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A Prospective Study to Assess the Cases of COPD in Known Population
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Background: To assess cases of COPD in known population. Subjects and Methods: Sixty- eight patients with COPD of both genders were enrolled in present study. History of smoking, type of cooking fuel combustion, family history, education level etc. was recorded. A thorough physical and clinical examination was performed in all patients. Results: Out of 68 COPD patients, male comprised 40 and female 28. Education was primary in 44, secondary in 10 and graduation in 2. BMI was underweight in 38, overweight in 12 and normal in 18 cases. Family history was positive in 40 and fuel used was LPG in 10, kerosene in 20 and wood in 38. A significant difference was observed (P< 0.05) [Table 2, Figure 1]. Conclusion: Chronic obstructive pulmonary disease is becoming common nowadays. Though underweight is one of the major cause but air pollution caused by combustion fuel cannot be overlooked. 
A study on the causes of Acute Kidney Injury in ICU in a Tertiary care centre and comparison of prognostic scoring systems (SOFA score and APACHE score) to predict mortality and renal outcome
No full textIntroduction: Acute kidney injury (AKI) is a complex clinical disorder that is associated with severe morbidity and mortality, which in spite of technological advances in Renal replacement therapy (RRT), continues to be associated with poor outcomes. AKI is a syndrome of sudden loss of kidney’s excretory function, often associated with oliguria, occurring over hours to days seen commonly in hospitalised patients who are critically ill. Subjects and Methods: A prospective and observational study was conducted at Sapthagiri Institute of Medical Sciences & Research Centre from January 2020 to December 2020. Patients with Acute Kidney Injury satisfying inclusion and exclusion criteria, admitted in the medical Intensive care unit (ICU), were selected after obtaining informed consent. Results: The mean age of the population was 64.51 ± 14.29 years. 65% patients were males. Most common age group was older age group (65 to 75 years) for both males and females. In the younger age group (18-44 years) most of them were males. In the elderly age group (85- 100 years) females exceeded males. The mean duration of hospital stay was 10.78 ± 8.39 days and the median duration of hospital stay was 9 days. The mean duration of ICU stay was 6.15 ± 5.31days and the median duration of ICU stay was 4 days. In our study some patients had AKI on day 1 of ICU admission and the others developed AKI later during the course of ICU stay. The median day of ICU admission on which patients presented with AKI in our study was on the day 1. RRT was initiated in majority of the patients (53%) on the 1st day of ICU admission itself. Remaining patients (25.6%) received RRT on day 2 of ICU admission. Only a few patients (21%) received RRT after 2 days. Conclusion: Elderly males are at higher risk for developing AKI. Sepsis with pneumonia is the leading cause of AKI in ICU. Pre-existing Chronic Kidney disease (CKD )has worse renal outcome. Kidney Disease Improving Global outcomes(KDIGO) staging is an independent predictor of ICU mortality, RRT requirement and ventilatory support. In the setting of acute kidney injury, Acute Physiology and Chronic Health Evaluation (APACHE) III is superior to Sequential Organ Failure Assessment (SOFA) and APACHE II for predicting in-hospital mortality. Patients with AKI have 2.33 times more risk of mortality compared to those without AKI. AKI is an independent predictor of mortality in ICU. 
Experience in the Treatment of Injuries of the Parenchymatic Organs of the Abdominal Cavity in Combined Injury
No full textBackground: The main problem is the diagnosis and treatment of combined closed abdominal trauma, accompanied by shock on the background of massive intra-abdominal bleeding with liver and spleen injuries. The hospital mortality rate for this type of pathology ranges from 17.3 to 72.7%. Methods: The treatment and outcomes of 539 patients with closed injuries of the abdominal organs in 2011 - 2021 were analyzed. Multi-stage ”damage control” surgical tactics in isolated and combined severe liver injuries is an effective method in unstable patients with the risk of coagulopathy and multiple organ failure. Results: Out of 539 patients with closed abdominal injuries, 269 (49.9%) were operated on. Of these, 131 (48.7%) had liver and spleen injuries. According to the localization of damage according to the Mooge classification, there were: liver grade I in 9 people, grade II in 18, grade III in 25, grade IV in 17, and grade V in 3 victims. Spleen ruptures were diagnosed as grade I in 6 patients, grade II in 15, grade III in 26, grade IV in 10, and grade V in 2 patients. Conclusion: A necessary component at the final stage of surgical intervention is intestinal decompression in order to conduct enteral tube feeding to correct hypermatabolism and prevent secondary systemic complications associated with emerging enteric insufficiency. 
The Outcome of Direct-Acting Antivirals in Treatment-Naïve Non-Cirrhotic, Chronic Hepatitis-C Infected Patients in a Tertiary Care Center
Get PDFBackground: To determine the outcome of Direct-Acting Antivirals in treatment-naïve Non-Cirrhotic, Chronic Hepatitis-C infected patients in a tertiary care Centre. Subjects and Methods: Hepatitis C positive non cirrhotics patients were included in the study. Treatment was given according to HCV Genotype and HCV Viral Load. 12 weeks after completion of treatment with Direct-acting antivirals patient were assessed for the Sustained Virological Response (SVR) ie.;SVR12. Results: The (Mean±SD) age was found to be 43.92±13.51 years. There are 11(44%) male whereas 14(56%) female. Out of total subjects, 3(12%) had diabetes mellitus whereas 5(20%) reported hypertension. Genotype 3 was found to be most common (72%). The mean±SD after treatment A.L.T U./L, A.S.T U/.L and I.N.R observed was 13.95±4.90, 14.97±5.03 and 1.40±0.54 respectively. The mean±SD Total Bilirubin mg/dL, Albumin g/dL and Hb g/dl observed was 0.72±0.32, 3.99±0.57 and 11.49±1.46 respectively. In 23 (92%) subjects S.V.R was achieved whereas in 2(8%) cases it was not achieved. Conclusion:Oral D.A.A accomplished higher SVR12 rates and were very much endured in this cohort based study associated with patients diagnosed with Chronic Hepatitis-C. 
To Predict the Occurrence of Esophageal Varices in Chronic Liver Disease Patients Using Transient Elastography (Fibroscan)
No full textBackground: Chronic liver disease (CLD) is a cause of significant morbidity all over the world including India. Progression of CLD to cirrhosis leads to multiple complications including development of esophageal varices (EV) with its risk of bleeding & consequent morbidity & mortality. Hepatic biopsy with its inherent limitations is still the gold-standard tool for diagnosis of cirrhosis while Upper gastrointestinal Endoscopy (UGIE) with its inherent limitations is still the gold-standard tool for diagnosis of EV in these patients. Transient elastography (TE-Fibroscan) is a recently developed tool for estimating hepatic fibrosis by liver stiffness measurements (LSM) to predict cirrhosis as well as EV in cirrhotic patients. Subjects and Methods: One hundred patients of CLD were enrolled and evaluated by Fibroscan for LSM and by UGIE for EV & their grades following approval from Institutional Ethics Committee and after obtaining the informed consent. Various statistical methods and tools were then used to find out correlation of LSM with grade of EV and bleeder vs non-bleeder EV. Results: Majority of the patients were males with 41-50years being the dominant age-group. HCV followed by NAFLD were the commonest identifiable etiologies in our study group. Patients with small varices outnumbered those with large varices (52 vs 39). The mean LSM value increased significantly from no Varices (14.60 ± 0.88) to Small esophageal varices (15.51 ± 2.76) to Large esophageal varices (23.80±3.17) with positive correlation with variceal grade. Mean LSM value for identification of varices was 15.51±2.76kPa while it was 23.80±3.17 kPa for large varices. The bleeders had significantly higher LSM value compared to the non-bleeders (34.93±10.45kPa vs 18.46±5.59kPa). Significantly positive correlation was found between mean LSM; Total, Direct & Indirect Bilirubin; Alkaline Phosphatase and serum Globulin while negative correlation was noted with serum Albumin. Conclusion: The noninvasive nature of TE (Fibroscan) makes it an attractive tool for screening of CLD patients needing UGIE not only for diagnosis of EV but those with large varices needing management. Thus, TE might play a crucial role in not only diagnosis but also in management of EV varices in patients with CLD obviating unnecessary UGIE. 
Estimation of Vitamin D Level in Patients of Chronic Liver Disease and its Association with Child Turcotte Pugh’s Score
No full textBackground: Chronic liver disease (CLD) has a fairly high occurrence in the Indian subcontinent due to variety of etiological factors including alcohol abuse, viral hepatitis, etc. As liver plays a crucial role in digestive as well as metabolic functions, its significant dysfunction is related to severe imbalance of vitamin D. Though for long the role of vitamin D in bone mineral metabolism is known yet recent literature has suggested its significant role in immune modulation, inflammatory response and in fibrosis. Since insufficient data on vitamin D levels in CLD patients exists in Indian population, hence we planned this study. Subjects and Methods: Hundred patients of CLD were included in our study following approval from institutional ethics committee, obtaining informed written consent and excluding bone disease, chronic renal disease, known cardiac disease & known malignancy. All patients underwent estimation of vitamin D levels and appropriate tests to diagnose CLD with further categorization into A, B, C as per Child-Turcot-Pugh (CP) Criteria. Appropriate statistical tests were then applied to find out the association between CLD and vitamin D levels. Results: Majority of the CLD patients were males and in 3rd-5th decade with most of them i.e. 89% in our study, had insufficiency or deficiency of vitamin D in their serum with majority having moderate to severe grades of CLD as per CP score. This association was statistically significant with p value of less than <0.01. Also, a negative Pearson correlation was observed meaning thereby that as the CP score increases, the vitamin D levels decrease. Conclusion: Since vitamin D plays a key role in immune based responses, its serum level is crucial in patients suffering with chronic liver diseases, where the serum vitamin D levels decrease as the Child-Turcot-Pugh score of liver disease increases. Early recognition of insufficient or deficient levels of serum vitamin D by their simple & inexpensive serum estimation may go a long way in not only instituting early therapy but also in preventing related morbidities. 
A Retrospective Observational Study of the Occurrence of Thromboembolic Complications in the Post COVID-19 Phase and its Association with CT Severity Score
Get PDFBackground: To present thromboembolic complications after recovery from covid-19 and determine its Association with CT severity score. Subjects and Methods: An observational study was conducted retrospectively over a period of 1 month during which all cases who presented with thromboembolic complications after being discharged from covid-19 were enrolled. The data pertaining to the socio-demography, haematological parameters and inflammatory markers such as LDH, IL-6, ferritin, CRP and D-Dimer were recorded at the time of admission with COVID-19. Initial chest HRCT scans were done at presentation. For determining the area of embolism, CT angiography was done in the region of head and neck, coronary and lower limb as per the presenting symptoms. The patients were thrombolysed/ revascularized and followed up until recovery/death. Results : HRCT scoring was normal in 59.18% cases, mild in 8.16% and severe in 32.65% cases. Thromboembolic complications were seen in all patients, common being peripheral vascular disease (53.06%) followed by coronary artery disease (38.78%) and lastly cerebrovascular accidents (8.16%). Mean value of post covid days of study subjects was 12.33 ± 5.34 with median (25th-75th percentile) of 11(8-16). There was only a single mortality in the present study. HRCT score showed a significant association with the presence of hypertension (p=0.011,) and leukocytosis (p=0.004). However there was no significant association of HRCT with the region of thromboembolism. Conclusions: Thromboembolic complications are common in the initial month of post covid phase. Comorbidities like hypertension needs to be controlled as it shows a significant association with HRCT severity. Inflammatory levels of IL-6 and CRP may be implicated in the occurrence of thromboembolism. An early identification, treatment and thromboprophylaxis is required in such cases for a better outcome. 
A Study of Microvascular Complications in Patients with Newly Diagnosed Type II Diabetes Mellitus in a Tertiary Care Hospital, Moradabad
No full textBackground: Diabetes mellitus is a metabolic syndrome which has reached epidemic levels in both developed and developing parts of the modern world. With rising prevalence of obesity, physical inactivity and other related metabolic syndromes, the incidence and prevalence of type II DM is sharply increasing along with the related complications. Type II diabetes mellitus is related with macrovascular and microvascular complications, latter being usually overt. In fact, in many cases the type II diabetes often reaches clinical attention due to the microvascular complications. The common microvascular complications including diabetic retinopathy, diabetic nephropathy and sensory neurological deficits are a common cause of morbidity associated with type II diabetes. Aim: The frequency of microvascular complications in newly diagnosed cases of Type II diabetes mellitus. Subjects and Methods: More than 200 patients newly diagnosed cases of type II DM were included in the study conducted in Medicine Department of our Institution following approval from IEC and after obtaining written & informed consent. The frequency of the microvascular complications including diabetic retinopathy, diabetic nephropathy and diabetic sensory neuropathy was calculated utilizing various tests and clinical examination along with presence of hypertension and smoking, latter are known factors in increasing the severity of the type II diabetes related morbidities. Appropriate statistical methods and tools were used to find out the statistical significance of various observations. Observations and Results: Significant number of patients in our study were in 41-60yrs age group with male predominance. Majority were obese and more than three-fourth had deranged HbA1c levels of >6.5. Significant number of patients had hypertension and were smokers that showed statistical correlation with increased incidence of microvascular complications in the corresponding subgroup. Significant proportion of patients in our study group were detected with microvascular complications in form of diabetic retinopathy, diabetic nephropathy and sensory neuropathy. Conclusion: Since the incidence of microvascular complications including retinopathy, nephropathy and sensory neuropathy is quite high in newly diagnosed patients of Type II diabetes mellitus, hence clinical & laboratory tests directed to their diagnosis should be included in the screening protocol of such patients. As these tests are inexpensive, hence their inclusion may go a long way in reducing the microvascular complication related morbidity in type II diabetes mellitus patients. 
Esophageal Candidiasis: Causative Species and their Antifungal Susceptibility Pattern in Hospital of Western U.P.
No full textEsophageal candidiasis is more commonly presented in persons with immunocompromised conditions but it can also be seen in immunocom petent patients. There has been an epidemiological shift towards the predominance of candida spp. other than C.albicans such as C. glabrata C. parapsilosis, C. krusei, C. tropicalis, C. dubliensis etc. accounting for more than 50% of the Candida infections. The rampant misuse of antifungals has increased the antifungal resistance among C.albicans as well as non-albicans species and poses a challenge to clinicians for the management of such cases. The current study was aimed to understand the isolation of various Candida spp. in patients diagnosed with esophageal candidiasis attending a tertiary care center in western U.P. and to analyse its association with various predisposing factors. This study also extends to determine the susceptibility pattern of the isolated candida spp. against different antifungal agents. The study was conducted for 3 years in the hospital of western U.P. North India from July 2017 to June 2020. Candidial esophagitis was suspected when in endoscopy, whitish plaques are seen attached to the mucosa and these plaques were collected using biopsy forceps and sent to the microbiology laboratory for its fungal culture and speciation. In the current study, 60.1% were Candida albicans while 39.9% were other candida spp. Among NAC, the commonest species was C. parapsilosis (14.1%) followed by C. dubliensis (9.2%), C. glabrata (8.6%), C. tropicalis (4.9%) and C. krusei (3.1%). All isolates were found sensitive to AmphotericinB, however 3.1% of the isolates were resistant to Voriconazole and 7.4% to fluconazole. Fluconazole resistance is a serious issue as it is considered the drug of choice in cases with esophageal candidiasis. Such studies help clinicians to select appropriate antifungals for these patients and reduces patient’s morbidity and mortality. 
Analysis of the Incidence and Risk Factors in the Development of Acute Kidney Injury after Off Pump Coronary Artery Bypass Grafting
No full textBackground: Acute kidney injury (AKI) is a serious complication after coronary artery bypass grafting and is associated with a high mortality. The aim of this study was to evaluate the incidence and the risk factors involved in the development of AKI after off pump coronary artery bypass grafting (OPCAB). Subjects and Methods: A retrospective analysis of 1378 adult patients who underwent OPCAB in Sapthagiri Institute of Medical Sciences and Research Centre during a one-and-a-half-year period was done. AKI was defined as an increase in creatinine more than 0.3 mg/dl or a decrease in urine output less than 0.5 ml.kg.hr for 6 hrs. The data relevant to the risk factors were collected and analysed using chi square test. Results: The overall incidence of AKI was 18.2%. The independent risk factors that were associated with AKI were increasing age, pre-operative chronic kidney disease, diabetes mellitus, left ventricular dysfunction, low mean arterial blood pressure and the need for intra-aortic balloon pump. Conclusion: AKI was common after OPCAB. Pre-existing renal dysfunction, diabetes mellitus, left ventricular dysfunction, advanced age, low mean arterial blood pressure during the intra operative period and the need for intra-aortic balloon pump were identified as the risk factors for the development of AKI after OPCAB.