International Journal of Health and Clinical Research
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A Hospital Based Comparative Study the Post Operative Pain, Duration of Procedure & Incidence of Complications Between Open Transinguinal Preperitoneal Hernia Repair and Lichenstein’s Hernia Repair
Get PDFBackground: Inguinal hernias are present in 1.7% of the world population. The Trans Inguinal Preperitoneal (TIPP) Hernia Repair (using prolene mesh) resulted in greater patient comfort with reduced post operative pain and also decreases the number of complications and recurrence rate and that it can be recommended for all primary unilateral Inguinal Hernias. The aim of this study to compare the post operative pain, duration of procedure & incidence of complications between transinguinal preperitoneal repair and lichtensteins repair procedures. Materials & Methods: A hospital based prospective study done 40 patients of inguinal hernias with ASA I or II, attending the district hospital Dholpur, in our surgical unit over a period 1 year. All cases were selected at random irrespective of the type of inguinal hernia, the age of the patient and the size of the defect. The material used for repair is monofilament polypropylene clear non absorbable synthetic knitted surgical mesh. About 20 cases of transinguinal pre peritoneal mesh repair & 20 cases of lichtensteins repair. Post operative pain, scrotal collection, seroma, cord oedema and wound infection were looked for they were asked to come for regular follow-up visit after discharge during each follow-up visit, the patients were assessed for pain, surgical site infection and recurrence.Results: The mean age of the patients subjected to lichenstein repair was 52.76 years and for TIPP it was 49.24yrs. The duration of operation was more in the TIIP group and was statistically significant (p < 0.05*). During the first follow up of patients at one month it was noticed that 20% of patients who underwent linchenstein repair had complications of SSI, cord edema, recurrence and pain. At second follow up it was noticed that only 2 patient who underwent LR had sensory loss. Occurrence of pain at 3 rd month between the lichenstein and TIPP repair is not statistically significant (p>0.05).Conclusion: We concluded that the transinguinal pre peritoneal mesh repair is an amazing simplistic technique which gives an approach to inguinal, femoral and obturator hernias and bears the same anatomical relationship in TEP and TAPP approaches which gives a better understanding of the TEP and TAPP procedures
A prospective study of cognitive functioning in bipolar disorders in a tertiary care hospital
Get PDFIntroduction: Bipolar disorder (BD) is characterized by episodic pathological mood alterations that can be manic, depressive or mixed [American Psychiatric Association, 1994]. In the last 10 years, there has been increased emphasis on the role of cognition in BD attested by the exponential growth in the number of relevant publications. A significant turning point was the realization that cognitive impairment was a replicable feature of BD with measurable changes being present both during episodes and in remission. Materials and methods: Study Design: A prospective comparative study was conducted at the Department of Psychiatry, Midnapore Medical College and Hospital, Midnapore, West Bengal for 1 year , Institutional ethical clearance was taken. 100 patients suffering from bipolar disorder I currently in remission and 100 healthy controls were included in this study. The clinical state of individuals was assessed by a psychiatrist using a semi-structured proforma for documentation which included socio-demographic data of the patient, history of psychological symptoms, and thorough Physical examination findings. 100 patients were selected for the study, which fulfilled the DSM-IV TR criteria for Bipolar disorder I. Remission was assessed with scores 8 or less on Hamilton Depression Rating Scale (H.D.R.S.) and 6 or less on Young’s Mania Rating Scale (Y.M.R.S.). Results: Patients with bipolar I disorder were found more cognitively impaired in comparison to the control group particularly in attention, working memory, and executive functioning. Factors affecting neurocognitive performances were early-onset, age, duration of illness and number of episodes. Conclusion: Cognitive functioning of an individual is very important as it not only reflects a patient’s socio-occupational functioning and ability to live independently but also about the insight of their illness and compliance to treatment. Adequate cognitive remediation at an early stage of illness might improve the outcome of bipolar illness. Therefore, the development of interventions targeting cognitive impairments is imperative for improving recovery rates and quality of life in patients suffering from bipolar disorder
A Hospital Based Prospective Study to Assess the Role of Amniotic Fluid Index (AFI) in Postdated Pregnancy and Perinatal Outcome
Get PDFBackground: Oligohydramnios is associated with increased maternal morbidity, increased rate of induction of labour and caesarean section. Thus, this study was conducted to find the significance of amniotic fluid index in determining the maternal and perinatal outcome in pregnant women who came postdated to our department, admitted, and evaluated to find out the feto-maternal outcome with regards to amniotic fluid index in those patients. Materials & Methods: A hospital based prospective study done on 100 antenatal women whose gestational age is >40 weeks admitted in our department in district hospital Dholpur, Rajasthan, India during one year period. A study proforma was filled for each case. During delivery the colour of liquor was observed. Birth weight of the baby recorded. The rate of NICU admission is recorded. The perinatal outcome is followed up for 28 days after delivery.Results: 90 out of 100 antenatal postdated women (90%) gave birth to babies of weight 2.5 to 4 kg, and 10 out of 100 women (10%) gave birth to < 2.5 kg babies out of which (N=2/10) 20% of babies were in anhydramnios group, (N=1/10) 10% were in AFI < 3 group, (N=2/10) 20% were in AFI 3 to 8 group. and (N=5/10) 50% of them had AFI > 8. By Chi Square test, there was high significance between AFI in postdated birth weight of the baby and the P value is less than 0.05*.Conclusion: AFI is a predictor of fetal tolerance in labour and its decrease is associated with increased risk of abnormal heart rate and meconium-stained fluid. This is overcome by assessing AFI through ultrasonogram at the earliest in third trimester, biophysical profile scoring, and proper intrapartum fetal heart rate monitoring
Evaluation of Spectrum of Prostatic Biopsies Using the Revised Gleason Grading System and Prostate Specific Antigen Assay
Get PDFIntroduction: The incidence of prostatic adenocarcinoma is rising worldwide, and a stratified uniform diagnostic approach is required to develop a treatment protocol for patients. This study was undertaken in a medical college in eastern Uttar Pradesh with the aim to estimate the burden of prostatic lesions in the area and to classify them according to the revised Gleason’s grading system.Materials and Methods: This was a descriptive type of observational study of three years duration were 238 cases of prostatic biopsies in Pathology department of Heritage institute of medical sciences, Varanasi. The lesions were classified on histopathology according to the revised Gleason’s grading system and association of prostatic lesions with serum Prostate Specific Antigen was also evaluated. The results were tabulated as pie chart and percentage and comparison was described. Results: The mean age of patients with benign prostatic hyperplasia was 56.74 years while it progressed to 75.5 years in patients with prostatic adenocarcinomas. The most common histopathological diagnosis was benign prostatic hyperplasia followed by BPH with chronic prostatitis. The most common Gleasons score in adenocarcinoma was 7. Serum PSA was found to be significantly raised in patients with prostatic adenocarcinomas in comparison to benign prostatic lesions.Conclusion: Benign prostatic hyperplasia is the most common prostatic lesion among adult males in eastern Uttar Pradesh. Implementation and awareness of Revised Gleason’s grading system will help in proper stratification and uniformity needed for better communication among pathologist and treating clinicians required for adequate treatment approach
A Hospital Based Prospective Study to Evaluate the Diagnostic Efficacy of Serum CRP Levels in Clinically Diagnosed Cases of Acute Appendicitis Confirm by HPR
Get PDFBackground: Acute appendicitis is one of the most common surgical emergencies and the most common source of infection in community-acquired intra-abdominal infections. Several prospective studies have shown that, in adults who have had symptoms for longer than 24 h, a normal CRP level has a negative predictive value of 97-100% for appendicitis. The aim of this study was to analyze the role of C-reactive protein (CRP) in improving the accuracy of diagnosis of acute appendicitis and to compare it with the histopathology findings. Materials & Methods: A hospital based prospective study done on 30 operated patients suspected of acute appendicitis in department of general surgery at district hospital Dholpur, Rajasthan, India during one year period. The normal CRP level in our laboratory is 0–6 mg/L. Levels above 6 mg/L were considered as being above normal.Macroscopic assessment was made from the operation. Appendectomy and a histopathology examination were performed on all patients. Gross description was compared with histopathology results and then correlated with CRP. Results: Out of 30 patients, 9 were classified as an inflamed appendicitis, 10 patients were shown to have suppurative appendicitis, 5 gangrenous, 4 perforated, and two necrotizing. Overall in the inflammation and suppurative groups (group A), the CRP was normal in 6 out of 19 patients. Complicated appendicitis included gangrenous, perforated and necrotizing (group B). CRP was normal in none of patients. Conclusion: We found that elevated serum CRP levels support the surgeon's clinical diagnosis. We recommend CRP measurement as a routine laboratory test in patients with suspected diagnosis of acute appendicitis
A systematic review of the quinolones, the novel pharmacotherapeutics, and the broad spectrum of their clinical indications and pharmacotherapeutic characteristics
Get PDFIntroduction: The newer fluoroquinolones have broad-spectrum bactericidal activity, excellent oral bioavailability, good tissue penetration and favourable safety and tolerability profiles. Objectives: The objective of this systematic review was a prismatic illumination on the quinolones, with an emphasis on the newer quinolones, the novel pharmacotherapeutics, thus enlightening on the expansive spectrum of their clinical indications and pharmacotherapeutic characteristics. Methods: The study was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) Statement and Guidelines, 2009, described by the Cochrane Collaboration in June, 2016. At first, the steps of identification included the records which were identified through database searching and the additional records which were identified through other sources. This led to the steps of screening, which included the screened records after the duplicates were removed. From these screened records, few records were excluded, as per the exclusion criteria. Then, in the eligibility step, the full text articles were assessed for eligibility, from which few full text articles were excluded, according to the exclusion criteria, with adequate reasons. This led to the final inclusion step, where the studies were included in the qualitative synthesis of a systematic review, according to the inclusion criteria, and ultimately the studies were included in the quantitative synthesis. Results: This systematic review, performed in accordance with the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) Statement and Guidelines, 2009, described by the Cochrane Collaboration, June, 2016, contributed 2210 refined and relevant medical records, among total 3266 records obtained from the study databases search. It also describes the broad spectrum of their clinical indications and pharmacotherapeutic characteristics, which authenticate, validate, clarify, elaborate and complete this systematic review. Conclusions: To conclude, this systematic review provided the refined qualitatively synthesised medical records, study literature and databases on quinolones, and specifically on newer quinolones, with well-comprehensible elaborations
An epidemiological study of etiology and management of abdominal pain in children: Government general hospital, Nizamabad
Get PDFBackground: One of the most prevalent childhood concerns is abdominal discomfort. It is more common in children under the age of 13 and is linked to a variety of causes and variables. The goal of the study was to look at the epidemiology, etiology, and treatment of children who presented with stomach discomfort to a tertiary level pediatric department. Methods: Over a year, 720 children visited the pediatric OP department, 100 of them satisfied the inclusion criteria and were all enrolled. Pre-schooling (3-5 years), schooling (6-10 years), and young adolescent are the three age groups studied in this study (11-13 years). Results: Abdominal discomfort was observed to be prevalent in 12.8 percent of children with OP. The majority of the participants were between the ages of 11 and 13, accounting for 53% of the total. There are 56 percent females and 44 percent boys among the 100 subjects, with 77 percent being rural and 23 percent being urban. FGID (36 percent), Gastritis (19 percent), and Worm Infestations were the most prevalent etiologies (16 percent). Conclusion: In conclusion, abdominal pain is a typical presentation in the pediatric OP department, and physicians must investigate a variety of etiologies, particularly those that require rapid management to reduce morbidity and death. With the advancement of science and technology, it is more important than ever for children needing pediatric surgical care to receive safe and effective treatment. Continuous pharmacological care services are required to improve the quality of life of children. The clinical pharmacist must increase knowledge of numerous etiologies producing stomach pain in a community environment to reduce the incidence and prevalence of abdominal pain in children
A Prospective Study Of Health Related Quality Of Life Before And After Lumber Disc Surgery For Herniated Lumber Disc At A Tertiary Care Centre Of Bihar
Get PDFIntroduction: Low back pain (LBP) is one of the most common health problems worldwide and a major cause of disability that affects performance at work and general well-being. LBP has an incidence of 15% amongst adults and a point prevalence of 30%. It is the leading cause of limitation in activity and absenteeism from work. Hence, this study was undertaken to address this lacunae in the literature. Methodology: A prospective study was conducted by the Department of neurosurgery of the Patna Medical College & Hospital, Patna, and Bihar. The current study was conducted over a period of 6 months that was from January 2021 to June 2021. Prior approval was obtained from the Institutional ethics Committee. All the patients admitted for elective discectomy for single level lumbar PIVD were selected for the study, after obtaining informed written consent from the patients or their next of kin. Statistical Package for Social Sciences (SPSS Inc released 2009), version 16.0 (Chicago, IL) was used to analyze the data. Results: The most common level of disc herniation was at L4-L5 level as proven by MRI of the lumbar spine (76%) which was followed by L5-S1. In more than half of patients, Low Back Pain (LBP) with Radiculopathy was the most common presenting complaint followed by Radiculopathy and paresthesia. Conclusion: Depression and anxiety are known to affect the outcome of the procedure. Therefore, assessment of depressive symptoms and its treatment should be a part of assessment of all patients in the preoperative as well as in the postoperative period
Utility of Procalcitonin as a Prognostic Marker in Critically Ill Children with Suspected Bacterial Infection: A Prospective Observational Study
Get PDFIntroduction: Sepsis in pediatric population is the cause of substantial morbidity and mortality. The clinical manifestations range from subclinical infection to severe manifestations of focal or systemic disease. Various markers of sepsis are available to diagnose and interpret early an ongoing sepsis. Aim: To evaluate the utility of procalcitonin levels in predicting the severity and prognosis of critically ill children in our hospital setup. Materials and Methods: This was a prospective, observational study of 80 children who were admitted to PICU. Serum PCT samples within 12 hours of admission was sent for evaluation in pathology lab. PRISM-III, PIM-2 and MODS was calculated at the time of admission. The duration of stay in PICU and outcome in the form of discharge or death was recorded. Results: PCT levels were elevated in most critically ill children admitted to PICU with suspected bacterial infection. 81.2% had elevated PCT levels with mean value of baseline PCT 37.4 ng/mL. Children who developed complications during hospital stay had significantly high levels of PCT. The correlation between PCT and severity scores (PRISM III score or PIM2 score) was poor but significant (ρ-0.333, p=0.0025 and ρ-0.3437, p=0.0018). Conclusions: PCT levels were high in patients who were critically ill, who developed complications during hospital stay and died in hospital. PCT is a better diagnostic marker for predicting severe sepsis, septic shock, multi organ dysfunction and mortality
Prevention of immediate and delayed pain on propofol injection: A comparative study of pretreatment with lignocaine and ondansetrone, India
Get PDFIntroduction: Pain on propofol injection (POPI) is a common problem and can be very distressing to the patient. POPI could be immediate as well as delayed after 10–20s. Many studies have shown the efficacy of Lignocaine in reducing this pain. Ondansetrone is found to have 15 times more potent local anesthetic property compared to Lignocaine. In this study we have compared the efficacy of Ondansetrone and Lignocaine pretreatment in reducing pain on propofol injection. during induction of anaesthesia. Aims: To compare the efficacy of the pretreatment with Ondansetrone with that of Lignocaine in reducing the pain injection of propofol during induction of anaesthesia. Materials and methods: A randomized control study was conducted on ninety adult patients aged between 20-60 yrs belonging ASA 1 and ASA 2 grade scheduled for various elective surgeries. Patients were assigned to one of the three groups: Group 1 to receive 5ml of 0.9% saline, Group 2 to receive 50 mgs of Lignocaine diluted in 5 ml, Group 3 to receive 4 mgs of Ondensetrone diluted in 5ml. The injections were given on the dorsum of the hand using 20G cannula. Tourniquet applied above the level cannula was released after one minute and then calculated dose of propofol was injected at a rate of two ml every five seconds. During injections patients were asked about the pain or discomfort at the site of injection and their behavioural signs were assessed using Mc Cririck and Hunter scale. Results: Lignocaine and Ondansetrone significantly reduced the incidence and severity of pain on propofol injection more than placebo (p <0.01-S). The efficacy of Ondensetrone in alleviating the pain on injection of Propofol was statistically comparable to that of Lignocaine. Conclusion: Intravenous Ondansetrone pretreatment may be used to reduce the incidence of immediate and delayed pain on injection of propofol