ABSTRACT
Background : There has been a steady rise in the geriatric population in India and increasing number of elderly patients are being admitted in Critical Care Unit (CCU). They need mechanical ventilation during their hospital stay. Hence, there is continued need for evaluation and research to develop a validating scoring systems used to predict the outcome of CCU patients supported by mechanical ventilation. Objective : Analysis to predict the outcome (survival or mortality) of mechanically ventilated elderly patients in different age groups at the CCU. Material and Method : A Prospective observational study was done in CCU for a period of one year. A group of 40 elderly ventilated patients greater than 60 years of age (Group 1-elderly case group) and another group of 40 ventilated patients less than 60 years of age (Group-2- control group) were included in the study. A clinical database was collected which included age, sex, Acute Physiology and Chronic health Evaluation II (APACHE II) score and an Sequential Organ Failure Assessment (SOFA) scores were calculated in the first 24 hours of ventilation,indication of mechanical ventilation, co-morbidity, according to the Charlson Comorbidity Index (CCI), functional capacity according to the Barthel Index (BI). Patients outcome (survival or mortality) were analyzed. All the patients in two groups were on ventilation support. Result : In case group (n=40), mortality was 55%. In control group (n=40), mortality was 52.5%. On comparison of outcome between two groups (case with control group) the difference was not statistically significant (p= 0.8225). In case group, association of outcome to different age groups (60-65 years, 66-75years, more than75years) (p=0.3357) andto gender (p=0.3854) was not statistically significant. Multivariate logistic regression analysis of the study variables showed APACHE II score to be statistically significant for outcome (p=0.0229). Conclusion : Mortality of elderly patients supported by mechanical ventilation at CCU were slightly higher(55%) than in mechanically ventilated younger populations (52.5%) though the difference was not statistically significant between two groups (p=0.82). APACHE II, score measured within 24 hours of ventilation was a significant predictor of mortality in the patients on mechanical ventilation.
ABSTRACT
Background:Undiagnosed fever has been a predicament to physicians all over the world for decades. This study was undertaken to evaluate the demographic and etiological pattern of a rural population in Eastern India. Objectives. 1. To study the spectrum of etiology of prolonged fever. 2. To evaluate the demographic characteristics of the patients. Methods: All patients with undiagnosed fever for more than three weeks attending the Medicine outpatient Department were included in the study. History and clinical examination were recorded in a proforma. All patients under went routine as well as relevant special investigations including RDT for Malaria, IgM ELISA for Leptospira and Chikungunya and Brucella. Blood, urine and other body fluid culture including BACTEC and CB NAAT (as required) were also done. Endoscopies, imaging studies and guided biopsies were performed where needed. Results were recorded and analysed using appropriate descriptive statistical methods using SPSS Software (version 20). Results:A total number of 110 patients were included in the study. Of them 52(47.2%) were male and 58 (52.7%) were female. The age of the patients varied from 15 years to 78 years mean age being 33.68±18.77. Conclusion: The patients were mainly from rural background, most common districts being Murshidabad (40%) followed by24 Parganas S (20%), Midnapur (14.5%) and Nadia (10.9%). Socioeconomic status of the patients varied from lower (47.2%) lower middle class (39%) to middle class(13.8%). 65.3% of the patients were literate of whom 10.9 % of the people were matriculate while 1.8% were graduates. The commonest etiology of prolonged fever were infections 76(69%) out of which Tuberculosis 44(40%), took the lions’ share. Tuberculosis was followed by chronic UTI (8.2%) enteric fever(5.5%) and malaria(4.5%). This was followed by various malignancies 14(12.7%) and inflammatory disorders 12(10.9%) It was notable that while prevalence of infections were comparable in males and females the prevalence of cancers (15.3%vs10.3%) and inflammatory disorders (7.6%vs 13.8%) varied. No diagnosis could be reached in 3.6% cases.