International Journal of Medical Research and Review

Incidence and profile of neurological disorders in alcohol dependents

Vijay Singh Baghel — 2020-05-30

Background: Alcohol is one of the most abused substances in the world. Alcohol has been known to produce toxic effects in almost every organ system in the body, many of these medical conditions can be attributed to the direct toxic effect of alcohol and its metabolites, whereas others are indirect sequelae that may result from nutritional deficiency particularly thiamine. A neurological complication of alcohol dependence is extremely common and affects every level of neuroaxis including the Brain-Peripheral nervous system-Muscle.

Aim & Objective: To quantify the number of different neurological disorders in alcohol-dependent patients and to the established relationship between the frequency of these disorders with type, duration, amount, and frequency of alcohol intake.

Method & Material: A cross-sectional study was conducted in 100 alcoholics who came to tertiary care centers of central India in the 1-year duration. Demographic data, questions related to their alcohol consumption, and Neurological examination of all patients were done as pre-decided protocol. Informed consent was obtained from all patients. Data was entered and analyzed using appropriate software.

Result: Study participants were mostly (70%) in the age group of 21 to 40 years, 87% resided in the urban area, 81% were Hindu. 78% were educated up to class 8th and 76% were employed with any kind of jobs. There were 64% of cases that had any kind of neurological manifestation, 20% had peripheral neuropathy and less than 10% has severe manifestation Korsakoff’s psychosis, and cerebellar degeneration.

Conclusion: Neurological manifestations were common among alcohol dependents, but it variably depends on the amount, pattern, chronicity, and type of alcohol consumption. There is a need for further studies that specifically point out alcohol-related nervous manifestations.

Conformal radiotherapy plans for palliative bone metastasis - comparison of dosimetric parameters

Naina Gupta — 2020-06-12

Background:Palliative radiotherapy offers significant relief in the huge physical distress of patients with bony metastasis. The enormous potential of conformal techniques has not been tested in palliative settings. However,the increasing life span of patients with metastatic disease demands to optimize the radiotherapy techniques to provide maximal durable symptomatic relief. Despitean increase in the utilization of the 3DCRT technique for palliative bony metastasis, the optimal beam arrangement remains unknown.

Materials and Methods:Ten patients of vertebral bony metastasis were retrospectively selected and four virtual 3DCRT plans were generated for each patient. The field approaches were a single field, two fields, three fields and five field approaches. For PTV, D90, D50, Dmean, Conformity index (CI) were evaluated.Dmean was evaluated for the esophagus, bowel, kidneys, and combined lungs. Dose-volume histograms were computed for the various treatment plans and compared. Statistical analysis was done by ANOVA test.

Results:A total of forty radiotherapy plans were generated. PTV parameters were significantly better with two field plans over one field plans in terms of D90 (p= 0.002), D50 (p= 0.02), Dmean(p=0.0009). Dmeanwassignificantly better with three field approach compared to two field approach (p=0.0006). The Dmeanwas significantly increased for organs at risk in two fields and three field plans.Five field approach did not showan advantage in terms of dosimetry of PTV but there was a significant rise in the dose to Organs at risk (OAR’s).

Conclusion:The three field plans showed better dose distribution to the PTV with an acceptable increase in the dose to OAR’s.

Haematological toxicity in cancer cervix patients treated with concurrent chemoradiation by conventional technique- correlation with bone marrow radiation dose

Prachi Upadhyay — 2020-06-18

Introduction: The standard of care for treatment of cancer cervix is concurrent chemoradiation followed by brachytherapy in the majority of cases. Conventional radiotherapy with chemotherapy causes haematological toxicities which may be related to radiation to pelvic bone marrow. The present study aims to study the haematological toxicities and correlate with the mean dose to the bone marrow.

Material and Methods: Retrospective data of cancer patients treated in the institute in the year 2019 was retrieved. Haematological toxicities were analyzed in terms of CTCAE criteria. Mean dose to bone marrow was calculated after the delineation in the CT scan. The correlation between haematological toxicity and mean bone marrow was done using a paired t-test for statistical significance.

Results: The data of 20 patients were retrieved. Anaemia Grade, I and Grade II-IV was seen in 65% and 35% respectively. Leukopenia Grade I and Grade II-IV were seen in 85% and 15% respectively and Lymphopenia Grade I and Grade II-Iv were seen in 55% and 45% respectively. The mean dose to bone marrow did not show any statistical significance with the severity of haematological toxicity. There was no Grade II-IV toxicity of neutropenia and thrombocytopenia.

Conclusion: Conventional radiotherapy can safely be practice for patients with cancer cervix with acceptable haematological toxicities.

A comparative study of PSI and Curb-65 scoring systems in predicting ICU admissions and mortality in cases of community-acquired pneumonia

Prashant Patil — 2020-06-18

Background:Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality worldwide. Despite advanced diagnostic modalities and treatment options, CAP is the fourth leading cause of death in developing countries.Several severity scores have been proposed to guide initial decision making on hospitalization and to predict the outcome. Pneumonia Severity Index (PSI) and CURB 65 are the two most widely used scoring systems to prognosticate pneumonia.

Aim: To compare the efficacy of PSI and CURB 65 scoring systems inprognosticating the ICU admission and outcome in cases of CAP.

Methodology: This wasan observational study conducted at a tertiary care hospital in westernMaharashtra.A hundred patients of CAP fulfilling the inclusion criteria were enrolled in the study, classified as per CURB 65 and PSI system and their outcome compared.

Result: The study subjects comprised of 100 patients (64 men and 36 women) of CAP. Twenty-four patients needed ICU admission.In both PSI and CURB-65 risk scoring systems, the need for intensive care unit (ICU) admission and mortality rates increased progressively with increasing scores.PSI class ≥IV and CURB 65 ≥III had 77.52% and 40.24% sensitivity and 88.46% and 69.48% specificity respectively in predicting ICU admissions. The PSI class ≥IV had more sensitivity and specificity in predicting ICU admission than CURB-65.CURB 65 class III and IV had sensitivity86.59% and 89.64% and specificity 89.64% and 97.54% respectivelyin predicting mortality, while PSI class IV and Vhadsensitivity68.92% and 72.58% and specificity 24.74% and 54.86% respectively. CURB 65 had more sensitivity and specificity than PSI in predicting mortality.

Conclusion: The PSI is better in predicting the need for ICU admission and CURB 65 is a better predictor of mortality in cases of community-acquired pneumonia.

A study to find the various causes for compressive myelopathy

Pottala Krishna Mohan — 2020-06-30

Introduction: Myelopathy was the term that describes any neurologic defect related to the spinal cord. A study was conducted to evaluate various causes of compressive myelopathy and also MR characterization of spinal cord compressive lesions.

Materials and Methods: It is a hospital-based cross-sectional study, conducted in the department of radiodiagnosis, GSL Medical College, Rajahmundry from December 2014 to August 2016. All patients referred to the department of radiology with symptoms of compressive myelopathy of the spine were included. Pre-contrast scanning was done using TiWI, T2WI, FLAIR Sagittal, STIR sagittal. A Chi-square test was used to find the statistical significance, P > 0.05 was considered to be statistically significant.

Results: During the study period total of 30 participants were included, spinal TB was diagnosed to be the most common cause of myelopathy (13; 43.3%) Extradural myelopathy was diagnosed in 23 (76.6%) participants and intradural in 7 (23.3%) members. Statistically, there was no significant difference between the age and cause for myelopathy and also between the gender.

Conclusion: The most common cause of compressive myelopathy was identified to be extradural compression form TB followed by trauma. Spinal TB was the commonest site involved. In spine injury, the common site involved was the thoracic.

A clinico-epidemiological study of the first outbreak of Nipah virus in India – report from ground zero

Rama Saha — 2020-06-30

Introduction: The first Nipah Virus (NiV) outbreak occurred in India in the year 2001 at Siliguri. The second outbreak happened at Nadia in 2007. Nipah Virus exhibits neurological and pneumonic tropism with the predominant clinical presentation being encephalitis in humans.

Material and Methods: The present study was a record based prospective study on 67 cases admitted with pyrexia of unknown origin in North Bengal Medical College during the period from 18.02.2001 to 30.02.2001 and a parallel study on epidemiological record carried out by PSM department also taken into account. All necessary investigations including autopsy examination, pathological, and microbiological study were done.

Results: There was a clustering of cases around Bhaktinagar. There was a strong H/O Medinova Nursing Home Contact among the patients. 18 out of 20 cases were staff of that Nursing Home. Serum samples tested show NiV specific IgM and IgG in 9 out of 17 samples with one sample which was positive for IgG only suggesting past infection. The cases were admitted with predominant neurological symptoms (53.73% cases) but about 80% recovered with no residual neuro deficit. The natural reservoir of NiV is present in Bangladesh and in Northern India.

Conclusion: When NiV infection is suspected, infection control practices must be strengthened to avoid an outbreak in a hospital setting. Here the present study is presenting the experience in the first outbreak of the Nipah virus in India at Siliguri for awareness of clinical personnel to control further outbreak at the very beginning.

Role of biochemistry, cytology, and biopsy in the etiological diagnosis of pleural effusion- a clinical study

Manan Bedi — 2020-06-30

Introduction:Pleural effusion is the most common pleural disorder. It refers to excessive or abnormal accumulation of fluid in the pleural space. It is a commonly occurring medical problem caused by various pathological conditions. To treat patients appropriately, it is important to establish an accurate etiological diagnosis.

Material and Method: This is an observational study conducted at a tertiary health care center. The pleural effusion was assessed clinically, biochemically, bacteriologically, cytologically, and histopathologically.

Result: Tuberculosis was the most common etiology, followed by malignancy. A pleural biopsy was done in 70 patients. Pleural tissue was obtained in 65 cases. On histopathology,Malignancy was diagnosed in 15, tuberculosis in 35, and non-specific inflammation in 13 cases. Out of 35 histological proven tuberculosis cases, 26 cases had adenosine de-aminase (ADA) more than 70 u/l.

Conclusion:Every pleural effusion is not due to tuberculosis but can be due to other causes, malignancy should always be excluded. Pleural fluid cytology and biopsy can give a definite diagnosis in a significant number of cases of pleural effusion. Tuberculosis is still the most common cause of pleural effusion followed by malignancy.

Role of pleural biopsy in patients of undiagnosed exudative pleural effusion

Nidhi Sanwalka — 2020-06-30

Introduction: Sometimes etiological diagnosis of pleural fluid is not possible by cytology, biochemical and microbiological examinations and labeled as undiagnosed exudative pleural effusion. Our aim of this study to make an etiological diagnosis in such undiagnosed exudative cases with pleural biopsy.

Material and method: In this study patients with undiagnosed exudative pleural effusion, where the diagnosis was not made by laboratory investigations were included. Pleural tissue was obtained by Abram’s Needle and sent for histopathology and culture to find mycobacterium tuberculosis.

Result: Out of 45 patients 34 (75.5%) were males and 11 (24.5%) were females. The side of pleural effusion was right-sided in 30 (66.6%) and left-sided in 15 (33.4%). The mean value of polymorphs and lymphocytes count was 7.24% and 92.76% respectively. Pleural fluid was hemorrhagic in 10 (22.22%) patients, straw-colored in 30 (71.11%) patients, and clear in 5 (11.11%) patients. The mean level of glucose was 65.66 mg/dl, the lowest being nil and highest being 110 mg/dl. The mean level of protein was 5.54 gm/dl (range 3.7-7.21 gm/dl). The mean value of the pH of pleural fluid was 65.44. Histopathology showed granulomatous inflammation compatible with tuberculosis in 24 (53.3%) cases, metastatic malignancy in 7 (15.5%) cases, chronic inflammation in 10 (22.3%) cases. In 4 (8.9%) cases pleural tissue was inadequate to give any opinion. Among 7 cases of malignancy, 5 (71.42%) cases showed adenocarcinomas and 2 (28.58%) cases showed squamous cell carcinoma.

Conclusion: This study suggests that tuberculosis and malignancy are the two common etiologies for exudative pleural effusion. The role of pleural biopsy is pivotal as it helps in making the diagnosis in the majority of cases where other laboratory investigations fail to provide a diagnosis.