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How to treat Vitamin D deficiency in sun-drenched India - guidelines
CV Harinarayan
July-September 2018, 7(3):131-140
Vitamin D plays an important role in calcium and mineral metabolism. It is astonishing to find vitamin D deficiency in sun drenched country like India. This could probably due to modernisation of India-mechanization, urbanization, change in life style, dress code and revision of vitamin D adequacy range. India has the unique problem of twin nutrient deficiency- vitamin D and calcium. Low calcium in the diet coupled with vitamin D deficiency has adverse consequences in the skeletal health. Any vitamin D schedule to treat/supplement should be accompanied by adequate calcium in the diet/supplementation. There are many international guide lines for vitamin D supplementation. This review aims at highlighting the vitamin D supplementation schedule suitable in Indian context keeping in mind the cost and compliance. Studies in south India using in vitro ampoule mode with 7-dehyrocholestrol has shown adequate formation of active form of vitamin D from mid-day sun. Time of the day, latitude, and increased skin pigmentation all influence the cutaneous production of vitamin D. Exposing 12%-18% of body surface area to unprotected sunlight for 30-45 mins is equivalent to taking 600-1000 IU of vitamin D which is the dose recommended by experts for fortification of food. Vitamin D synthesized in the skin last twice as long. We as human can get Vitamin D from abundant sunshine. There are various food fortification schedules suggested. The major source of vitamin D for both children and adults is unprotected sun exposure. In the absence of sun exposure adequate amount of vitamin D from dietary sources and supplementation is a must to satisfy body's requirement. In India, adequate amount of vitamin D should be accompanied by dietary/supplemental calcium to achieve desired skeletal benefits.
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The global D-Lemma: The vitamin D deficiency pandemic even in sun-drenched countries
Michael F Holick
July-September 2018, 7(3):101-105
  2,145 293 1
Stroke in patients with and without diabetes mellitus
Avin Subhash, Chinta Raj Kumar, Neelam Kumari Singh, Suresh Krishnamurthy, MV Nagabushana, YJ Visweswara Reddy
January-March 2018, 7(1):7-11
Background: Diabetes mellitus (DM) is a well-recognized risk factor for stroke. Stroke in diabetic patients is different from stroke in non-diabetics from several perspectives. This study was carried out with the aim to identify and compare distinctive patterns between diabetic and non-diabetic stroke cases. Methods: It is a hospital based cross-sectional study, carried out at PESIMSR Hospital, Kuppam, Andhra Pradesh, in which 80 consecutive patients with stroke (40 patients with and 40 without DM) were studied. Clinical features, risk factors, stroke patterns and outcome were studied. Results: The mean age (years) in stroke patients 57.5 ± 12.7 and 61.3 ± 12.9 (p=NS) stroke in patients with and without DM respectively. Males outnumbered females in both the groups (p=NS). Stroke patients with DM known to have hypertension were 75% and that of non-DM group was 42.5%. Diabetic stroke patients with history of coronary artery disease formed 32.5% and that of non-diabetic group was 27.5%. The mean high density lipoprotein (HDL) cholesterol (mg/dL) was lower in the diabetic group (38.8 ± 12.6) compared to that in the non-diabetic group (50.1 ± 6.9). The mean triglycerides (TG) (mg/dL) was significantly higher in the diabetic (216.9 ± 67.6) than in the non- diabetic group (150.05 ± 60.58). Both diabetic and non-diabetic patients had greater incidence of ischemic stroke (about 75%) than hemorrhagic stroke. In the present study, 37.5% of stroke patients with diabetes had a poor outcome compared to 22.5% of stroke patients without diabetes. Conclusions: DM is an independent risk factor for stroke. Stroke in patients with DM differs from that of stroke in persons without DM with respect to age, gender, stroke severity, prevalence of risk factors and outcome. Hypertension, HDL level and TG were significantly associated with DM. Diabetics stroke patients were having significantly higher levels of mean TG level, lower mean HDL level.
  814 129 -
Clinico-epidemiological study of melasma in men
Keerthi Charupalli, TS Rajasekhar, Madhusudan Mukkara
January-March 2018, 7(1):19-23
Background: Melasma is one of the most common and distressing pigmentary disorders presenting to dermatology clinics. There is paucity of data regarding the aetiological factors and clinical presentation of melasma in men. The present study was taken up to fill this lacuna and to understand the unique aspects of melasma in this group. Methods: Study was conducted in the Department of Dermatology at University teaching hospital from January 2015 to July 2016. A total of 72 male patients with melasma were studied. A detailed history including occupation, onset, duration and evolution of melasma, predisposing factors like sun exposure and genetic factors, were taken followed by general physical examination, cutaneous examination and Woods lamp examination and recorded in a proforma. Laboratory investigations like complete haemogram, hormonal profile, liver function tests were done whenever necessary depending on the presenting condition. Results: The mean age of onset was 31.5 years. The duration of melasma varied from 3 months to 6.5 years. The aetiological factors identified were, sun exposure in 42 patients (58.3%) and family history in 29 (40.3%). Laboratory investigations revealed hepatic disorders in 5 patients(6.9%), increased luteinizing hormone (LH) and low testosterone in 2 (2.8%) and hypothyroidism in 4 patients (5.6%). According to clinical patterns, malar pattern was seen in 65.3% of patients, centro-facial in 31.9% and mandibular in 2.8% of patients. The most common skin type found to be type IV. Conclusion: Melasma was evident in men in their fourth decade of life; malar pattern, type IV skin type were most commonly seen.
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Intermittent flow centrifugation technique used for large volume leucapheresis in a low-body weight paediatric patient
Yalamanchili Swapna
April-June 2018, 7(2):83-85
Paediatric leucapheresis is a preferred mode of stem cell collection compared to bone marrow harvest. However, the inherent risks of this procedure like difficult venous access, citrate toxicity, large extracorporeal volume and haemodynamic instability are of considerable importance. Leucapheresis can be done by continuous flow centrifugation (CFC) or intermittent flow centrifugation (IFC) technology. Based on the total blood volume that is processed; it is standard or large volume leucapheresis. The use of IFC blood cell separator in paediatric low body weight child to perform large volume leucapheresis is discussed.
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A prospective study on the common infectious causes of thrombocytopenia (dengue fever, leptospirosis, scrub typhus and malaria) in a tertiary care teaching hospital
G Nibandhana, Usha Kalawat, KK Sharma, Rashmi Patnayak, DT Katyarmal, Abhijit Chaudhury
January-March 2018, 7(1):2-6
Background: The present study was undertaken to know the contribution of four infectious causes of fever namely dengue, chikungunya, scrub typhus and malaria in patients presenting with fever of more than one week duration with thrombocytopenia in a tertiary care teaching hospital, Tirupati, Andhra Pradesh. Methods: In this prospective study, 1014 samples from different patients who presented with fever and of more than one week duration and thrombocytopenia were collected over a period of six months and were processed for the detection of non-structural 1 (NS1) glycoprotein antigen for dengue, immunoglobulin M (IgM) antibodies for leptospirosis and scrub typhus by ELISA and malaria parasite by quantitative buffy coat (QBC). Results: Among 1014 samples obtained from patients with fever with thrombocytopenia, 111 (10.94%) were due to thrombocytopenia due to infectious causes. Ninety (81.08%) were due to single infection and twenty one (18.92%) due to co-infections. Males were more affected. Peak incidence was in 40-49 years of age with scrub typhus as the predominant infection. Grade-3 thrombocytopenia was more common in all the four infections. Conclusions: Our observations suggest that scrub typhus was the predominant cause of fever with thrombocytopenia, along with dengue, leptospira and malaria. Diagnostic evaluation should include search for these causes in patients presenting with fever with thrombocytopenia. This can be helpful as both are easily treatable infections with commonly available oral antibiotics.
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Transfusion-related acute lung injury
V Arun Raja, C Rahul, M Krishna Kumar, V Pradeep, KV Sreedhar Babu, J Harikrishna
January-March 2018, 7(1):24-29
Transfusion-related acute lung injury (TRALI), an important non-infectious risk of blood transfusion is a leading cause of morbidity and mortality. Activation of polymorphonuclear (PMN) leucocytes by the mediators released due to the interaction of donor antibodies against the recipient monocytes is thought to trigger TRALI. Major histocompatibility complex Class II antibodies have been implicated in the direct causation of TRALI by direct activation of PMN leucocytes. TRALI has been reported in patients receiving all blood components that contain plasma. Awareness regarding TRALI among clinicians and a high index of suspicion will facilitate early diagnosis of the condition. TRALI is a clinical diagnosis that is suspected when new acute lung injury (ALI) develops within six hours of a transfusion. Diagnostic work-up should focus on ruling out other risk factors for ALI like sepsis, aspiration, among others. TRALI mitigation strategies are helpful to ensure blood safety and facilitate lessening of other transfusion reactions transfusion associated circulatory overload as well. The treatment for TRALI is symptomatic and supportive and is similar to that administered for ALI.
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Study of oxidant and anti-oxidant status in patients with chronic kidney disease
A V. S S. N. Sridhar, P V. L N. Srinivasa Rao, Vishnubhotla Sivakumar, P Satish, P Shalini, MM Suchitra, Vinapamula S Kiranmayi
July-September 2018, 7(3):124-130
Background: Chronic kidney disease (CKD) is associated with oxidative stress (OS), which occurs even in early stages of CKD and was shown to further contribute to progression of renal dysfunction and increased cardiovascular risk in CKD patients. Majority of studies have evaluated OS in CKD patients using limited biomarkers. Present study aimed at comprehensive evaluation of oxidant and antioxidant status in CKD patients. Methods: 120 patients diagnosed with CKD who were classified into three groups of 40 each [group-1 (CKD stage1 and 2), group-2 (CKD stage3 and 4) and group-3 (CKD stage 5] based on eGFR and 30 healthy controls were recruited. Malondialdehyde (MDA), protein carbonyls (PC), ferric reducing ability of plasma (FRAP), protein thiols, superoxide dismutase (SOD), glutathione peroxidase (GPx) and catalase were measured in all subjects. FRAP was corrected for uric acid (FRAP_UA) and MDA/FRAP_UA ratio was calculated. Score for oxidative stress (SOS) was calculated using the oxidant antioxidant parameters studied. Results: MDA, PC, MDA/FRAP_UA, FRAP and SOS were higher whereas protein thiols, SOD, GPx and catalase were lower in CKD patients than controls. Further, MDA, PC and FRAP and SOS increased progressively and protein thiols, SOD and catalase decreased progressively with increasing renal dysfunction. MDA, PC, FRAP and SOS showed positive correlation with creatinine and negative correlation with eGFR, whereas protein thiols, SOD, and catalase showed positive association with eGFR and negative correlation with creatinine. Conclusions: CKD patients are prone for oxidant injury which increases progressively with worsening renal dysfunction and is associated with degree of renal impairment. Score for oxidative stress helps in comprehensive assessment of oxidative stress in CKD patients.
  622 116 -
Does clinical posting in psychiatry change attitude towards psychiatry? A prospective study
Animesh Sharma, GK Vankar, PB Behere, KK Mishra
July-September 2018, 7(3):106-113
Background: Worldwide, mental illnesses are on rise. There is an acute shortage of psychiatrists. Young medical graduates find psychiatry specialty a less attractive career option. The present study was conducted to find out attitudinal change of medical graduates to psychiatry specialty after their clinical posting. Methods: The study was carried out in a tertiary medical care centre situated in eastern Maharashtra in a rural setting. The medical graduates undergo rotation which includes clinical posting in psychiatry while they are in second year. One hundred medical students were administered Attitudes Towards Psychiatry-30 (ATP-30) questionnaire at the beginning and the end of two weeks of posting. Results: The response rate was 93% and the mean pre-rotation score on ATP-30 questionnaire was not significantly different as compared with the mean post-rotation score [107 ± 11.7 (SD) vs. 106 ± 12.4 (SD); (p=NS)]. Subgroup analysis revealed a significant decline [56 ± 6.4 vs. 54 ± 6.6 (p< 0.05)] in attitude on 15 positive questions of the questionnaire. Students with urban background [(55.8 ±6.6 vs 58.6 ± 9.3 (p=0.88)] as compared with rural background [58.1 ± 3.2 vs 53.9 ± 6.1 (p=0.03)] had significantly more decline on ATP-30 questionnaire. Conclusions: Overall, there was no change in medical students' attitude following two weeks clinical posting. Based on these findings medical curriculum including duration and frequency of clinical posting in psychiatry during undergraduate training requires change.
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Clinical manifestations, imaging findings and laboratory abnormalities in 51 patients with autosomal dominant polycystic kidney disease: Experience at Tirupati, South India
KM Bhargav, B Siddhartha Kumar, Alladi Mohan, LR Aramadhaka, B Manoj Prajwal, D Prabath Kumar, B Vijayalakshmi Devi, V Sivakumar
October-December 2018, 7(4):165-169
Background: Autosomal dominant polycystic kidney disease (ADPKD) is an important cause of renal failure. Sparse recent data are available on clinical presentation ADPKD from India. Methods: We retrospectively studied the clinical presentation, imaging findings and laboratory abnormalities in 51 patients diagnosed to have ADPKD at our tertiary care teaching hospital at Tirupati, South India. Results: Their mean age at presentation was 49.1± 13.2 years; there were 32 (63%) males. Salient renal clinical manifestations at initial presentation included abdominal pain (47%); fever (35%), shortness of breath (33%); palpable mass per abdomen (25%); burning micturition (20%); haematuria (10%); and renal/ureteric caliculi (12%). Other manifestations were headache (21%); altered sensorium (12%); intracerebral bleed (8%) and chest pain (8%). Family history of ADPKD was present in 13 (26%) patients. On imaging studies kidneys were normal sized in 39%, enlarged in 59% and small sized in one patient; co-existent liver cysts were found in 12 patients. Hypertension (n = 20, 40%); chronic kidney disease (CKD) (n = 36, 71%) were evident at initial presentation. Other associated co-morbid conditions were type 2 diabetes mellitus (n = 6); Marfan's syndrome with mitral valve prolapsed and renal cell carcinoma (one patient each). Conclusions: In Tirupati, South India, ADPKD most commonly presented in fourth or fifth decade of life. Males were affected more frequently than females. Presence of CKD, hypertension at the time of inital diagnosis suggests that ADPKD is diagnosed late in the course of the disease. A high index of suspicion, specific diagnostic work-up including abdominal ultrasonography is required to diagnose ADPKD.
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Three-dimensional conformal radiotherapy versus intensity-modulated radiotherapy in carcinoma cervix
Revathi Badiginchala, Swapna Jilla, BV Subramanian, Prana Bandhu Das, Archana Prathipati, G Sanjeeva Kumar
July-September 2018, 7(3):114-118
Background: Cervical cancer is the most common gynecological cancer among Indian women. 3D-CRT treatment is associated with more acute and late toxicities, because of close proximity of bladder and rectum to the cervix. The newer technique like IMRT is associated with less toxicities. Our study is to compare 3D-CRT and IMRT in terms of dosimetric parameters, toxicities and clinical outcomes. Methods: From February 2015 to July 2016 total 40 newly diagnosed locally advanced cervical carcinoma patients were treated with concurrent chemo radiotherapy with weekly cisplatin. Those patients were randomized to arm A - 3D-CRT and arm B - IMRT. Results: The dosimetric parameters of the bladder, rectum, bowel bag, and pelvic bone marrow were significantly decreased in the IMRT arm as compared to 3DCRT arm except for V30, V50 of bowel bag and V50 of pelvic bone marrow. The acute and late toxicities were similar among both arms. All the patients were assessed for treatment response at 6 weeks after completion of the treatment. All achieved complete clinical response. Out of 40 patients only one had brain metastasis after a median follow up of 18 months. Conclusions: Though IMRT showed dosimetric reduction compared to 3D-CRT but it did not showed any clinical benefit. At present scenario in developing countries like India where the cancer centers are over loaded with the carcinoma cervix cases can be treated with the 3D-CRT technique without compromising clinical outcomes.
  572 102 -
Pre-analytical phase in clinical chemistry laboratory
Sohini Sengupta Neogi, Mohit Mehndiratta, Stuti Gupta, Dinesh Puri
July-September 2016, 5(3):171-178
The laboratory testing process is divided into the pre-analytical, analytical and post-analytical phases. For obtaining reliable test results, the prevention and detection of errors at all steps is required. While analytical standards have been developed by recognized quality control criteria, there is a scarcity in the development of standards for the pre- analytical phase. This phase is most prone to errors as the steps involved are directly dependent on humans and are out of direct control of the laboratory. Such errors in preanalytical stage often only become apparent in the analytical or post-analytical phase. The development of a pre-analytical quality manual is essential in achieving total quality control. Correct practices and strategies of error prevention can reduce preanalytical errors. This review focuses on prevention of pre-analytical errors that occur while collecting a specimen of blood, urine and cerebrospinal fluid. Most of these can be easily prevented with understanding and education of the personnel involved in and responsible for executing this crucial pre-analytical phase.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
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Medical Council of India's amended qualifications for Indian medical teachers: Well intended, yet half-hearted
Sunita V S Bandewar, Amita Aggarwal, Rajeev Kumar, Rakesh Aggarwal, Peush Sahni, Sanjay A Pai
October-December 2018, 7(4):155-158
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Trends of acute-phase dengue at a tertiary care hospital, Tirupati, Andhra Pradesh India
Rishi Gowtham Racherla, Mudhigeti Nagaraja, Alladi Mohan, Usha Kalawat
October-December 2018, 7(4):175-178
Background: The present study was designed to know the trends of acute phase dengue in the Rayalaseema region of Andhra Pradesh state. Methods: This was a retrospective study conducted at Sri Venkateswara Institute of Medical Sciences, a tertiary care teaching hospital in Tirupati, Andhra Pradesh. Samples received for dengue NS1 testing from January 2011 to December 2015 were analysed. Results: During the study period, 6182 serum samples were received from cases clinically suspected to have dengue fever. Of these 690 (11.2%) tested positive. Positivity was significantly higher among females compare to males (12.1% vs 10.4%; P = 0.037). Children (19.2%) were more affected than adults (12.2%) and elderly (3.6%) (P < 0.001). Conclusion: Acute dengue infections were high in children compared to other age-groups with preponderance during post-monsoon and monsoon periods.
  553 93 -
Smoking and Anaesthesia: Implications during perioperative period
Aloka Samantaray
April-June 2018, 7(2):75-79
There are considerable myths which surround not only about the different terminology used for smoking but also about their possible impact during the perioperative period. The health hazards posed by smokeless tobacco(electronic cigar) is lower compared to tobacco cigarette smoke whereas actually the levels of aldehydes aerosol generated from new-generation devices at high power levels (Electronic cigars) could approach or even exceed the levels found in cigarette smoke. Nicotine has analgesic properties and thus many believe that smoking tobacco or inhaling nicotine only (e.g., smokeless tobacco) may have a similar effect on pain perceptions in the perioperative period. Many others have opined and associated smoking as a protective factor against postoperative nausea and vomiting. However smoking whether active or passive is always a general health problem and when such patients come for surgery possess additional challenges to the anaesthesiologist. This review will give a brief account of who is a smoker and different terminology being described in literature to describe smoking who need to quit smoking before surgery and when how smoking adversely affects the physiology of body and based on the available literature formulate an anaesthetic plan in smokers.
  557 78 -
Ectopic parathyroid adenoma: single-centre experience from India
CV Harinarayan, Honey Ashok, Adil Sadiq, GR Prashant, Divya Badanidiyur, Neha Gupta, Indira Rajani, NK Sunil Kumar, Shabnam Roohi, G Nandita
April-June 2018, 7(2):69-74
Background: The commonest cause of primary hyperparathyroidism (PHPT) is hyperfunctional parathyroid adenoma (PA) (94%), parathyroid hyperplasia (<6%) and rarely parathyroid carcinoma (<1%). Excision of PA is a definitive cure with a success rate of 95%. Less than 15% have one or more hyperfunctioning glands in an ectopic location. Methods: Between 2014 to 2017, seven of the 13 patients with PHPT, who had failed surgical and noninvasive localisation, were included in the study. Hybrid localisation technique positron emission tomography-Computed tomography (PET-CT) with tracer 11C-choline was used. Location of parathyroid adenoma was classified using Perrier classification, which uses, letters A-G to describe the exact location of the adenoma. A 50% drop in PTH levels as compared with pre-incision values was confirmed as a cure. Results: The biochemical and hormonal profile of the 7 (54%) patients with ectopic PA are (mean±SD) serum calcium (mg/dL), 25OH-D (ng/dL) and PTH (pg/mL) 11.36 ± 0.82; 22.82 ± 8.57; 205 ± 105 respectively. Three of the seven had renal stones. In all, seven patients of PA were localised using PET-CT using tracer 11C-choline. The profile of PA were two type-G (intrathyroidal), one type-C (posterior mediastinum), two type-F (superior mediastinum), one of type D (mid region of posterior surface of thyroid parenchyma at the junction of recurrent laryngeal nerve and the middle thyroid vein) and one type B. Conclusion: Ectopic PA is rare. In a biochemically and hormonally confirmed PHPT and in failed imaging localisation techniques/failed neck exploration one should look for ectopic PA. Newer hybrid techniques combined with newer tracer agents (PET-CT) will help in localization of PA. To the best of our knowledge this is the first report of series of ectopic PA from a single center from India.
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Pseudopseudohypoparathyroidism: an unusual case
Srinivasa P Munigoti
July-September 2018, 7(3):141-144
We report unusual case of a 22-year-old male patient who presented with phenotypic features of Albright's hereditary osteodystrophy, but had associated multiple hormonal deficiencies suggestive of pseudo-pseudohypararthyroidism.
  560 65 -
Effect of sevoflurane with morphine or fentanyl on haemodynamic response to laryngoscopy and tracheal intubation: a prospective, randomised, double-blind study
S. R A. N Bhushanam Padala, Muralidhar Anakapalli, Hanumantha Rao Mangu, Madhusudan Mukkara, Aloka Samantaray
April-June 2018, 7(2):58-63
Background: Multimodal therapy can be used for obtundation of the haemodynamic response to laryngoscopy and tracheal intubation. The current study was undertaken to compare the haemodynamic response to laryngoscopy and tracheal intubation after administration of 0.2 mg/kg morphine or 2 μg/kg fentanyl with 2% end tidal sevoflurane during induction of anaesthesia. Methods: Sixty patients were randomised into two equal groups to receive either 2% end tidal sevoflurane + fentanyl 2 μg/kg (Group SF) or 2% end tidal sevoflurane + morphine 0.2 mg/kg (Group SM). General anaesthesia technique was standardised for both the groups. Haemodynamic parameters heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were recorded for 15 min. Results: The maximum increase in HR compared to baseline was statistically significant in Group SM (16.5%, P = 0.0002) which occurred at one min after tracheal intubation. The maximum increases in SBP, DBP and MAP compared to baseline occurred at one min after tracheal intubation in both the groups, Group SF (7.04%, 6.5% and 7.9% respectively) and Group SM (6.2%, 8.2% and 8.1% respectively) which was not statistically significant. The attenuation of haemodynamic response between the two groups was not statistically significant (for HR P = 0.1428, for SBP P = 0.8558, for DBP P = 0.1958 and for MAP P = 0.5303). Conclusions: With 2% end tidal sevoflurane during induction of anaesthesia, both 0.2 mg/kg morphine and 2 μg/kg fentanyl were equally effective in attenuating haemodynamic response to laryngoscopy and tracheal intubation. However morphine appeared to be less effective in attenuating the chronotropic response resulting in a greater increase in heart rate from baseline.
  554 71 -
Utility of serum total and free prostate-specific antigen in combination with serum carbohydrate antigen 15-3 and carcinoembryonic antigen in breast tumours
Pyreddy Swathi, N Lakshmanna, Kanchi Rama, AR Bitla, P. V L. N Srinivasa Rao, Hulikal Narendra, Yootla Mutheeswaraiah, Amancharla Yadagiri Lakshmi, BV Phaneendra
October-December 2018, 7(4):159-164
Background: Prostate Specific Antigen (PSA) is secreted by prostate gland as well as hormonally regulated tissues such as breast, ovaries and endometrium. We aimed to assess the utility of serum total and free PSA in combination with carcinoembryonic antigen (CEA) and carbohydrate antigen 15-3 (CA 15-3) in diagnosis of breast cancer. Methods: Seventy two female patients (38 with benign breast disease and 34 with malignant breast disease) who were histologically, cytologically confirmed with diagnosis of primary breast tumours were investigated. Serum total prostate specific antigen (PSA), Free PSA, CEA, CA 15-3 were analysed by enzyme linked immunosorbent assay (ELISA) method. Diagnostic performance of markers was studied using receiver operating characteristic curve and logistic regression analysis. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated. Results: Patients with malignant breast cancer had significantly higher levels of all tumour markers compared to benign breast tumours. A significant decrease in total PSA, CEA and a statistically insignificant decrease in free PSA concentrations were seen in malignant breast cancer patients after surgery. Performance of total PSA was best among all the markers with 100% sensitivity, NPV, 94.7% specificity and 94.4% PPV. Conclusions: Serum total PSA is a good diagnostic marker to differentiate benign breast disease from malignant tumours compared to currently used CEA and CA 15-3.
  486 134 -
Study of clinical features and outcomes in patients presenting to the emergency department with acute abdomen
N Ratna Kumar, B Sivarama Krishna, V Satyanarayana, V Venkatrami Reddy, M Madhusudhan, P Subramanyam
October-December 2019, 8(4):172-176
Background: Abdominal pain is one of the most common reasons for an emergency department (ED) visit. The present study, evaluated the clinicodemographic profile of patients presenting with acute abdomen to the ED in a tertiary care institute, South India. Methods: A prospective, observational study was done in patients presenting with non-traumatic acute abdomen to the ED at our teaching tertiary Care hospital between March 2016 and April 2017. Demographic profile, detailed history, physical examination, management and outcome were noted. Results: Of 200 patients, 56% were males. Their mean age was 46.2 years. Peptic ulcer disease (22%) was the most common presentation followed by surgical causes such as acute appendicitis (20%) and acute intestinal obstruction (11%). Diabetes mellitus was the most common co-morbid condition (25%) followed by hypertension (15%) and ischaemic heart disease (6%). Abdominal Ultrasonography was helpful in the diagnosis of 83% of the patients and 13% of the patients required computed tomography abdomen. Conclusion: Our observations suggest that peptic ulcer disease, acute appendicitis and acute intestinal obstruction were most common causes of acute abdomen. A high index of suspicion will help in early diagnosis and instituting effective treatment.
  452 116 -
The Journal of Clinical and Scientific Research: The leap forwards!
TS Ravi Kumar, P. V L. N Srinivasa Rao
January-March 2018, 7(1):1-1
  475 82 -
A study of clinical presentation and outcome of patients with Guillain–Barré syndrome: A prospective observational study at a tertiary care teaching hospital
Bhargavi Thota, Madhusudan Mukkara, Aloka Samantaray, Alladi Mohan, Bhuma Vengamma
October-December 2019, 8(4):182-187
Background: Guillain–Barré syndrome (GBS) is an immune-mediated damage to the nerve roots and peripheral nerves which may require intensive care unit management and adequate techniques for airway protection and ventilation. Methods: Sixty four patients with GBS were studied from March 2017 to February 2018 with a detailed history of demographic and clinical data (age, gender, season, and antecedent events), functional disability bed on Hughes score, Medical Research Council (MRC) sum score at the time of admission. Final outcome was dichotomized to good (0–3) or bad (4–6) based on Hughes Disability Scale and was compared with different patient variables to find their association with patient outcome. Results: The mean age of the patients studied was 45.9 ± 15.9 years. There were 37 males. Axonal variety was predominant GBS variant (85%). Twenty-four patients required mechanical ventilation and nine patients underwent tracheostomy. In total, 7 patients expired and 15 patients were discharged from the hospital with severe disability. Twenty patients developed complications during their course of stay in hospital. In total, 12 out of 15 (80%) with low MRC score (0–20) and 22 out of 49 patients with high disability score (Hughes score 4 or 5) at admission had a bad outcome (P = 0.001 and P = 0.001), respectively. Conclusions: We concluded that, in our study, predictors of poor outcome at discharge were low MRC sum score at admission, high GBS disability score at admission, axonal variant GBS, longer duration of mechanical ventilator support, need for tracheostomy, and presence of complications, were associatedwith a poor outcome in patients with GBS.
  479 75 -
Significance of antimicrobial stewardship programme
N Ramakrishna, R Jayaprada, KK Sharma
October-December 2018, 7(4):179-183
Antimicrobial resistance is an increasing threat in hospitalised patients and many of those are multidrug-resistant organisms. Antimicrobial Stewardship Programme (AMSP) has become a critical responsibility for all health-care institutions and antimicrobial prescribers. This aims mainly to optimise the antimicrobial use among patients to reduce antibiotic resistance, improve patient outcomes, safety and provide cost-effective therapy. This review describes the significance of AMSP, goals, strategies and key essentials for AMSP.
  467 80 -
A study on clinical features, complications and management of scorpion sting envenomation at a tertiary care hospital, in rural South India
Karuppan Yuvaraja, Natesan Chidambaram, Ravichandran Umarani, Kanchi Mitra Bhargav, S Pratheep Kumar, T Prabhu, E Balasubramaian
July-September 2019, 8(3):140-144
Background: Scorpion sting is a common medical emergency in rural India. Sparse published data are available regarding scorpion sting envenomation in adults from South India. Methods: We prospectively studied the clinical manifestations and two-dimensional echocardiography findings in fifty adult patients admitted with scorpion sting at a tertiary care teaching hospital in South India. Results: Their mean age was 34.8 ± 13.6 years; there were 28 (56%) males. Forty-one (82%) patients were stung over the limbs and the remaining over the rest of the body. Seventeen (34%) patients received prazosin within 5 h of sting; the remaining 33 (66%) received prazosin thereafter. Salient symptoms were pain over the sting area (n = 18, 36%), dyspnoea (n = 13, 26%), chest pain (n = 9, 18%), vomiting (n = 6, 12%), sweating (n = 5, 10%), nausea (n = 3, 6%), priapism (n = 7, 14%) and piloerection (n = 6, 12%). Common complications were accelerated hypertension (n = 12, 24%), pulmonary oedema (n = 10, 20%), myocarditis (n = 8, 16%), congestive heart failure (n = 6, 12%) and peripheral circulatory failure (n = 3.6%). Common electrocardiogram abnormalities were tachycardia (20%), T-wave inversion (10%), tall T-waves (10%), ST-depression (4%) and atrial fibrillation (2%). Mitral regurgitation was mild (Grade I) in 4 (8%) and moderate (Grade II) in 3 (6%) patients. Decline in left ventricular ejection fraction was noted (n = 14, 28%). Conclusion: Scorpion sting patients present with complaints of pain, palpitation, dyspnoea and paraesthesia. Complications such as hypertension, pulmonary oedema and sinus tachycardia are common. Early administration of prazosin is advocated for better outcome. Therefore, prudent knowledge on cardiovascular manifestations of the disease and timely management is pivotal for physicians.
  457 87 -
Comparison of intravenous dexmedetomidine and intravenous lignocaine for the prevention of conventional propofol injection pain: A prospective randomised double-blind study
K Aditya, A Krishna Simha Reddy, Mangu Hanumantha Rao
October-December 2018, 7(4):170-174
Background: Pain on injection with propofol is a well recognized problem sometimes very distressing to patient. Current study compared the effectiveness of intravenous dexmedetomidine and lignocaine pretreatment for the prevention of propofol pain during induction of general anaesthesia. Methods: Ninety, American Society of Anesthesiologists (ASA) grade I and II patients were randomised into three groups of 30 each, Group D, Group L and Group N. Group D, patients received dexmedetomidine 0.2 μg/kg diluted to 5 ml of normal saline, group L, patients received 0.5 mg/kg preservative free lignocaine diluted to 5 ml of normal saline and group N, patients received 5 ml of normal saline. Intravenous access was secured with 20 G cannula and venous occlusion was applied to forearm using a pneumatic tourniquet inflated to 90 mm of Hg for 1 minute. The study drugs were injected over 5 seconds and after 1 minute venous occlusion was released and 25% of total calculated dose of propofol (2 mg/kg) was given intravenously over a period of 60 seconds. Severity of pain was evaluated using McCrirrick and Hunter scale at 0 seconds, 30 seconds and 60 seconds respectively and then remaining propofol and neuromuscular blocking agent was given. Results: The groups were comparable demographically. There was significant difference in pain scores assessed at 0 seconds, 30 seconds and at 60 seconds between the three groups. Conclusions: Dexmedetomidine in a dose of 0.2 μg/kg before applying venous occlusion by tourniquet for one minute in the same vein before inducing the patient with propofol was effective in decreasing the propofol injection pain when compared to lignocaine in a dosage of 0.5 mg/kg and placebo.
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