International Journal of Health and Clinical Research
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A study on treatment profile and covariates of outcome of burn injury in a Tertiary Medical hospital in West Bengal
Get PDFBackground: Burns are a global public health problem due to its high mortality, morbidity and disability amongst young and middle-aged adults. Objective: The study was planned to understand of relevant underlying factors responsible for burn injuries, the treatment profile and covariates of outcome of burn injury. Method: A cross-sectional design and hospital based study was undertaken in the burn wards under the Department of Plastic Surgery in a tertiary care government hospital over a period of one year from 1st May 2020 to 30th April 2021 on patients of recent burn injuries. Data entry and statistical analysis were done using SPSS version 20.0. Descriptive statistics (frequency, percentage, mean and standard deviation) were used primarily to summarize and for analytical statistics, Chi-square was used. Univariate and multivariate logistic regression were applied and Odd’s ratio(OR) and adjusted Odd’s ratio (AOR) were calculated in 95 % confidence interval. Result: Only 22.8% patients reached hospital within 1 hour of the injury event. Application of medical ointment over the burnt skin surface was done for around one fourth (23.6%) of the study population prior to reach hospital. Mean duration of hospital stay was 40.5 days which ranged from less than 1 day to maximum 196 days. Wound infection (44.7%) followed by septicaemia (33.7%) were the two most common complications prevalent among the study population. Pseudomonas aeruginosa (38.3%) was the most common organism responsible for wound infection. Conclusion: The current study also found very poor outcome related to burn injuries in terms of survival (mortality rate: 39.5%), which is not related to the severity of injury only but others factors like delaying in hospitalisation, improper pre-hospital burn care is also responsible for high fatal outcome associated with burn injury
In vitro antifungal susceptibility testing of ocular filamentous fungal pathogens isolated from keratitis cases
Get PDFBackground: A variety of fungal species are known to cause keratitis. Filamentous fungi are often predominant cause of keratitis. As fungi belonging to different group usually differ in their pattern of susceptibility to antifungal agents commonly prescribed for mycotic keratitis, in vitro susceptibility testing usually guide ophthalmologists for selection of most appropriate agent from available antifungal armamentarium. The present study was conducted in a tertiary care teaching hospital with an aim to study antifungal susceptibility profile of ocular filamentous fungi. Material and Methods: Filamentous fungi were identified on the basis of macroscopic features of colony and microscopic characteristics. Antifungal susceptibility was performed exactly as per the methodology outlined in the Clinical and Laboratory Standards Institute (CLSI) M38-A2 document for antifungal susceptibility testing of filamentous fungi. Results: Among fungal isolates, 72 (77.4%) isolates were filamentous fungi whereas 21(22.6%) were yeasts. Fusarium spp. (43.1%) and Aspergillus spp. (29.2%) were common filamentous fungi isolated from keratitis cases. All filamentous fungi isolated from keratitis cases were susceptible to amphotericin B. Aspergillus spp. and Bipolaris spp. were resistant to natamycin. Conclusion: As inter and/or intra species variation in susceptibility to commonly used antifungal drugs do occur in ocular filamentous fungal pathogens, the present study highlights the importance of antifungal susceptibility testing of each and every isolate from mycotic keratitis cases
Descriptive Study of the Clinico Etiological Patterns of Stasis Dermatitis in Railway Employees Attending Tertiary Care Hospital
Get PDFBackground: Stasis dermatitis is a common chronic inflammatory disease of skin that occurs on the lower extremities due to chronic venous insufficiency and may be a precursor to various skin changes like eczema, venous ulceration and rarely lipodermatosclerosis. This study was done in exclusively railway workers whose occupation demands prolonged standing/sitting/actively moving to assess the clinico-etiological patterns and evaluate the demographic profile of Stasis dermatitis. Objective: To assess Clinico etiological patterns and demographic profile of stasis dermatitis. Materials and Methods: This is an Prospective observational study conducted in Tertiary care hospital for duration of six months. First 100 patients attending Dermatology outpatient department of age more than 20years with clinical features of stasis dermatitis are selected for the study. Results: Among 100 patients, 79(79%) were male and 21(21%) were female patients with male-to-female ratio of 4: 1 and mean age of incidence was found to be 40 years. The most common risk factor was found to be prolonged standing (76%) and most of the patients had complaints of itching (90%). Perforator vein incompetence was found in 36 % of patients. Conclusion: Our study highlights the significant association between venous skin changes and various risk factors. The present study proves the importance of other risk factors like prolonged standing, obesity in producing varicosities, eczematous skin changes. Many patients with chronic venous insufficiency present to dermatology department very late with skin changes of lipodermatosclerosis and venous ulcer. Hence, to identify the high-risk patients at very starting stage is important to avoid disease complications
A Study On Urinary Tract Infections Among Pregnant Women Attending Antenatal Clinic Of A Tertiary Care Center Of Bihar
Get PDFIntroduction: UTI has been reported among 20% of the pregnant women and it is the most common cause of admission in obstetrical wards. Urinary tract infection in pregnancy is associated with significant morbidity for both mother and baby. The combination of mechanical, hormonal and physiologic changes during pregnancy contributes to significant changes in the urinary tract, which has a profound impact on the acquisition and natural history of bacteriuria during pregnancy. Methodology: This study was carried out in the Dept. of Microbiology, Shri Krishna Medical College & Hospital, Muzaffarpur, Bihar. Prior ethical approval was obtained from the Institutional Ethics Committee. The urinary pathogens and their antibiotic susceptibility patterns from December 2020 to November 2021 were recorded for this study. Clean catch midstream urine sample was collected in sterile container from pregnant women from the antenatal clinic. Bacterial identification was done by colony morphology, Gram staining and standard biochemical tests. Antibiotic susceptibility testing was done by Kirby Bauer disk diffusion method as per CLSI guidelines. Descriptive statistics was used to analyze the data and results expressed as percentages. Results: A total of 240 urine samples were received from pregnant women and processed in Microbiology laboratory during the study period. Among 240 samples, 95 (39.6%) samples yielded significant bacterial growth. E.coli was isolated as predominant pathogen followed by Staphylococcus aureus. Only 29 (10.1%) isolates of E.coli were sensitive to ampicillin and 14 (73.7 %) were sensitive to nitrofurantoin. Conclusion: All pregnant women should be screened for UTI with a urine culture and treated with antibiotics if the culture is positive. The early diagnosis and treatment of UTI during pregnancy can prevent complications to the mother and the fetus
Perinatal and maternal outcome in post-dated pregnancy: A retrospective study
Get PDFBackground: Prolonged pregnancy or post-dated pregnancy is that pregnancy which has exceeded duration considered to be upper limit of normal pregnancy that is above 40 completed weeks or 280 days from the first day of last menstrual period. The objective was to evaluate the maternal and perinatal outcome of post-dated pregnancy. Materials and method: This is a retrospective observational study done in 1ST Jan 2020 and to 31st December 2020 in the Department of Obstetrics and Gynaecology in Mahatma Gandhi Medical College ,Indore. In this study, data was collected retrospectively from hospital records and we tried to find out the incidence of post dated pregnancy (pregnancies beyond 40 weeks) and it’s maternal and fetal outcome. Results: In the present study, total of 9167 cases were studied out of which 760 cases were post dated pregnancies. The incidence of post dated pregnancy was 8.29%. PRIMIs were more prone for post dated pregnancies according to our study. Foetal distress and meconium release occurred more commonly in postdated pregnancy. There was a progressive decrease in the amniotic fluid volume after 40 weeks. Rate of LSCS was higher that is 39%. Common indications being foetal distress, failure of induction, non-progress of labour thick meconium.in the perinatal outcome 25% of neonate require NICU admission with complications like birth asphyxia, transient tachynea of newborn, sepsis. Conclusion: Postdated pregnancy is associated with both, maternal and foetal complications. Timing of induction has to be decided carefully, as early induction leads to failure and increased rates of LSCS, while late induction leads to increased foetal complications. Maternal and fetal morbidity and mortality can be reduced by electively inducing pregnant women at 40+0 weeks as allowing them to continue beyond this gestational age has shown adverse feto-maternal outcome
Evaluation of Homocysteine Level- A Risk factor among patients with ischaemic Stroke admitted in emergency of tertiary care centre of Bihar
Get PDFBackground: Epidemiological investigations have shown that expanded complete homocysteine (tHcy) magnitude are related with an expanded risk of thromboembolic disease; nonetheless, controversy actually exists over which subtype of stroke is associated to hyperhomocysteinemia (HHcy). This investigation meant to examine whether raised tHcy is an autonomous risk factor for ischemic stroke and to contrast tHcy magnitude in patients and ischemic stroke subtypes. Objectives: To decide the recurrence of brought homocysteine level up in ischemic stroke. Methods: This forthcoming observational case control investigation was carried on 133 youthful ischemic stroke patients with 120 control match people over a time of 6 months, from March 2021 to August 2021 at Tertiary Care Centre, Patna. Results: The plasma fasting homocysteine magnitude was altogether higher in the cases than in the controls. The mean homocysteine magnitude was raised altogether in those with cardioembolic strokes contrasted and the controls. The plasma homocysteine level was related with a changed chances proportion of 2.15 for homocysteine over 16 μmol/L fixation for a wide range of stroke. Conclusion: Expanded degree of Serum Homocysteine is altogether connected with risk of cerebrovascular mishap, which is free of the risk credited to conventional risk factors
Histopathological assessment of placenta in PIH patients
Get PDFBackground: The occurrence of infection, haemorrhage and hypertensive disorders of pregnancy has great impact on mother and foetal well- being. The present study was conducted to perform histopathological assessment of placenta in PIH patients. Materials & Methods: 74 cases with normal and hypertensive pregnancies were selected and were classified patients into 2 groups of 37 each. Group I comprised of patients with hypertension (>140/90 mm Hg) and group II were normal pregnancy. Parameters recorded were gestational age, mean birth weight, mean placenta weight, mean fetoplacental birth ratio. Morphology of placenta was studied. Results: Maximum patients (19) were seen in age group 20-25 years in group I and 18 in group II. Minimum patients (3) in group I and in group II (3) were present in age group 30-35 years and <20 years respectively. Gestational age 37 weeks was seen in 12 in group I and 11 in group II, 38 weeks in 8 in group I and 7 in group II, 39 weeks in 6 in group I and 9 in group II, 40 weeks in 3 in group I and 2 in group II and 41 weeks in 1 in group I and 1 in group II. The mean birth weight was 2862.4 grams in group I and 2548.5 grams in group II, mean placental weight was 482.4 grams in group I and 476.2 grams in group II and fetoplacental ration found to be 6.52 in group I and 6.10 in group II. The mean Syncitial knots/100 villi was 71.4 in group I and 30.5 in group II, hyalinized villi/ 10 lpf was 6.8 in group I and 1.2 in group II, fibrinoid necrosis/100 villi was 12.5 in group I and 3.1 in group II, calcified areas/ 10 lpf was 2.4 in group I and 0.45 in group II and cytotrophoblastic proliferation/ 100 villi was 16.8 in group I and 3.4 in group II. Conclusion: The occurrence of syncitial knots, hyalinized villi, fibrinoid necrosis, calcified areas and cytotrophoblastic proliferation was more in PIH group than control subject
Comparison of the effect of I.V nalbuphine and fentanyl as premedicant in general anaesthesia for laparoscopic surgeries
Get PDFIntroduction: Laparoscopic surgeries are minimally invasive surgeries with reduced mortality and morbidity, minimal postoperative analgesic requirement and early mobilisation. To prevent hemodynamic response to laryngoscopy, intubation and pneumoperitoneum various drugs are used. Opioids are commonly used in premedication, being a good analgesic, to support analgesia during surgery and to provide pain relief in immediate postoperative period. Among opioids, Fentanyl and Nalbuphine effectively control the hemodynamic stress response associated with laparoscopic surgeries, especially after laryngoscopy, intubation and pneumoperitoneum. In our study, we observed and compared the potency of opioids- Fentanyl & Nalbuphine used as premedicant for attenuation of hemodynamic response in laparoscopic surgeries and postoperative complications if any. Objectives: The present study was designed to compare the effect of intravenous Nalbuphine and Fentanyl as premedicant in general anaesthesia for laparoscopic surgeries. Material and Methods: After institutional ethics committee approval, the study in 60 patients belonging to ASA 1 & 2 undergoing laparoscopic surgeries like appendectomy, cholecystectomyetc. whose duration was assumed to be <90 min under general anaesthesia was conducted. Pre-anaesthetic assessment of the patient was done with a complete history, physical examination and routine investigations and informed written consent was obtained. Eligible patients who gave consent were kept nil orally for at least 6 hours before surgery. Pulse Rate(PR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure(DBP), Mean Arterial Pressure (MAP), Oxygen Saturation (SpO2) was recorded at baseline, after giving study drug, immediately after laryngoscopy and tracheal intubation, thereafter at 10 minutes interval intraoperatively, post extubation at 1,3 and 5 minutes. Preoperative and postoperative sedation scoring was done using RASS. Results: The mean heart rate increased post extubation in both the groups. At 1min, 3 min and 5mins post extubation heart rate is better controlled in group N than group F and is statistically significant (P value < 0.05). Both groups showed a rise in SBP immediately after intubation. Group N showed a significantly lower SBP in comparison to group F (p<0.005). The DBP showed a similar trend. At one, three, and five minutes after intubation, HR, SBP, DBP, and MAP were similar between the groups. Post-extubation sedation score was significantly higher in group N (p < 0.005). Conclusions: From the findings of our study it is concluded that I.V. Nalbuphine when given in the dose of 0.2 mg/kg as a premedicant is significantly effective in attenuating the haemodynamic responses during intubation, laryngoscopy and pneumoperitoneum in laparoscopic surgery when compared to Fentanyl 2.0 μg/kg. It also provides better hemodynamic stability without major side effects during laparoscopic surgery
A clinical study to evaluate the functional outcome of fracture of femoral neck with bipolar prosthesis
Get PDFBackground and Objectives: Hip fractures are located in the proximal femur and can involve the femoral neck, trochanteric and subtrochanteric regions. The two most common types are trochanteric (intertrochanteric) and femoral neck (cervical) fractures (FNF). Fractures that extendfrom the trochanteric area and distally within 5 cm below the lesser trochanter are named subtrochanteric fractures. These fractures are a common sight at orthopaedic departments around the world and are a common cause of misery and mortality in the aging population. Methods: 23 patients aged more than 50years, who sustained fracture neck of femur, were treated by hemiarthroplasty using Bipolar prosthesis, in Dr VRK Womens Medical College & SIMS Hyderabad between October 2020 to September 2021 The patients were followed up for a minimum of one year. Short term functional outcome was analyzed using the Harris hip scoring system. Results: In our study the patients were in the age group of 51 to 78 years with the mean age of 59 years. 53.21% of the patients were females with 60.79% of all cases sustaining the fracture following a trivial trauma. The functional outcome using the Harris hip score was excellent in 16%, Good in 60%, fair in 16 %and poor in 8% of cases. So, 72% of the patients achieved an excellent or good result. Conclusion: The outcome of the hemiarthroplasty depends on various pre-operative factors like age of the patient, type of prosthesis, associated co-morbid conditions. The bipolar prosthesis has allowed freedom from pain, early weight bearing, early rehabilitation. It also allowed squatting and greater range of movements
Prediction of chemical composition of urinary calculi in-vivo based on ct attenuation values – An analytical study
Get PDFIntroduction: Chemically, stones are of various types including calcium stones, uric acid stones, struvite stones and cystine stones among others. Each pathophysiological group has a predisposition to form certain kind of stones. Hence, knowledge of the chemical composition of the stone that a patient forms can and does direct the management of the patient. Objectives: To evaluate if the chemical composition of urinary stones can be predicted with mean Hounsfield Unit (HU) value on computed tomography (CT). Methods: This is prospective and analytical study conducted in the Department of Radiology of a tertiary care teaching hospital in India. Patients diagnosed with urinary stones who had a non-contrast CT done and had stone retrieved were included in the study. The predominant chemical composition of the stone was analysed by X-ray diffraction crystallography. Results: Fifty-one stones of four types were studied. Statistically significant (p<0.001) differences were seen in the mean HU, maximum HU and median HU values between all the four types. No significant difference was observed in the difference between periphery and core HU values. Hierarchy of density among the stone types correlated with previous studies but absolute measurements varied among different studies. Conclusion: Mean HU of urinary stones correlates with their chemical composition. Calcium oxalate monohydrate, calcium oxalate dihydrate, uric acid and hydroxyapatite stones can be differentiated on their CT attenuation parameters if a database of attenuation characteristics for stones of known composition is built for given scanner and protocol