Introduction: Present study was planned to identify various sociodemographic factors influencing nutritional status in elderly and impact of nutritional status on activities of daily living in them. Methods: Total of 177 patients were enrolled in a prospective observational study. Nutritional status was assessed at the time of discharge by using Mini Nutritional Assessment form (MNA). Kartz Activity of Daily Living was assessed at 3 months before admission, at the time of admission, at discharge and 3 months after discharge. After written informed consent and ethics clearance patients were enrolled in the study. Analysis was done using the SPSS version 23 and Chi Square test was used to find the association between different qualitative variables. Statistical significance was set at P < 0.05. Results: Mean age of the study participants was 68.64 ± 7.73 years. 40 patients (22.6%) were found to be malnourished. Higher age, living alone, high CCI score and low ADL at discharge were associated with malnutrition. Mean ADL score was 5.82 at - 3 months time point in well-nourished patients which decreased during admission and then increased to 4.94 at the 3 months after discharge. Mean ADL score was of 5.33 at -3 months time point which kept on decreasing during admission and at 3 months after discharge in malnourished group. All these changes were statistically significant ( P < 0.001). Conclusion: Nutritional status is a modifiable risk factor in elderly so identifying and optimizing nutritional status of elderly will optimise their functional status and improve quality of life.

Hypoxic-ischemic encephalopathy (HIE) is a frequent complication in the patients who survive a cardiac arrest. It has a very bad course of morbidity and mortality. Many patients with HIE needs neurorehabilitation for a long time, sometimes until death. Diagnostic tests of choice in adults with HIE are magnetic resonance imaging (MRI) and the severity correlates with the extent of the lesion in MRI. Normal MRI is very rarely seen in HIE. Here, we report a case of a 25-year-old male with ruptured liver abscess, who developed cardiopulmonary arrest on laparotomy table and was resuscitated immediately and kept on ventilator support for 4 days. The patient developed altered mentation since then and was evaluated for the same. His sepsis improved with treatment, but the altered mentation did not improve initially. MRI was done twice to look for findings of HIE, but they came out to be normal. Electro encephalogram was suggestive of global cerebral dysfunction with slow waves, that was suggestive of HIE. With continuous rehabilitation patient mentation improved slowly and he is slowly attaining complete recovery now.

ContextElderly people are at a high risk of malnutrition leading to poor outcomes and quality of life. AimsWe aimed to find an association between the nutritional and functional status of hospitalized elderly patients and the three-month all-cause mortality among them. Settings and designA cross-sectional study was carried out at a tertiary care hospital in North India from July 2018 to December 2019. Methods and materialA total of 177 patients were recruited for the study, and their demographic and clinical data were collected on a preformed questionnaire. Comorbidity, nutritional status, functional status, and depression were calculated using the Charlson Comorbidity Index (CCI), Mini Nutritional Assessment (MNA) form, Katz Index of Independence in Activities of Daily Living (Katz ADL), and Geriatric Depression Scale (GDS), respectively. Statistical analysisA Chi-square test was used to find the association between different qualitative variables. A regression model was used to find out the odds for mortality. Statistical significance was set at p<0.05. ResultsAccording to the MNA score, 49.7% (88) were at risk of malnutrition, and 22.6%(40) were malnourished. Malnutrition, Charlson Comorbidity Index, and the functional status of the patients were found to be associated with three-month mortality, with a p value of 0.005, 0.017, and 0.021, respectively. On regression analysis, malnutrition (odds ratio (OR): 3.796; 95% confidence interval (CI): 1.178-12.234; p=0.025) and the functional status (OR: 3.160; 95% CI: 1.256-7.952; p=0.015) of the study participants were found to have higher odds for three-month all-cause mortality. ConclusionsNutritional status and ADL assessed at the time of discharge are good prognostic markers of health outcomes in the elderly population. Key messageADL and nutritional assessment at admission and discharge should be routinely incorporated in the geriatric assessment of hospitalized patients to triage and prognosticate.

Platypnoea-orthodeoxia syndrome (POS) is a rare clinical entity with very few cases reported worldwide. We report a case of a 27-year-old male with a seven-day history of fever, dry cough, and breathlessness; later on, diagnosed to have H1N1 (Swine flu) and acute respiratory distress syndrome. He was put on mechanical ventilation and weaned off in due course. However, he had persistent dyspnoea and desaturation in sitting position that relieved on lying down (platypnoea/ orthodeoxia). He was again mechanically ventilated. High resolution computed tomography of chest revealed tension pneumomediastinum and pneumothorax. Computed tomography-guided pigtail drainage of mediastinal air and bilateral intercostal drainage tubes were performed. His symptoms improved immediately. He had no underlying demonstrable cardiac disease. The diagnosis of POS was made due to a high index of clinical suspicion and helped in establishing POS as a presentation of concomitant pneumomediastinum-pneumothorax in this patient. To the best of our knowledge, acute respiratory distress syndrome complicated by concomitant pneumomediastinum-pneumothorax as an extra-cardiac cause of POS has not been reported.