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

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

EVALUATION OF DELIRIUM IN ELDERLY HOSPITALISED PATIENTS IN A TERTIARY CARE HOSPITAL

Objective: Delirium is common in older hospitalized patients and may indicate a life- threatening condition, where a prompt and appropriate evaluation is required for assessment and prevention of the disease which should be done at the time of admission and continue throughout the hospital stay. The present study was undertaken to evaluate delirium in elderly (&gt;65 years) hospitalized patients in a tertiary care hospital and to monitor outcome after 1 month. 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 August 2019 to September 2021. After clinical evaluation and diagnosis as delirium patients using (confusion assessment method) score, 50 patients (65 years and above) were selected for the study. Patients with dementia, any psychiatric condition, trauma, intoxication, and poisoning were excluded from the study. They were evaluated for etiology and then followed up for 1 month for outcome. Results: In this present study of 50 patients, 33 were male and 17 were female. About 64% belong to age group 65–75 years. Most common type of delirium was hyperactive (40%). The most common etiologies were hyponatremia (38%), infection (22%), and cerebrovascular accident (16%). Majority of population had both type 2DM (diabetes mellitus) and HTN (Hypertension) (38%). Overall recovery rate was better in metabolic causes (89.4%), most fatal was uremia followed by intracranial bleed. Lower (Glasgow coma scale) score at the time of admission indicates poor prognosis. Conclusion: Delirium in elderly patients is a medical emergency which needs prompt diagnosis and evaluation helping the family and physicians for better management with a good prognosis

A STUDY OF CLINICAL AND ECHOCARDIOGRAPHIC PROFILE IN PATIENTS OF DILATED CARDIOMYOPATHY

Objective: Dilated cardiomyopathy (DCM) is the third most common cause of heart failure (HF) and is the most common cardiomyopathy. The present study was undertaken with the aim to study the different clinical presentations of dilated cardiomyopathy, to correlate echocardiography findings with different clinical presentations and to find out the variables which determine the poor outcomes. &nbsp; Methods: This prospective observational study was conducted in the Department of General Medicine of MKCG Medical College and Hospital, Berhampur, Odisha, India from November 2019 to November 2021. Fifty cases of dilated cardiomyopathy (28 males &amp; 22 females), diagnosed on clinical and echocardiography criteria in the Department of General Medicine and Cardiology were selected for the study. &nbsp; Results: Out of 50 cases, there were 28(56%) males and 22(44%) females giving male to female ratio 1.27:1. Forty (80%) were idiopathic. Dyspnea was most common presenting clinical feature in 43(86%) cases. In echo study, maximum number of cases (n=21, 42%) were having ejection fraction (EF) in the range of 36-40% and maximum number of cases (n=26, 52%) had severe fractional shortening (FS). &nbsp; Conclusion: DCM is one of the commonest causes of heart failure and is most common type of cardiomyopathy found in middle aged and elderly male population. Biventricular failure followed by left ventricular failure was the most frequent clinical presentation. Early identification and treatment are very essential to improve cardiac function and alleviate patient symptomology