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Background: Hypertension is widely prevalent across India. The rule of halves is commonly used to describe the attrition and gaps in the care cascade of hypertension management across detection, availing treatment, and having controlled blood pressure (BP) on treatment. Objectives: Using nationally representative data, we aimed to assess the rule of halves in hypertension management in different states of India and across sociodemographic, health system, and personal factors. Methods: A descriptive analysis of secondary data from the National Family Health Survey?4 was conducted. We included 770,662 individuals(112,122 men and 658,540 nonpregnant women) of 15–49 years of age. The proportion of individuals not aware of hypertension status among those with high BP, known hypertensives not availing of treatment, and uncontrolled BP among those on treatment were expressed as percentage with a 95% confidence interval (CI). Results: Of those with high BP, 48.5% (95% CI: 47.8%–49.3%) were not aware of their hypertensive status. Among known hypertensives, 72% (95% CI: 71.2%–72.8%) had not availed treatment for hypertension. Among those on treatment, 39.8% (95% CI: 38.7%–40.9%) had uncontrolled hypertension. Conclusion: The rule of halves of India shows that the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke has made relatively good progress with the detection of hypertension and achieving BP control among those on treatment. However, with three?fourth of known hypertensives not availing treatment, more dividends from the detection of hypertension efforts could be realized. The program needs to especially focus on ensuring the treatment for those detected with hypertension.
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Background: Thyroid hormones have a crucial role in adapting the metabolic functions during stress and critical illness. Patients who are critically ill may have profound changes in thyroid hormone metabolism. Non-thyroidal Illness Syndrome (NTIS) is one among them, in which there is marked abnormality seen in the thyroid hormone levels. Hence this study is to understand the alterations of the thyroid function tests (TFTs) encountered in critically ill patients admitted in medical intensive care unit (MICU) without primary thyroid disease and to correlate with the severity of Acute Physiology and Chronic Health Evaluation (APACHE III) scoring. Methods: The study was conducted on 100 critically ill patients with no previous thyroid disorders, admitted in MICU in the Department of General Medicine in a tertiary care hospital between September 2017 and August 2019 who fulfilled the inclusion and exclusion criteria. Results: Out of 100 critically ill patients the abnormal thyroid function prevalence was seen in 78% patients. The most common abnormality seen in our study was low total triiodothyronine (TT3) (61%) followed by low free triiodothyronine (FT3) (36%), low total thyroxine (TT4) (29%), high thyroid-stimulating hormone (TSH) (18%), and low free thyroxine (FT4) (12%). Low TT3, TT4, and FT3 values had a significant correlation with increasing critical severity score of APACHE III with a p value which was statistically significant (p < 0.05). Conclusions: With increase in severity of critical illness assessed by APACHE III, TFT, that is, TT3, TT4, and FT3 levels were decreasing, suggestive of increasing non-thyroidal illness in critically ill patients.
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Aim: The aim of the present study was to evaluate the clinical and microbiological effects of subgingival administration of 1% chlorhexidine gel (Chlorhexamed® 1% gel) in patients with chronic periodontitis. Settings and Design: The study was done in a parallel?arm design with a total of 30 patients with 60 sites suffering from chronic periodontitis. The patients were divided into control and experimental groups. Materials and Methods: The clinical parameters recorded were plaque index, gingival index, modified sulcular bleeding index, probing pocket depth and relative attachment level at baseline, 1 month and 3 month. Microbiological colony?forming units were assessed for Porphyromonas gingivalis, Fusobacterium nucleatum and Tannerella forsythia at baseline, 1 week, 1 month and 3 months. The control group received scaling and root planing (SRP) after baseline evaluation; however, the experimental group received the application of Chlorhexamed® gel within 48 hours after SRP. Then, the values obtained were subjected to statistical analysis. Results: Both groups showed significant improvement from the baseline to 3 months in all clinical and microbiological parameters. The experimental group showed better improvement in all parameters. Conclusion: The use of Chlorhexamed® gel has proven to be an efficacious adjunct with SRP in the treatment of chronic periodontitis.
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Introduction: The skin acts as the first line of defense for the body against external injuries. With aging, the architecture of the skin undergoes intrinsic changes that impair its capacity for repair. In addition, the aging skin is more susceptible to injury by external stimuli, including ultraviolet rays and environmental pollutants. The combination of these factors predisposes the elderly to a variety of dermatological disorders, including xerosis, pruritus, photoaging, eczematous disorders, and tumors. The elderly (>60 years of age) population in India accounted for 8.6% (104 million) in 2011, and the figure has been projected to increase to 19% by the year 2050. It is imperative to identify the pattern of cutaneous disorders in this population as skin care regimens aimed to improve epidermal function have been shown to be effective inthe prevention and treatment of some of these aging-associated cutaneous disorders. Objectives: The objective of the study was to identify the pattern of dermatoses among the elderly population attending the dermatology clinic at a tertiary care hospital in South?east Rajasthan. Materials and Methods: We conducted a cross-sectional descriptive study of patients above the age of 60 years who attended the dermatology clinic at a tertiary care hospital in South?east Rajasthan from May 2018 to May 2020. A combination of history, physical examination, and clinical investigations (when appropriate) were used to establish the diagnosis. Results: A total of 210 patients were included in this study. Most patients were between the age group of 60–65 years (40.47%). One hundred and thirty?eight were male (65.71%) and 72 were female (34.28%), with a male to female ratio of 1.9:1. Our study demonstrated that xerosis was one of the most common diagnoses seen in 126 cases (60%), followed by eczematous skin conditions seen in 82 cases (39%). Conclusion: The elderly constitute an important part of the population. Cutaneous disorders in the elderly range from mild disorders such as cherry angiomas to dermatological malignancies. Therefore, it is important to recognize the pattern of dermatosis in this population so that appropriate therapeutic and preventive strategies could be implemented.
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ABSTRACT Objective: To analyze and compare the Von Mises stress and principal stress distribution in palatal bone around the palatal implant in lingual orthodontics (LiO) for single and double palatal implant systems with varying lengths of lever arm. Methods: Two groups were assessed: single (Group 1) and double (Group 2) palatal implant systems, which were further divided into two subgroups, based on lever arm length, for analyzing stress in the palatal bone around the implant. Hence, two 3D finite element models of bilateral maxillary first premolar extraction cases were constructed in each system. Lingual brackets (0.018-in slot) were positioned at the center of the clinical crown. In both systems, 150g of retraction force was applied, and ANSYS v. 12.1 software was used to analyze and compare stress in the palatal bone around the palatal implant. Results: In this study, higher stress was observed at the inner threaded interface of cortical bone. Magnitude of Von Mises stress was higher in Group 2 (0.63 MPa and 0.65 MPa) in comparison to Group 1 (0.29 MPa and 0.29 MPa). Similarly, magnitude of principal stress was higher in Group 2, in comparison to Group 1. Higher stress was observed in the apical region of the implant-bone interface of cancellous bone. Conclusion: This study concluded that the Von Misses stress as well as principal stress in the palatal bone were within the optimal limit in both groups. Finally, it can be concluded that both systems (single and double palatal implant) were safe for the patients in clinical use of 150g of retraction force.
RESUMO Objetivo: Analisar e comparar as tensões de Von Mises e a distribuição das tensões principais no osso palatino ao redor de implantes palatinos em Ortodontia Lingual (OL) para sistemas de implantes palatinos unitários ou duplos com comprimentos variados do braço de alavanca. Métodos: Foram delineados dois grupos para o presente estudo: Grupo 1 - com sistema de implante palatino unitário e Grupo 2 - com sistema de implantes palatinos duplos. Em seguida, os grupos foram divididos em dois subgrupos, com base no comprimento do braço de alavanca, para analisar as tensões no osso palatino ao redor do implante. Para cada sistema, foram construídos dois modelos 3D de elementos finitos (MEF) de casos com extração bilateral de primeiros pré-molares superiores. Braquetes linguais (slot 0,018") foram posicionados no centro das coroas clínicas. Nos dois sistemas, foram aplicados 150g de força de retração nos dentes anteriores, e o software ANSYS v. 12.1 foi usado para analisar e comparar as tensões no osso palatino ao redor dos implantes. Resultados: Foram observados maiores níveis de tensões na parte interna rosqueada no osso cortical. A magnitude das tensões de Von Mises foi maior no Grupo 2 (0,63MPa e 0,65MPa) em comparação ao Grupo 1 (0,29MPa e 0,29MPa). De forma semelhante, foi observada maior magnitude das tensões principais no Grupo 2 do que no Grupo 1. Maiores tensões foram observadas na região apical da interface osso/implante no tecido ósseo esponjoso. Conclusão: A tensões de Von Mises e as tensões principais no osso palatino ficaram dentro do limite ideal em ambos os grupos. Ambos os sistemas de implantes palatinos (unitário e duplo) foram seguros para o uso clínico em pacientes com força de retração de 150g.
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Background/Aims@#The management of patients with walled-off necrosis (WON) has undergone a paradigm shift from surgical to nonsurgical modalities. Real-world data on the management of symptomatic WON are scarce. @*Methods@#Prospectively collected data of symptomatic WON cases were retrospectively evaluated. The treatment modalities used were medical management alone, percutaneous catheter drainage (PCD) or endoscopic drainage, or a combination of PCD and endoscopic drainage. We compared technical success, clinical success, mortality, readmissions, complications, and length of hospital stay among these modalities. @*Results@#A total of 264 patients were evaluated (predominantly men: n=195, 74%). The mean age was 37.66 (±14.41) years. The etiology of acute pancreatitis was excessive alcohol consumption in 115 (44%) and biliary (gall stone, microlithiasis) in 89 (34%). The most common indications for drainage were pain (n=253, 96%) and fever (n=140, 53%). Of the patients, 74 (28%) were treated with medical therapy alone, 81 (31%) with endoscopic drainage, 98 (37%) with PCD, and 10 (4%) with a combined approach. Technical success and clinical success were achieved in 78 (93%) and 74 (91%) patients in the endoscopic arm and in 88 (90%) and 79 (81%) patients in the PCD arm, respectively (p=0.0004 for clinical success). Lower rates of complications (7% vs. 22%, p=0.005), readmission (20% vs. 34%, p=0.04), and mortality (4% vs. 19%, p=0.0012), and shorter hospital stay (13 days vs. 19 days, p=0.0018) were observed in the endoscopic group than in the PCD group. @*Conclusions@#Endoscopic drainage of WON is better than PCD and is associated with lower mortality, fewer complications, and shorter hospitalization.
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Background/Aims@#The severe acute respiratory syndrome coronavirus 2 pandemic has affected the gastrointestinal (GI) endoscopy units globally owing to the risk of transmission. We present our data on the use of rapid antigen test (RAT) as a screening tool prior to endoscopy to prevent the transmission of coronavirus disease (COVID-19). @*Methods@#This study was a retrospective analysis of patients who underwent any GI endoscopic procedure from July 2020 to October 2020 at a tertiary referral center in New Delhi, India. All patients underwent screening for COVID-19 using RAT, and endoscopy was performed only when the RAT was negative. The data are presented as numbers and percentages. @*Results@#A total of 3,002 endoscopic procedures were performed during the study period. Only one endoscopic procedure was performed in a COVID-19 positive patient. A total of 53 healthcare workers were involved in conducting these procedures. Only 2 healthcare workers (3.8%) were diagnosed COVID-19 positive, presumably due to community-acquired infection, during this period. @*Conclusions@#The COVID-19 RAT is easily usable as a simple screening tool prior to GI endoscopy during the COVID-19 pandemic.
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Background/Aims@#The severe acute respiratory syndrome coronavirus 2 pandemic has affected the gastrointestinal (GI) endoscopy units globally owing to the risk of transmission. We present our data on the use of rapid antigen test (RAT) as a screening tool prior to endoscopy to prevent the transmission of coronavirus disease (COVID-19). @*Methods@#This study was a retrospective analysis of patients who underwent any GI endoscopic procedure from July 2020 to October 2020 at a tertiary referral center in New Delhi, India. All patients underwent screening for COVID-19 using RAT, and endoscopy was performed only when the RAT was negative. The data are presented as numbers and percentages. @*Results@#A total of 3,002 endoscopic procedures were performed during the study period. Only one endoscopic procedure was performed in a COVID-19 positive patient. A total of 53 healthcare workers were involved in conducting these procedures. Only 2 healthcare workers (3.8%) were diagnosed COVID-19 positive, presumably due to community-acquired infection, during this period. @*Conclusions@#The COVID-19 RAT is easily usable as a simple screening tool prior to GI endoscopy during the COVID-19 pandemic.
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Background: Family planning services like use of modern contraceptives help the couples to delay pregnancy and avoid the unwanted pregnancies. So, understanding the choice of contraceptives for the underserved couples is a key for provision of family planning services. Objective was to assess the contraceptive use among married women of urban slums using semi-structured questionnaire.Methods: The present observational cross-sectional study was conducted over a period of one month i.e. November 2019 in urban slums of Trikuta Nagar, which is a field practice area of Department of Community Medicine, GMC Jammu. Information was gathered from married females of reproductive age group. 50% of the population was selected randomly by lottery method i.e. 90 females. But at the time of study, only 85 married females could be interviewed.Results: The results show that the maximum females belonged to the 15-25 years age group followed by 26-30 years age group. More than 50% were literate, 42.35% had education upto primary level. More than 50% females were self-employed as they were labourers and rests were home-makers. The duration of marriage of most of the respondent women was 0-5 years and 44.70% of women had three living children. 65.88% women had one year gap between the first two pregnancies.Conclusions: The information, education and communication activities about the advantages of using contraceptives and its side-effects while using these contraceptives need to be increased so as to promote the awareness among females of the urban slums.
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Background: Measles is a highly contagious virus, spread by contact with an infected person through coughing and sneezing. Like measles, rubella can be prevented with a safe, effective and inexpensive vaccine. This can be delivered as a rubella vaccine alone, or combined with measles vaccine (MR) or with measles and mumps vaccines (MMR). The objectives of the study were to analyze the barriers for acceptance of MR vaccination in the field area of New Type Primary Health Centre (NTPHC) Miran Sahib, one of the NTPHC of CHC R. S. Pura, field practice area of Department of Community Medicine, GMC Jammu.Methods: A qualitative study which consisting of interviews of parents of children both vaccinated as well as unvaccinated as well as teachers and principals of children of various government and private schools, Female Multipurpose Health Worker (FMPHW)s, accredited social health activist (ASHA) workers and Anganwadi workers where the campaign was conducted was also interviewed.Results: The major barrier to acceptance of MR vaccination was wrong message conducted through some social media that it results in deaths of some children in various places, and also the messages spread in some religions like in Muslim community that the Vaccine leads to infertility. But the sensitization meetings with the parents, school staff by the health team prior to vaccination played a major role and results in the vaccine coverage of 95%.Conclusions: Before eliminating MR, there are many barriers which are needed to be addressed
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Background: Good hygiene practices are very much needed during menstrual period. Adolescent girls especially in rural areas often lack information about good menstrual hygienic practices. Cultural beliefs about menstruation like food taboos, not going to the religious places also have a negative impact on the adolescent girls in the rural areas. This study was undertaken with an aim to evaluate the knowledge, attitude and practices of adolescent girls regarding menstruation and menstrual hygiene.Methods: This cross- sectional study was conducted among adolescent girls from 8th to 12th class, from 5 schools of zone Budhi; which is a field practice area of department of community medicine, GMC Kathua; by simple random sampling technique. Out of total 323 girls, 300 girls willing to participate in the study (convenience sampling) were included. A semi- structured self- administered questionnaire was used.Results: A total of 300 adolescent girls were enrolled in the study. Majority of adolescent girls had fair to good knowledge and practice scores regarding menstruation, menstrual hygiene and its management but poor attitude scores due to some cultural taboos like restrictions in kitchen, religious places etc.Conclusions: Proper IEC activities need to be performed at school level and Anganwadi level to create awareness among adolescent girls regarding menstrual hygiene management so that they are able to make appropriate choices so that it enable them to lead a healthy life and prevent the girls from reproductive tract infections.
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Background: Universal precautions is an approach to infection control to treat all human blood and certain human body fluids as if they were known to be infectious for HIV, HBV and other bloodborne pathogens. The CDC recommends Standard Precautions for the care of all patients, regardless of their diagnosis or presumed infection status. Health care personals are at risk of being exposed to blood-borne pathogens. The aim of the study to determine the knowledge, attitude and practice of medical and nursing students towards universal precautions.Methods: A cross-sectional survey was carried out at S. S. Institute of Medical Sciences and Research Centre, Davangere, Karnataka. The participants were medical and Nursing undergraduate students. A questionnaire was prepared based on the WHO and CDC guidelines on Universal Precautions and was validated and pre-tested before finalization. Degree of knowledge was ascertained by means of yes-no questions on each item being evaluated.Results: All students were aware of Universal precautions, but soundness of their knowledge is very poor. Compliance in Universal precautions is good to average in nursing students but poor to average in medical students.Conclusions: It can be concluded that interventions to improve Universal precautions among medical students, nursing students urgently needed. So, there is a need for developing strategies to promote the use of Universal precautions which take into account behaviour change and accuracy of knowledge including its integration into practice. Teaching universal precautions early in their curriculum is necessary for better learning and practices during their posting.
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Background & objectives: In acute pancreatitis (AP) gut barrier dysfunction is considered as an important predisposing factor leading to increased intestinal permeability (IP). In this study a pooled analysis of data published in our previous four studies on various aspects of gut permeability and endotoxaemia in patients with AP was attempted to find an association between increased IP and severity of disease and associated complications. Methods: This study was a pooled analysis of data of four previously published prospective studies on AP. Gut permeability, assessed by lactulose/mannitol excretion in urine and endotoxin core antibodies type IgG and IgM (EndoCab IgG and IgM) were measured on days zero and seven (D0 and D7) of admission. All patients received standard treatment of AP. We studied whether IgG and IgM anti-endotoxin titres and lactulose-mannitol ratio (LMR) at admission and D7 were associated with organ failure, infection and mortality. Results: The titres of anti-endotoxin IgG and IgM were lower in all patients of AP (n=204), both in mild AP (n=24) and severe AP (n=180) in the first week, compared to controls (n=15). There was no significant difference in serum IgG and IgM anti-endotoxin levels and LMR at baseline and at D7 among patients with organ failure, infection and mortality. Interpretation & conclusions: Our findings showed that serum IgG and IgM anti-endotoxin titres and LMR at admission and at day 7 were not associated with organ failure, infection, and death of patients with AP.
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Parathyroid glands always remain at risk of damage during the thyroid surgery as they lie in close proximity to the thyroid gland. Parathyroid glands are small endocrine glands that produce parathyroid hormone. The major function of parathyroid hormone is to maintain the level of calcium and phosphate within a narrow range in the body. Aim of the present study was to locate and identify the parathyroid glands during thyroid surgery and to observe their relationship with the surgical landmarks. The present study was a prospective study conducted in the department of otorhinolaryngology and HNS in SMGSH, GMC, Jammu for a time period of 1 year from Nov.2015 to Oct. 2016. 40 patients undergoing thyroid surgery were included in the study. Meticulous technique was employed during dissection and parathyroid glands were identified in the surgical field. Location of the each parathyroid gland was determined in relation to a nearby surgical landmark. The study included 12 right (R) and 8 left (L) hemithyroidectomies, 10 sub- total thyroidectomies and 1 total thyroidectomy. An average of 1.2 parathyroid glands were identified in hemithyroidectomies and 2.4 was the average number of parathyroid glands identified in subtotal and total thyroidectomies. Location of parathyroid glands was observed in relation to cricothyroid (CT) joint, recurrent laryngeal nerve (RLN), inferior thyroid artery (ITA) and tubercle of Zukerkandl for superior parathyroid glands, and in relation to RLN, RLN & ITA junction, tubercle of Zukerdandl & lower pole for inferior parathyroid glands. In this study RLN was the most frequent landmark for identification of superior parathyroid gland while the inferior parathyroid glands were frequently seen related to the lower pole of the thyroid gland.
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Background: Pain is an inevitable outcome of any periodontal surgery. Controlling postoperative pain is of utmost importance so as to increase patient compliance. The present study aims to compare the degree of postoperative analgesia with the use of oral diclofenac sodium and transdermal diclofenac patch following periodontal flap surgery in patients with chronic periodontitis. Materials and Methods: A total of 20 patients requiring full mouth flap surgery were selected for this study. Flap surgery was performed quadrant-wise and transdermal diclofenac patch was applied on the right arm following surgery of one of the quadrants and 100 mg oral diclofenac sodium twice daily was prescribed following surgery of the subsequent quadrant. The postoperative pain was recorded on visual analog scale and pain intensity scale 24 h after the surgery. Results: Both the statistical and clinical observation showed that diclofenac sodium administered transdermally has equal efficacy as compared to drug administered orally. Conclusion: The study concludes that the diclofenac administered transdermally has equal potency in relieving postoperative pain as compared to orally administered diclofenac sodium following modified flap surgery. Transdermal patch has an added advantage of better patient compliance as it does not cause gastric disturbance.
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Background: Peritonitis is common surgical emergency in which there occurs inflammation of peritoneum and peritoneal cavity. It is associated with increased morbidity and mortality. So the aim of the study was to evaluate the clinico-etiological profile of perforation peritonitis in our setting. Methods: This study was conducted in a tertiary care centre of Kashmir, over a period of 2 years in which 100 patients diagnosed with perforation peritonitis were serial evaluated. Results: In our study the dominant gender involved was male sex(68%). Mean age of study population was 34.12 years. The most common age group involved was 21-40 years (44%) . Abdominal pain was the commonest presenting symptoms (100%), followed by nausea and vomiting (88%). The commonest site of pathology was gastroduodenal region (50%) and peptic ulcer disease was the most common aetiology confirmed. Conclusion: Patients presenting to our emergency clinic with such clinical profile should be recognised promptly so as to rapidly develop a plan for further management and put our resources at best use.
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Diabetes Mellitus is a disorder of global proportion. Despite various treatment modalities presently being available, yet the desired glycaemic control and patient outcomes have not been achieved completely. Sodium glucose co-transporter type 2 inhibitors (SGLT2 inhibitors) are one such promising group of emerging drugs in diabetes treatment. Ertugliflozin prevents the reabsorption of glucose by inhibiting sodium-glucose cotransporter-2 (SGLT2) at proximal convoluted tubules. Ertugliflozin is available as 5mg and 15mg tablets. Ertugliflozin has been related to genital mycotic infections and urinary tract infections. Benefits of Ertugliflozin include better control on blood glucose, body weight and blood pressure.
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Background: Stroke, a serious neurological disease is a major cause of death and disability throughout world. The pathophysiology of stroke involves inflammatory pathways, oxidative damage, apoptosis, angiogenesis and neuroprotection. High sensitivity C - reactive protein (hs-CRP) is associated with atherosclerosis and predict incident stroke in many patients. Objective of present study was to find out change in pattern of hs-CRP in acute ischemic stroke (AIS) patients during 3-months follow up and its prognostic significance.Methods: Single centre prospective cross-sectional time bound study. 256 were screened and 130 meet the inclusion and exclusion criteria, of which 100 gave informed consent and 80 patients completed the study at 3 months. Demographic, clinical parameters including NIHSS scoring, biochemical analysis was collected at enrolment, discharge and at end of the study.Results: hs-CRP levels in AIS increased significantly (within 24 hours of stroke) and continued to increase further at discharge, while decreased significantly during 3 months follow up. >7mg/dl hs-CRP at admission had 3.5 fold higher risk of mortality. Age >60 years, metabolic syndrome, hyperlipidemic, SBP >160mmHg and hs-CRP > 7 mg/dL increases relative risk in AIS stroke patients by 1.42, 1.09, 1.11, 1.577 and 3.23 fold respectively.Conclusions: hs-CRP increased significantly in AIS patients during 1st weeks of stroke with subsequent gradual decrease by the end of 3 months, the severity scoring system could determine prognosis on admission to ICU while hs-CRP is the main factor determining short as well as long term prognosis. We recommend serial measurements of hs-CRP for prognostication in AIS subjects.