RESUMO
Background: Several types of neurological manifestations are associated with falciparum malaria. Cerebral malaria is one of the most dreaded complications. A significant number of survivors are left with disabling neurological sequelae, most of which are self-limiting. Neurological involvement is more frequent with falciparum malaria because of its unique characteristics leading to micro-vascular involvement.Methods: Present study was conducted at department of General Medicine, VIMSAR, Burla (Odisha). This observational study included in total 110 patients, who were confirmed cases of falciparum malaria. Clinical profile including detailed neurological examination with relevant investigations was done. Spectrum of neuropsychiatric manifestations were observed.Results: Out of 110 patients male and female ratio was 1:1 (M 55 and F 55). The mean age of presentation in male was 36.09 + 14.85 yrs. and in female was 31.85 + 14.00 yrs. The major presenting symptoms were fever, headache, vomiting, altered sensorium, altered behaviour and convulsions in their decreasing order of frequency. On neurological evaluation, diminished level of consciousness was found in 56.4% cases. 14% cases had GCS score ? 7 and 63% had GCS score ? 11. Convulsion was found in 31% cases, cranial neuropathy in 10.9%, cerebellar dysfunction in 12.7%, neck rigidity in 22.7%, speech abnormality in 3.6%, peripheral neuropathy in 8.2%, fundoscopic changes suggestive of retinal involvement in 44.5% cases. Atypical manifestation like; Intracerebral haemorrhage, subarachnoid haemorrhage, cortical venous sinus thrombosis were also found in few cases. 32.72% patients had Neuropsychiatric manifestations at discharge in the form of focal neurological deficits, psychosis, depression, speech disorder, memory loss, cerebellar abnormality & peripheral neuropathy.Conclusions: Neurological manifestations in falciparum malaria patients are common and encompass a wide spectrum of clinical presentation. In an endemic area, falciparum malaria should be kept as a differential diagnosis in patients presenting with atypical neurological manifestations.
RESUMO
Background: Increase in the elderly population presenting to Emergency Department is a prime concern as it has maximum implications on the delivery of health care. Older patients account for 12%-24% of all ED patients worldwide. A need for this study is to understand and analyze the current and future of Emergency department (ED) and examines the presentation of geriatric patient to emergency department in our institute in an urban setup of the fastest growing population segment in the city.Methods: An observational study over a period of one year from 2015 to 2016. All patients aged 60 years and above, visiting the Emergency Medicine. The following data were obtained. (I) Demographics, (II) Urban and Rural population (III) Presence of co-morbidities, (IV) Common conditions (V) Clinical symptoms and Diagnoses, Socio-demographic data collected directly from patient or immediate caregiver.Results: Total No of patients included during the study were 5489. Data was assessed male patient, predominance was found with 61%, 39% female. The urban population 74.8% was more predominant. Rural being at 25.2%, 1620 (29.2%) poisoning cases,1322 (24.1%) trauma cases,318 (5.8%) cancer cases, 247(4.5%) COPD cases and 230 (4.2%) stroke cases were encountered. Male72.58%, females 27.42%. CCU 58.5% male, 41.55% females. ICU 55.21% males and 44.79 % females. The average time was 3.75 to 4.25.Conclusions: Road Traffic accidents and poisoning together contributed to many cases. Observation was inadequate training amongst ED doctors and nurses in assessing and managing Trauma patients who lack ATLS protocols in stabilizing geriatric emergencies. Hence ED staff should be well trained to facilitate management of an ageing patients. Hazmat bay should be well organized with specific antidotes to the commonly available poisons. Atypically presentation was common in ED. Considerable overlapping of symptoms were commonly encountered in patients presenting to Emergency department.