Indian Journal of Emergency Medicine

Background: Dermatology is often thought of as non acute,outpatient centered speciality. However, there are many dermatological conditions presenting as emergency situations that demands early diagnosis, monitoring and multidisciplinary intensive care to minimize the associated morbidity and mortality. The aims of this study are to study the clinico-epidemiological profile and clinical pattern of various dermatological emergencies and to find out mortality in dermatological emergency cases. Methods: This is a prospective study which was conducted over period from September 2014 to December 2016. In this study we classified dermatological emergencies into Primary, where involvement of skin is the primary cause and Secondary, where cutaneous manifestations are the indicators of impending or underlying severe systemic involvement. A detailed history of all the patients was taken and recorded with all demographic details and clinical examinations. Results: Out of 154 patients, 88 (57.14%) were male and 66 (42.86%) female. Maximum 42 (27.27%) patients were in the age group of 31-40 years. In these study 89 (57.80%) cases were of primary dermatological emergencies and 65 (42.20%) cases of secondary dermatological emergencies. At the time of first presentation 81 (52.60%) patients were having mucosal involvement, 76 (49.35%) patients were having various systemic involvement. Total 16 different conditions were included during the study amongst them acute urticaria with or without angioedema was the commonest (34.41%), followed by Lepra reaction (12.33%), Acute erythroderma (10.38%), Pemphigus vulgaris with secondary infection (7.80%) and Steven johnson’s syndrome (7.14%). In the this study, mortality was 1.95%. Conclusion: Criteria for real emergencies needs to be further defined and classified properly. This study suggests that the role of the dermatologist in the emergency department is very important. 

Wellens' syndrome is a pre-infarction stage of critical proximal left anterior descending (LAD) coronary artery stenosis in patients with angina chest pain without typical ECG changes nor with elevated cardiac enzymes. Misdiagnosis or delayed diagnosis of this condition can lead to full-blown myocardial infarction and death if not intervened appropriately. We describe a case of 59 years old male who has had recurrent episodes of chest painwithout typical ECG changes and significant cardiac markers but was found to have critical LAD stenosis on angiography. We also describe the diagnosis criteria of Wellens’ syndrome and its importance. 
 

Introduction: Intraperitoneal rupture of the bladder is considered rare(20%) as compared to extraperitoneal [1]. Idi-opathic rupture of urinary bladder is even rare (1%) [2]. The causes of spontaneous bladder rupture are ill defined and may vary from chronic alcoholism to bladder over distension and trivial trauma such as minor falls.

Case Report: A 62 year old male patient presented to our emergency department with complaints of constipation and absent urine output for last one day. He had no known comorbidities. On examination he had normal vitals with no hypotension. The abdomen was distended, tense, non tender with absent bowel sounds. He was drowsy but arousable with no other neurological deficits. The USG screening in ED showed massive amount of free fluid in Morrison’s pouch. ABG and Chest X Ray were normal. NCCT Abdomen showed moderate to gross free fluid in peritoneal cavity with intraperitoneal rupture of bladder in the dome. He was urgently taken up for exploratory laparotomy which confirmed the CT findings.

Conclusion: This case illustrates a very rare incidence of intraperitoneal urinary bladder rupture with no apparent cause.

A 29 years old female G7P2A4L2 with 7 weeks amenorrhea, presented to ED with h/o pain abdomen since 18-19 days, spotting 10 days back and bleeding per vagina since 3-4 hrs with expulsion of clots? fetal parts. USG in ED revealed bicornuate uterus with irregular gestational sac (5.4 weeks) without fetal pole or cardiac activity at right cornua, suggestive of incomplete miscarriage.

Myxoedema coma is life threatening emergency of decompensated hypothyroidism, recognition of hypothyroidism may not always be easy in the emergency department setting. Laboratory evaluations of thyroid function are not usually performed on a 24-hour basis, and therefore the emergency physician, although suspecting the presence of hypothyroidism, may be unable to confirm the diagnosis while the patient is in the Emergency Department. Treatment consists of correction of electrolyte abnormalities, passive rewarming, treatment of infections, respiratory and hemodynamic support, administration of stress-dose glucocorticoids, and thyroid hormone replacement.
 

Phencyclidine (PCP, “angel dust”) is a hallucinogenic well known for its ability to induce disorganized thought processes, including euphoria, omnipotence, superhuman strength, and amnesia and dysphoria. It is an illicit street drug which is used widely among youth in the United States. However in India, it is used by dacoits and thieves to sedate people and rob them in public transport. We report a case of a 25 yr old male who was brought to the ER from the local government hospital with altered sensorium. He had an alleged H/o of being found unconscious outside the local bus stop, possibly poisoned by dacoits. Early prompt resuscitation in the ER followed by early initiation of Sustained Low Efficiency Dialysis in view of Acute Kidney Injury and Early IABP Insertion in view of Toxic Myocarditis led to the pt being successfully treated.
 

Dipeptidyl peptidase IV (DPP-IV) inhibitors such as sitagliptin prolong the duration of active incretin hormones such as glucagon-like peptide 1 (GLP-1) in the bloodstream and thereby enhances control of type 2 diabetes. Adverse events with sitagliptin include upper respiratory tract infections, sore throat, headache and diarrhea. It has also been linked with pan creatitis in case reports, animal studies and postmarketing drug surveillance studies. We report a case of 52 year old diabetic female taking sitagliptin since 2 months presented with abdominal pain and vomiting since 2 days and was diagnosed as acute pancreatitis.
 

The diagnosis of button battery ingestion in toddler age group can be quite difficult as the patient cannot give the history himself/herself (unless it is witnessed). Such ingestion can lead to serious complications due to either mechanical obstruction of the foodpipe or leakage of alkaline liquid from the battery which can cause necrosis and perforation of the GI tract leading to death if not intervened early. It is very rare to see prolonged impaction of a button battery in the esophagus without any life-threatening complications. We hereby describe a case of a one and a half year old boy who ingested a button battery approximately 20 days back (unwitnessed) which got impacted in the esophagus and remained there for about 20 days before presenting to us with complaints of poor feeding, cough and fever. He was managed in the pediatric ICU where the button battery was retrieved and the child was discharged in a stable condition.

A 2.6 years old boy previously healthy presented with h/o mild fever and generalized weakness 10 days back following which he became irritable and lethargic and lower limb weakness for 3 days. Plain MRI brain was normal but the CSF study showed albumino-cytologic dissociation and Nerve conduction study showed absence of ‘f ’ waves. He was started on IV Human Immunoglobulin (IV Ig) after which he improved and was discharged in stable condition.

Gallstone ileus is a rare cause of small bowel obstruction (SBO), representing 1–4% of all SBO. Bouveret’s syndrome is a raresubcategory of gallstone ileus where a gallstone lodges itself intothe duodenum and causes gastric outlet obstruction. It constitutes 2–3% of all gallstone related obstructions in the alimentary tract. Here we present a case of 68 year old female, known case ofbipolar disorder and diabetes, presented to ED with complaints of  abdominal discomfort and decreased appetite. On investigation, patient was diagnosed with cholecystoduodenal fistula and gall stone ileus, later on operated and discharged in stable condition.

Background: Deep vein thrombosis (DVT) refers to the formation of a thrombus, which is a blood clot, in a deep vein. Clot is usually formed in an inflamed vein, also known as thrombophlebitis. Common sites for DVT are femoral vein or the popliteal vein of the leg. DVT can lead to Pulmonary Embolism (PE), which is a serious complication of DVT. It occurs, if the clot dislodges and reaches the lungs. PE can be life threatening and therefore becomes a medical emergency.

Methods: Electronic database was searched for related articles published online till 2018. Following key words were used ‘DVT’, ‘D dimer’, ‘thrombophlebitis’, ‘thrombus’, ‘pulmonary embolism’, ‘deep vein thrombosis’. Studies relevant to our title were finally selected and those which failed to provide any detail were excluded from review.

Result: DVT affects predominantly elderly population, with slight inclination towards male sex. Clinical picture of DVT is affected by the extent of obstruction to venous outflow and degree of inflammation of the vessel wall. Most of the times it is asymptomatic. Pretest probability scores in an algorithm along with D dimer testing and compression ultrasonography are used to make the diagnosis.

Conclusion: DVT is a clinically entity with potential risk, as it can lead to pulmonary embolism. Therefore, it needs to be diagnosed as soon as possible, followed by quick intervention.

Background: Chest pain may be a symptom of a number of serious conditions and generally considered as a medical emergency. In ER the typical approach to chest pain involves ruling out the most dangerous cause and elimination or confirmation of the most serious cause, a diagnosis of the origin of the pain may be made.

Objective: To study clinical profile of patients presenting with chest pain in emergency department.

Method: This prospective observational study was performed on 71 patients who had presented with chest pain in emergency department of a tertiary care hospital in south India, Amrita Institute of Medical Sciences and Research Centre (Kochi).

Results: In all 71 patients included in the study, the cause of chest pain was reliably determined. There was 57 (95%) males and 14 (5%) females included in the study. The median values are as follows age group (60), Heart rate (74), Mean Arterial Pressure (100), Oxygen saturation (98), Respiratory rate (20), Temperature (98) and Random blood sugar (98).

Conclusions: In the 71 patients, the major cause of chest pain was cardiac in origin in 52 patients (73%) and remaining were non cardiac causes in 19 patients (27%). Among cardiac causes, ACS was found as the major cause of chest pain in 31 patients (43%) followed by other cardiac causes in 21 patients (30%).

Association between menopause and dyslipidemia has been documented by several studies. Several studies have shown that serum LDL & VLDL cholesterol levels, triglycerides are significantly higher and HDL cholesterol levels are lower in postmenopausal women when compared to age matched premenopausal women. So there is an increased risk of coronary artery disease (CAD) to women after menopause. The present study was carried out among 200 subjects, who were divided into two groups, 100 premenopausal and 100 postmenopausal groups. The study was done by obtaining serum sample from study group and controls, from randomly selected postmenopausal and premenopausal women of similar height and weight of general population of city. Significantly increased proportion of total cholesterol >200 mg/dl in postmenopausal women compared to premenopausal women. Postmenopausal women have significantly increased triglycerides level >150 mg/dl compared to premenopausal
women.

Menopausal symptoms are climacteric symptoms, hot flushes due to sudden change in the hormones levels and is not seen in women who are chronically hypo estrogenic. The term “hot flush” is descriptive of sudden onset of reddening of skin overhead, neck and chest accompanies by feeling of intense body heat and concluded by sometimes-profuse perspiration. The duration varies from few seconds to several minutes, rarely for an hour. Only 100 postmenopausal women and 100 premenopausal women and 100 premenopausal women were included after a detailed medical history and were selected on the basis of the following inclusion and exclusion criteria. The FBS of premenopausal group was 78.67 mg/dl and of postmenopausal group was 79.47 mg/dl. The PPBS of premenopausal was 97.3 mg/dl and of postmenopausal group was 97.25 mg/dl. There was no statistical difference in FBS, PPBS, between the two groups.

One of the important mechanisms responsible for the accelerated atherosclerosis in Diabetes is the non-enzymatic reaction between glucose and proteins or lipoproteins in arterial walls collectively known as Maillard or browning reaction. Glucose forms chemically reversible early glycosylation products with reactive amino groups of circulating or vessel wall proteins (Schiff bases) which subsequently re-arrange to form the more stable Amadori-type early glycosylation products. This single centre, prospective, observational study was carried out in Diabetes unit of tertiary care hospital in patients of type 2 Diabetes Mellitus (T2DM). After the approval of institutional ethics committee, Diabetic patients attending the Diabetology unit of a tertiary care center were recruited into the study. There was significant positive correlation of CIMT with age (Pearson Correlation coefficient: 0.611, p<0.01). But with BMI, though a positive correlation was observed, it was not significant (Pearson Correlation coefficient: 0.079, p=0.437). Similarly, with WHR (4C) positive correlation was observed but it was not significant (Pearson Correlation coefficient: 0.108, p=0.284).

Under normal physiological conditions plasma glucose concentrations are maintained within a narrow range despite wide fluctuations in supply and demand through a tightly regulated and dynamic interaction between tissue sensitivity to insulin (especially in liver) and insulin secretion. After initial screening, demographic details of the patient like patient identifier, age, gender, height, weight, smoking history, alcoholism history were recorded in case record form (CRF). Other relevant history like history of coronary artery disease (CAD), history of stroke or transient ischemic attacks (TIAs), history of peripheral arterial disease, autonomic neuropathy, retinopathy and renal disease was also noted in CRF. Mean values of fasting and post prandial blood sugar levels were 128.20±19.80 and 172.82±14.85 respectively. Glycated hemoglobin (HbA1c) mean level was 8.36±0.28. Mean duration of Diabetes was 11.16±2.12 years.
 

Background: Dexmedetomidine, is a imidazole compound, is a pharmacological active of dextroisomer of medetomidine. It is selective and specific to α2A adrenoreceptor, which is responsible for its sedative and analgesic effect. This property has made it popular drug as adjuvant to local anaesthetic drug in regional anaesthesia.

Method: The study was conducted on 60 patients undergoing lower limb orthopaedic surgeries under spinal anaesthesia patients were randomized and allocated into two groups using sealed envelope te hnique based on inclusion and exclusion criteria. All the
patients enrolled for this study were examined preoperatively, and allocated into group I and group II. Group I – 3ml of 0.75% isobaric Ropivacaine. Plus 0.5ml of normal saline. Group II – 3ml of 0.75% isobaric ropivacaine plus 5ug of Dexmedetomidine in 0.5ml of Normal saline.

Result: Time of onset of sensory block was 3.71+0.6min in group I in comparison to 4.94+1.12 min in group II with p value 0.01862. Maximum level of sensory level achieved in group I was T7 and in group II it was T6, with p value 0.0001. Time required to achieve maximum sensory level in group I was 12.6+1.96min, in group II it was 11.62+1.8min, with p value 0.204. Time for two segment regressions was 114.68+16.24min in group 1 but in group II it was 72.42+8.94min with P value 0.00001. Time to regression to S2 segment was 435.64+34.28min in group I and 259.46+26.45 in group II with p value 0.00001.

Discussion and conclusion: Five micro gram of dexmedetomidine when added to ropivacaine is associated with faster onset and longer duration of sensory blocked, haemodynamic stability, absence of sedation and reduced need for analgesia in first 24 hour.

The plant of Ranunculus arvensis, a member of Ranunculeceae family, has been used as a traditional method in order to treat a variety of diseases such as rheumatic pain, abscess drainage, burn injuries, wounds. In this study, Ranunculus arvensis-induced skin burns and their treatments were evaluated.

Methods: The cases in whom burn injuries developed as a result of the use of Ranunculus plant which is administered in the traditional treatment for arthralgia, headaches with analgesia purpose were evaluated retrospectively. The patients' age, gender, application duration of the plant, site of lesions, treatment method administered, duration and results of treatment were examined.

Results: Three of five cases were treated with a topical antibiotic and daily wound dressing as we applied in thermal burns. Additionally, partial thickness skin graft was placed in cases with deep burns.

Conclusion: In conclusion, Thermal burn-like lesions may occur secondary to Ranunculus arvensis. As these lesions can be superficial, they may be deep enough to require surgical treatment. Standard burn injury treatment can be applied in these cases.

Study Objective: We studied and describe the clinical and Para clinical profile, complications and outcome among 17 cases of Scrub typhus diagnosed in The Mission Hospital, Durgapur from March 2017 to April 2018.

Methods: This was a cross-sectional study of clinical prevalence and presentations of Scrub Typhus at the Emergency Department at the Mission Hospital, Durgapur. We observed suspected cases presenting with high grade fever and recorded patient demographics, vital signs, pulse oximetry, findings on thorough physical examinations. Clinical features at admission, complications occurring during stay, treatment and outcome were recorded for all cases and descriptive statistics are presented in this study. All treatment decisions were at the discretion of the treating provider who was blinded to study measurements to simulate usual care. At the end of the study, provider and patients were assessed for treatment satisfaction. 

Results: We observed 17 patients (3 children and 14 adults) from all age groups. The most common clinical features included were high grade fever (100%), headache (47.05%), rash (29.41%), hepatomegaly (23.52%), lymphadenopathy (17.64%), skin hyperemia (11.76%), nausea / vomiting (17.64%), cold and dry cough (17.64%), pain abdomen (17.64%) and An Eschar was found in 41.17% which were the predominant clinical features. Complications noted in the patients were mainly of pulmonary pathology noted in 41.17 % of cases, liver enzymes were elevated in MODS which were seen in 11.76% but none of the patients with MODS died. Overall, Use of empiric treatment was considered to reduce the high mortality observed with the disease and resulted in high patient and provider satisfaction.

Conclusion: In this study, diagnosis of scrub typhus largely based on a high index of suspicion and careful clinical, laboratory, and epidemiological evaluation with early diagnosis, identifying the complications and predictors of outcome among the diagnosed cases of scrub typhus which led to better outcome with no mortality [4].
 

Background: AIDS is caused by HIV, a non-transforming human retrovirus belonging to the lentivirus family; two genetically different but related forms of HIV, called HIV-1 and HIV-2 have been isolated from patients with AIDS.

Objective: The main objective of the current study is to investigate that the prevalence of subclinical hypothyroidism in HIV positive patients with treatment and without treatment.

Method: Those HIV positive patients which were admitted in Medicine ward or attending Medicine / ART OPD of NSCB Medical College, Jabalpur were selected for the study. The patient presented with signs & symptoms of hypothyroidism (like tiredness/weakness, dry skin, feeling cold, hair loss, constipation, dyspnoea, impaired hearing, hoarse voice, weight gain with poor appetite, difficulty Concentrating & poor memory etc.) were excluded from the study. Further, patients with diagnosed case of Thyroid disease, renal disease, Malignancy & patient receiving drugs Affecting Thyroid function were screened & were also excluded from the study.

Result: Finding of the present study shows that Thyroid Dysfunction in 200 HIV positive patients. Among those 26 patients (13%) had Thyroid Dysfunction. Out of these 26 patients, 15 were male &11were female. Thyroid Dysfunction was slightly more common in female patient (14.67%) Than male patients (12%).

Conclusion: In this present study, out of 200 HIV positive cases, 125 (62.5%) were male & 75 (37.5%) were female, age ranging from 14 to 70 years. Maximum HIV positive patients were in the age group of 26-45 years. Out of 200 HIV positive patients, 26 patients (13%) had Thyroid Dysfunction. Among these 26 patients, 23 patients (11.5%) had subclinical hypothyroidism. 88.5% cases of thyroid dysfunction were of subclinical Hypothyroidism. Prevalence of subclinical hypothyroidism was found to be slightly more among females (12%) than males (11.2%)

Introduction: Pneumonia is a commonly seen ailment in the department of general medicine and chest medicine. However with timely diagnosis and appropriate management the duration of morbidity and mortality rate can be reduced. Various grading systems are utilized to predict the mortality rate of pneumonia.

Objective: We aimed at analysing the utility of PSI score and CURB-65 in predicting the 30 day mortality rate in patients with community acquired pneumonia at our institute.

Materials and methods: A retrospective study was conducted at our institution in which the records of the patients who presented to the department of Chest and emergency medicine between January 2017 to December 2017 and diagnosed as community acquired pneumonia were retrieved reviewed. Clinical examination findings, radiological findings and the laboratory findings were recorded in the patient’s proforma. The PSI score and CURB-65 score were calculated and correlated with the patient’s clinical outcome.

Results: 175 patients were diagnosed as community acquired pneumonia (CAP) cases. Among them 85 patients were treated on OPD basis. The rest 90 patients were hospitalised for treatment. 22 patients were admitted to wards, and 68 patients were admitted to ICU. Of the total 90 hospitalised patients 27 patients were females and 63 patients were males. The patients were between 20 years to 70 years. Highest numbers of patients were seen in the age group of 50-59 years. The clinical outcome was defined as mortality among the hospitalised patients. The mortality rate in our study was 30% (27 patients). Considering class I, II, III of PSI score as low risk group and score 0 to 2 of CURB-65 as low risk group the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were calculated. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of PSI Score were 85%, 65%, 35%, 84% and 50% respectively. In comparison the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of CURB-65 were 27%, 71%, 60%, 100% and 80% respectively.

Conclusion: We conclude from our study that PSI score is more sensitive than CURB-65 in warranting the ICU admissions whereas CURB- 65 is more specific in predicting 30 day mortality risk among the patients. The diagnostic accuracy of CURB-65 was higher in our study.
 

Introduction: Chest pain is the most common key presentation of acute coronary syndrome presenting to Emergency department. But few patients may present with atypical symptoms and pose a great challenge to the Emergency physicians. Diagnosis has to be made early since maximal mortality occurs within first few hours if treatment is not instituted early. A cross-sectional study was conducted in our hospital to study the proportion of atypical symptoms in patients with acute coronary syndrome.

Methods: A Cross-sectional study was conducted in our hospital from September 2017 to April 2018. All patients aged >20 years presenting to emergency department and fulfilling the following diagnostic criteria were included. The WHO diagnostic criteria were used for diagnosis of Acute coronary syndrome [9]. 1) Clinical history of ischemic type of chest pain 2) Changes in serial ECG tracings a) ST-segment elevation of more than 1mm in 2 limb leads. b) ST-segment elevation of more than 2mm in 2 or more contiguous chest leads. c) ST segment depression >0.5mm at J point in >2 contiguous leads with positive troponin I. 3) Positive Serum cardiac biomarkers (troponin I) The diagnosis was confirmed if 2 out of 3 above components were positive. ECG was done for all patients presenting to ER with symptoms suggestive of acute coronary syndrome. Cardiac enzymes were sent in patients with nonspecific ECG changes.

Results: 323 patients were included in our study. Out of which, 269 patients presented with typical chest pain and 54 (16.71%) patients presented with atypical symptoms. The incidence in male and female population was 44.4% and 55.5% respectively. The incidence of atypical symptoms increased with increasing age and was highest in the age group of 71-80 yr.

Conclusion: It is crucial to consider acute coronary syndrome as a differential diagnosis in patient with atypical presentation & Emergency physicians should have a knowledge of various atypical presentations. As missed Myocardial Infarction has dire consequences, continued efforts are required to reduce incidence, overall mortality & morbidity.

Traditionally, post resuscitation phase in the emergency department concentrates on the normalization of easily demonstrable vital signs such as heart rate, mean arterial pressure (MAP) and central venous pressure. The ultimate end point of all resuscitative measures is to achieve adequate tissue oxygenation and perfusion. However, it has been studied that these demonstrable vital signs are poor indicators of tissue level oxygenation and perfusion in the critically ill patients [1,2]. Capnography is measurement of the concentration of carbon dioxide (CO2) at the end of each exhaled breath, commonly known as the end-tidal carbon dioxide (EtCO2). It is a fast, noninvasive, and relatively inexpensive monitoring tool. EtCO2 levels have been shown to be independently predictive of the patient’s clinical status (9). In this study, we aim to record the EtCO2 levels immediately after tracheal intubation and study if the subsequent trends in EtCO2 levels can predict patient outcome in terms of morbidity (length of ICU stay, duration of mechanical ventilation, total duration of hospital stay) and mortality.

Methods and Material: The study was conducted after approval from the institutional Scientific and Ethical committee. It was a prospective observational study; where in data was collected prospectively with no interventions on behalf of the investigator. For the purpose of statistical significance we have chosen to recruit eighty seven patients based on the results and statistical analysis from previous studies. The data collected was analyzed using specified statistical methods to derive association between the various study parameters under consideration.

Statistical analysis used: Based on the results of a previous study (12), the mortality of these patients is (28/36) equal to 0.78, the specificity of EtCO2 for mortality was observed to be 42.8% in the same subjects. Using these values, the sample size for detecting a minimum difference of 4% in specificity is 31, with power 80% and level of significance 5%. For the purpose of our study we choose to recruit a sample size of  Eighty seven.

Conclusions: Based on the results of previous studies and the results of our study it becomes imperative that EtCO2 levels strongly predict survival in patients resuscitated in the emergency department, patients who fail to attain a higher EtCO2 level (average mean 15 mm Hg at 0 min) post resuscitation have poorer outcomes in terms of survival.

Background and Aim: Organophosphates irreversibly inhibit the enzyme acetyl cholinesterase, leading to accumulation of acetylcholine at synapses and myoneural junctions. Present study was done with an aim to assess the severity of organophosphorus compound poisoning both clinically by using Peradeniya scoring, estimating seum cholinesterase levels and to correlate serum cholinesterase levels and Peradeniya OP poisoning scale to predict the need for ventilatory support.

Material and Methods: Present study was a prospective descriptive and intention to treat study conducted at Gujarat Adani Institute of Medical science, Bhuj, Kutch for the period of one year. There were 150 patients of OP compound poisoning admitted to the Department of Medicine during the study period from which 59 fulfilled the inclusion criteria. All patients who presented to emergency department with history of organophosphorus compound poisoning were taken as study subjects. In all study subjects, 3 ml of plain blood was collected on admission before administration of atropine and serum cholinesterase was estimated. Patients were classified as mild (20-50%), moderate (10- 20%) and severe (10%) poisoning based on PChe levels.

Results: Most of patients with moderate (41%) and severe poisoning (100%) according to POP scale expired. (p≤0.05) 84.9% of patients with PChe levels <50% required ventilatory support. Our study showed a highly significant correlation between PChe levels and the need for ventilatory support. Patients with PChe levels <50% had more mortality compared to patients with PChe levels >50%. (p≤0.05). 

Conclusion: pseudo cholinesterase levels were significantly depressed in patients who required ventilatory support and correlated with mortality. POP score of more than 5 correlated in predicting the need for ventilatory support and mortality.

Background and Aim: With the intention of ascertaining the magnitude of the problem and to generate awareness, the All India Ophthalmological Society (AIOS), in 2014, took an initiative to detect the presence of DR among persons with diabetes in eye clinics across the length and breadth of the country. Hence the present study was undertaken with the aim to calculate the frequency of DR in patients with diabetes mellitus.

Materials & Methods: A total of 400 individuals were included in the study. All the patients were suffering from diabetes or were newly diagnosed case of diabetes that had come for the screening of diabetic retinopathy. The patients in whom the posterior segment was not visualized were excluded from the study.

Results: Total of 200 patients were diagnosed with diabetic retinopathy. It means that 50% patients were diagnosed with diabetic retinopathy. Out of the total 200 patients diagnosed with diabetic retinopathy, 55 patients were suffering from proliferative diabetic retinopathy and rest of 145 patients were diagnosed with non proliferative diabetic retinopathy.

Conclusion: The presence of diabetic retinopathy is found to be minimal in less than 5 years of diabetes age. It is more in patients having diabetes of duration 20–25 years and in all patients with duration of diabetes more than 25 years. PDR was found to be present more in patients having DM of longer duration.

Background: Intracerebral hemorrhage (ICH) is a neurological emergency and it is the most severe form of acute stroke, accounting for 15–25% of all strokes, and 50% of stroke mortality [1,2]. The intracerebral hemorrhage complicated by seizures is often a life threatening condition. The subclinical seizures (Electrographic seizure) also gained attention even if they are infrequent, to prevent further ongoing neuronal damage [3]. EEG provides insight into the thalamocortical functions in patients with impaired consciousness and will help to detect the subclinical seizures before clinical manifestation and at the time of reversible stage. Role of prophylactic antiepileptic in ICH is still a matter of discussion. Subclinical seizures are identified with the help of continuous EEG monitoring. The goal of our study is to look for the EEG changes in different ICH locations and identification of electrographic seizures.

Aim: To look for EEG changes in different locations of ICH and to identify the electrographic seizures.

Method: A Retrospective observational study of 46 patients of ICH admitted in Department of Neurology, SAMC and PGI, Indore from January 2012 to March 2017.

Result: Total 16 patients (35%) had EEG abnormalities, 8 of them having abnormal epileptiform activities and rest 8 were having generalized low amplitude fast Beta activity. The electrographic seizures were seen in 4 patients (9%) and all of them having subcortical bleed. Two patient of cortical bleed had clinical seizures and were showing abnormal epileptiform activities in EEG record. Commonest site of ICH in our study was Basal ganglia and commonest cause is hypertension.

Conclusion: The continuous EEG monitoring in ICH patients is cost effective to identify subclinical seizures because they are detrimental to these patients. Our observation suggests it is better to use prophylactic antiepileptic drugs in lobar bleeds.

Background and Aim: Organophosphorus compounds (OPC) outlines a chief significant group airs a probable danger. India being agriculture based country; OPC has made their run fruitfully into agriculture division but at a price of many lives. The aim of current study is to examine the clinical silhouette of intermediate syndrome in patients with OPC poisoning.

Material and Methods: Present cross-sectional study was conducted at Gujarat Adani Institute of Medical Science, Bhuj, Kutch, Gujarat. Thirty Nine patients showing symptoms of Intermediate syndrome are explored largely and builtin in the research. Ventilator support patients are evaluated for the phase on ventilator and growth of ventilator associated pneumonia (VAP). Results of IMS were linked with type of compound, quantum of exposure, period of IMS, and respiratory failure.

Results: Uneven distributions in gender were observed with male dominating the study. Out of 39 OPC exposed patients, about 33 were improved and 06 were died. Out of 39, 15 patients consumed >120 ml of OPC. Of them on management, 9 are enhanced and 6 were expired and this dissimilarity were significant (p≤0.05) Respiratory failure caused significant number of mortality (p=≤0.05).

Conclusion: The occurrence of IMS in organophosphorus poisoning should be recognized in premature stages and cautious management, monitoring and follow up of affected patients are desirable to decrease the demises.

Head injury is a devastating problem worldwide including India. Loss of young people at their productive years is a great emotional and financial concern for the families affected by it which contributes to the economic loss of 3% to GDP [1]. The incidence of head injury shows a rising trend due to urbanization and industrialization. Injury to the head can be either primary or secondary. Primary injury occurs due to the initial processes occurring in neuronal tissue as a result of trauma to brain where as secondary injury is the consequence of further physiological insult [2-3]. Despite of major steps being taken during the “golden hour” to prevent head injury, regrettably secondary brain injuries contributes to a huge number in patients transferred to neurosurgical units [4]. Prognostication in Traumatic Brain Injury (TBI) is a multivariate analysis. Some of these factors are favourable while others unfavourable. Most commonly used factors to predict TBI are age, Glasgow Coma Scale, Pupils, CT findings, hypotension, hypoxia. Few factors like hyperglycemia and anemia are studied to have strongest effect on the outcome of TBI [5-7] However, rest metabolic and neurochemical abnormalities that underlie TBI remains poorly understood. So, the purpose of this study is to correlate few of these parameters in one study in order to generate fruitful results.

Objective of the Study: Primary Objective: To study the effects of these systemic markers of traumatic brain injury on mortality and morbidity of the patient. Secondary

Objective: To predict which amongst these markers has the highest effect on the outcome of the patient.

Methods and Materials: Study was done at Max Superspeciality Hospital, Shalimar Bagh. Patients coming with complaints of traumatic brain injury were included in the study. After obtaining informed consents, all the details of the patients were filled in a data collection forms. All the in hospital events were recorded from July 2015 to March 2017.

Statistical Analysis Used: The data collected was entered in the Excel spreadsheet using Microsoft Excel Software. Then this data was transferred to Statistics Package for Social Sciences (SPSS) version 20, IBM Inc. for analysis. It was subjected to descriptive statistics for calculation of mean, standard deviation, frequencies and percentages. Summarized data  was presented using Tables and Graphs. Shapiro Wilk test was used to check which all variables were following normal distribution. Chi-square test was used for comparison between categorical variables. Therefore, bivariate analyses was performed using the parametric tests i.e Independent ‘ t’ tests (for comparing two groups).

Results: Total number of patients reported to the Emergency Department who fulfilled the criteria of the study during the time period mentioned were 226 out of which 175 agreed and gave consent for the study as the rest did not gave consent for different reasons. Out of 175 who fulfilled the criteria, 127 were males, 48 were females. The purpose of the study was to individually calculate mortality and morbidity of five factors i.e., blood pressure, carbon dioxide levels, serum sodium, serum lactates and temperature and to identify the factor most likely responsible for poor outcome of the patient. The mortality was calculated by the number of deaths in the ICU and morbidity by the length of hospital stay. The abnormal values was the sum of the variables above and below the reference range of  individual marker. The results which we were able to calculate by the study are: 1. Mortality associated with abnormal systolic pressure was found to be 78.8% and morbidity is 88.2% 2. Mortality associated with abnormal diastolic pressure was found to be 51.8% and morbidity is 63.2% 3. Mortality associated with abnormal carbon dioxide levels was found to be 31.7% and morbidity is 63.1% 4. Mortality associated with abnormal levels of serum sodium was found to be 32.1% and morbidity is 36.8%. 5. Mortality associated with abnormal values of serum lactates was found to be 3.8% and morbidity is 84.2% 6. Mortality associated with abnormal temperature range was found to be 8.2% and morbidity is 100%.

Conclusion: The results generated from the study strongly emphasize strict temperature control along with serum sodium and lactate maintenance in a TBI patient with temperature control as the most significant criteria. Although keeping the values of blood pressure and carbon dioxide within limits was important in such patients but the results generated in this study were insignificant. So we drew a conclusion that it is important to quickly chart all the parameters of primary survey in a TBI patient and draw an ABG sample to look for serum sodium and lactate levels so that immediate action may be taken to maintain them in the ED and thereafter in the ICU. The results of all these factors were dependent on patients age, sex, co-morbidities, GCS or CT/MRI findings as all these are found to have a direct affect on the outcome of TBI patients.