scholarly journals Demographic Variables, Co morbidities and Clinical Presentation of Spontaneous Intracerebral Hemorrhage (ICH) in a tertiary Care Hospital in Bangladesh: A Cross Sectional Study

2021 ◽  
pp. 27-37
Author(s):  
Shoriful Islam ◽  
Richmond Ronald Gomes ◽  
Monjur Hasan
Keyword(s):  
Blood Pressure ◽  
Glasgow Coma Scale ◽  
Intracerebral Hemorrhage ◽  
Clinical Presentation ◽  
Blood Pressure Reduction ◽  
Tertiary Care ◽  
Care Hospital ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Cross Sectional ◽  
Coma Scale

Spontaneous intracerebral hemorrhage (ICH) has remained the least treatable form of stroke despite recent improvements in medical treatment. Treatment usually supportive and medical such as ventilatory support, blood pressure reduction, osmotherapy, fever control, seizure control and nutritional support and treatment of co morbidconditions. This study was carried out to see demographic variability, clinical presentation, causes and outcome of spontaneous intracerebral hemorrhage. Methods and Materials: This was a cross sectional observational prospective in study on 50 spontaneous ICH patients admitted in Medicine department of Khulna Medical College Hospital from November 2020 to April, 2021. Result: The study showed that spontaneous ICH was most common in between 41-70 years. Their age frequency were 14 (28%) in 41-50 years, 15 (30%) in 51-60 years, 12 (24%) in 61-70 years, 5 (10%) in 71- 80 years and 4 (8%) in more than 81 years age group. Among the patients, 64% (32) were male and 36% (18) were female. Headache, vomiting and seizure was present in 28, 27 and 8 patients respectively. Diabetes mellitus was present in 22% (11) of patients and absent in 78% (39) patients. Range of blood pressure at presentation –<140/90 in 24%(12), Systolic BP:140-159/Diastolic BP:90-99 (mm Hg) in 10%(5), Systolic BP:160-179/Diastolic BP:100-109 (mm Hg) in 22%(11),Systolic BP:180 or more/Diastolic BP:110 or more (mm Hg) in 44%(22) patients. Dyslipidemia was present in 30% (15) & absent in 70% (35) patients. Glasgow Coma Scale Score was 8 or less in 42% (21) and 9 or more in 58% (29) patients. Conclusion: Spontaneous ICH is common in Indian subcontinent. As our study showed that death occur due to ICH itself, associated co morbidities or complications, facilities for stroke care unit, high dependency unit and Intensive care unit is required in tertiary care health settings. Keyword: Spontaneous; Intracerebral Hemorrhage; Osmotherapy; Seizure; Glasgow Coma Scale

scholarly journals Evaluation of Clinical Presentation and Associated Comorbid Conditions in Patients with Spontaneous Intracerebral Hemorrhage in a Tertiary Care Hospital in Bangladesh

2021 ◽  
Vol 4 (1) ◽  
pp. 01-08
Author(s):  
Richmond Ronald Gomes ◽  
Shoriful Islam ◽  
FM Monjur Hasan
Keyword(s):  
Blood Pressure ◽  
Intracerebral Hemorrhage ◽  
Clinical Presentation ◽  
Indian Subcontinent ◽  
Blood Pressure Reduction ◽  
Tertiary Care ◽  
Ventilatory Support ◽  
Care Hospital ◽  
Spontaneous Intracerebral Hemorrhage ◽  
High Dependency

Spontaneous intracerebral hemorrhage (ICH) has remained the least treatable form of stroke despite recent improvements in medical treatment. Treatment usually supportive and medical such as ventilatory support, blood pressure reduction, osmotherapy, fever control, seizure control and nutritional support and treatment of co morbidconditions. This study was carried out to see demographic variability, clinical presentation, causes and outcome of spontaneous intracerebral hemorrhage. Methods and materials: This was a cross sectional observational prospective in study on 50 spontaneous ICH patients admitted in Medicine department of Khulna Medical College Hospital from November 2020 to April, 2021. Result: The study showed that spontaneous ICH was most common in between 41-70 years. Their age frequency were 14 (28%) in 41-50 years, 15 (30%)in 51- 60 years, 12 (24%) in 61-70 years, 5 (10%) in 71- 80 years and 4 (8%) in more than 81 years age group. Among the patients, 64% (32) were male and 36% (18) were female. No of smoker male was 25(50%) and female was 1(2%) and no of nonsmoker male was 7(14%) and female was 17(34%). Headache was present in 56% (28) and absent in 44% (22) of patients. Vomiting was present in 54% (27) and was absent in 46% (23)of patients.Seizure was present in 16% (8) and was absent in 54% (42) of patients. Diabetes mellitus was present in 22% (11) of patients and absent in 78% (39) patients. Range of blood pressure –<140/90 in 24%(12), Systolic BP:140-159/Diastolic BP:90-99 (mm Hg) in 10%(5), Systolic BP:160-179/Diastolic BP:100-109 (mm Hg) in 22%(11),Systolic BP:180 or more/Diastolic BP:110 or more (mm Hg) in 44%(22) patients. Dyslipidemia was present in 30% (15) & absent in 70% (35) patients. Glasgow Coma Scale Score was 8 or less in 42% (21) and 9 or more in 58% (29) patients. Conclusion: Spontaneous ICH is common in Indian subcontinent. As death occur due to ICH itself, associated co morbidities or due to complications, management in stroke care unit, High dependency unit and Intensive care unit is required.

Abstract TP330: Insular Cortex Lesions are Associated With Early Mortality in Patients With Intracerebral Hemorrhage

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Luis Prats-Sánchez ◽  
Fernando Fayos ◽  
Elba Pascual-Goñi ◽  
Celia Painous ◽  
Pol Camps-Renom ◽  
...  
Keyword(s):  
Glasgow Coma Scale ◽  
Intracerebral Hemorrhage ◽  
Independent Predictor ◽  
Tertiary Care ◽  
Insular Cortex ◽  
Brain Atlas ◽  
Lesion Volume ◽  
Care Hospital ◽  
Cox Regression Analysis ◽  
Coma Scale

Introduction: Insular lesions have been described as an independent predictor of death in acute ischemic stroke. This study was undertaken to determine the influence of insular damage on the mortality of patients with intracerebral hemorrhage (ICH). Hypothesis: Insular cortex lesions are an independent predictor of death in acute ICH. Methods: This is an observational study of consecutive patients with spontaneous acute ICH who were admitted to a tertiary care hospital. The following data were collected prospectively: age, sex, traditional vascular risk factors, vital signs, CT findings (secondary intraventricular hemorrhage, hematoma volume), Glasgow Coma Scale score, time and cause of death within hospitalization. The insular cortex damage (right, left or any) was assessed by a blind evaluator using an interactive brain atlas. The association between insular lesions and mortality was investigated by use of logistic regression and Cox proportional hazards models. Results: We included 276 patients whose mean age was 77±14.3 years; 52.7% of them were men. During a median of 7 days (interquartile range 2-15) of hospitalization, 91 (32.9%) deaths were recorded. We observed 72 (26%) patients with insular cortex lesions (right insula=34, left insula=38). Cox regression analysis showed that age (adjusted hazard ratio [aHR] 1.02, 95% CI 1.00-1.04; p<0.001), Glasgow Coma Scale (aHR 0.84, 95% CI 0.80-0.89; p<0.001), lesion volume (aHR 1.10, 95% CI 1.06-1.15; p<0.001) and any insular damage (aHR 2.19, 95% CI 1.40-3.42, p=0.002) were significant predictors of death within hospitalization. Conclusions: In conclusion, insular cortex lesions adversely influence survival after spontaneous ICH. This finding was observed even after adjustment for other well-known predictors of ICH mortality.

scholarly journals Eclampsia at a tertiary care hospital of Nepal: A five year study

2018 ◽  
Vol 6 (2) ◽  
pp. 14-21
Author(s):  
Shraddha Rana ◽  
Pramod Kattel
Keyword(s):  
Blood Pressure ◽  
Maternal Mortality ◽  
Maternal Death ◽  
Health Care Professionals ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
Fetal Mortality ◽  
Care Hospital ◽  
Cross Sectional ◽  
National Medical

Background and Objectives: Eclampsia poses a global threat in terms of feto-maternal morbidity and mortality and all medical practitioners fear the ailment. It is one of the major causes behind preventable maternal death. Etio-pathogenesis of the disease condition is ambiguous and is considered to be multi-factorial. This study was done to analyze cases of eclampsia in relation to maternal and fetal outcomes at a tertiary level care hospital. Materials and Methods: A descriptive cross-sectional observational study was carried out in patients developing eclampsia over a period of five years starting from July 2011 to June 2016 at National Medical College and Teaching Hospital, Birgunj. Relevant data were collected from the statistics section of hospital reviewing the case sheets. Results: There were 291 cases of eclampsia out of 16,445 deliveries and prevalence of eclampsia was calculated to be 1.77%. Fourty-five percent of eclamptic women had age less than 20 years and two-third was primigravida. Approximately 84% of women were unbooked. Antepartum eclampsia was observed in 78.8% followed by postpartum eclampsia (14.8%) and intrapartum eclampsia (6.5%).  At the time of admission systolic blood pressure more than 140 mmHg and diastolic blood pressure more than 90 mmHg were noted in 79% and 92.1% cases respectively. Caesarean section was the preferred mode of delivery and was performed in 62.9% cases. ICU admission was required in 35.7% and remaining cases were managed in general/eclampsia ward. Renal failure was the most common cause of maternal mortality seen in 29.4%. Still birth was noted in 13.4%. Conclusion: Institutional obstetric patients are gradually facing eclampsia as prime cause of maternal death and unfortunately most of the cases are primigravid at younger age. All health care professionals should be proficient to manage eclamptic women instantaneously. Key words: Eclampsia; Fetal Mortality; Maternal Mortality; Pre-Eclampsia

Frontal bur hole through an eyebrow incision for image-guided endoscopic evacuation of spontaneous intracerebral hemorrhage

2012 ◽  
Vol 117 (4) ◽  
pp. 767-773 ◽  
Author(s):  
Justin A. Dye ◽  
Joshua R. Dusick ◽  
Darrin J. Lee ◽  
Nestor R. Gonzalez ◽  
Neil A. Martin
Keyword(s):  
Glasgow Coma Scale ◽  
Minimally Invasive ◽  
Intracerebral Hemorrhage ◽  
Invasive Technique ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Midline Shift ◽  
Hematoma Volume ◽  
Coma Scale ◽  
Endoscopic Evacuation ◽  
The Mean

Object Surgical evacuation of spontaneous intracerebral hemorrhage (sICH) remains a subject of controversy. Minimally invasive techniques for hematoma evacuation have shown a trend toward improved outcomes. The aim of the present study is to describe a minimally invasive alternative for the evacuation of sICH and evaluate its feasibility. Methods The authors reviewed records of all patients who underwent endoscopic evacuation of an sICH at the UCLA Medical Center between March 2002 and March 2011. All patients in whom the described technique was used for evacuation of an sICH were included in this series. In this approach an incision is made at the superior margin of the eyebrow, and a bur hole is made in the supraorbital bone lateral to the frontal sinus. Using stereotactic guidance, the surgeon advanced the endoscopic sheath along the long axis of the hematoma and fixed it in place at two specific depths where suction was then applied until 75%–85% of the preoperatively determined hematoma volume was removed. An endoscope's camera, then introduced through the sheath, was used to assist in hemostasis. Preoperative and postoperative hematoma volumes and reduction in midline shift were calculated and recorded. Admission Glasgow Coma Scale and modified Rankin Scale (mRS) scores were compared with postoperative scores. Results Six patients underwent evacuation of an sICH using the eyebrow/bur hole technique. The mean preoperative hematoma volume was 68.9 ml (range 30.2–153.9 ml), whereas the mean postoperative residual hematoma volume was 11.9 ml (range 5.1–24.1 ml) (p = 0.02). The mean percentage of hematoma evacuated was 79.2% (range 49%–92.7%). The mean reduction in midline shift was 57.8% (p < 0.01). The Glasgow Coma Scale score improved in each patient between admission and discharge examination. In 5 of the 6 patients the mRS score improved from admission exam to last follow-up. None of the patients experienced rebleeding. Conclusions This minimally invasive technique is a feasible alternative to other means of evacuating sICHs. It is intended for anterior basal ganglia hematomas, which usually have an elongated, ovoid shape. The approach allows for an optimal trajectory to the long axis of the hematoma, making it possible to evacuate the vast majority of the clot with only one pass of the endoscopic sheath, theoretically minimizing the amount of damage to normal brain.

scholarly journals Clinical profile of patients with hypertensive crisis in a tertiary care hospital in Haryana, India – A retrospective cross-sectional study

2022 ◽  
Vol 13 (1) ◽  
pp. 66-72
Author(s):  
Navtej Singh ◽  
Tarun ◽  
Ravinder Pal ◽  
Ankit Chamoli
Keyword(s):  
Clinical Presentation ◽  
Target Organ Damage ◽  
Tertiary Care ◽  
Hypertensive Crisis ◽  
Organ Damage ◽  
Hypertensive Emergency ◽  
Time Interval ◽  
Care Hospital ◽  
Hypertensive Urgency ◽  
Cross Sectional

Background: A hypertensive crisis may manifest as hypertensive emergency or urgency. Hypertensive emergency is characterized by target organ damage and poses immediate threat to life, a situation not seen in urgency. Aims and Objectives: The aims of the study were as follows: (1) To determine the prevalence of hypertensive crisis classified as emergency, urgency, and pseudocrisis. (2) To assess the various systems (neurological, cardiovascular, and renal) affected in relation to a particular type of hypertensive crisis. Materials and Methods: The retrospective study comprised analysis of medical records of 100 patients of hypertensive crisis admitted to emergency unit of BPS Government Medical College and Hospital for Women, Sonepat, Haryana, India, in the 2 years period from January 2018 to December 2019 and study their prevalence among hospital emergencies and clinical presentation. Results: Total number of clinical emergencies analyzed during this time interval was 6666. The prevalence of hypertensive crisis accounted to 1.5% of all the clinical emergencies received. About 66% presented as hypertensive emergencies, 32% as hypertensive urgency, and 2% presented as hypertensive pseudocrisis. Males of the fifth decade of life while females of the sixth decade of life were most affected by hypertensive crisis. Headache (58%) followed by giddiness (44%) was the most common clinical presentation in the emergency. About 34% of patients had associated neurological deficit. Only 16% of patients had cardiovascular system involvement. Conclusion: Symptoms provided by patients in the emergency department are of paramount importance for the outcome of hypertensive crisis. Severe complication of hypertensive crisis can be prevented if hypertension is timely diagnosed and appropriately managed.

Incidence and Clinical Presentation of Polycystic Ovarian Syndrome in a Tertiary Care Hospital

2021 ◽  
Vol 15 (8) ◽  
pp. 1800-1805
Author(s):  
Muntiha Sarosh ◽  
Faiza Ghafoor ◽  
Najma Parveen ◽  
Rabiya Shahid ◽  
Shifa Khalil Ur Rehman
Keyword(s):  
Polycystic Ovarian Syndrome ◽  
Clinical Presentation ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Care Hospital ◽  
Obese Women ◽  
Cross Sectional ◽  
Medical College ◽  
Ovarian Syndrome

Aim: To determine Incidence of Polycystic Ovarian Syndrome and its clinical presentation in a tertiary care Hospital. Study Design: A Cross sectional study. Place and duration of study: The study was conducted in the Department of Obs. & Gynae, Avicenna Medical College and Hospital, Lahore for a period of six months, January 2020 to June 2020. Methodology: A total of 753 patients attending the gynecological outpatient department were included in the study. Among these the women presenting with clinical picture of menstrual irregularities weight gain, hirsutism and subfertility were evaluated for diagnosis of PCOS. Radiological findings by pelvic U/S were confirmed. Results: 169 women out of 753 patients were found to have PCOS. The incidence was thus 22.44%. Maximum number of women were overweight, BMI (25-29.9Kg/m2). 113(66.86%) presented with oligomennorrea followed by hirsutism and amenorrhea. 57.1% of married women with PCOD had subfertility. Conclusion: Polycystic ovarian Syndrome is common in our population. It is more frequently seen in unmarried obese women. Menstrual irregularity is the most common clinical presentation. Ultrasound criteria is a valuable tool to diagnose the Polycystic Ovarian Disease. Keywords: Polycystic 0varian Syndrome, oligomenorrhoea, amenorrhoea, hirsutism, obesity

Frequency of Pre-Eclampsia Induced Acute Kidney Injury

2021 ◽  
Vol 15 (10) ◽  
pp. 2580-2581
Author(s):  
Bilal Rasool ◽  
Hina Akbar ◽  
Anees Muhammad ◽  
Muzammil Riaz Malik
Keyword(s):  
Blood Pressure ◽  
Acute Kidney Injury ◽  
Tertiary Care ◽  
Hospital Setting ◽  
Kidney Injury ◽  
Operational Definition ◽  
Care Hospital ◽  
Cross Sectional ◽  
Mortality And Morbidity ◽  
Pregnant Females

Aim: To determine the frequency of preeclampsia induced acute kidney injury in patients presenting in a tertiary care hospital. Study design: Cross sectional study. Study setting: Department of Nephrology, KEMU/Mayo Hospital Gynecology, Lady Atchison Hospital Lahore, Methodology: All 180 pregnant females having acute kidney injury as per operational definition between 15 years to 50 years presenting in 3rd trimester of pregnancy for delivery were included in study after taking informed consent. Pregnant females with Blood Pressure >140/90mmHg after 20 weeks of pregnancy and laboratory investigation i.e. proteinuria were recorded. All investigations were done from laboratory of KEMU /Mayo hospital Lahore. After the diagnosis was made, the patients were treated according to the guidelines in hospital setting. Results: In this study, out of 180 cases, 118(65.56%) were between 15-32 years of age whereas 62(34.44%) were between 33-55 years of age, mean±SD was calculated as 30.21±5.35 years, mean blood pressure of the patients was recorded as 154.27±108.15mmHg, mean serum creatinine of the patients was calculated as 4.39±0.28 mg/dl, frequency of urinary protein was recorded as 62(62.22%) while 68(37.78%) patients had no proteinuria, frequency of preeclampsia induced AKI in pregnancy was recorded in 47(26.11%). Conclusion: Frequency of preeclampsia induces acute kidney injury is very high and it must be diagnosed and treated appropriately in time to reduce maternal mortality and morbidity. Keywords: Pre-eclampsia, acute kidney injury, frequency

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