International Journal of Health and Clinical Research
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Hysterolaproscopy As A Diagnostic And Therapeutic Tool In Female Infertility
Get PDFBackround: Hysterolaparoscopy is very effective tool because the uterus, tubes, adnexa, peritoneum, uterine cavity and tubal pathway can be assessed in one sitting and if required therapeutic intervention like ovarian drilling, septal resection, tubal cannulation etc can be done in same sitting. Keeping this in view present study was designed to assess the role of hysterolaparoscopy in evaluation of female infertility. Aim: To determine the role of hysterolaparoscopy in diagnosis and management of primary & secondary infertility. Materials and Methods: It is a retrospective observational study conducted at Alluri Sitaramaraju Medical College and Hosptial, Eluru from August 2020 to August 2021.The present study group consists of 80 patients with age group of (20- 40) years attending infertility OPD at Asram Hospital. Results: Out of 80 subjects, 16 lost to follow up and 14 presented with normal Hysterolaparoscopy findings .Among the remaining ones 10(12.5%) patients conceived spontaneously after hysterolaproscopy.16(20%) patients conceived on ovulation induction, 08 (10%) patients conceived after intrauterine insemination, 06(7.5%) patients after intracytoplasmic sperm injection(ICSI) and 06 (7.5%)patients conceived after in vitro fertilization,4 (5%) patients did not conceive. Conclusion: PCOD is the commonest cause for infertility followed by endometriosis and tubal factor. Diagnostic hysterolaparoscopy is the best procedure to assess almost all possible structural pathologies. Laparoscopy has better role than ultrasonography in diagnosing endometriosis and pelvic adhesions. The diagnosis and operative procedure for treatment can beaccomplished in same sitting.Thus, hysterolaproscopy remains gold standard procedure for evaluation of female infertility and before planning further management
Septic complications in perforation peritonitis: microflora and search for therapia sterilisans Magna
Get PDFObjective: This study was conducted to determine the etiology, anatomical site of perforation and the suitable empirical antibiotic in our region which decreases the bacterial load effectively and to decrease the morbidity associated with infectious complications in patients with peritonitis secondary to gut perforation. Methods: This study was a prospective study conducted for a period of one year. Patients who were fulfilled the inclusion criteria with peritonitis due to gut perforations and operated in our institute were included in this study. Data regarding patient demography, associated co-morbidities and relevant history were recorded. Duration of hospitalization, wound infection, wound dehiscence, anastomotic leak, re do surgeries and number of patients died after surgery were documented. Antimicrobial susceptibility testing was done by Kirby-Bauer disk diffusion method. Antibiotics were changed as per clinical progress of the patient and as per culture and sensitivity report. Results: Perforations were mostly ileal (38%) followed by duodenal (29%).Common etiology being peptic ulcer disease (38.7%) and typhoid fever (22.5%). Peptic ulcer perforations were managed by Graham patch omentopexy in 24 (38.6 %) cases, small bowel perforations by only stoma in 18 (29 %), primary repair 6 (9.6 %) cases and resection and anastomosis done in 8 (12.9%) who presented with multiple small bowel perforation. Appendicectomy was done in 6 (9.6%) cases.Sensitivity to Cefaperazone was about 66 % in E. Coli isolates while 75% for Ceftazidime while for Klebsiella 60% and 80% resperctively. Meropenam was sensitive in all the isolates of Staphyloccus, Streptococcus, Pseudomonas and Proteus while cefaperazone was sensitive only in 50 % of the cases. Piperacillin + Tazobactum were sensitive in all the isolates of Stryptococcus, Pseudomonas and Proteus. The sensitivity of Amoxicillin+ Clavulinic acid, Ceftriaxone, Aminoglycosides and Fluoroquinolones were very low. Conclusion: Most common organisms cultured from peritoneal fluid were E. coli and Klebsiella. Piperacillin + Tazobactum and Carbepenam were sensitive in most of the isolates and might be started in patients with perforation peritonitis as a empirical antibiotic therap
A study to evaluate desarda vs lichtenstein technique for the treatment of primary inguinal hernia
Get PDFBackground: Inguinal hernias rank among the commonest of all hernias and surgery is the only definitive treatment. The present study was conducted to evaluate desarda vs lichtenstein technique for the treatment of primary inguinal hernia. Material and methods: This prospective, observational study was conducted to evaluate desarda vs lichtenstein technique for the treatment of primary inguinal hernia. The study includes 60 patients of primary inguinal hernia. The patients were divided into two equal groups (30 patients for each group): Lichtenstein mesh-based repair (A group) or Desarda tissue-based repair (B group). Statistical analyses were done by using SPSS 22.0 (Statistical Package for the Social Sciences by SPSS Inc., Chicago, 1L, USA, 2017). Results: The study includes 60 patients of primary inguinal hernia. The patients were divided into two equal groups (30 patients for each group): Lichtenstein mesh-based repair or Desarda tissue-based repair. The mean operating time required for repair was more in Lichtenstein mesh-based repair (36.45min) while time taken by Desarda tissue-based repair was less(20.58min). Post-operative pain was assessed by visual analogue scale (VAS). The mean pain score at 1st POD in Lichtenstein mesh-based repair was 5.01and 2.56 in Desarda tissue-based repair. The mean pain score at 3rd POD in Lichtenstein mesh-based repair was 3.45 and 2.21 in Desarda tissue-based repair. Seroma occur in 10% patients in Lichtenstein mesh-based repair and in 6.66% patients in Desarda tissue-based repair. Testicular/cord odema occur in 13.33% patients in Lichtenstein mesh-based repair and in 6.66% patients in Desarda tissue-based repair. Minor SSI occurs in 6.66% patients in Lichtenstein mesh-based repair and in 3.33% patients in Desarda tissue-based repair. Foreign body sensation occurs in 7% patients in Lichtenstein mesh-based repair and in 0% patients in Desarda tissue-based repair. Chronic pain occurs in 13.33% patients in Lichtenstein mesh-based repair and in 6.66% patients in Desarda tissue-based repair. Conclusion: The present study concluded that mean operating time required for repair, post-operative pain score, post operative complications were less in Desarda tissue-based repair
Effects of Intravenously Administered Dexmedetomidine and Clonidine on Haemodynamic Response and Post Operative Analgesia in Laparoscopic Surgery: An Observational Study
Get PDFIntroduction: Laparoscopic surgery is become the normal now due to its advantages. To counter its disadvantages on haemodynamics, α-2 receptor agonists clonidine and dexmedetomidine are increasingly being used during laparoscopic procedures. Aim: To compare the haemodynamic response, perioperative analgesia, and sedative effects of intravenous dexmedetomidine versus intravenous clonidine given as premedication among patients receiving general anaesthesia for elective laparoscopic surgeries. Materials and methods: The study was an observational, prospective, comparative study in which Group D was given Injection dexmedetomidine 1 μ/kg in 100 ml of normal saline intravenously and Group C was given Injection clonidine 2μ/kg in 100ml of normal saline intravenously before induction of general anaesthesia. Results: Data was calculated as mean, median, and standard deviation. Any statistical difference between the two proportions was estimated using the Chi-square test and any statistical difference between had better hemodynamic control and post-operative analgesia. Both dexmedetomidine and clonidine attenuated the cardiovascular and pressor response to intubation. Dexmedetomidine caused deeper sedation and better analgesia in comparison to clonidine. Conclusion: Alpha 2 agonist dexmedetomidine and clonidine provide haemodynamic stability among patients undergoing laparoscopic surgery. Dexmedetomidine provided much better cardiovascular stability and superior analgesia
Adverse drug reactions associated with Antiasthmatics among children: A Prospective study
Get PDFBackground: Childhood asthma can cause bothersome daily symptoms that interfere with play, sports, school and sleep. In some children, unmanaged asthma can cause dangerous asthma attacks. The condition is a leading cause of emergency department visits, hospitalizations and missed school days. Anti-asthmatic drugs used in children may result in a beneficial and adverse drug reactions (ADR) and could contribute significantly to morbidity and mortality. Material and Methods: This is a Prospective and single centre study of children who presented to the Department of Paediatrics, Gayatri Vidya Parishad Institute of Health Care and Medical Technology over a period of 1 year. Paediatric patients of bronchial asthma (both acute and chronic cases) of either gender within the age limit of 1-13 years who attended outpatient department (OPD) as well as in patient department (IPD) were included in the study. Results: During the study period, a total of 19 ADRs were reported among 90 patients. The incidence rate of ADRs was found to be 21.1%. Our study revealed that out of 19 reported cases of ADR, 12 (13.3 %) occurred in males and 7 (7.7%) in females. The most commonly reported ADRs were 5.5% of Anorexia followed by 4.4% of palpitation, 3.3% of dryness of mouth and Headache, and least were 1.1% of oral candidiasis and nausea/vomiting. On causality assessment by WHO-UMC method, it was observed that 1 (1.1%) were certain, 7 (7.7%) were probable and maximum 11 (12.2%) was possible ADR. Assessment of severity of recorded adverse drug reactions with the help of Hartwig and Siegel scale showed that 12 (13.3%) accounted for mild reactions and 7 (7.7 %) were moderate reactions. No severe ADR were recorded during the study period. Conclusion: As compared to adults, ADRs in children can have a relatively more severe effect. Adverse drug reactions associated with anti-asthmatic drugs are quite common. This study highlights the incidence and pattern of ADRs associated with pharmacotherapy of pediatric bronchial asthma
Evaluation of lung and mediastinal masses by computed tomography with histopathological correlation
Get PDFAim: To study the computed tomographic characteristics of Lung and Mediastinal masses in plain and contrast enhanced scans. Material and methods: A total of 50 cases were used in this study to assess the efficacy of computed tomography in the diagnosis of lung and mediastinal diseases. Before the CT scan, a thorough clinical history and examination were performed. The distribution, CT features of the lung and mediastinal mass, as well as the involvement of adjoining tissues, were all assessed in all cases sent for CT. Results: The maximum number of cases occurred above 60th decade. Lung and Mediastinal lesions occurred more commonly in males. In this study among mediastinal masses, the anterior mediastinum was the most common compartment to be involved with 41% involvement followed by superior mediastinum (25%) and then middle and posterior mediastinum (16.6% each) and lung mass was found in upper lobe of left lung (42%) followed by upper lobe of right lung (31%) and then lower lobes of both lungs (23%). Neurogenic tumors, metastatic lymphadenopathy, teratoma were the most common lesions in posterior, middle and anterior mediastinum respectively. Cough was the most common presenting symptom (86% of cases). The CECT diagnosis of lung and mediastinal masses corroborate with histopathology in 45 cases (90%). Conclusion: In terms of the distribution pattern, benign and malignant characterization, and mass effect on surrounding structures, computed tomography played an important role in the evaluation of a lung and mediastinal masses
Clinicocytological and Histopathological Comparision of Palpable Breast Masses in and around Jabalpur
Get PDFIntroduction: Breast lesions are a heterogeneous group of disorders ranging from inflammatory lesions to invasive cancers.1 Diseases of the breast are showing a rising trend worldwide; from 1.05 million in 2000 to 2.08 million in 2018, the cases of breast cancer almost doubled up in 8 years.2 At of the end of 2020, there were 7.8 million women alive who were diagnosed with breast cancer in the past 5 years, making it the world’s most prevalent cancer. The accuracy of diagnosis can be increased by a combination of preoperative tests (like physical examination, mammography, fine-needle aspiration cytology, and core needle biopsy). These modalities are more accurate, reliable, and acceptable when compared with a single adopted diagnostic procedure despite of having their own technical limitations.3 Fine needle aspiration cytology (FNAC) is a relatively safe, quick, easy and a cheap diagnostic tool to decipher the benign or the malignant nature of the swelling. based on NHSBSP of Britain cytology was subclassified into 5 categories C1- C5. This study was conducted to document the spectrum of breast lesions encountered in a tertiary care centre in FNAC and sub classify them. Materials and Methods: A total of 90 cases of breast lesions which were referred for FNAC to the Department of Pathology, were evaluated. All of these patients presented with palpable swelling and a clinico- cytological and histological correlation was done. FNACs were performed and both air dried and alcohol-fixed smears were prepared and stained with haematoxylin and eosin. The adequacy of the diagnostic material and the results of FNAC were reported. Results: Out of the total of 90 cases of breast lesions on which FNAC were done and evaluated, there were 92 females and 3 males. The clinical diagnoses were confirmed by cytology. Fibroadenoma (60.32%) was the most common benign cytological diagnosis followed by fibrocystic disease (6.35%) and ductal carcinoma (62.96%) was the most common diagnosis in malignant category. FNAC was false negative in six cases; 01 case was fibrotic tissue; two cases were diagnosed as fibro adenosis and 3 cases were diagnosed as of carcinoma. The sensitivity, specificity, PPV , NPV and diagnostic accuracy of FNAC in diagnosing benign breast lesions were 98.41% ,85.19%, 93.94% ,95.83 % and 94.44% respectively while the sensitivity, specificity, PPV , NPV and diagnostic accuracy of FNAC in diagnosing malignant breast lesions were 85.19 % ,98.41%, 95.83% ,93.94 % and 94.44%.Conclusion: FNAC is rapid, accurate, minimally invasive, outpatient-based procedure and helps in diagnosis of benign and malignant breast lesions and involvement in experienced pathologist chances of false results are less
Detection of Metallo Beta Lactamase Production in Gram-Negative Bacilli Isolated in A Tertiary Care Hospital of Bihar
Get PDFIntroduction: This study was designed to generate updated information on the burden of metallo-beta-lactamase producing Gram negative bacteria from a tertiary care hospital of Bihar so that an effective antimicrobial stewardship policy can be formulated and implemented to circumvent the rising threat of antimicrobial resistance. Methodology: The prospective study was conducted at Jawahar Lal Nehru Medical College, Bhagalpur, Bihar from August 2020 January 2021 to assess the prevalence of metallo-beta-lactamase production. A total of 500 different clinical samples from patients of all age groups received in the microbiology laboratory for routine examination and culture, during the study period of six months were included in the study. All the sample specimens were processed by standard microbiological operating procedure for isolation and identification of microorganisms. Antibiotic susceptibility test of all the clinical isolates to antibiotics from various categories (supplier: Hi media Laboratory Limited, Mumbai, India) was performed by Kirby-Bauer disk diffusion method and interpretation of the results was made in compliance with CLSI guidelines. We considered the isolates resistant to at least three classes of first-line antimicrobial agents as the MDR strains. Result: Out of 500 samples ,15.2% of the samples showed growth. Out of these 76 growth positive samples, a little more than half, 56.5% were Gram-negative isolates with E. coli being the most prevalent. Out of the total 43 Gram negative isolates, 26 (60.5%) samples were from the outdoor patients (OPD) and the remaining samples were from the indoor (hospital admitted) patients. MBL was detected in 3 (6.9%) of the culture positive Gram-negative bacteria. Out of the 43 Gram negative bacterial isolates tested, majority of the Enterobacteriaceae members were found to be resistant to ceftazidime. Among the ceftazidime resistant Enterobacteriaceae members, the most effective antibiotics was nitrofurantoin followed by amikacin. All the ceftazidime resistant Enterobacteriaceae members were also resistant to ampicillin. Conclusion: antimicrobial resistance is a growing threat worldwide with increasing resistance to third generation cephalosporins becoming a cause of concern among Enterobacteriaceae; early detection and infection control practices are the best defense against these organisms
Ectopic Pregnancy: A study of epidemiology, diagnosis and management
Get PDFAims: The study was done to analyze the epidemiology, diagnosis and treatment aspect of patients with ectopic pregnancy. Methods: This was a prospective study of patients with ectopic pregnancy who received treatment. The data of all patients admitted during this period with the diagnosis of ectopic pregnancy were collected. Data on age, parity, risk factors, diagnostic methods, treatment, operative findings, etc. were analyzed. Results: There were 61 cases of ectopic pregnancy with the hospital incidence of 1.46%. Highest number of patients 20 (32.79%) were in the age range of 28-32 years. Most of the patients were nullipara 22 (36.06%) or with parity two 20 (32.79%). Some risk factors were found in 29 (47.54%) cases. The commonest risk factor was pelvic inflammatory disease in 12 (19.67%). All presented with pain abdomen, 48 (78.68%) had per vaginal bleeding, 17 (27.87%) presented in shock. Cervical excitation was present in 38 (62.29%). Urine for pregnancy test was positive in all and 37 (60.66%) had ultrasonography. Ten (16.39%) patients underwent emergency laparoscopic surgery and 40 (65.57%) had emergency laparotomy. Salpingectomy was required in 53 (86.89%) cases. The average hospital stay was 5 days. Conclusions: The study showed that ectopic pregnancy could occur at any reproductive age without obvious risk factors. Although not all patients gave history of amenorrhoea, pain abdomen was present in all
Seroprevalence of Transfusion Transmitted Infections Amongst Blood Donors in Muzaffarnagar–A Study in a Tertiary Care Centre from Western Uttar Pradesh
Get PDFIntroduction - A transfusion transmitted infection (TTI) is caused by virus, parasite or other pathogen and can be transmitted to a recipient via transfusion of the infected donated blood. TTI includes mainly Human Immunodeficiency Virus, Hepatitis B Virus, Hepatitis C Virus, Syphilis and Malaria. Blood transfusion is crucial component in the treatment of various diseases. Major concern is the asymptomatic stage in which infection can be transmitted to the recipient. To minimize this, Donor deferral criteria has been established and implemented.Objective - Objective of this study was to estimate the seroprevalence of TTI in the tertiary care hospital of western Uttar Pradesh.Materials and Methods – The present hospital based cross- sectional study was conducted in the Blood Bank, Department of Pathology, Muzaffarnagar Medical College, Muzaffarnagar from May 2019 to April 2020. During this period, 2887 blood units were screened.Results – Seroprevalence of HIV, HBV, HCV and Syphilis was observed to be 0.13%, 1.73%, 2.14% and 0.69% respectively. Seroprevalence for Malaria was nil as no donor was tested positive for Malaria. Majority of the donors were males forming male female ratio of 61.7 : 1 and belonged to the 2nd and 3rd decade. Seroprevalence of TTI was higher in replacement donors than the voluntary donors but this is not statistically significant.Conclusion- Screening of the blood products is essential to decrease the risk of TTI. Promotion of voluntary blood donation and discouragement of professional blood donation are also helpful