RESUMEN
Introduction: Coronaviruses have been suspected to be associated with neurological manifestations in patients with respiratory tract infections. Corona Virus disease (COVID-19) develop seizures as a consequence of hypoxia, metabolic derangements, organ failure, or even cerebral damage that may happen in people with COVID-19. There is scarce data about the development of seizures after recovery from acute COVID-19 illness, especially in those who have had a mild disease. Case: A thirty three year old male patient with recent history of mild COVID-19 disease, with no known comorbidities, no history of substance abuse, presented with history of transient loss of consciousness. On examination had no lateralising signs, tongue bite was present. Inflammatory markers were found to be raised. MRI brain showed no significant abnormality. EEG done showed bilateral intermittent slowing. Conclusion: Post COVID-19 infection, the post-infectious inflammatory response can give rise to many neurological complication, seizure being one among them, as noted in our patient.
RESUMEN
Background Upper gastrointestinal bleed (UGIB) is a life-threatening condition that presents as hematemesis (fresh blood), coffee-ground vomiting, or melena. Multiple scoring systems are developed to predict different clinical outcomes, which are important to managing UGIB and are essential to determining low and high-risk patients. The study aimed to compare the sensitivity and specificity of risk scoring systems and their optimum cut-off values in the assessment of UGIB. Methods The prospective cross-sectional study included patients (N = 81) with acute UGIB. Four different proposed scores [Glasgow-Blatchford score (GBS), AIMS65, pre-endoscopic Rockall, and full Rockall scoring system] were used for evaluating patients with UGIB. The optimum cut-off values of these risk scores were used to predict the clinical outcomes. Results The AIMS65 score [Area Under the Receiver Operating Characteristic curve (AUROC): 0.91, cut-off: >1, sensitivity: 100%, specificity: 76.62%] and pre-Rockall were similar (AUROC: 0.91, cut-off: >0, sensitivity: 100%, specificity: 93.51%) at predicting mortality. The GBS (cut-off: >9, AUROC: 0.79, sensitivity: 69.23, specificity: 87.50) and AIMS65 scores (cut-off: >0, AUROC: 0.67, sensitivity: 72.31, specificity: 62.5) were good predictors of need for ICU care. Conclusion GBS was superior in predicting categorization into high risk and low risk, and endoscopic intervention, blood transfusion, and intensive care unit (ICU) care in UGIB patients. Pre-Rockall score and AIMS65 score were similar in predicting the mortality rate in UGIB.
RESUMEN
Upper gastrointestinal bleed (UGIB) is a life threatening condition which presents as hematemesis, coffee-ground vomiting or melena. There are multiple scoring systems which have been developed for the same, which predict different outcomes, are important in the management of UGIB and are essential to determine high and low risk patients. AIMS AND OBJECTIVES: To compare the sensitivity and specificity for various risk scoring systems for UGIB and to determine the optimum cut-off values of various risk scoring systems in assessment of patients with UGIB. MATERIAL: 81 patients presenting with acute UGIB to M. S. Ramaiah hospitals between October 2018 to July 2020 were evaluated and Glasgow Blatchford score (GBS), AIMS65, pre-rockall and full- rockall scores were calculated for risk assessment in predicting clinical outcomes such as need for ICU care, blood transfusion, in-hospital mortality or discharge and endoscopic intervention. OBSERVATION: The GBS was the best at predicting mortality with the cut off of >14 (p 0.01, sensitivity 80%, NPV 98.6%) and blood transfusion at a cut-off >6 (sensitivity 97.6%, NPV 94.6%). The GBS and AIMS65 scores of more than 8 (p 0.000) and 1 (p 0.032) respectively were good predictors of need for ICU care. AIMS65 was the best at predicting duration of hospitalisation (p 0.032). CONCLUSION: The GBS was superior in predicting clinical outcomes, categorisation into high risk and low risk and need for blood transfusion. GBS and AIMS65 scores help in predicting the need for ICU care; AIMS65 being a simple score will reduce the cost burden of unnecessary ICU admissions.