International Journal of Medical Research and Review

A comparative study of endoscopic and conventional septoplasty

Soma Mandal — 2020-01-17

Objective: Nasal obstruction due to deviated nasal septum is a common problem encountered by otolaryngologist. The standard surgical treatment for symptomatic deviated septum is septoplasty which has gone through several modifications since its inception. Study objectives were to compare the endoscopic and conventional septoplasty and to evaluate the advantage, disadvantage and complication of both the procedures.

Materials and Methods: Prospective observational study was conducted in department of ENT and Head-Neck-Surgery of a tertiary care teaching hospital. Sixty patients undergoing either endoscopic septoplasty or conventional septoplasty were studied prospectively for a period of 3 months to compare the efficacy of both the techniques. Objective assessment was done by doing nasal endoscopy 90 days after the operation to note the following points- (1) Persistence of deviation (2) Spur (3) Formation of synechiae (4) Septal perforation.

Result: In this study the endoscopic approach showed better overall clinical result as compared to conventional technique with lesser complication. It was noted that endoscopic septoplasty group had minimum blood loss and shorter operative time than conventional method, but difference was not statistically significant.

Conclusion: Endoscopic septoplasty was founded with distinct advantage over conventional method due to better illumination, improve accessibility to remote area was founded. Further surgical experience and larger similar studies will help in coming to a greater consensus.

Helicobacter pylori chronic gastritis: correlation between endoscopic findings and histopathology with special reference to updated sydney system

Tarak Banik — 2020-01-20

Aims of the study: Helicobacter pylori (H. pylori) induces inflammatory changes in the gastric mucosa variably correlated to different endoscopic and histologic features. The present prospective study aimed to correlate different endoscopic findings with histomorphological changes and the presence of H. pylori in the gastro-duodenal mucosa, in samples of dyspeptic patients.

Methods: 60 dyspeptic patients of 18 years to 60 years of age were selected from outpatient department and screened with gastro-duodenoscopy and biopsy. The presence of H. pylori was determined by urease test on fresh biopsy specimens and histologically using the modified Giemsa stain. Findings were recorded and analyzed statistically.

Results: Highest (84.6%) H. pylori positivity was seen in the 41-50 years age group. Majority of the patients had a normal upper gastro-intestinal endoscopy; among them majority (61.2%) was positive for H. pylori infection. Most cases with endoscopic lesion in the gastro-duodenal mucosa were also positive for H. pylori infection. On biopsy, chronic gastritis was the most common (73.33%) finding in 44 cases, among them, more than two-third (70.4%) were positive for H. pylori.

Conclusion: H. pylori gastritis is strongly associated with peptic ulcer diseases, chronic gastritis and non-ulcer dyspepsia. Endoscopy and biopsy play the main role in diagnosis and identification of the spectrum of involvement.

Comparative evaluation of continuous epidural infusion of 0.0625% Bupivacaine + 0.0002% Fentanyl and 0.1% Ropivacaine + 0.0002% Fentanyl for labour analgesia

Manish Shivani — 2020-02-01

Aim& Objectives: To compare the total dose of Fentanyl and Bupivacaine with total dose of Ropivacaine and fentanyl in terms of total volume delivered-loading, infusion and top ups. Also, to compare Analgesic efficacy (VAS score) and adverse events if any.

Methods: 60 ASA physical status I or II parturients in labour who were either primigravidae or gravida 2 were included in a randomized, single blind, prospective study. After a bolus dose of 0.125 % Bupivacaine and 25 mcg Fentanyl, the group BF received a continuous epidural infusion of 0.0625% Bupivacaine and 0.0002% Fentanyl whereas the group RF received a bolus of 0.2% Ropivacaine and 25 mcg Fentanyl followed by an infusion of 0.1% Ropivacaine and 0.0002% Fentanyl.

Results: The Group BF and Group RF were comparable with respect to their physical parameters. It was seen that the pain relief in the group BF was excellent for 8 out of 30 patients (26.67%) whereas for the group RF it was excellent for 9 of 30 patients (30%). After that till delivery, both the groups had a comparable mean maternal pulse rate (p value >0.05). None of the parturient in study or control group ever had an episode of bradycardia. Throughout the remaining period of analgesia, the mean foetal heart rate was comparable between the two groups. In the present study groups only 2 parturients from group BF and only one parturient from group RF underwent caesarean section due to foetal distress. 6 parturients (20%) from group BF and 5 parturients (16.67%) from group RF developed hypotension.

Conclusion: Continuous infusion of 0.1% Ropivacaine + 0.0002 % Fentanyl provides equipotent labour analgesia and maternal satisfaction as 0.0625% Bupivacaine + 0.0002% Fentanyl infusion can provide.

Pattern recognition approach and clinico-radiological evaluation of compressive myelopathies at a tertiary care hospital

Sri Kiran Jakkula — 2020-02-08

Background: Neuroimaging is indicated in most instances of new-onset myelopathy for clinico-radiological correlation in terms of diagnosis, recovery, and prediction of recurrence.

Aim: This study was conducted to study the clinical profile of cases of Compressive Myelopathy and the pattern of spinal cord involvement, also to compare the sites of localisation of clinical diagnosis with MRI diagnosis. Methodology: The present study was a prospective study involving 30 patients. Patients with clinical suspicion of spinal cord disease of age group 20-80 years were included as study participants. The primary pulse sequences included T1 and T2 weighted images on MRI, the location of the lesion, its margins, signal intensity on both T1 and T2 weighted images was noted.

Results: The majority of 53.33% of participants were aged between 51 to 60 years. Difficulty in walking was observed in 97% of participants. Men were more often affected than women. Cervical spondylosis was the commonest cause of compressive myelopathy in 57%. A most common pattern of spinal cord involvement was combined Anterior + Posterior cord involvement. The cervical site of localisation (54%) was the commonest followed by the thoracic and lumbar spinal cord.

Conclusion: Myelopathies have male preponderance. The commonest cause of compressive myelopathy was Cervical spondylosis. Anterior plus posterior cord syndrome was the commonest pattern seen, followed by posterior cord syndrome, anterior cord syndrome being the least observed. MRI correlates well with a clinical diagnosis and is useful in suggesting the location of the lesion.

Classification, diagnosis of reversibility and severity assessment of patients having respiratory distress based on pulmonary function test

Saswata Ghosh — 2020-02-12

Introduction: Pulmonary function testing is the gold standard for physicians to diagnose and manage respiratory problems. An obstructive defect is indicated by low forced expiratory volume in one second/forced vital capacity (FEV1/FVC) ratio, defined as less than 0.7 or below the fifth percentile. If an obstructive defect is present, the physician should determine if the disease is reversible based on the increase in FEV1 or FVC after bronchodilator treatment (i.e., increase of more than 12% and 200 ml in adults). An FVC below the fifth percentile indicates a restrictive pattern based on NHANES III data in adults. If both the FEV1/FVC ratio and the FVC are low, the patient has a mixed defect.

Method: A total of 60 patients having respiratory distress, who attended chest OPD underwent a pulmonary function test.

Results: In this study out of 60 patients, 32 patients had obstructive airway diseases with low FEV1/FVC (53.33%), 8 of them (13.33%) had restrictive lung diseases, ten patients(16.66%) had mixed features and rest ten patients(16.66%) had normal spirometry. Among those 32 patients of obstructive features, 22 (68.75%) had reversible airway diseases. Severity was measured among the other ten non-reversible obstructive patients according to the GOLD criteria.

Conclusion: Pulmonary function test is the fundamental first-line investigation to diagnose obstructive and restrictive lung diseases and also to differentiate between reversible and non-reversible obstruction. It is also a vital tool for determining the severity among non-reversible obstructive airway patients.

Role of Computed Tomography (CT) in traumatic head injury evaluation – a cross-sectional study

D Venkata Ramanana Rao — 2020-02-12

Introduction: CT is the single primary modality in the evaluation of patients with acute head injuries. With these, a study was taken to find various clinico radiological patterns of head injuries and to correlate the CT features with clinical operative findings.

Materials and Methods: This was a cross-sectional study carried in patients of head injury. The patients with a head injury, craniofacial trauma who underwent CT scanning were included in the study. Patients on the ventilator and with Glasgow coma scale <6 were excluded. Patients were scanned using dual Slice CT, Siemens somatom Emotion duo. A P-value of less than 0.05 was considered statistically significant.

Results: Total 223 patients were included, 76.2% were males and 73.5% were abnormal scans. Among all intracranial traumatic lesions (ITL) the incidence of multiple ITLs were the most common (35%) and the death rate was 12.6%. Temporal bone fractures (15.2%) were the highest.

Conclusion: It was concluded that 21 – 40 years is the typical age group for head injuries, common among male and the incidence of mortality rate is more > 61 years. MICTLs are the most frequent type of hematomas.

Management of penetrating cardiac injury in a tertiary hospital in Northeast India

Chito S Thokchom — 2020-02-12

Background: Penetrating cardiac injuries are rare and considered the most lethal of all trauma patients. Managing cardiac injuries is a great challenge for the trauma surgeons and the outcome of the treatment of such critical condition depends on the mechanism of injury, haemodynamic status of the patients at the time of presentation, heart chamber involved and other associated injuries.

Materials and Methods: This is a prospective observational study of consecutive six patients with penetrating cardiac injuries from January 2015 to December 2019 treated in Regional Institute of Medical Sciences, Imphal, India. eFAST and CT scan of the chest were the main imaging methods used for diagnosis. All patients underwent tube thoracostomy for associated haemothorax in the emergency ward.

Results: All the patients had penetrating cardiac injuries due to stabbing. Five (63.3%) patients presented with features of cardiac tamponade or with severe hypotension (systolic BP less than 80 mmHg) and one (16.7%) patient who was haemodynamically stable at the time of presentation had developed features of cardiac tamponade after 24 hours. Four patients had undergone emergency left anterolateral thoracotomy, one patient had undergone median sternotomy, and one patient underwent left anterolateral thoracotomy on the second day after admission.

Conclusion: A high index of suspicion for cardiac trauma is extremely important in patients presented with penetrating thoracic injuries or upper abdominal injuries. Computed tomography of the chest can show the haemopericardium giving detailed information of associated pulmonary injury and hemothorax. Prompt diagnosis and early surgical intervention play a vital role to save these critically injured patients.

Assessment of levels of Vitamin D and Leptin in comparison of BMI among medical students

Sivakumar J. — 2020-02-13

Introduction: Vitamin D is one of fat-soluble vitamin that plays an important role in the absorption of calcium and phosphate. Deficiency of Vitamin D is unrecognized in many parts of the world. Leptin is a hormone which is derived from adipose tissue. Studies have shown that vitamin D has a negative and powerful control on leptin secretion by vitamin D by acting on the adipose tissue.

Aim and Objectives: The study was done to study the relationship between Vitamin D and Leptin based on Body mass index among the medical students.

Materials and methods: Vitamin D Leptin and Body mass index were the parameters measured in the study group. Individuals with an age group of 19-23 years of both sexes were included in the study. Individuals above the age of 23 years, those with renal and liver disorders, individuals with hormonal disorders, individuals on vitamin D supplementation were excluded in the study. Vitamin D was measured by Enzyme-Linked Immunosorbent Assay (ELISA) method. Leptin was measured by Enzyme-Linked Immunosorbent Assay (ELISA) method. BMI is calculated by the formula weight in kilograms divided by height in metre square.

Results: The results have shown that there is a decrease in vitamin D levels with increasing BMI. (pvalue≤0.001). furthermore, there is an increase in leptin levels with an increase in BMI. (pvalue≤0.001).

Conclusion: The study has put forth a suggestion that leptin and vitamin D has a causal relationship between them based on Body Mass index. Adequate vitamin D levels will maximize the effect of maintaining normal leptin levels as high levels of leptin could contribute to obesity-related disorders.

A single-centre experience of scrub typhus in a tertiary care centre - a re-emerging infection

Debananda Sahoo — 2020-02-13

Background: Scrub typhus is a documented disease in Himachal Pradesh, but there have been few clinico-epidemiological studies in this area. The present study is done with IgM ELISA as a diagnostic test which has higher sensitivity and specificity as most of the previous studies had used Weil Felix test as a diagnostic test.

Methodology: This was a prospective observational study. All the patients more than 18 years of age with positive IgM ELISA for scrub typhus with/without eschar were included. The clinical profile was observed. IgM scrub typhus was done by ELISA.

Results: Total of 39 patients were observed between July 2016 to Dec 2016. Maximum patients were observed in August, September, and October. Fever with Headache was the most common presenting complaint. Eschar was present in 10 % patients. Complications were seen in 76.92 %. The mortality rate was 0 %.

Conclusion: The varied presentations and high rate of complications require a high index of suspicion for Scrub Typhus. The general physicians should be sensitized for the early diagnosis and treatment to reduce morbidity and mortality.

Estimation of prostate size by trans-rectal ultrasound and its correlation with DRE and endoscopic grading

Sandeep Gupta — 2020-02-14

Aim: Digital rectal examination (DRE) grading and the grade of prostatomegaly on cystoscopy are routinely used in clinical practice, but its correlation to prostate volume is understudied. This study was done to assess the correlation of DRE and endoscopic grading with the prostate volume on trans-rectal ultrasound (TRUS).

Materials and Methods: This study was carried out in 101 eligible patients with prostatomegaly. Each patient was evaluated for three parameters, prostate volume by TRUS examination, DRE and endoscopic grading on cystoscopy. Pearson correlation coefficient was calculated to find the correlation between variables, p<0.05 was taken to be statistically significant. Data were analyzed using the Epi Info (TM) 7.2.2.2.

Results: Significant positive correlation (p<0.001) was found between TRUS Volume and DRE grading (Pearson Correlation=0.945) and TRUS volume and Endoscopic grading (Pearson Correlation=0.949). Both the grading were also significantly positively correlated (Pearson Correlation=0.989, p<0.001).

Conclusion: Our attempt for correlating the digital rectal grading and endoscopic grading with prostate volume is satisfactorily validated in the clinical setting. These grades are sufficient to provide a rough estimation of the prostate volume and to classify patients with prostatomegaly.

Spectrum of MRI abnormalities in pediatric seizures

Manoj Mathur — 2020-02-17

Background: Seizure is a pediatric emergency. Accurate determination of the etiology of seizures is very important to start an effective treatment. The study aims to determine the spectrum of Imaging abnormalities by Magnetic Imaging Resonance (MRI) in children who presented with seizures.

Methods: It is a hospital-based prospective observational study which was carried out in Government Medical College and Rajindra Hospital, Patiala. This study included 50 pediatric patients in the age group between 0 months to 18 years who were referred to the Department of Radiodiagnosis for brain MRI between October 2017 to September 2019.

Results: Neuroimaging abnormality was found in 19 (38%) cases. 31 (62%) patients had no abnormal finding. The most common imaging findings were inflammatory granuloma in 5 (10%) patients. Other findings were- Hypoxic-ischemic injury (HII) in 4 (8%), Mesial temporal sclerosis in 2(4%), cerebral atrophy in 1(2%), Hemorrhage in 1(2%), Tuberous sclerosis in 1(2%), Focal cortical dysplasia in 1(2%), Lissencephaly in 1 (2%), Joubert syndrome in 1(2%), and Arachnoid cyst in 1 (2%) patients.

Conclusion: The MRI was able to identify brain lesions in 38% of pediatric patients who presented with seizures. The study revealed inflammatory granuloma as the commonest cause of seizures in children, followed by Hypoxic-Ischemic Injury. Early recognition of potentially treatable diseases helps in timely treatment and arrest of disease progression. It is recommended to use MRI as a primary investigation during the evaluation and management of pediatric seizures.

A prospective study comparing induction chemotherapy followed by chemoradiation versus chemoradiation alone in stage III non-small cell lung cancer

Pritam K Sardar — 2020-02-18

Background: Although concurrent chemoradiation (CCRT) is the standard of care for stage III non-small cell lung cancer(NSCLC), the five years overall (OS) survival is very poor. Most of the patients developed distant metastasis later which can be improved by induction chemotherapy.

Aims: This study was designed to observe the difference in epidemiology, acute toxicities, overall responses [complete response (CR)+partial response (PR)] after treatment completion, disease-free survival (DFS) and progression-free survival (PFS) at the end of the study.

Settings and Design: This was a prospective, interventional, randomized hospital-based study.

Methods and Material: Eligible patients were randomized into arm A (CCRT with weekly paclitaxel(P) + Carboplatin(C) with 66 Gray radiation) and arm B (two cycles of induction chemotherapy consisted of P+C followed by CCRT as of arm A. During treatment weekly, after completion of treatment at 6th week and thereafter 3 monthly evaluation was done till the end of study. S

tatistical analysis used: Chi-Square and Fisher Exact test did statistical analysis, t-test with 95%CI, Kaplan Meier survival analysis, Log Rank test using SPSS version 18.

Results: Among 44 patients, male (88.6%), Smokers (85.1%) were predominant with the most common histology was squamous cell carcinoma (52.4%). Overall response (Complete Response +Partial Response) was higher in Arm B 66.66% but statistically non-significant. Acute toxicities in both the arms were comparable and similar. DFS and PFS in the induction chemotherapy arm (Arm B) were numerically superior to concurrent chemoradiation arm (Arm A) but statistically nonsignificant

Conclusion: To conclude there were no significant differences in results between two arms in the present study population. Further studies with the larger sample size and longer duration of follow up are necessary.

Deep venous thrombosis induced by intravenous thrombogenic drugs

Dr. Chito Singh Thokchom — 2020-02-20

Background: Deep vein thrombosis (DVT) is a major preventable cause of morbidity and mortality worldwide with the potential to cause a dreaded pulmonary embolism (PE). Disease and patient-specific considerations are preferably incorporated into therapeutic options for effective management.

Materials and methods: Sixty-eight cases of acute deep vein thrombosis were treated within a period of 3 years from January 2016. All the cases were subjected to routine investigations with the Doppler study of the affected limb. Low molecular weight heparin (dalteparin) was administered in all the cases for a period of 15 days and the Doppler study was repeated at the end of the drug therapy. After the course of low molecular weight heparin, the patients were given acenocoumarol 2mg daily. Estimation of partial thromboplastin time and prothrombin time were performed before starting and during the treatment of the low molecular weight heparin and acenocoumarol regularly. A venogram was done only when the repeated Doppler study revealed unsatisfactory response to low molecular weight heparin therapy. Eight cases underwent thrombectomy and the postoperative period was uneventful.

Results: Age group of 21-30 years was most affected (80.8%) with right lower limb being the commonest affected site of injection and associated lesions.

Conclusion: DVT in the young population remains a challenge to the evaluating clinician. A variety of disease states can alter the anticoagulant factors. Urgent diagnosis and appropriate intervention carry paramount importance.

A study of tubal ectopic pregnancy based on the histopathology of fallopian tubes in the age group of 20-35 years

Rudradev Meyur — 2020-02-26

Purpose: Ectopic pregnancy is a life-threatening condition for the mother. Disruptions of the fallopian tube are considered to be important in its pathogenesis. The present study was conducted to observe the histopathology of this dreaded disease which could lead to the development of suitable remedies.

Methods: Cases diagnosed with ectopic gestation in the fallopian tube who subsequently underwent salpingectomy were considered for the study. Histopathology of sections from the affected fallopian tubes was studied under the light microscope after staining with H and E.

Results: Most cases presented with amenorrhoea, whereas others had dysmenorrhoea, menorrhagia, and menometrorrhagia. Histopathologic findings included the presence of salpingitis (acute and chronic), calcification, sclerosed vessel and.

Conclusion: Past history of inflammatory diseases, especially PID plays an important role in the subsequent development of ectopic pregnancy. Its prevention and treatment can lead to a decrease in the incidence of ectopic pregnancy.

Profile of cancer patients attending a tertiary care center

Antoney Unni Xavier — 2020-02-29

Introduction: In India, around 555,000 people died of cancer in the year 2010. Cancer is a major cause of morbidity and mortality in developing and developed countries. In many low-income and middle-income countries, including India, most of the population does not have access to a well organized and well-regulated cancer care system.

Objective: (1) To study the socio-demographic profile of cancer patients attending tertiary care center.(2) To study the type, site and at what stage cancers are being reported to tertiary care center (3) To study the association of the cancer type with socio-demographic variables.

Material and methods: A Hospital-based Cross-Sectional Study carried out from November 2013 to October 2014. Detailed pre-designed and pre-tested proforma is used to collect information on the socio-demographic profile. All diagnosed cancer patients admitted at SDM College of Medical Sciences and Hospital. A total of 381 were studied during the study period.

Results: Total of the 381 cancer patients, Males were 154 (40.4%) and females were 227 (59.6%), it was found that majority of male, 78 (50.6%) study subjects were in the age group of 60-69 years, in socioeconomic status male subjects were in lower-middle and upper lower class i.e. 40 (26%) female were in upper-middle-class i.e. 70 (30.8%), according to the present study breast cancer (21.3%) was most prevalent, followed by CA liver and biliary tract (14.7%), followed by lungs (8.7%). the male was diagnosed in stage III of disease accounting 67(43.5%) female patients were diagnosed in stage II 86 (37.9).

Conclusion: Breast cancer more common among younger age group and upper SES, Cervical cancer more common among lower SES, Lung cancer in literates’. Liver cancer more common among the older age group and lower SES. So, these groups can be targeted for health education and screening for early diagnosis and treatment.

Hypothyroidism in type 2 diabetics – a hospital-based prevalence study

Ravi Kiran Narukurthi — 2020-02-29

Introduction: Thyroid hormones and insulin are the antagonists and both are involved in cellular metabolism. With this, the study was planned to find the prevalence of thyroid dysfunction in type 2 diabetes mellitus (DM).

Materials and Methods: Study was conducted in the department of General Medicine, GSL Medical College. The study protocol was approved by the institutional ethical committee. All type 2 diabetics aged >30yrs, irrespective of treatment were included in the study. Individuals on metformin therapy, smokers, thyroid hormone users, who underwent thyroid surgery, individuals on radioiodine therapy, pregnant women and individuals on steroids were excluded. Venous blood samples were taken from for fasting blood glucose and 2-hour post glucose blood sugar, glycosylated hemoglobin, lipid profile, and thyroid function estimated measured by using the autoanalyzer. Chi-square test was used to compare differences in categorical variables and p<0.05 was considered statistically significant.

Results: Among 104 participants, 82.7% were euthyroid, 12.5% had subclinical and 4.8% had clinical hypothyroidism; statistically the difference not significant when age/gender was correlated. But there was a significant association with dyslipidemia.

Conclusion: Hypothyroidism is very common among type 2 DM individuals and both complement others' metabolism.

Application of Thyroid Peroxidase (TPO) and Hector Battifora Mesothelial-1 (HBME-1) immunohistochemical markers in the diagnosis of papillary thyroid carcinoma of the thyroid

Vasundhara Singh — 2020-02-29

Background: Thyroid cancer is the most common endocrine malignancy accounting for >90% of malignancies of endocrine glands. The inter and intraobserver variation in the histomorphological diagnosis of Papillary Thyroid Carcinomas may sometimes pose a diagnostic difficulty. Application of IHC biomarkers may play an active or complementary role in their accurate classification.

Aim: The present study was conducted to evaluate if HBME-1 and TPO immunohistochemical analysis can reliably differentiate papillary carcinomas from other thyroid lesions.

Material and Methods: 50 cases of benign and malignant thyroid lesions were taken. Immunohistochemical staining for HBME-1 and TPO was performed. HBME-1 and TPO score was interpreted as absent and positive. Medical records were retrieved and their clinical data, surgical treatment, and pathological findings were noted.

Results: Out of 50 cases, 19 (73.1%) cases were diagnosed PTC, 4 (15.4%) cases were FTC, 3(11.5%) cases were of MTC and 24 cases of benign thyroid lesions. TPO expression was found positive in 91.7% of cases of Benign thyroid lesions. In malignant thyroid lesions, negative expression of TPO was seen in 63.16%, 0% and 33.33% of PTC, FCT, and MCT respectively. HBME-1 showed negative expression in 83.3% of cases of benign thyroid lesions. Whereas, in malignant thyroid lesion HBME-1 expression was positive in 78.95%, 50% and 0% cases of PTC, FCT, and MCT respectively.

Conclusion: Testing for expression of HBME-1 has been shown to improve the diagnostic accuracy for thyroid malignant nodules. The combination of HBME-1, and TPO may contribute to an accurate diagnosis of papillary thyroid carcinoma.

Electrocardiographic changes in patients with dilated cardiomyopathy

Vietla Sreeramulu — 2020-02-29

Introduction: Cardiomyopathy is the disease of the heart muscle, which causes deterioration of myocardial functioning. A study was conducted to find electrocardiographic findings in dilated cardiomyopathy.

Materials and methods: This was a hospital-based study, conducted in the department of General Medicine, GSL Medical College. Informed written consent was taken from each patient or his/her attendant prior to including in the study. Patients with dilated cardiomyopathy, both gender, all ages. Heart failure based on Framingham criteria, ECHO criteria – LV ejection fraction less than 45%, with left ventricular or biventricular dilatation, with global hypo-contractility were included in the study. ECG and 2 D Echo have been performed on the patients. Framingham criteria were used for the diagnosis of heart failure. Descriptive statistics were presented in the form of mean ± standard deviation and percentages.

Results: Total 102 patients were included in the study, with a mean age of 56.3 ±12.5 years, the male-female ratio was 1.9. Tachycardia was 61%, left axis deviation was present 34.3% and right axis deviation in 8.8%. Left ventricular end-diastolic and systolic diameters were elevated in most of the patients.

Conclusion: With these findings, it can be concluded severe LV systolic dysfunction is very common among dilated cardiomyopathy patients.

A study of the role of MRI and arthroscopy in the management of knee joint lesions

Laxman P. Ahirwar — 2020-02-29

Objectives: Aim of this study is to evaluate the types and incidence of injuries in internal derangement of the knee joint by MRI and to compare with arthroscopy findings in selected cases and to assess whether MRI can be used as a primary diagnostic tool for internal derangement of the knee joint.

Material and Method: This prospective study was done in the Department of Radiodiagnosis Chirayu Medical College and Hospital Bhopal, Madhya Pradesh, India. A total of 100 patients who were referred to the department with strong clinical suspicion of internal derangements of knee joint, underwent magnetic resonance imaging evaluation of knee followed by arthroscopy in selected cases, wherever indicated from August 2014 to July 2019.

Results: Majority of patients in the current study group belonged to the age group 20-29 years (31%) with a mean age of 24.3 years. In this study, the majority of patients were males constituting 76 % of cases. The most common clinical presentation was that of pain in knee joint seen in 79% of cases. The second most common presentation was swelling seen in 54%. The most common positive clinical test was McMurray’s test for meniscal tear seen positive in 48% of cases. In the current study left knee involvement was more common than right knee, constituting 54%. Medial meniscal tears were more common than lateral meniscal tears 49 (73.2%).

Conclusion: MRI is a useful non-invasive modality having high sensitivity, specificity and accuracy in the diagnosis of meniscal and cruciate ligament injuries. MRI should be done in every patient of suspected internal derangement of the knee joint, to save a patient from unnecessary arthroscopy

A study to find the correlation between mucocutaneous manifestations and CD4 counts among the newly diagnosed HIV individuals.

Subhodha Kumar Patjoshi — 2020-02-29

Introduction: Skin disorders are common manifestations of HIV disease. A study was conducted to find the correlation between the degree of immunosuppression and the incidence of specific skin disorders in patients with HIV infection.

Materials and methods: Study was conducted in the department of dermatology, SCB Medical College and Hospital, Cuttack from October 2010 to September 2012. Random sampling was considered in this study. Referred patients, after pretest counseling at ICTC Centre, were included and individuals who are on antiretroviral treatment were excluded. Relevant diagnostic tests were performed like scraping and KOH examination for the diagnosis of dermatophytoses and candidiasis, Tzanck smear for herpes infection, Darkfield microscopy for diagnosis of a syphilitic ulcer, Biopsy is done wherever required. CD4 count was done as per the guidelines.

Results: A total of 150 (100%) participants were included, the male-female ratio was 1.8. Age-wise, 57% (85) were included in 31–45 group and 15% were unmarried. Fungal infections constitute 17.9% of total mucocutaneous disorders followed by bacterial infections (10.5%), viral (8.09%) and parasitic (6.7%) infestations.

Conclusion: Age group, 31–45 years is the commonest for HIV infection. Fungal infections (dermatoses) of the skin were most common followed by bacterial folliculitis, herpes zoster, and scabies. Except for viral infections, the mean CD4 counts were <200cells/cu mm.

Pancreatic ketoacidosis-a rare case report

Dhivahar. G — 2020-02-10

Euglycemic Pancreatic Ketoacidosis is a syndrome of high anion gap acidosis in which the high anion gap is due to elevated serum ketone bodies comprising of acetone, aceto- acetate and beta hydroxyl-butyrate, due to increased peripheral adipose tissue breakdown by elevated serum lipase as a consequence of acute pancreatitis with normal blood glucose levels. There are multiple causes for ketonuria and/or ketonemia with or without acidosis like uncontrolled diabetes mellitus, usually of the insulin dependent type (diabetic ketoacidosis), lactic acidosis, prolonged starvation (starvation ketosis), ethanol ingestion (alcoholic ketoacidosis), sepsis, pregnancy and vomiting. Our patient was not a known diabetic and his blood glucose were always within normal limits, so this ketoacidosis cannot be attributed to Diabetes Mellitus. It cannot be attributed to starvation as our patient was not fasting when he got admitted and furthermore ketoacidosis is not a frequent manifestation of starvation adding to it that we transfused adequate amount of DNS and resumed oral intake during our observation period. It cannot be attributed to vomiting as our patient had only two episodes of vomiting. Our patient does not have any liver or kidney pathology and there is no history or evidence of alcohol intoxication. But, acute pancreatitis without diabetes-mellitus, causing ketoacidosis is a very rare presentation which is caused by high levels of pancreatic lipase in the circulation.