International Journal of Health and Clinical Research
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Analysis of radiographic findings of osteoarthritis (OA) of knee joint using kellgren-lawrence scores in osteoarthritis of knee patients
Get PDFBackground: The aim of this study was to investigate the radiographic findings in patients with knee osteoarthritis (OA). Methods: The present study was conducted on 120 symptomatic knees fulfilling American College of Rheumatology criteria for OA were included in the study. Patients with trauma, inflammatory, and infective conditions of the knee and with a history of intra‑articular interventions and surgery were excluded. Demographic data, body mass index (BMI), visual analog scale (VAS) were obtained. Kellgren–Lawrence (K‑L) score was obtained on radiography. Results: A total of 120 consecutive symptomatic knees were examined. The participants with a mean age of 50.66 ± 7.28 years, mean duration of disease of 4.20 ± 4.16 months, mean BMI of 28.20 ± 5.40 kg/m2, and mean score of VAS scale of 6.30 ± 1.50. K‑L grading of 1, 2, 3, and 4 was reported in 25%, 33.33%, 29.16%, and 12.5% of the knees, respectively. The mean VAS score showed statistically significant correlation with KL grading (P < 0.05). Conclusion: Our study found that K‑L grading and few ultrasonographic criteria showed a significant positive correlation with pain scores, while few other ultrasonographic criteria did not. Both imaging modalities are complementary to each other, rather than one being superior to the other
Evaluation of clinical profile of post menopausal women presenting with postmenopausal bleeding in tertiary care hospital
Get PDFObjectives: 1.To evaluate the clinical profile of postmenopausal women presenting with postmenopausal bleeding2.To evaluate the causes of postmenopausal bleeding. Methods: It is a retrospective observational clinical study of 48 postmenopausal women presenting with complaints of postmenopausal bleeding who attended out-patient department of Obstetrics and Gynaecology in Sri Padmavati medical college and hospital for women, Tirupathi from the period between January 2019 - December 2019.Detailed clinical history including obstetric history, past medical and surgical history, age at menopause; onset of symptoms since menopause noted; general physical examination, systemic examination, detailed gynaecological examination including per speculum, bimanual examination performed. Pap smear, cervical biopsy and endometrial sampling and transvaginal ultrasonography was performed in all cases.Results:29.16% of the women presenting with postmenopausal bleeding were in age group 61-65 years. 31.25% (15 cases) came with complaints of postmenopausal bleeding within 1-5 years of menopause. Pap smear was abnormal in 14 cases (29.16%). Histopathology of cervical biopsy showed 16.66% (8 cases) had carcinoma cervix. Histopathology of endometrial biopsy showed atrophic endometrium in 39.58% cases, 16.66% (8 cases) had endometrial carcinoma. Conclusion:Postmenopausal bleeding is a common clinical problem in postmenopausal women. It requires immediate evaluation. Community level awareness has to be made to decrease the time between symptom presentation and evaluation and treatment
Isometric hand grip exercise: Can it be beneficial for cardiovascular health?
Get PDFIntroduction: Isometric Hand Grip(IHG) exercise may be of value in maintaining the desired Blood Pressure(BP),Heart Rate(HR) and Capillary Blood Glucose(CBG) in individuals with inability or unwillingness to do conventional aerobic exercises. Contrary to the belief that IHG exercise causes cardiovascular strain, there are some evidences that IHG exercise leads to maintain the cardiovascular parameters. So this study is framed to establish the positive and negative effect in the above mentioned cardiovascular parameters post static exercise. Objective: To determine the immediate effect of graded isometric hand grip exercise on Systolic and Diastolic blood pressure, Heart Rate and Capillary Blood glucose in young healthy adults. Materials and Methods: Present study was conducted on 82 healthy adults aged between 18 to 25 years including both sexes. Subjects having any form of hypertension, other cardio-vascular co-morbidities and any diseases involving wrist joint and palmar diseases are excluded from this study. Systolic and Diastolic Blood pressure, Heart Rate& Capillary Blood Glucose are measured single handedly at resting condition, after 30% Maximum voluntary contractions (MVC), after high load contractions, Post sham, and 1 hour post sham. Result: It is revealed that after 30% MVC and post high load ,SBP and DBP is significantly increased compared to resting condition but after post sham, SBP and DBP is significantly decreased in both sexes.There is no significant change found in 1 hour post sham condition. Heart Rate is increased in 30%MVC and Post Highload condition but in post sham and 1hour post sham condition HR is not decreased significantly. Capillary Blood Glucose(CBG) is increased without any statistical significance in 30% MVC and Post High load condition but significantly decreased in 1 hour post sham condition. Conclusion: IHG Exercise for BP management in normotensive young people is significant. But it may not be useful in the management of Heart Rate and Blood Glucose
Corneal endothelial cell changes in patients with diabetes after manual small incision cataract surgery
Get PDFIntroduction: Cataract surgery can lead to endothelial cell damage and cell loss. Loss or damage to corneal endothelial cells during surgery may lead to corneal decompensation, causing corneal edema and loss of corneal transparency, which disrupts vision. Specular microscopy provides a non-invasive view of morphology of corneal endothelium. This study was undertaken to evaluate the changes in endothelial cells in patients with diabetes mellitus after manual small incision cataract surgery. Material and methods: Prospective, longitudinal study was conducted in 50 diabetic patients and 50 non-diabetic patients who underwent manual small incision cataract surgery. Endothelial cell density, coefficient of variation, hexagonality and central corneal thickness was assessed using non contact specular microscope preoperatively and 1 week, one month and three months postoperatively. Statistical analysis was done using using t-test. A p-value <0.05 was considered as statistically significant. Results: The mean preoperative endothelial cell density was lower in diabetics as compared to non diabetics (p-value 0.11). There was a statistically significant decrease in endothelial cell density in diabetics post-operatively as compared to non-diabetics (p value: 0.008). There was also a significant increase in corneal thickness in diabetics as compared to non-diabetics (p value: 0.02). The change in coefficient of variation was also higher in diabetic patients (p value: 0.01). However there was no significant change in percentage of hexagonal cells (p-value: 0.74). Conclusion: Diabetic patients have lower endothelial cell density and lower capacity for endothelial repair which increases the risk of decompensation in these patients. Thus, specular microscopy should be performed in every diabetic patient before undergoing cataract surgery, wherever possible and precautions should be taken to protect the corneal endothelium preoperatively
Study of Malaria Surveillance indicators of Visakhapatnam (GVMC) and evaluation of the status of functioning of Urban Malaria Scheme (UMS)
Get PDFIntroduction: National Framework for Malaria Elimination in India (2016-2030) was launched in the year 2016 with an objective of eliminating malaria throughout the country and to prevent not only re-establishment of transmission but also to reach the stage of zero indigenous cases by the year 2030. During the early 1970’s resurgence of malaria, maximum cases (7.4%) and deaths (10.9%) were reported from urban areas where Visakhapatnam was one among them. Urban Malaria Scheme (UMS) was launched in 1971in Visakhapatnam along with other cities like Chennai, Vadodara, Vijayawada, as a component of National Malaria Eradication Program me (NMEP) to reduce/interrupt transmission particularly effecting the towns and cities. Methods: The present study period is from 2012 to 2020. Secondary data has been collected from GVMC Chief medical officer, District and Zonal malaria offices with their approval. The present study design is retrospective trend analysis of malaria surveillance indicators of GVMC. Year wise parasitological indices were estimated. Vector density was also obtained for the study period. Integrated Vector Management (IVM) is prime activity in Visakhapatnam city under Urban Malaria Scheme (UMS). Results: Blood smear collections, total number of fevers subjected to blood smear examination, smear positives, type of malaria, estimation of API (from ABER and SPR) which is the key indicator for categorization of states and district falling under stage of elimination of malaria. Starting from the year 2013 there is consistent fall of API (2.21-0.02) and SPR (3.24-0.05) There is an under-reporting in the year 2020 where sufficient number of blood smears could not be collected under active and passive surveillance. The main activity of malaria control in GVMC under Urban Malaria Scheme is IVM which brings down the critical density of the vector for transmitting the malaria parasite. Deaths were not reported throughout the time line. Conclusion: It is evident that Visakhapatnam city parameters of malaria surveillance are comparable to that of country wide malaria surveillance data and GVMC is already a partner in National Frame work for Malaria Elimination in India (2016-2030) and hopefully reach the objective by 2030
Comparative study of the role of single-dose Antibiotic versus conventional 5 Days Antibiotic in clean surgery
Get PDFIntroduction- Infection is a typical issue in surgery and is experienced by all specialists ordinarily of their art; they constantly hinder the principal line of host protection. Bacteria might enter the injury during or later the activity and might be of endogenous or exogenous beginning. It is a significant reason for morbidity in surgical patients. Antibiotics assume a vital part to forestall infection. Objectives- To set up the adequacy of Antibiotic prophylaxis in clean surgeries. To think about the extent of early postoperative infection in clean surgery later 3 dosages of prophylactic Antibiotics and 5 dose customary postoperative Antibiotics. Materials and Methods– This was a prospective study conducted on patients in General Surgery Department, IGIMS Patna from 1st June 2020 to 31st May 2021. 50 patients were selected for this review. Two groups were created based on mathematical status. Patients with even numbers (Group-A) were taken for three dose preliminaries, and those with odd numbers (Group B) were taken for five days course of antibiotic treatment. Clean procedures were incorporated. The postoperative assessment was a finished improvement of fever or wound infection. Information was gathered and investigated and a two-sided p-value was analyzed. Observation and Results- Mean age was 35.51+/ - 20.79 years in group A and 26.17+/ - 19.79 years in group B. In any case, there was a fundamentally higher extent of male patients in group B than in group A (p=0.006). Measurable examination showed no critical distinction in the extent of early postoperative infection cases between the two groups (p=0.270). Staphylococcus aureus was the commonest life form refined from the injury release in our review followed by E. coli. Five of our cases having postoperative injury infection showed development in three cases, out of which 3 were shallow and 2 were profound. There was no huge contrast between the two groups in regards to terms of stay in the clinic. Conclusion- Utilization of 3 dose perioperative antibiotics is adequate to forestall SSI and no compelling reason to give 5 dose course of antibiotics in clean surgery. There is massive expense decrease is accomplished
A study of clinical profile and outcome of children who presented with status epileptics in the PICU of a tertiary care hospital of central India
Get PDFBackground: Status epileticus is an acute, life threatening neurological emergency that may lead to permanent neurological damage or even death. Status epileticus affects people of all ages, though it is more common and causes greater morbidity and mortality in infants and 1-5 yr age. Method: The Present study was conducted in the Department of Pediatrics tertiary care hospital. A total of 105 children were studied. All the children aged between 1 month - 14 year presenting with Status Epileticus , admitted in PICU in department of pediatrics. Data was collected after taking written consent, detailed history in a pretested proforma. Results: Total 105 subjects were included in final analysis out of which 55(52.4%) were male and 50(47.6%) female. Subjects had duration of seizure more than 30 minute at presentation . In our study showed that factors associated with a high risk of mortality in status epilepticus are GI hemorrhage (p value <0.001), significant mortality was observed in subjects who required MV on admission (p value < 0.0001 ) , hypotension (p-value 0.0003), prolonged duration of seizures (p- value 0.015), time taken to control seizures(p- value <0.0001), nutritional status (p value 0.008), infectious etiology(p value 0.0006).and distribution of subjects according to socioeconomic status and outcome also statically significant (p- value <0.0001), 100 % mortality was in super refractory group and 6(60%) mortality was seen in subjects who had not controlled seizure within 24 hour. Conclusion: In this study mortality was associated, risk factors being prolonged duration of seizures, infectious etiology, hypotension, Gastrointestinal hemorrhage and need for mechanical ventilation on admission. Prolong duration of seizures and not respond to AED were major contributing factors
Effect of Integration of Palliative Care and Critical Care in ICU of a Tertiary Health Care Centre
Get PDFAim: To observe and study the effects of integration of palliative care with critical care in ICU of a tertiary health care centre. Material and Methods: A retrospective study was performed between January 2019 to December 2019 at JK Hospital & LN Medical College, Bhopal, M.P. Patients characteristics were analyzed and then we studied the effects of integration by triaging the patients according to ECOG-PS. Results: The mean age of patients admitted in ICU was 57 years with neurological cause(45.39%) i.e. acute stroke as primary reason for ICU admission (26.47%) along with mortality rate of 11.82% and most common cause of mortality as MODS(44%). It was found that that a major part of patients who are terminally ill admitting to the ICU needs palliative care rather than aggressive critical care. Moreover, it was observed that at terminal stage of life in terminally ill patients, families preferred a peaceful death at home than at a hospital.Conclusion: Mortality rate is seen higher in age group >65 years with more than one organ failure. In these patients palliative care dominates over curative care. Segregation of these patients for palliative care showed better utilization of scarce medical resources and enhanced treatment decision making for the patients who required curative care and avoidable less financial burden on patients resources and ensuring a good death for the patients who require palliative care at terminal stage of illness
Efficacy Of Thoracic Paravertebral Block Vs Thoracic Epidural Analgesia for Post Operative Analgesia in Patient Undergoing Modified Radical Mastectomy
Get PDFIntroduction: Breast cancer is the most common cancer among women and most of them require surgery and surgery is conducted under general anaesthesia which is associated with post operative nausea vomiting, post operative pain and chronic pain. Acute post operative pain is an important risk factor for the development of chronic pain after breast surgery. Therefore, effective postoperative pain management after breast cancer surgery is necessary. Paravertebral block and thoracic epidural analgesia for breast surgery are considered a technique of choice for postoperative analgesia in breast surgery. Aims and objectives: To evaluate postoperative analgesia, incidence of postoperative nausea vomiting, requirement of rescue analgesia and to see hemodynamic changes between paravertebral block and thoracic epidural analgesia. Material and methods: This study comprised of 60 patients of age between 18 to 60 years of ASA grade II and III who were diagnosed case of breast cancer and scheduled for modified radical mastectomy. Patient were divided into 2 groups of 30 patients in each group. Group P received paravertebral block prior to general anaesthesia and Group E received thoracic epidural analgesia and all patients followed up 24 hr postoperatively and compared using VAS score and NRS scale. Result: VAS score of both the group were comparable for group P (mean sum VAS 1.51+/-3.44) and for group E (mean sum VAS 2.05+/- 2.54). Postoperative analgesia was good in both the groups. Group E had significantly higher NRS score (mean sum NRS 4.49+/-4.43) compared to group P (mean sum NRS 0.03+/- 0.18). Group P had more hemodynamic stability as compared to Group E. Conclusion: We conclude that Paravertebral nerve block has the potential to offer equivalent surgical condition and analgesia along with good patient satisfaction as compared to epidural anesthesia but better patient profile and tolerance and fewer postoperative side effects when used for breast surgery
Evaluation of Ponseti technique for the management of congenital talipes equinovarus
Get PDFBackground: Congenital talipes equinovarus (CTEV), also known as Clubfoot, is a complicated congenital malformation of the foot that, if left untreated, can limit a person's mobility by making walking difficult and painful. Low- and middle-income nations account for 80% of children born with clubfoot. Objectives: Present study was planned with objective to evaluate the functional outcomes of congenital talipes equinovarus management by the Ponseti technique. Materials and Methods: All clubfoot patients above the age of 12 months who had normal hips and spines and gave their consent to participate were included in the study. The study excluded patients over the age of 12 months who had previously undergone other surgeries and had linked neurological problems, spine, or hip concerns. The conventional approach described by Ponseti was followed, with the exception that percutaneous tenotomy of the tendo Achilles was performed when necessary. The Pirani score was employed in the evaluation. Results: 17 individuals with 28 feet of congenital idiopathic clubfoot were treated using the Ponseti technique. In our study, the mean initial Pirani score at the time of case presentation was 6.29 and was 0.66 at the final follow-up. The difference between starting treatment within two weeks versus starting treatment after two weeks was shown to be statistically insignificant. Relapse of the deformity occurred in 4 foot (14.29%). Conclusion: The Ponseti technique is a very safe, efficient, and cost-effective way to treat clubfoot in a developing country like India, where resources are scarce and the referral system is inadequate