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Background: COPD is a powerful and independent risk factor for cardiovascular morbidity and mortality which includes right ventricular (RV) dysfunction and cor pulmonale secondary to pulmonary arterial hypertension (PAH), left ventricular dysfunction. Echocardiography provides a rapid, noninvasive, portable, and accurate method to evaluate cardiac functions. Early diagnoses and intervention for cardiac comorbidities would reduce mortalities in COPD patients. The aim of this study is to find echocardiographic changes in COPD patients and to assess RV dysfunction by echocardiography and correlate with the disease severity.Methods: 100 patients of COPD fulfilling the inclusion criteria coming to OPD/wards of NMCH, Kota were recruited. They were staged by pulmonary function test (PFT) and evaluated by echocardiography. Statistical analysis of correlation was done with chi square test and statistical significance was taken p<0.05.Results: Most common echocardiographic finding was cor pulmonale, which was present in 62% of cases, other echocardiographic findings were PAH in 44% cases, RA/RV dilatation (43%), RVH (42%), LVDD (46%), RVSD (14%) and LVH in 11% of cases. Echocardiographic signs of RV dysfunction observed are PAH, cor pulmonale and RVSD which are correlated with the severity of the disease (p<0.05).Conclusions: Echocardiographic examination is reliable in following COPD patients with PAH instead of repeated cardiac catheterization. The incidence of RV dysfunction is more common as the severity of COPD increases and there is a significant correlation between the degree of air flow limitation (FEV1) and RV dysfunction.

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Background: Chronic obstructive pulmonary disease is the fourth leading cause of mortality worldwide. It is defined as a disease state characterized by airflow limitation that is not fully reversible. Patients with chronic obstructive pulmonary disease (COPD) are at increased risk of cardiovascular disease. Electrocardiography (ECG) carries information about cardiac disease and prognosis in COPD patients. Present study was undertaken to correlate ECG changes with severity of COPD.Methods: 100 patients of COPD fulfilling the inclusion criteria coming to OPD/wards of NMCH, Kota were recruited. They were staged by pulmonary function test (PFT) and evaluated by electrocardiography. Statistical analysis of correlation was done with chi square test and statistical significance was taken p<0.05.Results: Mean age was 63.18±8.66 years, with male preponderance, male to female ratio 6.14:1. Mean duration of disease was 7.58±2.92 years, mean exposure to smoking of 25.06 pack years. Most common ECG finding was RAD which was present in 69% of cases, other ECG findings are P. pulmonale (45%), incomplete RBBB (15%), PPRW (35%), RVH (53%). All ECG findings except incomplete RBBB significantly correlated with disease severity (‘p’ value <0.05).Conclusions: COPD is more common in male in 5th to 7th decade of life, with a smoking history of more than 20 pack years. The occurrence of ECG findings increase as severity and duration of disease increase. It can be inferred that ECG is a useful bedside test to assess the severity of COPD.

Objective: To study all aspects of delirium including occurrence, risk factors, precipitating causes and outcome in tertiary care hospital catering geriatric medicine services. Methods: A prospective observational study was done among 100 cases of delirium recruited from 520 patients admitted in geriatric block of general medicine ward during a calendar year. Patients were screened for delirium by confusion assessment method. Prevalent delirium and incident delirium was calculated. A set of predisposing risk factors were sought on admission. The cause of delirium was ascertained after full evaluation of patients by taking history, doing physical examination including neurological examination and appropriate investigations. Outcomes were measured in terms of length of hospital stay and inpatient mortality. Results: Out of 520 patients admitted in Geriatric ward during the study period, 100 patients had delirium (study prevalence 19.23%) and out of these, 7 patients developed delirium during hospitalization (study incidence 1.34%). The most common precipitating causes of delirium was infections (41%), followed by stroke (17%) and electrolyte imbalance (11%). Among infections, UTI was the most common cause. The most common predisposing risk factors for delirium were infections (52%), sensory impairment (51%), immobility/ being bedridden (40%), incontinence (32%), hypoxia (29%), electrolyte disturbances (hyponatremia-22%), dehydration (21%), and poly pharmacy (15%). At the end of the study, mortality was 24% and 38 (38%) patients were recovered from the delirium. Conclusion: Delirium was found in 19.23% admitted geriatric patients and associated with considerable mortality (24%). The most common precipitating and predisposing causes of delirium was infection. After effective management, 38 (38%) patients recovered from delirium and were discharged in stable condition.

INTRODUCTIONCardiovascular disease has emerged as the single most important cause of death worldwide. In our country, the CVD risk factors rise as a consequence of adverse life style changes accompanying industrialization and urbanization, the rates of CVD mortality and morbidity could rise even higher than the rates predicted solely by demographic changes. CVD probably represents 25% of all deaths in India. Prevalence of CHD in India recently was estimated at more than 10% in urban areas and 4.5% in rural areas. 1 The survival of patients with acute myocardial infarction has improved considerably during the past 10 years with the advent of PCI and better utilization of anticoagulants, aspirin, and cardioprotective drugs. Despite this improvement, mortality rates after MI ABSTRACT Background: Cardiovascular disease has emerged as the single most important cause of death worldwide. Every patient of MI has to be stratified according to the risk factors, so that high risk patients can be identified and can be managed effectively GRACE risk score is one of the score used to calculate the risk in MI. Present study was undertaken to correlate GRACE risk score and mortality in non-STEMI. Methods: 200 patients of non-STEMI fulfilling the inclusion criteria admitted in wards of NMCH, Kota were recruited. GRACE risk score was calculated for all patients. Each patient monitored closely throughout their hospitalization. Each component of GRACE risk score was studied for statistical significance. Statistical analysis of correlation was done with chi square test and statistical significance was taken p < 0.05. Results: Mean age is 59.45±8.66 years, with male preponderance, male to female ratio 3:1. Maximum GRACE score is 300 and the minimum score is 86. Patients were categorized into low (74 patients), intermediate (60 patients), high risk (66 patients) according to GRACE score. 14 patients were expired and all of them are in high risk category. GRACE score had sensitivity (100%), specificity (72.04%), positive predictive value (21.2%) and negative predictive value (100%). Serum creatinine (p<0.001), heart rate (p<0.001), blood pressure (p<0.001), Killip class (p<0.001), cardiac biomarkers (p<0.001), ST segment changes (p<0.001) were significantly associated with adverse events. Age>50 (p<0.110) is not significant. Overall grace score demonstrated excellent discrimination (p<0.001), C statistics 0.99, 95% CI 115.742-151.221 for in hospital mortality. Conclusions: This study has shown GRACE risk score is highly accurate in predicting in hospital mortality in patients of non-STEMI. We should routinely use GRACE risk score in our hospital settings to identify the high-risk patients to decrease mortality.