Objectives. Etiology and outcomes of acute lung injury in tropical countries may be different from those of western nations. We describe the etiology and outcomes of illnesses causing acute lung injury in a rural populace. Study Design. A prospective observational study. Setting. Medical ICU of a teaching hospital in a rural-urban fringe location. Patients. Patients ≥13 years, admitted between December 2011 and May 2013, satisfying AECC criteria for ALI/ARDS. Results. Study had 61 patients; 46 had acute lung injury at admission. Scrub typhus was the commonest cause (7/61) and tropical infections contributed to 26% of total cases. Increasing ARDS severity was associated with older age, higher FiO2 and APACHE/SOFA scores, and longer duration of ventilation. Nonsurvivors were generally older, had shorter duration of illness, a nontropical infection, and higher total WBC counts, required longer duration of ventilation, and had other organ dysfunction and higher mean APACHE scores. The mortality rate of ARDS was 36.6% (22/61) in our study. Conclusion. Tropical infections form a major etiological component of acute lung injury in a developing country like India. Etiology and outcomes of ARDS may vary depending upon the geographic location and seasonal illnesses.
A 44-year-old male presented to the emergency ward with chief complaints of recurrent episodes of generalized tonicclonic seizures for the past 5 h. He had a history of right-sided focal seizures 3 years ago, and on evaluation was found to have multiple infarcts in his brain. The patient had been taking the tablet sodium valproate 200 mg twice daily, with good compliance. On admission, he was drowsy and disoriented. Central nervous system examination did not reveal any focal neurological deficits. Other systemic examinations were unremarkable. His bladder was catheterized and his urine showed reddish-orange discoloration (Figure 1). The urinary catheter and the urine bag showed bright orange-colored deposits. Serum uric acid level was found to be 9.4 mg/dl on admission (normal cutoff being 3.5-7.2 mg/dl). His 24-h urine uric acid level was 1362 mg/day (normal cutoff being 250-750 mg/day). The urine pH was 5.5 and specific gravity was 1.030. Microscopic examination of urine revealed rosettes and rhomboid-shaped crystals of uric acid (Figure 2). His renal functions remained normal. The patient was adequately
Introduction Ocular injury is the commonest ocular emergency and can vary across geographical and socioeconomic regions. This study was conducted to determine the pattern of ocular injuries presenting to our tertiary care hospital located in Puducherry, Southern India. Methods A retrospective hospital-based study was performed and analyzed the records of the patients who presented with ocular injuries to the emergency department between January 2016 and December 2017. Data were collected using a structured format and noted the demographic profile and clinical profile of ocular injury. Results Of the 392 ocular emergencies, 318 (81.1%) were caused by ocular trauma. Mechanical trauma was most common (306; 96.2%). Males were more frequently affected (ratio; 3.7:1). Most cases of trauma belonged to the 21–30 years age group (86, 28.1%) and were caused by road traffic accidents (RTAs) (197; 64.4%). Adnexal injuries were commonest (285; 93.1%). The ocular injury was close globe type in 93 (30.4%) and the open globe in three (1.0%). Serious lid injury was present in 71 cases (23.2%). Serious injuries such as globe rupture and traumatic optic neuropathy were present in three (1.0%) and eleven (3.6%) cases, respectively. Conclusion Ocular trauma is the most common cause of ocular emergencies and RTA is the commonest cause of ocular trauma. We need to explore strategies to minimize ocular trauma as a priority.
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