The implementation of new treatment strategies based on current recommendations has enabled a greater number of patients with rheumatoid arthritis (RA) to achieve remission. However, there are no definite predictors of sustained remission. Moreover, the absence of clear consensus on the time of withdrawal or reduction of treatment further adds to the treatment burden. This pilot study was intended to evaluate the prognostic potential of various RA-related parameters. All the enrolled subjects (n=124) were clinically evaluated on the basis of various parameters including age, gender, duration of illness before the initiation of disease-modifying anti-rheumatic drugs, tender and swollen joints (28 joints), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), hemoglobin percentage, lymphocyte count, total white-blood cell counts, and neutrophil to lymphocyte ratio (NLR). Student's t-test and discriminant function analysis were performed. The specificity of all parameters and their best possible cut-off to predict relapse were calculated using the receiver operating characteristic (ROC) analysis. A significant difference in terms of pain perception, NLR, tendency to have a significant tender joint count and absolute lymphocyte counts was identified between the patients in sustained remission and those in relapse. The ROC analysis indicated that NLR was consistent in predicting remission. CRP, ESR, and/or disease activity score may not be very effective in differentiating patients with sustainable remission/low disease activity. NLR along with patient's perception of pain may assist in predicting sustained remission.
Background: The aim of the study was to determine the effect of age as a risk factor and a determinant of outcome in elderly ischemic stroke patients.Methods: This is an observational study. One hundred, successive elderly patients aged 60 years and above, admitted with acute ischemic stroke in PESIMSR over a period of 18 months were prospectively studied. Patients with hemorrhagic stroke, neurological deficits following trauma or following infection were excluded. Demographics, risk factors, stroke severity at admission were estimated by NIHSS. Risk factors and clinical profile were noted and compared among male and female patients. Outcome at discharge was measured by-mRS-modified ranking score.Results: Patients in age group 60-75 years presented with less severe stroke and better mRS when compared to >75 years age group. Complications were significantly higher among the older age group.Conclusions: The risk factors identified for ischemic stroke in the present study are diabetes, hypertension, dyslipidaemia, obesity, smoking, and alcohol. Severity of stroke at presentation, clinical outcome and complication rate during the in-hospital stay were all significantly affected by the age, more so in ischemic stroke. Age specific factors of stroke prevention are crucial for successful prevention and implementation of well-organized stroke care.
Background: Aims and Objectives: To study the effects of addition of Dexamethasone to Bupivacaine with respect to onset, duration of sensory and motor blockade, haemodynamic variables and rescue analgesics used in first 24 hours. Subjects and Methods: A prospective, randomized, study of 100 patients of ASA I &II, aged between 20-60years were included. Patients were randomized to two groups, 50 of bupivacaine group (B) and 50 of bupivacine and dexamethasone (BD). Brachial plexus block was performed via supracalvicular route using ultrasound machine. The onset of anesthesia, loss of sensory perception and temperature was recorded. The patients were also monitored for any side effects or complications. The data obtained was analyzed using (SPSS vs 18). Quantitative data were analyzed by using student 't' test, Qualitative by using Chi -Square test. p value of less than 0.05 was considered as statistically significant. Results: Demographics were comparable between the groups. The mean onset of sensory block [10.3 Vs 16.7] and motor block [5.6±0.7 Vs8.6±1.2] was earlier in BD group. Similarly the mean duration of sensory block in hours [5.9±0.67 Vs 4±6.3] and motor block was [4.3±0.9 Vs1.9±0.5]. The group BD received less rescue analgesics. There was a significant fluctuation in systolic blood pressure in group B. Conclusion: Use of dexamethasone as an adjuvant to bupivacaine in supraclavicular brachial plexus block results in faster onset of action of sensory and motor blockade. It also results statistically significant longer duration of sensory and motor blockade.
We report a patient with Parkinson's disease undergoing craniotomy for a brain tumor, who had clinically adequate hypnosis at a very low concentration of isoflurane. While the raw EEG showed low-voltage slow electrical activity, the EEG analyzer of the monitor displayed high burst suppression ratios. The role of intracranial pathology and drug therapy as possible causes of the low anesthetic requirement for adequate hypnosis are discussed. This report also draws attention to the possibility of erroneous analysis of burst suppression by EEG modules.
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