Journal of the Indian Medical Association

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    To Determine the Prevalence Pattern of Aeroallergens in Patients of Bronchial Asthma and Allergic Rhinitis Reporting to a Tertiary Care Centre in North India
    (THE INDIAN MEDICAL ASSOCIATION, 2024-08) Chaudhary, Kamran; Sen, Manas Kamal; Swati, Amrita; Sachdeva, Ruchi; Kumar, Avinash
    Background : Allergens have been associated with diseases such as Bronchial Asthma (BA) and Allergic Rhinitis (AR) which are of most concern, among the patients visiting the chest physicians. Exposure to various aeroallergens has direct impact on pathogenesis as well as outcome of BA and AR. Materials and Methods : It is a prospective study in which a cohort of 20 patients were assessed who were diagnosed as a case of BA or AR clinically or by pulmonary function test. These patients were subjected to skin prick test after taking written and informed consent. Results : Most common allergen were Suaeda fruticosa, Mucormucedo, House Fly, Locust, House Dust, Buffalo Dander, Cat Dander and Silk. Conclusion : The study concludes that most of patients of BA and AR had polysensitization. Majority of patients were female and belonged to the younger age group, 20-29 years followed by 0-19 age group. The patients who were found to be allergic should be educated regarding avoidance of allergens help in reduction of symptoms and morbidity and increasing the overall health status.
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    Current Spectrum of HIV Associated Ophthalmic Diseases among the Patients Enrolled for Antiretroviral Therapy and its Correlation with CD4-T Cell Count � A Cross Sectional Study
    (THE INDIAN MEDICAL ASSOCIATION, 2024-08) Biswas, Uttam; Chaudhuri, Pallabi Ray; Ghosh, Sandip; Dey, Asim Kumar; Ray, Soumya; Chakraborty, Milan
    Background : Various studies have demonstrated 40-45% of HIV patients have Ophthalmic Manifestations. Previous prevalence estimates done within populations selected based on symptoms or ophthalmological referral. This study aims to analyze the prevalence and nature of HIV-related eye involvement in all newly diagnosed HIV patients, before commencing Anti Retro-viral Therapy (ART). Materials and Methods : This cross-sectional study was done on 271 newly diagnosed HIV-infected patients. Based on a typical ocular lesion with systemic infection the diagnosis of ocular HIV was done. All data were analyzed on SPSS. Results : Ocular manifestations found in 33.6% of HIV patients. The majority were male (53%) and 14.3% of patients had low vision. The most common involvement was posterior segment (48%). We have found a large number of patients with Ophthalmic Manifestations were asymptomatic (46.2%). Increased chances of HIV ophthalmopathy are observed with increasing severity of HIV infection as evidenced by 74.1% and 91.7% of patients of stage 3 and stage 4 respectively having ocular involvement. The percentage of eye involvement is gradually increasing with decreasing CD4-T Cell Count that is 34.7% of patients of 200 to 500/?L CD4 count and 77.1% patients of less than 200/?L CD4-T Cell Count have ocular involvement. Conclusion : Multi-disciplinary approach with proper Ophthalmological evaluation is a must for patients with advanced immune deficiency as manifested by WHO clinical stages 3 or 4 and lower CD4 counts.
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    Infiltrative Cardiomyopathy Causing Heart Failure with Compromised Ejection Fraction (HFrEF) : An entity to look out for
    (THE INDIAN MEDICAL ASSOCIATION, 2024-07) Owuor, Henry; Gikonyo, Anthony; Ponoth, Premanand Menon; Gikonyo, Dan
    Infiltrative cardiomyopathy is characterized by deposition of abnormal substances within the heart tissue resulting in diastolic dysfunction and less commonly systolic dysfunction late stage of the disease. The more common types of infiltrative cardiomyopathy are cardiac amyloidosis, sarcoidosis and hemochromatosis. We present the case of a 73 year old male with dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea and fainting episodes. Electrocardiogram (ECG) showed low-voltage QRS complexes, Right Bundle Branch Block (RBBB) with associated Left Anterior Fascicular Block (LAFB) and on echocardiogram demonstrated reduced systolic function. The Cardiac MRI demonstrated restrictive cardiomyopathy with both systolic and diastolic dysfunction concluding that there is infiltrative cardiomyopathy due to either sarcoidosis or amyloidosis. Caution must be exercised while using the guideline medical therapeutic drugs that form the pillar of comprehensive heart failure therapy as they have many untoward side effects.
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    The Utility of MatriDerm (Skin Substitute) with Autologous Thin Split Skin Graft to Cover Deperiosted Exposed Tibia 6x4 cm Wound in Diabetic Old Man
    (THE INDIAN MEDICAL ASSOCIATION, 2024-07) Singh, Sudhir
    It has been found that MatriDerm (Skin Substitute) can successfully cover the deperiosted exposed bone if breadth is less than 3cm irrespective of length as vascularization is attained from adjacent vascular bed and migration of newer vascular tissue is at the tune of 15mm from one edge as reported in one study. My case was exposed left tibial bone of about 6x4 cm devoid of periosteum in a diabetic 87 years old man who sustained scald burn with this complication. It was successfully covered with MatriDerm with thin split skin graft in single stage and thus avoided local flap or microsurgical free flap surgery. This proves that MatriDerm can vascularise over the small exposed bone even if it is devoid of periosteum. Another inference is MatriDerm is able to cover beyond 3cm wound breath inspite of loss of periosteum and is first time to be reported in literature with long followup. So no drilling of bone required to sprout granulation tissue from bone marrow to create granulation vascularised bed for second stage skin grafting. It thus avoids local flap or microsurgical free flap surgery for small exposed deperiosted bone.
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    An Assessment of Knowledge and Attitude of Beneficiaries Attending Tertiary Care Hospital regarding Temporary Family Planning Methods and to Determine their Experienced Side Effects of Temporary Contraceptive Methods in Ahmedabad City, Gujarat, India
    (THE INDIAN MEDICAL ASSOCIATION, 2024-08) Saini, Vandana Kamlesh; Bhabhor, Mittal Babubhai; Patel, Divyesh M; Patel, Peenal Parbhubhai; Chaudhari, Vatsal Karshanbhai; Dagra, Jyusi Jivanbhai
    Background : Despite the fact that contraception usage has increased over a period of time, there exist a Knowledge, Attitude and Practice-gap of Contraceptives. Aims and Objectives : (1) To study the Knowledge and Attitude about temporary methods of contraception. (2) To determine the side effects of temporary family planning methods. Material and Methods : This was a hospital based prospective study carried out at Tertiary Care Centre during the year 2020. Selection of participants (150) was done through stratified sampling those patients who had received temporary family planning services. The interview was taken of beneficiaries attending the Tertiary Care Centre. Results : Majority of the women belonged to young age (70%). Most common source of information was a doctor at their antenatal clinic (50.67%). Women (82%) were aware of condoms, 70% of IUCD and only 31% aware of injectable contraception. Among users of Oral Contraceptive (OC) Pills, 40% had complaint of irregular bleeding, 36% over- weight, 30% nausea. Among IUCD users, 18% had problem of bleeding p/v, 6% patients had string problem like discomfort while intercourse and expulsion of IUCD (2%). Amenorrhea (72%) was side effects observed in Injection DMPA users. Conclusion : Most of the participants were aware of various temporary methods except injectable. Women users were experienced mild side effects and no major complications.
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    M黮lerian Duct Fusion Anomaly Associated with Unilateral Renal Agenesis
    (THE INDIAN MEDICAL ASSOCIATION, 2024-07) D R, Vishwaprem Raj; D, Naveen; B, Mallikarjunappa; Gupta, Akshay
    The purpose of this study was to check for the associated anomalies present in a suspected case of M黮lerian duct fusion anomalies. Almost one-third of women with a renal anomaly will have M黮lerian duct anomalies. MRI plays an important role in evaluating abnormal uterine morphology with other association like unilateral renal agenesis and vertebral anomaly. In this case report we present two cases of rare M黮lerian fusion anomaly associated with unilateral renal agenesis.
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    Effects of Prophylactic Retention Sutures on Closure of Laparotomy Wound in High-risk Patients in a Tertiary Care Hospital
    (THE INDIAN MEDICAL ASSOCIATION, 2024-08) Dagra, Risabh; Mukherjee, Ramita; Das, Sudip; Roy, Amit; Saha, Sudev
    Wound dehiscence is the postoperative separation of musculo-aponeurotic layers. It occurs in up to 4.5-8% laparotomies, usually on 7th-10th postoperative day. It carries a mortality rate of up to 15-20%. Retention Sutures are interrupted sutures placed across wound before formal fascial closure through rubber / latex bolsters and knotted in mattress fashion. The objective of this research was to study the effects of using Prophylactic Retention Sutures on wound complications, specifically on wound dehiscence and surgical site infections. The relevance of the study was to determine whether retention suture can be used prophylactically to prevent wound dehiscence, thus avoiding several complications, reducing health-care cost, providing better quality of life with a shorter hospital stay. The study was an observational, descriptive study with cross-sectional design. We performed the data collection from 1st March, 2021 till 28th February, 2022. The sample size was 65, which included all patients undergoing emergency laparotomy in NRS Hospital having any of the 17 high-risk factors. The data was checked for consistency and completeness and analyzed using SPSS version 20. Proportions were analyzed using Chi-square test. Four patients (6.2%) had wound dehiscence despite retention sutures and 29 (44.6%) had surgical site infection. Association of obesity with wound dehiscence and chronic cough, diabetes, jaundice and malignancy with surgical site infection were statistically significant. The outcome of Prophylactic Retention Suture on wound dehiscence (6.2%) is not statistically significant as opposed to the rate of wound dehiscence without it (4.5-8%). Hence, the use of Retention Sutures is left to the discretion of the operating surgeon.
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    A Cross Sectional Study of Socio-cultural and Clinical Determinants of Health-related Quality of Life in Indian Patients with Epilepsy
    (THE INDIAN MEDICAL ASSOCIATION, 2024-08) Asole, Dnyaneshwar; Bharote, Hareshkumar; Thakre, Mahendra
    Background : Health-related Quality of Life (HRQoL) is a vital component of adherence to treatment in patients with epilepsy. The present study was conducted to determine the level of HRQoL in patients with epilepsy attending the Outpatient Department of our hospital. Materials and Methods : This cross-sectional study was done by the Neurology Department of tertiary-level care Municipal Hospital in Mumbai from January, 2021 to December, 2021. Inclusion criteria included patients with a confirmed diagnosis of epilepsy, age 18 and older, receiving anti-epileptic drugs, and the ability to provide written consent. The QOLIE-31 questionnaire and a study proforma were administered to the patients. Results : 248 patients were included in the study. The QOLIE-31 overall score ranged from 17.4 to 78.6, and the average overall score was 66. It was observed that mean QOLIE-31 score was significantly lower (poorer QoL) in patients aged more than 40 years (58.6�4 versus 72.4�.5, p-value <0.05), female patients (51.4�6 versus 69.5�5, p-value <0.05), married (51.1�8 versus 68.4�4, p-value <0.05), epilepsy for more than 10 years (59.4�4versus 71.6�.6, p-value <0.05), and those on polytherapy (57.5�.8 versus 72.5�6, p-value <0.05). Conclusions : Older age, female gender, being married, higher seizure frequency, longer duration of epilepsy, and polytherapy were the factors associated with significantly lower QoL.
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    Impact of Psychological Intervention on the Quality of Life of Primary Care Givers of Patients with Cancer : Preliminary Report in City based Cancer Hospital, India
    (THE INDIAN MEDICAL ASSOCIATION, 2024-08) Gangopadhyay, Subir; Datta, Arunima; Nandy, Koushik; Dhar, Harsh; Jayaseelan, Prathna; Agarwal, Pooja
    Background and Aim : Caring for an individual with cancer can lead to significant stress, anxiety and feelings of sadness among primary caregivers, ultimately impacting their overall psychological and physical well-being. The aim of this research was to assess if cancer primary caregivers who underwent Psychological Interventions (PI) observed enhancements in their Quality of Life by decreasing levels of depression and anxiety. Materials and Methods : A single-centre randomized control trial was conducted among 53 adult primary caregivers aged >18 years of age to <65 years and those involved with their patients� actual care not less than 12 hours per day, between April, 2023 to August, 2023. All participants went through the assessment of QoL and Depression and Anxiety levels by using validated tools. Participants were randomly assigned into two groups : Group-A (N=31), participants receiving psychological support and Group-B (N=22), who did not receive any psychological support.The intervention comprised five sessions. Following department protocol participants were followed-up based on 21,42, 63, 84 and 105 days. Participants completed primary outcomes (Anxiety, Depression and Quality of Life) before one of each session to see the impact of each session. To identify the impact of PI, descriptive statistics were calculated as the Mean盨tandard deviation of the score of validated tools based on primary outcomes. Results : A total of 53, female caregivers (61%) were more than male individuals (39%). About 60.57% of the caregivers reported severe hampering of their QoL. The data showed significant improvements in outcomes measured from pre to post and from post-to-follow-up as compared to Group-B counterparts (p<0.005). Group-A had statistically significant improvements in QoL in 120 days� follow-uptime, compared with Group-B, p=<0.01. Conclusion : Under challenging circumstances during the period of cancer treatment, PI is a useful intervention for standing continuous psychological support as it is associated with better Quality of Life for primary caregivers. Further research examining factors influencing the outcomes of psychological intervention will be justified.
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    Statin Intake and Thrombotic Events in Indian Patients 鈥� A Cross Sectional Study
    (THE INDIAN MEDICAL ASSOCIATION, 2024-01) Sharma, Ankita; Donepudi, Aruna; Padmaja, Mekala
    The present cross-sectional study was planned to evaluate the incidence of (cardiovascular or stroke) events in patients on statin therapy using data collection form which included patient details such as medical history, treatment history and events occurred. Statin use was stratified to record the occurrence of primary event in patients using statin prophylactically and the occurrence of re event in the patients using statin in therapeutic manner. We enrolled 103 patients out of which thrombotic events occurred in 10 patients (9.7%). Among the 10 patients, 7 (6.7%) patients had Coronary Artery Disease (CAD) while 3 (2.9%) patients had stroke with statin use. Our study got similar incidence of major clinical events with statin use as in literature.
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    Risk Factors for Early Re-bleed following Endoscopic Variceal Band Ligation and Assessing Utility of Dedicated Score (BICAP Score) to Identify High Risk Groups
    (THE INDIAN MEDICAL ASSOCIATION, 2024-08) Unnikrishnan, Ramu Krishnan; A, Shafique; Rejoice, Poppy; Kumar, E Kandasamy; Durai, Geetha; R, Kishore Kumar
    Background : Endoscopic Variceal Band Ligation (EVBL) is a universally accepted and approved treatment for bleeding esophageal varices. Re-bleed is the most common complication following EVBL. Ours is a prospective study analyzing risk factors for Early Re-bleed (ERB) and for creating a laboratory based BICAP score (Bilirubin, INR, Creatinine, Albumin, Platelet) for detecting high-risk groups for re-bleed. Materials and Methods : The study period was between March, 2021 to March, 2022 when 111 patients underwent EVBL in our department. Patients were followed by telephone or direct visits weekly for 6 weeks. ERB was defined by active variceal hemorrhage presenting as hematemesis in a patient following EVBL within 6 weeks. Endoscopy was done for all patients after re-bleed to confirm. Results : Among 111 patients, 26 patients developed ERB with an incidence of 23.4%. ERB was higher in emergency EVBL than elective (29.3% versus 6.9%, p=0.014). Platelet count of < 50,000 and INR > 2.0 were associated with high ERB risk (52.4%, p>0.002) and (60%, p = 0.001). Overt encephalopathy was associated with 42.3% risk of ERB (p = 0.009). Usage of high number of bands (>6) were associated with increased risk of ERB (56.3%, p>0.001). Child Pugh C patients had high risk of ERB (37.5%, p = 0.001). BICAP score >7 was associated with increased risk of ERB (80%, p = 0.002). Conclusion : Child-Pugh score and BICAP score both can predict high risk groups for ERB, but BICAP score is a dedicated score and can be used even in non-cirrhotic patients. BICAP score is found to have high sensitivity in detecting patients with high risk for early Re-bleed.
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    Sensitivity of SARS-CoV-2 Rapid Antigen Test as Compared to RT-PCR Test
    (THE INDIAN MEDICAL ASSOCIATION, 2024-07) Mundhada, Shailendra Ghanshyam; Deogade, Neha; Tanna, Jay; Deshmukh, Madhavi; Mundhada, Anurag Shailendra
    It is well known that for detection of COVID-19, Rapid Antigen Test (RAT) is less sensitive than RT-PCR test. Here, we have compared both the tests when done in same patients, at same time, in a series of 352 patients from our lab. Symptoms of patients were also taken into consideration. This data is quite relevant as Government statistics include results of RAT and RT-PCR combined to determine daily and weekly positivity rates. The decision of Government restrictions to be imposed by civic authorities also depends on the positivity rate. RAT testing numbers are increasing for their low cost, less time to report and ease of doing the test. However, considering its low sensitivity, it portrays a false picture of low prevalence.
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    Assessment of the Level of Knowledge and Skills Pertaining to Selfmanagement among Adult Patients of Bronchial Asthma and COPD
    (THE INDIAN MEDICAL ASSOCIATION, 2024-07) Pal, Agnik; Biswas, Bodhisatwa; Shit, Priyabrata; Samajdar, Shambo S; Sen, Sukanta; Tripathi, Santanu Kumar
    Background : A large proportion of patients prescribed inhaled medications do not use their inhalers correctly. Hence in this backdrop, our study was done to assess the level of knowledge about the condition as well as skills for using inhaler devices. Materials and Methods : It was a cross-sectional study with consecutive 80 eligible patients diagnosed either with asthma or COPD, were recruited after taking informed consent and their skill and inhaler use technique was captured in data collection form. Knowledge about the disease the patient was suffering was assessed using pre- structured questionnaire and expressed as percentage of patients of asthma or COPD, answering the questions positive or negative. Skills pertaining to self-management were checked using structured checklist (taking reference from previous studies and guidelines and modified) and asking the patient to demonstrate the technique of using inhalational medication. The total score obtained by summing up scores for different steps were named as Device Appropriateness Index (DAI). Results : Certain steps in proper device technique were commonly omitted. Among MDI users, the steps least often optimally completed were exhalation to residual volume prior to putting the inhaler in the mouth (46.16%), shaking the device before use (41.03%) and holding the breath for 5-10s after removal of the inhaler (33.33%). Among DPI users, the steps least often completed were exhalation to residual volume prior to putting the inhaler in the mouth (44.44%), to inhale forcefully and deeply from the inhaler (37.04%) and holding the breath for 5-10s after removal of the inhaler (29.63%). Conclusion : The inappropriate use of inhalers and knowledge about their own conditions can lead to suboptimal adherence, poor clinical control, dissatisfaction and consequently high economic burden in patients suffering from asthma and COPD. The misuse of inhalers has been an important roadblock to both patients and clinicians for years.
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    Screening for Congenital Hypothyroidism � Umbilical Cord Blood TSH a Useful Tool : A Single Centre Eight Year Experience
    (THE INDIAN MEDICAL ASSOCIATION, 2024-07) Bhatia, Ravi; Bhatia, Gunjan; Rajwaniya, Dinesh; Mishra, Priyanka; Kaur, Jobanjeet
    Background : Congenital hypothyroidism remains the most common preventable cause of mental retardation in pediatric age group. Screening for Congenital Hypothyroidism remains an effective tool to prevent mental retardation among the general population. Umbilical Cord blood TSH is an easily available reliable tool for screening for Congenital Hypothyroidism. Aims and Objectives : The aim of the study was to find the normative Cord Blood TSH value for the study group and to assess the utility of Cord Blood TSH as a screening tool for Congenital Hypothyroidism. Design : Cross Sectional study. Material and Methods : CB TSH levels were measured in 8720 neonates over a study period of eight years. All neonates who had a cord blood TSH level greater than 20 mIU/L were called back on day 7 of life for a repeat thyroid profile. Results : Cord blood samples of 8848 neonates were sent for analysis, 128 samples were hemolysed hence only 8720 were analysed. A total of 8720 neonates formed the study group. Male to Female ratio was 4720:4000 ie, 1.18:1. The birth weight of the study group ranged between 0.9 kg to 4.2 kg. The average birth weight was 2.92 kg. The study group was divided into two cohorts, cohort 1 comprised of babies who were term gestation (6366 babies, 73%), cohort 2 comprised of babies who were born between after 28 weeks of gestation but before 37 weeks of gestation (2354 babies, 27%). The mean TSH value of the entire study group was 7.34 mIU/ml. majority of neonates (93%) had a cord blood TSH level less than 10 mIU/L. In 130 neonates had a cord blood TSH value greater than 20 and were recalled for a repeat testing on day 7 of life. Out of the 130 neonates recalled for repeat testing (recall rate 1.48%), only 104 neonates turned up, 26 were lost to follow-up. Out of the 104 neonates which turned up for repeat testing, 4 eventually turned to be hypothyroid on repeat testing giving us an incidence of 1 in 2180. TSH values corresponding to the 3rd , 10 th , 25 th , 50 th , 75th , 90 th , 95 th and 97 th percentile were 2.2, 3.1, 3.9, 6.1, 7.1, 10.67, 13.8, 23 respectively. 98% of our study group had a cord blood TSH value less than 20, so a cord blood TSH of greater than 20 mIU/ml can safely be used for screening for congenital hypothyroidism. Conclusion : A cut off of Cord Blood TSH value >20 mIU/ml can be used as a screening tool for Congenital Hypothyroidism.
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    Assessment of Time To Positivity (TTP) and Loading Delay Influencing the Positivity of Blood Culture by an Automated System
    (THE INDIAN MEDICAL ASSOCIATION, 2024-07) Patel, Naimika; Patel, Riddhi; Patel, Rupal
    Background : The presence of living micro-organisms in blood is known as bloodstream infection. It can be leading to sepsis, a critical condition associated with mortality ranging from 14% to 34%. Blood cultures are still considered the gold standard test for the detection of bacteremia and fungemia. The bacterial load in blood culture is assessed by the parameter of time to positivity in an automated system. Materials and Methods : It was a prospective observational study conducted 3 months after IEC approval. A minimum of one & maximum of three samples were collected from each patient. After receiving them at the microbiology laboratory all bottles were loaded into the BacT/ALERT machine. All the signaled positive bottles were studied for a time to detection and factors influencing it and the second objective was to observe the effect of loading delay on isolation rate and time to detection. The following parameters were prospectively extracted from BacT/ALERT systems� software the cell number, loading time, signal positive time and unloading time (hour, minute). Observations : A total of 761 blood culture bottles were received during the study period. Maximum bottles were received from male as compared to female patients. Maximum blood cultures were received from the 0-10 years of age group followed by from 21-30 years and from 51-60 years. The mean TTD for all the isolates was 22.71 hours. 81% of true pathogens were detected within 24 hours and 98% of true pathogens were detected within 72 hours. We observed that inadequate blood volume took longer TTP for GNB & Yeast isolates than adequate volume bottles. The true pathogen positivity rate decreases in case of loading delay. The mean unloading time during routine & emergency hours was 0.6 hours & 1.6 hours. Conclusion : As positive blood cultures are critical alerts; every step should be taken to decrease the loading & unloading delay of blood culture bottles for the final reduction of turn-around time and timely intimation of positive blood culture results to clinicians.
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    Prospective Study for Anterior Bridge Plate (ABP) for Humerus Shaft Fracture with Combination Screw : Innovative SPV Technique
    (THE INDIAN MEDICAL ASSOCIATION, 2024-07) Patel, Siddharth D; Desai, Ankit Kumar A; Patel, Amit A
    Background : The traditional conservative treatment for a shaft of humerus fracture is either immobilization or open reduction internal fixation with plate osteosynthesis. A novel method of internal fixation for humerus fractures is anterior bridge plating. The present study was conducted to find out the effect of Anterior Bridge Plate with combination screw for humerus shaft fracture patients. Material and Methods : The present prospective study was conducted among 20 patients of humerus shaft fracture at Department of Orthopedics for a period of one year. Using the UCLA score for the shoulder and the MEPI score for the elbow, the clinical and functional results of the procedure were evaluated at each follow-up period from the time of discharge on postoperative day 13 until the 6 months postoperative. Results : Maximum patients were in the age group of 29 to 38 years (50%) and least were in the age group of above 58 years (5%). Male patients (65%) were more as compared to female patients (35%). Fracture union was observed in the majority of the patients (60%) at 9-12 weeks postoperative. At 6 months almost all (95%) patients had an excellent MEPI score, while only 5% patient had a good score. There was no significant difference in MEPI scores over time with p>0.05. The UCLA score at 6 months was excellent or good in almost all 95% patients while only one patient had a fair score. There was no significant difference in UCLA scores over time (p>0.05). Conclusion : Anterior bridge plating with combination screw produces high rates of union, excellent functional recovery and minimal biological disruption.
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    A Study on Non-motor Manifestations in Young Onset Parkinsons Disease (YOPD) in Eastern Indian Population
    (THE INDIAN MEDICAL ASSOCIATION, 2024-07) Yadav, Praveen Kumar; KK, Samsudheen
    Background : Non-motor Symptoms (NMS) are extremely common in Young Onset Parkinson Disease (YOPD) with high incidence of neurobehavioral and autonomic dysfunction which should be given greater emphasis as it will affect the Quality of Life. Materials and Methods : This is a cross-sectional study in which all consecutive patients of age less than 50 years satisfying the UPKRDS Diagnostic criteria for Idiopathic Parkinson抯 Disease (IPD) attending the Neurology Outpatient services at a super speciality clinic during study period July 1, 2021 to April 30, 2022 were included in the sample. All secondary causes of parkinsonism like drug induced, multi-infarct state and normal pressure hydrocephalus were excluded. All patients were examined, and demographic data and non-motor symptoms were documented using the Non-motor Scale (NMSS) of International Parkinson抯 and movement disorder society and modified Hoehn & Yahr staging used for staging. Results : A total 32 patients were diagnosed with YOPD during the study period. Out of which 19 (59.37%) were Males and 13 (40.32 %) were Females. Majority of the patients were in the age group of 40-50 years (84%) and onset of illness in 1 month to 5 years (78.17%) with 37% each of patients were in the H & Y Stages I-1.5 and 1.5-2. Common Non-motor Symptoms (NMS) observed were anxiety (71.87%), memory loss (59.37%) and depression (56.25%). Most of the patients had one or more autonomic symptoms and sleep disturbances. Conclusion : Non-motor Symptoms were present in all patients (100%) with anxiety, memory loss, depression and constipation are being the commonest of the NMS.
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    Study of Assessment of Change in Lipid Profile Pattern in Patients on Hemodialysis
    (THE INDIAN MEDICAL ASSOCIATION, 2024-07) Deba, Zahoorunnisa; Jambale, Triveni A; Kalasker, Pavan S; Jaweed, Syed Abdul
    Background : Chronic Kidney Disease (CKD) is a debilitating condition associated with high Cardio Vascular Disease (CVD) morbidity and mortality. CVD is the leading cause of death in Hemodialysis (HD) patients accounting for almost 50% of death. One of the main risk factor for cardiovascular events is Dyslipidemia. Aims and Objectives : Aim of the study is toevaluate the pattern of development of Dyslipidemia in patients on Hemodialysis (HD). Materials and Methods : A case control study was done from April, 2022 to September, 2022. In 30 patients who were on hemodialysis and age and sex matched 30 healthy controls were included in the study. In all the subjects the serum levels of total cholesterol (CHOD-PAP), LDL cholesterol (Friedwald formula), HDL-cholesterol (CHOD-PAP) and triglycerides (GPO-PAP) were estimated. BMI was calculated in all the subjects as per WHO guidelines. Results : The study showed there is significant increase in TG and significant decrease in TC, LDL-C, HDL-C and BMI in patients on HD compared to controls. Conclusion : Patients on HD have significant decrease in TC, LDL-C, HDL-C and BMI depicting malnutrition leading to inflammation accelerated atherosclerosis process and cardiovascular complications.
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    Psychological Distress and Health-related Quality of Life in Lung Cancer Patients
    (THE INDIAN MEDICAL ASSOCIATION, 2024-07) Kumar, Arun; Verma, Ajay Kumar; Bajpai, Jyoti; Pandey, Anuj Kumar; Kant, Surya; Kar, Sujita Kumar; Verma, S K; Kushwaha, R A S; Kumar, Santosh; Garg, Rajiv; Srivastava, Anand; Bajaj, Darshan Kumar; Kumar, Ankit; Tripathi, Pranjal
    Background : The symptom burden of lung cancer is higher than that of other malignancies, but less is known about the incidence of psychological distress and how it can be connected to the physical symptom load in lung cancer patients. We evaluated the impact of physical illness on psychological distress among stable patients with lung cancer. Materials and Methods : The respiratory medicine department of a tertiary health care centre recruited 90 patients with stages I to IV lung cancer for a study. The study used the DASS-21 scoring tool to evaluate psychological distress. Regression analyses were conducted to determine the relationship between distress and symptoms, type of cancer and Tumor, Node and Metastasis staging. Results : Out of all the patients enrolled, 26.67% had moderate depression according to the DASS-21 scale. On the Likert scale, 55.56% of participants reported moderate anxiety and 9% had clinically significant severe anxiety. Mild depression was present in 34.44% of patients and moderate depression in 26.67%. Only 12% of enrolled participants showed signs of stress. Our analysis indicated that males were more likely to report symptoms of depression, anxiety and stress. Age also affected depression, anxiety and stress noted in our study participants. In addition, smoking, cancer stage and clinical symptoms showed significant associations with all DASS-21 subscales. Conclusion : This study showed that patients with lung cancer had a high proportion of depression and anxiety. It has been suggested that the psychological well-being of lung cancer patients should be given greater consideration to improve their overall management.
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    Functional Outcome of Patients Operated by Mini Open Rotator Cuff Repair in Tertiary Care Hospital of Ahmedabad City
    (THE INDIAN MEDICAL ASSOCIATION, 2024-07) Mistry, Janak; Patel, Tejas R; Patel, Parth M
    Background : Rotator Cuff Tear is likely due to trauma and age related degeneration. The incidence of rotator cuff tears increases with age. Symptomatic large full thickness tear can be progress, so needed early intervention. In management of rotator cuff pros and cons of operative and non-operative treatment should be consider along with patient age and occupation of patient. Aims and Objectives : (1) To evaluate the outcome of rotator cuff repair by mini open technique. (2) To assess post operative pain in rotator cuff repair patients. Materials and Methods : In this prospective study, 30 patient treated with mini open rotator cuff repair between March, 2021 to March, 2023 are considered. Outcome of this patient was evaluated with oxford shoulder score. Results : 30 patient with operated for rotator cuff tear with mini open rotator cuff repair between age 18 to 65 were studied. Most common cause was degenerative (43.4%), by chronic impingement (33.3%) and by Traumatic (23.3%). Optimum range of movement was achieved in these patient in mean time to 1.5 months with minimal residual pain or discomfort. 86.7% patients had 40-48 Oxford shoulder score. 56.7% patients had no difficulties postoperatively in follow-up. Conclusion : Result of this study indicate that rotator cuff tear repair with mini open technique shows good outcome in term of range of movement at shoulder joint and minimal or no postoperative pain with minimal postoperative complication.