Assess the Acute Physiology and Chronic Health Evaluation IV (Apache IV) Score in Predicting Hospital Mortality Rate Among Critically ill Patients in Intensive Care Unit

Background: Clinical evaluation is an important part of medical practice in which it predicts the prognosis of patients admitted to Intensive Care Units that can help in the definition of strategies, outlining plans for improving care, helping to prevent complications and achieving better quality indicators. Purpose: The purpose of the study is to assess the level of mortality among critically ill patients in association with their selected demographic variables. Materials and methods: Descriptive research design was conducted in the host institution of Saveetha Medical College and Hospitals with 60 samples who met the inclusion criteria were selected by convenience sampling technique.Demographic variables were collected by using multiple choice questionnaires. Acute physiology and chronic health evaluation IV score used for assessing the systolic and diastolic blood pressure, body temperature, heart rate, respiratory rate, glucose, blood urea nitrogen, serum sodium, creatinine, blood hematocrit, white blood cells, serum albumin and bilirubin, urine output during the first 24 h of ICU admission, pH, fraction of inspired oxygen, partial pressure of carbon dioxide, partial pressure of oxygen, and bicarbonate. Results:The study results concluded that, out of 60 samples ,that 52(86.7%) were under the estimated mortality between 0-25% and 8(13.3%) were under the estimated mortality rate between 26-50% and depicted that study findings shows patient with mechanical ventilator support, GCS had shown statistically significant association with APACHE IV score at p

Holistic Approach in the Management of Skeletal Deformity in a Case of Homocystinuria

INTRODUCTION

Homocystinuria has a wide range of clinical presentations ranging from near normal intelligence and appearance with just lens dislocation and minimal skeletal deformities to severe mental retardation with gross skeletal deformities. In this background, we describe one such case with skeletal deformity managed comprehensively.

CASE REPORT

A 17-year-old boy presented with complaints of deformity of the left lower limb since childhood more evident for the past 5 years along with a history of blurring of vision. On examination the pubis-heal length > crown-pubis length along with genu valgum of left lower-limb with 16 cm intermalleolar distance. He also had a superolateral subluxation of the lens in both eyes. Valgus angle was 16° on the left leg compared to 6° on the right. The diagnosis of homocystinuria was confirmed by biochemical investigations. The left side genu valgum was addressed with medial closing wedge osteotomy and fixed with distal femur locking compression plating. Lens subluxation was treated with posterior chamber intra-ocular lens surgery. He was also given medical treatment and on regular monitoring of his homocysteine levels. The patient had good functional outcome at 2-year follow-up.

CONCLUSION

Homocystinuria is a rare disease that needs early identification and effective management to avoid complications. Skeletal complications are common and include genu valgum, pes cavus, chest wall deformities, and skeletal deformities such as kyphosis and scoliosis. Skeletal deformities can be avoided when identified early and associated osteoporosis which is managed effectively. A holistic approach is needed in the management of such patients with inter-departmental coordination to bring quality to the life of patients with homocystinuria.

Ground scratching and preferred leg use in domestic chicks: changes in motor control in the first two weeks post-hatching

Lateralisation of a variety of visual functions: food discrimination, fear response, copulation, and performance of topographical and other tasks, such as olfactory and auditory functions, have been described in the domestic chick, Gallus gallus domesticus. A bias to left hemisphere control on day 8 and to the right on day 11 has also been demonstrated in the domestic chick. In this study we show that motor control as to foot preference in initiating a scratching bout and a tape-removing task is lateralised in both adults and chicks. There was a preference for the right leg to initiate a bout of ground scratching in both male and female adult birds. Second, foot preference is also affected by the changes in shifts of bias on day 8 and day 11. The right leg preference in initiating a ground scratching bout observed on day 5 is reversed to a left leg preference on day 8. This then reverts to the right leg preference after day 11. Hence it is postulated that the hemisphere that is not activated due to the bias of age controls the first leg to be used in initiating routine movements such as ground scratching. For the tape-removing task the right leg was used to remove a tape adhered to the beak of the chick for the trained group on day 8; but there was no preference in the naive group. Similarly, on day 11 a left foot bias was observed for the trained group and right foot bias for the naive group. To remove a tape the activated hemisphere on days of bias is used; whereas in a novel situation the foot use is reversed. Thus, footedness is affected by age, type of task, and changing hemispheric dominance.