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Analysis of Lipid Profile and Renal Parameters among Person Living with HIV/AIDS on CART
No full textComparison of USG Guided Fascia Iliaca Compartment Block and Femoral Nerve Block Positioning of Femur Fracture patients before Spinal Anaesthesia
No full textThe Study of Prognostic Significance and Association of C-Reactive Protein and LDL/HDL Ratio in Acute Myocardial Infarction
No full textEvaluation of Subfoveal Choroidal Thickness in Preeclampsia Women, Normal Pregnant and Non Pregnant Women using Optical Coherence Tomography
No full textClinico-Microbiological Profile of Group B Streptococci Colonization among Pregnant Women at a Tertiary Care Hospital in South India
No full textINTRODUCTION
Group B Streptococcus (GBS), aka Streptococcus agalactiae, colonization in pregnant women is one of the leading infectious causes of significant morbidity and mortality among neonates worldwide. GBS poses a major risk of infection especially in early neonates culminating in septicemia, pneumonia, meningitis, and/or serious neurological damage. Most women infected by GBS remain asymptomatic, but the organism could be found in the throat,
vagina and/or rectum. The incidence of GBS infection in pregnant women throughout the course of pregnancy is about 5–40% elsewhere. Recto-vaginal maternal colonization is the
most important determinant of neonatal GBS infection transmitted vertically from infected mothers. It has been estimated that the risk of acquiring neonatal GBS infection is more than 25-fold in colonized women compared to non-colonized women. Maternal GBS colonization rate during third trimester (35-37 weeks of gestation) ranges from 11.1% to 22.4% worldwide, with a mean prevalence of 17.9%. Indian studies report prevalence of 2.3% to 15.0%. Reducing
this vertical transmission to the neonate is now the priority of all screening protocol.
AIM OD THE STUDY:
To determine the prevalence of Group B Streptococcal colonization in the genital tract of pregnant women screened in late third trimester and to ascertain the risk factors associated with GBS colonized women.
OBJECTIVES:
1. To study the prevalence of GBS in genital tract in pregnant women.
2. To evaluate the various risk factors associated with GBS colonization in pregnant women.
3. Study the maternal and fetal outcome of those GBS screen positive women.
MATERIAL AND METHODS
Study design: Observational study.
Study population: Pregnant women with a gestational age of 35–38 weeks attending as outpatient and/or in patient in the department of obstetrics and gynecology in PSG IMSR, Coimbatore.
Sample size: 200 nos.
Inclusion Criteria:
1. Pregnant women with gestational age 35-38 weeks attending the antenatal clinic or admitted as an in-patient.
2. Aged above 18 years.
Exclusion Criteria:
1. Refusal to give consent were excluded from for the study.
2. History of antibiotic use within the last 2 weeks prior to screening.
Study method:
All enrolled participants were assessed by a predefined pro forma for their demographics, socio-economic characteristics, education, toilet habits (Indian/western style, wash/wipe), obstetric history and clinical outcome.
CONCLUSION:
On screening 200 participants in a tertiary care hospital in south India with the ACOG protocol, the prevalence of group b streptococcus in this region was 0%.
Utmost importance should be given to conducting Large scale multi centric studies which would be crucial to understand the true prevalence of GBS in the region an also through
the country.
With such low prevalence of the GBS organism, we need to answer the question – “Should routine GBS screening be adopted in our region?”. Currently recommendations cannot
be made for the adoption of universal screening as it would not be cost effective for a developing country.
On the basis of research purposes, new diagnostic techniques can be tried and compared with the standard culture screening
A Comparative Analysis in the Surgical Outcome of Bicondylar Tibial Plateau Fractures treated with Dual Plating and Lateral Locking Plate
No full textA Prospective study on Predicting Esophageal Varices in Cirrhosis with Platelet Count to Spleen Diameter Ratio, Right Lobe of Liver Diameter to Serum Albumin Ratio, Portal Vein Diameter in a Tertiary Care Hospital in Chennai
No full textA Study to Evaluate Rifampicin as a Cause of Resistant Hypertension in Known Hypertensive Patients on Anti-Tuberculosis Treatment in a Tertiary Care Centre
No full textINTRODUCTION:
Tuberculosis remains a major health related problem in low income and middle-income countries and the burden of noncommunicable diseases like hypertension, diabetes
mellitus is also on the rise progressively. Rapid urbanisation, improving socioeconomic status, decreased morbidity and mortality to infectious disease, evolving and changing lifestyle and dietary habits have led to a rapid rise of noncommunicable disease especially hypertension, diabetes mellitus, malignancy and cardiovascular disease.
hypertension is very important risk factor for cardiovascular related death, cerebrovascular accidents and kidney related disease.
AIM OF THE STUDY:
To study the effect of rifampicin on the target blood pressure in known hypertensives whose blood pressure has been previously controlled with antihypertensives.
MATERIALS AND METHODS:
STUDY DESIGN:
Prospective observational study.
STUDY PLACE:
Institute of Internal Medicine, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai.
STUDY PERIOD:
JUNE 2021 TO DECEMBER 2021.
SAMPLE SIZE: 160.
Inclusion Criteria:
1. All Patients above 18 years of age with microbiologically/clinically confirmed.
tuberculosis on anti-tuberculous therapy containing cases
2. Patients giving consent to the study.
3. Patients previously diagnosed as hypertensives and on antihypertensives.
Exclusion Criteria:
1. Patients below 18 years of age.
2. Patients with renal failure, coarctation of aorta, pheochromocytoma, renal artery cases stenosis, cushingoid and acromegalic features.
3. Patients with history of liver disease.
CONCLUSION:
• Initiation of Rifampicin based Anti-tubercular therapy is associated with increase in the requirement of anti-hypertensive drugs of different classes for attaining optimal blood pressure control in our study population.
• Thus, we conclude that Rifampicin has the potential to diminish hypotensive effects of many well established antihypertensives like calcium channel blockers, beta blockers and diuretics.
• Thus, stringent BP monitoring is needed when patients are started on Rifampicin based ATT for optimal management of hypertension.
LIMITATIONS OF THE STUDY:
➢ In our study, we were not able to measure the drug levels of the anti-hypertensive drugs in the study population. We took the inability to attain optimal blood pressure control and increased requirement of anti-hypertensive drugs of different classes as an indirect marker for reduced effectiveness of anti-hypertensive drugs after starting rifampicin-based ATT.
➢ Anti-Tubercular therapy may not be the only cause for development of resistant hypertension in these patients. The patients might have had poor compliance of Anti-hypertensive drugs; Co morbidities like Diabetes and Coronary artery disease can contribute the development of Resistant hypertension. We could not assess the effect of dietary habits, the amount of salt intake and sedentary lifestyle on Hypertension in the study population.
➢ Some studies have shown that there is an association (though not conclusively proven) between Tuberculosis and increased incidence of hypertension. Hence Tuberculosis itself may be contributory to the increased requirement of anti hypertensive drugs.
➢ Patients with Chronic Kidney Disease and those with Secondary Hypertension were not included in the study. Hence more studies are needed in this patient population
Clinical Profile and Outcome of Patients Undergoing Plasmaphersis for Phosphorus Rodenticide Poisoning in a Tertiary Care Hospital
No full textINTRODUCTION:
Poisoning is one of the leading causes of admission in emergency department and medical intensive care unit. Diseases borne due to rodents are a major health problem.
Moreover, rodent infestation causes huge economic loss. So, widespread availability of rodenticides have been commercialized. These rodenticides can be easily bought over the counter.
Illegally made rodenticides which are unregulated by proper authorities are widespread which in turn amplifies the magnitude of problem. These packets do not contain information on contents and proper warning signs in case of accidental or suicidal exposure to humans.
Toxicity includes a wide spectrum of manifestations from asymptomatic patients to death due to complications which include Acute Liver Injury, Bleeding in case of coagulopathy, Hepatic encephalopathy, Acute respiratory distress syndrome, Acute kidney injury.
There has been previous studies and reports about effects of various types of rodenticide poisoning. This study specifically focuses on phosphorus rodenticide poisoning and role of plasmapheresis in management.
AIMS AND OBJECTIVES:
1.To study the clinical profile of patients admitted for phosphorus rodenticide poisoning who have undergone plasmapheresis and their course of stay in hospital.
2. To correlate various clinical parameters with outcome.
MATERIALS AND METHODS:
This study was conducted at Madras Medical College Toxicology IMCU, Madras Medical College, Chennai, during the period of (6 Months). There were 54 patients admitted with an alleged history of ingesting rodenticide paste compounds in our emergency medical ward during the study period. After applying, the inclusion and exclusion criteria, 50 patients only fulfilled all the criteria and they were chosen as study subjects (n =50).
Inclusion criteria:
1. Patients admitted with the history of consumption of rat killer paste poisoning with age >18 years.
2. Patients who have undergone more than or equal to 3 cycles of plasmapheresis for liver cell failure.
Exclusion criteria:
1. Age less than 18 yrs.
2.History of consumption of other compounds with the rat killer paste.
3. Those with the history of acute or chronic liver disease
4. Those who refuse the study.
5. Pre existing renal failure and pregnant patients.
SUMMARY:
1. To study the clinical profile of patients undergoing plasmapheresis for phosphorus rodenticide poisoning and to correlate various clinical parameters with outcome of the patient.
2. This study was conducted at Rajiv Gandhi Government General Hospital, Chennai, Toxicology unit during the period of April 2021 to September 2021 (6 months). There were 54 patients who have undergone plasmapheresis for phosphorus rodenticide poisoning during this study period
3. After applying inclusion and exclusion criteria, 50 patients only fulfilled the criteria and included in study.
4. 50 cases were include. Upto 20 years – 7 cases (14.0%), 21-30 years -13 cases (26.05), 31 to 40 years -11 cases (22%), 41 to 50 (18 percent), 51 to 60 -7 cases (14.0%), above 60 – 3 cases (6.0%).
5. Categorizing as per amount of consumption – less than 5 grams -10 cases (20.0%), 5 to 15 grams- 17 (34.0%) , 15 to 25 grams -20 cases (40.0%), more than 25 grams -3 cases (6.0%).
6. USG findings: Normal in 30 cases (60.0%), ascites seen in 20 cases (40.0 %).
7. 82 % of study subjects showed gastrointestinal discomfort.
8. 38% of study subjects showed melena.
9. Among subjects, 7 patients (14.0%) showed no encephalopathy, 21 patients (42.0%) showed stage 1 encephalopathy, 32.0% showed stage 2 encephalopathy, 12.0% showed stage 3 encephalopathy.
10. 38% patients were in shock during admission.
11. 38% patients were in tachycardia during admission.
12. 20% consumed less than 5 grams, 34.0% consumed 5 to 15 grams, 40% consumed 15 to 25 grams, 6.0% consumed more than 25 grams.
13. 98% patients consumed with suicidal intention.
14. 52 % patients were discharged without any complications while 36.0 % patients were discharged with complications. 12.0% patients expired.
15. 34.0% patients had findings suggestive ARDS in chest X ray.
16. 40.0% patients showed ascites in USG abdomen.
17. 24.0 % patients had need for mechanical ventilation.
18. 16.0% patients showed features of myocarditis.
CONCLUSION:
1. Male to female ratio is 1.2:1.
2. Majority of the patients were in 20 to 40 years of age group. Higher age doesn’t showed higher mortality as p value is 0.262 in pearson chi- square test.
3. No difference in mortality between male and female subjects with p value at 0.497.
4. Admission duration more than 15 days had higher mortality (17.6%) as compared to 10 to 15 days (8.0%), 5 to 10 days (12.5%) with p value of 0.012.
5. Persons who consumed more than 25 grams showed 66.7% mortality while people consumed 15 to 25 grams showed 20.0% mortality. All people consumed less than 15 grans recovered completely. P value is less than 0.0001 which clearly reveals that higher quantity is related to higher mortality.
6. Persons who were admitted after more than 24 hours showed 33.3% mortality while people admitted less than 15 to 25 grams showed 20.0% mortality. All admitted within 24 hours showed 5.6% mortality. P value is less than 0.02 which clearly reveals that higher time lapse is related to higher mortality.
7. Persons with stage 3 encephalopathy showed 50% mortality while persons with stage 2 encephalopathy showed 18.8% mortality. P value is <0.0001 which tells us that higher stage of encephalopathy is associated with higher mortality.
8. Half of the subjects in need of mechanical ventilation showed 50% mortality.
9. Patients who had myocarditis showed 5 times more mortality than patients without myocarditis with p value of 0.014.
LIMITATIONS OF THE STUDY:
• Long term effects of the poison was not assessed.
• The poison tube was not brought in most cases and the quantity of poison is a rough estimate given by the bystanders or the subject.
• In terms of treatment, all cases of yellow phosphorus poisoning are given N acetyl cysteine on admission, since being a tertiary care Centre, most cases referred from other peripheral and private hospitals and are admitted beyond 24 hours of consumption. Comparison between early and late
administration of N acetyl cysteine could not be done
To Study the Prevalence of Renal Involvement in Patients Receiving Tenofovir Containing Anti Retroviral Therapy
No full text• The Group distribution were PTD is 12.0%, CKD is 12.0%, WRF is 76.0%.
• The Age distribution were 21-30 years is 8.0%, 31-40 years is 21.3%, 41-50 years is 37.3%, 51-60 years is 17.3%, >60 years is 16.0%.
• The Gender distribution were Female is 46.7%, Male is 53.3%.
• The Gender between Groups by Fisher’s exact test were 1 2=0.047, p=0.977>0.05 which shows no statistical significance between Gender and Groups.
• The Age between Groups by Fisher’s exact test were 1 2=40.458, p=0.0005<0.01 which shows highly statistical significance between Age and Groups.
• The Age between Groups by using Oneway ANOVA were F-value=8.989, pvalue=0.0003<0.01, which shows highly statistical significance difference at p <0.01
level. Followed by Post Hoc Tests - Tukey HSD - Multiple Comparisons table shows Highly Significant at p 0.05 between Groups.
• The Duration between Groups by using Oneway ANOVA were F-value=2.514, p value =0.088>0.05, which shows statistical significance difference at p >0.05 level.
The CD 4 count between Groups by using Oneway ANOVA were F-value=24.601, pvalue=0.0005<0.01, which shows highly statistical significance difference at p <0.01 level, Followed by Post Hoc Tests – Tukey HSD - Multiple Comparisons table shows Highly Significant at p <0.01 and Statistical Significance at p < 0.05 between Groups.
• The Urea between Groups by using Oneway ANOVA were F-value=168.287, pvalue=0.0005<0.01, which shows highly statistical significance difference at p <0.01
level. Followed by Post Hoc Tests - Tukey HSD - Multiple Comparisons table shows Highly Significant at p < 0.01 between Groups.
• The Creatinine between Groups by using Oneway ANOVA were F-value=299.429, p-value=0.0005<0.01, which shows highly statistical significance difference at p<0.01 level. Followed by Post Hoc Tests - Tukey HSD - Multiple Comparisons table shows Highly Significant at p < 0.01 between Groups.
• The Sodium between Groups by using Oneway ANOVA were F-value=48.164, pvalue=0.0005<0.01, which shows highly statistical significance difference at p <0.01
level. Followed by Post Hoc Tests - Tukey HSD - Multiple Comparisons table shows Highly Significant at p < 0.01 between Groups. The Potassium between Groups by
using Oneway ANOVA were F-value=56.251, p-value=0.0005<0.01, which shows highly statistical significance difference at p <0.01 level. Followed by Post Hoc Tests - Tukey HSD - Multiple Comparisons table shows Highly Significant at p < 0.01 between Groups.
• The Bicarbonate between Groups by using Oneway ANOVA were F-value=840.992, p-value=0.0005<0.01, which shows highly statistical significance difference at p <0.01 level. Followed by Post Hoc Tests - Tukey HSD - Multiple Comparisons table shows Highly Significant at p <
0.01 and No Statistical Significance at p > 0.05 between Groups.
• The Calcium between Groups by using Oneway ANOVA were F-value=370.588, pvalue=0.0005<0.01, which shows highly statistical significance difference at p <0.01
level. Followed by Post Hoc Tests - Tukey HSD - Multiple Comparisons table shows Highly Significant at p <
0.01 and No Statistical Significance at p > 0.05 between Groups.
CONCLUSION:
• The Group distribution were PTD is 12.0%, CKD is 12.0%, WRF is 76.0%.
• The Age distribution were 21-30 years is 8.0%, 31-40 years is 21.3%, 41-50 years is 37.3%, 51-60 years is 17.3%, >60 years is 16.0%.
• The Gender distribution were Female is 46.7%, Male is 53.3%.
• The Gender between Groups by Fisher’s exact test were ꭓ2=0.047, p=0.977>0.05 which shows no statistical significance between Gender and Groups.
LIMITATIONS:
In our study only small number of patients (75) were involved and since it was a cross sectional study, the causal relationship could not be identified using a
cross sectional analysis.
Renal biopsy could not be done because of ethical problems