International Journal of Medical Research & Review (IJMRR)
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Role of Physiotherapy in Hospitalised Patients of COVID-19 disease
Get PDFIntroduction: Respiratory physiotherapy is one of the therapeutic methods in various respiratory viral infections. Breathing exercises with other interventions, could enhance the total lung capacity and symptom alleviation in patients with virus-related acute respiratory distress syndrome (ARDS).
Aim: To study the clinical evaluation of the role of physiotherapy in hospitalised patients of covid-19 diseases.
Method: This was an Observational (prospective, cross-sectional) study. 187 patients were recruited and diagnosed as COVID-19 as per RTPCR at NSCB Medical College, Jabalpur (MP). Patients were randomised into the physiotherapy group and controlled group. Patients in the physiotherapy group were undergone positional changes, prone ventilation, Breathing exercise, Resistive training, Passive joint motion, Muscle stretching, Bedside standing training, endurance exercise by a specialized physiotherapist. Mean cough severity index, MMRC grade, respiration rate and peripheral blood saturation were recorded before and after intervention and compared with the controlled group.
Result: There was significant improvement found in MMRC grade and respiration rate after physical therapy in the physiotherapy group (p-value < 0.05). Exertional dyspnoea and cough severity index significant deceased in physiotherapy group. The positive change was found in peripheral blood saturation. There was decreased in hospitalization stay in the physiotherapy group as compared to the controlled group.
Conclusion: Our study revealed the positive effect of physiotherapy on covid-19 disease in terms of symptoms and hospitalization duration among the physiotherapy group. Physiotherapy exerts a beneficial role in the management of the covid-19 disease
Autologous Whole Blood Injection For COVID-19 Can Reduce Cytokine Storm and Severity of Illness
Get PDFAutologous whole blood injection is used for various indications. It has an immunomodulatory action on the immune system. A randomized controlled two-arm study was conducted to determine IL-6 levels, CT changes and mortality among adult COVID-19 patients. The trial included 30 patients divided into two groups. The interventional group received 2 doses of 2.5 ml of autologous whole blood injection spaced 2 days apart. There was a statistically significant reduction in IL-6 levels on day 6 in the group receiving treatment. CT score improved in patients who received treatment. No cases of mortality were reported in the treatment group. Autologous whole blood injection can be used as a simple, low-cost adjuvant in the treatment of adult COVID-19 patients, regardless of disease severity
Aberrant promoter hypermethylation of RAR-β in endometrial carcinoma- an Indian study.
Get PDFEndometrial cancer is the seventh most common cancer in women worldwide with and age standardized rate of 8.4 per 100,000 women. Epigenetic alterations such as promoter hypermethylation of TSGs are known to be early events in carcinogenesis. The aim of the present study, we assessed the aberrant promoter hypermethylation pattern of RAR-β in 78 endometrial cancer samples.
Methods: DNA was isolated from endometrial carcinoma samples and normal tissues and aberrant promoter hypermethylation was assessed using nested and methylation specific PCR. Chi square test was used for statistical analysis and a p-value<0.05 was considered to be statistically significant.
Results: 40 of the 78 (51.28%) endometrial carcinoma sample showed aberrant hypermethylation of RAR-β gene. Methylation status in each histological subtype, grade and stage of the disease was also assessed.
Conclusion: Aberrant hypermethylation is an important early epigenetic alteration that occurs during tumorigenesis. The Data shown here reports that promoter hypermethylation of RAR-β occurs in endometrial carcinoma and therefore could be used as a potential marker for early diagnosis and prognosis of the disease
Factors associated with poor outcome in tuberculous meningitis; study from a tertiary care referral Centre from South India
Get PDFIntroduction: Tuberculosis (TB) remains a worldwide burden with a large majority of new active cases occurring in underdeveloped and developing countries. This study is an attempt to look into various aspects of the disease that can be associated with the outcome, to promote a timely referral to an appropriate centre. Purpose: To identify various clinical, lab, CSF and radiological variables associated with poor outcome of TBM at the time of discharge.
Material & Methods: Demographic data, duration of symptoms before diagnosis, clinical presentation, staging of the disease at the time of admission of all the TBM patients who presented to our centre between December, 2015 and May 2018 were noted. Results of biochemical investigations and brain and spine imaging were retrieved. Outcome at the time of discharge as measured by MRC and mRS grades was correlated to clinical profile, lab, CSF and radiological findings.
Results: A total of 100 patients were included. 15 patients died. Subjects with MRC and mRS grades of 2 or more at admission constituted 65% and 93% respectively. At discharge, MRC and mRS grades of 2 or more were found in 29.63% and 39% respectively. Multivariable analysis showed a significant positive association of MRC stage at discharge with MRC stage (p = 0.001) and mRS score (p = 0.001) at admission and Vellore hydrocephalus grade (p < 0.001) when hydrocephalus first identified. Similarly, mRS score at discharge had an independent positive association with the MRC stage (p < 0.001) and the mRS score (p=0.002) at admission.
Conclusion: Stage of the disease (MRC) and functional status of the patient (mRS) at admission are the two most important independent factors determining the outcome of TBM patients at the time of discharge
The Potential of Prenatal Diagnosis in the Early Detection of Congenital Malformations
Get PDFWe present a unique association of fetal malformations very early diagnosed by ultrasound examination, at 14 weeks of gestation. A 28-year-old pregnant female, was addressed in a private medical center from Bucharest, Romania, for a routine ultrasound screening. A detailed ultrasound evaluation of the fetus showed numerous and significant cephalic and heart malformations. The ultrasound examination of the fetal head suggest the diagnosis of fetal lobar hydrocephalus, and the ultrasound examination of the fetal heart suggest the transposition of the great vessels. The parents were informed about the severity of the fetal malformations and decided to terminate the pregnancy due to medical reasons. Anatomopathological examination confirmed the prenatal diagnosis. First trimester ultrasonography was crucial in the early prenatal diagnosis and management of the malformed fetus with a unique association of fetal malformations
Study of ANC and immediate PNC mothers admitted with severe anemia in GMC Chandrapur
Get PDFMaternal mortality continues to be a major health problem in the developing world. About 20% of cases of maternal mortality are due to anemia (preventable cause).
Objectives:1. To define the geographical areas around Chandrapur from where the cases of anemia are referred. 2. To co-relate variables like maternal age, gestational age, parity and the time elapsed between last childbirth and current pregnancy.
Materials and Methods: Hb of ANC and immediate PNC patients referred with severe anemia was estimated with Sahli’s Haemoglobinometer.
Inclusion criteria:257 ANC and immediate postpartum patients admitted between July 2016 to September 2016 with severe anemia and transfused with blood.
Exclusion criteria: anemia due to acute blood loss.
Results:77.8%severe anemia cases were between 21 to 30 years.22% were from Chandrapur taluka.12.8%cases from Rajura and10.12% from Korpana taluka,68.26% cases had gestational age more than 28 weeks.59.92%cases were multipara. In 84.42% of cases last childbirth was less than 3 years.20%cases were of sickle cell anemia patients. There were no cases of abruption placentae, surgical wound infection and maternal mortality. No patient had postpartum haemorrhage as were managed with active management of the third stage of labour and prophylactic 3 tablets of misoprostol per rectum. There were 12 preterm deliveries with no intrauterine deaths.
Conclusion: Peripheral preventive services must be strengthened on a priority basis in Chandrapur, Ballarpur, Rajura and Korpana talukas which belong to south Chandrapur where the tribal area is predominant. Probable causes in these areas might be related to culture, ignorance, dietary habits and availability of medical staff which needs to be addressed. Effective counselling regarding early registration, restriction of parity, contraception for spacing births, diet and iron and folic acid supplementation is essential for preventing anemia
Dosimetric comparison of radiotherapy treatment plans done by IMRT and VMAT technique in head and neck cancer patients
Get PDFBackground: The increasing patient load in radiotherapy centres demands selection of the technique that provides plans with optimal dosimetry in terms of target volume coverage, organs at risk (OAR) sparing and a lesser treatment time. This study was designed to compare the two widely practised conformal techniques, IMRT and VMAT in head and neck cancer patients in terms of planning target volume (PTV) coverage, OAR sparing and treatment delivery parameters.
Materials and methods: For ten postoperative head and neck cancer patients who had been treated by IMRT technique virtual VMAT plans were generated for study purposes. The dose prescribed to PTV was 60 Gy in 30 fractions. The dose-volume parameters of PTV and OARs and the treatment delivery parameters were compared amongst both the techniques. Statistical significance was calculated using paired ‘t’ test.
Results: Both the plans were comparable in terms of dosimetry. The only significant difference being better conformity in the IMRT plans. The dose to OARs was also comparable in both the techniques except for a significant reduction in the point dose to brainstem with the IMRT technique. Given the treatment delivery parameters, there was a significant reduction in the treatment delivery time and monitor units with the VMAT technique compared to the IMRT technique.
Conclusion: VMAT technique gave comparable plans to that of the IMRT technique in terms of dosimetry but reduced the treatment time. It seems feasible in radiotherapy centres with increased patient load
Silent brain infarcts in chronic kidney disease patients with nonspecific neurological symptoms
Get PDFIntroduction: Silent brain infarcts (SBI) are parenchymal lesions of previous infarcts, classified as type III cerebrovascular disorder. A study was undertaken to find the relation between SBIs and nonspecific neurological complaints, an association of high sensitivity C-reactive protein (hsCRP) with silent brain infarcts.
Methodology: It was a cross-sectional study conducted in the department of Nephrology, GSL Medical College, from January to December 2020. Individuals aged > 18 years with nonspecific neurological complaints were included. MRI brain, hsCRP and electrocardiogram were also carried as per the standard protocol. Fischer exact test was used to find the statistical significance; P < 0.05 was considered statistically significant.
Results: A total of 51 members have included the male-female ratio was 1.04. SBI was presented in 27.4% (14). Age-wise, among the cortical SBI patients, maximum (75%) were in the> 61 years group. High density lipoprotein levels were > 40 mg/dL in 39.2%, normal triglycerides (TGL) were observed in 71% and raised hsCRP in 62.7% (32). Statistically, there was no significant difference in TGL levels. hsCRP levels were raised in 3 (75%) members with cortical SBI; statistically, there was no significant difference.
Conclusion: The traditional risk factors associated with stroke were present in the patients with SBI. hsCRP was raised in chronic kidney disease patients having NSCL and having SBI
A study on dietary recall among the maintenance haemodialysis patients in East Godavari district.
Get PDFIntroduction: Individuals with end-stage renal diseases are usually at an increased risk of nutritional disorders. Protein-energy malnutrition is observed in a significant number of maintenance haemodialysis (MHD) patients. Hence a study was conducted to find whether dietary intake meets recommended dietary allowance (RDA) among MHD individuals.
Materials and methods: This was cross-sectional research conducted in the department of Nephrology, GSL Medical College, for 18 months. Individuals are aged 18 years or more, metabolically stable and undergoing MHD were included. Software called Dietsoft was used to know the dietary calculations. Parameters including energy, carbohydrates, proteins, fats, vitamins, minerals and essential amino acids (EAA) were evaluated. Mann Whitney U test was used to find the significant difference, and P < 0.05 was considered statistically significant.
Results: Of the 31 patients, 18 were male, and 13 were female. The calorie intake was as recommended, but statistically, there was no significant difference. But the intake of the macronutrients and dietary fibre was higher than the recommended, which was statistically significant. In females, there was a considerable difference. The difference was statistically not significant in minerals intake.
Conclusion: There was considerable malnutrition among the patients undergoing MHD. Hence regular dietary assessment is required
Evaluation of spectrum of MRI findings in children with Hypoxic Ischemic Encephalopathy and its comparison with transcranial sonography
Get PDFBackground: Hypoxic ischemic encephalopathy is a serious concern among asphyxiated newborns due to the associated long term sequelae like cognitive impairment and cerebral palsy. Though the incidence of hypoxic injury remains higher in preterm babies due to incomplete brain maturation, it can occur in term babies as well despite institutional deliveries due to an array of unavoidable fetal, maternal and placental causes.
Aims: This study was conducted as an attempt to evaluate the risk factors, to study the correlation between the term of pregnancy with TCUS and MRI imaging findings in HIE and characterise patterns of CNS involvement.
Materials and methods: It was a cross-sectional study carried on 50 neonates with clinically diagnosed HIE presenting to the Department of Radiodiagnosis, Rajindra Hospital Patiala who were subjected to transcranial sonography and MRI.
Results and Conclusion: This study demonstrated term infants have significant involvement of basal ganglia thalamus type (central) pattern of involvement and preterm infants have periventricular leukomalacia type (white matter injury) of a pattern of involvement. The overall sensitivity and specificity of TCUS in detecting imaging findings in children with clinically diagnosed HIE compared to MRI was found to be 70.45% and 50% respectively, yielding the overall diagnostic accuracy of TCUS as 68% compared to MRI. TCUS can depict central and white matter abnormalities better than peripheral lesions. However MRI provides additional diagnostic information in many cases and can detect precisely the extent of brain injury