International Archives of Integrated Medicine

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Identification and antibiotic susceptibility pattern of Staphylococcus aureus with special reference to methicillin resistant Staphylococcus aureus in tertiary care hospital
(Educational Society For Excellence, 2023-02) Gadara, Shraddha; Pethani, Jayshri; Shaikh, N. M.; Shah, Hiral; Mesariya, Siddhi; Chauhan, Keyur
Background: The emergence of Methicillin-resistant Staphylococcus aureus (MRSA) has posed a serious therapeutic challenge. It is responsible for a wide range of infections including superficial skin infections, food poisoning, osteomyelitis and septicemia. Aim of this study was to identify and to determine antibiotic susceptibility pattern of Staphylococcus aureus from various clinical samples. Materials and methods: Different clinical specimens were collected and processed for routine culture and antibiotic sensitivity test by standard microbiology techniques. Results: A total of 129 S. aureus strains were isolated from various clinical specimens out of which 84 (65.12%) were Methicillin Resistance Staphylococcus aureus (MRSA). 66(51.16%) S. aureus were obtained from indoor (IPD) patients. S. aureus was found higher in male than female. S. aureus was found highly resistant to Benzylpenicillin (94.57%) followed by ciprofloxacin (77.51%), Erythromycin (61.24%), and Cotrimoxazole (51.94%), Clindamycin (44.19%), and Gentamicin (17.05%). 1 (0.78%) of the isolates were resistance to Vancomycin and Linezolid. For urine isolates Nitrofurantoin was drug of choice. Conclusion: Methicillin resistant Staphylococcus aureus was found 65.12% of Staphylococcus aureus isolates. It was most common in males and hospitalized patients. Teicoplanin or Tigecyline seems to be drug of choice followed by Vancomycin, Linezolid, Tetracycline and Gentamicin. It would be helpful to formulating and monitoring the antibiotic policy and ensure proper empiric treatment.
Covid-19 origin, transmission, immune response and treatment: A review
(Educational Society For Excellence, 2023-01) Al-ajmi, Anfal; Bazighifan, Arwa Saleh; Alamery, Salman; Zargar, Seema
The novel 2019 Corona viruses are enveloped RNA genome virus, with a 79% genome similarity to the previous 2003 SARS Coronavirus-1 (SARS-CoV-1). Up to date the confirmed cases worldwide 11,327,790 And 209,509 in Saudi Arabia. The SARS-CoV-2 is a single strand RNA belongs to Beta corona virus. The phylogenetic analysis suspected that bats are the primary reservoir, however the zoonotic intermediate host that transfer SARS-CoV-2 to human is not identified. The glycoprotein spike exclusively on the SARS-CoVs-2 species binds to the host cell receptor through a region called receptor-binding domain (RBD) and mediates viral entry. SARS-CoV-2 targeting Angiotensin-converting enzyme 2 explain the reason behind the infection of the respiratory system especially. S glycoprotein is the most important protein of the virus while it is the best target for entry inhibitors, neutralizing antibody, and vaccine development. Besides the role of antibodies to eliminate virus separation, it can also reas viral entry in some virus species through a mechanism termed antibody-dependent enhancement (ADE) under certain conditions. This mechanism is the main block in the way of vaccine development against SARS-CoV 2. The balance between getting the induction of immunity protection and developing an enhanced susceptibility to virus infection after vaccination against SARS-CoV-2 is a highly sensitive and delicate approach and has a high risk. This novel version of the virus has many routes for infection, this may describe its ability to spread at a high rate and its high aggressivity compared to the previous one every year.
Clinical Profile of Sharp Syndrome: Is it rare in India?
(Educational Society For Excellence, 2023-02) Ramesh, P.; Kumar, Samala Vishnu; Reddy, Yadavendra; Deepthi, R. Vijaya; Bhavana, Keerthipati
Background: In 1972, Dr Sharp and colleagues described a new connective tissue disease, characterized by overlapping features of systemic lupus erythematosus (SLE), systemic sclerosis (SSc), and polymyositis/ dermatomyositis (PM/DM) and by the presence of antibodies against the U1 small nuclear ribonucleoprotein autoantigen (U1 snRNP). This condition was termed mixed connective tissue disease (MCTD) and proposed as a distinct disease. Later, after observing the clinical evolution of MCTD patients, Sharp himself agreed that the original concept of MCTD had to be modified and that Internal organs were at risk for serious complications; patients were not always steroid responsive; prognosis was not always benign. Materials and methods: Patients in the age group of 15-50 years diagnosed to have connective tissue diseases were included. 8 patients in the age group of 15-50 admitted in Medicine department were taken and they were evaluated for the clinical profile of sharp syndrome by thorough clinical examination, routine laboratory tests and special investigations depending on the clinical profile. Results: 8 patients with connective tissue disease attending the medicine OPD were studied. Of these 8 patients were female patients. The median age of onset was 36 years, 8 patients met criteria by sharp and Alarcon-Segovia. The clinical features of patients at presentation are Raynaud抯 phenomena, Puffy fingers, esophagus dysmotility, skin rash, interstitial lung disease, arthritis, pulmonary hypertension, myositis, anemia. Conclusion: SHARP syndrome is a rare condition, as evidenced by the small series of cases reported to date. Diagnosis is based on clinical and paraclinical criteria. The evolution can be interspersed with various complications that can affect the short, medium and long-term prognosis
Diagnostic usefulness of triple biopsies (Skin, Muscle and Nerve) in clinically suspected cases of vasculitis in a tertiary care hospital in Gujarat
(Educational Society For Excellence, 2023-07) Shah, Jigar; Kothari, Atul; Kothari, Juhi; Shah, Siddharth
Introduction: The term vasculitis refers to a heterogeneous group of diseases, all characterized by inflammation and destruction of blood vessel walls leading to ischemic, thrombotic, and hemorrhagic damage to tissues of central and peripheral nervous system. The main indication for triple biopsy (skin, muscle and nerve) is to rule out peripheral vasculitis neuropathy. However, the drawback is that any systemic inflammatory process may show changes in a skin biopsy and hence these changes need to be interpreted with caution. The aim of this study is to establish the diagnostic yield and the usefulness of the triple biopsies in clinically suspected cases of vasculitis. Material and Methods: The present study was conducted in the Department of General Pathology, SBKS MI & RC, Vadodara over a period of one year (1/1/2022 to 31/12/2022). All the clinically suspected cases of vasculitis received at OPD were included in the study. Any case with either muscle, nerve or skin biopsy reported as inadequate were excluded from the study. Results: On evaluation the usefulness of triple biopsies for vasculitis, we found a very low diagnostic yield with only 3.3% of peripheral nerve biopsy and 0.8% of muscle and nerve biopsy showed definite vasculitis. In case of suspected peripheral/systemic vasculitic neuropathy, nerve biopsy was sufficient in the majority of case and has the diagnostic armamentarium for the evaluation of vasculitis. Conclusion: In conclusion, nerve biopsies provide the best yield for the diagnosis of vasculitis, as opposed to muscle and skin biopsies. The role of triple biopsies as a routine protocol for the evaluation of vasculitis is questionable.
Impact of childbirth preparation sessions towards the willingness and ability of husbands to accompany their wives during childbirth in the delivery room
(Educational Society For Excellence, 2023-07) Gautham, Kavitha; Jayakrishnan, Jayashree; Ramanathan, Vijayasarathi
Background and Objective: Most Fathers-to-be within Indian setting find it difficult to cooperate with their spouse抯 labour and encounter a great deal of stress during the journey of Childbirth. The study objective is to assess the impact of Childbirth preparation sessions (CPS) in a private maternity centre at Chennai towards shaping the willingness and attitudes of fathers-to be regarding their willingness and ability to accompany their wives during childbirth in the delivery room and to compare the attitudes with those fathers who did not attend the Childbirth preparation sessions. Materials and methods: A pilot study was conducted between October 2022 to January 2023 at a tertiary maternity hospital in a metropolitan city (Chennai) with a convenient sample of fathers-to-be who attended (Group 1, n=30) CPS and those who did not attend (Group 2, n =30). A questionnaire was given to fathers who had less than 2 year old child to analyze the difference in willingness and ability to go to the labour room among those who attended child birth preparation sessions and those who did not. Results: All men were well educated Indians and the mean age of men who attended childbirth preparation sessions were 33 years and most of them were fathers-to-be for the first time. The results showed that fathers-to-be who attended the childbirth preparation sessions were more likely to express willingness to attend labour room. Though majority of men (51 men out of 60) were willing to go to the labour room, only 47 men were able to go to the labour room out of which 28 had attended the CPS. There was a high significance in their ability to go to the labour room among those who attended the CPS (P-value - 0.010). Conclusions: The preliminary results of this pilot study indicated that a well-structured and delivered CPS could not only enhance the shared role of fathers-to-be in the critical childbirth journey but also provide them with adequate psychosocial support.
Microbiological Profile and Antibiogram of Uropathogens Isolate in Tertiary Care Hospital
(Educational Society For Excellence, 2023-02) Mesariya, Siddhi; Pethani, Jayshri; Shaikh, N.M.; Dalal, Parevee; Gadara, Shraddha; Chauhan, Keyur
Introduction: Urinary tract infections (UTIs) are one of the most common bacterial infections in humans, both in the community and the hospital settings. The distribution of antimicrobial susceptibility data of UTI-causing microorganisms changes from time to time and from place to place. The susceptibility data provided by regional microbiology laboratories helps to choose the empirical antimicrobials to treat UTI. Materials and methods: Total 1381 urine were received in Bacteriology section of microbiology department from January 2022 to August 2022. Urine was processed for culture according to standard operating procedures at Microbiology laboratory, tertiary care hospital. Identification and antibiotic sensitivity testing was performed by automated VITEK-2 compact system. Results: In total, 1381 urine were received during the study period, 433(31.35%) cultures yielded significant pathogens and no organisms were isolated in 941 cultures and some sample was contaminate. The most commonly isolated organism were Escherichia coli (38.8%), followed by Candida spp. 88(20.32%), Klebsiellaspp (13.40%), Pseudomonas aeruginosa (12.24%), Gram positive organisms 12(2%) isolated. E. coli were most susceptible to Amikacin (87%), Fosfomycin (83%), colistin (82%), and tigecycline (78.39%). Klebsiella spp were most susceptible to colistin (72%). Nearly, 75% strains of Klebsiella spp were showing resistance to Carbapenems due to Carbapenemase production. Conclusion: Over enthusiastic use of the antibiotic has resulted in the emergence of drug-resistant bacterial strains in patients. The study of antimicrobial susceptibility patterns of uropathogens in a particular area can guide the clinicians in the rational choice of empirical treatment to prevent the misuse of antibiotics.
Renal involvement and early prognosis in patients with Covid-19 pneumonia in tertiary health care centre
(Educational Society For Excellence, 2023-07) Vaishnavcharankumar, Dharmapuri; Parimala, Yeruva Veda; Vankayala, Uday Sankar Akash; Kulkarni, Ankit Sunil; Shree, Akkalashetty Uday
Background: The corona virus disease (Covid-19) is a pandemic which is rapidly evolving and expanding, has infected a population of more than 77 million across the globe and around 10 million in India as of 25th December 2020. This virus was first recognized in December 2019 in Wuhan of China when pneumonia of unknown origin came into limelight. It was identified as Covid -19, a neo virus causing severe pneumonia that rapidly led to a major health crisis with devastating consequences not only in India but also in major developed countries of the world. Initially data from China and Italy, which was identified as caused by Covid-19, shows that death rate worsens in persons with increasing age more than 50 years and also leads to higher risk due to co-morbidities like hypertension (HTN), cardiac disease, diabetes mellitus, chronic renal disease, cancer, etc. Severe acute respiratory viral infections are frequently accompanied by multiple organ dysfunction, including acute kidney injury (AKI). While diffuse alveolar damage and acute respiratory failure are the main features of Covid-19, and the incidence of AKI is not well described. The present study was conducted to assess the Renal Involvement and its association with Prognosis among Patients admitted with Covid- 19 Pneumonia. Aim: To assess the renal involvement and its association with prognosis among patients admitted withCovid-19pneumonia. Materials and methods: A single centered cross-sectional study was conducted at Malla Reddy Institute of Medical Sciences during 15th March to 1stMay 2021 where 151 Patients admitted with Covid-19 Positive on RT-PCR were included. Renal function tests include Creatinine and Urea. The most commonly used endogenous marker for the assessment of glomerular function is creatinine. The calculated clearance of creatinine is used to provide an indicator of GFR. Urea is a nitrogen- containing compound formed in the liver as the end product of protein metabolism and the urea cycle. Serum urea levels increase in conditions where renal clearance decreases (in acute and chronic renal failure/ impairment). Urea may also increase in other conditions not related to renal diseases such as upper GI bleeding, dehydration, catabolic states, and high protein diets. Data entry was done using Excel 2013 and analysis using SPSS v16. Student t test and chi-square test were used to find the significant association without come. Results: A total of 151 patients who had tested positive for COVID-19 were included in the study. The mean age in years of the study participants was 47.76�.85. 72.8% were male and 27.2% were female. The mean serum creatinine was 1.44�94 and mean Blood urea was 41.35�.06. Mortality observed in the study was 44.4%. Significantly high levels of serum creatinine (2.06�10) were reported among those who died due to COVID-19 compared to those who recovered (0.93�28) (p<0.0001) in the study. Our study poses a conclusion of increase in serum creatinine in COVID 19 affected patients that shows a temporal association of SARsCOV�with AKI. Conclusion: The Covid pandemic has posed major challenge around the globe. Renal clinical presentation ranging from mild proteinuria, hematuria to progressive AKI necessitating renal replacement therapy (RRT), thrombotic microangiopathy and rhabdomyolysis. More research is needed to obtain adequate evidence to support current clinical approaches and to develop new approaches to management. Kidney failure occurs in most patients with COVID-19 pneumonia. Although proteinuria, hematuria and AKI are usually resolved in such patients within 3 weeks after the onset of symptoms, kidney problems in COVID-19 have been associated with higher mortality. AKI is independent predictor of mortality in Covid-19
Rare case of multiple primary malignant neoplasms
(Educational Society For Excellence, 2023-01) Mavadiya, Shashikant; Punatar, Upasana; Vatsaraj, Shreem; Dattani, Pooja; Jain, Shubhangi; Khan, Ayesha aka Arnaz
Multiple Primary Malignant Neoplasms (MPMNs) are rarely reported and are defined as the diagnosis of ?2 independent, primary malignancies of different histologies/ origins in a single individual. In this study, we report a patient with Male Breast Cancer (MBC) and coexisting Small Lymphocytic Lymphoma (SLL) and Chronic Lymphocytic Leukemia (CLL). A 65-year-old male with complaints of a lump in his left breast since 2 years. CT scan findings were a non-homogeneous mass in the left breast along with bilateral axillary lymphadenopathy. Modified radical mastectomy was done. Microscopic examination showed the features of infiltrating duct carcinoma NOS: Modified Nottingham Bloom Richardson抯 Grade II in breast specimen. A peripheral smear of the patient showed features of chronic lymphocytic leukemia (absolute lymphocyte count was 16400 cells/mm3). IHC of breast tumor showed ER/PR positivity with H scores of 350 and 240 respectively and HER- 2/Neu protein expression was negative with a score of (1+). Lymph nodes were immunoreactive for CD 19, CD 23 and CD 5. Cells were non-reactive for Cyclin D1a and CD3. This is probably the first case of MBC with SLL and CLL. The diagnosis is consistent with synchronous MPMNs, which are increasingly reported nowadays.
Miliary Tuberculosis with Addisons Disease - in old case of pulmonary tuberculosis, and tuberculosis of seminal vesicles - A rare case report
(Educational Society For Excellence, 2023-01) Kumar, E.A. Ashok; Charan, Chokkavarapu Renuka; Parimala, Bachireddy
Addison's disease is a rare endocrinal disorder that was first described by Thomas Addison in 1855. Addison抯 disease occurs as a result of a lack of production of adrenocortical hormones, which is a rare but fatal disease if left untreated. The two most common causes of Addison's disease are autoimmune adrenalitis and tuberculosis which refer to hypoadrenalism caused by total or near total destruction or dysfunction of both adrenal cortices. Usual manifestations involve chronic fatigue, muscle weakness, loss of appetite, nausea, vomiting, diarrhoea, hypotension, and hyper pigmentation of the skin. A substantial proportion of patients presenting with extra-pulmonary tuberculosis (TB) have urogenital TB (UG-TB), which is easily under diagnosed because of non-specific symptoms, which are chronic and have cryptic protean clinical manifestations. Most of the clinician are not aware of the possibility of UG � TB. Calcification of seminal vesicle found in this case is a rare condition, which is commonly associated with diabetes, hyperparathyroidism, and genitourinary tuberculosis. We here in report a rare case of adrenal insufficiency due to miliary tuberculosis involving adrenal gland, old pulmonary tuberculosis and genitourinary tuberculosis (seminal vesicles calcification) in a 31 year old male person. He presented with multiple episodes of vomiting, and giddiness which wasalso accompanied with atypical hyperpigmentation. His symptoms resolved after starting anti tuberculous therapy.
Hypopituitarism in elderly � A case series
(Educational Society For Excellence, 2023-01) Gopi, Manigandan; Seshadri, M.S.
Hypopituitarism is found to be one of the under investigated disease in elderly as it produces non specific symptoms which can be easily attributed to ageing and related co morbidities. Unless the hypopituitarism is identified and proper therapy is instituted, the clinical consequences of the untreated patients will be fatal. Here we report three cases of hypopituitarism in elderly patients whose clinical presentation and etiology was completely different. The first patient was fifty year old lady who is a known asthmatic for the past thirty years on steroids and had iatrogenic Cushing抯. On tapering the steroids she developed hypotension and giddiness. On eliciting the history she was suspected to have Sheehan抯 syndrome and was confirmed with investigations. She was advised to continue the steroids with calcium supplements. The second patient is an 80 years old female who came with complaints of increased tiredness daily more in the morning while getting up and improves slowly in the afternoon time and getting tired again in the night. When she was examined she had hypotension of 90/50 mm of hg. She was evaluated for Partial hypopituitarism and investigation confirmed hypopituitarism and she was started on Hydrocortisone tablets and she improved. The third patient was a 65 year old lady who was diagnosed to have diabetes mellitus and hypothyroidism and was on oral hypoglycemic drugs and eltroxine supplementation respectively. She had multiple hypoglycemic symptoms unresolved in spite of tapering the oral hypoglycemic drugs and on evaluation found to have partial hypopituitarism and started on T. Hydrocortisone and she improved well. We report these three cases as hypopitiutarism has multifaceted clinical presentation and needs high level of suspicion to diagnose it in elderly
Expression and sensitivity of immunohistochemical markers SMA, Desmin, CD10 for uterine leiomyomas - A tertiary care centre experience
(Educational Society For Excellence, 2023-06) Shah, Siddharth; Goswami, Swapan; Kothari, Atul; Patel, Riya; Ganatra, Aayushi
Introduction: Leiomyoma is the most common benign tumor of the uterus which usually presents with menorrhagia, pain in abdomen or both. In extremely rare cases where uterine leiomyoma can be difficult to distinguish from other uterine smooth muscle tumors, immunohistochemistry is used. This study was aimed to study the expression and sensitivity of immunohistochemical markers SMA, Desmin, CD 10 for uterine leiomyomas and to find average number of mitosis in uterine leiomyomas using Ki 67. Materials and methods: The present study was carried out in the Department of Pathology, Dhiraj General Hospital and Smt. Bhikhiben Kanjibhai Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth, Piparia. A total 50 cases of uterine leiomyomas after its histological diagnosis were evaluated with immunohistochemical markers SMA, Desmin, CD 10 and Ki 67. Results: SMA expression was seen in all 50 cases of uterine leiomyomas with strong expression in 44 cases (88%). Strong SMA expression was seen more in usual leiomyomas as compared to leiomyomas with secondary changes. Desmin expression was also seen in all the 50 cases of uterine leiomyomas with moderate expression in 26 cases (52%). Weak CD 10 expression was seen in 15 cases of uterine leiomyomas (30%). Ki 67 was expressed very focally in only 3 cases of leiomyomas with mean value of only 0.3% tumor cells. Conclusions: Leimyomas was most frequently seen in the women in 4th decade. The most common clinical presentation was menorrhagia. SMA and Desmin expression was seen in all the cases with strong and moderate immunoreactivity respectively. SMA expression was found to be more specific than Desmin in uterine leiomyoma. Weak CD 10 and focal Ki 67 were expressed only in few cases and were found to be insignificant.
A rare case of Takayasu Arteritis in young woman with heart failure - A case report
(Educational Society For Excellence, 2023-05) Kumar, E.A. Ashok; Mandala, Pranavi Reddy; Anoushka, Siddabattuni Nainitha
Takayasu arteritis (TA) is a rare, systemic, granulomatous primary vasculitis of medium and large arteries. The name comes from Dr. Mikito Takayasu, who reported the problem in 1905 for the first time. It is also called as Pulseless Disease or Aortic Arch Syndrome and usually seen before 40 years with female and male ratio being 10:1. Takayasu arteritis is a major cause of high blood pressure levels in teenagers and young adults. Around 75 percent of the people having Takayasu get diagnosed usually at an average age of 29 years though they begin to show the symptoms at their teenage years because the early symptoms of Takayasu are nonspecific and common. Heart failure as the first presentation of the TA is rare but has been reported. Angiographic studies help in the diagnosis of Takayasu and patients usually respond to steroid therapy. We report a 16 years old female presented with history of upper limb claudication, dyspnea, orthopnea, non palpable pulse in bilateral upper limbs with non recordable BP, lower limb with high blood pressure recordings and bilateral carotid Bruit present. Imaging studies revealed circumferential wall thickening of arch of aorta, bilateral carotids, left sub clavian, left axillary. 2D echo revealed global hypokinesia with severe left ventricular dysfunction. Takayasu arteritis with heart failure diagnosis was made and administration of steroids, diuretics and ACE inhibitor improved the condition.
A rare case of primary ciliary dyskinesia with Kartagener抯 syndrome - A case report
(Educational Society For Excellence, 2023-06) Kumar, E.A. Ashok; Shriya, Pottala; Thalla, Amritaa
Primary ciliary dyskinesia (PCD) is an autosomal recessive hereditary disease that includes various forms of ciliary ultrastructural defects. The most serious form is Kartagener syndrome (KS), which accounts for 50% of all cases of PCD. Kartagener?s syndrome is a rare disorder and the prevalence is about 1 in 30,000. It is autosomal recessive ciliary disorder comprising the triad of situs inversus totalis, chronic sinusitis, and bronchiectasis. The defective movement of cilia leads to recurrent respiratory infections, and ear/ nose/ throat infections, and infertility. The diagnosis is made clinically and confirmed through electron microscopy, which reveals abnormalities of structural organization of the axoneme in cilia from respiratory epithelia and in spermatozoa. Underlying structural defects include 1) absent inner and/or outer dynein arms, 2) tubular defects, and 3) radial spoke defects. We hereby report a rare case of Kartagener?s syndrome, in an infertile male with immotile sperms. The clinician should have a high index of suspicion, so as to make an early diagnosis. An early diagnosis helps in making the options for timely treatment of infertility may be offered and unnecessary evaluation is avoided.
A rare case of intracranial dermoid cyst in a young woman � A case report
(Educational Society For Excellence, 2023-05) Kumar, E.A. Ashok; Anoushka, Siddabattuni Nainitha; Mandala, Pranavi Reddy
Intracranial dermoid cysts generally occurring along the midline are rare. They are benign, congenital, slow-growing cystic lesions located inside the skull. They account for<1% of all primary intracranial tumors and are more common in females in the first three decades of life. Many intracranial dermoid cysts are asymptomatic and are found by chance when brain imaging is carried out for other reasons. Clinical presentation usually relates to compression of adjacent structures or spontaneous rupture of the cyst. The signs and symptoms may range from headaches, seizures to cerebral ischemia. On CT imaging these lesions usually appear as well-defined lobulated midline masses with low attenuation and hyperintense on T1-weighted MRI imaging. We hereby report a case of an 18-year-old female presented with history of seizures involving right upper limb which spread to other limbs associated with frothing and tongue bite- 3 episodes since 2 months. She also had cleft lip. On examination CT images showed hypodense lesion in intrahemispheric region in frontal lobe and MRI image with contrast showed hyperintense T2W, hypointense T1W/FLAIR lesion. A diagnosis of an intracranial dermoid cyst in the intrahemispheric region of frontal lobe was made and the patient was advised a surgical excision of the cyst.
Determination of the Depression, Anxiety and Stress Levels of Hairdressers during the COVID-19 Pandemic and the Associated Factors
(Educational Society For Excellence, 2023-04) 諾TA?, Duygu; AKG躈, ?enay; UYMAZ, Pelin; 諾PULAT, Funda
Background: COVID-19 affected negatively almost every person in the world. This process has brought psychological disorders, social and economic problems at the societies especially in business sector. So this study was conducted to determine the factors related with depression, anxiety and stress levels of hairdressers during COVID-19 pandemic. Material and methods: This analytic research was conducted with 103 volunteer hairdressers who were reached by snowball sample. The data were collected with a personal data form and the DASS- 21 Scale. Results: Of the participants, 40.8% were in the 14-30 years age group, 57.3% were female, 58.3% were high school graduates. Of them, 68% were affected negatively due to the COVID-19. The COVID-19 had negative effects on the mental health status of hairdressers. The mental health of hairdressers was affected by gender, income status, chronic disease status, psychotherapy status, negative impact of COVID-19 process, daily working time and daily sleep duration significantly affect the mental health of hairdressers. Conclusion: The supporting mental health services and the adjustments can be given to small business owners, especially to hairdressers. In addition, further studies that determine of the effects of the COVID-19 on the economic and mental health of the small business owners can be useful.
Factors influencing medication adherence and quality of life in outpatients attending Department of Psychiatry in a tertiary health care centre
(Educational Society For Excellence, 2023-04) Jyothi, Vemuri Lakshmi Naga; Shasthri, Gouri Shanker; Srivastava, Anurag
Background: Nearly one third of people who suffer major psychiatric disorders end up with a long- term disability and dependency. They are most likely to be non-adherent to medication due to various reasons including lack of knowledge or insight about their illness and treatment which in turn leads to exacerbation of their illness, reduce treatment effectiveness, or make them less responsive to subsequent treatment, multiple hospitalizations and poor quality of life. Materials and methods: A cross sectional study was carried out in outpatients attending the Psychiatry OPD using the consecutive sampling technique. Subjects meeting the ICD-10 Diagnostic criteria for psychiatric disorders, age 18 year and above, subjects willing to participate in the study were included. A structured proforma, the Drug attitude inventory and the WHO-QOL-BREF questionnaires were used for assessment. Results: Mean age of subjects = 38.07 + 11.07 years. Mean medication cost = Rs. 917.82 + 397.89. 87 subjects participated in the study and of them 48% were adherent to medication and 52% were non-adherent. 56% of males and 43% females were adherent to medication. There was significant association between the occupation and the type of family of the subjects and medication adherence (p<0.05). Majority of patients with medication non-adherence were seen in schizophrenia, delusional disorder, bipolar disorder, generalized anxiety disorder, obsessive-compulsive disorder and substance related disorder. Majority (44.5%) of them reported fear of side effects, followed by stopping the medication when feeling better (35.5%) as the reasons for non-adherence followed by cost, embarrassment, etc. There was significant association between the psychological and social quality of life and medication adherence (p<0.05). Conclusions: This study implicates the importance of psycho education about the diagnosis, prognosis, need for medication and the expected adverse effects which should be clearly explained to the patient. The therapeutic alliance is the most effective component in helping the patient maintain medication adherence and subsequently better quality of life.
Persistence of traumatic infantile hemiparesis in an adult - A rare case report
(Educational Society For Excellence, 2023-04) Kumar, E.A. Ashok; Fathima, Shaik Aneesa
Hemiplegia is the physical manifestation of an injury to a specific area of the brain that controls motor function. Hemiplegia may develop suddenly, or evolve over days, weeks or months. Hemiparesis/ hemiplegia is rare in children. It causes significant mortality and morbidity. Infections are an important cause of neurological deficit, in the developing countries. Once the injury has occurred, the symptoms should not worsen. However, because of lack of mobility, other complications can occur. Complications may include muscle and joint stiffness, and shortening of limbs. The term acute infantile hemiplegia denotes certain cases of hemiplegia of sudden onset in children, of a few weeks to 6 or more years of age. The outcome may be fatal; or there may be permanent hemiplegia with mental impairment. There may be slow partial recovery; or rapid and complete recovery. We herewith present a 35 old male, who presented with seizures. 15 years ago he sustained head injury as he fell down from a tree. He was diagnosed with subdural hematoma and was evacuated through craniotomy, after which he developed residual right hemiparesis. The right hemiparesisis was still persisting as residual hemiparesis on right side with shortening of limbs. A diagnosis of Post traumatic Infantile hemiparesis on right side was made.
Serum Vitamin D Level in Psoriasis: A Prospective Study in a Tertiary Care Centre of Eastern India
(Educational Society For Excellence, 2023-01) Sinha, Rajesh; Pallavi, U K; Kumar, Rajeev; Kumari, Rekha
Background: Psoriasis is a systemic, inflammatory, chronic autoimmune disease characterized by multiple discoid plaques over body with silvery scales associated with cardiovascular diseases, obesity, diabetes mellitus, hypertension, and hyperlipidemia. Recently, association between psoriasis and Vitamin D level has also been reported. Our aim of study was to evaluate the association of vitamin D and its association with the severity of Psoriasis Materials and methods: 60 patients diagnosed with psoriasis, in our outpatient department from January 2021 to December 2021, were included the study. 58 age, gender- and skin phototype- matched healthy controls were included in the study. Results: The serum vitamin D level in patients and in the control group ranged from 7 to 24 ng/ml (mean: 13.04 �32 ng/ml) and from 16 to 65 ng/ml (mean: 23.91�08 ng/ml), respectively. The circulating vit D levels were less in patients compared to control. The analysis showed statistical significance (P< 0.05) between the two groups. Conclusion: Our results showed decreased level of vitamin D in patients suffering from psoriasis when compared to healthy controls. Vitamin D supplementation can be useful in psoriasis management.
A rare case of carotid stroke in young due to Takayasu Arteritis with positive anti- cardiolipin antibodies � A case report
(Educational Society For Excellence, 2023-04) Kumar, E.A. Ashok; Shriya, Pottala; Bai, P. Jijiya
Takayasu arteritis is a well-known yet rare form of large vessel vasculitis. Takayasu arteritis affects mainly women, and is most commonly seen in Japan, South East Asia, India, and Mexico, where it usually presents in the 2nd or 3rd decade of life. It is seen usually as pulseless disorder often with bruit at the stenosed arteries. Manifestations range from asymptomatic disease, to catastrophic strokes. Angiography remains the gold standard for diagnosis. Approximately half of those patients treated with steroids will respond, and half of the remaining patients respond to methotrexate; mycophenolatemofetil may be useful. Fertility is not adversely affected and pregnancy does not appear to exacerbate the disease, although management of hypertension is essential. We herewith report a rare case of an11 year old girl, who presented with left-sided hemiparesis, dysarthria, left UMN facial palsy, feeble pulses on right side, high Blood Pressure recordings and positive anti- cardiolipin antibodies. Imaging studies revealed Occluded right Common carotid artery, occluded right subclavian artery and stenotic right renal artery and MRI showed Acute Infarcts in Right Basal Ganglia and Right High Parietal Region, Hemorrhagic infarct in right MCA subcortical area.The diagnosis of Takayasu arteritis with recent cerebrovascular accident (left hemiparesis) with hypertension was made and the patient was started on steroids, anti-platelets, anti-hypertensives and physiotherapy.
Septic complications in patients of traumatic brain injury: An impact on clinical and functional outcome
(Educational Society For Excellence, 2023-05) Wani, Afeefah Jamsheed; Sidiq, Suhail; Lone, Abdul Qayoom; Rashid, Nowsheeba
Background: Septic complications in traumatic brain injury causes short- and long-term cerebral dysregulation by disruption of blood brain barrier, reduced brain perfusion, neuroinflammation and deposition of amyloid. Materials and methods: The present study attempted to observe patients of traumatic brain injury for the development of septic complications during the hospital stay. 89 patients were included in the study with different grades of brain injury (Injury Severity Score (ISS) range, 9-72). The patients were managed according to the trauma protocol and classified into 3 groups based on the severity of trauma (ISS 9-17 (moderate), 18-30 (severe), and >32 (most severe)). The patients were observed for the development of major septic complications during the course of their hospital stay, which impacted on the morbidity and mortality while determining the clinical and functional outcome at the end. Results: Mean age of the study population was 33.5 years. TBI was more common in younger age groups with severe grades of injury, those with multiplicity of head injuries, sepsis with a pulmonary focus, prolonged ICU and in-hospital stay together with high mortality. Septic complications were also more common in cases with higher grades of TBI and more prolonged hospital stay. Patients requiring intubation had a higher risk of developing infectious complications. 69 patients (77.5%) required intubation and mechanical ventilation. Pneumonia was the most common source of sepsis leading to the respiratory failure while the most common cause being aspiration at the time of injury Genitourinary complications were also common leading to urosepsis. Most common organisms isolated were Staphylococcus aureus, Acinetobacter, klebsiella and Pseudomonas. Conclusion: Traumatic brain injury (TBI) when complicated by sepsis and multi organ failure increases the mortality and morbidity with less favorable clinical and functional outcome together with increased duration of ICU and hospital stay.

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