CLINICAL PROFILE OF AES CASES IN A TERTIARY CARE CENTER OF NORTH BENGAL

2021 ◽  
pp. 71-73
Author(s):  
Sharma S ◽  
Chakrabarti D ◽  
Saha S ◽  
Banik S ◽  
Mondal S
Keyword(s):  
Scrub Typhus ◽  
Care Center ◽  
Tertiary Care ◽  
Babinski Sign ◽  
Neck Stiffness ◽  
Cross Sectional ◽  
Altered Sensorium ◽  
Acute Encephalitis Syndrome ◽  
Acute Encephalitis ◽  
North Bengal

Introduction: The clinical features of Acute Encephalitis syndrome (AES) vary widely across the world and little documentation is available from North Bengal. Materials and methods: A cross –sectional observational study was conducted at the Department of Medicine of a teaching hospital in North Bengal. 104 AES cases were enrolled and clinically evaluated and investigated as per the study protocol. Results:JE (72%) was most common causative agent followed by HSV Encephalitis (11.5%), Scrub Typhus (9.6%) and Dengue Encephalitis (2.88%). Male cases were predominant than female in our study. Fever and altered sensorium were most common presentation followed by seizures (51.9%), headache (29.8%), vomiting (18.2%), and hemiplegia (4.8%). Neurological evaluation revealed 80% of the patients had neck stiffness followed by positive Babinski sign (45.19%) and hypertonia (35%). Conclusions: JE is the commonest cause of AES in North Bengal and seizures are the commonest neurological manifestation after altered sensorium.

LABORATORY PROFILE OF INDOOR PATIENTS ADMITTED WITH ACUTE ENCEPHALITIC SYNDROME IN A TERTIARY CARE CENTRE OF NORTH-BENGAL

2021 ◽  
pp. 76-78
Author(s):  
Smarajit Banik ◽  
Debasis Chakrabarti ◽  
Sandip Saha ◽  
O P. Pandey ◽  
Dipanjan Bandyopadhyay
Keyword(s):  
Tertiary Care ◽  
Care Hospital ◽  
Tertiary Care Centre ◽  
Cross Sectional ◽  
Study Region ◽  
Male Predominance ◽  
Acute Encephalitis Syndrome ◽  
Acute Encephalitis ◽  
Wbc Count ◽  
North Bengal

Background: Acute encephalitis syndrome (AES) is dened as the acute-onset of fever and a change in mental status (including signs and symptoms such as confusion, disorientation, delirium or coma) and/or new-onset of seizures (excluding simple febrile seizures) in a person of any age at any time of the year. Most AES is considered to be due to a viral-encephalitis, virus like West Nile, Herpes simplex virus, Flaviviruse like JE and dengue are more prevalent in South East Asia. Methods: This observational Cross sectional Study was conducted in the indoor patients of Department of Medicine at Tertiary care Hospital in North Bengal from May 2013 to April 2014. All consecutive patients of AES admitted during this period were included in the study. The study region covers the various districts of North Bengal. Template was generated in MS excel sheet and analysis was done on SPSS 20.0 software. Results: Among 104 acute encephalitis syndrome patients, 68 (65.38%) were male and 36 (34.62%) were female. The majority of pts (54.81%) were >40yrs of age. The lowest wbc count was 3000/cumm and highest was 21,200/cumm with mean wbc count being 10462.56±3567.832/cumm. Asignicant number 56 (53.85%) of patients had serum potassium levels between 2.5-3.5meq/dl. The no. of JE Positive patients was 75 (72.12%) which may be due to the local endemicity of the disease Conclusions: Majority of cases were in the age-group of more than 40 years, with male predominance. The no. of JE Positive patients was 75 (72.12%) which may be due to the local endemicity of the disease.

scholarly journals A six years prospective epidemiological study of acute encephalitis syndrome among children admitted in a rural tertiary care center

2019 ◽  
Vol 6 (5) ◽  
pp. 2125
Author(s):  
Debadyuti Datta ◽  
Balai Ch. Karmakar
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Epidemiological Data ◽  
Public Health Issue ◽  
Gender Variance ◽  
Chi Square ◽  
College Hospital ◽  
Acute Encephalitis Syndrome ◽  
Acute Encephalitis ◽  
And Gender

Background: Acute Encephalitis Syndrome (AES) is a major public health issue in India. The common etiologies of AES in India are various infectious agents. There are seasonal and regional variations in etiologies making diagnosis and effective intervention often difficult. Our study represents the epidemiological data that will help in planning management in larger perspective.Methods: This is a six years prospective observational study conducted in the Department of Pediatrics, North Bengal Medical College Hospital, Darjeeling from January 1st, 2013 to December 31st, 2018. In this study all clinically diagnosed AES cases were included fulfilling inclusion and exclusion criterion.Results: 585 out of 39420 patients (1.48%) were diagnosed clinically as AES over six years. Male patients (372) contributing to 63.6% and female patients (213) 36.4% of the study. Majority cases (271) were seen in the age group of 1-5 years amounting to 46.3% with mean age 5.1±3.6 years. In July 2014 number of cases were maximum 59 (10%) followed by May 2013 20 (3.4%). Among the 585 AES cases, 263 (45%) were suspected for viral etiology (JE= 84, 14.3%). Total 457 cases (78.1%) were alive with insignificant to age and gender variance. Vaccination status revealed 11 among 15 JE deaths were unimmunized which is statistically significant (p < 0.05) by Chi-square test.Conclusions: The magnitude and etiologies of AES need to be explored and understood in various geographic regions and in different seasons to have a better insight for development of future policies to reduce the burden.

A Study of Hyponatremia in Acute Encephalitis Syndrome: A Prospective Study From a Tertiary Care Center in India

2017 ◽  
Vol 34 (5) ◽  
pp. 411-417 ◽  
Author(s):  
Usha Kant Misra ◽  
Jayantee Kalita ◽  
Rajesh Kumar Singh ◽  
Sanjeev Kumar Bhoi
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Enzyme Linked Immunosorbent Assay ◽  
Cerebral Salt Wasting ◽  
Urinary Osmolality ◽  
Salt Wasting ◽  
Acute Encephalitis Syndrome ◽  
Acute Encephalitis ◽  
Sodium Correction ◽  
A Prospective Study

Purpose: To evaluate the frequency and causes of hyponatremia in acute encephalitis syndrome (AES) and its effect on outcome. Patients and Methods: Consecutive patients with AES were subjected to neurological evaluation including Glasgow Coma Scale, focal weakness, movement disorder, and reflex changes. The etiology of AES was based on blood and cerebrospinal fluid enzyme-linked immunosorbent assay and polymerase chain reaction. We have categorized patients into neurological or systemic AES. Hyponatremia was diagnosed if 2 consecutive serum sodium levels were below 135 mEq/L, 24 hours apart. Serum and urinary osmolality and electrolytes were measured on alternate days. Fluid intake, output, and body weight were measured daily. The hyponatremia was categorized into syndrome of inappropriate secretion of antidiuretic hormone (SIADH), cerebral salt wasting (CSW), or miscellaneous group. Outcome at 1 month was assessed by modified Rankin scale. Results: Of 79 patients, 34 had neurologic AES and 45 had systemic AES; 22 (27.8%) patients had hyponatremia. The neurologic AES as compared to systemic AES was more commonly associated with hyponatremia (38.2% vs 20%, P = .07), need longer hospitalization (25.0 vs 12.5 days, P = .003), and longer time for sodium correction (13.3 vs 8.2 days, P = .05). The hyponatremia was due to CSW in 12 patients, SIADH in 2 patients, and indeterminate in 8 patients. Thirty-six patients had poor outcome (15 died) and 43 had good outcome which was not related to hyponatremia. Conclusion: Hyponatremia occurs in one-third of patients with AES, being commoner in neurologic AES, and CSW is the commonest cause.

scholarly journals Scrub Typhus among Febrile Children in a Tertiary Care Center of Central Nepal: A Descriptive Cross-sectional Study

2021 ◽  
Vol 59 (237) ◽  
Author(s):  
Isha Bhandari ◽  
Kalpana Karmacharya Malla ◽  
Pukar Ghimire ◽  
Bibek Bhandari
Keyword(s):  
Confidence Interval ◽  
Scrub Typhus ◽  
Care Center ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Care Hospital ◽  
Tertiary Care Center ◽  
Sectional Study ◽  
Cross Sectional ◽  
Central Nepal

Introduction: Scrub typhus is a mite borne infectious disease caused by Orientia tsutsugamushi, obligate intracellular bacteria, transmitted by chigger mites. Scrub typhus is an emerging febrile illness with clinical suspicion being the only key to diagnosis. This study was conducted to find out the prevalence of Scrub typhus among febrile children in a tertiary care center of central Nepal. Methods: A descriptive cross-sectional study was conducted from January 2018 to December 2019 in the pediatric inpatients of a tertiary care hospital after obtaining ethical clearance from Institutional Review Committee of Institute (Reference number 2020-105). Convenient sampling method was used. Data was analyzed using Statistical Packages for the Social Science version 16. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Out of 1024 febrile patients, prevalence of scrub typhus among febrile children was 55 (5.37%) (3.66-7.08 at 90% Confidence Interval). Of 55 patients, mean age was 9.2 years with 52 (94.6%) of cases diagnosed between July to November. Among 55 patients, other symptoms were vomiting 33 (60%), headache 22 (40%), abdominal pain 19 (34.5%), cough 15 (27.3%), nausea (25.5%), seizure 11 (20 %), and dyspnea 6 (10.9%). Major clinical signs was lymphadenopathy 29 (52.7%). Major complication noted was meningitis 11 (20%). Conclusions: The prevalence of scrub typhus is considerably high during July to November so it should be considered as a differential diagnosis of fever particularly in this period.

ACUTE ENCEPHALITIS SYNDROME IN CHILDREN: A DESCRIPTIVE CROSSSECTIONAL STUDY IN A RURAL BASED TERTIARY CARE HOSPITAL IN INDIA

2021 ◽  
pp. 9-12
Author(s):  
Bapan Kabiraj ◽  
Soumya Gayen ◽  
Ebna Rushad ◽  
Subinay Mandal
Keyword(s):  
Scrub Typhus ◽  
Adult Population ◽  
Tertiary Care ◽  
Abnormal Behavior ◽  
Cns Infection ◽  
Care Hospital ◽  
Term Outcome ◽  
Case Record ◽  
Acute Encephalitis Syndrome ◽  
Acute Encephalitis

Background: Acute Encephalitis Syndrome (AES) is a group of clinically similar neurologic manifestations due to encephalitis. AES is an important cause of mortality and morbidity in children in various parts of India. Most of the study has been done in adult population. So, I have done this study to evaluate clinical prole, short-term outcome and changing trends of etiologies of acute encephalitis in children. Methods: This is an institution-based descriptive cross-sectional study including sixty children aged one month to twelve years conducted over a period of one and half years in the pediatric department of a rural based medical college in India. Data collected in predesigned case record proforma and analysed with SPSS software version 25. Results: Incidence rate 4 per 1000 patients per year with 2 to 6 years age group with males predominating. Important presenting complaints were fever, convulsion, abnormal behavior, rash, vomiting, headache, lethargy, aphasia and quadriparesis. Poor Glasgow coma score (GCS), meningeal sign and raised intra cranial pressure were important examination ndings. Dengue and scrub typhus were important emerging etiologies replacing Japanese encephalitis. Overall mortality is around 13%. Conclusions:All febrile children with altered sensorium should be investigated for central nervous system (CNS) infection, unless clear evidence of another diagnosis. Viruses are the main culprit with Dengue and Scrub typhus being the important emerging etiology. Timely diagnosis and treatment can reduce morbidity and mortality signicantly.

Prehospital Intubations Are Associated with Elevated Endotracheal Tube Cuff Pressures: A Cross-Sectional Study Characterizing ETT Cuff Pressures at a Tertiary Care Emergency Department

2021 ◽  
pp. 1-4
Author(s):  
Ruo S. Chen ◽  
Laurel O’Connor ◽  
Matthew R. Rebesco ◽  
Kara L. LaBarge ◽  
Edgar J. Remotti ◽  
...  
Keyword(s):  
Endotracheal Tube ◽  
Cuff Pressure ◽  
Care Center ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Endotracheal Tube Cuff ◽  
Cross Sectional ◽  
Tube Cuff ◽  
Respiratory Therapists ◽  
Significant Difference

Abstract Introduction: Emergency Medical Services (EMS) providers are trained to place endotracheal tubes (ETTs) in the prehospital setting when indicated. Endotracheal tube cuffs are traditionally inflated with 10cc of air to provide adequate seal against the tracheal lumen. There is literature suggesting that many ETTs are inflated well beyond the accepted safe pressures of 20-30cmH2O, leading to potential complications including ischemia, necrosis, scarring, and stenosis of the tracheal wall. Currently, EMS providers do not routinely check ETT cuff pressures. It was hypothesized that the average ETT cuff pressure of patients arriving at the study site who were intubated by EMS exceeds the safe pressure range of 20-30cmH2O. Objectives: While ETT cuff inflation is necessary to close the respiratory system, thus preventing air leaks and aspiration, there is evidence to suggest that over-inflated ETT cuffs can cause long-term complications. The purpose of this study is to characterize the cuff pressures of ETTs placed by EMS providers. Methods: This project was a single center, prospective observational study. Endotracheal tube cuff pressures were measured and recorded for adult patients intubated by EMS providers prior to arrival at a large, urban, tertiary care center over a nine-month period. All data were collected by respiratory therapists utilizing a cuff pressure measurement device which had a detectable range of 0-100cmH2O and was designed as a syringe. Results including basic patient demographics, cuff pressure, tube size, and EMS service were recorded. Results: In total, 45 measurements from six EMS services were included with ETT sizes ranging from 6.5-8.0mm. Mean patient age was 52.2 years (67.7% male). Mean cuff pressure was 81.8cmH2O with a range of 15 to 100 and a median of 100. The mode was 100cmH2O; 40 out of 45 (88.9%) cuff pressures were above 30cmH2O. Linear regression showed no correlation between age and ETT cuff pressure or between ETT size and cuff pressure. Two-tailed T tests did not show a significant difference in the mean cuff pressure between female versus male patients. Conclusion: An overwhelming majority of prehospital intubations are associated with elevated cuff pressures, and cuff pressure monitoring education is indicated to address this phenomenon.

A Comparison of Falls and Dizziness Handicap by Vestibular Diagnosis

2021 ◽  
pp. 1-10
Author(s):  
Ryan J. Huang ◽  
Sherri L. Smith ◽  
Libor Brezina ◽  
Kristal M. Riska
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Demographic Variables ◽  
Vestibular Migraine ◽  
Cross Sectional ◽  
Positional Vertigo ◽  
Increased Risk ◽  
Risk Of Falls ◽  
Paroxysmal Positional Vertigo

Purpose There is a paucity of data that directly compares the falls rate and dizziness handicap of different vestibular diagnoses. The purpose of this study is to compare the falls rate and dizziness handicap of common vestibular diagnoses encountered among a cohort of vestibular patients at a single institution. Method We conducted a retrospective cross-sectional study of patients evaluated for dizziness at a tertiary care center vestibular clinic between August 1, 2017, and March 19, 2019. Vestibular diagnosis, demographic variables, comorbidities, falls status, and Dizziness Handicap Inventory (DHI) were extracted from the medical record for analysis. Associations between vestibular diagnosis and falls history or DHI were evaluated using multivariate logistic and linear regression, respectively. Results A total of 283 patients met our inclusion criteria with the following diagnoses: benign paroxysmal positional vertigo (BPPV; n = 55), acoustic neuroma ( n = 30), Ménière's disease ( n = 28), multiple vestibular diagnoses ( n = 15), vestibular migraine ( n = 135), or vestibular neuritis ( n = 20). After adjusting for age, sex, race, medications, and comorbidities, the odds of falling was 2.47 times greater (95% CI [1.08, 6.06], p = .039) and the DHI score was 11.66 points higher (95% CI [4.99, 18.33], p < .001) in those with vestibular migraine compared to those with BPPV. Other diagnoses were comparable to BPPV with respect to odds of falling and dizziness handicap. Conclusions Patients with vestibular migraine may suffer an increased risk of falls and dizziness handicap compared to patients with BPPV. Our findings highlight the need for timely evaluation and treatment of all patients with vestibular disease.

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