International Journal of Health and Clinical Research
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A Cross Sectional Study of Blood Pressure Profile in Adolescent School Children of North Kerala
Get PDFBackground: Cardiovascular Diseases (CVDs) are a major public health problem and hypertension is considered as an important risk factor for the development of CVDs. The prevalence of hypertension in children and adolescents seems to be increasing and it is often undiagnosed. We conducted this study with the aim of determining the prevalence of hypertension and its association with selected anthropometric variables in adolescent school children. Method: This cross-sectional study was conducted in adolescent school children aged between 12 and 16 years. Blood pressure was measured in participants between 9am and 11am in sitting position after 10 minutes of rest with an appropriately sized cuff. Three measurements were taken at an interval of five minutes each and the mean of these readings were taken as average systolic and diastolic blood pressure. Hypertension is taken as systolic and /or diastolic blood pressure >95th percentile for gender, age and height and prehypertension as 90-95th percentile and <90th percentile as normal blood pressure. Results: In this study 882 school children aged between 12 and 16 years were included and out of them 460 were males (52.2 %) and 422 were females (47.8 %). Based on Body mass index (BMI) 47 of them were underweight, 596 were normal weight, 239 were overweight / obese. Among them 613 (69.5 %) were having normal blood pressure, 197 (22.3%) were having elevated BP, 57 (6.5 %) were having stage 1 hypertension and 15 (1.7%) were having stage 2 hypertension.Conclusion: The prevalence of prehypertension and hypertension in school children is increasing in our community and BMI was found to have a significant association with elevated blood pressure. Regular screening of adolescent school children and detection of prehypertension through specific school health programme and early intervention is an urgent need to prevent hypertension and related comorbidities in young population
Corneal Collagen Cross-linking (CXL): Effectiveness and Safety in Progressive Keratoconus in Pediatric Patients with Adequate Corneal Thickness
Get PDFBackground: This study was undertaken to evaluate the outcomes of corneal collagen cross-linking for treatment of progressive keratoconus in pediatric patients who had adequate corneal thickness. Material and Methods: About 50 eyes of pediatric age group (<18years) with progressive keratoconus having corneal thickness more than 450 microns were subjected to accelerated corneal collagen cross-linking(CXL). Pre-op parameters were compared with1month, 6 months, 12 months post CXL. Scheimpflug Imaging was used to assess the Maximum keratometry (Kmax), Pachymetry (thinnest), Total corneal irregular astigmatism (RMS).Best Corrected Visual Acuity(BCVA), Spherical Equivalent and Corneal endothelial counts were also assessed. Results: At6 and 12monthsKmaxreduced from pre-op 57.26±4.69D to 57.73±5.06D and 56.34±4.90D (Pvalue<0.05); Pachymetry changed from 466.96±19.59μm to451.44±19.41μmand 449.28±20.75μm(P value <0.05); BCVA was improved from 0.598±0.318 to 0.530 ± 0.292 at 6 months andto 0.488 ± 0.283 at 12 months(P value <0.05). RMS reduced from 1.005±0.473 to 1.04±0.477 and 0.90±0.478 (P value <0.05) at 6 months and 12 months respectively. There was no significant change in spherical equivalent and endothelial count at 1 year of follow up. Conclusion: Corneal Collagen Cross-linking is a safe and effective procedureto freeze keratoconus progression in pediatric eyes
A Study On Metallo-Beta Lactamase Producing Pseudomonas Aeruginosa Species In Clinical Isolates Of A Tertiary Care Hospital Of Bihar
Get PDFIntroduction: Metallo-beta lactamase production is the most common mechanism of carbapenem resistance. Metallo-beta lactamase is a zinc dependent enzyme belonging to Ambler class B that can hydrolyse all beta lactam antibiotics including carbapenem. Keeping it in mind we have conducted a research to find out MBL positivity rate in clinical isolates of Pseudomonas in a tertiary care hospital of Bihar. Methodology: This is a descriptive cross-sectional study conducted in the Department of Microbiology, Jawaharlal Nehru Medical College and Hospital, Bhagalpur, Bihar, India over a period of 1 year from May 2020 to April 2021. Depending upon site of infection samples were collected like urine, pus, sputum, BAL, ear swab etc in sterile container. Carbapenem resistance was suspected when either imipenem or meropenem was resistant (mic>8 μl/ml).MBL production was tested in all carbapenem resistant Pseudomonas species by Combined disc test with imipenem and was confirmed by MBL- E test. Results: A total of 1357 various body fluids were obtained from various wards of the hospital over the study period, out of which, Pseudomonas species were isolated from 207 samples. Among 207 samples, 181 were P. aeruginosa and 26 were P. putida. Majority of the samples were obtained from OPD followed by IPD and ICU. MBL production (MBL +) was noted among 13.5% (28/207) of isolates and carbapenem resistance was observed among 14.9% (31/207). When both these characters were matched, it was noted that almost two-third (74.2%) of carbapenem resistance (CR) Pseudomonas were MBL positive. Both these characteristics were more common among p. putida as compared with P. aeruginosa. Conclusion: MBL producing Pseudomonas is difficult to treat but easy to prevent by proper hospital infection control measures and antibiotic policy
COPD with Atrial Fibrillation
Get PDFBackground: COPD is one of the leading cause of morbidity and mortality and is associated with variety of cardiovascular disease especially Arrhythmia which is directly associated with severity of COPD so there was a need to identify the incidence of Atrial Fibrillation (AF) in COPD patients and its effect on mortality and morbidity of patients admitted in hospital for COPD. Material and Methods: A retrospective study was conducted and data analysis was done, of all patients with established COPD diagnosis. The number of patients were divided into two groups: (1) Patients with diagnosed COPD in ordinance with GOLD guidelines (2) Patients with COPD diagnosed with AF, new onset and old. Post admission patients were divided on the basis of age, sex, H/o, CAD and H/o smoking. Results: Out of 200 study patients, 30% had AF (old and new). 34% had new onset AF and 66% were known cases of AF. Out of patients with AF 18% were less than 50 years of age, 60% between 50-70 years, 22% more than 70 years, 80% were smoker, 20% non-smokers, 80% had CAD; 75% were male and 25% female. Conclusion: COPD patients are at higher risk of developing AF. COPD with AF patients have longer Hospital stay and increased mortality
Evaluation of solid renal masses by qualitative and quantitative parameters in four phase MDCT with histopathological correlation
Get PDFIntroduction: Quantitative measurement of the degree of enhancement has not been widely reported for RCC subtypes and fat-poor angiomyolipoma. Previously enhancement in either one of the corticomedullary or nephrographic phases is used for evaluation of renal masses. From the past decade renal mass enhancement is viewed in terms of differences in contrast enhancement and deenhancement patterns over multiple phases on multiphasic MDCT as well as contrast-enhanced MRI to distinguish among RCC subtypes[1]. Most recent studies by Jinzaki et al[11], sun et al and Vargas et al, Stephanie A. Lee-Felkar et al[12] advanced the concept of multiphasic renal mass attenuation profiles for individual histological subtypes. In our study we follow the current novel approach to the imaging evaluation of renal masses using qualitative and quantitative MDCT feature. Aim/purpose: To characterize the incidentally detected solid renal masses as benign or malignant and differentiating the clear cell RCC from its benign and malignant mimics based on qualitative parameters like lesion contour, calcifications, neovascularity, enhancement and quantitative parameters like mean absolute attenuation, mean relative attenuation, absolute enhancement & absolute de-enhancement in a four-phase MDCT renal mass protocol. Materials and methods: This was an Observational prospective study conducted in 42 patients in the department of Radiodiagnosis at Apollo hospitals, Jubilee hills, Hyderabad referred from the Departments of urology, surgical oncology with a clinical suspicion renal tumors or renal masses which are incidentally detected on ultrasound and referred to CT for further characterizationfor 9 months, from October 2019 to June 2020.Patients of all age groups, both sexes, who were given consent for the study taken and subsequently histopathological findings were followed.Patients with angiomyolipoma with macroscopic fat detectable, predominantly cystic renal masses on CT, Pregnant women and allergic to contrast media are excluded. 128 SLICE PHILIPS INGENUITY CT machine was used for evaluation with parameters of 3mm slice thickness, FOV of 300.00mm, voltage of 120KV, tube current of 300-350mA. Results: This was an observational prospective study was conducted among all the patients who were referred to department of radiodiagnosis for further characterisation and correlate with histopathology as gold standard.The mean age of the study population was 49.2 ± 2.9 yrs. with majority of the patients belongs to 41 – 60 yrs.78.5% of patients in the present study were male and 21.5% were female.85.7% were symptomatic at the time of presentation and the most common symptom was haematuria followed by pain in abdomen.Most common solid renal mass was renal cell carcinoma (54%). Among renal cell carcinomas clear cell RCC is most common histological variant (53%). Among the benign oncocytoma is most common (19%). Among qualitative parameters, neovascularity showed statistically significant P value with high sensitivity, specificity, PPV, NPV & accuracy. All lesions showed maximal attenuation in corticomedullary phase and decreased in subsequent phases except papillary variant of RCC. High mean absolute attenuation in CM phase + Mean relative attenuation of >0% in CM phase + absolute de enhancement >50HU has good sensitivity, specificity in differentiating clear cell RCC from others.Progressive enhancement from corticomedullary to nephrographic phase with highest mean absolute attenuation during nephrographic phase had high sensitivity, specificity & accuracy in differentiating papillary RCC from others.Delayed de enhancement more than 30HU differentiated oncocytoma from chromophobe with high sensitivity and specificity. Conclusion: Qualitative & Quantitative MDCT features enables diagnosis of malignant masses with 100% sensitivity also discriminating CcRCC from its benign and malignant mimics with high sensitivity and specificity
Observational study on the incidence and risk factors for seroma formation following modified radical mastectomy
Get PDFIntroduction: Breast cancer is the most common malignancy in women and second leading cause of cancer death among women. The surgical treatment of choice for these patients is either modified radical mastectomy or breast preservation depending upon stage of the disease. Seroma formation is the most frequent postoperative complication after breast cancer surgery, of which the pathogenesis has not been fully understood. In view of this, we collected data to determine the incidence and risk factors related to seroma formation in our patients and increase its scope and hence attempt to prevent it. Materials and methods: An observational study was conducted in 126 female patients who have undergone MRM from the Department of General Surgery, Government Medical College, Kozhikode from November 2020 to November 2021. Those who are having seroma clinically within 4 weeks of surgery are sent for radiological evaluation (USG), size measured accordingly. Statistical analysis of the data performed and Pearson Chi-square test and Fisher’s Exact test were used for comparing categorical variables between groups. Results: The threshold age of development of seroma formation after MRM was ≥56.The threshold BMI of development of seroma formation after MRM was ≥27.50kg/m2.The threshold tumour size of development of seroma formation after MRM was ≥4cms. Out of 26 patients who underwent level 3 axillary dissection, 13 patients (81.2%) developed seroma. Level 2 axillary dissection was performed in 110 patients and only 26 ( 23.6%) patients developed seroma. >12 lymph nodes were removed in 33 patients and 25(75.8 %) developed seroma. In 93 patients with < 12 lymph nodes removed only 14 (15.1%) patients developed seroma. Conclusion: 1. 31% of patients in the study population who had undergone MRM developed seroma within four weeks after surgery. 2. Seroma formation after MRM showed positive correlation with age, BMI, tumour size, level 3 axillary dissection and >12 lymph nodes removed during surgery. 3. There was no correlation between seroma formation and day of drain removal, neoadjuvant chemotherapy, usage of breast bandage and shoulder exercises
Drug emergent metabolic syndrome among patients taking olanzapine: A prospective interventional study
Get PDFIntroduction: Olanzapine is one of the most commonly used atypical antipsychotic and is associated with significant deterioration of the metabolic profile among the patients taking it. Aim: To assess the emergence of drug induced metabolic syndrome among patients taking olanzapine. Materials and method: Eighty cases with diagnosis of Schizophrenia, schizoaffective disorders, bipolar affective disorder, persistent delusional disorder, unspecified nonorganic psychosis and no history of treatment with atypical antipsychotics in last 6 months were recruited from outpatient/ inpatient department of Institute of Mental Health, Amritsar, by purposive sampling after baseline screening and applying inclusion and exclusion criteria. It was a Prospective Interventional study. Patients were assessed for their metabolic profile at baseline, 2- and 4- months. Result: Statistically significant difference was found in all the metabolic parameters, including body weight, blood pressure, BMI, fasting blood glucose, fasting triglycerides and fasting HDL, after 4 months of initiating olanzapine as compared to baseline. One-fifth of the patients had attained the criteria of metabolic syndrome at the end of four months, and this ratio showed minimal variation with gender. Conclusion: Metabolic impairments have become a persisting menace with currently preferred patterns of lifestyles and drug management. Psychiatrists must be vigilant enough towards the potential metabolic side effects of antipsychotic medications so that appropriate precautions can be implemented in a timely manner. The general treatment provided to patients with severe mental illness should be at par with care provided to other patients
Comparative evaluation of efficacy and safety of aripiprazole versus amisulpiride as add on therapy to olanzapine in partial responders of schizophrenia
Get PDFObjective: Many newer agents are proposed as adjunctive therapy to olanzapine for better treatment of schizophrenia. Therefore present study is planned to compare efficacy, tolerability & safety profile of olanzapine plus aripiperazole versus olanzapine plus amisulpiride combination in schizophrenic patients partially responded to olanzapine monotherapy. Material and Methods: This is a longitudinal, prospective, randomized comparative study conducted in department of pharmacology and out patients of psychiatry in J.A. group of hospitals, Gajra Raja Medical College, Gwalior, M.P.from February 2018 to March 2019 after seeking Institutional ethics committee approval. Total 112 diagnosed cases of schizophrenia who were partial responders to olanzapine monotherapy were chosen for the study. Patients were divided into two groups randomly. Group I(n=54)received olanzapine(20 mg) in combination with aripiprazole(10mg) and Group II (n=58)received olanzapine(20mg) with amisulpiride (100mg) orally for 8 weeks. Effectiveness was assessed by change in Positive and Negative Symptom Scale Score (PANSS) & Clinical Global Impression-Improvement (CGI-I) score at 4th and 8th week as compared to baseline values.Safety was assessed by recording adverse effects during treatment period. Results: 45 patients in each group completed the study. On 8th week , percentage change in mean PANSS score from baseline was 41.6%and 34% in group I and group II respectively and was significant (P<0.05)as compared to baseline values. On Inter group comparison difference was not statically significant (P>0.05).Olanzapine with aripiprazolecombination therapy showed 54% improvement in CGI-I scale and was significant (P < 0.05)as compared to 40% change with olanzapine and amisulpiride combination therapy. Aripiparazole add on therapy has shown less adverse effects to that of amisulpiride. Conclusion: Aripiprazoleas add on therapy to olanzapine has shown better efficacy safety and tolerability than that of amisulpiride
A Prospective Study to evaluate the Hemodynamic Changes and Adverse reactions associated with Propofol and Etomidate during General Anesthesia
Get PDFBackground: Among general anesthesia induction drugs, etomidate is the only imidazole, and it has the most favorable therapeutic index for single bolus administration. Propofol has been shown in clinical studies to be a safe, effective, hypnotic, and amnesic anesthetic agent at induction doses of 2-2.5 mg/kg and maintenance doses of approximately 9mg/kg per hour. Aim: To assess hemodynamic changes and complications occurring with Propofol and Etomidate during general anesthesia. Methods: A total of 100 subjects were enrolled in the present study and were broadly and randomly divided two study groups with 50 subjects in each group: Group A: Subjects who received 1% Propofol injection, and Group B: Subjects who received 0.3mg/kg of etomidate injection. Monitoring of the blood pressure, mean arterial pressure and heart rate was done throughout the surgery and until 10 minutes after induction. Recording of the pain during injection was done on a scale of 0 to 10 with 0 referring to no pain while 10 referring to maximum pain. Results: No significant difference was observed while comparing the mean arterial pressure and heart rate among subjects of both the study groups at different time intervals except for at the time of induction. Mean pain score was found to be significantly higher in group A in comparison to group B. Conclusion: Among patients with associated altered hemodynamic status, etomidate is an improved option. However; further studies are recommended
An Analytical Cross-Sectional Study on the Impact of Clinical Profile on the Outcome of Patients on Mechanical Ventilation at a Tertiary Care Centre
Get PDFIntroduction: Mechanical ventilation (MV) is an invasive life supporting device to mimic the respiratory physiological function at the time of impending respiratory failure. There is dramatic improvement in the survival of critically ill patients, but also associated with complications affecting the overall outcome. A part from the severity of underlying disease, MV and care related parameters also influence the outcome. Aim: To determine the outcome of mechanically ventilated patients in an ICU depending on their clinical profile. Materials and Method: Retrospective cross sectional study for duration of 6 months. Inclusion criteria: Patients >18years of age, male and female patients, All patients requiring MV support for >12hours, Patients with failing respiratory drive or who failed O2 therapy and NIV are eligible for the study. Exclusion criteria: Patients <18years of age, Patients who died within12 hours of intubation, Patients who were extubated <12 hours of intubation, Pregnant and lactating women, patients with Incomplete data. Conclusion: Increased mortality observed in patients with sepsis and more number of ventilator days and increased length of hospital stay