International Journal of Medical Research & Review (IJMRR)
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Vaginal progesterone in prevention of preterm labour
Get PDFIntroduction: Preterm birth, defined as childbirth occurring at less than 37 completed weeks or 259 days of gestation since the first day of a woman’s last menstrual period, is one of the leading causes of neonatal morbidity and mortality. Across 184 countries, the rate of preterm birth ranges from 5% to 18% of babies born. Out of 27 million babies born every year (2018 data ) in India, 3.5 million babies born are premature. Recent literature review has shown that the use of Progesterone reduces risk of preterm birth. But there is little information available regarding the role of Progesterone in preventing preterm labour.
Objectives: Primary objective of the study is to find out the incidence of preterm labour among pregnant women taking vaginal progesterone. Secondary objective is toassess the safety and efficacy of progesterone in feto-maternal outcome.
Methods: This is a cross sectional study where100 prescriptions from IPD of Dept of O&G, VIMSAR, Burla of women who had recently undergone labour with singleton gestation and with previous history of preterm labour were analysed. Incidence of preterm labour among those taking and not taking vaginal progesterone were compared.
Results: There was decreased incidence of preterm labour as there is prolongation mean Gestational age by 9.383 weeks among pregnant women taking vaginal progesterone.
Conclusions: In the present study, women taking vaginal progesterone had significantly lowered incidence preterm birth rate
Cardiac evaluation of Covid-19 patients with post-discharge dyspnoea
Get PDFBackground: Dyspnoea is one of the common symptoms in COVID-19 patients after discharge from the hospital. So evaluation of cardiac function becomes necessary in COVID patients after hospital discharge.
AIM: To study the cardiac function of COVID 19 patients presenting with dyspnoea after discharge from hospital within 3 months of symptom onset.
Materials and methods: 245 post-hospital discharge COVID-19 patients enrolled in the study. The patients with abnormal echocardiography are further divided into three groups, A) patients with PAH±RVD, B) patients with LV diastolic dysfunction C) patients with LV systolic dysfunction. Data of the three groups were compared.
Results: Out of 245 patients, 64% (157) patients show abnormal echocardiogram.75 (30.6%) patient show PAH±RVD,61(24.8% ) patients shows LV diastolic dysfunction and 21(8.57%) patients shows LV systolic dysfunction. patients with ventricular dysfunction significantly associated with multiple risk factors and comorbidity. Grade 1,2,3,4 diastolic dysfunction seen in 27.8%,34.4%,29.5%,8.1% in group B respectively. LV systolic dysfunction is mild in 13 (61.9%), moderate in6(28.5%), severe in 1 (4.7 %) in group C patients. Ntprobnp, tropnin significantly higher in all groups. Also, CRP, D dimer significantly higher in group A, but non significantly higher in group B, C.
Conclusion: RV dysfunction is the most common pattern seen in around 30% of patients. LV diastolic dysfunction is not uncommon, seen in ¼ the patients. Patients with cardiac dysfunction have a high level of cardiac and inflammatory biomarkers, which can lead to grievous cardiovascular complications. So close follow up required
Prevalence of diastolic dysfunction in Normotensive diabetics below 45 years of age
Get PDFIntroduction: Dengue rarely affects the heart but clinical symptoms of cardiac involvement may range greatly from silent illness to severe myocarditis resulting in death. Clinical features are asymptomatic and most are transient among patients with DF/DHF.
Material and methods: It was an observational study conducted at the Department of General Medicine, Peoples College of Medical Sciences and Research Centre, Bhopal. The total duration of the study was One and a half years from November 2016 to APR 2018. All normotensive diabetic patients less than 45 years of age presenting to the Department of General Medicine, Peoples College of Medical Sciences and Research Centre, Bhopal during one and half years from which data was collected using as per given proforma.
Results: In the present study, It was found that significant Pearson\u27s correlation between age of diabetics and diastolic changes in ECHO, and serum creatinine and diastolic changes in ECHO. The rest of the parameters like blood urea, blood pressure, RBS, FBS, PPBS, and duration of diabetes were not significantly correlated.
Conclusion: It was concluded that in the present study, diabetes mellitus is itself a risk factor for developing diastolic dysfunction though its prevalence increases with increasing age, serum creatinine and there is no association found between duration of diabetes and diastolic dysfunction. So screening of every young normotensive diabetic for diastolic dysfunction should be done to prevent early cardiovascular disease
Comparative evaluation of continuous epidural infusion of 0.0625% Bupivacaine + 0.0002% Fentanyl and 0.1% Ropivacaine + 0.0002% Fentanyl for labour analgesia
Get PDFAim& Objectives: To compare the total dose of Fentanyl and Bupivacaine with total dose of Ropivacaine and fentanyl in terms of total volume delivered-loading, infusion and top ups. Also, to compare Analgesic efficacy (VAS score) and adverse events if any.
Methods: 60 ASA physical status I or II parturients in labour who were either primigravidae or gravida 2 were included in a randomized, single blind, prospective study. After a bolus dose of 0.125 % Bupivacaine and 25 mcg Fentanyl, the group BF received a continuous epidural infusion of 0.0625% Bupivacaine and 0.0002% Fentanyl whereas the group RF received a bolus of 0.2% Ropivacaine and 25 mcg Fentanyl followed by an infusion of 0.1% Ropivacaine and 0.0002% Fentanyl.
Results: The Group BF and Group RF were comparable with respect to their physical parameters. It was seen that the pain relief in the group BF was excellent for 8 out of 30 patients (26.67%) whereas for the group RF it was excellent for 9 of 30 patients (30%). After that till delivery, both the groups had a comparable mean maternal pulse rate (p value >0.05). None of the parturient in study or control group ever had an episode of bradycardia. Throughout the remaining period of analgesia, the mean foetal heart rate was comparable between the two groups. In the present study groups only 2 parturients from group BF and only one parturient from group RF underwent caesarean section due to foetal distress. 6 parturients (20%) from group BF and 5 parturients (16.67%) from group RF developed hypotension.
Conclusion: Continuous infusion of 0.1% Ropivacaine + 0.0002 % Fentanyl provides equipotent labour analgesia and maternal satisfaction as 0.0625% Bupivacaine + 0.0002% Fentanyl infusion can provide
A comparative study of PSI and Curb-65 scoring systems in predicting ICU admissions and mortality in cases of community-acquired pneumonia
Get PDFBackground:Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality worldwide. Despite advanced diagnostic modalities and treatment options, CAP is the fourth leading cause of death in developing countries.Several severity scores have been proposed to guide initial decision making on hospitalization and to predict the outcome. Pneumonia Severity Index (PSI) and CURB 65 are the two most widely used scoring systems to prognosticate pneumonia.
Aim: To compare the efficacy of PSI and CURB 65 scoring systems inprognosticating the ICU admission and outcome in cases of CAP.
Methodology: This wasan observational study conducted at a tertiary care hospital in westernMaharashtra.A hundred patients of CAP fulfilling the inclusion criteria were enrolled in the study, classified as per CURB 65 and PSI system and their outcome compared.
Result: The study subjects comprised of 100 patients (64 men and 36 women) of CAP. Twenty-four patients needed ICU admission.In both PSI and CURB-65 risk scoring systems, the need for intensive care unit (ICU) admission and mortality rates increased progressively with increasing scores.PSI class ≥IV and CURB 65 ≥III had 77.52% and 40.24% sensitivity and 88.46% and 69.48% specificity respectively in predicting ICU admissions. The PSI class ≥IV had more sensitivity and specificity in predicting ICU admission than CURB-65.CURB 65 class III and IV had sensitivity86.59% and 89.64% and specificity 89.64% and 97.54% respectivelyin predicting mortality, while PSI class IV and Vhadsensitivity68.92% and 72.58% and specificity 24.74% and 54.86% respectively. CURB 65 had more sensitivity and specificity than PSI in predicting mortality.
Conclusion: The PSI is better in predicting the need for ICU admission and CURB 65 is a better predictor of mortality in cases of community-acquired pneumonia
Is there any association between vitamin D deficiency and anti-thyroid peroxidase positive hypothyroidism: A cross-sectional study
Get PDFBackground: Vitamin D deficiency is prevalent worldwide and it is believed to have a role as an immune modulator. However, the association between vitamin D levels and anti-thyroid peroxidase positive (TPOAb) hypothyroidism is still controversial.
Aim: To elucidate the association between vitamin D levels and anti-thyroid peroxidase (TPOAb) positive hypothyroidism.
Materials and Methods: Serum Vitamin D, thyroid peroxidase antibody, and thyroid function test were measured in 105 patients, who were sub-grouped into the TPOAb positive and TPOAb negative hypothyroidism category.
Results: Vitamin D level, was found significantly lower in patients with TPOAb positive hypothyroidism as compared to patients TPOAb negative hypothyroidism (13.275.18vs. 17.746.03ng/ml, respectively, P<0.05), as well as between patients with TPOAb positive hypothyroidism and control group (13.275.18vs. 29.669.41 ng/ml, respectively, P<0.05). Within the patients\u27 group, there was a significant negative correlation between serum 25 (OH) vitamin D and TSH (r=−0.438, P<0.05), anti-TPO (r=−0.275, P<0.05). Furthermore, insignificant positive correlations were recorded between serum 25 (OH) vitamin D, and each of T3, T4 (r=–0.056, 0.097, P>0.05).
Conclusion: The current study observed significant low levels of 25(OH)D3 in TPOAb positive hypothyroid patients
A comparative clinical and echocardiography study of acute myocardial infarction, patients above and below 40 years of age
Get PDFABSTRACT
BACKGROUND
Myocardial infarction is one of the major health problems in both developed and developing countries and is the leading cause of premature death among adults in developed countries while its incidence is on an increase in developing countries as well, including India. Coronary Artery Disease (CAD) in young (<40 years) has aroused considerable interest in recent years.
OBJECTIVES.
To determine the prevalence of various risk factors in young AMI patients and to compare them with that of older patients. To compare the clinical presentation, course and complications among both the groups.
METHODS:
Clinical Criteria : Severe excruciating retrosternal pain with or without radiation to upper extremities, abdomen, back, neck or jaw, not relieved by rest, lasting more than 30 minutes and frequently for a number of hours suggested the diagnosis of MI. Where the pain was not a prominent feature other features like severe diaphoresis, syncope, shock, sudden dyspnoea, and sudden onset of pulmonary oedema in the absence of other known cause of acute left ventricular failure were taken into consideration. When any of these features including a prolonged retrosternal pain especially in a person with known coronary risk factors were present the possibility of acute MI was strongly suspected and further laboratory investigations were done to settle the diagnosis.
RESULTS & DISCUSSION
AMI was found to have male preponderance with M:F ratio of 9:1 and 2:8:1 in group I & II patients respectively. Smoking habit was found to be the commonest risk factors. Equal patients in each group had TC/HDL-C ratio in excess of 4.5.
Anterior wall infarction was the commonest form of infraction in both Groups. Among the early complications, the occurrence of heart failure was found to be significantly high in Group II patients. Other complications such as arrhythmias, & conduction defects, shock, pericarditis, post infarction angina, thromboembolic episodes & mitral regurgitation did not differ significantly in incidence when both groups were compared. Heart failure occurred in significantly higher percentage in group II patients than in Group I patients.
Anterior apical, septal, anterolateral, inferior, basal & posterior, wall motion abnormalities were found in both groups. Death was more in Group II patients during early hospitalization period.
CONCLUSION:
In the present study it is clearly evident that the natural course, extent of ventricular dysfunction arrythmias / wall motion abnormalities/ mortality in acute myocardial infarction bears many similarity in both younger and older patient population; but not in all aspects. Family history of coronary heart disease and obesity may be more associated with younger and older patient groups respectively while incidence of heart failure in older patients are significantly higher when compared with that is seen in younger patients.
Key words: Coronary Artery Disease (CAD), Young AMI, Echocardiography in AM
Tunica vaginalis flap – is it a better surgical choice for urethro-cutaneous fistula following circumcision?
Get PDFObjective: To study the effectiveness of tunica vaginalis flap in repair of post circumcision urethro- cutaneous fistula.
Materials and Methods: The current study reviewed all patients having surgical repair of post-circumcision urethrocutaneous fistula from December 2014 to April 2019 at our institution.
Results: Ten cases presenting at age 5 to 22 years were operated. Most [60%] of the circumcisions were performed by a doctor at peripheral hospitals and others were done by traditional circumcisers. All cases had a single fistula and the size was more than 5mm in all cases. Three-layered fistula closure was done in all cases using the tunica vaginalis flap as the second layer for closure. There was no recurrence in any case.
Conclusion: Use of Tunica vaginalis flap for repair of post circumcision urethro-cutaneous fistula is a highly effective technique regardless of size and site of the fistula. It is a simple procedure without any postoperative complications and without any recurrenc
From allergy to labial abscess following a bee sting: A Case report
Get PDFArthropod bites are a common problem worldwide that are capable of inflicting injury, inciting allergic reactions, and transmitting systemic disease. Members of the Hymenoptera order in particular are of importance as they are nearly ubiquitous in nature and few such as bees, are also used for commercial purposes. These insects have stinging apparatus that deliver venom to the affected tissues during a bite. Hymenopteran venoms contain a mixture of proteins, peptides, and small organic molecules that produce varied effects. Stings from bees, wasps, and ants produce a wide array of clinical manifestations that can be local or systemic. Additionally, these stings may cause life-threatening allergic reactions. Anaphylaxis following a Hymenoptera sting is the most common serious systemic complication. Local reactions can be immediate or delayed. In a few instances, local or disseminated infections have also been reported following bee stings; although very rarely have proved fatal in severe cases. Infection rates are found to be higher in immunodeficiency states. Infections at site of a bee sting can result in the localized pustular lesion with peripheral induration or in severe cases deep necrotizing fascia infection with sepsis and multisystem organ failure. Here we report a case of a bee sting in the upper lip leading to the painful swelling with abscess formation successfully treated with antibiotics, incision, and drainage. Numerous mechanisms for infection in arthropod stings have been described; in our case report, we would like to highlight the importance of timely identification and appropriate management of the infections that may have a significant impact on the overall outcome
Achievement of the Ancient Hindu way of Propagation of Education and suggestion of incorporation of some of the methods in the teaching of the modern Medical Education in India: Look back to go forward
Get PDFThe great Author F. Max Muller said that if written scripts were not invented the Indian scholars would have retained the treasure house of the knowledge of the Hindus in their memory even today with the same efficiency as of today’s written world of knowledge. The question appears here is what went wrong? Why the students cannot be taught how to learn a vast amount of literature as efficiently as the Hindus did for 9 millennia and more.Medical science is progressing in a quick stride. The amount of research materials being updated daily is very high. Expectations of patients and their attendants are also increasing day by day. The modern-day treating Doctors need to be aware of more things today than a hundred years back. The studies show that many patients may suffer from death or complications if their treating Doctors are not learned enough. It cannot be overemphasized that a learned Healer is way better than one who is half learned. The present-day experimentation with the teaching methods of the medical subjects needs to be revisited, at least in India. The experimentation of teaching the teachers in newer teaching methods and the introduction of the ATCOM module may or may not bear fruit. The involvement of non-treating faculties in imparting crucial parts of teaching like attitudes and communications in the hospital high tension areas will not be successful. Just the way a great Chef cannot train a Sniper, the same way this will surely fail. The proper person at a proper teaching position should be followed. A short advanced course in Medical Education, A short Fellowship or publication of few papers on education will not convert a Nontreating faculty equivalent to the faculty of Surgery. Theoretically, it sounds good,but in reality, it probably won’t work. The students would bein confusion. How can a teacher who has never faced a murderous mob or faced an intra-operative death or even diagnose a patient to cure him/her would teach how to behave in such scenarios? In such chaos, we thought of looking back on the historical aspects of the ancient medical education system and see if the great wisdom of the Hindu civilization can be utilized to improve the present Medical education system in India.It cannot be denied that the ancient Hindus had a system of Medicine far superior to whatever existed in the west.Great treatises were written in later times. These were learned and remembered by the students quite efficiently. The students often raised the standards to higher than those of their teachers. Such an efficient system needs to be paid attention to and if possible initiate some steps to bring back the great and lost glory of the system of medicine in practice. Teachers of the ancient period were known by the names of Acharya, Upadhyay, Charakas, and Guru.The learning methods were Storytelling, Memorization, hands-on methods, Critical analysis, Seminar, and finally Question – Answer sessions.The great Sushruta, maintained that Surgery was the most important subject of all. It was considered the first and foremost of the medical subjects. Maybe this should be looked into and Surgeons are brought in to take care of the higher medical education programs to make the teaching of the Higher medical learning strong and efficient.In this work, we tried to focus on such steps, which is incorporated in the education system of modern medical science in India, should improve the quality of the students. As a result, they will be better healers, and lives will be saved