International Journal of Medical Research & Review (IJMRR)
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Pancreatic ketoacidosis-a rare case report
Get PDFEuglycemic Pancreatic Ketoacidosis is a syndrome of high anion gap acidosis in which the high anion gap is due to elevated serum ketone bodies comprising of acetone, aceto- acetate and beta hydroxyl-butyrate, due to increased peripheral adipose tissue breakdown by elevated serum lipase as a consequence of acute pancreatitis with normal blood glucose levels. There are multiple causes for ketonuria and/or ketonemia with or without acidosis like uncontrolled diabetes mellitus, usually of the insulin dependent type (diabetic ketoacidosis), lactic acidosis, prolonged starvation (starvation ketosis), ethanol ingestion (alcoholic ketoacidosis), sepsis, pregnancy and vomiting. Our patient was not a known diabetic and his blood glucose were always within normal limits, so this ketoacidosis cannot be attributed to Diabetes Mellitus. It cannot be attributed to starvation as our patient was not fasting when he got admitted and furthermore ketoacidosis is not a frequent manifestation of starvation adding to it that we transfused adequate amount of DNS and resumed oral intake during our observation period. It cannot be attributed to vomiting as our patient had only two episodes of vomiting. Our patient does not have any liver or kidney pathology and there is no history or evidence of alcohol intoxication. But, acute pancreatitis without diabetes-mellitus, causing ketoacidosis is a very rare presentation which is caused by high levels of pancreatic lipase in the circulation
Role of Computed Tomography (CT) in traumatic head injury evaluation – a cross-sectional study
Get PDFIntroduction: CT is the single primary modality in the evaluation of patients with acute head injuries. With these, a study was taken to find various clinico radiological patterns of head injuries and to correlate the CT features with clinical operative findings.
Materials and Methods: This was a cross-sectional study carried in patients of head injury. The patients with a head injury, craniofacial trauma who underwent CT scanning were included in the study. Patients on the ventilator and with Glasgow coma scale <6 were excluded. Patients were scanned using dual Slice CT, Siemens somatom Emotion duo. A P-value of less than 0.05 was considered statistically significant.
Results: Total 223 patients were included, 76.2% were males and 73.5% were abnormal scans. Among all intracranial traumatic lesions (ITL) the incidence of multiple ITLs were the most common (35%) and the death rate was 12.6%. Temporal bone fractures (15.2%) were the highest.
Conclusion: It was concluded that 21 – 40 years is the typical age group for head injuries, common among male and the incidence of mortality rate is more > 61 years. MICTLs are the most frequent type of hematomas
A clinico-epidemiological study of the first outbreak of Nipah virus in India – report from ground zero
Get PDFIntroduction: The first Nipah Virus (NiV) outbreak occurred in India in the year 2001 at Siliguri. The second outbreak happened at Nadia in 2007. Nipah Virus exhibits neurological and pneumonic tropism with the predominant clinical presentation being encephalitis in humans.
Material and Methods: The present study was a record based prospective study on 67 cases admitted with pyrexia of unknown origin in North Bengal Medical College during the period from 18.02.2001 to 30.02.2001 and a parallel study on epidemiological record carried out by PSM department also taken into account. All necessary investigations including autopsy examination, pathological, and microbiological study were done.
Results: There was a clustering of cases around Bhaktinagar. There was a strong H/O Medinova Nursing Home Contact among the patients. 18 out of 20 cases were staff of that Nursing Home. Serum samples tested show NiV specific IgM and IgG in 9 out of 17 samples with one sample which was positive for IgG only suggesting past infection. The cases were admitted with predominant neurological symptoms (53.73% cases) but about 80% recovered with no residual neuro deficit. The natural reservoir of NiV is present in Bangladesh and in Northern India.
Conclusion: When NiV infection is suspected, infection control practices must be strengthened to avoid an outbreak in a hospital setting. Here the present study is presenting the experience in the first outbreak of the Nipah virus in India at Siliguri for awareness of clinical personnel to control further outbreak at the very beginning
Study of Tissue Inhomogeneity Effects on Central Axis Radiation Beam Parameters using Monte Carlo Methods
Get PDFAbstract:
Introduction; The central axis radiation beam parameters are used for the dose calculations in radiotherapy and usually measured in a homogeneous medium. Human body is not homogeneous in nature and the incident beam has to travel through different medium such as bone tissue air etc to reach the tumor. The presence of such Inhomogeneity perturb the central axis beam parameters.The experimental measurements of dose variation in the presence such Inhomogeneity is seldom possible and Monte Carlo methods can be used to study in cases.
Objective: The objective of the present work is to study the effects of tissue Inhomogeneity on central axis beam parameter such as Percentage Depth Dose using Monte Carlo Methods
Materials and Methods:The Monte Carlo simulation is a virtual experiment and can be conducted with the Monte Carlo software tool installed in a PC .Input files are written as per the specification of the Monte Carlo code. Two radiation beams beams commonly used for radiation treatment such as Cobalt 60 and 6MV X ray were used for the simulation. The study conducted for a homogeneous tissue medium,and two Inhomogeneity situations such as tissue air tissue and tissue bone tissue medium. Percentage Depth Dose(PDD) curves were generated from the simulated results.
Results: Depth Dose characteristics in homogeneous tissue medium for Cobalt60 and 6MV X rays beams were studied and is consistent with the published experimental values.In the second case, at the interface between tissue and bone the PDD pattern changed as reported by the previous works. And the absorbed dose at bone layer is higher than the dose value predicated in a homogeneous condition. In the next simulation we conducted the simulation for a tissue air tissue medium. It was observed that as the beam passes through the tissue air interface the distribution changes drastically. The dose deposition in air become very small and the PDD values at other points in the air medium show large variation than the homogeneous condition. Interestingly It is also observed that a buildup condition occur at the second air tissue interface.
Conclusion: The Monte Carlo Our studies clearly demonstrate the perturbation effects caused by the presence of Inhomogeneity when a radiation beam is transporting through the human tissues.For the accurate estimation of absorbed dose the Inhomogeneity effects must be considered in actual clinical practice and the Monte Carlo study can be used to estimate the Inhomogeneity correction factors that have to be incorporated for dose calculations.The present study clearly demonstrate that Monte Carlo methods simulation can be used as a tool for estimation of dose in tissue Inhomogeneity where measurements are seldom possible
Deep venous thrombosis induced by intravenous thrombogenic drugs
Get PDFBackground: Deep vein thrombosis (DVT) is a major preventable cause of morbidity and mortality worldwide with the potential to cause a dreaded pulmonary embolism (PE). Disease and patient-specific considerations are preferably incorporated into therapeutic options for effective management.
Materials and methods: Sixty-eight cases of acute deep vein thrombosis were treated within a period of 3 years from January 2016. All the cases were subjected to routine investigations with the Doppler study of the affected limb. Low molecular weight heparin (dalteparin) was administered in all the cases for a period of 15 days and the Doppler study was repeated at the end of the drug therapy. After the course of low molecular weight heparin, the patients were given acenocoumarol 2mg daily. Estimation of partial thromboplastin time and prothrombin time were performed before starting and during the treatment of the low molecular weight heparin and acenocoumarol regularly. A venogram was done only when the repeated Doppler study revealed unsatisfactory response to low molecular weight heparin therapy. Eight cases underwent thrombectomy and the postoperative period was uneventful.
Results: Age group of 21-30 years was most affected (80.8%) with right lower limb being the commonest affected site of injection and associated lesions.
Conclusion: DVT in the young population remains a challenge to the evaluating clinician. A variety of disease states can alter the anticoagulant factors. Urgent diagnosis and appropriate intervention carry paramount importance
Assessment of levels of Vitamin D and Leptin in comparison of BMI among medical students
Get PDFIntroduction: Vitamin D is one of fat-soluble vitamin that plays an important role in the absorption of calcium and phosphate. Deficiency of Vitamin D is unrecognized in many parts of the world. Leptin is a hormone which is derived from adipose tissue. Studies have shown that vitamin D has a negative and powerful control on leptin secretion by vitamin D by acting on the adipose tissue.
Aim and Objectives: The study was done to study the relationship between Vitamin D and Leptin based on Body mass index among the medical students.
Materials and methods: Vitamin D Leptin and Body mass index were the parameters measured in the study group. Individuals with an age group of 19-23 years of both sexes were included in the study. Individuals above the age of 23 years, those with renal and liver disorders, individuals with hormonal disorders, individuals on vitamin D supplementation were excluded in the study. Vitamin D was measured by Enzyme-Linked Immunosorbent Assay (ELISA) method. Leptin was measured by Enzyme-Linked Immunosorbent Assay (ELISA) method. BMI is calculated by the formula weight in kilograms divided by height in metre square.
Results: The results have shown that there is a decrease in vitamin D levels with increasing BMI. (pvalue≤0.001). furthermore, there is an increase in leptin levels with an increase in BMI. (pvalue≤0.001).
Conclusion: The study has put forth a suggestion that leptin and vitamin D has a causal relationship between them based on Body Mass index. Adequate vitamin D levels will maximize the effect of maintaining normal leptin levels as high levels of leptin could contribute to obesity-related disorders
Pattern recognition approach and clinico-radiological evaluation of compressive myelopathies at a tertiary care hospital
Get PDFBackground: Neuroimaging is indicated in most instances of new-onset myelopathy for clinico-radiological correlation in terms of diagnosis, recovery, and prediction of recurrence.
Aim: This study was conducted to study the clinical profile of cases of Compressive Myelopathy and the pattern of spinal cord involvement, also to compare the sites of localisation of clinical diagnosis with MRI diagnosis. Methodology: The present study was a prospective study involving 30 patients. Patients with clinical suspicion of spinal cord disease of age group 20-80 years were included as study participants. The primary pulse sequences included T1 and T2 weighted images on MRI, the location of the lesion, its margins, signal intensity on both T1 and T2 weighted images was noted.
Results: The majority of 53.33% of participants were aged between 51 to 60 years. Difficulty in walking was observed in 97% of participants. Men were more often affected than women. Cervical spondylosis was the commonest cause of compressive myelopathy in 57%. A most common pattern of spinal cord involvement was combined Anterior + Posterior cord involvement. The cervical site of localisation (54%) was the commonest followed by the thoracic and lumbar spinal cord.
Conclusion: Myelopathies have male preponderance. The commonest cause of compressive myelopathy was Cervical spondylosis. Anterior plus posterior cord syndrome was the commonest pattern seen, followed by posterior cord syndrome, anterior cord syndrome being the least observed. MRI correlates well with a clinical diagnosis and is useful in suggesting the location of the lesion
The paradigmatic shift in the clinical profile of dengue patients: a prospective observational study from a tertiary care center in north India
Get PDFBackground: Dengue a vector-borne viral disease transmitted by mosquito and has several complications causing fatalities and a bad impact on society. The paucity of studies in Uttar Pradesh and lack of epidemiological data necessitated to take up this prospective study. Thus, the current study looked into the causes of heavy prevalence, urban v/s rural ratio, gender difference, various complications to formulate a strategy to limit the severity of the disease by early diagnosis and rapid intervention. The fever caused by dengue is characterized by body ache, petechial rashes, myalgia, and nausea and vomiting. There can be varied manifestations of dengue involving the lung, pleura, peritoneum, pericardium, and complications of liver, kidney, brain, muscle, eye, and other organs. The disease is characterized by thrombocytopenia, dehydration, bleeding tendencies, shock, and multiorgan dysfunction. Current estimates reports about 40% (2.5-3 billion) of the world population are at risk.
Purpose: The study is aimed at detecting clinical signs and symptoms of patients with dengue fever presenting to TMU teaching hospital between January 2019 to December 2019.
Material and Methods: A prospective observational study was undertaken in serologically confirmed cases of dengue. The disease was analyzed for its clinical profile, required investigations were done and evaluated.
Results: In the present study the clinical outcome was: 1) Dengue fever without warning sign was (29.46%). 2) Dengue fever with a warning sign (57.87%). 3) Severe dengue fever (12.12%). Mortality noted in the present study was 1.8%. Bleeding manifestations were noted in 8.2% of patients. Thrombocytopenia (<100,000) was noted in (85.85%) patients. Fever was the presenting complaint in the majority of the patients (99.3%). Fever was followed by myalgia (91.9%), headache (58.8%), arthralgia (28.2%).
Conclusions: Patients of dengue presented with fever, headache, myalgia, nausea, vomiting. Bleeding manifestations were looked for. Lab findings like leucopenia and deranged liver function test were more than other studies
Estimation of serum creatinine, serum urea, glomerular filtration rate and proteinuria among apparently healthy adults to assess the renal impairment and its association with body mass index: An observational hospital-based study
Get PDFBackground: Serum urea, creatinine, and estimated glomerular filtration rate (eGFR) are the most widely accepted parameters for the assessment of renal impairment. Renal dysfunction in Indian obese adults has not been sufficiently investigated.
Aims: To evaluate the renal function by using serum urea, serum creatinine, eGFR, and proteinuria in normal, overweight, and obese adults to identify renal impairment.
Materials and Methods: This observational and cross-sectional study was done on a total of 100 normoglycemic, normotensive healthy adults, and these were divided into three groups as per the criteria of body mass index (BMI) as; normal, overweight and obese groups. Estimation of urea and creatinine was done by fully automated chemistry analyzer methods. eGFR was calculated by Modified Diet Renal Disease (MDRD) formula. The excretion of protein in urine was checked by the urine dipsticks method. p<0.05 was considered as significant level.
Results: The present study was conducted in 100 normal study subjects which included 48 males and 52 females. A maximum number of subjects were found in the obese subgroup (34%). Among subjects low eGFR prevalence was found 3% and prevalence of chronic kidney disease (CKD) was also found 3%. The obese subjects showed higher urea and creatinine levels compared to normal subjects. A significant negative relationship was noted in eGFR (MDRD) and BMI. The prevalence of proteinuria among subjects was 3%.
Conclusions: A total of 3% prevalence of renal dysfunction was noted among adults and out of this 2% was found in obese adults. Therefore, it can be concluded that increasing BMI has a significant contributing factor for renal impairment in obese adults
Practical guidance for healthcare professionals during the COVID-19 pandemic; with special emphasis on the care of cardiovascular patients and personal protection
Get PDFA novel, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is causing the COVID-19 pandemic. There are concerns regarding the spread of disease by asymptomatic carriers to healthcare workers who continue to see patients and to perform procedures on them. The infection then could be transmitted through them to other patients who eventually, could infect persons in the community. Further, limitations of existing tests to detect new cases that are negative early in the disease; and the inability to use appropriate personal protection equipment (PPE)also contribute to the spread of infection. This document, from the COVID-19 Working Group of Wellness and Radial Intervention Society, describes considerations for management and care of cardiovascular disease (CVD) patients with the concept of COVID 19 `designated` Vs. enabled` centers for those with symptoms of and/ or confirmed COVID-19 disease Vs. asymptomatic suspects. It also provides guidance to healthcare professionals, hospital administrators, and policymakers in general and to those managing patients with CV and other diseases, regarding the concept of `levels of personal protection` for staff; with suggestions for `equivalent innovative alternatives`, and a` protection plan` for patients to prevent the spread of disease. The guidance can also be broadly applied to surgical branches in general and to other specialties involved with invasive, semi-invasive, and non-invasive procedures such as gastroenterology, urology, anesthesiology, otolaryngology, and ophthalmology which carry a higher risk of exposure for healthcare professionals