Clinical and investigational study for the aetiological evaluation of patients in nontraumatic altered sensorium and its outcome

Background: Apart from head injury many patients present to the tertiary care hospital in unconscious state, the etiology of which is obscure in most of the cases. The present study was conducted with on objective to provide insight into the clinical features and diagnostic methods to know the aetiology of patients with non-traumatic cases of altered sensorium and to study the outcome of these patients.Methods: This is an observational study on 100 patients of altered sensorium of non-traumatic origin during the period from October 2012 to September 2014 conducted in the Department of General Medicine, MKCG Medical College Hospital, Berhampur, Odisha, India. All patients were selected for the study based on the inclusion exclusion criteria. Detailed history, clinical evaluation, laboratory investigations like neuroimaging studies etc. were carried out. Statistical data analysis was done using Graph pad Prism 6 and Microsoft Excel. P value <0.0001 was considered statistically extremely significant.Results: Out of 100 patients of altered sensorium, 64 were males and 36 were females. All patients were in the age group of 19 to 89 years. Cerebrovascular accident was the most common aetiology of altered sensorium followed by metabolic encephalopathy and infection. Altered sensorium in patients with CVA carries a high mortality. Metabolic causes and younger age indicated a better prognosis, patients with low (Glasgow Coma Score) GCS score of 3 to 4 had poorer prognosis.Conclusions: The results suggest that clinical assessments yield accurate predictive information about the potential for recovery in cases of altered sensorium. So, this study concludes that empirically based estimates of prognosis in the neurologically severely ill provides great reassurance to those involved in a decision-making process, including patients’ families and physicians

Transition metal-free synthesis of &#945;-ketoamides from arylmethyl ketones and alkylphosphoramides

A transition metal-free protocol has been developed for the synthesis of &#945;-ketoamides from aryl methyl ketones and alkylphosphoramides in the presence of oxidant, aqueous Tert-butyl Hydroperoxide (TBHP). A series of aryl methyl ketones having both electron-donating as well as electron-withdrawing groups were successfully employed for the synthesis of their corresponding &#945;-ketoamides using hexamethylphosphoramide and other alkylphosphoramides

ROLE OF RETICULOCYTE HEMOGLOBIN CONTENT IN DIAGNOSIS OF IRON DEFICIENCY ANEMIA

Objectives: Anaemia is a global problem of immense health significance affecting persons of all ages and economic groups. Iron deficiency anaemia (IDA) is the most common type of anaemia met with in clinical practice. For IDA diagnosis, estimation and treatment, many indices like serum iron (SI), total iron binding capacity (TIBC), serum ferritin (SF), soluble transferrin receptor assay are used. But reticulocyte haemoglobin content (CHr) is called as the gold standard for diagnosing IDA as it is the most valuable screening tool for identifying IDA with a sensitivity of 94% and specificity 80% and differentiates IDA from anaemia of systemic disease (ASD). The present study was undertaken to evaluate CHr as a most efficient marker in diagnosing IDA. Methods: This prospective observational study was carried out in the Department of General Medicine of M.K.C.G. Medical College and hospital, Berhampur, Odisha, India from October 2017 to October 2019. Sixty microcytic hypochromic patients of either sex &gt;18 yrs of age admitted in the medicine ward fulfilling the inclusion and exclusion criteria were included in this study. After taking detailed history and clinical examination, laboratory investigations including complete blood count (CBC), serum iron, serum, ferritin, serum transferrin saturation, TIBC, CHr and bone marrow aspiration with iron stain were done in all patients. Results: In the study group of 60 patients, 10(16.66%) patients had mild anaemia, 17(28.33%) had moderate anaemia and 33(55%) had severe anaemia. Mean haemoglobin of the patients was 6.86g/dL and SD was 1.95g/dL. Nineteen (31.66% patients) had TIBC in the range of 351-400 µg/dl. Mean ± SD of serum TIBC was 333.91 ± 67.26 µg/dL. Thirty-nine patients (65%) had transferrin saturation in the range of 0.1-10%. The Mean ± SD of the study group was 13.68 ± 3.22%. Fifty (83.33%) patients had serum ferritin in the range of 0-100 µg/dL. Twenty-three patients (38.33%) had CHr concentration between 15.1-20pg followed by 19(31.66%) between 20.1-25pg and 18(30%) between 25.1-30pg. The Mean ± SD of this study was 22.14pg ± 3.92. Conclusion: Reticulocyte haemoglobin content is a potential biomarker that can be used to differentiate iron deficiency anaemia from other causes of anaemia