Indian Journal of Emergency Medicine

Supraventricular Tachycardia (SVT) is one of  the common cardiac arrhythmias. When it occurs during pregnancy it poses a challenge to the treating physician because of the safety concern of the fetus. The basic principle of managing acute  episode of supraventricular  tachycardia in any pregnant woman is same as in nonpregnant and Adenosine is the first line drug therapy. We report here a case of successful cardioversion of Supraventricular Tachycardia with Adenosine in a woman with 33 weeks of pregnancy with ASD secundum and pulmonary hypertension.

Objective: Neurological features like parasthesias and carpel tunnel syndrome is not uncommon in patients with hypothyroidism but facial palsy with hypothyroidism has scarcely been reported. Case report: 40 year old male patient presented as isolated right sided infranuclear facial nerve palsy. Prednisolone (60 mg/day) was prescribed as we expected it to be Bell’s palsy, however, the patient’s facial palsy did not improve completely.Further inquiry revealed that he had overt primary hypothyroidism. He was put on Levothyroxine and there was complete recovery of facial palsy in two months. Conclusions: This case report highlights that facial palsy is not always idiopathic (Bell’s) palsy which could be part of some underlying multisystemic disorder and prompt recognition and treatment of the associated disorder should offer the best chance for complete recovery.

Takaysu’s arteritis, or “pulseless” disease is a rare, idiopathic, chronic granulomatous vasculitis that affects aorta and its major branches. Indian origin aortoarteritis is a rare variant of this disease presenting as severe uncontrolled hypertension, end-organ dysfunction and stenosis of major blood vessels affecting regional circulation. This report describes the case of a 33 year old male patient being evaluated for sudden onset uncontrolled hypertension associated with headache and vomiting. Of note in this patients presentation is that this patient also had history of tuberculosis , for which he had been treated and had completed treatment one year ago.
 

Hypokalemic periodic paralysis (hypoKPP) is characterized by muscle weakness or paralysis along with fall in potassium levels in the blood .This clinical entity is seen in adolescence and most commonly occur on awakening or after sleep or rest following strenuous exercise, high carbohydrate meals, meals with high sodium content, sudden changes in temperature.Weakness may be mild and limited to certain muscle groups, or more severe full-body paralysis. Attacks may last for a few hours or persist for several days. Some patients may fall into an abortive attack or develop chronic muscle weakness later in life.
 

Guillain Barré Syndrome (GBS), is an acute polyneuropathy characterized by immune–mediated peripheral nerve myelin sheath destruction. GBS is an uncommon diagnosis in the emergency department (ED), usually present with complaints of weakness. We report a case of 13-year old female who was presented to the emergency department with initial complaints of headache and sent home with a diagnosis of migraine and she returned to ED with weakness and ultimately found to be GBS.

Introduction: Metronidazole is a nitroimidazole antimicrobial drug prescribed to treat infections caused by anaerobic bacteria and protozoa. Metronidazoleinduced encephalopathy ( MIE ) is a rare toxic encephalopathy caused by the drug metronidazole. The incidence of metronidazole-induced encephalopathy is unknown , although several previous studies have addressed metronidazole neurotoxicity. Metronidazole is efficacious in treating trichomoniasis, amebiasis, and giardiasis and in infections caused by obligate anaerobes and microaerophilic bacteria. It has been used for treatment of brain abscess, because anaerobic and microaerophilic bacteria constitute the most common pathogens. Metronidazole may produce neurologic side effects such as cerebellar syndrome, and encephalopathy in rare cases. Metronidazole is a commonly used antibiotic agent in various conditions such as anaerobic bacterial infections, protozoa infections (for example, giardiasis), Helicobacter associated gastritis, and hepatoencephalopathy.Previous reports have demonstrated that metronidazole toxicity may induce several neurologic side effects, including peripheralneuropathy, ataxic gait, dysarthria, convulsive seizures. MRI brain usually clinches the diagnosis.Metronidazole is commonly used in the treatment of brain abscess to cover anaerobes and MIEP can lead to irreversible neurologic sequelae.Therefore, MIEP should always be borne in mind when administering metronidazole for the treatment of cerebral abscess. Here, we report the case of a patient with reversible cerebellar dysfunction on magnetic resonance imaging, induced by prolonged administration of metronidazole for the treatment of infectious colitis.
 

In the modern era of reperfusion, left ventricular free - wall rupture is seen in less than 1% of myocardial infarctions. Typically, acute left ventricular free - wall rupture leads to sudden death from cardiac tamponade. Here we present a case of left ventricular rupture as a complication of inferolateral wall myocardial infarction being saved by timely action and coordination of cardiologists and cardiothoracic surgeons. By presenting this case we would like to highlight that even deadliest complications like left ventricular free wall rupture can be treated and saved if aggressively managed.

Introduction: Cerebral hyperperfusion, or reperfusion syndrome, is a rare, but serious, complication following revascularization. Hyperperfusion is defined as a major increase in ipsilateral cerebral blood flow (CBF) that is well above the metabolic demands of the brain tissue. Quantitatively, hyperperfusion is a 100% or greater increase in CBF compared with baseline. This definition also extends to rapid restoration of normal perfusion pressure, for example, with thrombolytic therapy for acute ischemic stroke. Reperfusion syndrome can occur as a complication of carotid endarterectomy (CEA), intracranial stenting, and even bland cerebral infarction. The prognosis following hemorrhagic transformation is poor. Mortality in such cases is 36-63%, and 80%of survivors have significant morbidity. Case Report A 78-year-old male hypertensive, diabetic, and known coronary artery disease patient came to emergency department with complain of weakness in left upper limb since 4 hours which was progressively improving without slurring of speech, leg weakness, palpitation, or loss of consciousness. On arrival patient was conscious and oriented with normal vital parameters and normal blood glucose level. On examination patient was having left upper limb power 4/5. Other than that neurological and systemic examination was normal. Patient was undergone basic blood test and Magnetic Resonance Imaging of brain which was suggestive of small acute infarct in right high fronto-parietal region. Patient was treated with dual antiplatelets and supportive measures. On carotid doppler patient was found to have 90% obstruction of internal carotid artery on right side and 60% on left side. Patient was opted for digital subtracted angiography and angioplasty of right internal carotid artery. After the successful completion of procedure patient became progressively drowsy and developed left upper limb and lower limb dense hemiplegia.To rule out intracranial hemorrhage immediately computed tomography of brain was performed and which was suggestive of hyperdense fingerlike projection were noted in sulci all over right side of brain. Differential diagnosis of subarachnoid hemorrhage and hyperperfusion syndrome was suspected. Subsequent computed tomography of brain was suggestive of no hyperdence projections after 24 hours conforming the hyperperfusion syndrome. Patient was treated conservatively and improved in 15 days and discharge home with left hemiparesis. Disscussion: An abrupt increase in cerebral blood flow following revascularization has been identified as the direct physiological cause of hyperperfusion syndrome. Several factors including advanced age, underlying leukoaraiosis, and post-procedural high blood pressure have been associated with this condition .Two interlinked and synergistic mechanisms may lead to development of syndrome; impaired cerebral autoregulation and postoperatively elevated systemic blood pressure . If not treated properly, it can result in severe brain oedema, intracerebral hemorrhage, or death. Treatment strategies are directed towards regulation of blood pressure and limitation of rises in cerebral perfusion.

Electrolyte disturbance is a common finding in elderly individuals presenting to emergency with disturbed level of consciousness and hyponatremia is one of the commonest cause associated with lots of other clinical disorders . Most of these cases managed conservatively with sodium replacement and got discharged after correction of dyselectrolytaemia.Hyponatremia as the presenting manifestation of Empty sella syndrome (ESS) is rare. There is little clinical experience in the management and diagnosis of this problem and patient tends to present repeatedly to emergency due to electrolyte disturbances. We hereby report a case of 51 year old female with past history of CAD undergone coronary intervention presenting to emergency with diffuse pain abdomen,unable to pass flatus and vomiting mimicking symptoms of subacute intestinal obstruction found to have Recurrent hyponatremia during her hospital stay due to Partial Empty sella syndrome (ESS) .
 

Posterior reversible encephalopathy syndrome (PRES) is characterized clinically by headache, altered mental status, visual loss, and seizures. PRES is associated with neuroradiological findings characterized by white matter abnormalities, predominantly in the parieto-occipital regions of the brain. PRES is most often described in cases of hypertensive encephalopathy,eclampsia,renal failure,and immunosuppressive or anticancer therapy.We report a case of PRES associated with severe hypertension in the setting of a progressive renovascular hypertension from bilateral atherosclerotic renal artery stenosis.The pathogenesis of PRES is discussed and the importance of a prompt diagnosis and treatment is emphasized.

Emphysematous pyelonephritis (EPN) is a rare, severe gas-forming infection of renal parenchyma, Perirenal tissue and its surrounding areas. We report a case of diabetes mellitus that presented to the emergency department with abdominal pain, increase urine frequency and unable to pass stool after a trivial ground level fall, was diagnosed as perforation peritonitis. Early recognition in the emergency department prompted aggressive medical management followed by perinephric drainage and DJ Stenting due to which patient was successfully treated. Early diagnosis and management is a key to the prognosis in emphysematous pyelonephritis.
 

Background:A 72 years aged female patient presented with history of chest pain which was resolved with medication. Later she developed slurring of speech, weakness of left side of body, hoarseness of voice, deviation of mouth to right.Case presentation: Initial ECG had ST depressions and T inversion, bedside qualitative Trop-T was positive with a unremarkable CT brain plain even after 24 hours of onset of her symptoms suggestive of stroke, arouse a diagnostic dilemma for the emergency physician of coexisting NSTEMI with ischemic stroke in her case and patient was initially admitted under cardiology. Further work up ruled out NSTEMI and confirmed MCA territory acute ischaemic stroke. Conclusion: Acute stroke patients may have ischaemic changes and/or QT prolongation in ECG and elevated cardiac troponins, probably as a result of Neurogenic cardiac damage,which may arise diagnostic dilemma for the emergency physician as in this case and it shows prognostically poor outcome in acute stoke stroke patients.

Epidemics of acute encephalitis In young children: Lychee the sweet hypoglycemic or a silent killer a review of the literature. There have been reports of children presenting with acute neurological illness from Bihar India dating back to 1995, with recent ones being reported from China and Vietnam in 2012 and the latest ones being reported from Muzaffar India in 2014. The fact that is common to all these reports has been the association with lychee (lichi chinensis) a juicy sweet fruit grown in the summer months from May till June. Not surprisingly the cases coincide with the harvesting season of the fruit. The presentation is with varied neurological symptoms ranging from acute onset of behavioral disturbance to seizures accompanied by marked hypoglycemia with radiological evidence of cerebral edema and features suggestive of inflammation. Epidemiological and laboratory evaluations has postulated a spectrum of causes for this illness, including infectious encephalitis, exposure to pesticides, and Methylenecyclopropylglycine (MCPG) a compound found in litchi seeds known to cause hypoglycemia in animal studies. Current approach to the illness is focused on reducing the mortality by prompting the affected families to seek immediate medical attention and to ensure rapid correction of hypoglycemia. The varied presentation, absence of conclusive evidence to suggest a causative pathological agent warrant need for greater research to identify the culprit pathogen. Till such time lychee continues to be a sweet hypoglycemic, a silent killer.US researchers commented that a mysterious and sometimes fatal brain disease that has afflicted children in northeastern India for years could be linked to a toxic substance in litchi fruits, -Published in Leading Newspaper. The US Centers for Disease Control and Prevention have said that more research is needed to uncover the cause of the illness, which leads to seizures, altered mental state, and death in more than a third of cases. In the meantime, doctors who encounter sick children should takes steps to rapidly correct low blood sugar, which can make the disease more likely to be fatal, said the report.The outbreaks have coincided with the month-long litchi harvesting season in and around the Muzaffarpur district of Bihar state since 1995,- Published in CDC’s Morbidity and Mortality Weekly Report. In 2013, some 133 children were admitted to local hospitals in Bihar with seizures and neurological symptoms. Most were aged one to five, and nearly half (44 percent) of them died. Those who died were more than twice as likely as other patients to have been admitted to the hospital with low blood sugar.
 

Introduction: Endotracheal intubation, a routine lifesaving procedure in Emergency Medicine practice, can cause serious life threat to the intubated patient if the position of the tube is not confirmed appropriately.We did a prospective observational study on 289 patients to determine whether a bedside method of correct placement of the endotracheal tube can be obtained. Methodology: The operators recorded their findings of insertion depth of endotracheal tube, chest auscultation, observation of symmetrical chest movement and finally their impression regarding position of endotracheal tube in a sequentially numbered form.The principal investigator compared the findings of the operator, with the post intubation chest radiograph,which was taken as the gold standard. Results: We found a very high sensitivity of 99%, 100% and 100% for chest auscultation,chest movement and combination of all three methods (chest auscultation, chest movement and depth of the E.T. tube). However, the specificity was low at 49% for chest auscultation, 40% in chest movement and 51 % for combination of three methods.We calculated that,in subjects of Indian ethnicity, the safe depth of  E.T. tube was 22cm in male and 21cm in females (p<0.001) to reduce the chances of endobronchial intubation. Conclusion : We conclude that a single test is not confirmatory to ascertain tube position and it is better to combine all findings together to give a better sensitivity and specificity. A 21/22 cm (female vs. male) insertion depth of endotracheal tube is suitable for Indian ethnic groups.
 

Introduction: Heart disease is the leading cause of hospitalization and death in elderly patients. The elderly with acute myocardial infarction (AMI) have been reported to present with more atypical symptoms such as acute confusion, syncope, atypical chest pain, vomiting, and weakness. The role of conventional cardiovascular risk factors in older persons is incompletely understood because only fragmentary and inadequate data are available in most instances. Methodology: Data of 50 pts of elderly pts and 50 pts of younger patients who fulfilled the inclusion and exclusion criteria were collected. Their clinical profile including History, risk factors, past illness detailed physical examination, investigation findings, and the complications these patients developed in the hospital was recorded in the pretested proforma and the results were analyzed and the differences were compared Results: 64% of elderly patients had complications but in younger patients, only 32% had one or the other complications. 6% V/s 10% patients among elderly patients having LVF, 12% V/s 10% cardiogenic shock in elderly, 20% V/s 8% patients had arrhythmias in elderly group compared to younger patients. 68% of younger patients had no complications. Conclusion: The incidence of major complications like cardiogenic shock, and arrhythmias were significantly higher in elderly AMI patients (12%, 20%) compared to (10%, 8%) respectively in younger patients.
 

Introduction:A major portion of disease burden due to RA, including the excess mortality,appears to be due to its extra-articular manifestations. Extra-articular manifestations are seen in nearly 50% of patients with RA.,the commonly affected sites being the skin, eye, heart, and lungs .The prevalence of clinically “severe” extra-articular manifestations ranges up to 40% [5] and they are associated with severe active disease and increased mortality compared to the general population. Methodology: All patients newly / previously diagnosed to have RA & were willing to participate in the study were evaluated as per the proforma designed for the purpose of the study.All patients were diagnosed as rheumatoid arthritis on the basis of 2010 ACR / EULAR. Results: Among 50 patients joint deformities were found in 15 patients (30%). These included swan neck deformity in 13 patients, Boutonierre deformity in 9 patients, subluxation of superior radio-ulnar joint in 7 patients, ulnar deviation of hand in 5 patients, fixed flexion deformity of elbow in 2 patients and flexion deformity of hand in 1 patient. Conclusion: Mean duration of disease was longer in females but the difference was not significant statistically.
 

Introduction: Coronary artery disease is a leading cause of mortality among postmenopausal women in our country. It has been recognized that women are protected from CAD prior to the menopause. Statistics have showed that 4% of more deaths are arising from cardiovascular disease among 70 years of age. The
most common cause of CVD is the development of atherosclerosis. This condition is multifactorial in origin, but dyslipidemia has been identified as a major risk factor. Dyslipidemia is one of the important modifiable risk factor in CHD. Objectives: To study the prevalence of dyslipidemia and type of lipid abnormalities
in postmenopausal women with acute myocardial infarction. Methods: Around 50 postmenopausal women above the age of 45 years admitted in ICCU for acute MI under Khaja Banda Nawaz Teaching and General Hospital have been studied over a period of 3years. The patients below the age of 45 years and those who had associated diabetes mellitus, hypertension, 3smoking; congenital hyperlipidemias have been excluded from the study. After a detailed history and thorough clinical examination routine investigations were done. Other investigations like ECG, serum cardiac markers such as CPK-MB, LDH, SGOT and 2-D Echo was done to diagnose MI. A special attention was paid to lipid profile to study the dyslipidemia pattern. Results: Out of 50 patients, 54% were between 51-60 years of age.68% were above 10 years of postmenopausal women. Chest pain was the predominant symptom in 90% of cases followed by profuse sweating and restlessness.30% of patients were admitted within 6 hours after the onset of symptoms and 40% of patients admitted 6-12 hours after the onset of symptoms. 62% had STEMI as presentation in ECG. Dyslipidemia was observed in 38 patients,of themincreased LDL levels and triglyceridemia was predominantly observed. Hypercholesterolemia was observed in 60% of patients in study group. LVF was the most common complication. The mortality rate was 20%. Conclusion: Dyslipidemia was observed in most of thepostmenopausal women, in that increased LDL levels and triglyceridemia was the most predominant one. The mortality rate was high with dyslipidemia group to normal lipids group of patients. So life style modifications and early initiation of statin therapy in postmenopausal women would increase the cardiovascular benefits

 

Pruritus, a common complication of chronic kidney disease and end-stage renal disease (ESRD), is a uncomfortable, unpleasant symptom and apart from physical discomfort, affects social and psychological aspects of the life significantly. ESRD patients with CKD-aP have higher mortality rates, which have been reported to be as higher as 13% in DOPPS as compared to patients without pruritus. Aim of the study: The aim of this study was to provide a comprehensive description of the prevalence and clinical characteristics of pruritus affecting patients with end-stage renal disease on hemodialysis.Material And Methods:The study included 60 patients coming to the hemodialysis unit of Acharya Shri Chander College of Medical Sciences, for a period 18 months. Patients with active infection, recent hospitalization within three months, psychotic illness or other communication problems, primary skin disorders,cholestatic liver disease or acute hepatitis, and active malignancy were excluded from the study. Results: The 26 ( 43.3%) patients out of the sixty enrolled in study, were diagnosed with chronic kidney disease associated pruritus,18(69.2%) of the patients being male and females comprising remaining 8 patients (30.76%) .Conclusions: The problem of pruritus in uremic dialysed patients remains unsolved. Our study underscores that uraemic pruritus is an important health problem among haemodialysis patients and its proper diagnosis and characterization is important to improve overall outcome of these patients.
 

Introduction: Type 2 DM has a strong genetic component. The disease is polygenic and multifactorial. Among the identical twins the  concordance rate is 90%.In first-degree relatives with type 2 DM the risk of developing diabetes is 40%. Epidemiological studies indicate that type 2 DM appears to result from a collection of multiple genetic defects or polymorphisms, each contributing its own predisposing risk and modified by environmental factors.Methodology:All the patients underwent similar laboratory investigations, a 12 lead electrocardiogram was done for the patients in the study. All the 80 patients were then divided into two groups. The control group, in which included patients with type 2 diabetes mellitus diagnosed according to the criteria approved by the American Diabetic Association: Symptoms of diabetes plus casual plasma glucose concentration 200mg/dl (11.1mmol/L).Casual is defined as any time of day without regard to time since last meal. Results: In the study it was found that 22 patients [55%] in the study group had high blood pressure recording at the time of presentation as compared to only 12 patients[12%] in control group. Conclusion: It was seen that IHD and diabetes was commonly seen in the fourth to the sixth decade of life.

Diabetic coma is a reversible form of coma [1] found in people with diabetes mellitus. It is a medical emergency. Two different types of hyperglycaemic states are identified: 1) Diabetic ketoacidosis (DKA) and 2) Hyperglycemic Hyperosmolar State(HHS). Hyperglycemic emergencies continue to be important causes of morbidity and mortality among patients with diabetes. The cause of death in patients with DKA and HHS rarely results from the metabolic complications of hyperglycemia or metabolic acidosis but rather relates to the underlying medical illness that precipitated the metabolic decompensation. Thus, successful treatment
requires a prompt and careful search for the precipitating cause (s). A study done by Osuntokun et al [2]in 1971 in Ibadan reported DKA as the single major cause of death in diabetics. Necropsy studies carried out 5 years later in Ibadan by Smith and Adetuyibi [3] showed that 43% of deaths in acute decompensated diabetics were due to DKA. A mortality rate of 60% for HHS was reported from IleIfe in 2000 by Kolawole and Ajayi [4]. A study for this Diabetic Coma in India is untouched, this study is to fill the lacuna in that regard finding the factors associated with outcome and on emphasis on the determinants of outcome.

Introduction: India has nearly 33 million diabetic subjects. Indians have a genetic phenotype characterized by low BMI, high upper body adiposity, high body fat percent, and high levels of insulin resistance. In CUPS (Chennai Urban Population study), the prevalence of CAD was high among diabetics (21.4%, compared to
14.9% among patients with IGT and 9.1% among patients with normal glucose tolerance). Methodology: A total of 80 patients were included in the study based on the inclusion criteria as mention above. The data was collected in a predesigned proforma by questionnaire method, physical examination and lab investigation. Results: There were 16 patients [40%] with their blood sugars in between 201 to 300mg/dl as compared to 6 patients [15%] in the control group. Another 7 patients [17.5%] had blood sugars more than 300mg/dl as compared to 2 patients [5%] in the control group. Conclusion: Dyslipidemia also was more common in the IHD group, suggesting that a aggressive treatment of dyslipidemia initially may be beneficial in the long run.

Use of Ondensetron (antiemetic) is quite common practice before giving Tramadol (analgesics).Many of the ED patients present with pain and Tramadol is the drug of choice for us. It is usually given intravenously. This is an Opoid analgesic and acts via binding to the mu opioid receptor, but also inhibits the reuptake of serotonin and norepinephrine due to its action on the noradrenergic and serotonergic systems, such as its “atypical” opioid activity. Vomiting is due to central stimulation of CTZ and by peripheral labrynthine stimulation. A major proportion of patients presenting to our emergency department have various painful conditions. In our department, tramadol has been the intravenous opioid of choice. In our experience, the advantages of IV tramadol are its titratability (dose range 1-2 mg/kg) and predictability. Traditionally, it has been the norm to use prophylactic antiemetics along with opioids to counter their emetic side effects.All opioids have the well recognised side effects of nausea and vomiting, with some being worse than others. These symptoms are mediated both centrally, by stimulation of the chemoreceptive trigger zone and dopamine receptors in the medulla, and peripherally, by labyrinthine stimulation and reduced gastric emptying. Thus antiemetic prophylaxis is particularly common with the use of opioids for acute pain,and also in postoperative acute pain, where the incidence of nausea and vomiting varies between 8% and 92%.It is a normal practice in our ED to give prophylactic ondensetron before giving tramadol for prevention of vomiting.This sole aim of this work was to find out how far the practice of using prophylactic antiemetic before opioid was correct and how effective it was in preventing nausea and vomiting.
 

Introduction: Pulmonary involvement is the one of the most common extraarticular manifestations of rheumatoid arthritis which contributes significantly to morbidity and mortality of patients with rheumatoid arthritis. Therefore a study was conducted to study Pulmonary manifestation in patients with rheumatoid arthritis, irrespective of the presence of respiratory symptoms and to correlate pulmonary manifestations with disease activity. Methods:The study conducted was a cross-sectional descriptive study on fifty patients of Rheumatoid Arthritis, new or follow up, who presented to Medicine OPD or admitted to the wards of ESIC Medical College Hospital,Bangalore. Data was collected with the aid of a proforma, which included patient bio data,relevant history,a routine clinical examination with special attention to joints andres piratory system.Results: Age of the study individuals ranged from 22–64 years. Mean age of the patients in the study was 46.3±9.75.7 years. The female to male ratio was 3.2:1. Mean duration of the disease was 5.18 ±6.52 years (range 1-26 years). Rheumatoid factor was positive in 39 (78 %) patients. In our study, twenty (40%) patients had respiratory symptoms. Conclusion: Pulmonary manifestations were found in more than half of patients with RA. Asymptomatic pulmonary involvement was seen in one third of patients with RA. This highlights the importance of actively looking for asymptomatic pulmonary manifestations in RA patients.
 

Introduction: Elderly patients were more likely to have non Q wave MI. The key issue for the elderly is that only few patients have symptoms and ECG findings that qualify them for thrombolytic therapy. This may be because of a reduced incidence of sudden plaque rupture or because of extensive collateral protection against transmural infarction.Cardiovascular complications including cardiogenic shock, atrial fibrillation and heart failure were common in elderly patients. Methodology:In this study 100 cases of acute myocardial infarction patients admitted in ICCU of above hospital studied during the period of 2013 to 2015. The cases are followed up upto the hospital stay 100 cases are divided into 2 groups, Group –I Elderly (60 years of age)-50 patients and Group – II Younger patients–( 60 years of age)-50 patients. Results: Elderly patients were predominantly presented with breathlessness 50% V/s 16%, giddiness 24% V/s 10%,syncope 10% V/s 2%,palpitations 16% V/s 6%,altered sensorium and pain abdomen when compared to younger patients. Conclusion:Although chest pain was the commonest presenting symptom in both age groups 60% of elderly group presented with atypical chest pain compared to 24% in younger group.Elderly patients were presented more atypicaly with the symptoms like breathlessness, giddiness, syncope, altered sensorium and pain abdomen with breathlessness being the predominant atypical symptom.
 

Tuberculosis (TB) affects large number of people, especially the low socioeconomic status.It continues to intimidate the human race since time immemorial Tuberculosis can cause various haematological abnormalities. The comprehensive study on haematological changes and abnormalities associated with tuberculosis are still lacking. Also there is no systematic documentation about pre-treatment and regular follow up of post-treatment changes in haematological parameters of patients suffering from TB.In this study,an attempt has been made to investigate haematological changes in adult patients suffering from TB and whether deranged haematological parameters in them improves after intensive phase (IP) of antitubercular treatment(ATT).Fifty bacteriologically proven cases of pulmonary and extrapulmonary tuberculosis (EPTB)were studied for various haematological changes at diagnosis and at the end of IP ATT by using automated hematology analyser. At the end of IP ATT, in the RBC series there was statistically significant improvement in the mean haemoglobin ,Packed Cell Volume (PCV), Red cell distribution width (RDW), Mean Corpuscular Volume (MCV), Mean corpuscular Hemoglobin (MCH) and Mean Corpuscular Hemoglobin concentration (MCHC) In the WBC series , mean WBC count and mean granulocyte count in males showed a significant decrease.Rest of the WBC series showed no significant difference in both the groups before and after treatment. In the platelet series, mean platelet volume and mean platelet distribution width showed significant improvement after IP ATT. Thus various haematological changes occur in tuberculosis and these parameters improved after IP ATT without any transfusion of blood products.

Introduction: Pulse oximetry is a simple, non-invasive, continuous, bedside method of measuring blood oxygen saturation of patients in emergency departments. The accuracy of measurement in patient have been questioned due to its limitations when henna is applied in previous studies. Objective: Our study was done to determine whether pulse oximeter showed appropriate readings when henna has been applied. Material and Methods:100 normal healthy individuals with ages between 20 & 40 years of both sexes were included into the study. In all participants red and black henna was applied to right thumb and index finger, this was the test finger.Uncoloured left thumb was used as control. Oxygen saturation was measured in all participants, both in day or night and at constant room temperature. Arterial blood gas analysis was also done on each individual to see the accuracy of pulse oximeter with partial pressure oxygen. Results: Red henna causes statistically significant difference as it showed there is mild change in reading of oxygen saturation to that of control finger whereas black henna when applied caused potential error in all pulse oximetry reading.Conclusions:Red henna is not likely to drastically change the accuracy of oxygen saturation measured by pulse oximeter whereas black henna does not show any reading.

Objective: Degree of correlation between Emergency Department admission and hospital discharge diagnosis. Design: A prospective study in a six month period at Accident and Emergency Department of Peerless Hospital and B.K. Roy Research Centre, Kolkata, which had four in- patient specialties- Medicine, Surgery, Paediatrics and Orthopaedics.Subjects: All cases admitted through the emergency department in the study period. Main outcome measures:degree of correlation between emergency department admission diagnosis and hospital discharge diagnosis. Results: of all admission diagnosis, 75.77% was accurate or partially accurate to the final discharge diagnosis.The accuracy of diagnosis was statistically better in traumatic cases, male sex, and younger adults.Conclusion: history talking and physical examination remained the most important diagnostic tools in the emergency department. Simple investigations available at the emergency department were not helpful in improving diagnostic accuracy.
 

Background: Amitraz is a pharmaceutical, veterinary, and agricultural product which is used worldwide under numerous generic names as an acaricide and insecticide. Because of its widespread use, Amitraz has emerged as one of the common poisoning in rural areas. Aims and Methods: To report the clinical features, laboratory findings and the management instituted for the patients with acute Amitraz Poisoning and review the previously reported cases. Results: Total sixteen (Ten male and six female) patients aged between17 to 48years were admitted to our department. The ingested amount was ranging from 15 ml to 30 ml.The initial signs and symptoms were impaired consciousness, drowsiness, vomiting,disorientation, miosis, mydriasis, hypotension, hypertension, tachycardia, bradycardia, tachypnea, bradypnoea, and hypothermia. Six patients required mechanical ventilation. CNS depression resolved spontaneously within 8–48 hours in all. The length of hospital stay was three to sevendays; all the patientsrecovered Conclusion: Amitraz is a deadly poison with mainly central nervous system and respiratory system depression, without any antidote. Early and aggressive management helps in excellent patient outcome in the form ofcomplete recovery. Public awareness isrequired to prevent poisoning by such compound, especially among the illiterate farmers.
 

Objective: Application of Integrative Weaning Index in predicting weaning success. Materials and Methods: A prospective study on the mechanically ventilated 26 patients; after minimum 24 hours of ventilation criterias of readiness for weaning were recorded; those who met criteria were given 2 hour spontaneous breathing trial and Integrative Weaning Index (IWI) was calculated; those who tolerated the trial were immediately extubated; outcome was measured by the ability to maintain spontaneous, unassisted breathing for more than 48 hours aftet extubation. Results:IWI has high sensitivity (93%) and good negative predictive value of 75% Conclusion: Extubation using criteria of readiness for weaning and IWI >25 has good success rate of extubation with lower reintubation rate.
 

Introduction: The most important risk factor for the development of tetanus is lack of immunization. In taking care of wounds suspected of tetanus and use of prophylaxis for it, a history of patient’s vaccination is very important because in individuals who have received five initial vaccination doses completely no particular intervention is necessary, except for cases in which the wound is high risk for tetanus. Aims of the study: 1) to assess the knowledge of doctors about tetanus immunization in relation to injuries.2 ) To assess the current tetanus prevention practices among doctors while treating adult patients with trauma. Methodology: The study is a prospective, cross-sectional, multi-centric, observational, questionnaire-based study. For the purpose of this thesis,a descriptive co relational analytical survey was used, in which a qualitativ approach w be undertaken to determine the answers of the research questions. The sample size required for this survey was calculated as 322, rounded to 325.

Results: In our study a total of 115 Emergency Physicians responded via the Webbased software. Though in many places the physicians had considerable knowledge still a significant number of physicians lacked knowledge in various domains when we compared their answers with the latest World Health Organization Guidelines. Conclusion: Better cognizance of tetanus prophylaxis recommendations is necessary and tetanus prophylaxis. National recommendations should be followed at all times while administering the vaccine.

Objective: This study was done to compare Arterial values of pH , pCO2,B.E, K+ with Central venous values and to establish a correlation between arterial and central venous values of pH , pCO2, B.E, K+ in the clinical management of selected patients in the emergency department. Methods: The study population consisted of 40 critically ill patients in emergency and critical care units. Arterial and Central venous blood gas measurements of pH, pCO2 B.E, K+ were taken. Simultaneously other variables were noted Comparision of mean values of pH , pCO2, B.E , K+ between arterial and central venous was done using t –test. Results: As per the linear regression analysis arterial values of pH , pCO2 B.E, were found to be correlated significantly with central venous values (correlation coefficient r being 0.94 for pH and r =.96 for pCO2, r =.97 for B.E), while arterial and venous values of K+ were found to be poorly correlated (correlation coeffiecient,r =.375 .). Conclusion: Central venous blood gas values of pH, pCO2 B.E can be considered instead of arterial blood gas values in continuous assessment of critically ill patients. As per this study estimation of arterial values of potassium cannot be done based on venous potassium levels. Frequent arterial punctures can be avoided by recording central venous blood gas values in monitoring of critically ill patients.