ePrints@TNMGRM (Tamil Nadu Dr. M.G.R. Medical University)
ePrints@TNMGRM (Tamil Nadu Dr. M.G.R. Medical University)Not a member yet
20811 research outputs found
Sort by
Study of Clinical Electro Cardiographic and Echocardiographic Profile of Dilated Cardiomyopathy Patients admitted in Tirunelveli Medical College Hospital
No full textClinicopathological Evaluation of Vesiculobullous Lesions: A Cross Sectional study in a Tertiary Care Hospital of South Tamilnadu
No full textUltrasound Guided Transmuscular Quadrates Lumborum Block at L2, L4 Level for Midline Laprotomy Surgery
No full textA Study on Cytomegalovirus: Primary Infection/Reactivation and Its Impact on Graft Functions in Post Renal Transplant Recipients
No full textA Clinico-Bacteriological study of Neonatal Septicaemia & Correlation with Inflammatory Markers C-Reactive Protein and Interleukin-6 in a Tertiary Care Hospital
No full textA Study on Bacteriological Profile & Antimicrobial Susceptibility Pattern of Intra-Abdominal Infected Patients in a Tertiary Care Hospital
No full text
A Prospective Randomised Comparative study of Sleeve Technique Versus Conventional Dorsal Slit Technique for Circumcision
No full textA Study on Therapeutic Value of Gastrografin Comparative with Conservative Line of Management in Adhesive Small Bowel Obstruction
Get PDFINTRODUCTION:
Adhesive small bowel obstruction is a common surgical emergency, causing high
morbidity and sometimes even mortality. The adhesions causing such bowel obstructions are
typically the footprints of previous abdominal surgical procedures. Post-operative adhesions are
the leading cause of small bowel obstruction, accounting for 60% of cases.
Although ASBO is a common condition, the prevention and treatment is often
characterized by surgeons' personal preferences rather than standardized evidence- based protocols.
ASBO causes considerable harm, resulting in 16 days of hospitalization on average, after surgical
treatment and an in-hospital mortality rate of 3% per episode. There is a large amount of conflicting
and low- quality evidence in publications regarding treatment of ASBO.
Hence the World Society of Emergency Surgery postulated an evidence- based
guidelines the Bologna Guidelines for the diagnosis and management of adhesive small bowel
obstruction. In the absence of signs that require emergent surgical exploration (i.e., peritonitis,
strangulation or bowel ischemia), non-operative management is the treatment strategy of choice.
The aim of the study is to compare the non-operative strategies in terms of efficacy
and hospital stay.
OBJECTIVES:
1. To evaluate the therapeutic value of Gastrografin in the management of adhesive small
bowel obstruction in comparison with standard conservative line of management.
2. To evaluate it’s role in predicting the need for early surgery and decreasing the hospital
stay in comparison with standard conservative line of management.
MATERIALS AND METHODS:
• Study design: Case control study
• Study period: March 2021 to November 2021
• Study setting: Stanley Medical College & Hospital, Chennai.
• Study population: Patients being diagnosed as adhesive small bowel obstruction.
• Sample size: 50.
INCLUSION CRITERIA:
• Patients over 18 years of age with clinical and radiological evidence of adhesive small
bowel obstruction
EXCLUSION CRITERIA:
• Age < 18 years
• Gestation
• Other causes of bowel obstruction and with features of strangulation or peritonitis.
DISCUSSION:
The duration of hospital stay is less in gastrografin group when compared to standard
conservative group, 5.7 days versus 10.5 days, (P =0.005) respectively. The time of resolution of
symptoms from the time of admission is also reduced in gastrografin group compared to standard
conservative group; 14.5 hours versus 32.7 hours, with a significant P value. Number of patients
in whom the treatment was converted to surgical intervention was 3 in gastrografin group and 11
in standard conservative group, which also showed a significant P value.
CONCLUSION
Oral Gastrografin is safe and helps in a more reliable manner in both the diagnosis and
therapeutic management of adhesive small bowel obstruction. Gastrografin helps in the earlier
resolution of symptoms and signs thereby it reduces the duration of hospital stay. It also helps
in the early prediction of need of surgery and reduces the need for surgical exploration,
enabling a safe non-operative management
A Study on the Association of Elevated D-Dimer Levels and the Extent of Severity of Pre Eclampsia
Get PDFINTRODUCTION:
Pre-eclampsia, a pathology of pregnancy by nature, is a dynamic process of varying severity associated with high levels of maternal and fetal morbidity and mortality. Preeclampsia involves an increase in inflammatory mediators and pro-coagulation factors and decreased amount of fibrinolytics in response to cellular dysfunction attributable to the condition. The state of hypercoagulability rendered by pregnancy worsens and organ
malfunction can occur.
D-dimer is a fibrin degradation product and the main component of a thrombus. Its presence suggests activation of the coagulation cascade and fibrinolysis. The clinical utility of measuring D-dimer lies in its high negative predictive value (98%–100%) and high sensitivity (95%–100%) for detection of thromboembolic events. This prospective study is undertaken to assess the severity of pre-eclampsia using D-dimer levels that will guide in the management and prevention of complications in pregnancy induced hypertension.
AIM OF THE STUDY:
To study the association of elevated D-dimer levels and extent of severity of preeclampsia.
MATERIALS AND METHODS:
70 cases with pre eclampsia who are admitted at Government RSRM lying in hospital are included in this prospective observational study. Levels of D dimer at the time of hospitalization or during the time of diagnosis of pre eclampsia are measured by immunoturbidimetry, taking as reference the levels for a normal pregnant population adjusted for gestational age. D dimer test is done only once during admission or during the first diagnosis of pre eclampsia.
The severity of the disease is followed up until delivery or termination of pregnancy using other investigations suggestive of end organ damage (liver dysfunction –elevated transaminase and renal dysfunction-elevated creatinine), development of eclampsia, pulmonary edema, thromboembolic events and Foetal growth restriction.
INCLUSION CRITERIA:
Age >18 years, Patients who give consent for undergoing the blood investigation, Gestational age > 20 weeks to 40+3 weeks, Single pregnancy with a living foetus, Diagnosis of pre-eclampsia at hospitalization according to ACOG criteria (2013).
EXCLUSION CRITERIA:
Twin pregnancy, Use of anticoagulants during pregnancy, Systemic lupus erythematosus, Foetal death, Smoking, diseases affecting organs affected by preeclampsia, Chronic renal failure, Autoimmune hepatitis, Intrahepatic cholestasis.
CONCLUSION:
In our study, there was a strong association between severity of pre-eclampsia and elevated D-dimer levels (>97.5 percentile for gestational age), reinforcing the evidence that one of the condition's physiopathologic bases lies in the activation of the coagulation system and fibrinolysis. The exact time during pregnancy in which the mechanisms that unchain the pathology and allow the D-dimer to be used as a predictor marker have not been defined.
Increased levels of D-dimer should be interpreted as evidence of activation of the physiopathologic mechanisms that contribute to placental ischemia and multiple organ
dysfunction in pre-eclampsia