Indian Journal of Emergency Medicine

According to the rules of Medical Council of India and the National Board of Examinations, a student before being permitted to appear in the examination for the degree of MD/DNB in emergency medicine, is required to submit a dissertation as a proof of having undertaken a research of high order under the guidance of a recognized postgraduaute teacher during the period of training at the institute. The board of examiners appointed by the institute evaluate the research work which is submitted as thesis or dissertation. Thesis writing has evolved from simple reseach to a more comprehensive scientific writing with major emphasis on clinical and statistical content. We attempt to present the intricacies in writing scientific literature and expect that this information is useful to the postgraduate students. This review does not talk about how to conduct a study. However, we have hinted on them at few places to clear the common doubts.\

 Digoxin is a cardiac glycoside used widely in India for the treatment of heart failure and atrial fibrillation. Despite the apprehension of its use abroad, it continues to be a drug used extensively in our country when symptoms of heart failure remain despite use of other drugs. Digoxin toxicity can occur after an acute overdose or as a result of long-term therapy. It is also known to occur when serum digoxin levels are well within the therapeutic range owing to a variety of factors discussed below. Digoxin toxicity can present as almost any cardiac arrhythmia except rapidly conducted atrial dysrhythmias. Premature ventricular contractions and rarely, bidirectional ventricular tachycardia have be seen in this toxicity. Here we have reported a case of a 58 year old female, known case of RHD – post MVR with severe LV dysfunction presenting to the Emergency Department with progressively worsening palpitations and multiple epsiodes of vomiting over 1 day. On initial ED evaluation; patient was hypotensive and initial ECG was suggestive of first degree heart block. During further evaluation while in the ED; patient developed a wide complex regular tachycardia (Monomorphic VT) which was aborted only after DC cardioversion.

 Background and Objectives: Portal hypertension (PHT) commonly accompanies cirrhosis of liver. Development of esophageal varices is one of the major complications of PHT. Present study was performed with objectives to study clinical profile of patients admitted with liver cirrhosis, to study endoscopic findings of patients having portal hypertension and liver cirrhosis and to study hematological abnormalities associated with liver cirrhosis and its correlation with endoscopic findings. Material and Methods: A retrospective study was conducted at tertiary care centre over the period of 7 months which includes 40 patients with liver cirrhosis and portal hypertension and who had undergone gastroduodenoscopy. Study variable were anemia, thrombocytopenia, leucopenia. Esophageal varices were grades according to Westaby and colleagues grading system proposed in 1984, based on the luminal occupancy of esophageal varices, which has been endorsed by the British Society of Gastroenterology in its guidelines. Results: The most common hematological abnormality was prolongation of prothrombin time followed by anemia. Leucopenia was the least common while thrombocytopenia was present in more than half of the patients. The age range was from 16 to 80 yrs. with mean age of 44.2 years. Most common finding on clinical examination was pallor followed by splenomegaly. Conclusion: The Cirrhotic patients with normal hemoglobin or only mild anemia can be closely followed up and wait for endoscopy being at a low risk for variceal bleeding, especially in financially deprived countries andresource limited setting.

 Background and Aim: Magnesium monitoring among critically ill patients have prognostic and therapeutic implications as they are predisposed to symptomatic and asymptomatic magnesium deficiency which may lead to the development of neurotoxicity, psychiatric problems and leading to increased morbidity and mortality. Hence the aim of the present study was to study the serum magnesium levels in critically ill patients. Materials & Method: Total of 120 cases was included in the study. They were divided into two groups: cases were 60 and controls were 60. The serum magnesium of the included patients was estimated with Colorimetry method. Results: Among the 60 cases, it was found that 45 patients were males and the remaining 15 were females. Among the 60 controls, 45 patients were males and 15 were females. Among the cases, 18 patients had diabetes mellitus whereas 12 patients out of 60 controls had association of diabetes mellitus. In our present study, the mortality rate was higher in cases i.e 30% as compared to 2% in controls. Conclusion: Hypomagnesemia is common in hospitalized patients, especially the critically ill. It has a higher morbidity and mortality among these patients. The assessment of serum magnesium concentration is inexpensive and easy to employ and provides important information about magnesium status in patients. Hypomagnesemia, when detected, may require correction for the management of those with critical illness for better outcomes.

 Objective: To find the effectiveness of FFP transfusion on INR values in Chronic Liver Disease patient with deranged INR. The aim of this study is to find the usefulness of FFP transfusion before emergency invasive procedure in chronic liver disease patients with deranged INR in emergency department. Materials and Methods: This is a prospective observational study conducted in a total of 62 chronic liver disease patients with CHILD C grade with deranged INR who require emergency invasive procedure like central line insertion. Pre and post transfusional INR measured and mean improvement in INR calculated. Relationship between pre transfusional INR and improvement in INR per FFP was studied using Pearson correlation coefficient. Results: The mean improvement in INR was 0.55 (standard deviation 0.88). The correlation coefficient between pre and post transfusional INR was 0.50 and significance is 0.000. The linear relationship was noted between pre transfusional INR and improvement in INR per unit of FFP. Conclusion: FFP transfusion before emergency invasive procedure in chronic liver patients with deranged INR is effective in reducing INR values to some extend but not effective in normalisation of INR value.

 Background: Pulmonary thromboembolism (PTE) is a major health problem with significant mortality and morbidity. Although rapid advances have taken place in the diagnosis and management of VTE, PE is still an underreported entity from India. We are intended to study various clinical presentations with suspected pulmonary embolism and evaluate the abnormalities in investigations. Method: The present study is prospective and observational study, being carried out on suspected cases of pulmonary embolism. All patients admitted during the study period taken as a sample who fulfills inclusion and exclusion criteria. Result: Male preponderance (66% cases are male as compared to 34% females) with increased prevalence of pulmonary embolism after the age of forty years. Dyspnea (92%) is the most common presenting symptom followed by chest pain and cough (44% of patients). Hemoptysis was present in 16% of the patients. Most common ECG abnormality in our patients was sinus tachycardia (88%). On CT pulmonary angiography thrombi were found in lobar and segmental branches of pulmonary artery in 90%. Conclusion: Early recognition and aggressive and appropriate therapy improves outcome in this potentially fatal condition. Prevention of VTE in high-risk cases by lifestyle modification and early ambulation in hospitalized cases especially in Indian setting should be universally practiced. More emphasis need to be given on the high index of suspicion, early and appropriate diagnostic tests, prompt therapy, and preventive measures to improve the outcome in VTE patients.

 Aims and objective: Poisoning is a major problem all over the world, although its type and the associated morbidity and mortality vary from country to country. The nature of poison used varies in different parts of the world and may vary even in different parts of the same country depending on the socioeconomic factors and cultural diversity. We conducted this study to see clinical spectrum and in hospital-mortality of acute poisoning cases among adults presenting to our emergency. Material and methods: This prospective study was conducted in patients of acute poisoning admitted in the emergency wing of our hospital. A total of 540 patients fulfilled inclusion criterion. Cases were reviewed prospectively by a specially designed data collection form which was used to collect the detail of patient’s age, sex, type of poison, method/mode of poisoning and in-hospital mortality among acute poisoning cases either referred or reported directly. Results: Out of 540 patients in the study, 315 were male and 225 were female, most cases of acute poisoning comprised of young population ranging from 16 to 35 years, majority of cases were from urban areas and were married. Majority of patients were educated and were students. Circumstances leading to acute poisoning were intentional in majority. Route of administration was oral in 98%. A total of 52 people died due to acute poisoining with case fatality rate of 9.63%. Conclusion: Acute Poisoning is not uncommon in our region. Mostly young peoples are victims of poisoning. Establishment of a poison control center in the region will help in preventing and controlling such poisoning events.

 Background: Frequent outbreaks of dengue, malaria, typhoid, and influenza are very common in India, especially during the monsoon season. This study aimed at analyzing the cause and outcome of such febrile cases admitted in a tertiary care private hospital of Kolkata, India. Methods: An audit of patients (N=840) admitted to the hospital with fever was carried out from June to November, 2017 and were studied for diagnosis and clinical outcome. Data were collected, analyzed and documented using Microsoft Office Excel 2007 version. Results: Dengue was the most common infection accounting for 78.3% of all cases, followed by Influenza (8.2%) and Scrub typhus (6.5%). A total of 14 deaths occurred during the outbreak; mortality was higher among females (57.1%) and in patients with scrub typhus (8.3%). Discussion: This study confirms the need of including scrub typhus screening test in the fever panel. Studies assessing the prevalence and outcomes of scrub typhus must be done in Indian hospitals to understand the morbidity and mortality patterns better.

 Background: Haemoglobin E (HbE) is the commonest haemoglobin variant in South East Asia and second most common globally. In India, high prevalence has been reported from the North eastern states and from Bengal. Data regarding the same from Sikkim is scarce. Methodology: After approval from the Institutional Ethics Committee, a hospital based observational cross sectional study was carried out for a period of two months in the Department of Medicine and Department of Pathology of a tertiary care hospital of East Sikkim, Gangtok. The objective was to screen patients of ethnic groups suspected to have HbE (those presenting with haemoglobin less than 10.5 gm/dl and having Red Cell Diffusion Width more than 15 and Mean corpuscular haemoglobin less than 27 pg). Patients with anaemia due to blood loss or iron deficiency were excluded. Results: Out of 1739 patients screened, 46 fulfilled the inclusion criteria. After obtaining informed consent from the participants, Complete Blood count and electrophoresis was performed in these cases. The mean age was 31.5+3.9 yrs, 26 were females and 20 were males. No case of HbE was detected. Except for the haemoglobin level, all other indices did not show any significant difference between the two sexes. Conclusion: This was a hospital based pilot study and as HbE maybe asymptomatic, cases might have been missed. A larger population based screening is required to know the actual burden of HbE in Sikkim. 

 Background: Trauma is a leading cause of mortality and morbidity globally. In our country more than a million are injured and killed in road traffic accidents. This study aimed to describe the different pattern of injuries of patient attending the emergency department. Objective: An epidemiological study on road traffic accident victims presented to emergency department of Amrita institute of medical sciences and research centre. Methodes: A total number of 95 patients were enrolled in the study. A pre- organized data sheet was prepared for each patient attended the emergency department of amrita institute of medical sciences. It contains data about socio-demographics, trauma data, clinical evaluation result as well as treatment strategies. Results: Most (22.1%) of the patients were aged between 20-30 years. The mean age of the patient was 35.8 years. There were 76 Males (83%) and 19 females (18%). More than half of the patients were from urban areas. Most patients (57.8%) are injured by two wheelers. 16 patients did not wear helmet, in which 8 patients (50%) had head injury. Most road traffic accidents are occurs in between 8-10 am. Conclusion: Trauma is a major health problem, especially in the young population in our country. Two wheelers are the commonest vehicle involved in the road traffic accidents. Trauma is a leading cause of morbidity and mortality among all age groups and injuries from road traffic accident is the most common cause of disability in the developing world.