NCCT Head findings in patients of chronic renal failure with altered sensorium presenting in a tertiary care centre

Background: Scrub typhus is the most common rickettsial infection in the Indian subcontinent with the manifestation ranging from mild symptoms to serious disease with or complication or death. The objective of this study was to study epidemiology and clinical profile of scrub typhus outbreak in a tertiary care centre of central India.Methods: Present study is a record based retrospective study enrolling 173 confirmed positive cases with ELISA test during the period from 1st August to 31st December 2018.Results: Maximum number of the cases 94 (54.3%) had occurred in September 2019. Majority of the female 94(54.3%) were Ig M positive for scrub typhus. Maximum cases 134 (77.5%) were from rural area. Most common symptoms were fever 170 (98.3%), followed by fever with chills 65 (37.6%), breathlessness 49 (28.3%), cough 35 (20.2%), and 28 (16.2%) each with altered sensorium and headache. Mortality was recorded in 30 (173%) and amongst them 10 (34.5%) and 4 (13.8%) cases had ARDS and septicaemia as complication respectively.Conclusions: This study shows that majority of the cases occurred in the month of September 2018 with female preponderance. Most of the residence were from rural areas with common presenting symptoms as fever or fever with chills followed by breathlessness, cough and altered sensorium and headache.

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Clinical Profile and Outcome in Patients with Snake Bite in a Tertiary Care Centre in Kerala

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/646 ◽

2021 ◽

Vol 8 (41) ◽

pp. 3567-3572

Author(s):

Satish Kumar ◽

Sanghamithra Prabhakaran

Keyword(s):

Renal Failure ◽

Secondary Infection ◽

Tertiary Care ◽

The Body ◽

Snake Bite ◽

Clinical Profile ◽

Care Centre ◽

Tertiary Care Centre ◽

Cross Sectional ◽

Severe Degree

BACKGROUND The clinical profile and outcome of snake bite varies from place to place and depends on a number of factors including the type of snake bite, place of snake bite, time of bite, season, and duration of presentation after bite. The clinical profile, factors affecting the outcome and the outcome have not been previously well studied. METHODS This is a cross-sectional observational study conducted for a duration of six months from January 2021 to June 2021. Subjects meeting inclusion criteria were enrolled in the study group after obtaining written consent. Patients were evaluated based on the standard pro-forma with detailed history and clinical examination. All relevant investigations to assess systemic envenomation, treatment and outcome were documented in all the patients. RESULTS In the study, 204 (68 %) were male patients and 96 (32 %) were female patients. 108 (36 %) were admitted with venomous snake bite and 192 (64 %) were with non-poisonous snake bite. 52 patients had snake bite on the upper extremities, 234 had snake bite on the lower extremities, 8 patients had snake bite on the trunk whereas 6 patients had bite on other areas of the body. 202 patients had swelling at the bite site, 222 had pain at the site of bite, 86 patients had oozing of blood and 6 patients had vague somatic symptoms. 132 patients had local oedema, 148 had local tenderness, 66 patients had skin necrosis and 16 patients developed blisters at the site of bite. 124 patients had systemic manifestations of which 24 patients had vomiting, 12 patients developed abdominal pain, 10 patients developed anuria/oliguria, 14 patients developed hypotension, 12 patients developed bleeding manifestations, 10 patients developed neurological symptoms and 2 snakebite patients had syncope. Complications and mortality in poisonous snake bite due to renal failure was observed in 38 patients with a mortality of 1 patient, 10 patients developed intravascular haemolysis, 8 patients developed unexplained hypotension, 18 patients developed secondary infection, 4 patients developed intra-cerebral bleeding and 15 patients developed neurotoxity with a mortality of 2 patients. CONCLUSIONS Snake bite is a common problem encountered in tertiary care centres and the most common encountered type of snakebite was haemotoxic bite. Pain at the bite site was the commonest symptom and tenderness at bite site was the commonest sign in patients with snake bite. Mortality in venomous bite was 3.7%. Prolonged bite to needle time, development of renal failure, leukocytosis, neurotoxicity and severe degree of coagulopathy were factors associated with adverse outcome. KEYWORDS Clinical Profile, Outcome, Snake Bite, Tertiary Care Centre

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Hepatorenal Syndrome: Are We Doing Better?

Canadian Journal of Gastroenterology ◽

10.1155/2004/707695 ◽

2004 ◽

Vol 18 (2) ◽

pp. 121-122

Author(s):

Florence Wong

Keyword(s):

Renal Failure ◽

Medical Records ◽

Hepatorenal Syndrome ◽

Multiorgan Failure ◽

Tertiary Care ◽

Alcoholic Cirrhosis ◽

Care Centre ◽

Tertiary Care Centre ◽

Predisposing Factor ◽

Common Cause

This is a retrospective study assessing the accuracy of diagnosis, clinical features and outcome of patients coded with a medical record diagnosis of hepatorenal syndrome (HRS) between 1988 and 1998 in a tertiary care centre in Canada. The authors found that, of the 46 patients whose medical records revealed a diagnosis of HRS, only 27 patients (59%) fulfilled the criteria for the diagnosis of HRS defined by the International Ascites Club (IAC) (1). Most patients with HRS were middle-aged men with decompensated alcoholic cirrhosis, jaundice and hepatic encephalopathy. Infection (48%), gastrointestinal bleeding (33%) and overly aggressive paracentesis (27%) were the major precipitants of renal failure. Once HRS developed, the mortality rate was high (93%), with multiorgan failure being the most common cause of death. The authors concluded that diagnostic accuracy is paramount for studies of HRS. In addition, decompensated alcoholic cirrhosis remains the main predisposing factor for HRS, with various other factors precipitating its development.

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Red cell alloimmunization in multitransfused chronic renal patients on haemodialysis in a tertiary care centre of Jammu region

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20180004 ◽

2018 ◽

Vol 5 (1) ◽

pp. 73

Author(s):

Vijay Sawhney ◽

Neeti Dutt ◽

Sushil Sharma ◽

Kajal Khajuria

Keyword(s):

Renal Failure ◽

Chronic Renal Failure ◽

Tertiary Care ◽

Cross Sectional Study ◽

Blood Transfusions ◽

Tertiary Care Centre ◽

Cross Sectional ◽

Antibody Screening ◽

Positive Antibody

Background: There is a high incidence of alloimunization in many patients with diseases that require repetitive blood transfusions. One such group is chronic renal failure patients as majority of them have severe anemia due to deficiency of erythropoietin. As many such patients are unable to afford erythropoietin, they are treated with blood transfusions. This study was thus undertaken to study alloimunization in such patients at our center.Methods: A total of 96 patients found eligible were enrolled in this cross-sectional study that was carried out from June 2016 to august 2016. After detailed history, antibody screening was done by using Immucor Panoscreen three vial set and if screening came out to be positive antibody identification was then done by using Immucor Panocell-10.Results: 96 patients including 76 male and 20 female patients recieved a total of 912 transfusions. Alloantibodies were detected in a total of 12 patients (12.5%). Of these 12 patients 8 patients had a single antibody whereas 4 patients developed two antibodies. The antibodies developed at a rate of 1.8% per transfusion (16/912). On alloantibody type identification, the most common type found was anti E (4/16) followed by both anti D and anti C in 3 patients each.Conclusions: Alloimmunization to minor erythrocyte antigens occurs in many patients of chronic renal failure. This results in frequent pre-and post-transfusion complications. Inclusion of antibody screening test in routine pretransfusion testing protocol for the patients who are at higher risk of alloimmunization and require long-term transfusion dependence is desirable.

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