International Journal of Medical Research & Review (IJMRR)
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A study on incidence of subclinical hypothyriodism in patients with heart failure
Get PDFObjectives: Subclinical hypothyroidism (SCH) is a common disorder that is characterized by elevated thyroid-stimulating hormone levels in conjunction with free thyroxine concentrations within the normal reference range. Thyroid hormones are known to affect the heart and vasculature and, as a result, the impact of SCH on heart failure. Strong evidence points to a link between SCH and HF risk factors such as alterations in blood pressure, lipid levels, and atherosclerosis. Additionally, accumulating evidence indicates that SCH is associated with metabolic syndrome and heart failure. The present review proposes that SCH may be a potentially modifiable risk factor of heart failure and mortality.
Methods: This is an observational study to determine the incidence of subclinical hypothyroidism in patients with heart failure and the cardiovascular risk profile among patients in a 750 bedded tertiary health care centre in south India, over a period from June 2018 to November 2018.
Results: In our present study it was noticed that most of the patients were in the age group above 51-60 yrs (45.45 %). Our study data suggest that subclinical hypothyroidism with a TSH ≥10.0 mIU/L represents a potentially modifiable risk factor for HF in older adults but not subclinical hypothyroidism with moderate TSH levels (TSH 4.5 to 9.9 mIU/L) and subclinical hyperthyroidism.
Conclusion: Subclinical hypothyroidism are more prone to associated with heart failure as an asymptomatic which is essential to be identified and treated for a better outcome as its association is proven statistically in our study
Presentation of ischemic heart disease cases in tertiary care centres located in central India
Get PDFBackground: Cardiovascular disease, one of the non-communicable diseases, has become a major public health problem in many developing countries. There is an epidemiological transition from infective/ communicable disease to Non communicable/degenerative diseases, increases in the prevalence of cardiovascular risk factors, and ageing of the population, which eventually leads to an increase in the absolute numbers of people with coronary heart disease (CHD) especially ischemic heart disease. This will need an increase demand of health awareness and demand for health care facilities.
Aim: To know different ways of presentation of IHD cases.
Material & Method: In this study total 255 IHD cases aged between 21 to 90 years were assessed between April 2017 to March 2018. Study was conducted in tertiary care centre located I central India. Informed consent was taken from patients or their relatives in case of unconsciousness of patient.
Result: Total 255 patients were enrolled in this study out of which 175 were male with mean age of 58.57±7.2 years and 80 female patients were enrolled with mean age of 63.14±4.6 years. 18 patients were died. Most of the patients (59.22%) were mainly came with complain of chest pain. Other patients were coming with complain of breathlessness (7.06%), nausea/ vomiting (8.24%) and uneasiness (8.23%).
Conclusion: over the time after independence trends and presentation of cardiovascular diseases especially ischemic heart disease is change. Knowing of current way of presentation is important. As disease trend is changing, knowledge of their pattern and availability of health resources accordingly is must
Dosimetric comparison and clinical correlation between conventional four field radiotherapy versus three-dimensional conformal radiotherapy in cancer cervix
Get PDFIntroduction: With sectional imaging, wide variations are reported in pelvic anatomy of individual patients raising concerns over adequate coverage of target volume with conventional radiotherapy based on standard bony landmarks. Three-dimensional conformal radiotherapy (3DCRT) is reported to decrease normal tissue toxicity, along with decrease in chances of geographic miss. Present study is done for dosimetric comparison of Planning Target Volume (PTV) and Organs at Risk (OAR) in cancer cervix patients treated with conventional and conformal radiotherapy along with clinical correlation in terms of side effects and tumor response.
Materials and Methods: Fifty patients of cancer cervix underwent planning contrast enhanced CT scan. Target volumes & OAR were contoured. Patients were randomized into conventional & conformal arms. Conventional fields were planned using standard bony landmarks. CT based radiotherapy planning was done for 3DCRT arm. Field sizes &dose volume histogram (DVH) were recorded & compared for target coverage & OAR sparing in both arms. All patients received concurrent chemotherapy followed by brachytherapy.
Results: Field sizes used for the 3DCRT plans were significantly larger than those used for the conventional plans (p= 0.000). Optimal PTV coverage was significantly improved using 3DCRT as compared to conventional radiotherapy (p= 0.0001). Dose homogeneity in both arms were almost similar (p= 0.292), while conformity index was better in 3DCRT which was statistically significant between the groups (p= 0.000). Mean dose to the Planning Target Volume was increased significantly in the CT based plan when compared with the standard four field plan (p= 0.0001).Difference in doses to the organs at risk (urinary bladder, and small bowel)and their side effects were statistically significant across both groups. There was no difference in tumor response.
Conclusion: The present study showed significantly better target volume coverage & dose homogeneity with 3DCRT which may translate into better local control & survival but longer follow up is required to validate it
Distribution of Coronary Artery Anomalies and Their Evaluation with Different Imaging Modalities
Get PDFIntroduction: Coronary artery anomalies (CAA) are diverse abnormalities.
Methods: A retrospective review of coronary imaging of 17,245 patients over 2 years was performed. Patients with CAA detected on echocardiography, invasive coronary angiography (CAG) and multidetector computed tomographic angiography (MDCTA) were compared.
Results: CAAs were detected in 257 patients (1.49%). Prevalence were: absent left main trunk- 0.319%, anomalous coronary artery from opposite sinus (ACAOS)- 0.516%, coronary fistulae- 0.203%, myocardial bridge- 0.093%, malignant anomalies- 0.3%. The commonest CAA was absent left main trunk. The yield of echocardiography negatively correlated with age (r=-0.6). CAG and MDCTA were equal (p=1) for detection of absent left main trunk. CAG had low sensitivity (58.3%) and MDCTA was better than it (p<0.01) for detection of abnormal high origin. For ACAOS, detection by both were not different (p=0.5) but the course was delineated better with MDCTA than with CAG (p=0.05). Both were equal for detection of intramyocardial course (p=0.5). However, MDCTA delineated its course better than CAG (p<0.01). Echocardiography had 93% sensitivity for fistula in those <12 years in age. Radiation exposure with CAG, 7.3 ± 2mSv, was lower than that with MDCTA, 14.5 ± 3mSv (p<0.01). It correlated with CAA score (r=0.3), with CAG but not with MDCTA. Contrast exposure correlated with CAA score (r=0.4) for adults with CAG but not with MDCTA.
Conclusion: Echocardiography reliably detects CAAs in children. CAG and MDCTA are comparable for detection of most CAA. MDCTA delineates the course better than CAG. For MDCTA, radiation exposure is not correlated with complexity of CAA in contrast to that with CAG
To study the level of congestion in Pre anesthetic Check up (PAC) clinic and use of Self-answering Pre-operative questionnaire to decongest it
Get PDFBackground: Aim of the study was to reduce congestion in PAC clinic, which is the direct indicator of efficiency of the hospital. 1) To study overall waiting time in the PAC clinic. 2) To suggest action to improve the waiting time in PAC.
Methods: Prospective, Descriptive study, 40 patients in each group. Group “R” = Patients registered for PAC clinic, who’s all vitals and clinical assessment was done after arrival to PAC clinic as routine practice. Group “Q” = Patients were provided Self-answering Pre-operative in waiting area and whose vital parameters were taken before arrival to PAC clinic by a trained staff. Data was recorded for both the groups.
Results: We found in our study that average waiting time that is total time from registration to completion of PAC in OPD clinic was statistically significantly less in QT-1 (Group “Q”) in comparison to RT-1 (Group “R”). We found in our study that average Doctor – Patient time that is time of interaction with Doctor during PAC in OPD clinic was also statistically significantly less in QT-2 (Group “Q”) in comparison to RT-2 (Group “R”).
Conclusion: Present study was planned to reduce congestion in OPD for pre-anesthesia checkup for elective surgery or procedure. Patient satisfaction comes automatically as a byproduct with the achievement of the goal of the study. Time is money in the present scenario and thus best utilization of time with efficient outcome is the prerequisite of any good management
Correlation of blood sugar and lipid parameters with carotid intima media thickness among patients with type II diabetes mellitus
Get PDFBackground: Of the various non invasive imaging methods available, arterial intima media thickness measurement obtained by B mode ultrasound is currently recommended by the American Heart Association as being relatively safe, non invasive and inexpensive method of assessing sub clinical atherosclerosis, and being an independent predictor of atherosclerotic events.
Aim: To study the correlation between glycemic and lipid levels with carotid intima media thickness among patients with type II diabetes mellitus.
Methodology: A prospective longitudinal study was conducted for a period of one year. Patients in the age group of 30 to 70 years with type II diabetes for more than 2 years were included as our study subjects. A total of 100 patients were included as our study subjects. Anthropometric measurements, blood sugar parameters and lipid parameters were measured as per the guidelines. Carotid artery intima media thickness was measured by B mode ultrasound having an electric transducer with a mid frequency of 7.5 MHz. Scans were performed on both the right and left extracranial carotid arteries by trained personnel. The IMT values were measured in six well defined arterial segments- near wall and far wall of distal 6mm of common carotid, the carotid bulb and proximal 6mm of internal carotid artery of both sides. The final IMT considered was the average of the IMT values at the 12 sites examined.
Results: A multivariate analysis was performed to assess the various factors influencing the increase in the thickness of CIMT and among that we found a significant correlation had occurred with the factors like BMI, waist hip ratio, fasting and post-prandial blood sugar, HbA1C and among the lipid parameters LDL, total cholesterol and triglycerides had shown a statistical significant correlation (p<.05), whereas factors like age, gender, hypertension status, duration of diabetes and HDL cholesterol among the lipid parameter did not show a statistical significant correlation with CIMT (p>.05).
Conclusion: CIMT measurement can be used as a regular screening tool in diabetic patients for the early detection of atherosclerosis among them
Predictive accuracy of CURB-65 as comparedto PSI scorein the severity assessment of community acquired pneumonia
Get PDFIntroduction: Pneumonia Severity Index (PSI) and CURB-65 rule for community acquired pneumonia (CAP) have been developed to stratify patients based on mortality. Lack of a risk stratifying score like PSI or CURB-65 can lead to significant delay in starting treatment. This study was conducted to find out the ability of CURB-65 score and PSI to predict clinically relevant outcomes.
Methods: 78 patients diagnosed as CAP admitted to a tertiary care hospital were enrolled into the study. Detailed clinical history was noted and CURB-65 and PSI scores were given with the help of a structured questionnaire in <24 hours of admission. The patients were revisited at day 3 and at discharge and data collected.
Results:Out of 78 patients included in the study, 60 were males and 18 were females. Of the 78 patients, 14 died accounting for aninhospital mortality of 17.94%. Mortality in the mild, moderate and severe groups of CURB-65 were 0%, 16.7% and 47.8% respectively. Mortality in the mild, moderate and severe groups of PSI were 1.8%, 50% and 80% respectively. Area under the curve (AUC) for CURB-65 and PSI in terms of inhospital mortality were 0.935 and 0.920 respectively.
Conclusion:The CURB-65 and PSI scores correlated well with mortality and other severity indicators. The CURB-65 has a better discriminatory power than PSI inour study. Because of its simplicity in addition to its better discriminatory power than PSI, CURB-65 may be better suited as a severity scoring system in CAP
Prospective study on radiation dose escalation in the treatment of squamous cell carcinoma of oesophagus with definitive concurrent chemo-radiation using three-dimensional conformal radiation therapy
Get PDFBackground: Poor local control and survival rates associated with radiation and chemotherapy in the management of locally advanced carcinoma of oesophagus have encouraged use of radiation dose escalation. This study analysed outcome and tolerance of radiation dose escalation with concurrent chemotherapy in non-metastatic squamous cell carcinoma of oesophagus.
Materials and Methods: Patients diagnosed with stage I-III squamous cell carcinoma oesophagus, intended to be treated with radical chemo-radiation, between August 2015 to August 2017 were included in this prospective study. Baseline endoscopy, oral intake score and FACT E-QOL score were documented. Patients were treated with radiation dose of 60Gy in 2Gy per fraction schedule (initial 46Gy followed by 14Gy boost to tumour alone) with concurrent 3-weekly 5-FU/Cisplatin or weekly Cisplatin alone regimen.
Results: Out of total of 20 eligible patients with median age of 64 years, majority had middle thoracic oesophageal tumour (60%), grade 2 dysphagia (75%) on oral intake scale. Patients with tumour length of ≤5cm (55%) or >5cm (45%) were categorised. Majority patients (85%) showed complete response at 3 months post treatment. The oral intake score and quality of life improved in 55% and 85%of the patients, respectively. Ten patients had disease progression with 40% of patients showing disease recurrence. No patient developed oesophageal fistula, radiation-pneumonitis or cardiac toxicity. Median disease-free survival and overall survival was 16 months (95% CI, 10-21 months) and 28 months (95% CI, 13-42 months) with 1-year and 2-year survival rates of 72.4% and 53.7%, respectively.
Conclusion: Radiation dose escalation with concurrent chemotherapy in the management of stage I-III, non-metastatic squamous cell carcinoma oesophagus yields a good local control rate at 3 months with less severe complications and improved quality of life
Case report of anaesthetic management of neonate with large occipital encephalocele
Get PDFIn the present case report, endotracheal intubation in a case of large occipital encephalocele presented for surgical excision was performed. As the management of airway even in a neonate is different and complex as compared to airway of old child and that of adult. It was challenging because of the difficulty in securing airway because of prone position in occipital encephalocele. The major concerns during the operation were to avoid premature rupture of the encephalocoele and to manage a possible difficult airway due to restricted neck movement and inability to achieve optimal position for intubation of the trachea. Continuous monitoring of patient was done during the surgery
Role of grey scale ultrasound and Colour Doppler findings to differentiate ectopic pregnancy from corpus luteum cyst of pregnancy
Get PDFIntroduction: Ectopic pregnancy and corpus luteum cyst are two most common differential diagnosis in a patient with UPT positive and no sonographic evidence of intrauterine pregnancy.
Aim: To diagnose ectopic pregnancy and to differentiate ectopic pregnancy from corpus luteum cyst of pregnancy on the basis of grey scale ultrasound and colour Doppler findings.
Material and Methods: This was a hospital based prospective study carried out on a study group of 40 patients with UPT positive and clinical features suggestive of ectopic pregnancy over a period of two years.Grey scale ultrasound and colour Doppler parameters were studied.
Results: Out of 40 patients,30 were diagnosed with ectopic pregnancy and 10 with corpus luteum cyst. Ectopic pregnancies had thicker walls as compared to corpus luteum cysts. Most of the ectopic pregnancies had hyperechoic walls as compared to ovaries (80%) and endometrium (60%). Free fluid with echoes was seen in the pelvis in 70% ectopic pregnancies whereas most of the corpus luteum cysts (80%) had no free fluid. Most of the corpus luteum cysts (70%) had clear internal echotexture whereas ectopic pregnancies were mostly lacy or solid.Yolk sac was seen exclusively in ectopic pregnancy (30%). RI <0.4 and RI >0.7 was found to be highly specific for diagnosing ectopic pregnancy.
Conclusion: Wall thickness of the mass, echogenicity of the wall as compared to ovaryand endometrium, internal echotexture of the cystic mass, presence of yolk sac and presence of free fluid with echoes are significant ultrasound parameters which help to differentiate between the two. RI <0.4 and RI >0.7 was found to be highly specific for diagnosing ectopic pregnancy