International Journal of Medical Research & Review (IJMRR)
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Outcome analysis of patients presenting with neurological manifestations of Plasmodium Vivax malaria in tertiary care hospital of Mumbai.
Get PDFObjective: Plasmodium vivax (P. vivax) infection has been considered for a long time a benign and self-limited disease. Percentage of complicated cases of vivax malaria is on the increasing trend, cerebral malaria being the most dreaded and a potentially life-threatening complication.
Material and Methods: A prospective observational study was done after institutional ethics committee approval from July 2011 to February 2012 at tertiary care hospital in Mumbai. We studied the clinical profile and outcome of all the 48 patients above the age of 12 years diagnosed with Cerebral Malaria.
Results: Incidence of neurological manifestations of vivax malaria in our hospital was 14.15%, with 32(66.7%) out of 48 patients being males. The mean age of patients with neurological manifestations of vivax malaria was 29.66 years in discharged patients and 50.88 years in expired patients. Altered sensorium 37(77.1%) followed by convulsion 28(58.3%) were common findings, but focal neurological deficit, Bell’s palsy, ataxia, psychosis were also seen. Mortality was higher (62.5%) in patients with premorbid conditions (p value <0.05) and that of with other system involvements (87.5%) including hepatic, renal, hepatorenal, pulmonary involvement (p value<0.05). Association between outcome with older age & high parasite index patients is significant (p value<0.001), however no such significant association was found in terms of gender distribution.
Conclusion: Plasmodium vivax, as has been traditionally believed, is no longer a benign species and is causing presentations akin to P. falciparum. It is imperative that clinicians are aware of and ready to handle the complications caused by Plasmodium vivax
Effectiveness of social media as a medical teaching tool
Get PDFIntroduction: Social media has become a pervasive force in the lives of 21st century learners. Mobile learning has been increasingly used in the educational context. However, its adoption in medical education has been slow, and its effectiveness in medical education is a new area of inquiry. This study was conceived to assess the effectiveness of social media as a medical teaching tool.
Materials and Methods: The study was conducted as a cross sectional, observational study with 150 III year MBBS students as study participants who were already enrolled in social network groups for educational purpose. A questionnaire catering to the objectives of the study was distributed and the response was evaluated.
Results: 54% of the students answered that social media as a teaching tool, significantly made learning fun and lively. 55% of students responded that it significantly improved the academic enthusiasm. 66% of students observed that it was significantly effective in kindling interest in clinical learning. 61% felt that it simplified the difficult concepts moderately and 28% felt that it significantly simplified difficult concepts. 60% of students felt that it did not distract them from their routine studies. 42% and 54% of students rated the usefulness of the social media as an educational tool as excellent and as moderate respectively.
Conclusion: Social media is effective as a medical teaching tool improving enthusiasm in academics, kindling interest in clinical learning, making learning fun and lively, without much distraction to students and can be integrated in the medical educational context
High resolution computed tomography in the evaluation of interstitial lung diseases: Imaging perspective revisited with review of literature
Get PDFAims and Objectives: The study was designed with a broad objective of studying the imaging findings of the common interstitial lung diseases and to assess the severity of the disease and determine the reversibility capability of the pulmonary parenchymal damage in ILD’s.
Patients and Methods: This was a prospective, observational study in which we evaluated 50 patients suspected of having interstitial lung diseases based on radiographic or clinical findings, by high resolution computed tomography (HRCT) over a period of one year.
Results: Out of the 50 patients, majority of them had idiopathic pulmonary fibrosis (n=16) followed by interstitial pulmonary involvement in patients of rheumatoid arthritis (n=13), scleroderma (n=10) and systemic lupus erythematosis (n=9). The less common ILD’s included were Occupational lung disease (n=1) and Mycosis fungoides (n=1).
Conclusion: HRCT of the lung in cases of the suspected interstitial lung diseases forms an invaluable tool for accurate and early identification and in conjunction with the clinical findings can obviate the need of lung biopsy in diagnosis of ILD’s
Study of sternalis muscle in north Indian population- a cadaveric study
Get PDFBackground: Sternalis is anatomic variant of anterior thoracic region generally encountered on routine dissection, imaging procedures or surgeries. Although here is sufficient text available regarding presence and extent of sternalis muscle but state of confusion still exist regarding its nerve supply.
Aim: In our study we have tried to find out the incidence of presence of sternalis muscle in north Indian population and through fine dissection, we have focused on the innervation received by the muscle.
Materials and Method: 48 human cadavers including both male and female were dissected at Veer Chandra Singh Garhwali Government Institute of medical Science & Research, Paui- Garhwal and Sarojini naidu Medical College Agra. Special emphasis was laid on innervations and through fine dissection, detailed picture about innervations was recorded. For cases with doubt, histological examination was done and final observations were recorded.
Result: Sternalis muscle was reported in 4 out of 48 cadavers. All cases presented with unilateral type of sternalis muscle. Three were present in male while one in female cadaver. In one cadaver, it was innervated by medial pectoral nerve while in two, innervations were provided by intercostals group of nerves. Only one cadaver presented with dual nerve supply.
Conclusion: in north Indian region, incidence of sternalis is 8.3 percent with dual innervation in single cadaver
Study of arterial pattern of normal human placenta in reference to its shape, weight and Hyrtl’s Anastomosis
Get PDFBackground: Study of placenta in reference to its blood supply is very important for the reason that it is highly vascular organ which directly influences the growth and development of foetus. The shape of placenta, its weight together with Hyrtl’s anastomosis also directly or indirectly affects the health and wellbeing of the foetus.
Material & Method: 104 placentae were collected from Labour room, Gynaecology & Obstetrics Department and Lady Loyal Hospital. After cleaning and morphometry, Barium Sulphate was injected in the vascular tree of the placentae. Finally after radiography, observations were recorded.
Results: dispersed pattern of Arterial pattern was found in 72.88 percent placentae and in remaining 27.11 percent, Magestrial pattern was present. Average weight of placentae in the study was 468.4 gm. Hyrtl’s anastomosis was present in 100 out of 104 placentae.
Conclusion: study of vasculature of Placentae revealed that percentage of dispersed and magestrial pattern of placentae in north Indian population is not same as that reported in other studies of different regions
Ocular manifestations of childhood malnutrition- an overview
Get PDFVitamin A deficiency is the commonest cause of preventable childhood blindness in developing countries. Severity of xerophthalmia is directly proportional to the severity of malnutrition
Resuscitation of trauma patients- an overview
Get PDFTrauma is a major cause of mortality worldwide. Majority of trauma deaths occurs within 24 hours of injury. Survival depends on timely resuscitation. Initial evaluation uses primary survey involving Airway maintenance, Breathing, Circulation, Disability and Exposure. In secondary survey, thorough head to toe examination is done. Initial resuscitation begins with 2 intravenous access and restricted volume replacement strategy.Controlling active bleeding, treating coagulopathy and transfusion of appropriate fluids is mandatory. Hypothermia should be treated with passive/ active peripheral warming and core warming. Ventilation strategy should be focussed to avoid hypoxaemia, hyperventilation and hypocapnia. Colloids (albumin, hydroxyethyl starches, dextrans, gelatins) and crystalloids (normal saline, ringer’s lactate) are both used in resuscitation. For major blood volume loss, blood transfusion is recommended to maintain tissue oxygenation. Damage Control Resuscitation is the strategy for hemorrhagic shock management which requires large-volumes of blood product transfusion.Vasopressors maintain target arterial pressure in presence of myocardial dysfunction. For patients with expected massive haemorrhage, Plasma or Fibrinogen concentrate and RBC may be used.Head trauma severity is age specific. Sedation, analgesia and fluids should be started. Secondary injury from hypoxia, hypotension, hyperthermia or raised intracranial pressure should be avoided. After structured approach of airway, breathing, circulation and disability, definitive treatment of primary intracranial injury should be done. CT scan is done for moderate/ severe head trauma or if signs of basal skull fracture. Management of trauma patients is challenging and requires a multidisciplinary approach
Prenatal sonographic evaluation of Arnold Chiari II Malformation
Get PDFArnold Chiari malformations are a broad group of malformations with distinctive imaging findings. They are named after an Austrian pathologist Hans Chiari who first identified types I-III in 1891. It is a spectrum of congenital abnormalities of CNS, characterized by downward displacement of the parts of the cerebellum, fourth ventricle, pons and medulla oblongata into the spinal canal. Type II is the most common subtype and is invariably associated with open neural tube defects like myelomeningocele. They constitute an important cause of neonatal morbidity and mortality and hence the need for prenatal evaluation with ultrasound to detect the anomalies. In this article we describe the features of Arnold chiari malformation, illustrate type II cases with sonological parameters for assessment, discuss the findings for diagnosis and conclude with prognosis and management
Study of central line-associated bloodstream infections in intensive care unit: a prospective observational study
Get PDFIntroduction: Central line associated blood stream infection (CLABSI) is a primary blood stream infection in a patient that had a central line within the 48-hour period before the development of bacteraemia and is not related to an infection at another site. It is often associated with serious infectious complications resulting in significant morbidity, increased duration of hospitalization and additional medical costs.
Objective: We aimed to study the course of infection, microbiology of CLABSI, & to identify the degrees of severity of sepsis associated with CLABSI.
Materials & Methods: Patients admitted in Intensive care units who fulfilled the inclusion criteria were enrolled. Various demographic, microbial and patients characteristics were noted along with outcome using a prestructured proforma.
Results: We studied 58 patients in ICU in which males were common, Sepsis seen in 43% of patients, 37% had Staph. Aureus, and the mortality was 24.1%.
Conclusion: CLABSI infection is best prevented rather than cured. It has mortality as high as 24.13%. It can manifest with varying degrees of severity of sepsis. Organ Dysfunction, multi organ involvement, TLC abnormalities, Oliguria, altered mental status, Hypotension are all markers of poor prognosis. More scientific data on the subject is required to formulate guidelines and protocols for prevention and treatment of CLABSI
Role of C- reactive protein in diabetic retinopathy
Get PDFIntroduction: Diabetes mellitus is a major medical problem throughout the world. Diabetes causes an array of long-term systemic complications that have considerable impact on the patient as well as society, as the disease typically affects individuals in their most productive years. C Reactive Protein is an acute phase reactant and an inflammatory mediator involved in the pathogenesis of Diabetic Retinopathy.
Aim: The aim of this study is to determine the correlation of C-reactive protein with diabetic retinopathy and different grades of retinopathy.
Methods: The study was done on 200 diabetic patients attending the ophthalmology outpatient department, who were selected by purposive sampling. The patients were subjected to a complete ocular examination. Based on the fundus examination patients were categorized into the respective study groups: - 1) Controls 2) Diabetics without Diabetic Retinopathy 3) NPDR 4) PDR 5) CSME. The patients were then subjected to C- reactive protein estimation via laboratory analysis (Turbidometry Technique).
Results: The study showed that the mean CRP levels in diabetics were found to be 3mg/dl which is well within normal limits. The CRP levels were relatively higher in the PDR and CSME groups with it being elevated in 30% and 20% patients in the groups respectively.
Conclusion: CRP levels in our study did not show significant correlation with diabetes mellitus. Although higher grades of retinopathy had higher CRP levels, the correlation was not significant and consistent. Hence C- reactive protein cannot be used as a reliable screening tool for diabetic retinopathy