International Journal of Medical Research & Review (IJMRR)
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Study of opportunistic intestinal parasitic infections in people living with HIVand their relationship with immune status
Get PDFIntroduction: Diarrhea is one of the most common complaintspeople living with HIV(PLHIV), occurring in almost 90% of them. Intestinal parasites are one of the main causes of diarrhea in developing countries.
Objective: The present study was undertaken to detect enteric parasites in PLHIV with different levels of immune status (CD 4+ Counts).
Materials and Methods: The study included a total of 209 HIV seropositive subjects. Stool samples from each subject was examined microscopically for the presence of ova and cysts using wet mount preparations and stained smears (modified ZN stain).
Results: Enteric pathogens were detected in 57 (27.27%) of the 209 patients. The parasites identified were Cryptosporidium (25), Isospora belli (3), Strongoloides larvae (2), Ascaris ova (1).In our study it was observed that the prevalence of cryptosporidium in HIV sero-positive subjects was 49.01%, 33.33%, 17.6% in those having CD4 <200, 200-499, >500 cells/μl respectively.
Conclusion: Intestinal opportunistic parasitic infections were detected in 27.27 % among HIV-seropositive patients. Cryptosporidiumis an important emerging pathogen in HIV-seropositive individuals with or without symptoms.Early detection of opportunistic intestinal parasitic infections using simple techniques like wet mount and modified ZN staining will help in the timely management and will improve the quality of life of HIV infected individuals
Splenomegaly in malaria patients in a tertiary care institute: A study from central India
Get PDFIntroduction: The spleen is always affected in person suffered from malaria. The palpable spleen is one of the main clinical symptoms. History of fever, anemia and splenomegaly are predicting symptoms for clinical diagnosis of malaria infection in endemic area.
Material and Methods: The study was conducted in the department of Medicine, Chirayu medical college and hospital Bhopal. All patients of age equal or greater than 15 years presenting with the fever and had positive peripheral smear for malaria parasite were included in my study.
Results: 81% (n=21) patients of asexual stage had enlarged spleen where as 19% (n=5) patients of sexual stage had enlarge spleen. There is significant association of splenomegaly with asexual stage. All cases have splenomegaly in mixed species, 41.60% (n=20) splenomegaly seen in P. falciparum species and only 20% splenomegaly seen in P. vivax species.
Conclusion: Though clinical examination is one of the good method to detect splenomegaly USG examination is superior as its sensitivity and specificity is higher than clinical examination. Hence it is recommended that splenomegaly be detected by USG examination in cases of malaria
Vitamin D and Diabetic Retinopathy in Indian adults with Type 2 Diabetes Mellitus
Get PDFObjective: To find an association with Vitamin D levels and Diabetic retinopathy (DR).
Methods: In a prospective clinical study, 412 Type 2 DM patients were evaluated for their ophthalmic findings. All patients underwent complete ophthalmic examination including detailed history, best corrected visual acuity, slit lamp examination, indirect ophthalmoloscopy and +90D lens biomicroscopy. All relevant blood investigation for evaluation of glycemic status including Vitamin D was done on first presentation.
Results: Among the 412 patients that were examined, thepercentage of patients with HbA1C <6.4 was 15%, 6.5- 8.0 was 31% and >8.0 was 54%. Among 222 patients with >5 years duration of DM, 95(43%) had HbA1C >8.0. Among 96 patients with 5-10 years duration of DM, 67 (70%) had HbA1C .8.0. Among 94 patients with>10 years duration of DM, 59(63%) had HbA1C >8.0, with a significant P value of <0.001. Among 412 patients, 7% had vitamin D levels >30, 13% had levels between 20-30 and 80% had <20. A significant P value of <0.001 was seen with respect to association of DR with HbA1C levels.
Conclusions: Type 2 DM patients with retinopathy were found to have significant vitamin D deficiency as compared to those without retinopathy
Comparison of high-frequency transabdominal ultrasonography and spiral computed tomography with colonoscopy in diagnosis of colon cancer
Get PDFObjective: To compare high-frequency transabdominal ultrasonography (USG) and spiral computed tomography (CT) with colonoscopy in diagnosis of colon cancer.
Design: A prospective comparative study of accuracy of USG and CT scan with colonoscopy.
Subjects: Sixty patients with a clinical suspicion of colon cancer after a detailed clinical history and a thorough clinical examination were included. Patients with a known diagnosis of colon cancer or in whom histopathological diagnosis could not be established were excluded.
Methods: All 60 patients who met the inclusion and exclusion criteria underwent transabdominal USG, CT scan-abdomen & pelvis, followed by colonoscopy. The CT and USG scans were reported by different radiologists without previous knowledge of any findingsof the other test or of the subsequent colonoscopy. The colonoscopy was performed by different clinicians, none of whom was aware of the USG or CT diagnosis.
Result: Colonoscopy diagnosed 29 patients with colon cancer out of 60 enrolled patients. USG detected colon cancer in all the 29 patients with a sensitivity of 100% and a specificity of 87.1%. CT scan diagnosed colon cancer in all the 29 patients with a sensitivity of 100% and a specificity of 74.2%.
Conclusions: Colonoscopy is still necessary when a suspicious lesion is identified. However, CT and USG can screen out suspected patients who can be subsequently referred for colonoscopy. This would reduce the need for colonoscopy in a large proportion of clinically suspected patients andalso avoidan invasive procedure like colonoscopy as first line investigation in elderly patients suspected of having colonic cancer
Renal functions in patients with metabolic syndrome
Get PDFIntroduction: Metabolic syndrome consists of a constellation of metabolic abnormalities that confer increased risk of diabetes mellitus. The aim of the present study was to study renal functions in patients with metabolic syndrome.
Materials and methods: 50 controls and 50 individuals with metabolic syndrome were selected by purposive sampling technique. Waist circumference and blood pressure was measured and serum levels of fasting blood sugar, triglycerides and HDL were estimated and eGFR was calculated in controls and cases.
Results: We found that serum urea andcreatininelevels were significantly increased andeGFR levels were significantly decreased in metabolic syndrome when compared to controls.
Conclusion: Our study concluded that there is significant renal dysfunction in patients with metabolic syndrome
A comparative study of clinical profile & investigative parameters of systemic lupus erythematosus patients with & without metabolic syndrome
Get PDFIntroduction: The Metabolic Syndrome (MetS) often contributes to increased cardiovascular risk in patients with systemic lupus erythematosus (SLE) especially in younger age group. Determining the contribution of SLE phenotype and therapeutic exposures to the development of MetS in SLE patients would yield important insights into pathophysiology of cardiovascular events and help in Coronary Heart Disease (CHD) risk stratification.
Objective: We aimed to get prevalence of metabolic syndrome in SLE patients & to correlate its presence with demographic, socioeconomic, clinical manifestations, serological parameters, pharmacological treatment, disease activity, disease duration & damage index.
Method: A total 104 patients of SLE diagnosed as per American College of Rheumatology (ACR) criteria were enrolled during the study. Metabolic Syndrome was defined according to the American Heart Association & National Heart, Lung & Blood Institute modified National Cholesterol Education Programme Adult Treatment Panel III criteria (AHA/NHLBI modified NCEP/ATP III).
Result: Out of 104 enrolled patients, MetS was present in 35 patients (33.7%). Higher mean age (32.8 vs 27 years), Higher Body Mass Index (26.65 vs 21.07kg/m2), Increased triceps skin fold thickness (20.46 vs 15.80 mm), longer disease duration (223.9wk vs 64.78 wk), the presence of lupus nephritis, hypertriglyceridemia, positive anti-ds DNA, higher serum creatinine, higher damage index & higher cumulative dose of steroids were associated MetS in SLE patients.
Conclusion: Screening for metabolic syndrome in patients with SLE will be helpful to minimize morbidity and mortality
Comparison of Universal Plan Indices for Intensity Modulated Radiotherapy of Head and Neck Cancer treatment
Get PDFObjective: Manual evaluation of IMRT plans for head-and-neck cancers has been especially challenging necessitating efficient and objective assessment tools. Based on previous clinical experience, the radiation oncologists prescribe the dose to the tumour after critical evaluation of the dose to critical structures. We have evaluated the IMRT plan using Universal Plan Indices and Quality factor.
Methods and Materials: In the Eclipse Treatment Planning Systems, we have selected 15 head and neck cancer patients who underwent IMRT delivery in sliding window mode at Clinac DHX linear accelerator equipped with a 120 leaves MLC. All patients were treated using 6 MV photon beams. The UPI indices and Quality factor were calculated using HART software based on MATLAB background.
Results: The mean conformity numbers for all fifteen patients were found as 0.92±0.05 and the mean target volume ratio was 1.02±0.04. Similarly the other indices like DG, NCI and modified HI index were 0.95±0.03, 1.08±0.06 and 0.94±0.02 respectively. The mean overall quality factor was found to be 1.01±0.02. The typical value of this factor also to be unity and above unity referred to be overdosed and below the unity referred as under dosage of the structures contoured volume in the corresponding plan.
Conclusion: Hence, we have concluded that, evaluation of the IMRT plan of head and neck cancer patients using Universal plan Indices and Quality factor have been done successfully using HART softwar
Adenocarcinoma insitu presenting as extensive crazy paving pattern: HRCT findings and review of literature
Get PDFThe crazy-paving pattern seen on HRCT is comprised of diffuse areas of ground glass attenuation. This imaging finding has numerous differentials including idiopathic, infectious, neoplastic and other miscellaneous entities. A 52-year-old non-smoker presented with mild to moderate dyspnoea with occasional cough and restrictive pattern on PFT. Chest radiograph showed bilateral diffuse air space opacities with crazy paving pattern on High resolution CT of the lung. This pattern has numerous differentials with pattern of lung involvement, the patient’s history and clinical findings being helpful in narrowing the diagnosis
Associations between sleep duration, sleep quality and high sensitivity C-reactive protein among medical students of a medical college in Chhattisgarh, India
Get PDFBackground: Recent studies in human have indicated possible pathophysiologic mechanisms to support the biologic plausibility of an association between sleep deprivation and future cardiovascular risk. In addition, emerging evidence suggests that inflammatory markers are elevated in sleep-deprived individuals. However, the relationship between sleep duration and inflammatory markers is still unclear.The aim of this study was to investigate associations between self-reported sleep duration, sleep quality, and high sensitivity C-reactive protein (hs-CRP) levels among medical students of a medical college in Chhattisgarh, India.
Materials and Methods: A total of 150 Students (94 male, 56 female) of Government Medical College, Rajnandgaon, Chhattisgarh in the age group of 20 to 30 years were randomly enrolled in the present study. Blood samples were analyzed for fasting blood glucose and hs-CRP. Sleep duration and sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI).
Results: In the present study, a significant variation in serum hs-CRP levels with different sleep categories was observed (P<0.0001), with the hs-CRP levels being highest (Mean ± SD; 1.13±0.85 mg/L) in short duration (<6 hours) followed by long duration (>8hours) sleepers (Mean± SD; 0.79±0.41mg/L). In both linear and logistic regression analysis model adjusted for various risk factors for cardiovascular disease, short sleep duration was significantly associated with elevated serum hs-CRP levels.
Conclusion: Our findings suggest that in¬flammatory mechanisms may play a role in the cardiovascular risk associated with sleep deprivation
Volumetric modulated arc therapy and concurrent chemotherapy for esophageal cancers: Dosimetric comparison with 3D conformal radiotherapy and early clinical results
Get PDFPurpose: Despite Intensity Modulated Radiotherapy being the standard of care for most sites, 3D conformal radiotherapy (3DCRT) is still more widely used in esophageal cancers. This study compares dosimetric results of volumetric modulated arc therapy (RA) with that of 3DCRT and evaluates early clinical results of the patients treated with RA and chemotherapy.
Materials and Methods: Evaluation of clinical outcomes in 10 patients treated definitively with RA and concurrent chemotherapy for esophageal cancer were included in the study. These patients were retrospectively planned with 3DCRT using antero-posterior portals till 3960cGy followed by obliques to a total dose of 5940cGy. The dose and target in each phase were kept same in both the plans. Dosimetric parameters were compared between the two plans using paired T-test or a Wilcoxon sign-rank based tests of normality on data distribution.
Results: With a minimum follow-up of 4 months, all the patients tolerated the treatment without grade IV toxicities and treatment interruptions. 7 patients had a complete response and 3 had a partial response of which one patient underwent surgery and is disease free. RA resulted in higher conformity to the target compared to 3DCRT (mean conformity index 1.1 vs.1.8 respectively (p=0.002). RA plans significantly spared lung V15 (32%vs.40.2%, p=0.003), V20 (22.7%vs.29.7%, p=0.003), mean lung dose (13.8Gy vs.17.1Gy, p=0.003), heart V30 (46.8%vs.55.2% p=0.002), mean heart dose (24.3Gy vs.28.1Gy, p=0.003), and spinal cord maximum dose (44Gy vs.46.9Gy, p=0.002). The mean V5 and V10 values were similar with either technique.
Conclusion: Irrespective of site of involvement, the RA resulted in better conformity and better sparing of heart, spinal cord and lungs beyond 15Gy. The dosimetric advantage gained with RA may become clinically relevant in reducing cardio-pulmonary complications especially in multimodality setting