International Journal of Medical Research & Review (IJMRR)
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Survival at one year in patients with lung cancer in a tertiary care center
Get PDFIntroduction: Lung cancer is a leading cause of mortality worldwide and despite advances in treatment, prognosis of advanced lung cancer is extremely poor, with a median survival time of approximately 1year. Factors like age, sex, performance status at the time of diagnosis, histological type, extent of disease, smoking status were found to predict survival in lung cancer.
Aim of the study: To determine one year survival of lung cancer patients from the date of diagnosis and to evaluate factors that are associated with survival.
Methodology: Prospective cohort study, conducted at Medical College, Thiruvananthapuram, Kerala, in 160 consecutive patients with histopathological diagnosis of lung cancer. Data on demography, symptoms, smoking status, performance status according to WHO performance scale, histological diagnosis, TNM stage and death were recorded using a structured questionnaire. Proportion of patients who survived at one year from the date of diagnosis was determined. For inferential statistics between groups, comparison of qualitative variables were analysed by chi-square test and quantitative variables were compared by student t test. P value of less than 0.05 was considered as level of significance Cox proportional hazard model were used to evaluate the factors affecting survival of lung cancer patients.
Results: 160 consecutive lung cancer patients with histopathological diagnosis were included in the study. 86.9% of patients were males. Male to Female ratio is 6.6: 1. 84. 5% of patients were above the age of 50 years. 11.3% were nonsmokers. COPD was the commonest comorbidity (58%) in the study. Adenocarcinoma (41.9%) was the commonest histological type in our study and this was the commonest histological type seen in females and nonsmokers. In smokers, squamous cell carcinoma (91.3%) was more common. 66.9% of patients were at TNM stage 3 or 4 at the time of diagnosis. 17.5% patients survived at one year after diagnosis. Age more than 70 years, high smoking index, associated COPD, TNM Stage 3 & 4, poor performance status at the time of diagnosis were associated with poor survival. (p value <0.001). Squamous cell carcinoma had better survival compared to other histological types (p< 0.001). No significant association between gender and survival pattern was seen in the study.
Conclusion: We found that 17.5% of lung cancer patients survived at one year after diagnosis. There was significant association of factors like age, smoking status, comorbidities, histological type, TNM stage and performance status at diagnosis with survival pattern. But no significant association between gender and survival was found in our study
Renal cortical necrosis at autopsy: a 12 year experience at a tertiary care centre in Mumbai
Get PDFIntroduction: Renal cortical necrosis (RCN) is an unusual cause of acute renal failure but still causes significant mortality in developing countries.
Objective: To review autopsies of histologically proven RCN reported in complete autopsies over the last 12 years.
Methods: All autopsies performed from 2004-2016 with RCN were analyzed retrospectively.
Results: A total of 13,896 autopsies were done at this centre over this twelve year period from 2004-2016. Of these, 26 cases were diagnosed as RCN, with an incidence of 0.19%. 978 of our total number of autopsies presented with Acute Kidney Injury (AKI) and the incidence of RCN in AKI was 2.7%. There were 844 maternal mortality deaths during this period of which 134 (15.9%) had AKI. RCN accounted for 2% of all maternal mortality deaths during this period. Obstetric cases amounted to 65.4% and non-obstetric cases to 34.6%. Pregnancy induced hypertension; intrauterine foetal death and postpartum hemorrhage were the leading causes of RCN amongst obstetric causes while septicemia, hemolytic uremic syndrome and poisoning were the leading non-obstetric causes. Microscopically, diffuse cortical necrosis was seen in 53.8% autopsies and patchy cortical necrosis was seen in 46.2% autopsies. Histopathology also showed intra-alveolar hemorrhage, bronchopneumonia, cerebral edema and acute respiratory distress syndrome.
Conclusion: Our incidence of RCN was 0.19% at general autopsy, 2.7 % in autopsies with AKI and 2% of maternal mortality deaths at a tertiary care centre.RCN in AKI being 2.7% is significantly less than the 6-7% reported in developing countries. Diffuse pattern of cortical necrosis was more common than patchy cortical necrosis
A prospective evaluation of blunt trauma abdomen in rural setup
Get PDFIntroduction: Blunt abdominal trauma accounts for the majority of abdominal injuries seen in the Emergency Department. It is responsible for substantial morbidity and mortality. Selecting appropriate approach has been recently a point of conflict in management of abdominal blunt trauma, and criteria for non- operative management are being changed frequently.
Objective: With aim to identify some of the determining factors of successful non-operative management.
Methods: A 2 year tertiary care teaching hospital based longitudinal study was done. Selection criteria were defined and a prestructured proforma was made to assess and note the findings.
Results: 34 patients were studied. 29.4% of patients were in the age group of >20-30 years with the mean age 35.29 ± 15.84 years. 79.4% were male. Road traffic accident was responsible for 79.4% of blunt abdominal trauma cases while majority of the patients presented with abdominal pain (91.2%) and abdominal tenderness (91.2%). Associated extra abdominal injuries were found in 10 cases. The common extra abdominal injuries were head injuries (14.7%). 9 patients underwent exploratory laparotomy. 25 were selected for non-operative management. The most commonly injured organ was spleen (38.9%) followed by liver & stomach. 3 patients died in the present study. The sensitivity and specificity of the Emergency USG findings were 80.9% and 92.3% respectively, and that of the CT findings were 100% and 0% respectively.
Conclusion: Non operative management (NOM) was found to be highly successful and safe. Hemodynamic stability along with ultra sound, CT scan and repeated clinical examination were the sheet anchors of NO
Biofilm production by uropathogens causing catheter associated urinary tract infection
Get PDFBackground: The microbial populations within urinary catheter frequently develop as biofilms, directly attaching to the surface of catheters. Bacteria in biofilm are protected from antimicrobial chemotherapy as well as host defence mechanisms, establishing chronic persistent infections, septicemia and death if not treated.
Material and Method: The present study, includes 200 patients, catheterized for >48 hours at CIMS, Bilaspur. Urine samples were collected and inoculated in nutrient agar, blood agar and MacConkey agar plates and identification done as per standard procedure. This study was conducted to detect biofilm formation ability of uropathogens by two different methods (Tube and Congo red agar method) and compare their antibiotic sensitivity by using Kirby-Bauer disc diffusion method.
Results: Out of 200 urine samples significant bacteriuria were detected in 148(74%) of samples and no growth found in 52(26%) samples and 14 samples showed growth of 2 microorganisms. A total no. of 162 microorganisms were isolated from 200 urine samples. Among these 162 isolates E. Coli was 29.62%, Pseudomonas aeruginosa 11.72%, Klebsiella sp 18.51%, Citrobactor sp 7.40%, Staphylococcus aureus 3.08%, and Coagulase negative Staphylococci 11%. Among these 162 isolates, a total of 91(56.17%) isolates showed biofilm production. Percentage of biofilm formation was highest in P. aeruginosa (63.15%).
Conclusion: Tube test method was found to be more reliable method. The in vitro antibiotic susceptibility pattern of biofilm producing organisms showed less sensitivity as compared to non-biofilm producing organisms
Epidemiology of oral poisoning in paediatrics age group
Get PDFIntroduction: Poisoning in children is a common and preventable cause of morbidity and mortality. Our environment is still not child-safe and the medications are not dispensed in a child-safe manner. The incidence of childhood poisoning in India varies from 0.3 to 7.6 percent. Poisoning accounts for 0.03% of mortality in infants, 0.16% in preschool age group and 0.37% of in five to fourteen year’s age group as per the statistics projected by Government of India. The poisoning in paediatric age group includes obsolescent traditional poisons, the in fashion intoxications with recreational drugs as well as chronic exposure to industrial chemicals. The peak incidence of accidental overdoses is in the second year of life and 85% of accidental poisoning affect children under five years of age.
Methodology: This is a prospective case controlled study done over a period of two years. The study was conducted in S C B Medical College, Cuttack, Odisha.
Results: The poisoning constitutes 1.15% of total paediatric admissions. The commonest type of poisoning was due to Non-Medicaments (56 cases – 78.87%), out of which the commonest poisoning was due to hydrocarbons.
Conclusion: Non medicament ingestions particularly kerosene still one of the very common toxic ingestion in children used in accidental poisoning cases
A study of the correlation of non-motor symptoms of Parkinson’s disease and Parkinson plus syndrome with duration of the disease
Get PDFIntroduction: Depression is common in PD, occurring in up to one-half of the patients. Anxiety disorders may be as common as depression and the two are frequently co-existent. Parkinson plus syndrome (PPS) is a group of sporadic, neurodegenerative diseases of the central nervous system, less common and usually more severe than Parkinson’s disease. They are characterised by relatively rapid disease progression and the presence of features that are atypical for PD, such as early postural instability and dementia, severe autonomic failure, or pyramidal and cerebellar signs.
Material and Methods: The study was conducted to assess the effect of duration in non-motor dysfunction in 60 patients with Parkinsonism including idiopathic Parkinson’s disease and Parkinson plus syndrome who attended either the outdoor services, or were admitted in the Neurology ward of our tertiary care centre, PGIMER & Dr. RML Hospital, New Delhi, India.
Results: PD patients had no correlation between cognition and duration of disease (p=0.079 with MMSE and p=0.145 with SCOPA COG) but had significant correlation between depression, sleep problems, pain and autonomic dysfunction with duration of disease (p=0.027, 0.008, 0.010 and 0.042 respectively).
Conclusion: Early recognition and diagnosis of PD and PPS is important as treatment may improve quality of life in patients. Co-existence of non-motor dysfunctions in the disease significantly adds to the burden of disease and affects the quality of life
Pattern of admissions into the newborn unit of university of Uyo Teaching Hospital, Nigeria
Get PDFBackground: Neonatal conditions have been noted to contribute significantly to under-five mortality rate. Knowledge of its pattern in our environment will help in planning for improved health care delivery.
Aim: To determine the morbidity and mortality patterns of patients admitted into the neonatal unit of the University of Uyo Teaching Hospital, Nigeria.
Methods: A retrospective analysis of the medical records of patients admitted into the neonatal unit of the University of Uyo Teaching Hospital over a period of twelve months from 1st of January, 2011 to 31st of December, 2011 was carried out. Information extracted from the records included age at presentation, gender, duration of hospitalisation, main diagnosis, and outcome.
Results: A total of 997 neonates were admitted during the period of review. The male to female ratio was 1.1:1 in favour of the males (529:468). Of these, the commonest diagnoses were: neonatal sepsis 253(25.38%), prematurity 188(18.86%), neonatal jaundice 181(18.15%) and birth asphyxia 137(13.74%). Mean duration of admission was9 days. The overall mortality rate was 12.9% with a male to female death ratio of1.3:1. Gender-related fatality rate was higher in males than females at 13.8% and 12.0% respectively. Majority (80.6%) of the deaths occur among the out-born while (43.4%) occur within 24 hours of admission.
Conclusion: Most of the neonatal deaths were from preventable diseases. Good antenatal care is advocated for all pregnant women. This will help in screening, identification and timely referral of high risk pregnant women from primary health facilities to secondary and tertiary health facilities
Solid pseudopapillary epithelial neoplasm: a rare cause of intractable abdominal pain in young women
Get PDFSolid pseudopapillary epithelial neoplasms of the pancreas are extremely rare and usually affect young women. It distinguishes itself from other pancreatic neoplasms with its low malignant potential. These tumors have a long asymptomatic period and are usually detected when they have grown to a very large size. We report a case of a 16 year old female patient who presented with intractable abdominal pain since past 1 month. A provisional diagnosis of Solid Pseudopapillary Epithelial Neoplasm was made on CT scan and confirmed by biopsy and histopathology. Early preoperative recognition of this tumour and confirmation by histopathology is emphasized because complete resection usually results in cure
Cardiogenic shock in Non-ST elevated AMI patients in a rural tertiary care hospital in Eastern India
Get PDFIntroduction: Acute Myocardial infarction is one of the leading causes of morbidity and mortality worldwide. Cardiogenic Shock is the leading cause of death in patients hospitalised for acute MI. Although there is substantial evidence for a benefit of reperfusion therapy for ST elevation MI, the best treatment strategy for patients with non-ST segment elevated MI is less well defined. Outcome and prognosis differs with the presence or absence of ST segment elevation. Most of the studies have been done on urban population.
Objective: To determine the frequency and profile of Non-ST elevated MI. Any differences in profile in a Rural population with different social and economic structure will also be documented.
Methods: In this descriptive cross-sectional study conducted in Medicine department, Malda Medical College & Hospital, WestBengal, India 100 patients of non STEMI are selected by using consecutive non probability sampling technique. After taking ethical clearance from Institution and consent from patients and their relatives, 100 patients of non STEMI are enrolled as per inclusion and exclusion criteria. They are evaluated for cardiogenic shock on the basis standard clinical examination and are managed as per protocol. All relevant data are recorded in predesigned proforma.
Results: Out of 100 patients, 68 are male and 32 are female. Mean age of the patients is 60 + 1.26 years and majority of them are in the age group of 61-70 years(41%). 5% patients of non STEMI developed cardiogenic shock and majorities are male and more than 50% of patients with cardiogenic shock with non STEMI are above 70 years old.
Conclusion: Frequency and Profile is comparable to other studies. This rising trendin a rural population of a developing country is due to probably more urbanisationrelated to change in food habits and life style changes
Effectiveness of selected Yoga postures and procedures for improvement in pulmonary functions in 8-14 year old children of Nasobronchial allergy
Get PDFIntroduction: Yoga postures can be effective way to regularize immune functions. Nasobronchial allergy appears when immune mechanisms go haywire and start behaving autonomously. Yoga has been used in many centers in India to cure asthma and other allergic ailments. This systematic prospective control trial study was done on school going children of Amritsar District.,India.
Material & Methods: Study done on 150 school going 8-14 year old children taken from Paediatrics ward of GND hospital, Amritsar. 75 children were included in study group and another 75 children were taken as controls. Both study and control group was further divided into three groups each. Sub-group-A- Allergic Rhinitis, Sub-group-B- Bronchial Asthma, Sub-group-C- Allergic Rhinitis and Bronchial Asthma both. Study group were taught certain Yoga postures like Virassna, Stupassna etc. and were followed for 6-12 weeks and results were recorded at 0, 6 and 12 weeks. Pulmonary functions tests were done on computerized spirometer.
Results: In sub-group A and B highly significant (p<0.001) results were seen in study group in terms of improvements in FVC, FEV1and PEFR as compared to control group.
Conclusion: Yoga postures and its variant breathing exercises can effectively improve pulmonary functions and modulate immune functions for cure of allergy