International Journal of Medical Research & Review (IJMRR)
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Study of clinical risk factors and predictors of post stroke vascular cognitive impairment
Get PDFIntroduction: Cognitive impairment due to cerebro vascular disease is termed” vascular cognitive Impairment “(VCI) and forms a spectrum that includes vascular dementia and milder forms of cognitive impairment. Vascular cognitive impairment has some varied and diverse aetiology. This is particularly important as apart from age vascular risk factors, are the most important and presently the only treatable precursor to dementia. This prospective observational study was carried out in indept. Of medicine, GMC Bhopal.
Methods: A standard protocol was applied at admission and 3 months after stroke, this protocol included clinical, functional and cognitive assessments, various lab tests and MMSE.
Results: Amongst the various risk factors hypertension, diabetes mellitus, prior stroke, dyslipidemia, ischemic heart disease, tobacco chewing, smoking, family history of dementia was more frequently seen in vascular cognitive impairment group. In this study, the frequency of patients having post stroke vascular cognitive impairment (VCI)is 54%. 18%of the patients had VaD (Vascular dementia), 36% of the patients had VMCI(vascular mild cognitive impairment), 46% of the patients had NO VCI (no vascular cognitive impairment. There was significant association of risk factors like Hypertension (p=0.022) diabetes mellitus (P=0.038), dyslipidaemia (p=0.034), prior stroke(p=0.046) with development of vascular cognitive impairment. Post stroke dementia has considerable morbidity.
Conclusion: The predictors of development of Vascular cognitive impairment following stroke in this study are lower educational status, Hypertension, Diabetes mellitus, Dyslipidemia, Prior stroke, urinary incontinence, High sys. BP, NIHSS score, LDL level, abnormal ECG, Strategic site lesion and greater severity of age related white matter changes
A case report on phenobarbitone induced stevens-johnson syndrome: an alarming hypersensitivity reaction
Get PDFStevens-Johnson syndrome (SJS) is an Ig E mediated hypersensitivity reaction, sometimes complicated by ocular manifestations. Antiepileptics induced SJS is common with carbamazepine. Phenobarbitone is known to cause hypersensitivity reactions like mild to moderate rashes but not life-threatening reactions like SJS. We present a case report of an 18 years old female patient who presented with chief complaints of multiple, fluid-filled lesions associated with itching all over the body for 20 days and inability to open her eyes for 18 days. It had developed following ingestion of Tab. Phenobarbitone 30 mg orally BD for 15 days. She was diagnosed as a case of SJS and treated with parenteral followed by oral corticosteroids and antihistaminics and recovered over a span of 20 days. Causality was assessed as per WHO-UMC Causality Assessment criteria and Naranjo Scale. Main pathogenesis is apoptosis through an interaction between cell-surface death receptor like Fas and its receptive ligand or due to genetic deficiency. In case of aromatic anticonvulsants, cross reactivity is also suspected. Genetic studies and cross reactivity testing can help prevent further incidences in few
Comprehensive evaluation of MRCP versus ultra sonography in biliary obstruction
Get PDFBackground: Biliary disorders are one of the common problems routinely seen in clinical practice. Ultrasound (USG) is an initial investigation and Magnetic resonance cholangiopancreatography (MRCP) is a relatively new technique, which has gained popularity because of its excellent diagnostic capabilities in the evaluation of biliary obstruction.
Aims: The aim of our study was to know the cause and grade of obstruction in case of clinically suspected biliary obstruction and to evaluate and correlate the accuracy between MRCP and Ultra sonography.
Material and Methods: This prospective cross sectional comparative study was conducted in the department of Radiology, Government medical college and Rajindra hospital, Patiala. 50 patients with suspected biliary obstruction with clinical and laboratory features suggestive of obstructive jaundice who were referred for USG, followed by MRCP were studied.
Results: Most common disorder observed was choledocholithiasis 16 (32%), followed by carcinoma gall bladder with 7 (14%) cases, periampullary carcinoma with 6 (12%) cases, cholangiocarcinoma and benign stricture with 5 (10%) cases each, carcinoma head of pancreas with 4 (8%) cases, postoperative stricture with 3 (6%) cases and choledochal cyst and cholangitis with 2 (4%) cases each. The overall sensitivity, specificity, positive predictive value and diagnostic accuracy of MRCP in diagnosing biliary obstructive disease was 98%, 100%, 100% and 100%respectively as compared to 60%, 100%, 100%and 97% of USG.
Conclusion: Ultrasound is considered the primary screening investigation modality of choice However, owing to its low sensitivity in most of the benign stenosis and distal common bile duct disease, where the clinical and laboratory suspicion is strong, MRCP is highly accurate, non-invasive, sensitive, non-ionizing and superior diagnostic modality in establishing diagnosis of obstructive biliary pathologies
Comparison of two different doses of Epidural Butorphanol in Lower Limb Orthopedic Surgery
Get PDFIntroduction: Epidural and spinal anaesthesia both are effective alternative to general anaesthesia when surgical site is located in lower extremities. When post operative analgesia is required epidural anaesthesia is the choice. This study was conducted to assess the effect of Butorphanol added to local anaesthetic via epidural route and to optimize the dose of Butorphanol via epidural route i.e. 2mg and 3 mg and to observe the duration of postoperative analgesia with two different doses.
Methodology: A randomized control study was conducted on 40 ASA I & II patients of either sex aged 18-60 yrs undergoing lower limb orthopedic surgery under epidural anesthesia. The patients were randomly allocated into two equal groups. Group A received 2 mg of Butorphanol along with local anaesthetic solution and Group B received 3mg of Butorphanol along with local anaesthetic. The onset and peak effect of sensoryand motor block, level of sedation, hemodynamic changes and duration of postoperative analgesia and complications, if any were observed.
Results: For sensory effect, onset was 25±7.07 sec and peak effect 312.5±12.4 sec in Group A patients as compared to Group B where it was 12.81±21.68 sec and 162.8±21.68 sec respectively, which is statistically significant (P<0.05). For motor effect onset was 3.5±1.01 min and peak effect 11.4±3.91 min in Group A patients as compared to Group B patients where it was 2.7±0.67 min and 6.09±0.97 min (P<0.05). Hemodynamics remained stable and comparable in both the groups (P>0.05). Duration of postoperative analgesia according to VAS, pain relief in Group A patients was up to 8 hrs and in Group B it was up to 12 hours and rescue analgesia required only after 12hrs (P<0.05).
Conclusion: Newer synthetic opioid- Butorphanol can be used along with local anaestheticsolution via epidural route in lower limb surgeries with effective intraoperative sedation and prolonged postoperative analgesia without fear of nausea/vomiting and respiratory depression
Serum testosterone levels in type 2 diabetes mellitus
Get PDFIntroduction: Diabetes mellitus is a multifactorial disease which is characterised by hyperglycaemia, dyslipidaemia, involves various organ systems, and results in various long-term complications. Several studies have suggested that men with low testosterone levels are at a greater risk of developing type 2 diabetes mellitus, and that low testosterone levels may even predict the onset of diabetes. Recent studies have shown that a low serum testosterone level is strongly associated with an increased likelihood of the metabolic syndrome.
Aim: To compare the serum total testosterone levels in type 2 diabetes mellitus patients with that of non-diabetic healthy controls.
Material and Methods: The study was conducted in OPD of Medical College, Kolkata. In the present study 50 men aged 35-55 years who were diagnosed as type 2 diabetes mellitus patients and confirmed by the estimation of fasting plasma glucose (≥126mg/dl), post prandial blood glucose (≥200mg/dl) and HbA1C (≥6.5%) were selected, 50 healthy age and BMI matched individuals, were selected as controls. Patients with a known history of hypogonadism, panhypopituitarism, hyperthyroidism, patients taking exogenous testosterone and glucocorticoids, patients suffering from chronic debilitating disease, such as renal failure, cardiac failure, liver cirrhosis, or HIV, were excluded from the study. The laboratory investigations included evaluation of serum testosterone levels, fasting and postprandial blood glucose, with the levels of HbA1c and Creatinine. Statistical analysis was performed using SPSS 20.0. Results are represented as mean±SD and number (%). Pearson’s correlation test was performed to measure the linear dependence of the study parameters.
Results: Serum Total Testosterone level of diabetic group was 3.51±1.26ng/ml, which was found significantly lower than control group with serum total testosterone level 5.88±2.34ng/ml, (p-value < 0.0001).
Conclusion: This study has shown that there is a significant reduction in serum total testosterone levels in type 2 diabetes mellitus patients
Phenotypic characterization of Trichosporon species from clinical isolates
Get PDFIntroduction: Trichosporon spp. arepresent as normal flora of skin and perigenital area in humans. They can cause invasive trichosporonosis in immuno-compromised individuals. Trichosporon infections are difficult to treat, since they do not respond to routinely used antifungal agents.
Aim: This study was undertaken to characterize clinical isolates of Trichosporonsp, using phenotypic methods.
Material and Methods: Around 52 isolates of Trichosporon sp. obtained from various samples of patients in Sri Ramachandra Medical College & Research Institute, Chennai, were considered for the study. The isolates were studied for macroscopic morphology of the colonies on Sabouraud Dextrose Agar (SDA), microscopic morphology by Dalmau technique & Gram stain, ability to hydrolyze urea, sugar assimilation profile and growth at 37°C &0.1% cycloheximide.
Results and Conclusion: Two types of colony morphologies were observed, 47 isolates appeared flat with farinose covering and 5 were cerebriform with radial fissures. All isolates hydrolysed urea, and none of the isolates fermented but only assimilated sugars. The Trichosporon isolates were identified up to species level by phenotypic methods. Still the reliability of identification has to be confirmed with genotypic characterization techniques
Role of MRI in evaluation of oral cavity cancers from central India
Get PDFIntroduction: Squamous cell carcinoma of oral cavity ranks in the top three types of all cancer in the India. The diagnosisof it is basically clinical and bioptic, preoperative imaging is crucial for tumor staging that helps to decide appropriate therapeutic strategy and indicate prognosis.
Objectives: To evaluate the diagnostic accuracy of Magnetic resonance imaging (MRI) in staging of oral cavity cancers and to correlate the results with clinical and pathological data.
Methodology: This was a prospective study of 60 patients of oral cavity squamous cell carcinomas (SCC) where MRI was performed preoperatively to determine the tumor staging, tumor thickness, infiltration of surrounding structures and bone invasion. These findings were correlated with final pathological staging.
Results: Accurate correlation of T stages (TNM system) was obtained in 51 out of 60 cases on MRI. One lesion was classified as T2 on MRI but was found to be T4 on histopathology as MRI failed to detect subtle infiltration of the cortical bone. The accuracy of clinical data in T stage evaluation was 62 % (K- 0.470), however the MRI accuracy found to be 82 % (k 0.740). The sensitivity, specificity and accuracy of MRI in the detection of mandibular involvement were 94.1%, 60% and 81.5%, respectively.
Conclusion: MRI plays an important role in the evaluation of oral cavity carcinomas. MRIaccurately demonstrates the tumor size, depth of invasion, bone marrow involvement, perineural spread and lymphnode metastasis which are essential for treatment planning
Study of new onset cutaneous manifestations in Rheumatic Diseases
Get PDFBackground: Skin manifestations are an important clue to underlying rheumatological conditions and at times the first manifestation of the disease. Their identification helps in diagnosis, classification and follow up of these diseases. Hence we conducted this study to assess the new onset cutaneous lesions in patients with rheumatic diseases and correlate skin lesions with disease activity and study the response to therapy over a period of 3 months.
Materials and Methods: This prospective observational study was done in KEM Hospital, Mumbai over 18 months recruiting 78 patients, presenting to Rheumatology OPD / wards with new onset skin manifestations. Disease activity was calculated as per standard indices for each rheumatological disease. Skin lesions appearing due to adverse effects of drugs or unrelated to the disease were excluded from the study. The outcome of the skin lesions was assessed at 3 months follow up.
Results: Mean age of patients was 38 years with 91% being females. SLE was the most common diagnosis. The most common skin lesions were malar rash among SLE patients; rheumatoid nodules in patients of RA; Sclerodactyly in the Scleroderma patients and Heliotrope rash amongst the dermatomyositis patients. The mean SLEDAI score in the group with LE non -specific lesions was significantly higher compared to the group with LE-specific lesions (P<0.0001). At 3 months there was statistically significant reduction in SLEDAI score after treatment in SLE patients. In patients of RA, 74% patients showed reduction in DAS 28 ESR score with treatment at 3 months. Systemic sclerosis patients failed to show significant improvement in Modified Rodnan’s Skin Score after 3 months of treatment.
Conclusions: Among all rheumatological conditions SLE presents most often with skin involvement. Patients with LE specific lesions have lower disease activity (SLEDAI score) as compared to LE nonspecific lesions. At 3 months follow up the response to treatment is good in SLE patients with reduction in SLEDAI scores and also in RA patients with reduction in DAS 28 ESR scores
Color Doppler study of uterine vasculature in pregnancy induced hypertension
Get PDFObjectives: 1. To study the blood flow pattern of uterine vessels in pregnancy induced hypertension by Color Doppler. 2. To assess the predictive value of Color Doppler Studies of uterine blood flow patterns for perinatal outcome.
Materials and Methods: The period of our study was for 2 years at a tertiary care hospital in rural area in RMC Loni.50 cases diagnosed as pregnancy induced hypertension beyond 28 weeks of gestation, i.e, period of viability of fetus were screened by Color Doppler for uterine artery during the above-mentioned period. Outcome of these pregnancies was then collected.It included the gestational age of delivery, mode of delivery, birthweight, APGAR score, still births andlivebirths.
Results: In this study birth weight in grams in>36 weeks gestation at delivery showed highly significant difference between the present (1767+209.83) and absent (2289.98+358.96) diastolic notch group indicating that birth weight of the neonate was affected by the presence of diastolic notch. Similarly neonatal mortality was more(45.45%) in case of patients with presence of uterine artery diastolic notch as compared to absence of diastolic notch(0) which was statistically significant. Morbidity was 36.36% in diastolic notch group as compared to diastolic notch absent group (14.28%).
Conclusion: Doppler is an excellent armamentarium in the hands of obstetrician for non-invasive hemodynamic monitoring of PIH patients to identify the fetuses at risks and predicting perinatal morbidity and mortality. Doppler velocimetry gives us the idea about correct time of intervention so as to get good perinatal outcome thus preventing high fetal mortality and morbidity in hypertensive patients
Pure leydig cell tumour – a rare virilizing tumour in a young female
Get PDFSex cord stromal cell tumours constitute 5-8% of all ovarian neoplasms of which pure leydig cell tumours constitute 0.1%. These tumours are most commonly found in the post-menopausal age group and patients present with a rapid onset of symptoms of androgen excess like hoarseness of voice, clitoromegaly and hirsutism. We present a case of 39 year old female, who presented with virilising symptoms since 2 years. Serum Testosterone levels were raised and CT revealed homogeneously enhancing mass of 2.8 cm in size in the right ovary. An unilateral oophorectomy was done and sent for histopathological examination. On Gross examination, the ovary revealed the presence of a well circumscribed greyish white tumour with multiple yellowish areas. Microscopy revealed features suggestive of pure leydig cell tumour with reinke crystals. Post operatively, the patient improved symptomatically. The unusual features seen in this case were younger age at presentation and insidious onset of symptoms. The presentation of pure leydig cell tumour- hilar type at such a young age is extremely uncommon