Acute stroke is a medical emergency which can cause permanent neurological damage, complications and even may leads to death. Results of stroke vary widely depending on the size and location of the lesions. It is a heterogeneous condition with respect to prognosis. It is not possible to predict exact outcome of stroke with accuracy. The chances of survival in stroke depend on a great variety of variables. Globally, approximately 15 million new acute stroke events occur every year and approximately 55 million people had stroke at some time in the past. Two thirds of these individuals live in lowand middle-income countries such as India. By 2050, it is anticipated that 80% of stroke events will occur in people living in these regions. 1 A recent Indian study have shown different prevalence rates in rural and urban areas (rural areas 84-262/100,000; urban areas 334-424/100,000) with incidence rate of 119-145/100,000 and 30 day case fatality was found to be 41.08%. 2 According to Indian collaborative acute stroke study (2002)(2003)(2004) with 2162 cases, stroke incidence higher in age group of 41-70
INTRODUCTIONStroke defines an acute vascular event in the brain and is a leading cause of death and disability worldwide. Stroke ranks first in frequency and importance among all neurological disorders. At least 50% of neurological disorders are of this type. Stroke is uncommon in younger age groups and affects males more often than females. [1][2][3][4][5][6] The diagnosis of a stroke is often clinical aided by neuroimaging. A stroke is a medical emergency and can cause permanent neurological damage, complications and death. Risk factors of stroke are both modifiable and nonmodifiable. Results of stroke vary widely depending on the size and location of lesions.The chances of survival in stroke depend on a great variety of variables.Factors associated with poor outcome after strokes are as following. ABSTRACTBackground: Acute stroke is a heterogeneous condition with respect to prognosis. This study was undertaken with the aim to evaluate the significance of routine simple blood parameters and APACHE (acute physiology, age, chronic health evaluation) III scoring system as methods of prediction of 1-month mortality in stroke patients and to assess the sensitivity and specificity of APACHE III scoring system in predicting short term outcome in critically ill patients having stroke. Methods: Patients of stroke presenting within 48 hours of onset were included in the study irrespective of age, sex or type of stroke. The clinical evaluation, neuroimaging and blood investigations were performed. APACHE III scoring system was applied for each patient to calculate the score for each one. The outcome of the patients at the end of one month was determined as survivors and expired. Results: Among the total 120 cases in the study, 54.16% (n=65) patients survived at the end of one month. The mean APAPCHE III Score among the survivors was 45.3 and in expired patients it was 88.6. Taking a cut-off value of 50, APACHE III Score was significantly associated in predicting the mortality in stroke patients (P-value<0.0001). Conclusions:The study concluded that a low GCS at the time of admission and increased serum creatinine were independent predictors of mortality among patients presenting to the hospital within 48 hours with first time acute stroke. APACHE III scoring system was found to be sensitive and reasonably specific in predicting short term outcome in patients having cerebral stroke.
Introduction: Ectopic pregnancy is a common life-threatening gynaecological surgical emergency. Its incidence is rising globally and remains a major cause of morbidity and mortality in early pregnancy. The present study is aimed to determine clinical profile and outcome of ectopic pregnancies in a tertiary care teaching hospital. Methods: After protocol review committee and institutional ethics committee permission, this prospective observational study was conducted in the OBG department of Dr Rajendra Prasad Government Medical College in Tanda on pregnant women in their first trimester with ectopic pregnancy characteristics and diagnosis. The study covered all prenatal clinic and labor room patients who met the selection criteria from February 2020 to January 2021. Results: The most common USG finding of adnexal ectopic mass was detected in 97.2% (70 cases), out of which adnexal mass with mild free fluid in the pouch of Douglas on TVS was detected in 77.7% (56 cases). The presence of fluid in peritoneal cavity (Morrison pouch on TAS) indicating severe hemoperitoneum was detected in 20.8% (15 cases). Most common site of ectopic pregnancy was in the tubal ampullary region in i.e., 45.5% (30 cases), followed by isthmus 18.2% (12 cases), fimbria end of the tube 10.6% (7 cases) and isthmus-ampullary region in 10.6% (7 cases). Medically managed patients were 15.2% (10 cases) & their exact site of tubal ectopic was not known. The patients who were presented with ruptured tubal ectopic pregnancy were 63.6% (42 cases), unruptured tubal ectopic were 21.2% (14 cases), chronic ectopic were 7.5% (5 cases) and tubal abortion were 6.06% (4 cases). Conclusion: Ectopic pregnancies are common and deadly gynecological emergencies. Late diagnosis and referral cause high ruptured ectopic pregnancy rates in developing nations.
BACKGROUND: Serum albumin has been correlated with stroke outcome in previous studies and has shown that elevated levels of serum albumin has better outcome in stroke patients. But many of these studies has been done on acute ischemic stroke and evidence are scarce in hemorrhagic stroke. This study was done to assess albumin level in both ischemic and hemorrhagic stroke patients at tertiary care centered in north India. MATERIALS & METHODS: One hundred and fty patients with acute stroke were included in the study. All participants were evaluated by history, examination, laboratory and radiological modalities. Blood samples for assessment of albumin was collected at the time of admission. Stroke severity was assessed using NIHSS and GCS at the time of admission. Functional outcome was measured 1 week post admission and after 3 months using modied Rankin scale (mRs). Statistical analysis and interpretation of the data was done by using SPSS Software version 23. RESULT: A total of 150 patients with 94 patients Ischemic stroke and 56 patients with Intracerebral hemorrhage (ICH) were included in this study. Mean (SD) age was 64.12 (10.85). Among the study population, 102 (68.0%) were male and 48 (32.0%) were female. Hypertension was present in 68.0% of the patients and 50.0% of the patients were diabetic The mean S. Albumin (g/dL) was 3.63 (0.72). There was moderate negative correlation between serum albumin level and mRS score in both hemorrhagic and ischemic stroke at 1 week (rho = -0.48, p = <0.001). At three months there was no correlation in both ischemic and hemorrhagic stroke patients (rho = -0.12, p = 0.287). CONCLUSION: Patients with low serum albumin level had poor outcome at one week but did not show signicant impact on outcome at 3 month in both Ischemic and hemorrhagic stroke.
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