Volume 1 Issue 4
International Journal of Medical Sciences and Education (IJMSE)
Vol. 1; Issue: 4 (Jan 2015)
Date of Publication: 01.01.2015
A STUDY ON THE SOCIO-DEMOGRAPHIC PROFILES OF ROAD TRAFFIC ACCIDENT CASES ATTENDING THE EMERGENCY OF A TERTIARY CARE HOSPITAL OF UDAIPUR CITY.
Hemlata Mittal1*, Rupesh Kumar2
ABSTRACT:
Objectives: In present scenario, accidents are now considered as one of major epidemics of Non-Communicable Diseases which have become major health problems of developing countries like India. Road traffic accidents are not only a major but also a neglected global public health problem, requiring concerned efforts for effective and sustainable prevention. In India, road traffic accident is a major contributory factor in mortality and morbidity of people. Materials & Methods: The present study was a cross-sectional descriptive study, conducted at the Tertiary Hospital named Maharana Bhupal (M.B) Hospital Udaipur (Rajasthan) involving all cases of motorized vehicle road traffic accidents during the period of 1July 2010 to 31 December 2010. A total 400 cases were selected randomly for study among total reported cases 3975 in emergency during the selected period. Results: Among all selected road traffic accident cases (400), majority (81%) were males while 19% cases were females. The majority of road traffic accident cases 133 (33.25%) were found to be in age group of 15-25 years followed by 120 (30%) in age group of 25-35 years. In this study, it was found that majority of cases 227 (56.75%) belonged to urban area while 173 (43.25%) belonged to rural area. Conclusion: Road traffic accidents are a huge public health and development problem and contribute a large proportion of the national burden of total deaths and serious injuries. Despite the growing burden of road traffic accidents, road safety received insufficient attention at both the national and international levels.
Key Words: Socio-demographic, Road Traffic, Accidents, Emergency, Motorized vehicle.
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A STUDY OF CORRELATION BETWEEN VITAMIN B12 DEFICIENCY AND CLINICAL, HAEMATOLOGICAL AND ELECTROPHYSIOLOGICAL PARAMETERS OF VITAMIN B12 DEFICIENCY
Dr. Chetan Anil Bhole1, Dr. Tarun Kumar Ralot2, Dr. R L Meena3, Dr. Neera Samar4, Dr. Vignesh S.5 ,Dr. Chander Bafna 6
ABSTRACT:
Objectives: Vitamin B12 is an essential micronutrient essential for appropriate neuro-cognitive hemopoetic and cardiovascular function. This study was planned to find correlation between vitamin B12 deficiency and clinical , haematological and electrophysiological parameters of vitamin B12 deficiency. Material and Methods : This was a cross sectional study which included 125 patients who had attended Maharana Bhupal Govt. Hospital, Udaipur between 1st November 2013 to 31st August 2014. The study included all cases of anaemia with or without neurological manifestation with suspected B12 deficiency, Anaemia with history of chronic alcoholism, smoker, tobacco, beetle nut chewers, chronic diarrhoea and Past history of gastric surgery. Results: Total 125 patients were included in study, among them 53 were male and 72 were females & majority 69 (55.2%) patients were more than 60 years of age. 86 (68.8%) patients had severe Vitamin B12 deficiency, among them 42(63.6%) were females. Neurological complains like parenthesis. Ataxia, decreased vision, psychiatric and cognitive impairment were observed in 68 (54.4%) patients among them parenthesis were present in three fifth (60.29%) patients. Reduced vision was present in only 3 (5.8%) patients. 19% patients had myeloneuropathy and Optic atrophy was noted in all 3 patients who were presented with reduced vision. Conclusion: Deficiency disorders of vitamins associate with plethora of clinical manifestations. Old age person, Female gender and vegetarians are at considerable risk to develop B12 deficiency.
Key Words: Vitamin B12, hemopoetic, neuro-cognitive function, cardiovascular function, megaloblastic anaemia.
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NEUROPSYCHOLOGICAL PATTERN AMONG HIV-1 INFECTED ASYMPTOMATIC MOTHERS REPORTING TO ANTENATAL CLINIC, AT AIIMS
Lalit Kumar1, Arvind Sharma2, Dr Alka Parasher3, Prof. Suneeta Mittal4, Sangita Sharma5
Abstract
Objective: The objective of the present study is to determine whether the HIV-1 infection in asymptomatic stage can have any statistically significant impact on neuropsychological performance. Material & Methods: The stratified purposive sampling technique was used for the selection of subjects. 41 HIV-infected asymptomatic subjects were selected for the study over a period of seven months at AIIMS, New Delhi. Result: The cognitive deficits can occur in individuals during the early phase of HIV-1 infection. 41 asymptomatic HIV positive patients were enrolled, (N-41, 15 males & 26 females) from PPTCT Center, AIIMS. On assessing the neuropsychological pattern, we found impairment in some neuropsycological pattern. The main impairment was observed in areas of tactile (66%), memory (39%), intelligence processes (26%), and arithmetic (17%). A small number of subjects also showed impairment in motor (4%) and visual functions (2%). No subject indicated any deficit in reading, writing expressive and receptive speech areas. Conclusion: We have observed greater deficit in tactile, intelligence, memory and arithmetic areas. The decrement in performance on specific neuropsychological tests implicates an early and selective involvement of different brain areas.
Key words: Intratympanic (IT) injection, sensorineural hearing loss, dexamethasone.
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THE CORRELATION BETWEEN SERUM LIPID PROFILE AND ALBUMINURIA IN NORMOTENSIVE DIABETIC SUBJECTS
Dr.Abhijit Basu1* , Dr J.S. Jhala2
Abstract
Objective: This study is planned to study the relationship between dyslipidemia and albuminuria in normotensive diabetic subjects if any so that appropriate medical therapy may be initiated. Material & Method: The present study was conducted on 50 diabetic subjects between age group of 45-70 years, out of which 31 were males and 19 were females. Out of 50 subjects, 25 were in control group i.e. diabetic patients with no micro/macro-albuminuria and 25 patients were having either micro or macroalbuminuric. The fasting serum lipid levels were estimated and all the parameters obtained were correlated with micro/macro-albuminuria. Results: The longer duration of diabetes was significantly associated with higher level of albuminuria in test subjects (P<0.05).The male diabetic patients had significant higher level of micro/macroalbuminuria (P<0.05) in comparison to female diabetic patients. The BMI did not correlate significantly with albuminuria.The total cholesterol was significantly higher in diabetic patients with albuminuria(P<0.05).The triglyceride levels were significantly associated with macroalbuminuria in diabetic patients(P<0.05).The LDL-C and HDL-C did not correlate significantly with albuminuria in the study. Conclusion: Male sex has been found to be a risk factor for development of albuminuria in diabetic patients. High levels of serum cholesterol and serum triglycerides have been found to be one of the risk factors for development of albuminuria in diabetic patients despite good blood pressure control and non-smoking.
Keywords: microalbuminuria, Diabetes mellitus, Hyperglycemia, dyslipidemia.
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CATHETER ASSOCIATED URINARY TRACT INFECTION (CAUTI) INDUCED NOSOCOMIAL INFECTION WITH REFERENCE TO INCIDENCE, DURATION AND ORGANISM IN A TERTIARY CARE TEACHING HOSPITAL
Dr.Trilok Patil
Abstract
Objective: Background: Indwelling urinary-catheter induced urinary tract infections (UTI) are an important cause of nosocomial infection.To determine the incidence of catheter associated infections and to correlate the incidence of catheter-associated infection with the duration of catheterization and to find out the most common organism responsible for catheter associated UTI in our hospital.Materials & Methods: This prospective study was conducted in a tertiary care teaching hospital. The urine samples from 100 patients from different wards, belonging to different age-groups and with different clinical conditions were collected under all aseptic precautions. Total 4 samples from each patient were collected on day 1st, 3rd, 5th and 7th and transported in a sterile plain bulb to the microbiology laboratory for further processing. Urine samples were processed for inoculation, macroscopic examination, microscopic examination and gram staining.Results: Total 65% catheterized patients developed UTI within 7 days of catheterization. There was an increase incidence of UTI with duration of catheterization. Only 7 (10.77%) patients were infected on day 1, whereas by 7th day 100% of patients were infected. Most commonly isolated pathogen was Escherichia coli (30.76%) followed by Pseudomonas aeruginosa (26.15%) and Klebsiella (23.07%).Conclusion: CAUTI can be prevented if proper aseptic precautions are taken. Doctors and nurses should be trained in taking precaution necessary to prevent CAUTI. Minimizing the duration of catheterization and administration of prophylactic antibiotics can prevent infection in short-duration catheterized patients.
Key words: Urinary catheter, incidence, urinary tract infections, nosocomial infection.
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PATTERN OF INFECTIONS IN ADULT PATIENTS PRESENTING AS ACUTE ENCEPHALITIS SYNDROME (AES)
Dr Rakesh kumar , Dr Mridul Bhushan,Dr P.Nigam
ABSTRACT:
Objectives: Encephalitis is an acute inflammatory process that affects brain parenchyma, presents as a diffuse and/or a focal neuropsychological dysfunction and is almost always accompanied by inflammation of adjacent meningitis which is most commonly caused by viral infection. Acute viral encephalitis is the most common cause of acute encephalitis syndrome (AES). The study was regarding the pattern of infections in patients presenting as acute encephalitis syndrome in adults and to note any change in the pattern of infection particularly with reference to enterovirus infection. Material and Methods: A total of 200 patients with AES which were hospitalized patients in the Department of Medicine, Nehru hospital, attached to the B.R.D. Medical College, Gorakhpur during August 2009 to October 2010 and were followed during hospitalization. All were subjected to detail clinical examined and investigated along with viral diagnostic studies on cerebrospinal fluid (CSF) samples to determine the etiology of AES. Results: Non JE responsible for 57.5% cases while common presenting symptoms were fever and altered sensoriurn & mean GCS at the time of admission were 8.95 in AES cases. The AES cases was full recovery seen in 72.5% and common sequelae was cognitive impairment while the case fatality rate was 13%. Conclusion: Our results demonstrate that for this highly fatal condition a hospital-based monitoring system with periodic diagnostic testing is feasible and can provide information useful for clinicians as well as public health planners
Key Words: acute encephalitis syndrome, viral infection, enterovirus infection, cerebrospinal fluid.
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PERCEPTIONS AND PRACTICES OF OBTAINING CONSENT AMONG MEDICAL PROFESSIONALS
Dr. Sanjay K.Gupta,Dr. P. P. Sharma, Prof. P.K. Padhi
ABSTRACT:
Objectives: Medical professional’s knowledge of laws governing medical practice is essential in securing the patients’ rights. Given the spurt in medico legal compensation cases against the medical professionals in India, partly due to documentation of medical record pertaining to obtain Consent before treatment, we decided to perform an examining the levels of clinician’s perception and awareness of Informed Consent (IC) among surgeons. Material and Methods: A questionnaire-based cross sectional survey among surgeon both in the government and private hospital was conducted. Results: A total 150 participants included in present study & 66% were of males and rest of female. Majority of were from Private sector (58%) & around 64% had < 5 years’ experience in medical field following post-graduation. Majority of participants had taken consent from both patients & relatives. About 87% participants always explained procedure details to patient/relative and procedure related Complications were always explained by about fifty percent participants. About one third were agreed that they did not wait for relative to obtain consent when patient was conscious while 82% participants did not wait for relative to obtain consent when patient was unconscious. Regarding video consent, one forth was not agreed while about half were agreed that it should be optional or case based. Conclusion: All clinicians & medical researchers should take Informed Consent seriously to dignify the patient-doctor relationship & to change their attitude and acknowledge the patient’s autonomy. In the present study majority of the clinician were well aware of the consent procedure, however possibility of information bias did exist.
Key words: Informed Consent, tertiary hospital, video consent.
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ASSESSMENT OF SERUM LIPID PROFILE IN PATIENTS WITH TYPE 2 DIABETES MELLITUS AND ITS ASSOCIATION WITH DIABETIC NEPHROPATHY
Dr Virendra Kumar Goyal
ABSTRACT:
Background: Diabetes mellitus is a common cause of hyperlipidaemia, particularly in individuals with poor glycaemic control, which ultimately is an important risk factor for developing micro and macro vascular complications. Diabetic nephropathy is the main leading cause of end-stage renal disease. Material & Methods: In the present study a total 100 patients with type 2 diabetes mellitus randomly selected. General physical examination, detailed history and lab investigation for Fasting and post prandial blood sugar, fasting lipid profile, 24 hour urine protein, spot urine albumin levels, serum creatinine levels and spot urine albumin creatinine ratio were estimated. Results: The prevalence of dyslipidemia in our study was 70%. Most common pattern of serum lipid abnormality in our study was combined dyslipidemia. 34 out of 100 Diabetes patients had Diabetic Nephropathy. Out of 34 Diabetic Nephropathy patients 26 had micro albuminuria and 08 had macro albuminuria. Out of these100 diabetic patients, 62 patients had GFR > 90 ml/min/1.73 m2, 28 had GFR of 60-90 ml/min/1.73m2 and 10 patients had GFR < 60 ml/min/1.73 m2. We found highly significant association (p value < 0.001) of Diabetic Nephropathy with High LDL-C, High TG and High TC levels. There was no significant association of Diabetic Nephropathy with Low HDL-C levels (P > 0.05). Conclusion: Lipid profile should be done annually in all patients with diabetes and screening for Diabetic Nephropathy should include urinary ACR in a spot urine sample and estimation of GFR. Patients should be managed with life style modifications, adequate glycemic control with or without lipid lowering agents.
Key words: Diabetes mellitus, Diabetic nephropathy, Lipid profile.
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CLINICAL EVALUATION OF POST-PARTUM HAEMORRHAGE AT TERTIARY CARE HOSPITAL
Dr. Kuldeep Wagh
ABSTRACT:
Background: Post-partum hemorrhage (PPH) is described as blood loss of 500 ml or more within the duration of 24hours from the childbirth. Post-partum hemorrhageis reported to be responsible for more than 30% of maternal deaths and stated as most common cause of maternal mortality in Asia. Post-partum hemorrhage accounts for most common direct etiology of maternal mortality rate in India. Material & Methods: In the present study, 200 pregnant women who had vaginal delivery with 500 ml or more blood loss and who had caesarean section with 1000mls or more blood losses, were enrolled for study by simple random sampling. Clearance from Institutional Ethics Committee was taken before start of study. Written informed consent was taken from each study participant. Results: The most common etiology reported for the post-partum hemorrhage was atonicity of the uterus which was found in 77% of the cases. Traumatic cause for PPH was reported among 10% of the women. Atonicity with the traumatic cause both were reported in 5% of the pregnant women. Retained placental contents were found responsible in 3% of the pregnant women. Uterine inversion and infections were reported among 2% pregnant women respectively. Bleeding diathesis was reported in 1% of the pregnant women. Conclusions: The most common etiology reported for the post-partum hemorrhage was atonicity of the uterus. The post-partum hemorrhage was managed by the use of uterotonics and by applied active management of the third stage of labour along with blood transfusions. In some cases, surgical intervention was also required.
Keywords: Postpartum haemorrhage, Atonicity, uterotonics.
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ASSESSMENT OF CLINICALTRENDS OF PSORIASIS AT TERTIARY CARE CENTER
Dr. Jayesh Rashik Lal Shah
ABSTRACT:
Background: According to published reports, prevalence in different populations varies from 0% to 11.8%.2-5 Prevalence of psoriasis varies in different parts of world. So we can not rely on Western data. The exact prevalence of psoriasis in our country is not known and so the information on prevalence would be helpful for planning strategies for better management. Material & Methods: The study was a descriptive study on 400 self-reported patients during a period of 3 months from January 2013 to March 2014. We enrolled all patients without any exclusion based on sex, nationality, occupation or socioeconomic status. Results: In present study, chronic plaque psoriasis is the most common (63.2%) clinical pattern observed irrespective of age and sex. Scalp and Nail involvement were common. Co-morbidities associated include diabetes mellitus, hypertension, alcoholism, hypothyroidism, and depression. Conclusions: We concluded from the present study that prerequisite would be identifying and eliminating risk factors and triggers. Also there is need for a more effective targeted therapy for a better outcome. Usage of systemic steroids should be avoided as there is severe flare, or even development of life threatening generalised pustular psoriasis when steroids are tapered or stopped.
Keywords: Subungual hyperkeratosis, Koebner phenomenon, Comorbidities
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THYROID HORMONE STATUS IN DIABETICS AS A PREDICTOR OF GLYCEMIC CONTROL: A CASE CONTROL STUDY AT TERTIARY CARE CENTRE
Dr. Manoj Saluja, Dr Krishan Kumar Verma, SR Meena
ABSTRACT:
Background: The association between Diabetes and Thyroid dysfunction has been recognized since 1979.Thyroid hormones are insulin antagonist, both thyroid hormone and insulin are involved in cellular metabolism and excess/deficit of anyone can result in functional derangement of each other. This study is aimed to study the prevalence of thyroid dysfunction & correlation between glycosylated haemoglobin (HbA1c) and thyroid hormone status (T3, T4, TSH) in Diabetes Mellitus type-2 patients. Methods: A case control study of 240 patients, 160 diabetic (as per ADA criteria, age>40) and 80 non diabetic controls recruited as per inclusion/exclusion criteria, was undertaken at tertiary care hospitals of Kota. After detailed clinical & physical examination, all patients were subjected to thyroid profile and HbA1c estimation. Result: Hypothyroidism was more common as compared to hyperthyroidism among diabetic patients. Subclinical hypothyroidism constituted 12.5% of cases and clinical hypothyroidism was 5% of cases. Thyroid disorder in diabetics was more common in females (20%) as compared to males (15%). Thyroid disorder among diabetics (i.e. cases) was higher among overweight (27.5%) and obese (15.9%) as compared to those with normal BMI (7.1%). There was negative correlation between HbA1c and T3 level with Pearson correlation coefficient – 0.372 and this correlation was statistically significant (p<0.001).Conclusion: This study demonstrated that firstly, subclinical hypothyroidism has greater prevalence & second, serum T3 may be reliable index of glycemic control in diabetic patients. Overweight and obese diabetic patients are more prone to subclinical as well as clinical hypothyroidism. These patients with larger waist circumference must be screened for thyroid dysfunction.
Keywords: Thyroid Profile ( T3,T4, TSH ), Glycosylated hemoglobin ( HbA1c)
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HISTOPATHOLOGICAL PATTERN OF THYROID DISORDER AMONG THYROIDECTOMY SPECIMEN OF PATIENTS UNDERGOING THYROID OPERATIONS
Dr. Tanu Malhotra
ABSTRACT:
Background: Pathologic evaluations of lesions of the thyroid gland are of research importance because they directly affect the functioning of other organs of the body and along with that histopathological result forms the basis of highly effective medical and surgical treatment. Material & Methods: The present cross-sectional observational study was conducted at the department of pathology of our tertiary care hospital. The study duration was of six months from July 2012 to January 2013. A sample size of 50 was calculated at a 95% confidence interval at a 10% acceptable margin of error. Clearance from Institutional Ethics Committee was taken before the start of the study. Results: Multinodular goiter was the most common non-neoplastic thyroid lesion (56%) which is followed by thyroiditis. There was only 1 patient of toxic goiter among all the thyroid specimens received and examined. Among the 50 thyroid lesions, there were 18% specimens diagnosed as carcinomas. The frequency of malignancy among the total thyroid specimens is almost the same for both males and females (8% and 10%). In the present study, papillary carcinoma was found the most common malignancy, out of which half of the specimens were of the micropapillary subtype. One of the thyroid lesion specimens showed two different primary malignancies (papillary microcarcinoma and follicular carcinoma). There was one specimen of metastatic thyroid carcinoma which was from primary lung carcinoma. Conclusion: We concluded from the present study that the most common type of thyroid lesions was non-neoplastic and among these most common types was multinodular goiter and among the neoplastic lesions the most common type of neoplastic lesion was papillary carcinoma of the thyroid.
Keywords: Multinodular goiter, Thyroiditis, Papillary carcinoma
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CLINICAL PROFILE OF ACUTE ABDOMINAL PAIN AMONG CHILDREN AND ADOLESCENT AT TERTIARY CARE CENTRE
Dr. Jayant R. Deore
ABSTRACT:
Background: Acute abdominal pain defined as pain of nontraumatic in nature with a maximum duration of five days. Acute abdominal pain is among the most common complaints at outpatient department which accounts for 7–10% of all Emergency hospital visits. In majority of patient’s symptoms are self-limiting but few of these patients will develop serious intra-abdominal disease. Material & Methods: The present observational study was conducted at of our tertiary care hospital, with a study duration of six months from December 2013 to May 2014. 100 children of age 1 to 16 years, who were diagnosed with acute abdomen pain, were enrolled from outdoor department and from ward by simple random sampling. Results: In the present study, abdomen pain was present among all the study participants i.e. 100%, which is followed by abdominal pain with vomiting in 71% study participants. Diarrhea was present in 43% study participants followed by Abdominal distension in 31% study participants, fever present in 26% study participants and constipation was present in 12% study participants. Abdominal tenderness was present in 97% study participants which was followed by abdominal guarding/ rigidity found in 61% study participants. Acute gastroenteritis was reported the most common cause of acute abdomen pain which was found in 39% study participants which was followed by acid peptic disease in 26% study participants. Urolithiasis was found in 13% study participants and urinary tract infection were found in 10% study participants. Dengue was reported in 6% study participants, acute hepatitis, appendicitis and mesenteric adenopathy were found in 2% study participants respectively. Conclusion: Acute gastroenteritis was the most common cause of acute abdomen pain which was followed by acid peptic disease, urolithiasis and urinary tract infection. Early diagnosis and prompt treatment decrease the major morbidity as well as the duration of hospital stay.
Keywords: Acute Abdomen, Acute gastroenteritis, Appendicitis.
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Hemlata Mittal1*, Rupesh Kumar2
ABSTRACT:
Objectives: In present scenario, accidents are now considered as one of major epidemics of Non-Communicable Diseases which have become major health problems of developing countries like India. Road traffic accidents are not only a major but also a neglected global public health problem, requiring concerned efforts for effective and sustainable prevention. In India, road traffic accident is a major contributory factor in mortality and morbidity of people. Materials & Methods: The present study was a cross-sectional descriptive study, conducted at the Tertiary Hospital named Maharana Bhupal (M.B) Hospital Udaipur (Rajasthan) involving all cases of motorized vehicle road traffic accidents during the period of 1July 2010 to 31 December 2010. A total 400 cases were selected randomly for study among total reported cases 3975 in emergency during the selected period. Results: Among all selected road traffic accident cases (400), majority (81%) were males while 19% cases were females. The majority of road traffic accident cases 133 (33.25%) were found to be in age group of 15-25 years followed by 120 (30%) in age group of 25-35 years. In this study, it was found that majority of cases 227 (56.75%) belonged to urban area while 173 (43.25%) belonged to rural area. Conclusion: Road traffic accidents are a huge public health and development problem and contribute a large proportion of the national burden of total deaths and serious injuries. Despite the growing burden of road traffic accidents, road safety received insufficient attention at both the national and international levels.
Key Words: Socio-demographic, Road Traffic, Accidents, Emergency, Motorized vehicle.
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A STUDY OF CORRELATION BETWEEN VITAMIN B12 DEFICIENCY AND CLINICAL, HAEMATOLOGICAL AND ELECTROPHYSIOLOGICAL PARAMETERS OF VITAMIN B12 DEFICIENCY
Dr. Chetan Anil Bhole1, Dr. Tarun Kumar Ralot2, Dr. R L Meena3, Dr. Neera Samar4, Dr. Vignesh S.5 ,Dr. Chander Bafna 6
ABSTRACT:
Objectives: Vitamin B12 is an essential micronutrient essential for appropriate neuro-cognitive hemopoetic and cardiovascular function. This study was planned to find correlation between vitamin B12 deficiency and clinical , haematological and electrophysiological parameters of vitamin B12 deficiency. Material and Methods : This was a cross sectional study which included 125 patients who had attended Maharana Bhupal Govt. Hospital, Udaipur between 1st November 2013 to 31st August 2014. The study included all cases of anaemia with or without neurological manifestation with suspected B12 deficiency, Anaemia with history of chronic alcoholism, smoker, tobacco, beetle nut chewers, chronic diarrhoea and Past history of gastric surgery. Results: Total 125 patients were included in study, among them 53 were male and 72 were females & majority 69 (55.2%) patients were more than 60 years of age. 86 (68.8%) patients had severe Vitamin B12 deficiency, among them 42(63.6%) were females. Neurological complains like parenthesis. Ataxia, decreased vision, psychiatric and cognitive impairment were observed in 68 (54.4%) patients among them parenthesis were present in three fifth (60.29%) patients. Reduced vision was present in only 3 (5.8%) patients. 19% patients had myeloneuropathy and Optic atrophy was noted in all 3 patients who were presented with reduced vision. Conclusion: Deficiency disorders of vitamins associate with plethora of clinical manifestations. Old age person, Female gender and vegetarians are at considerable risk to develop B12 deficiency.
Key Words: Vitamin B12, hemopoetic, neuro-cognitive function, cardiovascular function, megaloblastic anaemia.
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NEUROPSYCHOLOGICAL PATTERN AMONG HIV-1 INFECTED ASYMPTOMATIC MOTHERS REPORTING TO ANTENATAL CLINIC, AT AIIMS
Lalit Kumar1, Arvind Sharma2, Dr Alka Parasher3, Prof. Suneeta Mittal4, Sangita Sharma5
Abstract
Objective: The objective of the present study is to determine whether the HIV-1 infection in asymptomatic stage can have any statistically significant impact on neuropsychological performance. Material & Methods: The stratified purposive sampling technique was used for the selection of subjects. 41 HIV-infected asymptomatic subjects were selected for the study over a period of seven months at AIIMS, New Delhi. Result: The cognitive deficits can occur in individuals during the early phase of HIV-1 infection. 41 asymptomatic HIV positive patients were enrolled, (N-41, 15 males & 26 females) from PPTCT Center, AIIMS. On assessing the neuropsychological pattern, we found impairment in some neuropsycological pattern. The main impairment was observed in areas of tactile (66%), memory (39%), intelligence processes (26%), and arithmetic (17%). A small number of subjects also showed impairment in motor (4%) and visual functions (2%). No subject indicated any deficit in reading, writing expressive and receptive speech areas. Conclusion: We have observed greater deficit in tactile, intelligence, memory and arithmetic areas. The decrement in performance on specific neuropsychological tests implicates an early and selective involvement of different brain areas.
Key words: Intratympanic (IT) injection, sensorineural hearing loss, dexamethasone.
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THE CORRELATION BETWEEN SERUM LIPID PROFILE AND ALBUMINURIA IN NORMOTENSIVE DIABETIC SUBJECTS
Dr.Abhijit Basu1* , Dr J.S. Jhala2
Abstract
Objective: This study is planned to study the relationship between dyslipidemia and albuminuria in normotensive diabetic subjects if any so that appropriate medical therapy may be initiated. Material & Method: The present study was conducted on 50 diabetic subjects between age group of 45-70 years, out of which 31 were males and 19 were females. Out of 50 subjects, 25 were in control group i.e. diabetic patients with no micro/macro-albuminuria and 25 patients were having either micro or macroalbuminuric. The fasting serum lipid levels were estimated and all the parameters obtained were correlated with micro/macro-albuminuria. Results: The longer duration of diabetes was significantly associated with higher level of albuminuria in test subjects (P<0.05).The male diabetic patients had significant higher level of micro/macroalbuminuria (P<0.05) in comparison to female diabetic patients. The BMI did not correlate significantly with albuminuria.The total cholesterol was significantly higher in diabetic patients with albuminuria(P<0.05).The triglyceride levels were significantly associated with macroalbuminuria in diabetic patients(P<0.05).The LDL-C and HDL-C did not correlate significantly with albuminuria in the study. Conclusion: Male sex has been found to be a risk factor for development of albuminuria in diabetic patients. High levels of serum cholesterol and serum triglycerides have been found to be one of the risk factors for development of albuminuria in diabetic patients despite good blood pressure control and non-smoking.
Keywords: microalbuminuria, Diabetes mellitus, Hyperglycemia, dyslipidemia.
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CATHETER ASSOCIATED URINARY TRACT INFECTION (CAUTI) INDUCED NOSOCOMIAL INFECTION WITH REFERENCE TO INCIDENCE, DURATION AND ORGANISM IN A TERTIARY CARE TEACHING HOSPITAL
Dr.Trilok Patil
Abstract
Objective: Background: Indwelling urinary-catheter induced urinary tract infections (UTI) are an important cause of nosocomial infection.To determine the incidence of catheter associated infections and to correlate the incidence of catheter-associated infection with the duration of catheterization and to find out the most common organism responsible for catheter associated UTI in our hospital.Materials & Methods: This prospective study was conducted in a tertiary care teaching hospital. The urine samples from 100 patients from different wards, belonging to different age-groups and with different clinical conditions were collected under all aseptic precautions. Total 4 samples from each patient were collected on day 1st, 3rd, 5th and 7th and transported in a sterile plain bulb to the microbiology laboratory for further processing. Urine samples were processed for inoculation, macroscopic examination, microscopic examination and gram staining.Results: Total 65% catheterized patients developed UTI within 7 days of catheterization. There was an increase incidence of UTI with duration of catheterization. Only 7 (10.77%) patients were infected on day 1, whereas by 7th day 100% of patients were infected. Most commonly isolated pathogen was Escherichia coli (30.76%) followed by Pseudomonas aeruginosa (26.15%) and Klebsiella (23.07%).Conclusion: CAUTI can be prevented if proper aseptic precautions are taken. Doctors and nurses should be trained in taking precaution necessary to prevent CAUTI. Minimizing the duration of catheterization and administration of prophylactic antibiotics can prevent infection in short-duration catheterized patients.
Key words: Urinary catheter, incidence, urinary tract infections, nosocomial infection.
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PATTERN OF INFECTIONS IN ADULT PATIENTS PRESENTING AS ACUTE ENCEPHALITIS SYNDROME (AES)
Dr Rakesh kumar , Dr Mridul Bhushan,Dr P.Nigam
ABSTRACT:
Objectives: Encephalitis is an acute inflammatory process that affects brain parenchyma, presents as a diffuse and/or a focal neuropsychological dysfunction and is almost always accompanied by inflammation of adjacent meningitis which is most commonly caused by viral infection. Acute viral encephalitis is the most common cause of acute encephalitis syndrome (AES). The study was regarding the pattern of infections in patients presenting as acute encephalitis syndrome in adults and to note any change in the pattern of infection particularly with reference to enterovirus infection. Material and Methods: A total of 200 patients with AES which were hospitalized patients in the Department of Medicine, Nehru hospital, attached to the B.R.D. Medical College, Gorakhpur during August 2009 to October 2010 and were followed during hospitalization. All were subjected to detail clinical examined and investigated along with viral diagnostic studies on cerebrospinal fluid (CSF) samples to determine the etiology of AES. Results: Non JE responsible for 57.5% cases while common presenting symptoms were fever and altered sensoriurn & mean GCS at the time of admission were 8.95 in AES cases. The AES cases was full recovery seen in 72.5% and common sequelae was cognitive impairment while the case fatality rate was 13%. Conclusion: Our results demonstrate that for this highly fatal condition a hospital-based monitoring system with periodic diagnostic testing is feasible and can provide information useful for clinicians as well as public health planners
Key Words: acute encephalitis syndrome, viral infection, enterovirus infection, cerebrospinal fluid.
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PERCEPTIONS AND PRACTICES OF OBTAINING CONSENT AMONG MEDICAL PROFESSIONALS
Dr. Sanjay K.Gupta,Dr. P. P. Sharma, Prof. P.K. Padhi
ABSTRACT:
Objectives: Medical professional’s knowledge of laws governing medical practice is essential in securing the patients’ rights. Given the spurt in medico legal compensation cases against the medical professionals in India, partly due to documentation of medical record pertaining to obtain Consent before treatment, we decided to perform an examining the levels of clinician’s perception and awareness of Informed Consent (IC) among surgeons. Material and Methods: A questionnaire-based cross sectional survey among surgeon both in the government and private hospital was conducted. Results: A total 150 participants included in present study & 66% were of males and rest of female. Majority of were from Private sector (58%) & around 64% had < 5 years’ experience in medical field following post-graduation. Majority of participants had taken consent from both patients & relatives. About 87% participants always explained procedure details to patient/relative and procedure related Complications were always explained by about fifty percent participants. About one third were agreed that they did not wait for relative to obtain consent when patient was conscious while 82% participants did not wait for relative to obtain consent when patient was unconscious. Regarding video consent, one forth was not agreed while about half were agreed that it should be optional or case based. Conclusion: All clinicians & medical researchers should take Informed Consent seriously to dignify the patient-doctor relationship & to change their attitude and acknowledge the patient’s autonomy. In the present study majority of the clinician were well aware of the consent procedure, however possibility of information bias did exist.
Key words: Informed Consent, tertiary hospital, video consent.
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ASSESSMENT OF SERUM LIPID PROFILE IN PATIENTS WITH TYPE 2 DIABETES MELLITUS AND ITS ASSOCIATION WITH DIABETIC NEPHROPATHY
Dr Virendra Kumar Goyal
ABSTRACT:
Background: Diabetes mellitus is a common cause of hyperlipidaemia, particularly in individuals with poor glycaemic control, which ultimately is an important risk factor for developing micro and macro vascular complications. Diabetic nephropathy is the main leading cause of end-stage renal disease. Material & Methods: In the present study a total 100 patients with type 2 diabetes mellitus randomly selected. General physical examination, detailed history and lab investigation for Fasting and post prandial blood sugar, fasting lipid profile, 24 hour urine protein, spot urine albumin levels, serum creatinine levels and spot urine albumin creatinine ratio were estimated. Results: The prevalence of dyslipidemia in our study was 70%. Most common pattern of serum lipid abnormality in our study was combined dyslipidemia. 34 out of 100 Diabetes patients had Diabetic Nephropathy. Out of 34 Diabetic Nephropathy patients 26 had micro albuminuria and 08 had macro albuminuria. Out of these100 diabetic patients, 62 patients had GFR > 90 ml/min/1.73 m2, 28 had GFR of 60-90 ml/min/1.73m2 and 10 patients had GFR < 60 ml/min/1.73 m2. We found highly significant association (p value < 0.001) of Diabetic Nephropathy with High LDL-C, High TG and High TC levels. There was no significant association of Diabetic Nephropathy with Low HDL-C levels (P > 0.05). Conclusion: Lipid profile should be done annually in all patients with diabetes and screening for Diabetic Nephropathy should include urinary ACR in a spot urine sample and estimation of GFR. Patients should be managed with life style modifications, adequate glycemic control with or without lipid lowering agents.
Key words: Diabetes mellitus, Diabetic nephropathy, Lipid profile.
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CLINICAL EVALUATION OF POST-PARTUM HAEMORRHAGE AT TERTIARY CARE HOSPITAL
Dr. Kuldeep Wagh
ABSTRACT:
Background: Post-partum hemorrhage (PPH) is described as blood loss of 500 ml or more within the duration of 24hours from the childbirth. Post-partum hemorrhageis reported to be responsible for more than 30% of maternal deaths and stated as most common cause of maternal mortality in Asia. Post-partum hemorrhage accounts for most common direct etiology of maternal mortality rate in India. Material & Methods: In the present study, 200 pregnant women who had vaginal delivery with 500 ml or more blood loss and who had caesarean section with 1000mls or more blood losses, were enrolled for study by simple random sampling. Clearance from Institutional Ethics Committee was taken before start of study. Written informed consent was taken from each study participant. Results: The most common etiology reported for the post-partum hemorrhage was atonicity of the uterus which was found in 77% of the cases. Traumatic cause for PPH was reported among 10% of the women. Atonicity with the traumatic cause both were reported in 5% of the pregnant women. Retained placental contents were found responsible in 3% of the pregnant women. Uterine inversion and infections were reported among 2% pregnant women respectively. Bleeding diathesis was reported in 1% of the pregnant women. Conclusions: The most common etiology reported for the post-partum hemorrhage was atonicity of the uterus. The post-partum hemorrhage was managed by the use of uterotonics and by applied active management of the third stage of labour along with blood transfusions. In some cases, surgical intervention was also required.
Keywords: Postpartum haemorrhage, Atonicity, uterotonics.
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ASSESSMENT OF CLINICALTRENDS OF PSORIASIS AT TERTIARY CARE CENTER
Dr. Jayesh Rashik Lal Shah
ABSTRACT:
Background: According to published reports, prevalence in different populations varies from 0% to 11.8%.2-5 Prevalence of psoriasis varies in different parts of world. So we can not rely on Western data. The exact prevalence of psoriasis in our country is not known and so the information on prevalence would be helpful for planning strategies for better management. Material & Methods: The study was a descriptive study on 400 self-reported patients during a period of 3 months from January 2013 to March 2014. We enrolled all patients without any exclusion based on sex, nationality, occupation or socioeconomic status. Results: In present study, chronic plaque psoriasis is the most common (63.2%) clinical pattern observed irrespective of age and sex. Scalp and Nail involvement were common. Co-morbidities associated include diabetes mellitus, hypertension, alcoholism, hypothyroidism, and depression. Conclusions: We concluded from the present study that prerequisite would be identifying and eliminating risk factors and triggers. Also there is need for a more effective targeted therapy for a better outcome. Usage of systemic steroids should be avoided as there is severe flare, or even development of life threatening generalised pustular psoriasis when steroids are tapered or stopped.
Keywords: Subungual hyperkeratosis, Koebner phenomenon, Comorbidities
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THYROID HORMONE STATUS IN DIABETICS AS A PREDICTOR OF GLYCEMIC CONTROL: A CASE CONTROL STUDY AT TERTIARY CARE CENTRE
Dr. Manoj Saluja, Dr Krishan Kumar Verma, SR Meena
ABSTRACT:
Background: The association between Diabetes and Thyroid dysfunction has been recognized since 1979.Thyroid hormones are insulin antagonist, both thyroid hormone and insulin are involved in cellular metabolism and excess/deficit of anyone can result in functional derangement of each other. This study is aimed to study the prevalence of thyroid dysfunction & correlation between glycosylated haemoglobin (HbA1c) and thyroid hormone status (T3, T4, TSH) in Diabetes Mellitus type-2 patients. Methods: A case control study of 240 patients, 160 diabetic (as per ADA criteria, age>40) and 80 non diabetic controls recruited as per inclusion/exclusion criteria, was undertaken at tertiary care hospitals of Kota. After detailed clinical & physical examination, all patients were subjected to thyroid profile and HbA1c estimation. Result: Hypothyroidism was more common as compared to hyperthyroidism among diabetic patients. Subclinical hypothyroidism constituted 12.5% of cases and clinical hypothyroidism was 5% of cases. Thyroid disorder in diabetics was more common in females (20%) as compared to males (15%). Thyroid disorder among diabetics (i.e. cases) was higher among overweight (27.5%) and obese (15.9%) as compared to those with normal BMI (7.1%). There was negative correlation between HbA1c and T3 level with Pearson correlation coefficient – 0.372 and this correlation was statistically significant (p<0.001).Conclusion: This study demonstrated that firstly, subclinical hypothyroidism has greater prevalence & second, serum T3 may be reliable index of glycemic control in diabetic patients. Overweight and obese diabetic patients are more prone to subclinical as well as clinical hypothyroidism. These patients with larger waist circumference must be screened for thyroid dysfunction.
Keywords: Thyroid Profile ( T3,T4, TSH ), Glycosylated hemoglobin ( HbA1c)
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HISTOPATHOLOGICAL PATTERN OF THYROID DISORDER AMONG THYROIDECTOMY SPECIMEN OF PATIENTS UNDERGOING THYROID OPERATIONS
Dr. Tanu Malhotra
ABSTRACT:
Background: Pathologic evaluations of lesions of the thyroid gland are of research importance because they directly affect the functioning of other organs of the body and along with that histopathological result forms the basis of highly effective medical and surgical treatment. Material & Methods: The present cross-sectional observational study was conducted at the department of pathology of our tertiary care hospital. The study duration was of six months from July 2012 to January 2013. A sample size of 50 was calculated at a 95% confidence interval at a 10% acceptable margin of error. Clearance from Institutional Ethics Committee was taken before the start of the study. Results: Multinodular goiter was the most common non-neoplastic thyroid lesion (56%) which is followed by thyroiditis. There was only 1 patient of toxic goiter among all the thyroid specimens received and examined. Among the 50 thyroid lesions, there were 18% specimens diagnosed as carcinomas. The frequency of malignancy among the total thyroid specimens is almost the same for both males and females (8% and 10%). In the present study, papillary carcinoma was found the most common malignancy, out of which half of the specimens were of the micropapillary subtype. One of the thyroid lesion specimens showed two different primary malignancies (papillary microcarcinoma and follicular carcinoma). There was one specimen of metastatic thyroid carcinoma which was from primary lung carcinoma. Conclusion: We concluded from the present study that the most common type of thyroid lesions was non-neoplastic and among these most common types was multinodular goiter and among the neoplastic lesions the most common type of neoplastic lesion was papillary carcinoma of the thyroid.
Keywords: Multinodular goiter, Thyroiditis, Papillary carcinoma
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CLINICAL PROFILE OF ACUTE ABDOMINAL PAIN AMONG CHILDREN AND ADOLESCENT AT TERTIARY CARE CENTRE
Dr. Jayant R. Deore
ABSTRACT:
Background: Acute abdominal pain defined as pain of nontraumatic in nature with a maximum duration of five days. Acute abdominal pain is among the most common complaints at outpatient department which accounts for 7–10% of all Emergency hospital visits. In majority of patient’s symptoms are self-limiting but few of these patients will develop serious intra-abdominal disease. Material & Methods: The present observational study was conducted at of our tertiary care hospital, with a study duration of six months from December 2013 to May 2014. 100 children of age 1 to 16 years, who were diagnosed with acute abdomen pain, were enrolled from outdoor department and from ward by simple random sampling. Results: In the present study, abdomen pain was present among all the study participants i.e. 100%, which is followed by abdominal pain with vomiting in 71% study participants. Diarrhea was present in 43% study participants followed by Abdominal distension in 31% study participants, fever present in 26% study participants and constipation was present in 12% study participants. Abdominal tenderness was present in 97% study participants which was followed by abdominal guarding/ rigidity found in 61% study participants. Acute gastroenteritis was reported the most common cause of acute abdomen pain which was found in 39% study participants which was followed by acid peptic disease in 26% study participants. Urolithiasis was found in 13% study participants and urinary tract infection were found in 10% study participants. Dengue was reported in 6% study participants, acute hepatitis, appendicitis and mesenteric adenopathy were found in 2% study participants respectively. Conclusion: Acute gastroenteritis was the most common cause of acute abdomen pain which was followed by acid peptic disease, urolithiasis and urinary tract infection. Early diagnosis and prompt treatment decrease the major morbidity as well as the duration of hospital stay.
Keywords: Acute Abdomen, Acute gastroenteritis, Appendicitis.
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