Research Article
Open Access
Anatomical Study of Axillary Artery and Its Branching Pattern
Pages 574 - 578

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Abstract
Background: Axillary artery is the principal arterial source for the upper limb, and is in intimate relation with components of Brachial plexus. Anatomical variations in the course and branching pattern of Axillary artery are highly appreciated in the literature. Objectives: the present study is designed to confront and to add on to the existing knowledge on the anatomical variations and to study the branching pattern of Axillary artery. Materials: Dead Fetuses and Cadavers from the Department of Anatomy were used in this study. Results: Variations were recorded in the course and number of branches of Axillary artery and in their sites of origin from the main arterial stem. Conclusion: These anatomical variations are quite interesting and are profound importance for the Cardiac physicians, vascular, plastic and neuro surgeons.
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Research Article
Open Access
Attenuation of hemodynamic responses to endotracheal extubation with different doses of Diltiazem with Lignocaine: A randomized control study
Pages 562 - 573

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Abstract
Background: Endotracheal extubation is one of the frequently performed procedure in the practice of Anaesthesia. This study was done to observe the haemodynamic responses during tracheal extubation and to compare the efficacy of IV diltiazem 0.3 mg/kg wih IV Lidocaine 1 mg/kg versus 0.2 mg/kg and 0.1 mg /kg IV Diltiazem with 1mg/kg IV Lignocaine in attenuating the hemodynamic response to tracheal extubation.
Methods: 120 patients aged 20 to 60 yrs, belonging to ASA I and II, normotensive were included in the study and they were randomly allocated into 3 groups of 40 each.
•Group –I The patient who receive injection Diltiazem 0.1mg/kg and inj Lignocaine 1mg/kg i.v. (n=40)
• Grade –II The patients who receive injection Diltiazem 0.2mg/kg and inj.Lignocaine 1mg/kg i.v. (n=40)
•Group -III The patients who receive injection Diltiazem 0.3mg/kg and inj.Lignocaine 1mg/kg i.v. (n=40) 2 min before extubation. At the end of the surgery, heart rate (HR), systolic blood pressure (SBP) diastolic blood pressure (DBP) and mean arterial pressure [MAP] were recorded served as base line values.
Results: After tracheal extubation, all the haemodynamic parameters increase from base line ,0.3 mg/kg inj. Diltiazem along with 1mg/kg inj Lignocaine provide better haemodynamic stability when compared with 0.1 mg/kg and 0.2 mg/kg inj Diltiazem along with inj. Lignocaine 1mg/kg each. 0.2 mg/kg inj.Diltiazem along with 1mg/kg inj Lignocaine provide better haemodynamic stability when compared with 0.1 mg inj Diltiazem with inj. Lignocaine 1mg/kg.
Conclusions: Based on the findings of our study, we concluded that combination effect of Inj. Lignocaine and Inj. Diltiazem, Attenuate the hemodynamic response to extubation.
0.3mg/kg Diltiazem with 1mg/kg Lignocaine is superior to 0.2mg/kg and 0.1 mg/kg Diltiazem with 1mg/kg Lignocaine in attenuating the hemodynamic response to extubation.
0.2mg/kg Diltiazem with 1mg/kg Lignocaine is superior to 0.1mg/kg Diltiazem with 1mg /kg lignocaine in attenuating the hemodynamic response to extubation.
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Further studies are required to evaluate the advantage, beneficial effect and safety of Diltiazem in comparison with other drugs when used for the purpose of attenuating the hemodynamic changes associated with extubation.
Research Article
Open Access
Clinicopathological study of 6 cases of Adrenal myelolipoma
Pages 556 - 561

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Abstract
Adrenal myelolipoma is an infrequent benign lesion characterized by the presence of mature adipose tissue and hematopoietic precursor cells. Typically, it is discovered incidentally on CT/MRI scans or during autopsies, occurring in only 0.08 to 0.4% of cases. Adrenal myelolipomas are mostly asymptomatic, non-functioning, small, unilateral adrenal tumors commonly detected as incidental findings in imaging studies. This study presents the clinicopathological characteristics of six cases of adrenal myelolipomas treated at HCG Cancer hospital and ESIC Medical College and Hospital. These cases are noteworthy due to their rarity and considerable size. Of particular concern is the increasing incidence of large adrenal myelolipomas (>10 cm) leading to life-threatening retroperitoneal hemorrhage and other complications, including abscess formation. Materials and Methods: Over a span of five years, we examined six cases of adrenal myelolipoma received at the Department of Pathology in HCG Cancer hospital and ESIC Medical College and Hospital. Following thorough gross examination, representative tissue samples were subjected to histopathological analysis. We evaluated the clinicomorphological features of these cases and compared them with findings from related studies. Results: All six cases were associated with known diabetes and hypertension. The age of the patients ranged from 55 to 70 years, and the tumors exhibited sizes ranging from 5 cm to 10.5 cm. On external examination, the tumors displayed a globular appearance with gray-brown areas, while the cut surfaces revealed gray-brown to gray-yellow areas. One of the tumors exhibited evidence of hemorrhage, and one case was concomitant with adrenal cortical hyperplasia. Conclusion: Adrenal myelolipoma is a rare, benign tumor, and histopathological examination is essential for confirming its diagnosis and distinguishing it from other adrenal and renal lesions.
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Research Article
Open Access
A Study of Epidemiology and Demographic Characteristics of Dengue and Chikungunya Virus
Pages 550 - 555

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Abstract
Introduction: Arboviruses are growing concern for state and central health authorities in India. Prevention of arbovirus infections or to break the chain of infection valuable strategy is by vector control measures. However, it's not effective to control the country's mosquito population. The primary aim of this study was to analyse the epidemiology and demographic characteristics of dengue and chikungunya. Materials And Methods: In this prospective study patients presenting with clinical features suggestive of dengue and chikungunya data was collected. Specimens about 5 ml of blood from each patient were collected for serological testing. Results: The mean age of dengue and chikungunya positive patients was 34.8±2.34 and 43±4.21 respectively with a slight male predominance. Dengue confirmed cases count increased in August and September and more number of cases was noted from November to January. Whereas, Chikungunya confirmed cases didn’t show any much seasonal variation during the studied years. 49.7% positives were detected as IgM antibodies, 28.57% were tested as NS1 antigen positive and remaining 21.6% positives were detected as both NS1 and IgM antibodies. Conclusion: South India region is endemic for dengue & chikungunya, research studies on incidence, demographic parameters and transmission dynamics will be useful for central and state government authorities to implement protocols like vector control measures, early diagnostic testing and health education at higher level.
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Case Report
Open Access
Case of Essential Thrombocytosis Presenting with Proximal Aortic Thrombosis and Spinal Cord ischemia
Pages 546 - 549

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Abstract
Background: Essential Thrombocytosis is a clonal hematopoietic stem cell disorder that causes increased platelet production. Patients are at risk of microvascular thrombosis and hemorrhage. Essential Thrombocytosis is a diagnosis of exclusion. We reported a case of Essential Thrombocytosis in 42 years female, where initial platelet count of 17 lakhs was reduced to post procedure count of 7.6 lakhs. Treatment consists of aspirin, platelet-lowering drugs (e.g., hydroxyurea, interferon, anagrelide), plateletpheresis, cytotoxic agents & rarely stem cell transplantation. The most important first step in the management of ET is to confirm the accuracy of the diagnosis and make sure that other myeloid neoplasms, which might mimic Essential Thrombocytosis in their presentation are excluded.
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Research Article
Open Access
A Comparative Study of Low Dose Bupivacaine and Fentanyl with Plain Bupivacaine in Spinal Anaesthesia for Transurethral Prostatectomy
Pages 534 - 539

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Abstract
Background: TURP has long been considered the gold standard for the surgical treatment of BPH. Spinal anesthesia is considered the anesthetic technique of choice when traditional M-TURP is performed [1]. Spinal anesthesia provides adequate anesthesia for the patient with relaxation of the pelvic floor and perineum for the sur¬geon. In this study the efficacy of intrathecal 0.5% hyperbaric Bupivacaine (12.5mg) and intrathecal 0.5%hyperbaric Bupivacaine (10mg) with 25 μg of Fentanyl were compared. Materials and methods: This study comprised of 70 male patients, of ASA grades II– III, between the age group 50 and 80 years, planned for elective Transurethral Resection of Prostate (TURP) who were randomly divided into group B (n=35) & group F(n=35). Group B – received 2.5ml of 0.5%hyperbaric Bupivacaine (12.5mg) intrathecally. Group F – received 2ml of 0.5% hyperbaric Bupivacaine(10mg) + 25μg Fentanyl intrathecally. Intra–operative hemodynamic parameters, onset of sensory and motor block, total duration of sensory and motor blockade, time for two segment regression, total duration of perioperative analgesia were recorded. Patients were observed for 72 hours post-operatively to look for any complications. Result: Time for onset of sensory (Group B 3.4±1.2 mins vs Group F 2.5±1.1 mins) & motor blockade (Group B 8.4±1.7 mins vs Group F 6.5±1.5 mins) was faster in group F compared to group B. Two segment sensory block regression time (Group B 65±8.4 mins vs Group F 75±10.9 mins) was relatively longer in group F. Duration of sensory (Group B 186±15 mins vs Group F 210±22 mins) & motor blockade (Group B 155±9.7 mins vs Group F 165±7.5 mins) was longer in group F. Duration of perioperative analgesia (Group B 210±18.5 mins vs Group F 235±25.6 mins) was longer in group F. Hemodynamic parameters between both the groups were comparable. Conclusion: Fentanyl as an adjuvant to bupivacaine when used in spinal anesthesia had showed early onset of sensory & motor blockade, prolonged perioperative analgesia, and showed good hemodynamic stability without significant adverse effects. Use of 25µg of Fentanyl as an adjuvant to low dose Bupivacaine (10mg) showed enhanced efficacy in spinal anaesthesia for TURP procedures.
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Research Article
Open Access
Hypomagnesemia in Patients with Diabetes Mellitus and Its Relation to Diabetes Mellitus Complications
Pages 529 - 533

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Abstract
Background: Diabetes mellitus is the most common disorder among endocrine disorders that are associated with hypomagnesemia. So far many studies have shown that Mg levels are lower in diabetic patients. According to CARDIA Study (Coronary Artery Risk Development in young Adults) there was an inverse relationship between Mg intake and the incidence of diabetes. Mg depletion may cause an insulin-resistant state, poor glycemic control and disordered lipid metabolism in diabetic patients. Furthermore, poor glycemic control in diabetic patients is a well-known risk factor for Mg depletion. Serum Mg depletion has been reported in diabetic patients who had advanced retinopathy and poor glycemic control. It has been shown that diabetic patients, hypomagnesemia has been associated with poor glycemic control and urine albumin excretion and complications Material And Methods This study was conducted for 1 year in the outpatient department of General Medicine, A. J. Institute of Medical Sciences and Research Centre, Mangalore starting from September 2019 to August 2020. Hospital based Observational study was conducted among 117 individuals. Diabetic patients were observed and serum magnesium levels were monitored. 23 patients were observed to have hypomagnesemia and the rest 92 were found to have normal serum magnesium levels. The results were analyzed using student ‘t’ test. Results The mean age in the hypomagnesemia group was 61.92 SD + .8.76, and in those with normal magnesium levels it was 60. 79 years SD + 8.90 years. In the hypomagnesemia group 52% were females and 48% were males and in those who had normal magnesium levels, 31.52%were females and 68.48% were males. 64 % in hypomagnesemia group and 12.77%, in the normal magnesium group had complications. The mean potassium in the normal magnesium group was 4.606 mEq/dl, hypomagnesemia group was 3.096 mEq/dl. The mean sodium in the normal magnesium group was 133.48 mEq/dL and in the hypomagnesemia group was 130.03 mEq/dL. Conclusion Prevalence of hypomagnesemia in diabetics is 25%. Prevalence of hypomagnesemia is significantly higher in patients with diabetic complications. Hypomagnesemia is significantly associated with glycemic control and potassium levels. No significant association was found to exist between hypomagnesemia, age and gender.
Research Article
Open Access
Third trimester sonographic evaluation in cases with repeated caesarean section; Sonographic “sliding” sign in pre-operative detection of viscera-peritoneal adhesions: Single-center cohort study
Pages 520 - 528

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Abstract
Introduction: Dense adhesions may cause prolonged surgery, injury to bowel, or bladder, and also excessive bleeding , during adhesiolysis and entry to abdominal cavity, especially when these procedures are performed by inexperienced surgeons as assistant doctors at training hospital Aims: Aim to study preoperative detection of adhesions by sonographic sliding sign and determines its accuracy rate which will highlight its effectiveness in prevention of the complications during C- section. Materials and methods: This was a prospective observational study conducted at the Department of Obstetrics and Gynaecology, Izmir Katip Celebi University, Ataturk Training and Research Hospital in 70 full term pregnant women with history of C- section, included in this study. All patients were admitted to our clinic for elective C-section and sonographic evaluation done preoperatively to assess the “sliding sign “for detection of adhesions between uterus and abdominal wall. Results: Our analysis shows that significant positive sliding sign in intraoperative adhesions, so the accuracy rate is 77.4%, which can be assumed as optimal. Other characteristics found to have no correlation with the adhesions and hgb drop level. Haemoglobin drop degree is also correlate with the sliding sign. The predictivity of hgb drop more than >2 g/dl has the highest correlation with the sliding sign. Accordingly, the sensitivity, specificity, PPV and NPV of sliding sign in predicting marked intra-operative adhesions were 87.5%, 62.5%, 77.7% and 76.9% respectively. The median of delivery time (time from skin incision till delivery of baby) was significantly longer in patients with negative sliding sign compared to those with positive sliding sign (18 minutes versus 8 minutes) Conclusion: The sliding sign by ultrasound has a sensitivity of 87.5%, specificity of 62.5%, a positive predictive value of 77.7%, a negative predictive value of 76.9%, and accuracy of 77.5%, considering it rapid, easy and reliable method for prediction of intraperitoneal adhesions.
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Research Article
Open Access
Role of Placental Growth Factor and Uterine Artery Doppler Velocimetry in Prediction of Early Onset of Preeclampsia
Pages 514 - 519

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Abstract
Background: One form of hypertension in pregnancy is preeclampsia, which is characterized by blood pressure ≥ 140/90 mm of Hg and protein in urine at gestational age after 20 weeks. Preeclampsia is a global problem affecting 2-8% of pregnancies, and an estimated 8.3 million pregnant women experience preeclampsia every year. In this review we will look at potential biomarkers and its correlation with uterine artery Doppler for early prediction and diagnosis of preeclampsia. Aim: To investigate the role of placental growth factor, and uterine artery diastolic notch to predict the early onset of preeclampsia. Materials And Methods: A hospital based prospective study conducted on 100 normotensive, non- proteinuric antenatal women less than 20 weeks of gestation were recruited. At 12-16 weeks, PLGF level was estimated from stored serum samples of all cases ad Doppler assessment of uterine circulation for uterine artery indices were done. These women were again rescanned at 24 weeks of gestation by transabdominal USG and further followed up clinically for development of preeclampsia. Methods used for the detection of PLGF is ELISA kit ad Uterine artery Doppler velocimetry was done by transabdominal ultrasound machine using a 4-6 MHz probe with the same sonographer Results: In this study,the median PLGF levels being significantly lower in pre-eclampsia cases (15 pg/ml) compared to normal (20.0pg/ml) with sensitivity being 90% and specificity being 23.4%, positive predictive value of 15.5% and negative predictive value of 93.8%. When Uterine arteries notch and RI >0.65 taken together increases sensitivity by 85.71%, 84.62% specificity and negative predictive value by 98.25%. We found 52.3% sensitivity rate and 84.62% specificity with 70.51% of Negative predictive value regarding Uterine arteries PI at >0.9573 with Optimal Cut off. Conclusion: The combined measurement of maternal serum PlGF concentrations and The uterine artery notching, high Resistance Index and Pulsatility Index in uterine artery Doppler waveform at <20 weeks has shown as best screening test for early prediction of preeclampsia.
Research Article
Open Access
Evaluate the Quality of Sleep in Pregnant Women at Tertiary Care Center
Pages 500 - 513

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Abstract
Background: Pregnancy-associated physiological and hormonal changes are known to contribute to increased prevalence and severity of sleep complaints and disorders. Aims: To evaluate the quality of sleep (according to PSQI score <5 and >5) in pregnant women and fetal outcomes. Materials and methods: The current study was conducted in the Department of Obstetrics and Gynaecology on pregnant women who visited O.P.D for antenatal visits. It is a descriptive, prospective and observational type of study. The duration of study was 1 year from 1st Jul 2017 to 30th June 2018 on all pregnant women who were in their first trimester which were further followed up to post-partum period. Results: APGAR at 1min, Mild Asphyxia was observed in 48.22% cases and severe Asphyxia was observed in 2.03% cases. The cases in poor quality sleep were 67.01% in 1st trimester followed by a decrease in 2nd trimester (42.13%) than again increase (84.77%) than further decrease in Postpartum period. This finding was statistically significant (P<0.001S). Score was significantly higher in LSCS, as compared to Normal delivery (P<0.001S). Although the PSQI score was higher in preterm as compared to Term Pregnancy. It was significant at 3rd Trimester. PSQI score was higher in <2.5 kg baby weight at birth as compared to ≥2.5 kg weight baby (P<0.001S). APGAR score at one minute was normal (7-10) among 93.33% of the good sleep group. PSQI score was higher in cases with NICU admission as compared to absence of NICU Admission (P<0.001S). PSQI score was higher in cases with Prolonged labour(>20hrs) as compared to normal labour(<20 hrs) but it was observed significant at 3rd trimester (P=0.048S). Significant correlation was observed with PSQI Score at 1st , 2nd , 3 rd Trimesters and post partum period with birth weight (r=-262, poor, negative correlation). No Significant correlation was observed with PSQI Score at 1st , 2nd and 3 rd Trimesters and post partum period with age, gravida, parity, Period of gestation at the time of delivery and duration of labour. Conclusion: During the analysis, we have also found a significant relationship between poor quality of sleep with poor fetal outcomes:
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Research Article
Open Access
Pathological study on osteolytic lesions of bone in a tertiary care centre
Pages 496 - 499

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Introduction: Bone lesions may present a diagnostic challenge to the histopathologists. Proper evaluation requires correlation of age, clinical presentation, site and imaging. In this study we aimed to evaluate the osteolytic lesions of the bone reported at the department of pathology in a tertiary care hospital. Material and Methods: We performed a retrospective study over a period of 5 years from 2018 to 2023. Osteosclerotic lesions were excluded from our study. The lesions were classified as non-neoplastic lesions, tumour like lesions, benign lesions and malignant lesions. Results: Over 5 years, 100 cases of osteolytic lesions of bone were reported. Of these, 37% were non-neoplastic lesions. The most common sites of osteolytic lesions were the femur, tibia and humerus. The most frequent histological diagnosis was giant cell tumour followed by chronic osteomyelitis and osteosarcoma. The most common benign neoplasm was giant cell tumour, and osteosarcoma was the predominant malignant lesion. Conclusion: Benign neoplasms are the most common osteolytic lesions. Bones of the extremities are the most frequent sites of involvement by both benign and malignant tumours. In addition to radiological correlation, a thorough knowledge of the age, sex and site of the common bone lesions were required for a correct histopathological diagnosis, so that proper treatment can be instituted. Most of these lesions do not require IHC for the diagnosis.
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Research Article
Open Access
Diagnostic Laparoscopy In Chronic Abdominal Pain: A Prospective Study
Pages 492 - 495

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Abstract
Background: To identify the different unidentified causes of chronic stomach pain. To evaluate the diagnostic laparoscopy's efficacy in cases of persistent abdominal pain. To assess the effectiveness of laparoscopy in the treatment of persistent abdominal pain. Method: This prospective descriptive cross-sectional study enrolled 40 consecutive chronic abdominal pain patients between May 2022 to April 2022. They were chosen from the Sri Venkateswaraa Medical College Hospital & Research Centre, Puducherry, India, general surgery outpatients for the research. Result: Appendicectomy 30%, adhesiolysis 20%, and hernioplasty 10% were performed in 54% of patients. 18% of patients exhibited enlarged mesenteric nodes in the terminal ileum that were biopsied and revealed nonspecific adenitis. Study found 8% of patients with negative laparoscopy. Conclusion: Diagnostic laparoscopy is beneficial in chronic stomach pain, revealing underlying problems. Chronic abdominal discomfort sufferers benefit from diagnostic laparoscopy. After a full diagnostic evaluation, it should be considered. Diagnostic laparoscopy can treat several problems surgically. It is safe and useful for diagnosing chronic stomach discomfort and guiding treatment.
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Research Article
Open Access
To Study of Dilated Cardiomyopathy and Echocardiography: A Cross Sectional Study
Pages 486 - 491

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Abstract
Background: Cardiomyopathies are conditions that affect the heart muscle and can be caused by genetic flaws, damage to the heart's myocytes, or infiltration of myocardial tissues. The most prevalent phenotype and frequently the last common pathway of many cardiac injuries is dilated cardiomyopathy. In the lack of echocardiography, histology, and genetic testing, it is mostly unknown. Material and Methods: This was an analytical cross-sectional study of hospital data on Echocardiographic findings in 60 DCM patients who visited the cardiology unit for Echocardiographic evaluation between the May 2022 to April 2023 in Department of General Medicine, Sri Venkateswaraa Medical College Hospital & Research Centre, Puducherry, India. Patients under the age of 18 and those who refused to give consent were excluded. Results: Among the 60 patients enrolled, 40 were male and 20 were female, resulting in a male to female ratio of 1.6:1. Elderly persons (61-75 years old) with an average age of 60 were frequently involved, and the majority of them had congestive heart failure, 32. An echocardiogram revealed that 28 had a slightly dilated Left Ventricle. With an average Ejection fraction of 39.6%, the majority showed impaired Left Ventricular Systolic Function. There was no significant difference in average EF% between male and female, and there was no significant relationship between age and average EF%. Conclusion: The most prevalent cardiomyopathy phenotype is dilated cardiomyopathy, which is characterized by congestive heart failure. It is frequently misdiagnosed in our part of the world, but echocardiography can easily detect it.
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Research Article
Open Access
The Association of Body Mass Index with Airway Indices for depiction of difficult Airway- A Demographic Study
Pages 478 - 485

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Abstract
Introduction: Airway management is a basic aspect of anesthesia practice and critical care medicine. The relationship between airway indices and BMI mostly seen in terms of obesity, there is also conflicting evidence regarding this. So this study will try to resolve the disagreement in result associating obesity with difficult airway and also envisage the broader aspect by finding association between BMI and airway indices. Material and Methods:Two hundred adult participants aged between 20 to 55 yrs. of age of both sexes going through pre-anaesthtic check-up (PAC) for variety of surgeries at MIMS, Barabanki, were enrolled in this quantitative prospective observational study after meeting inclusion and exclusion criteria.Consecutive sampling method was used and sample size calculated using Taro-Yamane formula.During the PAC, data regarding various parameters such as demographic detail, BMI and airway indices were collected. BMI, Age and Sex were the independent variables and all airway indiceswere the dependent variables. The data collected for the study was continuous and categorical.Subsequently data was coded. The BMI and airway association was analyzed by using STATA version 12. Continuous data were presented as mean ± SD and ordered data were presented as percentage and analyzed by ordered logistic regression (‘p’ value, ‘z’ value and co-efficient). Results: The mean of age, height, TMD, HMD and SMD were comparable in all the four BMI categories. The mean of weight, BMI, NC and HLM were increasing from underweight to obese. BMI association with NC,MPG, HLM, WSand H and N movementwere statistically significant and having ‘p’ value = 0.000 (for all indices) and ‘z’ value = 9.94,8.18, 7.53, 6.29 and 6.2respectively. BMI weakly associated with SM, SMD and ULBT. BMI association with IIG, TMD and HMD were statistically not significant and having ‘p’ value > 0.05 (for all indices). All airway indices have positive co-efficient except SMD, which have negative co-efficient. Conclusion: The findings confirm that there were association between BMI with NC,MPG, HLM, WS and H and N movementat p value = 0.000 which is significant and z value > 6 and hence corroborates that difficult airway could be anticipated with these variables. Among all individual airway indicators Neck circumference was strongly associated with BMI followed by MPG.
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Case Report
Open Access
Hyperthyroidism in pregnancy with fetal goitrous hypothyroidism treated with intra amniotic levothyroxine administration– A case report
Pages 475 - 480

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Abstract
Hyperthyroidism in pregnancy with fetal goitrous hypothyroidism is seen when pregnant mothers are on antithyroid medications. We present a similar case. A 32 years old woman was booked early in pregnancy with a history of Grave’s disease on Propylthiouracil. Anomaly scan showed fetal goitre. Foetal medicine consultant opinion taken. With regular scans, the increasing volume of thyroid was noted. Cordocentesis done which revealed high intra amniotic TSH, diagnosis of fetal goitrous hypothyroidism. She received intra amniotic levothyroxine at 3rd trimester. Gradually the volume of goitre reduced. At 39 weeks, she went into spontaneous labor and had normal vaginal delivery with no neonatal complications.The neonate had a transient hypothyroidism which settled in less than two weeks.
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Research Article
Open Access
Open, randomized, comparative clinical study of haemodynamic response to laryngoscopy and tracheal intubation after induction of anaesthesia with propofol or etomidate
Pages 472 - 477

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Abstract
Background: General anaesthesia is associated with marked cardiovascular changes. Previous studies say that etomidate can be used in patients with limited hemodynamic reserve and propofol can lead to more hemodynamic instabilities. Hence, the present study was undertaken to compare the effects of propofol and etomidate on hemodynamicA changes during induction of general anaesthesia. Method: total 70 patients of ASA grade I & II, aged 18-60 years, weighs 40-80 kg, undergoing surgeries with general anesthesia were included and randomly divided into two equal groups.Induction of anaesthesia was carried out by using 0.3 mg/kg of etomidate in group A patients and 2.0 mg/kg of propofol in group B patients. Hemodynamic parameters such as: heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and O2 saturation (SpO2) was measured and recorded at 1,3,5 and 10 minutes after intubation.Results: Both the groups were comparable and found no significant difference regarding demographic profile of patients, (p>0.05).At various time intervals i.e., T0 (before induction), T1 (after 1 min), T2 (after 3 mins), T3 (after 5 mins) and T4 (after 10 mins) the mean values of HR and SpO2 was comparable between two groups, (p>0.05) while the mean values of SBP, DBP and MAP were significantly lower in group B compared to group A, (p<0.05). Conclusion:Etomidate is haemodynamically more stable compared to propofol as the incidence and severity of hypotension are higher with propofol. Etomidate is a better option in patient’s particularly prone to hemodynamic instability at induction.
Research Article
Open Access
A study on clinical profile of Chronic Kidney Disease Patients
Pages 466 - 471

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Abstract
Background: Chronic kidney disease (CKD) has emerged as a significant global health problem with substantial morbidity, mortality, and economic burden. The prevalence of CKD varies across different regions, with a higher burden observed in low- and middle-income countries.CKD is often associated with a range of comorbidities, including hypertension, diabetes mellitus, cardiovascular diseases, and anemia, which further contribute to adverse outcomes.Understanding the etiology of CKD is crucial for implementing targeted prevention and management strategies.Objective: To assess the clinical profile of CKD Patients. Methods: This cross sectional study was done on 100 CKD patients after IHEC approval with Informed consent. The various etiology of CKD, stage of disease, coexisting medical conditions, laboratory findings, and ECG/ECHO were measured.Result: Anaemia and hypocalcemia was common among the study participants. All had Cardiac changes. Majority of patients had comorbidities such as alcoholism, cardiac disease, anemia, clubbing, pedal edema, and abnormal lipid profiles. Conclusion: Managing anemia, mineral and bone disorders, fluid and electrolyte balance, hypertension, dyslipidemia, and inflammation becomes crucial in the comprehensive care of CKD patients to mitigate cardiovascular risks.
Research Article
Open Access
The Frequency of Iron Deficiency and Iron Deficiency Anemia among Pediatric Patients with Hemophilia A
Pages 460 - 465

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Abstract
Background: Hemophilia is a hereditary X-linked recessive disorder that occurs due to either deficiency or absence of coagulation factor VIII (hemophilia A) or factor IX (hemophilia B). Hemophilia A is the commonest and is more likely to cause severe bleeding which occurs repetitively. These occult and apparent bleeding can predispose these patients to iron deficiency and iron deficiency anemia. These patients suffer from frequent joint bleeds which results iniron accumulation in the synovium of their joints and causes local inflammatory changes. Aim and objectives: This study aims to assess the frequency of iron deficiency and iron deficiency anemia among pediatric patients with hemophilia A. The frequency has also been correlated with severity of hemophilia A in these patients, severity being classified on the basis of factor level as mild (6-40%), moderate (1-5%) and severe (<1%). Material and methods: This is a cross-sectional study conducted for six months from January 2023 to June 2023 at our centre on 130 patients of hemophilia A. Data including demographic profile, complete blood counts and serum ferritin were collected and analysed. The correlation of serum ferritin with the disease severity was established. Results: Outof 130patients with hemophilia A all were male. Of these, 11% were cases of mild, 23% were cases of moderate and 66% were cases of severe hemophilia A. 53.84% patients had hemoglobin <11g% and 46.16% patients had hemoglobin ≥11g%. Out of 130 patients, there were 32 (24.6%) patients with serum ferritin <7ng/ml but Hb above 11g%, meaning they had iron deficiency (ID). While, 70 (53.84%) patients had low serum ferritin with low Hb, meaning they had iron deficiency anemia (IDA). 28 (21.56%) patients had normal Hb and serum ferritin levels. Conclusion: Iron deficiency and iron deficiency anemia are usual problems among hemophilia patients and their frequency increases with the disease severity.
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Research Article
Open Access
Clinical and Microbiological Profile of Diabetic Foot Patients
Pages 453 - 459

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Aim: This study aims to assess clinical and microbiological profile of diabetic foot patients. Material & Methods: We conducted descriptive type of study on patients with type 2 Diabetes mellitus of duration more than 10 years having diabetic foot infections, visiting OPD/IPD of SGRD hospital, Vallah, Sri Amritsar from April 2021 to July 2022. All the patients were assessed through detailed history, comprising of clinical features of diabetes, its duration, risk factors associated with it, detailed foot examination. Diabetic foot ulcer was classified according to University of Texas foot ulcer classification and microbiological profile was studied. Results: We recruited 100 patients, out of which71 % were males and 29 % constituted female population. Predominant symptom with which the patients presented was foot ulcer(88%) but the less frequent symptom was gangrene (12%). As per University Of Texas Foot Ulcer Classification, 45% patients were in grade 3D followed by 24% in grade 2B & only 1 % in grade 3C. Out of 100 patients, 46% swab culture showed growth of organism whereas 54% patients swab culture were sterile. The most commonly cultured organismis E.coli. On antimicrobial culture susceptibility, all Gram-positive organisms were sensitive to Linezolid and resistant to Erythromycin. All gram negative organisms were sensitive to Gentamicin except Pseudomonas which was sensitive to Tigecycline only. Among gram negative organisms, only E.aerogenes, E.coli, Klebsiella and M.morganii shows resistance to ciprofloxacin. Conclusion: Poor control of Diabetes Milletus puts a patient at higher risk of skininfections as being in a state of hyperglycaemia impairs the efficiency of the body’s immune or defence mechanism. . Poor healing status is a major cause of lower extremity amputations in diabetics. Early microbiological diagnosisand accurate treatment can decrease morbidity significantly.
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Research Article
Open Access
Evaluate the Quality of Sleep in Pregnant Women at Tertiary Care Center
Pages 439 - 452

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Abstract
Background: Pregnancy-associated physiological and hormonal changes are known to contribute to increased prevalence and severity of sleep complaints and disorders. Aims: To evaluate the quality of sleep (according to PSQI score <5 and >5) in pregnant women and fetal outcomes. Materials and methods: The current study was conducted in the Department of Obstetrics and Gynaecology on pregnant women who visited O.P.D for antenatal visits. It is a descriptive, prospective and observational type of study. The duration of study was 1 year from 1st Jul 2017 to 30th June 2018 on all pregnant women who were in their first trimester which were further followed up to post-partum period. Results: APGAR at 1min, Mild Asphyxia was observed in 48.22% cases and severe Asphyxia was observed in 2.03% cases. The cases in poor quality sleep were 67.01% in 1st trimester followed by a decrease in 2nd trimester (42.13%) than again increase (84.77%) than further decrease in Postpartum period. This finding was statistically significant (P<0.001S). Score was significantly higher in LSCS, as compared to Normal delivery (P<0.001S). Although the PSQI score was higher in preterm as compared to Term Pregnancy. It was significant at 3rd Trimester. PSQI score was higher in <2.5 kg baby weight at birth as compared to ≥2.5 kg weight baby (P<0.001S). APGAR score at one minute was normal (7-10) among 93.33% of the good sleep group. PSQI score was higher in cases with NICU admission as compared to absence of NICU Admission (P<0.001S). PSQI score was higher in cases with Prolonged labour(>20hrs) as compared to normal labour(<20 hrs) but it was observed significant at 3rd trimester (P=0.048S). Significant correlation was observed with PSQI Score at 1st , 2nd , 3 rd Trimesters and post partum period with birth weight (r=-262, poor, negative correlation). No Significant correlation was observed with PSQI Score at 1st , 2nd and 3 rd Trimesters and post partum period with age, gravida, parity, Period of gestation at the time of delivery and duration of labour. Conclusion: During the analysis, we have also found a significant relationship between poor quality of sleep with poor fetal outcomes:
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Research Article
Open Access
Diagnostic Utility of Immunohistochemical Markers Ck7, Ck 20 and CEA in Surface epithelial Tumors of Ovary
Pages 435 - 438

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Abstract
Background: Immunohistochemistry is the definitive diagnosis in cases where a definite diagnosis cannot be made morphologically and histologically. IHC helps classify tumors. It also helps to solve the diagnosis problem of benign and malignant tumors. Material And Methods: We studied 100 different ovarian epithelial tumors over a 2 year period. Three immune markers were included in the study. Result: Out of 100 case 70% are benign and 30% aremalignant.Serous cystadenoma was most common benign lesion(60%)& among malignant lesions Serous cystadenocarcinoma was most common(60%).83.33% cases of serous carcinoma showed positivity for CK7 & 100% negativity for CK20 & CEA Conclusion: IHC helps to classify and confirm the histological diagnosis. IHC is particularly useful in solving the diagnostic problem of ovarian cancer and is poorly differentiated.
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Research Article
Open Access
Assessment of Preoperative Scoring System in Determination of Intraoperative Difficult Laparoscopic Cholecystectomy
Pages 430 - 434

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Abstract
Background: Preoperative prediction of risk factors helps in assessing the intraoperative difficulties. Various scoring systems are available to predict the intraoperative difficulties in laparoscopic cholecystectomy. However, there is the need to find a consistent and reliable scoring and predictive system. The present study was undertaken to assess preoperative scoring system in determination of intraoperative difficult laparoscopic cholecystectomy (LC). Material and methods: The prospective observational study performed on 50 patients undergoing elective LC. All the patients were assessed and data regarding the previous history, clinical examinations, and USG findings were recorded. Preoperatively patients were assessed according to Randhawa and Pujahari scoring system. Whereas, intraoperatively, based on duration of surgery.m Results: Preoperative score suggested difficult and very difficult LC in 36% and 2% of patients respectively while intraoperatively 8% of patients had difficult and very difficult LC respectively. The sensitivity, specificity, and predictive value at the preoperative score of 5 was found to be 90%, 72.7%, and 96.7% respectively. Intraoperative difficult LC was found to be significantly associated with the previous history of hospitalization (P=0.021), palpable GB (P=0.003), wall thickness >4mm (P=0.000), pericholecystic collection (P=0.000), contracted GB (P=0.000), post ERCP (P=0.000), deranged LFT (P=0.000), and WBCs >11000 (P=0.000). Conclusion: Study finds the evaluated scoring system, reliable and useful for predicting difficulty in laparoscopic cholecystectomy.
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Research Article
Open Access
Comparison of Mixed Venous Oxygen Saturation vs. Serum Lactate Monitoring in the Management of Patients in Septic Shock
Pages 422 - 429

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Abstract
Background: This study was conducted to test early resuscitation, targeting lactate levels as the marker of adequacy of oxygen delivery, compare the return of normal ScvO2 in predicting 7th day mortality, and compare the clearance of serum lactate (at least 10%) in predicting 7th day mortality. Methods: This was a hospital-based randomized prospective study conducted among 120 adult patients admitted to the medical ICU with septic shock at Rajarajeswari Medical College and Hospital from November 2015 to August 2017 after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results: 7th day mortality was 21.7% in group L and 33.3% in group S, the p-value was 0.152 which was not clinically significant between both groups. But lactate clearance in group L at 24 hours was 57.50±25.82 and at 72 hours was 76.87±14.80 which was clinically strongly significant and ScvO2 at mortality was around 70.6% but still there was a mortality of 33.3% on 7th day, which is higher compared to the lactate group. Conclusion: Goal-directed therapy provided at the initial stages of severe sepsis and septic shock has significant short term and long-term benefits. We can also say that using lactate as an indicator of sepsis will help in early diagnosis with risk stratification and repeated measurements at regular intervals can assist in the progress of treatment.
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Research Article
Open Access
Comparison of Serum Fibrinogen Level in Acute Ischaemic Stroke and Haemorrhagic Stroke
Pages 417 - 421

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Abstract
Introduction: A stroke is defined by an abrupt onset of neurologic deficit that is attributable to a focal vascular cause. Thus, the definition of stroke is clinical; and laboratory studies including brain imaging are used to support the diagnosis. The clinical manifestations of stroke are highly variable because of the complex anatomy of the brain and its vasculature. Fibrinogen plays a key role in blood clotting. Fibrinogen plays a role in the process of aggregation of platelets. It crosslinks the platelets by the process of binding the glycoprotein IIb-IIIa receptor on the surface of platelets. Hence, Measurement of plasma fibrinogen levels could be more useful than other acute phase reactants such as C-reactive protein, as fibrinogen is more specific to vascular disease. Material and Methods: A Cross sectional study was conducted in the Department of Medicine. Patients with age>18yrs, in both genders, who met the clinical and radiological diagnostic criteria of stroke within 24 hours along with non-stroke controls with matched age, sex and risk factors. Patients with age>18yrs, in both genders, who met the clinical and radiological diagnostic criteria of stroke within 24 hours. All patients older than 18 years present with features of stroke like Hemiplegia, hemiparesis, hemianaesthesia, speech abnormality, with or without cranial nerve palsy were enrolled in the study. Results: In our study, 150 no of people were enrolled in our study after exercising inclusion and exclusion criteria. Among them 61-80 years of age groups were mostly affected by stroke followed by age group 46-60 years. Mean age of presentation was 69.89±12.75 in ischemic stroke group and 64±12.99 in hemorrhagic stroke group. Mean age among control is 66±13.10. The mean fibrinogen level among 50 ischemic stroke cases was 396.6±116, 50 cases of hemorrhagic stroke was 310.9±78.21 & among controls was 209.2±117.5. The p-value for mean fibrinogen between cases and controls was 0.001. There was statistically significant difference between mean fibrinogen level between cases and controls. Conclusion: Fibrinogen is found to be an independent risk factor for stroke; more specifically for ischemic stroke. It can be used in predicting stroke. The mean fibrinogen level increases with age and higher in females, hypertensives, diabetics, smokers, alcoholics, obese & hypercholesterolemia. Fibrinogen levels were higher in patients with acute stroke with very severe impairment; hence, can be useful in accessing stroke severity. Further study is required for a thorough understanding of its risk for stroke and its prognostic significance. Thus early detection of fibrinogen level and treatment with drugs along with dietary modifications and lifestyle changes can reduce the risk of stroke and can also decrease morbidity and mortality in stroke patients.
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Research Article
Open Access
Clinical characteristics and treatment of hepatic hydatid cysts: A retrospective observational study
Pages 411 - 416

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Abstract
Background and Objectives Hepatic Hydatid Cysts (HHCs) represent a significant and unaddressed public health concern in Indian population. The aim of this study was to evaluate the sociodemographic characteristics, clinical manifestations, and treatment approaches for individuals affected by HHCs in India. Materials & methods This retrospective study was conducted at an Indian tertiary care hospital. The study focused on 35 individuals who were diagnosed with an HHC based on clinical symptoms, imaging tests, or serology. A retrospective and descriptive analysis was performed on the collected data. Statistical analysis was carried out using Epi Info® to derive the results of the study. Results: 25 to 40 years was the most commonly affected group. Females were affected more than males. The most frequently reported symptoms among the patients was abdominal pain. For the diagnosis of HHC, computerised tomography (CT) and abdominal ultrasonography(USG) were the two main imaging tests utilized. The most common type of cystic lesion observed in these tests was unilocular and anechoic. Majority of patients had cysts in the right hepatic lobe. Surgical excision of hydatid cysts was performed in 47% of the patients included in the study. The most frequently performed surgical procedure for hydatid cyst removal was pericystectomy. Conclusion: HHC is a prevalent cause of morbidity in India. Despite advancements in medical treatments, surgery remains the preferred treatment approach for the majority of patients. Accurate diagnosis relies on a combination of clinical examination and imaging studies.
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Research Article
Open Access
Role of Epicardial Fat Thickness by ultrasound in diagnosis of Gestational diabetes: An observational study
Pages 407 - 410

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Abstract
Background and Objectives There exists a limited body of research investigating the correlation between gestational diabetes mellitus (GDM) with fetal epicardial fat thickness (FEFT). The primary objective of this study was to assess the potential of FEFT as an indicator for screening GDM in pregnant women. The study was designed as a cross-sectional analytical investigation. Materials & methods The study incorporated pregnant women who were scheduled to undergo a 75g oral glucose tolerance test (OGTT). Antenatal ultrasonography (USG) were conducted in all patients. Among the total of 200 patients, a subset of 70 patients was selected for further analysis. This subset included 35 patients with elevated results in the 75g OGTT (indicating cases of GDM) and 35 patients with normal results. Results: There was a significant increase in FEFT among pregnant women with GDM. Furthermore, the elevated FEFT demonstrated a positive correlation with 2-hour OGTT serum glucose values. The mean FEFT in mothers with GDM was found to be significantly larger compared to mothers without GDM. To assess the predictive capability of FEFT for GDM, an ROC curve was constructed which demonstrated a high sensitivity of 95.57% and specificity of 91% for FEFT as a predictor of GDM. Conclusion: Assessing the FEFT in fetuses could serve as a novel marker for diagnosing GDM.
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Research Article
Open Access
Clinical profile of patients with cirrhosis of liver in a tertiary care hospital of Kalaburagi, North Karnataka, India
Pages 396 - 403

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Abstract
Background: The profile of cirrhosis may vary with different age and ethinic groups, geographical, social and etiological factors. So the present study will be undertaken to study the clinical profiles of patients with cirrhosis of liver in the form of demography, aetiology, clinical presentation, laboratory evaluation and complications in this region of north Karnataka. Methodology: A two years observational study after ethical committee approval was conducted at a tertiary care hospital among 200 cirrhotic patients in whom after explaining the purpose of the study, detailed history, clinical and laboratory data was collected. The DATA was analyzed using IBM SPSS Statistics for Windows, Version 25.0. Result. In our study the commonest age group was 31-50 years, mean age 44.10±13.08 years. Majority (88.5%) were males. Symptoms were abdominal distension (85.5%), lower limb edema(63.5%), jaundice (48%), gastrointestinal bleed(18.5%), altered sensorium in 14%. Aetiology were alcohol related (57.5%), HBV (13.5%), NAFLD(11.5%), viral and alcohol(5%), HCV (3%), Cryptogenic cirrhosis (4.5%) and Autoimmune Hepatitis (2.5%). Commonest complications were hepatic encephalopathy (14%), Spontaneous bacterial peritonitis(14%), major renal impairment(12%) and Hepatocellular carcinoma (0.5%). 49% had CTP category B disease and 47.5% had CTP category C, 165 patients had MELD Na of >15. Conclusion: Cirrhosis is common among the most productive age group of society with change in lifestyle habits and increased alcohol use this has gained more importance. Recent advances in treating these patients may take a few more years in yielding new results and this article will act as a benchmark for comparison.
Research Article
Open Access
A Prospective Study on Management of Upper Limb and Lower Limb Long Bone Fractures by Titanium Elastic Nailing System in Children
Pages 388 - 395

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Abstract
Background: Despite ongoing disagreement regarding its indications, interest in operating to treat paediatric fractures has grown during the past 20 years. There is some debate over the best way to repair long bone fractures in kids under the age of six (POP cast) and teenagers over the age of sixteen (locked intramedullary nailing, plating). OBJECTIVES: To analyze the results of fixation of long bone fracture with TITANIUM ELASTIC NAILING SYSTEM (TENS) in the treatment of fracture shaft of long bones in children aged between 5 to 16 years with special emphasis on complications. Material & Methods: Study Design: A prospective hospital based observational study. Study area: Department of Orthopaedics, Dr. Patnam Mahender Reddy Institute of Medical Sciences, Chevella, Telangana. Study Period: 3 months. Study population: All children and adolescent patients between 5-16 years of age with diaphyseal fractures of long bones admitted in the department of Orthopaedics. Sample size: Study consisted of 20 subjects. Sampling method: convenient sampling. Study tools and Data collection procedure: As soon as the patient was brought to casualty, patient’s airway, breathing and circulation were assessed. Then a complete survey was carried out to rule out other significant injuries. Plain radiographs of AP and lateral views of long bone including one joint above and one joint below .to assess the extent of fracture comminution, the geometry and the dimensions of the fracture. Results: The duration of stay in the hospital ≤ 7 days for 3 (15%) patients, 8-10 days for 7 (35%), 11-15 days for 11 (50%). One case was operated within 6 days of injury, developed superficial infection which had to be dressed regularly, so stayed for 11 days. Another cases were who had multiple soft tissue injury had to stay 14 days. The average duration of hospital stay in the present study is 10.25 days. Conclusion: We draw the conclusion that the ELASTIC STABLE INTRAMEDULLARLY NAILING approach is the best course of action for treating paediatric long bone diaphyseal fractures. It provides elastic mobility that encourages quick union at the site of the fracture and stability that is perfect for early mobilisation. When compared to other forms of treatment, it has a reduced rate of complications and produces positive results.
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Research Article
Open Access
Effects of Fosfomycin against Gram Negative Bacterial isolates of Urinary Tract Infection at Tertiary Care Hospital
Pages 382 - 387

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Abstract
Background: Urinary tract infection (UTI) is due to infection of microorganism involved urinary tract. Recently, antibiotics resistance rate is continually increase in UTI isolates. So, choice of antimicrobial drug becomes limited. Fosfomycin may be a promising alternative antimicrobial drug in that resistance cases in current scenario. Objective: Study focused on detects vitro sensitivity of fosfomycin against gram negative UTI isolates. Method: A study conducted at Microbiology Department of Smt. B. K. Shah Medical Institute and Research Centre, Piparia from January 2022 to October 2022. During study period total 256 patient’s urine culture found positive for microorganisms. Out of 256 bacterial isolates, 199 (77.8%) gram-negative bacteria, isolates which were included in our study. Bacterial isolates identified by standard laboratory procedure and antibiotic sensitivity was done by VITEK 2 compact system of bioMerieux. Results: Sensitivity of fosfomycin against isolated bacteria revealed that, 96%, 72.4%, 75%, 100%, 75% & 61.9% isolates were sensitive to Escherichia coli, Kebsiella pneumoniae, Proteus mirabilis, Enterobacter sp., Citrobacter sp. & Pseudomonas areuginosa respectively. Against Extended spectrum beta-lactamases (ESBLs) producing Enterobacteriaceae, fosfomycin was given good result which were 91.4%, 76.9%, 60% and 100% sensitive for Escherichia coli, Kebsiella pneumoniae, Proteus mirabilis and Enterobacter sp. respectively Conclusion: Fosfomycin showed better drug of option in most of the common Enterobacteriaceae and non fermented bacteria as well as in ESBL-producing Enterobacteriaceae
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Research Article
Open Access
Factors Affecting Post-Laparotomy Wound Healing
Pages 378 - 381

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Background: Wound Healing is the summation of a number of processes that follow injury. Despite immense advances in the technique of wound creation and closure, there continues to be an important percentage of patients undergoing abdominal operations, suffering from delayed wound healing and partial wound failure. The aim of this study is to assess the various factors influencing post laparotomy wound healing. To identify the pre-operative, operative and post operative risk factors in patients having poor wound healing. Material and Methods: All adult male and female patients undergoing laparotomy for various indications were included in the study. This descriptive, non-interventional case study was conducted in the Departments of General Surgery in Veer Surendra Sai institute of medical science and research burla sambalpur. (Minimum of 100 cases). Results: This prospective study was conducted in VIMSAR hospital, burla, sambalpur. A total of 100 patients undergoing laparotomies were studied .40 patients were found to have delayed wound healing. The strongest association for delayed healing was found to be wound infection, followed by smoking, chronic cough, poorly controlled diabetes and alcohol. Conclusions: The incidence of delayed healing was found to be higher in our study with increased incidence of wound infection. It was found that emergency laparotomies were associated with an increased incidence of wound infection and thereby delayed healing. Poor wound healing is also associated strongly with poor nutrition and uncontrolled diabetes. These factors should be taken into account and efforts have to be made to correct the risk factors pre or post-operatively.
Research Article
Open Access
Morphometric Study of Superficial Veins of Leg in the Chronic Venous Disorders Patients on Duplex Ultrasonography and Its Correlation with Anthropometry and Venous Clinical Severity Score of Patients in the Indian Population: Multicentre Cross Sectional Study
Pages 369 - 377

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Abstract
The prevalence of Chronic Venous Disorder (CVD) and the socioeconomic impact of its symptoms are directly related to the importance of the disease. The most common symptom of CVD is varicose veins (VVs). 45-75% of VVs cases are related to insufficiency of the Great saphenous vein (GSV), and 15-25% are due to an incompetent Short Saphenous Vein (SSV). Objective of this study was to study the anthropometric measurements and the anatomical variations of GSV, Anterior accessory saphenous vein (AASV), Posterior accessory saphenous vein (PASV) and intersaphenous vein (ISV), and the diameter of GSV and Short SaphenousVein (SSV) in Chronic venous disease patients Methods: Patients of primary varicose vein(diagnosed clinically and on Duplex doppler USG )on 200 legs were enrolled. Age, sex, anthropometric data, and findings on duplex USG were noted. Venous reflux, GSV, SSV, AASV, PASV diameter was noted and its severity with Venous clinical severity (VCSS) score was also noted. Results: The mean age, weight (kg), height (cm), hip diameter(cm), waist diameter (cm), and BMI (kg/m2)of the patients were 35.65±9.91, 75.41±12.34, 63.48±5.06, 40.80±3.49, 40.09±4.35, and 29.37±6.97respectively. The percentages of male and female were 82.00% and 18.00%,. The mean VCSS, Diameter of GSVjust below SFJ (mm), at upper thigh (mm), mid-thigh (mm), above knee (mm), below knee (mm), at Mid leg (mm), at medial malleolus (mm), SSV diameter Just below knee (mm), SSV Diameter at mid-calf (mm) and SSV Diameter at Lat. Malleolus (mm) were 10.40±2.54, 9.09±2.04, 8.10±1.96, 7.13±1.93, 6.28±1.89, 6.81±1.77, 6.61±1.88, 4.79±4.13, 3.93±0.75, 4.47±5.84, and 3.85±2.86, respectively. Conclusion: Weight and BMI were significantly positively correlated with the diameter of competent perforators. . Moreover, the SFJ incompetent,SPJ-incompetent, AASV incompetency, perforator-incompetency, and GSV diameter were significantly positively correlated with VCSS. Other anatomical changes such as diameter of GSV and SSV were not significantly correlated with age, weight and BMI. Also, the hip, waist circumference, and hip-to-waist ratio were not significantly associated with the different anatomic changes in varicosities whereas SSV diameter just below the knee was significantly negatively correlated with VCSS.
Research Article
Open Access
A Study on Fetal Biometry Using Fetal Kidney Length after 20 Weeks of Gestation in a Tertiary Care Hospital
Pages 359 - 368

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Abstract
Background: The development of the foetal kidneys can be monitored during the entire pregnancy by measuring their length and comparing them to typical charts. The ultrasonogram is thought to be a useful tool for assessing kidney growth and anomalies in foetuses, and it can help with the early detection and treatment of some kidney-related disorders.
Objectives:
1. To perform obstetric USG in healthy women with uncomplicated pregnancy between 20 weeks and term gestation to determine correlation between fetal kidney length and gestational age.
2. To derive nomogram for estimating the gestational age of fetus from ultrasonographically measured fetal kidney length.
3. To assess the accuracy of fetal kidney length measurement in determining the gestational age of the fetus and its accuracy with other fetal biometric indices.
Material & Methods: Study Design: Hospital based observational study. Study area: Department of Obstetrics & Gynecology, Narayana medical college and hospital, tertiary care center at Nellore, Andhra Pradesh. Study Period: April 2022 – March 2023. Study population: Pregnant women with uncomplicated pregnancy more than 20 weeks Attending Antenatal Outpatient department. Sample size: Study consisted a total of 100 subjects. Sampling Technique: Simple Random technique. Study tools and Data collection procedure: All the statutory requirements under PNDT act were followed and form F was obtained from all the patients. All the relevant clinical history was obtained and the correct LMP was confirmed. Transabdominal ultrasonography was performed with patient in supine position. Good acoustics coupling was obtained using synthetic ultrasound gel. Ultrasonography is done using Siemens Sonoline or Philips HD 7 ultra sound scanner using a 3.5- 12MHz transducers, images were recorded in the thermal films using the digital camera Results: The association between the fetal measurements and FK GA. The correlation was best for FK GA versus AC (r: 0.876) and least for BPD (r: 0.808). All the correlation was statistically significant. Conclusion: FKL is reasonably a precise parameter for estimating GA. Measurement of FKL will prove significant when other biometric parameters failed to be measured in certain situations like engaged/fixed head and when head is not in correct plane. Hence, FKL can be used as a reliable parameter for determination of gestational age.
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Research Article
Open Access
A Comparative Study of Early Versus Delayed Emergency Appendectomy in the Treatment of Acute Appendicitis
Pages 352 - 358

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Abstract
Introduction: Acute appendicitis is a common surgical emergency, with appendectomy being the gold standard treatment for this condition. Traditionally, early appendectomy has been advocated to prevent the potential complications associated with delayed intervention. However, recent studies have questioned the necessity of immediate surgical intervention and proposed a conservative approach with delayed appendectomy or even non-operative management. The debate between early versus delayed appendectomy in the treatment of acute appendicitis has gained significant attention among surgeons, researchers, and healthcare providers. This comparative study aims to provide a comprehensive analysis of the outcomes, efficacy, and safety of these two approaches. Aims and Objectives: This study aims to compare the morbidity, mortality, postoperative length of stay and 30 days readmission rate of acute appendicitis patients who had appendectomy within 8 hours of visiting the emergency room with those who had surgery after that period. Material and Methods: This study was conducted on 175 patients retrospectively who underwent appendectomy procedures from January 2021 to December 2021 at Adesh Medical College and Hospital, Shahabad, Kurukshetra, Haryana, India. The study population was divided into two groups based on the length of time before the intervention: early appendectomy (group 1), which included patients who underwent surgery within 8 hours, and delayed appendectomy (group 2), which included patients who underwent surgery after that time. The underlying characteristics of the two study groups were then compared, including demographic, clinical, radiological, and perioperative data. The 30 days readmission rate, postoperative length of stay, and mortality and morbidity were all regarded as outcome measures. Data were manually collected by reviewing patient charts in the electronic medical record. The Statistical Package for the Social Sciences (SPSS) 24.0 was used for the statistical analysis. Statistical significance was evaluated at p<0.05. Results: A total of 175 patients met the inclusion requirements for the study population over the course of the twelve months of the trial period. Within 8 hours of their arrival at the emergency department, 100 patients (57.1%) underwent early appendectomy, while 75 patients (42.8%) did so after that time. The age was 43.8±11.85 years on average. A total of 54.28% (n = 95) of the population were male patients and the rest were females. Twenty patients (11.43%) overall experienced postoperative problems, including two postoperative hemorrhages (1.1%), five surgical site infections (2.86%), eight pneumonia (4.57%), one urinary tract infections (0.5%) and four patients (2.28%) who experienced multiple organ system failure. Within 30 days of surgery, six patients (3.4%) were readmitted. The 30‐day readmission rate (2% vs. 4%, p = 0.569) did not differ significantly between the two groups. The postoperative duration of stay did not differ significantly between the two groups: Median (IQR) 24.8 (11.2‐38.4) vs. 26.9 (11.6‐26.9) hours (p = 0.692). Conclusions: Our results concluded that eight hours delay in the appendectomy did not lead to longer postoperative stays, an increase in mortality or morbidity, or a higher 30‐day readmission rate, of patients with acute appendicitis. This comparative study investigated that early versus delayed emergency appendectomy in the treatment of acute appendicitis holds significant importance in guiding clinical decision-making. By critically analyzing the available evidence, this research aims to provide evidence-based recommendations to enhance patient care and optimize outcomes.
Research Article
Open Access
Association between Vitamin D Deficiency and Hypothyroidism in a Tertiary Care Centre
Pages 348 - 351

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Abstract
Background: To assess the association between vitamin D deficiency and hypothyroidism in a tertiary care center. Methods: Eighty- four subjects of both genders were divided into 2 groups of 42 each. Group I was healthy subjects (control) and group II was hypothyroid group. All were subjected to measurement of serum T3, T4, TSH, serum calcium and serum 25 (OH) D levels. Results: Group I had 22 males and 20 females and group II had 15 males and 27 females. The mean serum calcium level was 10.4 mg/dl and 7.1 mg/dl in group I and group II respectively. The serum 25(OH) vit D was 45.8 ng/dl and 15.3 ng/dl in group I and group II respectively. The mean serum TSH was 3.4 mU/L in group I and 6.2 mU/L in group II. The mean serum T3 was 2.8 pg/ml in group I and 1.5 pg/ml in group II. The mean serum T4 was 1.9 ng/dl in group I and 0.6 ng/dl in group II. The difference was significant (P< 0.05). Conclusions: Patients with hypothyroidism suffered from hypovitaminosis D with hypocalcaemia. All hypothyroid individuals should undergo tests to check their serum calcium levels and check for vitamin D inadequacy.
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Research Article
Open Access
Self-Reported Adherence among Individuals at High Risk of Metabolic Syndrome: Effect of Knowledge and Attitude in Kanyakumari district
Pages 343 - 347

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Abstract
Background: To assess knowledge and attitude regarding self- reported adherence among individuals at high risk of metabolic syndrome in Kanyakumari district. Methods: One hundred ten of both genders were enrolled and parameters such as sociodemographic characteristics; compliance with prescribed treatments and dietary adjustments; awareness of metabolic syndrome; and attitude toward health, education, smoking, alcoholism, exercise and family history of CVD was recorded. For direct inquiries, the response was graded on a five-point scale: 0% for never, 25% for seldom, 50% for sometimes, 75% for often, and 100% for always. Results: Out of 110 patients, males were 62 (56.3%) and females were 48 (43.7%). Education was primary in 50, high in 42 and above in 18. Smoking was seen in 34, alcoholism in 15, family history of premature CVD was seen in 40, 32 perform exercise and 78 not. The difference was significant (P< 0.05). 14% heard about metabolic syndrome, 15% had understanding of metabolic syndrome, 27% had knowledge of MS as risk for cardiovascular diseases, 61% sedentary lifestyle as a risk factor, 30% as central obesity as a component, 26% considered hypertension as a component for MS, 25% ha knowledge of diabetes as a component of MS, 28% knew that high triglyceride level is a component and 22% knew that low HDL-C level is a component of MS. Age, the presence of hypertension, and attitude toward health were positively associated with the adherence to medications score and income level had a negative association. Conclusions: The people with high-risk metabolic syndrome frequently had low adherence rates to medications and lifestyle adjustments. The two most significant variables affecting adherence rates were patients' knowledge of metabolic syndrome and attitudes toward health.
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Research Article
Open Access
Sonographic Evaluation of Non-Alcoholic Fatty Liver Disease(NAFLD) and Correlation with non-HDL Cholesterol to HDL Cholesterol Ratio
Pages 337 - 342

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Abstract
Non-alcoholic fatty liver disease (NAFLD) is a prevalent and progressive liver condition with significant health implications. This study aimed to investigate the sonographic evaluation of NAFLD and its correlation with the non-HDL cholesterol to HDL cholesterol ratio, a marker of dyslipidemia. A total of 200 participants with suspected or known NAFLD were included in the study. Sonographic evaluations were performed to assess the severity of NAFLD in terms of increase in liver echogenicity, liver to kidney contrast, blurring of intrahepatic vessel borders and diaphragm. Non-HDL cholesterol to HDL cholesterol ratio was calculated from lipid profile results. The study found a positive correlation between the non-HDL cholesterol to HDL cholesterol ratio and the severity of sonographic features of NAFLD. Participants with a higher ratio exhibited more severe grade of NAFLD. Furthermore, the non-HDL cholesterol to HDL cholesterol ratio was higher in participants who showed NAFLD progression compared to those who did not progress, suggesting its potential as a predictive marker for disease progression. These findings contribute to our understanding of NAFLD and highlight the association between dyslipidemia and disease severity. The non-HDL cholesterol to HDL cholesterol ratio may serve as a non-invasive marker for disease severity and progression, aiding in risk stratification and therapeutic interventions. Further research is needed to validate these results and explore the clinical implications of this association.
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Research Article
Open Access
A Study to Investigate Delays and Barriers in Early Treatment Initiation for Childhood Tuberculosis
Pages 331 - 336

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Abstract
Introduction: The treatment of childhood TB is based on the same principles as the treatment of adult TB. The standard treatment regimen for childhood TB consists of a combination of isoniazid, rifampicin, pyrazinamide, and ethambutol for two months, followed by isoniazid and rifampicin for four months. Children with TB are treated with weight-based dosages of anti-TB drugs. Aims: To investigate delays and barriers in treatment initiation in children with TB. Material and Methods: The Department of Pulmonary Medicine and Pediatrics at the Govt. Medical College in Patiala carried out this cross-sectional investigation. In the current investigation, 126 participants in total were included. The study comprised children who had been diagnosed with T.B. (Pulmonary or Extra Pulmonary TB) during the course of a year and were patients at the department of Pulmonary Medicine and Paediatrics, Govt. Medical College, Patiala. Result: Delay was seen in 48.41 percent of the patients. Reasons for delay in treatment initiation as per parents/caregivers was denial diagnosis, economic constraints, lack of understanding and transportation challenges found to be present in 10.32 percent, 7.14 percent, 15.08 percent and 15.08 percent of the patients respectively. Conclusion: Strengthening HCP awareness regarding the importance of TB symptom screening and encouraging early referrals are crucial for rapidly scaling up early treatment initiation in childhood TB.
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Research Article
Open Access
Observation of Serum Lipid Profile Level in Individual Suffering From Diabetes Melltus Type 2 in Age Group of 40 To 60 Years in North Bihar
Pages 327 - 330

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Abstract
Background: Salivary gland tumors (SGTs) are relatively less common, and they exhibit a wide variety of morphological features, even within one particular lesion. This has caused considerable problems in categorization and diagnosis. The epidemiologic factors are also variable across the world. Objectives: To study the site of occurrence, age, and gender-wise distribution with histopathologic features of various SGTs and their comparison with other studies. Material and Methods: This eight year cross-sectional study was conducted in a tertiary care teaching hospital of central India and included all diagnosed cases of SGTs. Results: A total of 100 cases of SGTs were retrieved during the seven-and-a-half-year study period. Out of which 61% were benign and 39% were malignant. The age range was 5–83 years. The most frequently encountered benign tumor was pleomorphic adenoma (86.8%), followed by Warthin’s tumor (8.2%). Mucoepidermoid carcinoma (MEC) was the commonest malignant tumor (33.3%). The parotid gland was the commonest site for both types of SGTs. Conclusion: SGTs had a wider age range of presentation. Benign tumors were more common and well-demarcated from surrounding tissue as compared to malignant tumors. They were more common in the major salivary glands, as the parotid was the commonest gland involved in both benign and malignant SGTs.
Research Article
Open Access
Histomorphologic spectrum of Salivary gland tumors: An experience from a tertiary care institute of Central India
Pages 321 - 326

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Abstract
Background: Salivary gland tumors (SGTs) are relatively less common, and they exhibit a wide variety of morphological features, even within one particular lesion. This has caused considerable problems in categorization and diagnosis. The epidemiologic factors are also variable across the world. Objectives: To study the site of occurrence, age, and gender-wise distribution with histopathologic features of various SGTs and their comparison with other studies. Material and Methods: This eight year cross-sectional study was conducted in a tertiary care teaching hospital of central India and included all diagnosed cases of SGTs. Results: A total of 100 cases of SGTs were retrieved during the seven-and-a-half-year study period. Out of which 61% were benign and 39% were malignant. The age range was 5–83 years. The most frequently encountered benign tumor was pleomorphic adenoma (86.8%), followed by Warthin’s tumor (8.2%). Mucoepidermoid carcinoma (MEC) was the commonest malignant tumor (33.3%). The parotid gland was the commonest site for both types of SGTs. Conclusion: SGTs had a wider age range of presentation. Benign tumors were more common and well-demarcated from surrounding tissue as compared to malignant tumors. They were more common in the major salivary glands, as the parotid was the commonest gland involved in both benign and malignant SGTs.
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Research Article
Open Access
Association between Thyroid Profile and Anaemia grading among pregnant Women: A Prospective and Observational study
Pages 309 - 320

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Abstract
Background: Thyroid physiology is perceptibly modified during normal pregnancy. These alterations take place throughout gestation, help to prepare the maternal thyroid gland to cope with the metabolic demands of pregnancy, are reversible post-partum and the interpretation of these changes can pose a challenge to the treating physician. Material and Methods: This is a prospective, descriptive and observational study conducted among hypothyroid pregnant women from their preconception to complete gestational phase (with whatever outcome), conducting to Index institute of Medical sciences and Hospital over a period of 2 years. The hypothyroid pregnant females visiting to Endocrine and Obstetric Department at the Index institute of Medical sciences and Hospital. All pregnant women who will be diagnosed hypothyroidism defined as either overt (elevated TSH and low FT4) or subclinical (elevated TSH and normal FT4) hypothyroidism and those labelled only ‘hypothyroidism’ (uncategorized) by the clinician either before or during pregnancy. Results: In my study most of the patients who were started on treatment responded well to it so that by 16 weeks 53% of them had their TSH restored to normal range. In my study of 266 patients started on Levothyroxine 140 of them (53%) had normal TSH by 20 weeks but 110 of them (41%) still had relatively higher levels of TSH which necessitated an increase in dose of Levothyroxine. In this table NA denotes those who abort spontaneously before 20 wks of gestation. In my study at 32 weeks period of gestation except for a single patient all the other patients attained normal TSH levels. one patient needed further increase in dose of Levothyroxine.Those who have been diagnosed before 10 weeks and on treatment, if their repeat TSH values become normal they were grouped under adequately treated group. Conclusion: Isolated Low free T4 followed by SCH have the highest rate of occurrence in the study sample. Though the occurrence of any low thyroid status, low isolated free T4 are more common in women with recurrent miscarriage, but the difference was not significant statistically. Anaemia in pregnancy was a mild public health problem in ours study. Ongoing interventions to target anaemia during pregnancy seem to be working in this setting and they should reach universal coverage.
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Research Article
Open Access
A Study to Evaluate the Relation of Crp with Acute Ischemic Stroke in A Tertiary Care Hospital
Pages 300 - 308

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Abstract
Background: One of the most prevalent and deadly disorders is cerebrovascular illness. The second most prevalent cause of mortality worldwide is stroke.1 It is one of the most prevalent neurologic diseases that can be fatal and devastating. Approximately 6.15 million fatalities worldwide occur each year as a result of cerebrovascular disease. According to several Indian research, the prevalence rate of stroke varies depending on the region and the time of study from 40 to 470/100000 people. In India, stroke is a significant cause of mortality and morbidity.2
Objectives:
1. To observe plasma CRP levels in acute ischemic stroke.
2. To evaluate the role of CRP as a prognostic and diagnostic aid in acute ischaemic stroke.
3. To evaluate CRP levels as a risk factor in acute ischemic stroke.
Material & Methods: Study Design: Hospital-based prospective observational study. Study area: Department of General Medicine, in a tertiary care hospital in south India. Study Period: April 2021 – March 2022. Study population: Patients admitted with a clinically first attack of the stroke to the medical intensive care unit or acute medical ward. Sample size: The study consisted of a total of 60 cases and 60 controls. Sampling Technique: Simple random method. Clinical history was taken from either the patient or his/ her relatives or attender, while taking history importance was given regarding the presence or absence of vomiting, headache, and convulsions. Known history of hypertension, diabetes, CAD, RHD, TIA, collagen diseases, meningitis, tuberculosis, endocrine disorders, and congenital disorders was taken. Personal history regarding dietary habits, smoking alcohol consumption, and tobacco chewing were noted. The NIH stroke scale was assessed in all patients to assess the neurological disability and its prognosis. A detailed neurological examination was done based on proforma. Results: CRP values of CT evaluated ischemic stroke patients after admission, > 12 hours < 72 hours after the symptoms onset 54 of the 60 thrombotic stroke patients had CRP >6 mg/dl only 6 patients had CRP<6mg/dl (P <0.001). The Chi-square test value was 73.65, which is statistically very significant. Only 7 patients in the control group had CRP>6mg/dl. Conclusion: In this study mean C-Reactive protein levels were significantly higher in patients with ischemic stroke when compared to controls. It is also observed that elevated C-Reactive protein in ischemic stroke can be diagnosed positively and is an indicator of a worse prognosis, but subtypes (cortical, subcortical) of cerebral infarction cannot be differentiated at the time of early diagnosis. C-Reactive protein levels were raised in all cases that expired.
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Research Article
Open Access
Comparative study of Hemodynamic and Intraocular Pressure changes following insertion of Laryngeal Mask Airway and Endotracheal Tube Insertion at a Tertiary Hospital
Pages 294 - 299

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Abstract
Background: Laryngoscopy and endotracheal intubation is the commonest method of securing a definitive airway for administering anaesthesia. However, it is associated with tachycardia and hypertension and an increase in intraocular pressure. Various pharmacologic and non-pharmacologic methods have been tried to limit the pressure responses and intraocular pressure changes following the insertion of endotracheal tube. One such attempt is the use of laryngeal mask airway, which has been shown to be an effective means of securing a clear airway in fasting patients for elective surgery. Its insertion requires neither the visualization of cords nor the penetration of larynx, making the placement less stimulating than tracheal tube insertion and it may provoke less sympathetic response and catecholamine release Methodology: Sixty patients, of 18-60 years of age, of either sex undergoing elective surgical procedures at Kidwai Memorial Institute of Oncology, Bangalore requiring general anaesthesia were selected randomly. The study was conducted in our institute from December 2019 to February 2021. Patients were randomly divided into 2 groups. In Group 1, appropriate size of LMA was inserted blindly without laryngoscopy using standard technique whereas in Group 2, appropriate size of endotracheal tube was used to intubate trachea under direct laryngoscopy using macintosh laryngoscope. Results: There were no statistical significant changes in hemodynamic parameters and IOP following LMA insertion. Conclusion: There were no statistical significant changes in hemodynamic parameters and IOP following LMA insertion. There was statistically significant rise in hemodynamic parameters and IOP following laryngoscopy and intubation.
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Research Article
Open Access
Hemodynamic stress response to endotracheal extubation with the combination of Diltiazem-Lignocaine, Esmolol-Lignocaine and Lignocaine alone - A prospective comparative randomized study
Pages 286 - 293

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Abstract
Background: Endotracheal extubation causes transient hemodynamic stimulation leading to increase in blood pressure and heart rate due to increase in sympathoadrenergic activity caused by epipharyngeal and laryngopharyngeal stimulation. Lignocaine, a Sodium channel blocker attenuates the hemodynamic response to tracheal extubation by inhibiting sodium channels in the neuronal cell membrane, decreasing the sensitivity of the heart muscles to electric impulses. Diltiazem, a Calcium channel blocker attenuates hemodynamic response by blocking voltage sensitive L type channels, and inhibiting calcium entry mediated action potential in smooth and cardiac muscle. It also has peripheral vasodilation property. Esmolol, a Beta blocker attenuates hemodynamic response by blocking sympathetic nervous system. Methodology- 90 patients admitted for elective surgeries posted under general anaesthesia at Kidwai memorial institute of oncology, Bangalore during the duration of December 2018 to May 2019 were included in the study. Patients were randomly divided into 3 groups of 30 each. Randomization done by computer generated table. Group A: received Inj. Diltiazem 0.1mg/kg and preservative free lignocaine 1mg/kg. Group B: received Inj. Esmolol 0.5mg/kg and lignocaine 1mg/kg. Group C: received Inj. lignocaine 1mg/kg. Hemodynamic parameters HR, SBP, DBP, MAP were recorded before extubation (pre reversal) and 1min, 2mins, 3mins, 5mins and 10mins post extubation. In this study, the dosage was fixed based on previous studies. Results- Post extubation, the decrease in mean heart rate was statistically significant in Group B in comparison with Group C (control group) from 1 min post extubation till 10 min. There was increase in heart rate in Group A compared to Group C (control group) which is not statistically significant. Also there was slight decrease in heart rate in Group B compared to Group A (both study group) which is statistically significant at all the intervals. Conclusion- Smaller doses of esmolol when combined with lignocaine gives much better results when compared to Diltiazem + Lignocaine combination and lignocaine alone.
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Research Article
Open Access
Comparison of Low Dose Intrathecal Buprenorphine and Fentanyl as an Adjuvant to 0.5% Hyperbaric Bupivacaine in Spinal Anaesthesia for Lower Limb and Lower Abdominal Surgeries
Pages 279 - 285

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Abstract
Background: Subarachnoid block is one of the commonest local anesthetic technique and would probably maintain its place in the developing countries because of simplicity minimal skill requirement, onset, economy and minimum post-operative complications. The use of neuraxial opioids has increased dramatically in recent years augmenting the analgesia produced by local anesthetics like bupivacaine by binding directly to the opioid receptors. The aim of the current study is to compare the efficacy of opioids Buprenorphine and Fentanyl as adjuvants to 0.5% hyperbaric bupivacaine in spinal anaesthesia for lower limb and lower abdominal surgeries. Materials and methods: This study comprised of 70 patients, of ASA grades I– II, between the age group 18 and 60 years, planned for lower limb and lower abdominal surgeries who were randomly divided into B group(n=35) & F group(n=35). Group B received intrathecal 60μg of buprenorphine with 3.5cc (15mg) of 0.5% hyperbaric Bupivacaine. Group F received intrathecal 25μg of fentanyl with 3.5cc (15mg) of 0.5% hyperbaric Bupivacaine. Onset of sensory block and motor block, two segment regression, duration of sensory & motor block, duration of analgesia, haemodynamic changes and side effects were recorded. Result: Time of onset of sensory (4.2±1.3 vs 4.5±1.07 in mins) & motor blockade (7.4±1.3 vs 7.8±2.5 in mins) were similar and comparable in both buprenorphine and fentanyl groups. Duration of 2 segment regression time of sensory block was comparatively longer in buprenorphine group (125±8.8 in mins) compared to fentanyl group (100±10.9 in mins). Duration of sensory blockade was longer in buprenorphine group compared to fentanyl group (280±17.5 vs 195±21.12in mins). Duration of motor blockade too was longer in buprenorphine group compared to fentanyl group(165±10.8vs155±9.5 in mins).Duration of perioperative analgesia was significantly higher in buprenorphine group(355±30.5 vs 254±27.7 in mins).Hemodynamic parameters were comparable between the two groups. The mean Vas pain score in the first 12 hours postoperatively were comparable between both the groups and statistically insignificant. Time of first voiding was longer in buprenorphine group compared to fentanyl group (282±25.35 vs 273±30.20 in mins). Adverse effects between both the groups were comparable. Conclusion: The duration of sensory block, motor block,2 segment sensory regression time and perioperative analgesia was longer in buprenorphine group compared to fentanyl group. Hence Buprenorphine was considered as superior opioid adjuvant to local anesthetic for spinal anaesthesia with better efficacy and potency compared to fentanyl.
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Research Article
Open Access
A study to assess the sociodemographic profile and utilisation of antenatal services among pregnant women in rural Coimbatore
Pages 271 - 278

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Abstract
Background: Identifying the women who are likely to miss receiving complete ANC care during their pregnancy and understanding the causal factors is essential towards the development of effective and targeted public health interventions. Objectives: To assess the sociodemographic profile and the factors influencing the utilisation of antenatal services among pregnant women in rural Coimbatore. Methods: A community based cross-sectional study was conducted among antenatal women residing in the field practice area of Rural Health Training Centre using multi-stage sampling method from June 2021 to May 2022 (one year) in the Rural Field Practice Area of a Medical College in Coimbatore district using pre-tested, validated, semi-structured questionnaire. Results: Majority (55.2%) of the participants were aged between 18-25 years. Only 10% of the women were currently employed. Tests of association showed that sociodemographic factors were significantly associated with ANC utilization (p<0.05). Among the study participants, 80.4% utilized the services completely (ANC visit to healthcare facility, consumption of IFA tablets, Td vaccination, basic blood, and urine investigations and ultrasonogram); 19.6% had incomplete ANC care and none had “No ANC”. Conclusion: The overall high ANC utilisation in the study area could be attributed to the favourable knowledge, attitude, and practice of the antenatal women towards maternal and child health as a result of high literacy rate, ongoing IEC and health promotional activities. Attention should be given to regular and sustained contact between healthcare workers and antenatal mothers especially through home visits to develop mutual confidence in preparing them for pregnancy, childbirth, and care beyond.
Research Article
Open Access
Physical Fitness Index and Body Parameters in Medical Students
Pages 262 - 270

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Abstract
Physical fitness implies not only the absence of disabling deformity of disease and the capacity to perform a sedentary task efficiently but also a sense of physical well being and the capacity to deal with emergencies demanding unaccustomed physical effort. There is a need to know the physical fitness levels of our future doctors. They can be sensitised to pursue a healthy life style right from the begining of their medical career. The present study was undertaken to assess the physical fitness index using modified Harvard Step Test. Present Cross Sectional Observational Study was conducted in Department of physiology, MGM Medical College and Hospital, Aurangabad [MH], India in Medical Students of 1st MBBS. The physical fitness of 192 male and 173 female medical students was evaluted using modified Harvard Step method 25.2% of study subject had excellent physical fitness. It was found that females had better fitness when compared to males. It was found that BMI had a statistically significant negative correlation with physical fitness, which means as BMI increases physical fitness decreases. Physical activity scores had a statistically significant positive correlation with physical fitness. Gender was also found to be correlated with physical fitness. In the present study, females had higher physical fitness than their male counterparts and this difference was statistically highly significant. Pulse rate was found to have a negative correlation with physical fitness. Systolic and diastolic blood pressure had statistically significant positive correlation with physical fitness.
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Research Article
Open Access
Clinical Profile of Acute Kidney Injury in Haematotoxic Snake Bite
Pages 255 - 261

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Abstract
Background: This study was conducted to study the clinical profile of acute kidney injury in haematotoxic snake bites. Methods: This was a hospital-based prospective observational study conducted among 120 patients who were admitted in ward and ICU with haematotoxic snake bites in the Departments of General Medicine in Government Medical College, Trivandrum, over a period of one year after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results: The mean age group was 49.8+/-17.8. Among them, 76.7% showed local reactions, and 23.3% showed systemic manifestations. 35.8% developed AKI and 16.7% needed haemodialysis. Associated neurological manifestations were seen in 2.5%. 42.5% developed sepsis, 9.2% developed DIC, and 14.2% developed a capillary leak. 33.3% had cellulitis of which 3.3% developed functional disabilities. 8.3% required ventilatory support and 4.2% succumbed to death. Conclusion: A cascade of events tends to occur in severe haematotoxic envenomation such as bleeding disorders, hypotension or circulatory shock, intravascular haemolysis, disseminated intravascular coagulation and acute respiratory distress syndrome (ARDS). Early hospitalization, quick anti-snake venom administration and adequate supporting care provided promising results.
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Research Article
Open Access
An epidemiological prospective study on the relation between gallbladder cancer and gall stones disease
Pages 250 - 254

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Abstract
Gallstone’s status was based on information from self-reports, imaging procedures, surgical notes, and medical records. Among controls, a transabdominal ultrasound was performed to detect asymptomatic gallstones. Gallstones were removed from cancer cases and gallstone patients were classified by size, weight,color, pattern, and content of cholesterol, bilirubin, and bile acids. cancers of the gallbladder, extrahepatic bile ducts, and ampulla of Vater, respectively, persisting when restricted to those with gallstones at least 10 years prior to cancer. Biliary cancer risks were higher among subjects with both gallstones and self-reported cholecystitis, particularly for gallbladder cancergallbladder, bile duct, and ampulla of Vater cancers, respectively, could be attributed to gallstones. Cancers of the biliary tract encompass those arising from the gallbladder, extrahepatic bile ducts, and ampulla of Vater. Biliary cancer is relatively uncommon in most parts of the world, although high-risk populations and upward incidence trends have been reported in certain areas (Hsing et al, 1998, 2006). Although gallstones are a well-documented risk factor for gallbladder cancer (Diehl, 1983, 1991; Zatonski et al, 1997; Lazcano-Ponce et al, 2001; Hsing et al, 2006), their role in cancers of the extrahepatic bile duct and ampulla of Vater is less established. Material and Methods: A prospectivestudy was conducted on patients admitted in various Departments of the J.A. Group of Hospitalsfrom Jan. 2021 to Aug. 2022. 75 patients will be selected for the study with gallstone disease and 75 patients as controls for conducting this study. Result: Females are mostcommonly affected with gallbladder cancer than males. Patients in the age group of 45-59 years were found to have the highest risk of gall bladder cancer. The mean age of the patients affected was 52 years. Patients having gallstone disease were more prone to developing gallbladder cancer.The size of the stone also has a significant risk factor for gallbladder cancer ,No of stone also a significant role in developing gall bladder cancer. that gallstones were a strong risk factor for all three subsites of biliary cancer.cholesterol stones were commoner in gallbladder cancer while pigment stones predominated in bile duct cancer is consistent with the view that gallbladder cancer is more associated with lifestyle factors (diet, obesity, etc.), while bile duct cancer is associated with chronic infection or inflammation. Conclusion: That cholesterol stones were commoner in gallbladder cancer while pigment stones predominated in bile duct cancer is consistent with the view that gallbladder cancer is more associated with lifestyle factors (diet, obesity, etc.), while bile duct cancer is associated with chronic infection or inflammation (Cetta, 1991). Cholesterol stones are associated with lithogenic bile supersaturated with cholesterol, due to increased hepatic secretion of cholesterol or diminished secretion of bile salts and phospholipids that maintain the solubility of cholesterol (el Zayadi et al, 1991). In contrast, pigment stones have a high biliary concentration and are closely linked to cirrhosis, chronic infection, and blood disorders (Swidsinski and Lee, 2001). past few decades, there has been an increase in cholesterol stones and a decrease in pigment stones, probably related to increasing obesity and a more westernised diet and lifestyle. In our study, the magnitude of the biliary cancer risks associated with gallstones was higher than in most previous studies (Lowenfels et al, 1985; Vitetta et al, 2000), possibly due to our more comprehensive assessment of gallstone status and only assessment of gall stones in relation to gall bladder cancers.
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Research Article
Open Access
Risk factors for lower extremity amputation in patients with diabetic foot ulcers: a hospital-based study
Pages 243 - 249

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Abstract
Study Conducted: AT dept of generalsurgery, gajra raja medical college and JahGroup of Hospitals, Gwalior Madhya Pradesh Background: Diabetic foot ulcers (DFU) may cause significant morbidity and lower extremity amputation (LEA) due to diabetic foot problems can occur more often compared to the general population. The purpose of the present study was to use an epidemiological design to determine and quantify the risk factors of subsequent amputation in hospitalized DFU patients. Methods: This study was conducted on 100patients of diabetic foot in the Department of Surgery, JA Group of Hospitals and GR Medical College, Gwalior (MP) from January 2020 to June 2021 Patients’ demographical data and all risk factors-related information were collected from clinical records using a short structural chart. Using LEA as the outcome variable, we calculated odds ratios (ORs) and 95% confidence intervals (CIs) by logistic regression. Univariate and stepwise logistic regression analyses were used to assess the independent effect of selected risk factors associated with LEA. The data were analyzed in SPSS version 21 Results: A total of 100 cases of diabetic foot wounds were studied from January 2020 to August 2021 in the Department of Surgery JAH Hospital and G.R. Medical College, Gwalior.In our study,most diabetic foot wound patients presented in the 50-69 years age group with a mean age of 52.23±14.92 years. Male to female ratio of 4.5:1 was shown in our study.Total of 56% of patients presented with a diabetic foot wound within <10 years of duration of diabetes mellitus.67(67%) out of 100 patients gave a positive family history of diabetes.The most common cause was trauma/injury (65%) and the most common presentation was an ulcer (70%).Out of 100 patients, 66(66%) patients belonged to rural areas and 75% were illiterate.The most commonly affected patients are farmers (47%) and labors (29%) by occupation. Most of the patients were using ill-fitted shoes or barefoot walking.Most of the patients developing complications had uncontrolled RBS with delayed presentation and longer duration of diabetes and not took proper precautions and treatment.50% of patients underwent surgical debridement and 15 % of patients underwent amputation.Mortality was 2% in our study. Conclusions: Several risk factors for LEA were identified. , PAD, hypertriglyceridemia, and hypertension have been recognized as predictors of LEA in this study. Good glycemic control, the active investigation against PAD, and management of comorbidities such as hypertriglyceridemia and hypertension are considered important to reduce amputation riskNot all diabetic foot complications can be prevented, but it is possible to reduce their incidence through appropriate management. The multidisciplinary team approach to diabetic foot disorders has been demonstrated as the optimal method to achieve favorable rates of limb salvage in high-risk diabetic patients.
Research Article
Open Access
Obstetric and Neonatal Outcome among Women Presenting with Decreased Fetal Movements in Term Pregnancy in a Tertiary Care Centre
Pages 229 - 242

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Abstract
Background: Decreased fetal movements perceived by the mother in pregnancy can cause apprehension and increased incidence of unscheduled antenatal check-up and labour room admission. Decreased fetal movements are associated with a wide variety of intra-partum and postpartum complications.Aims And Objectives: To identify the demographic and pregnancy characteristics, obstetric and neonatal outcome among women presenting to hospital with reduced fetal movements.Materials And Methods: A prospective observational study conducted among 150 term antenatal women who attended the labour room of Obstetrics department, Government Medical College, Thrissur with complaints of DFM from January 2020 to December 2020.These women were categorized into 2 groups after evaluation-immediate termination group and conservatively managed group (reassured and delivered later).Obstetric and neonatal outcomes were studied.Results:. 5 women had intrauterine demise at the time of presentation.58.6% of women with DFM required immediate termination of pregnancy out of which 57.2% of cases were induced. A highly significant association between intra-partum CTG and perinatal complications were noted.Caesarean sections and instrumental deliveries were more in immediate termination group when compared to latter group. Perinatal complications(RDS at birth, APGAR scores, resuscitation and HIE) were more in immediately terminated group compared to latter group which was statistically significant. There was increased risk of RDS at birth as the number of DFM increases which was statistically significant.Conclusion: Maternal perception of DFM should receive adequate medical attention and can be used as a predictor of adverse obstetric and neonatal outcome. DFM result in increased rate of planned early delivery, induction of labour and caesarean sections. Unless intervened, these cases of DFM would have ended up in still births. Universally accepted evidence based guideline needs to be developed enabling optimal management of cases of DFM
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Research Article
Open Access
Comparative evaluation of intrathecal morphine and intrathecal dexmedetomidine as adjuvant with 0.5% hyperbaric bupivacaine for spinal anaesthesia in infraumbilical surgeries in gynaecological procedures
Pages 224 - 228

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Abstract
Postoperative pain management is one of the main challenges for anaesthesiologists. The addition of different adjuvants intrathecally is an attractive analgesic strategy due to simple and quick technique with low risk of failure and infection. Intrathecal opioids are the gold standard for the treatment of postoperative pain with morphine as the most effective due its potent and prolonged effects. However, over the years it is losing popularity due to dose dependent side effects such as pruritus, nausea, vomiting and the most feared risk of delayed respiratory depression. Dexmedetomidine is a highly selective alpha 2 agonist which possesses sedative, analgesic and sympatholytic properties and gives prolonged analgesia when used intrathecally without respiratory depression.
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Research Article
Open Access
To Study the role of clinical assessment and uroflowmetry analysis in operated cases of benign prostate hyperplasia and evaluation of prognosis postoperatively
Pages 219 - 223

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Abstract
Introduction: Benign prostatic hyperplasia (BPH) is the most common neoplastic condition afflicting men and constitutes a major factor impacting male health. Clinical evaluation to assess the presence and degree of voiding dysfunction and/or the role of BPH in its presence has an increasingly broad spectrum of treatment goals. The goals of the evaluation of such men are to identify the patient’s voiding or, more appropriately, urinary tract problems, both symptomatic and physiologic; to establish the etiologic role of BPH in these problems; to evaluate the necessity for and probability of success and risks of various therapeutic approaches; and to present the results of these assessments to the patient so he can make an informed decision about management recommendations and available alternatives. Aims and Objectives: This study aims to evaluate the role of Bulbocavernosus Reflex, Anal Tone, Perianal Sensation reflex, and Uroflowmetry assessment in establishing the prognosis after surgical management in patients of benign prostate hyperplasia. Materials and Methods: Operated Cases of BPHin the Department of General Surgery, Mahatma Gandhi Medical College. Pre- and post-operative reflexes status and uroflowmetry parameters analysis were recorded. Results: A total of 400 patients were included with a study period of 2 years. The follow-up period was 6 months. Out of these, 352 patients had good pre-operative reflexes and 48 patients had weak/absent reflexes. All the patients had poor uroflowmetry parametersOut of 48 patients with absent reflexes or decreased anal tone, 46 patients (95.83%) showed no improvement in the uroflowmetry parameters and LUTS still persisted among them. Conclusion: There was no significant improvement in the lower urinary tract symptoms after surgery in patients whose clinical reflexes were weak/absent pre-operatively in different age groups ie. 40-60, 60-80 &>80 years and also there was no improvement in uroflowmetry study parameters. These clinical reflexes give an idea about detrusor activity. Patients with weak/absent reflexes give an idea about detrusor underactivity which may be due to various underlying neurological conditions. The majority of the patients who are having weak/absent clinical reflexes do not improve even after surgery since they have underlying detrusor underactivity. This study concludes that there is no benefit of surgery in patients having weak/absent clinical reflexes pre-operativelyie. in patients having detrusor underactivity. Also, not all the patients having preoperative poor uroflowmetry parameters will improve after surgery. The improvement depends on the pre-operative clinical reflexes.
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Research Article
Open Access
To determine the KAP of Medical Students towards Hepatitis B and Hepatitis C
Pages 213 - 218

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Aim: To determine the KAP of Medical Students towards Hepatitis B and Hepatitis C. Material and Methods: The medical students participated in a research that consisted of filling out questionnaires. The questions sought information on the respondent's knowledge and attitude towards diseases caused by hepatitis B and C. 100 students enrolled in the MBBS programme took part in the research. Knowledge, attitudes, and practises with regard to hepatitis B and hepatitis C were evaluated with the use of a pretested proforma that included a questionnaire. Results: Respondents' awareness of hepatitis B risk factors included the following: 98% knew about infected blood transfusions, 97% knew about sharing needles, 88% knew about infected mother to child transmission, 91% knew about unsafe sexual contact, and 94% knew about body piercing and/or tooing. Responders were aware of the risk factors for Hepatitis C, including the transmission of the virus via blood transfusions. 88%, 81% knew about sharing needles; 6% knew about transmitting infection from mother to kid; 63% knew about risky sexual contact; and 64% knew less about tattooing and piercing, which was demonstrated to be the case. 79% of students were aware that nausea and vomiting are symptoms of hepatitis C, and 75% were aware that a yellowish tint is one of those symptoms. 78% of students were aware of anorexia as a sign and symptom of hepatitis C, whereas 63% were aware of stomach discomfort, and 58% were aware of joint pain. Conclusion: The medical students have a strong understanding of both Hepatitis B and C, as well as a positive attitude towards the topic. It is very necessary, in order to prevent the further spread of Hepatitis B and Hepatitis C, to educate medical students about the many facets of the illness and the need of vaccination as part of an active health education programme.
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Research Article
Open Access
A Comparative Study of Effects of Bupivacaine Alone and Bupivacaine with Dexmedetomidine in Epidural Anaesthesia for Lower Limb Orthopaedic Surgery
Pages 205 - 212

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Abstract
Background: Epidural anaesthesia has several benefits over general anaesthesia like reduced stress after surgery, maximum postoperative analgesia and less respiratory depression. The neuraxial dexmedetomidine, by promoting analgesic effects can reduce the dosage of local anaesthetics requiredfor epiduralanaesthesia. Our present study was designed to compare dexmedetomidine as an adjunct to bupivacaine along with plain bupivacaine in lumber epiduralanaesthesia in lower limb orthopaedic surgery for perioperative analgesia and anaesthesia. Methods: Eightypatients were assigned into group B (Bupivacaine plain) and group D (Dexmedetomidine with bupivacaine). The efficacy in terms of onset and duration of anaesthesia and analgesia were assessed along with the sedation score, heart rate, blood pressure (mean arterial pressure) at regular intervals throughout the perioperative period. Data was collected and then analyzed with appropriate statistical tools. Result: In present study patients who received lumber epidural bupivacaine plain (0.5%)(Group B) experienced significantly late onset effective anaesthesia and less longer duration of sensory and motor block and analgesia in comparison to the patients received lumber epidural bupivacaine (0.5%) plus dexmedetomidine 1 µg/kg (Group D) as an adjuvant. The patients of dexmedetomidine group had significant sedation than the patients of plain bupivacaine group. Around 12.5% of total patients experienced shivering and very few noticed urinary retention. Conclusion: Dexmedetomidine as adjuvant with 0.5% bupivacaine in epidural anaesthesia produced faster onset of sensory and motor block, excellent surgical anaesthesia and extended analgesia in postoperative period with increase in the duration of sensory and motor blockade. Dexmedetomidine can be a good adjuvant to bupivacaine for epidural blockade in lower limb orthopaedic surgeries.
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Research Article
Open Access
A Comparative Study between Oral Clonidine and Oral Gabapentin as Premedicants in Attenuating the Haemodynamics Response to Laryngoscopy and Endotracheal Intubation in Normotensive Patients
Pages 198 - 205

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Abstract
Background: This study was conducted to compare the efficacy of oral clonidine 200 mcg with oral gabapentin 900 mg in attenuating haemodynamic response to endotracheal intubation with regard to heart rate, blood pressure (systolic and diastolic), mean arterial pressure, and rate pressure product. We also wanted to ascertain the effectiveness of oral clonidine 200 mcg with oral gabapentin 900 mg or vice versa in attenuating haemodynamic response to laryngoscopy and endotracheal intubation. Methods: This was a hospital-based study conducted among 100 ASA1 and ASA2 patients posted for surgeries under general anaesthesia in KIMS, IEC/D/-49/2017, from 16th November 2017 to 23rd October 2018, after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results: Both groups showed attenuation of stress response. In gabapentin group, there was an increase in SBP, DBP and MBP up to 3 minutes, RPP up to 4 minutes HR up to 10 minutes after that, it was maintained below the baseline. In clonidine group, there was no rise in systolic and diastolic blood pressure, mean arterial blood pressure or rate pressure product compared to the baseline from the 1st minute of intubation which was statistically significant (p<0.0001). Post extubation, clonidine group patients were more sedated than those in gabapentin group. Conclusion: Both clonidine and gabapentin attenuate the stress response to laryngoscopy and intubation. When both of these drugs were compared, clonidine attenuated the stress response to laryngoscopy and intubation better than gabapentin and afforded good haemodynamic stability. Post extubation, clonidine group patients were more sedated than those in gabapentin group.
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Research Article
Open Access
Effect of 10 mg and 20 mg of Intrathecal Meperidine (Pethidine) with 0.5 % Hyperbaric Bupivacaine in Preventing Intraoperative Shivering in Lower Limb Surgeries under Sub Arachnoid Block
Pages 188 - 197

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Abstract
Background: This study was conducted to evaluate and compare the effect of adding two different doses (10 mg and 20 mg) of intrathecal meperidine with 0.5% hyperbaric bupivacaine on the onset, incidence and intensity of shivering during lower limb surgeries under spinal anaesthesia. Methods: This was a hospital-based randomized controlled trial study conducted among 60 patients aged between 18 and 60 years of physical status ASA grade 1 and ASA grade 2 of either sex undergoing elective lower limb surgeries at the Department of Anaesthesiology and Critical Care, Kempegowda Institute of Medical Sciences, Bangalore, from December 2015 to September 2017 after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results: The onset and intensity of shivering were greater in group 1 than in group 2 (p =0.007). The duration of shivering was significantly prolonged in group 1 compared to group 2 (p=0.004). There was a significant drop in temperature in both groups at 25 minutes (p<0.001) and 1 hour (p<0.001). The noted side effects were vomiting and pruritis. Conclusion: 0.5% hyperbaric bupivacaine with 20 mg of meperidine prevents shivering better with respect to incidence, intensity and duration of shivering when compared to 10 mg meperidine. Hence, we conclude that meperidine can be safely used at dosages of both 10 mg and 20 mg for the prevention of shivering with no significant difference with respect to complications.
Research Article
Open Access
Uric Acid and Thyroid Profile in Diabetic and Non Diabetic Cardiovascular Patients
Pages 183 - 187

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Abstract
Background: Cardiovascular disease remains the leading cause of death globally, accounting for a significant burden of mortality and morbidity. It affects people of all ages and socio-economic backgrounds, with a particular impact on low- and middle-income countries. Risk factors such as high blood pressure, tobacco use, unhealthy diets, physical inactivity, and obesity contribute to the global prevalence of cardiovascular disease. Aims and Objectives: The aim of this research was to study and compare the thyroid profile and serum uric acid levels in diabetic and non-diabetic cardiovascular disease patients. Materials and Methods: The present hospital based observational study was carried out Osmania General Hospital and included 44 cardiovascular disease patients. All the patients underwent detailed history taking, thorough clinical examination and relevant laboratory investigations. Thyroid profile and serum uric acid levels were compared between diabetic and non-diabetic cardiovascular patients. Data was collected in MS Excel and presented as numbers and percentages in the form of tables and figures. Results: More than 60% of the patients considered for the study were male. Majority of the patients, nearly two-third (65.91%), were non-diabetic. Of the 15 patients who were diabetic, almost all the patients (86.67%) fell into the Euthyroid category, while Hypothyroidism and Hyperthyroidism were found in only one patient (6.67%) each. None of the non-diabetic patients from the study had Hyperthyroid. Majority of the non-diabetic patients (86.21%) exhibited Euthyroid state while only 4 non-diabetic patients (13.79%) had Hypothyroidism. Almost all the diabetic patients (93.33%) from the study had normal uric acid levels, while only one diabetic patient (6.67%) had a raised uric acid level. Among the non-diabetic patients, majority of them (89.66%) had normal uric acid levels. Only 3 of the 29 non-diabetic patients (10.34%) had raised uric acid level. Conclusion: There is a strong association between diabetes and cardiovascular disease. However, further research needs to be carried out to in view of thyroid profile and uric acid levels in diabetic and non-diabetic cardiovascular disease.
Research Article
Open Access
Comparing the Effects of Low Dose of Ketamine, Tramadol and Ondansetron in Prevention of Post Spinal Anesthesia Shivering in Cesarean Section in Rural northern Indian population
Pages 176 - 182

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Abstract
Background: Shivering is a frequent side effect in cesarean section (CS) after spinal anesthesia (SA). Pethidine has been considered as the gold standard for post – SA shivering control, but it is contraindicated in breastfeeding women. Methods: This randomized double-blind study was conducted at SDH Hospital Nowshera Rajouri (J&K), from June 2022 to Dec 2022. A total of 160 eligible term parturient women were enrolled and randomly divided into four groups of low dose ketamine (K) tramadol (T), ondansetron (O) and placebo (P). The incidence and severity of shivering and patients’ complication were recorded and compared among the groups. Results: The demographic data of the patients in all the groups was comparable. Shivering was seen in 21 (52.50%) ,8 (20.0%), 24 (60.0), 26 (65.0) in K, T, O and P groups respectively (P<0.0001) Regarding shivering severity that was significant difference among the four groups (P<0.0001) Conclusion – As there was high incidence of shivering in the placebo group prophylactic intervention is CS under SA seems to be necessary. Among the studied groups tramadol was the most effective one followed by a low dose of ketamine and ondansetron.
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Research Article
Open Access
Adherence to Antihypertensive Therapy Based On the Prescribing Pattern in Postmenopausal Women-A Prospective Study
Pages 172 - 175

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Abstract
Introduction: Menopause is defined as the cessation of menstrual cycles for 12 consecutive months, although many women seek medical advice before this time because of the onset of menopausal symptoms. The prevalence of hypertension in postmen opausal women is higher than in men. The aim of the present study was to identify the adherence to antihypertensive therapy based on the prescribing pattern in postmenopausal women. Methodology: Aprospective observational study was conducted in 116 post-menopausal patients visiting General Medicine OPD for the treatment of hypertensionin a tertiary care centre in South India, for a period of 6 months. Results: Prescribing pattern of drug sin post-men opausal women is more complicated than in pre-menopausal women. The commonly prescribed anti-hypertensive agent is Calcium channel blocker (CCB) (45.16%), followed by Diuretics (19.35%), An giotensin receptor blockers (ARB)(14.51%), Beta blockers (9.67%) and An giotensinconverting enzyme inhibitors (58%). In monotherapy, ARB and CCB women achieved significant reduction fB Pandin combination therapy ARB with Diuretics gaves ignificant reduction. Conclusion: Inpost-menopausal women most commonly prescribedoral anti-hypertensive drugs are calcium channel blockers & diuretics. It is evident that good adherence to therapy and regular checkups will protect the post-menopausal women with HT from other major complications.
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Research Article
Open Access
Prevalence of Depression in Sexually Transmitted Disease Patients in Tertiary Care Hospital
Pages 166 - 171

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Abstract
Background: Psychiatric morbidity is on the rise among patients having STI’s in India. Little data is available on the prevalence of depression in patients having STI’s. Aims And Objectives : The present study aims to assess the prevalence of depression in patients with Sexually transmitted infections. Materials And Methods : This cross sectional study was conducted in the STI clinic of Mahavir Institute of Medical Sciences & General Hospital. A total of 100 participants of both the genders who met inclusion and exclusion criteria were considered for the study after taking informed consent. Participants were those patients who were diagnosed with STI. The study was conducted from August 2019 to March 2020.The study was carried out in single phase, screening for depression was done for all the patients using the " HAMILTON DEPRESSION RATING [HAM-D] SCALE, which is designed to grade the severity of depression.SPSS-23 was used for statistical analysis of data. Results : Majority of individuals who had STI’s were in the age group of 20-30 years followed by age group of 31- 40 years. Since patients of 20 – 30yrs had risk taking behavior & also were sexually active, they are more prone to develop STI’S. Overall prevalence of depression was found be 35% out of which 24 % had mild depression & 10% had moderate depression. Depression was more prevalent in age group of 20-30 years, 35.3% of this age group were found to have Mild depression. Among the age group of 31-40 years, 18.7% had mild depression and 6.3% had Moderate depression. When compared with the distribution of sex and gender, 42.2% females had depression among which 31.1% suffered with Mild depression and 8.9%, with Moderate depression. Prevalence of depression was high in females when compared with males (29.1%). The prevalence of depression was high among unmarried patients (77.45) when compared to married individuals (16%). It was found that less number of educated people suffered from depression (23.9%) when compared with illiterates (57.6%). Depression was more prominent among HIV +ve patients (76.5%), majority of them had Mild depression & few had Moderate and Severe depression. Subjects who had multiple sexual partners (72.2%) were found to have depression when compared to other individuals. Conclusion : This study suggested that there is strong need to screen the patients visiting the STI clinic for depression. The sexual behavior in the study population put them at a high risk of developing STI’S.
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Research Article
Open Access
Study of clinical, hematological, cytogenetic and molecular profile of CML in tertiary care centre Mysore
Pages 153 - 158

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Abstract
Background: Chronic Myeloid Leukemia (CML) is clonal hematopoietic disease characterized by proliferation and expansion of myeloid cell lineages in bone marrow. It is a malignancy of considerable duration consisting of chronic phase followed by accelerated, and blast crisis phase. Objective: To study the clinical, hematological, cytogenetic and molecular profile of CML. Methods: This cross-sectional study was conducted in the department of Medicine and Oncology, KR hospital, Mysore Medical College and Research Institute, Mysore during the study period of one and half year from January 2020 to July 2021. Results: The mean age of presentation was 44.5. There was slight male preponderance with Male: female ratio of 1.41:1. Cigarette smoking was seen in 31% patients which was statistically insignificant. An incidental diagnosis was made in 1 person. Anemia, thrombocytosis, leukocytosis and massive splenomegaly were striking features. The peripheral blood smear showed shift to left with spectrum of myeloid cells with varying degree of differentiation. Basophilia was striking in all the cases (100%). The bone marrow showed marked hypercellularity with increased M:E ratio. Majority of the patients were in CML-CP phase followed by 1 patient in AP phase and none in blast phase. Majority of the patients had standard Ph positive CML. Conclusions: The present study highlights that cytogenetics play a vital role in diagnosing and prognosticating CML and also the importance of routine health check-up.
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Research Article
Open Access
Assessment of Stigma Self Esteem and Quality of Life in Euthymic Patients of Bipolar Affective Disorder
Pages 143 - 152

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Abstract
Background: Bipolar disorder is the sixth leading cause of disability worldwide, affects about 60 million people worldwide3 and has a lifetime prevalence of about 1-3% in the general population worldwide. Objective: To assess the level of perceived Stigma, Self-esteem and Quality of Life in euthymic patients of Bipolar Affective Disorder. Methods: This cross-sectional study was conducted among all euthymic patients of Bipolar Affective Disorder, attending Psychiatry services in the Department of Psychiatry, Tertiary care center of a General Hospital. Results: Bipolar Affective Disorder patients have significantly higher stigma associated with illness even when they are euthymic. Their self-esteem is significantly lower even when they are not symptomatic and it is significantly associated with number of relapses. Their quality of life is also significantly lower than healthy population across all domains specially social relation and psychological heath domain. High level of Stigma and lower Self-esteem significantly affect the Quality of Life in patients of Bipolar Affective Disorder and can predict change in it, though stigma and self-esteem show significant association but they do not seem to be predictive of each other’s severity. Conclusions: This study is a small step in demonstrating that Bipolar Disorder patients, even when they are in a euthymic period, experience lower Quality of Life, have lower Self-esteem and experience higher internalized Stigma associated with illness.
Research Article
Open Access
Methicillin-Resistant Staphylococcal Aureus Infection in Dengue Fever
Pages 138 - 142

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Abstract
Aim: To describe the presentation and outcome of secondary Methicillin-resistant Staphylococcal aureus (MRSA) infections in a cohort of confirmed dengue fever patients over a 5-year period, a rare but severe complication. Methods: There were 18 patients with culture-confirmed Methicillin Resistant Staphylococcal infection of the 1170 patients admitted with Dengue fever over five years at Calicut Medical College, Kerala. Their mode of presentation, complications and outcome were studied. Results: The Average age of the subjects were 45.8 years (range 22 -71 years) and the male-female ratio was 3:2. Most patients with MRSA complicating Dengue fever had a relapse of fever after 11-18 afebrile days (78%). Four patients had continued fever for more than one week, which is unusual for uncomplicated Dengue fever. Mortality in MRSA patients was 22% (4/18). The site of MRSA infection was most often skin and soft tissue, followed by lungs. Characteristic laboratory markers of leukocytosis following initial leucopenia and raised Erythrocyte sedimentation rate (ESR) were seen in all patients. Conclusions: MRSA secondary infection in Dengue fever occurred in 1.5% of the cohort and carried a mortality of 22%. It usually manifests about one week after the initial onset of fever with varying manifestations dependent on the infection site. Leukocytosis and raised ESR occurred in all patients. Preventing MRSA in patients admitted with dengue is of utmost importance. Early detection and treatment are essential for a better outcome.
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Research Article
Open Access
Correlation of fragility fractures of hip with Vitamin D levels
Pages 134 - 137

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Abstract
Introduction -Vitamin D plays a role in optimization of the skeletal function. Vitamin D helps in calcium homeostasis which further helps in bone mineralization and preventing osteomalacia, hence older individuals with low vitamin D levels (<30ng/ml) must be prone to fragility fractures of the hip. Methodology
● Study design – Prospective observational study.
● Study population Patients at Justice K. S. Hegde Charitable Hospital with closed fractures of the hip involving the proximal femur diagnosed by a physical examination and plain radiography in the pelvis with both hips Anteroposterior View (AP) and lateral view of the involved hip.
Study setting - Justice K. S. Hegde Charitable Hospital attached to K. S. Hegde Medical Academy, a unit of Nitte (Deemed to be University), Deralakatte, Mangaluru – 575018 (Hospital-based study).
● Study Duration - Study was conducted from February 2021 till October 2022.
● Sample size – Sample size was calculated using nMaster software (version 2.0). Based on the alpha level of 5% SD of vitamin D in hip fragility fractures is 8.05(12), for the estimation error of 1.5, sample size was decided as 111. This was calculated using master version 2 software.
Methods: All patients over 45 with hip fractures from minor trauma, such as a slip and fall while standing or walking, were clinically and radiologically assessed. A patient history and injury information were documented using a predesigned proforma. The history consists of accidents/trauma, fractures in the past, surgeries, drug/supplement use history, and co-morbid conditions. The pelvis and affected limb were radiographed. Boyd and Griffin for intertrochanteric fractures and Garden for neck of femur fractures, Russel-Taylor classification for Subtrochanteric fracture to classify the kind, comminution pattern, and grade of fracture. A biochemist evaluated 25-hydroxyvitamin D (25-OH Vit.D) levels in venous blood samples taken after admission. Our laboratory tested serum vitamin D levels using electrohemiluminescence Immuno Assay (ECLIA) on an automated analyzer. Vitamin D values <20ng/ml were judged inadequate, while 20–20ng/ml were considered insufficient. 30-100mg/ml vitamin D was typical. Finally, vitamin-D levels correlated with fracture comminution. Data Analysis: On statistical analysis, the data was expressed in mean SD, frequency & percentage. Chi-square test was used for the analysis of the data. Results In the present study, 111 patients were evaluated with X-ray radiographs to investigate the comminution pattern of hip fractures and the presence of hypovitaminosis D in patients diagnosed with hip fractures. The mean age of patients was 70.40 ± 11.29 years. Out of 111 patients, 19 patients (17%) belonged to the age group of 46 to 60 years, 60 patients (53.6%) belonged to the age 61 to 75 years. 33 patients (29.5%) belonged to the age group of >75 years. Out of 111 patients, patients (71.4%) were females and 32 patients (28.6%) were males. Based on symptoms, 45 patients (40.17%) presented with left Hip/Groin pain with inability to bear weight and 66 patients (59.82%) presented with right Hip/Groin pain with inability to bear weight. Based on comminution, 59 patients (52.7%) had comminution. The mean vitamin D levels was 20.98 ± 13.11. 46 (41.1%) of the 111 patients had deficiency 20ng/dL, 4 (3.6%) had insufficient 21-29ng/dL, 6 (5.4%) had optimal 40-60ng/dL, and 3 (2.7%) had sufficient 30-39ng/dL. The correlation between comminution and Holick's classification was statistically significant. (p=0.001). The findings of the study conclude that Vitamin D have a significant effect on the presence of comminution and fracture site pattern. Conclusion -According to our study, osteoporosis, vitamin D deficiency, and fracture site comminution are all coexisting conditions. Early identification and treatment with vitamin D for osteomalacia and anti-osteoporotic regimens for osteoporosis will enhance bone, muscle, and general health, reducing falls and the associated fractures. Incorporating findings from bigger research into Indian hip fracture prevention recommendations is necessary.
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Research Article
Open Access
Comparative Study of Nalbuphine versus Fentanyl as Adjuvants to Intrathecal Hyperbaric Bupivacaine for Lower Extremity Surgical Procedures
Pages 127 - 133

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Abstract
Objectives: Adding adjuvants to local anaesthetics hastens the onset and prolongs the duration of blocks with favourable postoperative analgesia. The principal objective of our study was to compare the duration of postoperative analgesia between the two intrathecal opioids (as adjuvants with bupivacaine). This prospective, randomized, double blind study was conducted at a tertiary care centre. Techniques: After institutional ethical committee approval and informed patient consent, sixty healthy patients who were scheduled for elective lower extremity surgery under spinal anaesthesia were divided into two equal groups and enrolled in the study. They received 15 mg of hyperbaric bupivacaine 0.5% with either nalbuphine 0.4mg (Group N) or fentanyl 25 mcg (Group F) Onset time and duration of sensory blockade along with 2 segment regression of sensory blockade were noted. Time for onset of complete motor block and duration of effective analgesia were also noted. Adverse effects, if any, were noted. Quantitative data are presented as means and standard deviations and confidence intervals, while qualitative data are presented as proportions. An independent t-test and a chi-square test for proportions were used to compare the significance of differences in the means using R software 3.2.2 version. P ≤ 0.05 was considered statistically significant. Results: Post operative analgesia lasted significantly longer in the nalbuphine group compared to the fentanyl group. Conclusion: Thus, nalbuphine is a better adjuvant to bupivacaine than fentanyl when administered intrathecally for lower extremity surgical procedures in terms of duration of postoperative analgesia.
Research Article
Open Access
A Study on Serum Magnesium in Acute Myocardial Infarction in a Tertiary Care Hospital
Pages 119 - 126

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Abstract
Background: The range of the normal magnesium concentration is 1.7–2.2 meq/L. Usually, a serum level of less than 1.7 meq/L is used as a benchmark. When there is a low level of magnesium in the blood, there is an electrolyte disruption called hypomagnesemia. Numerous factors, such as insufficient magnesium intake, persistent diarrhoea, malabsorption, ongoing stress, drunkenness, and medications like diuretics, can cause hypomagnesemia. Objectives:
1. To know whether there is any change in the serum magnesium level in patients with acute phase of myocardial infarction.
2. Changes in the serum magnesium level, and its relation with the occurrence of complications of acute myocardial infarction like ventricular arrhythmias, supraventricular arrhythmias, left ventricular failure, cardiogenic shock, bundle branch block, hemi block, atrio ventricular block, mortality.
3. To compare the patients with altered serum magnesium levels with normal serum magnesium levels in A.M.I.
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Material & Methods: Study Design: Case-control study. Study area: Department of General Medicine, Nimra Institute of Medical Sciences, Vijayawada. Andhra Pradesh. Study Period: April 2022 – March 2023. Study population: Patients with acute myocardial infarction admitted in department of medicine. Sample size: Study consisted a total of 50 cases and 10 controls. Sampling Technique: Simple random method. Study tools and Data collection procedure: 50 acute myocardial infarction cases and 10 healthy controls were selected. The subjects were informed about the nature and purpose of the study and consent was taken from subjects themselves or family members in case of unconscious patients. Patients presenting with chest pain suggestive of myocardial infarction, who showed E.C.G. evidence of acute infarction changes were assessed by detailed history and physical examination as outlined in proforma. The infarction was confirmed by elevated CPK/troponin levels. Serum magnesium is estimated within first 24 hours of chest pain. Serum magnesium estimated by Colorimetric method using calmagite. Clinical findings, and serum magnesium levels are used as parameters to assess the incidence of complications likes arrhythmias, left ventricular failure, cardiogenic shock, supraventricular arrhythmias. Bundle Branch Block, Hemi Block, AV Block and Mortality in patients with AMI. Results: There were more number of deaths in AMI patients with hypomagnesemia than in patients of AMI with normal serum magnesium levels. There is no statistically significant association of hypomagnesemia with death in cases of AMI as p value is 0.091. Conclusion: Prophylactic administration of the intravenous magnesium sulphate may be considered in all cases of Acute Myocardial infarction as an adjuvant to thrombolytic therapy and in patients not suitable for thrombolysis to prevent cardiac arrhythmias & reduce short term mortality irrespective of serum magnesium levels as it is safe and cheap.
Research Article
Open Access
A study of coronary artery atherosclerosis in dead bodies subjected to medico-legal autopsy
Pages 111 - 118

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Abstract
Background and objectives: This research has been carried out on all the autopsies performed at a teaching hospital, satisfying the inclusion criteria with an objective to ascertain the presence or absence of atherosclerotic disease of the coronary blood vessels. Method: This is a histological study done on 445 heart specimens in the department of forensic medicine for a period of one year, irrespective of cause of death, age and sex to evaluate the presence of coronary atherosclerosis. Results: Out of the 445 specimens of hearts examined, the most commonly affected coronary blood vessel was the LAD. No atherosclerotic changes were noted in 32 heart specimens examined which belonged to individuals between 18 years to 45 years. Triple vessel disease was also encountered in many cases that were asymptomatic. Out of 31 cases of natural death, coronary artery disease was found in all the cases, in varying grades and death due to coronary insufficiency due to CAD was found in 9 cases. The higher grades of coronary artery atherosclerosis were found more towards advanced age group. Males were more commonly affected than the females.
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Research Article
Open Access
Allopurinol, Probenecid and Benzbromarone Monodrug Therapy in Treatment of Goutly Arthritis Patients in Attending Tertiary Care Hospital
Pages 102 - 110

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Abstract
Background: Hyperuricaemia is defined as an elevation of the uric acid level in the blood to more than 0.38 mmol/l. This increased uric acid gets deposited in the form of monosodium urate crystals in joint tissue to form a micro trophi complex. An increased uric acid level is associated with increased gouty risk. Antigout drugs such as allopurinol, Colchicine, probenecid, and Benzbromarone. The main action of these drugs is to decrease uric acid levels and symptoms of gouty arthritis. The main aim of our study is to detect a suitable mono-drug therapy for the treatment of gouty arthritis. Aim: To study the effect of allopurinol, probenecid, and Benzbromarone mono-drug therapy in gouty arthritis patients in tertiary care hospitals. Material and method: The present study was conducted on 150 gout patients. All the patients were equally divided into three groups; group -1, 50 patients were treated with allopurinol, group 2, 50 patients treated with probenecid, and group -3, 50 patients were treated with Benzbromarone. All these patients were monitored with symptoms and also tested with blood pressure, serum creatinine, blood urea, and blood uric acid. Results: In our study majority of the patients were male followed by female (p 0.342). With the age group of 61 – 65 years in all the groups (groups – 1, 2 & 3) respectively. On the basic characteristics of the gouty patients, 45.33% were alcoholic abuse, 35.33% were smokers, 52.66% were hypertensive, 80.66% were diabetic patients, 17.33% were Hypertriglyceridaemia, 45.33% were obesity, 21.33% positive family history and 58.66 % chronic tophaceous gout respectively. Based on the location of gouty arthritis and symptoms toes and swelling was observed in the majority of patients in all group – 1, 2 & 3. Based on biochemical parameters after 3 months of treatment, no significance was observed in serum creatinine in groups -1, 2 & 3 (p. >0.05) On blood urea no significance was observed in group -1(p>0.05), and significance was observed in blood urea in group 2 & 3 (p<0.05). Based on uric acid levels significance (p< 0.05) was observed in all three groups (group – 1, 2 & 3) respectively. Conclusion: Benzbromarone followed by is the better drug of choice in lower urea and uric acid levels compared with Probenecid and allopurinol group
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Research Article
Open Access
Acute Kidney Injury in Different Poisoning Cases Reported From Central India
Pages 95 - 101

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Abstract
Background and Objectives: The aim of this was to present our firsthand observations and findings pertaining to the occurrence of acute kidney injury (AKI) subsequent to exposure to toxic substances. Methods: This retrospective study involved the collection of data from patient case records at a prominent nephrology hospital situated in central India. Patient records were carefully examined to obtain information regarding the ingested substance, symptoms observed upon presentation, basic laboratory test results obtained upon admission, the treatment modality employed, and the ultimate outcome. It is important to note that patients who developed AKI following snake envenomation or scorpion stings were specifically excluded from this study. Results: A total of 200 cases involving AKI resulting from poisoning were identified. The largest group within this cohort consisted of patients who were affected by paraphenyline diamine poisoning. Additionally, there were cases of methanol poisoning, organophosphorus compounds, paraquat, and copper sulphate poisoning, tartaric acid poisoning, phenobarbitone poisoning. Notably, 9 patients had ingested a combination of multiple substances. Among the affected patients, 95% required renal replacement therapy. Overall, 70% of patients achieved complete recovery, while 30% succumbed to the acute phase of the illness. Conclusion: The reporting of toxic substances that lead to the failure of vital organs is of utmost importance in order to enhance awareness among the general population and healthcare providers. By providing comprehensive documentation and dissemination of information regarding these substances, the understanding of the potential hazards associated with them can be improved.
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Research Article
Open Access
Assessing magnitude of hypertension: A community based study in the rural field practice of a Medical college
Pages 86 - 94

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Abstract
Background: Hypertension is one of the most important risk factors for cardiovascular diseases particularly Ischemic Heart Disease & stroke. According to a nationally representative study on burden of high blood pressure in India, 70% of the people suffering from hypertension are not aware of it. Deaths due to hypertension are largely preventable. In comparison to other evidence-based interventions for non-communicable diseases, control of hypertension has the largest potential to save lives. Objective: 1.To estimate the magnitude of hypertension in a rural community. 2. To determine the significance of factors associated with hypertension Design and Methodology: A Community based cross sectional study was conducted in two pre-selected villages near Kakaramanahalli, rural field practice area of RajaRajeswari Medical College for a duration of six months among the people aged 18 years and above. A person was considered to be a hypertensive if he/ she were already diagnosed case of hypertension and / or on treatment or with a current SBP of ≥ 140 mm Hg or DBP ≥ 90 mm Hg and a person was considered as pre hypertensive if he/ she were with a current SBP of 120 – 139 mm Hg or DBP 80 – 89 mm Hg. Results: Out of 101 participants, the mean age was 52.13±16 years. Majority of the people were in the age group of 60 years & above accounting for 44 (43%). Females outnumbered the males accounting for 66 (65%). Illiterates were more among the study participants accounting for 54 (53.5%). Majority of the people in the study were agriculturists accounting for 51 (50.5%) . Overall, the magnitude of Hypertension among the study population was found to be 33.7% and 32.7% were falling under the category of pre-hypertensive. There was no statistically significant association between blood pressure and age, gender, type of family, BMI and waist circumference. Conclusion: Our study concluded that more screening activities to be implemented at rural levels for the population who are above the age of 40 years. There is a need for frequent monitoring of Blood pressure irrespective of BMI, waist circumference in the population above the age of 40 years.
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Research Article
Open Access
Evaluation of Risk Factors of Surgical Wound Dehiscence in patients After Laparotomy
Pages 82 - 85

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Abstract
Objectives: The percentage of patients with difficult and prolonged healing of the wound is still high, while immediate complications such as wound dehiscence occur in up to 3 % of all treated patients in abdominal surgery. The aim of the study was to analyze the risk factors and comorbidities in the group of patients undergoing laparotomy and associated with early postoperative wound dehiscence. Methods: The prospective study included all patients treated surgically undergoing laparotomy at the Department of General Surgery,JA Group of Hospitals and GR Medical College, Gwalior (MP) Results: The results showed a statistical proportion of male patients102 (85%) compared to females18 (15%). The largest number of respondents were in the age group 21 to 40yrs. Surgical wound infection was evident in(103)85.3% of patients, hypoproteinemia was found in(86)71.76% of patients, anemia in(99)82.5%, peritonitis in 36% and diabetes in (34)28.33% of respondents. Of the total respondents with surgical wound dehiscence, 78 (65%) had comorbidities present. By analyzing the prevalence of comorbidity and risk factors recorded in relation to comorbidity, it was noted that hypertension is most often associated with hypoproteinemia (X2 =4.399; p=0.036), wound infection (X2 =4.112; p=0.043. The frequency of the anemia, peritonitis, and diabetes in the sample was not different in relation to the comorbidity conditions (p >0.05) Conclusions: The risk factors occurrence of surgical wound dehiscence in our study were identified as hypoproteinemia, tuberculosis, anemia, and active infection. The highest incidence of dehiscence was in patients operated on in medical emergencies and in patients with malignant disease.
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Research Article
Open Access
A Clinical and Radiological Presentation in Patients with Obstructive Jaundice: A Prospective Observational Study
Pages 77 - 81

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Abstract
INTRODUCTION: Obstructive jaundice is a common surgical problem. Occurs due to both benign and malignant conditions.Evaluation in patients with obstructive jaundice was a challenging problem. Presentation of obstructive jaundice patients is late and mostly present after the disease becomes advanced or uncurable Aims And Objectives: To assess age and sex patterns, clinical presentation, and radiological and biochemical patterns in obstructive jaundice patients. Materials And Method: 100 patients with obstructive jaundice were studied. Proformas form was filled an assessment of demographic and clinical patterns in benign and malignant obstructive were observed and radiological findings in benign and malignant obstructive were carried out to assess the operability. Result: we enrolled 100 patients, 18 were male and 82 were female having mean age was 52.58 yr. All patients have icterus, 60% lumping women, and 31% have pruritus. Gallbladder was palpable in 40% of patients which were due to pancreatic and Periampullary malignancy. Our study reveals the most common overall and benign cause of biliary tract obstruction was CBD stone(33%) and the most common malignant is gall bladder carcinoma(31%) followed by Periampullary carcinoma(17%). CBD stonesare treated by CBD exploration(85%) and palliative treatment by ERCP(15%) and the rest of the benign conditions are completely treatable. Among malignant causes of gallbladder carcinoma treated by radical cholecystectomy (16%), cholangiocarcinoma was mostly inoperable, and Periampullary carcinoma by Whipple's procedure (25%). Conclusion Malignant causes of obstructive jaundice outnumbered benign causes. The most common overall and benign cause was Choledocholithiasis and the malignant was gallbladder carcinoma followed by Periampullary carcinoma. Benign causes were prevalent in younger age groups (31-40 yr) and malignant in older age groups (61-70 yr). A common presentation of obstructive jaundice was icterus and palpable gallbladder was indicative of malignant etiology. Ultrasound followed by MRCP/ERCP and CT scan was the investigation of choice. Benign conditions have better outcomes and cure rates while malignant conditions were inoperable (83%).
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Research Article
Open Access
Comparison of Preemptive Dexmedetomidine and Magnesium Sulphate in Requirement of Post Operative Analgesia in Patients Undergoing Surgeries in General Anaesthesia
Pages 69 - 76

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Introduction: Pre-emptive analgesia provides some short-term (reduction in perioperative pain and acceleration of recovery) and long-term (prevention of chronic pain syndrome) benefits. Therapies that have been tested in pre-emptive trials include NSAIDS, intravenous opioids, IV Ketamine, peripheral local anesthetics, caudal and epidural analgesia, dextromethorphan, gabapentin, magnesium and dexmedetomidine. Aim & Objectives: As dexmedetomidine and magnesium seem to be new weapons in the armamentarium of anaesthesiologists to combat post-operative pain to reduce the requirement of anesthetics intra operatively; we planned this study to compare these two agents in our set up to know exactly their effectiveness in terms of intensity of pain relief and it’s duration, side effects and effect on haemodynamics. Material & Method: This was a double-blinded prospective study in which patients were randomly divided into 2 groups, 55 patients in each group. Group A (n=55) patients were administered intravenous dose of 1.0µg/kg dexmedetomidine for 10 minutes in 100 ml saline followed by a continuous infusion of 0.7µg/kg /hr till completion of the surgery. Group B (n=55) patients were administered intravenous dose of 50mg/kg magnesium sulphate for 10 minutes in 100 ml saline followed by a continuous infusion of 15mg/kg/hr till completion of surgery. Complaints of pruritus, nausea, vomiting, respiratory depression and shivering among all patients were carefully observed, recorded and managed symptomatically. Results: During the intraoperative and postoperative periods, Dexmedetomidine found to show better haemodyamic profile when compared to Magnesium sulphate. The postoperative analgesic scores and the requirement of rescue analgesics, both in terms of frequency and dosage were found significantly lower in Dexmedetomidine group (p=<0.001), compared to Magnesium group. The patient satisfaction scores were significantly higher (P = 0.011) in patients administered Dexmedetomidine, compared to Magnesium. Hypotension and bradycardia were more frequently observed in magnesium group, though no statistical significance could be attributed to this finding. Side effects like vomiting and nausea were more frequent in patients administered Magnesium. Conclusion: Dexmedetomidine as a preemptive analgesic provides better postoperative analgesia with a better haemodynamic profile as well as better patient and surgeon satisfaction with minimal side effects.
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Research Article
Open Access
Study of Relation between Hyperhomocysteinemia and Deep Vein Thrombosis in Females in Tertiary Care Hospital in Central India
Pages 64 - 68

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Abstract
Introduction: Deep Vein Thrombosis (DVT) is the third most common vascular disease after myocardial infarction and ischemic stroke. DVT is a multi-factorial disorder with many inherited and acquired risk factors playing in its etiopathogenesis. Homocysteine (Hcy) is a sulphur-containing amino acid which plays a vital role for development of the tissues. Hyperhomocysteinemia is a disorder of methionine metabolism and a modifiable risk factor of myocardial infarction, peripheral arterial thrombosis as well as deep vein thrombosis and pulmonary embolism. Increasing prevalence of DVT worldwide causes increased morbidity & mortality & have increased economic burden in the community. Pathogenesis of DVT may be associated with the destruction of vascular endothelial cells resulting from immune and inflammatory mediators.mStudies about the role of Homocysteine in the pathogenesis of vascular thrombo embolism, shown conflicting results hence any reliable clue will be considered valuable. Aims & Objective: To estimate serum Homocysteine in female DVT patients and to assess the relation between hyperhomocysteinemia and deep vein thrombosis. Materials and Methods: This cross-sectional study included 60 female patients of DVT. Venous blood sample was collected in heparinized vial and analyzed for homocysteine levels. Results: In our study we found significantly raised serum homocysteine levels (p value <0.05) in females belonging to more than 40 yrs. of age as compared to the other age group. Conclusion: In our study we found that women are more susceptible to the pathological effects of elevated homocysteine levels in age group more than 40 yrs. which may be a risk factor for DVT
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Research Article
Open Access
Role of Neutrophil Lymphocyte Ratio as a cheap prognostic marker in predicting disease Severity in COVID-19 patients in a resource constraint setting
Pages 53 - 63

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Background: Inflammation plays an important role in development and progression of the COVID 19 disease. Among all inflammatory markers, IL6 is a good predictor for symptomatic cases. But it is time-consuming, less cost-effective that cannot be done in low resource constraint setting. So, we want to search another equally effective inflammatory biomarker that can be done in low resource setting. NLR and d-NLR are inflammatory parameters, we estimate association of NLR and d-NLR with disease severity and mortality. Methods: 150 COVID-19 patients aging between 18 and 45 years and 150 age and sex matched apparently healthy people were included. Then case group participants are subdivided into three sub-groups according to disease severity. Thereafter, all of the patients and healthy persons were subjected to the estimation of serum IL-6 and find out NLR and d-NLR. Results: It was found that the mean NLR d-NLR and IL6 were increased with disease severity. Then Pairwise multiple comparison in the post hoc ANOVA analysis with Bonferroni correction within the case group was performed and it became evident that IL6 concentration and NLR were significantly increased. It also found that IL6 and NLR were well correlated with disease severity. Then Pearson correlation was done and it was shown that IL6 with NLR and d-NLR are well correlated with disease severity. Then to determine the diagnostic value of the NLR for COVID 19 ROC curve and logistic regression analysis were performed and found that NLR of 5.89 and d-NLR 2.78 were demonstrated as the optimal cut-off value as a predictor of disease severity and 9.48 was disease mortality. Conclusion: NLR and d-NLR equally effective like IL6 for disease severity, prognosis and mortality from COVID-19. They can be done in primary health care level as they are cheap, easily available.
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Research Article
Open Access
A Prospective Study on the Role of Oral Propranolol and the Combination of Oral Propranolol and Topical Timolol Maleate Therapy for Surfaced Infantile Haemangiomas
Pages 47 - 52

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Abstract
Purpose: The aim of this study was to evaluate the therapeutic effects and safety of oral propranolol along with topical timolol maleate or oral propranolol alone for treatment. To study the increases in the success rate of propranolol when used along with timolol solution. Whether there is a decrease in the duration of therapy.To study the speed of improvement in haemangioma treatment with propranolol therapy when used along with timolol solution. Methods: From March 2019 to June 2020, 40 cases of Surface Infantile Patients were treated. The experimental group (20 patients with 7 males and 13 females) was treated using oral propranolol combined with topical timolol maleate, whereas the control group (20 patients with 5 males and 15 females) was treated with oral propranolol alone. Vas scale is used to grade the improvements. Results: In terms of the volume reduction of the lesion at the endof the study, the combination therapy (P+T) was found to be more efficacious than the monotherapy (only Propranolol), volume reduction percentage was(67.28 ± 17.11 %) for the combined therapy group (P + T) and (55.547 ± 16.39 %) for the single therapy group i.e only Propranolol, with P value (P=0.033), when the analysis was further carried on for the earlier age group, Reduction in terms on depth was found to be better in the Propranolol + Timolol group (Depth 0.765 ± 0.437 cm) thanthe propranolol alone, the combination therapy failed to show better results in terms of shortening of the duration of treatment and ameliorating the efficacy of propranolol However it was found that volumetric reduction was better in combination therapy than propranolol alone. Effects were seen better when the treatment was started in early age groups that is 0-6 months. Conclusions: In our study, we found out that the Propranolol 2-3mg per kg and Timolol solution of 0.5% applied thrice over the lesion were well tolerated by all the patients without any serious adverse events. The Propranolol and Timolol combination therapy fails to demonstrate a statistically approvable shorter period of treatment as well as efficacy when compared to Oral Propranolol alone. But clinically there is Volumetric reduction in terms of depth reduction and a decrease in duration of treatment. This was found to be better in the combination group than propranolol alone and was significant for early-age group patients. 0-12 months.
Research Article
Open Access
Study on the efficacy of the role of modified seton placement fistula plug technique for complicated fistula in ano cases
Pages 44 - 46

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Abstract
Ideal surgical treatment for anal fistula should aim to eradicate sepsis and promote healing of the tract, whilst preserving the sphincters and the mechanism of continence. the more complex fistulae where a significant proportion of the anal sphincter is involved, great concern remains about damaging the sphincter and subsequent poor functional outcome, which is quite inevitable following conventional surgical treatment. The anal fistula plug, derived from porcine small intestinal submucosa, is safe but modestly effective in long-term follow-up, with success rates varying from 24%-88%. The failure rate may be due to its extrusion from the fistula tract. Introduction: It is a granulomatous tract, single, or multiple external openings, which connects perianal skin to the epithelium of the anal canal or rectum. Aims and Objective: The objective of the study was to assess the role and benefits of the fistula plug technique (modified seton placement) using absorbable sutures in the treatment of fistula-in-ano. Materials and Methods: This prospective clinical study was carried out on 50 patients between March 2019 and February 2021 Results: most of the patients were in the age group of 20–40 years (52.0%) with male preponderance (82%). The majority of the patients 37 (74.0%) showed recurrence at 1-year follow-up. Post-operative wound infection was seen in 24.0% of patients. Intersphincteric fistula was seen in 60.0%. No complications such as anal stenosis or incontinence were seen in our study subject. Conclusion: It is a very good alternative in cases of anal fistula. However, this technique has the vast disadvantage of a high incidence of recurrence and it cannot be used as a permanent alternative to surgery.
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Research Article
Open Access
A comparative study and Analysis of varicose vein lower limb management via open surgical methods and the previous studies and reported data of endoscopic approach
Pages 39 - 43

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Abstract
Background: Varicose veins could be a complicated condition, which may lead to limb swelling, pain, and venous ulcer. Conservative hemodynamic correction of venous insufficiency (CHIVA) has been developed over the past two decades and is currently the second most common surgical procedure for the operative treatment of varicose veins. Endovenous laser treatment of great saphenous vein was approved by FDA in 2002 and short saphenous vein (SSV) was approved in 2003. Endovenous laser ablation (EVLA) is a clinically safe, feasible, and well-tolerated technique without scar and allows people to return to their normal daily activities rapidly. Aims And Objectives: To study the surgical management (great saphenous vein [GSV] stripping and perforator ligation) and its outcome and compare the outcome of GSV stripping in case of saphenofemoral junction incompetence and perforator ligation in case of perforator incompetence with the results of endoscopic and endovenous procedurespublished in the literature. Results: The patients with varicose veins were treated with high ligation with stripping followed by foam sclerotherapy and RFA. None of the patients undergoing high ligation with stripping had DVT and recurrence which favors the procedure selection for management. However, high ligation with stripping was associated with tenderness followed by infection. complications were less prevalent and only two patients had tenderness. Similarly, in radiofrequency ablation (RFA), one patient each had recurrences, skin color changes, and tenderness. None of the patients undergoing HL/S and foam sclerotherapy had recurrences. It was found that the duration of hospital days was more with HL/S; the majority had 6 to 8 days duration of hospital days whereas 13 patients had it for 4 days. In RFA, the majority had a duration of hospital days of 2 to 3 days only. Conclusion: open surgical management remains important in the treatment of varicose veins and is usually preferable to endovenous procedures and associated with less morbidity if carried out correctly.
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Research Article
Open Access
Factors determining outcomes in acute exacerbations of chronic obstructive pulmonary Disease
Pages 31 - 38

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Abstract
Background: The factors that determine acute exacerbations and hospitalization in COPD patients are poorly understood. Factors that have been studied as predictors of mortality and other outcomes include FEV1, blood gases, co-morbidity, chronic mucus hypersecretion (CMH), muscle weakness, poor nutritional status, low BMI, socioeconomic status and support, number of previous physician visits or hospital admissions, influenza vaccination, pneumococcal vaccination, pulmonary rehabilitation, inhaled corticosteroids and long-term oxygen therapy. Hyperglycaemia is associated with poor outcomes from pneumonia, myocardial infarction and stroke, but the effect of blood glucose on outcomes from acute exacerbations of chronic obstructive pulmonary disease (AECOPD) has not been established. Recent UK guidelines do not comment on measurement or control of blood glucose in AECOPD. A study was therefore undertaken to determine the relationship between blood glucose concentrations, length of stay in hospital, and mortality in patients admitted with AECOPD. Materials and methods: This study was a prospective study in a tertiary care hospital over a period of 48 months. During the initial 24 months, the patients were recruited in the study and for the next 24 months all these patients were followed up systematically for stability of the disease or any adverse impact. Patients who had acute exacerbation of COPD during the initial entry period of 24 months were included in the study. The inclusion criteria were: (i) patients with a principal diagnosis of AECOPD; (ii) age over 50 years; (iii) current smokers or ex‑smokers with a history of smoking equivalent to at least 20 pack‑years; and (iv) surviving patients with stable COPD status on discharge. Result: Of 115 COPD patients admitted for AECOPD, 54% had one or more readmission, and another 45% had two or more readmissions over a period of 2 years. There was a high prevalence of current or ex‑heavy smokers, associated co‑morbidity, underweight patients, low vaccination prevalence and use of domiciliary oxygen therapy among COPD patients. A total of 12% mortality was observed in the present study. Immediate failure rates after first exacerbation was observed to be 34.8%. Multivariate analysis showed that duration >20 years (OR = 0.43; 95% CI: 0.15‑0.91), use of Tiotropium (OR = 3.33; 95% CI: 2.16‑6.74) and use of co‑amoxiclav during first admission (OR = 3.48; 95% CI: 2.28‑6.84) were significantly associated with higher immediate failure rates. Conclusion: it has been shown that half of all chronic obstructive pulmonary disease patients hospitalised with acute exacerbations died within 3 yrs. These findings may help clinicians with important information about the probable short- and long-term survival of these patients. Thus, low levels of serum albumin strongly predict poorer long-term outcome, and longer duration of disease and longer time elapsed since first hospitalisation appear as new mortality related independent factors. The authors believe that the current findings will provide clinicians with new insights, allowing them to implement more individualised treatment strategies by better predicting the life expectancy of chronic obstructive pulmonary disease patients.
Research Article
Open Access
Radiological study to correlate Ultrasound Categorized Breast lesions with FNAC findings in Diagnosing benign & Malignant Breast Lesions at a Tertiary hospital
Pages 24 - 30

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Abstract
Background: Breast cancer is the most common cancer in women worldwide and second most common after cervical cancer in India. Sonographic demonstration of suspicious findings appropriately leads to further evaluation with core needle biopsy, even when mammographic findings are negative. Present study was aimed to correlate ultrasound categorised breast lesions with FNAC findings in diagnosing benign & malignant breast lesions at a tertiary hospital. Material and Methods: Present study was single-center, prospective, observational study, conducted female patients of age > 18 years had suspicious lesions on mammography. All patients underwent BIRAD score interpretation by USG & FNAC procedure. Results: In present study, 233 women were included. Majority were from 31-60 years age group, with mean age of 47.22 ± 11.43 years. Common radiological characteristics were microlobulated (35.6 %) & Circumscribed (29.6 %) margins of lesion, hypoechoic (60.9 %) & hyperechoic (17.6 %) echogenicity of lesion. Posterior features of lesion were Post acoustic Enhancement (27.9 %) & Shadowing (51.5 %). In present study common BIRAD grade were high suspicion of malignancy (IVc) (23.60 %) followed by benign (II) (19.74 %), highly suggestive of malignancy (V) (18.88 %), moderate suspicion of malignancy (IVb) (13.73 %), probably benign (III) (13.30 %), low suspicion of malignancy (IVa) (7.73 %) & negative (I) (3 %). USG-FNAC correlation was concordant in 222 patients (95.3 %). Sensitivity and Specificity of BIRAD ≥ IVb was highest (90.9 % & 89.1 % respectively) followed by BIRAD ≥ IVa (88.6 % & 75.3 % respectively) & BIRAD ≥ IVc (71.2 % & 95.1 % respectively). Conclusion: Combined ultrasonography (gray scale & colour Doppler) and FNAC offers the best approach in diagnosing a breast pathologies / lesion.
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Research Article
Open Access
A Study on Abnormal Fissures on Liver Lobes in the Region of Andhra Pradesh
Pages 20 - 23

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Aim: To observe the abnormal fissures over the surface of the liver lobes. Introduction: Liver has numerous functions essential to the wellbeing of the individual and has got lot of significance in connection with various neoplasm’s, infective and degenerative diseases. The knowledge on the variations acts as a guidance for the radiologist and surgeons while performing the procedures. Material And Methods: The Present study has been carried out in 50 formalin fixed human cadaveric livers and are observed for presence of abnormal fissures over the surfaces of lobes of liver. Results: Among the 50 liver specimens, on the right lobe it is observed, 1 accessory fissure in 6 specimens, 2 accessory fissures in 4 specimens, 3 accessory fissures in 1 specimen. In the caudate lobe, 1 accessory fissure is seen in 4 specimens and 2 accessory fissures in 3 specimens. In the quadrate lobe, 1 accessory fissure is seen 2 specimens. Conclusion: Knowledge of the fissures of the liver is useful in performing liver surgeries and various non invasive diagnostic procedures.
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Research Article
Open Access
A Study on Clinical Spectrum of Pediatric Dermatoses in Patients Attending a Tertiary Care Hospital
Pages 12 - 19

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Background: The symptoms of many viral and non-infectious diseases manifest as dermatological problems in children (1). The distribution of dermatoses varies; eczema is more common in industrialised countries than infections and infestations in poorer countries (2-4). As more cases of malnutrition are seen in developing countries, healthcare practitioners who interact with children have encountered a variety of dermatosis patterns in different geographical regions. Objectives: To assess the clinical and epidemiological pattern of dermatological manifestations of Pediatric dermatoses. Material & Methods: Study Design: Cross sectional Observational study. Study area: Department of Pediatrics &Department of Dermatology, S.V.R.R.G.G.H, TIRUPATI. Study Period: March 2021 – Feb. 2022. Study population: All neonates and children below 12 years attending in Department of Pediatrics & Department of Dermatology at S.V.R.R GOVERNMENT GENERAL HOSPITAL, TIRUPATI. Sample size: Study consisted a total of 381 cases. Sampling Technique: Simple random method. Study tools and Data collection procedure: All cases of neonate and pediatric dermatoses were included in the study. All the patients were subjected to detailed history taking and meticulous examination as per the proforma after getting the informed consent. The clinical manifestations in relation to pediatric dermatoses were recorded. Detailed systemic evaluation was carried out in each case. Results: In our study, most common dermatoses were inflammatory dermatoses, in this most common was popular urticaria (23%), eczema (15.9%), atopic dermatitis 11.5%, seborrheic dermatitis 8.8%, vitiligo 7.1%, psoriatic lesion 5.3%, contact dermatitis 5.3%, prurigo simplex 4.4%, lichen planus 3.5%, polymorphic light eruption 2.7%, alopecia areata, anaphylactic reaction, Kawasaki disease each of 1.8%. Conclusion: The current study reveals that infections and infestations were the most prevalent paediatric dermatoses (38.6%), as these conditions are easily transferred among kids.This study highlights the significance of raising sanitation awareness and educating parents about children's personal hygiene practises in order to reduce the prevalence of dermatoses caused by infections and infestations in the community.
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Research Article
Open Access
Retrospective Observational Study of Medicolegal Autopsy Cases to Determine Histomorphological Changes in Heart
Pages 1 - 11

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Background: There is an increased in incidence of cardiac deaths especially among urban population. As postmortem analysis of heart is the sole way to study gross and histopathological changes in healthy and diseased heart, an autopsy study of heart was planned as. Cardiac autopsy is the gold standard, key education and diagnostic tool to study changes in normal and diseased heart. Materials and Methods: An observational study was done on medicolegal autopsy cases submitted over period of 2 years in Department of Pathology, at a tertiary care hospital. The clinical records were scanned for age, sex, mode of presentation, past history, the presence of risk factors and investigations if any. Morphology of hearts were studied in detail. Specimens were identified by notes & labels. After fixation of specimen in 10% formalin, grossing was done to obtain blocks and slides which were stained with haematoxylene & eosin. Results: Out of 603 autopsies, specimen of heart was received in 576 autopsies. Out of 576 cases, 361 cases showed pathology in heart, coronaries and aorta. Out of 361 cases, 267 (73.96%) were males and 94 (26.03%) were females. Cardiac pathology was more common in males than females. In present study majority of cardiac deaths manifested in 31-50 year age group. Conclusion: Pathological changes in heart, coronaries and aorta are found in more than 60% of cardiac deaths. Males are more prone to such changes as compared to females
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