated with NEWS score (LP NEWS) could serve as a more effective early prognostic tool compared to established severity scores. Spanning 12 months, the study enrolled adult patients meeting the criteria of sepsis in the ICU and medicine ward of a tertiary care hospital in North India. Data collection included demographics, clinical characteristics, and blood samples for lactate and PCT at admission. NEWS, Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA), and LP-NEWS scores were calculated with treatment administered per Surviving Sepsis-3 guidelines. The research included 200 participants, uncovering significant correlations between blood lactate, PCT levels, and mortality. Survivors had a mean lactate of 2.12 ± 0.70 and PCT of 11.27 ± 11.75, while nonsurvivors had 3.30 ± 1.17 and 30 ± 18.48, respectively (P < 0.001). LP-NEWS significantly differentiated survivors from nonsurvivors (8.23 ± 2.02 vs. 14.12 ± 2.23), with a cutoff of 11 showing 96.9% sensitivity and 88.5% specificity for predicting mortality. LP-NEWS had the highest odds ratio = 3.12, P < 0.001, and area under the receiver operating characteristic curve value (0.966), outperforming APACHE II and SOFA scores. The LP-NEWS score which integrates blood lactate and serum PCT levels could serve as an effective standalone bedside score, particularly in the initial risk stratification of sepsis.
Trauma scoring systems are essential for predicting outcomes in trauma patients, guiding clinical decisions, and optimizing resource allocation. Common systems include the Injury Severity Score (ISS), New ISS (NISS), Revised Trauma Score (RTS), Trauma and ISS (TRISS), Emergency Trauma Score (EMTRAS), and Rapid Emergency Medicine Score (REMS). This study aims to evaluate the predictive accuracy of REMS and EMTRAS in comparison to traditional trauma scoring systems. This prospective observational study involved 1090 trauma patients admitted to the Department of Emergency Medicine from January 2021 to December 2023. Eligible patients were aged 18 or older with documented trauma. Data collection encompassed demographics, clinical parameters, and trauma severity, assessed using six scoring systems. Outcomes were monitored until patient discharge or death. The cohort consisted of 915 (83.9%) male patients with a mean age of 36.1 years. Road traffic accidents were the leading cause of trauma, 934 (85.6%). Intensive care unit patients exhibited higher ISS and lower RTS scores (P < 0.0001), indicating more severe injuries. Nonsurvivors showed higher ISS and NISS and lower RTS and TRISS scores. EMTRAS demonstrated higher sensitivity and specificity than REMS, while TRISS proved the most effective in predicting trauma outcomes. REMS and EMTRAS had reasonable sensitivity and specificity but were less effective than traditional systems such as ISS, NISS, RTS, and TRISS. TRISS emerged as the most reliable tool for predicting outcomes, supporting its continued use as the gold standard in trauma assessment.
Thiamine is a vitamin that plays a role in lactate clearance. Patients with sepsis may present with elevated lactate, and also in cirrhosis, as lactate is hepatically metabolized. Prior studies showed mixed results regarding the role of thiamine for lactate clearance with limited inclusion of cirrhosis patients. The purpose of this study was to determine the association of high-dose intravenous thiamine on time to lactate clearance among patients with cirrhosis and sepsis. We performed a single-center retrospective cohort study of critically ill patients with cirrhosis with a diagnosis of sepsis with lactate >4 mmol/L between January 1, 2020, and December 31, 2024. Patients who received ≥400 mg were classified as receiving high-dose thiamine. Fine-Gray competing risks models adjusted for demographic, comorbidity, and illness severity variables estimated the association of receiving high-dose thiamine with time to lactate clearance, defined as a lactate <3 mmol/L. Additional secondary outcomes included intensive care unit and in-hospital mortality. A total of 136 patients were identified and included in the analysis. Median age was 58.4, and 54% were male. Thirty-three patients received high-dose thiamine. Patients had similar baseline characteristics, including on indicators of illness severity, cirrhosis severity, and use of vasopressors. In both unadjusted and adjusted models, the receipt of high-dose thiamine was not associated with differences in time to lactate clearance or mortality. Thiamine use in patients with cirrhosis who experienced sepsis did not result in improved lactate clearance compared to those who did not receive high-dose thiamine. These data do not support empiric high-dose thiamine to aid lactate clearance in this population.
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Neonatal sepsis is a significant cause of mortality in children under 5 years of age globally, with the highest incidence reported in India. The challenges in diagnosing neonatal sepsis often result in the irrational use of antibiotics. The aim of the study was to determine the diagnostic efficacy of interleukin 27 (IL-27) as a novel biomarker for the early diagnosis of neonatal sepsis. This prospective cohort study was conducted at a tertiary care hospital in North India from May 2019 to April 2020. Eighty neonates suspected of sepsis were enrolled based on the sepsis screen criteria approved by the National Neonatal Forum of India. Blood samples were collected for culture and biomarker analysis, with C-reactive protein (CRP), procalcitonin (PCT), and IL-27 levels measured. The diagnostic performance of IL-27 was compared to that of CRP and PCT. Out of 80 neonates, 56% were male and 44% were female. Blood cultures were positive in 51.2% of cases. The most common pathogens isolated were Gram-negative bacteria (41%), fungi (34%), and Gram-positive bacteria (25%). IL-27 demonstrated a sensitivity of 78.05%, specificity of 61.54%, positive predictive value of 68.09%, and negative predictive value (NPV) of 72.73%. In comparison, PCT showed the highest sensitivity (82.93%), and CRP had the highest specificity (79.49%). IL-27 levels were notably higher in blood culture-positive cases. IL-27 is a promising biomarker for the early diagnosis of neonatal sepsis, showing comparable sensitivity and NPV to PCT, but with lower specificity than CRP.
Endotracheal intubation (ETI) is a commonly performed emergency procedure used to secure the airways in critically ill patients. Despite its importance, ETI presents significant risks to patients with difficult airways. The availability of different types of laryngoscopes, most notably video laryngoscopes and direct laryngoscopes (DLs), has contributed to improved intubation success rates and reduced complications. While numerous studies have compared video laryngoscopes and DLs, there remains a limited synthesis of evidence evaluating the full range of all laryngoscopes across different patient population and clinical settings. A narrative synthesis approach was employed in this review. Relevant articles were obtained from multiple databases, including PubMed (MEDLINE), CINAHL, and PsycINFO. Articles published up to June 23, 2025, were considered for inclusion. The methodological rigor and reporting quality of each article were appraised. The screening and exclusion process were documented using the PRISMA flow diagram. Titles, abstracts, full texts, and reference lists of all retrieved articles were thoroughly reviewed to identify potentially relevant publications. Video laryngoscopes, particularly the McGrath, GlideScope, and C-MAC D-Blade, demonstrated superior performance compared to laryngoscopes. There was better first-pass success, better view of the larynx, less need for external adjusting maneuvers, and shorter time to intubation. Other devices such as Airtraq and Bonfils fiberscope have good results in some clinical settings, but are useful only where there is high operator dependence and have a more difficult learning curve. Video laryngoscopes have proven to be better than DLs in managing adult patients with difficult airways due to the advantages of the success rate, visualization of the glottis, and efficiency of the procedure. However, methodological heterogeneity and an absence of consistently high quality in clinical trial data lead to inadequate evidence for recommending one specific laryngoscope as being better for all difficult airway scenarios. Further well-designed high-quality clinical studies are required to determine the most effective laryngoscope for intubating adults with difficult airways across diverse clinical settings.
Effective and timely weaning is essential for improving the outcome of intensive care unit (ICU) patients. This study was conducted to determine whether diaphragmatic thickness fraction measured by ultrasound provides any additional benefit when combined with clinical parameters for successful weaning. This prospective observational study was conducted on 100 mechanically ventilated patients in the ICU. When the criteria for weaning were satisfactorily fulfilled, a spontaneous breathing trial was administered. Rapid Shallow Breathing Index (RSBI) and bedside ultrasound to measure diaphragmatic thickness fraction (DTF) were recorded. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of RSBI and DTF were calculated utilizing a cutoff value of RSBI <82 and a DTF cutoff of >37%. The predictability of weaning success was evaluated by the area under the receiver operating characteristic curve (AUROC). Of the 100 patients observed, 68 patients had weaning success while 32 patients experienced weaning failure. The sensitivity, specificity, PPV, and NPV of RSBI were greater compared to DTF (88.23%, 96.87%, 98.36%, and 79.48% vs. 88.23%, 84.37%, 92.30%, and 77.14% respectively). The AUROC values for RSBI, DTF, and their combination were 0.86, 0.78, and 0.90, respectively. The Pearson correlation coefficient of RSBI with DTF was found to be -0.475. RSBI proved to be a highly reliable predictor of successful weaning, demonstrating superior diagnostic accuracy. The combination of RSBI and DTF improved the diagnostic validity profile, suggesting that integration of diaphragmatic ultrasound with conventional clinical indices enhances the reliability of weaning assessment.
Road traffic accidents (RTAs) remain a prominent cause of mortality and morbidity worldwide. Wearing a helmet while riding a motorbike can significantly minimize injury severity and fatality. This study aimed to identify the factors associated with the use and nonuse of helmets among motorized two-wheelers. This observational study was conducted on victims of RTAs who presented to the emergency department of a hospital in Eastern India. Data were collected through a semi-structured questionnaire from March 2021 to December 2021. The data on sociodemographic details of the victims and various extrinsic and intrinsic factors associated with the nonuse of helmets were collected and analyzed. A total of 346 patients were included. The prevalence of helmet use was 35.7%, and most young adults were helmet nonusers (32.31 ± 12.3 vs. 37.1 ± 12.3, P = 0.15). The pillion riders, alcohol abuse, lower educational levels, and riding on municipal/panchayat roads were associated with statistically significant (P < 0.05) nonuse of helmets. The injury severity score was significantly higher in helmet nonusers (13.20 ± 6.44 vs. 11.23 ± 6.01, P = 0.004). Among the extrinsic factors, fewer traffic checkpoints (P < 0.001), visibility issues (P = 0.02), and use of ear pods (P = 0.01) were significant factors for the nonuse of helmets. In the intrinsic factors, traveling short distances (P < 0.001) and forgetfulness (P < 0.01) were significant factors for the nonuse of helmets. Traveling short distances, forgetfulness, and fewer traffic check posts are significantly associated with the nonuse of helmets among motorcyclists. Traveling on village or municipality roads and alcohol abuse is significantly associated with helmet nonuse.
Stroke is a leading cause of mortality and disability in India, and the hospital and intensive care unit (ICU) beds are limited. This randomized controlled trial (RCT) aimed to assess the effectiveness of early tracheostomy (ET) in reducing 30-day mortality in stroke patients, and secondary objectives included evaluating rates of ventilator-associated pneumonia (VAP) and length of ICU stay compared to late tracheostomy (LT). This open-label RCT was conducted over 18 months at a tertiary care hospital in north India, involving 60 patients (30 in each group). Eligible participants were adults (≥18 years) with nontraumatic stroke (acute ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, and vasculitic infarcts) requiring prolonged intubation (stroke-related early tracheostomy score ≥8). Exclusions included preexisting pneumonia, high oxygen needs, pregnancy, and those on ventilation for over 4 days. Patients were assigned to ET (day 4) or LT (day 10), with demographics and clinical characteristics recorded. Mortality was assessed on day 30 postintubation and data for secondary outcomes were collected every other day. Sixty-four patients were randomized, 30 to the ET group, and 34 to the LT group, with a mean age of 55.48 (±15.94) years. Mortality within 30 days was 50% in both groups. VAP rates were 43.3% in the ET group and 50% in the LT group (P = 0.605). The mean ICU length of stay was 12.07 days for ET and 18.43 days for LT (P = 0.0001). The RCT found no significant differences in mortality or VAP rates but noted reduced ICU hospital stays for the ET group, suggesting benefits for severe stroke patients.
Neurogenic fever (NF) is a noninfectious, centrally mediated hyperthermia seen in patients with traumatic brain injury (TBI) and other neurological conditions. Fever exacerbates secondary brain injury, increases metabolic demand, and worsens patient outcomes. Dopamine agonists such as bromocriptine, which modulate hypothalamic thermoregulation, have been proposed as potential therapeutic agents. This study evaluates the efficacy of prophylactic bromocriptine in preventing NF in patients with severe TBI. In this randomized, double-blind, placebo-controlled trial, 100 adult patients with isolated severe TBI admitted within 24 h of injury were assigned to receive either bromocriptine (5 mg twice daily, n = 50) or placebo (n = 50) through enteral administration. NF was defined as a temperature >38.3°C for at least one episode over 2 consecutive days after excluding infectious causes. The primary outcome was NF incidence. Secondary outcomes included fever severity, frequency, onset, mortality, and heart rate-temperature correlation. Data were analyzed using parametric and nonparametric statistical methods. After exclusions and dropouts, 43 patients in the bromocriptine group and 45 in the placebo group were analyzed. NF incidence was lower in the bromocriptine group (41.86%) compared to placebo (55.56%), but the difference was not statistically significant (P = 0.199). No differences were observed in fever onset, mortality, or heart rate-temperature correlation. Bromocriptine was associated with a reduction in peak temperature on day 5 (P < 0.05). Prophylactic bromocriptine did not significantly reduce NF incidence in severe TBI but showed trends toward lower fever severity. Further research with larger cohorts and optimized dosing is warranted.
Chronic liver disease is the destruction and regeneration process of the liver parenchyma. Liver cirrhosis is associated with a wide range of cardiovascular abnormalities including hyperdynamic circulation, cirrhotic cardiomyopathy (CCM), and pulmonary vascular abnormalities. CCM was first defined in 2005 at the Montreal World Congress of Gastroenterology. It is considered a condition of latent heart failure that manifests only under stress, resulting in a blunted increase in cardiac output during exercise. A total of 100 cases as per the diagnostic criteria of liver cirrhosis were enrolled from the Department of General Medicine of PGIMS, Rohtak. The assessment of cardiac function was done in all the patients. Two-dimensional echocardiogram was done to find evidence of cardiomyopathy and electrocardiogram (ECG) was done to find QT-interval prolongation. Child Turcotte Pugh (CTP) score was calculated for severity. The cardiac dysfunction was compared to the seriousness of the CTP score. In our study, 57% of patients showed diastolic dysfunction while systolic dysfunction was not seen in any case. Furthermore, 56% of the cases had prolonged QTc interval in ECG. Our study also shows that there is a definitive association between QTc prolongation and disease severity. CCM is considered an important predictor of morbidity and mortality. The left ventricular ejection fraction at rest is normal in CCM, but there is a blunted increase in cardiac index and cardiac output during exercise. This is difficult to identify because these symptoms are similar to fatigue and exercise intolerance commonly seen in cirrhotic patients.