Online ISSN: 2515-8260

Keywords : mortality


Use Of Mannheim Peritonitis Index Screening System, In Predictingthe Outcome In Patients With Peritonitis At Sharda Hospital

Mridula Kashyap, Mudasir Ahmad, Ayaz Ahmad Bhat, Suresh Kalyanasundar .

European Journal of Molecular & Clinical Medicine, 2023, Volume 10, Issue 1, Pages 3517-3525

Background: Peritonitis is inflammation of peritoneum and peritoneal cavity caused by localized or generalized infection.
Primary peritonitis results from bacterial, chlamydial, fungal, or mycobacterial infection in absence of perforation or inflammation of GI or GU tract. Secondary peritonitis occurs in the setting of GI or GU perforation or inflammation with common causes including acute appendicitis, colonic diverticulitis, and pelvic inflammatory disease.
Methods: This is an observational prospective cross sectional study including 73 patients presenting to surgical emergency with features of peritonitis. Patient’s information were collected both on hospitalization and after surgical exploration; severity of peritonitis was evaluated using the MPI. According to MPI score patients were divided in appropriate groups(<21,21-27,>27) and analyzed accordingly. The statistical analysis used chi-square test, Kolmogorov-Smirnov test, Kruskal Wallis test& ANOVA test.
Result: In groups <21, 21‑27 and > 27 points according to MPI mortality was 0%, 10.53% and 76% respectively. age > 50 was largely associated with increased mortality. There has been a significant correlation between the MPI score and organ failure, Hospital stay.
Conclusion: MPI scoring system is a simple and effective tool for assessing this group of patients, and can be used as a guiding tool to decide on the management of the patient after the definitive procedure is done.Increasing scores are associated with poorer prognosis, needs intensive management and hence it should be used routinely in clinical practice

Metabolic Syndrome and Outcomes in Acute Ischemic Stroke: A Study Using the Modified Rankin Scale

Shailendra Mane, Rajashri Mane, Rajesh Khyalappa

European Journal of Molecular & Clinical Medicine, 2023, Volume 10, Issue 1, Pages 4476-4490

Several pieces of data imply that metabolic syndrome (Met S) increases the risk of stroke. The modified Rankin scale (MRS), a clinician-reported evaluation of global impairment, is frequently used to assess the outcomes of patients with acute ischemic stroke. Patients with Met S and AIS were examined using modified Rankin Scale scores to determine their prognosis.
Methods:
The study involved fifty patients hospitalised at the D Y Patil Medical College Kolhapur between October 2020 and August 2022 with acute ischemic stroke symptoms. Initial symptomatic atherothrombotic ischemic stroke was detected using the diagnostic criteria of the Trial of Org 10172 in Acute Stroke Treatment (TOAST). They were utilising the NCEP ATP III criteria for metabolic syndrome evaluation. Mortality at three months was the primary outcome. (a Rankin modified score of 4-6) At three months, secondary outcomes included recovery, disability, and death.
Results:
Fifty individuals were hospitalised for the trial. In the present study, 62 per cent (31 out of 50) of ischemic stroke patients were found to have metabolic syndrome. Compared to patients without metabolic syndrome, 67.74% of those diagnosed had an MRS score of more than 3. In contrast, only 31.58% of those without metabolic syndrome had an MRS value larger than 3. Compared to persons who did not have metabolic syndrome, those who did were more likely to die (19%) and be handicapped (71%) than those who did not have metabolic syndrome (47% and 16%). The incidence of discharge was significantly higher among individuals without metabolic syndrome (37%) compared to those with metabolic syndrome (10%).
 Conclusion:
According to the results of our research, Met S was shown to be associated with a bad outcome in individuals diagnosed with acute ischemia. The development of efficient prophylactic interventions against metabolic syndrome and its separate components is required to bring the risk of future strokes down to a more manageable level

Dyselectrolytemia and its outcome in critically ill children- A Prospective study

Renuka Jadhav, Dhivakar K.T, Harshitha Avileli, Vineeta Pande, Shalaka Agarkhedkar, Sharad Agarkhedkar

European Journal of Molecular & Clinical Medicine, 2023, Volume 10, Issue 1, Pages 3208-3213

The objective of this study is to look for various and common electrolyte imbalances in critically ill children admitted to Paediatric Intensive Care Unit(PICU) and to study the outcome among those cases. Methods: This was a prospective observational study done on 84 critically ill children  in the age group of 1 month to 12 years admitted in PICU of a tertiary care hospital. Under aseptic conditions venous samples were obtained for estimating serum levels of sodium, potassium, chloride, magnesium and phosphorus. The commonly occurring electrolyte imbalance was observed and the outcome is compared by morbidity, cure and mortality. Results: Electrolyte abnormalities were observed in 84 children(100%). Most common electrolyte abnormality observed was hypocalcemia in 70.2% cases (n=59). Morbidity was seen in 35.7% cases (n=30) and mortality associated with dyselectrolytemia was seen in 25.1% cases(n=21). Conclusion: This study showed increased incidence of dyselectrolytemia in critically ill children admitted to PICU. But the signs and symptoms are often difficult to recognize an electrolyte imbalance as the imbalances may be primary or secondary to underlying systemic illness. Early recognition and prompt management of electrolyte imbalances can lead to decrease in morbidity and mortality
Dyselectrolytemia, Critically ill, PICU, Mortality, Morbidity 

Study of Electrocardiographic Changes in Patients with Cerebro Vascular Accidents

Niraj Diwakar, Sintu Kumar, Akanksha Srivastava, Govind Prasad, Ramesh Kumar, Arshad Ahmad

European Journal of Molecular & Clinical Medicine, 2023, Volume 10, Issue 1, Pages 971-977

Background: Cardiac abnormalities occur in majority of patients after cerebrovascular accidents, accounting for unex-pected deaths during the first month. The most common disturbances include electrocardiogram (ECG) abnormalities, cardiac arrhythmias, and myocardial injury and dysfunction. Material and Methods: This prospective study was carried out in a superspeciality hospital during 2 years which comprised of 100 patients. Patients were categorized based on computerized tomography findings into cerebral infarction, intracerebral hemorrhage, and subarachnoid hemorrhage. ECG changes are interpreted with rate, rhythm, and abnormal-ities and conclusions were derived.
Results: Stroke was most common in 5th and 6th decade. Cerebral infarction formed the largest group. Males had higher preponderance. Hypertension was the most common risk factor. In total, 74% had electrocardiographic abnormality. ECG changes are more common among cerebral hemorrhage and subarachnoid hemorrhage. Most common ECG abnormality was prolonged QTc interval. Overall immediate mortality was 23%. It was high in cerebral hemorrhage. Morality was high in patients with abnormal ECG, mostly with prolonged QTc and with T-wave inversion.
Conclusion: Patients with cerebrovascular accidents often have abnormal ECG in the absence of known organic heart disease or electrolyte imbalance. QTc prolongation and U-wave are the common ECG abnormalities in hemorrhagic strokes.

Comparative Assessment of Intubating Conditions in Abdominal Surgeries using Video Laryngoscope and Macintosh Direct Laryngoscope

CKV Sirisha, K Satish, T Jaya Chandra, Gattu Vijaya Lakshmi .

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 8, Pages 3250-3254

Introduction: Failure to successfully intubate the trachea and to secure the airway remains a leading cause of morbidity and mortality in the operative and emergency settings. A study evaluating the intubating conditions using video laryngoscope and Macintosh direct laryngoscope for visualization of the vocal cords, success rate for intubation, time for intubation, and the need for additional manoeuvres in adult patients in elective general anaesthesia cases was planned.
Methods: It was a prospective study conducted in the department of Anaesthesiology, GSL Medical College. Individuals aged 18 to 60 years, ASA physical status grade 1 and grade 2 were included; ASA grade >3, mouth opening < 4cm were excluded. A thorough preanesthetic evaluation was conducted. Airway was assessed using modified Mallampatti grading. In the operating room, standard monitoring devices were applied including a pulse oximeter, 3 lead ECG and blood pressure. Baseline measures of Blood pressure, heart rate, oxygen saturation were made. Vital signs were recorded every minute from the time induction of anesthesia was begun until five minutes after the patient had been intubated, and then at five-minute intervals thereafter for fifteen minutes.
Results: In this study, 40 members each were recruited in group D and V, respectively. Age wise, majority were 21 – 30 years, respectively in group D (40%) and group V (42.5%).
In group D, majority (45%) were graded to be MMG 1 and in group V, majority were in grade 2 (47.5%). When the overall intubation was considered, it was easy in 37.5% for V group members and major difficult to 5% individuals; statistically there was no significant difference.
Conclusion: Video laryngoscope was associated with better visualization of laryngeal structures as compared to Macintosh direct laryngoscope. Videolaryngoscope is suitable for tracheal intubation in routine clinical practice as an alternative to Macintosh laryngoscope

Serum Electrolytes as Mortality Indicators in Hypertension Cases

Syeda Parveen Fatima, Deva Pragna Prashanthi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 3721-3727

Background: According to the pressure natriuresis theory, monogenic hypertension, and dietary salt reduction studies, Na+ is a primary predictor of blood pressure and mortality. The evolved response to a salt or water shortfall is more efficient than the response to salt surplus. Cl is the most abundant anion outside of cells and derives from food. The current epidemiological investigation examined the relationship between blood electrolyte levels and hypertension in a salt-consuming community. Fluid and electrolyte balance is necessary for postoperative and critically ill patients' metabolic care, gastrointestinal function, and nutrition. Artificial nutrition should be prescribed with the same care as other nutritional and pharmaceutical needs.
Materials and Methods: Secondary study of epidemiological study was carried out at the Government Medical College, Jagitial, India, which was carried out between the December 2021 to November 2022. Using regression models, the relationship between the amounts of sodium, potassium, chloride, total calcium, phosphate, and magnesium in the serum and blood pressure and the presence or absence of hypertension was investigated.
Results: 81 previously diagnosed hypertension patients were included in this study. 56% of participants experienced electrolyte problems. 62% of hypercalcaemic subjects had hypertension, followed by hypokalaemia (56%) and hypernatremia (54%). Hypercalcemia was linked to IH and PDH. Higher serum calcium quartile increased IH and PDH risk. Serum salt and hypertension were unrelated. PDH U-shaped serum potassium. Higher chloride quartile had lower PDH chances. Highest phosphate quartile was solely related with lower IH probabilities, although higher magnesium lowered IH and PDH odds.
Conclusions: We found a link between IH/PDH and serum calcium, magnesium, and chloride. Patients with IH may have concurrent electrolyte issues, such as hypercalcemia, which may reflect additional underlying etiologies. When prescribing fluid and electrolytes, it's important to understand the relationship between internal and external balance, starvation, and injury to reduce physiological and clinical side effects. Prescriptions need detail and education

Effect of Diabetes mellitus in patients with acute exacerbation of the chronic obstructive pulmonary disease

Dr. Kodithyala Prashanth Kumar; Dr. Ruchi Thakur; Dr. M Prathyusha; Dr. M. Siva Ashish

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 1739-1751

Background: Acute exacerbation chronic obstructive pulmonary disease (AECOPD) is the leading morbidity and mortality cause worldwide. Many studies showed the association of hyperglycaemia with poor results from a wide range of acute illnesses.
 Aim and Objectives: To investigate the association between concentrations of blood glucose & clinical outcomes in AECOPD patients admitted to the hospital.
Material and Methods: This is a hospital-based retrospective analysis carried out on AECOPD patients admitted during the period of January 2021 to March 2022. Detailed history, clinical examination, blood investigations were performed. Random blood glucose levels at the admission were noted, and the subjects were separated into groups of four on the basis of blood glucose levels (≤ 140 mg/dl, 141- 170 mg/dl, 171-200 mg/dl, >200 mg/dl). The clinical outcome was compared among these four groups.
Results: In this study majority were male patients (86%) with age ranging from 66-75 years (46%). About 85% of patients were smokers, and 15% were non-smokers. 68% of the study group population was hyperglycaemic (RBS >140 mg/dl). Among different quartiles, the mean length of stay in hospital was statistically considerable (p=<0.05), signifying an increased length of stay in hospital trend as the admission RBS levels increase. There was no statistically significant relationship amongst the RBS quartiles of ≤140 mg/dl and RBS quartiles of 141-170mg/dl (p=0.997). There was a statistically considerable correlation amongst the RBS quartiles ≤140 mg/dl and RBS quartiles ≥201 mg/dl(p=000), and this study’s crude rate of mortality was 5%. The population under quartile of RBS ≥201mg/dl had the highest percentage. All the people who died were over the age of 56 years. The mean HbA1c among dead (9.43 ± 2.25) and alive (6.78±1.70) showed significant relation (p=<0.05).
Conclusion: Higher the admission RBS, longer was the mean length of stay in hospital and mortality in the AECOPD diagnosed patients. Maintaining the blood glucose levels < 170 mg/dl than the strict glycaemic control, i.e.<140 mg/dl, could benefit these patients' outcome. This study indicates that for clinically treating the AECOPD patient population, targeted surveillance, as well as DM management, are critical.

To study the elevated resting heart rate (RHR) represents a separate risk factor for mortality or only a sign of physical fitness

Dr Prabhjot Singh, Dr Manoranjan Kumar, Dr.Gowtham Raj

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 3572-3578

Aim: To study the elevated resting heart rate (RHR) represents a separate risk factor for mortality or only a sign of physical fitness.
Material and methods: The sample size for this research was 410 males. All men were given a clinical examination by a doctor (FG) that included a discussion of their responses to a questionnaire and a test of their aerobic capacity (VO2Max) on a bicycle ergometer. Heart rate and labour load data from a bicycle ergometer were used to calculate estimates of physical fitness using the strand nomogram. Using a manometer created by the London School of Hygiene and Tropical Medicine, BP was taken on the right arm of sitting subjects after at least 10 minutes of rest. The survey's questions on hypertension care led to the collection of useful data.
Results: An elevated resting heart rate has been linked to decreased fitness, hypertension, total cholesterol, triglyceride, and body mass index. Everyone got along, regardless of age or status. Smoking prevalence was greater among participants with lower resting heart rates than among those with higher resting heart rates. The VO2Max and HR at rest correlated extremely significantly (R=0.29, p0.001). Higher fitness levels were associated with decreased resting heart rates. Using heart rate as a continuous variable in an adjusted model, we find that for every 10 bpm beyond 60, the chance of death rises by 16%. Resting heart rate, smoking, and mortality all interacted to a nearly statistically significant degree. Resting heart rate was included as a continuous variable in the final model, and an increase of 10 beats per minute was associated with a 25% increase in risk for smokers and a 15% increase in risk for non-smokers.
Conclusion: Resting heart rate was shown to be an independent risk factor for death in this research of 410 healthy middle-aged and older people, regardless of physical fitness (VO2Max) as measured by a bicycle ergometer, recreational physical activity, or other traditional risk factors.

Vitamin D deficiency: A potential risk factor for sepsis development and correlation with qSOFA score in patient admitted to medical ICU in MMMCH, Solan

Dr. Joshna Prathyusha CHB, Dr. Sumeet Chadha, Dr. Sharad Lodhi, Dr. Rajesh Kashyap

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 9811-9817

Recent studies have also revealed that vitamin D may help protect against a number of chronic diseases, including the risk of developing diabetes, cardiovascular disease, lung disease, and other chronic illnesses, such as systemic infections. The growing body of knowledge around vitamin D has started to suggest possible associations between sepsis and vitamin D insufficiency. The understanding of the relationships between these disorders is still in its infancy.
Aim: The aim of the study was to assess the role of Vitamin D deficiency as a potential risk factor for sepsis development and correlation with qSOFA score in patient admitted to Medical ICU in MMCH, Solan.
Methodology: This was a cross sectional study conducted among 120 patients diagnosed with Sepsis presenting to the Medical ICU.
Results: The mean age of the study participants was 55.87 ± 13.07. Majority of the study participants were males. The prevalence of diabetes mellitus and hypertension were 45.8% and 40% respectively. Mortality was seen among 3.3% were alive and dead respectively. 100% of the study participants with sepsis with qSOFA score of more than 2, had Vitamin D deficiency and the mean Vitamin D level was 12.21 ± 5.38. The Vitamin D level was significantly lower among those who died than those who are alive (p=0.019).
Conclusion: 100% of the sepsis patients had Vitamin D deficiency in the present study. It has been shown that this has a detrimental effect on inpatient morbidity and death. This emphasises how crucial it is for the general public to have enough vitamin D supplements.

STUDY OF THE RELATIONSHIP OF ACUTE PHASE REACTANTSLEVEL WITH SEVERITY OF ILLNESS AND MORTALITY IN PATIENTS WITH SEPSIS AND ITS CORRELATION WITH APACHE IV SCORE

DR.NIDHI RANA, DR.JAGANNATH S. DHADWAD, DR.GOVIND S.SHIDDAPUR, DR.NIKHILA PHADNIS, DR.PRATEEK HARSH

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 7678-7687

Background- With sepsis as a major cause of concern in increasing ICU mortality, several prognostic scoring systems, including the Acute Physiology and Chronic Health Evaluation (APACHE)  or the Mortality Probability Models (MPM)have been used so far to assess the acute clinical condition of seriously ill patients with sepsis, to predict prognosis and to assist physicians clinical decision. 
Aim- To study the relationship of acute phase reactants level with severity of illness and mortality in patients with sepsis and its correlation with APACHE IV score
 
Study Design: Propective observational study.
Place and Duration of Study: This study was conducted at Department of General Medicine, Dr D Y Patil Medical College, Hospital and research centre, Pune from October 2020 to September 2022.
Methodology- This study conducted in a semi-urban teaching Hospital in Maharashtra, India. Study included patients admitted to ICCU of the study institute for sepsis (Sepsis is any suspected (or documented) infection and an acute increase in ≥2 sepsis-related organ failure assessment (SOFA) points.) and full filling the below mentioned inclusion and exclusion criteria.The collected data was analyzed with IBM, SPSS (IBM Corp., Statistics for Windows, version 24.0, Armonk, NY). Continuous variables were expressed as mean ± standard deviation (SD) and categorical variables were expressed as a percentage.
Results and Conclusion- Mean level of Acute phase reactants proteins like C reactive protein, ESR, lactate dehydrogenase level, D Dimer, Serum Procalcitonin, Serum lactate, Serum Ferritin, APACHE IV score was significantly higher in patients who died during the treatment as compared to patients who survived.

CORRELATION OF VITAMIN D AND LIPID PROFILE IN CORONARY ARTERY DISEASE”

Dr Shivu Bidari , Dr Sankar Kalairajan , Dr Praveen Gandhi,Dr Manju M

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 7194-7207

Background: Cardiovascular disease (CVD’s) are the chief cause of mortality in country like India, were quarter of all mortality are due to CVD. Vitamin D inhibits inflammation through a variety of mechanisms. The aim of the study was to assess the influence of vitamin D level on the  lipid profile of patients of coronary artery disease.
Material & Method: The present hospital based observational study was conducted among the patients who are more than 18 yrs with signs, symptoms and investigation (ECG) of coronary artery disease admitted to the AVMC hospital. Patients with chronic kidney disease, patients with elevated CRP, fever, patients with cancer and on supplementation of Vitamin D3 were excluded from the study.  The lipid parameters and vitamin D3 were measured to assess the relation.
Results: In present study total of 160 patients included with mean age of patients was found to be 51.75±8.58yrs, 68.8% were male. Vitamin D deficiency was seen in 50%, insufficiency in 40.6% and sufficiency in 9.4% patients. We found a significant higher incidence of dyslipidemia among the patients with deficiency and insufficient vitamin D compared to sufficient vitamin D levels.(p<0.05) Also there is significant negative correlation of total cholesterol and LDL cholesterol with the vitamin D3 level and a significant positive correlation with the HDL cholesterol. (p<0.05)
Conclusion: There is higher incidence of presence of vitamin D deficiency and insufficiency among the patients with coronary artery disease in the present study

To determine the role of risk factors for increased morbidity and mortality in perforated peptic ulcer in Western area of Rajasthan

Dr.Manish Jakhar, Dr. Manoj Kumar Mali

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 3915-3929

Aim: To determine the role of risk factors for increased morbidity and mortality  in perforated peptic ulcer
Methods and materials: All patients aged 18 and above who had abdominal surgery for PPU were included in this research. Intravenous fluids, nasogastric suction, and intravenous antibiotics were then administered to the patients. After proper resuscitation, the perforation site was located and a laparotomy was performed via a midline incision. The hole was simply closed and reinforced with a pedicle omental patch. Peritoneal lavage with 4 to 5 litres of normal saline was performed. An intraperitoneal drain is placed at the discretion of the operating surgeon. All patients were placed on a double antibiotic regimen that included Ceftriaxone (1gm bid), Metronidazole (500 mg tid), and Omeprazole (20 mg bid). Patients were monitored for up to six months following surgery. The research covered morbidity and mortality during the hospital stay as well as the following 6-month follow-up

Comparison of serum magnesium levels and sequential organ failure assessment score in patients with systemic inflammatory response syndrome

Pranav Ravi Kulkarni, Ashok Raja, Ramkumar Murali, Jagadeesan Mohanan*, Prasanna Karthik Suthakaran, Kannan Rajendran, Mageshkumar Sivanesan, Damodharan Jayachandran

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 6, Pages 802-809

BACKGROUND
Systemic Inflammatory Response Syndrome (SIRS) is an inflammatory condition which affects multiple systems in the body and often occurs as a response which is immunologically mediated by the protective immune system to infectious agent. Magnesium plays a vital role in sepsis and systemic inflammatory response syndrome (SIRS) The aim of this study is to estimate the serum magnesium concentrations in patients with SIRS in the medical ICU, to correlate with prognosis of SIRS patients by comparision with sequential organ failure assessment scoring and to assess the clinical outcome.
 
MATERIALS AND METHODS
This Observational analytical study was conducted in 100 patients admitted at the medical intensive care unit of Saveetha medical college and hospital, chennai who satisfy the diagnostic clinical criteria for SIRS. Detailed clinical examination was done for each patient. Serum magnesium levels were sent and the results were analysed.
 
RESULTS
In the study, 100 patients were included. The mean age of the study population was 42. 92 + 16. 69 years. 70 % of the patients in the study group were  male and 30 % were females. The mortality rate in the hypomagnesemia group was 81. 8% where as it was 14.3 % in the  normomagnesemia  group.  There was Significant mortality in the hypomagnesemia group when compared to the normomagnesemia group. The mean duration of ICU stay for patients in the hypomagnesemia group was 5. 424 days and in the  normomagnesemia group  it  was  5.286  days.  Among 66 patients with hypomagnesemia 50 patients required mechanical ventilation and it was 66 %. Among 28 patients in normomagnesemia group, 2 patients required ventilatory support.
 
CONCLUSION
Serum magnesium levels have prognostic value in  patients diagnosed as SIRS. Serum magnesium concentration shows association with increased mortality rate. There is significant greater need for mechanical ventilation and increased duration of stay under ventilator support in the patients with lower magnesium levels. There is a significant association in prognosticating the patients with SOFA scoring in hypomagnesemia and  magnesium correction may improve the outcomes in sepsis and SIRS patients.

A retrospective study of critical incidents during anaesthesia in a tertiary care government hospital

Dr.Richa Gupta, Dr.Devshri Raval, Dr. Rachana Gandhi, Dr. Aalap Shah

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 6, Pages 828-835

Introduction: Patient safety is the primary objective of health care. Success and failures are part of it. Adverse events can be controlled but cannot be eliminated. They should be reported, documented, and studied. Such data is important to monitor hospital performance and also they serve as a medium for training, simulation and improvement in standards of anaesthesia care.
Material and method: An observational retrospective study was conducted in a teaching tertiary level government hospital from patient records who underwent adverse events or deaths related to anaesthesia over one year from October 2016 to September 2017. Type of adverse events and their relation to ASA grading, type and speciality of operation, age, sex and comorbidities of the patient, time of critical incident when occurred with relation to anaesthesia were analysed. Mortality was included as a critical event in our study and analysed.
Results: Critical events were documented in 50 patients (0.5%), with mortality 54%, while rest recovered completely. Highest number were documented in age group 31 to 50 years (26%) and ASA III patients(50%). Critical incidences happened more with emergency surgeries (52%), in patients with single preoperative comorbidity(35) and under general anaesthesia(78%) in maintenance phase(32.8%). Highest cause of mortality was related to cardiovascular and respiratory events.
Conclusion:  Morbidity and critical events will always be part of anaesthesia practice. They might be prevented with proper vigilance. When they happen, it should be reported without fear of punitive results. They should be studied and analysed, and proper protocols and checklists should be developed according to local guidelines and medical practices. Such studies are important part of medical education process and improve patient care.

To identify rising level of CRP and D-Dimer as a predictor of increased morbidity and mortality in COVID -19 patient- A retrospective study

Dr. Mayank Varshney, Dr. Y.P. Singh, Dr. Akhil Taneja, Dr. Saurabh Jain, Dr. Gaurav Pratap Singh

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 6, Pages 847-855

Aim and objectives: The present study assessed the correlation between rising levels of CRP and D-dimer with morbidity and mortality in adult Covid -19 patients.
Materials and method: This retrospective observational study was conducted at Max Super speciality Hospital I.P. Extension, Delhi a tertiary care centre in North India. CRP and D-Dimer values were collected at the time of admission and within 15 days after admission. The statistical analysis was done by independent t-test.
Results: The study population consisted of 194 (64.7%) males and 106 (35.3%) females. The mean age of the study population was 56.78±15.42 (28-94) years. The mean age of the non-survivors (58.83±15.64 years) was significantly more than survivors (54.43±14.85 years). The mean CRP and D-DIMER at the time of admission and within 15 days after admission was significantly more among non-survivors compared to survivors.
Conclusion: A high CRP and elevated D-Dimer levels among COVID-19 patients predict higher odds of mortality; however, large scale and longer-term studies are needed to validate our findings. The predictive model based upon CRP and D-DIMER levels can help the clinicians to improve individual treatment, make timely clinical decisions, and make optimal use of limited clinical resources.

Identification Of Acute Necrotizing Soft Tissue Infections Through Clinical Indicators

Sanjeev , Kumar; Wakhariya Darshit Narendra; Sharad Goel

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 6, Pages 2068-2071

Background: Necrotizing soft tissue infections (NSTIs) are a quickly deadly illness whose prognosis is dependent on early detection and treatment.
Methods: The study included 626 patients, 378 of whom were men and 248 of whom were women, ranging in age from 19 to 67 years. The research was carried out at Department of General Surgery, LSK Hospital, Kishanganj, Bihar for 5 years. The study's samples were taken from patients who came to the hospital with Necrotizing fasciitis. These individuals are undergoing clinical, radiological, and laboratory examinations. Tissue samples are taken for bacterial culture and sent to a laboratory for identification and antibiotic sensitivity testing. The area was examined using X-rays and CT scans. Blood samples were also obtained and sent to a laboratory for a full blood analysis.
Results: In compared to the control group, severe cases have the lowest mean value of WBC (7.1806±1.95788), the lowest mean value of haemoglobin (6.9260±2.25653), and the highest blood levels of creatinine (145.9758±2.33841), glucose (13.8547±1.71067), and the lowest serum sodium (94.0986±0.22220). At the 0.05 level, the mean difference is significant (P<0.05).
Conclusion: A necrotising soft tissue infection is a fatal disorder. It is critical to focus on the aetiology of such a problem in order to begin treatment as soon as possible in order to avoid mortality.

Prevalence of Congenital heart Diseases in children- An analysis of 197 patients in a tertiary care Hospital of Kerala

Dr. Shrinath G,Dr. Muhammed Basheer K T,Dr. Vidhu Ashok,Dr. Anjali T R

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 215-226

Background: Congenital heart disease (CHD) is one of the commonest causes of infant mortality rate in developing countries. Early detection, referral and treatment of infants and children with CHD contribute to the reduction in the infant mortality rate. There are differences in the prevalence and distribution in different parts of India. A study was conducted in a tertiary care Hospital to know the prevalence of CHD in this state. Aim of the Study: To study the prevalence, age and gender distribution and clinical spectrum of congenital heart disease (CHD) among pediatric patients attending outpatient department (OPD) of a tertiary care hospital in Kerala. Materials: A prospective cross sectional study was carried over 36 months on children aged from newborn to 12 years and 179 children with CHD were screened, included and analyzed. Infants/ children aged 0 to 12 years with symptoms of CHD, or suspicious of CHDs were included. After initial clinical examination and pulse oxymetry diagnoses were confirmed by detailed 2-D Echocardiography and color Doppler studies. Two dimensional and color Doppler echocardiography were done with Neonatal (12MHz) and Pediatric (8MHz) sector transducer. ASD with less than 4.0 mm diameter was not included as a CHD. If more than one lesion was observed, the defects which caused hemodynamic imbalance or which required immediate treatment were considered as the main CHD.

“Socio-demographic profile and treatment Outcome of Covid-19 Patients attending Covid Hospitals of Datia, M.P. INDIA’’

Adhikari P., Kumar Sanjeev, Swami Piyush, Gupta Shubhanshu, Tiwari R

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 4, Pages 3107-3115

Background- In December 2019, a series of pneumonia cases were identified with presumptive viral origin in Wuhan, China, the virus was initially designated as the novel coronavirus (2019-nCoV), later WHO renamed as Corona Virus Disease 2019 (COVID-19).
Objective- To describe the sociodemographic profile & Treatment Outcome of Covid -19 Patients attending Covid Hospitals of Datia district of M.P.
Methods -it was descriptive, cross sectional observational study conducted among COVID-19 positive cases admitted & managed at Covid hospitals (DCH & DCHC) affiliated to Government Medical College Datia ,M.P. from 1st April 2020 to 15th December 2020. Data was collected regarding age ,sex, Occupation, Residence and Treatment Outcome of Covid 19 patients and analysed accordingly with the help of EpiInfo software.
Results- The mean age of the patients was found 37.69±16.74 years. 65.7% of patients were belonged to a middle age group & male sex. Only 23.14% belongs to peripheral area& remaining were of urban area. Out of total 1620 positive patients, 78.76% patients were admitted & remaining were advised for home isolation. 92.47% had been discharged &cured ,only 1.72 % patients were up referred and only 0.39 % death had been occurred among of all admitted patients.
Conclusion- As only 1.72 % patients were up referred and 0.39 % death had been occurred among of all admitted patients which shows a good quality care of covid patients and may be also be due to mainly middle aged patients were found infected with covid -19 without any more significant co morbid conditions.

Assessment of incidence of CBD injury who underwentLaparoscopic cholecystectomypatients

Dr.Nayan Pancholi, Dr.Latif Bagwan,Dr.Sandipkumar Chaudhari

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 584-587

Background:Laparoscopic cholecystectomy (LC), one of the most commonly performed surgical
procedures worldwide is accepted as the gold standard in the treatment of symptomatic gallstones.
The present study was conducted to assess incidence of CBD injury who underwent LC.
Materials & Methods:180 patients who underwent laparoscopic cholecystectomy of both genders
were included. Predictors of CBD injury were assessed based on grading of degree of difficult LC and
visualization of critical view of safety (CVS). BDI was classified according to Strasberg
classification.
Results: Out of 180, males were 110 and females were 70. Diagnosis was acute cholecystitis in 90,
chronic cholecystitis in 40, empyema gall bladder in 30 and mucocele gall bladder in 20 cases. Degree
of difficulty was mild in 46, moderate in 84, severe in 28 and extreme in 22. CVS was seen in 160.
The difference was significant (P< 0.05). Type of bile duct injury was type A in 5, type B in 1, type D
in 2 and type E4 in 3 patients. The difference was significant (P< 0.05).
Conclusion: Majority of bile duct injuries, results mainly from the surgeon’s inexperience,
misinterpretation of anatomy and poor surgical technique.

A retrospective cohort study on laparoscopic cholecystectomy in cirrhosis patients

Dr. Faisal Mumtaz,Dr.Urooj Najami,Dr.Prabodh Bansal,Dr Gopal

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 2797-2803

Background:The advanced instruments like harmonic shears have made laparoscopic cholecystectomy (LC) a safe option. The present study determined twoyearsexperience of patients after laparoscopic cholecystectomy in cirrhosis patients.
Methods: A total of 50 cirrhotic patients underwent LC from August 2020 to February 2022. The type of surgery performed was laparoscopic cholecystectomy. The parameters recorded were,presence of adhesions,use ofharmonic devices, amount of bleeding during surgery,rate of conversion to open surgery and the reasons thereof, operative time in minutes, plasma and platelet transfusion postoperatively and duration of hospital stay .
Results:Majority of the patients were of Child-Pugh class A. The cause of cirrhosis was hepatitis C virus (HCV) in most of the patients. Biliary colic was found to be the most common presentation. Higher CTP, model for end-stage liver disease (MELD) scores, higher mean international normalization ratio (INR) value, lower mean platelet count, higher operative bleeding, higher blood, and plasma transfusion rates, longer mean operative time and postoperative hospital stays were found to be statistically significantand  correlated well with 30-day morbidities and mortalities.
Conclusion: LC could be a better surgery performed in patients with cirrhosis. However, higher CTP and MELD scores, greater operative bloodloss, largerno of  blood and plasma transfusion in units, longer operative time, lower platelet count, and higher INR values can be considered factors resulting in poor outcome. 

“COVID-19 AND LOW PLATELET COUNT-A RELATIONSHIP”

DR.SHAILZA, DR. AMARJEET SINGH VERMA, DR. JYOTI SINGH RAJPUT .

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 766-771

BACKGROUND
Easily accessible, inexpensive, and widely used laboratory tests that demonstrate the severity of COVID-19 are important. Therefore, in this study, we aimed to investigate the relationship between mortality in COVID-19 and platelet count, Mean Platelet Volume (MPV), and platelet distribution width.
METHODS
In total, 100 COVID-19 patients were included in this study. The patients were divided into two groups. Patients with room air oxygen saturation < 90% were considered as severe COVID-19, and patients with ≥90% were considered moderate COVID-19. Patient medical records and the electronic patient data monitoring system were examined retrospectively. Analyses were performed using the SPSS statistical software. A p-value <0.05 was considered significant.
RESULTS
The patients’ mean age was 64,32 ± 16,07 years. According to oxygen saturation, 38 patients had moderate and 62 had severe COVID-19. Our findings revealed that oxygen saturation at admission and the MPV difference between the first and third days of hospitalization were significant parameters in COVID-19 patients for predicting mortality. While mortality was 8.4 times higher in patients who had oxygen saturation under 90 % at hospital admission, 1 unit increase in MPV increased mortality 1.76 times.
CONCLUSION
In addition to the lung capacity of patients, the mean platelet volume may be used as an auxiliary test in predicting the mortality in COVID-19 patients.

Study of Pulmonary Hypertension in Patients with Chronic Kidney Disease

Meroz Pillarisetty,Ganga Prasad, Aparna

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 11633-11650

Background:To study the prevalence of Pulmonary Hypertension (PH) in patients with Chronic Kidney Disease (CKD).
Materials and Methods: The present study assessed the prevalence of PH in 50 patients with CKD, at DR.PSIMS & RF, Chinnavutpalli, Gannavaram.
Results: The commonly affected age group in study population was 31-50 years. The mean age of patients was 48.98±12.53years. Diabetes Mellitus was present in 15 (30%) and Hypertension in 48 (96%).  Majority of the patients were in CKD stage 5, i.e.,46 (92%), CKD stage 4 -3 (6%), CKD stage 3- 1(2%). The prevalence of PH in CKD is 22 (44%). PH was not found in the patient with CKD stage 3. PH was found in 2 of the 3(66.6%) patients with CKD stage 4. Out of the 46 CKD stage 5 patients, 20 (43.4%) had PH. With reference to the severity of PH with CKD, the two patients of PH  CKD stage 4 had moderate PH . Out of the 20 patients of PH with CKD stage 5, 10 patients had mild PH, 9 with moderate PH and 1 with severe PHOn Chest X ray, descending right pulmonary artery dilatation and cardiomegaly were seen in more number of patients with PH, compared to those without PH. (p<0.001). In this study, LV systolic dysfunction was present in 18 out of 50 patients (36%). Among 22 patients with PH, it was present in 13 (59.09%). Among 28 patients without PH, it was present in 5 (17.85%). LV systolic dysfunction was significantly higher among the patients with PH compared to those without PH. The mean EF of all patients with CKD is 55.62± 9.54. The mean EF of patients with PH and without PH in the study was 50.50±9.78% and 59.64±7.26% respectively. (p<0.02). LV diastolic dysfunction was present in 41 out of 50 patients (82%). Among 22 patients with PH, it was present in 20 (90.9%). Among 28 patients without PH, it was present in 21 (75%). Prevalence of LV diastolic dysfunction was significantly higher among the patients with PH, compared to those without PH. RV dysfunction was present in 1(3.6%) and in 10 (45.5%) in patients without PH and in patients with PH respectively. Significant difference was found with RV dysfunction more prominent in patients with PH than in patients without PH (p<0.001). 64%of the patients studied had CKD of less than 6 months including 24%of new cases. 16%of the patients had CKD between 6 months and 1year. 20% had CKD of more than 1yr. In relation to PH, out of the 12 new cases of CKD,7 (31.8%) had PH and 5(17.9%)were without PH. Of the 20 patients having history of CKD less than 6 months (excluding new cases), 7 (31.8%) had PH and 13 (46.4%) were without PH. Out of the 8 patients  of CKD between 6 months and 1 year,4(18.2%) had PH and  4(14.3%)were without PH. In patients having CKD of more than 1 year, 4 (18.2%) had PH and 6 (21.4%) were without PH.
Conclusion: The study showed that PH is common in patients with CKD. Left Ventricular systolic and diastolic dysfunctions are strongly related to the outcome of these patients. Unexplained dyspnoea in patients with CKD must be evaluated for PHPulmonary Hypertension, CKD, Chest X-Ray, Left Ventricle, Mortality, ECG, 2D-Echo

Analysis of the Association Between Serum Vitamin D Concentration and Mortality in Severe Septic Patients at a Tertiary Care Centre

Ashok Parmar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 10996-11000

Background: Pathophysiologically, vitamin D deficiency has been related to inflammation
and immune dysfunction, which may be the potential reason for the increased susceptibility
of the individual to severe infection or sepsis. The present study was conducted to analyze the
association between serum vitamin D concentration and mortality in severe septic patients.
Materials and Methods: Whole blood collected was placed into the tubes containing
ethylenediaminetetraacetic acid as an anticoagulant. After completion of samples, the
concentration of serum 25-hydroxy vitamin D3 was measured by enzyme-linked
immunosorbent assay (ELISA). SPSS version 20.0 (IBM Corp., Armonk, NY, USA) was
used for data analysis. P-values less than 0.05 were considered statistically significant.
Results: In the present study a total of 250 patients were included in which 110(44%) were
females and 140(56%) were males. The prevalence of vitamin D insufficiency in critically ill
subjects with sepsis was 100% (250/250). 32% patients with non-severe sepsis,16% with
severe sepsis, and 48% with septic shock. Patients suffering from severe septic had lower
levels of vitamin D compared to those with septic shock and non-severe sepsis. 12.5%
patients with severe sepsis who had vit D3 deficiency died and 50% patients with septic
shock who had vit D3 deficiency died.
Conclusion: 12.5% patients with severe sepsis who had vit D3 deficiency died and 50%
patients with septic shock who had vit D3 deficiency died.

External Ventriculostomy and Intraventricular Instillation Of Recombinant Tissue Plasminogen Activator For Management Of Spontaneous Intra-Ventricular Hemorrhage: A Prospective Study

Dr. Sourabh Guria,Dr. Shubhamitra Chaudhuri,Dr. Shahid Iftekhar Sadique

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 5892-5901

Aim: To evaluate external ventriculostomy and intraventricular instillation of recombinant tissue
plasminogen activator for management of spontaneous intra-ventricular hemorrhage.
Material and method:The present non-randomized prospective study was done in the
Department of Neurosurgery among 30 patients who underwent external ventriculostomy and
intraventricular instillation of recombinant tissue plasminogen activator at Bangur Institute Of
Neurosciences & SSKM HOSPITAL, IPGME&R, KOLKATA between April 2020 – August
2021. Various parameters studied were GOSE SCORE: 7 days------>30days------>90 days,
Ventriculitis: (0-180days) (y/n), 30 days survival (y/n), worsening hemorrhage during t/t till 72
hr. of last dose (y/n), worsening hemorrhage during t/t > 72 hr. of last dose (y/n), hydrocephalus
during follow up (y/n) and Qol (EQ5D) at 1 month and 3 months.
Results: Mortality was reported among 33.33% of the subjects after 3 months. After seven days,
good recovery was not found in any of the subject but after 1 month and 3 month, good recovery
was reported among 4 (13.33%) and 9 (30%) of the subjects respectively. After 3 months;
vegetative state, severe disability and moderate disability was found in 2, 7 and 2 subjects
respectively. There was significant decrease in clot volume (cc) after the intervention of external
ventriculostomy and intraventricular instillation of recombinant tissue plasminogen activator i.e.
it decreases from 38.23 to 8.11 after 5 days.
Conclusion:rtPAwas efficacious in decreasing the modified GOSE scoresand clot volume of all
study subjects at end of treatment. Ventriculitis was demonstrated only in six subjects

Risk factors of intrauterine growth restriction in term pregnancy

Dr. Sahana PR, Dr. Jeevitha H, Dr. Prajwal M, Dr. Chandrashekar K

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 1620-1624

Fetal growth restriction (FGR) is a pathological condition in which a fetus has not achieved his genetic growth potential, regardless of fetal size (1) Worldwide FGR is observed in about 24% of newborns; approximately 30million infants suffer from FGR every year. The burden of FGR is concentrated mainly in Asia which accounts for nearly 75% of all affected infants. National neonatal perinatal database of India reported the incidence of FGR to be 9.65% among hospital born live birth infants. Study was conducted for all cases with clinical/ Sonological term FGR admitted under department of OBG. A detailed history as per questioner will be taken with general physical examination and investigations will be done as per requirement. The accumulated data was evaluated and statistically analyzed. In the present study 70 patients with term gestation with FGR were recruited. Maternal (74.28%) was the commonest cause followed by Idiopathic (11.43) and Placental (10%) and Fetal (4.29%) causes. Among Maternal causes Pre Eclampsia was found to be in 50% cases. Most of the patients (50.7%) required caesarean section. A total of 9 (12.86%) neonate had birth weight of <1.5 kg, 48.6% had Birth weight between 1.6 to 1.9kg, 38.5% had birth weight between 2-2.4kg and 95.8% had asymmetrical FGR, 4.2% were symmetrical. 26 (40%) neonates had morbidity with 17(24.3%) neonatal mortality with Respiratory distress syndrome (41.18%) being most common cause. No Maternal Mortality.

A study on clinical profile of non traumatic intracranial hemorrhage in children in tertiary care hospital

Dr. Kalyani Srinivas, Dr.KavithaVislavath, Dr. B .SravanKumar ,Dr. P Sirisha

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 5646-5656

Introduction: Intracranial bleeding is abnormal accumulation of blood inside the vault of
cranium it may occur inside the brain parenchyma as intracerebral bleeding or covering
the meningeal space Intra cranial hemorrhage is rare among children but often disabling
disease leading to high morbidity and mortality.
Aim: To study the etiology, clinical profile, laboratory and radiological findings of nontraumatic
intracranial bleed in children.
Material and methods: Prospective observational study ,The study was conducted in the
Department of Paediatrics, Niloufer hospital from November 2019 - November 2021.35
Children were included in this Study. Study was based on the child’s clinical presentation,
the cause of ICH as well as radiology criteria of hematoma.
Results: The outcome after the intracranial bleeding depends on many different factors
such as size and localization of hemorrhage as well as the clinical status at the time of
presentation. Intra cranial bleed due to bleeding diathesis has better outcome because of
appropriate diagnosis and treatment of the underlying disease, in addition to early surgical
intervention when indicated. Study showed a higher frequency of complex chronic illness
as risk factor for paediatric ICH. The mortality due to paediatric ICH remains high but
risk of death may reflect the underlying risk factors for intracranial hemorrhage and not
just the risk from the hemorrhage itself.
Conclusion: All cases of liver failure should be monitored with PT, APTT and INR, timely
vitamin K should be given to prevent ICH.

Prognostic Factors Associated with Mortality in Covid 19 Disease: A Retrospective Single Centre Institutional Study

Atul Kumar, Devendra Nargawe, Sanjay Kumar Dubey, Shivani Sinha, Neelam R. Charles

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 4721-4728

Background:To evaluate the association of the demographic, clinical sign and symptoms
and laboratory biomarkers in predicting the mortality in COVID-19 infected patients.
Materials and Methods: This was a single centre retrospective observational study
carried out in atertiary care centre of a tribal region of central India, which was a
referral centre for COVID-19.Parameters taken into account were physiological
parameters,symptoms at admission,radiographic findings and laboratory findings.
Results: Out of 103 deaths included in this study 76 were male and 37 females (2:1).
Mean age of the deceased were 54.90 years (18-90 years). The most common symptom
on admission was breathlessness in 92 patients (89.32%). Abdominal symptoms like
diarrhoea and vomiting were associated in 7.7 % of the deceased patients only.Most of
the patients who died were older patients having age 60 years and above (65.04 %).
Most of the patients who died had Spo2 less than 90 % on admission (85.43
%).Lymphopenia (92.23 %) was the most commonly observed finding on blood
investigations done in deceased patients followed by increased CRP level (78.64 %).
Comorbidities were present in 77 patients out of 103 patients (74.75%) included in this
study. Diabetes and hypertension were being the most common comorbidities associated
in these patients.Death was not commonly observed in patients with COVID 19
associated with respiratory diseases.
Conclusion: Identified prognostic factors can help clinicians and policy makers in
tailoring management strategies for patients with COVID-19 infectious disease while
researchers can utilize our findings to develop multivariable prognostic models that
could eventually facilitate decision-making and improve patient important outcomes.

Neutrophilic lymphocyte ratio and lymphocyte monocyte ratio: prognostic significance in COVID 19

Dr Fayaz Ahmad Wani, Dr Aabhasha Parotra, Dr Aakriti Mahajan

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 2809-2818

Aim: To evaluate neutrophilic lymphocyte ratio and lymphocyte monocyte ratio as prognostic markers in COVID 19.
Material and method: The present retrospective observational studyconducted in the department of Medicine, Government Medical College, Jammu for a period of one year. The study comprised of 100 Covid 19 RT PCR positive cases admitted patient in ICU as well as Ward, in covid care centre of Government Medical College, Jammu. Patients characteristics were obtained from the hospital covid care centre satisfying inclusion criteria from electronic medical records and demographic, clinical, laboratory data were extracted included age, sex clinical features, signs and symptoms, comorbidities, exposure history, oxygen support during hospitalization, duration of oxygen support during hospitalization,imaging features of the chest (CT scoring), laboratory findings (Hemogram, Total leucocyte count, differential counts, NLR and LMR. Complete blood count including NLR and LMR collected at day of admission and day 3 of admission and documented on a standardized proforma. Two outcomes were evaluated: “discharge” or “died.”
Results:In majority (53%) of patients, ventilation given was high flow followed by bipap (21%), ventimask (19%) and ventilator (5%). Ventilation given was room air in only 2 out of 100 patients (2%). In present study, only 10 out of 100 patients (10.00%) died.Discriminatory power of neutrophil lymphocyte ratio (AUC 0.865; 95% CI: 0.781 to 0.925) was excellent and discriminatory power of lymphocyte monocyte ratio (AUC 0.791; 95% CI: 0.698 to 0.867) was acceptable. Among both the parameters, neutrophil lymphocyte ratio was the best predictor of CTSI severity at cut off point of >3.57 with 86.50% chances of correctly predicting CTSI severity.
Conclusion: It can be concluded from the results that NLR may be a rapid, widely available, useful prognostic factor in the early screening of critical illness in patients with confirmed COVID-19.

Assessing risk factors of 1 year mortality in patients with hip fractures: A hospital-based retrospective cohort study from a developing level 1 trauma centre in Northern India

Dr. Chethan MH,Dr.Himanshu Agrahari,Dr. Arvind Kumar Yadav, Dr.Bhaskar Sarkar, Dr.Siddharth Dubey, Dr. MD Quamar Azam

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 1, Pages 308-313

Purpose: Proximal femoral fracture is one of the major causes of morbidity and mortality in
elderly group patientswith 11-23% of mortality is reported to occur at 6 months and 22-29%
at 1 year. Despite the huge burden of osteoporosis, there is paucity of data regarding
epidemiology, risk factors and outcome of fragility hip fractures in Indian population. As
most of the published literature are from western world, we conducted the study to look for
risk factors for early-mortality in hip fracture in Indian sub-continent and compare the same
with published literature.
Methods: Total of 174 patients were available for final evaluation. Primary outcome was to
see the mortality in elderly patients undergoing operative treatment and the secondary
outcome measures were predictors of mortality in this age group with regard to age, sex,
Charlson comorbidity index, injury severity score, pre-operative ASA grading, injury-surgery
duration and length of hospital stay. Cox proportional regression hazards regression
modelling was performed to assess the effect of different variables on time of mortality.
Results: Mean age of the patients was 70.56 (± 8.05) years. Mean Charlson Comorbidity
Score was 1.68 (± 1.54; 2SD). Mean time from injury to operation time was 35.59 (±19.02; 2
SD) hours and the mean length of hospital stay was 4.78 (± 1.68; 2 SD) days. Mortality at
one-year after surgery was 18.4%.On univariate and multivariate regression analysis variables
significantly associated (p<0.05) with ‘Mortality’ are: Age, Charlson Index, Charlson Index
Category, Injury to operation time(Hours), Length of hospital stay and pre-operative ASA
grade.
Conclusion: We suggest that, without a dedicated hip-fracture protocol in a resource-poor
set-up, early aggressive management to optimize patients for surgery and surgical
intervention as soon as feasible lead to early return to pre-fracture status and reduces early
mortality.

The effect of body mass index (BMI) on the mortality among patients with stroke

Salah Elsayed, Muath Othman

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 4, Pages 181-186

Stroke is considered one of the leading causesof morbidity and mortality in many
countries. Many studies investigated the outcomes after the occurrence of stroke.
Some of those research studies indicated that obesity and the increasein the
bodymass index areestablished risk factors for mortality among stroke patients.
However, the results of these studies were inconsistent.The main aim of this review
article was to examine the association between bodymass index and mortality
among stroke patients. The majority of the studies had shown a possible effect of
overweight on mortality among stroke patients; the evidence regarding the
association's presence is limited.On the other hand, the majority of the studies had
shown a protective effect of obesity (mild obesity, bodymass index between 30-35)
onreducingthe risk of mortality among stroke patients. This means underweight
stroke patients have more risk of mortality. Thus, the argument regarding the effect
of high bodymass index on mortality has been explained by the obesity paradox.
However, most of those studies were observational, and results could be attributed
to the methodological flaw. There is a need to well-designed prospective studies that
to overcome the limitation of the previous studies.

Molecular Diagnostic Methods For Viral Infections

Dhakshinya M; Smiline Girija A.S; Ezhilarasan D

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 1, Pages 2595-2605

Viral diagnostic tests are categorized as direct diagnosis, indirect examination (virus isolation), and serology. Molecular testing is often done to detect potent viral markers resulting from any gene or chromosomal modifications during viral replication in the host. The clinical specimen is tested specifically in direct analysis for the presence of virus particles, virus antigens or viral nucleic acids. Molecular diagnosis of viruses can be achieved from clinical samples like blood, hair, skin, amniotic fluid, or other tissue. Molecular biology techniques are considered to be the standard and confirmatory protocols in the analysis of viral DNA, RNA and protein. Molecular viral diagnosis are considered to be more specific and sensitive in preliminary viral screening and can pave the way for rapid diagnosis. However, the procedures are costly and involve automated bio-instruments to perform the same. This review thus highlights the various molecular diagnostic methods used in diagnostic virology with their limitations and challenges.