International Journal of Health and Clinical Research
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Clinical, etiological and radiological profile of cerebral venous thrombosis in obstetric population at a tertiary care center in Tamil Nadu
Get PDFBackground and objective: Cerebral venous thrombosis (CVT) is any thrombosis that occurs in intracranial veins and sinuses. It is a rare disorder affecting 5 persons per million per year and has a huge regional variation. In India the prevalence of CVT is about 4.5/1000 obstetric admissions. The exact pathogenesis of pregnancy associated CVT is still not clear. The clinico etiological profile also has wide regional variation. Hence this study is being done to study the clinical ,demographic profile, etiology , neuro imaging findings of CVT in obstetric population presenting to Thanjavur medical college hospital, a tertiary care center in Tamilnadu. Methods: Patients who are either pregnant or in their puerperal period with MRI brain and venogram reported as CVT and patients presenting to OPD with diagnosis of CVT during their pregnancy and puerperal period were included. A detailed history, examination was carried out and all patients were treated according to standard treatment protocol. They were followed up in OPD and procoagulant factor work up was done in patients when possible. Results: Maximum occurrence of CVT were primi, 67% were multipara, 53.3% of patients had CVT in the 2nd week of postpartum period, 44% had undergone caeserean section. We found Anemia (37.3%), Headache was the most common symptom. 78.6% had single sinus involvement and 21.3% had multiple sinus involvement. Interpretation and conclusion: People must be made aware of the risk factors and early symptoms of cerebral venous thrombosis. Postpartum headache deserves prompt and focused evaluation. Early diagnosis and early initiation of treatment reduces the mortality of CVT in young femal
Congenital anomalies of ribs and its clinical significance
Get PDFIntroduction: The thoracic skeleton includes sternum, 12 pairs of ribs and associated costal cartilages, 12 thoracic vertebrae and the intervertebral discs interposed between them. The ribs and costal cartilages form the largest part of the thoracic cage. Congenital anomalies of the ribs usually reported are cervical, lumbar or bifid rib and synostosis of ribs. These abnormalities can cause nervous and vascular symptoms and misinterpretation during counting of ribs in physical examination. Materials and methods: The present study was carried out on 50 dry adult human ribs belonging to both sides. The morphological variations of bones were studied in detail and noted. Results: In first specimen, rib of right side revealed fusion of the two ribs in midshaft region with free anterior and posterior ends and in the second specimen of aleft side rib bifurcation was seen in anterior end. Conclusion: This congenital abnormalities may cause compression of neurovascular bundles at the root of the neck causing thoracic outlet syndrome. This abnormalities may also be an indication for few systemic disorders.So knowledge of this congenital anomalies will be helpful to diagnose systemic diseases and also to avoid misinterpretation during counting of ribs
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
Morphological pattern of anaemia in adults-A retrospective study
Get PDFIntroduction: Anemia most often a sign of an acquired or genetic abnormality. It is one of the commonest manifestations of the underlying medical condition. Anemia functionally defined as an insufficient RBC mass to adequately deliver oxygen to peripheral tissues. Hemoglobin concentration estimation is the ideal and convenient way of detecting Anemia. Other measurements, which are also helpful are haematocrit and the RBC count. It is not enough to just report that patient has anemia, but also morphological sub typing of anemia is required, so that the clinician can be properly guided in the proper management and follow up of the anemic patient[1]. Materials and Methods: A hospital based retrospective study was carried out at Department of Pathology, Tagore Medical College and hospital, chennai from April 2020 to March 2021. 200 patients were evaluated for morphological pattern of anaemia based on red cell indices, peripheral smear, and leukocyte and platelet parameters. Anaemia was defined according to WHO criteria as haemoglobin concentration lower than 13 g/dL in men and 12 g/dL in women. Elderly was defined as a person 60 years and above according to WHO criteria. Results: The results of CBC and PBP showed that 58 (29%), 110 (55%), and 32 (16%) of the patients had normocytic normochromic, microcytic hypochromic and macrocytic pattern of anaemia respectively [Table 1]. The gender wise classification of the patterns revealed that 36 male patients and 28 female patients had normocytic normochromic patterns, while 104 female patients and 26 male patients had microcytic hypochromic patterns whereas 18 males patients and 14 cases of female patients showed macrocytic pattern [Table 2]. Conclusion: The microcytic hypochromic pattern of anaemia is highly frequent among this sample of patients while the macrocytic pattern of anaemia is the lowest. According to gender groups, microcytic hypochromic pattern of anaemia is more common among females; malnutrition, increase of blood loss due to pregnancy or menstruation, and lack of iron absorption are the main causes, while the normocytic normochromic anaemia is highly prevalent among males, which is mainly due to blood loss or chronic diseases
Comparative study between Buprenorphine and Fentanyl transdermal patch to evaluate post-operative pain relief after cardiac surgery: A randomized control trial study
Get PDFIntroduction: Pain due to thoracotomy creates greatest demand for postoperative analgesia. Multimodal analgesia with various routes can be of great help to fulfill demands of analgesia in these patients. Opioids given by transdermal route offers newer modality of management with potential benefits of being noninvasive, sustained blood levels and bypasses first pass metabolism. We aimed to evaluate efficacy of Buprenorphine and Fentanyl Transdermal patch for post-operative pain relief after cardiac surgery. Methods: It was prospective, randomized, double-blind study in which 60 adult patients undergoing cardiac surgery were randomly segregated into two groups. Group A: 30 patients received Buprenorphine transdermal patch (10mcg/hr) and Group B: 30 patients received Fentanyl transdermal patch (50mcg/hr) 12- 24 hours prior to extubation. Analgesia was assessed using VAS score along with hemodynamic parameters and adverse effects. Results: Demographic parameters, baseline hemodynamics and perioperative hemodynamics were comparable. Baseline VAS score was comparable in two groups however statistically significant difference in two groups in VAS was observed thereafter till 72 hours. VAS score was higher in group A as compared to group B at the time of removal of ICD. 3 (10%) and 2 (6.7%) patients in Group A and Group B respectively required rescue analgesic which was not significant. Time for requirement of first rescue analgesic was significantly longer in Group B compared to Group A ie767.13 ± 73.59 minutes vs. 1224.37 ± 39.37 minutes. Adverse effects were comparable in two groups. Conclusion: Fentanyl and Buprenorphine TDDS are effective in postoperative analgesia in cardiac surgical patients. However Fentanyl TDDS has better analgesia
Comparison of Ultrasound Guided Femoral Nerve Block And Parenteral Tramadol In Acute Trauma Patients With Fracture Femur: An Observational Study
Get PDFAim: The aim of present study is to compare the analgesic effects of USG guided femoral nerve block (FNB) with parenteral tramadol in patients with fractured femur shaft. Methodology: This prospective randomized observational study was carried out in the Department of Anaesthesiology and Critical care, Dr. S.N. Medical College, Jodhpur and associated group of hospitals after getting approval from ethical committee. In our study total 60 patients were enrolled and divided randomly into two groups. One group received Femoral Nerve Block (Group R- 0.5% ropivacaine) and other group received intravenous tramadol ( group T). A written and informed consent was taken from the patient after explaining the procedure to the patient. Patients were observed for onset and duration of analgesia, hemodynamic and respiratory parameters changes, side effects or complications of study drugs and block. Results: it was observed that FNB with ropivacaine provides earlier and prolonged duration of analgesia as compared to intravenous tramadol. The reduction in rescue analgesia might be due to prolonged and better analgesia provided by ropivacaine in R group. None of our patients in both the study groups experienced haemodynamic unstability. Conclusion: The USG guided Femoral nerve block with 0.5% ropivacaine is safe, simple and effective method for relieving intense pain due to femur shaft fracture. No systemic side effects were observed and haemodynamic stability was also well maintained in patients with moderate general condition
Prevalence of the risk and cases of Type -2 diabetes mellitus among the residents in a rural area of a coastal district of Andhra Pradesh - A cross-sectional study
Get PDFIntroduction: Diabetes is a major cause of blindness, kidney failure, heart attacks, stroke and lower limb amputation. Approximately 537 million adults are living with diabetes in the world. 3 in 4 adults with diabetes live in low- and middle-income countries. India is set to be diabetic capital of world with 74.19 million diabetics and 39.39 million undiagnosed diabetics. Objective: To estimate the prevalence of high risk for developing Type 2 Diabetes in adults aged 30 years and above using the Indian Diabetic Research Score (IDRS) in the study population and determine their association with various modifiable, non-modifiable risk factors (age, waist circumference, family history of diabetes, physical activity) and other socio-demographic variables. To estimate the prevalence of Type 2 Diabetes Mellitus in the study population. Methodology: A community based cross-sectional study was conducted among 207 eligible, sampled residents of the field practice area > 30 years of Rural Health and Training Centre of a private medical college in Visakhapatnam, Andhra Pradesh.. The data was collected from the study subjects by a using a pre-designed, pretested questionnaire. Statistical analysis was done by using Chi-square to determine the association of risk factors and socio-demographical variables of the study subjects with the status of risk of diabetes in them. Results: After excluding the 35 existing diabetics in the study, the data of rest of 172 research subjects was collected, The data of 2 research subjects was missing and was excluded. Maximum 43.5% of the study subjects were in the age group of 35-49 years. Proportion (71.8%) of females was higher than males. As per IDRS, 32 (18.8%) participants were at low risk,102 (60%) participants were at moderate risk and 36 (21.2%) participants were at high risk of diabetes. 4 out of 36 high risk research subjects had Random Capillary Blood Glucose (RCBG) of more than 140 mg/100 ml of blood and were further confirmed by Oral Glucose Tolerance Test (OGTT) to be diabetic. The association of variables like age, literacy, family history of Diabetes, physical activity, waist circumference with categories of risk of development of Diabetes Mellitus was found to be statistically significant. The prevalence of Type 2 Diabetes Mellitus (existing diabetics=35 and new diabetics=4) was found to be 18.8%, out of the total study sample (n=207). Conclusion: A considerable proportion of the study population were in moderate and high categories of risk of development of Diabetes. A healthy diet, regular physical activity, maintaining a normal body weight and avoiding tobacco use are ways to prevent or delay the onset of type 2diabetes. Diabetes can be treated and its consequences avoided or delayed with diet, physical activity, medication and regular screening and treatment for complication
Clinical, radiological and histopathological profile of sinonasal masses: An observational study at a tertiary care centre in Uttarakhand
Get PDFIntroduction: Sinonasal masses are commonly encountered in clinical practice of Otorhinolaryngology. These masses are sometimes difficult to be differentiated from each other due to their similar clinical presentation and their radiological features also create confusion. Histopathology plays a key role in differentiating these masses from each other. The aim of present study was to study the clinical presentation, radiological characteristics and histopathological findings of some commonly occurring sinonasal masses. Materials and methods: This observational cross sectional study comprising of 60 patients was done in Government Medical College, Haldwani and associated Dr Susheela Tiwari Government Hospital between the periods of January 2019 to September 2020.All patients (18 years and above) presenting with complaints suggestive of sinonasal masses were included in this study after taking due consent. These cases were subjected to thorough history taking and clinical examination, routine hematological and biochemical evaluation, nasal endoscopy, CT scan of nose and paranasal sinuses/ MRI(where required) and biopsy. Final diagnosis was made after histopathological examination. Observations and results: 60 cases were studied out of which 40(66.66%) cases were males and 20(33.33%) were females with a male to female ratio of 2:1. Maximum cases was recorded in the third decade of life with 17(28.33%) patients. Nasal obstruction was the most common complaint.( 54patients (90%) In 49 (81.66%) cases radiology indicated involvement of more than one region of the sinonasal tract. Histopathology proved (70%) of the total cases ie.42 to be non neoplastic and rest (18 (30%) neoplastic. Benign neoplastic masses were 14(23.33%) and malignant masses were 4(6.66%) of the total cases. Inflammatory nasal polyps were the most common non neoplastic lesions. In case of neoplastic variety, inverted papilloma and capillary hemangioma were the most common benign lesions. Squamous cell carcinoma was the most common malignant lesion. Conclusion: Histopathological examination is mandatory for final diagnosis in patients with sinonasal masses. Combined clinical, radiological and histopathological evaluation is necessary to determine the true nature of the sinonasal mass and further management
A clinical study of optic atrophy
Get PDFMethods and materials:50 patients of optic atrophy attended to ophthalmology outpatient department from November 2019 to May 2021 were enquired about history of present illness, ingestion of toxic substances, Tobacco, alcohol, and examined for visual acuity,slit-lamp examination, ophthalmoscopic examination, perimetry, IOP measurement. Medical check was carried out in each case. TLC, DLC, ESR, Hb%, Mantoux test, serological test for syphilis, complete urine and CSF examination, CT brain, nasal sinuses, chest screening were done. Results: In this study, bilateral optic atrophy was found in 87% of the cases, and unilateral optic atrophy was found in 13%. Male and the female ratio was found to be 2:1. Conclusion: Prevalence of optic atrophy was found to be more in the first five decades. The commonest optic atrophy in this study is the primary optic atrophy. The next common type of optic atrophy is consecutive atrophy
Comparison of esmolol versus magnesium sulfate for inducing controlled hypotension for functional endoscopic sinus surgery: a randomized double blinded interventional study
Get PDFBackground and Aims: Excessive bleeding during Functional endoscopic sinus surgery (FESS) can lead to poor visibility of surgical field which can be improved by controlled hypotension. Aim of this study was to compare hypotensive properties of esmolol and magnesium sulfate and to compare quality of surgical field during FESS.Methods: A hospital based prospective randomized double blinded interventional study in which 130 patients undergoing FESS randomly allocated to two equal groups. Group A received inj. Esmolol 1mg/kg bolus diluted to 10ml in saline and maintenance infusion at 1mg/kg/hr. Group B received inj. Magnesium Sulfate 40mg/kg bolus in 10ml of saline followed by 15mg/kg/hr infusion. Hemodynamic parameters, quality of the surgical field (average category score), amount of blood loss, emergence time, time to first analgesic request and postoperative sedation were recorded. Outcome was analysed using appropriate statistical test. P value <0.05 was considered statistically significant.Result: Mean Heart Rate and Mean Arterial Pressure were statistically significantly lower in group A compared to group B at all time intervals (P=0.001). Surgical field quality was found better in group A. Emergence time, postoperative sedation score and time to first analgesic request were significantly more in group B.Conclusion: Esmolol provides comparatively better surgical field and better hemodynamic stability over magnesium sulfate without any significant side effect. Magnesium sulfate provides additional benefit of postoperative analgesia and sedation