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An Experimental study on Optimization of Intra Abdominal Pressure in the Perioperative Period and Its Effect on Outcome in Patients Undergoing Laparotomy
No full textINTRODUCTION:
Wound complications are still extremely prevalent even in this advanced era of surgery, especially in an emergency situation. There are several factors that contribute to these wound complications, but intra-abdominal hypertension is the one that is least understood. The purpose of this study is to ascertain whether intra abdominal hypertension has a role in wound complications and whether lowering it can help.
AIMS AND OBJECTIVES:
1. To determine the incidence of perioperative increased intra abdominal pressure among elective and emergency laparotomy at our institution.
2. Optimization of IAP, if found to be elevated, using WSACS protocols.
3. To correlate whether optimization of perioperative IAP has a positive effect in outcome in the above mentioned cases.
MATERIALS AND METHODS:
This study was conducted among patients undergoing elective and emergency laparotomy in our institution. 70 patients were enrolled (35 cases and 35 controls). Flowmanometry technique via an indwelling foley’s catheter was used to measure IAP. IAP monitoring was done in the pre-operative period and post operatively at 0, 6, 24 and 48 hours. Among controls, intervention to reduce IAP was carried out according to the WSACS protocols. Incidence of intra-abdominal hypertension in the pre-operative period was computed and Chi-square test was used to correlate between the occurrence of wound complications in cases and controls.
RESULTS:
The incidence of IAP in the pre-operative period (at admission) ranged from 25% in elective cases and 50% in emergency cases. Mass lesions and hollow viscus perforation were the predominant iintraoperative findings. The overall complication rate was significantly lower in cases (intervention group) than controls (p value = 0.005). When individually analysed, the percentage of wound dehiscence were significantly lower in controls in whom steps to reduce IAH according to WSACS protocol was followed (p value = 0.07). The occurrence of rectus dehiscence were not significant among the two groups.
CONCLUSION:
This is an experimental case control type of study to analyse the effect of Optimization of intra abdominal hypertension in the post operative period as per the
guidelines given by WSACS protocol on the outcome of laparotomy wound in both elective and emergency cases.
IAP was measured for all patients who underwent laparotomy (Both elective and emergency) in the study period in our institution and the incidence of intra abdominal
hypertension was found to 25% in elective and 50% in emergency cases.
The sample size was comprised of 70 patients with eleavted IAP in the immediate post operative period, of which 35 patients were taken as cases and 35 patients were taken as
controls.
In control group, steps to reduce IAP were carried out according to World Society of the Abdominal Compartment Syndrome(WSACS) protocol, which was not done in the case group.
The incidence of wound dehiscence and rectus dehiscence was calculated in both groups and the incidence of wound dehiscence was found to be significantly high in the case
group in which measures to reduce IAP was not done, whereas the incidence of rectus dehiscence was found to be insignificant in both groups.
Thus from the study we can draw the following conclusions;
(1) IAP monitoring by Flowmanometry method is a very easy bedside method which should be followed in all patients undergoing laparotomy.
(2) World Society of the Abdominal Compartment Syndrome (WSACS) protocol to manage intra abdominal hypertension is an effective method which should be carried out in all patients with Intra abdominal hypertension in the post operative period.
(3) The incidence of wound dehiscence can be reduced to a greater extent with an effective management of intra abdominal hypertension
A Comparitive study to Decrease Wound Dehiscence and Infection when Approximating Scalp Wounds with Pulley Sutures Compared to Conventional Simple Suture Technique
No full textTo Study Certain Biochemical Parameters and Related Gene Polymorphisms that Influence Unexplained Infertility
No full textA Study on Predictive Role of Neutrophil Lymphocyte Ratio on Early Mortality of Patients with Stroke in Chengalpattu Medical College
No full textINTRODUCTION: The stress response that occurs after the event of acute stroke causes the activation of the hypothalamo–pituitary–adrenal (HPA) axis. Certain studies have found that increased serum cortisol level in patients with acute stroke is related to greater stroke severity. Whether the stress response is just an epiphenomenon to stroke severity or independently contributes to prognosis remains uncertain. But there is a immense need to detect a biomarker for predicting the outcome of acute stroke.15
OBJECTIVE OF THE STUDY:
The aim of the study was to investigate if a single serum cortisol determination was related to severity of acute stroke.
METHODS:
A cross sectional study was conducted in 120 patients with acute stroke presenting within 24hours of stroke onset after getting informed consent. The patients were studied from medical wards and IMCU in Chengalpattu government hospital. Scandinavian Stroke Scale (SSS) was used to study severity of acute stroke. Diagnosis of Acute Ischemic or Hemorrhagic stroke was based on CT imaging in all patients. Blood samples are taken for assessing serum cortisol levels. Data was entered in MS excel analyzed using SPSS software for appropriate descriptive and inferential statistics.
RESULTS:
The mean age group is 50 to 59 years with 50% males and 50 % females. The mean cortisol level was 637nmol/L. Of the 120 cases 98 had acute ischemic stroke and 22 had acute hemorrhagic stroke. The mean SSS score was 20.85 and mean time duration was 9.5 hours. The correlation coefficient for SSS and serum cortisol was -0.984 which had significant correlation indicating high serum cortisol levels had low SSS score and also the P value being < 0.001 which was statistically significant.
CONCLUSION:
Acute stroke severity related to increasing serum cortisol levels. Serum cortisol was associated with stroke severity and markers reflecting stroke severity
A Study on Noninvasive Predictors of OGD Scopy Confirmed Esophageal Varices in Cirrhosis in a Tertiary Care Hospital in Chengalpattu
No full textBACKGROUND:
All patients with liver cirrhosis should have endoscopic evaluations for varices at the time of diagnosis. It has been suggested to repeat endoscopy in patients without varices every 2-3 years and in patients with moderate varices every 1-2 years in order to assess the evolution. The applicability of these endoscopy principles is debatable in a developing country like ours where there are relatively few endoscopic facilities. Additionally, they place an additional strain on the existing resources and the economy.
Esophageal varices are typically identified non-invasively using routine lab measurements and clinical indicators of liver function and fibrosis, portal HTN.
Platelet count, Child turcott pugh scoring, serum albumin level, APRI, serum bilirubin level, serum transaminases, Hb level, total count, platelet count/spleen diameter ratio, PT, spleen size, PV diameter, splenic diameter, Spider angiomata and ascites are some of the noninvasive predictive variables. Due to the shared characteristics of these noninvasive methods, esophageal varices can be predicted with high reproducibility, low cost, and minimal patient burden.
AIMS AND OBJECTIVES:
To study non invasive clinical, biochemical, and radiological factors that can forecast the presence and severity of oesophageal varices in cirrhotic patients.
MATERIALS AND METHODS:
After getting approval from IEC, 55 patients patients admitted with cirrhosis liver at internal medicine wards who fulfilled the inclusion and exclusion criteria were recruited for the study. The demographic and clinical details of the patients were collected using a structured proforma. All the patients were subjected to detailed clinical examination, appropriate blood investigations, imaging studies (ultrasound with Doppler) and upper GI endoscopy.
RESULTS: The presence of higher grades of Ascites, low platelet count, high total bilirubin, low serum albumin, higher portal vein diameter, increased spleen size, lower platelet count /spleen diameter ratio, Child Pugh class B/C, were concluded as significant predictors for the presence of large esophageal varices.
The presence of large varices correlated well with severity of liver disease, as CHILD PUGH class C has maximum percentage of large varices. In large varices group, 50% in CTP class C group, 31% in CTP – class B group, and 19% were in CTP- class A group.
Prolongation of prothrombin time did not significantly correlate with size of esophageal varices, these parameters of our study going against our expectation based on theoretical knowledge.
CONCLUSION:
These non invasive predictors may be of great help to the practising and treating physicians where facilities for upper gastrointestinal endoscopy are not readily available. It will be a strong basis for initiating appropriate primary pharmacological prophylaxis in these patients. Predicting the presence and grade of varices using non-invasive approaches reduces the need for the invasive upper G.I. endoscopies in a resource-constrained environment like ours, where cost concerns are a key issue
A Clinical Biochemical Profile of Type 2 Diabetes in Women with Special Reference to Vitamin D Status in Obese and Non Obese Person
No full textIntroduction:
Diabetes mellitus type II (DM II) is a condition that affects multiple body systems and has a rapidly rising prevalence. Therefore, it is essential to adequately manage DM II in order to prevent complications such diabetic nephropathy, peripheral neuropathy, and retinal. Among its many advantages, vitamin D helps regulate haemoglobin A1c (HbA1c). It improves insulin sensitivity and secretion.
OBJECTIVES:
1. To study the clinical, biochemical profile of type 2 diabetic women.
2. To assess the vitamin D status in type2 diabetic obese and non-obese women.
3. To determine the influence of glycaemic status of a patient in vitamin D level.
4. To determine the correlation of duration of diabetes on vitamin D level.
5. To establish the relationship between anthropometric measurement with vitamin D levels.
METHODOLOGY:
100 patients were selected according to inclusion and exclusion criteria and written informed consent was taken for their participation. Patient history in relation to the duration of type 2 diabetes was also taken. Patients were evaluated for anthropometric measures like height, weight, waist/hip ratio, glycaemic value, renal function test, urine routine and vitamin D levels. Vitamin D levels were correlated with the anthropometric measure and glycaemic control. All data were entered I to Microsoft excel analysed using SPSS version 16.
RESULTS:
The mean Age (years) among the subjects was 49.94 (± 6.69) years ranging from 38 to 64 years. The mean Weight (kg) among the subjects was 72.43 (± 8.06) kg, mean height in cm
was 160.04 (± 4.23), mean BMI was 28.4 (± 3.79) kg/m2 Among the subjects, 90 (90%) had > 1 and 10 (10%) had < 1 Waist Hip ratio.
The mean Duration of Diabetes (years) among Obese was 10.7 (± 3.99) which is higher by 2.66 and statistically significant compared to 8.04 (± 3.85) in Non-Obese. The mean Fasting Blood Sugar (mg/dl) among Obese was 248.42 (± 29.83) which is higher by 36.68 and statistically significant compared to 211.74 (± 19.77) in Non-Obese. The mean Post prandial blood sugar (mg/dl) among Obese was 296.42 (± 41.52) which is higher by 48.28 and statistically significant compared to 248.14 (± 21.36) in Non-Obese. The mean Total Cholesterol (mg/dl) among Obese was 233.52 (± 16) which is higher by 14.86 and statistically significant compared to 218.66 (± 12.84) in Non-Obese. The mean Blood Urea (mg/dl) among Obese was 43 (± 5.86) which is higher by 3.7 and statistically significant compared to 39.3 (± 6.73) in Non-Obese.
The mean Serum Vitamin D (ng/ml) among Obese was 24.21 (± 3.83) which is lower by 7.17 and statistically significant compared to 31.38 (± 2.53) in Non-Obese. Comparing the
Vitamin D level with Obesity distribution, Obese group had higher proportion of Inadequate Vitamin D level with 78% followed by Deficient Vitamin D level with 22% and least in
Adequate Vitamin D level with 0% compared to Non-Obese group which had higher proportion of Adequate Vitamin D level with 72% followed by Inadequate Vitamin D level with 28% and least in Deficient Vitamin D level with 0%. The difference in Vitamin D level distribution between Obese and Non-Obese was statistically significant (p < 0.05).
The mean Duration of Diabetes (years) among Deficient Vitamin D level was 13.64 which is higher than mean among Inadequate Vitamin D level which was 10.45 followed by Adequate Vitamin D level with a mean of 6.47 and the difference was statistically significant (p < 0.05). The mean Fasting Blood Sugar (mg/dl) among Deficient Vitamin D level was 287.64 which is higher than mean among Inadequate Vitamin D level which was 232.36 followed by Adequate Vitamin D level with a mean of 209.14 and the difference was statistically significant (p < 0.05). The mean Post prandial blood sugar (mg/dl) among Deficient Vitamin D level was 344.55 which is higher than mean among Inadequate Vitamin D level which was 276.25 followed by Adequate Vitamin D level with a mean of 244.36 and the difference was statistically significant (p < 0.05). The mean Total Cholesterol (mg/dl) among Deficient Vitamin D level was 250.55 which is higher than mean among Inadequate Vitamin D level which was 227.75 followed by Adequate Vitamin D level with a mean of 216.17 and the difference was statistically significant (p < 0.05). The mean Blood Urea (mg/dl) among Deficient Vitamin D level was 46.27 which is higher than mean among Inadequate Vitamin
D level which was 42.32 followed by Adequate Vitamin D level with a mean of 37.86 and the difference was statistically significant (p < 0.05).
The model with these predictors explains 78.53% variability (predictability) of Serum Vitamin D (ng/ml). Serum Vitamin D (ng/ml) decreases -0.03 times for each unit increase in
Post prandial blood sugar (mg/dl) and is statistically significant. Serum Vitamin D (ng/ml) decreases -0.04 times for each unit increase in Total Cholesterol (mg/dl) and is statistically significant. Serum Vitamin D (ng/ml) decreases -0.09 times for each unit increase in Blood Urea (mg/dl) and is statistically significant. Serum Vitamin D (ng/ml) decreases -0.3 times for each unit increase in Duration of Diabetes (years) and is statistically significant. Serum Vitamin D (ng/ml) decreases -0.46 times for each unit increase in BMI (kg/m2) and is statistically significant.
CONCLUSION:
There is a high prevalence of hypo-vitaminosis D among patients with type-2 diabetes, particularly among patients with poor glycaemic control and in those with longer diabetes durations. Therefore, every diabetes patient needs lifestyle changes, prompt glycaemic management, and early vitamin D treatment
A Study on Prevalence of Hyperprolactinemia in CKD Patients and Its Correlation with CAHD
No full textINTRODUCTION:
The frequency of Chronic Kidney Disease (CKD) is significant and increasing in the general population.
Additionally, it is linked to significant morbidity and an increase in cardiovascular mortality like Coronary
Atherosclerotic Heart Disease (CAHD), which is responsible for 5 to 10 million deaths each year globally.
CKD patients experience elevated prolactinaemia compared to the general population, and those with high hormone levels experienced higher odds of cardiovascular death than those with normal prolactin levels.
OBJECTIVES:
1. To estimate the prevalence of hyperprolactinemia in CKD patients.
2. To Study the link between hyperprolactinemia in CKD patients and Occurrence of CAHD in them.
METHODOLOGY:
The observational study was done among 100 subjects with an aim to study the prevalence of hyperprolactinemia in CKD patients and Occurrence of CAHD in them. The subjects with age more than 18 years, both sex, with established chronic kidney disease, with Symptoms of uraemia for more than
3 months and with elevated blood urea and serum creatinine and decreased creatinine clearance.
Patients with prolactinomas, Cushing’s disease, Acromegaly, adrenal insufficiency, Known patients of hypothyroidism, chronic liver disease, seizure disorder, Those who are pregnant, and Patients on following medications - Phenothiazines, butryphones, chlorpromazine, protease inhibitors, H2 blockers, opiod abuse, MAO inhibitors were excluded from the study.
The subjects selected into the study where made to undergone these parameters-Complete Blood Count, peripheral smear, Renal Function Test, Urine routine analysis, Echocardiography Ultrasound Abdomen, Fasting lipid profile and serum prolactin.
The data was entered into Microsoft excel and analysed using SPSS 23.
RESULTS:
The mean Serum Prolactin (ng/ml) among the subjects was 32.88 (± 27.47) mg/dl ranging from 4.37 to 126.59 mg/dl. Among the subjects, 56 (56%) had Hyperprolactinemia. Analysis of different variables like age group, gender, presence of diabetes mellitus, dyslipidaemia, mean serum urea, creatinine and creatinine clearance with the presence or absence of CAHD< there showed nil significant difference in terms of these variables among the subjects.
Comparing the Hyperprolactinemia with CAHD distribution, 55.4% of the subjects with Hyperprolactinemia had CAHD which is higher compared to those without Hyperprolactinemia of whom 6.8% had CAHD and the difference was statistically significant (p < 0.05). Hyperprolactinemia had an odds of 16.95 times of acquiring CAHD in CKD patients compared to those without Hyperprolactinemia which was statistically significant.
CONCLUSION:
The study showed that Chronic Kidney Disease subjects with hyperprolactinaemia had the occurrence of Coronary
Atherosclerotic Heart Disease
A Study of SAAG Ratio, Portal Vein Diameter and Platelet Count to Spleen Diameter Ratio (PSDR) as Non Invasive Predictors of Esophageal Varices in Liver Cirrhosis: A Cross Sectional study
No full textBACKGROUND AND AIM OF THE STUDY:
Cirrhosis is a common disease which has significant morbidity and it is one of the cause for premature mortality. The major complication of cirrhosis is portal hypertension which in turn leads to variceal bleeding which accounts for 35-40% mortality. Endoscopic screening is currently recommended for esophageal varices (EV) in all patients at the time of diagnosis of cirrhosis. In order to improve the compliance of patients and to reduce the
burden on physicians and hospitals, invasive procedures to diagnose the incidence of oesophageal varices need to be avoided and replaced with simple and easily available and
reproducible investigation/screening. This study is done to analyse the predictive value in the diagnosis of Oesophageal varices in patient with Cirrhosis with a non-invasive
parameter like Platelet count Splenic Diameter ratio, Portal vein diameter, SAAG ratio.
MATERIALS AND METHODS:
This study is a cross sectional study done among 70 patients diagnosed with Liver cirrhosis. This study is done in Govt Thanjavur Medical College, in the year 2022. After the informed consent from participants, the study is conducted. The Data is then entered in MS Excel and analysed using SPSS. Appropriate descriptive statistics like Mean, Median,
Mode, SD and Percentage and inferential statistics like t tests, Fischer exact test and regression analysed are used.
RESULTS:
Our study shows that the mean (SD) age of the participants is 48 years (9 years). About 87.1% of participants are males and 12.9% are females. The mean (SD) hemoglobin of the participants is 8.4gm/dl (1.7gm/dl). The mean (SD) platelet count of the participants is 1,43,572 (75538). The mean (SD) total protein of the participants is 5.8 (0.4). The mean
(SD) albumin level of the participants is 3 (0.4). About 92.9% had high SAAG ratio. The mean (SD) portal vein diameter of the participants is 11.8 (1.8). The mean (SD) spleen size of the participants is 117.8 (16.2). The mean (SD) PCSD ratio of the participants is 1263 (766). About 47.1% had large varices, 42.9% had small varices and 10% had no varices.
There is a statistically significant association exist between SAAG ratio and Occurrence of varices. There is a statistically significant association exist between Hemoglobin, Platelet count, Albumin, Spleen size, PCSD ratio and Occurrence of varices. Low hemoglobin, low platelet count, low albumin, increased spleen size, low PCSD ratio may be considered to predict the presence of varices. The logistic regression model was not statistically
significant, χ2 = 5.23, p 0.73. The model explained 48.0% (Nagelkerke R2) of the variance in varices and correctly classified 94.3% of cases.
CONCLUSION:
The study was done with an intend to evaluate the SAAG ratio, Portal vein diameter, Platelet count to spleen diameter ratio as non-invasive predictors of esophageal
varices in Liver Cirrhosis. The study concludes that High SAAG ratio, Low hemoglobin, low platelet count, low albumin, increased spleen size, low PCSD ratio may be considered
to predict the presence of varices
