International Journal of Health and Clinical Research
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Placenta previa and it’s maternal and fetal outcome- A prospective observational study in a tertiary care hospital of West Bengal
Get PDFBackground: Placenta previa is characterized by the abnormal placenta overlying the endocervical os, and it is known as one of the most feared adverse maternal and fetal-neonatal complications in obstetrics. Objectives: We aimed to find out the prevalence of placenta previa including Morbidly Adherent Placenta amongst pregnant mothers attending antenatal OPD and Emergency Department and evaluate maternal and fetal outcome in all cases of placenta previa. Methods: A prospective observational study was carried out in the department of Obstetrics and Gynaecology of a Tertiary Care hospital in Kolkata. Data from one hundred and twenty pregnant women presenting with bleeding per vagina during the third trimester of pregnancy either symptomatic or asymptomatic with ultrasonographic diagnosis of placenta previa. Department during the one-year period from 1st April 2020- 31st March 2021 were analysed. Demographic data including age, parity, gestational age and previous caesarean delivery or other uterine surgery, details of medical and obstetric history and information on the intraoperative and postoperative events were recorded. Descriptive analysis was used to report the frequency of maternal and neonatal adverse outcomes. Result: The incidence of Placenta previa was 1.03%. Majority (62.9%) were unbooked cases. Placenta previa cases was highest in the age group 22-30 years (80.9%). It was found that second gravida formed majority of the cases (42.5%), 68.4% of the cases presented at 37 weeks gestational age. From this study, we found that clinical presentation with antepartum haemorrhage was seen in 76 (63.4%) case. Among the admitted PP patients,108 (90%) of the cases were in the class 1 category of Benedetti classification. Out of the120 neonates born, 5 (4.1%) were still born. Out of 115 live-born babies, 56 (48.7%) required NICU admission. Among these neonates 6.7% were in early preterm
Biomarkers in Clinical Medicine: Perspective from a Clinical Biochemistry Laboratory
Get PDFBiomarkers have been used in clinical medicine for decades. With the rise of genomics and other advances in molecular biology, biomarkersstudies have entered a whole new era and hold promise for early diagnosis and effective treatment of many diseases. A biomarker is acharacteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes or pharmacologicresponses to therapeutic intervention. There is increasing pressure to provide cost -effective healthcare based on "best practice." Consequently,new biomarkers are only likely to be introduced into routine clinical biochemistry departments if they are supported by a strong evidence baseand if the results will improve patient management and outcome. This requires convincing evidence of the benefits of introducing the new test,ideally reflected in fewer hospital admissions, fewer additional investigations and/or fewer clinic visits. Carefully designed audit and cost-benefitstudies in relevant patient groups must demonstrate that introducing the biomarker delivers an improved and more effective clinical pathway.From the laboratory perspective, preanalytical requirements must be thoroughly investigated at an early stage. Good stability of the biomarker inrelevant physiological matrices is essential to avoid the need for special processing. This article will focus on how these biomarkers have beenused in preventive medicine-diagnosis therapeutics and prognostics as well as public health and their current status in d practice. This article alsodescribes the major uses of biomarkers in clinical investigation. Careful assessment of the validity of biomarkers is required with respect to thestage of disease. Causes of variability in the measurement of biomarkers range from the individual laboratory. Issues that affect the analysis ofbiomarkers are discussed along recommendations on how to deal with bias and confounding
Incidence of PDPH following spinal anesthesia in obstetric patients undergoing cesarean section in our setup
Get PDFBackground: Post dural puncture headache has remained a well-known complication of spinal anaesthesia. The potentially serious nature of this complication necessitates inclusion of informed consent involving any procedure that may result in post dural puncture headache. Aim: To determine the overall incidence of post dural puncture headache in obstetric patients in our set up and determine the onset, duration and severity of postdural puncture headache. Methods: This prospective, observational study was conducted in Postgraduate Department of Anaesthesiology, Critical Care and was done in Lalla Ded Hospital, an associated hospital of Government Medical College, Srinagar on patients who underwent cesarean section under spinal anaesthesia for incidence, onset, duration and severity of postdural puncture headache. Results: Incidence of post dural puncture headache was 10.6% (102 of 960) in our study patients, mean time of onset of post dural puncture headache was 26.4+8.92 hours, severity of PDPH was mild in 62 (60.8%) patients, moderate in 39 (38.2%) patients and severe in 1 (1.0%) of the patients. The mean duration of PDPH was 5.3+2.89 days. Conclusion: To prevent PDPH, the use of size 26 gauge quincke’s needles may be encouraged as this study has shown but cost consideration especially in the developing countries setting is always a limiting factor. Conservative measures as treatment for PDPH, should be tried first in view of the good response obtained for all the cases of PDPH in this study
Prevalence and Antimicrobial Susceptibility of Bacterial Isolates from Intensive Care Unit of a Tertiary Care Hospital of Bihar
Get PDFIntroduction: Antimicrobial resistance is a modern warfare against trillions upon trillions of microorganisms which is constantly evolving. The intention of the study is to find out the prevalence of common infection and sensitivity pattern among bacterial pathogens in a tertiary care hospital of Bihar. Methodology: The current study was carried out in the Department of Microbiology, Jawaharlal Nehru Medical College and Hospital, Bhagalpur, Bihar, India over a period of 1 year from November 2020 to October 2021. The prior approval was obtained from the Institutional Ethics Committee. The data comprising a total of 615 samples collected over a period of one year. Isolates from clinical specimen such as urine, pus, blood, sputum, wound, ear, throat swabs, and peritoneal fluid sample were analyzed. The positive cultures and their antibiotic susceptibility testing were performed under the guidelines of Clinical and Laboratory Standard Institute (CLSI). Results: During the study period, total of 615 samples were received for culture and sensitivity test in the Department of Microbiology from the various intensive care units of the hospital. Out of 252 positive samples, based on microscopy and culture characters 179 (71.1%) were Gram Negative isolates and 73 (28.9%) were Gram positive isolates. The most predominant isolated organism in Gram Negative isolates are Klebsiella - 98 (54.7%), Pseudomonas – 38 (21.2%), Escherichia coli – 29 (16.2%) & Proteus vulgaris – 14 (7.8%). Similarly the most predominant Genus/Species in Gram Positive isolates is Staphylococcus – 71 (97.3%). Conclusion: Existing and future medical community, health care professionals, Government should address this emerging problem and curb this at its root or else a scenario of pre antibiotic era in near future is inevitable
Comparison of two conservative methods in treatment of ureteric stones
Get PDFBackground: Urolithiasis is important major public health problem. This study was undertaken in order to compare the efficacy of tamsulosin in comparison with the oral fluids. Material and Methods: A comparative study was undertaken among 50 patients where the patients were equally divided in to two equal groups of 25 patients each. One group received oral fluids and other group received tamsulosin. The patients were observed strictly on weekly basis and asked for any history of passage of calculi and findings were recorded and patients were monitored and followed up for a period of one month. Results: Majority of the patients in Oral fluids and Tamsulosin group were males and aged between 41 – 50 years. Right ureter was affected in majority of the patients. Lower 1/3rd of the Ureter is affected among 36% of the oral fluid group and 40% of the Tamsulosin group. About 56% of the oral fluid group patients had stone size of less than 5 mm and 56% of the patients in Tamsulosin group had stone size of 6 – 10 mm. About 32% of the patients in oral fluid group passed the stone by 21 days of follow up and 48% of the patients in Tamsulosin group passed the stone by 14 days of follow up. Giddiness was noted in 16% and Headache was noted in 8% of the patients in Tamsulosin group. No side effects were noted in Oral fluids group. Conclusion: The tamsulosin group had expulsion of ureteric stones when compared to the oral fluid group
Burden of care among caregivers of patients with schizophrenia and bipolar disorder
Get PDFIntroduction: Caregivers of patients with severe psychiatric illnesses suffer significant impairment in their socio-occupational, interpersonal as well as emotional functioning, amounting to enormous burden. Aim: To compare the burden of care among the caregivers of patients with schizophrenia and bipolar affective disorder. Methodology: It was a cross-sectional study, conducted at a tertiary care hospital, and involved 30 caregivers each of patients with schizophrenia and bipolar disorder. Burden Assessment Schedule (BAS) was used for assessing the burden experienced by the caregivers, along with a specially designed proforma was used to gather socio-demographic information about the patients and their caregivers. Result: Most subjects were males, were spouses in case of bipolar affective disorder patient (43.30%) and parents (46.70%) among schizophrenia patients. In terms of socio-demographic profile, no significant difference was found between the groups. 17 (12 of schizophrenia and 5 of bipolar group) of the total 60 subjects were found to experience severe burden of care. Total burden score was 64.4 ± 13.88 for the subjects of bipolar disorder group and 75.03 ± 13.7 among the subjects of schizophrenia group and, the difference was statistically significant. Conclusion: Severe burden of care worsens the quality of life and poses substantial subsyndromal psychiatric morbidity among the caregivers of patients with chronic psychiatric morbidities. Support programme should be planned to help the caregivers, acknowledging the uniqueness of each caregiving situation, monitoring the individual care process and taking into consideration the phase in the caregiving process
Comparative study of the effects of intrathecal clonidine and fentanyl as adjuvant with low dose hyperbaric bupivacaine for unilateral spinal anaesthesia in lower limb surgery
Get PDFBackground and Aims: Unilateral Spinal anaesthesia with bupivacaine is administered for lower limb surgeries. The aim of the study is to compare between the effects of Clonidine and Fentanyl when added as an adjuvant to low dose bupivacaine in unilateral spinal anaesthesia in lower limb surgery on the basis of onset and duration of sensory and motor blockade and post-operative analgesia. Material & Methods: After obtaining the institutional ethics committee approval total 150 patients ofeither sexbetween 18 to 55 years of age, American Society of Anaesthesiology (ASA) I and II scheduled for elective lower limb surgery were divided into three groups. All patients received 0.5% hyperbaric bupivacaine (7.5mg) 1.5ml intrathecally along with ± adjuvant ( In Group A - clonidine (30 microgram) 0.2 ml diluted with normal saline to make 0.5 ml, Group B- fentanyl 25 microgram or 0.5 ml, Group C only 0.5ml normal saline) to make total 2ml solution . The results of observations were tabulated, compiled and statistically analysed using SPSS (version) 25.0 and Graph Pad prism version 5. Result : Fentanyl and clonidine both when added to low dose bupivacaine in unilateral spinal anaesthesia prolonged the duration of sensory and motor block compared to only low dose local anaesthetic agent. The time duration before the use of first dose of rescue analgesic is more prolonged in the group receiving clonidine as compared to Fentanyl group patient
A Hospital Based Prospective Study to Evaluate the Clinical Profile & Outcome of Severe Acute Malnutrition (SAM) in Infants Below 6 Months of Age
Get PDFBackground: Severe acute malnutrition is increasingly being recognized in infants under 6 months of age and is often associated with higher mortality in young infants than in older infants and children. The aim of this study is to identify the clinical profile and primary outcomeof severe acute malnutrition as defined by WHO growth reference standards in infants aged below 6 months of age at district hospital in Rajasthan. Materials& Methods: A prospective observational study was conducted in the Department of Pediatrics, District hospital, Dholpur, Rajasthan, India during one year period. 30 comprised infants with SAM as defined by current WHO guidelines: weight‐for‐length Z‐score (WLZ) <−3 and/or bilateral nutritional oedema. Exclusions were infants from twin/multiple pregnancies and those with obvious congenital anomalies that could affect feeding (e.g., cleft lip or palate).Detailed clinical examination and anthropometric measurements-weight, height and mid arm circumference was recorded. Results: The mean age of admitted patients was 5.03 ± 1.18 months.Majority of the cases, i.e. 24 (80%) were Hindus and amongthem 18 (60%) were living in rural area. 26 (86.66%) patients belong to lower socioeconomic scale(III,IV&V) and only4(13.33%)patients belonged to socioeconomic scale I and II. Fever was the most common presenting complaint in 21 (70 %) patients, followed by vomiting in 15 (50 %), loose motion in 15 (50%) and loss of appetite or weight loss in 10 (30%) patients. 18 (62.06%) were stunted at this time, and 11 (38%) severely stunted. Conclusion: We concluded that many factors such as literacy, income, age of marriage and sanitation facility indirectly or directly influence the nutritional status of infants
Functional Outcome in Patients Undergoing Sauve-Kapandji Procedure in the distal radioulnar joint disorders-A Mid Term follow up
Get PDFIntroduction: The Sauvé-Kapandji procedure is useful for treating a variety of pathologic conditions that alter the normal function of the distal radioulnar joint. The present study was aimed to evaluate the clinico-radiological outcomes of the sauve-kapandji procedure in various distal radioulnar joint disorders. Materials and methods: The study included 14 females and 4 males with a 5 years mean follow up. The mean age at time of surgery was 48 years (range 22-72). The indication for surgery was posttraumatic osteoarthritis in 10 patients, inflammatory arthritis in 5 patients, and painful DRUJ luxation in 3 patients. Results: At final follow-up, VAS and quickDASH scores showed statistically significant improvement from a mean of 5.3 ± 0.9 to 1.2 ± 0.6 and 48.6 ± 9.8 to 20.7 ± 4 respectively. Mean grip strength improved significantly from 3.5 ± 1.2 kg preoperatively to 6.4 ±1.6 kg postoperatively (P<0.005). There was a statistically significant improvement in the preoperative versus postoperative range of motion of the wrist and forearm. Radiologically, successful union at the arthrodesis site was noted in all patients. Conclusion: The Sauvé–Kapandji procedure is an established treatment method for distal radioulnar joint dysfunction. This study supports the pragmatic utility of the S-K procedure in treatment of DRUJ disorders with a significant clinical improvement
Serodiagnosis of dengue using NS1 antigen, dengue IgM, dengue IgG antibody with correlation of platelet counts
Get PDFIntroduction: The dengue virus causes one of the most important mosquito-borne viral diseases.Annually, it affects up to 100 million people. Early laboratory diagnosis of dengue infection isimportant, as itcan allow early intervention and better prognosis. Dengue IgM antibody isdetected usually after five days of infection. NS1 antigen can be detected as early as day one.Platelet count is the only non-dengue parameter that can support the diagnosis of the dengueshock syndrome (DSS) and dengue hemorrhagic fever (DHF). This study was done to correlate the platelet count and dengue parameters detected either by rapid card test or by ELISA methods. Materials and Methods: Five hundred ninety three clinical samples suspicious of dengue were collected from April2020 to September2020. The received samples were tested by rapid methods and ELISA for dengue parameters and for platelet count by automated Becmon Coulter5partcellanalyser. Results: Out of 593 samples, 90 samples were positive by rapid tests that included NS1 antigentest, IgM and IgG dengue by immune chromatographic tests. Sixty one samples were positive bydengue IgM and dengue IgG ELISA.Samplespositivefordengue IgM antibodies orNS1antigen alone or positive for both were classified as primary dengue infection. Samples positivefor dengue IgG antibody or dengue IgG and IgM antibodies were classified as secondary dengue infections. Of the 90 cases positive by rapid card test, 62 cases were classified as primary dengueinfection and 28 cases as secondary dengue infection. Total 61 cases were positive by ELISAtests of these 35 cases were diagnosed as primary dengue and remaining 26 cases as secondary dengue infection. Conclusion: Thus the rapid tests such as NS1 antigen test, IgM and IgG dengue antibody can be used for the diagnosis in small peripheral laboratories. Thrombocytopenia was more consistent with cases positive for only IgG. Though MAC ELISA is more sensitive and specific than rapid methods, detection of NS1 antigen by immunochromatograpy test helps in early detection