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Background: The elderly population ≥60 years is increasing as the life span is increasing. So is the number of elderly patients who are refusing to get discharge from the hospital is also increasing. Authors are conducting this study in the elderly population who want to stay against medical advice.The aim to find the prevalence of elderly patients who refuse to get discharge from Coronary Care Unit (CCU) in a Tertiary care hospital of North IndiaMethods: A retrospective, observational study conducted in patients of age ≥60 years admitted to the coronary intensive care unit of a tertiary health care centre who refused discharge from the unit, were included in the study. Results: Of the 575 patients 44(7.65%) were willing to stay against medical advice. Of these 24(54.5%) were males and 20(45.5%) females. 6(13.6%) patients were terminally ill suffering from malignancies. Among all the patients who were willing to stay against medical advice, 8(18.2%) were covered by some health insurance scheme of either State or Central Government. 3(6.8%) patients were discharged after 24 hours, 22(50%) patients after 48 hours, 14(31.9%) patients after 72 hours and 5(11.3%) patients after 96 hours of advising discharge from hospital.Conclusions: As the intensive care beds at tertiary healthcare level are limited, the treatment of other salvageable sick patients who need the intensive care is affected by the unnecessary stay in hospital. Apart from the worsened nurse to patient ratio this increases the cost of treatment. This is need of hour to provide safe environment for the elderly outside the hospital settings and increase resources to provide better homecare.
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Background: Management of liver trauma earlier used to be primarily surgical. With advancement in diagnostic modalities it has gradually shifted to non operative management. Methods: The present study was conducted on 40 patients with severe hepatic injuries (grade 3 onwards). All the patients were compared in terms of various methods adopted for their management and their clinical outcomes Results: Out of a total of 40 patients, maximum numbers of patients were in age group 18-24 years. 82.50 % patients had grade IV and rest had Grade V. 12 patients presented with shock on admission. Failure of NOM (non operative management) was seen in 25% of cases . The average requirement of blood transfusion in our study was 2.157 1.74 units. Average hospital stay in successful NOM cases was lower than in failed NOM. A total of 6 patients had to be operated upon in our study. Active bleed was seen on laparotomy in four patients with no evidence of any injury causing peritonitis. Conclusion: The success rates of non-operative management were significantly higher than the failures rates of non-operative management, without any significant incidence of complications and delayed laparotomies. Grade of liver injury or the amount of hemoperitoneum as detected on CT scan did not influence the outcome of non-operative management. Non-operative management is thus the gold standard in hemo-dynamically stable patients.
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Background and Objectives: Severe acute pancreatitis (SAP) affects the nutritional status of the patient. This prospective study was carried to assess the tolerance and outcome of early enteral nutrition via naso-jejunal feeding tube (NJFT).Methods: 30 patients of SAP were given enteral feeding via endoscopically inserted NJFT within 48 – 72 hours of admission. The volume of the feeds was increased as per tolerance. The patients who tolerated the feed (Group A) and those who did not tolerate (Group B) were followed up by biochemical parameters, amount and duration of feeding. The patient outcome noted and the results statistically analyzed. Results: 27 (90%) patients tolerated the feed, reached the goal feed volume and were subsequently started on oral feeds. No complication related to NJFT insertion was encountered. A significantly higher ICU stay (p=0.04) and number of complications (p = 0.048) was observed in Group B patients than in Group A. All nutritional parameters improved in patients in Group A with significant improvement in serum calcium, serum albumin and fasting blood glucose levels. Conclusion: Enteral nutrition is an economical and effective way to provide nutrition to patients with severe acute pancreatitis. The patients who tolerated feeds had less morbidity, mortality and hospital stay.
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Background and Objectives: Around 20% of the patients of acute pancreatitis develop acute severe pancreatitis in the form of extensive pancreatic or peripancreatic fat tissue necrosis with associated peripancreatic collections. These patients run a protracted clinical course, multiorgan failure, high morbidity and mortality. Methods: Clinically and radiologically diagnosed 30 patients of acute severe necrotizing pancreatitis were prospectively evaluated for the clinical outcome with respect to extent of pancreatic necrosis and severity in terms of CTSI. Results: 18 patients had pancreatic necrosis between 30-50% (Group A) whereas 12 patients had necrosis more than 50% (Group B). The rate of organ dysfunction and mortality (11.11% versus 50.50%) the rate of was significantly higher in the group B. Multiorgan failure (MOF) was present in 5.56% of group A and 58.33% of group B patients. 66.67% patients were managed conservatively of whom 80% survived and 33.33% patients underwent surgical intervention of whom 60% survived. Conclusion: CECT is the modality of choice to help stage the severity of pancreatic necrosis, depict severity of inflammatory processes and local complications. Patients with pancreatic necrosis with transient end organ dysfunction can be treated conservatively with favorable outcome. The need for intervention should be individualized and based on the clinical condition of patient.
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Background & Objectives: To study the clinical profile of hospitalised patients of malaria aged 15-60 years. Methods: This was a prospective analysis of patients suffering from malaria diagnosed by malaria serology and/or peripheral smear. The mode of presentation, clinical course, treatment history, laboratory investigations and complications were recorded and the data statistically analyzed.Results: P. vivax was the most common (80.39%) plasmodium species, the rest (19.61%) being P. falciparum. The mortality rate was 6.54%. A fall in hemoglobin (p=0.005) and platelet count (p=0.040) was observed in the patients who expired. There was an improvement in the final platelet counts in both the groups (p=0.00052). The mean total bilirubin at admission was higher in P. falciparum group than P. vivax group (p = 0.00789). Renal failure was observed in 16.34% patients. The mean systolic and diastolic blood pressure in patients who expired was lower than patients who were discharged (p=0.007, 0.001). The mean heart rate was higher (109.40) in patients who expired (p = 0.002). Conclusion: Factors associated with poor prognosis in malaria are moderate grade fever, hypotension, tachycardia, anaemia, thrombocytopenia, hyperbilirubinemia, high transaminase and renal failure. A high clinical suspicion, early diagnosis and treatment is recommended in highly prone areas.
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Background & Objectives : Dementia is a serious loss of cognitive ability in a previously unimpaired person, beyond what might be expected from normal ageing. This cross sectional study was undertaken to study clinical profile of dementia and its association with plasma homocysteine levels. Methods : 30 patients (indoor or outdoor) > 55 years with dementia were screened on Mini-Mental State Examination (MMSE) and Clinical Dementia Rating (CDR) Scale. A clinical dementia rating questionnaire was asked and plasma homocysteine levels measured by ELISA using Bio-rad reagents. Data was collected and statistically analyzed. Results : There was a statistically significant correlation between loss of memory (p = 0.047), orientation (p = 0.038), judgement/problem solving (p = 0.048), outer (p = 0.042), household (p = 0.048) and personal care activity (p = 0.0099) with hyperhomocysteinemia. A statistically significant correlation was found between CDR (p = 0.0081) and MMSE (p = 0.0095) score with hyperhomocysteinemia. Interpretation & Conclusion : A significant correlation was seen between memory loss, worsening of cognitive dementia, limitation of household activity, worsening of personal care, impairment of judgment and problem solving with hyperhomocysteinemia. As hyperhomocysteinemia can be effectively treated with a low cost therapy of B vitamin supplements, it is important to recognize these problems and treat them early.