International Journal of Health and Clinical Research
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Study on clinical profile of neonates born to diabetic mothers in level III NICU
Get PDFIntroduction: Due to raise of diabetes most of the infant of a diabetic mother (IDM) are at an increased risk of long term morbidities. With this knowledge, a study was conducted to find the clinical profile of IDMs and to know the incidence of congenital anomalies. Methodology: It was a prospective study, conducted in the department of Paediatrics, Gandhi Medical College from January 2018 to June 2019. An informed consent was taken from all the participants. Newly born babies to gestational diabetes (GD) and Pregestational diabetes (PD) mothers, were included. Mothers with heart, renal complications were not considered. GD was diagnosed using Carpenter and Couston Criteria and PD based on serial estimation of fasting glucose. The babies were evaluated by the specialist. Immediately, glucose level in the cord blood was measured and later at regular intervals using glucometric reagent strip method; mean was considered. Chi-square was used to find the significance; P<0.05 was considered to be statistically significant. Results: Total 140 diabetic women were recruited, 73% were diagnosed to be GD. Thirty four underwent normal vaginal delivery. Hypoglycaemia is the predominant (53%) metabolic abnormality. GD was diagnosed in 56% of the neonates; statistically there was significant difference. Hyperbilirubinemia (61%; 85) was the predominant haematological abnormality CVS abnormality was diagnosed in 8, 80% (112) of GD neonates were improved; statistically the difference was significant. Conclusion: GD is the major contributor among the pregnant women with diabetes. IDM are at high risk, due to congenital abnormalities. Hence, it is always ideal that they are delivered and managed at tertiary care centre so that intensive monitoring as well as therapy can be provided
A study to evaluate the efficacy of transdermal nitroglycerine patch in enhancing analgesia of intrathecal neostigmine following inguinal hernioplasty under bupivacaine subarachnoid block
Get PDFObjectives: We aimed to evaluate and compare the safety and efficacy of combining intrathecal neostigmine with transdermal nitroglycerine patch for pain relief in patients undergoing inguinal hernioplasty under bupivacaine subarachnoid block. And to evaluate the adverse effects of intrathecal neostigmine with transdermal nitroglycerine patch. Methodology: After taking informed consent, 60 patients of ASA Grade I and II were systematically randomized into two groups of 30 each. Patients were infused with Ringer's lactate solution 10ml/kg preoperatively. Group N patients received Intrathecal injection of 15 mg of 0.5% hyperbaric bupivacaine with 10 mcg of neostigmine and transdermal nitroglycerine patch (5 mg/24 hours). Group P patients received Intrathecal injection of 15 mg 0.5% hyperbaric bupivacaine with 10 mcg of neostigmine and transdermal placebo patch. Subarachnoid Block was performed at L3-L4 level, with 25 gauge spinal needle and 3.5 ml of the drug solution was injected intrathecally per the group allocation. Sensory block was assessed by using pin prick method and motor block was checked by using modified Bromage scale. Pulse rate, blood pressure and SpO2 were monitored. Intra-operative complications were noted. Sample size was calculated to be 60 with a total of two groups with a power of 90 % and a alpha of 0.05. Test for analysis among two groups was done by Unpaired t test. A p value less than 0.05 was taken statistically significant. Results: The characteristics of study were comparable among two groups. The mean duration of analgesia in Group N was significantly longer (p < 0.001) than in Group P (367.4 ± 16.7 vs. 218.7 ± 16.8 min respectively). Group P had higher VAS scores and the number of rescue analgesic requirement was significantly more in Group P as compared to Group N. Hemodynamic changes remained insignificant in both groups. Incidences of side effects were not significant in both the groups. Conclusion: We conclude that the nitroglycerin transdermal patch used as an adjuvant to intrathecal neostigmine and bupivacaine prolongs postoperative analgesia
Evaluation of clinical profile of febrile thrombocytopenia
Get PDFBackground: Fever is the most common presenting symptoms. An A.M temperature of >37.2°C (98.9°F) or a P.M temperature of >37.7°C (99.9°F) will be considered as fever. Thrombocytopenia is defined as platelet count <150,000/μl. This is due to decreased production of platelets, increased destruction and increased sequestration in the spleen. Study aimed to evaluate clinical profile, infective etiology for fever with thrombocytopenia and to study the presentation and complications of thrombocytopenia. Method: The prospective study was conducted in patients admitted in medical college hospitals affiliated to Vijayanagar Institute of Medical Sciences, Ballari, period of 2 years from November 2017 to October 2018. Patients presenting with fever with thrombocytopenia were taken up for study. Age and gender distribution, duration of fever, clinical features, platelet counts, bleeding manifestations, liver function tests and presence of various etiologies was studied. Results: A total of 120 patients were studied. The patient age ranged from 18 years to 70 years and the mean age was 35.38 years (SD=14.19) and the male (n=72) patients were more than female(n=48) patients. The diseases which contributed mainly to febrile thrombocytopenia in our study were Dengue (40%), Malaria (24%), Leptospirosis (8%) and septicemia (10%) and other causes (18%) acute viral fever. The duration of fever ranged from 1-15 days with mean duration of 6.05 days and 92% of them had duration of < 10 days. Headache was the most common symptom other than fever in the present study. Derangement of LFT was also observed in most of the cases. Spontaneous bleeding were seen 42 number of patients. In our study 112 patients recovered and 6 expired. Conclusion: Fever with thrombocytopenia consists of occult presentations of common diseases rather than rare disease. Febrile illness patients should be investigated for platelet count irrespective of bleeding manifestations. Infection is the commonest cause of fever with thrombocytopenia. Among infections, dengue and malaria were the commonest cause. Fever and thrombocytopenia as decreased platelet count could indicate the severity of disease without external manifestation and could be an indicator of bad prognosis and treatment of underlying condition will lead to rapid improvement in platelet count with complete clinical recovery
Prospective study on effect of obesity on maternal and fetal outcomes in obese pregnant women
Get PDFObjectives: To analyse adverse maternal and fetal outcomes in obese pregnant women. Materials and Methods: This study was conducted in department of OBG, Government general hospital, Anantapur. 211 pre pregnant obese women and 211 non obese pregnant women were enrolled as study population and controls respectively. Results: Obese pregnant women were at increased risk of gestational diabetes mellitus, pregnancy induced hypertension, preeclampsia, preterm labour, cesarean section, instrumental deliveries, postpartum infection morbidities when compared to non–pregnant women. Large for gestational age, macrosomia, birth injuries, shoulder dystocia, premature deliveries, late fetal deaths and congenital malformations were more common in new borns of obese pregnant women than in non–pregnant obese women. Conclusion: Obesity is a modifiable risk factor. Preconception counseling and creating awareness regarding health risks associated with overweight and obesity should be encouraged
Burden of Type 2 Diabetes Mellitus among Chronic Obstructive Pulmonary Disease Patients: Challenge of dual Co-Morbidities among Indians?
Get PDFIntroduction: Non Communicable diseases (NCDs) like chronic respiratory diseases, stroke, cardiovascular diseases, metabolic disorders like diabetes and obesity are burden on the global health. Chronic obstructive pulmonary disease (COPD) is projected to the third leading cause of death in world by 2030. Chronic obstructive pulmonary disease can lead to diabetes mellitus (DM) and vice versa. Objective: To find out the prevalence of type 2 diabetes mellitus (T2DM) among COPD patients. Materials and Methods: Total 369 study participants were included in the study. Estimation of Fasting Plasma glucose (FPG), Post Prandial Plasma Glucose and Gylcated Hemoglobin (HbA1C) and Anthropometric measurements were done as per WHO guidelines. Type 2 Diabetes Mellitus was diagnosed as per American Diabetes Association (ADA). COPD was diagnosed and classified as per © 2020, Global Initiative for Obstructive Lung Diseases (GOLD). Result: Prevalence of T2DM was found to be 39.6%, 20.3% were known cases of T2DM and 19.2% were newly diagnosed. Increasing age, female gender, urban residence, longer duration of COPD, high BMI and smoking were found to be significant risk factors for T2DM among COPD patients. Presence of T2DM was associated with significantly more severe COPD cases. Conclusion: High prevalence of T2DM was found among COPD patients. More frequent screening of T2DM and good control of T2DM should be done because about 1/5th of the COPD patients had newly diagnosed T2DM and presence of T2DM significantly resulted in more severe disease
Ki 67 expression in breast carcinoma – Its relationship with age of the patients and pathological stage of the disease
Get PDFBackground: Breast carcinoma is a heterogeneous tumor with different histological subtypes and classifications. The role of proliferative molecule Ki67 in breast carcinoma is both as a prognostic and theranostic marker. However it lacks analytical validity and not recommended for routine use. In the recently concluded Galen’s conference, Ki 67 cut off of 30% was recommended to determine the chemotherapy requirement. Ki 67 working group recommends 5% Ki 67 as negative and 30% Ki 67 index as significant.This study was done to analyze the ki67 expression in different age groups and different TNM stages. Materials and Methods: During our one year study period, the received breast specimen cases were analyzed by our panelists. Ki67 Immunohistochemistry was done and on which manual scoring was done. Age wise incidence of breast carcinoma, correlation between ki67 and age and relationship between ki67 and various stages were tabulated. p value was calculated to find out if there is any significance between the variants analyzed. Results: Out of 113 cases received, on ninety cases Ki67 Immunohistochemistry was done and rest was excluded. Mean age incidence was 51.8 years. High Ki 67 proliferating index was seen in younger age group, and in those with higher disease stage. No significant p value was reached when Ki 67 indexes was correlated with age or with stage of disease in our study. Conclusion: Proliferation marker Ki 67 though lack analytical validation, is still recommended for deciding chemotherapy for breast carcinoma cases. Despite the availability of automated count, manual method is followed in many centers. This study was done to underline the fact that consensus should be reached for uniform assessment of Ki 67 so that the dilemma among pathologists is meted out. The grey zone ki67 index level between 6-30% should be addressed as well for better clarity
A study on relationship between serum ferritin and HbA1c in type 2 diabetes mellitus
Get PDFBackground & Objective: To find the association of elevated serum ferritin levels with Type 2 Diabetes Mellitus and to study the relationship between serum ferritin levels and Hba1c in type 2 Diabetes mellitus. Our objective is to assess the serum ferritin levels in type 2 diabetes patients, to determine the role of serum ferritin level as an indicator of glycaemic control like HbA1c and also as a marker of insulin resistance. Methods: Physical examination and Laboratory investigation such as FBS, PLBS, Serum ferritin, HbA1c are done in every patient and collected detailed History. Results: Most common age groups are 51-60 years and 61-70 years, majority of study population comprised of males (69%), significant difference seen with gender wise and age wise distribution of Diabetes mellitus, mean values of HbA1c is 7.26%, FBS is 151.34 mg/dl, PPBS is 209.17 mg/dl and serum ferritin is 193.78 mg/dl. Correlation between duration of Diabetes and HbA1c with serum ferritin is statistically significant with p-value <0.001. With spearman correlation it is 1.0 with serum ferritin and HbA1c shows strong positive correlation. Conclusion: In our study we conclude that elevated levels of serum ferritin seen in patients with type 2 diabetes mellitus, Diabetic patients with increased HbA1c had significant hyperferritinemia and serum ferritin can be used as marker of glycaemic control as HbA1c and also a marker of insulin resistance in Diabetic patients
Morphometric Assessment of Western Indian Crania by discriminant function analysis
Get PDFBackground: Craniometric measurements are used in anatomy, anthropology bioarchaeology, forensic medicine, neurosurgery, maxillofacial surgery and plastic surgery. Despite the fact that sex determination using craniometric traits is commonly used worldwide, very few studies are noted in Western Indian region which fill up the gaps existing in local forensic literature. Objectives: The purpose of this study is to evaluate sexual dimorphism in the cranium and to develop a population specific discriminant function equations that can be applied in sex determination from cranium during personal identification. Material and Methods: This study was conducted on 136 adult crania of known sex (102 male and 34 female) available in Anatomy departments of M P Shah Government Medical College, Jamnagar and other medical colleges across Gujarat. Five cranial parameters were measured and analyzed using both univariate and multivariate discriminant function analysis. Results: Males are statistically significantly greater than females in all dimensions with p value < 0.001. Maximum cranial length provide an accuracy rate of 83.8% on average by univariate discriminant analysis. By multivariate analysis accuracy is raised up to 88.2%. Conclusion: Sexual dimorphism in Western Indians is well reflected in cranial measurements. Mutivarite analysis give the highest classification accuracy and maximum cranial length is most dimorphic variable in univariate analysis. The study derived population specific discriminant equations for sex determination from crania of Western Indian population
Study of lipid peroxidation and antioxidant status in ischemic stroke patients
Get PDFBackground: Oxidative stress is probably one of the mechanisms involved in neuronal damage induced by ischemia. During ischemia, high amounts of free radical formation together with reduced antioxidant defense causes oxidative stress that may play a role in the pathogenesis of stroke associated neuronal injury. Aim and objectives: To study the correlation between lipid peroxidation and antioxidant status in ischemic stroke patients in comparison with normal controls. Materials and Methods: Cross sectional study includes 50 Ischemic stroke cases and 50 healthy controls. Fasting Venous blood samples were collected in ischemic stroke patients within 24hours from the time of onset of stroke and blood levels of Lipid profile, Malondialdehyde, Vitamin C, Vitamin E and Uric acid are estimated in both cases and controls. Results: In the Ischemic stroke group total cholesterol, triglycerides and LDL levels were significantly increased and HDL level was significantly decreased. Malondialdehyde a lipid peroxidation product was significantly increased, while antioxidants Vitamin C and Vitamin E were significantly decreased. The other antioxidant Uric acid has increased significantly in cases when compared to controls. Conclusion: This study showed an altered antioxidant status in ischemic stroke patients, which may be an indirect proof for the existence of Lipid Peroxidation
Clinico pathological study of gestational trophoblastic disease – A two years study
Get PDFIntroduction: Gestational trophoblastic disease is one of the most fascinating of all the gynecologic neoplasms partly due to their comparative rarity in western hemisphere but also because of their unique status as tumors derived from the tissues of one individual and growing in other. Aims: To study and establish the histopathological diagnosis and clinicopathological correlations.Methods: A study of 85 cases with gestational trophoblastic disease diagnosed in the Department of Pathology, GIMS District Hospital, KALABURAGI during the period from September 2018 to August 2020. Biopsies and hysterectomy specimens were processed routinely, embedded in paraffin, stained with H&E. Studied as per proforma. Results: Maximum cases were in the age group of 21-30 years (52.9%). Common in first, second and fourth pregnancies and in ‘A’ blood group. Most of the patients belonged to Hindu (72.8%) community. Common presenting symptom was bleeding per vagina (100%).Histopathological examination of specimens revealed hydatid form mole 84.7%, invasive mole 1.17%, choriocarcinoma 4.7%, placental site trophoblastic tumor 1.18% and placental site trophoblastic reaction 8.2%. Summary & Conclusion: The incidence of gestational trophoblastic disease was more in the South-East Asian Countries as evidenced from the review of literature, but unfortunately these are the countries where an organized study of these tumors in the form of National Registries as in USA, UK and Japan is lacking. Hence, the diagnosis and follow-up of these patients is essential for the early detection of malignant trophoblastic disease and reduce the mortality rates