Methods. In order to minimize a selection bias, we have compared the outcome of our HHD and CHD patients with a nested case-cohort study. For each patient trained for HHD at our dialysis centre between 1970 and 1995 (n ¼ 103), a corresponding match was searched from the CHD patients by retrospective chart analysis. The pairs were matched for sex, age (±5 years), time of dialysis therapy onset (±2 years) and renal disease category. For 58 of the 103 HHD patients, a corresponding matched CHD patient was identiﬁed. Both treatment groups had the same mean age (50±13 years) at dialysis onset and were compar- able with respect to the Khan comorbidity index, prevalence and duration of hypertension, smoking habits, history of myocardial infarction, stroke and peripheral vascular disease. In both groups, 50% of the patients were transplanted during the observation period.
MULTIORGAN FAILURE 3 6 %
MORTALITY 5 10% In present study the most common complications were DIC and thrombocytopenia occurring in 24 % and 22 % of the cases respectively. Study by Ambreen et al showed that DIC was the most common complication accounting for 20.7% patients, similar to the study (5) . Nath J et al showed hepatic encephalopathy as a major complication present in 17% of cases which is 8 % in present study (6) . TABLE-6 PREGNANCY OUTCOME IN PATIENTS OF JAUNDICE OUTCOME TOTAL NO OF PATIENTS (50) VAGINAL PRETERM 19 (38% ) TERM 12 (24% ) LSCS PRETERM 8 (16 %) TERM 7 (14%) ABORTION 3 ( 6%) EXPIRED UNDELIVERED 1 ( 2%) In Our study 62% patients of cases had vaginal delivery while the rest 30% patients had LSCS as the mode of delivery. 54 % patients had preterm delivery and 38% patients had term delivery. And 6% of cases had abortion. TABLE-7 PERINATAL OUTCOME IN PATIENTS AFFECTED WITH JAUNDICE Outcome of pregnancy No. of case(n=46) Percentage % 1. PRETERM 27 54%
DKA presents with various clinical manifestations . One such manifestation is altered sensorium which occurred in 20% of the study population and was the commonest manifestation following vomiting which occured in 26% of DKA population studied. The initial GCS calculated significantly affected the outcome. The worst outcomes were documented in individuals with less than 8 score. The previous studies did not show constant association of outcome with GCS. In study by Otieno et al., 173 altered level of consciousness was a major predictor of mortality in DKA patients whereas Agarwal et al. dID not show such association. 9
worsening in 3%, whereas Barthel index showed improvement in 40 % and worsening in 8% of the patients.
One interesting s tudy by Ebner et al 38 , has shown that patients diagnosed to have extended intramedullary lesions have a worse neurological status in the perioperative as well as inthe 3-month followup. In contrast, our study which attempted to assess the impact of specific disease related factors associated with the functional status at presentation and 6 month functional outcome found that although LETM was found to correlate with functional status at admission, it did not have any significant association with the functional outcome at 6 months.
Exclusion criteria included patients with other causes of polyneuropathy such asdiabetic, uremic, hypothyroidism, drug-related neuropathy, para neoplastic neuropathy or hereditary neuropathy.
All patients were subjected to the following; a full medical, neurological his- tory and the history of any antecedent events occurring during the few weeks before the onset of neurologic symptoms. Full Neurological examination at the time of presentation and laboratory investigations; Random blood sugar, Com- plete blood picture, Serum urea, Serum creatinine, Serum electrolytes (sodium, potassium, calcium), Liver function tests, Erythrocyte sedimentation rate, and C-reactive protein (quantitative). Nerve conduction studies and electromyogra- phy were performed within two weeks from admission. Motor and sensory nerve conduction studies (NCS) and F wave response were done for the median and ulnar nerves in both upper limbs, posterior tibial and common peroneal in both lower limbs and sensory conduction for sural nerve. Electromyography (EMG) study was done for motor units to the abductor pollicus brevis, deltoid and tri- ceps muscles in upper limbs, and tibialis anterior and gastrocnemius in the lower limbs. Various lines of treatment such as PE, IVIG or both were received during the period of admission in hospital. Outcome was assessed by the Hughes func- tional score (F-score), that applied to the patients on admission, at end of 4 weeks from onset of neuropathy and at the end of 8 weeks for follow up and to assess outcome . Hughes functional grading scale consists of Grade 6: dead, Grade 5: requires assisted respiration, Grade 4: bed bound, Grade 3: able to walk 5 meters with aid , Grade 2: ambulates independently, Grade 1: minimal signs and symptoms, able to run and grade 0: normal. Experimental procedures were previously approved by the Ethical Committee for Human Research at the fa- culty of medicine Ain Shams University.
Methods: The present prospective study was conducted in the Department of Obstetrics and Gynecology and associated Dr. B.R.A.M. Hospital Raipur (C.G.), India from January to December 2013 among the patients diagnosed as premature rupture of membrane with women complain of leaking attending antenatal OPD and antenatal ward. On admission detailed history was taken. General and Systemic examination were done including Per Abdomen, Per Speculum and per vaginum carried out and investigations were done as per protocol. Diagnosis of PROM was confirmed by any of this method. Continuous monitoring of maternal and fetal condition done, antibiotics was given intra/ post natal period. P/ V exam were done when necessary. Investigations done and maternal and fetal outcome were noted.
various types of neurological problems are increasing due to rapid industrialization and mechanization. Ambulatory stroke problem on of them and patients may suffer prolong period, ultimately they were burden to family and society. 8 & 15 Impairments resulting from stroke lead to persistent difficulties with walking and subsequently, improved walking ability is one of the highest priorities for people living with a stroke. In addition, walking ability has important health implications in providing protective effects against secondary complications common after a stroke such as heart disease or osteoporosis. 16 The tendon vibration technique has been widely used to investigate the influence of proprioception, particularly muscle spindle endings in spatial perception and motor control which will help on gait performance on ambulatory stroke patients. 17 The objective of the study is to find out the treatment outcome profile of Achilles tendon vibration on gait performance in ambulatory stroke patients.
Done in the correct manner, under contrast-enhanced fl uo- roscopy, or CT-guided, ESIs are considered safe. The com- plication rate, including infection and bleeding, is very low.
However, a recent study evaluating clinical outcome after ESIs reported disquieting results: those patients treated with ESIs were less likely to benefi t from subsequent surgical or nonoperative treatment compared with patients who had not received ESIs. 10 In both groups of patients, treated sur- gically or nonoperatively, pain and physical function were worse in the subsequent 4-year follow-up period in patients and no prior ESI 0.29 ( P = 0.85). When adjusted for confounding factors, the reduction in SSM-symptom score was greater for surgery than for nonoperative treatment by 0.41 points ( P < 0.001); the effect of having had an ESI prior to study entry was –0.08 ( P = 0.40).
education status, occupation, socio-economical class, type of family, number of family members, social habits and outcome of patients in term of cured, treatment complete, treatment failure, defaulter, transferred out and died; were collected by interviewing all new tuberculosis patients, registered under RNTCP in all three tuberculosis units during study period so that the treatment outcome of those patients would be available by next 6 to 8 months. All the patients were interviewed, door to door, at their homes with the help of health visitor. These patients were followed up for sputum examination by smear microscopy during 3 visits carried out namely at the end of intensive period, mid-way of continuation phase and at the completion of treatment regimen. The final outcome and other relavant data were confirmed with the help of TB register. The data collected was grouped into cured and non-cured group and expressed in percentage. The cured group includes all those who were declared cured and completed the treatment. The non-cured group includes treatment failures, defaulters, died and transferred out cases.
This is to certify that this dissertation titled “STUDY ON ETIOPATHOGENESIS CLINICAL PRESENTATION AND OUTCOME IN 100 YOUNG STROKE PATIENTS” is a bonafide work done by Dr.S.SENTHUR RAJA PANDIAN, Department of NEUROLOGY, Government Rajaji Hospital and Madurai Medical College, Madurai under my direct guidance and supervision in partial fulfillment of the regulations of The Tamilnadu Dr.M.G.R.Medical University for the award of D.M, Branch I (Neurology) during the academic period of August 2011 to August 2014.
Background: Besides cardiac disease, critical illness patients are often subjected to myocardial injury. Hence, the goal of present study was to analyze the incidence of elevated cardiac troponin levels in critically ill patients and its outcome which in turn can act as a prognostic marker.
Methods: The settings were the ICU’s of a tertiary care hospital in south India. A sample of 54 was identified using purposive sampling technique. Serial monitoring of troponin T was done on day 1, 3 and 5. A performa was used to collect the baseline data of who met the inclusion and exclusion criteria. The collected data was analyzed by using descriptive and inferential statistics.
Targeted sequencing of 59 genes associated with cardiomyop- athies revealed P/LP mutations in 38% of HCM cases in the na- tionwide FinHCM Genetic Study and VUS or CON variants favouring pathogenicity in 20%. The four most frequent sarco- meric mutations accounted for 28% of the HCM cases, indicat- ing that these few major mutations explain a substantial number of HCM cases in Finland. In contrast, P/LP variants in non-sarcomeric genes were rare and found only in GLA and PRKAG 2 genes in three patients. In the FinHCM OutcomeStudy, annual all-cause mortality exceeded that of the age- matched and gender-matched general Finnish population. His- tory of systolic heart failure and maximal LV wall thickness were independent predictors of HCM-related mortality and life-threatening cardiac events. The patients with a P/LP muta- tion underwent an ICD implantation more often than patients without a P/LP mutation, but all-cause/HCM-related mortality or combined HCM mortality and life-threatening events did not differ between the two groups. Finally, among 5.2 million Finns, there were at least 27 HCM-related deaths annually.
Background: Intra Uterine Fetal Death (IUFD) is an important issue in modern obstetrics. This study has been undertaken to find out the incidence of IUFD, socio-demographic factors, probable etiological factors, mode of delivery, its outcome and complications if any.
Methods: This retrospective observational study was carried out at a tertiary care hospital. Data was collected from case papers of patients who have delivered beyond 20 weeks and/or baby weighing more than 500 grams and having IUFD prior to onset of labor or during labor with singleton pregnancy.
Although our results seem in line with other inpa- tient treatment studies, post-treatment seizure con- trol in our study is difficult to compare with other inpatients treatment studies, due to differences in several patient characteristics. For example, in the Rush study, 9 65% of patients were seizure-free after a 6 months follow-up, but most seizure-free patients had a PNES history of less than 12 months, which is considered as a favourable prognostic factor. In our study only 1 patient had a seizure history of less than 12 months and the mean seizure duration was 6.7 years. Patients with comorbid epilepsy participated in the studies of Rush 9 and Kim. 19 We excluded them because it was not possible to determine the seizure frequency in a reliable way. McDade 14 also included patients with an IQ < 80 and found a significant association between low IQ and outcome. In our studypatients with an IQ < 80 were excluded from treat- ment at this unit.
efficacy of paracetamol in febrile ICU patients with known or suspected infection is currently underway [20,21].
Our findings that paracetamol was associated with decreased mortality in each subgroup, even after adjusting for confounding factors, are of importance and are not in keeping with our hypothesis. The use of paracetamol for not only antipyretic but also analgesic effect is believed to be common but has not been evaluated as an independent risk factor for outcome in the ICU overall and in specific ICU subgroups. Our findings that close to two-thirds of our patients received paracetamol confirm that, at least in the Australian and New Zealand context, paracetamol prescription in the ICU is common. Our additional findings that its administration is independently associated with improved survival and that such association remains after the use of propensity analysis, adjustments for key outcome-predictive baseline variables, and consideration of paracetamol administration as a time-dependent variable all suggest the need to more formally evaluate the role of paracetamol therapy in ICU patients. In addition, the variability of this association when adjusted for the degree of fever or illness severity or the presence of suspected infection further invite assessment in such specific groups.
Previous studies have examined cardiac morbidity as a prognostic factor, but results have been contradictory. Some have found an association with mortality 21, 31,81,84,90
whereas others have not 24, 41. It is difficult to compare these studies because of a wide variation in the definition of "cardiac failure," including hypotension, CHF, infective endocarditis, myocarditis, arrhythmias, and myocardial infarction. At least three prior studies have found CHF specifically, rather than the broadly defined "cardiac failure," to be a risk factor for hospital mortality in ARF. Lien and Chan evaluated 58 patients retrospectively and found CHF, not specifically defined, to be associated with increased mortality by univariate (RR = 1.9), but not multivariate analysis 84. Lohr, McFarlane, and Granthan retrospectively evaluated 126 patients with ARF and found CHF, defined as characteristic radiographic appearance, rales, decreased cardiac output, or the presence of a third heart sound, to have a significantly increased risk of mortality (RR = 1.3) 21 . In our study ATN due to cardiogenic shock secondary to acute myocardial infarction, acute decompensated cardiac failure was associated with poor outcome
ANTI- PLAGIARISM CERTIFICATE
This is to certify that this dissertation titled - “A study of the clinical profile, etiopathogenesis and outcome of patients with Sodium and
Calcium abnormalities in tuberculosis” of the candidate Dr. Rohith Salim with registration Number 201511464 has been submitted for verification and I have personally verified the urkund.com website for the purpose of plagiarism check. I found that the uploaded thesis file contains pages from introduction to conclusion and the result shows 1 percentage of plagiarism in the dissertation.
Mode of delivery
In present study caesarean section was done in 50.5 % of subjects. 49.5 % of subjects were delivered by vaginal route. 7 out of 8 neonatal deaths occurred in subjects, delivered vaginally and only 1 death occurred among babies delivered by LSCS. Percentage of caesarean section in different studies done by Chandra P et al, Casey et al, Sriya et al, Umber et al, Vasvalingam G et al Chate P et al were 76.9 % ,51%, 43.05 % ,32%, and 75.6% , 64% respectively. 4,16-20 Ahmad and Munin noted a more than 2-fold higher caesarian section rate in oligohydramnios (42%). For avoidance of adverse effects on perinatal outcome in most cases caesarian section was done. 21 The higher caesarean rate in present study could be to avoid fetal complication like cord compression, patient’s desire and associated co-morbidities like PIH.
Pregnancy is a matter of joy for a woman and her family.
Many a times it comes with its share of complications.
One such dreaded condition is pregnancy in women suffering from heart disease. Previously, the high maternal mortality in cardiac patients who became pregnant prompted the assertion women with an abnormal heart should not become pregnant. 1 This longstanding notion needs to be revised today. There has been a progressive and substantial reduction in maternal death and improved fetal outcome in pregnant women
NEED FOR SCORING SYSTEMS FOR TRIAGING SEPTIC PATIENTS
Sepsis is a life threatening condition which needs timely recognition and appropriate treatment. However no rapid diagnostic tests are currently available to accurately identify the patients with sepsis or those at high risk of developing sepsis. This is unlike certain other life-threatening conditions (eg: myocardial infarction), for which highly accurate diagnostic tests are available. Moreover, diagnostic tests for sepsis like culture will take atleast 48 hours to become positive and that delay in antibiotics while waiting for a culture wil be associated with poorer outcomes. Thus in the meantime, clinicians must rely on their clinical judgement to identify sepsis among patients with infection.