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Background: Stroke has been found to be the fourth most fatal cause of death around the globe. Decreased activity and physical work are the major causes of increased incidences of stoke worldwide. It has also been studied that elevated levels of high-sensitivity C-reactive protein (hs-CRP) have been related to vascular inflammation whereas CRP is an important biomarker of systemic inflammation. Aim of this study to measure serum high-sensitivity C-reactive protein (hs-CRP) levels in the patients presenting with stroke, and evaluating its correlation as a prognostic marker in stroke patients.Methods: It was an observational prospective hospital-based case study carried out at Teerthanker Mahaveer Medical College and Research Centre, a tertiary care hospital situated in Moradabad, India for 5 months period from 1st November 2018 to 31st March 2019. 100 patients of new-onset stroke were included in the study.Results: According to the Scandinavian score, the majority of the patients who had ischemic stroke depicted a score range from 2-8. On the other hand, the majority the patients with hemorrhagic score had a Scandinavian score >14. The mean hs-CRP, when observed between different ranges of the Scandinavian score, showed that in 2-8 range the mean hs-CRP was 31.49±15.00, the mean hs-CRP for 9-14 range was 7.99±6.32 and the mean hs-CRP for >14 range was 7.10±0.32.Conclusions: It can be identified that levels of hs-CRP can be used as a marker to predict the long term prognosis of patients with stroke. In addition to this, it can also be identified that patients with higher levels of hs-CRP have lower Scandinavian score and the patients with lower hs-CRP levels have a higher Scandinavian score. Also, the results show that patients with ischaemic stroke have higher hs-CRP levels as compared to hemorrhagic stroke.
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Background: Malaria is a parasitic disease which is majorly caused by the bite of an infected Anopheles mosquito. It has been estimated that the most common type of malaria affecting the human race is known as Plasmodium vivax. Human malaria is a global burden with 3.4 billion people at risk over 91 endemic countries. According to the WHO, the involvement of liver dysfunction in Plasmodium vivax malaria is not an uncommon phenomenon. Aim of the research was to study various clinical manifestations and biochemical parameter for liver dysfunction in association with Plasmodium vivax malaria.Methods: It was an observational study carried out at Teerthanker Mahaveer Medical College and Research Centre, a tertiary care hospital situated in Moradabad for a period of 1 year (March 2017-Feb 2018). Total of 200 patients aged above 15 years, with either sex were part of it. All the patients having mixed malaria with dengue, pregnant women and the patients who did not give written consent for being a part of the study were excluded from the study. A detailed clinical examination was done, including all the hematological and biochemical examinations.Results: The results depicted that the number of male patients was 95, and the number of female patients was 105. The majority of the patients belonged to 15-30 years of age group. The major clinical features of the patients suffering from P. Vivax were fever and jaundice. The number of patients with serum bilirubin >3 mg/dl was 55.Conclusions: In light of the above results, it was evident that Plasmodium vivax has the capability of producing jaundice, hepatic dysfunction and anemia. The doctors must be very vigilant while treating the patients with Plasmodium vivax for any symptoms of jaundice as they are often misunderstood as hepatitis.
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Background:Among the commonly existing endocrine disorders found in India, Thyroid disease contributes fairly to the clinical scenario affecting around 9-15 % of the female population as well as the male population to a milder degree. Among the principal targets of the thyroid hormones is the cardiovascular system. The effects noted on the CVS are changes in the cardiac contractility, myocardial oxygen consumption, alterations in the systemic vascular resistance (SVR), decreased cardiac contractility leading to decreased cardiac output, increased rate of atherosclerosis and hence greater potential of CAD. Hypothyroidism also causes QT interval prolongation. Only few studies have been done in our country to assess these cardiovascular parameters in hypothyroid patients. Principally the thyroid hormone-T3, affects the heart with variations in cardiac gene expression principally mediated by T3. On 2D-ECHO mild Left Ventricular Diastolic Dysfunction (LVDD), mild concentric Left Ventricular Hypertrophy (LVH) with or without Left Ventricular Diastolic Dysfunction, mild mitral insufficiency or minimal pericardial effusion can be found. Since there does exist some evidence of a causal relationship, it is advisable to perform a basic cardiac work-up which should also include an echocardiogram to assess systolic and diastolic dysfunction as part of initial evaluation of the hypothyroid patients. Also to make note is the fact that persistent subclinical thyroid dysfunction may notably increase the cardiovascular disease risk ratio.
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Objective A short pre-hospital delay, from the onset of symptoms to rapid initiation of reperfusion therapy, is a crucial factor in determining prognosis of myocardial infarction (MI). The purpose of this study was to evaluate symptoms and presentation delay times in MI patients with and without diabetes. Methods This cross-sectional study was conducted in 3 tertiary care hospitals of Pakistan over a period of 6 months. The study sample consisted of 280 consenting individuals diagnosed with ST-elevation MI (STEMI) or Non-ST elevation MI (NSTEMI), out of which 130 were diabetic and 150 were non-diabetic. Data was collected using a standardized questionnaire, investigating MI symptoms along with causes and duration of pre-hospital delay within 72 hours of admission. Results No significant difference was found in the intensity of chest pain between diabetics and non-diabetics. Atypical symptoms of MI such as anxiety (p < 0.001), cold sweats (p = 0.034) and epigastric pain (p = 0.017) were more frequently reported in diabetics. MI patients with diabetes had a significantly longer presentation delay time with 75% of the patients presenting after elapse of 3 h. Only a few patients reported to the hospital within an hour of onset of symptoms (n = 23, 8.2%), out of which majority were non-diabetics (n = 18). A majority of patients (n = 146, 52%) in both groups did not use emergency medical services. Conclusion This study provides an incentive for further research, aiming to reduce pre hospital delay along with investigating the effectiveness of emergency medical services.
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Background: Referrals are an essential part of the health care system and have a significant impact on patient services, medical staff, and health care costs. The referral process is a complex one in which the General Practitioner (GP) plays the essential role as a decision maker. However, once the referral initiated, its implementation involves the GP, the patient, the specialist and the health system. Aims & Objective: This study aims to identify the factors related to inappropriate referrals and to suggest the best management approach to improve the quality of referrals in Wazarat Health Center (WHC) in Riyadh, Saudi Arabia. Material and Methods: The study surveyed all the primary care doctors (GPs) who work in the WHC through anonymous, self-completed, web-based questionnaires. A total of 51 GPs were included in the study. The survey obtained the participants’ opinions about 32 different factors that contribute to making inappropriate referrals in WHC. Results: The study results show that 67.44% of surveyed GPs either agree or strongly agree that “poor GP awareness of the available secondary care clinics” is the main GP’s factor for making inappropriate referrals. 83.8% of surveyed doctors agreed or strongly agreed that “patients’ requests and demands for referral” is the main patient’s factor that contributes to making inappropriate referrals, and 86.04%of GPs agreed or strongly agreed that a “lack of specialist referral feedback” is the main specialists’ factor that contributes to making inappropriate referrals. 90.7% of surveyed GP either agreed or strongly agreed that “the lack of continuity of care” in WHC and “difficulty with GP-specialist phone communication” in Riyadh Military Hospital are the two main factors concerning the RMH system that contribute in making inappropriate referrals. Finally, 83.7% of GPs agreed or strongly agreed that the best management approach for improving the referral process from primary care to secondary care in RMH would be to conduct “periodic referral auditing”. Conclusion: The study identified a number of barriers to achieve high-quality referrals in WHC. Effort put towards improving the system to ensure the continuity of care and to facilitate GP-specialist communication are priority recommendations. The study also recommends a review of the hospital policy that obligates specialists to provide referral feedback within a reasonable time frame. Furthermore, the study encourages distributing the GPs in small teams and advocating for team work. Finally, the study recommends establishing a referral audit project as a tool to monitor and improve the quality of referrals in WHC.
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To assess if thrombocytopenia has a predictive value for bleeding and/or liver decompensation following percutaneous radiofrequency ablation [RFA] therapy of hepatocellular carcinoma [HCC] in patients with liver cirrhosis. 64 consecutive patients with cirrhosis complicated by hepatocellular carcinoma, and associated with mild thrombocytopenia ranged from 37 to 99 x 10[9] platelets/L, and had undergone percutaneous RFA for treatment 86 hccs, were retrospectively studied. Nine possible factors were analyzed for their ability to predict bleeding or liver decompensation using the Cox proportional hazards regression model; Age, sex, Child-Pugh class, etiology of cirrhosis, platelet count, prothrombin activity, number of tumors, maximum size of the tumor, and type of electrode. It was shown that platelet threshold of 37 x 10[9]/L and the other variables were not significant risk factors of bleeding. Statistical [univariante and multivariente] analysis revealed that liver decompensation was clearly linked to prothrombin activity [p = 0,010 and p = 0.006, respectively] and < 63% of prothrombin activity was found to be a significant threshold for the occurrence of liver decompensation [p = 0.003] confirmed by Cox model [p = 0.05] Mild thrombocytopenia > 37 x 109/L is not an independent risk factor of bleeding or liver decompensation after RFA therapy of HCC in patient with cirrhosis. However, in such situation a significant higher risk of liver decompensation followed the procedure was found in cases of prothrombin activity < 63%.Radiofrequency ablation, hepatocellular carcinoma, thrombocytopenia, prothrombin activity, liver cirrhosis RFA= radiofrequency ablation, HCC = hepatocellular carcinoma, US = ultrasonography, CT = computed tomography