ABSTRACT
Background: Several scoring systems have been designed for risk stratification and prediction of outcomes in upper GI bleed. Endoscopy plays a major role in the diagnostic and therapeutic management of UGIB patients. However not all patients with UGIB need endoscopy. The objective of the present study was compared the prediction of mortality using different scoring systems in patients with upper GI bleed. A decision tool with a high sensitivity would be able to identify high and low risk patients and for judicious utilization of available resources.Methods: 100 patients were assessed with respect to their clinical parameters, organ dysfunction, pertinent laboratory parameters and five risk assessment scores i.e. clinical Rockall, Glasgow Blatchford, ALBI, PALBI and AIMS65 were calculated.Results: For prediction of outcomes, AIMS65 was superior to the others (AUROC of 0.889), followed by the GBS (AUROC of 0.869), followed by clinical Rockall score (AUROC 0.815), followed by ALBI score (AUROC of 0.765), followed by PALBI score (AUROC of 0.714) all values being statistically significant.Conclusions: The AIMS65 score is best in predicting the mortality in patients with upper GI bleed. The optimum cut off being >2. Though GBS may be better in predicting the need for intervention, it is inferior in predicting the mortality. The newer scores like ALBI and PALBI are inferior to AIMS65 and GBS in predicting mortality.
ABSTRACT
Background: International diabetes federation has highlighted that 搕he diabetic epidemic is here and threatens to overwhelm health systems if unchecked拻. The global prevalence of diabetes among adults has risen from 4.7% in 1980 to 8.5% in 2014. India unfortunately tops the list of countries with the largest number of people living with diabetes. Diabetes and depression are independent risk factors for one another and both are associated with increased risk of cognitive decline. Prevalence of depression is doubled in Diabetes mellitus, and also appears to vary by type of Diabetes mellitus, race/ethnicity, and duration of diabetes and associated debilitating complications and co-morbidities. Various studies using different methodology have revealed varying prevalence of depression. Data on this association of Diabetes and depression is limited in Indian context.Methods: This is a cross sectional study conducted on type 2 Diabetics attending outpatient department of Victoria and Bowring and Lady Curzon Hospital. Data regarding duration and treatment of diabetes, HbA1c levels and associated comorbidities were collected along with basic particulars of the patient. Becks depression questionnaire were used for analyzing the depressive symptoms.Results: A total of 302 diabetic patients were included in the study, out of which Males were 156 and Females were 146. Severe depressive symptoms were found in 18.21% of diabetics, and moderate depressive symptoms were found in 39.74% of study population. It is also found that the significant predictors of these depressive symptoms are increasing age, longer duration of diabetes, treatment intensity.Conclusions: In conclusion depressive symptoms are more common in diabetic subjects compared to non-diabetic population. Especially this increases with duration of diabetes and uncontrolled sugars. Hence there is a need to screen all diabetes subjects for depression.