International Journal of Health and Clinical Research
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An Approach to Diagnosis and Management of Diabetic Foot in The Indian Population
Get PDFIntroduction: The problem of the Diabetes is worldwide, and India is one of the major countries affected by it. One such common example seen among diabetics is Diabetic foot ulcer which affects nearly 12 % of the patients and one of the major causes of morbidity among them. Treatment includes thorough wound management, good microbiological control using appropriate antibiotics and strict glycemic control and lifestyle changes. Many recent approaches like vacuum dressing, platelet derived growth factors, larval therapy have revolutionized the management of diabetic foot. Hence the present study has been undertaken to evaluate modes of presentation and management protocols and predisposing factors in diabetic foot. Methodology: An observational and prospective Hospital based Study was conducted in a Tertiary care hospital from January 2019 to June 2019. A total of 50 patients with Diabetes Mellitus and suffering from diabetic foot ulcer admitted in the department of surgery were included in the study. . Ethical clearance was taken from Institutional Ethical Review Board. Data was entered in Microsoft Excel and analysed using SPSS v20 for frequencies, mean, SD and chi square test. Results: A total of 50 patients were included in the study. The age of the patients ranged from 45 to 78 years in our study. The mean age was 62+12.7 years. The males were 35 (70%) and 15 (30%) females. The Cellulitis (40%) was the most common modes of presentation of the diabetic foot ulcer in our study followed ulcer presentation (36%), abscess seen in 9 (18%) cases and gangrene in 6% of cases. Conclusions: Diabetic patients have always suffered from complications affecting the lower limbs. If foot complications are detected early, it can reduce the chances of amputation. Education regarding foot care and early signs of neuropathy play a vital role in the prevention of recurrence
A study of the prevalence of intestinal parasitic infections and its correlation to demography in the eastern Indian population
Get PDFBackground: Intestinal parasitic infections are a serious public health problem in the world, especially in developing countries, and account for a major cause of morbidity and mortality among different high-risk groups[1]. Aims: To find out the prevalence of intestinal parasitic infections and compare and correlate it with gender, age group, and area (rural or urban). Materials and method: This prospective study was conducted at the Department of PSM at Government Medical College, Bettiah, and Jan Nayak Karpuri Thakur Medical College & Hospital (JNKTMCH), Madhepura, Bihar, India. The study was approved by the institutional ethical and research committee. The study was conducted from September 2020 to August 2021. The stool samples from suspected patients were collected and subjected to routine stool investigations during the study, i.e., a macroscopical examination was carried out for the presence of adult worms or their body segments and a microscopic examination, such as stool wet mounts (both saline and iodine mounts) after the Formol-ether concentration technique. Results: Out of a total of 643 patients, 102 (15.86%) had parasitic infections. The maximum number of patients was in the age group of 0–10 years (277, 43.08%), whereas out of these, 36 patients were found positive (13%). A total of 112 parasites were isolated from 102 positive patients. Mixed infections with two parasites were most commonly seen in the 0–10 year age group (7 out of 10 cases). A combination of Giardia lamblia and Hymenolepis nana were most commonly isolated (3 out of 10 mixed infections). The parasite most commonly isolated was Hookworm 35 (31.25%), followed by Hymenolepis nana 25 (22.32%) and Giardia lamblia 19 (16.96%). Enterobius vermicularis was the least common isolate (1.78%), followed by Taenia species (2.68%). Parasitic infections affect mostly male patients (59.57%). and the majority of the positive patients (72%) were from rural areas (64.28%). Conclusion: The prevalence of intestinal parasites was comparatively high owing to poor sanitization and low literacy
Study on emergency obstetric hysterectomy over a two year period–Saving mothers
Get PDFIntroduction: Emergency obstetric hysterectomy needs a timely decision and good clinical judgment as undue haste can result in maternal morbidities like bladder injuries and unnecessary delay can cause maternal mortality. Maternal outcome greatly depends on the timely decision, surgical skills along speedy interventions taken by the team of obstetricians, anesthetists, and physicians. Aim: The study has been done with the purpose to know the incidence, etiology, maternal age, parity, risk factors, maternal morbidity and mortality, and fetal outcome and analyze the factors associated with it. The study was conducted in a tertiary care hospital which caters to the rural population of Jharkhand, India. Materials and Methods: Sixty-five women underwent emergency obstetric hysterectomy during the study period of 2 years. All women who needed emergency obstetric hysterectomy for any obstetric reason during antenatal, intra-natal period or postnatal period up to 6 weeks were included in the study. Results: In this study, the main etiological factor was rupture uterus (58.5%). The incidence of emergency obstetric hysterectomy in this study was 0.52%. Maternal mortality in the study was 6.1%. Conclusion: Maternal and perinatal mortality are sensitive indicators of the health care system, thus identifying and avoiding the factors which lead to maternal mortality which will, in turn, improve maternal health and perinatal outcome
Outcome of canal wall down mastoidectomy with Tympanoplasty
Get PDFChronic supportive otititis media is potentially serious disease because of their complications. In chronic cases complications are usually caused by progressive erosion of temporal bone thus increasing the risk of damage to facial nerve, labyrinth and the dura. With new surgical techniques, the complications and related mortality have been greatly reduced and furthermore the hearing threshold is also improved. The importance of this study is to achieve a stable hearing and to maintain the hearing mechanism as best as possible. The aim of the study is to assess the audiological and surgical outcome of canal wall down mastoidectomy with tympanoplasty. This study was conducted at Jawahar Lal Nehru Institute of Medical Sciences, Porompat, Imphal . The procedure and data collections of 50 patients were carried out for two years with effect from September 2018 to September 2020 and each case was followed up for 6 months. The data were entered and calculated statistically using SPSSv.20 software. The study shows significant hearing improvement in hearing post operatively. The mean air bone gap of 33.52 db reduced to 21.72 dB at 1 month post operatively and to 23.32 dB at 6 months post operatively (p= 0.00). In this study, 9 (18%) patients had wax in the cavity and were cleaned, graft retraction was seen in 3(6%) patients, vertigo was seen in 2(4%) and 1 patient had graft failure
Modified Left Ventricle Fetal Myocardial Performance Index: A cross sectional study in a tertiary care hospital
Get PDFIntroduction: Modified left ventricular fetal myocardial performance index (MPI) is a pulse wave Doppler index that can be utilized to assess global fetal myocardial function. Fetal MPI is handily performed non- invasive method for the assessment of foetal cardiovascular well-being.Aim: This study aimed to access normal values for foetal modified left ventricular (LV) MPI and its correlation with heart rate and gestational age among foetuses in central india.Material and Method: This cross sectional study was conducted in department of Radio-diagnosis from January 2020 to December 2020. In our study, total seventy one singleton pregnant women with normal pregnancy were included. The Mod-LV MPI was calculated as the ratio of sum of the isovolumetric constriction time (ICT) and isovolumetric relaxation time (IRT) upon ejection time (ET). MPI = ICT+IRT/ ET. We also assessed correlation of MPI with foetal heart rate and gestational age. SPSS Statistics software version 20 was used for the statistics analysis.Results: The normal mean MPI of second and third trimester fetuses of Indian population was 0.409±0.052. Mean ICT was 45.7 ± 7.0ms, mean IRT was 55.9 ± 6.7ms, and mean ET was 148.2 ± 10ms. The mean FHR was 142.26 ± 5.8 bpm and mean gestation age (weeks) is 33.16 ± 4.8. The coefficient correlation (r) between MPI and gestational age was 0.017 and that between MPI and heart rate was 0.030 suggesting MPI is independent of both gestational age and FHR. Conclusion: Our study gives the normal range of MPI in the normal heart foetuses of the Indian population, and it also shows that MPI is independent of gestational age and FHR. MPI has role in subclinical foetal cardiovascular malfunction and intrauterine foetal cardiovascular monitoring for foetal wellbeing
Open versus arthroscopic surgical management for recurrent anterior instability of the shoulder: A prospective Study
Get PDFBackground: The best surgical treatment for recurrent anterior shoulder instability is still up for debate. We didn't know much about the advantages and disadvantages of old open and newer arthroscopic methods. We expected that regardless of surgical approach, all patients' results would be identical. Material and Methods: This is a comparative study, Prospective and cross-sectional study conducted at Department of Orthopaedics, Tertiary care Teaching Hospital over a period of 1 year. According to the surgical management, they were divided into two groups: Group A Patients had either open surgery with suture anchors and capsular shift. Group B Arthroscopic Surgery Suture anchors and suture capsulorrhaphy are used. Result: In our study, time of surgery was significantly longer in the arthroscopic surgery group than the open surgery group (P < 0.05). Intraoperative blood loss was significantly more in the open surgery group than the arthroscopic surgery group (P < 0.0001) and total time of hospital stay was significantly more in the open surgery than the arthroscopic surgery group (P < 0.05). VAS pain scores after the surgery was significantly higher in the open surgery group than the arthroscopic surgery group (P > 0.05). Increase in Rowe score after the surgery was significantly higher in the open surgery group than the arthroscopic surgery group. Conclusion: Recurrent anterior shoulder instability may be safely treated with arthroscopic stabilisation. Range of motion is marginally better following arthroscopic treatment when compared with open repair. Although open surgery is more intrusive than arthroscopic Bankart surgery, it should still be considered for certain patients because of its impact on shoulder joint long-term stability
Utility of Magnetic Resonance Imaging in the Diagnosis of Placenta Accreta
Get PDFBackground: Placenta accrete is one of the causes of postpartum hysterectomy. Accurate prenatal diagnosis can aid in its management. Objectives: To evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) in the diagnosis of placenta accrete. Methods: This prospective observational study was conducted in the department of radiodiagnosis at Sri Ramachandra Institute of Higher education and research from April 2014 to September 2017. The study included 27 patients with suspected placenta accreta based on prenatal sonography or in conclusive sonogram or at high risk for placenta accrete. Placenta accreta findings as per MRI were compared with clinical findings at delivery. Data were analyzed by using coGuide software, V.1.03. Results: Out of 27 participants, 70.4% were in the age group of 21 to 30 years, 9(33.33%) participants were second and third gravida, respectively, and 21(77.78%) were in >36 weeks of gestational age. Among the study participants, 70.4% (19/27) had positive findings in MRI for placenta accrete, and 40.74% (11/27) had positive clinical findings. In MRI findings, 9(81.8%) had Indistinct myometrium, and 6 (54.55%) had T2 bands. The total diagnostic accuracy of MRI findings for placenta accreta was 70.37%. Conclusion: MRI has a sensitivity of 100% and specificity of 50% in diagnosing placenta accreta. The overall diagnostic accuracy was 70.37%. Hence, MRI in the antenatal period can be used in diagnosing placenta accreta in a high-risk population
Assessment and treatment of chronic low back pain with psychological impact
Get PDFStudy design: A prospective intervention study.Purpose: Assessment and treatment of chronic low back pain with psychological impact.Introduction: Around 60 to 80% of the adults experience low back pain at some point or other in their life. Current studies have noticed that there is an association between low back pain with the mood of sufferers which lead to: Anxiety, Depression, Poor social interactions, Irritability.Methods: 80 patients with chronic back pain are been taken and Psychological assessment of these patient were done by:General anxiety disorder(GAD-7) for anxiety andPatient health questionnaire (PHQ-9) for depression. Each patients was treated and followed up for 3 months.Results: Out of 80 patients 51.3% were old & 48.8% were young, 80.0 % were female & 20.0 % were male,presenting complaints duration: 72.5 % suffering since < 1 Year, 22.5% since 1 to 2 Years, &5.0 % since> 2 Years. The Comparison of Anxiety, depression, oswestry score at the Follow-Up of subjects were significant (P- value is <0.05) in our study. Comparison of mean scores among Presenting Complaints groups,Anxiety, depression, oswestry scorewas significant (P- value is < 0.05) in our study.Conclusion: After carrying out the analysis, the results support that efficiency of the psychological interventions are significant for reducing the low back pain which are self-reported along with depression and anxiety levels which in turn increases the quality of life related to health within the persons suffering from chronic lower back pain
Comparative study of hysteroscopy with ultrasonography and its correlation with histopathology in cases of abnormal uterine bleeding in perimenopausal women
Get PDFAim: To compare the diagnostic efficacy of ultrasonography and hysteroscopy in detecting uterine abnormalities in abnormal uterine bleeding by correlating the results with histopathological examination. Material and Method: This prospective study was conducted among women attending OPD of Department of Obstetrics and Gynaecology, IMS & SUM Hospital, Bhubaneswar from April 2019 to March 2021. A total of 100 perimenopausal women with abnormal uterine bleeding attending Obstetric and Gynaecology OPD were included in this study. All patients underwent transvaginal scan to note down the endometrial thickness and to rule out uterine and adnexal pathology. All the patients underwent diagnostic hysteroscopy, followed by a biopsy of the endometrium. The endometrium was sent to the pathologist. Findings of these diagnostic modalities then correlated. Results: Out of 100 women, USG detected that 54 patients (54%) had no pathology and 46 patients (46%) had abnormal findings, out of which maximum patients i.e., 29 patients (63.04%) had endometrial hyperplasia. According to Hysteroscopy, 46 patients (46%) had normal hysteroscopic findings while 54 patients (54%) had abnormal findings of which maximum were 18 patients (33.33%) who had endometrial hyperplasia. Histopathology findings revealed that 47 patients (47%) had normal findings and 53 patients (53%) had abnormal findings out of which maximum patients 20(37.7%) had endometrial hyperplasia. In our study of 100 women with AUB, on USG only 1 patient had endometrial malignancy and the same was reported by hysteroscopy and histopathology. Conclusion: In our study hysteroscopy proved to be highly sensitive and specific considering histopathology as gold standard. Ultrasonography has good sensitivity and specificity but less as compared to hysteroscopy
Management of locally advanced soft tissue tumors with major vessel reconstruction - A case series
Get PDFManagement of soft tissue tumors in the advanced stage often precludes complete surgical resection in view of major vessel involvement and demands major amputation for tumor clearance. We present a series of patients presented with advanced tumor presentation by major vessel resection and reconstruction (using vein or synthetic graft) without compromising tumor clearance. This preserves the limb function without increasing the tumor recurrence rate