Intra-cerebral haemorrhage (ICH) is a rare complication of warfarin that is life-threatening and requires emergent treatment. Also, as ICH is unpredictable, large cohort studies are not possible especially in elderly patients. Treatment will continue to be based on case series and clinical experience. We present observational study of 4 cases of elderly patients with haemorrhagic stroke secondary to warfarin therapy with supratherapeutic INR. All patients received 10mg IV Vitamin K and 4 factor Human Prothrombin Complex Concentrate (Octaplex) for warfarin reversal. Of the 4 patients, 2 patients had good clinical outcome due to prompt reversal of INR with octaplex, while the other 2 patients had fatal outcome due to delay in warfarin reversal. Our study though small reiterates, as ‘Time is Brain’ in ischaemic strokes, likewise it holds true for haemorrhagic strokes. Larger trials are required to assess time for "door to reversal" similar to "door to needle" in stroke thrombolysis.

Background: Hyponatremia is a condition when serum sodium is <135 meq/L and is considered severe when <125mEq/l. It can be due to abnormal sodium or water balance and is the most common electrolyte disorder occurring in critically ill patients and particularly so in the elderly. Aims: Present study aims to ascertain etiological factors, frequency and outcome of hyponatremia in critically ill geriatric patients and describe its clinical manifestations. Methods: This observational study was conducted in an intensive care unit of a tertiary care hospital of Rajasthan on 100 geriatric patients over a period of 1 year. Observation: In this study 62 males and 38 females were admitted with hypopnatremia with 25% having mild and 67% moderate hyponatremia; of which 58% were symptomatic having lethargy (34%) and postural dizziness (27%)as the common clinical presentation. Hypertension(57%) and diabetes (43%) were frequent comorbities while CCF (40%) followed by drugs (16%) were the common etiologies. Fluid restriction (63%) was the major treatment followed by diuretics (23%), normal saline (14%) and hypertonic saline (5%) with an overall mortality of 10% unrelated to the severity of hyponatremia at presentation. Conclusion: Hyponatremia is a significant cause of morbidity and mortality in critically ill geriatric patients and needs special consideration to decrease the ICU stay and associated morbidity.

There is two parts in life- forenoon and afternoon. The afternoon part of life indicates the life at post retirement. At the afternoon stage of life, individual usually follows the rules of renunciation and detachment which the Vanaprastha of the Vedic Age directed. But at present global age, the elderly population lead a highly consumerised life. The present paper attempted to explore the above differences in the lives of elderly. For this purpose 100 elderly population of 60-70 years of age living at Kolkata Metro were studied. From this study, it revealed that majority of them was suffering from various problems (physical and mental). They used to follow highly consumerised life. While a little portion of them lived with happiness because they were practicing the rules of Vanaprastha and they led a simple living with renunciation. They used to practice a spiritual living. So, it might be a path of happy aging and acceptance of death.