A Prospective Study of Factors affecting Mortality in Acute Stroke

Introduction: Stroke is leading cause of death after cardiacdisease and there has been a paradigm shift in the managementof stroke after the advent of intravenous thrombolysis andmechanical thrombectomy. Clinicians are often challengedregarding the outcome as the morbidity and mortality are highif not managed appropriately. As there are various factorswhich influence the mortality in each type of stroke, our studyhas been designed out find the mortality rates and to identifythe factors influencing in each type of stroke.Material and methods: This prospective study was conductedat tertiary care centre for a period of one year among 190patients who presented with acute stroke. All patients wereevaluated by complete medical history, meticulous physicaland neurological examination, necessary blood investigationsand brain imaging. All the patients were categorized intoischemic and haemorrhagic stroke. The outcome of patientswas noted in terms of mortality. Various parameters thatinfluenced the mortality were analysed using statisticalpackage for social sciences and compared.Results: Out of the 190 patients, 151 had ischemic and 39had a haemorrhagic stroke. Regarding the outcome 22.6%died. Elderly patients, patients with stress hyperglycemia anddiabetes, patients with prior history of CVA, raised intracranialtension, low Glascow coma scale, higher BP on admission,altered renal function and presence of nosocomial infectionswere predictors of mortality in both stroke types. Additionallyin ischemic stroke we found that the involvement of more thanone vascular territory of the brain and the presence of atrialfibrillation have higher mortality.Conclusion: Considering these factors with larger sample sizein both tertiary and other care centres we can evolve bettercriteria and guideline in the management of stroke.

comparative study of sedation with dexmedetomidine or midazolam during spinal anesthesia

Background: Regional anesthesia offers several benefits over general anesthesia. But to the patient it may be stressful as they stay awake. Sedation during regional anesthesia plays an important role in reducing the stress and patient satisfaction. It gives anxiolysis and amnesia. In contrast to general anesthesia, verbal contact is possible whenever necessary. Dreaming might be considered as the purest form of sub consciousness and it is purely subjective. The incidence of intraoperative dreaming has not been reported by many. We designed this random prospective study to compare 2 different IV sedation protocols midazolam and Dexmedetomidine with respect to dreaming during sedation under regional anesthesia

Methodology: One hundred and twenty adult patients were randomly assigned to 2 groups; Group M received IV inj midazolam and Group D received inj dexmedetomidine for sedation during spinal anesthesia. Sedation was assessed on Ramsay Sedation Score. Patients were interviewed on emergence and 30 minutes later to determine the incidence of dreams. Postoperatively, patient satisfaction with the sedation was also evaluated. The patients satisfaction was assessed using a scale from 1-100. Any untoward side effects were noted. Quantitative variables were compared between groups using Student's t-test. Data for heart rate and mean arterial pressure were analyzed using a Friedman test. Chi-square analysis was used for comparison of categorical variables

Results: 60 patients in each group were included in the final analysis. The incidence of dreaming was 16 % in the midazolam group and 3% in the dexmedetomidine group. High level of satisfaction with the sedation was observed in dexmedetomedine group. In this group 66% patients expressed sedation as excellent, 11%- good and 15% termed it as satisfactory. Midazolam was associated with decreased patient satisfaction; 26% patients termed it as excellent, 58% good and 15% satisfactory

Conclusion: During spinal anesthesia with sedation, patients receiving midazolam had 5 times more dreaming than those receiving dexmedetomidine. However, dexmedetomidine provides better quality of sedation during regional anesthesia resulting in superior patient satisfaction than midazolam

Rectus sheath hematoma – An uncommon complication following caesarean delivery.

Rectus sheath hematoma is a well documented clinical entity, though uncommon and often clinically misdiagnosed cause of acute abdomen. The non-specific nature of presentation combined with a lower incidence of the disorder leads to difficulty in diagnosing. Our patient presented with rectus sheath hematoma, following caesarean section on 9th post-operative day. She presented with wound discharge and lower abdominal pain. The case report is presented to increase the awareness in considering this entity in the differential diagnosis and management of acute lower abdominal pain. Rectus sheath hematoma’s early diagnosis and appropriate treatment may help to prevent complications.