International Journal of Health and Clinical Research
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Effects of Chronic Otitis Media on Contralateral Ear
Full text linkChronic otitis media (COM) is rarely an isolated entity, because the responsible factors for its development in one ear were in a similar way willimpact the contralateral ears, since both ears had a common “nasopharyngeal” drainage. Methods: The following study is a cross sectional studycarried out on 200 patients having COM (mucosal and squamosal type) presenting in the OPD in the department of ENT at Dr Susheela TiwariGovernment Hospital, Haldwani between January 2019 and September 2020. Result: Otoendoscopy, pure tone audiometry and X ray mastoid findings were noticed in both the ears in patients of COM (mucosal/ squamosal). Otoscopically the most common finding in contralateral ear in mucosal type of disease was tympanosclerosis (42.53%) and in squamosal type of disease it was pars tensa retraction (34.62%). Pure tone audiometry shows more severe hearing loss in the contralateral ear of squamosal COM than mucosal COM. Radiologically pneumatization was noticed in the contralateral ear in the mucosal and squamosal COM. Tympanometry was also performed in the patients with COM. Conclusion: Chronic Otitis media is a disease with a very varied clinical presentation and disease in one ear has been sometimes found to be associated with subtle to gross changes without any symptoms observed in the contralateral ear. These changes can eventually result in the beginning of a gradual and chronic inflammatory process in the contralateral ear. Clinical assessment of the contralateral ear is equally important as of the diseased ear
The Use of Mini Mental Status Examination For The Diagnosis of HIV Associated Neurocognitive Disorder with Special Reference To The Duration of HIV Infection And Antiretroviral Therapy
Full text linkBackground: Mini Mental Status Examination can be used as a tool to detect cognitive, motor and behavioural changes seen in HIV associated neurocognitive disorders with special reference to the duration of symptoms and duration of antiretroviral therapy.Aims and objectives: To describe the prevalence of HIV associated neurocognitive impairment by using Mini Mental Score. To correlate the prevalence of HIV associated neurocognitive impairment with the duration of HIV. To assess the effect of antiretroviral drug therapy on neurocognitive decline seen in HIV patients. Material and methods: 100 HIV positive patients visiting the ART outpatient department were included, Mini Mental Status Examination was conducted, the scores were correlated with the duration of symptoms and the duration of antiretroviral therapy.Results and Conclusion: In our study, out of 100 patients, 77.2% of study participants did not have any cognitive impairment (MMSE Score ≥24) while 22.8% of participants had mild cognitive impairment (MMSE Score 18-23). A significant decline in the mini mental status examination score was found as the duration of symptoms. It also declined with the duration of antiretroviral therapy but this could be a confounding factor. A decline in the MMSE scores was also observed with a lag in starting antiretroviral therapy, from the onset of symptoms
Comparative Study on Laparoscopic vs Open Appendicectomy in the Treatment of Perforated Appendicitis
Full text linkBackground: Acute appendicitis is one of the most common causes of surgical emergency and perforated appendicitis is associated with higher morbidity and longer hospital stays. In recent times considering the overall benefits of laparoscopic surgeries, it has been widely preferred in the treatment of complicated appendicitis.Aim: To compare the outcome of laparoscopic appendicectomy (LA) vs open appendicectomy (OA) in the treatment of perforated appendicitis.Materials and Methods: 62 patients presenting with perforated appendicitis and undergoing surgical intervention in the Department of General Surgery, Kozhikode. Patients were monitored immediate postoperative period for 4 weeks for the development of complications.Results: Out of 31 patients who underwent laparoscopic none of the patients developed wound infection with a mean duration of hospital stay of 3.5 days. In open appendicectomy 7 patients developed wound infection with a mean duration of hospital stay of 5.3 days.Conclusion: Laparoscopic procedure for perforated appendicitis is a safe and feasible procedure which can be performed with a low incidence of infectious complications, possibly offering patients faster recovery and better cosmetic benefits than the open procedure. It has a clinically significant advantage. The patient’s factor and the experience of the surgeon both are deciding factors in the decision-making for the treatment approach
Evaluation of mammogram findings of breast lesions with trucut biopsy
Full text linkIntroduction: Breast cancer is the most common malignancy in women and second leading cause of cancer death among women aged 20 to 59 years. Radiological assessment of the breast lesion by diagnostic mammography remains one of the key investigation in the so called triple assessment of breast lesions. Classification of the mammogram findings as BI-RADS score also helps in the study of the lesions by categorising it into benign, suspicious of and suggestive of malignancy[1]. Comparing its results with the gold standard histopathological (TRUCUT) findings confirms the diagnosis and helps to assess the reliability of mammogram in diagnosing the pathology. Materials and methods: A cross sectional study was conducted among 66 patients who has clinically suspicious malignant breast lesions, attending the General surgery OPD, Casualty, wards of Calicut medical college during the study period. Statistical analysis of the data performed, results of mammogram and trucut biopsy results are compared and analysed. Results: On comparing the mammographic findings to that of the Trucut results 96.96% turned out to be true positive and the rest 3.03% as false positive. Out of the false positive results all were in the category BI-RADS 4a, low suspicion of malignancy (2-9%). In the present study, because the inclusion criteria is “the lesion which are suspicious of malignancy” hence the study population includes only those with results of BIRADS IV - V but not the other categories. Conclusion: Since Mammogram helps in easily identifying the breast lesions, even the impalpable ones, also assess the multicentricity and helps in characterisation of breast lumps, results being reproducible and less subjective and non invasive, it can be considered a primary diagnostic tool in the evaluation of breast lesions and a reliable and useful tool in differentiation of malignant and benign breast masses
Thyroid Dysfunction in Cirrhosis of Liver and Its Correlation with Severity of Liver Cirrhosis
Full text linkBackground: The liver plays an important role in thyroid hormone metabolism and action. Liver cirrhosis leads to impairment of liver functions, including thyroid hormone metabolism. Aims and Objectives: To study thyroid dysfunction in patients with liver cirrhosis and its correlation with the severity of liver disease. Materials and Methods: Ninety-six in-hospital patients with liver cirrhosis were studied. Detailed history and physical examination were done as per a pre-fixed proforma. Relevant hematological, biochemical, and radiological investigations were done to assess thyroid function and liver cirrhosis. The severity of liver cirrhosis was judged by the Child Pugh score. Results: The prevalence of hypothyroidism in chronic liver disease was found to be 33.3% (32/96), with 27.1% (26/96) of patients having subclinical hypothyroidism, 3.1% (3/96) for primary hypothyroidism and sick euthyroid each. Most of the participants were in the age group of 41-59 years. Out of them, 78.1% were males, while 21.9% were females. There was a significant correlation between hypothyroidism and the severity of liver disease (p-value 0.001). Sixteen cases of subclinical hypothyroidism belonged to Child Pugh C, while ten belonged to B. No thyroid abnormality was seen in Child Pugh A category. Also, levels of serum albumin and T3 were also showing a statistically negative correlation with the severity of liver disease with p-values of 0.005 and <0.001, respectively. Conclusion: The prevalence of hypothyroidism in liver cirrhosis was found to be 33.3% with subclinical hypothyroidism being the most common. There was a significant association of hypothyroidism, low serum albumin, and low T3 levels with the severity of liver disease. Therefore, all patients with liver cirrhosis should be evaluated for thyroid function test to prevent the development of overt hypothyroidism and also to use thyroid function tests as a marker of liver disease severity
To Study the Importance of Electrocardiographic and Echocardiographic Findings in Patient of Chronic Kidney Disease with Special Reference to Lipid Profile
Full text linkIntroduction: Dyslipidemia is one of the most common complications of chronic renal failure (CRF) reflected even in the early stages of CRF and usually parallels the deterioration in renal function. As a consequence, dyslipidemia as a risk factor in CKD progression should be explored and documented more. dyslipidemia in CKD patients may actively participate in the progression of cardiovascular disease (CVD) and in the deterioration of kidney function. In the general population, dyslipidemia is a known risk factor for CVD but the relationship of dyslipidemia as a risk factor in CKD progression should be explored and documented more. One of the most important pathophysiological mechanisms for CVD in patients with CKD is the widespread and possibly accelerated formation of atherosclerotic plaques due to hyperlipidemia, uremic toxins, inflammation, oxidative stress, and endothelial dysfunction. Recent studies showed that the level of oxidized low-density lipoprotein (LDL) cholesterol increases and high density lipoprotein (HDL) cholesterol dysfunction occurs as kidney function declines and inflammation becomes more pronounced. Aim & Objective: To study the pattern of involvement of cardiovascular system in CKD patients. Correlation of ECG and ECHO findings in hemodialysis and nonhemodialysis patients. To compare the lipid profile in chronic kidney disease patients with and without hemodialysis. Methodology: A detailed clinical history and physical examination will be done and findings will be recorded. All the patients in the study will be subjected to biochemical tests like, CBC, renal function tests, and ultrasonographic examination of abdomen to confirm the presence of end stage renal disease and to assess echocardiographic findings of heart. Patients attending the I.P.D. of General Medicine Subjects meeting the inclusion criteria shall be selected. Haemodialysis Patients Nonhaemodialysis Patients ECG, Lipid profile. Results: Among CKD patients with hemodialysis, most common ECG abnormality was LVH (n=38), followed by ST changes (n=26), 18 patients had QTc prolongation and P-mitrale or p- pulmonale and 8 patients had tall T wave. Out of 46 hypertension patients of CKD patients without hemodialysis, 24 had LVH in ECG while out of 71 hypertension patients of CKD patients with hemodialysis, 28 patients had LVH in ECG. This correlation between hypertension and LVH in CKD patients with and without hemodialysis came out to be statistically insignificant with chi square value 0.058 (with yates correction) and p value 0.81. Conclusion: CKD patients should undergo baseline and regular electrocardiography to screen for cardiovascular diseased as the earliest so that early intervention can be done. Echocardiography is better the electrocardiography in detecting LVH because LVH was detected in 46.3% CKD patients via echo while LVH was detected in 41.2% CKD patients via ECG. ECG showcases the heart's electrical system, whereas ECHO showcases the heart's mechanical system for further investigation and planning of the respective patient's treatment
A Study on Non-Endoscopic Predictors of Esophageal Varices in Patients With Chronic Liver Disease - A Prospective Study
Full text linkBackground: Esophageal varices are a serious consequence of portal hypertension in patients with liver diseases. Non-invasive markers of esophageal varices helps to reduce unnecessary endoscopies in patients with cirrhosis. Aims and Objectives: To evaluate various clinical, biochemical and ultrasonographic parameters in predicting the presence of large esophageal varices. Materials and Methods: Ninety-four in-hospital patients with chronic liver disease were studied. Detailed history and physical examination was done as per pre-fixed performa. Relavant haematological, biochemical and radiological investigations were done to confirm chronic liver disease and to record spleen diameter, portal vein diameter and ascites. Screening for esophageal varices was done by upper GI endoscopy. The severity of liver cirrhosis was judged by the Child Pugh score. Results: The prevalence of large esophageal varices was found to be 45(47.9%). 69 (73.4%) of the participants were male and 25(26.6%) were female with mean age 45 years. Alcohol was the most common etiology found. Ascites, hepatic encephalopathy, Child-Turcotte-Pugh score, low platelet count, serum bilirubin, PT/INR, spleen diameter and portal vein size were found statistically significant (p value<0.001) in univariate analysis in predicting the presence of large esophageal varices. However on multivariate analysis, low platelet count, splenomegaly and portal vein diameter found to have independent predictive value (p value<0.001). Conclusion: Low platelet count, splenomegaly and increased portal vein diameter were found to be the independent predictors of large esophageal varices in chronic liver disease patients. Hence using these noninvasive predictors for the detection of esophageal varices seems to be more cost effective than the “scope all strategy”. This may help reduce the cost and discomfort for patients and the burden on endoscopy units
Prevalence of sensorineural hearing loss among the patients with Diabetes Mellitus
Full text linkHearing loss is a very common problem worldwide affecting all age groups & leading to marked disability and handicap. Among the causes such as multiple sclerosis, syphilis and autoimmune disorders, Diabetes is the most common of all. Thus, the present study was conducted to evaluate the relation and degree of sensorineural hearing loss with Diabetes Mellitus along with its severity. For the study, a total of 300 patients were enrolled with complaints of hearing loss and or tinnitus. A complete ENT evaluation was done on the patients. Mean age of the patients was 49.54 ±8.9. About 80.7% patients complained of hearing loss while tinnitus was present in 58.3% of diabetes patients. The association between age and hearing loss was statistically significant with older patients (p<0.001) as compared to younger ones. Association between type of diabetes and sensorineural hearing loss was also statistically significant. The diabetic subjects had higher hearing threshold with bilateral mild to moderate degree sensorineural hearing loss. Age of diabetic patient and duration of diabetes, type of diabetes and levels of HBA1c had significant correlation with hearing loss
A Cross Sectional Study of Feto-Maternal Outcome for Second Stage Cesarean Delivery
Full text linkBackground: Caesarean delivery at full dilation of cervix is associated with increased technical difficulty and feto-maternalcomplications.Objectives: To know the short term maternal and foetal outcome in second stage caesarean deliveries. Material & Methods: Thisis a descriptive, prospective cross-sectional study done at Vani Vilas hospital attached to Bangalore medical college and research institute fromJan 2022 to Dec 2022. Intra operative and immediate post operative complications were collected from case record, mother and new-born were followed during hospital stay till discharge. Data entered in MS excel sheet and analysed using SPSS version 20.0. Descriptive statistics of the explanatory and outcome variables were calculated by mean, standard deviation for quantitative variables, frequency and proportions for qualitative variables. Results: Sample size was 98 women in one year. Mean Age of the sample population is 25.71±3.26 years, 67.3% are primi gravid women. Common methods of extraction included Vertex and Patwardhan method. Extension of hysterotomy incision seen in 20.4%. PPH seen in 16% of women. About 16% of new-borns required NICU admission. One still birth and two neonatal deaths were noted. Conclusions: Second stage caesarean delivery carries increased morbidity both to mother and child. Skill and expertise are required to reduce the complications during second stage caesarean sections
Liver Function Tests (LFT) in pregnant women at a tertiary care center in Ratnagiri district of Maharashtra, India
Full text linkIntroduction: Abnormal liver tests occur in 3–5% of pregnancies and show many different causes. Although alterations of liver enzymes could be a physiological phenomenon, it may also reflect potential severe liver injury, necessitating further assessment and accurate management. The present cross-sectional study was undertaken to study liver function test profile in pregnant women. Methodology: All the pregnant patients referred to Pathology section were studied prospectively from January 2018 to April 2019 involving 90 cases. Blood sample was studied for Total protein, Albumin, Globulin, Bilirubin, SGOT, SGPT, Alkaline phosphatase. All the findings filled in MS-Excel sheet and was analysed manually. Results: The mean age was found to be 26.61 (±5.42) yrs. Mean total protein level was 11.66 (±53.55) Gm/dl. Mean Albumin was 3.01 (±0.71) Gm/dl. Total patients showed hypalbuminaemia majority of patients in the age group of 24 – 29 yrs [31 (34.4%) cases] and in third Trimester [35 (38.8%) cases]. Mean total Bilirubin is 1.66 (±3.56) Mg/dl, Mean Direct Bilirubin is 0.98 (±2.42) Mg/dl and Mean Indirect Bilirubin is 0.74(±1.40) Mg/dl. Total 57 (63.3%) patient showed increased SGOT, majority of patient in the age group of 24 to 29 yrs [24 (26.6%) cases]. Total 36 (40%) patient showed increased SGPT, majority of patient in the age group of 18 to 23 yrs [11 (12.2%) cases]. Total 62 (68.8%) patient showed increased Alkaline Phosphatase, majority of patient in the age group of 24 to 29 yrs [28 (31.1%) cases]. Conclusion: Liver disease in pregnancy is a complex issue that deserves a multidisciplinary approach