International Journal of Medical Research & Review (IJMRR)
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Familial clustering and presenceof maternal influence on the transmission of type 2 diabetes in South Indians
Get PDFType 2 diabetes mellitus (T2D) is a chronic metabolic disorder, characterized by hyper glycaemia caused by impaired glucose homeostasis and represents a serious public health problem. T2D is a multi-factorial disorder depending on complex interactions between environmental factors and genetic variants.
Objective: To evaluate the degree of familial aggregation and maternal influence on the transmission of type 2 diabetes in the South Indian population.
Methodology: A total of 1063 subjects with type2 diabetes with knowledge of history of presence or absence of diabetes in relatives were randomly recruited. 652 were male and 411 were female.
Results: This study showed familial clustering and maternal transmission in our study population. 78.3% of the subjects had at least one relative with diabetes. Familial aggregation was significant with presence of diabetes in 1st degree relative like parents and in siblings. 2nd degree relatives too had significantly associated with diabetes to a similar extent like 1st degree relatives.Patient’s age range between 50-59 showed highest incidence of diabetes at 44% followed by 37% in age group 40-49. Our study showed an advancement of incidence of diabetes by one decade compared to similar studies in different regions.
Conclusion: Maternal factors do play an important role in the incidence of diabetes, prevalence of diabetes. Several factors may be involved in this in terms of polycystic ovaries, gestational diabetes, malnourishment during pregnancy, and other socioeconomic factors. We need studies and further research in ascertaining the exact mechanisms. Familial aggregation is common and may help us to screen for diabetes in high risk populations. Preventive strategies for type 2 diabetes should be directed at these high risk groups
Intubating conditions, onset, duration and side effects with rocuronium and atracurium: A comparative
Get PDFObjective(s): To compare the intubating conditions, onset and duration of action, side effects and complications with rocuronium bromide and atracurium besylate.
Material and Method: This prospective, randomized double blind study was conducted with a sample size of 100 patients. After standard general anaesthesia technique group I received IV. rocuronium bromide 0.6 mg/kg and group II received iv. atracurium besylate 0.5 mg/kg. Laryngoscopy was attempted60 sec after administration of NMBA and thereafter every 30 sec till good or excellent intubating conditions were achieved. Intubating condition was scored on fourpoint scale (0-3). Intubating conditions, onset and duration, side effects and complications were observed and recorded.
Result: Overall intubating condition was acceptable (excellent + good) in 50(100%) patients in group I and 47(94%) patients in group II. It was excellent in 45(90%) and 16(32%) patients in group I and II respectively. Good intubating condition was found in 5(10%) and 31(62%) patients in group I and II respectively. Fair intubating condition was found in 3(6%) patients in group II. None of the patients had poor intubating condition in either group. Cutaneous flushing was found in 4% cases in group II. No other side effects and complications were observed.
Conclusion: Rocuronium with its faster initial response and possibly early laryngeal muscle paralysis provides better intubating conditions in shorter duration of time than atracurium
Altered Fractionation Intensity Modulated Radiotherapy with concurrent chemotherapy in head and neck cancer : a feseability study
Get PDFPurpose: To assess the loco regional response and toxicity of patients to concurrent chemo-radiation with 6 fractions/week using Intensity Modulated Radiotherapy in locally advanced head and neck cancers. (oropharynx and hypopharynx).
Materials and Methods: 20 patients with Stage III and stage IV , squamous cell carcinoma of Head and neck were enrolled. Target Volume Delinetion was done in accordence with Danish Head and Neck cancer group (DAHANCA) contouring guidelines. Differential radiation dose of 70 Gy, 63Gy and 56Gy in 35 fractions using IMRT, delivered to GTV, CTV1 and CTV2 with weekly cisplatin with weekly assessment of response and toxicity.
Results: The median age of the patients was 54 years ranging from 40 to 65 years. 14 and 6 patients had Hypopharyngeal and Oropharyngeal malignancy of squamous cell origin. 95 % of patients received 70 Gy in 35 fractions with 4 cycles of concurrent Cisplatin. 18 patients completed treatemnt within 45 days of OTT. 16 patients had complete response and 4 had partial response. Grade I, II dermatitis was observed in 70% and 30% of patients, respectively. 5 patienst developed Grade 2 and 1 patinet developed grade 3 leucopenia. 2 patients had weight loss of more than 10%. 85% oforopharyngeal cancers and 67% of hypopharyngeal cancers showed complete response. Nodal response was 100% complete in N1 & N2a, 92% and 0% in N2b and N3 lesions respicyively. TNM stage group wise the complete response rates were 100% in stage III, 92% & 0 % IVA & IVB.
Conclusion: Accelerated fractionation with IMRT and concurrent chemotherapy is a feasible in locoregionally adanced head and neck cancers with acceptable toxicities and good locoregional response rates
Spinal tuberculosis: imaging features on MRI
Get PDFIntroduction: Spine is the most common site of skeletal tuberculosis.Radiographic manifestations of tuberculous spondylitis include intraosseous and paraspinal abscess formation, subligamentous spread of infection, vertebral body destruction and collapse, and extension into the spinal epidural space. Significant instability and deformity of the spine can result, mandating prompt diagnosis and treatment to prevent permanent neurologic damage.
Objective: This is a prospective and descriptive study to evaluate the role of MRI in spinal tuberculosis and various spectrum ofits manifestations.
Materials and Methods: This prospective study was on 25 patients of either age or sex with clinical suspicion of spinal TB over a period of 2 years and subsequently went MR Imaging and features were correlated with other investigations and histopathological diagnosis in few patients.
Results: Thoracic spine was the most common site of involvement.Vertebral body wedge collapse or compression fracture was seen in 64 % of patients. Posterior element involvement was found in 10 out of 25 cases. Prevertebral & paravertebral collections were seen in88% of cases. Epidural soft tissue component was seen in 56% of cases.
Conclusion: MRI is the best diagnostic modality for spinal TB and to demonstratethe various associated manifestations which help in assessing the extent and severity of the disease and thus inearly and correct management planning
Psycho physical test in normal individual and diabetic patients with and without diabetic retinopathy: comparative study
Get PDFPurpose: To investigate the differentiating ability of psychophysical test which include contrast sensitivity function (CSF), dark adaptation (DA)and best corrected visual acuity (BCVA) in detecting functional losses in diabetic participants with and without retinopathy.
Methods: In this cross-sectional study we examined 90 patients in L.N. Medical college and J. K Hospital, Kolar road, Bhopal between June to November 2017 including 60 diabetic patients (30 with retinopathy and 30 without retinopathy in fundus photography) with 30 control non-diabetic subjects matched for age and sex. The diabetic participants were sub grouped according to the level of retinopathy (EDTRS classification). CSF was examined by means of pelli robson chart in each eye; DA was assessed with photostress test and BCVA by Snellen chart.
Results: When comparing visual performance of the right and left eyes of patients in each group, CSF was significantly lower in the diabetic eyes with retinopathy than in the normal eyes or the diabetic eyes without retinopathy. Comparing to control group, there was a statistically significant CSF loss in the diabetic eyes without retinopathy (P<0.05). The mean logMAR BCVA and DA abnormalities were significantly higher in the diabetic eyes with retinopathy than in the normal eyes or the diabetic eyes without retinopathy (P<0.001). There was no significant difference observed in mean log MAR BCVA and DA between those of diabetic eye without retinopathy compared to the control group.
Conclusion: There was significant difference observed in visual performance of those diabetics with retinopathy compared to those without. The findings also suggest that the appropriate combination of existing tests can be a useful method of improving screening accuracy in diabetic patients
Unanticipated cytodiagnosis of filariasis: A Study of 16 cases
Get PDFBackground: Bancroftian Filariasisisatropical and sub tropical disease caused by Wuchereriabancrofti and transmitted by the Culexmosquitoes. The diagnosis of it is conventionally made by demonstrating microfilaria eintheperipheral blood smear. Microfilariae and adult filarial worm have been incidentally detected in fine needle aspirate of swelling at various sites in amicrofilaremic patients. Currently 1.4 billion people worldwide are at risk of being infected. In India 600 million people are at risk of filariasis.Cytology has important role in the diagnosis of occult Filariasis.
Objectives: To discuss the role of FNAC in diagnosing occult Filariasis. Material and Methods: This is a retrospective study carried out in the Department of Pathology at SRMS IMS, Bareilly, Uttar Pradesh. Aspiration was made by 22-23 gauze needle, smears were stained by Papanicolaou and May-GrünwaldGiemsa stain.
Result:16 cases of cytological specimensincidentallyshowed microfilaria without any clinical suspicion which included breast lumps (three cases), thyroid swelling (three cases), lymph nodes (two cases), subcutaneous swelling (two cases), ascitic fluid (one case), pleural fluid (one case), lung mass (one case), scrotal swelling (one case), cervical smear (one case) and space occupying lesion in liver (one case). Fragments of adult worm were reported in four cases. Only one patient with scrotal swelling had microfilaremia.
Conclusion:FNAC can play an important role in diagnosing occult Filariasis in clinically unsuspected cases
Stature estimation and its reliability in different types of dental alignment using the Carrea’s Index
Get PDFIntroduction: Estimation of stature holds a special place in the field of forensic medicine.
Objectives: This study was designed to investigate the ability of estimating stature from the dimensions of lower anterior teeth.
Method: The study was carried out by taking the measurement from the mesio-distal widths of lower central incisor, lateral incisor and canine of 100 undergraduate students for examination. Each hemiarch was considered separately equaling 200 inferior hemi-arches, which were divided according to the dental alignment into normal, crowded and diastema and the measurements (arch and chord) were made with a ‘divider caliper’.
Result: A statistically significant difference between the types of dental arch was obtained for both males and females with regards to the different dental alignments; higher correlation between stature the arch for normal alignment (r=0.9658; r =0.8347); moderate correlation for crowded alignment (r=0.8097; r =0.6958); and a weaker correlation for diastema (r = 0.656, r = 0.3938) for male & female respectively. The left side of the hemiarch showed a higher success rate (82%) in comparison to right side (72%). Statistically significant differences were also found between the types of arches for both right and left side (p<0.005).
Conclusion: The present study would be useful for stature estimation to the forensic experts
Role of GeneXpert in Rapid Molecular Detection of Extrapulmonary Tuberculosis in Tertiary Care Hospital
Get PDFIntroduction: Tuberculosis, the most common infectious disease with prevalence of 9.6 million globally. Most prevalent (23%) in India. Extrapulmonary tuberculosis (EPTB) accounts for 20% of total burden of tuberculosis. Rapid detection of Mycobacterium Tuberculosis (MTB) is essential for effective disease management. CBNAAT (Cartridge Based NucleicAcid Amplification Test) or GeneXpert MTB/RIF assay - novel diagnostic tool to detect MTB and RIF resistance simultaneously. WHO recommends its utility for non-respiratory samples also. Burden of EPTB and drug resistance vary from place to place.
Objective: Study was conducted to gather information about burden of disease in our locality and to assesutility of CBNAAT in detecting MTB and rifampicin resistance in suspected EPTB cases.
Methods: Retrospective analysis of 281 samples from suspected cases collected in falcon tubes and processed using CBNAAT.
Result: Total of 281 extrapulmonary samples received, 67(23.8%) were positive and 214(76.1%) were negative for MTB. Of 67 positives, RIF resistance detected in 1(1.49%) case. Maximum number of MTB detected in the age group 21-30 years (n=23, 34.3%). Among 165 males and 116 females, MTB detected in 44(26.6%) and 23(19.8%) respectively. Out of 281 patients, 24(8.54%) were HIV positive. Of these 24, only 8(33.3%) found positive for MTB. Among 257 non-HIV patients, MTB detected in 59(22.9%). Among different samples received, maximum number were Pleural fluid n=115(40.9%) and Maximum MTB positives found in FNAC (of lymphnodes) samples [n=35(52.2%)].
: CBNAAT is a rapid test to detect MTB and rifampicin resistance simultaneously in EPTB and it reduced the treatment abuse in suspected cases
Artemisin Combined Therapy in malaria patients: Do we need to search for more?
Get PDFIntroduction: Malaria is a vector borne disease highly prevalent in the topical developing countries. Two main species of plasmodium causing majority of diseases manifestations are P. Vivax and P. falciparum. The approach to antimalarial selection is determined based on the location of the patient. For treatment of uncomplicated P. falciparum malaria, according to WHO guidelines first line therapy mainly includes Artemisin Combined Therapy. Concerns about the emergence of resistance to artemisin derivatives have increased recently. The main aim of the present study is to investigate the effect of using a combination of intravenous artesunate along with oral doxycycline, as a novel ACT for Malarial infections – falciparum vs. vivax.
Methodology: Prospective observational study was carried out at V S General Hospital in Ahmedabad, Gujarat, India. A full history of current illness was taken followed by examining the serial peripheral smear reports of the patients till the malarial parasites are not seen on two consecutive occasions. Samples were taken at least 6 hours apart by the capillary method and oral temperature was measured every 6 hours. We excluded other associated viral fevers such as dengue, pediatric age group (<12 years) and Co-Morbid illnesses like hepatic or renal dysfunction. Data analysis was done using SPSS software version 20.
Results: Student t test showed that PCT was significantly more in falciparum (mean= 74.53 hours) patients as compared to vivax patients (mean= 51.89 hours). (p<0.001). Also duration of stay was significantly more in patients having falciparum (mean =3.63 days) as compared to patients having vivax (mean = 2.32 days) (p<0.001) Multivariate analysis by linear regression showed that species of the parasite was the most significant independent predictor (B=12.552) of the time to parasite clearance and other significant variable was Grade of parasitemia at 0 hour (B= 12.798). We also found that patients with residual parasitemia was 83.78 %, 40.54% and 10.81% in vivax group whereas it was 100%, 88.15% and 46.05% in falciparum respectively at 24, 48 and 72 hours.
Conclusion: The study shows that PCT and residual parasitemia is very high in falciparum patients as compared to previous reports of different studies and also as compared to vivax group patients. ACT resistance is a grave concern for falciparum and more studies should be done to understand pathophysiology and its prevalence in India. We strongly suggest that a continues monitoring needs to be implemented in health policy to understand the dynamicity of emerging resistanc
Comparison of thyroid profile in premenopausal and postmenopausal women: A case control study
Get PDFIntroduction : After menopause, diminishedgonadal hormones are found to influence thyroid status. There are a few published literature in this area, to the best of our knowledge. Aim of the study was to compare thyroid profile of postmenopausal women with those in reproductive age group as well as to find the correlation between age and thyroid profile. compare thyroid profiles of young men with those in geriatric age group iii. find if anygender differences in thyroid profiles.
Methods: In a case control study, thyroid profiles of 76 post menopausal women and 131 women in reproductive age group were compared. Thyroid profile of 78 young men was compared with that of 24 men in geriatric age group. Genderdifferencesin thyroid profile were studied by comparing thyroid profiles of 207women and 102 men. Statistical analysis was carried out using MannWhitney U test and Linear regression analysis.
Results: A significantly higher TSH levels (P<0.05) and decreased T3 (P<0.0001) were observed in postmenopausal women compared to the controls. There was no statistically significant difference in thyroid profiles among men in geriatric age group and young men. There was a significant elevation of TSH in women compared to men (P<0.05). A negative correlation between age and T3 levels was observed in women.
Conclusion: Subclinical hypothyroidism was observed in post menopausal women in our setting. A higher tendency of women having subclinical hypothyroidism compared to men was also observed. This suggestsa necessity to assess functional status of thyroid gland periodically in the post menopausal period