scholarly journals Risk factors for swallowing dysfunction in stroke patients

2012 ◽  
Vol 49 (2) ◽  
pp. 118-124 ◽  
Author(s):  
Anna Flávia Ferraz Barros Baroni ◽  
Soraia Ramos Cabette Fábio ◽  
Roberto Oliveira Dantas
Keyword(s):  
Tertiary Care ◽  
Care Hospital ◽  
Stroke Patients ◽  
Radiologic Diagnosis ◽  
Risk Of Death ◽  
Increased Risk ◽  
Swallowing Dysfunction ◽  
Level Of Consciousness ◽  
Swallowing Evaluation ◽  
Oral Expression

CONTEXT: Stroke is a frequent cause of dysphagia. OBJECTIVE: To evaluate in a tertiary care hospital the prevalence of swallowing dysfunction in stroke patients, to analyze factors associated with the dysfunction and to relate swallowing dysfunction to mortality 3 months after the stroke. METHODS: Clinical evaluation of deglutition was performed in 212 consecutive patients with a medical and radiologic diagnosis of stroke. The occurrence of death was determined 3 months after the stroke. RESULTS: It was observed that 63% of the patients had swallowing dysfunction. The variables gender and specific location of the lesion were not associated with the presence or absence of swallowing dysfunction. The patients with swallowing dysfunction had more frequently a previous stroke, had a stroke in the left hemisphere, motor and/or sensitivity alterations, difficulty in oral comprehension, alteration of oral expression, alteration of the level of consciousness, complications such as fever and pneumonia, high indexes on the Rankin scale, and low indexes on the Barthel scale. These patients had a higher mortality rate. CONCLUSIONS: Swallowing evaluation should be done in all patients with stroke, since swallowing dysfunction is associated with complications and an increased risk of death.

scholarly journals Predictors of mortality in adult patients with dengue: a study from South India

2018 ◽  
Vol 6 (5) ◽  
pp. 1605 ◽  
Author(s):  
Vasudeva Acharya ◽  
Mohammed Fahad Khan ◽  
Srinivas Kosuru ◽  
Sneha Mallya
Keyword(s):  
Renal Failure ◽  
Prothrombin Time ◽  
Tertiary Care ◽  
P Value ◽  
Bleeding Tendency ◽  
Care Hospital ◽  
Laboratory Parameters ◽  
Prolonged Prothrombin Time ◽  
Risk Of Death ◽  
Increased Risk

Background: Dengue is one of the important causes of acute febrile illnesses in India. Dengue can be a fatal disease, however there are no reliable markers which can predict mortality among these patients.Methods: A prospective cross sectional study was done in patients who were admitted to a tertiary care hospital with features of dengue fever. A total of 364 patients with IgM dengue serology positive were included in the study. Relevant clinical and laboratory parameters were collected from all patients. Association between clinico-laboratory parameters with mortality was studied using appropriate statistical methods.Results: Among the 364 patients recruited in this study, 14 (3.85%) patients died. Mortality among patients with age group 18-40 years was 2.04%, in patients aged above 40 years was 7.56%. Mortality among patients with hypotension was 42.42% (14 out of 33), bleeding manifestations was 15.38% (8/52), platelets <20,000/mm3 was 10.41% (10/96), ALT >200 was 13.04% (6/46), AST>200 was 12.34% (10/81), prolonged prothrombin time was 60%(12/20), renal failure was 28%(14/50), encephalopathy was 31.57% (6/19), multi organ dysfunction syndrome(MODS) was 43.33% (13/30), acute respiratory distress syndrome (ARDS) was 45.45% (5/11), pleural effusion was 7.5% (6/80).Conclusions: The overall mortality in the present study was 3.85%. Following variables were associated with increased risk of death among the dengue patients: Age >40 years, presence of hypotension, platelets <20000 cells/mm3, ALT>200U/L, AST>200U/L, prolonged prothrombin time, presence of renal failure, encephalopathy, MODS, ARDS and bleeding tendency (p value <0.05). Early identification of factors associated with mortality can help to make appropriate decision on care required.

scholarly journals Role of thromboelastography in the evaluation of septic shock patients with normal prothrombin time and activated partial thromboplastin time

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Sang-Min Kim ◽  
Sang-Il Kim ◽  
Gina Yu ◽  
June-Sung Kim ◽  
Seok In Hong ◽  
...  
Keyword(s):  
Septic Shock ◽  
Prothrombin Time ◽  
Partial Thromboplastin Time ◽  
Tertiary Care ◽  
Alpha Angle ◽  
Maximum Amplitude ◽  
Care Hospital ◽  
Normal Value ◽  
Risk Of Death ◽  
Increased Risk

AbstractCoagulopathy is frequent in septic shock and plays a key role in multiple organ dysfunction. The aim of this study is to investigate application values of thromboelastography (TEG) for outcome in septic shock patients with a normal value of prothrombin time (PT) and active partial thromboplastin time (aPTT). Prospective observational study using 1298 consecutive septic shock patients with TEG at admission was conducted at the emergency department (ED) of a tertiary care hospital in South Korea between 2016 and 2019. After excluding overt-disseminated intravascular coagulation (DIC) defined by scoring system, we included patients with a normal value of international normalized ratio ≤ 1.3 and aPTT ≤ 34 s. The primary outcome was 28-day mortality. 893 patients were included and 129 patients with overt DIC were excluded. Of the 764 remaining patients, 414 (54.2%) patients showed normal PT and aPTT (28-day mortality rate, 11.4%). TEG values such as reaction time, kinetic time (K), alpha angle (α), maximum amplitude (MA) and lysis index (LY 30) showed no significant mean difference between the survivor and non-survivor groups. However, hypocoagulable TEG values such as α < 53° (12.0% vs. 23.4%; p = 0.039), and MA < 50 mm (6.3% vs. 21.3%; p = 0.002) were significantly higher in the non-survived group. In multivariate analysis, hypocoagulable state (defined as K > 3 and α < 53 and MA < 50) was independent factors associated with increased risk of death (OR 4.882 [95% CI, 1.698–14.035]; p = 0.003). In conclusion, septic shock patients with normal PT and aPTT can be associated with impaired TEG profile, such as hypocoagulability, associated with increased mortality.

scholarly journals Correlation of Glasgow Coma Scale Score at Hospital Admission with Stroke Hemorrhagic Patient Mortality at Hasan Sadikin Hospital

2019 ◽  
Vol 2 (4) ◽  
Author(s):  
Ary Setio Hartanto ◽  
Andi Basuki ◽  
Cep Juli
Keyword(s):  
Glasgow Coma Scale ◽  
Hospital Admission ◽  
Hemorrhagic Stroke ◽  
P Value ◽  
Stroke Patients ◽  
Coma Scale ◽  
Risk Of Death ◽  
Increased Risk ◽  
Level Of Consciousness ◽  
Gcs Score

Stroke is the most common cause of death in Indonesia. Stroke is divided into ischemic and hemorrhagic stroke. Hemorrhagic stroke has a higher risk of death than ischemic stroke. Hemorrhagic stroke can disrupt patient’s consciousness. The Glasgow Coma Scale (GCS) is a scale that is widely used to assess level of consciousness. Accurate predictors can help doctors determine prognosis and treatment for stroke patient. This study was conducted to determine the correlation of GCS scores at the time of hospital admission and mortality of hemorrhagic stroke patients at Hasan Sadikin Hospital. This study is a retrospective cohort analytic study involving 134 subjects. Data were analyzed using Kolmogorov-Smirnov’s and Fisher's analysis test with significance of p <0.05. From the results of the study, the p value was 0.00, subjects with GCS score somnolence (12-14) had six times higher risk in mortality (P = 0.02, RR = 6.38) and subjects with GCS score sopor and coma (3 - 11) had twenty four times higher risk in mortality (P = 0.00, RR = 23.85). We concluded that decreased score of SKG at the time of hospital admission was associated with increased risk of death in hemorrhagic stroke patients at Hasan Sadikin Hospital.   Keywords: Glasgow Coma Scale, hemorrhagic stroke, mortality

scholarly journals Frailty Assessment in Hospitalized Older Adults Using the Electronic Health Record

2017 ◽  
Vol 19 (2) ◽  
pp. 213-228 ◽  
Author(s):  
Deborah A. Lekan ◽  
Debra C. Wallace ◽  
Thomas P. McCoy ◽  
Jie Hu ◽  
Susan G. Silva ◽  
...  
Keyword(s):  
Older Adults ◽  
Electronic Health Record ◽  
Clinical Data ◽  
Tertiary Care ◽  
Health Record ◽  
Care Hospital ◽  
Risk Of Death ◽  
Frailty Assessment ◽  
Increased Risk ◽  
Electronic Health

Introduction: Frailty, a clinical syndrome of decreased physiologic reserve and dysregulation in multiple physiologic systems, is associated with increased risk for adverse outcomes. Purpose: The aim of this retrospective, cross-sectional, correlational study was to characterize frailty in older adults admitted to a tertiary-care hospital using a biopsychosocial frailty assessment and to determine associations between frailty and time to in-hospital mortality and 30-day rehospitalization. Methods: The sample included 278 patients ≥55 years old admitted to medicine units. Frailty was determined using clinical data from the electronic health record (EHR) for symptoms, syndromes, and conditions and laboratory data for four serum biomarkers. A frailty risk score (FRS) was created from 16 risk factors, and relationships between the FRS and outcomes were examined. Results: The mean age of the sample was 70.2 years and mean FRS was 9.4 ( SD, 2.2). Increased FRS was significantly associated with increased risk of death (hazard ratio = 1.77−2.27 for 3 days ≤ length of stay (LOS) ≤7 days), but depended upon LOS ( p < .001). Frailty was marginally associated with rehospitalization for those who did not die in hospital (adjusted odds ratio = 1.18, p = .086, area under the curve [AUC] = 0.66, 95% confidence interval for AUC = [0.57, 0.76]). Discussion: Clinical data in the EHR can be used for frailty assessment. Informatics may facilitate data aggregation and decision support. Because frailty is potentially preventable and treatable, early detection is crucial to delivery of tailored interventions and optimal patient outcomes.

scholarly journals Common Comorbidities Among Stroke Patient and Their Outcome in a Tertiary Care Hospital, Bangladesh

2021 ◽  
Vol 33 (1) ◽  
pp. 8-11
Author(s):  
MM Bodiuzzaman ◽  
Aminur Rahman ◽  
Md Alamgir Hossain ◽  
Md Towfiqul Islam ◽  
Md Shuktarul Islam ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Prognostic Factors ◽  
Tertiary Care ◽  
Stage Ii ◽  
Care Hospital ◽  
Stroke Patients ◽  
Altered Level ◽  
Hospital Outcome ◽  
Large Size ◽  
Level Of Consciousness

Background: Stroke is worldwide second leading cause of death and the most common cause of disability. The aim of the study is to evaluate the common comorbidities and their impact on hospital outcome in patients after stroke Methods: This observational study was carried out amongst 228 of acute stroke patients after fulfills the inclusion and exclusion criteria and were admitted indifferent medicine unit of Bangabandhu Sheikh Mujib Medical College Hospital, Faridpur, Bangladesh from May 2020 to April 2021. All cases were confirmed by CT scan or MRI of brain. Stroke were categorizes as Ischemic stroke, Intra-cerebral hemorrhage (ICH) and Subarachnoid hemorrhage (SAH). HTN, DM, IHD were considered as common comorbidities. Prognostic factors were included stage II or III hypertension, altered level of consciousness, previous stroke and large size of stroke. Results: In this study, male affected more than female (68.42% vs 31.58% and ratio 2.1:1). Age >60 years were more affected (68.86%). Most affected patients were Ischemic stroke (61.40%), then ICH (34.21%) and then SAH (3.07%). Common comorbidities were HTN and DM (48.68% and 34.64% respectively). Most of expired patients had comorbidities (80.64%). Worst prognostic factors were altered level of consciousness, stage II or III hypertension and large size of stroke (27.19%, 25.0% and 19.29% respectively). Among hospital outcome most of patients improved and discharged eventfully (41.22%), Deteriorate (17.98%), remain static and discharged (14.03%) and death 13.59%. Conclusion: The most of patients had been suffered from ischemic stroke which were more common in male. The commonest risk factor of stroke was hypertension followed by diabetes mellitus and ischemic heart disease. Our pooled result showed that majority of the patients were improved and discharged and around one sixth of stroke patients have died during hospitalization. The control of comorbid conditions will be much help for prevention of occurrence of stroke and will reduces the disability from stroke events. Bangladesh J Medicine July 2022; 33(1) : 8-11

scholarly journals TO ESTIMATE THE INCIDENCE OF POTENTIAL DRUG-DRUG INTERACTION IN STROKE PATIENTS ADMITTED IN A TERTIARY CARE HOSPITAL, TELANGANA

2020 ◽  
pp. 48-52
Author(s):  
SIDRAH FIRDOUS ◽  
SAFA AMREEN SALIM AWAD ◽  
AFIFA FATIMA ◽  
MOHAMMAD FARHAN AHMED ◽  
N. ANITHA ◽  
...  
Keyword(s):  
Drug Interactions ◽  
Health Care Cost ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Haemorrhagic Stroke ◽  
Care Hospital ◽  
Potential Drug ◽  
Severity Scale ◽  
Stroke Patients ◽  
Increased Risk

Objective: To determine the frequency and pattern of potential drug-drug interactions in hospitalized stroke patients. Methods: A retrospective study was carried out among patients treated for ischemic and haemorrhagic stroke at a tertiary care hospital, Hyderabad for a period of 1 y. A total of 177 prescriptions were analyzed during the study period. The potential drug-drug interactions were identified using Clinirex software. Results: Among the 177 prescriptions, 63.8% were male and 36.2% were female. Out of 177, 79 % of prescriptions had shown potential drug-drug interactions. The patients prescribed with more than 5 drugs developed higher incidence of drug-drug interactions. Based on severity scale we observed 12% major, 71% moderate and 17% minor drug-drug interactions. The incidence of pharmacodynamic interactions was 68% and the pharmacokinetic interactions were 32%. Conclusion: This study suggests that patients with stroke are frequently exposed to potential drug-drug interactions. The incidence of potential drug-drug interactions was higher in patients above 40 y. Most of the prescriptions contained polypharmacy which may lead to increased risk of hospitalization and higher health care cost. It is essential to identify potential drug-drug interactions especially in elderly patients as early as possible in order to prevent adverse drug reactions and ensure patient’s safety. 

scholarly journals Outcome of Acute Myocardial Infarction Patients Admitted in a Tertiary Care Hospital

2017 ◽  
Vol 28 (1) ◽  
pp. 6-8
Author(s):  
Mona Islam ◽  
Biplob Bhattacharjee ◽  
Md Abu Yusuf Chowdhury ◽  
Abu Naser Siddique ◽  
Abul Mansur Md Rezaul Karim
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiac Arrest ◽  
Tertiary Care Hospital ◽  
Communicable Disease ◽  
Tertiary Care ◽  
Care Hospital ◽  
Risk Of Death ◽  
Increased Risk ◽  
History Of

Acute myocardial infarction (AMI) is a common non - communicable disease prevailing in developed as well as in developing countries like Bangladesh, causing a great number of mortality and morbidity and impart a huge economic burden to family as well as to society. This study was designed to see the various complications and outcome of the patients of AMI, admitted in a tertiary care hospital in Bangladesh. In this observational study, 100 patient of AMI admitted in Cardiology ward of CMCH were enrolled. Clinical diagnosis was made from history and clinical examination and confirmed by ECG and biochemical markers. Informed written consent was taken from the patient or from the patient's attendant. Among the 100 cases of AMI, 89% were suffering from STEMI and 11% were from NSTEMI. Most of the patients (39%) were in 50-59 years age group. Majority of patient had chest pain (52%), followed by dyspnoea (23%), palpitation 10%, syncopal attack 7% and cardiac arrest 8% respectively. Important risk factors were history of smoking (37%), Diabetes (33%), Hypertension (31%), Dyslipidaemia (21%) and family history of IHD (16%). ECG showed ST-elevation in 80% of patients. It has been revealed that the important complications were cardiogenic shock(31%) followed by acute LVF(21%), bradyarrythmia (12%), tachyarrhythmia (10%), cardiac arrest(8%) and 12% patients died within 24 hours of admission. Patients with AMI have a substantially increased risk of death after hospitalization when shock, LVF or arrhythmias occur during their hospital stay. These complications should have to be treated promptly to achieve a good outcome.Medicine Today 2016 Vol.28(1): 6-8

Seroprevalence of anti-SARS-CoV-2 IgG antibodies in hospitalized patients at a tertiary referral center in North India (Preprint)

2020 ◽  
Author(s):  
Dr. Animesh Ray ◽  
Dr. Komal Singh ◽  
Souvick Chattopadhyay ◽  
Farha Mehdi ◽  
Dr. Gaurav Batra ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Age Groups ◽  
Hospitalized Patients ◽  
North India ◽  
P Value ◽  
Care Hospital ◽  
Igg Antibodies ◽  
Igg Antibody ◽  
Increased Risk ◽  
Significant Difference

BACKGROUND Seroprevalence of IgG antibodies against SARS-CoV-2 is an important tool to estimate the true extent of infection in a population. However, seroprevalence studies have been scarce in South East Asia including India, which, as of now, carries the third largest burden of confirmed cases in the world. The present study aimed to estimate the seroprevalence of anti-SARS-CoV-2 IgG antibody among hospitalized patients at one of the largest government hospital in India OBJECTIVE The primary objective of this study is to estimate the seroprevalence of SARS-CoV-2 antibody among patients admitted to the Medicine ward and ICU METHODS This cross-sectional study, conducted at a tertiary care hospital in North India, recruited consecutive patients who were negative for SARS-CoV-2 by RT-PCR or CB-NAAT. Anti-SARS-CoV-2 IgG antibody levels targeting recombinant spike receptor-binding domain (RBD) protein of SARS CoV-2 were estimated in serum sample by the ELISA method RESULTS A total of 212 hospitalized patients were recruited in the study with mean age (±SD) of 41.2 (±15.4) years and 55% male population. Positive serology against SARS CoV-2 was detected in 19.8%patients(95% CI 14.7-25.8). Residency in Delhi conferred a higher frequency of seropositivity 26.5% (95% CI 19.3-34.7) as compared to that of other states 8% (95% CI 3.0-16.4) with p-value 0.001. No particular age groups or socio-economic strata showed a higher proportion of seropositivity CONCLUSIONS Around, one-fifth of hospitalized patients, who were not diagnosed with COVID-19 before, demonstrated seropositivity against SARS-CoV-2. While there was no significant difference in the different age groups and socio-economic classes; residence in Delhi was associated with increased risk (relative risk of 3.62, 95% CI 1.59-8.21)

scholarly journals Nasogastric Tube Feeding Practice and Associated Complication in stroke Patients in a Tertiary Care Hospital in Bangladesh

2018 ◽  
Vol 4 (1) ◽  
pp. 23-27 ◽  
Author(s):  
Kazi Mohibur Rahman ◽  
Sharif Uddin Khan ◽  
ATM Hasibul Hasan ◽  
Sirajee Shafiqul Islam ◽  
Rajib Nayan Chowdhury ◽  
...  
Keyword(s):  
Aspiration Pneumonia ◽  
Nasogastric Tube ◽  
Tertiary Care ◽  
Tube Feeding ◽  
Electrolyte Imbalance ◽  
Feeding Practice ◽  
Care Hospital ◽  
Stroke Patients ◽  
Nasal Irritation ◽  
Nasogastric Tube Feeding

Background: Nasogastric tube feeding is an integral part of management of stroke patients with feeding difficulties.Objectives: The purpose of the present study was to evaluate the nasogastric tube feeding practice and its complication on stroke patients.Methodology: One hundred (100) adult patients aged ≥ 18 years with stroke were enrolled in the study. The diagnosis of stroke was established by the clinical presentation, neuroimaging. Patients requiring nasogastric tube feeding was included in the study. They were thoroughly examined for any complications from possible use of nasogastric tube. Their caregivers were also thoroughly interviewed using a standard preformed questionnaire regarding any complications as well. Results: A total number of 100 patients were recruited for this study. In this study population, 63.0% patients had ischaemic stroke; 26.0% had haemorrhagic stroke and 9.0% population had sub-arachnoid haemorrhage. The most common indication for NG feeding was difficulty in swallowing (39.0%) followed by semi consciousness (26.0%), unconsciousness (22.0%), inability to maintain feed (10.0%). About 71.0% of the patients had complications from NG tube feeding such as nasal irritation (53.0%), electrolyte imbalance (43.0%), aspiration pneumonia (40.0%) and diarrhea (38.0%).Conclusion: Nasal irritation, aspiration pneumonia, electrolyte imbalance, diarrhea are common complications associated with NG tube feeding which in part may be related to faulty feeding technique.Journal of National Institute of Neurosciences Bangladesh, 2018;4(1): 23-27

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