bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of left and right ventricular functions pre and post balloon mitral Valvuloplasty using speckled tracking echocardiography
Authors: Mehta Pawan , Tripathi Vishwa Deepak
Published: August 2017

Background: Rheumatic heart disease remains a considerable cause of cardiovascular morbidity and mortality in developing countries such as India. The aim of the present study was to compare ventricular (LV and RV) function in patients with severe mitral stenosis (MS) undergoing balloon mitral Valvuloplasty (BMV) with those on medical management and also with healthy controls and to assess the burden of ventricular (LV and RV) systolic dysfunction, its determinants, and its reversibility with percutaneous balloon mitral Valvuloplasty using speckle tracking echocardiography in patients with severe MS.Methods: This prospective study was performed in a tertiary care center, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow in patients with severe MS, from September 2014 to September 2015. A total of 60 were divided into three groups. Cases (n=30), patients with severe MS undergoing BMV; case controls (n=20), patients with severe MS who did not give consent for BMV and chose medical management and healthy controls (n=10). Cases who underwent BMV were analyzed pre and post BMV and detailed echocardiographic and speckle-tracking echocardiography (STE) was done at baseline, 24-48 hours after BMV and at post one month after BMV. Appropriate statistical analysis was applied and different parameters were compared.Results: Most of the cases (56.7%) control (65%) and healthy controls (40%) were between 21-30 years of age. Female preponderance was observed in the study. A significant (p=0.01) decrease in the LA size, PASP (p=0.0001), MV PG area (p=0.0001) and significant (p=0.0001) increase in the LVEF, MVA area was observed from baseline to post 24-48 hours and at post one month after BMV among cases. Significant improvement was noticed in longitudinal strain and regional rotation in different LV segments as assessed by STE at post 24-48 hours and post one month after BMV (p value 0.001) among cases. No significant (p>0.05) difference in the 2D echo parameters was seen from baseline to follow-ups among the case controls. No significant improvement was observed in regional rotation, global rotation in different LV and RV segments after one month as assessed by STE among case controls whereas significant improvement was seen in cases.Conclusions: BMV results in marked improvement in LV and RV GLS immediately post BMV with improvement towards normalization at follow up after one month and the same can be easily assessed by Speckle tracking echocardiography.
Burden of Chlamydia trachomatis infection amongst infertile women compared with pregnant controls in North-central Nigeria
Authors: Ogbu George I. , Anzaku Stephen A. , Aimakhu Chris
Published: August 2017

Background: Female infertility due to tubal damage resulting from pelvic infections including Chlamydia trachomatis is common among women in our environment. The study aimed at determining the prevalence of Chlamydia trachomatis antibody amongst infertile women and to assess the relationship between exposure to Chlamydia trachomatis infection and tubal infertility in Garki Hospital, Abuja, Nigeria.Methods: This was a case control study among 76 infertile patients with tubal occlusion diagnosed with hysterosalpingography and confirmed by laparoscopy compared with 81 pregnant women recruited from the antenatal clinic. Both cases and control were investigated with a study protocol which solicited information on socio-demographic variables, sexual and reproductive risk factors and history of previous pelvic infection. Each subject and control had 5 ml of blood collected for serological assay for Chlamydial antibody titre using the immunocomb Chlamydia trachomatis 1gG kit. The data was analyzed using the SPSS version 20 (IBM, Armonk, NY, USA). A p-value of < 0.05 was considered statistically significant.Results: The prevalence of serum Chlamydial antibody was 57 (75.0%) and 19 (23.5%) among the cases and the pregnant controls respectively (P-value < 0.001). The results showed statistically significant associations between tubal infertility and early age at sexual debut, three or more sexual partners, nulliparity and positive Chlamydia trachomatis antibody titre (P-values < 0.001).Conclusions: The prevalence of Chlamydia trachomatis antibody titre was higher among women with infertility compared to the pregnant controls. The findings suggest that tubal infertility is associated with exposure to Chlamydial trachomatis infection.
Clinico-epidemiological study of stasis eczema
Authors: Shankar S. Vijay , Shariff V. N. S. Ahamed , Nirmala S.
Published: August 2017

Background: This study was done to determine the epidemiological aspects of stasis eczema and the association of various risk factors of the disease in the local population.Methods: This cross-sectional study was done at a tertiary hospital in southern India over a period of 1 year. Epidemiological and clinical data of stasis dermatitis patients above 20 years of age were recorded. Data was tabulated and analyzed using Microsoft excel software.Results: Of the study population of 120 prevalence is found to be highest in the age group of 50 to 60 years (42.5%) and males are more commonly affected. Occupation involving prolonged standing or sitting and lack of exercise activity is found to be a significant risk factor. The commonest skin finding in present study is eczema (80%). The most common complication was ulcer which was seen in 12.5% of our patients. Reticular veins are the most common dilated veins seen in our patients. About 70% of patients in present study fall under C4a stage of CEAP classification. About one half of symptomatic patients in present study (53.3%) had no radiological evidence of incompetent veins. Among patients with valvular incompetence, perforator veins were most commonly found to be incompetent (62.5%) followed by involvement of the saphenous venous system (23.2%).Conclusions: The study confirms the importance of environmental factors in the development of stasis eczema. There is a ten-fold higher prevalence of the disease in men in our population compared to previous studies which invariably reports a female preponderance.
Profile of endoscopic removal of foreign bodies from upper gastrointestinal tract at a tertiary care hospital in North India
Authors: Chandial Vijant Singh , Sharma Richu , Jamwal Vinu , Kotwal Suman Kumar
Published: August 2017

Background: Foreign body (FB) ingestion is a common clinical problem seen in medical practice. Its size can range from a pin head size to coin size. The aim of this study is to report the outcome of patients coming with FBs in their gastro intestinal tracts (GIT) using upper GI endoscopy (UGIE).Methods: The records of all the patients who presented to the department of gastroenterology and who underwent UGIE between May 2015 to May 2017 were reviewed with details on age, sex, type of FBs and its anatomical location and outcome.Results: A total of 31 patients with history of FB ingestion, were subjected to UGIE, over a period of 2 years. The patients were in the age group of 3 years to 100 years. The mean age was 51.27±20.63 years, with males constituting 74.19% of the patients. Most patients were in the age group of 41-60 years (41.9%) followed by 21-40 years age group (22.58%). The majority of FBs found were pieces of bone (n=9) and meat bolus (n=7), making 29.03% and 22.58% respectively. The other FBs included food bolus, coins, dentures, fruit seeds and round worm impaction.Conclusions: It is recommended that all those patients with a history of FB ingestion should be evaluated and if it is located in the upper gastrointestinal tract, should be subjected to UGIE for endoscopic removal.
Frequency of masked hypertension in non-obese diabetics and obese diabetics
Authors: Kumar Donakonda Arun , C. J. Tejeswini
Published: August 2017

Background: Masked hypertension defined as clinic BP <140/90mmHg but home BP is in the hypertensive range of >135/85mmhg. It is an emerging clinical entity. Several risk factors, including sex, age, diabetes, obesity, smoking, have been associated with it. Masked hypertensives are usually under-treated and are at risk of cardiovascular complications. As the prevalence is high it is necessary to determine its frequency. Objectives was to evaluate the frequency of masked hypertension in non-obese diabetics and obese diabetics who had never been treated for hypertension.Methods: The study was carried out in JSS hospital, Mysore over a period of 2 years from 2014 to 2016. The study was designated as a comparative and exploratory study. 200 people each of non-obese diabetics and obese diabetics were selected based on inclusion and exclusion criteria. Clinic SBP and DBP was recorded and self-monitoring automatic BP apparatus was given to record home SBP and DBP. Each patient was categorized into either of the four groups normotension, sustained hypertension, masked hypertension and white coat hypertension.Results: Frequency of masked hypertension among non-obese diabetics and obese diabetics is 16% and 20% respectively. Average clinic SBP, DBP home SBP and DBP among non-obese diabetics with masked hypertension are 133.06, 83.15, 139.06 and 84.45 respectively when compared to normotensive which are 113.44, 71.46, 109.81, 70.86 respectively (significant p value of <0.0001). Average clinic SBP, DBP home SBP and DBP among obese diabetics with masked hypertension are 135.60, 84.13, 140.63, and 86.93 respectively when compared to normotensive which are 117.80, 74.10, 115.59, 72.71 respectively (significant p value of <0.0001).Conclusions: In summary, present study demonstrated frequency of masked hypertension among non-obese diabetics and obese diabetics was higher when compared with other studies done on general population. There are no studies done on masked hypertension among obese and non-obese diabetics for proper comparison of data from current study. As the frequency is higher in both non-obese diabetic and obese diabetic groups in current study it signifies the importance of recording the home blood pressures to detect masked hypertension.
Fine needle aspiration: a simple and handy tool to diagnose malignant lymphadenopathy
Authors: P. Sravani , M. Neeraja , C. Bhavani
Published: August 2017

Background: Fine needle aspiration cytology (FNAC) of the lymph node is a simple useful screening test to diagnose suspected and unsuspected secondary and primary lymph node malignancy. The aim of the present study is to know the role of FNAC in the diagnosis of clinically suspected and unsuspected lymph node malignancies. Study design: prospective cohort study.Methods: Study material comprise of ‘76’ lymph nodes aspirates reported as malignant on cytology, out of total 445 cases of lymph node aspiration in two years period i.e. from October 2014 to September 2016.These 76 smears were studied and tabulated according to their cytomorphology and the lymph node group affected was noted. The clinical and radiological data were also noted.Results: Males were found more affected than females. cervical lymph node is the commonest group involved. Metastasis from squamous cell carcinoma was the most common diagnosis made on cytology.Conclusions: FNAC is found simple and very useful tool for diagnosing malignant lesions of lymph nodes especially in case of metastasis.
Prevalence of thyroid dysfunction and its association with controlled and uncontrolled type 2 diabetes mellitus in northern Andhra Pradesh population: a retrospective study
Authors: D. K. V. Prasad , T. S. Prabhakara Rao , G. Krishna Murthy
Published: August 2017

Background: The two important endocrinopathies, diabetes mellitus and thyroid dysfunction are interrelated to each other where the correlation is poorly understood. The thyroid dysfunction is more frequent in diabetics than general population. The present study was aimed to know the prevalence of thyroid dysfunction in type 2 diabetes mellitus (T2DM) and its association with controlled and uncontrolled T2DM.Methods: A retrospective study of 600 T2DM patients between 13-60 years of age with known thyroid status were included and the following parameters were examined: age, sex, body mass index (BMI), fasting blood sugar (FBS), HbA1C, free triiodothyronine (fT3), free tetraiodothyronine (fT4) and thyroid stimulating hormone (TSH).Results: The prevalence of thyroid dysfunction in T2DM patients was found to be 26.5% whereas 9% in healthy controls. Significantly elevated levels of FBS, HbA1C and TSH were observed whereas the levels of fT3, fT4 were found to be low in patients when compared to controls. Subclinical hypothyroidism (SCH) in diabetics (both controlled and uncontrolled) was more prevalent (15%) than it was found in healthy controls (5%). Similarly, overt hypothyroidism was also found to be high in diabetic patients (6%) as compared to healthy controls (2%). Significant difference (p <0.05) in the levels of TSH was found between group I (Controlled T2DM) and II (uncontrolled T2DM patients), also between groups II and III (Controls). Group II patients were found to have significant low levels of fT3 as compared to other two groups (Group I and III) (p<0.005).Conclusions: As SCH is more frequent in T2DM diabetes mellitus and untreated SCH patients have higher rate of complications, periodical screening is advised for thyroid dysfunction to prevent micro vascular and cardiovascular complications.
Assessment of knowledge, attitude and practice regarding rabies and its prevention among construction workers: a cross-sectional study in Berhampur, Odisha
Authors: Tripathy Radha Madhab , Satapathy Sushree Priyadarsini , Karmee Nivedita
Published: August 2017

Background: Rabies is a viral zoonosis and human infection usually occurs following transdermal bite or scratch by an infected animal. It is one of the most dangerous and completely preventable diseases. Construction workers are vulnerable to animal bites. So, this study was undertaken to study the knowledge, attitude and practice regarding animal bite and rabies among construction workers.Methods: A cross sectional study was done in campus of MKCG medical college, Berhampur, Odisha, India. Data was collected by using pre-designed interview from 400 construction workers. Data was entered and analyzed using SPSS V.17. Descriptive statistics and chi square test were applied. KAP score were calculated. P<0.05 was considered statistically significant.Results: Mean age group of study participants was 37.75±15.8, 72.5% were male and 27.5% were female. 84% of the participants had heard the word rabies. 65.75% among them had poor KAP score. KAP score was significantly associated with age, sex, education and residence.Conclusions: Construction workers had poor knowledge about animal bite and rabies. Their knowledge, attitude and practice with respect to prevention and treatment of rabies can be improved by providing proper health education.
Knowledge and attitude of nursing staff towards nebulization therapy in a tertiary care hospital
Authors: Aithal Suhas , S. V. Jagmohan , S. Niveditha
Published: August 2017

Background: Nebulization is an important tool in the treatment of respiratory conditions. Nurses are primary health care providers for using the nebulizers in a hospital setting. The examination of nurse's knowledge and performance regarding the nebulizer therapy is of utmost importance for proper nebulization. Aim of the study was to access the knowledge and attitude of staff nurses towards nebulization therapy.Methods: A cross sectional study was conducted at the RL Jalappa hospital, Kolar, Karnataka, India. 50 nurses working the intensive care units and wards were given a questionnaire regarding the key aspects of nebulization therapy. A workshop was then conducted for the same participants on correct nebulization techniques and the questionnaire was given and the results post workshop was analyzed.Results: In pre-study, most nurses had unsatisfactory knowledge with respect to breathing pattern during nebulization (72.2%), types of masks used (83.3%), changing of filter (62.5%). On comparing satisfactory knowledge level of nurses pre-and post, it was found statistically significant increase in knowledge for breathing pattern during nebulization, knowledge of types of nebulization, nebulization time, nebulization end point, types of drugs used, type of dilution, proportion of dilution, ideal volume of drugs in medication, replacement of tubing, changing of filter, types of disinfections used, types of nebulization and types of mask (p <0.05).Conclusions: The knowledge of the staff nurses regarding the nebulization therapy was unsatisfactory which was reflected by improvement in the knowledge post workshop training. The staff nurses should be provided periodic training on nebulization therapy to give effective and safe care to patients.
Assessment of periodontal health status among Koraga tribes residing in Mangalore taluk: a cross sectional study
Authors: Dey Suneethi Margaret , D. V. Nagarathna , D. V. Nagarathna , Jude Mathews , Jude Mathews
Published: August 2017

Background: To assess the periodontal health status among Koraga tribal community residing in Mangalore Taluk.Methods: The study subjects comprised of 400 Koraga tribal’s in the age range of 20-55 years living in Mangalore Taluk. The data regarding oral hygiene practices prevalent in the tribal population was collected by interviewing. Intra oral examination was carried out by using mouth mirror and CPI probe and included simplified oral hygiene index (OHI-S), community periodontal index (CPI), loss of attachment and dental aesthetic index (DAI).Results: Of the total population examined, 81% brushed once daily with 34% of the subjects using tooth paste and brush as oral hygiene aid while, the rest of them used a combination, with other indigenous methods. Majority of them used tobacco in the smokeless form (36%). The oral hygiene status was poor in 56% of the subjects. The present study showed that majority of the Koragas suffered from various gingival and periodontal diseases as assessed by community periodontal index. The dental aesthetic index indicated that 37.5 % of study subjects had very severe malocclusion.Conclusions: This group of people has a poor oral hygiene and periodontal status because they are deprived of the awareness and availability of treatment facilities. Their inappropriate oral hygiene practices, inadequate dental health resources and low socio-economic status are the major factors in this population to cause increased prevalence of periodontal disease.
Prophylactic use of Midazolam, Ketamine, and Ketamine plus Midazolam for prevention of perioperative shivering during spinal anaesthesia in patients undergoing infraumbilical surgeries: a comparative study
Authors: Kumar Manoj , Kumar Ankur , Singh Dheer , Saxena Surekha
Published: August 2017

Background: Shivering is a common problem faced by an anaesthesiologist during perioperative period. Shivering occurs during both general anaesthesia and regional anaesthesia but it is more troublesome during neuraxial anaesthesia. To evaluate the effectiveness of intravenous Midazolam, Ketamine and combination of Midazolam with Ketamine in control of shivering.Methods: The study was conducted in 90 ASA I and II patients receiving neuraxial anaesthesia with comparable dose of hyperbaric bupivacaine. The patients were allocated in three groups of 30 each to receive Midazolam 75 mcg/kg, ketamine 0.5 mg/kg and Midazolam 37.5 mcg/kg plus Ketamine 0.25 mg/kg IV after the appearance of shivering. Disappearance and recurrence of shivering as well as temperature and haemodynamics were recorded with scheduled intervals.Results: IV Midazolam plus Ketamine at the dose of 37.5 mcg/kg and 0.25 mg/kg is more effective in prophylaxis of shivering than IV Midazolam 75 mcg/kg or IV Ketamine 0.5 mg/kg. Small number of patients showed, clinically as well as statistically insignificant, incidence of hypotension, bradycardia and respiratory depression of various degrees at various time intervals.Conclusions: Thus, IV Midazolam plus Ketamine at the dose of 37.5 mcg/kg and 0.25 mg/kg IV is more effective in prophylaxis of shivering than IV Midazolam 75 mcg/kg or IV Ketamine 0.5 mg/kg following subarachnoid blockade for infra umbilical surgery. The side effects like Hypotension, nausea, vomiting and pruritus are also very less with combination and prove that it is a better agent for prophylaxis of shivering following regional anesthesia.
Serum BUN and creatinine estimation in patients of overt hypothyroidism: a case control study
Authors: Kumari Bandana , Kumar Pawan , Keshari Jiut R. , Kumar Arun , Pankaj Sangeeta , Chaudhary Radha K. P.
Published: August 2017

Background: Hypothyroidism or underactive thyroid or low thyroid is a common endocrine disorder characterized by low serum T3 (triiodothyronine), T4 (thyroxine) and raised TSH (thyroid stimulating hormone). Thyroid hormones are involved in renal development and hemodynamic, kidney structure and GFR (glomerular filtration rate). Aim of this study was to see the alteration of basic renal markers in patients of hypothyroidism.Methods: A total of seventy subjects were included in the study. Thirty-five were patients of hypothyroidism and thirty-five were age and sex matched normal controls. Serum T3, T4, TSH, creatinine and BUN (blood urea nitrogen) were estimated in both groups.Results: Serum T3, T4 were significantly decreased and TSH was significantly raised among cases as compared to controls. Mean value of serum creatinine and BUN were within normal range in both the groups but these values were significantly raised among cases as compared to controls with p value 0.02 and 0.003 respectively. Also, there was positive correlation of TSH with BUN and creatinine among cases.
A questionnaire based study to evaluate the perception, attitude and feedback of second year undergraduate students with respect to their pharmacology teaching methodology
Authors: Dutta Sayeri , Devi Ngangbam Kilabati , Das Rajesh , Das Ananya , Devi N. Meena
Published: August 2017

Background: Pharmacology, like any other branch of medicine, is progressing by leaps and bounds. Attempts have been made all over India to make the teaching of pharmacology more interesting and relevant. The course assessment instruments like feedback may help to know about the pros and cons of teaching and assessment methods. Currently, student’s feedback represents the primary means used by most programs to assess their methodology.Methods: A questionnaire was designed and given to second-year medical students to fill in and make suggestions according to the options given and were also free to express their own opinion at various places.Results: Majority of the students showed preference for tutorials, short answer questions and revision classes. About one third of the students felt that more group discussions should be introduced during teaching sessions. Students’ interest in microteaching and problem based learning was evident from their feedbacks.Conclusions: There is a need of conducting few microteaching sessions and more of clinical oriented problem based learning with MCQ based revisions at the end of each class in the pharmacology teaching at undergraduate level.
Assessment of glycemic status of COPD patients on long term corticosteroid therapy
Authors: Verma Vivek Kumar , Nim Ranjit Kumar , Kumar Manoj , Singh Premshanker , Singh Geeta , Singh Anand Kumar
Published: August 2017

Background: Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases. Among the pharmacological therapy, inhaled beta- agonist and anticholinergics are the mainstay therapy of COPD along with corticosteroid. Steroid therapy is associated with various potential adverse effects like steroid induced deranged glycemic status. So, we sought to examine the association between long term corticosteroid therapy and glycemic status in COPD patients.Methods: A cross sectional study was done to assess the glycemic status in COPD patients on long term corticosteroid therapy in a rural tertiary care centre on patients satisfying inclusion and exclusion criteria. Inclusion criteria includes COPD patients on steroid based therapy (inhaled/systemic or both) for at least 6 months. Known case of type 2 diabetes mellitus, bronchial asthma, interstitial lung disease, coronary artery disease, cardiomyopathies, connective tissue disorders, recipients of organ transplant or immunosuppressive therapy, patients having co morbidities like renal failure, liver failure, heart failure and patients on other drugs known to cause hyperglycemia were excluded. Random blood sugar, HbA1C etc, was done and data was analyzed by SPSS version 22.0.Results: Total 46 patients were included in study. Mean age was 63.22 years with minimum age 47 years and maximum age 80 years. 35 patients (76.09%) were male and 11 patients (23.91%) were female. Sex ratio was 3.18:1. 26 patients (56.52%) were taking both inhaled and systemic corticosteroids, 12 patients (26.09%) were taking only inhaled corticosteroids and 8 patients (17.39%) were taking systemic corticosteroid therapy. 14 patients (30.43%) were found to have impaired glucose tolerance, 7 patients (15.22%) were diagnosed as a case of diabetes mellitus and 25 patients (54.35%) were found to be euglycemic.Conclusions: We conclude that incidence of deranged glycemic status is more common among COPD patients receiving only systemic corticosteroid therapy or both systemic and inhaled corticosteroid therapy. Further, inhaled corticosteroids are better in terms of glycemic control among COPD patients on corticosteroid therapy. Hence, we recommend routine screening of glycemic status in COPD patients on corticosteroid therapy.
A study of profile of patients with different degrees of anemia
Authors: K. L. Azad , S. K. Dwivedi
Published: August 2017

Background: It has been estimated that 1.62 billion population of the world are suffering from anemia. Preschool children show a highest prevalence of 47.4%. Adult males show a lowest prevalence of 12.7% of anemia. Objective was to study the profile of patients with different degrees of anemia.Methods: Over a period of seven months, from January 2014 to July 2014, a cross sectional study was conducted at department of pathology, Lt. BRKM government medical college, Jagdalpur, Chhattisgarh, India. It was possible to study the 250 cases during the tenure of the study period for the present study.Results: It was found that only 3.2% of cases were not having anemia. Thus, the overall prevalence of anemia in the present study was found out to be 96.8%. 62.5% of males and 37.5% of females were having normal hemoglobin. It was found that with normal hemoglobin of more than 12 gm%, no case was having serum iron less than 10.6 µmol/l. All cases without anemia had normal serum iron. 30.3% of cases of anemia had normal serum iron levels. 75.6% of cases across all degrees of anemia were showing microcytosis. This was more in moderate anemia having hemoglobin of 6-9 gm% followed by 42.4% in cases having mild anemia of hemoglobin of 9-12 gm%. Only 13.5% with severe degree of anemia were showing the microcytosis. 24.4% of cases were showing the normocytosis whereas no case has shown the macrocytosis.Conclusions: Prevalence of anemia was more in females. Serum iron did not correspond with the degree of anemia. There is need to emphasize more on awareness about anemia and its prevention especially in mother and child age group.
Assessment of depression among chronic obstructive pulmonary disease (COPD) patients at rural tertiary care centre of Northern India
Authors: Gautam Aditya Kumar , Kumar Adesh , Gupta Ashish Kumar , Kushwaha Bal Krishna , Yadav Prashant , Pandey Achyut Kumar
Published: August 2017

Background: Chronic obstructive pulmonary disease COPD is a more complex systemic disease that has significant extra pulmonary effects along with pulmonary involvement. Complexity and mortality of COPD is increased by its co-morbidities and exacerbations. Depression is One of the commonest co-morbidity that occurs in patient with COPD and is associated with poor quality of life therefore we planned to assess depression among COPD patients.Methods: This was a cross-sectional study done in the respiratory medicine department of tertiary care centre, during the period from January 2015 to June 2016. A total of 200 patients of COPD of either sex having age more than 40 years included in the study. Patients who were critically ill and uncooperative excluded from the study. Patients who did not give consent and having previous history of any psychiatric illness also excluded from the study. The diagnosis of COPD was made on the basis of the clinical history, examination, X-ray chest and spirometry. Further, depression was evaluated with the validated Hindi version of nine items PHQ-9 (a subset of patient health questionnaire).Results: The data of all 200 COPD patients were analysed and it was observed that- prevalence of depression in COPD was found to be 49%. Prevalence was higher in male patients 147 (73.5%) as compared to female 53 (26.5%) patients in the present study. Minimal depression was found in 14.28 % COPD patients and mild depression in 25.51 % moderate depression in 39.79 % cases and severe depression in 20.40% cases.Conclusions: Symptoms of depression are common in patients with COPD and its presence may have significant impact on the quality of life of such patients and may be associated with a higher mortality rate.
Increased resistance to Nalidixic acid and Ciprofloxacin in Salmonella isolates from the Sub Himalayan region
Authors: Bhagra Suruchi , Sood Atal , Singh DigVijay , Kanga Anil
Published: August 2017

Background: During the last two decades, increased resistance to nalidixic acid and ciprofloxacin has become a cause of global concern. The present study was undertaken to ascertain nalidixic acid and ciprofloxacin resistance in Salmonella isolates from our region. To know the true pattern of ciprofloxacin resistance by determining the minimum inhibitory concentration (MIC) through E-test.Methods: All the Salmonella isolates recovered from blood cultures were screened for nalidixic acid resistance using 30µg disc by the Kirby Bauer disc diffusion method. Ciprofloxacin susceptibility was done both by disc diffusion and MIC using CLSI breakpoints.Results: We analysed a total of 80 Salmonella isolates during the last three years. Salmonella enterica serovar Typhi was the predominant serovar in 51 (64.8%) isolates, followed by Salmonella enterica serovar Paratyphi A comprising 28 (36.2%) isolates. Amongst the total isolates 78 (97.5%) were nalidixic acid resistant. Of these 54 (67.5%) showed intermediate susceptibility and 9 (11.2%) were ciprofloxacin resistant by the disc diffusion technique. On the contrary 29 (36.2%) had decreased susceptibility to ciprofloxacin; while a larger number 38 (47.5%) were detected resistant to ciprofloxacin on determination of MIC by the E-test.Conclusions: Screening for nalidixic acid acts as a surrogate marker to detect ciprofloxacin resistance. However, the true pattern of ciprofloxacin resistance can be determined by calculating the MIC by the E-test.
Clinico-microbiological analysis of bactibilia isolates in patients of cholecystectomy
Authors: Katyal Ashima , Bala Kiran , Bansal Anand , Chaudhary Uma
Published: August 2017

Background: The current study determined microbial flora in bile aspirates from patients undergoing cholecystectomy along with antibiotic susceptibility pattern and resistance mechanism viz. extended spectrum β-lactamase (ESBL).Methods: The study included 110 such patients which were divided in three groups as: Group A that included acute cholecystitis with or without cholelithiasis, Group B included chronic cholecystitis with or without cholelithiasis and Group C included other hepatobiliary ailments requiring cholecystectomy viz. gallbladder carcinoma, acute emphysematous gall bladder and mucocele gall bladder. The bile was subjected to complete microbiological and histopathological examination. Antimicrobial susceptibility of the isolates was performed as per CLSI guidelines.Results: Bacteria were recovered from 07 samples (20%) in Group A, 17 (48.57%) in Group B and 11 (31.43%) in Group C. The polymicrobial infection was seen in 04 (11.43%) patients. The most common organisms isolated were Escherichia coli 15 (38.46%), Klebsiella pneumoniae and Pseudomonas aeruginosa 8 (20.51% each). The majority of Enterobacteriaceae isolates were susceptible to piperacillin-tazobactam and carbapenems. The ESBL production was observed in 17 (43.58%) isolates.Conclusions: Therefore, antimicrobial susceptibility of potential causative organisms, presence of resistant strains in bile, the severity of the cholecystitis, and the local susceptibility pattern must be taken into consideration while prescribing antibiotics. A protocol regarding the management of such cases should be formulated based on observations of similar studies.
Morphological and topographic study of diaphyseal nutrient foramen of femur and its clinical implications in North Indian population
Authors: Jha Shweta , Chauhan Renu
Published: August 2017

Background: Nutrient foramen of long bones defines the extent of bone vascularisation. Information regarding nutrient foramen is necessary to conserve circulation during orthopaedic and surgical procedures. The present study was conducted to examine the position, number and calibre of nutrient foramina in 100 dry femora belonging to North Indian population.Methods: The total length (TL) of each femur was measured by taking the measurement between the most proximal aspect of the head of the femur and the most distal aspect of the medial condyle. Number of nutrient foramina was determined by using a magnifying lens. Distance of nutrient foramen from upper end was measured. Direction and obliquity of nutrient foramina were noted. Position of nutrient foramina was determined in relation to length of femur and linea aspera. Caliber of nutrient foramen was measured using 18, 20, 22 and 24-gauge needles.Results: Length of femur on right side was 435.2 mm (Range 393-523 mm). Length of femur on left side was 437 mm (range 369-524). 78 (78%) femora had single nutrient foramen, 11 (11%) had double nutrient foramen and 11 (11%) had no nutrient foramen. All foramina were directed upwards. Maximum foramina were located in middle third of femur (84%) followed by upper third of femur (8%). Most common location was on the intermediate area between two lips of linea aspera (42%) followed closely by medial lip of linea aspera (36%).Conclusions: This study has provided additional data on the subject which will help in resection, surgical procedures and transplantation techniques by orthopedician in North Indian population.
Correlation of thrombocytopenia with degree of atypical lymphocytosis as a prognostic indicator in dengue
Authors: Joshi Anagha A. , B. R. Gayathri , Kulkarni Swathi
Published: August 2017

Background: Dengue viral infections may occur as epidemics and are of public health concern in India especially due to high mortality in advanced stages. Early diagnosis and treatment reduces the mortality significantly. To assess the utility of atypical lymphocyte counts with relation to platelet counts as a marker for severe dengue.Methods: A total of 132 serologically proven (by rapid card method) cases of dengue with atypical lymphocytosis (≥10%) and thrombocytopenia (<150×109/l) were analyzed during November 2016. The complete blood counts (obtained from automated hematology analyzer and Leishman stained peripheral smears) were analyzed.Results: Dengue infections were mostly seen in younger age (12-25 years) with slight male predominance. The relevant haematology findings noted were leukopenia in 36% and severe thrombocytopenia (<50×109/l) in 57% of cases. The differential count showed lymphocytosis in 64% with significant (≥20%) atypical lymphocytes in 52% which inversely correlated with platelet counts. Atypical lymphocytosis (≥20%) was noted in 9% of cases with mild as against 32% of severe thrombocytopenia.Conclusions: Atypical lymphocyte count can be used as predictor of severe thrombocytopenia and severe dengue. This helps in early diagnosis and proper management and drastic reduction in mortality.
Umbilical artery doppler and biophysical profile score: a study of their efficacy in pregnancy induced hypertension and intrauterine growth retardation
Authors: Meherishi Shuchita Sharma , Mangal Suchika
Published: August 2017

Background: Accurate diagnostic tests to identify fetuses at risk for in-utero death or injury have long been an important goal for obstetricians and perinatologists. Umbilical Artery Doppler and biophysical profile score are two tests available for antepartum fetal surveillance.Methods: The study consisted of 100 patients with either presence of PIH (30) or IUGR (28) or both (42). Testing was begun was at 33 weeks. UAD was performed; S/D, RI and PI indices were calculated. Fetal BPS was determined.Results: Fetal weight was estimated to be less than 2kg in last scan was 23.52% cases in pih/ iugr group versus 6.4% in controls whereas incidence of oligohydramnios was 29.5% versus 91.17% respectively, and number of babies admitted to NICU was 11.47% versus 70.58% respectivelyConclusions: Doppler and biophysical studies can greatly help in arriving at an appropriate strategy for management.
Cost variation analysis of antimalarial drugs available in India
Authors: Kumar Lalit , Dinkar Jyoti Kumar , Mohan Lalit , Dikshit Harihar
Published: August 2017

Background: Malaria has been a problem in India for centuries. There are innumerable brands of antimalarial present in the market. Malaria can be extremely fatal if not treated promptly. Costly drugs can lead to economic burden which results in decreased compliance or even non-compliance. Non-compliance leads to incomplete treatment which tends to increase morbidity. Increase in the patient medication cost was found to be associated with decreased adherence to prescription medication. Hence this study was done to assess the cost variation of malaria therapy.Methods: The maximum and minimum price of each brand of the drug in INR was noted by using CIMS January to April 2017 edition and Drug Today January to March 2017, Vol 2. The cost ratio and the percentage cost variation for individual drug brands was calculated. The cost of 10 tablets was calculated in case of oral drug and the cost of 1 ampoule or vial was noted in case of injectable drug. At last the cost ratio and % cost variation of various brands was compared.Results: The analysis of data reflected a considerable cost variation among antimalarial drugs. Artemether injection showed the highest cost ratio and cost variation (cost ratio = 16.96 and % cost variation = 1596). Overall injectable antimalarials showed considerable cost variation as compared to oral antimalarial agents. Chloroquine which is one of the most used antimalarial showed very low values for cost variation and cost ratio.Conclusions: The analysis showed that there is not much significant price variation among oral antimalarial drugs. The maximum variation shown by oral antimalarial was found to be for fixed dose combination of Artemether and Lumefantrine [cost ratio>2 (2.03) and % price variation >100 (103.7)]. But there was significant price variation among injectable antimalarial. Injectable antimalarials are often the choice of drug when dealing with critically ill malaria patients specially when suffering from complicated malaria. So, such significant price variation creates burden on poor patients economically which leads to non-compliance and hence increased morbidity and mortality due to incomplete treatment.
Analysis of factors influencing colostomy closure after low anterior resection for cancer rectum
Authors: Das Prafulla Kumar , Satpathy Bharat Bhusan
Published: August 2017

Background: De-functioning colostomy or ileostomy is a procedure known worldwide as a protection measure to the rectal anatomises in low anterior resections and even some of anterior resections. Though the primary intention is a temporary one, many a times they end up in a permanent stoma. As the patients with stomas with attached bag appliances to their abdominal wall go through a lot of stress related to the quality of life and body image, they are always keen to get it closed as early as possible. Unfortunately, many factors come into play during and after the indexed surgery till the closure of stoma without any complication, prohibiting their early or even delayed closure.Methods: Authors here conducted a cohort study with retrospective data analysis and a prospective follow up patients in a tertiary care regional cancer centre from April 2011 to mid-June 2017. Statistical analysis was used by mean and percentage method.Results: Temporary colostomy was required in 88.37% of low anterior resections and some anterior resections. Most of those (92.11%) were transverse colostomy. Only 36.86% of those stomata were reversed. Four (10.83%) patients were dead by the end of the study. Twenty patients of stoma (52.63%) were not yet reversed and were deemed to continue with a permanent colostomy. This was found to be a very high figure as opposed to the literature of 9-25%. The reason behind this high figure was probably due to low general condition, lower socio-economic status, and low literacy prevailing in our patient population group. Moreover, the patient attendants and the surgeon himself also had played some role responsible for this situation.Conclusions: Patients should be told before initial rectal surgery that there is a risk of non-closure and possible complications associated with permanent stoma.
Prevalence of sensory peripheral neuropathy in diabetic patients at diabetes care centre: a cross sectional study
Authors: Battula Pradeep , Afreen S. , Meena E. , Reddy S. Siva Ram , Sujatha G.
Published: August 2017

Background: Diabetic neuropathy is a nerve damaging disorder associated with diabetes; result from micro vascular injury involving small blood vessels that supply to the nerve (vas nervorum) in addition to macro vascular condition that can culminate in diabetic neuropathy. By the year 2025 hundreds of people were estimated to become diabetic. The rates of prevalence of neuropathy increasing worldwide which is directly related to the nonmodifiable risks like age, duration of diabetes, obesity, alcoholism, gender.Methods: A cross sectional interventional study was conducted on diabetic patients. Questionnaire, instruments and demographic details were used to collect data from patients. The diabetic neuropathy is conformed in patients by using biothesiometric analysis, tuning fork, monofilament, NSS and NDS.Results: Total 331 subjects included in the study, 200 cases diagnosed with DPN according to biothesiometry and prevalence percentage was found to be 60.4% and incidence was found to be 8.76% respectively. A significant greater proportion of males reported neuropathy more than females. The association between the obesity and the DPN was (r2=0.7922) low positive correlation. High positive correlation was confirmed with NSS, NDS respectively.Conclusions: It was concluded that there is a higher prevalence (60.4%) and incidence (8.76%) of neuropathy among the diabetic subjects and it may go on increasing as the age progress.
Role of early CT scan in diagnosis of occult scaphoid fractures- a prospective study
Authors: Singh Omeshwar , Sen Anuradha , Charak Sumeet Singh , Ahmad Shakeel
Published: August 2017

Background: Wrists injuries are one of the common presentations to emergency departments and orthopaedic clinics. The scaphoid bone is the most commonly injured of the carpal bones accounting for 50-80% of carpal injuries and predominantly occurs in young healthy individuals. Scaphoid fractures are the most problematic to diagnose in a clinical setting because it can take up to 6 weeks for scaphoid fractures to become conclusive on plain X-ray films. Aim of the study was to retrospective study was carried out to study the role of early CT scan in diagnosis of occult scaphoid fractures.Methods: A total of 123 patients presented with an acute wrist injury with subsequent signs of scaphoid injury in the absence of a diagnostic fracture on plain X-ray within the time period from June 2014 to May 2016 in a tertiary care centre.Results: This study shows that 31% of normal X-rays were pathological on CT scan and out of these; scaphoid fractures (74% of pathologies) represent a large number of patients with fractures that were missed by initial plain films.Conclusions: This study shows an extremely high false-negative rate for plain X-rays and advocate CT at the first attendance to fracture clinic if there is suspicion of scaphoid injury. An earlier diagnosis leads to appropriate management and reduces restrictions to the patient in terms of prolonged immobilization and repeated clinical reviews.
Assessment of socio-clinical profile of neonates admitted in sick neonatal care unit of tertiary care hospital: Odisha
Authors: Jena Dhaneswari , Tripathy R. M. , Pradhan Srabani , Sethi Geetanjali
Published: August 2017

Background: Neonatal mortality rate of 29 and early neonatal mortality rate is 20 which contributes 53% of IMR. India targets to achieve single digit under 5 and neonatal death by 2030. Early identification and management of common morbidities among neonates is desirable for improving the survival. Therefore, this study was conducted with the aim of assessing socio-clinical profile of neonates admitted to SNCU and its impact on morbidities of newborn from different strata.Methods: A cross sectional study was conducted in SNCU of MKCG medical college from January 2016 to December 2016. Convenient sampling was done. Data was collected using pre-designed semi structured questionnaire.Results: Total 752 study subjects were taken. Most common cause of admission was sepsis (47.4%) followed by prematurity (27.8%), birth asphyxia (13.9%) and IUGR (7.5%). Majority of out born neonates were admitted for sepsis (87.9%) while in born neonates for birth asphyxia (81.9%). All the morbidities were significantly higher among early neonates, babies born to illiterate mother and those with inadequate antenatal check-up.Conclusions: Majority of babies were out born, may be due to delay and lack of quality new born care in the referring facilities. Sepsis was most common preventable morbidity by simple intervention of clean delivery practices which should be promoted. Birth asphyxia can be reduced by adequate skill development training of the staffs and minimising the 3 delays maternal care.