International Journal of Health and Clinical Research
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A prospective study of morphological pattern of anemia at a tertiary care centre
Get PDFIntroduction: Anaemia is a medical condition in which the haemoglobin (Hb) concentration and erythrocyte count are lower than the normal range. The normal range of Hb and RBCs in general vary between males and females, it is defined as a Hb level of <13.5 g/dL and <12.0 g/dL in adult males and females respectively. The main causes of anaemia are a decrease in RBCs, insufficient Hb synthesis or increased RBCs destruction, and the primary cause is an iron deficiency. Materials and Methods: A hospital based observational study was carried out at Department of Pathology, Vardhman Institute of Medical Sciences, Pawapuri, Nalanda, Bihar, India from October 2020 to September 2021. 250 patients were evaluated for morphological pattern of anaemia based on red cell indices, peripheral smear, and leukocyte and platelet parameters. Anaemia was defined according to WHO criteria as haemoglobin concentration lower than 13 g/dL in men and 12 g/dL in women. Results: The results of CBC and PBP showed that 72 (29%), 138 (55%), and 40 (16%) of the patients had normocytic normochromic, microcytic hypochromic and macrocytic pattern of anaemia respectively [Table 1]. The gender wise classification of the patterns revealed that 44 male patients and 28 female patients had normocytic normochromic patterns, while 105 female patients and 33 male patients had microcytic hypochromic patterns whereas 23 males patients and 17 cases of female patients showed macrocytic pattern [Table 2]. Conclusion: In our present study, adolescent women were found to have high prevalence of anemia. Since anemia is more prevalent among low socio-economic groups, the higher diagnostic tests lead to financial burden to the patients. The study of basic blood parameters and peripheral smear examination are less expensive and mandatory in the work up of anemia. Morphological patterns of anemia reflects the underlying etiology, the study of which would ensure benefits in the early detection and appropriate treatment. Iron deficiency anemia being a nutritional anemia which can be prevented by improving nutritional status, creating awareness and educating people
Comparison of effects of oral methylprednisolone with oral prednisolone in Acute Exacerbations of COPD
Get PDFBackground: Exacerbations are common in Chronic Obstructive Pulmonary Disease. Corticosteroids are the mainstay of therapy for treatment of acute exacerbation of COPD. In the present study we compared the effects of 32mg oral methylprednisolone and an equivalent dose of 40mg oral prednisolone in patients with AECOPD. Methodology: This was an analytical, experimental study conducted on 44 inpatients of AECOPD at a tertiary care centre in central India over a period of one and a half years. Patients were divided into two groups: Group A received 32mg methylprednisolone and Group B received 40 mg prednisolone for five days. Results: Both methylprednisolone and prednisolone were equally effective in relieving AECOPD symptoms at the end of day 5 (Group A: 72.2% vs Group B: 86.4%, p = 0.26). Mean length of hospital stay was similar in both the groups (Group A: 9.09 days vs Group B: 8.77 days, p = 0.68). There was no difference in the number of patients who failed treatment in both the groups (Group A: 72.7% vs Group B: 86.4%, p>0.26). The number of days on O2 was similar in both the groups (Group A: 5.55 days vs Group B: 5.14 days, p = 0.46 ). O2 free days was also similar in both the groups (Group A: 3.55 days vs Group B: 3.64 days, p = 0.64). Majority of the patients did not have any adverse effect (Group A: 59.9% vs Group B: 72.7%, p = 0.051). Conclusion: Prednisolone and Methylprednisolone had similar effects in AECOPD
Clinical profile and pattern of water and sodium disturbances in children suffering from diarrhoea with dehydration- experience of a tertiary care center
Get PDFBackground and Objectives: Diarrhoeal disorders contribute significantly to childhood morbidity as well as mortality. Despite much advancements in medical field, diarrhoea continues to be the 3rd most common cause of deathin children less than 5 years of age. The commonest cause of complications in acute diarrhoea is dehydration and dyselectrolytemia, particularly sodium disturbances. Thorough understanding of variousclinical features, high index of clinical suspicion, timely recognition and proper managementof different types of dehydration is necessary in preventing deaths. Based on this background, we intended to study the clinical profile as well as spectrum of sodium disturbances in children suffering from AGE with some to severe dehydration. Methodology: We conducted this prospective observational study over 1 year from September 2020 to August 2021 at department of Pediatrics, NMCH, Patna, Bihar including children of 6-60 months of age admitted with acute diarrhoea and clinical features suggestive of some or severe dehydration as per WHO criteria. Results: Over the study period, we enrolled 148 children. Of these, 90 were males and 58 were females. Mean age at presentation was 2.04 ± 0.97 years and mean weight on admission was 9.553 ± 3.826 Kg.Mean serum sodium level was 138.6 ± 8.25 mEq/L. Majority of children suffered from isonatremic dehydration (n= 89, 60.1%) followed by hyponatremic dehydration (n= 45, 30.4%) and hypernatremic dehydration (n= 14, 9.5%).Only 51 (34.5%) children had been administered ORS prior to admission, while the rest 97 (65.5%) were deprived of this life saving remedy. Of these only 18 (35.3%) were given ORS in appropriate dilution and the rest 33 (64.7%) were given either over- or under concentrated ORS. Malnutrition was found in 51 (34.5%) children. 27 (52.9%) of such malnourished children had hyponatremia, 14 (27.4%) had Isonatremia and 10 (19.6%) had hypernatremia.Duration of hospital stay was 3.67 ± 1.39 days. Duration of hospital stay was maximum in children with hypernatremia, however no statistically significant trend was found between type of sodium disturbance and duration of hospital stay (p=0.13). Average duration of hospital stay in malnourished children was higher (4.75 days) as compared to non-malnourished children (3.0 days) which was statistically significant (p<0.01). Unfortunately, 10 (6.75%) children died. Hypernatremic dehydration had the highest mortality rate (14.3%) as compared to hyponatremic dehydration (5.7%) or isonatremic dehydration (5.6%). But, no statistically significant trend was found between the type of sodium disturbance and mortality (p=0.17). Conclusion: The incidence of sodium disturbance (hyponatremia and hypernatremia) in children is quite high (nearly 40%). Malnourished children and children taking improperly diluted WHO ORS were at a significantly higher risk of developing hyponatremia or hypernatremia. Hypernatremia in AGE was noted to be significantly more in infants of 6-12 months when compared to 1–5-year-old children. AGE with hyponatremia or hypernatremia is significantly associated with increased risk of seizures, increased duration of hospital stay and increased risk of death as compared to AGE with isonatremia
Knowledge, Attitude, and Practice (KAP) of Pharmacovigilance among the different categories of frontline Covid-19 healthcare workers in a tertiary care hospital in West Bengal, India
Get PDFBackground: In these difficult times of Covid19 pandemic, there are rampant increase in uses of new/ old drugs which are approved or waiting to be approved or repurposed with a different dose and schedule to treat and prevent the disease. Information regarding ADRs are lacking for those drugs. Hence the need for ADR reporting by frontline Health Care Workers (HCW) are reemphasized to generate data regarding ADRs of these drugs. That’s why this study was required to evaluate the status of Knowledge, attitude & practice (KAP) of HCWs regarding ADR reporting and to plan steps to improve if found not sufficient. Materials & Methods: A hospital-based cross sectional pretested close ended questionnaire-based observational study was carried out in-inpatient departments (IPD), outpatient department (OPD) & Pharmacy Department of RG Kar Medical College & Hospital, Kolkata aimed at evaluating KAP regarding ADR reporting in different categories of frontline Covid-19 HCWs. Results: About 138 HCWs participated in the study after properly filling up informed consent form. Data collected and analyzed to find out that there was inadequate knowledge in about half of the participants (47.1%) & poor practice regarding ADR reporting. Only 22.5% HCWs encountered & reported ADRs. But there was no lack of favorable attitude regarding ADR reporting (84.78%). Conclusion: These findings indicate that proper encouragement and appropriate steps by administration can reverse the status of knowledge practice regarding ADR reporting
Effect of anticonvulsant drug sodium valproate on hepatic profile in children
Get PDFBackground: Sodium valproate is one of the most common antiepileptic medications used in clinical practice. The period of treatment is commonly associated with benign alternation of the liver enzymes due to drug metabolism. Evaluation of asymptomatic enzymatic changes could be challenging to the expert clinician and may expose patients to unnecessary procedures or expenses. Thus, this article aims to focus on the frequency of liver enzyme abnormalities among epileptic children. Materials & Methods: The current prospective observational study was conducted on children with seizure disorder attending Pediatric OPD of Rajendra Institute of Medical Sciences, Ranchi. Period of study was extended from February 2014 to October 2015. Patient randomly selected from outdoor of department of Pediatric having seizure disorder. All children aged 2 years to 10 years, of either sex having partial or generalized seizure and who have recently started either phenytoin, valproate or carbamazapine were selected for study. Routine investigations like complete blood count, peripheral blood smear, CRP, blood glucose, CT Brain/Spine, EEG and hepatic profile like aspartate aminotransferase (AST/SGOT), alanine aminotransferase (ALT/SGPT), alkaline phosphatase, total serum bilirubin (direct & indirect), prothombin time or international normalized ratio (INR), serum albumin and Australia antigen (HbsAg) on valproate therapy were done. Results: The present study revealed that, the patients treated with valproate have shown significant increase mean ALP level after 1 year of treatment as p values were 0.03, 0.02 and 0.03 respectively. The patients treated with valproate have shown no significant increase mean SGPT and SGOT level after 1 year of treatment. It was also found that there was no significant increase in mean TSB and mean PT. Also there was no significant decrease in mean serum albumin. Conclusion: The significant increase was seen in mean ALP level these increase is probably due to enzyme-inducing or enzyme-inhibiting properties of drugs. SGPT, SGOT levels increases from the initial value but not to significant level. The study recommends obtaining baseline liver enzymes tests prior to commencement of treatment. However, the benefit of routine screening in asymptomatic patients has not proved. Further controlled studies with a large sample size are warranted
Assessment of nutritional status and stress among adolescent girls
Get PDFBackground: The three most serious and common effects of stress are adrenal fatigue, neurotransmitter imbalances and hormonal and immunological disorders. The present study was conducted to assess nutritional status and stress among adolescent girls. Materials & Methods: 90 adolescent girls aged 12-18 years was recorded. The daily nutrient intake was calculated in terms of energy, protein, fat, ascorbic acid, iron, retinol, folic acid, and calcium. Results: The mean energy (Kcal) was 1406.4, 1540.2, 1724.3, 1892.2, 1911.2 and 1956.4, protein (g) was 19.2, 25.2, 27.0, 30.2, 31.2 and 30.6, fat (g) was 30.4, 31.6, 31.5, 31.6, 32.0 and 18.6, calcium (mg) was 435.4, 502.4, 560.5, 618.9, 620.4 and 468.2, iron (mg) was 15.4, 17.6, 19.4, 20.4, 20.5 and 17.2, retinol (μg) was 310.2, 310.5, 472.4, 501.4, 512.5 and 494.2, vit C was 19.4, 19.0, 21.9, 22.5, 23.3 and 23.4 and dietary folate (μg) was 98.2, 98.8, 119.4, 132.0, 134.2 and 126.5 in 12 years, 13 years, 14 years, 15 years, 16 years and 17 years respectively. The reasons for stress among adolescent was unhealthy dietary habits was seen in10%, inadequate sleep in 14%, academic work load was 22% and inadequate exercise in 7%. The difference was significant (P< 0.05). Conclusion: There was low nutritional status among adolescent girls. Reasons for stress among adolescent was unhealthy dietary habitsinadequate sleep, academic work load and inadequate exercise
A comparative study of anthropometric parameters and their relation to arterial blood pressure and fasting blood glucose in type -2 diabetes mellitus patients and non-diabetic controls
Get PDFBackground: Patients of Diabetic Mellitus (DM) are more prone for cardiovascular disease. Concomitant chronic diabetes mellitus and cardiovascular disease can have devastating consequences which can worsen the future outcomes of these diseases related to mortality and morbidity. Hence constant follow up of the patient with effective prognostic indicators is very important in modulating the disease outcome either by medical or surgical intervention. At the same time it is even more important in identifying appropriate indicators for assessing the status of the patient. Even though few available indicators are useful in accurately predicting the disease status of the patients, considering the socioeconomic status of countries like India it is desirable to find alternative approaches having qualities of affordability, adoptability, accessibility and applicability. Objectives: To assess Body mass index (BMI), Waist circumference (WC), Arterial Blood pressure (BP) and Fasting blood glucose (FBS) in persons of 40-60 years having Type 2 diabetes mellitus and in age and sex matched healthy persons.To compare the parameter in the above two groups and also to find correlation between anthropometric parameters like BMI and WC with FBS and BP. Materials and methods: Anthropometric measures (BMI, WC) ,Fasting blood sugar (FBS) and blood pressure (BP) were measured ,compared and their correlation was studied in male patients with type 2DM (Group 2) and normal healthy male subjects (Group1) of age group 40-60 years. Results on continuous measurements are presented on Mean ± SD and significance was assessed at 5 % level of significance. Student t test (two tailed, independent) has been used to find the significance of study parameters. Pearson correlation has been used to find the correlation of BMI and WC with FBS and BP. Result: In the present study, there was significant increase in DBP in diabetics and not much difference in SBP when compared to healthy individuals. Also, it is observed that BMI is positively correlated with FBS, and SBP. It is also observed that WC is strongly positive correlated with SBP and DBP and a weakly positive correlated with FBS. Conclusion: From the findings of the present study it is concluded that both BMI and WC had a positive correlation with FBS and BP.Thus simple anthropometric measures like BMI and WC can independently contribute to the prediction of risk factors of CVD and can be routinely used to identify those at risk
Prevalence of Acanthosis Nigricans in a Population Attending a Tertiary Care Centre in Western India and it’s Utility to Detect Metabolic Syndrome
Get PDFBackground: Acanthosis Nigricans (AN) is a dermatosis with thickened, hyperpigmented plaques immediately recognizable. The metabolic syndrome (MetS) is a collection of metabolic risk factors that include central obesity, glucose intolerance, hyperinsulinemia, low HDL cholesterol, high triglycerides, and high blood pressure. The skin biomarker AN is linked to this syndrome.Aims and Objectives: To study the prevalence of AN and associated factors in patients that predicts the risk of MetS.Materials and Methods: Five hundred and forty-seven patients with AN were studied over a period of two years. Complete dermatological assessment of skin, including distribution and grading of AN, was performed. Evaluation for metabolic syndrome, including body mass index (BMI), waist and hip circumference, waist-hip ratio (WHR), blood pressure, was noted. Laboratory investigations like fasting blood sugar (FBS), post prandial blood sugar (PPBS), fasting insulin, lipid profile, serum B12, and thyroid function test were done in all patients of AN. Results: Prevalence of AN was 6.5%. The majority had an age between 11-20 years (32.9%). Benign acquired AN (70.7%) was the commonest type of AN, while syndromic AN (17.9%) was the second most common type. Patients of AN with MetS were older (28.4±11.7 years; p=0.0184), had BMI more than 30 (31.5±4.6; P<0.001), higher waist circumference (100.6±10.9 cm; P<0.001), higher WHR (0.92±0.05; P=0.0242), higher FBS (102.3±21.6; P<0.001) and PPBS (130.9±39.1; P<0.001) and higher fasting insulin level (25.7±13.7; P<0.001) compared to those without MetS. Linear regression revealed that BMI (R2=0.08334, P=0.0004 for patients of AN without MetS and R2=0.06377, P<0.001 for patients of AN with MetS), waist circumference (R2=0.05999, P=0.003 for patients of AN without MetS and R2=0.07336, P<0.001 for patients of AN with MetS) and WHR (R2=0.03603, P=0.0222 for patients of AN without MetS and R2=0.008235, P=0.0764 for patients of AN with MetS) has a much more significant effect on insulin in the patients of AN with MetS.Conclusion: AN was common in our study population and the presence of AN strongly predicts metabolic syndrome
Clinical and Electrophysiological Profile of Chronic Kidney Disease Patients Undergoing Peritoneal Dialysis at a Tertiary Care Centre of Bihar
Get PDFChronic kidney disease (CKD) is a progressive decline in renal function, which is responsible for significant morbidity and mortality. The present study was carried out to assess prevalence of peripheral neuropathy in CKD patients on PD patients with special emphasis on electrophysiological parameters and severity of peripheral neuropathy and its relation with diabetes mellitus. Methodology: During the period from November 2020 to April 2020, 50 consecutive patients diagnosed to have CKD and are on OPD at J.N.K.T. Medical College, Madhepura, Bihar, India were included in the present study. Patients with pre-existing peripheral neuropathy prior to the diagnosis of CKD were excluded from the present study. The study was approved by the Institutional Ethics Committee and written informed consent was obtained from the patients for their participation in the study. The patients were divided into two equal groups, randomly: Group 1 included 25 diabetic patients Group 2 included 25 nondiabetic patients. All cases were subjected to nerve conduction studies (NCS) using Medelec synergy and Natus machines. NCS procedure was done for both motor conductions and sensory conductions. Median nerve, ulnar nerve, common peroneal nerve, and posterior tibial nerve were assessed for motor conductions. Median nerve, ulnar nerve, and sural nerve were assessed for sensory conductions. Results: The prevalence of peripheral neuropathy among the study participants was 62% (31 out of 50) based on clinical symptoms and 80% (40 out of 50) based on electrophysiological parameters. Based on electrophysiological data, prevalence of peripheral neuropathy in CKD patients on PD with DM and without DM was 100% and 60%, respectively. Conclusion: Rationale management of diabetes in CKD patients on PD probably lowers the prevalence and severity of peripheral neuropathy
Efficacy of intravenous tranexamic acid at reducing blood loss during elective caesarean section in a tertiary care hospital in North Kerala
Get PDFIncreasing caesarean section rate is a source of concern to obstetricians due to the attendant increased health risk, its commonest complication is bleeding, which occasionally may be life threatening. Tranexamic acid has recently been investigated as a potentially useful adjunct for the prevention of maternal morbidity. The research aimed to evaluate the efficacy of tranexamic acid at reducing blood loss during elective caesarean section. The method used was a Randomized, Double blind, Interventional study among women who had elective caesarean section at KMCT Medical College, Kozhikode, Kerala. Data analysis was done using statistical Package for Social Science (IBM SPSS). Mean blood loss in study arm was 352.4 ml, whereas in control arm it was 521.65 ml, which was statistically significant. Only 9.1 %of study population had >10% of fall in perioperative haemoglobin, whereas 43.2 % of control population had >10% fall, which was significant. Statistically significant difference between the two groups was noted with respect to duration of surgery. Intravenous tranexamic acid significantly reduced blood loss at elective caesarean sections. It also reduced the risk of blood loss greater than 1000 ml without increasing maternal risks