International Journal of Medical Research & Review (IJMRR)
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A Study of clinical profile, disease severity and treatment response of Movement disorders at a tertiary care teaching hospital
Get PDFBackground: Movement disorders are one of the common neurological problems seen by General physicians and neurophysicians. The clinical phenotype of Movement disorders is variable.
Aim of the study: The objective of the study was to study the clinical profile, disease severity and treatment response of Movement disorders at a tertiary care teaching hospital.
Results: The present study was a prospective observational study comprising 55 clinically detectable patients of movement disorders. Out of fifty-five, the frequency of various Movement disorders were as follows: Parkinson’s disease- 25 (45.5%), Wilson`s disease (WD)-9 (16.36%), Progressivesupranuclear palsy- 8(14.54%), Essential Tremor with Parkinson disease 5 (9.0%), Choreiform disorders- 5(9.0%). Mean MDS-UPDRS Part III score in OFF stage of PD was 57.7±13.2 and in ON stage was 28.2±10.2 suggesting significant improvement. Seventy-six percentages of PD patients had Good response to Dopaminergic agonists and Levodopa administration, while better response was seen in WD, ET+PD and the poor response in PSP patients respectively.
Conclusion: Identifying and describing the clinical phenomenology of Movement disorders is the first step in the diagnostic evaluation of the patients as against to the localization in General Neurological disorders. Disease severity scales do assess the progression of the disease at the earliest and there are affordable regimes of various medications are available to treat them at the earliest, so as to reduce the morbidity and to increase health related quality of life
Morphological study of variation in shape of coronoid process of mandible in dry human bone in Mahakaushal region
Get PDFIntroduction: The coronoid process is present at the ramus of mandible bone. The coronoid process projects upwards and slightly forwards as a triangular plate of bone. The variations in shape of coronoid process may acts as anthropological markers, to assess different populations & races. It may also be useful in forensic studies for determination of gender. With keeping above facts in mind, present study was planned.
Material methods: The shape of the coronoid processes of both sides of 52 dry adult human mandibles (29 male and 23 female) were studied to classify the variations. The study was conducted in NSCB Medical College, Jabalpur. Three types of shapes were observed which are hooked, triangular and round shaped.
Results: Triangular shape of coronoid process was present in 48.08% mandibles. It was of rounded shape in 19.23% mandibles. In 32.69% mandibles found hooked shaped. out of total 52 mandibles, in 29 belonging to male, triangular shape was found in 36.21%, rounded shape in 22.41% and hooked shape was found in 41.37% mandibles. Out of remaining 23 mandibles which were of females, triangular shape was found in 63.04%, rounded shape in15.22% and hooked shape in 21.74% mandibles.
Conclusion: In present study, it is found that hooked shape coronoid is more common in male mandibles and in females, most common shape is triangular. As, no study was done previously at shapes of coronoid process at Mahakaushal area, hence, present study may be useful for maxillofacial surgeons and forensic experts especially of Mahakaushal region
Comparative evaluation of Intrathecal Fentanyl with different doses of Bupivacaine on lower limb surgery
Get PDFIntroduction: Intrathecal administration of opioids and local anaesthetics provides good analgesia. Fentanyl potentiates the afferent surgical blockade and improves both intra and post operative analgesia. The synergism between intrathecal opioids and local anaestheticsachieves a reliable spinal anaesthesia with minimal hypotension. The optimal doses and dilutions of intrathecal combination of bupivacaine and fentanyl remain a subject of discussion. Therefore, we designed this study to compare the effects of different doses of hyperbaric bupivacaine 0.5% (10 mg, 12.5 mg, 15 mg) with fentanyl 25 microgram in subarachnoid block on quality of anaesthesia and recovery.
Objectives: To observe sensory and motor blockcharacteristics and effects of different doses of bupivacaine on haemodynamic parameters.
Method: A prospective randomized study was carried out on three groups of 20 each. Group A patients were given 0.5% hyperbaric bupivacaine 10 mg, fentanyl 25 µg and 0.9% normal saline 1.5 ml. Group B patients were given with 0.5% hyperbaric bupivacaine 12.5 mg, fentanyl 25 µg and 0.9% normal saline 1ml. Group C patients were given 0.5% hyperbaric bupivacaine 15 mg, fentanyl 25 µg and 0.9% normal saline 0.5 ml.
Results: Duration of sensory block was prolonged in group C (139.50±16.05 minutes) than group A (129.00±18.32 minutes). On statistical comparison, group B and C (126.25±15.29 minutes and 132.75±10.70 minutes respectively) had significant prolonged duration of motor block than group A (114.00±18.11 minutes).
Conclusion: Fentanyl 25µg with 0.5% hyperbaric bupivacaine 12.5 mg is superior in terms of characteristics of sensory and motor block and haemodynamic stability
A correlation study of lipid profile with body mass index and waist hip ratio in Rohilkhand region
Get PDFBackground: Central or abdominal obesity is associated with metabolic disorders such as hypertension, diabetes mellitus and cardio vascular disease (CVD). Anthropometric tools especially BMI is commonly used to categorize obesity. BMI, calculated from the weight and height of an individual, represents generalized fat distribution. Waist hip ratio (WHR) is more reliable anthropometric tool for measuring abdominal obesity as it takes waist circumference into consideration. Therefore, this study was undertaken to study the correlation of dyslipidemia with BMI and WHR and conclude if WHR could be used as a reliable tool for identifying high risk patients.
Materials and Methods: Two hundred participants aged between35 to 45 years were randomly chosen. Lipid profile of all the participants was determined. These participants were divided into three groups based on their BMI. Same participants were also divided based on their WHR into two groups – Low risk and high risk. Mean of lipid profile was analyzed for significance by ANOVA and independent t test using SPSS 23.0. Correlation of dyslipidemia and BMI and WHR was analyzed using Pearson Coefficient. P<0.05 was considered significant.
Result: Participants with WHR in the high-risk category had TC/HDL ratio of 3.8±0.5 which was similar to those with BMI>30 Kg/m2. Pearson correlation coefficient of Total cholesterol, LDL-C and TC/HDL with WHR was 0.505, 0.484 and 0.528 respectively which was stronger than that with BMI.
Conclusion: WHR is a reliable tool to identify patients who are at high risk to develop CVD and other metabolic diseases
Early CRRT and antibiotic management in shock patient due to urosepsis with immunocompromised post renal transplantation
Get PDFSeptic shock is a major cause of morbidity and mortality in the ICU. A 32-year-old patient was diagnosed with septic shock due to urosepsis, hospital-acquired pneumonia (HAP), and acute kidney injury (AKI) post renal transplantation. Continue Renal Replacement Therapy (CRRT) was performed to remove inflammation mediator. Broad-spectrum antibiotics, blood glucose control, adequate volume status, nutritional support, and temporary withdrawal of immunosuppressive drugs were ensured. Patient was stable on the 5th day, extubated by day 8th, and discharged from ICU 10 days later. It can be concluded that early CRRT could prevent organ failure and further complications caused by septic shock
Predictors of clinical outcome after mitral valve replacement
Get PDFBackground: To identify and study predictors of morbidity, mortality, and survival after mitral valve replacement.
Methods: We have examined 186 patients undergoing isolated mitral valve surgery between January 2013 to January 2015, with respect to preoperative clinical features, echocardiographic findings, hemodynamics and surgical approaches. Coronary angiography was done as a routine in all patients above 40 yrs of age & coronary artery bypass grafting with mitral valve replacement was done in 7 patients. The operative mortality was 5.37%. Postoperatively patients were followed up at 3 months interval for first 1 year & at 6 months interval thereafter.
Results: Multivariate statistical analysis demonstrated that patients age > 60 years, patients with symptoms NYHA Class–IV, ventricular arrhythmias, associated disease (Coronary artery disease, Infective endocarditis), end diastolic diameter measuring ≥60 ± 10mm, left atrial Dimension ≥ 65 mm, chordal preservation (Partial / Total) independently influenced the morbidity and Mortality.
Conclusion: Strategies to diminish operative mortality should include careful assessment of the risks factors in elderly patients, early operative intervention before deterioration that necessitates urgent surgery, and use of improved techniques of myocardial protection in high-risk patients
Spectrum of dermatological manifestation in all female attending tertiary health care in a developing country
Get PDFBackground:Skin diseases occur all over the world at significant levels. Skin conditions are both widespread and among the most prevalent and disabling diseases, and a source of considerable loss of healthy life. They have been identified as a public health problem in developing countries. Skin diseases affect all segments of the population without ethnic variability but are more prevalent among children and women in low socioeconomic groups, essentially due to poor hygienic practices.
Objective:Objective was to study the dermatoses in females attending a tertiary health care dermatology clinic.
Patients and Methods:Total 600 female patients who were attending the Skin outpatient department during data collection period and were willing to participate constituted the study population. The diseases of the patients were then classified according to infectious and non-infectious dermatoses.
Results:Out of 600 Female patients, 36% belonged to the age group of 21-30 years, 28% were illiterate and 59% were unskilled worker. 58% of the patients had various noninfectious dermatoses while 42% had various infectious dermatoses.
Conclusions: Apart from environmental factors, skin diseases are mostly dependent on occupation, socioeconomic status and age of the patients
Clinicopathological profile of mediastinal masses in a tertiary care hospital of Eastern India
Get PDFIntroduction:The Mediastinum is the central part of thorax where various organs are located which gives rise to various neoplastic and non- neoplastic lesions.Accurate diagnosis is important to formulate proper therapeutic strategy and predict prognosis. Studies are very few in this part of the country.
Objective: To analyse presentation of patients with Meditastinal Mass and to classify according to the location of mass. Also, to document Malignant versus Non-malignant nature oflesions.
Methods: Total 33 patients with mediastinal masses diagnosed by Imagingand Histopathological study were taken up consecutively in the study during one year of study.
Results: of the 33 cases, 21 were male (63.6%) and 12 were female (36.4%), Male; female ratio being 1.8: 1. Age ranged from 14 years to 72 years maximum of 8 Patients (24.2%) in the 12-20 years of age group. 57% of the masses were malignant and 43% were benign. Most common lesion was Lymphoma in 10 cases (30.3%) followed by8 cases of Thymic tumours (24.2%). Metastatic Carcinoma was found in 6 patients (18.2%) followed by 3 patients of Germ cell tumours.One case each of Neurofibroma, Neurolipoma and 6 are of different less common category. Compartment wise, 9 cases (27.3%) were in Anterior Compartment, 1 (3%) case in Post Compartment, 3 case in superior mediastinum, 6 case in Middle mediastinum. Maximum cases, 14(42.5%) were occupying Multiple Compartments. Most common symptom was cough (72%). Pleural and Pericardial effusions were common complication of malignant lesions contributing 7 out of 19(36%) and 3 out of 19(17%) respectively.
Conclusion: Mediastinal masses creates a diagnostic dilemma to the clinician. Uncommon cause of common symptoms like cough and common presentation of pleural or pericardial effusion may have Mediastinal mass behind the screen
Assessment of attitude towards innovative approaches related to nursing care in intensive care units among staff nurses of P.B.M. Hospital, Bikaner
Get PDFBack ground: Innovation is process of developing new approaches, technologies and ways of working. It can apply to tools and technologies and processes, or the way anorganization or an individual behaves works or acts. Nursing care is changing in the face of technology, and innovation is the most important tool for improving the quality of care of community. Creativity and innovation are needed to continue the expression of genuine care and concern, not only through human contact, but also through the use of technology.Technology and its increased use in the healthcare field is constantly evolving and changing. The attitudes of the staff nurses can impact the successful use of that technology and thereby improve not only competency, but also job satisfaction, quality of nursing care.
Objectives: 1. To assess the attitude towards innovative approaches related to nursing care in Intensive Care Unit (ICUs) among the staff nurses working in PBM hospital. 2. To associate the attitude towards innovative approaches among staff nurseswith selected background variable.3. To conduct the seminar on innovative approaches related to nursing care inICUs.
Materials and Methods: Using non experimental study with descriptive design data were collected from 100 staff nurses working in ICUs. Likert type scale was used to collect data on attitude and structured questionnaire for back ground variable. Analysis of data was done using descriptive and inferential statistics.
Results: Analysis of data showed statistically significant association between attitude towards innovative approaches and professional education and participation in continuing education among nurses. Study findings depicts positive attitude of nurses towards innovation in nursing care, whereas nurses working in ICUs have limited access to innovative and evidence based information.
Conclusion: The study concluded that the attitude of staff nurses towards innovation in nursing care need to be enhanced by conducting educational training program and seminar on innovation in nursing care. There must be adequate access to information on innovative and evidenced based practice in nursing care
Role of trans rectal and scrotal ultra sonography in male infertility
Get PDFIntroduction: Investigation of male infertility is assuming greater importance with male factors implicated as the cause in up to half of the infertile couples. This prospective cross-sectional study aims to establish the role of transrectal and scrotal ultrasonography in male infertility. Besides routine investigations trans rectal and scrotal ultra sonography was performed to detect testicular and post-testicular etiology or abnormality.
Aims: The aim of this cross-sectional study was to determine the role of transrectal and scrotal ultrasonography in the evaluation of male infertility and to compare the findings of ultrasonography with clinical and surgical findings.
Material and Methods: The prospective cross-sectional study was carried out on 50 patients visiting the ultrasound section of Rajindra Hospital; Patiala with complaint of infertility over the span of 2 years. All the patient undergoes transrectal and scrotal ultrasonography with high frequency transducer having a frequency of 7.5 MHz and Color Doppler wherever indicated.
Results: Ultra sonographic findings of scrotum in 50 patients reveals 24 cases of varicocele, 7 cases of epididymal cysts, 8 cases of hydrocele, 3 cases of epididymitis, 2 cases of cryptorchidism, 2 cases of testicular microlithiasis and 1 case of bilateral testicular cyst. Apart from the patient who had cryptorchidism, the testis of all the patients were normal in size, site, shape and echo pattern. The clinical palpation when compared to ultrasound was found to be have a sensitivity of 58.33% and a specificity of 92.31%. The positive predictive value was found to be 87.50% and negative predictive value 70.59%.
Conclusion: Trans rectal and scrotal ultrasound provides valuable information in the diagnostic evaluation of infertile men and substantially more pathological conditions can be detected on ultrasound compared to clinical palpation