| Name of the Candidate | Dr. Krishna Prasad G |
|---|---|
| Year of enrollment | 2014 |
| Postgraduate course | DNB |
| Institute | Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla, Kerala |
| Topic of Thesis | A study to evaluate the effectiveness of NGAL (Neutrophil Gelatinase-Associated Lipocalin) in predicting severe sepsis and its outcome in those presenting to the ED (emergency department) of a tertiary care hospital with signs and symptoms of sepsis |
| Abstract | Background: Sepsis is rapidly emerging as major causative factor for registrations in Emergency Departments (EDs) across the world. Accurate assessment to identify actual or impending organ dysfunction or shock at the early stage may influence outcome, since this is the major driver of mortality of sepsis. Serum NGAL has been shown to be elevated in patients with sepsis and septic shock. The purpose of this study is to evaluate the effectiveness of NGAL in predicting severe sepsis and its outcome which will eventually empower the treating physician in decision making and management. Methods: Data from 40 patients, who presented to the Emergency Department of Pushpagiri Medical College Hospital with sepsis over a period of one year, was collected. Venous blood was tested for NGAL. Specific scoring systems to assess final outcome (e.g. SOFA, REMS) were calculated. The end point for this study was taken as most severe form of sepsis according to standard consensus. Results: The area under curve (AUC) demonstrated highest value for NGAL (AUC = 0.829) compared to other variables. High NGAL values have correlation with SOFA score at 0 hours but not with SOFA score at 48 hours. Conclusions: NGAL is effective in predicting the severity of sepsis but it does not correlate with the final outcome of the patient. |
| Published (Yes/No- If yes, provide link) | No |
THESIS ABSTRACTS
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| Name of the Candidate | Dr. Ajmal Abdul Kharim |
|---|---|
| Year of enrollment | 2014 |
| Postgraduate course | DNB |
| Institute | MES Medical College and Hospital, Kerala |
| Topic of Thesis | Acute pulmonary oedema in chronic dialysis patients, causes, clinical course and outcome admitted into emergency department |
| Abstract | Background: Chronic dialysis (CD) patient are at increased risk of multiple organ dysfunction. Recent study, estimated that 2% of CD patients require intensive care unit (ICU) admission every year. Acute Pulmonary Oedema is major cause for ICU admissions, objective of the study is to determine the cause, clinical course and outcome of APO in CD patients admitted in Intensive Care Units under Emergency Department. Methods:Prospective and observational study conducted for 1 year in our institute, a tertiary care centre, was done on chronic dialysis(CD) who presented with Acute pulmonary oedema(APO) for determine cause for APO, severity of outcome by APACHE II and sofa score. Data was entered in Microsoft Excel spread sheet and analyzed using SPSS software. Descriptive analysis and chi square test was done. Results: Study included 100 CD patients. Main etiologic factor of CKD was T2DM 56%. Etiology of APO in this study showed as 34% are due to excessive interdialytic weight gain. Only 4 patients were assessed by SOFA score and high sofa score no patients had expired. Study showed survived patients got mean APACHE II score of 24±3.4 and expired patients got mean APACHE II score of 32.9±2.5, with a significant P value <0.001. Conclusions: Main etiology of APO in CD patients were excessive interdialytic weight gain 34 %. APACHE II score as outcome predictors. APACHE II score of more than 30 have poor outcome |
| Published (Yes/No- If yes, provide link) | Yes; http://dx.doi.org/10.18203/2349-3933.ijam20174685 |
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| Name of the Candidate | Dr. Sarat Kumar Naidu |
|---|---|
| Year of enrollment | 2014 |
| Postgraduate course | DNB-EM |
| Institute | Max Super Speciality Hospital, Shalimar Bagh, New Delhi. |
| Topic of Thesis | Shock Index and Early Recognition of Sepsis in Emergency Department – An Observational Prospective Study |
| Abstract | Background: Sepsis is recognised as one of the major causes of non-traumatic deaths despite high treatment expenditure. Thus, it is important to diagnose sepsis early to reduce mortality and morbidity rates. This paper aims to study if Shock Index (SI) can be used an indicator to diagnose sepsis early in ED on presentation of the patient. It also analysed that co-morbid conditions along with high SI are also related with Sepsis. Methods: Data from 239 patients were collected on vital stats, symptoms, past history, results of investigations, treatment provided, hospital stay, and final diagnosis and these data were analysed using Chi square test and Logistic regression analysis. Results: The results of the study suggested that SI of more than 0.7 is closely related to Sepsis manifestation and SI more than 0.9 is closely related to deaths due to Sepsis. The length of stay for Sepsis patients was also reported to be longer than 4 days as compared to patients who did not have Sepsis. About 60 % of the patients were reported to have Diabetes and other complexities, which apparently had increased the chances of developing Sepsis. Conclusions: The outcomes of the study were quite encouraging and have shown positive correlation between SI and Sepsis. Thus, it may be concluded that SI may be used as an initial assessment tool for patients to recognise Sepsis and applying early intervention. Limitations: Data was collected from a single centre; multicentre data collection can provide more representative samples, which may result in a better conclusive outcomes. And also a larger sample size would give more significant results. |
| Published (Yes/No- If yes, provide link) | No |
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| Name of the Candidate | Dr. AdityaChandramohan |
|---|---|
| Year of enrollment | 2014 |
| Postgraduate course | DNB |
| Institute | Apollo Specialty Hospitals, Madurai, Tamil Nadu |
| Topic of Thesis | Fascia iliaca compartment block in the emergency room in fracture of neck of femur, intertrochanteric and shaft of femur |
| Abstract | Background: Fascia iliaca block, a well established method of local anaesthesia is underused in the emergency department in India. This study aimed at assesssing the efficacy, ease of administration by a junior doctor, and the reduction of opioid requirement in patients with fractures of hip and shaft of femur. Methods: In this prospective randomized blinded case control study. 57 patients were randomly assigned into case and control groups to receive 0.25% Ropivacaine and 0.9%NS in the fascia iliaca space respectively with Fentanyl as on demand analgesia titrated to response in both groups.There was a significant difference between the 2 groups in the visual analog scale between 2 to 6 hours. Results: The reduction in pain score was statistically significant in the case group (from its baseline) compared to the control group (from its baseline). The opioid requirement was also significantly reduced in the case group compared to the control group. Conclusions: The study was effective in demonstrating that fascia iliaca block was successful at reducing the need for opioid analgesia and that it could be performed without much complication by a relatively inexperienced clinician. |
| Published (Yes/No- If yes, provide link) | No |
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| Name of the Candidate | Dr. Anoop James George |
|---|---|
| Year of enrollment | 2014 |
| Postgraduate course | DNB |
| Institute | Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla, Kerala |
| Topic of Thesis | Alvarado Score and Obesity: A Prospective Observational Study to Evaluate the Accuracy of Alvarado Score with Varying Body Mass Index |
| Abstract | Introduction: Acute appendicitis is one of the most common surgical emergencies presenting to the Emergency Department (ED). The Alvarado score is commonly employed as a bedside tool for clinical diagnosis of acute appendicitis. Objectives: This study aims to evaluate the efficacy of Alvarado score as a diagnostic tool for early diagnosis of acute appendicitis in ED, as well as to compare the accuracy of Alvarado score with varying body mass index (BMI). Methods: All patients suspected of acute appendicitis were screened using the Alvarado score and evaluated using ultrasonography. The BMI of the subjects were calculated by measuring their height and weight. The statistical data was then analyzed for sensitivity of Alvarado score for different BMI groups. Results: The study included 76 patients. At a cut-off value of ≥5, the Alvarado Score had an overall sensitivity of 96.3% and specificity of 27.27%. The optimal cut-off value was found to be ≥6, which has a sensitivity of 92.59% with a specificity of 77.27%. In patients with BMI <23, sensitivity of Alvarado score was 100% while participants with a BMI ≥ 23 had a sensitivity of only 91.3%. Conclusion: Alvarado score was found to be a useful tool for early diagnosis of acute appendicitis in ED. At a cut-off value of ≥5, the sensitivity and specificity of Alvarado score was found to be lower in patients with higher BMI values and also with advancing age. |
| Published (Yes/No- If yes, provide link) | No |
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| Name of the Candidate | Dr. Arjun James |
|---|---|
| Year of enrollment | 2014 |
| Postgraduate course | DNB |
| Institute | Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla, Kerala |
| Topic of Thesis | Accuracy of Rapid Ultrasound in Shock(RUSH) protocol for determination of shock etiology in patients presenting to the emergency department. |
| Abstract | Introduction: Clinical assessment and classification of shock is extremely difficult to conduct on critically ill patients especially upon arrival at the emergency department. Use of RUSH protocol as a bedside tool in evaluation of these patients in conjunction with history and physical examination findings has been shown to improve the diagnostic accuracy. Objectives: To determine the validity of “RUSH Protocol” in predicting the etiology of shock, among patients brought to Emergency Department of a tertiary care hospital in South Kerala. Methods: The investigator will perform the RUSH protocol and record his/her findings in the USG proforma and form a diagnosis/impression of the etiology of shock in the patient. The final diagnosis (as arrived at by a senior certified consultant) with the help of clinical history, physical examination findings, and reports of the blood investigations and imaging will be compared with the impressions of the investigator. Results: The study included 96 patients. Our study demonstrated ac¬ceptable general agreement between the results of this early ultrasonography study and final clinical diagno¬sis of patients in shock (Kappa = 0.810). Good sensitivity, specificity and agreement for RUSH Protocol were seen in cardiogenic shock,100% sensitivity, and 100% NPV with hypovolemic shock and obstructive shock.Our study concluded the need for serial studies in patients suspected to have distributive shock eti¬ology to enable the clinician to monitor the response of the cardiovas¬cular system to resuscitative interventions and provide more efficient applications of this protocol. Conclusion: RUSH protocol has good sensitivity, specificity and diagnostic accuracy for identification for etiology of shock. |
| Published (Yes/No- If yes, provide link) | No |