International Journal of Health and Clinical Research
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Clinical Profile, Serum Vitamin B12 Levels and Outcome of Children with Infantile Tremor Syndrome (ITS) and Correlation with Maternal Serum Vitamin B12 Levels
Get PDFBackground: Infantile tremor syndrome (ITS) is a tetrad of mental and motor changes, pigmentary disturbances of skin and hair, pallor and tremors. It was first described in 1957 by Dikshit from Hyderabad who named it as Nutritional dystrophy and Anaemia. Usually, cortical atrophy and calcification takes time to develop and ITS has been reported as early as 3 to 6 months of age. Objective: To compare vitamin B12 levels of ITS patients with non-ITS healthy infants of similar age group. Methodology: This study was a prospective study, conducted at department of paediatrics, medical college & S.S.G hospital, Vadodara, Gujarat over the period of 2 years. Children between the age 6 months to 2 years, admitted with their mothers in department of paediatrics diagnosed as ITS clinically based upon clinical features like pallor, delayed milestones, skin pigmentation, hair changes and with/without tremors. 30 controls were also taken in same age group with history of appropriate complementary feeding with normal development and no or mild anaemia and no malnutrition or PEM I/II. Results: Majority of the subjects had fever (86.7%) has a major clinical symptoms followed by Cough (80%) and delayed development milestone in 567% of the subjects. In the present study 56.7% of the children were exclusively breastfed and 43.3% had inadequate complimentary feeding practices. The levels of vitamin B 12 was compared with the case and control group, among the study group 93.3% of the subjects had low Vitamin B 12 level and in the control group 13.3% had low Vitamin B 12 levels. The Association between study subjects and vitamin B12 levels was found to be statistically significant. Among the case subjects with ITS only 2 children subjects had normal vitamin B12 and 28 had low vitamin B 12 levels. On comparing with vitamin B 12 levels of mother it was found that 83.45 of the subjects had low Vitamin B12 Levels and the association was also found to be statistically significant. Conclusion: mothers having strict vegetarian diet making themselves prone to vit B12 deficiency leading to low vit B12 serum levels in their exclusive breastfed or inadequately weaned infants. Upon supplementation of vit B12 general condition including tremors, pigmentary changes, anaemia improves as well as mental motor quotient improves. However, they were still lagging behind their normal counterparts, more so in mental scale
Evaluation of Serum Uric Levels in Nasopharyngeal Carcinoma: An Institutional Based Study
Get PDFBackground: Nasopharyngeal carcinoma (NPC) is one of the Epstein-Barr virus (EBV)-associated malignancies. The present study was conducted to assess serum uric acid levels in nasopharyngeal carcinoma.Materials and Methods: In the present study 80 pathologically diagnosed NPC patients free of distant metastasis were enrolled in this retrospective study. The study included a total of 160 subjects, 80 patients with NPC in the experimental group and 80 patients in control group. Two milliliters of intravenous blood were taken from all participants after an overnight fast. The blood was centrifuged at 3000 rpm for 5 min and separated serum was aspirated into tubes and analyzed for uric acid using the reagent kit and BTS 350 Semi-Auto analyzer. Tabulation of the results was carried out for both groups. For all tests, P values ≤ 0.05 were utilized for statistical significance.Results: The study included a total of 160 subjects, 80 patients with NPC in the experimental group and 80 patients in control group. The mean age among study group was 54.8 years and that of the control group was 53.65 years. In study group 56.25% were males and in control group 52.5% were males. Malees were in predominance. In the study group, out of 80 patients, 37.5% patients had low serum uric acid levels (<3 mg/dl), 56.25patients had normal serum uric acid levels (3–6 mg/dl) and 6.25%patients had high serum uric acid levels (>6 mg/dl). Among 80 subjects in control group, 10% subjects had low serum uric acid levels (<3 mg/dl), 30.0% subjects had normal serum uric acid levels (3–6 mg/dl), and 60% subjects had high serum uric acid levels (>6 mg/dl). The distribution of serum uric acid levels among the study group and the control group showed statistically very high significance (P < 0.001)Conclusion: The present study concluded that serum uric acid was lower in nasopharyngeal carcinoma patients compared with healthy volunteers and low serum uric acid was associated with increased risk of nasopharyngeal carcinoma development
Choice of either anaesthesia technique for caesarean section
Get PDFAim: To compare the hemodynamics and duration of analgesia using fractionated / bolus dose of bupivacaine with fentanyl for spinal anaesthesia (SA) in patients undergoing elective caesarean section (CS). Method: Comparative, interventional randomized study in tertiary care hospital in Delhi, India for a period of 12 months (1st January 2019 till 31st December 2019). 204 female antenatal patients of Indian origin between age 18 to 40 years were studied. Bolus group (Group B) patients received intrathecal injection of 0.5% hyperbaric bupivacaine with fentanyl (10mcg) as single bolus dose. Fractionated group (group F) patients received intrathecal injection of 0.5% hyperbaric bupivacaine with fentanyl (10 mcg) with an initial bolus equal to two-third of the calculated volume and remaining volume injected after 90 seconds. Both groups received doses according to Harten’s chart. The groups were compared in terms of maternal hemodynamics, duration of analgesia, sensory and motor block level. Results: Group F patients were noted to have a better haemodynamic profile, both in terms of blood pressure (p<0.001) and heart rate, though not statistically significant (p=0.08). Time taken to reach sensory level T5 was higher in group F, while time taken for motor block was lower in group F (p<0.05). Time for providing rescue analgesia was lower in group B making duration of analgesia lower in bolus group (p<0.05). Conclusions: Fractionated dose of local anaesthesia in subarachnoid block can give better hemodynamic stability, produce quicker onset and later regression of both sensory and motor block along with prolonged duration of analgesia. Trial Registration: CTRI No. CTRI/2019/07/020121
Study of self-drug administration among MBBS professional medical students
Get PDFBackground: Self-medication involves obtaining medicines using old prescriptions to purchase medicines or without a prescription, sharing medicines among each other or using leftover medicines from previous illness. The present study was conducted to assess self-drug administration among MBBS professional medical students. Material and methods: The study was conducted among 130 students from first, second and final year MBBS. All selected students were asked o fill the details of questionnaire. The questionnaire was in two parts. The first part contained questions on demographic information. Socio-economic variables were covered in second part of questionnaire. The data were recorded in MS excel and analyzed using Graph pad prism version 6. Results: In the present study total participants were 130 in which, 56.15% were male and 43.84% were female. In first year 65.90% were male and 34.09% were female, while in second 46.93% were male and 53.06% were female. Likewise in final year 56.15% and 43.84% were male and female respectively. Maximum participants were of age group 18-20 yrs(43.84%). In first and second year maximum participants were of age group 18-20yrs. In final year maximum participants were of age group 24-26yrs. Likewise in final year 56.15% and 43.84% were male and female respectively. Maximum students takes self-medication for headache all groups. Maximum students takes Tablet paracetamol as self-medication. Conclusion: The present study concluded that Self-medication had been widely practiced among medical students
Application of Six Sigma tool as Quality Indicator for evaluation of analytical phase of sample processing
Get PDFIntroduction:In a Clinical Biochemistry Laboratory (CBL), the measures used to assess the QC are Internal QC (IQC) and EQAS. For Quality assessment in an objective and quantitative manner, sigma metrics have been used. Higher Sigma metric values represents few analytical; i.e. 3.4 defects per million opportunities. Based on the sigma metrics, appropriate QC rules are applied. The present study intends to evaluate the performance of Analytic phase of testing at Laboratory Services, GMERS Medical College & General Hospital Vadnagar in terms of Sigma metrics, and Quality Goal index for routine biochemical parameters.Material Method:We calculated (A) Sigma (σ) value and (B) Quality goal Index of 14 parameter. Sigma metrics were calculated using Total allowable goals as per i) Clinical Laboratory Improvement Amendments (CLIA) guidelines from US(2019) and ii) the biological variation database specifications. Microsoft Excel spreadsheet version 2016 was used for statistical analysis. Bias, CV, QGI and sigma metrics were calculated using the above formulae. Bias and CV were presented as percentages.Result:For 2 parameters; Urea and ALT sigma metrics was more than 6, which is a marker of world class quality. The lower performance of Total Bilirubin, Creatine, Cholesterol, HDL, Uric acid, Total Protein, Albumin in was however attributable to both lack of accuracy while for IQC norm and path.Conclusion:Sigma metrics is an excellent self-assessment tool for performance analysis of various test parameters in the laboratory. On applying the same to our routine biochemistry laboratory at Laboratory Services
Prevalence of gestational diabetes mellitus among women attending antenatal clinic of a teaching hospital
Get PDFIntroduction: India is the diabetes capital of the world with 41 million Indians having diabetes. Every fifth diabetic in the world is an Indian. Hence relatively pregnant population is at greater risk for developing diabetes in India and the prevalence is as high as 16.55%. Materials and methods: Study design - Retrospective hospital based study was conducted at Department of General Medicine, Maheshwara Medical College & Hospital, Patancheru, Medak District, Telangana. Total of 270 pregnant women who had attended the Antenatal Clinic of a teaching hospital during the period of 3 months (January to March, 2021). Data was obtained from hospital records. Diagnosis of GDM was made according to WHO guidelines. All the pregnant women had undergone oral glucose tolerance test at 24 - 28 weeks of gestation. Blood samples obtained after 8 hours of overnight fast and 1 and 2 hours after 75 g oral glucose load. The diagnosis of GDM was made when any of the following plasma glucose values exceeded: fasting ≥ 92 mg/dL, 1 hour ≥ 180 mg/dL and 2 hours ≥ 153 mg/dL. Results: Total of 270 pregnant women were registered and screened for GDM as per records. Of these 270 cases, GDM was detected in 32 antenatal women. Among the antenatal women, maternal complications were seen in 14 (43.8%) of those with GDM and 126 (52.9%) of those without GDM. Statistically, there was no association between GDM and maternal complications. Of 32 cases of GDM 10 (31.25%) cases had normal delivery, while 22 (68.75%) underwent LSCS. Conclusion: Among the 270 women, 32 (11.9%) had GDM. Prevalence of GDM was more in the age group of 25 - 31 yrs. and among multigravidae. This gives an insight into groups, which require more attention in terms of screening. Out of 32 cases of GDM, majority underwent LSCS. Of the neonates born to these mothers only 2 was preterm, 2 had low birth weight and neonatal complications were seen in 12 of them. The impact of GDM is emphasized by these findings
A prospective analytical study on epidemiology and management of incisional hernia
Get PDFIntroduction: A hernia is the protrusion of viscous or a part of viscous through a normal or abnormal opening in the wall of its containing cavity. A ventral hernia is any hernia protruding through the abdominal wall, while Incisional hernia (IH) is a hernia protruding through an operational scar. According to the various studies abdominal surgeries have 11% to 19% chance of developing IH. Materials and Methods: The study is a prospective study and study group was patients admitted and operated in Bidar Institute of Medical Science, Bidar Karnataka from April 2019 to December 2020. Total 75 cases of various types of hernias operated. Out of 30 cases of incisional hernias were included in this group for study. In this series patients admitted in surgical wards under all surgical units were examined to assess the abdominal wall defects, etiological and predisposing factors. A detailed case history and thorough clinical examination was done to determine the type and cause of hernia and necessary investigations were done according to proforma. After detailed physical examination of patients, clinical diagnosis was established including the associated etiological and predisposing factors. Results: During the period of our study, a total of 75 patients have been operated for various types of hernia, out of these 30 cases were incisional hernia. Inguinal hernia was most common type accounting for 42.66%, next common hernia was incisional hernia (40%) remaining rare type of hernias constituting 17.34% of total cases studied. Maximum number of cases in middle age group (30-60 yrs.) constituting 80%. Incisional hernia was found to be more common in females with male female ratio of 1:2.3. Conclusion: Mesh repair results in less recurrence than anatomical repair for incisional hernia. The incidence of incisional hernia is more common in women than men due to abdominal wall weakness secondary to multiple pregnancies, increased number of caesarean sections and gynaecological surgeries. Sterile aseptic technique and appropriate use of pre-operative antibiotics is necessary to reduce the occurrence of incisional hernia
Psychological impact of COVID-19 on health care workers
Get PDFBackground: Entire world witnessed unusual situations during COVID-19 pandemic. Along with physical health, mental health was also recognized at stake due to uncertainty, fear and lack of knowledge. When general population was advised to stay at home, health workers were required to serve sick by stepping out of their homes. This added mental pressure on them. Hence it was desired to assess psychological impact on health care workers who had been posted at COVID-19 outdoor and indoor centres. Methodology: An online survey was conducted on medical and paramedical staff of a tertiary health care centre. Impact of Event– Revised (IES-R) Scale was applied to measure mild, moderate or severe psychological impact. Stress coping behavior scale was used to assess coping strategies of study participants. Epi Info software version 7.2.2.6 was used for statistical analysis. Result: 249 eligible staff participated in current study after applying inclusion and exclusion criteria. Various grades of psychological impact (IES-R score more than 23) were seen in 35.34% of study participants. Younger age and female gender were significantly associated with presence of psychological impact. Use of adaptive coping strategy was more than maladaptive strategies. Conclusion: Psychological impact was observed in about one third of participated health workers which is quite high as compared to general population. As female health workers showed significantly higher impact than males, they need more psychological support. Mental health needs equal attention in current pandemic especially among health workers
Ovarian tissue cryopreservation as an option for fertility preservation in young unmarried girls suffering from cancer
Get PDFIn the present society, women in the reproductive age group delay their marriages, due to various social and economic reasons and the age of bearing their first child also gets delayed. It is well known fact that women steadily lose their oocytes from birth to menopause. Moreover, if the woman develops some kind of malignancy in due course, it leads to infertility due to unwanted gonadotoxic side effects of cytotoxic chemotherapeutic drugs and/or radiotherapy. Although survival in case of malignancy takes utmost priority, infertility also is an issue of prime concern which haunts such patients. In such patients ovarian tissue cryopreservation remains one of the methods of fertility preservation. This method has the advantage of requiring neither the sperm donor nor the ovarian stimulation as both these requirements presents ethical and social issues for an unmarried girl. In young unmarried girls suffering from malignancy, where IVF-ET (In Vitro-Fertilization-Embryo Transfer) is contraindicated, ovarian tissue cryopreservation and transplantation could become the technique of choice in the future
Variable presentations of Vitamin B12 deficiency in Eastern India: A Case Series
Get PDFVitamin B12 deficiency causes anemia with other hematological, neurological and systemic manifestations. Skin manifestations may also occur due to dietary deficiency in vegeterians. Acral hyperpigmentation occurring in distal parts of upper and lower limbs must be differentiated from Addison’s disease and vascular occlusion. The cases presented here showed acral hyperpigmentation( Case 1 and 3) which reversed following vitamin B12 therapy and the patient recovered. Case 2 showed anemia and symptoms reversing after vitamin B12 replacement. Leukopenia also reversed in case 3 following therapy.The importance of the case series lies in the fact that vitamin B12 deficiency may present not only with anemia and neurological manifestations, but also as acralhyperpigmentation which reverses following treatment