International Journal of Health and Clinical Research
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A Study of Thyroid Profile and Vitamin D Levels in Type 2 Diabetes Mellitus Patients
Get PDFIntroduction: Non-communicable disease continues to be an imperative public health problem in India, leading to substantial increase in mortality and morbidity. Among these, Type-2 diabetes mellitus (T2DM) and hypertension are increasing at an alarming rate. T2DM increases the risk of thyroid dysfunction in the long-term.T2DM and hypothyroidism is the primary reasons for mortality and morbidity in most high income and developing countries. Materials and Methods: A cross-sectional single centre study was conducted among 100 patients with T2DM attending a tertiary care centre between January 2019 to June 2019. Eligible patients were 20 years or older. Exclusion criteria were known hepatic or renal disease, metabolic bone disease, malabsorption, hypercortisolism, pregnancy and medications influencing bone metabolism. The serum concentration of 25-OHD was measured by competitive protein binding assay using kits (Immunodiagnostic, Bensheim, Germany). Vitamin D Deficiency (VDD) was defined as serum 25-OHD concentration <50 nmol/L.Glycosylated hemoglobin (HbA1c) was measured by the high performance liquid chromatography method (Bio-Rad Laboratories, Waters, MA, USA). TSH levels between 0.22-4.2 mIU/L were regarded normal. Participants were divided to three subgroups according to their TSH level (below <0.22 mIU/L, 0.22-4.2 mIU/L and >4.2 mIU/L). Study was approved by the Institutional Ethical Review Board. Data are presented as means±standard deviation (SD) and numbers. Results: A total of 100 participants were included in this study. Average age of the study population was 50.1±17.3 years and females predominated males. Vitamin D Deficiency was found in 49% of the participants. In 5% of the cases, TSH was lower than 0.22 mIU/L and in 75%, TSH was within normal reference range. Abnormally high levels of TSH (>4.2 mIU/L) were reported in 20% of participants. Conclusion: The present study shows high prevalence of Vitamin D Deficiency levels among diabetic patients and there was a positive association between the VDD and TSH level among T2DM patients
Role of Mid Arm Muscular Area (MAMA) in identification of Severe Acute Malnutrition
Get PDFBackground: Mid arm muscular area (MAMA) and triceps skin fold thickness (TSFT) were introduced for the body composition and nutritionalstatus assessment. Currently these parameters in the identification of Severe Acute Malnutrition (SAM) are unutilized. This study compared agespecific upper arm composition and nutritional status among children with normal nutrition and Severe Acute Malnutrition (SAM). Method: Thiscase control study was conducted in Special Malnutrition Treatment Unit (S.M.T.U.) and children medical wards of a medical college hospital inMadhya Pradesh. In the age group of 6-to-59 month, 100 children with SAM and 100 normal nutritional status children as control were taken.Mid upper arm circumference (MUAC) was measured by nonflexible colour coded tape and TSFT by Harpenden skin fold calliper to calculateMAMA by formula, MAMA = (MuAC – ×TSFT)2/4. Result: Mean MAMA, mean MUAC and mean TSFT are more among controls ascompared to case (p<0.001). In normal nutritional status children MUAC, MAMA and TSFT increases as the age advances, unlike in SAMchildren where MUAC, TSFT and MAMA were almost stationary. MAMA and MUAC are significantly correlated (p<0.001). TSFT wassignificantly correlated with MAMA and MUAC. Each unit change in TSFT i.e., with 1 cm increase in TSFT, severity of malnutrition (z scoredecreased by 10.3) decreased significantly [ z score = 7.47 – 10.31 (TSFT)]. Similarly, with each cm2 increase in MAMA, the severity ofmalnutrition decreased i.e., z score decreased by 0.52 which was statistically significant [ z score = 8.81 – 0.52 (MAMA)]Conclusion: Theupper-arm composition can be a useful measure for the nutritional status assessment in SAM children. The MAMA is a valuable parameter thatcan be used to measure specifically the muscle-mass. The use of MAMA can improve the accuracy of assessment in oedematous SAM and henceseems to be a more appropriate tool in a health care settin
A study of the efficacy of medical management of AUB in Perimenopausal women
Get PDFBackground: Abnormal Uterine Bleeding (AUB) is caused by either Organic lesions such as genital tract infections, tumors, adenomyosis, pregnancy and its complications, systemic disorders or Dysfunctional Uterine Bleeding (DUB). In women ≥ 40 years, and certainly in menopausal patients, it mandates evaluation to confirm benign nature of the problem, by ruling out endometrial carcinoma, so that medical treatment or conservative surgery can be offered and unnecessary radical surgery can be avoided. Aim: Categorizing of Perimenopausal women with AUB for further management according to histo-pathological report and to study the efficacy of medical management. Material and Methods: A total of 60 patients were selected who presented with symptoms of abnormal uterine bleeding at perimenopausal age group (40-54 years). Histopathological results were evaluated after obtaining endometrial tissue and patients are treated accordingly. Treatment response was assessed and tabulated. Statistical Analysis has done by danielsoper.com using chi-square test. Results: Abnormal uterine bleeding was mostly seen in multiparous women with parity >2 about 63.3%. Among menstural irregularities, 45% of cases presented with menorrhagia. Most of the patients were diagnosed as Anovulatory DUB about 60%. Out of 11 hyperplasia patients, 2 (18.1%) patients diagnosed as complex hyperplasia without atypia. No progression of AUB has seen after MPA treatment among all patients with endometrial hyperplasia. Conclusion: Cyclical oral progestogens are effective in regulating and reducing irregular bleeding due to Oligo/Anovulation. Majority of the cases of endometrial hyperplasia without atypia can be successfully treated with progestogen therapy
A Questionnaire Study to Assess the Patient’s satisfaction Level After Caesarean Section
Get PDFAim: To assess the level of satisfaction with caesarean delivery and to see the relation between different parameters and satisfaction. Materials &Method: This was a cross sectional study. A total of 423 post-caesarean women were included in the study. The structured questionnaires were usedfor the collection of data from the patients and the data were processed and analyzed with the help of software SPSS. Results: During the studyperiod, among the 465 caesarean delivery 423 were enrolled for the study. The mean age of the patients was 23.99±5.29 years and mean paritywas 1.22±1.27. Initial negative reaction to the decision of caesaren section was expressed by 71.9% of the patients, 18.4% remained indifferentand 9.7% showed positive reaction. The major reasons of initial negative reaction were fear of death and dislike of caesarean section. Thesatisfaction following caesarean delivery was significantly associated with age, educational status and initial positive and negative reaction to thedecision of caesarean section. Three hundred and fifty five (83.9%) women expressed their overall satisfaction following caesarean section.Conclusion: Most patients expressed their overall satisfaction to caesarean delivery
Study of demographic factors and effect of high protein diet on Severity of patients with Covid-19 at a tertiary healthcare center in Northern Maharashtra: An analytical study
Get PDFBackground: In general eating habits and lifestyle modification always seen to threaten our health. Maintaining a correct nutrition status is crucial, especially in a period when the immune system might need to fight back. Covid-19 pandemic is a global health emergency, and therefore it’s prevention and treatment is an important priority of world health. The dietary patterns of people play an important role in health aspects of people. The present study was conducted to assess the effect of high protein diet, age and its co-relation with severity of COVID-19 disease. Material & Methods: The present study was a cross-sectional study. Data was collected from people in rural areas of Dhule district. Outcome measures were symptoms, RTPCR result, HRCT score, hospital stay, diet during and after infection, intake of protein powder and multivitamins, that was evaluated with a questionnaire. Results: Study included 42 patients. All patients had history of Covid-19 infection or were suspected cases. The vegetarian diet was compared with severity of Covid-19 (p=0.0023) thus there is an association between vegetarian diet and more severity of disease. There is significant association between age of the participants and breathlessness (P=0.042). There was significant association between consuming protein powder and multivitamins with lesser duration of post Covid-19 weakness (p=0.002) and (p= 0.036). Conclusion: The study tells that severity of Covid-19 is higher in people of advanced age, poor consumption of protein in diet, reduced intake of multivitamins during and after the infection. Those who have taken high protein diet have less severity of Covid-19 infection and it helped in early recovery
Early enteral nutrition versus parenteral nutrition after resection of esophageal cancer
Get PDFBackground: Esophagectomy for esophageal cancer is one of the most invasive procedures among gastrointestinal surgeries, and patients undergoing esophagectomy are unable to gain nutrition by mouth within the first few days after surgery. The present study compared early enteral nutrition versus parenteral nutrition after resection of esophageal cancer. Materials & Methods: 52 cases of esophageal cancer of both genders were divided into EEN group and PNgroup. Each group Comprised of 26 each. Factors such as site of lesion, pathologic stage, time to first fecal passage, post-operative albumin infusion, differences of serum albumin value, hospital stay, systematic inflammatory response syndrome (SIRS) duration and mortality was recorded. Results: Group I comprised of 18 males and 8 females and group II 14 males and 12 females. Site of lesions was upper thoracic in 12and 11, middle thoracic in 9 and 10 and lower thoracic in 5 and 5 in group I and group II respectively. Pathologic stage was 0 seen in 1 and 2, I in 4 and 6, II in 12 and 10, III in 6 and 6 and IV in 3 and 2 in group I and group II respectively. Preoperative adjuvant therapy was neoadjuvant in 15 and 16 and chemoradiotherapy in 11 and 10 in group I and group II respectively. The mean preoperative serum albumin (g/L) was 33.5 and 34.2, first fecal passage (day) was 2.7 and 3.8, hospital stay (day) was 16.2 and 18.7, albumin infusion (g) was 30.5 and 40.3, SIRS duration (day) was 3.4 and 4.7 and in-hospital mortality was seen in 1 and 2 in group I and group II respectively. The difference was significant (P< 0.05). Conclusion: Early EN is safe, economic, and superior for promoting early recovery of intestinal movement
To determine difference between pain score in total knee replacement in patient with intra operative periarticular steroid infiltration vs without periarticular steroid infiltration in 1st month of post surgery period
Get PDFBackground: Total knee arthroplasty (TKA) has been much improved recently and it is regarded as one of the most common and successful surgical procedure that provides pain relief and improves function in patients with severe knee arthritis.The aim of the present study is to determine difference between pain score in total knee replacement in patient with intra operative periarticular steroid infiltration vs without periarticular steroid infiltration in 1st month of post-surgery period. Methods: There are 200 patients scheduled in the present study conducted from March 2019 to December 2020. Eligible patients included patients were between the ages of 50 and 70 years. Out of 500 patients, 200 patients were recruited, and one knee was randomly assigned to the intra operative periarticular steroid infiltration orwithout periarticular steroid infiltration. Result: For patients in the group receiving steroid injection, significantly lower pain scores from the second postoperative day were noted. The pain level was significantly lower in steroid-treated knees compared to non-steroid treated knees on the night of the operation (VAS, 1.2 vs. 2.3; p=0.021). Interestingly, rebound pain was observed in both groups 1 day after the surgery (VAS, 3.2 vs. 3.8; p=0.248). Conclusion: The present study has demonstrated the efficacy and safety of periarticular infiltration of corticosteroid, bupivacaine and epinephrine following TKA. Patients who received the steroid cocktail have reported better visual analogue pain scores and required less parenteral morphine postoperatively
Pattern of Breast Fibroadenoma in females and its Clinical Approach: An Observational Study
Get PDFIntroduction: Comprehensive studies describing the histologic features of fibroadenomas are not available in literature. If hyperplasia behaves in a similar way as in the otherwise normal breast, it may contribute to the higher risk of subsequent invasive breast carcinoma. Hence the aim of this study was to make a thorough inventory of the histologic features of the epithelium and stroma within breast fibroadenomas in a large group of cases. Materials & Methods: The present study was a comparative prospective study done from April 2021 to October 2021 in the department of general surgery at American International Institute of Medical Sciences, Kothibagh, Udaipur. A total of hundered patients suspected of benign breast diseases were included in the study. After initial evaluation of the patient in the OPD of medical hospital, by senior residents of general surgery, patients with features suggestive of Benign Breast Diseases were subjected to a detailed history and clinical examination. Results: The youngest patients were of age 16 years diagnosed with fibroadenoma and the oldest patient was of age 40 years. The mean age of th patients with fibroadenoma was found to be 24 years. Majority of the lumps 76.19% had a size of 2 to 5 cms. The largest lump in the fibroadenoma group was seen in a 16 years old girl with 8x5 cms. Selected cases of fibroadenoma of 2-3 cms in size were reassured and asked for regular follow-up. Discussion & Conclusion: It has been known for many years that some benign breast lesions are more highly associated with breast cancer than others. In this study the types of benign breast lesions were recorded and the study has shown that benign breast lesions are common in our environment and the age incidence of benign breast lesions peaks in 2nd and third decade and with few exceptions our data was comparable to other studies on breast lesions
Comparison study of Routine Coagulation Tests and Thromboelastography for Detection of Hypocoagulable State in Patients Undergoing Cardiac Surgery on Cardiopulmonary Bypass
Get PDFBackground & Aims: Excessive bleeding occurs after cardiac surgeries on cardiopulmonary bypass (CPB) due to various nonsurgical causes. Finding these causes, and correction using appropriate blood product therapy, conventionally routine coagulation tests (RCT) were used, but recently point of care test Thromboelastography being used. We want to compare different RCT with TEG and their value with postoperative blood loss for correlation. Methods: This prospective study was done on patients undergoing cardiac surgery on CPB to correlate between different RCT (PT/INR, aPTT, Fibrinogen level, platelet and Hct) and thromboelstography parameters before heparinization and after reversal with protamine and their correlation with chest-tube output at 24 hours after surgery. Result: We found most RCT parameters changed significantly after cardiopulmonary bypass, but only prebypass platelet count and postbypass PT and fibrinogen level were significantly correlated with the postop blood loss at 24hr. In TEG parameters only MA was changed significantly after bypass but alpha angle and k-time after bypass was significantly correlated with postop blood loss. Routine lab-based coagulation tests and TEG parameters correlation was found in both prebypass and postbypass samples except in few pair. Conclusion: In our study different RCT and TEG parameters correlate and PT and fibrinogen level derangement after bypass and their corresponding part in TEG, k-time and alpha angle correlate significantly with amount of blood loss, so TEG can be used to guide blood component therapy postoperatively in ICU rather than providing empirically due to non-availability of routine coagulation test due to long turnaround time
A comparative randomized study of USG guided transversus abdominis plane block versus caudal block for post operative analgesia in paediatric unilateral open inguinal hernia repair
Get PDFBackground: Inguinal hernia surgery is associated with moderate to severe post-operative pain especially in paediatric age groups as pain threshold is lesser in children so in this study our aim was to compare usg guided transversus abdominis plane block and caudal block for post-operative analgesia for unilateral inguinal hernia repair surgeries. Materials and Methods: 60 pediatric patients of American society of anaesthesiologist (ASA) I /II aged 1-8 years of either gender, scheduled for elective open unilateral inguinal hernia repair under general anesthesia were divided into two groups. Patients of group 1 were given caudal block group using 0.25% bupivacaine 1ml/kg and group 2 were given ultrasound guided TAP block using 0.25% bupivacaine 0.5ml/kg. The postop analgesic efficacy, hemodynamic stability, degree of motor weakness and Adverse effects if any was noted. Results: There was no significant difference in median CHEOPS score until 6 hours in postoperative period. No Significant difference was observed in hemodynamic parameters in intraoperative and postoperative period. All patients in both the groups were comfortable with a CHEOPS score between 5-6 in the post-operative period with no opiate requirements. No significant haemodynamics changes and adverse effects were observed. Conclusion: We found that children in both the study groups i.e caudal block and USG guided TAP block were having stable intraoperative and post-operative hemodynamic conditions. Post-operative analgesia measured using CHEOPS score was maintained between 5-6 and patients in both groups were comfortable throughout the study period. There was no need of any rescue analgesia during post-operative period for the study period of 6 hours