International Journal of Health and Clinical Research
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A Study of Cutaneous Adverse Drug Reactions in A Tertiary Care Centre in Central Andhrapradesh, South India
Get PDFBackground Cutaneous adverse drug reactions (CADR) are common, accounting 10-30% of reported adverse drug reactions. Severe and potentially life-threatening reactions may occur in approximately 1 in 1000 hospital patients. There is a spectrum of cutaneous adverse drug reactions varying from transient maculopapular rash to fatal toxic epidermal necrolysis (TEN).The most common morphological types of cutaneous ADRs range from maculopapular, urticaria/angioedema to fixed drug eruptions, and the common incriminating drug groups remain antimicrobials, anticonvulsants and non-steroid anti-inflammatory drugs (NSAIDS). Aims: To determine the prevalence of cutaneous adverse drug reactions among the patients attending KIMS, Amalapuram. Methods: Type of study: The study is a hospital based cross sectional study.Duration: December 2018 - September 2020. Place:This study was conducted in Konaseema institute of medical sciences and research foundation & research foundation, Amalapuram, East Godavari, and Andhra Pradesh. Method of collection:Data will be collected after obtaining informed/written consent from the patient. Detailed history, clinical examination and relevant laboratory investigations will be done. The data will be entered into a case record form specially designed for the study and statistical analysis will be done. Results:In our Study 0.17% was the overall incidence of Cutaneous drug reactions during this period found in this study,females are outnumbered, The most common cutaneous adverse drug reactions were FDE 58 (46.77), followed by Maculopapular Drug Rash 18 (14.51%), Acneiform Eruption 10 (8.06%).Conclusion: The overall incidence in this study was 0.17%
A descriptive study of clinical profile of psychiatric referrals from dermatology unit in a tertiary care center in north India
Get PDFBackground: Psychological stress has been known to play an important role in initiation and maintenance of many dermatological illnesses, however there is lack of awareness among dermatologists regarding this. Aim: To study the pattern and prevalence of psychiatric referrals from dermatology OPD. Methods: The study was carried out jointly in dermatology and psychiatry department of D.M.C.H., Darbhanga, Bihar, North India. Sample was drawn from confirmed dermatology cases attending the dermatology OPD. Those patients who gave consent to participate in the study and scored above the desired cut off (>3) on GHQ-12 were sent for psychiatric evaluation. Socio-demographic data were collected and based on clinical interview and mental state examination, psychiatric diagnosis was made. Findings: As per ICD-10 criteria 24.5% of dermatology patients had a diagnosable psychiatric illness. Depressive disorder was the most common diagnosis seen in 27.8% patients (n=92), followed by anxiety disorder in 15.7% patients (n=52). Other diagnoses were; OCD (7.5%, n=25), adjustment disorder (6.9%, n=23), somatoform (8.7%, n=29), substance abuse (4.2%, n=14), psychosis (2.7%, n=9). No psychiatric diagnosis could be made in 26 patients (7.8%).Amongst the dermatological diagnosis, Psoriasis (19.3%) was the most common followed by Urticaria (13.3%). Conclusion: Patients with dermatological illnesses have a high prevalence of psychiatric morbidity. Awareness programmes would help in removing stigma towards psychiatric illness and would lead to holistic management of such patients
Outcome of Late Presentation of Posterior Urethral Valves
Get PDFBackground: Posterior urethral valves (PUVs) are one of the most common structural causes of lower urinary tract obstruction in male infants. The present study conducted to assess the outcome of Late Presentation of Posterior Urethral Valves. Material and methods: This is a retrospective descriptive study conducted to assess the outcome of Late Presentation of Posterior Urethral Valves. Data such as age at presentation, symptoms and duration of symptoms, complications, investigation, and initial management were collated. Data was analyzed using Statistical Package for the Social Sciences version 20.0. Results: There were 30 boy patients. Clinical findings at presentation include voiding anomaly (100%); recurrent fever (86.66%); ballotable kidneys (80%); palpable bladder (83.33%); failure to thrive (33.33%); other symptoms like urinary incontinence, polyuria, and enuresis (33.33%). Renal failure occurs in 70% patients. Of these, 60% required renal replacement therapy but only 16.66% were able to receive the therapy during the study period. Conclusion: The present study concluded that clinical findings at late presentation include voiding anomaly (100%); recurrent fever (86.66%); ballotable kidneys (80%); palpable bladder (83.33%); failure to thrive (33.33%); other symptoms like urinary incontinence, polyuria, and enuresis (33.33%). Renal failure occurs in 70% patients. Of these, 60% required renal replacement therapy but only 16.66% were able to receive the therapy during the study period
FNAC playing its role in Diagnosing and Managing Solitary Thyroid Nodules
Get PDFBackground: Thyroid nodule diagnosis with fine-needle aspiration cytology (FNAC) being a simple and cost-effective procedure has increased sensitivity and specificity rates which has resulted in a significant increase in malignancy rates of removed nodules. Aim: The goal of this investigation was to see if FNAC was efficient in evaluating thyroid nodules by comparing the results to histopathologic evaluation and comparing the results to the literature. Materials and Methods: This study looked at 1610 FNACs from 1335 patients who were classified using the Bethesda criteria, as well as 126 histological examinations from the cohort. The patients' average age was 51.24 years (range: 17-89, 17 percent male and 83 percent female). The accuracy rates, sensitivity, specificity, positive and negative predictive values were all assessed. Result: The specificity was 64.6 percent and sensitivity was 87.1 percent. 76.1 percent, 79.5 percent, and 77.3 percent, respectively, were for positive and negative predictive value plus accuracy. Conclusion: The Bethesda system's calculation of thyroid FNAC samples was substantially linked with the outcomes of histological diagnosis in our investigation. FNAC plays a key part in diagnosis and therapy of solitary thyroid nodules as well as dominant nodules in multi nodular goitre because of its high accuracy, specificity, and sensitivity. In India, pathologists obtain the much of thyroid aspiration samples via manual palpation. TBSRTC is most extensively utilised reporting system at the moment, with multiple studies showing its usefulness and inter observer agreement
Assessment of Disease Activity Score with Respect to Vitamin D in Rheumatoid Arthritis: An Observational Study
Get PDFBackground: Rheumatoid Arthritis (RA) is a crippling disorder with a prevalence rate ranging from 0.3% to 1% globally having an annual incidence rate of 3 per 10,000 adults. Vitamin D has unavoidable effects on numerous physiological functions as well as pathological conditions and several studies have analyzed the association of vitamin D deficiency in rheumatoid arthritis and have reached varied conclusions. Identifying the role of Vitamin D in curbing the articulation of RA is a topic of enormous importance having practical applications too. Material & Methods: This was an observational study conducted on 42 patients in the age group of 18-45 years having RA, diagnosed by the American College of Rheumatology criteria (ACR/EULAR criteria), for assessing disease activity score concerning vitamin D in them. Results: In the distribution of Disease Activity Level, the proportion of moderate activity level was found higher i.e. 66.7%. The mean vitamin D level was 10.93 ± 2.70, the minimum was 7 and the maximum was 18. The mean DAS-28 Score was 4.46 ± 0.82 with a minimum value of 2.63 and a maximum of 6.08. Conclusions: A notable association has been found between the comparison of the level of vitamin D and the DAS-28 score. The deficiency of vitamin D can be speculated to be a substantial reason for rheumatoid arthritis
Evaluation of Procalcitonin (PCT) and C-reactive protein (CRP) as biomarkers in suspected cases of sepsis among patients attending Emergency Department and ICU of the tertiary care hospital in Western Uttar Pradesh
Get PDFBackground: Procalcitonin has characteristics of a biomarker, as there is a fast and specific increase in sepsis and it differentiates infections from non-infectious causes of sepsis. The present study was conducted to evaluate procalcitonin (PCT) and C-reactive protein (CRP) as biomarkers in suspected cases of sepsis. Materials & Methods: The study was conducted on 80 cases in the department of medicine at Uttar Pradesh University of Medical Sciences (UPUMS), Saifai, Etawah. Cases clinically suspected of sepsis on admission to emergency department were included. 5ml of venous blood sample was withdrawn simultaneously for detection of PCT and CRP. Results: There were 45 (56.2%) male and 35 (43.7%) female. Blood culture was positive in 26 (32.5%) and negative in 54 (67.5%). Among 26 positive blood culture cases, 5 (19.23%) were caused by Gram-positive bacteria and 21 (80.76%) by Gram-negative bacteria. In Gram-positive cultures all 5 isolates identified were of Staphylococcus aureus. In Gram-negative cultures most common isolates were E. coli 9 (34.61%), followed by Klebsiella pneumoniae 6 isolates (23.07%) and 6 isolates of non-fermenting gram-negative bacilli (NFGNB) were isolated. Clinical conditions present in study subjects were chronic lung disease in 31cases (38.7%) followed by acute kidney failure in 27 cases and anaemia in 24 cases. Three cases also had gastrointestinal disease. Source of infection in culture positive patients were pneumonia 9 cases (34.6%), UTI 8 cases (30.7%), skin wounds/cellulitis 4 cases (15.3%), meningitis and biliary tract infection 3 cases each (11.5%). Source of infection in culture negative cases was pneumonia 19 cases (35.1%) followedbyUTI11cases (20.3%). Conclusion: PCT proved to be a reliable marker for sepsis diagnosis and is more relevant than CRP in patients with a positive blood culture
Pattern and visual outcomes of ocular fire-cracker injuries during Diwali festival in a tertiary Care Hospital in North India
Get PDFBackground: The firecrackers are used widely during Diwali. Eyeball is one of the most commonly injured organ in firecracker injuries. The fire-crackers can cause irreparable damage to ocular structures, leading to blindness. This study was conceptualized to study the pattern of injuries resulting from fire-cracker use and their visual outcomes, in order to generate evidence for managing these injuries more effectively. Material and Methods: This longitudinal, descriptive study was carried out over a period of one week during Diwali festival in 2019, in a tertiary care teaching hospital in North India in 21 patients who presented to hospital with ocular injuries caused by firecrackers. Visual acuity was recorded and complete slit lamp examination, non-contact tonometery, and gonioscopy was done. Ultrasound B-scan and X-ray were also done, when required. Results: The mean age in our study was 18.42±11.88 years with age range of 7-57 years. There were 20 males and 1 female in the study. Most of the injuries were caused by bombs and sparkles. Most of the patients (50%) had visual acuity in range of 6/6-6/24 at the time of presentation. Conjunctival surface was involved in all the patients, followed by lids and cilia (59.09%). One patient had corneal perforation with uveal tissue proplase.Six patients had vitreous haemorrahge and seven patients had hyphema. Final visual outcome was favorable with 63.64% patients achieving vision of 6/6- 6/24 at the end of six weeks. Conclusion: Severe injuries can lead to permanent loss of vision or decreased vision from squealae of wound healing such as astigmatism. Hence, stricter implementation of existing laws and regulations, public education and awareness is needed to prevent avoidable blindness resulting from use of fire crackers
A Study On Correlation of Various Prostate Pathology With Serum Prostate Specific Antigen at a Tertiary Care Centre in Bihar
Get PDFIntroduction: Diseases primarily inflicting prostate gland are inflammation, benign nodular enlargement, and tumors. Serum prostate-specific antigen (PSA), a marker for prostatic carcinoma has high sensitivity, specificity, and compliments histopathological diagnosis. Gleason's microscopic grading is a paramount feature and with PSA are important for diagnosis, management, and prognosis of carcinoma. Methodology: Clinicopathological study of 100 prostatic biopsies was conducted in the Department of General Surgery, Darbhanga Medical college and Hospital, Darbhanga, Bihar, India, over a period of One year from January 2020 to Dcember 2020. The study was approved by the Institutional Ethical Committee and all patients gave informed written consent. All patients presenting with LUTS underwent DRE and were worked up with USG KUBP, Serum PSA and biopsy (if indicated) after obtaining consent. Results: A total of 100 patients were included in the study. The mean age in our study was 62.5 years [range 50-90 years]. The majority of the patients in the study group were in the age group of 61-70 years. PSA levels of the patients were compared according to their age. The mean serum PSA for age group 50-60 years was 3.9 ng/ml, for age group 61-70 was 15.2 ng/ml, for age group 71-80 was 11.3ng/ml, for age group 81-90 was 11.4 ng/ml. The mean serum PSA for the whole group was 13.2 ng/ml. The mean serum PSA level was found to increase with each decade, starting from 50 years up to 90 years (p< 0.05). Conclusion: Mean serum PSA levels rises with increasing age. Serum PSA levels has a significant correlation with International prostate symptom severity scoring wherein mean serum PSA level rises with severity of LUTS. However, serum PSA levels do not show significant correlation with Gleason score or clinical stage of prostate cancer
Histomorphological Spectrum of Endoscopic Biopsies in Upper Gastrointestinal Lesions
Get PDFBackground: Patients presenting with gastrointestinal (GI) symptoms are very common in clinical practice, and aetiologies range from congenital, inflammatory and neoplastic causes. Histopathological diagnosis provided from endoscopic biopsies provide us with a clear picture of the underlying lesion which mostly have such obscure clinical presentations. Upper gastrointestinal endoscopic biopsies are performed not only for the diagnosis of the disease but also for monitoring its course, determining its extent and responses to therapy and for early detection of complications. Therefore, accurate diagnosis facilitates a prompt and efficacious treatment outcome. Methods: In this 2-year retrospective study of upper gastrointestinal endoscopy (UGE) biopsies, A total of 55 patients were evaluated, two biopsies were deemed inadequate, and hence excluded from the study. The remaining cases were evaluated along with relevant clinical history and endoscopy findings. Results: Out of the 53 patients, 37 (69.8%) were male and 16 (30.1%) were female. Most of the malignant cases were diagnosed in the 4th and 5th decade. The study included 32 biopsies (60.3%) from the duodenum, 16 biopsies (30.1%) from the stomach and 5 biopsies (9.4%) from the esophagus. Nine cases (17%) were diagnosed as neoplastic; of which eight were Adenocarcinomas and one case of Squamous cell carcinoma (SCC). The non-neoplastic category comprised of 44 cases (83%). Conclusions: UGE is an effective investigative modality to assess patients with upper gastrointestinal symptoms, and to obtain representative biopsies to come to a concrete diagnosis to initiate effective management. Histopathology is therefore the gold standard for the diagnosis of endoscopically detected lesions of the GI tract
A study on thyroid profile in chronic liver disease patients admitted in a rural tertiary care hospital of West Bengal, India
Get PDFIntroduction: Abnormal thyroid function tests occur in various non-thyroidal illnesses, like chronic liver disease(CLD), where no pre-existinghypothalamic-pituitary and thyroid gland dysfunction is present. Available studies reported decreased T3 and fT3 in most cases. But a limi tedstudy reported the association of fT4, rT3 and TSH level with severity of CLD. Aim is to measure thyroid functions in patients with CLD and toassess the severity of liver dysfunction in relation with thyroid functions a in tertiary care hospital. Methods: 100 patients of CLD were included.Blood sample was analysed for Thyroid profile (TSH, FT4, FT3, total T3 and rT3), Serum LFT, Serum creatinine, Prothrombin time, INR andUSG of Hepatobiliary apparatus. Results were analysed to find out the correlation of thyroid profile with the severity of liver dysfunctionaccording to Child–Turcotte–Pugh (CTP) score and Model for End-Stage Liver Disease (MELD) score. Results: Majority of the patient had lowFT3 (90 %), Normal FT4 (58%), Normal TT3 (57%), high rT3 (57 %), and a normal TSH (72%). High TSH, low FT4, low FT3, low Tota l T3(TT3) and high rT3 correlated with the severity of liver disease as per CTP score. High TSH, low FT3 and low total T3 correlated with theMELD score. Conclusion: This study showed the existence of several abnormalities in thyroid function test in CLD, although euthyroidism wasmaintained in the majority. Low FT3 and low TT3 might be used as a predictor of severity in CLD