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Comparitive study on Flow-Mediated Vasodilation Versus Nitroglycerin-Induced Vasodilation in assessing the Severity of Coronary Artery Disease and Its Correlation with Angiogram
No full textCardiovascular diseases is one of the highest causes of mortality worldwide. Patients with Cardiovascular diseases such as NSTEMI, UNSTABLE ANGINA, STEMI are prone to early detection by non invasive methods. The vascular endothelium is a delicate monolayer of cells lining the blood vessels. Endothelium dysfunction leading to forming and progression of coronary plaque is one of the proposed pathogenesis behind cardiovascular diseases. Flow mediated vasodilatation is a phenomenon governed by nitric oxide where there is increased blood flow on dilatation which the self regulation owing to physical and chemical stimuli. This study aims at comparing flow-mediated dilatation and nitroglycerine induced vasodilation as markers of endothelium dependent and independent vascular dysfunction thereby making them predictors of cardiovascular events. This shall eventually make it as a prognostic tool inn near future. This study also correlates with modified GENSINI scoring and % increase in FMD for assessing the cardiovascular events. This is a retrospective Observational study conducted over a period of 6 months from March 2022 to October 2022 at Government Royapettah Hospital Chennai. A sample size of 125 patients were included in the study. The study included patients admitted with CAD which includes chronic stable angina, ST elevation MI, NSTEMI and Unstable angina within the last 3 months and those who underwent CAG. The analysis reports concluded the high prevalence of CAD and higher male dominance in those with higher FMD and NID
A Study Comparing Pre-Operative Prophylactic Intravenous Antibiotic with Combined Intravenous and Intra-Incisional Antibiotic Administration for Reducing Surgical Site Infection
No full textThe Proportion of Malignancy in Multinodular Goiter in a Tertiary Care Hospital: A Prospective Observational study
No full textComparison of Fistulectomy and Fistulotomy in the Management of Low Lying Fistula in Ano: A Prospective Randomised Trial
No full textProspective Randomized study on Effect of Steroid And Tranexemic Acid On Seroma Following Modified Radical Mastectomy For Breast Cancer
No full textStudy on Effectiveness of Lateral Anal Sphincterotomy as an out Patient Procedure using Diathermy Under Local Anaesthesia for Chronic Anal Fissure in TMCH
No full textMicroalbuminuria as a Predictor of Coronary Artery Disease in Non Diabetic Individuals
No full textINTRODUCTION:
Coronary artery disease is one of the primary causes of death and disability in both industrialised and developing countries. Among the various risk markers that have been proposed to more accurately identify people who may be at risk for CAD, urinary albumin is a strong contender. The degree of endothelial damage and the extent of atherosclerosis can therefore be predicted among previously healthy patients without renal illness based on the level of urine albumin.
OBJECTIVES:
The main objective of the study is to assess the prevalence of microalbuminuria (MAU) in non-diabetic individuals with coronary artery disease and to find out the association between Microalbuminuria and Coronary artery disease in non diabetic individuals.
METHODOLOGY:
The study was a hospital based cross sectional study among 82 subjects who are consenting adult patients presenting to Thanjavur Medical College with features suggestive of coronary artery disease in Non Diabetic individual. Patient with Diabetes, Renal failure, malignancy and with active infection along with non consenting patients were excluded from the study. Relevant history was obtained from the patient including their history and comorbidity. Initially patients were screened for the echocardiographic evidence of CAD, then spot Urine
albumin/creatinine ratio(ACR) were assessed. Data was entered into Microsoft excel and analysed using SPSS 23.
RESULTS:
In our study the mean Urine Albumin Creatinine Ratio (mg/g) among the subjects was 134.95 (± 100.61) ranging from 20 to 350 mg/g. Among the subjects in terms of urine albumin excretion, 51 (62.2%) had 30 - 300 mg/g, 16 (19.51%) had 300 mg/g. Among the subjects, 51 (62.2%) had Microalbuminuria. Comparing the Age group with Microalbuminuria distribution, 21 - 30 years had higher significantly proportion of Microalbuminuria with 82.35% followed by 41 - 50 years with 61.9% and in 51 - 60 years with 28.57%. Comparing the Smoker / Alcoholic with Microalbuminuria distribution, 77.41% of the subjects with Smoker / Alcoholic had Microalbuminuria which is significantly higher compared to those without Smoker / Alcoholic of whom 52.94% had Microalbuminuria. Comparing the Severity of CAD with Microalbuminuria distribution, subjects with Ejection fraction 46 - 60% had significantly higher proportion of Microalbuminuria with 70.21% followed by EF 31 - 45% with 58.62% and in EF < 30% with 16.66%. Urine Albumin Creatinine Ratio (mg/g) has a statistically significant negative correlation with Ejection Fraction by ECHO with a correlation coefficient of -0.35. Gender, lipid profile and HbA1c had no significant relationship with micro albuminuria.
CONCLUSION:
Among the subjects, 51 (62.2%) had Microalbuminuria. Urine Albumin Creatinine Ratio (mg/g) has a statistically significant negative correlation with Ejection Fraction by ECHO.
The study showed that higher proportion of microalbuminuria was seen in younger age group, presence of smoker/alcoholic and 46-60% ejection fraction
Knowledge of Anticoagulation, Compliance with Oral Anticoagulation and Association with Adequacy of Anticoagulation in Patients on Long Term Oral Anticoagulation Therapy with Vitamin K Antagonists coming to the General Medicine Outpatient Department of a Tertiary Care Center
No full textINTRODUCTION:
Vitamin K antagonists are a class of drugs which are very commonly used in practice for oral anti coagulation in both prophylactic and therapeutic roles in an outpatient basis for patients with both arterial and venous thromboembolism in various vascular beds or patients having risk factors for developing the same. The patients are then monitored using the PT/INR which is a lab test on a regular basis to see if they are within their targeted INR range for their specific condition. However, many studies done show that many of the patients receiving long term oral anti coagulation spend a lot of time outside the therapeutic range. Due to the common use of Vitamin K antagonists for various conditions and the possibility that inadequate anti coagulation may increase risk of thrombosis, it may be beneficial to assess the adequacy of anticoagulation, the factors affecting adequacy including knowledge and also describe the profile of patients who have adverse thrombotic as well as bleeding events.
AIM OF THE STUDY:
To study the adequacy of anti-coagulation, compliance and the factors affecting compliance, and knowledge of patients on long-term oral anticoagulant therapy with vitamin K antagonists and to see if there is an association between knowledge and adequacy of anticoagulation.
OBJECTIVES:
Primary Objective:
1. To determine the adequacy of oral anticoagulation.
Secondary Objectives:
1. To determine compliance and factors affecting compliance with oral anticoagulation therapy.
2. To determine knowledge regarding anticoagulation.
3. To compare the knowledge between the adequately anti-coagulated and inadequately anti-coagulated groups.
4. Clinical profiling of patients who are on long-term oral anticoagulation with vitamin K antagonists.
METHODOLOGY:
This was a cross sectional survey with a retrospective chart review component where patient information regarding demographic profile, diagnosis, treatment and their PT/INR values were obtained from the electronic record system and a prospective component where patients were telephonically interviewed to obtain data regarding compliance and were made to answer a knowledge questionnaire. 135 patients were a part of the retrospective arm and a subset of 43 patients were included in the prospective part of the study. The data was then used to determine the adequacy of anticoagulation along with factors affecting adequacy including knowledge by using descriptive statistical analysis.
RESULTS:
The mean adequacy of anticoagulation in the population assessed was found to be 52.31 with a standard deviation of 28.4. 71.11% people spent less than 75% of their time below therapeutic range and 57.04% spent less than 57.04% below the same.
20.58% of the patients developed an adverse thrombotic event and 13.8% developed an adverse bleeding event in the entire period of treatment. Knowledge assessment revealed that the mean knowledge score was 6.6+/-1.72 out of a total 11 possible score. There was an association noted with better knowledge and better time spent in therapeutic range which was statistically significant. There were other statistically significant negative associations between smoking, alcohol consumption, concomitant antiplatelet medication and.time spent in therapeutic range. here was a statistically significant positive association between higher TTR and patients living in the same locality as the hospital as well. The patient characteristics of patients receiving anticoagulation and developing adverse thrombotic as well as bleeding events were described.
CONCLUSIONS:
The proportion of patients adequately anticoagulated was found to be low and one in five patients were found to have an adverse thrombotic and one in seven patients were found to have an adverse bleeding event. There was an association between better knowledge and better time spent in therapeutic range. There was a positive association between proximity to the hospital and better time spent in therapeutic range. There was also a negative association between smoking, alcohol consumption, concomitant antiplatelet agent consumption with time in therapeutic range.
Based on this study, we recommend giving good anticoagulant education to patients covering all the aspects of knowledge that is relevant to them in order to improve the time spent in therapeutic range
Prediction of Mortality in Trauma based on Viscoelastic Assay (ROTEM - Rotational Theromboelastometry)
No full textA Randomized Controlled Trial to Compare the Use of Cutting Electrocautery Versus Scalpel for Skin Incisions
No full textINTRODUCTION:
The outcome of every surgical intervention begins from the planning of the type, site and method of incision which has a wide influence over a number surgical variables such as ease of the operation, accessibility, cosmesis, maneauverability, and post operative pain. The choice of application of incision selection has transformed in a number of ways ranging from using traditional methods to the use of novel electrosurgical equipments.
Such maneauvering of inscional varieties needs, needless to say a lot scrutiny and perusal. Hence this study is aimed at comparing a number of outcome variables between the usage of scalpel versus the cutting diathermy, a prinicipal mode of electrosurgical energy. Though a number of parameters are being touted as beneficial in using both methods of insicion, an inhospital study among the two types of surgical incisions helps in better selection and hence optimal patient outcomes in every surgical domain.
AIMS AND OBJECTIVES:
To compare the outcome variables of incision time,blood loss,wound character and post operative pain between the usage of scalpel and cutting diathermy in elective surgeries.
METHODOLOGY:
Design of study: Randomised controlled study.
Study centre: Rajiv Gandhi Government General Hospital, Madras medical College, Chennai – 03.
INCLUSION CRITERIA:
Patients who are posted for elective surgeries in the general surgical theatre.
EXCLUSION CRITERIA:
Patients with clotting disorder.
Patients with known infectious or inflammatory skin conditions.
Patients with collagen vascular diseases.
Patients with bodily states of poor wound healing such as uncontrolled diabetes, malignancy and chronic steroid use.
Patients with known retroviral diseases.
DISCUSSION:
RANDOMIZED CONTROLLED STUDY TO COMPARE THE USE OF CUTTING ELECTROCAUTERY VERSUS SCALPEL FOR SKIN INCISIONS:
Scarring from scalpel incisions is minimal. Diathermy has been widely used for haemostasis, but incisions into the skin have been avoided due to concerns about scarring and improper tissue healing. Using diathermy to make an incision in the skin speeds up the healing process and decreases blood loss, but it has no effect on the strength of the wound. The purpose of this study was to evaluate the differences between diathermy and scalpel incisions for elective abdominal surgeries in terms of incision duration, intraoperative blood loss, postoperative pain, and wound complications. Incisions in the skin and dissections of tissue planes are increasingly being performed using diathermy, as evidenced by a number of studies. It speeds up the process of stopping bleeding, cuts down on the length of time needed for the operation as a whole, and leaves the wound looking healthy and minimal. Modern electrocautery units (using pure sinusoidal current) have led to a rise in the popularity of cautery for skin incision in recent years. Using electrocautery instead of a scalpel has been shown to shorten the duration of surgery, minimise blood loss, lessen pain immediately after surgery, and reduce the need for painkillers later on. In our study equal number of participants were divided to diathermy and scalpel (50%) respectively.
GENDER:
In the current study, males accounted to 59% and females to 41%. There is no significant difference between two groups when compared between males and females which is statistically significant with p-value>0.05.Nandurkar et al [1] 81% of scalpel Group patients and 76.2% of diathermy Group patients were male. In both groups, the distribution of males and females was similar.
AGE:
The mean age in the study was 40 years with SD 11. The mean age in diathermy group was 38 (SD 11) and in scalpel group 42 years (SD 11) and it was not statistically significant. VS et Subjects in their study had a mean age of 46.718.3 years (meanSD) in the scalpel group and a mean age of 50.416.0 years (meanSD) in the diathermy group. In both studies, participants aged 51-60 made up the largest age group (31% and 23.8%, respectively). Distribution of ages was similar between the two groups (p = 0.372). Guru K et al [11] reported no significant statistical difference between two groups in their study in terms of age and gender.
INCISON TIME AND RELATED BLOOD LOSS:
The mean incision time was 8.70 with SD 0.56 and the mean incision related blood loss was 2.1ml/cm2 (SD 0.4). There is significant difference between the incision time when compared with two groups which is statistically significant with p-value<0.05.Also There is significant difference between the blood loss between when two groups which is statistically significant with p-value<0.05. With scalpel group, the average incision time was significantly longer (36.88.8 vs. 27.010.1; p.001), according to one study [1]. Similarly, the diathermy group had significantly less blood loss than the scalpel group (2.61.5 ml vs. 3.41.5 ml, p =.021). However, there was no discernible difference in the mean incision length between the two groups. Statistically, there was no significant difference between the two lengths (72 cm and 6.92.9 cm; p =.811). After comparing electrocautery and scalpel, Talpur et al. [2] found that the former resulted in significantly shorter incision times and less blood loss. The figures were 7.3057sec/cm2 and 8.9025sec/cm2,
and 1.1346 ml/cm2 and 1.8262ml/cm2, respectively. Ly et al [3] conducted a systematic review and meta-analysis of fourteen randomised trials with a total of 2541 patients (1267 undergoing abdominal wall incision by cutting diathermy and 1274 by scalpel) and found that diathermy may offer significant advantages in a number of variables, such as operative blood loss, incision time, and postoperative pain. 7 They found that diathermy incisions resulted in significantly less blood loss than scalpel incisions (mean difference 0.72 ml/cm2; P0.001) and required significantly less time overall (mean difference 36 seconds; P0.001). Guru K et al [11] reported outcome parameters like incision length, wound assessment, and POD suture removal were not statistically different between the two groups (P value > 0.05). Among the study population, the median blood loss was 10 ml (interquartile range [IQR] 9–14] for cases and 15 ml (IQR] 14–15] for controls; this difference was statistically significant (P Value less than 0.001).Pandey et al [12] reported minimal blood loss with diathermy group. Both Chau JK et al. (210.3368.82 in the electrocautery group and 23982.99 in the scalpel group) and Dixon AR et al. (9022 in the electrocautery group and 12625 in the scalpel group) found that diathermy incision took less time than scalpel incision.[13,14] POSTOPERATIVE PAIN:
The postoperative pain in the current study was studied among the participants on postoperative day 1 to 5 and was graded in severity as mild, moderate and severe. Only on day 1, 71% reported moderate pain, subsequently, 73 to 88% reported mild pain on respective POD days. There is significant difference between day 1 to day 5 of post operative pain when compared with two groups which is statistically significant with p-value,<0.05 . Post operative pain was less in diathermy group. Nandurkar et al [1] reported in their study that As of Day 0, each and every one of the subjects in both groups had been experiencing at least grade 2 pain. On day 1, all of scalpel Group reported pain at the Grade 1 level, while in Group dithermy, 88.1% reported pain at that level and 11.9% reported no pain at all. On day 1, there was a statistically significant difference in pain scores between the two groups. They all reported no pain by Day 2, which is a significant improvement. While using electrocautery to perform prosthetic mesh inguinal hernioplasties, Chrysos et al. [15] found no increase in wound complication rates, concluding that it is just as safe as the scalpel. In their study, Stoltz et al [16]. found no significant difference in the rates of early and late wound healing between a scalpel incision and an electrosurgical thoracotomy incision. Postoperative scar evaluation revealed no discernible distinction between the scalpel and diathermy groups. Dixon et al [14] found that electrosurgical needle incision was significantly more effective, consistently quicker, and yielded better cosmetic results with minimal complications than scalpel incision. It's an easy method that causes no extra distress for the patient and has a high success rate.
WOUND COMPLICATIONS:
The present study reports no wound complications on postoperative day 1 and day 2. On day 3, 6.7% reported wound complications and to a maximum of 27% on day 5. There is significant difference between two groups when compared with wound complication which is statistically significant with p-value<0.05. In group Scalpel group, wound complication is seen lesser compared to diathermy. At G0, G1, G2, and G3, Nandurkar et al [1] found no statistically significant differences in wound characteristics between the two groups. The primary intention of 2.4% of scalpel group patients was absent, and 2.4% of patients had delayed healing. For the people in diathermy group, 4.8% didn't have primary intent, and 2.4% had delayed healing. When comparing primary intention and delayed healing complications, neither group significantly differed from the other. Consistent with previous research by Ombolaji et al.,[4] we found that the electrocautery group experienced significantly less postoperative pain on day 1 after surgery (p value = 0.021). 8 Consistent with the present study, Kearns et al [5] found that the diathermy group experienced significantly less postoperative pain within the first 48 hours following surgery. On postoperative day 0 and subsequent days, there was no discernible difference in pain levels between the two groups. Electrocautery, as noted by Aird et al.,[6] greatly lessened postoperative wound pain. 10 Findings from the current study are in line with those from studies by Siraj et al., Gilmore et al., and Shivagouda et al.,[7,8,9] all of which found that elective laparotomies performed with electrocautery incisions were significantly more beneficial than scalpel incisions in terms of reduced early postoperative pain. In the current study, there was no discernible difference between electrocautery and scalpel use in terms of wound complications. There was no statistically significant difference between electrocautery and scalpel wound healing, according to the research of Talpur et al. [2]. Patients with gastrointestinal malignancies who underwent surgery with either a scalpel or electrocautery showed no statistically significant difference in wound infection when comparing the two incision methods, according to a study by Eren et al. [10] According to Gilmore et al [8], no one in either group experienced wound infection or dehiscence. However, wound discharge was seen in four patients treated conservatively with daily dressing in the scalpel group.
CONCLUSIONS:
This study concludes that, among the compared variables incision time ,incision related blood loss ,and post operative pain were significantly lesser among the diathermy group. With regards to wound character and complications there was no discernible differences among the two groups, Hence this study concludes that the use of diathermy to be a safe and effective means in the application of elective surgical incisions