International Journal of Medical Research and Review

Efficacy of standard treatment protocol in recently diagnosed Lupus Nephritis at our tertiary care teaching hospital

Dr. Tushar Dhakate — 2021-05-31

Introduction: Lupus Nephritis occurred in approximately 50% of Systemic Lupus Erythematosus patients at some point during their illness and is associated with a poor prognosis.

Material and Method: A prospective observational study of 50 newly diagnosed LN cases was conducted to investigate the response of standard treatment protocol (Cyclophosphamide -NIH protocol and Mycophenolate Mofetil-MMF).

Results: Of the 50 newly diagnosed cases of LN, 94 % (n=47) were females, and 6 % (n=3) were males, with class IV LN accounting for the majority of patients 69.39 % (n=34). At six months, 36.7 % (n=11) of patients in the cyclophosphamide (CYP) group had a complete response. Only 27.3 % of patients in the MMF group had a complete response; however, this difference was not statistically significant. At the end of one year, only 56.7 % of the CYP group and 81.8 % of the MMF group had a complete response; however, this difference was not statistically significant (p=0.282). Although the initial response with CYP was better and later in the MMF group, these differences were not significant statistically. Tuberculosis or its reactivation was the most common complication during treatment, either with MMF or CYP. One patient died due to latent tuberculosis reactivation, another as a result of severe disease activity at presentation (proteinuria was 20 gm/24 hours in that patient), and the third as a result of pneumonia with septicemia.

Conclusion: Treatment with either CYP or MMF is equally effective, but underlying infection, particularly tuberculosis, should be ruled out before initiating therapy.

Factors associated with poor outcome in tuberculous meningitis; study from a tertiary care referral Centre from South India

Neeharika L Mathukumalli — 2021-06-17

Introduction: Tuberculosis (TB) remains a worldwide burden with a large majority of new active cases occurring in underdeveloped and developing countries. This study is an attempt to look into various aspects of the disease that can be associated with the outcome, to promote a timely referral to an appropriate centre. Purpose: To identify various clinical, lab, CSF and radiological variables associated with poor outcome of TBM at the time of discharge.

Material & Methods: Demographic data, duration of symptoms before diagnosis, clinical presentation, staging of the disease at the time of admission of all the TBM patients who presented to our centre between December, 2015 and May 2018 were noted. Results of biochemical investigations and brain and spine imaging were retrieved. Outcome at the time of discharge as measured by MRC and mRS grades was correlated to clinical profile, lab, CSF and radiological findings.

Results: A total of 100 patients were included. 15 patients died. Subjects with MRC and mRS grades of 2 or more at admission constituted 65% and 93% respectively. At discharge, MRC and mRS grades of 2 or more were found in 29.63% and 39% respectively. Multivariable analysis showed a significant positive association of MRC stage at discharge with MRC stage (p = 0.001) and mRS score (p = 0.001) at admission and Vellore hydrocephalus grade (p < 0.001) when hydrocephalus first identified. Similarly, mRS score at discharge had an independent positive association with the MRC stage (p < 0.001) and the mRS score (p=0.002) at admission.

Conclusion: Stage of the disease (MRC) and functional status of the patient (mRS) at admission are the two most important independent factors determining the outcome of TBM patients at the time of discharge.

Role of Physiotherapy in Hospitalised Patients of COVID-19 disease

Dr. Sanjay Kumar Bharty — 2021-06-17

Introduction: Respiratory physiotherapy is one of the therapeutic methods in various respiratory viral infections. Breathing exercises with other interventions, could enhance the total lung capacity and symptom alleviation in patients with virus-related acute respiratory distress syndrome (ARDS).

Aim: To study the clinical evaluation of the role of physiotherapy in hospitalised patients of covid-19 diseases.

Method: This was an Observational (prospective, cross-sectional) study. 187 patients were recruited and diagnosed as COVID-19 as per RTPCR at NSCB Medical College, Jabalpur (MP). Patients were randomised into the physiotherapy group and controlled group. Patients in the physiotherapy group were undergone positional changes, prone ventilation, Breathing exercise, Resistive training, Passive joint motion, Muscle stretching, Bedside standing training, endurance exercise by a specialized physiotherapist. Mean cough severity index, MMRC grade, respiration rate and peripheral blood saturation were recorded before and after intervention and compared with the controlled group.

Result: There was significant improvement found in MMRC grade and respiration rate after physical therapy in the physiotherapy group (p-value < 0.05). Exertional dyspnoea and cough severity index significant deceased in physiotherapy group. The positive change was found in peripheral blood saturation. There was decreased in hospitalization stay in the physiotherapy group as compared to the controlled group.

Conclusion: Our study revealed the positive effect of physiotherapy on covid-19 disease in terms of symptoms and hospitalization duration among the physiotherapy group. Physiotherapy exerts a beneficial role in the management of the covid-19 disease.

Aberrant promoter hypermethylation of RAR-β in endometrial carcinoma- an Indian study.

Nagaratna Shivanandappa — 2021-06-30

Endometrial cancer is the seventh most common cancer in women worldwide with and age standardized rate of 8.4 per 100,000 women. Epigenetic alterations such as promoter hypermethylation of TSGs are known to be early events in carcinogenesis. The aim of the present study, we assessed the aberrant promoter hypermethylation pattern of RAR-β in 78 endometrial cancer samples.

Methods: DNA was isolated from endometrial carcinoma samples and normal tissues and aberrant promoter hypermethylation was assessed using nested and methylation specific PCR. Chi square test was used for statistical analysis and a p-value<0.05 was considered to be statistically significant.

Results: 40 of the 78 (51.28%) endometrial carcinoma sample showed aberrant hypermethylation of RAR-β gene. Methylation status in each histological subtype, grade and stage of the disease was also assessed.

Conclusion: Aberrant hypermethylation is an important early epigenetic alteration that occurs during tumorigenesis. The Data shown here reports that promoter hypermethylation of RAR-β occurs in endometrial carcinoma and therefore could be used as a potential marker for early diagnosis and prognosis of the disease.

Dosimetric comparison of radiotherapy treatment plans done by IMRT and VMAT technique in head and neck cancer patients

Dr. Aparajeeta — 2021-06-30

Background: The increasing patient load in radiotherapy centres demands selection of the technique that provides plans with optimal dosimetry in terms of target volume coverage, organs at risk (OAR) sparing and a lesser treatment time. This study was designed to compare the two widely practised conformal techniques, IMRT and VMAT in head and neck cancer patients in terms of planning target volume (PTV) coverage, OAR sparing and treatment delivery parameters.

Materials and methods: For ten postoperative head and neck cancer patients who had been treated by IMRT technique virtual VMAT plans were generated for study purposes. The dose prescribed to PTV was 60 Gy in 30 fractions. The dose-volume parameters of PTV and OARs and the treatment delivery parameters were compared amongst both the techniques. Statistical significance was calculated using paired ‘t’ test.

Results: Both the plans were comparable in terms of dosimetry. The only significant difference being better conformity in the IMRT plans. The dose to OARs was also comparable in both the techniques except for a significant reduction in the point dose to brainstem with the IMRT technique. Given the treatment delivery parameters, there was a significant reduction in the treatment delivery time and monitor units with the VMAT technique compared to the IMRT technique.

Conclusion: VMAT technique gave comparable plans to that of the IMRT technique in terms of dosimetry but reduced the treatment time. It seems feasible in radiotherapy centres with increased patient load.

A Prospective Study of Profile of Agricultural Orthopaedic Injuries in North India in a Tertiary Care Centre

Dr. Roop Singh — 2021-06-30

Background: Over time agriculture has transformed into an industry, both in scale and mechanization. Growing demand for agricultural yield and increasing mechanization has led to growth in the numbers of agricultural accidents and injuries causing significant morbidity and economical loss.

Aim: To study the causes, patterns, outcomes of injuries due to agricultural accidents, their effect on the productivity of the victims, and to suggest possible remedial measures, a prospective study was undertaken.

Methods: A total of 106 patients reporting agricultural injuries (AI) over 14 months in 2019-20 were enrolled and data was recorded on a pre-structured proforma.

Results: With the preponderance of male victims, educational status, skill levels, lighting & climatic conditions, intoxication and fatigue were found to be major determinants in the causation of injuries with upper limbs being the predominantly involved part (75.47%) and most of the cases ended up requiring some form of surgery (88.68%). Agricultural machinery (56.60%) was the main cause of AI and Chaff Cutter Machine caused the maximum AI (37.73%). Amputations were the most common injuries sustained (47.16%). Agricultural injuries affected the range of motion of body parts (32.07%) and work (58.49%) & household activities (49.05%); thus impairing work efficiency and economy.

Conclusion: The present study highlights the need for a robust surveillance and data analysis leading to better design of farming machinery and equipment, more relevant education and training systems, stronger legislations as well as a comprehensive rehabilitative program aimed at reducing the socio-economic burden caused by agricultural injuries.

Role of liquid-based cytology and cell block study of pleural fluid in the evaluation of cases of malignant Pleural effusion with special reference to immunohistochemistry

Dr. Rama Saha — 2021-06-30

Introduction- Lung cancer is the most common primary tumor associated with malignant pleural effusion (MPE). In this study, we aim to use cell remnants for cell block preparation after performing liquid-based cytology (LBC) of effusion fluid. Immunohistochemistry was helpful to evaluate those cases having diagnostic dilemmas in LBC and cell block.

Method: It was a cross-sectional, prospective, single institution-based study, conducted in the department of Pathology in collaboration with the Department of Respiratory Medicine IPGMER & SSKM Hospital, from January 2018 to June 2019 in the institution.

Result: Most of the study population were in between the age group of 51 to 60 years with male predominance and with fever and cough being the predominant symptoms. Liquid-based cytology was positive for malignancy in 58% of cases and suspicious of malignancy in 22% of cases of malignant pleural effusion and it had 95.35% sensitivity, 58.82% specificity in diagnosing malignant pleural effusion.LBC was done followed by cell block preparations are studied further by Immunohistochemistry.

Discussion: Morphological features were better identified by the cell block method when compared to LBC. Multiple sections can be obtained for special stain or IHC study which bridges the gap between cytology and histology.

A rare case of iii cranial nerve palsy - mucormycosis involving the right maxillary and ethmoidal sinus

K. Praveen Gandhi — 2021-07-28

IIIrd Cranial nerve palsy, known as oculomotor nerve palsy, may result from various causes, however, the etiology remains unknown in some instances. This case report aims to present the authors' experience with a case of IIIrd cranial nerve palsy, together with a review of the literature. Many etiologies have been associated with isolated oculomotor nerve palsies. We report the case of a patient who presented with right maxillary and ethmoidal sinusitis with IIIrd cranial nerve palsy associated with mucormycosis. Careful examinations to rule out other causes must be done and then treatment with antifungals should be considered after early diagnosis.

Role of Low Environmental Temperature in Peptic Ulcer Development

Serah Funke Ige — 2021-07-30

Peptic ulcers are described as acid-induced lesions found in the stomach and duodenum caused by the imbalance between the defending factors of the mucosa and the attacking factors such as hydrochloric acid in gastric juice, with Helicobacter Pylori (H. Pylori) and Non-Steroidal Anti-Inflammatory Drugs NSAIDs. They exhibit seasonal patterns in their occurrence, with higher occurrence in winter and spring and a low occurrence in summer. Temperature plays a major role in their occurrence, some of which have resulted in increased morbidity in some number of diseases, such as gastrointestinal bleeding, caused by an increase in air pressure, dry air (relative humidity) occurring from cold air, and also its actions on the protective effect helicobacter pylori in the human body. Their actions excite the adrenal gland marrow and the sympathetic nerve, causing rapid secretion of adrenaline and non-adrenaline, angiotensin II and endothelin, resulting in damage to the mucosa epithelial, caused by the contraction effect of the adrenal agents on the duodenal mucosa and blood vessel. It causes low expression of Epidermal Growth Factor Receptor (EGFR), Epidermal Growth Factor (EGF), Heat Shock Protein (HSP) 70, Occludin, Nitric Oxide Synthase (NOS), in the gastric mucosa, in extremely cold temperature than those in extremely hot temperature, increasing the gastric acid secretion in extremely cold temperature than in extremely hot temperature. Therefore, this review aims to give general insight into the role of low temperature in peptic ulcer development and further consideration in the treatment of peptic ulcer diseases.

Autologous Whole Blood Injection For COVID-19 Can Reduce Cytokine Storm and Severity of Illness

M. Christopher — 2021-06-09

Autologous whole blood injection is used for various indications. It has an immunomodulatory action on the immune system. A randomized controlled two-arm study was conducted to determine IL-6 levels, CT changes and mortality among adult COVID-19 patients. The trial included 30 patients divided into two groups. The interventional group received 2 doses of 2.5 ml of autologous whole blood injection spaced 2 days apart. There was a statistically significant reduction in IL-6 levels on day 6 in the group receiving treatment. CT score improved in patients who received treatment. No cases of mortality were reported in the treatment group. Autologous whole blood injection can be used as a simple, low-cost adjuvant in the treatment of adult COVID-19 patients, regardless of disease severity.