Morbid Illness Research Articles

Carbon dioxide (CO2) as an alternative contrast agent in percutaneous transluminal angioplasty procedures for chronic limb-threatening ischemia patients with chronic kidney disease

Background: Chronic limb-threatening ischemia (CLTI) is a very morbid illness that significantly reduces quality of life. The severity of this disease may necessitate revascularization or amputation. Arteriography is frequently performed for the planning of revascularization. Patients with compromised kidney function need alternative contrast agents. CO2 may be utilized in lower extremity vascular diagnostics and intervention, especially in patients at risk for contrast-induced nephropathy (CIN). Case Illustration: An 80-year-old female with bilateral leg pain and leg swelling had an ulcer on her toe for 2 weeks. She had a history of intermittent claudication for 1 year, hypertension for 5 years, kidney stones for 2 years, and chronic kidney disease for 1 year. She underwent an ECG, laboratory, USG, DUS, and CT-angiography examination. From her laboratory result, her initial creatinine was 5.02 mg/dL (eGFR 8 mL/m/1.73 m2). After good hydration, it became 1.28 mg/dL (eGFR 39 mL/m/1.73 m2). After a CT-angiography procedure, her creatinine level was increased (3.7 mg/dL; eGFR 10.9 mL/m/1.73 m2). She was diagnosed with CLTI Rutherford V Fontain 3 left lower extremity. She suggested doing an angioplasty procedure with a safer contrast agent. An angioplasty procedure was done at RSSA Malang with CO2 contrast. After the procedure, her leg pain improved, and her creatinine didn’t elevate. Conclusion: CO2 angiography might be used as a safe alternative contrast medium in patients with CLTI, which benefits the preservation of renal function and prevents limb amputations. Keyword: chronic limb-threatening, chronic kidney disease, CO2 angiography, contrast-induced nephropathy, peripheral artery disease

The hidden threat: subdural empyema strikes a healthy teen

BackgroundThe incidence estimates for intracranial subdural empyema are 0.1 per 100,000 individuals, making it a rare clinical condition. It is a highly morbid and fatal illness that is most commonly the result of a primary infection somewhere else.Case presentationThe authors present a young male patient 15 years presented with 1 week history of headache, fever, confusion and seizure attack with initial negative CT head and nearly negative CSF analysis. With few days he developed left sided weakness. MRI brain showed right temporoparietal subdural fluid collection with midline shift. Urgent neurosurgical evacuation was made and revealed subdural empyema. The boy received combination therapy of vancomycin, ceftriaxone, and metronidazole. The culture of the pus was negative but 16S rRNA gene sequencing (bacterial) revealed streptococcus intermedius. He made a good recovery with no recollection or neurological deficit on follow up.ConclusionThis case highlights the possibility of occurrence of this rare infection in otherwise healthy individuals without obvious precipitating factor. It also indicates the superiority of MRI brain over CT head in detection of subdural collection. The rapid diagnosis and intervention improve the outcome of the patient.

Short-term memory assessment by visual tasks in yoga practitioners and non-yoga practitioners: A comparative study

Background: Memory is the storage of acquired knowledge for later recall. Learning and memory form the basis by which individuals adapt their behavior to their particular external circumstances. Without these mechanisms, it would be impossible for individuals to plan for successful interactions and to intentionally avoid predictably disagreeable circumstances. Yoga unites the individual self with the cosmic consciousness, which can be achieved by pranayama, asanas, and meditation. Aims and Objectives: To compare the short-term memory in yoga practitioners and Non yoga practitioners by visual tasks and to assess by visual tasks, the improvement in short-term memory after applying memory-improving methods in yoga practitioners and non-yoga practitioners. Materials and Methods: 50 female subjects performing yoga at least 5 days a week for the past 3 months with no any morbidities and 50 female subjects as controls with no any morbid illness were selected randomly from the general population for the study. The memory assessment and memory-improving methods were applied as per Washington’s Chudler memory assessments. Results: The present study was conducted in the Department of Physiology at Rajarajeswari Medical College Bengaluru on 50 yoga practitioners and 50 controls aged 20–65 years who volunteered for the study. Short-term memory status by the visual task before and after application of certain memory improvement methods by using four tests i.e. Alphabetical test (six trials), Numerical test (six trials), Words test, and Object test were done and analyzed both for the controls and yoga practitioners. The mean age of controls and yoga practitioners was 37.78 ± 9.83 years and 37.16 ± 9.53 years respectively. There is no significant age difference in between the groups. The P = 0.74 (Student’s unpaired t-test). Short-term memory status in yoga practitioners significantly increased in Alphabetical and Numerical tests in Trials 5 and 6 and also in word and object tests, The P = 0.0001 (analysis of variance test), meanwhile, their short-term memory status were compared before and after the practice of yoga for 3 months. In the present study we found there is increase in the short-term memory of the yoga practitioners when compared to their own memory before and after the practice of yoga. Conclusion: The present study was undertaken to compare the short-term memory status in yoga practitioners and non-yoga practitioners and also to evaluate the use of memory-improving methods to improve the short-term memory in them. On the basis of the study results we can conclude that the short-term memory can be improved by practicing yoga. The study showed an improved memory status when the non-yoga practitioners were compared with yoga practitioners after practicing yoga. The memory-improving methods showed improved memory status in the control group.

CLINICO-ETIOLOGICAL PROFILE OF ATRIAL FIBRILLATION IN A TERTIARY CARE HOSPITAL

Background And Objectives: Atrial Fibrillation is one of the frequently encountered arrhythmia in our population. This also has a significant effect on economic burden to the society by causing both morbidity and mortality. This study is intended to find out the varied presenting symptoms of AF and also possible underlying predisposing factors- cardiac and non-cardiac in Indian context. Methods: This is a cross-sectional study done over 1 year. All patients above the age of 18 with clinically proven new onset AF and hemodynamically stable were enrolled after obtaining their informed consent. Any arrhythmia other than AF or with hemodynamic instability was excluded. All the demographic characteristics, past history, presence of co morbid illness were noted. Basic blood panel with thyroid profile were obtained. Trans thoracic echo with M-mode and colour doppler was done for every patient. The collected data were analysed with IBM.SPSS statistics software 21.0 Version. For descriptive data, frequency and percentage analysis were used. Results: In our study 63% of patients were females. Most common age group was 41-60 years. Rheumatic heart disease was the most common cause of AF in our study, Systemic hypertension was the second most common cause for AF.CAD was seen in 17 cases, diabetes in 22 cases and COPD in 13 cases Breathlessness was the most common complaint followed by palpitation. Cardiac failure was seen in 37 % of cases while ejection fraction was decreased in 29 patients. Uncontrolled heart rate or tachycardia was seen in 49 % of patients. Coming to ECHO findings, increased LVIDd was seen in 30 patients. Regional wall motion abnormality was seen in 15 % of patients in our study group. Increased left atrial size – the most common ECHO finding seen in atrial fibrillation was present in 61 patients while increased right atrial size was seen in 26 patients. Conclusion: Rheumatic heart disease was the most common aetiology followed by dilated cardiomyopathy in our patients. Breathlessness was the most common presentation, complete echocardiographic evaluation is valid in these patients for etiological evaluation and follow up.

Clinical Profile of Patients Admitted to the PICU in a Tertiary Care Teaching Hospital in Bangladesh

Background: Care of critically ill children remains one of the most demanding and challenging aspects in the field of pediatrics. PICU aims at promoting early intervention with an objective of achieving good results and better prognosis. This study was undertaken to know about the clinical profile and outcome of patients admitted in pediatric ICU in a tertiary care teaching Hospital. Objective: To find out the Clinical profile of patients admitted to the PICU of a tertiary care teaching hospital in Bangladesh. Methods: This is a hospital based, retrospective, descriptive study, done on patients admitted to pediatric ICU of Dhaka medical College Hospital from October 2019 -June 2022 (2 years and 9 months). Results: Total 437 patients were admitted in pediatric ICU. According to the age distribution of patients, most 172(39.36%) respondents were aged <1 year. The mean age was 3.55±3.52 years SD. There was a male preponderance 299(68%), females were 138(32%). Patients from rural area were 308(70%) and 129(30%) from urban area. Clinical profile showed that meningoencephalitis was the most common diagnosis 85(19.45%) for admission in PICU. This was followed by pneumonia 75(17.16%), septicemia 39(8.92%), and neurosurgical patient 34(7.78%). Although few percentages, some other diseases were significantly important like GBS, AGN, hepatic encephalopathies, accidental emergencies, Dengue shock syndrome, needed PICU support. The outcome revealed, overall mortality was 92(21.05%), 330(75.52%) were discharged, 9(2.06%) patients went against medical advice, 6(1.37%) patients were referred for specific comorbidities. Use of inotropes, need for mechanical ventilation, and presence of co morbid illness and low level of Glasgow coma scale less than seven were independent predictors of mortality. Conclusions: Mortality is moderate in our PICU. We conclude that a well-equipped intensive care unit with modern and innovative intensive care and appropriate training greatly ..........

Antibiotic Susceptibility of Bartonella Grown in Different Culture Conditions.

Bartonellosis is caused by a Gram-negative intracellular bacterium with a zoonotic transmission. The disease, caused by any of several genospecies of Bartonella can range from a benign, self-limited condition to a highly morbid and life-threatening illness. The current standard of care antibiotics are generally effective in acute infection; these include azithromycin or erythromycin, doxycycline, gentamicin, rifampin, and ciprofloxacin. However, treatment of chronic infection remains problematic. We tested six different antibiotics for their ability to stop the growth of Bartonella sp. in the standard insect media and in an enrichment media. All antibiotics (ceftriaxone, doxycycline, gentamycin, azithromycin, ampicillin, and azlocillin) had minimum inhibitory concentrations (MICs) below 0.5 µg/mL in the BAPGM enrichment media but were ineffective at inhibiting growth when the standard insect media was used. Azlocillin was the most potent, with a MIC of 0.01 µg/mL. When Bartonella was tested under intracellular growth conditions, none of the antibiotics were efficacious singly. However, growth inhibition was observed when azlocillin and azithromycin were combined. These studies illustrate the impact of growth medium and intracellular environment on antibiotic susceptibility testing and indicate that azlocillin combined with azithromycin may be an effective drug combination for the treatment of Bartonellosis.

MO956APPRAISAL OF PSYCHO-SOCIAL BURDEN AND QUALITY OF LIFE OF KIDNEY DONORS- IS THERE A DEEP ROOTEDAPPREHENSION ?

Abstract Background and Aims Living kidney donation is a very complex psychological experience for donor candidates as well as the recipients improving self-esteem and donor-recipient relationships on one hand while may add on to emotional stresses increasing psychic vulnerability and predisposition to the development of mental disorder. The present study aimed to look into psychosocial outcome among donor characteristics and quantification of the psychological impact of kidney donation. Method This was a retrospective random study conducted among 506 renal transplant donors from 2010 till 2018 at Department of nephrology and transplantation at a tertiary care centre in northern part of India. Results Majority of donors were females ie mothers (38.1%) and wife (35.5%). A total of 18.6% developed one or more co morbid illness following transplantation. Most of the donors (98.9%) were motivated by affection and love for the recipient and out of them (89.1%) felt that there were the first choice among the available donors. A majority of them (94.5%) felt that donation had positively affected their relationship and were respected. These donors showed lesser degree of both depressive and anxiety (HAD score 3.5) and depressive score (BDI II 4.8). Donation had upgraded the stature of the donor in the family and recipient which proved statically significant predictor on donor related outcome. Donors well being was dependant on recepients wellbeing and 20% of the donors felt or were made to feel the guilt of the graft failure or a poor outcome. Conclusion The study showed a positive acknowledgement for the donors from the recipients and society thus giving a meaning to life Need of the hours is greater post donation monitoring as well as due recognition among donors which can improve long term donor outcomes.

MO949APPRAISAL OF PSYCHO-SOCIAL BURDEN AND QUALITY OF LIFE OF KIDNEY DONORS- IS THERE A DEEP ROOTED APPREHENSION

Abstract Background and Aims Living kidney donation is a very complex psychological experience for donor candidates as well as the recipients improving self-esteem and donor-recipient relationships on one hand while may add on to emotional stresses increasing psychic vulnerability and predisposition to the development of mental disorder. The present study aimed to look into psychosocial outcome among donor characteristics and quantification of the psychological impact of kidney donation. Method This was a retrospective random study conducted among 506 renal transplant donors from 2010 till 2018 at Department of nephrology and transplantation at a tertiary care centre in northern part of India. Results Majority of donors were females ie mothers (38.1%) and wife (35.5%). A total of 18.6% developed one or more co morbid illness following transplantation. Most of the donors ( 98.9%) were motivated by affection and love for the recipient and out of them (89.1%) felt that there were the first choice among the available donors. A majority of them (94.5%) felt that donation had positively affected their relationship and were respected. These donors showed lesser degree of both depressive and anxiety (HAD score 3.5) and depressive score (BDI II 4.8). Donation had upgraded the stature of the donor in the family and recipient which proved statically significant predictor on donor related outcome. Donors well being was dependant on recepients wellbeing and 20% of the donors felt or were made to feel the guilt of the graft failure or a poor outcome. Conclusion The study showed a positive acknowledgement for the donors from the recipients and society thus giving a meaning to life Need of the hours is greater post donation monitoring as well as due recognition among donors which can improve long term donor outcomes.

Trans-oral endoscopic assisted radio-frequency for adenoid ablation; A randomized prospective comparative clinical study

ObjectiveThis study compared the efficacy and safety of conventional adenoidectomy using a curette and the Radio-frequency (RF) adenoid ablation using endoscope via the trans-oral technique. MethodsA randomized prospective comparative study was conducted in a tertiary care hospital. The study included 80 patients with a diagnosis of adenoid hypertrophy, which was confirmed by X-ray of a lateral view of the skull. The patients were submitted into two groups 40 for each: curettage group and Radiofrequency group. Patients with bleeding diathesis, congenital anomalies, previous adenoidectomy, and morbid illness were excluded from the study. We evaluated the time consumption, the adenoid tissue remnant by the endoscope, blood loss, and clinical correlations like pain by Visual Analog Scale, halitosis, and secondary bleeding in both study groups. ResultsIntra-operative blood loss was 20–40 ml in the Radio-frequency (RF) group, but in the curettage group was 36 – 55 ml. Post-operative pain in the (RF) group was lower than the curettage group. Secondary bleeding was reported mostly in the curettage group (15%). The duration of the operation in (RF) group was relatively long. Halitosis decreased mainly after curettage adenoidectomy. ConclusionThe endoscopic radio-frequency adenoid ablation surpassed the conventional method. We encourage using Radio-frequency in adenoid surgery as a replacement for the traditional method.

The study of Cellulitis in non-diabetic

Lower limbs are commonly involved in cellulitis as they are more susceptible to injuries. This study analyzes the various causes and risk factors for cellulitis in the non-diabetics. Methods: This prospective study was conducted at the Department of General Surgery, Navodaya Medical College and included 100 non-diabetic patients with cellulitis. The severity of cellulitis was graded as per the CREST guidelines. Demographics, risk factors, grades, management and treatment outcomes were recorded and analyzed.Results: Cellulitis was more common in females (56%) and old age group (39%). It was more unilateral (87%) and resulted more from post bite wounds (22%). 76% had culture-positive wound infections. Severe grades of cellulitis needed surgical intervention and many patients needed skin grafting.Conclusions: Non diabetic patients with lower limb cellulitis can also result in severe morbid consequences but in the absence of co-morbid illness, they usually recover with minimal residual disabilities. Non diabetic elderly patients have to be motivated to take care of their feet as the diabetic patients, as neglect of minor trauma or bites can lead to morbid illness necessitating major treatment like skin grafting.

Evaluation of Mean Platelet Volume Level as a Biomarker in Acute Appendicitis

Background: Acute appendicitis is one of the important causes of emergency surgeries. Diagnosis of acute appendicitis remains to be challenging with up to 30% negative exploration rates. In addition to careful clinical history and physical examination, we still need easily applicable, cheap and effective biomarker. Complete blood count is the primary investigation for any inflammatory condition. Total WBC count and neutrophil percentage are widely used biomarkers to diagnose acute appendicitis. Mean platelet volume (MPV) is an emerging biomarker that has been considered to be affected by inflammatory burden. MPV value is also estimated during complete blood count. This study may help to reveal the change of MPV in acute appendicitis.
 Study design: This was a prospective observational type of study.
 Study setting and period: The study was carried out in the Surgery In-patient Department of Dhaka Medical College Hospital, Dhaka from 15-11-2013 till 15-04-2014.
 Materials: A total of 150 patients of both sex aged 15-65 years who got admitted in the surgery department for acute appendicitis were selected. Pediatric patients (aged less than 14years), patients with co morbid illness like ischemic heart disease, inflammatory bowel disease, general peritonitis and the patients having lack of necessary investigations were excluded from the study.
 Methods: The variables like total WBC count, neutrophil percentage, platelet count and mean platelet volume (MPV) of all 150 selected patients were noted after admission by doing complete blood count and compared with normal value. The appendix samples obtained after surgery were sent for histopathological confirmation and reports were collected.
 Results: A total of 150 patients with the mean age of 25.72 (ranging 15-65) years were studied. Among them 93(62%) were male and 57(38%) were female. Mean MPV value was 11.7 ± 0.183 fL (p value 0.02). 122 patients have increased MPV value (81.33%). Among them 113 were eventually diagnosed as acute appendicitis. Negative exploration rate was 14%.Negative exploration was less among MPV raised patients (7.38%). Whereas negative exploration was more among normal MPV patients (21.42%).Total WBC count and neutriphil percentage are important biomarkers to diagnose acute appendicitis which is accepted. However this study revealed MPV value is an important biomarker in acute appendicitis also which is statistically significant and can reduce negative exploration.
 Conclusion: In this study mean platelet volume increases in acute appendicitis. MPV can be used as a biomarker in diagnosis of acute appendicitis.
 Journal of Surgical Sciences (2018) Vol. 22 (2) : 83-88

Effectiveness of Ice Compress Application upon the Level of Pain among Patients with Chest Drainage

Effectiveness of Ice Compress Application upon the Level of Pain among Patients with Chest Drainage

Paediatric Asthma associated with passive smoking and garbage burning: A case report from Kedah, Malaysia

Background Combatting with childhood asthma is a global challenge. Exposure to allergens, air pollutants, tobacco smoke, cold air, viral infection, and family history, are the few major causative factors for asthma. An eleven years old boy from Kedah, Malaysia, had the first asthmatic attack at the age of eight. Possible causes behind the development of his asthmatic attack include passive smoking, environment pollutant created by open residential burning of rubbish practiced by his family members, repeated exposure to allergens such as pollen, house dust mite, animal dander, and eczema. The patient has been treated with inhaled salbutamol BP (100μg/day), oral montelukast Na (5 mg/day) and mometasone furoate (55mcg. once daily). In conclusion, episodes of asthmatic attacks were mainly correlated with passive smoking & burning garbages. Comprehensive approaches such as health education, avoidance of the allergen, cleaning, and maintaining these practices can prevent the development of this morbid illness.

Mortality profile of confirmed cases of swine flu attending a tertiary care center of Udaipur region of Rajasthan, India

Background: Mortality profile is an analytical tool used to identify the various factors responsible for poor outcome of disease and it can also use to evaluate quality and efficiency of healthcare providers. The aim of this study is to summarise the clinical and epidemiological factors as well as to identify the risk factors associated with mortality among swine flu cases.Methods: It is a cross-sectional, descriptive, hospital-based study conducted on 62 deceased patients due to swine flu reported at Maharana Bhupal Government Hospital, Udaipur, Rajasthan during the outbreak of influenza A H1N1 in the year 2015. A standardized pre-structured questionnaire with consent was filled by help of bed head tickets and by interview of attendants of deceased patients.Results: Deaths were higher among age group of 31-45 years (35.48%). Case fatality rate for male patients (13.88%) was higher. Mortality was highest in females of rural background 27(43.55%). Majority of deceased patients (70.97%) had delay of 4-7 days in admission after onset of symptoms. Diabetes, cardiovascular diseases and pregnancy was the major risk factors for poor outcome.Conclusions: Delay in diagnosis and admission may be the reason for higher mortality rate. The most common co morbid illness was Diabetes mellitus, cardiovascular diseases (Ischemic heart disease, Rheumatic heart disease, Hypertension) and pregnancy.

Emerging Resistance in Cases of Septicemia with Special Reference to Vancomycin

Introduction: Blood Stream Infections increase the mortality rate, prolonging hospital stay in ICU, posing a challenge to the skill of not only the clinician but also to the microbiologist. Easy availability and indiscriminate use of antibiotics is leading to antimicrobial resistance. Objective: To review the spectrum of organisms isolated and their antibiotic sensitivity pattern in the Intensive Care Unit to minimize the risk of morbidity and mortality. Method: 235 suspected cases of septicemia from ICU were taken; co morbid illness and outcome were noted. Blood culture and their antibiotic susceptibility profile were done. Results: Of the 235 suspected cases, 47 (20%) were culture positive with Gram Negative Organisms predominant (70.21%) over Gram Positive Organism (27.65%). Klebsiella species was the most common organism isolated (38.29%). Of the 13 GPC, 38.46% cases showed Vancomycin resistance. Conclusion: Gram Negative Organisms were most common etiological agents with Klebsiella being most predominant. The rate of Vancomycin resistance from isolated organisms was high. Mortality rate was high (17.02%).

GCS score and MRI grading does not predicts the outcome in dai patients - a prospective study

Abstract Diffuse axonal injury (DAI) is a type of brain injury due to extensive lesions in white matter tract occurring over a wide area. It is one of the most common and devastating types of traumatic brain injury and major cause of unconsciousness and persistent vegetative state after head trauma. DAI occurs in about half of all cases of severe head trauma. The study was undertaken to correlate the GCS at time of admission and Grade of DAI with the outcome. Aim: - To correlate GCS Score and MRI grading with the outcome in DAI patients. Setting and Design: - A 3 months prospective study was conducted in Department of Neurosurgery. Material and Method: - Sources of Data: - Patients admitted with clinical diagnosis of Diffuse Axonal Injury under Department of Neurosurgery. Sample size: - 50 cases of Diffuse Axonal Injury. Inclusion Criteria: - All traumatic DAI Patients requiring ICU care. Exclusion Criteria: - Head injury patients requiring Surgery. Patients other findings on imaging as contusion, EDH, SDH, IVH.Patients with Sepsis. Patients with other co morbid Illness as DM, Hypertension. Patients who were haemodynamically unstable at the time of admission. Patients with other systemic injuries. Statistical Analysis. Data so collected was analysed using IBM SPSS Statistics Windows, version 20.0 (Armonk, NY: IBM Corp) for the generation of descriptive and inferential statistics. The statistical significant difference among age groups was determined by Chi square test and one way analyses of variance. The level of significance was set at p˂0.05. Results: Distribution of patients according to Gender and MRI Grading shown in Table 1. Total 50 patients were evaluated out of which 38 (76%) were male and 12 (24%) were female. Number of patients according to Grading [Table 2 and Fig. 1] Out of 50 patients admitted 10% (5) constitutes Grade 1 DAI, 28% (14) grade II, and 62% (31) Grade III. Grades of DAI according to age of patients [Table 3]. Mean age in Grade I patients was 20.83±3.63, Grade II 23.36±7.089 and in Grade III 22.32±11.38. Comparisons of Mean ICU stay Mean Hospital stay and Mortality in Different GCS Groups [Table 4]. In patients with GCS 3-8 the mean ICU stay was 18.48±14.53, mean hospital stay was 37.24±12.31 and Mortality was 15.21%, in patients with GCS 9-12, mean ICU stay was 10.5±4.12, Hospital stay 19.4±5.79 and mortality was 25%. Comparison of Mean ICU stay, and Ventilator stay in different MRI Grade [Table 5]. In patients with Grade I DAI Mean ICU stay was 17.13±14.65 and Mean Ventilator stay was 6.24±2.57, In Grade II DAI mean ICU stay was 20.57±15.45 and Ventilator stay was 12.01±3.82 and in Grade III mean ICU stay was 23.4±15.41 and mean Ventilator stay was 10.89±2.58. Mortality of patients in different Grades and GCS groups [Table 6 and Fig 2] In patients with GCS 9-12 and Grade III only 1 patient died, while in patients with GCS 3- 8 total 7 died, 2 in Grade I, 2 in Grade II and 3 in Grade III. Complications [Table 7] Out of 5 patients in Grade I, electrolyte imbalance was seen in 1 patient in the form of hypernatraemia, 1 patient developed seizure, and septicaemia was seen in 1 and 1 patient developed shock. In patients with Grade II DAI out of 14 patients 1 had ventilator associated pneumonia, hypernatraemia was seen in 1, 1patient developed bed sore, seizures seen in 3, 2 had septicaemia & shock was seen in 2, and in 1drug reaction occurred. Out of 31 patients with Grade III DAI 2 developed ventilator associated pneumonia, hypernatraemia and hyponatraemia was seen in 2 & 1 patient respectively, 2 developed bedsore, seizure in 1 and septicaemia and shock was seen in 3-3 patients. Conclusion:-Diffuse axonal injury is a very common finding in traumatic head injury patients. Magnetic resonance imaging and GCS scoring does not have appropriate prognostic value in pure DAI patients and a better survival rate can be achieved with dedicated neurocritical care and neurosurgical management.

Lower limb cellulitis in non-diabetic patients: a prospective study

Background: Lower limbs are commonly involved in cellulitis as they are more susceptible to injuries. This study analyzes the various causes and risk factors for cellulitis in the non-diabetics.Methods: This prospective study was conducted at the Department of General Surgery, Government Thanjavur Medical College and included 100 non-diabetic patients with lower limb cellulitis. The severity of cellulitis was graded as per the CREST guidelines. Demographics, risk factors, grades, management and treatment outcomes were recorded and analyzed.Results: Cellulitis was more common in females (58%) and old age group (37%). It was more unilateral (86%) and resulted more from post bite wounds (21%). 76% had culture-positive wound infections. Severe grades of cellulitis needed surgical intervention and many patients needed skin grafting.Conclusions: Nondiabetic patients with lower limb cellulitis can also result in severe morbid consequences but in the absence of co-morbid illness, they usually recover with minimal residual disabilities. Nondiabetic elderly patients have to be motivated to take care of their feet as the diabetic patients, as neglect of minor trauma or bites can lead to morbid illness necessitating major treatment like skin grafting.

A prospective observational study of prescription appropriateness of elderly hypertensive patients using Beers criteria in a tertiary care teaching hospital

Background: The prevalence of hypertension has been increased among the urban population especially among the elderly. Use of inappropriate medication is one of the major problems seen among elderly age group above 60 years who take more medication when compared to that of younger population. Inappropriate prescriptions can be avoided by identifying safer pharmacological alternatives and also utilizing non-pharmacological therapy. Quality and safety of prescribing in elderly patients is one of the global healthcare concern and efforts should be made to improve appropriateness of medication among this group of population. This study was done to assess the relationship between inappropriate medication use and its health outcomes in elderly hypertensive population.Methods: A prospective observational study was conducted over a period of 3 months, after getting approval from Institutional Ethics Committee. Total of 117 elderly hypertensive patients aged >60 years were analysed for three months duration for the rationality of medication prescribed using Beer’s criteria and the health outcome due to inappropriate medication use.Results: Out of 117 elderly hypertensive patients analysed, 49 (41.9%) were males and 68 (58.1%) were females. Most of the patients had associated co morbid illness like diabetes mellitus (48.7%), respiratory diseases (24.8%), cerebrovascular accident (30.8%), cardiovascular diseases (19.7%), fever (13.7%), anaemia (9.4%), etc. Out of 117 patients <5 drugs were used in 6.8%, 5 -10 drugs were used in 89.7% and >10 drugs were used in 3.4% of cases. Antihypertensive drugs that were commonly used in our study was calcium channel blocker (52.1%), diuretics (42.7%), Angiotensin converting enzyme inhibitors (36.8%), β-blockers (17.1%) and Angiotensin receptor blockers (11.1%). Adverse health effects like drug induced gastritis, electrolyte imbalance, metabolic dysfunction and renal impairment was seen in few patients because of inappropriate medication.Conclusions: Use of inappropriate medication is one of the major problems seen among elderly, because of the co morbid illness associated with the primary disease which leads to polypharmacy. Prescription inappropriateness was seen among 86.3% of elderly hypertensive patients as per Beers criteria which may be because of comorbid illness that was seen among these patients. It is necessary to implement certain policies in geriatric healthcare to prevent the poor outcome due to drug therapy.

Impact of early FDG-PET directed intervention on preoperative therapy for locally advanced gastric cancer: A Cooperative Group random assignment phase II study (Alliance A021302) Impac.

TPS4135 Background: Gastric cancer is a prevalent and morbid illness for which new treatment strategies are needed. Peri-operative therapy is a standard approach that is associated with only a 15% improvement in overall survival. Early FDG-PET scanning, performed prior to cycle 2, can distinguish patients (pts) responding to chemotherapy from those who are not. FDG-PET non-responding pts have poorer survival. This study addresses the question of salvage therapy in pts who are PET non-responders. Specifically, does salvage chemotherapy with docetaxel /irinotecan improve pt survival in FDG-PET-nonresponding pts with locally advanced gastric cancer. Methods: This is a multicenter, cooperative group, NCI supported, randomized phase II study of salvage chemotherapy + surgery versus surgery and post-operative chemoradiotherapy in pts who are FDG-PET non-responders (defined as a decrease in SUVmaxof the primary tumor of less than 35%). A total of 176 pts with locally advanced, resectable gastric cancer who were FDG-PET non-responders to cycle 1 of platinum/capecitabine based chemotherapy will be randomized in a 1:1 manner to receive either (Arm A) surgery followed by fluoropyrimidine-sensitized radiotherapy (4500 cGy), or (Arm B) salvage chemotherapy with docetaxel / irinotecan (DI) for 2 cycles followed by standard resection and 3 cycles DI post-operatively. DI is administered as D 30 mg/m2, I 50 mg/m2 given on D1, D8 of a 21 day cycle. 416 pts will be screened to yield 162 non-responders (81 FDG-PET non-responders per treatment group). With expected 120 events, the study will have 80% power to detect a hazard ratio of 0.625 for improved survival at the one-sided significant level of 0.15. Pts will be required to provide tissue at the time of resection, as well as whole blood prior to resection for correlative studies associated with platinum sensitivity, FDG avidity, and prognostic markers. This study is available through all cooperative groups (SWOG, ACRIN/ECOG, Alliance, and NRG) and the National Clinical Trials Network. Enrollment began in November 2015. Support: U10CA180821, U10CA180882; Clinical Trial Information: NCT02485834 .

The association between implementation strategy use and the uptake of hepatitis C treatment in a national sample

BackgroundHepatitis C virus (HCV) is a common and highly morbid illness. New medications that have much higher cure rates have become the new evidence-based practice in the field. Understanding the implementation of these new medications nationally provides an opportunity to advance the understanding of the role of implementation strategies in clinical outcomes on a large scale. The Expert Recommendations for Implementing Change (ERIC) study defined discrete implementation strategies and clustered these strategies into groups. The present evaluation assessed the use of these strategies and clusters in the context of HCV treatment across the US Department of Veterans Affairs (VA), Veterans Health Administration, the largest provider of HCV care nationally.MethodsA 73-item survey was developed and sent to all VA sites treating HCV via electronic survey, to assess whether or not a site used each ERIC-defined implementation strategy related to employing the new HCV medication in 2014. VA national data regarding the number of Veterans starting on the new HCV medications at each site were collected. The associations between treatment starts and number and type of implementation strategies were assessed.ResultsA total of 80 (62%) sites responded. Respondents endorsed an average of 25 ± 14 strategies. The number of treatment starts was positively correlated with the total number of strategies endorsed (r = 0.43, p < 0.001). Quartile of treatment starts was significantly associated with the number of strategies endorsed (p < 0.01), with the top quartile endorsing a median of 33 strategies, compared to 15 strategies in the lowest quartile. There were significant differences in the types of strategies endorsed by sites in the highest and lowest quartiles of treatment starts. Four of the 10 top strategies for sites in the top quartile had significant correlations with treatment starts compared to only 1 of the 10 top strategies in the bottom quartile sites. Overall, only 3 of the top 15 most frequently used strategies were associated with treatment.ConclusionsThese results suggest that sites that used a greater number of implementation strategies were able to deliver more evidence-based treatment in HCV. The current assessment also demonstrates the feasibility of electronic self-reporting to evaluate ERIC strategies on a large scale. These results provide initial evidence for the clinical relevance of the ERIC strategies in a real-world implementation setting on a large scale. This is an initial step in identifying which strategies are associated with the uptake of evidence-based practices in nationwide healthcare systems.