Background: Factors associated with risk with leaving hospital against medical advice (AMA) in neurology patients is unknown. Objective: To determine prospectively, the association of gender, age, religion, care type received, economic status and prognosis of the neurology patients, with the discharge AMA (DAMA) and correlate them with the reasons for DAMA cited by the patients or their relatives. Material and Methods: In-patients who left AMA between the year 2013 and 2016 (n = 689), were prospectively included in the study. Determinants of DAMA and the factors associated with DAMA within eight hours of admission (AMAe; n = 177) were analysed. A pre-AMA questionnaire was completed by those who left AMA after 8 hours (AMAd; n = 512). Results: Higher odds of AMA were associated with female gender (OR:1.48), age beyond 50 years (OR:1.35) and admission to intensive care (OR:2.59). Financial constraint was cited as reason of AMAd by the patients with low income (OR:1.72). Higher odds of association of influence of a first degree relative in the decision of AMAd were found in women (OR: 1.33) and persons more than 50 years (OR: 2.95). Discussion: Women and person older than 50 years had higher risk of DAMA, mostly due to the influence of a first-degree relative. The risk of leaving AMA was significant in those admitted in the neurological intensive care unit. Of all cited reasons of leaving AMA, financial constraint was most significant. Conclusion:The study provides an insight into the factors for associated with risk of DAMA from neurology wards.
The current study was aimed to find out whether the COVID-19 virus is detectable upon the fruits and vegetables after coming in close contact with a patient suffering from nSARS-CoV-2. We included ten subjects, who tested positive for nSARS-CoV-2 RNA within seven days of the experiment. After explaining the experiment, a tray filled with seasonal vegetables and fruits were placed in front of them. The tray remained within their reach, for next thirty minutes. The subjects were requested to remove their face masks and remain so throughout the task. They were requested to manipulate the food articles the way they liked. Subjects were instructed to cough into their hands and then to manipulate each item at least 5 times, during the experiment. Thereafter, the trays were moved into an open and shaded area with free flow of natural air but no direct sunlight. After 1-hour, swabs were taken from surfaces of items by thoroughly rubbing over each of them. Samples were sent immediately to our RT-PCR lab. The nSARS-CoV-2 RNA was not detected, from the samples collected from the fruit/vegetable, at the end of one hour of the direct exposure to the COVID-19 patients. Our results suggest, even after direct exposure to and significant handling by the COVID-19 patients the nSARS-CoV-2 RNA remains undetected after one hour of storage in open. The fruits and vegetables, in real-life situations, are unlikely to act as a fomite and play any significant role in the spread of this disease.
Background: Respiratory system involvement and fever are considered as a cardinal manifestation of Covid-19 infection for the screening of case detection. We (India) are into the fourth month of Covid-19 and cases are still rising, this could mean that fever and respiratory symptoms may not be the only initial symptoms. Therefore, we intend to investigate whether neurological symptoms can precede the cardinal symptoms. Methods: Totally, 391 Covid-19 RTPCR positive hospitalized patients were enrolled. All included subjects were presented with a questionnaire pertaining to systemic symptoms. For analysis of the chronology of symptoms, the study population was sub-grouped according to onset of their systemic involvement e.g., (1) Fever (2) Respiratory symptoms (3) Neurological symptoms (4) Gastrointestinal symptoms. Results: New-onset neurological symptoms were found in 106 (27.1%) out of 391 patients irrespective of their chronology to the onset of other symptoms. Of these 106 patients, altered taste (33.1%), altered smell (24.5%), and headache (22.6%) were the most common neurological symptoms. However, 38 (9.7%) subjects recognized neurological symptoms, as the initial manifestation of their illness. Mean duration of neurological symptoms before the onset of respiratory symptoms or fever was 2 ± 1.57 days. Conclusion: New-onset headache, altered taste, and smell were the most common neurological symptoms. In the context of the current pandemic, a high index of suspicion should be kept in patients presenting with these symptoms even in the absence of fever and respiratory symptoms. To the best of our knowledge, this is the first study from India comparing chronology of neurological symptoms with cardinal symptoms.
Background:The determinants of the outcome in adult convulsive status epilepticus(CSE), also the implication of the value of mean arterial blood pressure (MAP), and random blood sugar at admission on the outcome are not clear.Objectives:The objective of this study is to look for the determinants of unfavorable outcome in CSE.Materials and Methods:Ambispectively gathered data from 55 patients, treated consecutively with identical protocol during January 2010–December 2016, were analyzed. The demographic and clinical variables were identified and correlated with outcome in each individual.Results:There were 65.45% males and 34.55% females. Favorable outcome (conscious and discharged) was seen in 63.6%, unfavorable (death 14.5%, absent cortical functions 10.9%, and inability to wean-off anesthetic agents 10.9%). The parameters associated with unfavorable outcome were female gender (odds ratio [OR]: 1.45), MAP ≤80 mmHg (OR: 2.57), time to first medical attention >5 h (OR: 127.8), and time to control clinical seizures >3.5 h (OR: 7.87). Almost 44.2% of patients with SE severity score >2 had unfavorable outcome (sensitivity 75% and specificity 45.7%). New scoring system, the CSE outcome score (CSEOS, developed by combining the predictors associated with higher odds of poor outcome), predicted the poor outcome with the sensitivity and specificity of 90% and 54.29%, respectively.Discussion and Conclusion:Low MAP and delay of >3.5 h in treatment initiation or seizure control are the key determinants of poor outcome in CSE. With the incorporation of CSEOS, we believe that our findings can be helpful in the process of clinical decision-making and prognostication of patients with CSE.
Guillain-Barre syndrome (GBS) in pregnancy is a rare co-occurrence and it is generally accepted that it carries a high maternal risk. We report a 40-year-old housewife who developed GBS with respiratory failure during the third trimester (31 weeks of gestation). She had preterm vaginal delivery on ventilator support at 34 weeks of gestation in neurology intensive care unit. She managed successfully with ventilatory support, intravenous immunoglobulin and other supportive measures.
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