International Journal of Health and Clinical Research
Not a member yet
3275 research outputs found
Sort by
Comparision between transabdominal and transvaginal sonography in various gynecological disorders
Get PDFObjectives: To assess the diagnostic accuracy of Transvaginal sonography as compared to transabdominal sonography in various gynecological disorders. Methodology: Total number of 100 patients attending OPDs with various complaints were selected by random technique of the study. All the patients have informed consent and thorough clinical examination including general, systemic and pelvic examination was conducted after taking a detailed history then the patients underwent transabdominal sonography and transvaginal sonography followed by one of the procedures like fractional curettage, dilatation and curettage and abdominal hysterectomy (with or without conservation of ovaries) or conservative management with regular follow up. Results: Our analysis, showed that transvaginal sonography had high diagnostic accuracy when compared to clinical examination 70% of fibroid, 8% of ovarian cyst, 100% paraovarian cyst, and 66.6% cases of endometrial polyp were missed by clinical examination. 50% of PID were misdiagnosed by clinical examination which were diagnosed as ovarian cyst. There was statistical significant difference of TAS findings with TVS findings of patients (P< 0.05). There was statistically highly significant difference of clinical findings with TVS findings of the patients (P<0.01). Conclusion: The final outcome is that transvaginal ultrasonographic examination is an important non-invasive investigation, can be used as important diagnostic method in various gynecological disorders as it has got a high diagnostic accuracy in small pelvic masses where transabdominal sonography is helpful in evaluating large pelvic masses
A clinico-pathological study of acute appendictis with management and the role of ultrasound in diagnosis of appendictis
Get PDFBackground and Objectives: Acute appendicitis is the most prevalent cause of acute surgical abdomen, and appendiciectomy is the most often performed emergency surgery in the United States and Canada. Its diagnosis continues to be a difficult problem, made more difficult by a high percentage of negative investigations. There is currently no one reliable test that has appropriate sensitivity and specificity characteristics. The study's main goal is to analyse the clinical presentations, signs, and treatment of acute appendicitis, as well as the effectiveness of various treatments. The role of ultrasound in the diagnosis of acute appendicitis and in lowering the rate of negative appendicectomies are also discussed. Methodology: From January 2019 to October 2021, the current study included 80 patients who were clinically diagnosed with acute appendicitis and were admitted to the General Surgery Department of the Kerala Institute of Medical Sciences (KIMS), Narketpally, for emergency appendectomy. Prior to surgery, blood was drawn to check the WBC count, DC, and USG abdomen. Following surgery, all patients were subjected to a histological examination, which was considered to be the gold standard. The results of ultrasound were compared to those of HPE reports in order to determine their importance in the diagnosis of acute appendicitis. Observations: In the current study, we had 80 participants, with 61 (61 percent) of them being men and 39 (39 percent) of them being female. The age range of 20 to 29 years was the one with the greatest number of patients (33 percent ). Anorexia was discovered in 87 percent of patients, and Migrating Pain to RIF was discovered in 76 percent of patients. Nausea and vomiting were experienced by 79 percent of the patients. Tenderness in the right iliac fossa was detected in 98 percent of the cases. Patients with rebound discomfort were reported in 68 percent of cases. In 45 percent of the cases, a fever was seen. In our current investigation, the total leucocyte count was found to be high in 80 percent of the cases. In 42 percent of the cases, a shift to let was observed.All of the patients in our study were subjected to abdominal ultrasonography examination. Using Ultrasonography to diagnose acute appendicitis, the sensitivity and specificity of the test are 92.0 percent and 78.0 percent, respectively. The accuracy rate was 93 percent. For acute appendicitis, the positive predictive value (PPV) and negative predictive value (NPV) of ultrasound are 95 percent and 41 percent, respectively. In this study, the rate of negative appendectomy was 5.5 percent. Females account for the vast majority of cases (60 percent). Conclusion: Ultrasound is a non-invasive, reproducible, and safe diagnostic technique that is quick, easy, and reliable. There are no complications with ultrasound. It has higher sensitivity and positive predictive value in the diagnosis of acute appendicitis, and it lowers the rate of negative appendicectomy in the treatment of the condition
Study to evaluate the role and efficacyofdiagnosticlaparoscopy in chronic abdominal pain
Get PDFBackground:Chronic idiopathic pain syndromes are among the most difficult and time-consuming disorders to manage, and they affect people of all ages. Despite the fact that these individuals have undergone several diagnostic tests, their pain continues to pose a challenge to all currently available diagnostic and therapy options.Aims and Objectives:In this prospective trial, we hope to determine the diagnostic and therapeutic efficacy of laparoscopy in the therapy of such patients.Materials and methods:In this study, 40 individuals with persistent discomfort in the abdomen were enrolled and evaluated. Every one of these patients was experiencing pain that was either of unknown origin or that was not responding to the treatment prescribed following a clinical assessment and had lasted for more than three months. Patients less than 15 years of age and those suffering from pain of shorter duration were excluded from the study. Patients underwent diagnostic laparoscopy as well as the operation in all cases. We tallied and assessed the outcomes of our study.Results:Females were found to be more impacted by this illness, with the periumbilical region being the most commonly reported site of pain. In 34 patients (85.0 percent), a conclusive diagnosis was made during surgery, while in the remaining six (15.0 percent), no evident pathology was discovered. Among the most prevalent findings in our study were recurrent appendicitis (62.5 percent), which was followed by post-operative adhesions (15.0 percent), gall stones (7.5 percent), tuboovarian disease (5.0 percent), and abdominal tuberculosis (5.0 percent) (5.0 percent ). Pain assessments performed at one month and three month follow-ups revealed that 87.7 percent of patients had experienced pain alleviation, and 84.5 percent had experienced pain relief at three months.Conclusion:Chronic abdominal discomfort is caused by a variety of factors, the most common of which is recurrent appendicitis. In such patients, diagnostic laparoscopy is a safe and effective method for both the diagnosis and therapeutic therapy
“Acute versus chronic hemodynamic response of Carvedilol in Chronic Liver Disease with Portal hypertension”
Get PDFBackground: Hemodynamic studies give objective method to measure the response but need to be repeated during the course of therapy. Data comparing acute with chronic hemodynamic response of Carvedilol is scarce and needs to be studied further to elucidate the course and predictors of response, so the single hemodynamic study envisages the long-term response. Aims and Objectives: The purpose of this study was 1.To assess and compare the acute and chronic hemodynamic response to Carvedilol along with their predictors in Cirrhotic patients.2.To evaluate if acute response is maintained long term. Methods: In one hundred two consecutive patients of chronic liver disease with esophageal varices, Hepatic Venous Pressure Gradient (HVPG) was measured at baseline and 90 minutes after initial administration of 12.5 mg of Carvedilol to assess the acute response. These patients were reassessed at 3 months of dose optimization for chronic response. The acute responders were compared with chronic responders. Results: Acute response was seen in 51% and chronic in 62% patients. Most of the patients who responded to optimized therapy after no acute response belonged to CTP A. Mean reduction of HVPG in responders was 4.5± 2.2 mmHg to loading dose and 5. 5± 1.7 mmHg at 3 months. Low Cardiac output (CO), more than 2.5 mmHg drop acutely and dose optimization were independent predictors of response for acute, chronic and chronic response with no acute response respectively. Conclusion: Acute response assessed by hemodynamic study at initiation of treatment is important predictor of chronic response and is maintained over period of time. Dose optimization to achieve response is more appropriate for CTP A then B and C
Comparison between continuous ambulatory peritoneal dialysis and automated peritoneal dialysis: An Indian perspective
Get PDFBackground: CAPD & APD are two modalities of chronic PD. Usage of APD has been steadily increasing in western countries. Data regarding APD from India are lacking. This study was undertaken to compare the outcomes of APD & CAPD. Methods: Retrospective study of 40 patients on APD matched with 40 CAPD patients from 2011-2015. Results: A total of 80 (40-APD, 40-CAPD) incident PD patients were retrospectively analysed. Baseline characteristics were similar in both groups. 42.5% in APD and 55% in CAPD group respectively had one or more episodes of peritonitis (Ns). Peritonitis rate in APD group was 0.27 episode per year as compared to 0.30 episode per year in CAPD group. Exit site infection developed in one APD patient & 2 in CAPD. 16 patients in APD and 20 patient in CAPD developed PD peritonitis. 77% were culture negative & 23% were culture positive. 2 patients developed fungal peritonitis. 61.5% responded to standard therapy& 28.5% had refractory peritonitis (APD-7 vs. CAPD-8). Need for hospitalisation for any cause more in CAPD than APD (CAPD-33 vs. APD-29, ns). Hospitalisation rate was also less in APD than CAPD (0.55 episode per year vs. 0.63 episode per year). Residual urine output at tie of admission & the end of follow up was less in APD than CAPD, although non-significant. Technique failure was not significant between groups (APD- 6 vs. CAPD-7). Overall 28.7% had died at the end of follow up. APD had 11 deaths as compared to CAPD who had 12 deaths. Peritonitis related death was commonest cause in either groups. Conclusion: APD when compared to CAPD did not differ significantly in terms of peritonitis rate, hospitalisation rate, preserving of residual renal function, technique failure. All-cause mortality did not differ significantly between groups. Our study did not show any clear benefit of APD over CAPD
Percutaneous pinning for non-comminuted extraarticular fractures of distal radius
Get PDFBackground: Displaced Colles' fractures are treated by manipulation and below elbow cast application. Fracture stabilization by percutaneous pinning is a simple, minimally invasive technique that helps prevent displacement of the fracture, thereby minimizing complications. Various treatment modalities have been described for the treatment of extra-articular distal radius fractures each with its own merits and demerits. Our technique involves percutaneous pinning of the fracture and immobilization in neutral position of the wrist for three weeks. This study’s aim was to examine the functional outcome of percutaneous K-wiring of these extra-articular distal radius fractures with immobilization in neutral position of the wrist. Method: This is a prospective study of 28 patients aged between 20 and 60 years with extra-articular distal radius fracture. Patients were treated with closed reduction and percutaneous pinning using two or three K-wires. A below- elbow plaster of paris dorsoradial slab was applied in neutral position of the wrist for 4 weeks. At the end of 4weeks, the slab was removed and wrist physiotherapy started. The radiographs were taken postoperatively, at 4 weeks, 6 weeks. Results: Excellent to good results were seen in 93.75% of the cases while 6.25% had fair results. The complications observed were pin loosening (n=6), pin tract infection (n=1), malunion (n=1), wrist joint stiffness (n=1), reduced grip strength (n=1). Conclusions: Displaced extraarticular distal end radius fractures should be reduced and stabilized with percutaneous K-wires to achieve an excellent functional outcome
Study on diagnostic accuracy of fine needle aspiration cytology in different breast lesion and histopathological correlation
Get PDFIntroduction -FNAC is being performed as a pre-operative test to evaluate breast lump. FNAC is cost effective and can prevent unnecessary surgery. As FNAC became more reliable in diagnosing malignancy .Confirmation of breast diseases by clinical examination and pathological confirmation by fine needle aspiration cytology (FNAC) and histopathologic examination has been found to be an important part of diagnostic workup in breast diseases. Material and method-A retrospective study done on119 cases presented with history of palpable breast lumpduringNovember 2019 to October 2020 in department of pathology Government Medical College Shivpuri, India. All female patients were included of age 11-70 year, irrespective of their, religion, marital status, occupation or social status. Every patient underwent a FNAC done on OPD basis by a trained pathologist from the Pathology Department, histopathology was available in 54 cases for correlation with cytology. Result- Results of all patients were collected and tabulated. Statistical analysis was performed on the tabulated data and sensitivity and specificity with positive and negative predictive value were obtained. Maximum cases(54.1%)of benign lesion as fibroadenoma were diagnosed in age group of 21-30 years and malignant cases (80%) were diagnosed 51-60 years. The sensitivity and specificity and diagnostic accuracy for malignancy were found to be 95%,97% And 94.5%, respectively. Conclusion- FNAC serves as a rapid, economical, and reliable tool for the diagnosis of palpable breast lesions because the cytopathological examination of these lesions before operation or treatment, serves as an important diagnostic tool. Most common breast lesion in this study is fibroadenoma
Anterolateral surgical approach for the treatment of humeral shaft fractures
Get PDFBackground: The posterior approach is the most commonly used approach for mid-shaft and distal humeral fractures. However, fixation via the posterior approach is associated with iatrogenic radial nerve palsy. The purpose of this study was to evaluate the functional outcomes of shaft humerus fracture plating with anterolateral approach. Material and Methods: The present retrospective study was conducted in the Department of Orthopaedics, PGIMS Rohtak and included 20 cases aged between 20-70 years, who were operated for shaft humerus fractures over last 3 years with plating by anterolateral approach. Results: The mean age was 42.65±12.42 with a range of 20-70 years. Mean time of fracture union was 15.65±1.82 weeks. Range of motion at elbow at final follow up was 120±15.46 degrees. 1 patient had superficial infection which was managed with intravenous antibiotics. One case of non-union with implant failure was noted in this study which was further managed by replating and bone grafting. No case of neurovascular injury post injury was reported in the present study. The mean MEPS score was 88.45±8.18. Conclusion: We conclude that anterolateral approach is a good approach for the treatment of humeral shaft fractures with a lower complication rate and better functional outcomes
The comparison of the combined effect of preoperative diclofenac and precurarisation with atracurium on succinylcholine induced myalgia in laparoscopic cholecystectomy: A double blinded randomised study
Get PDFBackground and Aims: Succinylcholine is the only available depolarizing neuromuscular blocker which was widely used in induction of anaesthesia and it is the drug of choice for rapid-sequence induction of anaesthesia due to its rapid onset of effect and ultra-short duration of action owing to its rapid hydrolysis by acetyl-cholinesterase. Post-operative muscle pain (myalgia) and muscle stiffness are the most common side effects and observed most frequently on the first postoperative day in ambulatory surgery. The use of succinylcholine in induction of anaesthesia and intubation in routine cases has been discouraged because of such adverse effects, however because of its cost effectiveness and easy availability it is still used by some institutions routinely. The aim of this study was to study the efficacy of pre-operative diclofenac along with atracurium precurarization alleviating succinylcholine-induced myalgia. Material and methods: It is a double blind randomised comparative study carried our in a tertiary care hospital. Study sample was 60 and divided in two equal groups. All data entered in MS-Excel Sheet and Wilcoxon Signed Rank test was done for non-parametric data and one way ANOVA for parametric data. The normal distribution of study sample was tested by Shapiro Wilk test. Result and Conclusion: The incidence of fasciculation in the two groups were found to be significant with p < 0.00001. The results for incidence of myalgia in the two groups were as follows - p value at 24 hr was 0.00018 and at 48 hr was 0.0028 respectively. Creatine kinase levels at preoperative and 24 hr postoperative period were 49.47 ± 7.24 in group D , 53.30 ± 7.98 in group B and 87.38 ± 15.16 in group D , 188.41 ± 33.27 in group B respectively. Succinylcholine induced myalgia has a complex pathophysiology, however the pre-emptive use of diclofenac in combination with precurarization can alleviate the incidence and severity of succinylcholine induced myalgia. Therefore its use may be considered in routine cases for induction of anaesthesia for facilitating laryngoscopy and endotracheal intubation
Quantitative evaluation and grading of neurological recovery after Anterior Cervical Surgery for Single or Double Level cervical Spondylotic Myelopathy
Get PDFBackground: Cervical Spondylotic Myelopathy (CSM) is a common cause of spinal cord dysfunction it may lead to function disability as well as neurological deterioration. Surgical decompression is essential in progressive disease. Postsurgical neurological recovery assessment is essential. Most of these methods of assessment is either subjective or numerical values at a time. It is important to quantify these outcome and grade it into a scale for better understanding. Materials and Methods: 48 patients with single or double level CSM underwent anterior cervical discectomy and fusion (ACDF) or anterior cervical corpectomy and fusion at our institute from January 2017- 2019. Data analyzed for age, sex, duration of follow-up, operative time, blood loss and complication. Moderate and severe grade myelopathy considered surgical candidates. 31 patients had moderate (mjoa,12-14) and 14 patients had severe (mJOA ,11 and less) myelopathy. Metallic spacer for ACDF and titanium mesh cage (TMC) for ACCF with Morcellised local auto graft and all cases supplemented with variable angle cervical plates. MJOA scores and Hirabayashi recovery rate calculated at 1st month, 3rd month, 6th month and 12th month post-operatively. Results: Out of 48 patients, we had final follow-up of 45 patients. Mean age of our study 58.53±6.61 years (range 35- 73 years) Mean duration of follow-up 19.71±5.29 months (13 – 34 Months). Mean operative time and mean blood loss was more in single level ACCF cases as compare to single ACDF cases. C5-C6 ACDF and C5 Corpectomy were most performed surgeries in our study. Our all patient has shown neurological recovery from some to complete extent at final follow-up of 12 months. All moderate grade patient improved to mild grade or normal neurology and all severe grade patients improved to either moderate or mild grade .We have observed 100 % improvement in mJOA grade after anterior cervical surgery. At 12 months follow-up, 12 patients had normal (18) mJOA Score, 30 mild (mJOA, 15-17) grade and 3 moderate grade. At final follow-up 93.3% patients had shown excellent to good recovery rate(29/ 45 excellent , 13/45 good whereas 3/45( 6.66%) have shown fair recovery rate .One patient had deep surgical site infection, three patients had transient dysphagia, one had dural injury and one patient had subsidence of TMC. Conclusion: Anterior cervical surgery is safe and effective surgery for single/ double level cervical spondylotic myelopathy (CSM) with less complication rates