International Journal of Medical Research & Review (IJMRR)
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Profile of intractable epilepsy in a tertiary referral center in upper Assam
Get PDFIntroduction: Epilepsy is a common and diverse disorder with many different causes.Outcomes are varied with 60—70% of newly diagnosed people rapidly entering remission after starting treatment, and 20—30% developing a drug-resistant epilepsy with consequent clinical and psychosocial distress.
Methods: It is a Descriptive Cross-sectional study which was conducted in Assam Medical College and Hospital, Dibrugarh from April 2014 to April 2016. A total of 42 patients of IE attending the neurology, paediatrics and medicine department were included in the study.
Results: Forty-two patients (males 24, females 18) with intractable epilepsy were included for the study. Maximum patients were in between 20-40 years of age (42.9%) and their mean duration of epilepsy was13.2 ± 7.13 years. The seizure frequency varied from once every month to more than 200 per (mean 26.2 ± 24.17) month. Twenty-six patients (61.9%) had partial seizures, 8 (19.1%) patients had generalized seizures and 8(19.1%) had multiple seizure semiology. Thirty-six patients had risk factors of intractable epilepsy. Seven (16.6%) patients were having family history of epilepsy and 4(9.5%) patients had history of febrile seizures. Mesial temporal lobe sclerosis (MTLS) and birth hypoxia are the two major risk factors for intractable epilepsy. EEG was abnormal in 66.7% cases, with generalized background slowing in 19.1%, focal slowing in 14.2%, generalized epileptiform discharges in 9.5% and focal epileptiform discharges in 23.8%. CT brain was abnormal in 18(42.9%) patients. MRI brains were abnormal in 25 out-off 36 patients (69.4%). Carbamazepine was the most commonly used drug (57.1%) followed by clobazam (47.6%). Phenytoin, levetiracetum, Phenobarbitone, oxcarbazepine, zonisemide, lacosemide are the other AEDs used in combination.
Conclusion: This study showed, patients with partial seizures, birth hypoxia, history of febrile seizures, family history of seizures, structural brain abnormalities and background EEG abnormalities were the most common risk factors for development of intractable epilepsy
Case report- a case of Creutzfeldt-Jakob disease
Get PDFCreutzfeldt-Jakob Disease (CJD) is a rare invariably fatal neurodegenerative disease believed to be caused by an abnormal isoform of cellular infectious glycoprotein called prion protein. Though it is arare disease; yet it is the most common among prion diseases. Clinical presentation consists of rapidly progressive loss of memory, cognitive & visual disturbance, lack of coordination, myoclonus, cerebellar, pyramidal and extra pyramidal signs, akineticmutism & with progression of disease deterioration in higher mental functions become more pronounced. Periodic sharp triphasic wave complexes on EEG, high signal abnormalities in caudate nucleus and putamen on diffusion weighted (DW) or FLAIR MRI of Brain and positive 14-3-3 protein in CSF substantiate the diagnosis of CJD but definitive diagnosis is established by brain biopsy or autopsy materials. We report a case of 58-year old female patient who was admitted with complaints of rapidly progressive dementia, cognitive disturbance, blurring of vision and myoclonic jerks. Initial MRI brain and CSF findings were normal. Differential diagnoses that can present with rapidly progressive dementia and thereby mimic sporadic Creutzfeldt-Jakob disease were considered after review of literature. In EEG triphasic wave complexes were seen, repeat DWMRI after two weeks showed bilateral hyper-intensities in basal ganglia involving caudate nucleus and putamen, suggesting a diagnosis of probable CJD on the basis of center for disease control and prevention (CDC) criteria. The case is reported because of its rarity and also to emphasise that patients with rapidly progressive dementia, associated visual and cognitive disturbances and myoclonus should be investigated with DW MRI, EEG&CSF for diagnosis of CJD
Prevalence of cardiac dysfunction in type 2 diabetes in a tertiary health care setup
Get PDFIntroduction: Diabetes mellitus (DM) may be one factor that specifically influences cardiac diastolic function. The present study was designed to examine cardiac dysfunction in diabetes subjects with non-chronic renal failure (CRF).
Materials and methods: Study was approved by Institutional ethics committee, Informed consent from the study subjects. Diagnosis of diabetes was made according to WHO criteria. Plasma glucose concentration, serum lipids (total cholesterol, triglycerides, LDL cholesterol and HDL plasma cholesterol concentrations) were measured as per standard procedures. Glycosylated hemoglobin (HbA1c) was estimated by ion exchange resin method. ECG recording was obtained for every subject to rule out ischemic heart disease.
Results: Of the 150 study Type 2 diabetes participants, the male female ratio was 1.1. The mean HbA1C was 9.112±1.36 %. 2D ECHO findings showed 34% left ventricular hypertrophy and 51.3% diastolic dysfunction. Dyslipidemia was identified in 54.7% and statistically there was no significant association between dyslipidemia and diastolic dysfunction (P = 0.532).
Conclusion: In this study, diastolic dysfunction dyslipidemia was identified in 51.5% participants without dyslipedemia. Though, there was no significant difference, this number is to be considered. However, studies should be conducted with big samples size
Comparison of efficacy of Lignocaine 1.5 mg/kg & Dexmedetomidine 1 μg/kg in attenuating the hemodynamic pressure response to laryngoscopy & intubation
Get PDFBackground: Dexmedetomidine attenuates the hemodynamic stress response tolaryngoscopy and intubation more effectively compared with Lignocaine without any deleterious effects. To study the efficacy of Lignocaine 1.5 mg/kg & Dexmedetomidine 1 μg/kg in attenuating the hemodynamic pressure response to laryngoscopy & intubation.
Material and Methods: A total of 100 American Society of Anesthesiologists (ASA) physical status I and II patients aged between 18 and 50 years undergoing elective surgery were enrolled in the study. Patients posted for elective surgery were randomly selected and divided into two groups. Group L = 50 Patients had given 1.5mg/kg Lignocaine; Group D = 50 Patients had given 1µg / kg Dexmedetomidin.
Results: In Dexmedetomidine group, HR, SBP, DBP and MAP showed significant decrease throughout the study period, as compared to Lignocaine group. The statistical analysis shows that, in Dexmedetomidine group, HR, SBP, DBP and MAP showed significant decrease throughout the study period, as compared to Lignocaine group.
Conclusion: Newer agents like Dexmedetomidine, a centrally acting alpha-2 agonist suppresses reflex sympathetic stimulation caused by laryngoscopy & intubation more effectively than Lignocaine. Thus, it is concluded that Dexmeditoedine is a better drug compared to Lignocaine in attenuating pressure response to laryngoscopy & intubation
Efficacy of chemo-radiotherapy versus radiotherapy alone in the treatment of esophageal carcinoma
Get PDFBackground: The treatment of esophageal carcinoma may demand multiple approaches including combination of radiotherapy and chemotherapy, particularly cases which are considered unresectable, such as upper third esophageal cancers, locally advanced middle and lower third cancers.
Methods: This was a prospective, randomized, open-label, single-center study conducted between December 2014 and July 2016. Patients of either sex aged more than 18 years with the confirmed diagnosis of previously untreated advanced esophageal carcinoma were included in the study. Eligible patients were randomized to receive one of the treatments (chemo-radiotherapy [cisplatin] or radiotherapy alone). Response criteria included dysphasia free survival (DySF), disease free survival (DFS), and overall survival (OS). Tolerability was also assessed.
Results: A total of 31 patients (chemo-radiotherapy, n=13; radiotherapy alone, n=18) were enrolled in this study. At one year, the probability of remaining dysphagia free was 40% and 20%, respectively for chemo-radiotherapy and radiotherapy alone groups; and the probability of OS was 64% versus 21%, respectively. The median DFS was 12 months and 5 months for chemo-radiotherapy and radiotherapy alone group, respectively. There were no significant differences in both the groups in EBRT, total treatment duration and duration of EBRT. No patient reported thrombocytopenia or nephrotoxicity.
Conclusions: Concurrent chemo-radiotherapy with cisplatin can improve dysphasia and OS in patients with esophageal carcinoma
Evaluation of prolactin and insulin resistance in women with polycystic ovarian syndrome
Get PDFBackground: Polycystic ovarian syndrome has been one of a major public health problem in India that leads to medical consequences. It causes multifactorial in etiology such as menstrual dysfunction, hyperandrogenism, hirsutism, insulin resistance, dyslipidemia and obesity which increased risk of diabetes mellitus and cardiovascular disease. Prolactin has been reported as a potent lipogenic and diabetogenic factor, that affecting energy balance and fuel metabolism. The present study was designed to assess serum prolactin and insulin resistance in PCOS women and to compare them with healthy women as controls.
Material and Methods: A comparative study including 50 women diagnosed as PCOS and 50 age and BMI matched healthy women as controls was conducted. The age group for the study was 18-35 years. Body Mass Index was calculated as a physical parameter. Fasting blood samples were drawn to assess serum prolactin, serum insulin, HbA1c and fasting blood sugar. Insulin resistance was calculated by homeostasis model assessment.
Results: A significant increase in fasting serum insulin (p<0.001) and HOMA – IR (p<0.001) were found in patients with PCOS in comparison with controls. Mean BMI, prolactin, HbA1c and FBS were found elevated in the PCOS women but they were not statistically significant. No significant correlations were found between BMI, serum prolactin and serum insulin.
Conclusions: The current study provides further evidence that significantly higher fasting insulin and HOMA in PCOS group indicates presence of IR. IR in PCOS group may have a potential role in the prediction of dysglycemic disease in women with PCOS. This study could not find any significant correlation between serum prolactin, serum insulin and BMI
Study of fine needle aspiration cytology evaluation of peripheral lymph nodes
Get PDFIntroduction: Lymph nodes are an integral component of the immune system and their enlargement is commonly noted in clinical practice in a wide spectrum of diseases, including infections like tuberculosis and malignancy. FNAC is an important diagnostic tool for rapid evaluation of mainly superficial lesions, especially of lymph nodes. It is cost effective, relatively less traumatic, and enables the pathologist to provide the clinician with a diagnosis in a very short time, and hence is ideal especially for OPD patients.
Objectives: 1. To study the age and sex distribution of the patients of FNAC of peripheral lymph node. 2. To study the spectrum of diseases diagnosed on FNAC of peripheral lymph nodes.
Methods: Cross-sectional hospital based Observational study. Total 50 patients who had superficial lymphadenopathy were included in this study. Male patients were 21 (42%) and Female patients were 29 (58%). FNAC was performed on this 50 patients. Diagnosis was made by light Microscopy. Result was tabulated and statistical analysis was done.
Results: Male patients were 21 (42%) and Female patients were 29 (58%). 50 % patients were in the age group of 21 to 40 years. Reactive hyperplasia was 46% and Granulomatous lymphadenitis was 18%. Cervical lymph nodes were most commonly involved.
Conclusion: FNAC is a simple, quick, low cost, minimally invasive and easy diagnostic procedure which is very much helpful in the diagnosis of diseases causing superficial lymphadenopathy in all age groups. Reactive hyperplasia of lymph node was the most common cytological diagnosis followed by Granulomatous lymphadenitis
Comparative analysis of biochemical parameters and gene expressions of novel markers in type II Diabetes mellitus
Get PDFBackground: Diabetic nephropathy (DN) is the most common cause of end stage renal disease (ESRD). Early detection of the disease and treatment of this chronic complication which would reduce the medical and economic burden. Early detection of kidney injury by evaluating gene expressions of Il-6, Il-10, LDLr, and CD36 in T2DM with pre-ESRD microalbuminuria minimizes the risk of DN.
Methods: Present research work conducted at the Department of Biochemistry, School of Medicine, Navi Mumbai. This study includes 241 subjects (118 male, 123 women, and age ranges 30-70 years) were included after screening for T2DM by measurement of blood glucose in fasting, post-prandial, glycosylated haemoglobin. Microalbumin in urine and e-GFR is measured to eliminate patients of ESRD. Subjects were recruited after written consent and enrolled as per inclusion/exclusion criteria. Categorization of subjects in three study groups; group I (30-45 years), group II (46-70 years) were done on the basis of T2DM duration 3-6 years, glycosylated haemoglobin level (HbA1c) ≥ 7.0% with fasting blood glucose ≥126 mg/dl) and microalbuminuria (30-300 mg/dl) in study group, equal numbers of healthy volunteers enrolled in control group. Blood samples were processed for other renal parameters and RT-PCR to check expressions of novel genes
Results: In study groups all renal, lipids parameters are within normal range except albumin/creatinine ratio (p <0.012), e-GFR (p <0.00) and cholesterol (p <.00). Descriptive analysis showed high significance (p <.00) of delta CT gene expressions, parameters in pre-ESRD microalbuminuria subjects.
Conclusion: Screening biochemical renal parameters are not enough to prevent DN even in microalbuminuria. Early detection of gene expressions of novel biomarkers predicts risk of kidney injury. Early intervention may prevent morbidity and mortality of kidney due to diabetic nephropathy
Dosimetric parameters of heart and left ventricle – comparison of 3D CRT and IMRT in left cancer breast
Get PDFBackground: Conformal Radiotherapy techniques adapting to the ballistics of delineated volumes allowed significant reduction in excess radiation induced mortality however the increasing number of long-term survivors and expanding use of cardiotoxic drug highlight the persistent need for maximal cardiac possible sparing. The low dose volume of left ventricle are better predictor of acute coronary events than mean heart dose.
Materials and Methods: 38 post-MRM patients were randomized to treatment by 3Dimensional Conformal Radiotherapy (3D CRT) and Intensity Modulated Radiotherapy (IMRT) technique. Two tangential beams were used in 3D CRT technique while five to seven (mostly tangential beams) were used in inversely planned IMRT technique. The dose volume parameters of planning target volume, heart and left ventricle were compared.
Results: The dosimetry of Planning target volume showed significantly better coverage in IMRT technique (D90, D95) however the D50 was comparable in both the techniques. In dosimetry of heart, the high dose volumes (V30, V40) were nearly comparable in both the techniques. The other dose volume parameters (V5, V10, V20, V25, D33, D67, D100) and the mean dose were significantly lesser in 3D CRT technique along with significantly better sparing of left ventricle (Dmean and V5).
Conclusion: The dosimetry of target volume was better with IMRT technique, but this was accompanied by a huge increase in dose to whole heart and specifically the left ventricle which has strong potential to translate into an increased cardiotoxicity. A better distribution of the target region may be obtained by multiple segmentation of the two tangential fields in 3D CRT plans with further reduction in dose to heart and left ventricle
A quasi-experimental study to assess the effect of modified communication board on communication ability of post-operative CABG patients at selected hospital Bhopal, Madhya Pradesh, India
Get PDFInability to communicate can be a distressing problem for the patient who may be unable to speak because of the use of the paralyzing drugs or the endotracheal tube. The nursing management of the mechanically ventilated patient is challenging on many levels require acquisition of highly technical skills. Mechanically ventilated patient’s having more communication difficulties. Communicating effectively with ventilator-dependent patients is essential so that various basic physiological and psychological needs can be conveyed and decisions, wishes, and desires about the plan of care and end-of-life decision making can be expressed. Patient communication board improve communication, organize information and create a comfortable, attractive setting for patients, nurses, doctors, other care givers and visitors.
Methods: The study subjects were 60 post operative CABG patients, 30 in each group; control group and experimental group selected through purposive sampling technique is often referred to as theoretical or judgmental sampling. Non equivalent control group design was used to assess the effectiveness of modified communication board on communication ability of post-operative CABG patients.
Results: The obtained ‘t’ value is 12.15** is higher than the table value this indicates modified communication board is effective to enhance communication ability of post-operative CABG patients. Among experimental group about age and gender there was significant association found and in control group about gender association found, in clinical profile history of previous surgery strongly associated with communication ability of postoperative CABG patients.
Conclusion: there was significant relation found between modified communication board and communication ability of post operative CABG patients. This type of studies helps the nurses working in intensive and critical care unit in communicating with the mechanically ventilated patients. It is important for nurses to assess communication needs; identify appropriate alternative communication strategies to promote effective communication with non-vocal patients