International Journal of Health and Clinical Research
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Melancholic Face Since Puberty; A Rare Case Report Of Primary Hypertrophic Osteoarthropathy
Get PDFPachydermoperiostosis or Touraine-Solente-Gole syndrome is a rare genetic disorder that follows autosomal dominant pattern of inheritance, wherein males are more commonly affected than females. The prevalence of the disease in the general population is about 0.16%. It is characterized by diffuse thickening of skin and subcutaneous tissue of distal extremities, coarsening of facial features, spade like enlargement of hand with clubbing of digits and excessive sweating. We hereby present a rare case report of pachydermoperiostosis with little skeletal involvement. The diagnosis was made by considering the clinical appearance of patient and ruling out other causes of hypertrophic osteoarthropathy. Primary hypertrophic osteoarthropathy constitutes about only 5% of all cases of hypertrophic osteoarthropathy; lack of awareness of this entity can lead to confusion and misdiagnosis
A Hospital Based Prospective Study to Assess the Early Lactate Clearance For Predicting Hospital Mortality of Children with Sepsis
Get PDFBackground: Sepsis is one of the most common and deadly diseases worldwide. It is characterized by a life-threatening “disproportionate” immune response to infection, with high mortality. Lactate is known to play a major role in energy production and cellular metabolism. Hence, the present study was undertaken for assessing the role of early lactate clearance for predicting n hospital mortality children with sepsis. Martials &Methods: Assessment of all the patients of the pediatric ICU was done. A total of 50 sepsis patients were enrolled. Complete demographic and clinical details were obtained. Lactate levels were measured in arterial blood using a blood gas analyser at different time intervals. Outcome was recorded. All the results were summered and were subjected to statistical analysis. Results: A total of 50 subjects with mean age of 52.1 months were enrolled. Among them, 60 percent were males while the remaining were females. Pneumonia, Encephalitis, Meningitis, Dengue, Burn and Abscess were the underlying pathology in 36 %, 30 %, 20 %, 6 %, 4 %, and 4 % of the patients respectively. Mortality rate was 30 percent. Lactate clearance was found to be significant predictor of mortality. Conclusion: From the above results, the authors conclude that persistently high lactate levels are a predictor of mortality in pediatric patients with sepsis
Comparison of Airway Maneuvers Manual in line stabilization[MILS],Modified Jaw thrust, Conventional maneuver for Oro tracheal Intubation during Direct Laryngoscopy
Get PDFBackground: During performing orotracheal intubation with direct laryngoscopy adequate laryngeal visualization depends on proper airway maneuvers. There are different type of airway maneuvers. Aim: This study aimed to compare airway maneuvers ; MILS, jaw thrust , conventional maneuver to assess better laryngeal visualization and ease of intubation among them and associated complications. Material & Methods: This observational study was conducted in 90 adult patients. Patients divided in to three groups. Laryngoscopy and intubation in group M was done in MILS and in group J jaw thrust , In Group C as conventional maneuver performed. Laryngeal visualization assessed using modified Cormack lehane (CL)grading and ease of intubation assessed by usingintubation time, number of attempts between these three groups. The data were compared using Anova test, chi-square test. Results: While comparing between these groups better laryngeal visualization seen in jaw thrust group while the MILS maneuver worsen the view. Conclusion: The present study concluded that jaw thrust maneuver improved the laryngeal visualization and conventional maneuver made intubation faster and easy
Misplaced cilia in lacrimal punctum presenting as allergic conjunctivitis- A case series
Get PDFBackground- Normally shed eye lashes (cilia) sometimes get dislodged in lacrimal punctum causing symptoms resembling allergic conjunctivitis. If not diagnosed it may lead to improper treatment and complications. Purpose- To describe a series of cases of misplaced cilia in lacrimal punctum who were misdiagnosed and treated as unilateral allergic conjunctivitis. Method- The study included 8 patients who presented with symptoms of allergic conjunctivitis and were found to have misplaced cilia in their lower or upper lacrimal punctum. In all patients, cilia were removed with plain forceps under slit lamp. Results- There were 8 patients (6 males and 2 females). Mean age of patients were 28.44+/-4.27 years. Mean duration of symptoms (ocular irritation, watering and redness) were 5.25+/- 2.37 days. All patients were treated with topical anti allergic and lubricating eye drops before presenting to us. Five patients had cilia in upper punctum and 3 patients had it in lower punctum. In all patients, after removal of cilia from punctum, all symptoms were resolved promptly. Conclusion- In patients presenting with symptoms of allergic conjunctivitis, eyelid margin should be examined carefully and presence of cilia in the punctum should be specially looked for
Association of common mental disorders with pulmonary tuberculosis: A cross sectional study
Get PDFObjectives: Tuberculosis (TB) and mental illness share few similar factors e.g., poverty, malnutrition, and stress. Our objective was to determine the association of TB among mentally ill patients. Methods: A cross-sectional study was conducted at tertiary care center located in a rural area. All patients having respiratory symptomswere screened for TB, and thepatients diagnosed with TB were taken as subjects and those who did not tested positive for TB were taken as control. Sociodemographic proforma and Self Report Questionnaire (SRQ-20) were used as study tools. Results: Presence of pulmonary TB is treated as outcome (dependent variable) while Common Mental Disorders (CMD) as independent variable, both were categorized as present or absent. We found statistically significant (P=0.005) association between overall CMDs and TB (OR:2.16, 95% CI 1.32-3.55). Conclusions: TB among mentally ill patients is very high, and we recommend that TB care and prevention services be integrated into mental health centers
Clinical Correlation of Conjunctival Vessel Width With Grades of Retinopathy in Diabetes Mellitus
Get PDFBackground: Diabetes is a chronic, progressive, metabolic disorder which is characterised by elevated levels of blood glucose (or blood sugar) that can lead to various macrovascular (cardiovascular, cerebrovascular, and peripheral artery disease) and microvascular (diabetic retinopathy, nephropathy, and neuropathy) complications. Diabetic Retinopathy is one such complication with high socioeconomic impact. Early diagnosis and timely intervention can prevent its progression to vision threatening complications.Purpose: to study clinical correlation between conjunctival vessel width with grades of retinopathy in diabetes mellitus.Materials and Method: 300 eyes of 150 patients of diabetes mellitus of age group 50-70 years were examined between May2020 to July2021. Anterior segment imaging for measurement of conjunctival vessel width and Posterior segment examination for the grading of diabetic retinopathy was done. All findings were noted and statistical analysis of conjunctival vessel width with grade of retinopathy was done.Results: The average conjunctival (most prominent temporal bulbar conjunctival) vessel width was 27.4μ diabetic with no retinopathy and 32.6μ in mild, 36.8μ in moderate, 40.2μ in severe and 43.9μ in proliferative diabetic retinopathy. With increasing grades of diabetic retinopathy there was increase in conjunctival vessel width (p<0.001).Conclusion: Conjunctival vessel width positively correlates with increasing grades of severity of diabetes mellitus
“A Comparative Study Of Dexmedetomidine And Fentanyl For Attenuation Of Hemodynamic Response To Laryngoscopy And Endotracheal Intubation”
Get PDFBackground: Laryngoscopy and endotracheal intubation provoke a transient, but marked sympathetic and sympathoadrenal response leading to hypertension and tachycardia. No single anaesthetic technique has been accepted to be completely effective in preventing or attenuating this sympathetic response. Fentanyl, an opioid, and dexmedetomidine, a highly selective alpha-2 agonist, have shown to partially attenuate the hemodynamic response to laryngoscopy and intubation.Aim: To compare the effect of iv.fentanyl and iv.dexmedetomidine for the attenuation of hemodynamic response to direct laryngoscopy and endotracheal intubation.Materials and Methods: Sixty patients, of either sex, ASA I & II, admitted for elective procedure under general anaesthesia were randomised into two groups. Thirty patients received 1mcg/kg dexmedetomidine, 5 minutes before induction and the remaining 30 patients received 2mcg/kg fentanyl, also 5 minutes before induction. Patients were induced with thiopentone 5mg/kg and muscle relaxant rocuronium 0.6mg/kg given. Systolic, diastolic and mean blood pressures, along with heart rate, were measured in all the patients at baseline, before induction and intubation, and at 1,2,3 and 5 minutes post intubation.Discussion: Both fentanyl and dexmedetomidine attenuated the rise in systolic, diastolic and mean arterial pressure, as well as the rise in heart rate. The rise in systolic pressure was significantly lower in the dexmedetomidine group at 1 to 5 minutes post intubation (p< 0.001). Dexmedetomidine was more successful in reducing the heart rate post intubation when compared to fentanyl (p< 0.001).Conclusion: Dexmedetomidine was more effective than fentanyl in attenuating the rise in systolic pressure and heart rate due to laryngoscopy and intubation
Comparative study of epidural 0.2% ropivacine and fentanyl with 0.2%levobupivacine and fentanyl for postoperative pain relief for modified radical mastectomy
Get PDFBackground: Effective pain control is crucial for optimal care of surgical patients.Effective post operative analgesia results in decreased stress response and also reduces risk of recurrence and metastasis in cancer patients.Epidural anaesthesia offers most post operative pain relief compared with systemic drugs.Thoracic epidural analgesia is most effective in reducing pain after thoracic and upper abdominal surgeries.In this study,thoracic epidural technique is chosen for post operative management of patients undergoing modified radical mastectomy procedure.Aims and objectives: To compare the analgesic efficacy and adverse effects after adding 0.2%Ropivacine and 0.2%Levobupivacine with Fentanyl when administered post operatively in thoracic epidural infusion for post operative pain relief. Methodology: This is a prospective randomised clinical study, approved by the institutional ethical committee.An individual consent was taken from all patients selected for the study. Total 100 adult female patients undergoing modified radical mastectomy were divided into 2 groups with 50 patients in each group.All patients belonging to ASA grade III.Patients with contraindication for epidural anaesthesia were excluded. Discussion: Thoracic Epidural analgesia offers effective postoperative pain relief for patients undergoing oncological breast surgeries.In this study we are comparing the local anaesthetics Levobupivacine and Ropivacineincombination with Fentanyl for epidural analgesia for modified radical mastectomy. Conclusion: Ropivacaine 0.2% and Levobupivacaine 0.2% concentration when combined with fentanyl were found out to be equally effective in providing postoperative pain relief with no rescue analgesic consumption, but with a significant higher incidence of hemodynamic side effects and motor blockade noted in Levobupivacaine group,which were easily manageable. There was no significant difference in sedation level and other adverse effects
A study on clinical profile and outcome of low birth weight neonates admitted to NICU in a tertiary care hospital
Get PDFBackground: Neonatal period is the first 28 days of life since birth. it is considered as the most susceptible period for mortality and morbidity [1]. Neonatal mortality accounts for 2/3 rd of the infant mortality. Objectives:1. To study clinical profile of LBW neonates2. To evaluate morbidity and mortality in LBW neonates3. To analyse the risk factors for mortality in LBW neonatesMaterial & methods: Study Design: Prospective hospital based observational study.Study area: The Neonatal Intensive Care Unit, Department of Paediatrics, Alluri SitaRamaRaju Academy of Medical Sciences, Malkapuram, Eluru, West Godavari (dist.), Andhra Pradesh. Study Period: September 2020 to September 2021. Study population: All neonates with birth weight less than 2,500 grams admitted to NICU. Sample size: study consisted a total of 46 cases. Sampling method: Simple Random sampling method. Study tools and Data collection procedure: All neonates less than 2500gms irrespective of gestational age, examined and a detailed Antenatal, Natal and Postnatal history was obtained and recorded in a predesigned proforma. Neonate’s birth weight, gestational age, sex, mode of delivery, indication for any interventions, immediate postnatal events like APGAR score and if any resuscitation done, were recorded in a predesigned proforma. Results: The Most common morbidity found in this study subjects were RDS (30.4%), followed by EONS (28.3%), NNJ (13%), NEC (6.5%), HYPOGLYCEMIA(6.5%), BIRTHASPHYXIA (4.3%), DIC & MAS (2.2%). Pre term LBW babies were more effected by these morbidities than the term LBW babies, but there was no statistical significance in our study. Conclusion: RDS and Sepsis were the most common factors associated with LBW. The factors associated with mortality were found to be Birth asphyxia, Sepsis, RDS
A Prospective to evaluate Nitric Oxide Concentrations in Normal Pregnancy and Preeclampsia
Get PDFBackground: During pregnancy Nitric oxide is one of the most important relaxing factors for myometrium and also in the control of blood flow in uterus and placenta. Nitric oxide is generated by endothelial type II nitric oxide synthase (NOS) and acts as a vasodilator. Aim: To investigate the level of nitric oxide (NO) production in pregnancies complicated by preeclampsia and in normal pregnancy. Materials and Methods: A case control study was undertaken in Department of Gynaecology and Obstetrics. The study population was pregnant women having preeclampsia and normal pregnancy between 29 to 40 weeks of gestation. As because of transient and volatile nature of nitric oxide, it was unsuitable to measure the nitric oxide level by conventional method. However, two stable break down product, nitrate and nitrate could be easily detected by sprectophototric means. Nitrate (NO2 ) was first converted to Nitrite (NO3 ) by reduction process using cadmium. Then concentration was measured by using Griess reagent in U- V sprectophototric machine. Results: The mean nitrite level was found 18.37±3.64 mol/L in case group and 25.57±2.11mol/ L in control group, which was significantly (p<0.05) higher in control group. The mean serum creatinine level was found 1.19±0.28 mg/dl in case group and 0.65±0.1 mg/dl in control group. The mean serum creatinine level was significantly (p<0.05) higher in case groups. Nitrite level had no correlation with onset of hypertension (r=-0.006; p=0.966), onset of proteinuria (r=0.071; p=0.623), systolic blood pressure (r=0.012; p=0.933), diastolic blood pressure (r=-0.159; p=0.269) and urine protein (r=0.047, p=0.748). Conclusion: As pregnancy progressed there was a decrease in plasma nitric oxide levels in preeclampsia. Urine uric acid to creatinine ratio increased with the decrease in nitric oxide levels and can be used as a marker for preeclampsia