International Journal of Health and Clinical Research
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Pregnancy Complicated By Maternal Heart Disease: A Clinical Study At A Tertiary Referral Centre
Full text linkBackground: Heart disease remains a leading cause of indirect maternal deaths during pregnancy accounting for 20% of all cases. Many significant circulatory changes accompany pregnancy in women with preexisting cardiovascular disease, these alterations in haemodynamics can be dangerous. Therefore, patients should be evaluated for underlying cardiac disease to select appropriate management. Aims: The aim of this study is to evaluate the influence of biological factors in Maternal and Perinatal Outcome in Heart Disease Complicating Pregnancy. Materials and Methods: Department of Obstetrics and Gynecology, Sri Krishna Medical College & Hospital (SKMCH), Muzaffarpur, Bihar from Sep 2020 to Aug 2022 on 50 pregnant women with heart disease. Results: Based on age among the pregnant women with heart disease, about 38% were in the age group of 21 to 25 years. Gestational age of the pregnant women at the time of admission to the hospital was studied: 66% of the patients belong to term gestation. Preterm labour accounted to 32% & 1 women with heart disease was referred to our hospital as post-dated. Majority of the cases with heart disease were referred with antenatal check-up elsewhere i.e., outside government hospital 84% and 62% of the patients had cardiac disease diagnosed prior to present pregnancy. The cardiac functional status of the pregnant women with heart disease at the time of admission to the hospital was studied: Most of the patients have stable cardiac status and they fall under class I- i.e., 66%. 18% of the pregnant women belong to NYHA class II, 10% belong to NYHA class III and 6% of the cases belong to NYHA class IV at the time of admission. Conclusion: Heart disease is the most common non-obstetric cause of maternal morbidity and mortality. It also has a major impact on neonatal outcome. Favourable outcome is noted in women with NYHA class I and II, avoidance of factors precipitating heart failure like anemia, infections, arrhythmias, regular cardiac follow up, strict adherence to cardiac medications
Incidence of overlap syndrome of functional dyspepsia and irritable bowel syndrome in Western UP
Full text linkAim: To determine the incidence and risk factors for the clinical overlap between Functional Dyspepsia and Irritable Bowel syndrome defined by Rome IV criteria in Indian patients. Materials and methods: The present cross sectional study was carried out in ChattrapatiShivaji Subharti Hospital, Meerut in the Department of Medicine among consecutive patients with upper gastrointestinal symptoms who was referred for endoscopy. A structured questionnaire containing the FD and IBS modules of functional gastrointestinal disorders (FGIDs) and the putative risk factors for dyspepsia was administered to the participants. Results: Out of 500 subjects; FD, IBS and overlap was reported among 17.4%, 13.8% and 10.2% of the subjects respectively. Overall functional gastrointestinal disorders (FGID) were found in 207 (41.4%) subjects. Alcohol consumption was reported among 6.90%, 15.94% and 27.45% of the subjects having FD, IBS and overlap syndrome respectively. Hard or lumpy stools and defecation straining was reported more in subjects with overlap syndrome subjects followed by FD and IBS with statistically significant difference. Loose or watery stools was found least in FD subjects. A feeling of incomplete bowel movement was maximally revealed in overlap syndrome subjects. Conclusion: Patients having either FD or IBS overall have less severe symptoms and patients with overlap may represent the more severe symptoms as compared with FD or IBS
To Study the Spectrum of Clinical Features, Prevalence, Risk Factors, Type of Management and Clinical Outcome in Relation to the Type of Management in Patients with Peripheral Arterial Disease
Full text linkBackground: Peripheral artery stenosis or blockage is frequently one of the manifestations of systemic atherosclerosis. The most frequent causes of Peripheral arterial disease (PAD) are atherosclerosis and/or thromboembolic disease. The patient may display a variety of clinical manifestations and symptoms, which can be categorized into the following groups: loss of sensation, changes in colour, temperature, pulsations of the arteries, movement, ulceration, gangrene. Digital subtraction angiography (DSA) still yields the sharpest images, even though CT angiography and magnetic resonance (MR) angiography are more recent techniques that are gaining favor. Risk Factors. Cigarette smoking, Diabetes Mellitus (DM), High blood pressure and abnormal lipid levels, Insufficiency of the kidneys and raised inflamatory markers. Imaging, Duplex Ultrasound, Angiography Done Through a Catheter, Non-operative management, Operative Procedures Surgical revascularization plays a predominant role in the management of patients who have vascular disease; however, the modern treatment paradigms have evolved significantly with an increased emphasis on catheter-based percutaneous interventions over the past two decades. Aims and Objective: To study the spectrum of clinical features, prevalence, risk factors, type of management and clinical outcome in relation to the type of management in patients with peripheral arterial disease. Conclusion: Prevalence of total peripheral arterial disease patient as compared to patients presenting with either unilateral or bilateral lower limb pain is 24.5%. It can be seen that 82% population is male and the rest is female. 57% of the population that was analyzed in this research project had diabetes mellitus. The population had 33% people who were known hypertensives who were suffering from peripheral arterial disease. Tobacco is another risk factor that goes hand in hand with smoking, where males are mostly known to be smokers
Importance of Six Minute Walk Distance Test in Patients With Idiopathic Pulmonary Fibrosis
Full text linkBackground: The most common idiopathic interstitial pneumonia is idiopathic pulmonary fibrosis (IPF) and it is one of the most severe forms of IIP. The incidence of IPF is about 10.7 per 100,000 people for males and 7.4 per 100,000 people for females. Objective: To study the association between the six-minute walk distance test in patient with idiopathic pulmonary fibrosis. Methodology: A cross-sectional observational study (inpatients and outpatients) visiting the Department of Respiratory Medicine, Gandhi Medical College, Bhopal for the period of 18 months from November 2019 to April 2021. Results: The association between different types of IPF and 6MWT was found to be statistically significant (P-value <0.05). 6MWT was found abnormal in 65 (62.5%) of cases, out of which most cases were seen with definitive UIP 57 (54.8).In this study, significant desaturation after the 6-minute walk test was found in 29 patients (27.9%) of IPF and mostly with the definitive UIP 27(26%). Conclusion: Significant desaturation in the 6-minute walk test was found in IPF. The association between different types of IPF and 6MWT was found to be statistically significant with a P value <0.05. and maximum with definitive UIP. So 6MWT Should be performed in all cases of idiopathic pulmonary fibrosis
Prospective Study of Metabolic and Electrolyte Disturbances in Patients with Chronic Kidney Disease
Full text linkBackground: Kidneys play a critical role in regulating body fluids, electrolytes and acid base balance. CKD can lead to metabolic as well as electrolyte disturbances that can result in serious adverse outcomes. Aim & Objective: To study metabolic and electrolyte disturbances in CKD patients and its correlation with GFR. Materials and Method: 100 patients of CKD were studied. Detailed clinical history and physical examination were done as per pre-fixed Performa. Relevant hematological, biochemical, radiological investigations were done for assessing renal function. Staging of CKD was done with GFR. Results: Mean age of study participants was 43 years out of them 70% were males. All the study participants were anemic out of them 28% severely, 51% moderately and 20% mildly anemic. Majority of study participants belonged to G5 category of GFR. Among electrolytes only serum sodium was found significantly associated with GFR (p value- o.oo2). Among metabolic parameters low triglyceride levels was significantly associated with GFR (p value-0.009). Conclusion: CKD patients are more prone to develop metabolic as well as electrolyte disturbances. Hence, every CKD patient should be screened for any such disturbances. Although studies on this regard is still lacking and we need further study for better understanding and management, as early screening can defer early morbidity and mortality. Therefore, serum electrolyte as well as metabolic disturbances to be included as one of the first line investigations in patients with chronic kidney disease
Prevalence of Non-Alcoholic Fatty Liver Disease and Its Correlation with Coronary Risk Factors in Patients with Type 2 DM
Full text linkBackground: Type 2 diabetics appear to be at greater risk of NAFLD and certainly of fibrosis and cirrhosis development. Type 2 diabetes and NAFLD are more common than previously thought, especially in India. To find out if there is a connection between NAFLD and CVD in a large group of type 2 diabetics, the current study was designed.Aim: 1) To study the prevalence of NAFLD by USG in patients with type 2 diabetes mellitus. 2) To correlate NAFLD with coronary artery disease and coronary risk factors in patients with type 2 diabetes mellitus.Methods: This was an observational, cross-sectional, open-labelled, single-centric, parallel design study conducted in the department of general medicine of a tertiary care hospital among patients with type 2 DM. Results: Among the 120 patients that took part in the study, there were 69 NAFLD patients and 51 non-NAFLD patients. Individuals with NAFLD had a significantly longer mean diabetes duration. In the NAFLD group, the prevalence of hypertension, obesity, visceral obesity, and metabolic syndrome was greater. The NAFLD group had much worse glycemic control. Sr. HDL and Sr. Triglyceride levels were found to be greater in the NAFLD group, whereas Sr. LDL levels were found to be higher in the non-NAFLD group, and Total cholesterol levels were practically comparable in both groups. ALT and AST values were higher in NAFLD patients than in non-NAFLD patients.Conclusion: The prevalence of NAFLD increases dramatically in the presence of type 2 diabetes, with majority patients affected in fourth decade of life. Obesity, hypertension, and dyslipidemia were considerably more prevalent with NAFLD compared to subjects without NAFLD
Prognostic Study of Aluminium Phosphide Ingestion Patients and Their Correlation with Cardiac Manifestations On The Basis of ECG Abnormality
Full text linkIntroduction: Mortality due to Aluminium phosphide ALP ingestion is very high (37-100%) and is directly related to freshness of tablet, dose of pesticide consumed and delay in institution of treatment etc. Death is mainly due to cardio toxicity, development of ARDS, non-responsiveness of shock to resuscitative measures, lack of an antidote and subsequent development of complications like acute massive GI bleed, acute respiratory arrest, acute CHF, DIC etc. Aim & Objective: To Study the ‘Clinico investigatory’ findings in Aluminium phosphide ALP poisoning. Assessment and correlation of ECG findings with the survival of these patients. Methodology: Patients of age group > 18 years and both sexes, who fulfilled criteria of patient's selection, will be taken into consideration. Results: Majority of victims were young patients in struggling phase of life as study, career and family matters between age range of 14-30 years and males & females ratio was 1.9:1 predominantly males.Majority of patients consumed one exposed tablets of Aluminium phosphide poisoning. Shock was the cardinal manifestation in majority of the patients. Tachycardia, cold clammy skin, mid pupillary dilatation with sluggish pupillary reaction and chest crepitations were the next common physical signs. Various ECG abnormalities recorded on the third day were the sinus tachycardia (10/77), non specific ST-T changes (00), low voltage complex (10/77) and RBBB in 06/77 cases. Conclusion: Thus, it can be concluded from the present study that Aluminium phosphide is cardiotoxic in 100% cases as evident from various changes in ECG recording an ECHO confirmed this and evident of focal carditis and wet pericarditis was evident. It is further stipulated that toxicity of conduction system of heart are more prominent than the myocardium
Prospective Study of Renal Impairment in Stroke Patients
Full text linkIntroduction Renal impairment is commonly seen in stroke patients. more common in hemorrhagic strokes. In stroke patient renal impairment is transient so required renal replacement therapy is rarely. e-GFR decreased <40mL/min the risk of symptomatic stroke in the general population more 3.1 times. Aim & Objective: Study of renal impairment in stroke patients, To compare the renal impairment between hemorrhagic and ischemic stroke. Methodology: The study comprised 100 patients admitted in Department of Medicine, J.A. Group of Hospitals. A detailed clinical history and physical examination will be done and findings will be recorded. Renal function testing was performed in hospitalized stroke patient. Serum urea and creatinine were evaluated on alternate days throughout their hospital stay, and the e-GFR was calculated. Results: All participants were having normal Renal USG. Low eGFR< 60mL/minute per 1/73m2 was found significantly higher in CVA Hemorrhage 25 (75.8%) in comparison to CVA Infract 23 (34.3%). Outcome was statistically insignificant between CVA Hemorrhage (6%) and CVA Infract (3%) group. Conclusion: Decrease eGFR < 60mL/minute per 1/73m2 was found in 48 participants out of 100 participants significantly higher in CVA Hemorrhage 25 (75.8%) in comparison to CVA Infract 23 (34.3%) (p value <0.001)
Single-Stage Vs Two-Stage Urethroplasty For Hypospadia
Full text linkHypospadias is the most frequent congenital external genital deformity in boys, which affects 1/300 live male births worldwide with varying incidence rates in different nations. Hypospadias surgery has been historitically characterized by a multitude of techniques available for repair. This study compared single-stage and two-stage urethroplasty with regard to the outcomes and complications. This review was synthesized and obtained from various online databases. Scientific articles were selected based on the inclusion criteria. The result showed that hypospadias is a congenital anatomical abnormality of the male external genitalia and the second most common congenital disorder in males after cryptorchidism, but it is the most common penile congenital malformation. The purpose of surgery in hypospadias is to enhance genital attractiveness, stop splaying of the urine flow, allow the patient to pee while standing, eliminate sexual problems brought on by curvature, and enable semen deposition into the vagina during sexual activity. the choice of operation is frequently influenced by the surgeon's experience. Surgery can be broken down into one- or two-stage operations as well as into operations including tubularization, augmentation, and replacement of the urethral plate. Single-stage urethroplasty can be used for anterior to posterior hypospadias, but two-stage urethroplasty is preferremce for treating proximal hypospadias with less complication and more desirable aesthetic consequences
Review on Microspheres
Full text linkMicrospheres can be employed to deliver medication in a rate-controlled and sometimes targeted manner. Medication is released from a microsphere by drug leaching from the polymer or by degradation of the polymer matrix. The current review provides an in-depth discussion of therapeutic aspects of microsphere drug delivery including consideration of the prerequisite area for micro particulate, types of polymers used, method of preparation, method of release & kinetics, type of microspheres in brief, characterization & targeting of microspheres & practical aspects of microsphere