Journal of the Indian Medical Association

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Effect of Papain Urea versus EUSOL in Diabetic Foot Ulcer Management
(THE INDIAN MEDICAL ASSOCIATION, 2024-10) Rajkumar, Sharath; Philip, Achu Jacob; Rajkumar, Sathish; C L, Rahul Raj; Chand, Ashwin; C S, Umaakanth Soundar
Background : Cases of Diabetes Mellitus (DM) are increasing day by day with a perpetual increase in diabetic foot ulcer among these patients. Most of the patients present with infected ulcers with slough and unhealthy tissue. Surgical debridement needed as a initial line of management and later slough removal by chemical debridement agents. In our study we compared the effectiveness of chemical wound debridement using papain urea dressing as against Edinburgh University Solution of Lime (EUSOL) in diabetic foot ulcer. Also we tried to study the associated risk factors involved in the outcome of an ulcer. Materials and Methods : Patients diagnosed with Type 2 Diabetes Mellitus with a foot ulcer classified under Wagner’s classification I and II were taken up for the study. They were randomly allocated into two groups of 51 members each. EUSOL was used in one group and Papain Urea in the other groups as dressing agent.The rate of healing and other factors related to the foot ulcer were compared between the two groups. Results : It was observed that there was significant reduction in ulcer size and slough in ulcers where Papain Urea was used as dressing agent. There was also better and faster granulation tissue formation among the group of patients using Papain Urea as dressing agent. The observation was made by measuring the surface area of slough and granulation tissue. Conclusions : In diabetic foot ulcer, Wagner’s classification I and II Papain Urea dressings showed significant reduction in the duration of healing time and faster slough removal. It also helped in forming healthy granulation tissue, without any associated complications. Hence, Papain Urea dressings can be considered as a good option for chemical debridement and wound healing for diabetic foot ulcer.
Study of Effectiveness of Self-directed Learning Compared to the Traditional Method of Learning for Undergraduate Medical Students
(THE INDIAN MEDICAL ASSOCIATION, 2024-10) Mohapatra, Dipti; Sahoo, Prakash Kumar; Meher, Arati; Behera, Manasi; Mishra, Tapaswini
Background : Competency-based Medical Education (CBME) is giving emphasis on a learner-centric approach for medical students rather than a teacher-centric approach. Self-directed Learning (SDL) is a learning process where the learner takes responsibility for their own learning process. Though it is an active learning process and encourages health professionals to be lifelong learners, very few studies have been done on SDL. Therefore, this study aimed to find out the effectiveness of implementing SDL in the undergraduate medical students curriculum. Material and Methods : The study included 200 undergraduate medical students. A questionnaire was used to obtain the perception of students on SDL. Pre-test and post-test were carried out before and after the traditional lecture and SDL and the effectiveness of SDL was found by statistically comparing the test values. Result : The students showed a positive perception toward SDL. The students scored significantly higher marks in the pre-test compared to the post-test marks. The post-test marks of the SDL session were significantly higher than the post-test marks of the lecture session. Conclusion : We concluded from our study that SDL is an effective learning method and can be adopted as a teaching-learning method along with the traditional method of learning.
Evaluating Farmers’ Knowledge, Attitude and Practice Regarding Pesticide Use and Its Impact on Human Health in Northern Karnataka — A Cross Sectional study
(THE INDIAN MEDICAL ASSOCIATION, 2024-12) Angirekula, Nagendra; Patil, Shailaja S
Background : In India, a significant agricultural workforce operates with many relying on Pesticides for Farming. However, handling pesticides during mixing and spraying poses high exposure risks. Detecting these hazards early falls under occupational hygiene. Our study aims to assess rural Farmers’ understanding, attitudes and behaviours concerning pesticide usage. This exploration is crucial for developing strategies to promote safer agricultural methods and protect Farmers’ health. Aims and Objectives : Assessing the Knowledge, Attitude and Practice of Farmers concerning pesticide usage and its harmful effects on human health. Methodology : In Vijayapura district, a cross-sectional survey of Farmers was conducted. Convenience sampling was used to select study participants. Data was gathered from June, 2023 to October, 2023 using a semi-structured, pre-tested questionnaire. The data was then imported into Excel. Data analysis was done using SPSS V.26. Results : Most of the Farmers commonly report symptoms like skin irritation, headaches and burning sensation of eyes after pesticide usage. In 51% lacked knowledge of the chemical names of pesticides and this was found to be statistically associated with their level of education. In Practice, 87.3% not using long gloves it was statistically associated with income. Over 61.8% of Farmers indicated that they would rinse their eyes with water in case of accidental pesticide spillage into their eyes. Farmers noted that Grapes, Toor dal and cotton require higher pesticide application compared to Jowar and Wheat, which requires less. While over 65% of participants do not use Personal Protective Equipment (PPE), a majority adhere to changing their clothes after Pesticide usage. Conclusion : The majority of Farmers demonstrated a positive attitude and inadequate pesticide usage procedures; they did not wear PPE when mixing or spraying. Therefore, ongoing instruction in safe mixing or spraying will broaden their understanding and aid in preventing negative health effects.
Cardiac Steatosis — An Emerging Entity
(THE INDIAN MEDICAL ASSOCIATION, 2024-12) Bagchi, Aradhya Sekhar; Bagchi, Ananda
In this era of obesity pandemic and increased global prevalence of Type 2 DM (T2DM) and Metabolic Syndrome (Met S), cardiovascular diseases are also increasing globally and is a real concern for morbidity and mortality. In modern lifestyle with sedentary habits, excessive intake of calories and with unfavorable genotypes leads to lipid overflow resulting in failure of Subcutaneous Adipose Tissue (SAT) to expand and store the excess circulating Free Fatty Acids (FFA). This excess FFA is being deposited as Visceral Adipose Tissue (VAT) in the major organs like Liver, Heart, Pancreas, Skeletal muscles causing Hepatic Steatosis, Cardiac Steatosis etc. Nowadays Cardiac steatosis is considered as an important predisposing factor for Diastolic Dysfunction, AV block and Sudden Cardiac Death.
A Comparative Study on Nebulised Levosalbutamol versus Adrenaline in Wheeze Associated Condition of Children Between 1 Month to 6 Months of Age Admitted in Paediatric Ward of a Tertiary Medical College during COVID-19 Pandemic
(THE INDIAN MEDICAL ASSOCIATION, 2024-10) Das, Subhadipa; Sardar, Subhasis; Basu, Rajarshi; Mahapatra, Tapan kumar Sinha
Background : It is seen that most wheezing episodes in infancy during the COVID-19 pandemic are of viral origin commonly diagnosed as Acute Viral Bronchiolitis, Pneumonia or Wheeze associated Respiratory Tract Infection. Previous trials have provided conflicting evidence regarding the benefit of bronchodilators like ?2 agonists, adrenaline, ipratropium bromide etc. It is proved that levosalbutamol is much safer alternative than salbutamol, but no clinical trial till date has assessed it's efficacy to nebulised adrenaline in wheezing episodes in infants. Thus this study will attempt to verify the efficacy of bronchodilators in wheeze associated respiratory conditions and assess the benefits of a ?-2 specific agonist versus combined ? and ? (non-specific) agonist among the first time wheezing infants during this COVID-19 pandemic. Materials and Methods : The study was conducted with 60 infants aged 1 month to 6 months of age attending the Paediatric Medicine Emergency Department of NRS medical college in Kolkata with first time wheeze. The study period was 1.4 years from March, 2020 to July, 2021. Of these 30 received nebulised levosalbutamol (0.1mg/kg/dose) (Group A) and remaining 30 were given adrenaline nebulisation (0.1mg/kg/dose in1:10,000 solution) (Group B) maintaining CDC COVID-19 protocol. In 3 doses of each drug were given along with O 2 at 15 mins interval. Respiratory rate, Respiratory Distress Assessment Index (RDAI) score, heart rate and pulse oximetry were recorded before intervention, just after 2nd dose, 30 mins after last dose and 1 hour after last dose. Results : Both adrenaline and levosalbutamol caused significant improvement in mean respiratory rate, RDAI score and oxygenation. However, the adrenaline group showed a significantly better improvement in study parameters than levosalbutamol group. Conclusion : The study concluded that nebulised adrenaline is signifantly superior to levosalbutamol in reliving symptoms in infants with wheeze.
Peritoneal Fluid from Pouch of Douglas is not a Suitable Specimen for Molecular Testing in the Diagnosis of Female Genital Tuberculosis in Women Presenting with Infertility
(THE INDIAN MEDICAL ASSOCIATION, 2024-10) Mishra, Debadutta; Turuk, Jyotirmayee; Palo, Seetu; Ray, Pratyush Kumar; Mishra, Bharadwaj; Pati, Sanghamitra
Background : Female genital tuberculosis is a form of Extra-pulmonary tubercular disease that primarily manifests as infertility in women. It's diagnosis is challenging because of difficulty in obtaining appropriate samples for testing. Conventional diagnostic methods, such as microscopy and culture, have limited effectiveness, leading to the use of molecular techniques for accurate diagnosis. This study was conducted to evaluate the suitability of Peritoneal Fluid in the pouch of Douglas or peritoneal washings as an alternate specimen for diagnosing female Genital Tuberculosis. Materials and Methods : A prospective cross-sectional study was conducted on 30 infertile women, clinically suspected of Genital Tuberculosis. Laproscopy was performed to ascertain the presence of morphological signs of Genital Tuberculosis and Peritoneal Fluid or washings were collected for molecular testing of tuberculosis. Results : Among the 30 infertile women (primary infertility = 20; secondary infertility = 10), 11 were aged 21-30 years, while 19 were aged 31-40 years. Pelvic ultrasonogram showed abnormalities in only a third of the cases. In laparoscopy, definite findings of Genital Tuberculosis were noted in 13 cases (43.3%). Others had probable findings of Genital Tuberculosis, comprising of, Pelvic Adhesions, Bilateral or Unilateral Tubal Block, Tubo-ovarian Mass, Fitz Hugh Curtis Syndrome and Hydrosalpinx. Laproscopically obtained Peritoneal Fluid or washings from all the 30 women were tested using cartridge-based Nucleic Acid Amplification and Polymerase Chain Reaction for Mycobacterium Tuberculosis. However, all the samples tested negative. Conclusion : The use of Peritoneal Fluid as a specimen for molecular detection of Mycobacterium Tuberculosis did not yield positive results in this study. Further research is warranted to validate the study’s result and to explore better alternative approaches for the diagnosis of Female Genital Tuberculosis.
Comparative Analysis of Sensitivity and Specificity of Creatinine Kinase MB and Cardiac Troponin I for the Diagnosis of Acute Myocardial Infarction
(THE INDIAN MEDICAL ASSOCIATION, 2024-12) Purandare, Nidhi Rohan; Goyal, Astha; Shinde, Sarita; Jain, Shilpa
Background : Early diagnosis is of crucial importance for the successful management of individuals with Acute Myocardial Infarction and is one of the leading causes of mortality and morbidity. We aimed to determine the sensitivity and specificity of two markers commonly used in our institution to diagnose patients with complaints indicative of Acute Myocardial Infarction. Material and Methods : Patients admitted to the tertiary care center with complaints of chest pain were screened. Creatine Kinase Myoglobin Binding (CKMB) and Cardiac Troponin I (cTnI) were performed by following standard protocols. Depending upon the onset of chest pain subjects were divided into two groups, Group 1 : Within 24 hours of chest pain, Group 2 : Within 24-72 hours of chest pain. They were subdivided based on a diagnosis of MI. Results were used to calculate the specificity and sensitivity of CKMB, cTnI, and CKMB and cTnI together. Results : Total of 368 patients were studied. Majority of them were >60 years of age. Of these, 133(36%) had confirmed diagnosis of MI. CKMB is more sensitive (82.19%) within 24 hours of MI but after 24 hours sensitivity decreases to (57.53%). CKMB is specific after 24 hours of MI (92.26%) compared to within 24 hours of MI (65.81%) whereas, cTnI is more specific (95.00%) after 24 hours. Conclusion : For the diagnosis of Acute Myocardial Infarction (AMI), CKMB is more sensitive and cTnI is more specific, therefore it will be better if we perform cTnI rapid card test in combination with CKMB.
Association Between T p-e / QT Ratio In 12 Lead ECG and Major Adverse Cardiac Events during Hospital Stay among Acute ST Elevation Myocardial Infarction Patients
(THE INDIAN MEDICAL ASSOCIATION, 2024-10) Patel, Ankur Sumantrai; Bavaria, Deep Rasikbhai
Background : T peak to T end interval divided by QT interval (T p-e / QT ratio) in 12 lead ECG (Electrocardiogram) is better indicator of total repolarization dispersion as compared to other ECG parameters. Elevated value of T p-e / QT ratio detected in acute ST elevation Myocardial Infarction (MI) patients on admission is associated with poor in hospital prognosis due to various Major Adverse Cardiac Events (MACE) like Tachyarrhythmia, Cardiogenic Shock, Congestive Cardiac Failure and Death. Material and Methods : This is a hospital based prospective study done in 73 patients of acute ST elevation MI admitted in our Tertiary Care Hospital. Patients having age of more than 18 years, giving informed written consent and having acute ST elevation MI were enrolled from duration of March, 2021 to October, 2022. Patients who were not willing for study as well as ECGs unsuitable for analysis, taking antiarrhythmic drugs, having electrolyte abnormalities, previous history of MI and having other Structural Heart Diseases like Valvular Heart Disease, myocarditis, pericarditis, Cardiomyopathies were excluded. On admission, T p-e / QT ratio was calculated in all enrolled patients confirmed with acute ST elevation MI. This was correlated with relevant demographic and clinical variables as well as MACE, mortality and recovery of patients during hospital stay. Results : Total 41 patients (56.16%) had normal ratio of T p-e / QT (<0.25). 24 patients (32.87%) had Mild elevation of ratio between 0.25 to 0.35. In 8 patients (10.96%) presented with very high ratio of >0.35. Association of all MACE showed positive correlation with high values of T p-e / QT ratio (> 0.25). It was very strongly associated with values >0.35 and statistically significant too. Conclusion : In acute ST elevation patients, deranged T p-e / QT ratio predicts poor in hospital prognosis even in ECG carried out on admission. This interpretation helps to explain poor prognosis, to provide close monitoring for MACE and early referral to higher center for further intervention.
Evaluation of the Impact of Reinforced Training of BLS on the Ability to Retain the Imparted Knowledge and Skill amongst OT Personnel Including Nursing Staff and Technicians : A Prospective Interventional Study
(THE INDIAN MEDICAL ASSOCIATION, 2024-10) Acharya, Geetha Rajesh; Lagoo, Jui Yeshavant; Chate, Sphurti Uday
Background : Operation Theatre being a critical area, it is vital for OT staff to have knowledge and skills of Basic Life Support (BLS). Although this training is conducted as a part of induction, retention of knowledge and skills remains questionable. This prospective interventional study included OT nurses, technicians and patient attendants. A pre-test comprising of 25 structured questions was used to assess baseline knowledge of BLS and training was conducted based on AHA guidelines, followed by assessment. Reinforced training was conducted every month, which concentrated on specific aspect of BLS. Post-test and Objective Structured Clinical Examination (OSCE) were conducted immediately, 3 months and 6 months later to assess retention of Knowledge and Skills. Results : Average scores for questionnaire were 12.54 (Pre-test), 16.61 (Post test), 18.24 (3 months) and 19.60 (6 months). OSCE scores were 13.24 immediately following training, 13.6 at 3rd months and 13.7 at 6th months. Teamwork with good team dynamics is essential for favorable outcome of cardio-pulmonary resuscitation. In Crisis situations in OT, optimum assistance must be ensured for better outcome. It has been observed that knowledge and skills were improved immediately following training, but it does not ensure retention. AHA proposes reinforced training at shorter intervals with focus on specific content, thus ensuring retention. Reinforcing BLS training of OT personnel at periodic intervals results in positive outcome especially in critical zone such as Operation Theater. BLS training should be reinforced for staffs in critical areas at regular interval
Prevalence of Depression and Anxiety among Elderly Patients Visiting Tertiary Care Hospital
(THE INDIAN MEDICAL ASSOCIATION, 2024-12) Kour, Samreen; Singh, Manmeet; Gupta, Parul; Arora, Raghav; Gupta, Urvi
Background : Among the elderly population, the most common psychiatric conditions include depression and anxiety, which often go untreated or unrecognized, owing to the lack of knowledge and misperceptions about these conditions. As the rise in ageing population is the current trend all over the World, these morbidities may result in decreased Quality of Life among elderly population if left untreated. Materials and Methods : The study was conducted at Tertiary Care Hospital ASCOMS on 90 cases above 60 years of age. Data was collected by doing face to face interviews using Geriatric Depression Scale -10 and Geriatric Anxiety Scale-10. Results : The mean age of the participants was 71.8±8.2 years. Most of the participants were Males (54.4%), 85.6% were physically independent and 81.1% had some physical problems. Regarding depression, 16.7% had mild Depression, 18.9% had moderate depression followed by 5.5% with severe Depression. Whereas, 7.8% had severe symptoms of anxiety. The anxiety and depression were significantly correlated with companion of living, education status, physical dependency and co-morbid physical problem. Conclusion : Elderly cases have symptoms of depression and anxiety. Having physical health problems, being physically dependent are likely to result in poor psychological health in elderly. There is a need to recognize the mental health problem of elderly in community settings.
Scrub Typhus with Unilateral Parotitis and Encephalopathy : A Rare Case Report and Literature Review
(THE INDIAN MEDICAL ASSOCIATION, 2024-12) Mahapatra, Umakanta; Bakshi, Soham Das; Mukhopadhyay, Soumyadip; Gayen, Biplab Kumar
Scrub Typhus is an acute febrile illness recently re-emerging. Scrub Typhus is a zoonosis caused by Orientia tsutsugamushi (formerly Rickettsia). Though in majority of the cases Scrub Typhus has self limiting course, it may involve any organ resulting in multiorgan dysfunction. Scrub Typhus has to be thought of in the differential diagnosis of febrile illness. Here, we report a case of Scrub Typhus presenting as unilateral parotitis and multiorgan dysfunction. Doxycycline administration rapidly altered the clinical course. Knowledge about the non-specific clinical presentations and complications of Scrub Typhus, will help in early recognition and treatment so that complications can be avoided.
Assessment of Perceived Stress in Healthcare Professionals Working in a COVID Hospital in West Bengal during COVID-19 Pandemic
(THE INDIAN MEDICAL ASSOCIATION, 2024-10) Halder, Shekhar; Seikh, Prabir; Sarkar, Arnab; Chatterjee, Somsubhra; Mallick, Asim Kumar
Background : Pandemic, being unprecedented that can leads to several mental health problems, especially among the front-line Healthcare Professionals (HCPs). Front-line HCPs often suffer from many psychiatric morbidities like Anxiety, Depression, Burnout, Insomnia and Stress-related disorders. Despite the huge burden of mental health problems among the front-line HCPs, their psychological health is frequently overlooked. Aims : This study is aimed to investigate the Perceived Stress in different Healthcare Professionals (HCPs) and to observe any changes occur in this COVID pandemic situation. Objective : (1) To assess the Perceived Stress in HCPs. (2) To identify the factors associate with Perceived Stress in HCPs. Materials and Methods : The present study was a Hospital based Cross-sectional observational study. This study was conducted 1.5 years at College of Medicine and Sagore Dutta Hospital, Kamarhati. In 126 HCPs (Consultants, Senior Resident, Junior Residents, Interns, Nurses, Paramedical Staffs, Non-clinical staffs) were included in this study. 10 Item Perceived Stress Sale (1) was used to assess the psychiatric morbidity. Result : In our study 65(51.6%) HCPs had low stress, 47(37.3%) HCWs had moderate stress and 14(11.1%) HCWs had High Perceived Stress. 46.15% of Consultants had low stress, 53.84 % had moderate stress but no one had severe perceived stress, in Senior residents 60% had low stress, 20% had moderate and 20% had severe stress, 52.94% Junior Residents had low stress and moderate and severe stress in Junior Resident are 29.41%,17.64% respectively. 55% Interns faced moderate stress where as low stress and severe level of stress in interns are 25% and 20% respectively. 61.11% Nurses had low level stress and 27.77% had moderate stress and only 11.11% had severe stress. Conclusion : Healthcare Professionals had to do their duty in many adverse situations in COVID pandemic. They had face tremendous mental and physical pressure, frequently they became exhausted, in spite this they did their duty properly and saved millions of lives.So, their mental health should be assessed and proper intervention should be taken.
Extent of Disability and Behavioral Disturbances of the Children with Intellectual Disability and the Coping Mechanisms of their Parents : An Observational Study from a Tertiary Care Hospital of Eastern India
(THE INDIAN MEDICAL ASSOCIATION, 2024-12) Patra, Paramita; Dan, Amitava; Sarkar, Sharmila; Mukhopadhyay, Asish; Sanyal, Debasish
Background : Parents experience great challenge in bringing up their children with Intellectual Disability (ID). The present study was undertaken to examine the level of disability, magnitude and pattern of Behavioral Disturbances of the children with ID and the coping mechanism of their parents to combat against this great challenge. Materials and Methods : The current observational study was conducted on consecutive 92 children (<18 years) with mental retardation [Intellectual Disability (ID)] as per International Classification of Mental and Behavioral Disorders, Tenth Edition, Diagnostic Criteria for Research version (ICD-10, DCR) and their parents (<65 years) who was living with their children with ID. Socio-demographic data of both children and parents, Intellectual Quotient (IQ), level of disability of the children were assessed. Behavioral Disturbance of the children was assessed by Behavioral Assessment Scale for Indian Children with Mental Retardation (BASIC-MR) and coping mechanism of the parents was assessed by Brief Cope Questionnaire (BCQ). Results : Majority of the children were male with mean age of the sample was 11.34 (SD 5.07) years with mean IQ was 79.87 (SD 11.28). Majority of the children (53%) had severe disability (> 90%). Children had high level of behavioral problems having higher scores in domain 1, 2 and 3 of BASIC-MR with mean scores were 105.79, 113.13 and 118.48 respectively. Majority of the parents were above 40 Years. A large portion of families came from upper middle class followed by lower middle-class background. Among the domains of BCQ, both parents had applied ‘acceptance’ (mean score of fathers 6.89, mothers 7.00), ‘positive refraining’ (mean score of fathers 5.93, mothers 6.00) and ‘active coping’ (mean score of fathers 6.13, mothers 6.00) mostly. Conclusion : Parents, both the fathers and the mothers were using their coping strategies well to combat against their stress, on account of care-giving their disabled children.
Atypical Presentation in a Lady with Acromegaly : A Case Report
(THE INDIAN MEDICAL ASSOCIATION, 2024-11) Purkayastha, Arnab; Bhattacharjee, Prithwiraj; Khakholary, Madhusmita
Background : The blood IGF-1 level is a suitable marker for assessing the integrated secretion of GH and is advised for acromegaly diagnosis, monitoring and screening. Systemic diseases like Catabolic Disorders, Liver or KIdney Failure, Malnutrition and Diabetes Mellitus can lower IGF-1 levels and cause acromegaly screening to give false-negative results. Case Report : A 49-year-old female presented with dysphagia, vomiting, abdominal distention with no associated pain but Grade 3 edema of both lower limbs, with frontal bossing, prominent jawline, and acral thickening. The abdomen was distended with fluid thrill otherwise unremarkable. Ascitic fluid showed predominantly mononuclear cells with an elevated protein (4.56 mg/dL) and normal ADA. Ascitic culture was negative with no evidence of malignant cells found. Lower levels of IGF-1, LH, FSH were observed with elevated TSH and Prolactin. Ultrasonography of the abdomen suggested Chronic Liver Parenchymal Disease with massive ascites. Doppler study of lower limbs showed DVT. Heel pad thickness of 30.7 mm and 26.4 mm on the left and right sides respectively. MRI of the Brain showed Pituitary Macroadrenoma (13 mm). Discussion : IGF-I concentrations correlated with heel pad thickness, fasting blood sugar concentrations and response to an OGTT in patients with acromegaly. Low IGF-1 in the context of clinical acromegaly may also indicate a later stage of a disease process that was once linked to high IGF-1 and caused the clinical signs of acromegaly but has now “burned out”. Recent research has shown that acromegaly patients may have coagulation abnormalities causing hypercoagulable states and, therefore, increasing the risk of Thrombosis. Conclusion : Renal or hepatic disease or impaired nutritional status should be viewed as confounding conditions and may cause alterations in IGF-I production and/or bioactivity, such that the IGF-I concentration may no longer accurately reflect disease activity.
Neutrophil to Lymphocyte Ratio (NLR) as an Inflammatory Marker in Predicting Severity in Acute Ischemic Stroke Patients
(THE INDIAN MEDICAL ASSOCIATION, 2024-12) Sharma, Deepti; Nagar, Gordhan Lal; Fageria, Narendra; Mangal, Anup Kumar; Kumar, Pawan
Background : Inflammation plays an important role in Acute Ischemic Stroke (AIS). Chemokines and cytokines releases from ischemic tissue and recruit peripheral circulating leukocytes mainly neutrophils into the brain which precipitate ischemic brain injury and increases stroke severity. Lymphocytes on the other hand represent the protective or regulatory component of inflammation which decreases due to increased release of cortisol in response to stress. Aims and Objectives : To find the role of Neutrophil to Lymphocyte Ratio (NLR) in predicting the severity in patients of AIS. Materials and Methods : This study included 100 patients of AIS admitted in Government Medical College and Hospitals, Kota with all relevant exclusion criteria. Peripheral blood sample was taken before initiating any treatment and CBC test was performed from which NLR was calculated. The ratio was then compared with healthy control group and also among patients of AIS . Results : Mean value of NLR in AIS patients was 3.44 which was higher than NLR of control group which was 1.89 (p=0.001). Conclusion : Thus, NLR is a cost effective, easy to calculate and newer inflammatory marker that can help in predicting severity of acute ischemic stroke score.
Microvascular Density of Invasive Breast Carcinoma as an Independent Prognostic Factor in Comparison with Already Established Ones : A Study from Northeast India
(THE INDIAN MEDICAL ASSOCIATION, 2024-12) Devi, Junu; Suhana, Asreen
Background and Objectives : Breast Carcinoma is the most common cancer in women Worldwide. This study was done to assess the tumour angiogenesis using CD34 immuno-reactivity and thereby see the relationship of the same with already established prognostic factors like age, histological type, tumour size, tumour grade (Modified Bloom Richardson Scoring System) and lymph nodal metastasis. Materials and Methods : The 19 Breast Carcinoma cases included in this study were diagnosed in the Department of Pathology, Gauhati Medical College and Hospital within 1 year and Tumour Angiogenesis was assessed using CD34 immunoreactivity. The results were then compared with the already established prognostic factors. Results : The relationship of MVD/HPF with tumour size, MBR tumour grade and lymph nodal metastases was found to be statistically significant at p-value <0.05. MVD/HPF with patient age was not statistically significant. Grade I &II IDC and medullary carcinoma had low MVD/HPF, whereas grade III IDC, metaplastic carcinoma and invasive papillary carcinoma had high MVD/HPF. Conclusion : Tumour angiogenesis assessed by MVD/HPF following CD34 immunostaining can be used as a prognostic factor in Breast Carcinoma alongwith other known factors with more studies and standardized methods to calculate the MVD/HPF and can also be a potential targeted therapy with anti-angiogenic factors.
Levels and Risk Factors of Diabetes Mellitus among Tuberculosis Patients Attending District Tuberculosis Centre, Vijayapur
(THE INDIAN MEDICAL ASSOCIATION, 2024-12) Yadavannavar, Mallikarjun C; Pattankar, Tanuja P; Kouttalmatt, Daneshwari P
Background : The co-existence of diabetes and tuberculosis is becoming a public health problem in India, as they are the cause of morbidity, mortality and pose a burden on healthcare system. Aims and Objectives : To assess the risk factors of diabetes mellitus and its status among Tuberculosis patients. To compare the response to treatment and drug resistance among diabetic and non-diabetic patients. And to study the prevalence of MDR-TB among Diabetic patients with Tuberculosis. Methodology : It was a cross sectional study done in Vijayapura district during June, 2019 to July, 2019. The patients who had attended the District Tuberculosis Centre in previous 3 months of the beginning of the study were considered and data was collected from the records maintained in the center. The sample size calculated to be 300 cases. Data was collected from them. Results : The majority of 21.7% of study participants belonged to the age group 26-35 years. The overall prevalence of diabetes was 21.6 % among TB patients. Among males the prevalence was 67.3% and among females was 32.7%. When prevalence of diabetes mellitus was compared with the age it was found that majority (30.7%) of the diabetes were in the age group of 56-65 years and it was statistically significant. Conclusion : Diabetes is a prevalent comorbidity in both drug sensitive and drug resistant tuberculosis. Age group of more than 55 years is significantly associated with diabetes mellitus and other factors like alcohol consumption is also a associated factor.
Diagnostic Yield of Bronchoscopy in Benign Lung Diseases at Tertiary Health Care Hospital in South Gujarat
(THE INDIAN MEDICAL ASSOCIATION, 2024-12) Gengadiya, Jignesh Karamshibhai; Tamakuwala, Grinish Pravinbhai; Vadgama, Parul Kishorbhai; Mangrola, Jeel Vijaybhai; Khatri, Gopika Premchandra
Methodology : Sixty patients with benign lung disorders like Suspected Sputum Negative Pulmonary Tuberculosis, Suspected Fungal Pneumonia, Suspected Bacterial Pneumonia and Suspected Interstitial Lung Disease were enrolled from April, 2020 to April, 2021 in this study. Detailed clinical history, physical examinations and necessary investigations were carried out. Eligible patients were subjected for fiberoptic video bronchoscopy. During Bronchoscopy Gross fiberoptic bronchoscopy findings noted and Bronchoalveolar lavage or tissue were sent for necessary investigations. Data entry and analysis were done using MS Excel sheet 2013. Result : Overall diagnostic yield of bronchoscopy in 60 patients was 63.3%. Out of 37 Sputum negative suspected cases of Pulmonary Tuberculosis posted for bronchoscopy, 22(59.4%) cases were confirmed to have tuberculosis, only 1(2.7%) case was having Bacterial pneumonia and 2(3.4%) cases were diagnosed with Tuberculosis had super added bacterial infection. Other 13 patients suspected of having bacterial pneumonia, 7(53.3%) patients were confirmed to have bacterial pneumonia while 2(15.3%) cases were found positive for tuberculosis. Out of 5 suspected cases of fungal pneumonia and 5 suspected cases of Interstitial Lung Disease, each 2(40%) patients had positive findings respectively. Overall complications developed in 7(11.7%) patients. Conclusion : Our study suggests, fiberoptic bronchoscopy can provide good sample material for diagnosis of suspected cases. Bronchoalveolar Lavage and Bronchial Brushing sent for AFB, CBNAAT, TB Culture, Cytology, KOH etc were cumulatively used to increase diagnostic yield of bronchoscopy.
A Research Protocol on Efficacious Evaluation of Thrombus Recanalization Techniques Employing Pigtail Catheter versus Spray Catheter for Vessel Patency in Acute Iliofemoral Deep Venous Thrombosis — A Randomized Controlled Trial
(THE INDIAN MEDICAL ASSOCIATION, 2024-11) Arora, Sakshi Pritam; Mishra, Gaurav V; Banode, Pankaj; Dass, Abhilasha; Banode, Priyanka; Naqvi, Waqar M; Rathi, Rajkiran Kanhaiya
Background : Iliofemoral Deep Vein Thrombosis involves either partial or total occlusion of iliac and/or common femoral vein led by intravascular thrombus causing obstruction of resultant lumen. Venous valvular incompetence is one of the common factors leading to Deep Venous Thrombosis making it a vicious circle. Now-a-days, the concept of pharmacomechanical catheter directed thrombolysis is being utilised to treat Deep Venous Thrombosis of the lower limbs. The present study compares two thrombus recanalization techinques in iliofemoral deep vein thrombosis with respect to vessel patency. Materials and Methods : In a randomised controlled parallel group trial, subjects (n=80) with acute iliofemoral Deep Venous Thrombosis will be enrolled into two groups A and B with 1:1 ratio of allocation. Group A will be subjected to spray catheter thrombus recanalization and group B will be subjected to pigtail catheter thrombus recanalization techniques. Follow-up will be on a periodic basis till 9 months. Primary outcome will be vascular patency representing anterograde flow across thrombosed vascular segment. Purpose of the study : The outcomes of the current study will analyse the patency percentage of thrombosed iliofemoral venous segments after spray catheter and pigtail catheter thrombus recanalization techniques with respect to anterograde vascular flow. Expected clinical implications : This study attempts to investigate the outcomes of two thrombus recanalization techniques at different points in the timeline up to 9 months with reference to vascular patency in terms of the anterograde flow across the thrombus site.
DA Study of the Clinico-demographic Profile and Clinical Outcomes of COVID-19 Patients in a Tertiary Care Hospital of India
(THE INDIAN MEDICAL ASSOCIATION, 2024-12) Nath, Rupankar; Sutradhar, Deepannita; Thakuria, Riturag
Background : The SARS-CoV-2-induced COVID-19 pandemic has presented substantial challenges to healthcare systems across the globe. This study aimed to investigate the clinico-demographic profile and clinical outcomes of COVID-19 patients in a tertiary care hospital in Barak Valley, Assam, India. Methodology : A retrospective, single-center, hospital-based cross-sectional study was conducted, focusing on patients with laboratory-confirmed COVID-19 admitted between July, 2020 and December, 2020. Results : A total of 353 patients were analyzed with 69% being male and 31% female. Patients were classified into three severity groups: mild, moderate and severe. The mean ages in the mild, moderate and severe groups were 41.58 years, 57.70 years and 59.54 years, respectively. Cachar district accounted for the majority of patients (68.83%), followed by Karimganj district (18%) and Hailakandi district (10%). The common presenting complaints included fever, cough and dyspnoea. Co-morbidities were present in 61.76% of patients, with diabetes and hypertension being the most prevalent. Pulmonary comorbidities showed a strong association with increased mortality rates. Vital signs and laboratory parameters worsened with disease severity with neutrophils increasing and lymphocytes decreasing. Ferritin and LDH levels also increased with severity, reflecting disease progression. Treatment involved remdesivir and convalescent plasma therapy, with the combination showing better outcomes compared to individual therapies. Conclusion : Overall, the study provides valuable insights into the unique challenges and characteristics of COVID- 19 patients in the low HDI region of Barak Valley, Assam. The findings can aid in targeted public health interventions, resource allocation and equitable healthcare delivery, ultimately mitigating the impact of the disease and improving patient outcomes in the region. However, the study has certain limitations and further prospective multi-center studies are needed to validate and expand upon these findings.

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