No abstract

Background:The knowledge and skills about the basic life support (BLS) and the advanced life support are the most important determining factors of the cardiopulmonary resuscitation (CPR) success rates. Objectives: To determine the level of awareness on BLS and skills among undergraduate and postgraduate students of medical and dental profession, as well as nursing students and interns in a tertiary care hospital.Materials and Methods:This descriptive cross-sectional study was conducted in a tertiary care hospital in South India. The awareness level on BLS and factors associated which include age, sex, level of training (undergraduate, internship, and postgraduate groups), course of study (nursing, dental, and medical groups), and previous exposure to BLS were assessed by using a structured questionnaire. The association of these variables with awareness level was assessed by independent t test, analysis of variance, and linear regression analysis.Results:Among 520 study subjects, 229 were students, 171 were interns, and 120 were postgraduate students. The overall mean score of awareness was 4.16 ± 1.40 (score range: 0-10). Age, sex, level of training, course of study, and previous exposure to BLS were significantly associated with awareness level in univariate analysis (P < 0.05). Linear regression model also showed that all the above variables were significantly associated with awareness level (P < 0.05). About 322 (61.9%) subjects attributed lack of awareness about BLS to lack of available professional training. About 479 (92.1%) responded that BLS training should be a part of medical curriculum.Conclusion:Awareness level on BLS is below average indicating the importance of professional training at all levels in a tertiary care health institution.

A 39-year-old female presented with one year history of dragging abdominal discomfort and fatigability of six months duration. She was non-alcoholic and had no other medical illness. General physical examination was unremarkable and abdominal palpation suggested splenomegaly of 10 cms below left coastal margin, which was firm and nontender. There was no ascites or hepatomegaly. Examination of other systems was unremarkable.Investigations revealed normal complete blood counts, urine analysis, liver and renal function tests and peripheral smear study. Investigation reports are shown in [Table/ Fig-1]. Ultrasonography (US) with color doppler of abdomen revealed splenomegaly, normal liver echotexture and cavernous transformation of portal vein with multiple spleno-renal collaterals. ECG and echocardiography was normal. Upper gastro-intestinal endoscopy showed grade 1-2 esophageal varices with portal hypertensive gastropathy. Multidetector Computed tomography (MDCT) abdomen revealed multiple aneurysms in the distal half of splenic artery, the largest one measuring (5.1cmx5.8cmx4.4cms) with dilated and tortuous course of the proximal splenic artery with multiple collaterals along the course of splenic and portal vein b,. Wall calcification and organized thrombus was seen in few of the aneurysms at the splenic hilum. DisCussionSplenic artery aneurysms (SAA) are the most common visceral aneurysms, accounting for up-to 60% of cases [1,2]. Splenic artery is the third most common site for intra-abdominal aneurysm after aorta and iliac artery [2]. It has an incidence of 0.01-0.2%, females being more commonly affected (4:1). SAA presenting as extrahepatic portal hypertension is rare [1,3]. Here we report a patient with multiple splenic artery aneurysms presenting as extrahepatic portal hypertension and massive splenomegaly. SAA are very rare with a varied prevalence of 0.01%-10.4% [4]. SAAs are associated with several conditions, including pregnancy, degenerative atherosclerosis, portal hypertension, medial fibrodysplasia, arteritis, collagen vascular disease, α 1-antitrypsin deficiency, and pancreatitis [2]. Hormonal changes during pregnancy, increased blood volume and cardiac output causing portal congestion are the proposed mechanisms of SAA in pregnancy internal medicine section [5]. SAA are usually single, isolated and <3cms in size. It is usually located in the distal part of splenic artery. Larger aneurysms like in our patient are seldom reported [1,3,6]. The aneurysm generally develops on the main splenic artery commonly on its distal third or on intrasplenic branches. Multiple Splenic Artery Aneurysms: A Rare Cause of Extrahepatic Portal Hypertension and Massive Splenomegaly aBstRaCtA 39-year-old nulliparous female was admitted with massive splenomegaly. Computed tomography of abdomen revealed multiple aneurysms in the distal half of the splenic artery. Splenic artery aneurysms are rare in nulliparous women and most cases are reported in females with a past history of pregnancy. Splenic artery aneurysms, though very...

Background:India is one of the seven identified Southeast Asian countries reporting frequent outbreaks of dengue fever (DF).Aims:This study was to analyze clinical and laboratory profile and predictive markers of thrombocytopenia and length of hospital stay in DF.Materials and Methods:This record-based retrospective study conducted in a coastal district of Karnataka, South India, included all dengue cases in adults aged >18 years, admitted during period of January 2011 to December 2014. Multivariate logistic regression analysis was carried out to compute odds ratio (OR) and 95% confidence interval (CI) to assess independent associations of variables with low platelet count and longer duration of hospital stay.Results:Among 207 dengue immunoglobulin M (IgM) antibody confirmed cases (mean age of 36.94 ± 14.61 years), 143 (69.1%) were males and 64 were females. The mean duration of illness and hospital stay were 4.94 ± 3.58 days and 5.98 ± 2.58 days, respectively. Abdominal symptoms included nausea and vomiting (53.6%), abdominal pain (25.1%), and diarrhea (13.5%). Bleeding manifestations were seen in 24 (11.6%) cases and fluid accumulation was revealed in 18 (8.7%) cases. The mean platelet count was 110,159.42 ± 68,397.32 (cells/mm3). Low platelet count on admission was associated with the presence of rash (OR = 0.43, 95% CI 0.23-0.81), high aspartate aminotransferase (AST) levels (OR = 3.14, 95% CI 1.58-6.23), high alanine aminotransferase (ALT) levels (OR = 2.91, 95% CI 1.55-5.47), and low albumin levels (OR = 4.48, 95% CI 1.02-19.75). The duration of hospital stay was associated with diarrhea (OR = 0.4, 95% CI 0.18-0.9), abdominal pain (OR = 0.52, 95% CI 0.27-1.00), ascites (OR = 0.26, 95% CI 0.09-0.69), and low hemoglobin (OR = 0.46, 95% CI 0.25-0.86) level on admission.Conclusions:Though thrombocytopenia on admission was associated with the presence of rash, high AST and ALT levels, and low albumin levels, it was not predictive of length of hospitalization. Duration of hospital stay was longer with the presence of diarrhea, abdominal pain, ascites, and low hemoglobin level on admission.

Background: Thyroid hormone plays a pivotal role in the adaptation of metabolic function to stress and critical illness like sepsis. Thyroid dysfunction is associated with increased mortality in sepsis. The role of thyroid dysfunction as a prognostic marker in sepsis remains unclear. Aims and Objectives: To correlate the baseline thyroid function tests with APACHE II score and mortality in adult patients admitted with sepsis in Intensive Care Unit (ICU). Materials and Methods: This was a cross sectional, observational study done for a period of one year from September 2019 to September 2020 in a tertiary care referral hospital. Patients admitted with sepsis to ICU were scored on admission using APACHE II score. Blood was sent for thyroid function tests on admission. Patients were divided into survivors and non-survivors based on the outcome. Statistical analysis was done by calculating mean values, Fisher’s exact test and Pearson’s correlation. Results: A total of 52 patients were included. The mean age was 55.65± 18.55 years with a male predominance (M: F=1.4:1). Pneumonia was the commonest cause of sepsis in the study (20 patients,38.5%). Mortality was seen in 20 patients (38.5%) The mean values of thyroid hormones were lower in non-survivors. APACHE II Score was higher among the non-survivors as compared to survivors. (21.7±5.571 vs 19.78 ± 5.939, p value>0.05). Thyroid hormones (T3, T4, FT3, FT4) had a negative correlation with APACHE II score in non-survivors. TSH had significant positive correlation with APACHE II score in non-survivors (p value=0.027). Conclusion: Thyroid hormone levels did not correlate significantly with APACHE II score and mortality among the non-survivors of sepsis.