International Journal of Medical Research & Review (IJMRR)
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An analysis of 2800 CT Head scans in patients with chronic headache
Get PDFIntroduction: Chronic headache is a common health problem in general medical practice and there is increasing demand of CT scan from specialist as well as non-specialist doctors to refer patients for CT head scan.
Patients and methods: The present study was done on 2800 CT head scans of patients with problem of chronic headache. While patients in Group 1 (n=1900) had only chronic headache without any neurological findings, Group B comprised of cases (n=900) referred by specialist doctors after neurological examination. CT scan was done by trained technicians and contrast was injected where necessary.
Results: Present study showed majority of patients in both group 1 and group 2 (90% and 87.7% respectively) had normal CT findings or insignificant findings. However, difference was not significant in both groups when significant findings (10.0% Gr. A and 12.2% Group B) were compared.
Discussion: Our findings are consistent with other studies concluding that routine CT scan may not provide clinically useful information in chronic headache
Analysis of risk factors of acute kidney injury in organ donors
Get PDFBackground: To investigate the occurrence and risk factors of acute kidney injury (AKI) in organ donors.
Methods: Clinical data of 153 donor patients who donated organs in our hospital from January 2016 to July 2018 were collected. Patients were divided into AKI group and non-AKI group according to AKI diagnostic criteria. Clinical indicators of patients in the two groups were compared, and the related risk factors were analyzed by unifactorial and multivariate logistic regression.
Results: The incidence of donor patients complicated with AKI was 48.37%. Unifactorial analysis suggested that the SOFA score, positive rate of blood culture, hypothermia incidence and vasoactive drug dose in donor AKI group were larger than those in non-AKI group. Multivariate Logistic regression analysis showed that the dose of booster drugs (P=0.02, OR=3.53) and the positive rate of blood culture (P=0.01, OR=6.64) were independent risk factors for donor patients complicated with AKI.
Conclusion: The incidence of acute kidney injury in organ donors is high, with the dose of booster drugs and the positive rate of blood culture as independent risk factors for evaluation basis to assess the incidence rate of donor patients complicated with AKI
A cross-sectional study of thyroid autoimmunity in women with type 2 diabetes: case for routine thyroid dysfunction screening
Get PDFIntroduction: Subjects with diabetes have a higher prevalence of thyroid disorders compared to the general population. The reported prevalence of thyroid disorders is 10-24% in subjects with diabetes and 6 - 13% in subjects without diabetes. Auto immunity is held responsible for the increased prevalence of thyroid dysfunction in diabetes. Studies have proven the higher rates of autoimmune thyroid dysfunction in type 1 diabetes, but there is very little information regarding thyroid autoimmunity in type 2 diabetes.
Objective: To estimate the prevalence of thyroid dysfunction and thyroid autoimmunity in women with type 2diabetes.
Material and Methods: Samples for thyroid function test including free thyroxin (fT4), thyroid stimulating hormone (TSH) and thyroid peroxidase antibodies (anti -TPO) were obtained from 100 women with type 2 diabetes, attending the outpatient department of Karnataka Institute of Endocrinology and Research, Bangalore.
Results: Thyroid dysfunction was found in 42% subjects, where 36% had subclinical hypothyroidism and 6% had overt hypothyroidism. Anti - TPO positivity was seen in 30% of the subjects. Anti-TPO positivity was found in 24.1% euthyroid subjects, 33.3% subclinical hypothyroid subjects and 66.7% overt hypothyroid subjects. Significant positive correlation was observed between anti-TPO and TSH (p value <0.001*). No statistically significant association was found between thyroid dysfunction and age, BMI, Hba1c, and diabetes duration.
Conclusions: The prevalence of thyroid dysfunction is significantly high in women with type 2 diabetes. The most common abnormality is subclinical hypothyroidism and autoimmunity is the cause of thyroid dysfunction in large proportion of these subjects
Evaluation of stress parameters in new medical entrants based on their admission criteria to a south Indian medical college
Get PDFObjectives: Globally medical education is now recognized as a highly stressful course and students that enter this program are subject to multiple stress producing factors that affect their academic performance as well as their mental and physical well being. This study was done to determine the prevalence of stress among first year medical (MBBS) students based on their admission criteria and to identify the sources of stress among them.
Material and method: A Cross sectional study. The study was conducted in a semi-government medical college, Kerala, India. Subjects included first year medical students (both male and female) enrolled in the college during the year of study.
Interventions: GHQ-12 Questionnaire was used to assess the psychological stress. A pretested structured closed ended questionnaire to collect information regarding the academic and non-academic sources of stress was charted out.
Result: A total of 100 students were admitted to the first year of which 85 consented to take part in this study. Of the 85 students, 42 (49.4%) were having stress. Of these, 35 (83.3%) were repeaters (attempted the medical entrance examination more than once) and among them, 26 (61.9%) were students who secured admission based on merit. A statistically significant association was seen between the number of attempts, admission criteria and stress (p<0.05). The main academic stressors identified were language of communication, peer competition, long working hours, frequent examinations and increased study work load. The main nonacademic stressors identified were parental pressures, decreased recreation period and stay away from home.
Conclusions: This study found that stress was more among repeaters and those who secured admission based purely on merit. Nonresident Indian (NRI) students who secured admission through higher financial investments along with sudden displacement from home environment also suffered from significant stress levels. The possible sources of stress found in the study can be a preliminary step towards developing solutions for stress management and stress prevention in new medical entrants which could help in developing a new generation of stress free doctors capable of effectively providing high quality medical care to the community at large
Metabolic Syndrome in psoriasis: a hospital based cross-sectional study in Central India
Get PDFBackground: Psoriasis is a chronic immune-mediated inflammatory disorder, reported to be associated with obesity, dyslipidaemia and diabetes via common immunological mechanisms. All of these components ultimately increase the risk of metabolic syndrome and cardiovascular morbidities.
Aims and Objectives: To assess the association of Metabolic Syndrome (MS) and its components in patients suffering from psoriasis. To study the relationship between the duration and severity of psoriasis and MS.
Materials and Methods: A hospital based cross-sectional study was conducted involving 100 adult patients with psoriasis and 100 controls. All participants were evaluated forpsoriasis and the components of MS. Psoriasis was categorized as mild, moderate and severe based on Psoriasis Area and Severity Index (PASI) (<7, 8–12 and >12, respectively). In all patients and controls, body mass index was calculated, blood pressure and waist circumference were measured and fasting blood sugar and lipid profile were estimated.
Results: In the present study, a higher prevalence of MS in Psoriasis patients than in controls (38% v/s 23%) was observed. Psoriatic patients had higher prevalence of hypertension (36% v/s 14%). It can be concluded that association of MS and psoriasis is independent of the type, duration and severity of psoriasis.
Conclusion: The present study suggests that subjects with psoriasis present a greater risk of MS and should trigger a higher clinical suspicion for their co-existence. Psoriasis is a systemic disease with significant morbidity and mortality. This study emphasizes the critical need for providers to screen psoriasis patients for early diagnosis and treatment of associated MS. However, more number of large population based cohort studies are required to establish stronger association between psoriasis and MS
Evaluation of trans thoracic invasive diagnostic procedures in 50 adult patients of mediastinal diseases
Get PDFIntroduction: Mediastinum is a “Pandora’s box” with many neoplastic and nonneoplastic lesions. Clinico-radiological pattern of mediastinal diseases depends on the size, location and etiology. Hence, non-invasive approach to these cases sometimes leads to diagnostic dilemma.
Aims: A prospective study was performed over a 1-year period with the objective of evaluation of diagnostic yields and risk of trans thoracic ultra sound (TTUS) and computed tomography (CT) guided fine‑needle aspiration cytology (FNAC) and Tru-cut biopsy along with comparison of cost-effectiveness among mediastinal diseases where clinical and non-invasive imaging could not conclude the diagnosis.
Materials and Methods: A prospective study of mediastinal diseases of the adult population without having any diagnosis admitted in a tertiary care hospital in Eastern India was performed after clearance of the ethical committee of the institute. Fifty cases of mediastinal diseases were seen during the study period. One patient sometimes had undergone more than one procedure. The choice of a procedure depended upon the location of the lesion, nature of disease and complication and cost effectiveness ofthe procedures. During the calculation of diagnostic yield of procedure, conclusive results and concordant results to more invasive procedures were considered.
Results: Among 50 patients diagnostic yield of TTUS guided FNA and Tru-cut biopsy were 60% and 63.6% respectively. Diagnostic yield of Thoracic CT guided FNA and Tru-cut biopsy were 85% and 92.3% respectively. As a whole TTUS guided invasive procedure and Thoracic CT guided invasive procedure had a diagnostic yield of 61.5% and 87.9% respectively. Complication is less in CT guided invasive procedures (9.1%) compared to Transthoracic USG guided invasive procedures (11.5%) and complication is more common in Tru-Cut biopsy (16.7%) than fine needle aspiration (5.7%).
Conclusion: Tru-cut biopsy if applicable is much superior to FNAC for a definite diagnosis of the mediastinal diseases. TTUS guided invasive procedures are very much cost-effective and have added advantage of real time guidance and is comparable with CT guided invasive procedures in respect to risk and diagnostic yields
A study of serum magnesium level in hypothyroid cases in a tertiary care hospital, Perambalur
Get PDFMagnesium is an incredibly vital mineral found in the human body. Magnesium clearly affects the entire body and naturally will interact with thyroid functions, both directly and indirectly.
Objectives: To assess the levels of serum magnesium in patients with hypothyroidism and its correlation with TSH levels.
Methodology: An observational study consists of 174 cases of hypothyroidism were selected. All patients with hypothyroidism, newly diagnosed with age above 18years were included, all patients with malignancy, multiple endocrine disorder, CKD and patients supplemented with minerals were excluded in the study. Thyroid function and serum magnesium levels were done and analyzed in these patients.
Results: In our study mean serum magnesium level in hypothyroid cases was 2.18±0.02 mg/dl. Our study done with a follow up of thyroid function and serum magnesium level in hypothyroidism after supplementation with thyroid hormone and diet supplementation for magnesium showed a significant improvement which reciprocate the incidence of hypo magnesium in hypothyroidism and which is inversely proportionate to TSH levels which was not statistically significant.
Conclusion: The alteration of serum magnesium level in hypothyroidism was not established in our study statistically
Assessment of efficacy of Anti-IgE (Omalizumab) therapy in patients with severe allergic asthma in a tertiary care hospital of Eastern India
Get PDFIntroduction: Immunoglobulin E dependent mechanisms play an important role in the development of airway inflammation in allergic asthma. Atopic patients with severe asthma frequently have poorly controlled disease. Many have poor asthma control despite intensive treatment. Severe allergic asthma patients frequently treated with oral corticosteroids and therefore may develop serious side-effects. Anti-IgE antibody had been used in severe persistent allergic asthma in Western countries. However, its long-term efficacy in patients in India has not been reported.
Objective: To assess the efficacy of anti IgE therapy in patients with severe allergic asthma.
Method: 30 (16 male and 14 female) patients, with mean age of 49 having severe persistent allergic asthma, with recurrent exacerbations and on oral/IV steroids, received Omalizumab 150mg/300mg/450 mg for 1 year. Total dose of oral Steroids, use of rescue medications, changes in lung function (FEV1) were recorded at the baseline, 16 weeks & at end of the treatment (52 weeks) and then analyzed.
Results: Significant reduction observed in total oral steroid use at 16 week & at 52 weeks. -10.5mg (p<0.003) & 22.5mg respectively. Use of rescue medications decreased by -7.90 puffs(p- <0.001) at 16 weeks and by -13.67 puffs (13.67 (p -<0.001) at 52 weeks. Improvements in lung Function (FEV1) observed with a tune of 700 ml. from Baseline after 52 weeks therapy.
Conclusion: Use of anti-IgE antibody for 1 year is well tolerated and led to an overall significant improvement in patients with severe persistent allergic asthma
A clinicopathological study of pleural effusion with special reference to malignant aetiology in a tertiary care hospital in West Bengal
Get PDFBackground: Pleural effusion has varied aetiological factors. It constitutes one of the major causes of morbidity in India as well in other parts of world. Because of the various aetiologies that can cause pleural effusion, itoften present a diagnostic problem, even after extensive investigations.
Objective: In this study, authors aimed to identify the common aetiologies causing pleural effusion and their clinical profile in a tertiary care hospital.
Materials and Methods: A hospital based cross-sectional study is conducted over a period of one year in tertiary care hospital in West Bengal. 150 patients of pleural effusion above 10 yrs of age were studied. Clinico-pathological, radiological, hematological and biochemical parameters were documented.
Results: The most common cause pleural effusion in this study was tuberculosis (64.67%), followed by malignancy (14.67%), parapneumonic effusion (7.33%), cardiac failure (5.33%) and other minor causes. It was commonly seen in male (70%). The occurrence of tubercular pleural effusion was maximum in the age group 31-40 years. Right-sided effusions were more common. Pleural fluid cytology and adenosine deaminase played a pivotal role in the diagnosis of tubercular pleural effusion.
Conclusion: The present study highlights tuberculosis as the common causative factor for pleural effusion, labels lung carcinoma as the most common cause of malignant pleural effusion, and defines the clinico-pathological, biochemical and imaging characteristics of different aetiologies of pleural effusion
The correlation of doxorubicin related cardiotoxicity with B-type natriuretic peptide levels in South Indian population
Get PDFBackground: Anthracyclines represent the greatest risk for development of cardiotoxicity. Cardiotoxicity of anthracyclines may develop during the treatment (acute cardiotoxicity) and during the follow-up (chronic and late cardiotoxicity). Natriuretic peptides - Atrial Natriuretic Peptide (ANP), B-type Natriuretic Peptide (BNP) and N-terminal pro B-type natriuretic peptide (NT-pro-BNP) are released by myocardium in response to wall strain and pressure overload. The applicability of natriuretic peptides (ANP, BNP, NT-pro-BNP) as markers for Anthracycline-induced cardiotoxicity has been investigated only in a few studies and there is scarcity of data from India.
Aims and Objectives: To observe correlation of NT-pro-BNP levels with cardiotoxicity in patients receiving doxorubicin.
Methods and Materials: Eighty patients who were planned for treatment with Doxorubicin > 200 mg/m2 were included in this study. Each patient was assessed clinically (History, Pulse rate, Blood pressure) along with ECG, ECHO and NT-pro-BNP levels prior to initiation of chemotherapy, after completion of 200 mg/m2 of Doxorubicin, 3 months and 6 months after chemotherapy.
Result: There were total of 80 patients in the study and they received a total of 384 cycles of Doxorubicin containing regimens according to respective protocols. The median number of cycles was four (range four to six cycles). The mean cumulative dose of doxorubicin was 267.75 mg/m2. As none of the patients developed any cardiac symptoms during or after the planned chemotherapy nor was there a drop in Ejection Fraction on serial ECHO, correlation with BNP levels was not possible. There were 4 patients who had very high values of NT-pro-BNP (>300 pg/ml) and 4 patients with moderate elevation of NT-pro-BNP (200-300 pg/ml) prior to the initiation of chemotherapy. 14 patients had serially increasing values of NT-pro-BNP in the 6 months follow-up.
Conclusion: Based on the findings in this study it can be concluded that high upfront BNP values or increasing values of BNP does not correlate with the incidence of acute and early onset chronic cardiotoxicity. Whether or not the BNP values correlate with the incidence of late onset cardiotoxicity can be concluded only with a longer follow-up of these patients