scholarly journals Pattern of drug-induced bleeding in a tertiary care hospital

2017 ◽  
Vol 5 (4) ◽  
pp. 1198 ◽  
Author(s):  
Rajinder Negi ◽  
Rajesh Kashyap ◽  
Anupam Prashar ◽  
Brij Sharma ◽  
Sanjeev Asotra ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Categorical Variables ◽  
P Value ◽  
Severe Bleeding ◽  
Care Hospital ◽  
Drug Induced ◽  
Upper Gastrointestinal

Background: It is a well-known fact that drug-induced bleeding causes considerable morbidity and mortality. Drugs that induce bleeding do so by affecting either anti-platelet Function and /or coagulation. By the frequency of their use, anti-platelet, a coagulant, thrombolytic and NSAIDs are the most commonly implicated drugs. Upper gastrointestinal bleeding is commonest adverse drug reaction associated with hospital admission. Significant number of these could be prevented if simple guidelines are followed. Spontaneous cessation of bleeding occurs in as many as 85% of cases. Early intervention is required in those if bleeding does not stop spontaneously. Objective of the study was to determine the pattern of drug induced bleeding in tertiary care hospital setting.Methods: It was a hospital based observational study conducted during one year study dura on ((June 1, 2014 to May 31, 2015) amongst all adult patients admitted to the hospital with drug induced bleeding. Statistical analysis was done by frequency measurement for categorical variables. Chi- square test was used to determine associations. A p-value of<0.05 was taken as statistically significant.Results: A total number of 110 cases with history of bleeding were enrolled. Commonest drug that caused bleeding was a platelet with 29 (26%) cases followed by combination of 2 or more drugs in 25 (23%) cases, then NSAIDs and anticoagulants in 24 (21%) and 23 (20%) cases respectively. Upper gastrointestinal bleeding was the commonest site of bleeding seen in 64 (58%) cases. The commonest drugs causing upper GI bleeding were NSAIDs seen in 24 (37.5%) cases followed by a platelet 22 (34.3%), combined drugs in 09 (14%) cases. (P<0.001) In overall severity most cases of drug induced bleeding had mild bleeding with 61 cases as compared to 38 cases of moderate and 11 cases of severe bleeding. There were significantly higher proportion of mild and moderate bleeding in upper gastrointestinal bleed cases in comparison to other sites of drug induced bleeding in this study (p<0.01). 7 (6.4%) out of 110 patients died and 103 (93.6%) patients recovered and were discharged.Conclusions: Clinical management of bleeds requires careful assessment of the patient, haemodynamic stabilisation, discontinuation of the offending medication and, where appropriate, reversal of the haemorrhagic effects and specific therapies such as endoscopic haemostatic therapy.

scholarly journals Spectrum of Endoscopic Findings in Patients of Upper Gastrointestinal Bleeding at a Tertiary Care Hospital

Cureus ◽  
2019 ◽  
Author(s):  
Waseem Sarwar Malghani ◽  
Romaisa Malik ◽  
Farooq Mohyud Din Chaudhary ◽  
Asim Tameez Ud Din ◽  
Misbah Shahid ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Endoscopic Findings ◽  
Upper Gastrointestinal

scholarly journals Outcome of Cranioplasty Done within and Beyond 2 Months after Decompressive Craniectomy for Traumatic Brain Injury

2021 ◽  
Vol 10 (10) ◽  
pp. 711-714
Author(s):  
Khongbantabam Vyas ◽  
Khaidem Mani Singh
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Decompressive Craniectomy ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Categorical Variables ◽  
P Value ◽  
Consecutive Series ◽  
Complication Rates ◽  
Care Hospital

BACKGROUND Cranioplasty although a simple elective neurosurgical procedure is burdened by considerable morbidity. The timing of doing cranioplasty and a good outcome remains a topic of much debate. We wanted to compare the outcome of doing cranioplasty within (early) and beyond (late) 2 months after decompressive craniectomy for traumatic brain injury. METHODS The study was carried out in a tertiary care hospital. A 5-year retrospective study of patient records was analysed. Consecutive series of traumatic brain injury patients who underwent cranioplasty after decompressive craniectomy from a tertiary care hospital operated by a single neurosurgeon, were studied. Data was analysed using SPSS version 21, IBM. Associations of categorical variables were compared using chisquare test and of continuous variables by using unpaired 2-tailed Student t-test. RESULTS Altogether 90 patients were identified who had undergone cranioplasty after decompressive craniectomy for traumatic brain injury and were grouped into early (within 2 months; 44 patients) and late (beyond 2 months; 46 patients). Cranioplasty operative time was significantly shorter in the early (59.39 mins) than the late (77.28 mins) with a P value of 0.001. Infection rates were significantly higher in the early (4.55 %) than late (0 %), with P value 0.144. Other complication rates were postoperative haematoma (0 % early, 2.17 % late, P = 0.325), hydrocephalus (0 % early, 6.52 % late, P = 0.085), sunken brain (0 % early, 4.35 % late, P = 0.162), and bone graft resorption (0 % early, 2.17 % late, P = 0.325). These differences were not statistically significant though. CONCLUSIONS Early cranioplasty performed within 2 months of decompressive craniectomy has better outcome in the form of reduced hospital stay, decreased cost, and fewer complications. KEY WORDS Traumatic Brain Injury, Decompressive Craniectomy, Outcome, Cranioplasty

scholarly journals Early Endoscopic Findings in Patients with Upper Gastrointestinal Bleeding in Bangladesh

2015 ◽  
Vol 3 (2) ◽  
pp. 60-62
Author(s):  
Uzzwal Kumar Mallick ◽  
Mohammad Omar Faruq ◽  
SM Ishaque ◽  
ASM Areef Ahsan ◽  
Kaniz Fatema ◽  
...  
Keyword(s):  
Duodenal Ulcer ◽  
Gastric Ulcer ◽  
Gastrointestinal Bleeding ◽  
Esophageal Varices ◽  
Upper Gastrointestinal Bleeding ◽  
Tertiary Care ◽  
Care Hospital ◽  
Stomal Ulcer ◽  
Female Ratio ◽  
Upper Gastrointestinal

Objective: To determine etiological pattern of patients presenting with upper gastrointestinal bleeding in a tertiary care hospital of Bangladesh.Methods: This study was a prospective observational study, carried out in the Department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2013 to June 2013. Fifty adult patients presenting with haematemesis and/or melaena admitted into gastroenterology inpatient unit from outpatient department or patients referred from other inpatient units of Department of Medicine of BSMMU were included in the study. Endoscopic examination was performed within 24 to 48 hours of presentation. Lower GI endoscopy was done in selected cases.Results: The study patients were predominantly young or of early middle age with mean age being 34.45 ± 16.5 yrs. A male preponderance was observed with male to female ratio being 7.3:1 (44 male and 6 female). 62% of the patients presented with both haematemesis and melaena, 26% with melaena only and 12% with haematemesis alone. Endoscopy of upper gastrointestinal tract demonstrated duodenal ulcer to be predominant finding (50%), followed by gastro-esophageal erosions (20%), gastric ulcer (12%), esophageal varices (10%), gastric adenocarcinoma (4%) and stomal ulcer (4%).Conclusions: Endoscopy revealed that duodenal ulcer was the most common cause of upper gastrointestinal bleeding followed by oesophageal erosion, gastric ulcer, esophageal varices and stomal ulcer. Peptic ulcer disease still remains as the major cause of acute upper gastrointestinal haemorrhage, though cases of oesophageal erosion were also significant.Bangladesh Crit Care J September 2015; 3 (2): 60-62

scholarly journals A STUDY ONCYTOPENIAS AND THE FACTORS ASSOCIATED WITH CYTOPENIAS AMONG HIV INFECTED PATIENTS ADMITTED AT A TERTIARY CARE HOSPITAL

2021 ◽  
Vol 9 (08) ◽  
pp. 172-179
Author(s):  
Manju Rose Sebastian ◽  
Seena Sankar ◽  
Mary George
Keyword(s):  
Opportunistic Infections ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Prevalence Ratio ◽  
Developed Countries ◽  
Categorical Variables ◽  
P Value ◽  
Care Hospital ◽  
Hiv Patients ◽  
Factors Associated

Introduction: India has the third highest burden of HIV in the world. Haematological complications are common in HIV patients, of which cytopenias are the most frequently encountered. The cytopenias have been found to adversely affect the outcome of HIV patients with greater mortality and decreased quality of life. Aims and Objective: To assess the prevalence of cytopenias among patients admitted in a tertiary care hospital and to assess the factors associated with the cytopenias. Materials and Methods: The present study was conducted in the department of general medicine at a tertiary care hospital and 191 patients admitted in the hospital during the study period were taken for the study. The baseline investigations at the time of admission were taken into consideration. Patients were interviewed and charts reviewed to collect the data. The data collected was analysed with SPSS-2018. Continuous variables were expressed as mean +/- standard deviation and as median and interquartile ranges as appropriate. Categorical variables were expressed as percentages and frequencies. Comparisons between data was done by student’s t test and chi square. The factors associated with various cytopenias was assessed using log binomial regression. A p value of < 0.05 was taken as significant. Results: The overall prevalence of any cytopenia was found to be 85.9%. The most common cytopenia was anaemia with a prevalence of 78.5% followed by thrombocytopenia and leucopenia with prevalences of 28.8% and 24.1% respectively. Anaemia was found to be more prevalent among females with a prevalence ratio of 3.05 (95% CI: 1.39- 10.16, p value 0.009) when compared to males. The most common cause of anaemia was found to be B12 deficiency. There was significant association between leucopenia and CDC staging with the prevalence of leucopenia being higher among patient with CDC stage 3. [Prevalence ratio:1.46 (95% CI 0.67-3.17, p 0.024)]. No significant association was found with gender, duration of HIV, ART regimen, CDC stage or presence of opportunistic infections and thrombocytopenia. Conclusion: The prevalence of cytopenias among HIV patients was found to high – 85.9% especially compared to other developed countries. The most common cytopenia among the patients was found to be anaemia with a prevalence of 78%. The next most common cytopenia was thrombocytopenia, followed by leucopenia. The factors associated with these cytopenias can help to screen for patients at higher risk of developing these cytopenias and hence establish preventive strategies against them.

scholarly journals MP15: Blood transfusion in upper gastrointestinal bleeding: evaluating physician practices in the emergency department

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S47
Author(s):  
J. Stach ◽  
S. Sandha ◽  
M. Bullard ◽  
B. Halloran ◽  
H. Blain ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Tertiary Care ◽  
Blood Transfusions ◽  
Care Hospital ◽  
Current Guideline ◽  
Transfusion Threshold ◽  
Physician Practices ◽  
Upper Gastrointestinal

Introduction: Acute upper gastrointestinal bleeding (UGIB) is a common presentation to emergency departments (ED). Of these patients, 35-45% receive a blood transfusion. Guidelines for blood transfusion in UGIB have been well established, and recommend a hemoglobin (Hb) level below 70 g/L as the transfusion target in a stable patient. There is no consensus on a transfusion threshold for unstable UGIB. There is limited data regarding physician practices in the ED. The aim of our study is to determine the appropriateness, by expert consensus, of blood transfusions in UGIB in a tertiary care hospital ED. Methods: We retrospectively reviewed patients presenting with UGIB to the University of Alberta Hospital ED in 2016. These patients were then screened for blood transfusions. Data were obtained from the patient records. Chart derived data were verified with records obtained from the blood bank. For each patient, the history, vitals, Glasgow Blatchford Score (GBS), relevant labs, and record of blood transfusions were collected and organized into a case summary. Each patient summary was presented individually to a panel of three expert clinicians (2 Gastroenterology, 1 Emergency Medicine), who then decided on the appropriateness of each blood transfusion by consensus. Results: Blood transfusions (data available 395/400) were given to 51% (202/395) of patients presenting with UGIB. Of these, 86% (174/202) were judged to be appropriate. Of the 395 patients, 34% (135/395) had a Hb of &lt;70 g/L. Of these, 93% (126/135) were transfused, and all of these were considered appropriate. 18% (70/395) had a Hb between 71-80. 74% (52/70) of these patients were given blood, and 79% (41/52) were considered appropriate. 13% (50/395) of the patients had a Hb between 81-90, with 28% (14/50) receiving a transfusion. Of these, 36% (5/14) were deemed to be appropriate. 35% (140/395) of patients had a Hb of &gt;90. 7% (10/140) of these received blood. 20% (2/10) were considered appropriate. Conclusion: The panel of expert clinicians judged 86% of the blood transfusions to be appropriate. All transfusions under the recommended guideline of 70 g/L were considered appropriate. In addition, the majority of transfusions above a Hb of 70 g/L were considered appropriate, but 37% were not. Further studies evaluating the feasibility of current guideline recommendations in an ED setting are required. Educational interventions should be created to reduce inappropriate blood transfusions above a Hb 70 g/L.

scholarly journals Pharmacotherapy of upper gastrointestinal bleeding along with its utility at tertiary care hospital

2021 ◽  
Vol 12 (2) ◽  
pp. 1437-1444
Author(s):  
Surakanti Bhavani ◽  
Racha Snigdha ◽  
Malreddy Bhavani ◽  
Surakanti Sushma Reddy ◽  
Shravan Kumar P ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Drug Prescription ◽  
Tertiary Care ◽  
Major Complication ◽  
High Dose ◽  
Care Hospital ◽  
Mortality And Morbidity ◽  
Upper Gastrointestinal

Acute upper gastrointestinal bleeding (AUGIB) is the most common GI emergency observed with mortality of 6-10% overall. The authors aimed to assess the pharmacotherapy of upper gastrointestinal bleeding along with its drug utility and their performance. A total of 120 patients were enrolled meeting the criteria and observed that the main cause of upper gastrointestinal bleeding was found to be esophageal varices followed by duodenal ulcers.The major contributing factor for UGI bleed was alcohol and smoking. The study revealed that males are predominantly being affected with UGI bleed; probable reasons may be habitual behaviour of the patients. Majority of the population who are affected were associated with comorbidities like hypertension, cirrhosis, jaundice, hepatitis, ulcers and diabetes mellitus. Portal hypertension was the major complication seen among the study population, followed by Jaundice and Ascites.The most common cause of portal hypertension is cirrhosis of liver. As an initial evaluation modality of all our UGI bleed patients were done with UGI endoscopy for both therapeutic and diagnostic purposes. The most commonly prescribed drugs were anti-secretory agents [pantoprazole], mucosal protectants [sucralfate], vasoactive agents [terlipressin], antibiotics [rifampicin, ceftriaxone, metronidazole]. It is observed in the study with high dose of alcohol consumption results into serious complications and increasing mortality and morbidity.  In the modern era of medical management, it would be better to deal with rational drug prescription in association with clinical pharmacologist suggestions during medical rounds by clinician.

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