International Journal of Health and Clinical Research
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Pitfalls in FNAC diagnosis of carcinoma breast
Get PDFThe Breast lesions commonly present as a breast lump. A palpable breast lump is a common diagnostic problem to both general practitioners and surgeons.The most accepted protocol followed for the diagnosis of a breast lump is a triple assessment which includes clinical assessment, radiological imaging, and pathological diagnosis. Since FNAC forms the most important aspect of cytopathology as a part of the triple assessment, it is expected to be an efficient technique which can be relied upon in terms of avoiding further diagnostic surgery before proceeding with the final definitive excisional procedure. FNAC has limitations in diagnosing conditions especially if cellularity is low on the smear. FNAC diagnosis should be given in correlation with clinical and radiological diagnosis to avoid false positive and false negative cases as even one case of misdiagnosis lead to a hazardous effect on that patient
A clinico-hematological study of pancytopenia in a tertiary care center
Get PDFBackground: Pancytopenia is triad of findings characterized by reduction in all three major formed elements of the blood: erythrocyte, leukocytes and platelets. The present study has been undertaken to study the clinical profile of the patient’s presenting with pancytopenia, identify the underlying etiology leading to pancytopenia and bone marrow morphology due to various causes of pancytopenia. Materials and Method: An observational study was conducted on 100 patients of pancytopenia admitted in general medicine department. Selected patients were subjected for detailed clinical history, physical examination followed by lab investigations. Collected data were presented in tabulated or graphical form and were analyzed. Result: A total of 100 patients in the age range of 15- 85 years were taken in the study. There was male predominance with a male: female ratio of 2.2:1. Commonest clinical presentations were generalized weakness in 61% followed by fever in 47%. Most common physical findings were pallor observed in all patients followed by splenomegaly and hepatomegaly in 15 and 8 patients respectively. Bone marrow aspiration cytology showed hypercellular marrow in 62%, normocellular in 13% and hypocellular in 25%. Megaloblastic erthyopoeisis with hypercellular marrow were observed in 39 cases. 13 cases were diagnosed as acute leukemia and 02 cases were diagnosed as MDS. Hypocellular marrow was diagnosed in 25 cases out of which 18 cases were idiopathic aplastic anemia, 02 each of scrub typhus and SLE, 01 case each of post-partum aplastic anemia, disseminated tuberculosis and methotrexate induced. Normocellular marrow were observed in 04 cases of dimorphic anemia, 02 cases of Kala- azar, 01cases each of disseminated TB , falciparum malaria, metastatic adenocarcinoma and NHL. Conclusion: The present study concluded that Megaloblastic anemia is the most common and reversible cause of pancytopenia
A prospective study of audiological profile in patients with diabetes mellitus in tertiary care hospital
Get PDFIntroduction: Diabetes mellitus (DM) is a metabolic disorder characterized by hyperglycemic resulting from defects of the secretion and/or action of insulin, which can cause a variety of metabolic, neurological and vascular complications. Materials and methods: A hospital-based cross-sectional study was carried out from January 2021 to December 2021. 100 consecutive diabetic patients (type 1 and type 2) of either gender visiting the outpatient department of medicine patients were included in the study. They were diagnosed to have diabetes mellitus according to the criteria given by the American Diabetes Association. Inclusion criteria included diabetic patients were in the age limit between 30 – 55 years and patients willing to undergo the investigations. Results: In our study, the subjects were divided into 4 groups on the basis of duration of diabetes. It is found that greater the duration of diabetes, greater is the prevalence of SNHL. The duration of DM is a significant factor responsible for SNHL in diabetics (chi-square test, p value < 0.001). Conclusion: Greater the duration of DM, greater will be the prevalence of SNHL. Greater the duration of DM, higher will be the severity of SNHL. Uncontrolled diabetic status has an increased prevalence of SNHL. Severity of SNHL is high among uncontrolled diabetic group compared to controlled diabetic group
An observational study of drug prescription pattern in the treatment of acne vulgaris
Get PDFBackground: Acne Vulgaris is the most common skin disorder of the pilosebaceous unit with excess sebum production, follicular epidermal hyperproliferation, inflammation and Propionibacterium acnes activity, affecting about 80% of teenagers and has considerable psychological and social consequences and physical disability. Aim: To evaluate the pattern of prescription and its rationale in the drug therapy of acne vulgaris. Methods: This prospective, hospital based, observational study evaluated Demographic data, Disease data and data pertaining to the drug therapy of the subjects considering the Inclusion and Exclusion criteria. Results: The prescription data of 346 patients were analyzed of which 45.1% were males with an average age of 21.94±0.3 years. Among the four grades of Acne Vulgaris, Grade II (53.17%) was more prevalent followed by Grade I (26.58%), Grade III (13.87%) and Grade IV (6.35%). The number of drugs prescribed for topical use was 514 of which the most commonly prescribed drugs were Tretinoin alone (19.46%), a combination of Tretinoin and Clindamycin (17.12%), Benzoyl Peroxide (12.45%), Clindamycin alone (10.51%) etc. The number of drugs prescribed for systemic use was 98 consisting of Doxycycline (55.1%), Azithromycin (34.7%), Isotretinoin (6.12%) and Erythromycin (4.08%). Conclusions: There was rationality in most of the prescriptions giving no scope for polypharmacy
Histo-Morphological Features of Ligature Mark in Hanging - A Descriptive Study
Get PDFBackground: Hanging is the most common method of suicidal death in India. All hangings are suicide, until otherwise it is proved contrary. The ligature mark on the person is the most critical discovery that will guide the investigation. The correlation of external and internal features of ligature mark will help us to establish the critical facts in cases of hanging.Objectives:1.To study various pattern in ligature marks in case of hanging in comparison with age, sex, type of ligature material used, type of hanging, level and colour of ligature mark.2.To study various histopathological features of skin in ligature mark in cases of hanging.Materials & Methods: It is a retrospective descriptive study with a study period of two years from 1 January 2018 to 31 December 2019. All compatible autopsies of hanging received during the study period were included in the study. The records of all the victims died due to hanging were collected from autopsy register maintained by the department of forensic medicine. Haematoxylin and eosin slides were retrieved from department of pathology and reviewed the microscopic findings in hanging cases. The data was entered into Microsoft excel spreadsheet and was analysed. The data was segregated with respect to age, sex, type of ligature material used, morphology and histopathological parameters.Results: A total of 79 cases of hanging were studied. Out of which, 57 (72%) were men and majority belong to 31 to 40 years (26.6 %). Most common gross findings were complete hanging (42%), ligature mark above thyroid cartilage (61%) and parchmentization (50%). Common histopathological findings were epidermal thinning (57%), dermal compression (56%), dermal congestion (36%), dermal hemorrhage (17%), inflammatory infiltrate (10%) and adnexal compression (24%). Out of 79 cases of hanging, 57 cases (72.1%) were reported as antemortem, 21 cases (26.6 %) as non- specific and opinion of one case was unable to establish as it did not have epidermis. Conclusion: The present study concluded that a detailed evaluation of the gross and histopathological findings of the ligature mark, if undertaken would be more conclusive in establishing the cause and manner of death to aid in the administration of justice
Correlation of Hematological Parameters in Covid Positive Patients with The Severity of their Illness at A Teaching Hospital in India
Get PDFIntroduction: This study was done to evaluate importance of hematological parameters to identify severity of covid 19 positive patients. So that, it will be evaluated who need ICU or emergency treatment. A comparison of biomarkers from the peripheral blood between the covid 19 and non-covid 19 has been done. A comparable study with respect to age, gender and clinical complaints between covid 19 and non-covid 19 patients has been performed. Materials and Methods: A retrospective study was conducted at Autonomous government medical college society of Firozabad on 150 covid positive confirmed patients who were admitted in the covid hospital. Data was collected from the record section of this institute.Result: As covid 19 is a systemic infection involving multiple systems of the body but the hematopoietic system and hemostasis showed the major impact. Leukocytosis with neutrophila, lymphocytopenia, thrombocytopenia along with raised PT, APTT and D-dimer were reported with poor prognostic potential. Biomarkers such as serum ferritin, serum pro-calcitonin, CRP, interleukin 6 proved to be the important inflammatory marker, which are associated with the severity of the covid 19 positive patients so that proper intervention should be taken at the appropriate time.Conclusion: Laboratory tests were found to be useful in the diagnosis and management of the disease. Hematological abnormalities included lymphopenia, neutrophilia, thrombocytopenia, and slight fall of hemoglobin. CD4+ and CD8+ T lymphocytes count declined as the disease aggravated
A Retrospective Study of Emergency Laparotomies done in a Tertiary Care Centre of Mysuru
Get PDFIntroduction: Compared to elective setting, poorer clinical outcomes are observed in laparotomy done in emergency. Nowadays interventional research designed to enhance the outcome, care and quality from emergency surgery is being done with respect to previous observational studies which just assess the outcome of surgery. To conduct research with optimal approach, there are no proper consensus. This study mainly focuses on intra operative presentation and postoperative complications in the patients presenting to tertiary care centre Perforation of hollow viscus is the commonest finding in patients underwent laparotomy. These conditions are of utmost significance as death of the patient might occur due to delay in timely surgical intervention. Following laparotomy, morbidity and mortality of patients depends on symptomatology, etiology, time gap between onset of symptoms and laparotomy, patient’s general condition and comorbidities, anaesthetic complications and postop care.Methods: This is a hospital-based retrospective study. Those patients who presented to our tertiary care centre with acute abdomen or trauma were included in our study. Study period was from 16 August 2020 to 15 August 2021, and the data were collected from hospital OT records from medical records department. It was conducted in accordance with the institutional guidelines.Results: This is a hospital based retrospective study of 77 emergency midline laparotomies done in our institute. Most of the patients belonged to the age group of 40–60-year. Around 93 % cases presented with acute abdomen , amongst which around 62% of them had gastrointestinal perforation. Around 90 % of the cases had pain abdomen as the most common presentation associated with other symptoms. Fever was the most common complication followed by wound infection. No complications were seen in 13 percent cases and mortality occurred in 13 percent cases.Conclusion: Early detection and immediate intervention with better postoperative care can minimise both morbidity and mortality associated with emergency laparotomy. To reduce both morbidity and mortality for patients who needs emergency intervention, it is of utmost importance to have public awareness, health education amongst public to get proper medical care, timely referral and mobilization of patient to a well equipped centre without any delay
Comparitive study of 600 mcg sublingual misoprostol and oxytocin 10 iu i. min active management of third stage of labour
Get PDFAims: This study was done to assess the efficacy of oral misoprostol in the active management of the 3rd stage of labour in comparison with intramuscular oxytocin and to assess the side effects of the drugs. Materials and methods: 200 women of low risk category were selected randomly with 100 women in each group. After delivery of the baby, the cord was clamped and cut. Misoprostol group was given 3 tablets of misoprostol 200μg each sublingually and oxytocin group was given 10 IU of oxytocin in the intramuscularly. Placenta was delivered by controlled cord traction. Blood loss was measured in both the groups for 1st hour after delivery. The hemoglobin concentration before and 24 hours after delivery was noted. The side effects of the drugs up to 24 hours after delivery were noted. Results: The results of the misoprostol group (100 patients) were compared with oxytocin group (100 patients). The average blood loss was 217.9 ml in misoprostol group compared to 233.45 ml in oxytocin group. The fall in hemoglobin percentage was 0.9g/dl in misoprostol group compared to 0.8g/dL in oxytocin group. The difference in observation of both groups was statistically not significant (p>0.05). The incidence of postpartum hemorrhage was 2% in both the groups. There was no case of retained placenta in either of the groups. The need for additional oxytocics was also 2% in both the groups as they were given only when the blood loss is more than 500 ml. Shivering and pyrexia were the commonest side effects noted in misoprostol group. Conclusion: We found that both sublingual misoprostol and intramuscular oxytocin were equally effective in the management of 3rd stage of labour
Abdominal emergencies performed in general surgery department
Get PDFBackground: Abdominal surgical emergencies constitute a significant portion of a surgeon’s clinical experience and often present with diagnostic and treatment challenges. The present study evaluated various abdominal emergencies performed in general surgery department. Materials & Methods: 158 patients undergone abdominal emergencies performed in general surgery department of both genderswere enrolled. Parameters such as organ system involved, operation performed, initial diagnosis in the emergency room, final diagnosis, and outcome of treatment was recorded. Results: Out of 158 patients, males were 90 and females were 68. Surgeries were performed on liver in 12, lung in 5, small bowel in 27, pancreas in 10, stomach in 20, biliaryin15,rectumin 8, hernia in 19, esophagus in 4, spleen in 12, appendix in 17 and ovaries in 9 patients. Postoperative complications were abscess in 24, bleeding in 15, anastomotic leaks in 5 and anastomotic perforationsin 2. Mortality seen in patients undergoing surgery for small bowel in 5, pancreas in 2, stomach in 4, biliary in 3, rectumin 1, hernia in 1, spleen in 2 and appendix in 1. Conclusion: Common involved organs were liver, lung, small bowel, pancreas, stomach, biliary, rectum, hernia, esophagus, spleen, appendix and ovaries
Microbiological profile of blood culture Isolates in a Tertiary Care Hospital in Maharashtra
Get PDFBackground: Blood stream infections (BSI), ranging from self-limiting infections to life threatening septicaemia remain one of the most important cause of morbidity and mortality. BSI can be preceded, followed or be concomitant to a localized or disseminated infectious disease. Blood cultures remains the gold standard diagnostic test for detecting septicemia.Objective:1.To study the profile of microbiological isolates causing Blood Stream Infections in suspected cases of septicaemia2.To determine the antibiotic susceptibility pattern of bacterial isolatesMaterials and methods:The study was carried out in Department of Microbiology at GMC, Akola from January 2018 to December 2020. Blood samples from 2322 patients with a clinical diagnosis of sepsis were processed under standard protocol. Results:A culture positivity of 5.25% was observed. Of the total 122 isolates, 52 (42.59%) Gram‑negative rods, 46 (37.7%) Gram‑positive cocci and 24 (19.66%) Candida species were isolated. The predominant GNR were Pseudomonas spp. 16(13.11%) followed by Klebsiella spp. 14(11.47%) and Escherichia coli 12(9.83%). E. coli (16.66%) and Klebsiella spp. (28.57%) were found to be ESBL producers. Among Gram-positive cocci, S. aureus 32(26.22%) was commonest with MRSA (87.5%), followed by Enterococci spp. (4.9%) and CONS (4.9%). Conclusion: Timely identification of pathogen and its susceptibility to antimicrobial agents is of great diagnostic and prognostic importance to decrease related mortality and morbidity. Antimicrobial stewardship programme on regular basis guides in decreasing antimicrobial resistance