IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Background and objective: One of the diseases that increase the risk of seizures in the person is multiple sclerosis. Several studies have reported multiple sclerosis as a risk factor for seizure. This study was conducted to determine the frequency of seizure types in patients with Multiple Sclerosis (MS) referred to Alavi hospital in Ardebil city north-west of Iran.
Irina Gontschar and Igor Prudyvus
Abstract
Introduction: The purpose of the study is to provide information about the database of 1421 adult patients with acute ischemic stroke (IS) developing ≤ 48 hours before admitting, research methods, study protocol, and clinical predictors of the evolving stroke course (EIS).
Methods and Materials: EIS outlined as an increase of NIHSS ≥ 2 points within seven days or in-hospital lethal outcome. Clinical, demographic, instrumental, laboratory data acquisition, as well as the IS course variant and the functional outcome assessment, were carried out prospectively. Statistical analyses were performed using R V.3.2.5 statistical package software and IBM SPSS Statistics 26.0.
Results: The incidence of EIS reached 30.0%. The average age of patients with EIS was 72.6±10.2 years, compare the age of patients without EIS - 68.1±11.3 years; p = 0.005. Female sex increased the odds of EIS (OR, 1.36; 95% CI 1.08-1.73). Total anterior carotid stroke (OR, 7.78; 95% CI 5.91-10.23), the initial NIHSS score > 14 points (OR, 3.74; 95% CI 2.83-4.94), and the right anterior circulation was also associated with EIS (OR, 1.30; 95% CI 1.02-1.66). The odds of EIS were significantly higher in the presence of diabetes mellitus (OR, 1.29; 95% CI 1.01-1.66), cerebral artery stenosis ≥ 70% (OR, 1.96; 95% CI 1.30-2.93), atrial fibrillation (OR, 1.89; 95% CI 1.51-2.39), congestive heart failure (OR, 1.90; 95% CI 1.51-2.39), and peripheral artery disease (OR, 1.69; 95% CI 1.27-2.25). Respiratory (OR, 2.82; 95% CI 2.22-3.59), gastrointestinal (OR, 1.34; 95% CI 1.05-1.70), and urologic diseases (OR, 2.10; 95% CI 1.65-2.66), stroke-associated infection (OR, 3.47; 95% CI 2.09-5.76), and gradual development of initial IS symptoms before admitting increased the odds of progression of the neurological deficit during treatment (OR, 2.37; 95% CI 1.78-3.15)were associated with the evolving clinical course of IS. The patients with the EIS compared with patients without EIS, showed higher serum levels of glucose (p < 0.001), urea (p = 0.001), creatinine (p < 0.001), sodium (p = 0.025), and direct bilirubin (p = 0.015). Potassium level in EIS group was lower than in the group without EIS (p < 0.001). In patients with EIS, a higher amount of RBC (p = 0.030) and WBC (p < 0.001) was found.
Conclusion: The in-hospital database contains information about EIS by the bases subtypes of IS, patient demography, cardiovascular risk factors, comorbid pathology, clinical and laboratory tests, instrumental methods of examination, medications, the severity of neurological deficit, and post-stroke outcome.
Background and objective: One of the diseases that increase the risk of seizures in the person is multiple sclerosis. Several studies have reported multiple sclerosis as a risk factor for seizure. This study was conducted to determine the frequency of seizure types in patients with Multiple Sclerosis (MS) referred to Alavi hospital in Ardebil city north-west of Iran.
Irina Gontschar and Igor Prudyvus
Abstract
Introduction: The purpose of the study is to provide information about the database of 1421 adult patients with acute ischemic stroke (IS) developing ≤ 48 hours before admitting, research methods, study protocol, and clinical predictors of the evolving stroke course (EIS).
Methods and Materials: EIS outlined as an increase of NIHSS ≥ 2 points within seven days or in-hospital lethal outcome. Clinical, demographic, instrumental, laboratory data acquisition, as well as the IS course variant and the functional outcome assessment, were carried out prospectively. Statistical analyses were performed using R V.3.2.5 statistical package software and IBM SPSS Statistics 26.0.
Results: The incidence of EIS reached 30.0%. The average age of patients with EIS was 72.6±10.2 years, compare the age of patients without EIS - 68.1±11.3 years; p = 0.005. Female sex increased the odds of EIS (OR, 1.36; 95% CI 1.08-1.73). Total anterior carotid stroke (OR, 7.78; 95% CI 5.91-10.23), the initial NIHSS score > 14 points (OR, 3.74; 95% CI 2.83-4.94), and the right anterior circulation was also associated with EIS (OR, 1.30; 95% CI 1.02-1.66). The odds of EIS were significantly higher in the presence of diabetes mellitus (OR, 1.29; 95% CI 1.01-1.66), cerebral artery stenosis ≥ 70% (OR, 1.96; 95% CI 1.30-2.93), atrial fibrillation (OR, 1.89; 95% CI 1.51-2.39), congestive heart failure (OR, 1.90; 95% CI 1.51-2.39), and peripheral artery disease (OR, 1.69; 95% CI 1.27-2.25). Respiratory (OR, 2.82; 95% CI 2.22-3.59), gastrointestinal (OR, 1.34; 95% CI 1.05-1.70), and urologic diseases (OR, 2.10; 95% CI 1.65-2.66), stroke-associated infection (OR, 3.47; 95% CI 2.09-5.76), and gradual development of initial IS symptoms before admitting increased the odds of progression of the neurological deficit during treatment (OR, 2.37; 95% CI 1.78-3.15)were associated with the evolving clinical course of IS. The patients with the EIS compared with patients without EIS, showed higher serum levels of glucose (p < 0.001), urea (p = 0.001), creatinine (p < 0.001), sodium (p = 0.025), and direct bilirubin (p = 0.015). Potassium level in EIS group was lower than in the group without EIS (p < 0.001). In patients with EIS, a higher amount of RBC (p = 0.030) and WBC (p < 0.001) was found.
Conclusion: The in-hospital database contains information about EIS by the bases subtypes of IS, patient demography, cardiovascular risk factors, comorbid pathology, clinical and laboratory tests, instrumental methods of examination, medications, the severity of neurological deficit, and post-stroke outcome.
Deep vein thrombosis prophylaxis in a tertiary care center: An observational ...Apollo Hospitals
Deep vein thrombosis (DVT) is a major health problem with substantial mortality and morbidity in medically ill patients. Prevention of DVT by risk factor stratification and subsequent antithrombotic prophylaxis in moderate- to severe-risk category patients is the most rational means of reducing morbidity and mortality.
A less-invasive-approach-of-medial-meniscectomy-in-rat-a-model-to-target-earl...science journals
In order for insulin to exert its biological actions on target cells in peripheral tissues like muscle and adipose tissues, Insulin must pass through the endothelial barrier into the interstitium.
Study of Congenital Heart Diseases in Pediatric Patientinventionjournals
Introduction: Congenital heart disease is important cause of morbidity and mortality in pediatric practice. Objectives: - 1) To establish the diagnosis and find out incidence of CHD in various age group. 2) To study various mode of presentation of various CHDs. 3) To study morbidity and mortality in various CHDs in children. Methodology:- Total 60 cases of congenital heart diseases coming to K.T. Children hospital, Rajkot from July 2016 to November 2016 were studied. Informed consent and detailed history was taken followed by thorough clinical examination as per Performa attached. Echocardiography of all patients was done. School health cards were prepared for the patients having abnormal echocardiography and referred to higher centre for cardiologist opinion. Conclusion:- Correct diagnosis can be made with help of thorough history and clinical examination especially in acyanotic congenital heart diseases. Early diagnosis and timely referral of patient can greatly improve outcome of patients with CHDs.
Introduction: Stroke is an even more dramatic major public health problem in young people. Goal of the study: Contribute to the knowledge of strokes in young people. Methodology: This was a retrospective study carried out over a period of 02 years (January 2017 to December 2018) including the files of patients aged 18 to 49 years hospitalized for any suspected case of stroke in the Neurology department of the University Hospital
Center of the Sino-Central African Friendship (CHUSCA) of Bangui.
Introduction: Chronic Kidney Disease (CKD) is a worldwide public health problem and it is increasing over time. Cardiovascular disease is a major concern for patients with end stage renal disease, especially those on hemodialysis. It is the leading cause of death among patients with chronic kidney
disease, particularly in dialysis population.
Clinico-haematological Profile of Falciparum Malaria in a Rural Hospital of T...iosrphr_editor
Aim: To study the clinico-haematological profile malaria in a rural hospital of Tripura.
Material and methods: A cross-sectional hospital-based study was done from at Kulai District
Hospital,Tripura. This hospital based cross sectional study was done on 60 confirmed cases of falciparum
malaria (either by peripheral smear or rapid diagnostic test) admitted in Kulai District Hospital. A case sheet
proforma was prepared and data (demographic profile,clinical feature, investigation, treatment, and
complication) from all indoor patients was collected and analyzed.
Result: Out of 60 patients, 40(66.6%) were males and 20 (33.4%) were females. Most of the patients were
between the age group 21-40 years with the highest prevalence between the age group of 21-30. Fever was the
most common symptom. Anemia was present in 42(70%) patients, out of which 6(10%) patients had severe
anemia. Thrombocytopenia was present in 36(60%) patients.Abnormal liver function tests were observed in
26(43.3%) subjects while abnormal kidney function tests were observed in16(26.6%) patients. All the 60
patients received Artemisinin based antimalarial drugs.
Conclusion: Early detection, prompt management, and adequate supportive therapy may reduce mortality due
to falciparum cerebral malaria.
An Analytical Study of Acute Flaccid Paralysis in a Tertiary Care Centreiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Irina Gontschar and Igor Prudyvus
Abstract
Introduction: The goal of the study was to identify the most significant prognostic clinical criteria for the survival of patients with ischemic stroke (IS) within 1 year of observation.
Methods and Materials: The object of the clinical prospective study was 1421 patients with IS hospitalized in 2002-2015 in the neurological (stroke) departments of the 5th Minsk City Clinical Hospital and the Minsk Emergency Hospital. Analyzing the obtained data, we adhered to the prospective-specimen-collection, retrospective evaluation design of the study. The primary endpoint of the study was the patient's death from any reason within one year of the development of IS. Information on poststroke all-cause mortality was obtained through linkages to the official source - the centralized archive of deaths of residents of the city of Minsk. Patients without a confirmed death date were censored at the date last known alive. All patients that were alive at one year are assumed to be censored at that time. The collection of clinical, demographic, neuroimaging, laboratory data, as well as the final determination of the stroke outcome, was performed blindly with respect to survival data.
Results: To build the model, 22 multivariate clinical indicators were used that demonstrated the relationship with post-stroke survival at the stage of preliminary data analysis: stroke subtype according the Oxfordshire Community Stroke Project, age, gender, the severity of the neurological deficit according to the NIHSS scale at hospitalization, previous stroke or TIA, the presence of arterial hypertension, atrial fibrillation, myocardial atherosclerosis, congestive heart failure, diabetes mellitus, peripheral arterial diseases, alcohol abuse, level of creatinine, glucose, urea, potassium, sodium in blood, amount of hemoglobin, erythrocytes and leukocytes on the 1st day of treatment, the level of systolic and diastolic blood pressure in the hospital admission department.
In the construction of a survival decision tree of patients with IS, of the 22 initially embedded parameters, only 6 independent predictors were finally included in the prognostic model: the stroke subtype according to the OCSP, the presence of a lacunar infarction, the severity of neurologic deficit at hospitalization according NIHSS, level of urea and glucose in the blood, and the presence of congestive heart failure.
A 2 year multidomain intervention of diet, exercise, cognitive training, and ...Nutricia
A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial
Approach to a case of Fever with altered sensoriumRoy Shilanjan
A brief description about the possible d/d of fever with alteration of sensorium and how to approach the diagnosis through systematic yet focused history taking , physical examination and lab and radiological investigations.
Visual Evoked Potential in Normal and Amblyopic Childreniosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Deep vein thrombosis prophylaxis in a tertiary care center: An observational ...Apollo Hospitals
Deep vein thrombosis (DVT) is a major health problem with substantial mortality and morbidity in medically ill patients. Prevention of DVT by risk factor stratification and subsequent antithrombotic prophylaxis in moderate- to severe-risk category patients is the most rational means of reducing morbidity and mortality.
A less-invasive-approach-of-medial-meniscectomy-in-rat-a-model-to-target-earl...science journals
In order for insulin to exert its biological actions on target cells in peripheral tissues like muscle and adipose tissues, Insulin must pass through the endothelial barrier into the interstitium.
Study of Congenital Heart Diseases in Pediatric Patientinventionjournals
Introduction: Congenital heart disease is important cause of morbidity and mortality in pediatric practice. Objectives: - 1) To establish the diagnosis and find out incidence of CHD in various age group. 2) To study various mode of presentation of various CHDs. 3) To study morbidity and mortality in various CHDs in children. Methodology:- Total 60 cases of congenital heart diseases coming to K.T. Children hospital, Rajkot from July 2016 to November 2016 were studied. Informed consent and detailed history was taken followed by thorough clinical examination as per Performa attached. Echocardiography of all patients was done. School health cards were prepared for the patients having abnormal echocardiography and referred to higher centre for cardiologist opinion. Conclusion:- Correct diagnosis can be made with help of thorough history and clinical examination especially in acyanotic congenital heart diseases. Early diagnosis and timely referral of patient can greatly improve outcome of patients with CHDs.
Introduction: Stroke is an even more dramatic major public health problem in young people. Goal of the study: Contribute to the knowledge of strokes in young people. Methodology: This was a retrospective study carried out over a period of 02 years (January 2017 to December 2018) including the files of patients aged 18 to 49 years hospitalized for any suspected case of stroke in the Neurology department of the University Hospital
Center of the Sino-Central African Friendship (CHUSCA) of Bangui.
Introduction: Chronic Kidney Disease (CKD) is a worldwide public health problem and it is increasing over time. Cardiovascular disease is a major concern for patients with end stage renal disease, especially those on hemodialysis. It is the leading cause of death among patients with chronic kidney
disease, particularly in dialysis population.
Clinico-haematological Profile of Falciparum Malaria in a Rural Hospital of T...iosrphr_editor
Aim: To study the clinico-haematological profile malaria in a rural hospital of Tripura.
Material and methods: A cross-sectional hospital-based study was done from at Kulai District
Hospital,Tripura. This hospital based cross sectional study was done on 60 confirmed cases of falciparum
malaria (either by peripheral smear or rapid diagnostic test) admitted in Kulai District Hospital. A case sheet
proforma was prepared and data (demographic profile,clinical feature, investigation, treatment, and
complication) from all indoor patients was collected and analyzed.
Result: Out of 60 patients, 40(66.6%) were males and 20 (33.4%) were females. Most of the patients were
between the age group 21-40 years with the highest prevalence between the age group of 21-30. Fever was the
most common symptom. Anemia was present in 42(70%) patients, out of which 6(10%) patients had severe
anemia. Thrombocytopenia was present in 36(60%) patients.Abnormal liver function tests were observed in
26(43.3%) subjects while abnormal kidney function tests were observed in16(26.6%) patients. All the 60
patients received Artemisinin based antimalarial drugs.
Conclusion: Early detection, prompt management, and adequate supportive therapy may reduce mortality due
to falciparum cerebral malaria.
An Analytical Study of Acute Flaccid Paralysis in a Tertiary Care Centreiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Irina Gontschar and Igor Prudyvus
Abstract
Introduction: The goal of the study was to identify the most significant prognostic clinical criteria for the survival of patients with ischemic stroke (IS) within 1 year of observation.
Methods and Materials: The object of the clinical prospective study was 1421 patients with IS hospitalized in 2002-2015 in the neurological (stroke) departments of the 5th Minsk City Clinical Hospital and the Minsk Emergency Hospital. Analyzing the obtained data, we adhered to the prospective-specimen-collection, retrospective evaluation design of the study. The primary endpoint of the study was the patient's death from any reason within one year of the development of IS. Information on poststroke all-cause mortality was obtained through linkages to the official source - the centralized archive of deaths of residents of the city of Minsk. Patients without a confirmed death date were censored at the date last known alive. All patients that were alive at one year are assumed to be censored at that time. The collection of clinical, demographic, neuroimaging, laboratory data, as well as the final determination of the stroke outcome, was performed blindly with respect to survival data.
Results: To build the model, 22 multivariate clinical indicators were used that demonstrated the relationship with post-stroke survival at the stage of preliminary data analysis: stroke subtype according the Oxfordshire Community Stroke Project, age, gender, the severity of the neurological deficit according to the NIHSS scale at hospitalization, previous stroke or TIA, the presence of arterial hypertension, atrial fibrillation, myocardial atherosclerosis, congestive heart failure, diabetes mellitus, peripheral arterial diseases, alcohol abuse, level of creatinine, glucose, urea, potassium, sodium in blood, amount of hemoglobin, erythrocytes and leukocytes on the 1st day of treatment, the level of systolic and diastolic blood pressure in the hospital admission department.
In the construction of a survival decision tree of patients with IS, of the 22 initially embedded parameters, only 6 independent predictors were finally included in the prognostic model: the stroke subtype according to the OCSP, the presence of a lacunar infarction, the severity of neurologic deficit at hospitalization according NIHSS, level of urea and glucose in the blood, and the presence of congestive heart failure.
A 2 year multidomain intervention of diet, exercise, cognitive training, and ...Nutricia
A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial
Approach to a case of Fever with altered sensoriumRoy Shilanjan
A brief description about the possible d/d of fever with alteration of sensorium and how to approach the diagnosis through systematic yet focused history taking , physical examination and lab and radiological investigations.
Visual Evoked Potential in Normal and Amblyopic Childreniosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Strategies for Enhancing Teaching of Food and Nutrition in Mutare Urban Secon...iosrjce
The study was carried out in an effort to come up with strategies for enhancing the teaching of Food
and Nutrition (FN) at secondary level, in Mutare urban, Manicaland Province. It assessed the most common
teaching methodologies used by FN teachers. The target population was derived from ten urban secondary
schools offering FN, with an average of 4 teachers per school, thereby giving a total population of 40 teachers.
Out of this population, a sample of 15 teachers was purposively extracted, with teachers from every location to
make generalizations more meaningful and realistic .The main instrument used in the study was the
questionnaire which sought to solicit information from teachers using both open and close ended questions. The
descriptive survey research was employed and both the two research paradigms (qualitative and quantitative)
were use. The major findings revealed that most teachers were qualified and knew the methods appropriate for
the teaching of Food and Nutrition. However, the major challenge was unavailability of resources, such as
ingredients for practicals as well as lack of improvisation by the teacher. Thus, marrying practice with theory
was a challenge for most pupils. It was recommended that school administrators fully furnish FN laboratories
for learning to be real for pupils. Teachers were also encouraged to avoid pupil boredom by using a variety of
teaching methodologies rather than sticking to one or two only and to improvise as much as they possibly can.
Risk Factors and Pregnancy Outcome of Preterm Laboriosrjce
IOSR Journal of Nursing and health Science is ambitious to disseminate information and experience in education, practice and investigation between medicine, nursing and all the sciences involved in health care. Nursing & Health Sciences focuses on the international exchange of knowledge in nursing and health sciences. The journal publishes peer-reviewed papers on original research, education and clinical practice.
By encouraging scholars from around the world to share their knowledge and expertise, the journal aims to provide the reader with a deeper understanding of the lived experience of nursing and health sciences and the opportunity to enrich their own area of practice. The journal publishes original papers, reviews, special and general articles, case management etc.
Matching Sketches with Digital Face Images using MCWLD and Image Moment Invar...iosrjce
Face recognition is an important problem in many application domains. Matching sketches with
digital face image is important in solving crimes and capturing criminals. It is a computer application for
automatically identifying a person from a still image. Law enforcement agencies are progressively using
composite sketches and forensic sketches for catching the criminals. This paper presents two algorithms that
efficiently retrieve the matched results. First method uses multiscale circular Weber’s local descriptor to encode
more discriminative local micro patterns from local regions. Second method uses image moments, it extracts
discriminative shape, orientation, and texture features from local regions of a face. The discriminating
information from both sketch and digital image is compared using appropriate distance measure. The
contributions of this research paper are: i) Comparison of multiscale circular Weber’s local descriptor with
image moment for matching sketch to digital image, ii) Analysis of these algorithms on viewed face sketch,
forensic face sketch and composite face sketch databases
Causesand Prevention of Occupational Stressiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Ethics in the Search of Knowledge: A Note to Muslim Studentsiosrjce
Muslims should inculcate in their mind the idea that knowledge in Islam is sought and spread
purposely for Allah’s sake but not for one’s recognition or fame as viewed by many. When searching for
knowledge appropriate manners (A’daab) are to be observed with a view to getting beneficial knowledge from
the teachers. This is because good manners lead to prosperity while bad ones lead to misery. The Prophet
(SAW) was reported to have said in one of his traditions that "through good manners one reaches the status of
the person who not only fasts but who also stands late in the night to pray". He also says in another Hadith that
"Shall I not inform you of the most beloved to me and the one seated closest to me on the Day of Resurrection?
Those of you who are best in manners". The two Ahadith quoted stress the importance of good manners
expected to be imbibed by every Muslim who, particularly, wants his search for knowledge yield positive result.
This is true if we only understand that knowledge cannot be acquired or gained by merely consulting books.
Therefore, it is against this background that this article intends to discuss ethics in the search of knowledge: A
note to Muslim students.
Cryptanalysis and Security Enhancement of a Khan et al.'s Schemeiosrjce
IOSR Journal of Computer Engineering (IOSR-JCE) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of computer engineering and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications in computer technology. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Upsurge of chikungunya cases in Uttar Pradesh, IndiaAhmad Ozair
Background & objectives: Chikungunya (CHIK) re-emerged in India in 2006 after a gap of three decades. In Uttar Pradesh (UP), <100 confirmed cases per million were reported during this outbreak. Based on an upsurge of CHIK cases at UP, this retrospective study was conducted to investigate clinical and serological profile of CHIK cases in UP. Methods: A retrospective study was done on all clinically suspected CHIK cases that had been tested by ELISA for anti-CHIK virus IgM antibodies from September 2012 to December 2017. Based on clinical features, a subset of patients had earlier been tested serologically for dengue and Japanese encephalitis (JE). Results: Of the 3240 cases enrolled, 771 (23.8%) were seropositive. Patients had a range of clinical manifestations with seropositivity highest in those exhibiting arthralgia with fever (40%), followed by fever of unknown origin (FUO) (22%), encephalitis (13%) and fever with rash (12%). Cases (total, seropositive) increased over 20-fold in 2016 (1389, 412) and 2017 (1619, 341), compared to 2012-2015. Nearly a third of dengue serology-positive cases and a fifth of JE serology-positive cases were co-positive for CHIKV. Interpretation & conclusions: Archival data from 2006-2011 and data from this study (2012-2017) indicated that UP experienced first CHIK outbreak in the decade in 2016, as part of a large-scale upsurge across northern India. CHIK should be considered as a differential diagnosis in patients presenting with fever of unknown origin or fever with rash or acute encephalitis, in addition to classical arthralgia.
Red cell alloimmunization in blood transfusion dependent Patients with Sickle...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Methods: Two groups were selected by non-probability random sampling technique including case group of 154 patients with
suspected dengue (fever>2days and <10days) and control group of 146 patients with febrile illness other than dengue. Clinical,hematological and serologic markers of cases and control groups were analyzed. The frequency distribution was used to compare categorical serologic markers and paired sample T test was applied for hematologic variables before and after treatment of dengue using SPSS version 21.
A case report on Rheumatoid Arthritis with sickle cell traitPARUL UNIVERSITY
A female patient aged 6 years, a suspected case of sickle cell trait (SCT) having symptoms of Rheumatoid arthritis (RA),
while evaluating joint complaints in adult sickle cell disease (SCD) patients, a number of sickle cell-based entities come
to mind such as avascular necrosis, osteomyelitis, bone infarcts, and septic arthritis. RA is a chronic systemic
inflammatory disease, many reports highlighted the occurrence of RA in SCD presenting as diagnostic challenges for
cases with chronic inflammatory arthritis, SCT also have appeared to persist in some populations at a perplexingly high
rate given the degree of early mortality of homozygosity of SCD, our case report showed that not only SCD but if a patient
has SCT they can develop RA as complication. Our case report concludes that during the evaluation of a SCT patient who
presents with chronic synovitis, one should strongly consider the possibility of coexistence of RA and SCT.
Study of Neonatal Outcome with Low Apgar Score in Term Neonatesiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
A Study On Clinical Profile Of Sepsis Patients In Intensive Care Unit Of A Te...dbpublications
Background : Sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection which is one of the most important cause of mortality & morbidity in critically ill patients. In this study clinical profiles of the sepsis patients admitted in ICU in this part of India have been evaluated. Methods & Materials: This prospective hospital based observational study was undertaken in the department of Emergency Medicine ICU of Gauhati Medical College & Hospital, over a period of one year from August 2014 to July 2015 after obtaining institutional ethical committee clearance.
RESULTS: Clinical profiles of 50sepsis patients, with male preponderance (56%) & mortality rate 36% were studied. Mean age was 48.36 years (SD ±17.16). fever & tachycardia were present in all patients. 30 patients (60%) required ventilatory support, 28 patients (56%) required inotropic support, 10 patients (20%) required dialysis. Gram negative bacteria were found to be the predominant pathogens associated with sepsis(73.4%) where most common organism responsible was Klebsiella (36.8%). Conclusion : assessment of clinical signs & initial serological & radiological investigations are of utmost importance to detect more critically ill patients as early as possible to intervene earlier for saving the life of the sepsis patients.
Presentation given by Dr Catherine Poots from Craigavon Area Hospital at the 2014 Northern Ireland Intensive Care Society annual Coppel Prize on Wednesday November 26th
Evan Syndrome A Case Report by Parimala L | P Anjaneyuluijtsrd
Evan syndrome is an autoimmune disorder in which auto antibodies are directed against antigens specific to red blood cells, platelets, and neutrophils. Also known as Immune mediated thrombocytopenia ITP , Autoimmune hemolytic anemia AIHA , or immune pancytopenia. Clinical symptoms are thrombocytopenia, hemolysis, and severe anemia. The first line treatment for Evan syndrome intravenous corticosteroids or intravenous immunoglobulins and the second line treatment with rituximab or mycophenolate mofetil or splenectomy for those who are refractory to steroids. We report the case of a 35 year old female who presented with high grade fever with chills and rigors associated with hematuria and she has undergone a diagnosis of Evan Syndrome. Parimala L | P Anjaneyulu "Evan Syndrome: A Case Report" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-8 | Issue-1 , February 2024, URL: https://www.ijtsrd.com/papers/ijtsrd62406.pdf Paper Url: https://www.ijtsrd.com/medicine/other/62406/evan-syndrome-a-case-report/parimala-l
An Examination of Effectuation Dimension as Financing Practice of Small and M...iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Does Goods and Services Tax (GST) Leads to Indian Economic Development?iosrjce
IOSR Journal of Business and Management (IOSR-JBM) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Childhood Factors that influence success in later lifeiosrjce
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
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Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
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6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Clinical Profile and Outcome of Children Admitted with Acute Encephalitis Syndrome in a tertiary Care hospital in West Bengal, India
1. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS)
e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 14, Issue 11 Ver. VII (Nov. 2015), PP 08-12
www.iosrjournals.org
DOI: 10.9790/0853-141160812 www.iosrjournals.org 8 | Page
Clinical Profile and Outcome of Children Admitted with Acute
Encephalitis Syndrome in a tertiary Care hospital in West
Bengal, India
Saumyen De, MD1,
Sanjana Samanta, MD2
Sanjay Halder, MD3
,
Pronabesh Sarkar4
1
Assistant Professor,2
Senior Resident, 3
RMO Cum Clinical Tutor, 4
Post graduate trainee Department of
Pediatrics, Nilratan Sircar Medical College,West Bengal University of Health Sciences, India
Abstract: Acute encephalitis syndrome (AES) is an important cause of mortality morbidity in children. We
undertook the study for better understanding of clinical profile and outcome of AES in our settings . We
retrospectively evaluated 24 patients of AES admitted in our institute from August to October 2015 by
evaluating their outcomes using the Glasgow Outcome Scale (GOS). Among 24 cases AES patients, 6(25%)
were recovered completely (GOSV) , while 11 (45.83%) cases had neurological sequelae (GOS II –IV) with a
wide range of severity varying from mild to severe at the time of discharge.7(29.16%) patient died in the
hospital (GOS I). Use of mechanical ventilation, lower Glasgow coma score, and concurrent seizures are
predictors for a poor outcome.
I. Introduction
Viral encephalitis is a globally distributed disease that seriously affects public health, threatening
almost half of the world’s population 1
. It may be sporadic like herpes simplex encephalitis (HSE), or epidemic
such as Japanese B encephalitis (JE). The etiological agents are varied, and physicians treating such children
often feel limited by the lack of availability of diagnostic testing for most of these agents. In developed
countries, 50–60 % of survivors of viral encephalitis with clear etiologies had a poor prognosis after long-term
follow-up 2– 6
.
At present, pathogen detection for viral encephalitis is not widely used for clinical diagnosis and
treatment in India; the diagnosis is largely based on clinical data and auxiliary examination of patients 7-8
. In
addition, research shows that no more than 30–40 % of encephalitis cases can be pathogenically diagnosed, of
which Japanese encephalitis (JE) is the most common cause in India9-10,36
. And more than half of pathogenically
diagnosed viral encephalitis have a poor prognosis11
. On the other hand, 10–30 % of patients with clinically
diagnosed viral encephalitis also have a poor prognosis. In India, nearly all states have reported JE cases except
that of Jammu & Kashmir, Himachal Pradesh, and Uttaranchal 12
. The Northeastern region (NE region) of India,
particularly the upper part of the state of Assam, has been experiencing recurrent episodes of JE with different
magnitudes from July to October every year 13
.Therefore we conducted retrospective study of the patients
admitted for acute encephalitis syndrome during current season 1st
August 2015 to 31st
October 2015.This study
is done for a better understanding and to determine the clinical profile and outcome of AES in hospitalized
children and also to determine the incidence of J E in all cases of AES.
II. Matirial And Methods
Children with AES upto12 years of age who admitted in our pediatric ward of NRS Medical College
& hospital (West Bengal, India) were included in this study during August to October 2015. This is a tertiary
level hospital and provides health care services to four to five districts in west Bengal. Most patients are
referred to this apex level institute from periphery because of lack of neuroimaging and intensive care facilities
in the periphery.
For investigating AES cases, WHO case definition was adopted. Clinically a case of AES is defined as
fever or recent history of fever with change in mental status (including confusion, disorientation, coma, or
inability to talk) and/or new onset of seizures (excluding simple febrile seizures). Other early clinical findings
could include an increase in irritability, somnolence or abnormal behavior greater than that seen with usual
febrile illness 14-15
Such Patients were excluded if they: (a) had other severe disease, such as severe infection other than in
the central nervous system, malignancy, brain infarction or cerebral hemorrhage, malaria; (b) a diagnosis of
delirium or encephalopathy secondary to sepsis, toxins, or metabolic causes.
2. Clinical Profile and Outcome of Children Admitted with Acute Encephalitis Syndrome...
DOI: 10.9790/0853-141160812 www.iosrjournals.org 9 | Page
The outcome of patients was graded with a functional outcome score (Glasgow Outcome Scale, GOS),
as follows:
I death; II severe sequelae greatly impairing function and incompatible with independent living; III
moderate sequelae mildly affecting function (including seizures), but compatible with independent living; IV
minor sequelae including altered personality or clinical signs not affecting functions; V full recovery and normal
neurologic examination findings 16
, Prognostic analyses of the individual characteristics were calculated using a
t test (for quantitative variables) or chi square test (for qualitative variables).
III. Results
This study examined 24 patients (14 boys; 56.5 %) with a mean onset age of 5.32 years (range 0.5-12
years).Out of 24 cases of AES, 6 patients (25%) were JE and 18 patients (75%) were non-JE. The JE cases were
confirmed following detection of JEV specific IgM antibody either in CSF or serum. All the samples were
found to be negative for the presence of IgM antibody against other flaviviruses, namely,Dengue prevalent in
this region. Among the JE positive patients 2 were diagnosed by only serum testing positive for anti-JEV IgM
antibodies and 1 was identified following detection of anti-JEV IgM antibodies in CSF only. In 3 AES patients
both serum and CSF were positive for JEV specific IgM antibody. Among the JE positive cases 4 (66.6%) were
male and 2 (33.3%) were female. The predominant age group affected was 4 to 12 years (Table 1) and the
youngest child affected was 9 months old. Majority of the patients (85%) were from the rural area and belonged
to low socioeconomic group (72%).Most of the children (83.3%) were not vaccinated against JE.
The demographic profile and clinical characteristics of the patients are shown in Table 1.
Basic blood investigations include a complete blood count (including platelet count), blood glucose,
serum electrolytes, liver and kidney function tests, blood culture, arterial blood gas is done in all patients with
AES . A peripheral smear for malarial parasite and rapid diagnostic test for malaria were also screened. CSF
analysis done in all hemodynamically stable patients after excluding features of raised intracranial pressure. A
neuroimaging study done prior to the CSF analysis where lumbar puncture was contraindicated.
Investigations are summarized in Table 2.
Among 24cases AES patients, 6(25%) were recovered completely (GOSV) , while 11 (45.83%) cases
had neurological sequelae (GOS II –IV) with a wide range of severity varying from mild to severe at the time of
discharge, 7(29.16%) patient died in the hospital (GOS I).
Clinical characteristics and investigations of patients with a poor or favorable outcome at discharge are
compared in Tables 3.
Table 1Demographic profile and clinical characteristic (n=24)
Characteristic Value
Age 5.32 yr (0.5-12)
Male 55%
GCS (on
admission)
<8 11
>8 13
Length of hospital stay 7.36 days (3-28)
Duration of fever on presentation 9.8 days (2-30)
Headache 43%
Unconsciousness 90%
Seizure 60%
Limb weakness 25%
Altered behavior 20%
Table 2Investigation results and value
Characteristic Value (mean, median, SD)
CSF cell (/ c mm) 58.4,6,(137.6)
CSF protein (mg/dl) 76.08,54.5 (70.13)
CSF glucose(mg/dl) 74.2,29.5 (24.55)
Serum protein(gm/dl) 5.03, 5.8 (1.3)
SGOT (IU) 152, 69 (195)
SGPT (IU) 162, 38.5 (33)
Hemoglobin (Gm/dl) 11.34, 11 (1.8)
Platelet (lacs/cmm) 2.9, 2.5 (1.63)
Total leucocyte count (/cmm) 14800,11000 (955)
3. Clinical Profile and Outcome of Children Admitted with Acute Encephalitis Syndrome...
DOI: 10.9790/0853-141160812 www.iosrjournals.org 10 | Page
Serum sodium (meq/L) 137.38, 137 (5.5)
Serum potasium (meq/L) 4.28,4.45 (0.64)
Serum ionized calcium (mol/L) 0.84,0.85 (0.22)
Blood urea(mg/dl) 26.5,27 (14.9)
Serum creatinine(mg/dl) 0.76,0.75 (0.27)
Table 3Characteristic vs outcome
Character Unfavourable outcome favourable outcome P value
Length of hospital stay
(days)
<7 10 4 1
>7 7 3
Need for mechanical
ventilation
Yes 15 3 0.038
No 2 4
GCS on admission <8 15 2 0.0085
>8 2 5
Recurrent seizures Yes 16 4 0.05
no 1 3
MRI abnormality yes 16 4 0.05
no 1 3
IV. Discussion
This study retrospectively analyzed data of 24 patients diagnosed with AES in a tertiary care hospital
largest hospital from 1st
August to 31st
October 2015 . The etiological agent of AES is varied. Viral agents that
may be encountered in AES in an epidemic form include Japanese encephalitis, which is a major public health
problem because of large endemic areas in the country, the high case fatality rate (20-30%) and frequent
residual neuropsychiatric damage (50-70%) 17
; Enteroviruses, especially EV 71 18
, reported also from sporadic
encephalitis cases 19
; Chandipura virus 20-21
; Nipah virus 22
; and, Chikangunya virus 23
. Another common viral
agent of AES in the epidemic setting, being recognized more commonly now, is Dengue virus 24
. Viral agents
responsible for sporadic encephalitis include Varicella zoster virus, Mumps, Human herpesvirus 6 and 7,
Epstein Barr virus, and most importantly, Herpes simplex virus. Herpse simplex virus encephalitis (HSE) is the
most common cause of sporadic fatal viral encephalitis, with an incidence of 1-3/million in western countries 25
.
Not much information is available regarding proportion of AES cases due to HSE in the Indian setting.
The present study demonstrates that JE is one of the leading forms of viral encephalitis of children in
this part of the Country becasuse around 25% of children with AES admitted in our institution were diagnosed
as confirmed JE. Similar study carried out in Cuddalore district, Tamil Nadu also reported 29.3% patients with
JE in hospitalized AES children 26
. In our study, children mostly affected were from rural areas (85%) and
belong to low socioeconomic group (72%). This correlated well with the earlier studies where the patients were
children of farmers or farm laborers of low socioeconomic group residing in rural areas 27-28
. This may be due to
favorable epidemiological factors like presence of water logged paddy field supporting profuse breeding of
vector mosquitoes, piggeries in close proximity to residence, nonuse of bed nets and outdoor playing habits of
children. JE incidences have been declining sharply in pediatric age group in Taiwan after the vaccination
programme began in 1967 29
. This emphasizes the need of quality coverage of JE mass vaccination program and
consequently vaccination campaign should be evaluated for appropriate corrective measures 30
. Moreover,
continuation of JE vaccination of children in routine immunization in these JE endemic districts of West bengal
should be a public health priority.
Among the clinical presentation, fever, altered sensorium, seizures and headache were the most
common symptoms observed in this study. In children similar manifestation was also noted in earlier studies 31
.
In our study, the use of mechanical ventilation, a GCS score below 8, and concurrent seizures were
found to be poor prognostic factors of encephalitis. These risk factors have also been identified in various
studies. One retrospective study by Ooi et al. 32
, concludes that low perfusion, GCS score below 8, and
convulsions were associated with poor prognosis. Another retrospective study done at French over 253
encephalitis cases found similar results. 34
. Use of mechanical ventilation, lower Glasgow coma score (GCS)
and concurrent seizures are good predictors of poor outcome in acute encephalitis syndrome .So we should
manage the patient aggressively when these poor prognostic factors present without wasting golden hours
irrespective of etiology . Children with Glasgow Coma Score less than 8 should preferably be intubated;
mechanical ventilation should be provided in case the breathing efforts are not adequate.
In our study, 45.83% AES patients had neurological sequelae at the time of discharge, while 29.16%
had died in hospital. Mortality was associated with GCS within 3 to 8. Neurological sequelae in AES are the
common observation 34
. Our study corroborates with the findings A Fowler et al study which indicates sequele
at discharge in 60% of the patients.35
4. Clinical Profile and Outcome of Children Admitted with Acute Encephalitis Syndrome...
DOI: 10.9790/0853-141160812 www.iosrjournals.org 11 | Page
V. Conclusion
This study offers a description of the present etiology, clinical presentation and short-term outcome of
AES. Need of mechanical ventilation, lower GCS score, and concurrent seizures are good predictors for a poor
outcome in these patients. However, the large group of cases with unknown etiology and the lack of data on
long-term outcome all indicate the need for further studies in this field. Reporting and appropriate workup of all
cases would strengthen the AES surveillance and go a long way in reducing the morbidity and mortality due to
this disorder.
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