International Journal of Medical Research & Review (IJMRR)
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Anesthesia- patient’s apprehension, concerns, and counseling
Get PDFIntroduction: To allay anxiety and resolve the patient’s apprehension regarding general anesthesia through counseling. Patients presenting to PAC were asked to participate in a 2-way conversation meant to evaluate and study his apprehension, concerns in relation to anesthesia, and subsequently, a counseling session was given to answer his doubts and resolve his fear.
Material and Methods: In the study, it was found the fear of death was the greatest concern. The other major concerns were fear of paralysis and heart attack.
Results: The level of fear decreased as the severity of surgery decreased. For major surgery, the fear of death differed significantly with age, especially with increasing age came a lessened fear of death. Counseling by anesthesia provider regarding the fear that the patient reported help to reduce the anxiety. It allows for a more personalized approach towards the patient. It helps anesthesia provider to tailor the informed consent process.
Conclusion: In general, the study increases awareness regarding anesthesia among patient and their relatives
Clinical and functional profile of 6-12-year-old children with attention deficit hyperactivity disorder referred to a tertiary care center in South India
Get PDFObjective: To describe the clinical, socio-demographic, and functional profile of children with Attention Deficit Hyperactivity Disorder (ADHD) referred to a tertiary care center in Kerala, India.
Methods: A retrospective descriptive study was conducted from records of developmental evaluation clinic over a period of one year. All-consecutive cases the first time diagnosed as ADHD were enrolled. Autism Spectrum Disorder, genetic disorders, and children with sensory impairments were excluded. Clinical profile was based on presenting symptoms, gender, and socio-demographic characteristics; functional status assessed by Conner’s 3 Parent Scale and cognitive status by Intelligence Quotient.
Results: ADHD prevalence in a clinically referred sample was 12.7%. Boy to girl ratio was 6:1. The mean age of presentation was 8.2 years (SD 6.09). The most common presenting symptom was hyperactivity and behavioral problems followed by poor scholastic performance and poor memory. The functional status assessment showed major concerns in all six domains - Inattention, Hyperactivity, Learning Problem, Executive Functioning, Aggression, and Peer relation, in the majority of children. Children presenting with ADHD symptoms at a later age (9-12 years) had lower IQ scores than those diagnosed at a younger age.
Conclusion: Course of childhood ADHD shows a consistent clinical and functional pattern. Early diagnosis and quantification of difficulties at the outset is suggested, which can help in providing early intervention and is likely to improve long-term outcome in these children
Management of multiple rib fractures-results from a Major Trauma Centre with the review of the existing literature
Get PDFIntroduction: Rib fractures are amongst the most common fractures following major trauma presenting to the Emergency Department. The impact of rib fractures is even more significant in the patient with underlying chronic respiratory conditions.
Aim: To assess our current management of rib fractures at our trauma center. Method: The current study collected our data from the TARN Registry primarily focussing on patients with multiple rib fractures. The main components were the analgesic requirement of our patients. The number of rib fracture stabilization procedures and the average number of ribs fixed were also studied.
Results: The data were collected retrospectively over 12 months. There were 313 patients identified as having chest wall injuries. From the data, 41.9% (131) of patients were over the age of 65 years. A significant proportion of our patients 34.5% (108) were noted to have multiple rib fractures (>3 Ribs). It was noted that 3% (9) of the 313 patients required operations. The average of the patients included in the study was noted to be 61 years with an age range of 17-92 years.
Conclusion: The mainstay management of rib fracture is a provision of adequate analgesia and the prevention of respiratory complications that can all stem from poor ventilatory function amongst other patient factors and injury patterns. Through the decades, surgical stabilization has gained pace and has found its niche in the management of rib fractures
A study to assess the role of contrast-enhanced multiphasic, multidetector computed tomography in the evaluation of renal lesions
Get PDFAim: To assess the role of Contrast-Enhanced Multiphasic Multidetector Computed Tomography in the evaluation of renal lesions and its potential role in differentiating benign from malignant lesions.
Material and Method: This prospective study was done in the Department of Radiodiagnosis Chirayu Medical College and Hospital Bhopal. A total of 100 patients to our department with strong clinical suspicion of renal lesions and those diagnosed by ultrasonography underwent Contrast-Enhanced Multiphasic Multidetector Computed Tomographic evaluation of abdomen using 64 Multislice Spiral CT scanner from August 2015 to July 2019.
Results: The majority of patients presenting with renal lesions were each of the age groups <15 years and >40 years. Most of the patients were males 57%. The most common clinical complaint was renal colic 58(46%) and hematuria. The most common pathology was calculus 35(35%) second most common pathology was congenital anomalies 23(23%). The CT accuracy for detection of benign cystic lesion in this study was 94.7%, benign lesions were 92.6%and for malignant lesions was 86.6% in the present study.
Conclusion: The accuracy of Contrast-Enhanced Multiphasic Multidetector Computed Tomography in detecting and characterizing renal lesions is high and it should be considered in the imaging workup of any patient with a renal complain
A comparative study of endoscopic and conventional septoplasty
Get PDFObjective: Nasal obstruction due to deviated nasal septum is a common problem encountered by otolaryngologist. The standard surgical treatment for symptomatic deviated septum is septoplasty which has gone through several modifications since its inception. Study objectives were to compare the endoscopic and conventional septoplasty and to evaluate the advantage, disadvantage and complication of both the procedures.
Materials and Methods: Prospective observational study was conducted in department of ENT and Head-Neck-Surgery of a tertiary care teaching hospital. Sixty patients undergoing either endoscopic septoplasty or conventional septoplasty were studied prospectively for a period of 3 months to compare the efficacy of both the techniques. Objective assessment was done by doing nasal endoscopy 90 days after the operation to note the following points- (1) Persistence of deviation (2) Spur (3) Formation of synechiae (4) Septal perforation.
Result: In this study the endoscopic approach showed better overall clinical result as compared to conventional technique with lesser complication. It was noted that endoscopic septoplasty group had minimum blood loss and shorter operative time than conventional method, but difference was not statistically significant.
Conclusion: Endoscopic septoplasty was founded with distinct advantage over conventional method due to better illumination, improve accessibility to remote area was founded. Further surgical experience and larger similar studies will help in coming to a greater consensus
Helicobacter pylori chronic gastritis: correlation between endoscopic findings and histopathology with special reference to updated sydney system
Get PDFAims of the study: Helicobacter pylori (H. pylori) induces inflammatory changes in the gastric mucosa variably correlated to different endoscopic and histologic features. The present prospective study aimed to correlate different endoscopic findings with histomorphological changes and the presence of H. pylori in the gastro-duodenal mucosa, in samples of dyspeptic patients.
Methods: 60 dyspeptic patients of 18 years to 60 years of age were selected from outpatient department and screened with gastro-duodenoscopy and biopsy. The presence of H. pylori was determined by urease test on fresh biopsy specimens and histologically using the modified Giemsa stain. Findings were recorded and analyzed statistically.
Results: Highest (84.6%) H. pylori positivity was seen in the 41-50 years age group. Majority of the patients had a normal upper gastro-intestinal endoscopy; among them majority (61.2%) was positive for H. pylori infection. Most cases with endoscopic lesion in the gastro-duodenal mucosa were also positive for H. pylori infection. On biopsy, chronic gastritis was the most common (73.33%) finding in 44 cases, among them, more than two-third (70.4%) were positive for H. pylori.
Conclusion: H. pylori gastritis is strongly associated with peptic ulcer diseases, chronic gastritis and non-ulcer dyspepsia. Endoscopy and biopsy play the main role in diagnosis and identification of the spectrum of involvement
Electrocardiographic changes in patients with dilated cardiomyopathy
Get PDFIntroduction: Cardiomyopathy is the disease of the heart muscle, which causes deterioration of myocardial functioning. A study was conducted to find electrocardiographic findings in dilated cardiomyopathy.
Materials and methods: This was a hospital-based study, conducted in the department of General Medicine, GSL Medical College. Informed written consent was taken from each patient or his/her attendant prior to including in the study. Patients with dilated cardiomyopathy, both gender, all ages. Heart failure based on Framingham criteria, ECHO criteria – LV ejection fraction less than 45%, with left ventricular or biventricular dilatation, with global hypo-contractility were included in the study. ECG and 2 D Echo have been performed on the patients. Framingham criteria were used for the diagnosis of heart failure. Descriptive statistics were presented in the form of mean ± standard deviation and percentages.
Results: Total 102 patients were included in the study, with a mean age of 56.3 ±12.5 years, the male-female ratio was 1.9. Tachycardia was 61%, left axis deviation was present 34.3% and right axis deviation in 8.8%. Left ventricular end-diastolic and systolic diameters were elevated in most of the patients.
Conclusion: With these findings, it can be concluded severe LV systolic dysfunction is very common among dilated cardiomyopathy patients
Clinical profile and outcome of organophosphorus poisoning in a tertiary care centre, a prospective observational study
Get PDFIntroduction: Acute organophosphorus (OP) pesticide poisoning is widespread in the developing world. Being predominantly an agricultural country, pesticides and insecticides are used abundantly for cultivation, and access to these poisonous chemical substances by the population is easy. The objectiveof the study was to identifythe nature of the demographic profile, type of compound, clinical manifestations, and outcome of organophosphate poisoning presenting to a tertiary care teaching hospital in India.
Material and methods: A cross-sectional study was conducted among 100 patients admitted with OPC poisoning inthe department of general medicine,Velammal Medical College Hospital and Research Institute, Madurai from January 2016 to July 2019. The diagnosis was made based on history or evidence of exposure to OP compound within 24 hours; characteristic manifestations of OP poisoning include, miosis, fasciculations, excessive salivation, improvement of signs and symptoms with administration of atropine were recorded. IBM SPSS version 22 was used for statistical analysis.
Results:The majority of the subjects were males(80%). The majority (66%) were in the age group of 21-40 years. The most common OPC to be consumed was Methyl parathion (27%), followed by chlorpyrifos (22%). The major GIT complications were abdominal pain/cramps (100%), followed by nausea and vomiting (83%). Mechanical ventilation was needed in 40% and mortality was reported in 25% of the subjects.
Conclusion:OP poisoning affects resonantly males in their economically productive phase of life. Considering the high mortality, adequate strengthening of health services, especially at the primary level is the need of the hour
Fibrosarcoma of Maxilla: youngest case report
Get PDFFibrosarcomas are rare but highly fulminant and aggressively malignant neoplasm which occurs as a result of mutated spindle-shaped fibroblasts. According to WHO, they are soft tissue sarcoma commonly present seldom at cutis. The etiology of such a malignancy is obscured nevertheless it has several predisposing factors like pre-existing pathology but the commonest of them is radiation. Mesenchymal malignancies were initially over-diagnosed and were the epicenter of diagnostic dilemma to the pathologist, but with the advent of Vimentin staining and immunohistochemistry, the diagnostic front has fairly advanced for fibrosarcomas. Incidence of Fibrosarcoma in Maxilla accounts for less than 0.1%, when compared to other head and neck malignancies, and is predominantly found between 2nd to 6th decades of life. Various approaches have been documented in the literature regarding its treatment, but aggressive surgical excision remains the mainstay of treating Fibrosarcomas. The role of adjuvant medicinal therapies have been well debated but do have a conclusive outcome. Through this article, we want to highlight and document a case, which occurred at an exceptionally young age, at a site that had no predisposing factors but has proven immunohistochemical diagnosis and was rapidly fulminating and aggressively malignant. The preoperative diagnosis of the patient was inconclusive reporting it to be a mesenchymal tumor, therefore, the patient was treated with the intraoral approach for wide surgical resection. The surgical specimen was subjected to immunohistochemistry with Vimentin staining which reported it to be a Fibrosarcomas, therefore the patient was advised chemotherapy, yet the prognosis is guarded
Role of pleural biopsy in patients of undiagnosed exudative pleural effusion
Get PDFIntroduction: Sometimes etiological diagnosis of pleural fluid is not possible by cytology, biochemical and microbiological examinations and labeled as undiagnosed exudative pleural effusion. Our aim of this study to make an etiological diagnosis in such undiagnosed exudative cases with pleural biopsy.
Material and method: In this study patients with undiagnosed exudative pleural effusion, where the diagnosis was not made by laboratory investigations were included. Pleural tissue was obtained by Abram’s Needle and sent for histopathology and culture to find mycobacterium tuberculosis.
Result: Out of 45 patients 34 (75.5%) were males and 11 (24.5%) were females. The side of pleural effusion was right-sided in 30 (66.6%) and left-sided in 15 (33.4%). The mean value of polymorphs and lymphocytes count was 7.24% and 92.76% respectively. Pleural fluid was hemorrhagic in 10 (22.22%) patients, straw-colored in 30 (71.11%) patients, and clear in 5 (11.11%) patients. The mean level of glucose was 65.66 mg/dl, the lowest being nil and highest being 110 mg/dl. The mean level of protein was 5.54 gm/dl (range 3.7-7.21 gm/dl). The mean value of the pH of pleural fluid was 65.44. Histopathology showed granulomatous inflammation compatible with tuberculosis in 24 (53.3%) cases, metastatic malignancy in 7 (15.5%) cases, chronic inflammation in 10 (22.3%) cases. In 4 (8.9%) cases pleural tissue was inadequate to give any opinion. Among 7 cases of malignancy, 5 (71.42%) cases showed adenocarcinomas and 2 (28.58%) cases showed squamous cell carcinoma.
Conclusion: This study suggests that tuberculosis and malignancy are the two common etiologies for exudative pleural effusion. The role of pleural biopsy is pivotal as it helps in making the diagnosis in the majority of cases where other laboratory investigations fail to provide a diagnosis