ABSTRACT
Background: Seizures are a common neurological disorder encountered globally in regular medical practice. Hospital onset seizures may occur in patients who never had a history of seizure before hospitalization and may be due to causes that lead to hospitalization or acquired during hospitalization like stroke, neuro infection etc. The objectives of this study were the purpose of the present study was to study the incidence and to describe demographic and clinical characteristics of patients developing new onset seizures in an intensive care unit of a tertiary care hospital.Methods: A prospective study for two years was conducted on cases of seizures admitted in an intensive care unit of a tertiary care hospital. The etiology of all the cases was recorded based on the clinical history and necessary investigations like EEG and imaging studies of the brain in cases if required.Results: About 238 cases with males 177 and females 61 cases were enrolled, and 31-50 years was most common age group. Diabetes was the most common co morbidity associated and generalized seizures were most common. CVA was most common etiology (26.89%) and idiopathic next common. Infarct was most common cause of CVA and meningitis in infections. Generalized tonic clonic seizures was most common in cases with CVA as the aetiology followed by infective cases.Conclusions: It is mandatory to deal cautiously and carefully the cases of seizures developing in an ICU in addition to proper history and examination, each patient must undergo detailed EEG, imaging investigations and other ancillary investigations if necessary.
ABSTRACT
Background: Current statistics show that 36.9 million (31.1-43.9 million) people were living with HIV globally at the end of 2017. 15-73% of people with HIV may develop neurological disorders with sometimes as a presenting illness. The aim of present study is to document the various neurological manifestations and presentations with relation to CD4 counts among the HIV/AIDS cases attending a tertiary care hospital of south India.Methods: A prospective study was conducted for two years at a tertiary care hospital among confirmed cases of HIV and the neurological manifestations were diagnosed and clinical signs and symptoms were noted. CD4 counts of all the cases were performed by FACS counter and Neuroimaging study was performed on necessary cases.Results: Total of 125 cases with 69.6% males and 30.4% females were enrolled. Mean age of cases was 35.14±3.8years. 86.4% were positive for HIV-1 type. Headache was the most common ailment (78.4%). Meningeal enhancement observed in 24.5% followed in order by ring enhancing lesion (18.37%), cerebral atrophy and infarction (12.24%). Tubercular meningitis was the commonest type (33.6%). In 12 cases of cryptococcal meningitis the CD4 counts were <100 cells/mm3.Conclusions: To conclude in present study, secondary neurological manifestations were more common than primary manifestations in present study. Tubercular meningitis being the most common and CD4 counts <100cells/mm3 were associated with cryptococcal meningitis. Cases with CD4 counts less than 100cells/mm3 had poor prognosis.
ABSTRACT
Background: Magnesium is the fourth abundant cation in the human body and second most abundant intracellular cation after potassium and also serving as cofactor in more than 300 enzymatic reactions. Magnesium deficiency is the most commonly overlooked condition in critically ill patients and associated with other coexisting electrolyte abnormalities. The aim of the present study was to evaluate serum magnesium levels in critically ill patients and to correlate with patient outcome and other parameters like length of stay in ICU, ventilator support, APACHE-II score and duration and mortality.Methods: A two years observational study after ethical committee approval was conducted at a tertiary care hospital among critically ill patients admitted in ICU. Serum magnesium levels and other relevant investigations were performed within 24 hours of admission. Patients management and progress were followed till the outcome. The data was analysed by using SPSS software version 16.0 for windows.Results: Total of 150 patients with 102 males and 48 females were enrolled. 97 cases (64.7%) of hypomagnesemia were observed and 11 cases of hypermagnesemia and 42 cases with normal serum magnesium levels were observed. Hypomagnesemia cases were compared with normal cases and found that: Hypomagnesemia cases had higher mortality rate, higher APACHE II score, more length of hospital stay and ventilator duration. Significant association was identified with diabetes and chronic alcoholism (p valve <0.05).Conclusions: Monitoring of magnesium levels in critically ill patients has several prognostic and therapeutic implications and should be recommended as a regular parameter as it is commonly out looked condition. Statistically significant association of hypomagnesaemia was found with hypocalcaemia, hypoalbuminaemia, septicaemia, diabetes and chronic alcoholism. Higher APACHE II score is associated with higher mortality and more length of stay in ICU among the cases of hypomagnesaemia.