18 research outputs found
Neurological Neuro Surgical and Neuro Psychological aspects of Headache
No full textThe study was conducted to analyze the demographic factors, headache characteristics and neuro-psychological factors of headache patients. A sample of 320 patients were studied, out of which 295 were classified as patients with primary headache and 25 with secondary headache based on IHS criteria. Primary headache patients were sub-classified into migraine, tension headache and cluster headache.
Of all the painful states that afflict humans, headache is undoubtedly the most frequent. Headaches are a nearly universal experience, with a 1-year period prevalence of 90% and a lifetime prevalence of 99%. Worldwide, an estimated 240 million persons suffer 1.4 billion migraine headaches yearly. Five per cent of women and 2.8% of men have headaches 180 days or more per year (Randolph W. Evans).
H eadache and associated syndromes (or) symptom complex extracts a tremendous toll from the society that most of the neurophysicians prefer to treat more commonly occurring headaches and the related problems. It is the investigator’s opinion that the neurophysicians are the best persons to evaluate the headache patients, recommend treatment and to perform the necessary research to determine the pathophysiology namely neurological, neuro-surgical and neuro- psychological aspects of headaches.
Headache is one of the complaints most frequently faced by internists and Neurologists. Most people accept an occasional headache as part of their lives. Patients come to physicians because of chronic (or) recurrent headache that have persisted unabated (or) occurred repeatedly over months (or) years (or) because of acute severe headache unrelated to previous headaches and characterized by a violent onset (or) relentless progression. Most chronic (or) recurrent headaches are of vascular (or) psychogenic origin while acute severe headaches carry a more ominous prognosis and may reflect serious underlying disease.
Headache has been a neglected subject in the field of neurology for decades. Myth and misconceptions about the disease especially the common myth of headaches being all in the head have hindered physician progress in understanding the basic pathophysiology of headache. Fortunately, the advent of new investigations and a great deal of interest and enthusiasm on par of the doctors as well as the public on learning more about this major problem, bring in the new therapeutic research approaches about headache.
AIM OF THE STUDY:
1. To study the demographic characteristics of the headache patients and to analyze the key factors that contribute to each type of headache.
2. To study the different types of headache and their typical characteristics.
3. To study the neuro-psychological characteristics and their association with different types of headache.
METHODOLOGY:
Materials and methods
This study was conducted at the Headache special clinic, Department of neurology; Government Stanley Hospital is one of the oldest Institute of Neurosciences in our country. This Department of Neurology is the tertiary referral centre for the entire state of Tamil Nadu and neighbouring states like Andhra Pradesh, Karnataka and the Union Territory of Pondicherry.
Sample size determination and sampling methodology used in the present research.
A pilot study conducted by the researcher indicated that about 25% of patients visiting government hospitals suffered from head ache problems. Remaining 75% of patients suffered from other ailments. Expected difference in the percentage of actual population suffering from head ache is 5%. The sample size to conduct the present study is computed as follows:
Proportion of people suffering with head ache problems (p) = 0.25; Proportion of people not suffering with head ache problems (q) = (1- p) = 0.75; Approximate deviations expected in the population on the proportion of head ache patients(d) = 0.05; It is assumed that the these proportions follow normal distribution and the normal probability value with a critical margin of 5% is 1.96.
Inclusion Criteria:
1. Patients presented with headache that had satisfied IHS criteria for that
particular type of headaches,
2. Age between 15 to 65 years,
3. Both males and females,
4. Patients who have maintained the headache diary and have come for regular follow-up were alone included.
5. Only newly diagnosed headaches.
Exclusion Criteria:
1. Below 15 years of age,
2. Pregnancy,
3. Toxic and other major diseases (like cardiac respiratory system),
4. Psychiatric and seizure patients.
CONCLUSION:
Out of the six major hypothesis with their minor hypothesis, it is observed that the neurological factors including demographic factors, headache characteristics and neuro-psychological factors had significant association with headache. The secondary headache characteristics, because of its numerically and statistically insignificant values, individual case studies reveal especially tumor headache having 60% of migraine like headache characteristics. Thus, it is summarized the clinical aspects of primary headaches and the tumor headache behave almost similarly
Prevalence of Pediatric shock, etiological classification, severity and outcome of management in children admitted to Medical College Hospital, Tirunelveli
No full textStudies analyzing the demographic profile and prevalence of stock in pediatric patients who present to a tertiary care hospital are very few in both western and Indian literature.
Most Western literature as well as Frankel LR, Mathers LH; Shock – In Nelson Textbook of pediatrics 17th edition publish that approximately 2% of all hospitalized children are diagnosed with shock.
Indian study at Dayanand Medical College Hospital, Ludhiana, Punjab, by Daljit Singh et al in Indian Pediatrics / July 2006, 43:619-623 who studied 98 shock cases out of 2274 admitted patients give their percentage as 4.3%.
In this study conducted at Tirunelveli Medical College, 57 cases of shock were registered out of the 2035 pediatric cases admitted during the study period, which works up to 2.8%.
47.3% (n=27) of the total shock cases were infants while in the study by Daljit Singh et al infants made upto 39.8% of total cases (n=39).
Mean age of study population in this study was 3.3. ± 3.8 years while in the study compared it is 2.8 ± 3.4 years.
Sex wise distribution of shock patients did not show any
significance though of those children admitted, 846 were females and 1189 were males and 3% and 2.7 % of them respectively were diagnosed to have shock. Neither did the severity of shock – compensated or decompensate have any difference among the two sexes.
But infants were affected more by decompensated shock at time of presentation than any other age group in this study but Daljit Singh et al study showed no significance to relation between age and severity of shock.
Analysis of clinical features revealed the following. All 57 cases were assessed by rapid cardiopulmonary assessment at presentation and the data of clinical findings obtained is discussed below.
The most consistent finding noticed in the cases was altered level of sensorium at presentation. This was done using the A/V/P/U scale.
All children (100 %) had impaired consciousness of varying degrees.
Next common finding was that of decreased urinary output noticed in 81.6% of children. Only 38 children with shock were catheterized for monitoring urine output out of which 31 had oliguria.
Capillary refill time was prolonged in 91.2 % (n=52) and flash refill noted in 8.8 % (n=5). All these 5 children were among the warm septic shock category at presentation.
Tachycardia surprisingly was seen in only 73.7% (n=42) children.
The rest had relative / absolute bradycardia.
Respiratory problems ranged from bradypnea, respiratory arrest, effortless tachypnea to respiratory distress.
Respiratory distress was seen in 40.4% (n=23) children and all of them had septic / cardiogenic shock.
Unstable airway / bradypnea was noticed in 33.3% (n=19) and these children were having decompensated shock / imminent arrest.
57.9 % (n=33) cases of shock were decompensated while
presentation to this hospital in while only 40% (n=39) cases were decompensated in the study conducted by Daljit Singh et al. In our study Children presented to the hospital in a more severe degree of shock.
63.6% (n=21) of the 33 compensated shock cases died and 16.7% (n=4) of the 24 compensated shock cases died in our study while the percentage of death among the two groups was 67% and 2% respectively in the Punjab Study by Daljith Singh et al.
Septic and cardiogenic shock accounted for 37.8% of total shock cases while septic shock alone accounted for the single most common form of shock among the cases in 28.1% (n=16).
Also Septic shock was the major form of shock among the infants accounting for 19.3% (n=11) the infants. Septic and cardiogenic causes were seen in upto 33.4%(n=19) of infants with shock.
The next common form of shock noticed was distributive shock which accounted for 22.8% (n=13) of 57 cases of shock. All these cases were suspected and later proved to be children with Dengue shock syndrome or Dengue hemorrhagic shock.
Hypovolemic shock came in next with 15.8% (n=9) of cases. All of them were due to diarheal dehydration.
One case of anaphylactic shock due to multiple bee sting was admitted in decompensated shock and responded well to isotonic fluid replacement, IM adrenaline and IV Hydrocortisone.
One case of neurogenic shock was a result of Omam water
poisoning and the child succumbed to decompensated shock.
In the study by Chang et al 1999 Critical Care pediatrics 1999. Outcome of Pediatric Shock – 22 cases, were studied of which 50% (n=11) was due septic shock as compared to 45.6% (n=26) in our study. 7 were due to hypovolemia and 4 were due to carcinogenic shock.
End points of management were achieved with isotonic fluids alone in 9 (15.8%) of cases with compensated shock and 2 (3.5%) of cases with decompensated shock. These two children who had received more than 80ml/kg of isotonic fluids were hospitalized with severe diarrheal dehydration.
Dopamine in addition to isotonic fluids was administered to achieve end points in 14 (24.6%) with compensated shock and 13 (22.8%) of patients with decompensated shock.
Adrenaline infusion was used in 16 children (28%) of which 8 were administered Adrenaline following post arrest stabilization and 8 were administered Adrenaline infusion because they were catecholamine resistant. All the 16 children were in decompensated group. Intravenous Hydrocortisone was used in 5 children with septic decompensated shock who were resistant to inotropic support. Inodilators were not used in our study.
Intensive care medicine 32, 7.7.06, 995-1003 article titled. Fluid resuscitation in Hypvolemie shock has concluded there is a significant decrease in mortality when > 40ml /kg of fluids were administered in the first hour hospitalize.
In our study 40 children (70.2%) out of the 57 cases had received >40ml / kg of fluid resuscitation in the first hour of management of these 40 children 20 of them died of which 85% (n=17) and 15% (n=3) of them suffered from decompensated and compensated shock respectively.
Remaining 20 of those children survived.
19 (33.3%) of 57 children required endotracheal intubation and one more child required bag and mask ventilation. All of these children 94.7% (n=18) were among the decompensated group expect for one child 5.3% (n=1) who was compensated at time of presentation. Only one child of the 19 requiring intubation survived.
Liver function tests were elevated in 28.1% (16 out 45) of children with shock and no significant difference was found between the compensated and decompensated groups.
Renal function tests were elevated in 40.4% (23 out of 50) of children with shock and a significant difference was noticed with more children from the decompensated category having increased values.
Death occurred in 43.9 % (n=25) of 57 cases of shock when
compared to 26.4% (n=31) of 98 cases in the Punjab study by Daljit singh et al statistically significant improvement among etiological classification was seen with children in the Hypovolemic group and significant no of deaths occurred in the group which had features of both septic and cardiogenic shock.
CONCLUSION:
Shock constitutes a significant percentage of diagnosis in critically ill children. Infants are affected by shock and have severe degree of shock at diagnosis than more than any other age group in the study. No difference in prevalence or severity of shock at presentation between the two sexes was noticed. Septic shock accounts for majority of decompensated shock and poor outcome to management. Infancy decompensated shock, septic shock and those requiring ventilatory support were the factors influencing the outcome of management
A study on status of neonatal transport to a level III neonatal intensive care unit
No full textBackground: In the past decade, great advancements in Neonatal care contributed to a fall in IMR. A further fall in IMR can only be achieved by improving the neonatal transport facilities. Hence to assess the current status of neonatal transport we undertook this study.Methods: This is a cross-sectional study of 75 neonates transported to our NICU. For all the babies, data regarding the place of birth, mode of delivery, mode of transport, etc. were collected. On admission parameters like blood glucose, temperature, CRT, SPO2, the presence of cyanosis, shock was assessed.Results: In the present study 64% of neonates came to our NICU on their conveyance. 67% of referrals from PHCs did not utilize ambulance facility. 30% of neonates had hypothermia on arrival. 35%had hypoglycemia on arrival. 15% had a low oxygen saturation on arrival. 15% had prolonged CRT on arrival. Only 8% of neonates received prior treatment. 11% babies did not have any referral slip. Only a very few had complete and proper referral advice.Conclusions: To further reduce the neonatal mortality rate, the neonatal transport facilities should be upgraded. A standard protocol should be formulated for interfacility transport. A separate fleet of neonatal ambulances well equipped and manned by trained personnel is the need of the hour.</jats:p
Study of prevalence, etiology, response to treatment and outcome of paediatric shock in a tertiary care hospital
No full textBackground: Shock accounts for 2% of children admitted to Paediatric casualty worldwide as per most western literature and in Nelson text book of Paediatrics. About 10 million children die of shock every year in the world. Highest mortality is observed in under 5 children in developing countries. Clinical manifestations are due to decreased perfusion to tissues, the compensatory mechanisms that are triggered by the decreased perfusion and the inadequate removal of metabolic wastes. This study was carried out to assess the prevalence of paediatric shock in children admitted to Paediatric ICU, to identify possible aetiology and the response to treatment and outcome in patients admitted with shock in Paediatrics Department of Government Mohan Kumaramangalam Medical College, Hospital, and Salem.Methods: All sick children admitted to Paediatric intensive care unit of Government Mohankumaramangalam Medical College Hospital, Salem with the suspicion of shock are assessed by using the rapid cardiopulmonary assessment and diagnosed suffering from shock. Possible etiology, type and severity of shock would be arrived at using a targeted history, clinical examination and relevant laboratory investigations.Results: All children who had unstable airway or bradypnea, were having decompensated shock and except one among them all expired despite prompt airway management. Respiratory distress noticed in 23 (40.4%) of children and all of them had either cardiogenic, septic shock or a combination of both. Capillary refill time was prolonged in 52 (91.2%) of children and the remainder 5 (8.8%) had flash refill and managed as warm septic shock. Decompensated shock as evidenced by low blood pressure was seen in 57.9% children. All of them had altered mental status. Urinary output was monitored in 38 children of which 31 (81.6%) had oliguria.Conclusions: Septic shock accounts for majority of decompensated shock and poor outcome to management. Infancy decompensated shock, septic shock and those requiring ventilator support were the factors influencing the outcome of management.</jats:p
Microhardness Studies of Pure and Doped Crystals of Lead(II)Chloride and Lead(II)Bromide
No full textGrowth and Characterisation of Gel‐grown Lead(II)Chloride and Lead(II)Bromide Single Crystals
No full textAn Unusual presentation Of Lateral Medullary Syndrome With Ipsilateral UMN Facial Palsy - An Anatomical Postulate
No full textThe clinical features of lateral medullary syndrome include ipsilateral decreased pain and temperature sensation over face, Horner′s syndrome, gait ataxia, vertigo with nausea and vomiting and reduction of pain and temperature of contra lateral half of body (6). At times, there is also an ipsilateral facial weakness due to ischemia of the caudal part of the 7the nerve nucleus just rostral to the nucleus ambiguus (11). Rarely an ipsilateral upper motor neuron (UMN) facial weakness may be present and the same may be explained by the interruption of the hypothetical looping supranuclear corticofacial fibres which are said to ascend up in the dorsolateral medulla to reach the 7th nerve nucleus from below (8, 9, 10). A single case report is presented here in support of the above neuroanatomical postulate
Early Dropped Head Syndrome In A Case With Amyotrophic Lateral Sclerosis
No full textWe Report a case of "Dropped head syndrome" [DHS] due to Amyotrophic lateral sclerosis [ALS]. A thirty seven year old gentleman was admitted with progressive limb and bulbar weakness of 10 months duration. He developed drooping of the head six months after the onset of illness. After clinical examination and investigation a diagnosis of Amyotrophic lateral sclerosis was made based on El Escorial criteria
