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A Comprehensive study on Conduction Block in Acute Stemi in Thanjavur Medical College
No full textBACKGROUND: Acute myocardial infarction is a grave clinical condition that remains the leading cause of mortality worldwide. World wide around 3 million people suffer from STEMI and another 4 million people develops NSTEMI. Conduction blocks are commonly seen in patients associated with myocardial infarctions. Several studies have shown data that AV and infranodal blocks are present approximately 12 to 25% in acute MI. But this largely varies with studies. Several studies have pointed out that the AV blocks complicating STEMI are associated with increased morbidity and mortality. The prognosis of the patient may vary depending upon the type of AV block and timely intervention as well.
OBJECTIVES: To study the prevalence of conduction block in acute STEMI in Thanjavur Medical College and the association with various modifiable and non modifiable risk factors and also the prognosis of the patients.
METHODS: The study was conducted as a cross sectional observational study in Thanjavur Medical College from the period of JANUARY 2021 to JANUARY 2022. A total of 100 cases who presented as acute STEMI in Thanjavur Medical College were studies and the prevalence of various heart blocks developed in them where studied and their associations were various risk factors and outcomes were assessed. All the cases were assessed for demographic and clinical presentation b the principal investigator using a pre structured proforma. Patients were followed along the course of treatment ; serial ECG monitoring was done. patient was followed with ECHO and assessed until the patient is discharged or has been expired. Patients were subjected to following investigations to identify the comorbidities : CBC, RBS, RFT, LIPD PROFILE. The data were entered in MS office excel SPFTWARE and analysed using SPSS version 2.0
RESULTS: In our study 100 subjects were taken into consideration and Commonest age group who developed acute STEMI were within the age group of 45 to 60 years males. Incidence of conduction block in our study was 28 %. In literature the conduction blocks in STEMI varies from 12% to 25% depending on various studies. Also the mortality of study subjects was 16% in the study. Age, gender, and comorbidities have no association with conduction block or prognosis of patients. In our study AWMI have the highest incidence being 64% followed by IWMI which is 17%. In our study the most common conduction block was infranodal blocks, of which RBBB more than LBBBB (7%). Conduction blocks and alcoholism has statistically significant association with prognosis of the patient so are the Ejection fraction and killip class at presentation.
CONCLUSION: The incidence of heart block in the study was 28% There is significant association between alcoholism and conduction block. RBBB and LBBB are the most common conduction blocks seen. Bundle branch blocks are more seen with AWMI and AV nodal blocks are common with inferior wall MI. There is significant association with mortality of the patient as well as the duration of stay of discharged patients with conduction blocks. There is also association between conduction block and Killip class at the time presentation and reduced Ejection fraction in ECH
A Comprehensive study on Serum Ferritin Level in Acute Kidney Injury Patients as a Prognostic Indicator
No full textINTRODUCTION:
For researchers and practising clinicians, various biomarkers have been used in acute kidney injury for risk assessment, prediction, prevention, diagnosis, management, and renal recovery. Majority of the biomarkers are not available and cheap, apart from the varying accuracy parameters such as sensitivity and specificity. Serum ferritin may reduce the high oxidative stress associated with AKI and hence contribute to the positive renal outcome. Thus measurement of serum ferritin level in AKI patients helps in assessing prognosis in these patients.
OBJECTIVES:
To study the serum ferritin level in acute kidney injury patients and its outcomes and association among a series of 70 cases in a tertiary care institution.
METHODOLOGY:
This is a prospective analytical study, among 70 in-patients with acute kidney injury, admitted under the Department of General Medicine, Thanjavur Medical College and Hospital. Severity of AKI was assessed based on KDIGO criteria. Other relevant history was derived from the patients including drug history and comorbidities like diabetes, hypertension. Serum ferritin level was measured in these patients after diagnosing as AKI. Outcomes such as Recovery, morbidity and mortality were assessed and compared with various groups in the study.
RESULTS:
The mean levels of Serum Ferritin (ng/ml) in the study population were 264.56 (± 60.66) ng/ml ranged between 110 and 372 ng/ml. Serum Ferritin levels were not significantly different between the different age groups, gender, AKI etiology, comorbidities such as diabetes mellitus, hypertension. The mean Serum Ferritin (ng/ml) was significantly lower among the patients with coronary artery disease, AKI Stage 3 of KDIGO, received hemodialysis. Serum Ferritin has significant negative correlation with the duration of the hospital stay. Serum Ferritin was significantly lower among the patients who died.
CONCLUSION:
Serum ferritin can be used as a marker for risk assessment, morbidity, severity and mortality among the patients with acute kidney injury
A Comprehensive study on Metastatic Involvement of Interpectoral Lymph Nodes related to Tumor Location, Size, Grade and Hormone Receptor Status in Breast Cancer
No full textNeutrophil to Lymphocyte Ratio Compared to N-Terminal Pro B- Type Natriuretic Peptide as a Prognostic Marker of In-Hospital Mortality and Duration of Hospital Stay in Acute Decompensated Heart Failure
No full textINTRODUCTION:
The most common consequence of all cardiac disorders, heart failure is a clinical condition that is the predominant factor in morbidity, death, and hospitalization in this patient population. Heart failure and cardiac dysfunction, which are currently major health issues, affect about 26 million individuals worldwide. With the ageing population, the worldwide burden of heart failure and cardiac dysfunction is rising quickly and significantly. The identification of heart failure and cardiac dysfunction is crucial in clinical practice because of the high morbidity and mortality rates.
According to reports, the 1-year and 5-year death rates following hospitalization are as high as 22% and 42.3%, respectively. Therefore, predicting heart failure outcomes with the help of biomarkers may help with HF management and lower the mortality rate. In individuals with both acute and chronic HF, the inflammatory response may contribute to the pathophysiology and unfavorable remodeling process. Both HF with reduced ejection fraction and HF with intact ejection fraction are susceptible to myocardial injury, detrimental left ventricular remodeling, and disease progression brought on by neutrophil- and T-cell-derived enzymes and cytokines. A developing biomarker for assessing the risk and prognosis of cardiovascular disorders is the neutrophil-to-lymphocyte ratio (NLR).
Its value in risk stratification and cost-effectiveness for patients with cardiovascular diseases has been established. Previous research has shown the connection between NLR and acute and chronic HF, as well as the complications, severity, and prognosis that go along with it.
AIM OF THE STUDY: To compare neutrophil-to-lymphocyte ratio to N-terminal pro-B type natriuretic peptide as a prognostic marker of in-hospital mortality and duration of hospital stay in acute decompensated heart failure.
OBJECTIVES: To compare neutrophil-to lymphocyte ratio to N-terminal pro-B type natriuretic peptide for predicting the severity of heart failure, need for ICU care, duration of ICU stay, duration of hospital stay and in-hospital mortality.
METHODS: 80 patients with acute decompensated HF after applying exclusion criteria were enrolled into the study. Apart from routine investigations admission day NLR and NT-proBNP were done and these values were compared to assess the objectives of the study.
RESULTS: NLR and NT-proBNP showed a p value of < 0.001 in predicting in-hospital mortality, severity of heart disease, need for ICU care and duration of hospital stay in patients with acute decompensated HF.
CONCLUSION: In patients with acute decompensated HF, NLR is a clinically useful, cost-effective value that forecasts in-hospital mortality and length of hospital stay. Elevated NLR in HF at the time of admission is a reliable indicator of both the length of hospital stays and short-term death which is comparable to NT-proBNP which is a novel biomarker
Serum Ferritin, CRP, RDW in Correlation with Severity of Acute Ischaemic Stroke
No full textINTRODUCTION:
Stroke is an abrupt onset of a neurological deficit attributable to a focal vascular cause. Globally, it is one of the leading causes of death and disability-adjusted life-years (DALYs) as per the estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study. They are broadly classified as ischemic and haemorrhagic strokes. About 85% of all strokes are ischemic, and 15% are haemorrhagic. Ischemic strokes result from interruption of the blood supply to the brain, while haemorrhagic strokes result from the rupture of blood vessels.
NIHSS, on the other hand, evaluates patients on 11 different parameters and has been found to be an excellent predictor of patient outcomes. Red cell distribution width (RDW) is a measure of the variation in red blood cell (RBC) sizes, based on the width of the mean corpuscular volume (MCV) and is easily and inexpensively determined by automated flow cytometer, as part of a complete blood counts. High RDW levels may be associated with elevated levels of inflammatory markers such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and interleukin (IL) levels (6). High RDW levels have been found to be associated with a poor prognosis in acute myocardial infarction and peripheral artery disease. RDW has also been evaluated as a predictor of mortality in patients with cardiovascular disease, cancer, chronic lung disease, symptomatic chronic congestive cardiac insufficiency and acute cardiac insufficiency. Utility of RDW in predicting stroke severity, is still being evaluated. In this study, we tried to correlate RDW with the severity of acute ischemic stroke and also tried to find out whether RDW can be used as a predictor of mortality in acute ischemic stroke.
AIMS AND OBJECTIVES:
To study the severity of acute ischemic stroke in correlation with serum ferritin, CRP and RDW concentration.
MATERIALS AND METHODS:
All patients who presented within 48 hrs of onset of stroke and who gave informed consent to participate in the study were included As ferritin, CRP, RDW is an Acute phase reactant samples are taken with in 48 hrs of onset.
RESULTS:
The present study included 183 participants who presented with acute ischemic stroke and were evaluated with several markers. A high prevalence of acute ischemic stroke was reported in patients aged 61-70 (33.33%), followed by the age group of 41-50 (26.8%). In addition, a male predominance was reported in the current study, with a high incidence of hypertension (56.8%), diabetes mellitus (54.1%), the social habit of smoking (26.2%), and alcohol intake (17.5%). The NIHSS stroke severity assessment revealed that a majority of the patients were in the mild scoring criteria (42.6%), followed by moderate (21.9%), moderate to severe (16.4%), and severe criteria (19.1%). The clinical outcome of the study reports a loss of life due to mortality among 36 participants, with acute ischemic stroke accounting for 19.7% of the total participants. The RDW elevated levels, compared with the NIHSS score, revealed a significant difference (p-value <0.0001). Our study also reported that patients with a high RDW level had an increased mortality risk compared with the NIHSS score. The study revealed that patients with high CRP levels were associated with stroke mortality in AIS. In addition, higher CRP levels were also associated with larger infarct volumes in patients with acute ischemic stroke. [73] The findings revealed that patients with elevated CRP levels are more prone to developing complications in acute ischemic stroke, and the levels of CRP can be used to reflect the severity of AIS among patients. The comparison of mortality (loss of life) and recovery also reported a statistical difference concerning elevated serum CRP levels and mortality.During admission, elevated ferritin levels were reported based on the severity of the NIHSS score, which was in an upward trend with increasing severity (p-value <0.0001), which signifies that with increased severity of a stroke, high levels of serum
ferritin can be reported. Literature has suggested that elevated serum ferritin levels can be a prognostic marker in ischemic stroke and act as a risk factor for ischemic episodes by causing atherogenesis.
CONCLUSION: The study concludes with a linear relationship between the RDW, serum CRP, and serum ferritin levels in predicting the severity of stroke and mortality outcomes in patients with acute ischemic stroke.The study also reports a significant difference in clinical outcome and mortality (loss of life) when compared with all three markers (p-value <0.0001) respectively, which conclude that RDW, serum CRP levels, and serum ferritin levels can be used as a prognostic marker for assessing the severity of the stroke and formulating a therapeutic plan based on the severity
A Prospective study of Subcutaneous Injection of Low Molecular Weight Heparin in Prevention of Flap Necrosis in Postoperative Wounds of Open Onlay Mesh Repair for Ventral Hernias in GRH Madurai
No full textThe Role of Clinical Prediction Model of Intestinal Necrosis (CPMIN) Score in Acute Mesenteric Ischaemia: A Retrospective study
No full textEffectiveness of Ariscat Scores in Predicting the Incidence of Postoperative Pulmonary Complications in Patients After Emergency Laparotomy Surgeries
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