Giant Left Atrium - A Rare Case of Acute Upper Gastrointestinal Bleeding.

Acute upper GI bleeding is a common medical emergency with a hospital mortality of approximately 10%. Non variceal UGI bleeding is the most common cause followed by oesophageal varices. Various rare causes have been described in the literature but there are very few cases of giant left atrium leading to oesophageal erosion and causing upper GI bleeding. We are presenting a case of rheumatic valvular heart disease with giant left atrium who presented in our department with acute upper GI bleeding.

A study of clinical and endoscopic profile of acute upper, gastrointestinal bleeding.

BACKGROUD: Acute Upper Gastrointestinal Bleeding is a common medical emergency with a hospital mortality of approximately 10 percent. Higher mortality rate is associated with rebleeding. Rockall scoring system identifies patients at higher risk of rebleed and mortality. OBJECTIVE: To study the clinical and endoscopic profile of acute upper gastrointestinal bleed to know the etiology, clinical presentation, severity of bleeding and outcome. METHOD: This is a prospective, descriptive hospital based study conducted in Gastroenterology unit of College of Medical Sciences and Teaching Hospital, Bharatpur, Nepal from January 2012 to January 2013. It included 120 patients at random presenting with manifestations of upper gastrointestinal bleed. Their clinical and endoscopic profiles were studied. Rockall scoring system was used to assess their prognosis. RESULT: Males were predominant (75%). Age ranged from 14 to 88 years, mean being 48.76+17.19. At presentation 86 patients (71.7%) had both hematemesis and malena, 24 patients (20%) had only malena and 10 patients (8.3%) had only hematemesis. Shock was detected in 21.7%, severe anemia and high blood urea were found in 34.2% and 38.3% respectively. Upper Gastrointestinal Bleeding endoscopy revealed esophageal varices (47.5%), peptic ulcer disease (33.3%), erosive mucosal disease (11.6%), Mallory Weiss tear (4.1%) and malignancy (3.3%). Median hospital stay was 7.28+3.18 days. Comorbidities were present in 43.3%. Eighty six patients (71.7%) had Rockall score < 5 and 34 (28.3%) had >6. Five patients (4.2%) expired. Risk factors for death being massive rebleeeding, comorbidities and Rockall score >6. CONCLUSION: Acute Upper Gastrointestinal bleeding is a medical emergency. Mortality is associated with massive bleeding, comorbidities and Rockall score >6. Urgent, appropriate hospital management definitely helps to reduce morbidity and mortality.

A study of seven day mortality in acute ischemic stroke in a teaching hospital in Chitwan.

BACKGROUND: Stroke mortality rate indicates a measure in hospital quality care. Most of the available data are from developed countries and are for late mortality. Only few studies on 7-day fatality, a recently implemented indicator of early stoke mortality, are reported. We attempted to identify the predictors of clinical outcome by 7th day in acute ischemic stroke. METHODS: This descriptive study included 100 consecutive cases of acute ischemic stroke admitted to Neurology center of a teaching hospital in Chitwan, Nepal. Common risk factors were identified. The cases were classified as per TOAST classification and severity at admission assessed using National Institutes of Health Stroke Scale. Univariate and multivariate analysis was used to analyze the data. RESULTS: Thirteen percent patients expired by 7th day. On univariate analysis severity of stroke, fever, atrial fibrillation, hypertension at admission and early neurological deterioration were related to early 7-day mortality where as age, gender, smoking, diabetes mellitus, coronary artery disease, early onset seizures, dyslipidemaia, and hematocrit were unrelated to early mortality. Multivariate analysis showed that only NIHS score was significantly correlated with early mortality. CONCLUSIONS: A mortality rate of 13 percent was noted by 7th day. A positive association was noted with stroke severity, early neurological deterioration, arterial fibrillation, hypertension and fever at onset.

C-reactive protein and early mortality in acute ischemic stroke.

BACKGROUND: There is growing evidence that inflammation plays an important role in atherogenesis. Several studies have shown that C-reactive protein (CRP), an inflammatory marker, is associated with stroke severity and outcome. But limited studies are there which show the relationship of CRP with early mortality i.e within seven days. OBJECTIVE: To study the association of CRP within 24 hours after acute ischemic stroke onset with severity during admission, types of ischemic stroke and outcome. METHODS: This cross sectional study was done including 100 consecutive cases of acute ischemic stroke admitted to Neurology center of College of Medical Sciences, Bharatpur (Chitwan), Nepal. The cases were classified as per TOAST classification and severity at admission assessed using National Institutes of Health Stroke Scale. C-reactive protein (CRP) level was estimated by latex particle agglutination test. RESULT: Thirteen percent patients expired by 7th day. In the expired group, CRP was positive in 15.3 percent, 15.3 percent and 61.5 percent in patients with lacunar, cardioembolic and large artery atherosclerotic infarction respectively (p 0.19). CRP was positive in all 7 patients (53.8%) who had expired with severe NIHS scale (p 0.004). CONCLUSION: High CRP level is associated with stroke severity at admission and is an independent predictor of early seven day mortality after ischemic stroke.