ABSTRACT
Background: At 140 million, India has the second largest population of old people in the world, as per the 2011 census. 1 The covid 19 pandemic has wreaked havoc in millions of lives. Elderly are especially vulnerable to COVID-19 and experience high morbidity and mortality as a result of immunosenescence. Age is independently linked with mortality, but age alone does not adequately capture the robustness of older adults who are a heterogeneous group. The current research was done in a tertiary healthcare hospital in Maharashtra to understand the clinical profile and factors that affected the outcome of elderly during the second wave of the COVID pandemic. Method: This was a single centre retrospective observational study done in a tertiary hospital which was admitting both covid and non-covid patients during the time of this study. All elderly patients admitted with COVID 19 disease in Covid ward and covid ICU (Intensive care unit) were included in the study. Their Demographic details, duration of illness, vital parameters, oxygen saturation, partial pressure of arterial oxygen compared to fraction of inspired oxygen (PaO2-FiO2 ratio) were recorded and also relevant investigations such as complete blood count, kidney function tests, liver function tests, arterial blood gases, chest X-rayand ECG (Electrocardiogram),CT scan of the brain, CSF(cerebrospinal fluid) studies and other tests where relevant were recorded. Inflammatory markers such as C-Reactive Protein (CRP), Ferritin, D-Dimer and Chest CT scan were noted. Clinical profiles and outcomes were noted till discharge or death. Results: Among 231 patients that were included in this study, 81(35%) were female and 150 (65%) were male. Ninety-two patients died (39.8%) while 139 patients (60.2%) survived in our study. Majority of our patients (211;91.3%) presented in category E(pneumonia with respiratory failure) or category F(pneumonia with respiratory failure and multiorgan dysfunction syndrome). Factors which had a major impact on mortality were- a low PaO2-FiO2 ratio on admission, high C-Reactive Protein (CRP) levels, high d-dimer levels, a finding of bilateral ground glass opacities on x-ray, and need for invasive ventilation on admission. Conclusions: Elderly remain vulnerable to severe consequences of COVID-19 infection owing to the increasing comorbidities and immunosenescence in them. Prolonged oxygen therapy and intensive respiratory rehabilitation are the mainstays of effective management. Given the constant threat of mutating virus, masking, maintaining hand sanitization, vaccination and also caring for our elders while still maintaining social distance are our best bet against a fatal third wave.
ABSTRACT
Background:Prognostication of patients with community-acquired pneumonia (CAP) is important from clinical, research, and quality-improvement perspectives. The pneumonia severity index (PSI) is a rigorously studied prediction rule for prognosis that objectively stratifies patients into quintiles of risk. The present study aimed to assess whether PSI can predict mortality, need for intensive care and ventilator support. Methods: An observational study of fifty patients aged 60 years or higher who were admitted in the general medicine ward of Department of Medicine, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai from April 2014 till September 2015 was conducted. A questionnaire with demographic information, clinical signs and symptoms, laboratory and radiographic findings was completed for each patient. Patients were classified according to PSI risk classification and their clinical outcome was noted. Results: Mean age of the patients was 66.5± 6.3 years; 68% were males, and 32% were females. The sensitivity, specificity, positive and negative predictive value of PSI risk class IV in predicting ICU admissions was 100%, 55.9%, 40.9% and 100%, respectively. Similarly, the sensitivity and specificity of PSI in predicting death and ventilator support to patient were maximum for PSI class IV. Defervescence time significantly correlated with PSI score (Spearman’s rho = 0.563, p value = 0.001). Conclusion: PSI was a good predictor of mortality, need of ICU admission and mechanical ventilation. Future studies are needed to support our findings and should further assess the long term outcome in these patients.
ABSTRACT
Background:We aimed to assess the clinical profile of Chronic obstructive pulmonary disease (COPD) occurring in elderly patient according to GOLD criteria/BODE index and to study the association of COPD with various risk factors in an elderly patient. Methods: We designed a hospital based observational study, in which we included patients with COPD who are elderly and admitted at the Lokmanya Tilak Municipal Medical College and Hospital, Mumbai from January 2015 till July 2016. After obtaining approval of the institutional ethics committee, all the eligible patients were interviewed for socio-demographic variables, clinical history and examination and risk factors for COPD. Post- bronchodilator spirometry and imaging studies were performed on the study patients, based on which patients were classified as per the GOLD criteria and BODE index. Associations between various risk factors and severity of pulmonary function impairment and prognosis was analysed. Results: During the study period 50 patients were included in the study. Body mass index and two dimensional echocardiography findings of pulmonary artery hypertension were found to be significantly associated with the staging of pulmonary function according to GOLD staging criteria. Additionally, statistically significant association between BODE index and smoking index, body index and two dimensional echocardiography findings of pulmonary artery hypertension (p value less than 0.01, 0.01 and 0.05 respectively) was found. We found higher creatinine levels, leucocyte count and acute on chronic type 2 respiratory failure to be significantly associated with death. Conclusion: Patient variables have a strong association with severity and prognosis of COPD.
ABSTRACT
Background: Opportunistic infections of the central nervous system (CNS) are common complications of advanced immunodeficiency in individuals with human immunodeficiency virus (HIV) infection. We aimed to study the clinical profile of CNS infections in HIV patients, effect of antiretroviral therapy (ART) on various patient variables and mortality outcomes associated with various patient characteristics. Methods: After approval of the ethics committee, we enrolled 100 patients from the Department of Medicine at Lokmanya Tilak Municipal General Hospital from January 2011. Patients who were diagnosed with HIV using ELISA and admitted with a CMS infection were consented and enrolled for the study. Various clinico-laboratory parameters like CD4 counts, ART, signs and symptoms were collected and analysed with approapriate statistical techniques. P vlaue less than 0.05 was taken as staistically significant. Results: Out of 100 patients, 71 were males, average age 35.24 years. Majority had headaches, CD4 counts between 101-200 cells/mm3and 57 were on ART. Tubercular mengitis was the most common CNS infection in our patient population. We found statistical signifiance in the occurance of CNS infections and ART among patients. Mortality outcomes were significantly associated with signs and symptoms of the patients (p < 0.05). Conclusion: Our results show that CNS infections can occur even with high CD4 counts. So strict monitoring and long term followup of HIV patients is needed. Areas of future research should focus on long term clinical outcomes of HIV patients and elucidating factors reponsible for it.
ABSTRACT
Introduction: Bedside Index of Severity in Acute Pancreatitis (BISAP) is a simple bedside tool which helps in early identification of risk of higher mortality in acute pancreatitis. Objectives: Our aim was to study clinical and laboratory profiles of patients with acute pancreatitis presenting to a tertiary care hospital in Mumbai, India and to stratify patients according to their risk of mortality by applying the BISAP score and its correlation with Computed Tomography Severity Index (CTSI). Material and methods: Patients who came to Lokmanya Tilak Municipal Medical College (LTMMC) and General Hospital, Mumbai with definitive features of acute pancreatitis from January, 2013 to April, 2013 were prospectively observed for 24 hours and their clinical information was collected. CT abdomen was used as the gold standard for the diagnosis of acute pancreatitis. Descriptive analysis for various patient variables was performed using SPSS. Results: Alcoholism was the most common etiology; 97% patients presented with abdominal pain. Higher serum amylase, lipase and blood urea nitrogen levels, hypocalcemia, presence of systemic inflammatory response syndrome and bilateral pleural effusion were found to significantly associate with mortality. There was a statistically significant trend for increasing mortality with increasing BISAP score (p<0.001). However, no significant correlation between BISAP score and CTSI was found [(p = 0.101), Pearson’s correlation coefficient = 0.168]. Conclusion: Traditional severity indices have not been clinically useful since they require collection of huge amount of clinical and laboratory data over time. In such circumstances, BISAP score can predict patients who are at higher risk of mortality.