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Role of Cyto-morphometric WBC Changes in Early Detection of Intra-abdominal Sepsis in Patients Undergoing Bowel Resection
No full text
Lifestyle Determinants of Severity of SARS COVID 19 Infection
No full textOBJECTIVES:
Primary:
1. To corelate the clinical severity of patients with COVID-19 infection with lifestyle practice (nutrition, physical activity and stress questionnaires).
LIFESTYLE VARIABLES:
1. Nutrition,
a. 24 hours recall,
b. Food frequency questionnaire,
c. Nutrition Biomarkers – Serum vitamin D and Zinc.
2. Physical activity
a. IPAQ questionnaire.
3. Stress.
a. Perceived stress scale questionnaire.
Secondary:
To corelate the clinical severity of COVID-19 infection with age, gender, co-morbidities, addictions – nicotine, alcohol, others; nutritional parameters such as calories, macro-nutrients – carbohydrate (simple & complex), protein (plant Vs animal source) and fats (saturated Vs unsaturated), fibers, carotenoids and vitamins.
METHODS:
This was a hospital based prospective observational study using pre-validated questionnaires as well as laboratory assessment of biochemical samples. This study included patients 18 years of age and above who were admitted to the Level 1 COVID wards of a tertiary care hospital in South India, that is, the patients not requiring oxygen at admission.
175 patients had samples collected at day 1 of admission of which complete details including dietary, exercise and stress questionnaires were complete for 124 and demographic details and Vitamin D and Zinc levels were assessed for all 175 patients as per the sample size.
This study was done as a prospective cohort study where patients were assessed with respect to their baseline nutrition assessed in terms of 24 hour food recall, food frequency questionnaire and laboratory assessment of nutritional biomarkers (Vitamin D and Zinc); physical activity assessed in terms of IPAQ questionnaires and psychological stress assessed in terms of the Perceived stress scale. Those patients who were unable to be assessed during hospital stay were telephonically contacted after discharge for completion of 24 hour food recall, physical activity and stress questionnaires. Demographic details, addictions and comorbidities were identified through hospital records of the patients. Patients were followed up through their course in the hospital to determine the progression in disease severity, assessed in terms of staying in level 1 wards(not requiring supplemental oxygen) to shift outs to level 2 wards( requiring oxygen to maintain saturation ). Lifestyle factors and disease were analysed to see if patient’s lifestyle factors played a role in the severity of manifestation of COVID 19 infection. Secondary end points include analysing a relation between age, comorbidities and addictions on disease severity of COVID 19.
RESULTS:
This was a hospital based prospective cohort study done in a tertiary care hospital in South India between July 2020 to July 2022 using pre-validated questionnaires and laboratory analysis of collected samples. 175 patients admitted to the level 1 COVID wards of this hospital were recruited to this study and followed up to assess the severity of their disease with respect to oxygen requirement. The patients were recruited during the first and the second COVID 19 waves where admissions in view of the same peaked in the hospital. This study showed that 27 out of 88 diabetics (30.68%) required oxygen while only 11 out of 87 (12.79%) required oxygen among the non-diabetic patients. It also showed that showed that 38 out of 150 (25.33%) of the patients with low vitamin D (/= 30 ng/ml) required oxygen during hospital stay. Animal proteins were found to have a protective role with the group that consumed more animal protein (mean of 12.74 ± 4.25 g) having less oxygen requirement that the group that consumed less animal protein (mean of 10.83 ± 3.75 g). The p value for the above was significant at 0.069.
We found that the patients who consumed more carotenoids (mean intake of 7228.48± 626.83 mcg) had less requirement of oxygen than the group that consumed less carotenoids (mean intake of 6941.26± 681.86 mcg). In the multivariate analysis, we found that patients with diabetes mellitus were 2.97 more times at risk of developing severe SARS COVID 19 disease as compared to non-diabetic patients. (Unadjusted OR 2.97 (1.38, 6.39), p = 0.005). We also found that low Vitamin D levels (< 30 ng/ml) was associated with increased severity of disease with respect to oxygen requirement (adjusted OR 12.24 (0.69, 217.93), P = 0.088). Stress levels had a direct relationship with the severity of COVID in terms of oxygen requirement with the percentage of people requiring oxygen showing a graded increase from 14.29 to 16.67 to 25 percent in the low, moderate and high stress categories respectively, however the p value for this correlation was 0.782. Thus, diabetes mellitus and low vitamin D levels were found to predispose to more severe SARS COVID 19 disease while animal protein intake and carotenoids had a protective role
Development, Evaluation and Optimization of Chronomodulated Drug Delivery Systems by Various Approaches for Antihypertensive Drugs
No full textShock Index as a Predictor of Outcome in Patients with Sepsis in Chengalpattu Medical College Hospital
No full textABSTRACT
BACKGROUND: The importance of early recognition of sepsis with initiation of treatment and its effects on survival outcome have long been recognized. Due to this non- availability of easy diagnostic scores and criteria, multiple attempts are being made to develop scores which can identify sepsis early.
AIM OF THE STUDY: To assess whether in patients with suspected sepsis at Chengalpattu Medical College Hospital, shock index is a good predictor of clinical outcome.
MATERIALS AND METHODS:
After getting approval of Institutional Ethical committee, 100 patients with suspected infection above 18 years of age, who are admitted in the Intensive medical Care Units (IMCU) of Govt. Chengalpattu medical college are selected for this study. The disease spectrum and the outcomes are studied. Shock index at initial presentation to the emergency medicine department (ED) was compared to the traditional mortality predictors like SOFA score and the newly designed q SOFA score.
RESULTS:
Among the 100 patients, 78 (78%) had a suspected sepsis Initial shock index was less than 0r = 1 in 28 (28%) patients and 72 (72%) had shock index values greater than 1.0 at presentation.
CONCLUSION:
Shock index perfomed as a good indicator of in-hospital mortality, and its performance was comparable to other established indices like q SOFA scores, SOFA score.
Shock index greater than or equal to 1.0 at initial assessement is associated with greater rates of ICU admission, inotropic requirement and ventilator support. Usefullness of shock index as a mortality predictor was comparable over all the etiologies of sepsis
The Impact of Compliance with 6 Hour Sepsis Resuscitation Bundle on Mortality in Patients with Sepsis
No full textA Study of Relationship Between Uric Acid, CRP and NLR Ratio as Risk Factors in Nonvalvular Atrial Fibrillation
No full textINTRODUCTION:
Atrial fibrillation is the most common supraventricular arrhythmia. Uric acid has recently emerged as a cardiovascular risk marker associated with oxidative stress and inflammation. But the exact role of uric acid in pathogenesis of Nonvalvular Atrial Fibrillation (NVAF is unclear. Uric acid can induce inflammation. Inflammation can cause structural and electrophysiological changes in atria. So we wanted to confirm the causal role of uric acid in NVAF by causing inflammation using inflammatory markers like CRP and NLR. This inflammatory markers can be used as a cheap and noninvasive screening tool in NVAF.
AIM OF THE STUDY:
1. To assess the relationship between uric acid and nonvalvular Atrial fibrillation.
2. To assess the role of inflammation in non-valvular AF
OBJECTIVES:
1. To study clinical characteristics and etiological profile in cases of non-valvular atrial fibrillation.
2. To estimate serum uric acid(SUA) in cases of non-valvular atrial fibrillation (NVAF) and to compare it with age -gender matched controls.
3. To estimate inflammatory markers like NLR and CRP in nonvalvular AF and to compare it with age and gender matched controls.
4. For estimating whether inflammation associated with raised uric acid and its role in non valvular AF.
SETTINGS AND DESIGN: case control study in a tertiary care centre involving 80 cases and 40 controls. The study was conducted using history, clinical examination, structured questionnaire, electrocardiogram (ECG), echocardiography and investigations like Serum Uric Acid (SUA), C Reactive protein (CRP) and Neutrophil lymphocyte ratio (NLR)
RESULTS: study revealed that hypertension was the significant risk factor. We also concluded that left atrial enlargement in echocardiography is more relevant marker in NVAF. We also found that serum uric acid CRP and NLR were elevated in cases than in controls.
CONCLUSION: Left atrial enlargement along with elevated serum uric acid CRP and NLR can be used as a screening tool in hypertensive patient for development of AF
A Study on the Correlation of QRS Amplitude in ECG in ST Elevated Myocardial Infarction to its Outcome and Extent of Vessel Involvement in Coronary Angiogram
No full textINTRODUCTION:
Myocardial infarction is one of the most frequently encountered reasons for hospital admission and is commonly seen in all populations worldwide. Theoretically, infarction of the myocardial muscle can be detected based on certain pathological features like coagulation necrosis, causing the loss of muscle cells (myocytes). When such a pathological change occurs, it triggers inflammation, leading to fibrosis and healing with a scar. The 12-lead electrocardiogram is one of the essential diagnostic factors that can be used to detect acute coronary syndrome (ACS).
The clinical approach to a patient suspected of acute coronary syndrome consists of detailed history taking, electrocardiogram (ECG) changes, cardiac biochemistry evidence and imaging. The reliability of each of these modalities as a diagnostic tool depends on multiple factors, the most significant being the window period between the infarction and the time the patient seeks medical attention.
The current approach to patients presenting with typical or atypical features of myocardial ischemia or infarction starts with making the provisional diagnosis of the acute coronary syndrome. Then, depending on the changes seen on the twelve lead ECG, the acute coronary syndrome is classified into ST-elevation myocardial infarction (STEMI) or non-ST-elevation myocardial infarction (NSTEMI).
ST-elevation myocardial infarction (STEMI) is a clinical syndrome characterised by the symptoms of ischemia in correlation with the persistent electrographic ST-elevation (STE) and subsequent release of biomarkers of myocardial necrosis. STE elevations have been significant for detecting acute coronary artery occlusion with collateral circulation, which can be used to assess myocardial injury and infarction that requires immediate reperfusion therapy.
OBJECTIVE:
PRIMARY OBJECTIVE:
To assess the value of QRS amplitude in STEMI patients as a prognostic indicator with the extent of Vessel involvement in coronary angiogram.
SECONDARY OBJECTIVES:
1. To assess outcome in terms of ECHO findings with respect to Ejection fraction.
2. To assess Age and Sex distribution.
3. To assess correlation with respect to Smoking, Alcoholism, Comorbidites - Diabetes and Hypertension.
METHOD:
Study design: Comparative study.
Period of Study: May 2022 to November 2022.
Duration of Study: 6 months.
Place of Study: Government Royapettah Hospital, Chennai-600 014 and Government Kilpauk Medical College, Chennai – 600 010.
RESULT:
Our study reports significant differences in the QRS amplitude with a correlation between Ejection Fraction (EF%) and vessel obstruction. The comparison yielded with Pearson correlation stated a sig. (2-tailed) value of 0.031 for EF% and a significant difference with vessel obstruction % with angiography (p-value <0.0001).
CONCLUSION:
ECG is one of the predictive tools which can be used to detect the outcome of the disease, Patients with a low QRS amplitude score are more prone to complications and longer hospital stays. Therefore, it is essential to correlate the reciprocal changes in the ECG and angiography for a better clinical assessment and to provide an adequate therapeutic outcome. A lower QRS amplitude score has also affected the ejection fraction (EF%) and can be correlated with the % vessel obstruction. Hence, ECG can be used as an early diagnostic tool for predicting the severity of STEMI and non-STEMI disease in patients
