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Introduction: In patients presenting to Emergency Department(ED) with traumatic brain injury, it is important to evaluate the neurological status to determine the present clinical status and to predict outcome of the patient. GCS is the most widely used score,but it has some drawbacks which led to the development of other scores such as the Full Outline of Unresponsiveness (FOUR) score. In our study, we compared the GCS and the FOUR scores in patients presenting with traumatic brain injury. Aims: 1) To compare the FOUR score with the GCS score in traumatic brain injury (TBI) patients. 2) To understand the effectiveness of FOUR score as an assessment tool. 3) To assess whether FOUR score is an alternative tool in TBI patients or could be complimentary. Methods: We conducted a prospective observational study at a trauma centre of a tertiary care hospital during January 2019 to March 2019 after taking institutional ethical committee approval. All patients presenting with clinical diagnosis of TBI were evaluated and given a GCS and FOUR score by the emergency physician. Relevant investigations were done and findings were noted. We tabulated all information in Microsoft Excel 2019 and statistical analysis was done with SPSS software. Results: The mean age of study population was 38.295+/- 15.33 years. Male patients were 79% and 21% were female patients. Road traffic accidents contributed highest percentages of causes of TBI (60%). By comparing the median value of FOUR score with mortality and the median value of GCS score with the mortality by using the Mann-Whitney test showed a p-value of ?1, which is statistically non-significant. Conclusions: FOUR score is equally reliable with GCS score. Both have their own significance
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Introduction: Guillain–Barre syndrome (GBS) is an acutepolyradiculoneuropathy with varied severity of presentation.Objectives: To study clinical presentation, electrodiagnosticvariations, hospital care and outcome of patients of GuillainBarre Syndrome (GBS). Current research aimed to studyefficacy of Plasmapharesis and Intravenous Immunoglobulin(IVIG) in patients of GBS.Material and Methods: 78 patients of GBS were studiedin detail including history, clinical examination andinvestigations. Patients were treated with Plasmapharesis andIVIG; and outcome was observed.Results: Commonest age group affected was 13-40 yrs.The male:female ratio was 1.2:1. Antecedent infection werepresent in 42 out of 78 patients. Quadriparesis was presentin 74 patients and paraparesis in four patients. Cranial nerveinvolvement was seen in 47 out of 78 patients. Areflexia wasfound in all 78 patients. Albuminocytologic dissociation waspresent in 44 out of 61 patients underwent CSF examination.NCV findings show conduction velocity slowing, delayedf latencies in 92% patients. Out of 72 patients, 33[43%]required mechanical ventilation. Out of 78 patients, 71 weretreated with Plasmapharesis and seven patients were treatedwith IVIG. Out of 78 patients 56 [72%] patients recoveredcompletely, 19 [24%] patients died and three [four%] patientsdeveloped severe neurologic deficit.Conclusion: GBS is more common in male as compare tofemale. Commonest presentation is paresthesia in legs andascending paralysis. Patients who received treatment early inthe course of disease had faster recovery. Plasmapheresis andIVIG both showed similar efficacy in treating GBS.
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T-wave abnormalities are common electrocardiographic occurrences in patients with acute coronary syndromes. The clinical and electrocardiographic course and angiographic findings in patients with evolving inverted or biphasic T waves have not been fully elucidated. Patients with abnormal T waves associated with unstable angina represent a subgroup with a high probability of near total obstruction of coronary artery and myocardial dysfunction. In the present study we describe a subgroup of patients with myocardial ischemia who during the acute Ischemic phase did not develop elevation but only biphasic or inverted T waves in the ECG and had >90% stenosis of 1 or more coronary arteries. Methods: The study comprised 125 patients presented with unstable angina pectoris. Patients’ characteristics, Electrocardiographic Data, Cardiac enzymes and Coronary angiography findings were obtained. Collected data was analyzed and sensitivity, specificity, positive predictive value, significance of test (p value) were calculated using appropriate statistical method. Results: Of the 125 patients deep symmetrical and sustained T-wave inversions were present in 72 patients & biphasic T-waves in 28 patients. 125 patients underwent coronary angiography, 92(74%) patients had >90% stenosis of 1 or more coronary arteries; sensitivity of abnormal T waves for significant stenosis was 90%, specificity 92%, positive predictive value 97.83 % and p value <0.001. Conclusion: We have identified a subgroup of patients with critical obstruction of coronary artery in patients with unstable angina and non diagnostic ECG T-wave abnormalities are significant electrocardiographic occurrences in patients with acute coronary syndromes and frequently associated with coronary artery obstruction
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Dyspnoea can be defined as an unpleasant or uncomfortable sensation of difficult breathing experienced by an individual. The differential diagnosis includes acute heart failure (AHF), acute coronary syndrome (ACS) and pulmonary embolism (PE) as the main diseases to be excluded for their potential acute severity and mortality. NT-pro BNP is a sensitive and specific marker of ventricular dysfunction. Materials & Methods : Observational cross sectional study was done from October 2016 to October 2017 with 70 patients of acute dyspnoea presenting to emergency department. An automated immuno-analytical test for NT-pro BNP was carried out. Data was analyzed using appropriate statistical tests. Observation : Out of 70 cases of breathlessness, 48 patients were diagnosed with cardiovascular disease, 17 had Respiratory disease and 5 were of other causes (non respiratory, non cardiac). In Cardiovascular causes of breathlessness (n=48) the mean NT-pro BNP level was 2234 pg/ml, and in Non cardiovascular causes of breathlessness (n=22) the mean NT-pro BNP level was 677 pg/ml. Thus, there was a significant difference in the levels of mean NT-pro BNP. Conclusion : The statistically significant difference was observed when plasma NT-pro BNP levels of cardiovascular disease were compared to non cardiovascular disease (in respiratory causes levels were significantly lower) .Thus it supports the ability of NT pro BNP to provide specific information about the cardiac involvement in acute dyspnoea
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Introduction: Hemorrhagic shock is the leading etiology in most cases of trauma and can be rapidly fatal. Thus adequate fluid resuscitation is required to improve the outcome of patients. CVP is usually used to guide resuscitation. Point-of-care sonography in emergency medicine provides non-invasive assessment of intravascular volume status. Measurement of inferior vena cava does not require special preparation as it can be done along with FAST examination. Materials & Methods : This observational study was conducted on patients with history of trauma presenting to Emergency Department. The patients were divided into two groups: a hypotension group with hypotension on presentation and a normotensive group with normal blood pressure. The diameters of IVC both during inspiration (IVCi) and expiration (IVCe) were measured by M-mode ultrasound using a 3-5 MHz Phased Array Transducer. Results: Both IVCe and IVCi were significantly smaller in hypotension group as compared to normotension group of patients, while collapsibility index was increased in hypotensive group. The mean IVCe diameter was 7.8 mm in hypotension group. There was positive correlation of IVC parameters to blood pressure, and shock index. Post-resuscitation there was increase in diameters of IVC, decrease in collapsibility of IVC, and significant improvement in the vital parameters. Conclusion: The study showed that the measurement of IVC diameter can be used as a reliable tool to guide resuscitation in trauma patients and can help to predict significant hypovolemia, in patients having normal blood pressure