International Journal of Medical Research & Review (IJMRR)
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Pattern of lipid alterations in subclinical hypothyroidism: response to Levothyroxine replacement
Get PDFObjectives: (1) To assess the association of subclinical hypothyroidism (SCH) and lipid profile (2) To quantify the effect of thyroxine treatment on lipid profile.
Methods: In a non-randomized matched design, 320 patients who were detected to have SCH and 180 euthyroid controls, matched for age and BMI (body-mass index), werestudied for lipid parameters. Subjects with SCH were further subdivided on the basis of their thyroid functional status: SCH with TSH≤10.0 mIU/L (SCH-1) and SCH with TSH>10 mIU/L (SCH-2). Subjects in SCH-2 group were started on thyroxine replacement and were followed up after 3 months with a repeat lipid profile.
Results: Mean total cholesterol (TC) and low-density lipoprotein (LDL) levels were higher and mean high-density lipoprotein (HDL) significantly lower in SCH (SCH-1 and SCH-2) compared to euthyroid controls, but there was no statistically significant difference in the mean triglyceride (TG) levels. Subjects in SCH-2 group had significantly higher mean LDL and lower mean HDL compared to SCH-1 group. There was a significant reduction in mean TC and LDL and increase in HDL after treatment with thyroxine, while there was no significant difference among the mean TG levels.
Conclusion: Subclinical hypothyroidism is associated with TSH dependent rise in TC and LDL and fall in HDL compared to controls. Achieving euthyroid status with thyroxine has a favourable effect on lipid profil
Cannabis induced psychosis - an overview
Get PDFPsychosis is a condition where there is a loss of contact with reality with symptoms like delusions, hallucinations, paranoia, disorganized thinking & speech, loss of motivation, depression, anxiety & poor sleep. It can be associated with Schizophreniform disorder, Bipolar disorder, Schizoaffective disorder, Depression with psychotic features, Drug-induced psychosis, Organic psychosis or Post-traumatic stress disorder. Psychosis is so common that about 3 out of every 100 people will have a psychotic episode in their lifetime. The phases of psychosis include an initial Prodromal Phase where there is subtle changes in thinking, perception and behavior. During acute Phase full blown symptoms occur which may affect the individual\u27s daily living. Later Recovery Phase starts
A comparative study to determine vitamin D status in type 2 diabetes and normal subjects in south India
Get PDFBackground: Vitamin D deficiency is common in general population in India in spite of adequate sunlight. We have decided to compare the prevalence of vitamin D deficiency in type 2 diabetes and normal individuals.
Methods: 370 type 2 diabetes individuals attending Karnataka Institute of endocrinology and research outpatient department and 100 normal individuals were studied. Fasting plasma glucose, post prandial plasma glucose, lipid profile, vitamin D levels, BMI, waist circumference and BP of these subjects were measured.
Results: Out of 370 type 2 diabetes subjects 67.3% were males and age group ranging from 21 to 80 years. Duration of diabetes vary from 0 to 20 years. Vitamin D deficiency was present in 83%, insufficiency in 13.8% and only 3.2% had normal vitamin D levels in type 2 diabetes. Vitamin D deficiency was common in individuals >50 years, males, BMI 25-30. Family history of diabetes was present in 60%. Hypertension was present in 47.6%. Total cholesterol, LDL, Triglycerides were lower and HDL levels were higher in type 2 diabetes individuals with vitamin D more than 20 nanograms per ml. In 100 normal individuals taken as controls 62% were males, age group ranging from 21 to 80 years. Vitamin D deficiency was present in 82% and insufficiency in 12% and 6% had normal vitamin D levels.
Conclusions: Vitamin D deficiency was present in 83% of type 2 diabetes individuals and 82% of normal individuals. So both type2 diabetes and normal controls from south India are equally deficient in vitamin D. Total cholesterol, LDL, Triglycerides were lower and HDL levels were higher in type 2 diabetes individuals with vitamin D more than 20 nanograms per ml
Dermatoglyphics patterns in patients suffering from primary amenorrhea and control population
Get PDFBackground: Dermatoglyphics is branch of medical science, which deals with the study of epidermal ridges and their configuration on the palmer region of hand and finger and planter region of foot and toes. Inspection of skin ridges provide a simple, inexpensive means of information to determine whether a given patient could have a particular chromosomal defect. Amenorrhea is defined primary when menarche does not occur by the age of 16 years in a girl with complete secondary sexual development. In the present study an attempt has been made to correlate primary amenorrhea and dermatoglyphics.
Method: 40 normal females with primary amenorrhea were taken as case and 40 normal females with normal menstrual cycle were taken for study. Dermatoglyphic prints were obtained using ink method.
Result: The mean value of atd angle shows statistically significant increase in patients than that of controls. Frequency of thenar/ ID1 pattern, ID2area, ID3area, IDarea in a both right and left hands of primary amenorrhea patients and in control is insignificant. Similarly, there is increased frequency of hypothenar area pattern in patients as compared to controls in left hand, which is found to be statistically significant.
Conclusion: Primary amenorrhoea and Dermatoglyphics, both have the suspected multifactorial (genetic and environmental) aetiologies. Dermatoglyphics, due to their suspected genetic aetiology. use for prognosis of disease and also the identification of people with the genetic predisposition to develop certain disease or early onset of symptoms
The diagnostic accuracy of diffusion weighted magnetic resonance (MR) imaging for discrimination of malignant from benign cervical lymphadenopathy in head and neck tumours using histopathology as the reference standard
Get PDFHead and neck cancers accounts for maximum number of cancer cases in Indian hospital settings. Involvement of neck nodes is a very important prognostic factor of its outcome. Differentiation between benign and metastatic lymphadenopathy often presents a diagnostic challenge with conventional imaging techniques. Diffusion-weighted imaging (DWI) has emerged as a powerful non-invasive imaging technique that is capable of characterisation of these lesions as benign or malignant with the help of apparent diffusion coefficient (ADC) maps.
Aim: The aim of this cross-sectional study was to determine the diagnostic accuracy of DWI to differentiate benign from malignant cervical lymph nodes in head and neck tumours, subsequently confirming the results using histopathology as the reference standard.
Materials and Methods: The cross-sectional study was conducted on 60 patients of either age or sex with enlarged neck lymph nodes over a period of 2 years, subsequently these patients underwent DW MRI imaging followed by histopathology of either neck dissection specimen or core biopsy or US guided FNAC as a part of the study.
Results: Out of 60 patients, 41(68.33 percent) cases came out as malignant and 19 (31.67 percent) cases came out as benign. The results obtained were 36 true positives, 4 false positives, 15 true negatives and 5 false negatives. The overall sensitivity of DWI for differentiating malignant from benign cervical lymphadenopathy was 87.80% with specificity of 78.95%. The positive predictive value and negative predictive value were 90.00% and 75.00% respectively. The best ADC threshold value for distinguishing benign and malignant nodes was 1.005 × 10-3 mm2/sec.
Conclusion: DWI is an important tool to differentiate benign vs malignant lymphadenopathy and helps in guiding the clinician to treat these nodes accordingly
Skill based training of accredited social health activists: training effectiveness assessment using training and programme evaluation model
Get PDFBackground: Accredited Social Health Activists (ASHAs) are gross root health workers introduced under NRHM; for delivery of health services in rural areas. Training them for capacity building and functioning was a big challenge which has been tackled through skill based training. The study has been done to evaluate training effectiveness using managerial approach (Kirkpatrick’s model) and find out the gaps and suggest measures to improve ASHAs knowledge and skills.
Methods: A cross sectional study on 580 ASHAs selected by sequential random sampling at training centres of Indore and Dewas districts. Sample size reduced to 10% of original for qualitative assessment. Interview of subjects and inspection of records was done using questionnaires/Performa. Paired, unpaired t test, Mcnemar test were applied with p<0.05for statistical significance.
Results: Significant improvement in knowledge was found and the mean knowledge score got almost doubled after training (from 8.68 to 15.27 in a 30 point score, paired t test p<0.0001). 80% of ASHAs learnt the skills of hand washing, recording temperature and applying eye ointment and 50-60% learnt skill of weighing newborn, preventing baby from cold.
Conclusion: Training was helpful in improving knowledge, skills and activities done by ASHAs. But still very few ASHAs were able to score passing marks and competent in all skills essential for new born care
Hypoplasia of lung a rare entity mimicking as a case of tuberculosis
Get PDFPulmonary hypoplasia, a congenital malformation, is characterized by incomplete development of the lungs, leading to an abnormally less number or dimensions of bronchopulmonary segments / alveoli resulting in small fibrotic and non-functional lung. It is usually diagnosed in the neonatal period or in early childhood. Hypoplasia may be primary (idiopathic) or secondary. Primary pulmonary hypoplasia, not related to other congenital anomalies is extremely seldom diagnosed in adults. We report the case of a 32-year-old married female with two kids presented to us with chief complaints of cough and fever for past nine months. Chest radiograph showed opacification of the left hemi-thorax with decrease in its size and marked ipsilateral mediastinal displacement with an increase in volume of right lung. After investigations she was diagnosed as a case of left lung primary pulmonary hypoplasia. High level of excellent clinical judgement needed to spot and diagnose this congenital aberration, often wrongly diagnosed in adults. Hence, once confronted with an opaque hemi-thorax in a young person with ipsilateral shift of the mediastinum, differential diagnosis of “lung hypoplasia” ought to be kept in mind
Antimicrobial resistance pattern of faecal Escherichia coli isolates: story of antibiotic use and misuse
Get PDFIntroduction: Antimicrobial resistance is a major challenge of concern for treating patients. Emergence of antibiotic resistance among hospitalized patients has received considerable emphasis, while multi drug resistance also has an impact on community. It is well known that commensal faecal flora are reservoir of resistance genes, as well as site where resistance genes can be transferred.
Aims & Objectives: The aim of the present study was to determine the antimicrobial resistance pattern of Escherichia coli isolates from patients with suspected intestinal infection with and without diarrhoea attending outpatient department in tertiary care center.
Material & Methods: This retrospective short observational study was carried out on 111 non repetitive fecal samples received in microbiology laboratory. Escherichia coli (E.coli) strains isolated were evaluated for resistance pattern.
Results: Among 46(41.81%) isolated E.coli strains 84.78% isolates exhibited resistance to two or more antimicrobials, whereas 45.65% isolates were multi drug resistant. Decreased susceptibility was observed for first line antibiotics which tend to be more affordable and accessible to families, followed by 3rd generation cephalosporin’s. However, resistance among quinolones and aminoglycosides varies between 20-30%. Imipenem was observed as most sensitive followed by Piperacillin + Tazobactum (100.00% and 86.95% respectively).
Conclusion: Consequences of resistance are harder to define than microbiologists might wish. Some patients recover despite inadequate treatment whereas others failed to respond despite appropriate therapy. Increased morbidity and mortality are the most dramatic consequences of drug resistance
Study of renal function test in asphyxiated newborns and their outcome
Get PDFIntroduction: There is a high incidence of acute kidney injury (AKI) among asphyxiated term. AKI manifests by changes in urine output and blood chemistries & can have serious clinical consequences. Oliguria has been reported in higher number of neonates affecting nearly 25%- 70% babies.
Methodology: This study was undertaken to study renal failure in asphyxiated neonates. This is a prospective case controlled study done over a period of two years. Various clinical, biochemical and radiographic parameters pertaining to renal injury among asphyxiated neonates were studied.
Results: About 64 asphyxiated newborns were studied. Majority (53.12%) was term weighing between 2.5-3 kg & most of them were in HIE-2 grade (43.75%). Oliguria was mostly noted among HIE - 3 (31.57%). Birth asphyxia and subsequent acute renal failure was more in babies delivered vaginally. Biochemical parameters also showed correlation with the severity of asphyxia. Premature babies were more prone to develop renal failure secondary to asphyxia. Mortality was directly related to severity of perinatal asphyxia and presence of oliguria.
Conclusion: The incidence of acute renal failure due to perinatal asphyxia was high. Incidence with oliguria was high in severe asphyxia. Prevention of asphyxia & prompt management of morbidities like ARF can improve the outcome of perinatal asphyxia
Spectrum of CT findings in gall bladder carcinoma patients in north Indian population
Get PDFBackground: Gallbladder carcinoma is the most common malignancy of the biliary tract and ranks fifth amongst gastrointestinal cancers. In Asia, increased frequency of gall bladder carcinoma is seen in north Indian Females.
Method: A prospective study was carried out on 60 patients of gall bladder(GB) mass who were selected from OPD and wards of the hospital. CT scan of these patients was done using Siemens Somatom Emotion 6 slice machine.
Results: Among the 60 patients of GB mass included in this study, 46 patients were diagnosed as gall bladder carcinoma based on the multidetector computed tomographic findings and its correlation with histopathology. Out of 46 patients 30 were females and 16 were males. Infiltrating masses were detected in 28 patients, intraluminal polypoidal masses were detected in 10 patients while eight patients presented with mural thickening of the gall bladder wall.
Conclusion: We conclude that multidetector CT is the diagnostic tool of choice in the detection of gall bladder carcinoma and extension of tumour to distant sites