RESUMEN
BACKGROUND: Stroke is the fourth leading cause of disability worldwide. The present study was designed to assess functional disability in middle cerebral artery (MCA) territory ischemic stroke patients by applying standard scales for stroke severity, cognitive impairment, disability, dependency and depression. We also wanted to study whether baseline assessment predicts outcome at 1 month. METHODOLOGY: After institutional ethics committee approval, patients were enrolled from the inpatients of the Department of Medicine at Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai from July 2014 to December 2015. Various clinical parameters were recorded on admission. On day 5(±1) the National Institutes of health Stroke Scale (NIHSS), Mini Mental state examination (MMSE) were administered. On 1 month follow up, these were repeated along with Modified Rankin scale, Barthel's index (BI) and Hospital Anxiety and Depression Scale (HADS). Presence of certain risk factors for stroke were reviewed at 1 month. RESULTS: 75 patients were enrolled. There was a delay in reaching the hospital and therefore imaging, in a greater majority. Only 4% could be imaged within the first 3 hours. Mean NIHSS score at day-5 was 9 and at day-30 was 6. Thus it had significantly reduced over 1 month. The MMSE remain unchanged at day 5 and at day 30. Lower baseline MMSE scores correlated with poorer outcomes on NIHSS, BI and mRS at 1 month. Both BI and mRS at 1 month indicated that about 60% of the cases had poor outcome. Amongst 48 of the non-aphasic MCA strokes, 11(22.92%) had depression. An NIHSS score of 6 or above on day 5, predicted poor outcome at 1 month. Presence of aphasia, dominant lobe affection and female sex were associated with a higher disability at 1 month. Around 30% cases had at least 1 risk factor uncontrolled at 1 month follow-up. CONCLUSIONS: Our findings show that disability assessment late in the first week after onset of stroke using NIHSS accurately forecast outcome at one month after onset of stroke. The MMSE too is not expected to change at 1 month. Those with aphasia are expected to have greater disability. Based on or study we recommend that stroke patients should be assessed with NIHSS and MMSE before discharge, to explain the prognosis of the patient. Also more intense counselling on controlling blood pressure and diabetes as well as abstinence from smoking should be undertaken routinely.
Asunto(s)
Isquemia Encefálica/epidemiología , Infarto de la Arteria Cerebral Media/epidemiología , Accidente Cerebrovascular/epidemiología , Humanos , Arteria Cerebral Media , SobrevivientesRESUMEN
Amebic liver abscess is a parasitic disease which is often encountered in tropical countries. A hepatogastric fistula secondary to an amebic liver abscess is a rare complication of this disease and there are only a handful of reported cases in literature. Here we present a case of an amebic liver abscess which was complicated with the development of a hepatogastric fistula. The patient presented with the Jaundice, pain and distension of abdomen. The Jaundice and pain improved partially after he had an episode of brownish black colored increase in frequency of stools for 5 to 6 d. Patient also had ascites and anemia. He was a chronic alcohol drinker. Esophagogastroduodenoscopy performed in view of the above findings. It showed a fistulous opening with bilious secretions along the lesser curvature of the stomach. On imaging multiple liver abscesses seen including one in sub capsular location. The patient was managed conservatively with antiamebic medications along with proton pump inhibitors. The pigtail drainage of the sub capsular abscess was done. The patient improved significantly. The repeat endoscopy performed after about two months showed reduction in fistula size. A review of the literature shows that hepatogastric fistulas can be managed conservatively with medications and drainage, endoscopically with biliary stenting or with surgical excision.
RESUMEN
Background: Acute respiratory distress syndrome (ARDS) is a clinical syndrome of severe dyspnoea of rapid onset, hypoxemia, and diffuse pulmonary infiltrates leading to respiratory failure in the absence of cardiac failure. We did the study to asses various aetiologies of ARDS, to determine the correlation between the diagnostic criteria, mortality predictors, need of mechanical ventilation and the outcome of patients. This was an observational, prospective study in medical intensive care unit (MICU) of a tertiary care hospital, over a period of 15 months. Methods and Material: This study encompassed 116 patients of ARDS admitted to an MICU at a tertiary care centre in Mumbai. We included all consecutive patients with ARDS in this study. We excluded patients with known ischemic heart diseases, valvular heart diseases or in congestive cardiac failure, chronic kidney diseases with fluid overload states and age below 18 years. Results: Males comprised almost 70% (81) of the study population and the presentation was more common in younger age group with total mortality of 57.8% (67 out of 116). Factors attributable for ARDS were malaria in 31 patients (26.72%), pneumonia in 23 (19.82%), sepsis in 20 (17.2%), dengue in 15 (12.96%), undiagnosed fever in 13 (11.1%), leptospirosis in 7 (6.03%), pancreatitis in 3 (2.58%), H1N1 infection in 2 (1.72%), urinary tract infection (UTI) in 1 (0.86%) and UTI with pyelonephritis and Dengue in 1 (0.86 %) patients. Tropical diseases in present study constituted 66 (56.89%) cases of which 31 (47%) died. This difference was statistically found to be significant. Mean PaO2/FiO2 was 178.32 amongst discharged and 127.69 amongst those who expired. Sixty patients had severe LIS, out of which 45 (75%) patients expired, as compared to 56 patients with moderate LIS out of which 22 (39.3%) expired. Conclusion: Tropical diseases like malaria, dengue, and leptospirosis were the main factors responsible for ARDS. LIS, Modified LIS and PaO2/FiO2 ratio predicted outcome as well as need for mechanical ventilation. Renal failure, metabolic acidosis appeared to be good predictors of mortality.