Online ISSN: 2515-8260

Keywords : Prognostic Indicators

A Hospital Based Observational Study to Assess the Clinic-Etiological Profile and Prognostic Indicators in Critically Ill Patients who Develop Acute Respiratory Distress Syndrome (ARDS) in Medical Intensive Care Unit

Suman, V.B. Singh, Deepak Kumar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 2255-2260

Background: Aspiration pneumonia and pneumonia are the most common cause of ARDS in direct lung injury whereas sepsis is the most common cause of ARDS in Indirect lung injury. The aim of this study to assess the clinic-etiological profile and prognostic indicators in critically ill patients who develop acute respiratory distress syndrome (ARDS) in medical intensive care unit.
Materials& Methods: A hospital based prospective study done on 50 ARDS patients those were admitted in the medical ICU over a period of one year at SMS Medical College, Jaipur, Rajasthan, India. Baseline characteristics including comorbidities, routine investigations, initial SOFA Scores & APACHE II (Acute Physiology & Chronic Health Evaluation) score was evaluated. Descriptive & Statistical analysis and interpretation of the data collected is done by using SPSS version 22.0 with mean and standard deviations computed.
Results: Among 50 patients, 27 patients represent the male group and 23 patients represent the female group. Diabetes mellitus (36%) and SHT (20%) having a higher prevalence. Breathlessness and fever were the most common symptoms. Gender comparison of mean Fio2/Pao2 ratio, MAP, Initial SOFA and APACHE II scores are shown in table 4 showing a higher Fio2 requirement in female group when compared to the male group and more or less equal with the remaining variables. The mean duration of hospital stay was longer in the female group when compared to the male group (table 4). The mortality rate in our study was 16.0% (8 patients).
Conclusion: The incidence of ARDS studies in India are very few and lacking. Early identification and etiology work up for ARDS with timely administration of antibiotics/ antivirals or antimalarial drugs is necessary for the improvement in survival rates in view of increased morbidity and mortality associated with ARDS.

IgM ELISA value for scrub typhus as a prognostic indicator: our experience in Pediatric and adult cases

Srikant Kumar Dhar; Rachita Sarangi; Swati Samant

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 6, Pages 1236-1241

Aim of the study: Many studies from various parts of India have reported scrub typhus with diagnosis based on IgM ELISA; however no definite data available for IgM for Scrub Typhus as prognostic indication .Our study gives a correlation of IgM level with the clinical presentations as well as organ involvement and complications thus depicting the prognostication.
Material and methods: - This descriptive observational investigation was carried out over a time of two years. Hospitalized cases with complaints of Indistinct febrile disease with a lymphadenopathy, organomegaly as well as head pain were taken over a period of five days deprived of a recognizable cause. as probable scrub typhus patients and advised for initial Weil- Felix test and scrub IgM level. The spectrum of clinical manifestation and end organ damage were analyzed with scrub typhus serum IgM level.
Results:Among 113 patients diagnosed as scrub typhus basing on IgM value, 48 are children (below 14 yrs) and 65 are adults. Mean age of presentation in children is 3.6 Yrs and adult is 41.5 yrs. Maximum no 43 (26.27%)of patients have IgM value between 2.5 to 3.5 and only five patients have very high value i.e. more than 3.5 . There is significant correlation (P= 0.0027) of presence of clinical and lab finding like rash, eschar, lymphadenopathy, leukocytosis, thrombocytopenia with increasing value of IgM. Among 113 cases, majority had hepatopathy 56(49.5%) followed by nephropathy and sepsis (23.9% each). Only five no of patients have cardiac complications. The percentage of distribution of end organ complications is increasing (P= 0.048) with increasing IgM value except cardiac illness, where the burden is very negligible.
Conclusions: The prognostic indicator of severe disease can be established with increasing trend of serum IgM level with available evidence but a larger study with paired sera will ascertain the correlation..