RESUMO
Background:Stroke is the second leading cause of death worldwide. In the acute phase, stroke patients are susceptible to complications like chest infections, cardiac dysfunction, and urinary tract infections. Globally, the incidence of pneumonia among stroke patients is e stimated to be around 14%. The A2DS2 score (age, atrial fibrillation [AF], dysphagia, sex, and stroke severity using the National Institutes of Health Stroke Scale[NIHSS] score) is a simple scoring system to find risk of stroke associated pneumonia (SAP). Here our aim is planned to assess the risk of SAP in patients with acute stroke using the A2DS2 score.Material And Methods:This prospective observational study was conducted on patients with Ischemic stroke, time from symptom onset within 7 days and Age > 18 years admitted in tertiary care hospital. NIHSS score and A2DS2 score were calculated on admission. Follow up of all thepatients was done during their hospital stay and those who fulfilled Mann’s diagnostic criteria for pneumonia were diagnosed as SAP. Result:Out of 110 patients (M:60, F:50, Mean age 60.37+7.07), the commonest comorbidity was Hypertension (85, 77.27%) andthe commonest symptom was Facial Asymmetry (73, 66.4%). Among these, 19 (18.8%) patients developed SAP. Patients with SAP had higher mean age, male preponderance, commonest symptom dysphagia, higher NIHSS score and higher A2DS2 score. Patients with acute ischemic stroke who had high A2DS2 scores (5-10) higher risk of developing SAP and worse outcome (P <0.05). Conclusion:In conclusion, patients in the high A2DS2 score group had higher incidence of SAP and non-favourable outcome compared to patients with low A2DS2 scores who had more favourable outcomes
RESUMO
Background:The metabolic syndrome is a highly prevalent condition among the patients with detrimental impact on short-term outcome. Early diagnosis, treatment including lifestyle modification and prevention of the metabolic syndrome may reduce the development of cardiovascular diseases like myocardial infarction including its complications. So, in this study we tried to find out prevalence of metabolic syndrome and study clinical profile, analyzebiochemical parameters and study risk factors in patients with metabolic syndrome. Material And Methods:A prospective cross-sectional study was conducted in the department of medicine of tertiary care teaching hospital, Ahmedabad, India. Between August 2017 to August 2019. A total of 280 patients were selected randomly who visited the medical OPD. Diagnosis of Metabolic syndrome is based on: NCEP-ATP III 2001 (National cholesterol Education Program Adult Treatment Panel III). A detailed medical history ofthe patient including symptomatology, details of past illness, occupation, habits (smoking and alcohol) was obtained. A complete physical examination and systemic examination was performed. Results were expressed as mean± SD for continuous data and were compared by chi square test between two groups. Result:Out of the 280 cases, metabolic syndrome was present in 184 cases with incidence of 65.72%. 30% of males and 70% of females had metabolic syndrome. Mean age of metabolic syndrome in was 58 (57.84+11.35) years with age of patients ranged from 20 to 85 years with maximum number of cases were in the 51-60 years age group (33.2%). The most common mode of presentation in metabolic syndrome group was chest pain 45 (24.5%), followed by headache, 41 (22.3%), gabharaman, 29 (15.8%), fatigability, 29 (15.8%), and giddiness, 28 (15.2%).31.5%, 22.3% and 22.8% of metabolic syndrome patients had past history of diabetes mellitus, hypertension and IHD respectively. In patients with metabolic syndrome, mean values of fasting blood glucose, serum triglyceride level, systolic blood pressure were 155.19mg/dl, 179.16mg/dl, 143.43 mm of Hg respectively. In patients with metabolic syndrome mean values of hdl level were 31.29mg/dl and 39.29mg/dl in male and females respectively. The most common biochemical abnormality was found to be increased triglyceride levels followed by increased fasting blood sugar. Conclusion:Early diagnosis, treatment including lifestyle modification and prevention of the metabolic syndrome may reduce the development of cardiovascular diseases like myocardial infarction including its complications. So, cardiovascular disease patients with metabolic syndrome must be identified and managed aggressively to reduce both morbidity and mortality. In this study,metabolic syndrome was more common amongst women who can be particularly attributed to high BMI, low HDL and increased waist circumference.
RESUMO
Introduction: Sevoflurane is a volatile anesthetic agent, which is non-irritant with low solubility and lack of arrhythmogenicity, which makes it an ideal agent for ambulatory anesthesia. The aim of our study is to compare the cardiovascular effects at equivalent minimum alveolar concentration (MAC) doses and the recovery profile of sevoflurane and isoflurane, in patients undergoing valvular replacement surgery. Materials and Methods: This is a hospital-based, randomized, interventional, comparative study with sample size of seventy participants divided into two groups. Group A (35) received sevoflurane (1MAC) and Group B (35) received isoflurane (1MAC). Patients were of the American Society of Anesthesiologists Grade 2–4. The age group was 20–25 years with body weight of 30–65 kg, undergoing valvular heart surgery. The primary outcomes are to compare the changes in heart rate, systolic and diastolic blood pressures, mean arterial pressure, cardiac output (CO), cardiac index, systemic vascular resistance index (SVRI), and stroke volume variable, during maintenance of anesthesia. The secondary outcomes are the time taken for eye opening on verbal commands and extubation. Results: There was a decrease in blood pressure, CO, and SVRI with both agents (statistically insignificant, P > 0.05), but comparatively hemodynamics was more stable along with early recovery with sevoflurane (statistically insignificant). Conclusions: Sevoflurane and isoflurane can safely be used for fast-track anesthesia in patients undergoing valvular heart surgery. Sevoflurane provided a better hemodynamic profile, early awakening, and extubation as compared with isoflurane, even though the difference was insignificant. Thus, sevoflurane with opioids may be preferred in patients undergoing valvular heart surgery