Journal of Evolution of Medical and Dental Sciences

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https://imsear.searo.who.int/handle/123456789/163767

Executive Editor: Dr. Sridhar.A.
ISSN: 2278-4802 (Print); 2278-4748 (Online)

Frequency: Biweekly

Language: English

Open Access Peer-reviewed journal

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Prognostication in Traumatic Brain Injury- A Prospective Study of 100 Patients in Tertiary Care Hospital in Rural Area.
(Akshantala Enterprises Private Limited, 2020-02) Rohilla, Devanshu; Tyagi, Sandeep; Singh, Sohan; Narula, Harneet; Bansal, Tanu; Yadav, Narender; Garg, Shankey; Jain, Amit
Traumatic brain injury is a major health issue responsible for considerable mortality and morbidity worldwide especially in subjects under the age of 40 yrs. It is important to assess and grade the TBI as soon as possible to guide management and decrease the comorbidities. Various guidelines have been issued by the neurosurgical societies to immediately assess and intervene when ever required. In this study, we have tried to assess the role of basal cisternal effacement in the management and prognosis of RTA patients, and hence tried to simplify the prognostication process and improve the patient management.METHODS100 subjects were studied who were having history of traumatic head injury. NCCT was done for all the patients using 128 slice Multidetector CT- Ingenuity (Philips Medical Systems, USA). Other parameters like pupillary reaction, GCS at the time of presentation, midline shift and associated fractures and bleed were assessed. All the patients were followed up till the time of discharge. The data so obtained was analysed.RESULTSParameters like age, pupillary reflex, GCS at presentation, associated intracranial bleed, associated cranial vault fractures and presence or absence of midline shift correlated well with the final outcome with p value consistently <0.05. We analysed that the degree of obliteration of perimesencephalic cistern was a good prognostic marker in traumatic head injury patients. 36% of patients had favourable outcome out of which none of the patients had obliterated perimesencephalic cistern or interpeduncular cisterns. 64% patients had unfavourable outcome out of which 60% and 48% had obliterated or partially obliterated perimesencephalic cisterns and interpeduncular cisterns respectively, and only 4% and 16% had normal perimesencephalic cisterns and interpeduncular cisterns respectively.CONCLUSIONSIt is important to investigate, grade and prognosticate traumatic head injury patients at the earliest. Our study and various other studies prove that various clinical predictors including age, Glasgow coma scale, and pupil reactivity correlate with outcome of patient. Presence of midline shift, intraventricular haemorrhage, and obliteration of cisterns in patients of traumatic brain injury also correlate with the outcome and can be used; thus, making the prognostication process much easier. These findings can be used on the first day of admission itself.
High-Sensitivity C-Reactive Protein in Metabolic Healthy Obesity (MHO)..
(Akshantala Enterprises Private Limited, 2020-02) Rasheed, Aamil; Acharya, Sourya; Shukla, Samarth; Kumar, Sunil; Yarappa, Roopesh; Gupte, Yash; Hulkoti, Vidyashree
Metabolically Healthy Obesity/Metabolic Healthy Obesity (MHO) is a paradox in scientific medical literature and discussion is still on regarding the safety status of MHO phenotype. It is an obesity phenotype where the subjects have BMI more than or equal to 30 Kg/m2 but are devoid of conventional metabolic complications such deranged lipid profile, altered glucose tolerance, or metabolic syndrome as they have less adverse inflammatory profile, low visceral fat, less disturbed insulin signalling, and lipid metabolism. But recently studies are coming up with robust evidence that MHO is not a benign condition. It may lead to metabolic syndrome in future and it is also associated with cardiometabolic risks.METHODSThis cross-sectional study was done in a tertiary care hospital conducted for a period of two years from October 2017 to October 2019. After obtaining institutional ethical clearance, this cross-sectional study was conducted on 120 MHO subjects, 120 metabolic syndrome (MS) and 120 Metabolic Healthy Non-Obese (MHNO) subjects. Anthropometric data was obtained, and hs-CRP was estimated and compared with MS and MHNO group. The data was analysed using appropriate statistical significance tests.RESULTSIn one-way Analysis of Variance (ANOVA), anthropometric determinants and metabolic variables differed significantly across the groups (p<0.0001). The mean hs-CRP in MHO was; 4.45 ± 1.46 and in the control group it was 1.84 ± 0.77 (p<0.0001). Using Pearson’s correlation coefficient, significant positive correlation was found between hs-CRP with other anthropometric and metabolic parameters. In multiple regression analysis, Body Mass Index (BMI), Waist Circumference (WC), were significantly associated with elevated hs-CRP. Adjusted odd’s (AOR) of abnormal hs-CRP in MHO was 1.9 times that of MHNO subjects.CONCLUSIONSMHO phenotype is associated with increased hs-CRP levels as compared to MHNO phenotype suggesting that obesity even if associated with a healthy metabolic profile, still harbour subclinical inflammation. So, subjects with MHO should be targeted for appropriate preventive strategies in the form of health education, lifestyle alterations to avoid future cardiovascular morbidities. MHO phenotype with evidence of subclinical vascular inflammation should not be considered a benign condition.
A Short-Term Prospective Study of Retroperitoneal Tumours in a Tertiary Hospital in Eastern India.
(Akshantala Enterprises Private Limited, 2020-02) Das, Saurabh; Das, Arindam; Mandal, Priya Ranjan
Retroperitoneal tumours are rare but diverse group of neoplasms that arise from the retroperitoneum, and account for 10% of all soft tissue tumours. Managing retroperitoneal tumours is challenging because they typically present at a relatively late stage, and are anatomically proximate to major vessels and vital organs. This study was carried out to find out different clinicopathological profiles of patients who presented with retroperitoneal tumours in our hospital during the tenure of this study.METHODSThis is an observational study. 25 patients with retroperitoneal tumours were studied. For statistical analysis, data was entered into a Microsoft Excel spreadsheet and then analysed with SPSS Version 25.0.RESULTSIn our study, we studied 25 patients with retroperitoneal tumours. Most of the patients were in the age group of 40-60 years (48.00%) with a mean age of 42 years and standard deviation of 15.0416. The most common presenting complaint (s) in the patient population attending our institution was abdominal lump and pain (40.00%) followed by pain (32%). Amongst the signs, 96% of the patients had an abdominal lump and 92% had tenderness. Transabdominal ultrasonography revealed 16 homogeneous and 9 heterogeneous masses for which computed tomography (CT Scan W/A) was done for all 25 patients studied which depicted 19 homogeneous (solid or cystic) and 6 mixed primary retroperitoneal tumours. All patients underwent open surgery at our institute, but complete resection was possible in only 18 (72.00%) patients whereas 4 (16.00%) underwent a partial resection and 3 patients were inoperable. 17 cases are reported to be malignant (68.00%) with complete curative resection with margins free of tumour in 52.94% of them and 8 cases were benign (32.00%) and all of them were found to have clear margins. Among the malignant tumours, liposarcomas were the most common while neural tissue tumours were the most common benign type.CONCLUSIONSThe incidence of retroperitoneal tumours is maximum in the 5th decade of life, though it can occur in any age group. Symptoms of pain abdomen, abdominal lump should be properly evaluated to diagnose retroperitoneal tumours
Megalencephalic Leukoencephalopathy with Subcortical Cysts.
(Akshantala Enterprises Private Limited, 2020-02) Gupta, Ranjana; Kumar, Akshay; Yadav, Narender; Singh, Simar Abheet; Mittal, Puneet
Megalencephalic Leukoencephalopathy is a rare entity which was first described by Van Der Knaap et al in 1995.[1] It is a progressive neurodegenerative disorder characterized by slow progression of mental deterioration. Megalencephaly sets in early in the disease usually in first year and can be more than 4 standard deviation above the mean. Seizures are present in almost all the patients. [2] We present typical MRI findings in a case of megalencephalic leukodystrophy with sub-cortical cysts.Megalencephalic leukoencephalopathy with sub-cortical cysts is a rare entity that presents with macrocephaly and seizures. Mental deterioration is often mild with slow progression. Macrocephaly may be present at birth or develops in first year. Typical magnetic resonance imaging (MRI) findings help to clinch the diagnosis.
Vitamin B12 Deficiency Presenting as Acute Psychosis.
(Akshantala Enterprises Private Limited, 2020-02) Sahoo, Manoj Kumar; Sahu, Anupama; Biswas, Harshita; Agarwal, Sanjay Kumar
Psychiatric symptoms attributable to vitamin B12 deficiency have been described for decades. Vitamin B12 deficiency is common in developing countries and its prevalence ranges up to 67% among Indian population.1 The earlier reports are for the most part in accordance with more recent ones, despite being diagnostically less specific in psychiatric and haematological terms. These symptoms seem to fall into several clinically separate categories like slow cerebration, confusion, memory changes, delirium, with or without hallucinations and/or delusions, depression, acute psychotic states, and (more rarely) reversible manic and schizophreniform states.2 Apart from these conditions, some cases of dementia, violent behaviour and fatigue have also been documented to be caused by vitamin B12 deficiency.3 Reports of patients initially presenting to psychiatric facilities without associated haematological manifestations are rare. There are a few case reports of acute psychosis attributed to vitamin B12 deficiency, but more evidence is required to substantiate and establish this association.4 We describe three patients who developed acute psychosis accompanied by features suggestive of organic aetiology. They were found to have cobalamin deficiency in the absence of typical neurological or haematological abnormalities.
MDCT Findings in Focal Fat Infarction of Appendage of Falciform Ligament- An Unusual Cause of Epigastric Pain.
(Akshantala Enterprises Private Limited, 2020-02) Gupta, Ranjana; Yadav, Rishabh; Singh, Simar Abheet; Mittal, Puneet; Yadav, Narender
The pathophysiology and clinical course of focal fat infarction of appendage of falciform ligament is similar to other acute fat infarction abdominal conditions like omental infarction and epiploic appendagitis in that it presents with acute abdominal pain and responds well to conservative treatment. Importance of radiological diagnosis is to avoid unnecessary surgery.[1] Torsion and focal fat infarction of appendage of falciform ligament is an extremely rare condition which presents with acute abdomen. It can mimic other serious abdominal conditions which require urgent surgical intervention. It is important to be aware of its computed tomography (CT) findings so as to avoid unnecessary surgical intervention. We present CT findings in case of focal fat infarction of appendage of falciform ligament in a young male who presented with acute epigastric pain.
A Rare Case of Urethral Fibroid.
(Akshantala Enterprises Private Limited, 2020-02) Jayalakshmi, Medikonda; Rotte Subbarao; Poornima, Penmetsa; Srujana, Palavalasa; Manasa, Nakkina; Himabindu, Gali
Leiomyomas are benign mesenchymal tumours that arise from the smooth muscle, mostly located in genital tract. M/C site of leiomyoma is uterus. (1) Leiomyoma arising from urethra are rare. Leiomyomas are most commonly seen in uterus. (2) Extra uterine leiomyomas are usually seen arising from vulva, ovaries, urethra, urinary bladder, GIT, and Vagina. (3) Leiomyoma of urethra is a rare benign mesenchymal tumor that affects women more often than men. Usually located in proximal urethra, seen in reproductive age group (mean age 41 yrs.) with possible hormone dependence. Presents with a variety of symptoms include – UTI, urinary retention, mass per urethra, dysuria. Diagnosis is by USG, MRI (4) confirmed by HPE. Complete surgical excision is the treatment of choice, recurrence is rare.
Molecular Speciation and Antifungal Susceptibility Profile of Candida Species in a Tertiary Care Centre in Central Kerala.
(Akshantala Enterprises Private Limited, 2020-02) Bhaskaran, Reshma; Valsan, Chithra; K. A., Sathiavathy
Candidiasis is a common life-threatening condition with various clinical manifestations. It can cause significant morbidity and mortality, especially in critically ill patients. Though mainly caused by C. albicans, it has shown a change in the epidemiological pattern with an increase in the prevalence of non albicans Candida (NAC) in the recent years. This change has also reflected in the profile of antifungal susceptibility since many of these species show high level of antifungal resistance associated with treatment failures. Thus, it is important to know the regional distribution of Candida species and also find their antifungal susceptibility profile to the commonly used antifungal agents.METHODSThis is a descriptive study conducted for a period of two years on the clinical isolates of Candida species which satisfied the inclusion and exclusion criteria. Speciation was done by phenotypic methods which include germ tube test, chromogenic medium, corn meal agar and VITEK-2 system and by molecular methods using multiplex PCR. Antifungal susceptibility testing was done using automated method by VITEK-2 compact system.RESULTSAmong the 80 isolates studied, on speciation C .albicans 25(31.25%) was the most common, followed by C. tropicalis 23 (28.75%), C. parapsilosis 13 (16.25%), C. krusei 12 (15%), C. pelliculosa 4 (5%), C. auris 2 (2.5%) and C. glabrata 1 (1.25%). Most isolates were susceptible to almost all the antifungal agents tested, but C. krusei showed high level of resistance.CONCLUSIONSC. albicans was the commonest individual species, but there was an overall predominance of non-albicans Candida (NAC). Speciation of Candida isolates is important as there is wide variation in their antifungal resistance pattern. Knowledge about the prevalent species and their antifungal susceptibility will help in early initiation of appropriate treatment, thus reducing the morbidity and mortality associated with Candida infections.
Computed Tomography Thorax- Role in the Diagnosis of Pulmonary Tuberculosis.
(Akshantala Enterprises Private Limited, 2020-02) Devi, RK. Jayshree; Singh, Kh. Mani
Tuberculosis is one of the leading causes of mortality in a developing country like India among the infectious diseases. Early diagnosis of tuberculosis is by chest X-Ray, sputum examination, culture and nucleic acid amplification. Chest X-Ray findings are not very specific, sputum examination and culture take many days thus delaying the diagnosis. CT scan is very fast, non-invasive and accurate. It can diagnose the cause of unexplained cough, chest pain, fever and other chest symptoms. Because of accuracy, high speed and better resolution, CT scan is the modality of choice for early detection of pulmonary TB. The aim of the study is to evaluate the role of CT and HRCT in pulmonary TB.METHODSIt is a cross sectional study conducted at Jawaharlal Nehru Institute of Medical Sciences from January 2016 to June 2016 in a series of cases sent for CT or HRCT using AQUILION, Toshiba 64 slice multi detector CT. All the data were entered in excel sheet and transferred to SPSS Version 2 and then analysed by using descriptive statistics like mean, standard deviation and percentage. Chi square test was used. p Value of <0.05 was taken as statistically significant.RESULTSAmong 358 cases, 49.7% (178 cases) were diagnosed as pulmonary tuberculosis. In cases diagnosed as pulmonary TB, 104 (58.4%) were male and 74 (41.7%) were female. Over 60 yrs. of age, 56.1% of the cases had TB with cavitary and parenchymal lesion, followed by TB with lung destruction & cicatrisation in 17.3% of the cases. In younger age group, 20 years and below, had TB with cavitary & parenchymal lesions in 75% of cases and TB with chronic empyema & fibrothorax in 25% cases. Incidence of TB in higher age groups was statistically significant (p<0.05).CONCLUSIONSCT and HRCT can diagnose different stages of pulmonary TB and any associated diseases. It helps in taking treatment decisions and preventing disease spread which is an important health issue. For early detection of pulmonary TB, CT and HRCT is a must for diagnosis.
A Prospective Study to Determine Clinico-Etiological Factors in Hoarseness of Voice.
(Akshantala Enterprises Private Limited, 2020-02) K., Srirangaprasad; Mahajan, Ritesh; K., Kanithavalli; P., Deepa
Hoarseness of voice is a very common symptom and needs thorough clinical examination and investigation to determine the underlying cause in every patient. The spectrum of the symptom ranges from minor infections to life threating malignancies. Acute onset causes may be due to secondary viral infections, voice abuse, smoking, trauma to the larynx during thyroid surgeries. Chronic onset may be due to vocal polyp, vocal cord nodules, laryngeal papillomatosis, laryngeal neoplasms, tumours of the vocal cord, functional dysphonia, smoking, gastro-oesophageal reflux, malignancy of thyroid, oesophagus, lungs and neurological involvement by systemic disease like diabetes and TB. We wanted to evaluate the common causes of hoarseness of voice.METHODSThis was a longitudinal study conducted among 100 patients with benign laryngeal lesions attending the Department of ENT-HNS of Rajarajeswari Medical College and Hospital, from 1st December 2015 to 31st November 2016. A detailed history including information on patient’s demographics, clinical presentation, history of trauma, along with history of associated medical and surgical condition was obtained. A thorough systemic examination and laryngeal examination was done.RESULTSMale:Female ratio was noted to be 1.7:1. Labourers constituted the single largest group of patients comprising of about 36% of cases. Three fourth of patients were from the rural area. Duration of hoarseness ranged from 1 day (acute onset) to 5 yrs. (mean - 3 months). Septic foci in oral cavity and oropharynx were noted in 42% cases. Apart from change in voice other common symptoms were cough, fever and vocal fatigue. Signs of chronic laryngitis were noted in majority of the cases (22%).CONCLUSIONSThe spectrum of etiological factors for hoarseness varies from minor functional voice disorders to major pathological conditions such as malignancy. Septic foci are important predisposing factor for chronic laryngitis.
Study of Serum Uric Acid Level in Patients with Systemic-Essential Hypertension in the Context of New 2017 ACC/AHA High Blood Pressure Clinical Practice Guideline.
(Akshantala Enterprises Private Limited, 2020-02) Ghosh Atanu; Pal, Debasish; Debbarma, Sagar Samrat; Chakraborty, Pranabesh
Hypertension poses a challenge to public health as well as to the medical science. Final metabolite of purine in humans is uric acid, increased serum level of which is associated with cardio-renal risk, although serum uric acid (SUA) level appears to have different effects on blood pressure (BP), depending on level and how long subjects were exposed. We wanted to study the association between hyperuricemia and hypertension, in various aspects, in the context of new 2017 ACC/ AHA High Blood Pressure Clinical Practice Guidelines.METHODSThe study was conducted in a tertiary care hospital, Agartala, Tripura. It is a case control study. SUA estimation was in 160 hypertensive patients and 160 normotensive controls, by using uricase method. SPSS version 24 was used for data entry and analysis. Chi square test and unpaired t test were used, wherever applicable.RESULTSOut of 320 subjects, who were included in the study, 160 subjects were hypertensive and 160 subjects were normotensive. There was strong association between hypertension and hyperuricemia. Hyperuricemia is more common in males and in patients with stage II hypertension.CONCLUSIONSThe association between hyperuricemia and hypertension, has long been recognized. It remains unresolved whether the association of high uric acid level with high blood pressure is solely because of the underlying renal and metabolic abnormalities. Association of hyperuricemia and hypertension indicated that, hyperuricemia might be a target for the proposed therapeutic evaluation for the prevention of hypertension and provided impetus for the future design research work including interventional studies.
Acute Physiology and Chronic Health Evaluation Apache II - An ICU Scoring Tool to Assess Critically Ill.
(Akshantala Enterprises Private Limited, 2020-02) Arshad, Abdul Majeed; Ramachandran, Deepika; Hariharan; Surya; Koganti, Sindhura; Thangasamy, Dhanasekar; Rajagopalan, B.
The Acute Physiology and Chronic Health Evaluation (APACHE II) is the severity score and mortality estimation tool developed for use in ICU’s around the world. It is calculated during the first twenty four hours of admission of the patient to an ICU. An integer score ranges from values 0 to 71. During the stay, the score is not recalculated; and by definition, is an admission score.METHODSThis is a cross sectional study done on 100 patients admitted in the medical ICU in Sri Ramachandra Institute of Higher Education and Research.RESULTSOur results showed an APACHE II score of 16.5 which was significant and values equal to and higher than that correlated with the severity of illness.CONCLUSIONSAPACHE II score is a good predictor of mortality in acute respiratory failure patients. It is a useful audit tool which helps the healthcare professionals to interpret and compare their care performance over time.
Outcome of Surgically Managed Diaphyseal Fractures in Children- A Prospective Study.
(Akshantala Enterprises Private Limited, 2020-02) Reddy, Sridhar Maryada; Dhaniwala, Nareshkumar Satyanarayan
Childhood injuries have become a global public health concern. It is estimated that 10-25 % of paediatric injuries are fractures. The definitive treatment of paediatric diaphyseal fractures has always remained controversial and determined by surgical experience and local trends of practice. The aim of this study was to study the outcome of surgically managed diaphyseal fractures in children.METHODSA prospective interventional study was done comprising of 42 fractures in 28 children having displaced diaphyseal fractures of major long bones. Flynn’s scoring criteria was used to study the outcome.RESULTSThe observations of this study are based on 42 surgically managed diaphyseal fractures in long bones in 28 children. The mean age of patients was 10.85 years. The commonest mode of injury was fall while playing (from level ground) (18 cases, 4.29%). The commonest bones to get fractured were both radius and ulna together (50%), followed by femur (25%), tibia (21.43%) and ulna singly (3.57%). The commonest location of fracture was middle third shaft (25 fractures, 59.52%). Transverse fractures accounted for major proportion of this series. Among the 42 fractures, 39 fractures were treated with titanium elastic nailing and 2 compound fractures were treated with debridement and external fixator application. One 15 year old girl was treated by femur interlock nailing. Among the 25 children who could be followed up, the average follow up period was 22.08 weeks. The mean period of union was 10.69 weeks. Majority of the fractures had excellent outcome (30 fractures, 76.92%), 7 fractures (17.95%) had satisfactory outcome while only 2 fractures (5.13%) had poor outcome.CONCLUSIONSTitanium elastic nailing (TENS) is found to be an effective method of treating closed displaced diaphyseal fractures in children. It is better than plaster cast immobilization due to shorter period required for union, better fracture reduction and stabilization besides prevention of stiffness of adjacent joints and fracture disease. More use of this method is recommended due to these advantages
Knowledge, Attitudes and Practices towards Oral Health among School Teachers in Chengalpattu Taluk, Kanchipuram District Tamilnadu.
(Akshantala Enterprises Private Limited, 2020-02) Venugopal, Balaji; Ranjith Kannan; Parasuraman, Buvaneshwari; Nagamani, Sivakumar
Dental professionals are often invited by different school authorities to deliver lectures on oral health and to provide preventive services. The usual target population behind most endeavors comprises the, young school children, and it is with the aim of improving their oral health knowledge, that such programmes are held. However, the fact remains that any child's knowledge and practices are by and large a reflection of what he sees or is taught in his immediate surroundings. We wanted to assess the level of knowledge, attitudes and practices towards oral health among schoolteachers in Chengalpattu taluk, Kanchipuram district.METHODSUsing simple random sampling technique, a questionnaire study was carried out among 50 government schoolteachers and 50 private schoolteachers in Chengalpattu Taluk. The questionnaire used was a closed ended, self-administered questionnaire consisting of 30 questions pertaining to Knowledge, Attitudes and Practices towards oral healthRESULTSAbout 37.9% of government teachers and 36% of private teachers had knowledge regarding dental caries, 48% of government teachers and 34.9% of private teachers had knowledge regarding gum diseases and 26% of government teachers and 22.7% of private teachers had knowledge regarding malocclusion. Moreover 41% of government teachers and 32.1% of private teachers had knowledge regarding oral cancer. 83.9% schoolteachers were getting information regarding oral health through dentists or doctors. When enquired regarding practices, 63% of schoolteachers brushed their teeth twice daily.CONCLUSIONSKnowledge was highest among the government schoolteachers compared to private schoolteachers among Chengalpattu taluk in Kanchipuram district.
Correlation between Clinical and Radiographic Findings in the Assessment of Adenoid Hypertrophy.
(Akshantala Enterprises Private Limited, 2020-02) Aljahdali, Aseel Abdu; Reda, Azza Sami; Ahmad, Rani Ghazi; Barnawi, Rashid A.; Abduljabbar, Ahmad Haitham; Wazzan, Mohammad Abdulrahim
The significance of radiological assessment in the treatment plan of patients with adenoid hypertrophy cannot be undermined. This study evaluated the correlation between clinical symptoms and radiological findings in the clinical assessment of patients with adenoid hypertrophy.METHODSA cross-sectional study was conducted by recruiting 147 individuals aged between 1 to 27 years from September 2017 to February 2018. Clinical assessment was performed through questionnaires prepared for primary caregivers. Radiographic findings were obtained through lateral nasopharyngeal radiographs. Frequencies, percentages, cross-tabulation, chi-square analysis, and Pearson correlation test were used to analyse the collected data via Statistical Package for Social Sciences (SPSS).RESULTSA positive correlation was observed between clinical presentations of snoring and adenoid thickness. No significant correlations were observed between mouth breathing, obstructive breathing during sleep, and the total clinical score obtained with the nasopharyngeal diameter. A significant correlation of nasopharyngeal diameter with mouth breathing and soft palate thickness was noted. The ratio of soft-palate tissue was also significantly correlated with nasopharyngeal diameter.CONCLUSIONSFindings revealed a significant correlation between mouth breathing with all the radiological findings at 5% level of significance. It also suggests that suspected adenoid hypertrophy in children can be treated with lateral radiograph of the nasopharynx for better treatment outcomes.
Correlation of Thyroid Disorders with Abnormal Uterine Bleeding (AUB).
(Akshantala Enterprises Private Limited, 2020-02) Kolli, Sri Nayana; Agrawal, Manjusha; Khithani, Yogesh; Kotdawala, Kanan
AUB is a common and complicated clinical entity. Thyroid disorders are the most common endocrine disorders in India with a prevalence of 26% in women and its incidence increases with age.Menstrual disturbances may accompany or may even precede thyroid disorders. We wanted to study the correlation between thyroid disorders and abnormal uterine bleeding in women of reproductive age group.METHODSThis is cross-sectional study conducted on 165 subjects who fulfilled the eligibility criteria in the Department of OBGY, AVBRH, Sawangi for a period of 2 years. Thorough clinical examination, ultrasonography and thyroid function tests of the patients was done. RESULTSIn this study, maximum number of patients were in the age group of 21-30 years. Regarding bleeding patterns, maximum patients had complaints of menorrhagia (46.06%). 77.58% of patients were euthyroid, 12.12% were subclinical hypothyroid, 17.88% were overt hypothyroid and 2.42% patients were hyperthyroid. Among both subclinical and overt hypothyroid patients, the most common menstrual irregularity was menorrhagia in 55% followed by polymenorrhagia, acyclical bleeding, polymenorrhoea, oligomenorrhoea and metrorrhagia. Among hyperthyroidism, the most common menstrual irregularity was oligomenorrhoea in 75% followed by hypomenorrhoea in 25%.CONCLUSIONSOur study concludes that the work up of any patient with AUB should essentially consist of T3 and T4 levels along with TSH levels as a mandatory part otherwise cases of subclinical hypothyroidism may be missed if only TSH levels are measured
A Clinical Study on Epidemiology and Management of Incisional Hernia.
(Akshantala Enterprises Private Limited, 2020-02) Kunche, Sanjeeva Raju; A., Chetan Kumar
Incisional hernia is one of the common complications encountered following abdominal surgery and is an important cause of morbidity. It can be repaired by following anatomical, mesh or laparoscopic methods. The incidence of these hernias is high even with recent advances in surgery, anaesthesiology, antibiotics, and suture materials used. We wanted to study the epidemiology, aetiology, mode of presentations, modalities of treatment and its outcome, of incisional hernia.METHODSThis study was done from July 2017 and June 2019, 50 patients with incisional hernia who got admitted in the Department of Surgery at Sri Venkateshwaraa Medical College and Research Center, Ariyur were subjected to anatomical or mesh repair depending on the surgeon’s choice and size of defect. A total of 50 cases were studied and followed for a period of 6- to 18-months. Patients of age 12 years and above of both sexes who presented with incisional hernia post abdominal surgery were included in this study. Age below 12 years and those presented with other hernias like inguinal/ventral hernias were excluded. Data was collected and analysed by various statistical methods. RESULTSIncisional hernia was found to be the second most common type of hernia. The incidence was more common in females, who underwent gynaecological procedures by lower midline incisions. It was found to be more common in the age group 30-60 years. Predominant risk factors being wound infection and obesity. Infraumbilical midline incision (50%) was found to be more common compared to other incisions. Majority of patients who underwent emergency surgery developed incisional hernia. Postoperative complications noted were mainly due to wound infections and seroma.CONCLUSIONSMesh repair results in less recurrence than anatomical repair for incisional hernia. The incidence of incisional hernia is more common in women than men due to abdominal wall weakness secondary to multiple pregnancies, increased number of caesarean sections and gynaecological surgeries. Sterile aseptic technique and appropriate use of pre-operative antibiotics is necessary to reduce the occurrence of incisional hernia.
Candida Species Causing Neonatal Septicaemia - Experience in a Tertiary Care Centre.
(Akshantala Enterprises Private Limited, 2020-01) Lakra, Supriya Sneha; Baradkar, Vasant P.; De, Jayanthi S. Shastri Anuradha
BACKGROUND Candida species is one of the most common causes of bloodstream infections among neonates and accounts for 9-13% of such infections. Non-albicans Candida have emerged as important opportunistic pathogens, notably C. tropicalis, C. glabrata, C. parapsilosis and C. krusei. With the introduction of antifungal agents, the causes of Candida infections shifted from an almost complete dominance of Candida albicans to the common involvement of Candida glabrata and other non-albicans Candida species.METHODSThis prospective, microbiological observational study was conducted in a tertiary care hospital for one and a half years from July 2016 to December 2017. Blood samples of neonates collected into Bactec Peds Plus/F Culture vials of an automated blood culture system (Bactec 9120, Becton Dikinson, USA) from clinically suspected cases of neonatal septicaemia were subjected to culture. Detailed clinical history such as presence of respiratory distress, abdominal distension, lethargy, feed intolerance, failure to thrive, poor perfusion, history of convulsions, duration of NICU stay and antibiotic use was taken from the medical records. The Candida species isolated were identified using standard mycological techniques. RESULTSOut of the total 250 clinically suspected cases of neonatal septicaemia, fungal growth was positive in 30 (12%) cases. Candida albicans accounted for 10% and non albicans Candida accounted for 90% of the fungal isolates. Candida glabrata (73.33%) was the commonest species followed by Candida tropicalis (16.67%) and Candida albicans (10%). Failure to thrive (60%), lethargy (50%) and respiratory distress (30%) were the most common clinical presentations seen, followed by feed intolerance (26.67%), abdominal distension (13.33%) and fever (10%). Among the risk factors observed for neonatal candidemia, low birth weight (76.67%) and prematurity (73.33%) were commonest followed by broad spectrum antibiotic use (66.67%), total parenteral nutrition (53.3%), ventilator support (36.67%) and indwelling catheters (26.67%).CONCLUSIONSNon-albicans Candida has emerged as an important pathogen causing neonatal septicaemia. Fungal sepsis is more common among preterm, low birth weight infants, those with prolonged antibiotic use and those on total parenteral nutrition. Candida glabrata caused the highest number of cases of fungal septicaemia
Morphometric Assessment of Human Corpus Callosum on Cadaveric Brain Specimens.
(Akshantala Enterprises Private Limited, 2020-02) Choudhury, Pradipta Ray; Choudhury, Purujit; Baruah, Prabahita
Corpus callosum is the main commissural tract between the two halves of the brain and assumes an essential job in transferring sensory, motor, and cognitive data from identical regions in the two brain hemispheres. Literature on the issue of the human corpus callosum sexual dimorphism is not universal. Similarly, age related change in corpus callosum measurements is also not consistent.METHODSDifferent diameters of brain and corpus callosum like longitudinal and vertical diameters of brain and length, height, widths of corpus callosum etc. were measured with digital vernier caliper.RESULTS37 brains were collected, out of which 24 were male & 13 were female brains of various ages between 20 years and 70 years of age. Average longitudinal & vertical diameters of brain specimens under study were 158.29 mm and 102.41 mm respectively and average length of corpus callosum was 72.19 mm. Change in length of corpus callosum in relation to gender is not significant with p value >0.05. There is decrease in length of corpus callosum after 65 years of age.CONCLUSIONSPositive linear correlation was observed between length of corpus callosum and the length & vertical diameters of brain. The study has failed to establish statistically significant gender differentiation in the diameters of corpus callosum. Also, there was decrease in the length of corpus callosum (EZ) in 65 years and above age group with decrease in height and width of body as well as splenium of corpus callosum between 50 - 60 years age group.
Study of Organisms Causing Osteomyelitis in a Tertiary Care Hospital.
(Akshantala Enterprises Private Limited, 2020-01) Meshram, Rupali Bhaurao; Gajbhiye, Sunita Raj; Raut, Sharmila Sanjay
BACKGROUND The term osteomyelitis (OSM) was first used by the French surgeon Edouard Chassaignac in 1852, who defined the disease as an inflammatory process accompanied by bone destruction caused by an infecting microorganism.The clinical manifestation and the natural history of OSM depend on several factors. OSM mostly affects the growing ends of long bones.We wanted to study the organisms causing osteomyelitis and their antimicrobial susceptibility pattern.METHODSPus and bone aspirate were collected from 115 diagnosed patients of osteomyelitis and were processed for isolation of organisms by standard microbiological techniques. Isolates were identified by various biochemical reactions and were subjected to antimicrobial susceptibility test as per CLSI guidelinesby Kirby-Bauer disk diffusion technique on Mueller Hinton agar (MHA). Data collected in the questionnaire was entered and analysed in Epi Info software version 7.2.RESULTSIn 101 samples, 116 organisms were isolated. In 14 samples no organism was isolated, which can be attributed to the viral aetiology, parasites and anaerobes. Acute Osteomyelitis (AOSM) was found to be more common in the age group of 1-10 years, whereas chronic osteomyelitis (COSM) was found more commonly in 21-30 and 31-40 years age group. Male to Female ratio was 2.2:1. Bones involved in AOSM and COSM were mostly femur followed by tibia and humerus. S. aureus was the most predominant isolate. All the isolates of S. aureus showed 100% sensitivity to Vancomycin, Amikacin, Netilmicin, Chloramphenicol. Out of 48 isolates of S. aureus, 37.50% were MRSA, 6.25% were ICR, 14.58% were MRSA+ICR found.CONCLUSIONSOsteomyelitis is found to be highest in third decade, with the males being predominantly affected. Acute osteomyelitis is predominantly seen in children, whereas chronic osteomyelitis in adults. Even though Staphylococcus aureus has always remained the most common etiological agent of osteomyelitis, increasing infections due to Gram negative bacilli and even poly-microbial infections are gaining importance. MRSA infection is known to increase post-operative complications. Introduction of MBL or carbapenemase production in Gram negative bacilli is a matter of great concern. Timely knowledge of aetiology and antimicrobial resistance pattern of osteomyelitis isolates can help in rational use of antibiotics and control of drug resistance.

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