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Effect of Partial Cutting of Sternothyroid Muscle on Postoperative Vocal Outcome During Total Thyroidectomy
No full textA Prospective study of Non Operative Management Over Interval Appendicectomy After Successful Medical Management in Appendicular Mass Formation in GRH Madurai
No full textComparative Study of Stainless Steel Staples Closure of Skin Wound Versus 3-0 Ethilone Closure
No full text
A Clinical study of Role of Papaya (Carica Papaya) Dressing in the Management of Diabetic Ulcer in RGGGH
No full textINTRODUCTION:
The incidence of diabetes mellitus (DM) is assuming epidemic
proportions in the world, particularly in India. Lower extremity disease, including peripheral neuropathy, foot ulceration, peripheral arterial disease and lower extremity amputation, is twice as common in diabetic persons compared to non-diabetic persons. It affects 30 per cent of diabetic persons who are older than 40 yrs. In persons with diabetes mellitus, the annual population-based incidence of foot ulcer ranges from 1.0% to 4.1% and the prevalence ranges from 4% to 10%. This suggests that the lifetime incidence of diabetic foot ulcer may be as high as 25%. Plantar ulceration often leads to amputation. Diabetic foot ulcer precedes almost 85% of amputation.
Diabetic foot ulcer is characterised by a classical triad of
neuropathy, ischemia, and infection. Due to the metabolic mechanisms in DM, there is an increased risk of infections and poor wound healing due to a series of mechanisms which include decreased cell and growth factor response, diminished peripheral blood flow and decreased local angiogenesis. Thus the feet is predisposed to peripheral vascular disease, damage of peripheral nerves, deformities and gangrene. Loss of sensation due to peripheral neuropathy may result in painless injuries.
AIMS AND OBJECTIVES:
1. To study efficacy of papaya dressing.
2. Number of days needed for healing.
3. Rate of reduction in mean surface area.
4. To assess the effect of papaya on bacterial load by comparing culture sensitivity of wound before and after application.
MATERIAL AND METHODS:
Study Centre: Institute of General surgery, Madras Medical College, Rajiv Gandhi Government General Hospital, Chennai 600 003.
Duration of study: 6 months (July 2022 to December 2022).
Sample size: 60 patients.
Study Design: Prospective study.
Methodology: Prospective longitudinal study performed at RGGGH, where 60 patients with diabetic foot ulcer more than 2 weeks participated in the present study. The wounds covered with the raw papaya slices were applied to the wounds over sterilized gauze pieces for dressing. Patients and attendants were also educated for the dressing. Dressings were changed after every 24 hours. Patients were discharged after initial wound management, pus culture sensitivity and control of blood sugar. after 1 week the wounds were examined for healthy granulation tissue and reduction in surface area, culture reports.
Inclusion criteria:
• Patients between 12 to 75 years of age.
• Duration of the diabetic ulcer more than 2 weeks.
• Size of ulcer less than 15 x 15 cm.
• Patients giving consent for papaya dressing.
Exclusion criteria:
• Pulse less limb.
• Immunocompromised patients.
• Associated septicaemia and osteomyelitis.
• Skin malignancies.
• Diabetic Ketoacidosis.
• Exposed bones, tendon.
• Charcot joint.
CONCLUSION:
Papaya (CARICA PAPAYA) Dressing in the management of Diabetic ulcer shows cost effective, with favourable outcomes in terms of duration of healing, less surgical debridement and enzymatic sloughectom
Value of Rox Index in Predicting In-Hospital Mortality in Patients with Community Acquired Pneumonia requiring Supplemental Oxygen Therapy
No full textBACKGROUND:
ROX index is known to predict need for ventilation in patients on High flow nasal cannula (HFNC) therapy. Multiple studies have also explored the extended utility of this simple tool in predicting need for invasive ventilation and mortality in multiple groups of patients. The existing predictive tools to predict mortality in patients in community acquired pneumonia are either cumbersome or require laboratory parameters. A simple, fast, non-invasive bedside tool like ROX score may be more useful in this regard, if found effective. ROX Index is S/F ratio divided by Respiratory rate. This study aims to establish the usefulness of ROX Index to predict mortality and establish an optimal cut -off for ROX score to predict mortality. We also assess the ROX score’s early predictive ability with regard to need for NIV and invasive Ventilation.
SETTING AND DESIGN:
This observational retrospective study was performed in a large tertiary care teaching hospital.
METHODOLOGY AND MATERIALS:
ROX Index is the ratio of oxygen saturation as measured by pulse oximetry /fraction of inspired oxygen [FiO2] to respiratory rate. An electronic search of the Discharge Summaries was conducted in Electronic Medical Records (Clinical Workstation) of the Hospital using the following key works – “Pneumonia”, “Community Acquired Pneumonia”, “CAP”, Lower Respiratory Tract Infection”, “LRTI”, “Consolidation”.
Patients who classified the IDSA/ATS classification of CAP and did not have any exclusion criteria were included in analysis. Baseline parameters, ROX Index and outcomes were obtained from hospital records. The ROX Index cut off for mortality and with respect to age and associated comorbidities were established using ROC curve and AUC analysis. Secondary outcomes like predictive ability of ROX Index for the requirement of NIV and invasive ventilation were studied.
RESULTS:
95 patients with community acquired pneumonia including COVID 19 with acute hypoxemia requiring oxygen supplementation from September 2020 to August 2022 were included. Majority of patients had COVID-19 related pneumonia. ROX index was found to be independently predict mortality in the patient population. A ROX Index value < 6.23 was associated with in hospital mortality [area under the curve/AUC-0.743.95% CI-0.643-0.827, p-Value-0.0007], ROX Index value 9.42<was associated with need for non-invasive ventilation[AUC- 0.77295%CI-0.673-0.854, p-Value-0.0001] and ROX Index Value <6.23 was associated with predictive ability of the need for invasive ventilation[area under the curve, AOC-0.741, 95% CI-0.641-0.826p-Value-<0.0001].
CONCLUSIONS:
ROX Index at admission predicts mortality in patients with Community Acquired Pneumonia due to COVID 19. The simplicity of ROX Index makes it a potentially universally applicable tool for prognosticating outcomes in Community Acquired Pneumonia
A Comprehensive study on Thrombolysis Outcome Using Streptokinase between Diabetic and Non Diabetic Myocardial Infarction Patients with ECG as a Tool in Thanjavur Medical College
No full textDiabetes Mellitus, which is a major risk factor for cardiovascular disease is associated with MI and sudden cardiac death. In patients with diabetes, morbidity and morbidity are always higher following MI than non-diabetic patients. The rate of re-infarction is also very high. Diabetes has its both short term as well as long term morbidity in MI patients. Platelet activation is enhanced; Diabetes is associated with a procoagulant state. Thrombus propagation is very high hence the efficacy of thrombolytic treatment is impaired. Measures which are simple as well as inexpensive are needed to assess the thrombolytic efficacy. Several studies have shown the utility of ST segment monitoring as a simple and rapid means to assess reperfusion status in patients receiving thrombolysis treatment for acute ST elevation myocardial infarction.
It is necessary to achieve successful recanalization of the epicardial vessel but microvascular flow strongly correlates with outcome. ST-segment changes are better than coronary angiogram in assessing myocardial perfusion.
AIMS AND OBJECTIVES:
To study the thrombolytic effect of streptokinase infusion between diabetic and nondiabetic myocardial infarction patients with ECG as a tool.
MATERIALS AND METHODS:
DESIGN OF STUDY:
Prospective observational study.
PERIOD OF STUDY:
May 2021 to April 2022.
SELECTION OF STUDY POPULATION:
This study is to be conducted among patients, admitted in Thanjavur Medical College with the diagnosis of ST elevation myocardial infarction.
STUDY POPULATION:
100 patients.
STUDY PROTOCOL:
Patients who are diagnosed with ST elevation myocardial infarction are included in the study. Random blood sugar values are obtained on admission. Electrocardiogram is obtained on admission and 90 min after streptokinase infusion. Fasting and post prandial glucose values are recorded from all patients, in the morning of day following admission, or once the patients are stable. The results are then analysed.
RESULTS:
On comparing the ST segment resolution among Diabetic and non-diabetic myocardial infarction patients, by using Chi square test, it is found that successful thrombolysis (70% resolution) is more in non-diabetics than diabetics (p value is 0.0001; significant). In diabetic MI patients (n=50), the number of people with successful thrombolysis (>70% ST resolution) is 7, whereas failed thrombolysis (< 30% ST resolution) is 32. p value is <0.001, which is significant.
In non-diabetic MI patients (n=50), the number of people with successful thrombolysis (>70% ST resolution) is 27 , whereas failed thrombolysis (<30% resolution) is 8. P value is <0.0001 which is also significant.
CONCLUSION:
On comparing the thrombolytic effect of Streptokinase, it is observed that failed thrombolysis (70% ST resolution) is more in non-diabetic (27) than diabetic STEMI patients (n=7). Among patients with failed thrombolysis 80% were diabetics and 20% were non-diabetics, among patients with successful thrombolysis 20.6% were diabetics and 79.4% were non-diabetics. So, the outcome of thrombolysis of acute ST elevation myocardial infarction patients is affected by type 2 diabetes mellitus
Study of Clinical Profile in Diabetic Ketoacidosis and Its Outcome in relation to Bicarbonate Levels
No full textINTRODUCTION:
Diabetic Ketoacidosis (DKA) is a common complication of diabetes which comes to the emergency as the disease diabetes turns to be the common non communicable disease affecting the world. The understanding of the pathophysiology of the sickness, features, early diagnosis, and adequate treatment of DKA, and the triggering causes, can change how the disease affects the study population. This will help to reduce the disease's rates of morbidity and mortality.
OBJECTIVES:
1. To evaluate age, sex distribution , common presentation and precipitating factor in diabetes ketoacidosis.
2. To study the incidence of DKA in poorly controlled diabetes by HbA1c level.
3. To study the correlation between serum bicarbonate level and duration of hospital stay in DKA patients.
4. To study the outcome of DKA during treatment.
METHODOLOGY:
The study was a prospective study conducted among 46 subjects with an aim to assess the clinical profile, precipitating factors, outcome and correlation of bicarbonate level among DKA subjects. The subjects with diabetic ketoacidosis were included in the study. Patient with hyperglycaemic hyperosmolar coma, chronic renal disease, with hyperemesis gravidarum, with starvation ketosis and severe anaemia. After selecting the subjects the clinical profile including age, Sex, Total stay in Hospital, family history and treatment history was assessed. Clinical findings including level of consciousness, heart rate, respiratory rate, blood pressure, random blood sugar, renal function test, bicarbonate, plasma/urine acetone was assessed. The data was entered into Microsoft excel and analysed using SPSS 23.
RESULTS:
In the study the mean Age (years) among the subjects was 47.87 (± 17.15) years ranging from 17 to 85 years. Among the subjects, 28 (60.87%) were Males and 18 (39.13%) were Females. In our study among the subjects, 33 (71.74%) had Type 2 and 13 (28.26%) had Type 1 Diabetes. In the study the mean Serum Bicarbonate (mEq/L) among the subjects was 13.84 (± 3.53) ranging from 7 to 21 mEq/L. The mean HbA1C (%) among the subjects was 8.98 (± 1.07) ranging from 6.7 to 11.4. Among the subjects, 10 (21.74%) had Vomiting, 9 (19.57%) had Fever and 5 (10.87%) had Altered Sensorium/Fever. Among the subjects, 32 (69.57%) had due to Non-Compliance, 6 (13.04%) had due to Infection and 5 (10.87%) had due to Inadequate dose. Among the subjects, 43 (93.48%) had Recovered and 3 (6.52%) had Death. Comparing the Treatment History with Outcome distribution, OHA + Insulin had significantly higher proportion of death with 28.57% followed by Insulin with 5.88% and least in OHA with 0%. The mean Random Blood Sugar (mg/dl) among subjects with Death was significantly higher 600 (± 0) vs. 450.35 (± 68.02). The mean Serum Bicarbonate (mEq/L) among subjects with Death outcome was significantly lower than recovered outcome subjects was 7.6 (± 0.53) vs.14.28 (± 3.22) .The mean HbA1C (%) among Death was 10.5 (± 1.31) which is higher by 1.63 and statistically significant compared to 8.87 (± 0.98) in Recovered. Serum Bicarbonate (mEq/L) has a significantly negative correlation with Duration of Stay (days) with a correlation coefficient of -0.84. Duration of Stay (days) decreases by -0.65 times for each unit increase in Serum Bicarbonate (mEq/L).
CONCLUSION:
Diabetic Ketoacidosis with increased blood glucose value, decreased serum bicarbonate, and higher glycosylated haemoglobulin had death as an outcome. As the bicarbonate level decreases the duration of hospital stay increases
A Comparison study on Early Versus Interval Laparoscopic Cholecystectomy in Mild Acute Gallstone Pancreatitis
No full textA Study of Serum Lipid Profile in T2DM Patients and Its Association with Diabetic Nephropathy
No full textBACKGROUND:
Diabetes is the most prevalent endocrinopathy with life threatening macrovascular and mierovascular complications which has to be prevented. Diabetic nephropathy develops in majority of diabetes patients. Recent studies showed that alteration in lipid profile does play a significant role in pathogenesis of development of diabetic nephropathy. However the pattern of
alteration in lipid profile are different among different studies.
OBJECTIVES:
1. To study serum lipid profile in type 2 diabetes mellitus patients.
2. To estimate the association between serum lipid profile and nephropathy in type 2 diabetes mellitus patients.
METHOD:
This study was conducted as an observational cross sectional study in the department of General Medicine in Thanjavur Medical College among cases diagnosed with diabetes and diabetic nephropathy during January 2021 to January 2022.A total of hundred and two cases were included in this study. Ethical committee approval was obtained for this study from the institutional human ethics committee. For assessing, blood and urine samples analysis, fundus examination, ultrasonographic examination of abdomen was done. Data was entered in excel sheet and analysis using SPSS version 2.0.
RESULTS:
A positive correlation of LDL-cholesterol, triglycerides and total cholesterol levels with occurrence of diabetic nephropathy in diabetic patients.
VLDL levels and HDL levels doesn’t have any significant impact on occurrence of diabetic nephropathy.
CONCLUSION:
Appropriate use of antilipidemic drugs, with regular follow up of lipid profile in diabetic patients in addition to lifestyle modification, control of hypertention and blood sugar levels will make a significant impact on life of diabetic patients and prevent occurrence of diabetic nephropathy and slow down its progression to end stage renal disease