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Introduction: In patients presenting to Emergency Department(ED) with traumatic brain injury, it is important to evaluate the neurological status to determine the present clinical status and to predict outcome of the patient. GCS is the most widely used score,but it has some drawbacks which led to the development of other scores such as the Full Outline of Unresponsiveness (FOUR) score. In our study, we compared the GCS and the FOUR scores in patients presenting with traumatic brain injury. Aims: 1) To compare the FOUR score with the GCS score in traumatic brain injury (TBI) patients. 2) To understand the effectiveness of FOUR score as an assessment tool. 3) To assess whether FOUR score is an alternative tool in TBI patients or could be complimentary. Methods: We conducted a prospective observational study at a trauma centre of a tertiary care hospital during January 2019 to March 2019 after taking institutional ethical committee approval. All patients presenting with clinical diagnosis of TBI were evaluated and given a GCS and FOUR score by the emergency physician. Relevant investigations were done and findings were noted. We tabulated all information in Microsoft Excel 2019 and statistical analysis was done with SPSS software. Results: The mean age of study population was 38.295+/- 15.33 years. Male patients were 79% and 21% were female patients. Road traffic accidents contributed highest percentages of causes of TBI (60%). By comparing the median value of FOUR score with mortality and the median value of GCS score with the mortality by using the Mann-Whitney test showed a p-value of ?1, which is statistically non-significant. Conclusions: FOUR score is equally reliable with GCS score. Both have their own significance
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Introduction: Guillain–Barre syndrome (GBS) is an acutepolyradiculoneuropathy with varied severity of presentation.Objectives: To study clinical presentation, electrodiagnosticvariations, hospital care and outcome of patients of GuillainBarre Syndrome (GBS). Current research aimed to studyefficacy of Plasmapharesis and Intravenous Immunoglobulin(IVIG) in patients of GBS.Material and Methods: 78 patients of GBS were studiedin detail including history, clinical examination andinvestigations. Patients were treated with Plasmapharesis andIVIG; and outcome was observed.Results: Commonest age group affected was 13-40 yrs.The male:female ratio was 1.2:1. Antecedent infection werepresent in 42 out of 78 patients. Quadriparesis was presentin 74 patients and paraparesis in four patients. Cranial nerveinvolvement was seen in 47 out of 78 patients. Areflexia wasfound in all 78 patients. Albuminocytologic dissociation waspresent in 44 out of 61 patients underwent CSF examination.NCV findings show conduction velocity slowing, delayedf latencies in 92% patients. Out of 72 patients, 33[43%]required mechanical ventilation. Out of 78 patients, 71 weretreated with Plasmapharesis and seven patients were treatedwith IVIG. Out of 78 patients 56 [72%] patients recoveredcompletely, 19 [24%] patients died and three [four%] patientsdeveloped severe neurologic deficit.Conclusion: GBS is more common in male as compare tofemale. Commonest presentation is paresthesia in legs andascending paralysis. Patients who received treatment early inthe course of disease had faster recovery. Plasmapheresis andIVIG both showed similar efficacy in treating GBS.
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T-wave abnormalities are common electrocardiographic occurrences in patients with acute coronary syndromes. The clinical and electrocardiographic course and angiographic findings in patients with evolving inverted or biphasic T waves have not been fully elucidated. Patients with abnormal T waves associated with unstable angina represent a subgroup with a high probability of near total obstruction of coronary artery and myocardial dysfunction. In the present study we describe a subgroup of patients with myocardial ischemia who during the acute Ischemic phase did not develop elevation but only biphasic or inverted T waves in the ECG and had >90% stenosis of 1 or more coronary arteries. Methods: The study comprised 125 patients presented with unstable angina pectoris. Patients’ characteristics, Electrocardiographic Data, Cardiac enzymes and Coronary angiography findings were obtained. Collected data was analyzed and sensitivity, specificity, positive predictive value, significance of test (p value) were calculated using appropriate statistical method. Results: Of the 125 patients deep symmetrical and sustained T-wave inversions were present in 72 patients & biphasic T-waves in 28 patients. 125 patients underwent coronary angiography, 92(74%) patients had >90% stenosis of 1 or more coronary arteries; sensitivity of abnormal T waves for significant stenosis was 90%, specificity 92%, positive predictive value 97.83 % and p value <0.001. Conclusion: We have identified a subgroup of patients with critical obstruction of coronary artery in patients with unstable angina and non diagnostic ECG T-wave abnormalities are significant electrocardiographic occurrences in patients with acute coronary syndromes and frequently associated with coronary artery obstruction
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Background: Purpose of current study was to study the ocular manifestations in beta-thalassemia major patients and assess the ocular side-effects of iron chelating agents. Methods: Cross sectional study included 45 β Thalassemia major patients from age group of 6months to 12 years were taken. Full medical history, thorough physical examinations were done to all patients groups, and ophthalmological examination to determine the prevalence of ocular manifestations for all patient groups and to correlate these manifestations or changes with iron chelating agents. Results: In 45 patients (22 males and 23 females) with age ranging between 2 years to 12 years, ocular involvement is seen in 35% in the form of decreased visual acuity 26%, tortuous blood vessels in 4.5%, disc hyperemia in 4.5%, heterochromia in 2.5%, retinal pigment epithelium mottling in2.5% and this involvement were more with older age group. Conclusion: Most of the ocular changes of beta thalassemia are attributed to the course and severity of the disease. Reduction in serum iron and serum Ferritin levels by iron- chelating agents and regular ocular examination to look for side-effects of such agents can aid in preventing or delaying ocular complications.