Introduction: Stroke is defined as an abrupt onset of neurologic deficit due to vascular cause. It is one of the leading causes of mortality and morbidity all over the world making early diagnosis and treatment inevitable. Lesions of extra cranial carotid arteries are implicated in majority of cases of acute ischemic stroke. Carotid Doppler is a non-invasive imaging technique, with sensitivity approaching that of angiography. Computed Tomography (CT) plays a major role to assess the site and nature of the lesion in patients with acute ischemic stroke.
Background/Aim:The recent years have witnessed an increase in number of people harboring chronic liver diseases. Gastroesophageal variceal bleeding occurs in 30% of patients with cirrhosis, and accounts for 80%-90% of bleeding episodes. We aimed to assess the in-hospital mortality rate among subjects presenting with variceal gastrointestinal bleeding and (2) to investigate the predictors of mortality rate among subjects presenting with variceal gastrointestinal bleeding.Patients and Methods:This retrospective study was conducted from treatment records of 317 subjects who presented with variceal upper gastrointestinal bleeding to Government Medical College, Patiala, between June 1, 2010, and May 30, 2014. The data thus obtained was compiled using a preset proforma, and the details analyzed using SPSSv20.Results:Cirrhosis accounted for 308 (97.16%) subjects with bleeding varices, with extrahepatic portal vein obstruction 9 (2.84%) completing the tally. Sixty-three (19.87%) subjects succumbed to death during hospital stay. Linear logistic regression revealed independent predictors for in-hospital mortality, including higher age (P = 0.000), Child-Pugh Class (P = 0.002), altered sensorium (P = 0.037), rebleeding within 24 h of admission (P = 0.000), low hemoglobin level (P = 0.023), and serum bilirubin (P = 0.002).Conclusion:Higher age, low hemoglobin, higher Child-Pugh Class, rebleeding within 24 h of admission, higher serum bilirubin, and lower systolic blood pressure are the independent predictors of in-hospital mortality among subjects presenting with variceal gastrointestinal bleeding.
The present study was designed to check the serum levels of protease‐activated receptor (PAR‐1) in patients during different phases of dengue severity. Moreover, a correlation between serum PAR‐1 levels and hematological parameters, inflammatory cytokine levels, and liver functional changes was also determined. Based on the World Health Organization criteria, the study population was divided into: nonsevere dengue fever (DF; n = 30), severe dengue hemorrhagic fever (DHF; n = 19), and severe dengue shock syndrome (DSS; n = 11). The platelet count (PLT) and hematocrit (HCT) were analyzed using an automated hematology analyzer and liver function enzymes aspartate transaminase (AST), alanine transaminase (ALT), and alkaline phosphate (ALP), bilirubin were checked by auto‐analyzer using diagnostic kits. Moreover, the levels of inflammatory mediators C‐reactive protein (CRP), tumor necrosis factor‐α (TNF‐α), interleukin‐6 (IL‐6), interleukin‐17 (IL‐17), and PAR‐1 were determined using respective ELISA kits. The HCT levels were elevated and platelet count decreased significantly during dengue complications (DHF and DSS) compared to the DF patients, while the levels of liver functional biomarkers AST, ALT, ALP, and bilirubin remained elevated in DHF and DSS groups than in the corresponding DF group. Similarly, the inflammatory cytokine levels of CRP, TNF‐α, IL‐6, and IL‐17 in DHF and DSS subjects were markedly increased when observed against DF subjects. Notably, the PAR‐1 levels were significantly elevated in DHF and DSS groups than in the DF group and positively correlated with changes in HCT levels, inflammatory biomarkers, and liver enzymes. Our findings conclude that PAR‐1 levels persistently increased with the severity of the dengue infection and are strongly associated with various clinical manifestations. Thus, PAR‐1 levels can be used as a diagnostic marker for assessing dengue severity.
INTRODUCTIONThe advances in the current medical science and technology have strived forward in increasing longevity of the population. Major economies in the worlddeveloping and developed alike are facing an ever increasing graying population with the inherent risk of morbidity and mortality. The combined endpoint of a mechanized and sedentary lifestyle added up with an increase in life span invites our acuity towards a fragile unbalanced segment of the society to whom we are obliged for what we are.Epilepsy is the third most common neurological disorder in old age after dementia and stroke. The elderly are now the group with the highest incidence of epilepsy in the general population. 1 Incidence rates of over 100 per 100000 for epilepsy in people over 60 years old have been reported in contemporary literature. 2The incidence of acute symptomatic or provoked seizures also rises significantly in older persons 3 and the prevalence of epilepsy increases with advancing age, although to a lesser degree.Different studies show considerable variability in the etiology and risk factors for epilepsy. [4][5][6] The most frequently reported risk factor is cerebrovascular disease. Tumors, metabolic and toxic causes and cerebral hypoxia secondary to the many causes of syncope in old age account for around 10% of all seizures. 5,7 Other causes of seizures include head injury, infection, subdural haematoma and neurodegenerative disorders. ABSTRACTBackground: Seizure disorder and epilepsy are one of the common presenting symptoms to an emergency department for geriatric population. Cerebrovascular accident, metabolic derangement, trauma, neurodegenerative diseases, tumor, infections and psychiatric illnesses add up to the frequent etiological spectrum of seizure in elderly. Objective of current study was to describe clinical and etiological spectrum of seizures in later life. Methods: This retrospective study was conducted from medical records of 227 cases of elderly subjects presenting with seizure to emergency department, during a period of 3 years (2010)(2011)(2012)(2013). Results: Most common age group involved was 65-75 years. Mean age of subjects included in the study was 68.13 ± 23.38 years. The most common etiology was cerebrovascular disorders 132 (58.14%), followed by CNS tumor in 16 (07.04%), hypoglycemia in 14 (06.16%), infections 14 (06.16%), substance abuse 12 (05.28%) and trauma 10 (04.40%). The most common presentation was with focal seizures, with 119 (52.42%) subjects whereas 82 (36.12%) presented with generalized tonic clonic seizure, 20 (08.81%) with generalized tonic seizure and 05 (02.20%) with absence seizures. Conclusion: The present study aims at pointing out the different clinical features and etiologies of geriatric seizures, thereby lets the reader have a head start with the management of an elderly patient presenting with seizure.
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