International Journal of Health and Clinical Research
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A Study on Hyponatremia among Pediatric Patients With Pneumonia At A Tertiary Care Centre Of Bihar
Get PDFIntroduction: Lower respiratory tract infections (LRTIs) are common during childhood and can have high morbidity and mortality rates if not treated. The 2005 report of the World Health Organization states that LRTIs cause approximately 19% of the 10.5 million annual deaths. Hyponatremia related to pediatric pneumonia is most typically due to the syndrome of unsuitable antidiuretic hormone secretion (SIADH). The rationale of this study is to find out the prevalence of hyponatremia in a child with pneumonia so that while treating pneumonia, hyponatremia is not overlooked and treated simultaneously. Methodology: It is a prospective study with sample size of 60. Children between 2 month to 5 years visiting OPD clinic and admitted to Patna Medical College & Hospital between January 2013 to June 2013 in the duration of 6 months with clinically or radiologically confirmed pneumonia were the study population. Inclusion criteria were children between 2 months to 5 years with radiologically confirmed pneumonia and clinical features defined as per modified WHO/BTS guidelines. All children were screened for dyselectrolytemia on admission. Other investigations were done whenever required. Collected data were analyzed by frequencies, percentages, mean, and standard deviation by Chi-square test using SPSS 16.0. Results: The mean age of children was 2.2 ± 1.9 years. Maximum number of children belonged to age group between 2 months to 24 months. There was a male preponderance a male to female ratio of 2.3:1. Respiratory rate was increased in all the children. The range of respiratory rate for children aged 2 months to 12 months was 52 to 80 per minute and for those above 12 months were 46 to 76 per minute. Hyponatremia was revealed in 86.7% of the children with pneumonia. Conclusion: The children admitted with pneumonia have higher morbidity when associated with hyponatremia. Hence along with management of pneumonia, hyponatremia should also be cautiously addressed in these patients
A prospective study of aetiology and outcome of acute kidney injury in type 2 diabetes patients
Get PDFIntroduction: Acute kidney injury (AKI) describes the clinical syndrome earlier called acute renal failure. AKI is defined as structural or functional abnormality of the kidney that manifests within 48 h, as determined by blood, urine, tissue tests or by imaging studies. AKI is depicted by rapid (over hours to days) decline in glomerular filtration rate, retention of nitrogenous waste products and perturbation of the extra-cellular fluid volume, electrolytes and acid-base homeostasis. AKI constitutes approximately 5% of hospital admissions and up to 30% of admissions to intensive care units (ICU). Materials and Methods: A prospective study was conducted at Department of Internal Medicine, KIMS Hospital, Ongole from January 2021 to December 2021 (1 year). Type 2 diabetic patients 30 years or above, irrespective of gender, diagnosed to have acute kidney injury using KDIGO criteria, admitted to ICU or wards under the Department of Internal Medicine, KIMS Hospital, Ongole were included in the study. Patients with preexisting renal disease and those who received renal transplantation were excluded from the study. Type 2 diabetic patients admitted in the ICU and wards under Medicine and Nephrology department, KIMS Hospital, Ongole were evaluated in detail after taking prior consent. Evaluation includes detailed history taking and physical examination. Acute kidney injury will be assessed on the basis of their serum creatinine and/or urine output fulfilling the KDIGO criteria. Results: The study was conducted in a total of 150 diabetic patients who developed acute kidney injury. There were 94 males and 56 females. The aetiology and outcome of acute kidney injury in the above patients were found out. Blood urea, serum creatinine, serum electrolytes, fasting and post-prandial blood sugar, WBC count, platelet count and haemoglobin were included as the baseline parameters. Conclusion: Infection was the most common cause of AKI in Type 2 diabetes patients in our study. Among drug induced renal failure patients, NSAIDS were noted to be most common cause. Age >60 and male gender were prevalent in the majority of AKI patients. About 52.66% of the total patients recovered to normal renal function, 13.3% recovered partially, with 14% of the total patients progressed for maintenance hemodialysis. Crude mortality rate among patients with AKI in the study group was 20%
BISAP Score as a predictor of outcome in Acute Pancreatitis – A prospective study
Get PDFObjectives: To predict the outcome of Acute Pancreatitis using BISAP score. To find the association of mortality and morbidity with BISAP score in Acute Pancreatitis. Methods: The prospective study was conducted over a period of 1 year and included 100 patients, who presented within 24 hours of the onset of symptoms, and the BISAP score was obtained. The study population was divided into two groups – Mild Acute Pancreatitis (BISAP <3) and Severe Acute Pancreatitis (BISAP ≥ 3). The outcome, mortality and morbidity in the study group was analyzed. Results: The study group with BISAP ≥ 3 was associated with a significantly higher risk of Pancreatic necrosis, transient organ failure and persistent organ failure; and was associated with a statistically significant mortality, morbidity and hospital stay. Conclusion: BISAP score is a simple scoring system which can clearly prognosticate severity, morbidity and mortality of acute pancreatitis patients. It enables us to risk stratify the patients early in the disease process and thus helps in improving the clinical care and facilitates necessary intervention
Complications of intra-arterial digital subtraction angiography in patients investigated for cerebral vascular disease in Tertiary Care Hospital
Get PDFBackground: Cerebral DSA is mainly performed as a diagnostic procedure but at times used for intervention. Usually DSA is safe procedure but rarely could it be associated with complications such as nausea, vomiting, transient hypotension, anaphylaxis, and groin hematoma, neurological complications secondary to thromboembolism which occurs secondary to thrombus formation within catheters or device-induced micro-dissections. The purpose of this study was to determine the complications of intra-arterial digital subtraction angiography in patients investigated for cerebral vascular disease. Methods: Present study was prospective in nature conducted on 100 dengue patients. All patients fulfilling inclusion criteria and exclusion criteria were taken up for the study. Study was carried from August to October 2021. Results: Majority of the patients was in the age group of 40-60 years and most of them were male. Complications of the DSA procedure were neurological & non-neurological. Most of the non-neurological complications were local like pain at the puncture site, puncture site hematoma, femoral artery dissection & few were systemic as nausea, vomiting, contrast dye allergy. Neurological complications were transient ischemic attack of motor type, transient ischemic attack of sensory type & stroke of sensory type. Incidence of neurological complications in our study was 4.83%. Conclusion: DSA is a safe procedure with rare incidence of neurological complications
A Hospital Based Prospective Study to Assessment of Postoperative Complications of Patients Underwent Gallbladder Surgery (Open Cholecystectomy)
Get PDFBackground: Gallstones are the most common biliary pathology. Minor complications (biliary and non-biliary) are usually treated conservatively. Major complications (biliary and vascular) are life threatening and increase mortality rate, therefore creating the need for conversion to open surgical approach in order to treat them. The aim of this study to assessment of postoperative complications of patients underwent gallbladder surgery (Cholecystectomy).Materials & Methods: A hospital based prospective study done on 50 cases of open cholecystectomy have been selected in the department of general surgery. The analysis included operative protocols, anesthesiology records, the medical history which included the history of the disease, documented laboratory findings and imaging results. The results were considered statistically significant if the p < 0.05. The statistical analysis was performed by using statistical package SPSS v. 21.Results: Out of the 50 patients in the study, 24 were female (48%), and 26 were male (52%). The median age was 60.7 years, including participants that were 20 to 85 year old. Mostly patients (90%) had <30 kg/m2 BMI in our study. Duration of surgery was 66.5 minutes, 26.4 ml blood loss, 6.7 days stay in hospital and return to work was 19.2 days approximately in open cholecystectomy.Conclusion: Major biliary and vascular complications are life threatening, while minor complications cause patient discomfort and prolongation of the hospital stay. It is important recognizing IOC complications during the surgery so they are taken care of in a timely manner during the surgical intervention
A Hospital Based Prospective Study to Compare the Outcome of Perianal Surgery Wound when Using Silver Colloidal Solution Spray V/S Povidone Iodine Sitz-Bath
Get PDFBackground: The pain of anal ulcer is intolerable and always disproportionate to the severity of the physical lesion. Many different wound irrigation solutions, including soaps, antibiotics and antiseptics, have been used to reduce surgical site infection. The aim of this study to compare the outcome of perianal surgery wound when using silver colloidal solution spray v/s povidone iodine sitz-bath. Materials & Methods: A hospital based prospective study done 50 patients of perianal surgery with ASA I or II, attending the district hospital Dholpur, in our surgical unit over a period 1 year. Critically ill patients and patients with underlying bone osteomyelitis or malignancy were excluded. Fifty patients were randomly assigned to receive silver colloidal solution spray (Group A) or a twice-daily sitz bath along with povidone iodine (Group B). Weekly pain score and patient satisfaction score were evaluated on visual analogue scores. Results: Our study showed that there was no significant difference in age, gender distribution and the number of excised haemorrhoid piles between the two groups. No significant difference in postoperative mean pain score between groups (P >0.05) was noticed. The satisfaction score was higher in the sitz bath group with povidone iodine when compared with the silver colloidal solution spray group; however, it did not reach a statistically significant level. Conclusion: We concluded that povidone-iodine with sitz bath may be effective in preventing surgical site infection as compare to silver colloidal solution spray. However, more studies, especially double-blind RCTs, should be conducted to determine the “ideal” solution of povidone-iodine irrigation as well as specific risks associated with its use
A Comparative Study Of Twist Drill Craniotomy And Burr Hole Craniotomy In Patients Of Chronic Sub-Dural Hematoma Attending A Tertiary Care Centre Of Bihar
Get PDFIntroduction: Chronic subdural hematoma (CSDH) is one of the most commonly encountered neurosurgical conditions, common in elderly population. It may be associated with substantial morbidity and mortality and its incidence is estimated to be 13.1 cases per 100,000 populations in recent studies. This study aimed to compare recurrence rate, mortality, morbidity, surgical complications, and duration of hospital stay of these two procedures. Methodology: A study comparing burr hole craniostomy (BHC) with twist drill craniostomy (TDC) for unilateral hemispheric CSDH was carried out over a period of one year, from February 2021 to January 2022 in the Department of Neurosurgery, Patna Medical College & Hospital, Patna, Bihar. 50 unilateral CSDH patients of more than 10 mm thickness on CT scan were included, and thin CSDH, bilaterally significant CSDH, radiologically doubtful hygroma or empyema and infantile subdural collection were excluded. Two groups were randomly created out of these 50 cases with 25 patients each. Patients from one group A underwent BHC and patients of another group underwent TDC. All patients were followed up at 1, 3 and 6 months. Protocol was approved by the Institutional Ethical Committee and a written informed consent was obtained from each patient or next of kin before participation in the study was confirmed. All the statistical analysis was done using Statistical Package for Social Sciences (IBS, Chicago) ver. 16.0. Results: The mean (SD) of the patients in groups TDC and BHC were 55.1(11.3) years and 57.5 (12.2) years, respectively. Overall, there was a male preponderance with a male to female ratio of 5.25:1. Most common predisposing factor was trauma (70%) followed by hypertension (14%), alcoholism (8%), Diabetes mellitus (6%) and only one patient (2%) had a history of anticoagulant use. On pre-operative assessment, mean GCS at admission in group TDC was 12.3 and that in group BHC was 13.1. Mean (SD) thickness of hematoma in both the groups were 24.1(4.3) mm and 22.4(5.1) mm, respectively. Mean (SD) midline shift was 12.1(3.2) mm and 10.3(2.9) mm in group TDC and BHC respectively. Conclusion: BHC and TDC both are equally effective procedures for chronic SDH with respect to recurrence rate, morbidity and mortality. Follow up up-to 3 months in cases of unilateral chronic subdural hematoma is sufficient
Sonological estimation of gestational age by measuring length of fetal kidney after 20 weeks of pregnancy in healthy women with uncomplicated pregnancy
Get PDFBack ground and Objectives: In pregnant women accurate estimation of gestational age and dating is of paramount importance influencing the management. Methods to estimate the date of delivery in pregnancies should be simple and straightforward, irrespective of gestational age. Obstetrics sonography, because of its accuracy, plays a significant role in determination of gestational age. Fetal kidney length is emerging and claiming to be a new parameter and also it is more accurate in certain situations. Methods: This study was conducted in department of obstetrics and gynaecology, Institute of maternal & child health, Kozhikode during the period from December 2012 to October 2013. Obstetric sonography was performed in 179 women with uncomplicated pregnancy to evaluate the efficacy of FKL as a measure to calculate the predicted gestational age. Gestational age ranges from 20weeks to term. Only patients within inclusion criteria were taken for the study. Fetal biometry evaluated includes BPD, HC, AC, FL, FKL (Fetal kidney Length). Results: FKL correlate well with clinical gestational age, even though the correlation coefficient is slightly less than the other parameters. Overall in combined second and third trimester, FK GA correlates with gestational age with high correlation coefficient of 0.95 along with other parameters ( BPD, HC, AC,FL ) as the accurate parameters for assessing the gestational age. Conclusion: FKL correlated with other fetal biometric parameters and clinical gestational age. The correlation was found to be significant. Nomogram of the FKL shows that there is a linear relationship between the fetal kidney length growth and the gestational age. So FKL can be used as a reliable parameter for determination of gestational age along with other parameters
A Health Information Seeking Behavior on Internet for Health-related Problems: Perception and Impact on Mental Health of Engineering Students of Jodhpur, India
Get PDFIntroduction: Internet has become a very popular tool for health information seeking among young adults. The study was designed to explore this behavior among the engineering students of Jodhpur city. Methods: It was a questionnaire based cross-sectional study on engineering students (n=120) who have ever searched the Internet for their health problems. Information was collected on Likert’s-five point scale and data were presented as frequencies. The association of the perception of the Internet as the source of health information was evaluated. Results: Internet based self-diagnosis and self-medication were reported by 52 (43.33%) and 43 (35.83%) students respectively. Three-fourths of participants searched for symptoms online. The majority students (80.83%) preferred Google/Yahoo search engines. Only 48 (40%) participants accepted the Internet search as a good option for solutions to their health-related problems. Online health information adversely affected students’ minds leading to over-thinking in 52 (43.33%), stress in 39 (32.5%), restlessness in 38 (31.67%), sleeplessness in 33 (27.5%) and depressed feelings in 32 (26.67%) and more confusion in 46 (38.33%) participants. However, 53 (44.17%) participants felt reassured by the Internet search results. The perception of the Internet search as a good option for finding solutions to health problems was positively associated with accuracy, accessibility, understandability of the found information (P= 0.000), feeling reassured (P= 0.03) and sharing of the information with family(P= 0.01) and health professional(P= 0.01). Conclusion: The students use the Internet in various ways for health information seeking despite the adverse mental effects and non authenticity/reliability of the contents available online
A comparative study of RIPASA score and Modified Alvarado score in the diagnosis of acute appendicitis- A valuable tool for decision making
Get PDFBackground-Acute appendicitis is the most common cause of an acute abdomen requiring emergency surgery.The routine diagnosis of appendicitis is based purely on clinical history and examination combined with laboratory investigations.Our study is an attempt to compare both scoring systems (MODIFIEDALVARADO and RIPASA) in diagnosis of acute appendicitis and correlating both the scoring systems with the intraoperative and histopathological findings. Objectives-To correlate the diagnostic scoring systems (Modified Alvarado and RIPASA) with intraoperative and histopathological findings in cases of acute appendicitis. To compare RIPASA and Modified Alvarado scoring systems. Methods-A Hospital basedProspective study was conducted at Department of General Surgery, Adichunchanagiri Institute of Medical Sciences, B G Nagara, Mandya from August 2020 to May 2021. Patients presenting to the General surgery department and emergency in our hospital with RIF pain was included in this study. Total Sample size of 138 was studied.Data was collected from the patient’s records. For all patients RIPASA and Modified Alvarado scoring was done. Modified Alvarado score contains 7 parameters where as RIPASA score contains 16 parameters and Operative and histopathological findings were compared. Results- Out of the 138 patients, 113 patients were <39.9 years of age and 25 patients were ≥40 years. Percentage of 81.9% and 18.1% respectively.92 were male and 46 were females.Right iliac fossa pain was present in all the 138 patients in the study group. Fischer’s exact test has been applied and Modified Alvarado scoring system diagnosis correlates well with the histopathological diagnosis (p-value is <0.0398).Sensitivity of the scoring system in the study is 72.31% and specificity comes out to be 75%.The mean score for normal appendix, healed appendix, healing appendicitis and acute appendicitis is 5.00, 6.777, 7.125 and 8.414 respectively. There has been increase in mean modified Alvarado score with increase in histopathological severity. Conclusion-By comparing both scoring systems, RIPASA scoring system found out to be an easy and reliable diagnostic tool for the diagnosis of acute appendicitis and RIPASA scoring system is better than Modified Alvarado scoring system for the diagnosis of acute appendicitis in our study population