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Introduction: Chronic kidney disease (CKD) is a major health concern in India and has high prevalence, morbidity, and mortality due to significant percentages of subjects with poor socioeconomic status as well as poor management of health resources. Many apparatuses are available to assess nutrition status among patients of CKD. This study was conducted to identify nutritional risk in CKD patients using a modified Nutrition Risk in Critically ill (m-NUTRIC) score without using interleukin-6 values. Method: This prospective observational study was conducted at a tertiary care teaching hospital for a time period of 2 years from 2020 to 2022. The modification of diet in renal disease approach was used for the staging of the CKD. m-NUTRIC scores were calculated and scores ≥5 were graded in high-risk categories and were associated with adverse outcomes, whereas scores <5 were categorized as low risk. Result: Among 250 patients with CKD enrolled, 65 patients were in the age group 18 to 40 years having a mean m-NUTRIC score of 4.46 ± 1.76; in the age group 40 to 60 years 5.18 ± 1.67; and in the age group older than 60 years 5.88 ± 1.77. The mean (standard deviation [SD]) m-NUTRIC score in hemodialysis group was 5.69 ± 1.63 and in nonhemodialysis group was 4.15 ± 1.66. At m-NUTRIC cutoff of 5, predicted hemodialysis is having 66% specificity and 77% sensitivity. It predicts mortality with a sensitivity of 93% and a specificity of 89% at a cutoff of m-NUTRIC of 6. Conclusion: This study showed that m-NUTRIC score may be an important tool that determines requirement of hemodialysis and mortality in CKD patients. Moreover, these scores were higher in stages 4 and 5 of CKD. [ABSTRACT FROM AUTHOR]

Background: Till date, there is no consensus reached on the foremost tool for identifying the propensity of risk in critically sick patients. In this study, we plan to assess the nutritional risk in critically ill patients admitted to the medical ICU using the modified nutrition risk in critically ill (mNUTRIC) score and to anticipate the outcome in terms of overall mortality, 72-hour mortality, and the use of mechanical ventilation. Method: A total of 1,990 patients were analyzed by calculating their mNUTRIC scores using various variables, which were a part of the scoring system, such as age, a thorough history and clinical examination, and pre-existing comorbidities. Group differences were compared using the t-test or the Wilcoxon test for continuously distributed data and the chi-squared test for categorical data. Results: In this study, the mean age of the patients were 50.48 ± 17.58 years. Of them, 395 died while 1,595 survived; and 799 had a high ($6) mNUTRIC score, and 1191 had a low (#5) mNUTRIC score. The area under the curve for mNUTRIC score in predicting overall mortality and 72-hour mortality was 0.938 and 0.89, respectively, thus demonstrating better diagnostic performance. Conclusion: The discriminative performance of mNUTRIC scores for assessing overall mortality and the need for mechanical ventilation was found to be effective in this study. [ABSTRACT FROM AUTHOR]

Introduction The red blood cell distribution width (RDW) is a measurement of variations in the size of red blood cells. As the width increases, the rate of mortality also increases, although the reason for it is still not known. On the other hand, platelet distribution width (PDW) is also useful in predicting morbidity and mortality in sepsis and other critically ill patients. In our study, we planned to study the impact of both RDW and PDW and evaluate their prognostic importance with outcome in patients admitted in medicine intensive care unit (MICU). Material and Method In these cross-sectional observational studies, 1,300 patients were included who were admitted in MICU. Critically ill patients were defined on the basis of qSOFA score greater than 2. PDW and RDW were obtained from Coulter report of complete blood count. Parameters included in Acute Physiology and Chronic Health Evaluation (APACHE) IV scores were taken and APACHE IV score was calculated. Correlation of RDW and PDW with outcomes such as length of ICU stay, use of mechanical ventilator, and discharge/death was done. Result The mean RDW (%) for the entire study population was 15.17 ± 3.01. The RDW (%) was significantly on the higher side in patients who succumbed to the disease as compared with the patients who were discharged. The correlation between the length of ICU stay (days) and RDW (%) was moderately positive and was significant (rho = 0.37, p ≤ 0.001). The correlation between the length of ICU stay (days) and PDW (%) was moderately positive and was significant (rho = 0.5, p ≤ 0.001). Conclusion RDW and PDW were found as significant indicators for period of stay in ICU, requirement for mechanical ventilation, and mortality rate in patients admitted to ICUs. As these are simple, easy to conduct, universally available tests, they can be regularly incorporated in patients admitted in ICUs. [ABSTRACT FROM AUTHOR]

Background/Purpose Magnesium deficiency has been a common, but easily ignored, electrolyte abnormality. Studies on magnesium deficiency are lacking in India, especially in a rural setting. Here, we have correlated serum magnesium levels with outcomes in elderly patients admitted to the medical intensive care unit with respect to the length of intensive care unit stay, need for mechanical ventilatory support and its duration, and outcome (discharge/death). Methods A prospective, observational study was conducted in patients aged 60 years and older, who had been admitted to the intensive care unit of the medicine department for over a year. The chi-square test was applied to correlate hypomagnesemia with the outcome. Results In our study, 59.30% of the elderly patients had hypomagnesemia. Compared with patients with a normal magnesium level, hypomagnesemic patients had no correlation with the duration of medical intensive care unit stay (5.57 ± 6.10 days vs. 5.61 ± 5.55 days), but the need for mechanical ventilation (57.84% vs. 45.71%), rate of discharge from the intensive care unit or cure (60.28% vs. 71.42% ), rate of death (39.21% vs. 28.57%), and mean duration of ventilation (3.07 ± 5.05 days vs. 2.15 ± 3.46 days) were higher. However, no significant statistical difference was found between these groups. Conclusion Hypomagnesemia was associated with a slightly higher mortality rate. Requirement and duration of ventilatory support were also higher, although not statistically significant. Hypomagnesemia was not found to have any impact on the duration of medical intensive care unit stay. Monitoring of serum magnesium levels may have prognostic and perhaps therapeutic implications in the elderly. [ABSTRACT FROM AUTHOR]

Objective: To understand the temporal trends in mortality in Rural Central India. Design: Retrospective review of physician issued death certificates from a rural teaching hospital. Materials and Methods: Physician issued death certificates from 1979 to 2008, available with a rural teaching hospital were analyzed and information on age, gender, date, and cause of death was abstracted. We estimated cause-specific, proportional mortality ratio (PMR) stratified by age, and gender. We compared the difference in PMR in first fifteen years of the study period (period A, 1979-1993) with the later (period B, 1994-2008). Results: We found 20494 death certificates between 1979 and 2008. Proportion of infectious disease related mortality declined from 35% in 1979-1983-26% in 2004-2008. In the same periods, injury related mortality increased from 4.6% to 13.4%, and chronic disease mortality from 19% to 28%. The absolute difference in PMR (per 1000 deaths) was statistically significant between period B and period A, for infections (a decline of 80.67 [95% CI 66.97-94.03]), chronic diseases (an increase of 45.85 [95% CI 33.49-58.55]), and injuries (an increase of 42.98 [95% CI 33.87-52.26]). Conclusion: Temporal trend in mortality from a single hospital in rural Central-India over the past three decades shows decline in infectious diseases, and rise in injuries and chronic diseases. [ABSTRACT FROM AUTHOR]