Pneumonia Severity Index In Predicting Outcome In Elderly Patients With Community Acquired Pneumonia At A Tertiary Level Hospital In Mumbai

Background:Prognostication of patients with community-acquired pneumonia (CAP) is important from clinical, research, and quality-improvement perspectives. The pneumonia severity index (PSI) is a rigorously studied prediction rule for prognosis that objectively stratifies patients into quintiles of risk. The present study aimed to assess whether PSI can predict mortality, need for intensive care and ventilator support. Methods: An observational study of fifty patients aged 60 years or higher who were admitted in the general medicine ward of Department of Medicine, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai from April 2014 till September 2015 was conducted. A questionnaire with demographic information, clinical signs and symptoms, laboratory and radiographic findings was completed for each patient. Patients were classified according to PSI risk classification and their clinical outcome was noted. Results: Mean age of the patients was 66.5± 6.3 years; 68% were males, and 32% were females. The sensitivity, specificity, positive and negative predictive value of PSI risk class IV in predicting ICU admissions was 100%, 55.9%, 40.9% and 100%, respectively. Similarly, the sensitivity and specificity of PSI in predicting death and ventilator support to patient were maximum for PSI class IV. Defervescence time significantly correlated with PSI score (Spearman’s rho = 0.563, p value = 0.001). Conclusion: PSI was a good predictor of mortality, need of ICU admission and mechanical ventilation. Future studies are needed to support our findings and should further assess the long term outcome in these patients.

Study of renal complications of malaria

Background: Plasmodium falciparum malaria is one of the major health problems in many tropical countries including India and due to increase in the drug resistance in India the incidence of complicated malaria has increased. Objectives: To study the renal complications of malaria. Materials and methods: 50 malaria positive cases with clinical renal disease were prospectively observed clinically and by laboratory investigations till the discharge. Results: Among the 50 malaria positive cases 41 (82 %) patients had p. falciparum infection, 4 (8%) had p. vivax and 5 (10%) had mixed infections. P. falciparum and mixed infection found to be responsible for ARF in 25 (89.28%), 3 (10.70%) respectively. Volume depletion was found to be the prominent cause (75%) of ARF, hyperbilirubinemia was noted in 64.28% of patients. Urinary abnormalities were noted in 24 (48%) cases, proteinuria in 20(40%), microscopic haematuria in 20 (40%), granular casts in 7 (14%). In the present study electrolyte abnormalities were noted in 46 (92%) of the patients. The overall mortality in the present study was 5 (10%). The cause of death was multi-factorial. MODS were the commonest cause of death. Conclusion: Renal complications were seen as the commonest complication of malaria. Early diagnosis, treatment specially the fluid management reduces the overall mortality

Study of etiology, clinical features and outcome following treatment of hyponatremia in elderly in intensive care unit

Background: Hyponatremia is a common electrolyte disturbance in the hospitalized elderly sick patients. Objectives: To study etiology, clinical features and outcome following treatment of hyponatremia in elderly hospitalized patients. Materials and methods: All elderly patients being admitted to ICU were screened for hyponatremia and 100 patients with severe hyponatremia (<125 meq/L) were included in this study, these patients were investigated as per the protocol and were treated as per the standardized regimen. Results: 100 patients with severe hyponatremia (<125 mEq/L) were studied. There was female preponderance of cases (55%). The common causes of hyponatremia were SIADH (30%) and drugs (24%) of which diuretics (79%) was a major chunk. The common CNS symptoms were drowsiness, lethargy and irrelevant talk. The common co-morbid conditions were hypertension (62%) and diabetes mellitus (51%). Females tolerated hyponatremia better than males with mortality of 9.09% in females and 33.33% in males (p=0.0026). 20 (20%) patients succumbed to their primary illness with a possible contribution attributable to hyponatremia or its treatment. M. Krishna Naik, Md. Yousuf Khan, D. Prathima Raj, D. Venkatesh, Krishna Kumar T V. Study of etiology, clinical features and outcome following treatment of hyponatremia in elderly in intensive care unit. IAIM, 2017; 4(11): 144-152. Page 145 Conclusion: Hyponatremia is common in females and they seem to better tolerate it than their male counterparts. Early detection, strict adherence to treatment protocol is required. Diuretics should be used with caution in elderly.

Stratospheric ozone in the perspectives of exploratory data analysis for Pakistan atmospheric regions

In order to study physical behavior of Stratospheric ozone in Pakistan's atmospheric regions [PARs], the Exploratory Data Analysis [EDA] is performed. Using this analysis Probabilistic and mean deviation models are developed to study the ozone layer depletion for Pakistan Atmospheric Regions. These models provided a comprehensive description of the underlying process. The information attained from these forecasts by analyzing these models, can be further employed to vary possible parameters and variables in the physical system to achieve an optimal performance. Such an approach is well explained within the likelihood of computational analysis. The models presented in this paper along with their physical interpretations are very useful for public and private sector organizations