ABSTRACT
Background: The study was done to find out the prevalence of coagulopathy in Dengue fever patients with thrombocytopenia and its clinical significance. Methods: The patients admitted in medical wards and ICU were included in the study after considering certain inclusion and exclusion criteria. APTT, PT & D-dimer assays were also done in the study population. Coagulopathy was considered when APTT values were ≥41seconds. Results: 22.3% of the study population showed evidence of coagulopathy. Bleeding manifestations significantly increased with increasing APTT values. There is also significant association between platelet counts and bleeding manifestations. As platelet count falls there is a tendency for APTT to rise. Conclusion: In addition to thrombocytopenia, coagulopathy also contribute to the presence of bleeding manifestations in dengue fever patients. There is a significant correlation between bleeding manifestations with abnormal APTT values. As platelet count decreases there is tendency for rise in APTT values.
ABSTRACT
Background: This study was done to know about the clinical profile of Guillain Barre syndrome in a tertiary care centre and to correlate certain clinical features with outcome at discharge and thereby to identify a poor outcome group in early stages. Methods: 33 patients admitted in the medical wards were included in the study based on the diagnostic criteria modified by Asbury. Detailed history and physical examination as per a structured profroma was taken and necessary lab investigations were done including CSF study and electrodiagnostic study. Results: The factors affecting the outcome at discharge were 1. Requirement of mechanical ventilation 2. Features of axonopathy in electrodiagnostic studies 3. Decreased CMAP (<10% of lower limit of normal) 4. Presence of cranial nerve involvement 5. Presence of autonomic involvement. Conclusion: There is a high percentage of Miller Fisher variant of GBS this study. Older age is not found to have adverse effect on outcome at discharge in this study. Axonal variant of GBS is found to have a bad outcome. Requirement of mechanical ventilation was found to be a factor adversely affecting outcome. Cranial nerve involvement and autonomic involvement adversely affects the outcome at discharge.
ABSTRACT
Background: The study was designed to find out whether the addition of clopidogrel for patients with ST- elevation myocardial infarction [STEMI] who are receiving a standard fibrinolytic therapy, including aspirin, reduce the incidence of primary and secondary end points like recurrent ischemia, re-infarction, need for urgent Target Vessel Revascularisation [TVR], mortality & bleeding. Methods: The patients were randomly assigned to receive the study medication. The patients were divided into two groups. Those receiving fibrinolytic therapy & aspirin were included in Group A. Those receiving the study drug in addition to aspirin & fibrinolytic agent were included in Group B. The study drug was given daily upto 1 month. These patients were assessed during their hospital stay & followed up for a period of 30 days for end points like recurrent ischemia, re-infarction, need for urgent TVR, bleeding episodes & mortality. Results: There was reduction in primary endpoints in group B compared to group A of which only reduction of recurrent ischemia was statistically significant (26% vs 2%). The same pattern of benefit was seen with secondary end points with significant reduction in recurrent ischemia in group B (28% vs 2%). Safety end points showed some increased bleeding in group B patients which was statistically insignificant (4% vs 0). Conclusion: Addition of Clopidogrel to aspirin and fibrinolytic therapy in ST-elevation MI showed a significant reduction in recurrent ischemia during in hospital stay and during the first 30 days. The patients received clopidogrel had less mortality compared to aspirin group. There were only minor bleeding episodes reported with use of clopidogrel