International Journal of Medical Sciences and Education (IJMSE)
Vol. 8 Issue: 3 (July -Sept. 2021), Date of Publication: 01.10.2021
1. ASSOCIATION BETWEEN PLASMA LEVELS OF VITAMIN B12 AND HYPERTENSION 1-5
Dr. Shreya Nigoskar, Dr. Naresh Kumar PDF FULL TEXT
Dr. Shreya Nigoskar, Dr. Naresh Kumar PDF FULL TEXT
ABSTRACT
Background: Hypertension is an important community health concern all over the world, which is influenced by both genetic and environmental factors. Epidemiological studies have discovered that numerous environmental factors are linked with hypertension, such as sodium intake, obesity, physical inactivity, and alcohol consumption. Methods: The present cross-sectional prospective study was conducted at the department of Biochemistry of our tertiary care hospital. The study duration was of six months between April 2019 and March 2020. The patients were grouped into two groups 75 patients in hypertension and 75 normotensive persons based on sphygmomanometer readings. Results: The age of the subjects in the study group ranged from 20 to 50 years. The mean and standard deviation for the age of the Cases and control individuals were 27.81 ± 6.1 and 26.92 ± 5.6 respectively; there was no significant difference among the cases and controls with reference to the age. The significant difference is there in BMI, WHR, B12 level, (Mean and SD) between cases and control. Conclusion: In our study, blood levels of B12 is a conjunct parameter with Homocysteine to predict risk for CVD, the relationship between elevated vitamin B12 and CVD is causal and probably due to multiple, potentially synergistic, pathogenetic mechanisms. Measurement of blood vitamin B12 is recommended for risk assessment in CVD patients.
Keyword: Postoperative analgesia patient-controlled epidural analgesia patient-controlled intravenous analgesia.
Keyword: Postoperative analgesia patient-controlled epidural analgesia patient-controlled intravenous analgesia.
2. POSTOPERATIVE ANALGESIA AFTER MAJOR ABDOMINAL SURGERY: INFLUENCE OF FENTANYL- BUPIVACAINE PATIENT CONTROLLED EPIDURAL ANALGESIA VS FENTANYL PATIENT CONTROLLED INTRAVENOUS ANALGESIA 6-13
Dr Abeezar Hussain PDF FULL TEXT
Dr Abeezar Hussain PDF FULL TEXT
ABSTRACT
Background - Patient-controlled epidural analgesia with Local anaesthetics either alone or in combination with opioids and patient controlled analgesia with intravenous opioids are two clinical ways to tackle postoperative pain after major surgeries. This prospective, randomized clinical study was conducted to compare these two ways in regards to pain control, sedation score , overall patient satisfaction & complications after major abdominal surgeries. Methods: 70 patients with ASA grade I & II aged 25-65 yrs of either sex were randomized to EPCA group - patient-controlled epidural analgesia with fentanyl–bupivacaine IVPCA group - patient controlled intravenous analgesia with fentanyl . Parameters monitored were pain scores, rescue analgesia required, sedation scores, complications & overall patient satisfaction. Results: Both the groups were comparable with regards to demographic characteristics, hemodynamic variables at baseline, duration of surgery .While in Group IVPCA ,immediate postoperative pain was statistically significantly less observed (p<0.05). In Group EPCA , pain was statistically significantly less noted at 2hr, 4hr, 8hr & 12 hrs as compared to Group IVPCA(p<0.05) . In context to sedation scores, Group IVPCA observed higher sedation scores, at immediate postoperative period , with no difference statistically at 2, 4, 8,12 & 24 hrs (p<0.05). Minimal adverse events of nausea ,vomiting, pruritis & shivering were noted. The average overall patient satisfaction score in Group EPCA & Group IVPCA was 9 and 6 respectively. The overall patient satisfaction was statistically significantly higher in Group EPCA (p<0.05). Conclusion: Both epidural & intravenous groups were effective in postoperative pain management after major abdominal surgery . The patient controlled analgesia via epidural route provided better pain relief, less sedating effects , minimal side effects & enhanced overall patient satisfaction.
Keywords- Patient controlled analgesia ,Epidural analgesia , Intravenous analgesia , Patient satisfaction
Keywords- Patient controlled analgesia ,Epidural analgesia , Intravenous analgesia , Patient satisfaction
ABSTRACT
Chikungunya, is a vector borne disease, epidemics were reported and various studies were conducted to halt its diseases cycle and implement the vector control measures. The diseases burden is widely distributed among subtropical, tropical and monsoon zones worldwide along with cultural and socio-economic factors. Chikungunya is present as an acute illness, with fever, skin rash and incapacitating arthralgia as its salient feature.Material & Methods: The present prospective study was conducted at department of general medicine of our tertiary care hospital. The study duration was of one year and sample size of 50 was calculated at 95% confidence interval at 5% acceptable margin of error. All patients who were diagnosed with chikungunya were enrolled from outdoor department and from ward by simple random sampling. Results: In the present study, the most presenting symptom was fever and arthralgia which were present in 100% of cases which were followed by headache and body ache which was present in 98% cases, followed by nausea and vomiting in 70% cases. weakness was present among 64% patients and abdominal pain was present in 32% patients. Splenomegaly was the most common organomegaly finding, which was present in 24% patients which was followed by hepatomegaly was present in 20% patients. Among 8 patients there was both Hepato-splenomegaly present. In present study, none of patients had cardio-vascular symptoms and complications. Out of the total patients, serum urea levels were in normal limits however, serum creatinine values were higher among 8% of patients. There was no other morbidity and mortality reported in present study. Conclusion: We concluded from the present study that majority of patients had fever and arthralgia which were present in 100% of cases which were followed by headache and body ache which was present in 98% cases, followed by nausea and vomiting in 70% cases. weakness was present among 64% patients and abdominal pain was present in 32% patients.
Keywords: Chikungunya, Clinical feature, Epidemic.
Keywords: Chikungunya, Clinical feature, Epidemic.
4. OCULAR TRAUMA SCORE IN CLINICAL PRACTICE: A PROSPECTIVE STUDY OF MECHANICAL EYE INJURIES IN INDIA 20-26
Dr.Yash Rajubhai Gandhi PDF FULL TEXT
Dr.Yash Rajubhai Gandhi PDF FULL TEXT
ABSTRACT
Background: Ocular trauma is a major cause of visual impairment, with mechanical injuries being particularly severe. This study evaluates the prognostic value of the Ocular Trauma Score (OTS) in predicting visual outcomes in patients with mechanical eye injuries. Methods: A prospective observational study was conducted at a tertiary care center in Udaipur, India, over one year, involving 100 patients. Clinical parameters were assessed, and OTS was calculated based on standardized criteria. Outcomes at six months were correlated with initial OTS scores to evaluate visual prognosis. Results: Of the 100 patients, most were males (76%) aged 21–50 years. Hyphema (67%) was the most common associated factor, with metallic objects being the leading cause of injury (52%). Patients with OTS 1 (scores 0–44) had poor visual outcomes, with 70% showing no light perception, while 93% of OTS 5 (scores 92–100) achieved near-normal vision (≥20/40). Results highlight a strong correlation between higher OTS scores and favorable visual outcomes. Conclusion: The OTS is a practical and reliable tool for predicting visual recovery in mechanical eye injuries, aiding clinical decision-making and patient counseling. The study underscores the need for standardized protocols in managing ocular trauma in resource-limited settings.
Keywords: Ocular Trauma Score, Mechanical Eye Injuries, Visual Prognosis, Hyphema, Visual Acuity, Prognostic Tool.
Keywords: Ocular Trauma Score, Mechanical Eye Injuries, Visual Prognosis, Hyphema, Visual Acuity, Prognostic Tool.
5. ASSOCIATION OF SOCIODEMOGRAPHIC AND CLINICAL FACTORS WITH METABOLIC ABNORMALITIES IN UROLITHIASIS 27-33
Dr. Ritesh Mehta PDF FULL TEXT
Dr. Ritesh Mehta PDF FULL TEXT
ABSTRACT
Background: Urolithiasis is a prevalent urological disorder characterized by kidney stone formation, influenced by multiple metabolic, sociodemographic, and clinical factors. Understanding the association between metabolic abnormalities and urolithiasis is crucial for developing effective prevention and management strategies. Objectives: This study aimed to evaluate the relationship between sociodemographic characteristics, clinical parameters, and metabolic abnormalities in urolithiasis patients. The primary focus was to identify key metabolic risk factors contributing to stone formation and their association with comorbidities. Methods: A cross-sectional study was conducted at a tertiary care hospital from January 2020 to December 2020. A total of 150 adult patients were screened, and 100 were included after excluding those on medications affecting urinary metabolic profiles. Sociodemographic and clinical data were collected through structured interviews and medical record reviews. Blood and 24-hour urine samples were analyzed for metabolic abnormalities, including hypercalciuria, hypocitraturia, hyperoxaluria, and hyperuricosuria. Statistical analysis was performed using SPSS version 26.0, with multiple logistic regression to identify independent predictors. Results: Hypercalciuria (52%) and hypocitraturia (43%) were the most common metabolic abnormalities, followed by hyperoxaluria (35%) and hyperuricosuria (31%). Overweight and obesity were observed in 60% of patients. Comorbid conditions, including hyperlipidemia (29%), hypertension (26%), and diabetes mellitus (15%), were significantly associated with metabolic abnormalities. Conclusion: Metabolic disorders play a significant role in urolithiasis. Comprehensive metabolic evaluation, lifestyle modifications, and targeted interventions are essential to reduce stone recurrence. Further longitudinal studies are required to establish causal relationships and optimize management strategies.
Keywords: Urolithiasis, Metabolic Disorders, Hypercalciuria, Hypocitraturia, Kidney Stones, Risk Factors
Keywords: Urolithiasis, Metabolic Disorders, Hypercalciuria, Hypocitraturia, Kidney Stones, Risk Factors
6. PROGNOSTIC ACCURACY OF CSF LACTATE COMPARED WITH CONVENTIONAL MARKERS IN NEUROSURGICAL PATIENTS WITH MENINGITIS 34-39
Dr.Vijay Kataria PDF FULL TEXT
Dr.Vijay Kataria PDF FULL TEXT
ABSTRACT
Background: Postoperative meningitis remains a significant complication following neurosurgical procedures, with early diagnosis and prognosis assessment being crucial for patient outcomes. Cerebrospinal fluid (CSF) lactate levels have emerged as potential biomarkers for bacterial meningitis, but their prognostic value in postoperative neurosurgical patients requires further investigation. Objective: To evaluate the prognostic significance of CSF lactate levels in predicting clinical outcomes in postoperative neurosurgical patients who develop meningitis. Methods: This retrospective cohort study analyzed 156 postoperative neurosurgical patients who developed meningitis between January 2017 and December 2019. CSF samples were collected within 24 hours of clinical suspicion. Primary outcomes included 30-day mortality, length of hospital stay, and Glasgow Outcome Scale scores at discharge. CSF lactate levels were measured using enzymatic assays and correlated with clinical outcomes using multivariate regression analysis. Results: Mean CSF lactate levels were significantly higher in patients with poor outcomes compared to those with favorable outcomes (8.2 ± 3.4 vs 4.1 ± 2.1 mmol/L, p<0.001). CSF lactate >6.5 mmol/L demonstrated 85% sensitivity and 78% specificity for predicting poor neurological outcomes. Multivariate analysis revealed CSF lactate as an independent predictor of mortality (OR 2.34, 95% CI 1.45-3.78, p<0.001). Conclusion: CSF lactate levels serve as reliable prognostic indicators in postoperative neurosurgical patients with meningitis, providing valuable information for clinical decision-making and family counseling regarding expected outcomes.
Keywords: cerebrospinal fluid lactate, postoperative meningitis, neurosurgery, prognosis, biomarker
Keywords: cerebrospinal fluid lactate, postoperative meningitis, neurosurgery, prognosis, biomarker
7. EFFICACY AND SAFETY OF TRANSDERMAL DICLOFENAC VERSUS KETOPROFEN IN POSTOPERATIVE PAIN MANAGEMENT FOLLOWING ORTHOPAEDIC PROCEDURES 40-45
Dr. Vishal Jain PDF FULL TEXT
Dr. Vishal Jain PDF FULL TEXT
ABSTRACT
Background: Effective postoperative analgesia is crucial for early mobilization, patient satisfaction, and prevention of chronic pain. Transdermal drug delivery systems offer a non-invasive, sustained release of analgesics while avoiding gastrointestinal and systemic adverse effects of oral and parenteral non-steroidal anti-inflammatory drugs (NSAIDs). Among NSAID patches, diclofenac and ketoprofen are commonly used, but comparative evidence regarding their efficacy in lower limb orthopaedic surgery remains limited. Objective: To compare the analgesic efficacy, onset and duration of pain relief, opioid-sparing effects, and safety profile of single-dose transdermal diclofenac and ketoprofen patches in patients undergoing lower limb orthopaedic surgeries. Materials and Methods: A prospective, randomized, double-blind, controlled clinical study was conducted on 60 adult patients (ASA I–II) undergoing elective lower limb orthopaedic surgery under spinal anaesthesia. Patients were randomized into two groups: Group D received a 100 mg diclofenac transdermal patch, and Group K received a 20 mg ketoprofen patch applied 2 hours before surgery. Postoperative pain scores (VAS), time to first rescue analgesia, total rescue analgesic consumption within 24 hours, hemodynamic parameters, and adverse events were recorded. Results: Both diclofenac and ketoprofen patches provided effective postoperative analgesia. Group K showed significantly lower mean VAS scores at 6 and 12 hours (p < 0.05), longer mean duration of analgesia before first rescue analgesic (8.2 ± 1.1 h vs 6.9 ± 1.3 h, p < 0.01), and reduced total rescue analgesic requirement (65 ± 15 mg vs 85 ± 18 mg tramadol, p < 0.01). Hemodynamic stability was maintained in both groups, with mild gastrointestinal discomfort observed in 2 patients of Group D and local erythema in 1 patient of Group K. Conclusion: Both diclofenac and ketoprofen transdermal patches are effective non-invasive alternatives for postoperative analgesia in lower limb orthopaedic surgery. However, ketoprofen provides longer analgesic duration, reduced rescue analgesic need, and better pain control, suggesting it may be a superior option in this setting.
Keywords: Diclofenac, Ketoprofen, Transdermal patch, Postoperative analgesia, Orthopaedic surgery
Keywords: Diclofenac, Ketoprofen, Transdermal patch, Postoperative analgesia, Orthopaedic surgery
7. WHO MODIFIED PARTOGRAPH AND ITS CLINICAL IMPACT ON DELIVERY MODE AND NEONATAL OUTCOMES IN PRIMIGRAVIDAS 46-53
Dr. Mansi Gupta PDF FULL TEXT
Dr. Mansi Gupta PDF FULL TEXT
ABSTRACT
Background: The World Health Organization (WHO) modified partograph serves as a vital tool for monitoring labor progress and detecting complications early in spontaneous labor. Primigravidas are particularly vulnerable to prolonged labor and associated complications, making effective labor monitoring crucial for maternal and neonatal outcomes. Objective: To evaluate the effectiveness of WHO modified partograph in managing spontaneous labor in primigravidas and assess its impact on maternal and neonatal outcomes. Methods: A prospective observational study was conducted at a tertiary care hospital from January 2018 to December 2019. A total of 350 primigravid women in spontaneous labor at term were included. Labor progress was monitored using WHO modified partograph, and outcomes were analyzed including duration of labor, mode of delivery, maternal complications, and neonatal outcomes. Results: The mean maternal age was 24.2 ± 3.8 years. Normal vaginal delivery occurred in 68.3% of cases, while 31.7% required operative intervention. Labor crossing alert line was observed in 22.9% cases and action line in 8.6% cases. Women whose labor progressed normally had significantly shorter labor duration (8.4 ± 2.1 hours) compared to those crossing alert line (12.8 ± 3.4 hours, p<0.001). APGAR scores <7 at 5 minutes were significantly higher in cases crossing action line (18.7% vs 3.2%, p<0.001). Conclusion: WHO modified partograph is an effective tool for early detection of abnormal labor progress in primigravidas, enabling timely intervention and improving maternal and neonatal outcomes. Its routine use should be encouraged in all labor monitoring protocols.
Keywords: Partograph, primigravida, labor monitoring, maternal outcomes, WHO
Keywords: Partograph, primigravida, labor monitoring, maternal outcomes, WHO
7. PROPENSITY SCORE-MATCHED OUTCOMES OF ACTIVE CHEST TUBE CLEARANCE IN CARDIAC SURGICAL PATIENTS 54-60
Dr.Palkesh Agarwal PDF FULL TEXT
Dr.Palkesh Agarwal PDF FULL TEXT
ABSTRACT
Background: The World Health Organization (WHO) modified partograph serves as a vital tool for monitoring labor progress and detecting complications early in spontaneous labor. Primigravidas are particularly vulnerable to prolonged labor and associated complications, making effective labor monitoring crucial for maternal and neonatal outcomes. Objective: To evaluate the effectiveness of WHO modified partograph in managing spontaneous labor in primigravidas and assess its impact on maternal and neonatal outcomes. Methods: A prospective observational study was conducted at a tertiary care hospital from January 2018 to December 2019. A total of 350 primigravid women in spontaneous labor at term were included. Labor progress was monitored using WHO modified partograph, and outcomes were analyzed including duration of labor, mode of delivery, maternal complications, and neonatal outcomes. Results: The mean maternal age was 24.2 ± 3.8 years. Normal vaginal delivery occurred in 68.3% of cases, while 31.7% required operative intervention. Labor crossing alert line was observed in 22.9% cases and action line in 8.6% cases. Women whose labor progressed normally had significantly shorter labor duration (8.4 ± 2.1 hours) compared to those crossing alert line (12.8 ± 3.4 hours, p<0.001). APGAR scores <7 at 5 minutes were significantly higher in cases crossing action line (18.7% vs 3.2%, p<0.001). Conclusion: WHO modified partograph is an effective tool for early detection of abnormal labor progress in primigravidas, enabling timely intervention and improving maternal and neonatal outcomes. Its routine use should be encouraged in all labor monitoring protocols.
Keywords: Partograph, primigravida, labor monitoring, maternal outcomes, WHO
Keywords: Partograph, primigravida, labor monitoring, maternal outcomes, WHO
