International Journal of Medical Research & Review (IJMRR)
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Pattern of inflammatory phenotypes using sputum cytology among patients with asthma in a tertiary care centre, Kerala –A prospective cohort study
Get PDFBackground: Asthma is a chronic inflammatory airway disease in which various inflammatory cells play a pivotal role in pathogenesis. Based on the inflammatory cells count in the sputum, various inflammatory phenotypes are identified. The identification of asthma phenotypes has potential clinical significance, as natural history and treatment response differ according to phenotype.
Objectives: To find out pattern of inflammatory phenotypes of asthma patients and to compare the level of asthma control after 3 months of optimized treatment in different phenotypes.
Methods: We did a hospital based prospective cohort study in the Department of Pulmonary Medicine, Medical College, Thiruvananthapuram, Kerala, over a period of one year. 138 consecutive non-smoker, asthma patients were included. Sputum was examined for differential count .The phenotype was considered eosinophilic if eosinophil count was ≥3% and noneosinophilic if eosinophil count < 3%. Each patient was reassessed after 3 months of optimized treatment and level of asthma control was assessed according to GINA guidelines.
Results: 53.6 % of study population were in the eosinophilic and 46.4 % were in the noneosinophilic phenotype. Mean age of eosinophilic phenotype was 38.4 ± 11.7 years and that of noneosinophilic was 48.8 ± 10.6 years (p<0.001). Mean BMI of eosinophilic asthma patient was 23.3 ± 2.4 and that of noneosinophilic was 24.9 ± 2.3 (p <0.001). Atopic symptoms were present in 73% of the eosinophilic phenotype and 25% of the noneosinophilic phenotype (p<0.001). There was no statistically significant difference between the two phenotypes with regard to the gender, duration of illness, family history of asthma, or initial severity of the disease. After 3 months of optimized treatment, in eosinophilic phenotype 73 % of patients became controlled or partially controlled. In noneosinophilic group only 46.9 % became controlled or partially controlled (p= 0.002).
Conclusion: Noneosinophilic asthma occured in older, obese patients, were usually non atopic and had poor asthma control after three months optimized treatment, compared to eosinophilic phenotype. Thus phenotypic classification could help to guide clinical decisions in personalized medicine approach
Association between mean platelet volume and Microalbuminuria in Type 2 Diabetes Mellitus Patients
Get PDFBackground: Type 2 DM is characterized by increased platelets activation, hence platelet functional markers like the mean platelet volume (MPV) can play a vital role in identifying subjects at high risk of developing microvascular complications.
Objectives: To study the association between mean platelet volume and micro albuminuria and to analyse factors associated with MPV in patients with Type 2 diabetes mellitus.
Materials & Methods: A cross sectional study was conducted in the department of internal medicine, Velammal medical college and hospital, between June 2016 and December 2016. Subjects with DM, with age > 20 years were included. Latex Turbidimetric method was used to assess urine micro albumin.
Results: A total of 269 diabetic patients with mean duration of disease of 4.84 years were included. There was a moderate, statistically significant positive correlation between HbA1 C level and Mean platelet volume (PCC=-0.198, p value 0.001). The other factors had shown no statistically significant correlation with MPV. There was a Statistically significant mild negative correlation between serum uric acid and MPV (PCC= -0.196, p value 0.001). The mean MPV in people with low and high Urine micro albumin was 7.716 ± 0.876 and 7.705 ± 0.890 respectively, and the difference was statistically not significant.
Conclusion: Poor glycaemic control may lead to higher MPV in diabetic population. Very minimal and statistically non-significant difference was observed in mean MPV value between subjects with high micro albuminuria and low micro albuminuria
Spectrum of abnormal epithelial lesions of cervix in a tertiary care teaching hospital in South India
Get PDFIntroduction: Cervical cancer is the leading cause of death in developing countries like India. Cervical cytology by papanicolaou (pap) smears is an effective means of screening for cervical premalignant and malignant lesions.
Aim: To study the role of pap smear in detecting premalignant and malignant lesions of cervix and to determine the prevalence of various lesions.
Materials and Methods: This was a retrospective study of 1030 conventional pap smears reported from the Department of Pathology, Government Medical College, Anantapuramu. The time period was from October 2014 – September 2016.
Results: In our study out of 1030 cases, inflammatory smears were reported in 713 cases (69.22%), Epithelial cell abnormalities were found in 71 smears(6.89%), atypical squamous cells of undetermined significance (ASCUS) in 27 (2.62%), AGUS in 0.10%, LSIL in 25 cases (2.43%), HSIL in 1.26% cases and invasive squamous cell carcinoma in 5 (0.48%) cases
A prospective randomized study for comparison of onset time of intubation and intubating conditions using rocuronium with priming and without priming
Get PDFBackground: Rocuronium, a non-depolarizing neuromuscular blocking agent, with priming, can be used as an alternative to succinylcholine for rapid sequence intubation because it produces rapid onset of intubation with comparable intubating conditions. We aimed to compare the onset time of intubation and intubating conditions using rocuronium with priming and without priming.
Methods: Sixty adult patients of either sex, aged 18-60 years, ASA grade I and II, scheduled for various elective surgeries under general anaesthesia were randomly allocated into two groups (30 patients in each group). Group P received 0.06 mg/kg of rocuronium as priming dose and Group C received normal saline as placebo before induction. The patients in both groups received fentanyl 1.5 µg/kg and induced with propofol 2.5 mg/kg. The intubating dose of rocuronium 0.54 mg/kg for Group P and 0.6 mg/kg for Group C were given after 3 min of priming. The time interval between the intubating dose and the loss of T1 of TOF stimuli was considered as the onset time of intubation and Cooper’s scoring system was used to compare the intubating conditions.
Results: The onset time of intubation was significantly shorter (P <0.05) in group P (54.87 ± 3.75 sec) than group C (94.37 ± 3.52 sec). Intubating conditions were found to be excellent in both the groups with no any adverse effects.
Conclusion: Rocuronium (0.6 mg/kg) with priming provides rapid onset time of intubation (<60 sec) along with excellent intubating conditions without any adverse effects which may be particularly useful for rapid sequence intubation and where succinylcholine is contraindicated
A comparative therapeutic evaluation of topical Ivermectin Vs topical Permethrin for the management of scabies
Get PDFObjective: To compare the therapeutic efficacy of topical ivermectin 0.5% vs. topical permethrin 5% cream in the treatment of scabies.
Methods: This was open labelled, parallel group, prospective and comparative clinical study. Depending on the treatment to be received, there were two study groups comprising 50 patients each. Group 1 patients received topical 5 % Permethrin cream on day 1 and repeat application on 1st week follow up and if required then on second week; Group 2 patients received topical 0.5% Ivermectin cream on day 1 and repeat application on 1st week follow up and if required then on second week. The patient were also given antipruritic drug Tablet levocetirizine in a dose of 5 mg once daily given for 2 to 3 weeks. A total of 50 patients in each group were included in the study.
Results: More than half of the patients in both Group 1 (56%) and Group 2 (54%) were below 30 years. More than half of the patients in both Group 1 (54%) and Group 2 (52%) were males. Majority of site of lesions were absent at 2 weeks in both the groups. Moderate and severe itching of lesion became nil at 2 weeks in both the groups. Grade 2 of itching of lesion was in 2% at 2 weeks in both the groups. KOH was positive in 94% patients in Group 1 and in 96% in Group 2 at baseline which decreased to 14% in Group 1 and 18% in Group 2 at 1 week. KOH positivity became nil at 2 weeks in both the groups.
Conclusion: Topical Permethrin 5 % and Ivermectin 0.5 % were equally effective in the treatment of scabies up to 2 weeks
A study of the factors associated with anxiety and depression among the patients of arthritis
Get PDFBackground: Arthritis is one of the common chronic disease and leading cause of disability in India. Due to increasing number of older adults, the prevalence of arthritis is expected to rise dramatically. Depression and anxiety are generally more common among people with arthritis than in general population and interplay independently and synergistically with clinical outcomes such as pain and disability.
Aim: To study the prevalence of depression, anxiety and the factors associated with them among Indian adults suffering from arthritis in a tertiary care centre.
Material and Methods: The study sample comprised of adults age above 30 years with clinician diagnosed arthritis (n=370). Depression and anxiety were measured using separate and validated scales. Prevalence was estimated for the sample overall and stratified by subgroups. Associations between correlates and each condition were estimated with prevalence ratios.
Result: Depression was more common than anxiety (24% and 11% respectively) overall; about 8% of patients have mixed depression and anxiety disorder. Among them only 2-3% of patients seek consultation for mental health condition.
Conclusion: Despite of high prevalence of depression and anxiety among the patients of arthritis help seeking for the psychiatric disability appears to be minimal. Untreated anxiety and depression may negatively impact on pain, mobility and quality of life
A study on incidence and severity of acute renal failure and its association with parasite density in hospitalised patients with falciparum malaria
Get PDFAims of the study: To find out the incidence of acute renal failure in falciparum malaria and to correlate between the degree of parasitism at presentation with acute renal failure and its outcome in falciparum malaria.
Methodology: Each patient with a history of fever, suggestive of severe malaria was subjected to peripheral blood smear examinations, up to 3 samples were examined or till positive and/or Pf antigen positive cases. The selected patients were then grouped according to the clinical features, laboratory parameters and were followed up for the outcome.
Results: Out of the 50 cases of acute renal failure due to falciparum malaria, 21 had Parasite density <5% (42%), 13 had 5-10%(26%) and 16 had >10%(32%). Out of 21 cases of mild ARF 12 patients had parasite density<5% and 9 had >5%. Out of 29 cases of severe ARF 9 patients had parasite density<5% and 20 had >5%. Dialysis was done in a total of 31 cases (62%). In the severe form of acute renal failure. hemodialysis was required in 29 cases (58%), in the milder form of renal failure; only 2 cases (4%) required hemodialysis. Rests of the cases were managed by conservative treatment.
Conclusion: Parasite Density has significant impact to predict the severity of renal failure, duration of hospital stays as well as the number of dialysis required. As the study was conducted with small number of cases, further study is necessary with large number of cases to arrive at a conclusion regarding the malady of acute renal failure in falciparum malaria
Clinical etiological evaluation of Pancytopenia: Experience of tertiary care teaching hospital in central India
Get PDFIntroduction: Pancytopenia is a common clinico-hematological entity. There are significant variations in incidence of disorders causing pancytopenia.
Objectives: To evaluate different causes of pancytopenia & to correlate underlying etiology of pancytopenia with clinical profile.
Methods: This prospective observational study was done in the Department of Medicine, Gandhi Medical College & Hamidia Hospital, Bhopal between July 2014 to Nov. 2015. 70 cases of pancytopenia were included. All participants underwent clinical evaluation and baseline investigations followed by bone marrow examination.
Result: Out of 70 patients, 71% were < 40 years and male to female ratio of 1.41:1. Most common presentation was fever and weakness. Most common physical findings were splenomegaly seen in 48 cases. Lymphadenopathy was noted in 6 cases. Megaloblastic anaemia (41.4%) was most common cause of pancytopenia irrespective of age and sex. It was followed by aplastic anaemia, hypersplenism and leukaemia. Together these four accounted for 94.3% cases. In younger patients common causes after megaloblastic anemia (42.9%) were aplastic anemia followed by leukemia, hypersplenism, autoimmunity and infection. In older age group common causes were hypersplenism (23.8%), aplastic anemia, leukemia and infection after megaloblastic anemia. Aplastic anemia was more common in males and hypersplenism in females.
Conclusion: In our study megaloblastic anemia is most common cause of pancytopenia in this part of India irrespective of age and gender. Splenomegaly was more common in megaloblastic anemia, hypersplenism and malignancies. Most of the patients without splenomegaly had aplastic anemia
Comparative evaluation of ultrasonography and computed tomography findings in focal hepatic masses
Get PDFIntroduction: Focal liver lesions are defined as solid or liquid-containing masses foreign to the normal anatomy of the liver that may be told apart from the latter organ using imaging techniques. They can have a number of etiologies including congenital, neoplastic and infectious and inflammatory conditions as well as trauma and miscellaneous entities. The data was analyzed to compare between ultrasonography (USG) and computed tomography (CT) findings in these cases.
Aims and Objectives: To evaluate the role of ultrasound and computed tomography in diagnosis of focal hepatic masses and compare the ultrasound and CT findings of focal hepatic masses and correlate with histopathological and surgical findings.
Material and Methods: USG and CT were performed on 40 focal hepatic mass patients. The diagnostic value of ultrasound was compared to those of CT. Final diagnosis was made after correlation with surgical findings, serological findings and histopathological examination. The data collected was analyzed statistically.
Results: Final diagnosis of focal hepatic masses was simple cysts (n=5), polycystic liver (n=1), metastasis (n=22), hydatid cysts(n=5), hemangioma (n=6), hepatocellular (n=11), focal nodular hyperplasia (n=1), abscess (n=16), cholangiocarcinoma (n=1). The sensitivity, specificity positive and negative likelihood ratio were 84.38%, 67.74%, 2.62 and 0.23 respectively, for USG and 100%, 97.14%, 35 and 0 respectively, for CT.
Conclusion: USG and CT are the modalities having comparable specificity and sensitivity, CT being slightly more accurate than USG in evaluation of focal hepatic lesions in atypical cases. USG is useful in follow-up cases
Local anesthesia for Reduction of Nasal Bone Fracture: our experience
Get PDFIntroduction: Nasal bone fractures are very common injuries, reduction under local anesthesia is the usual management, yet there is controversy about the efficacy of this management and if it satisfies the patient\u27s functional and cosmetic needs.
Objective: To assess both efficacy of nasal bone reduction under local anesthesia and patient\u27s degree of satisfaction in regards to aesthetic and functional results.
Patients and Methods: Retrospective analysis and review of 31 patients underwent nasal bone reduction under local anesthesia in Prince Hashim Military hospital in Zarqa, Jordan between May 2015 and June 2016. Digital and instrumental reduction under local anesthesia was performed with and without splint application after clinical and radiological assessment. Results were evaluated by objective clinical examination and subjective functional and cosmetic satisfaction.
Results: Patients were divided into two groups according to gender, group A: males 23 (74.19%), group B: females 8 (25.8%), 20 patients of group A (86.95%) were happy with the functional and cosmetic outcome, 3 patients of group A (13.04%) were not happy with the cosmetic outcome but happy regarding the functional outcome, 5 patients of group B were happy with the functional and cosmetic outcome, 3 patients of group B were not happy regarding the cosmetic outcome but satisfied with the functional outcome, all patients in both groups except one patient in group A were had patent nasal airway on clinical and endoscopic examination. 2 patients from both groups sought revision surgery for cosmetic concerns only.
Conclusion: Use of local anesthesia for reduction of nasal bone fractures offers both patent nasal airway and satisfactory cosmetic results