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Background and objectives: Ambulatory blood pressure (BP) monitoring has become useful in the diagnosis and management of hypertensive individuals. In this study we tried to know the role of office and ambulatory BP in treated hypertensive patients. Methods and patients: Prospective cohort of 561 treated hypertensive patients were enrolled in the study. Hypertension definitions were according to JNC 8 classification. Office BP and ambulatory BP monitoring was done according to defined protocol. Results: From a subgroup of 158 treated hypertensive patients, 91(16.2%) patients were having white coat hypertension (p value 0.00 by Pearson chi square test). In a subset of 403 patients who were having controlled BP on the day of enrolment as well as on the day of attaching ambulatory BP monitor; 98 (17.4%) patients were having masked uncontrolled hypertension (MUCH). In addition there was very significant percentage of non-dippers and reverse dippers. In our study we found that office BP has a moderate to low specificity and sensitivity and low negative predictive value for overall control in treated hypertensive patients. Conclusion: Ambulatory BP monitoring should be included in the management protocol of treated hypertensive patients, for the optimal BP control.
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Background : A comprehensive, thorough, accurate, legible and professional operative note allows seamless and proper transfer of patient care from the operating table to the postoperative care room and beyond. Further, incomplete and illegible handwritten operative notes in medico legal cases may be an Achilles heel in the surgeon’s defense. Aims : This study audited the quality of operative note keeping of general surgical procedures against the standards set by the Royal College of Surgeons of England (RCSE) guidelines. The aim of the study was to assess the compliance while also improving record keeping, documentation, the quality of operative notes, and educating surgery residents. Materials and Methods : The information from operative notes of every patient undergoing general surgical procedures was collected over a period of seven months. The data was formulated and analyzed using the SPSS version 20. Results : Total of 560 operative notes were recruited and audited. All the notes were hand-written, with the majority being written by postgraduate residents (86%).The postoperative care advice, fluid and antibiotic instructions were documented in the finest manner (100%). However, only 1% of the notes mentioned the Patients’ name, Gender and Age. All operative notes (>99 percent) included the names of the operative surgeon and assistants. The consultant in charge was documented in only 12 percent emergency notes and 100 percent elective procedures. The name of runners (Nursing Orderly) was missing from all the notes. Notably, no details of closure techniques were mentioned in any of the operative notes. Almost all of the operative notes were not signed properly to include the resident’s name and code. Conclusion : The quality of the operation notes that were entered into the patient’s case sheets was poor and insufficient, and it needed to be greatly improved. The findings of the study underline the necessity for residents to receive mandatory training on data collection and how to produce operative notes according to institutional
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Objective: To compare the safety and efficacy of valsartan/sacubitril (angiotensin receptor neprilysin inhibitor [ARNI]) against enalapril (angiotensin-converting enzyme inhibitor [ACEI]) in patients with acute heart failure at 6-month follow-up. Methods: In this prospective, single centre, and observational study conducted between September 2017 and February 2020 in India, patients with acute decompensated heart failure with reduced ejection fraction (<40%) were included. Patients were divided in two groups: valsartan/sacubitril (ARNI) group and enalapril (ACEI). Patients were followed up for at least 6 months after administration of first dose and were evaluated for safety, efficacy, and tolerability of target drug. Student's independent t-test was employed for comparing continuous variables. Chi-square test or Fisher's exact test, whichever appropriate, was applied for comparing categorical variables. Results: A total of 200 patients were included in the present study, 100 each in ARNI and ACEI group. The mean age of the population was 61.2 ± 8.4 years and 62.6 ± 8.6 years in ARNI group and ACEI group, respectively. The mean maximum tolerated dose by population in ARNI group was 203.6 mg and 8.9 mg in ACEI group. Readmission for heart failure were seen significantly higher in ACEI group than ARNI group (p value ¼ 0.001). Parameters like ejection fraction, left ventricular end diastolic and systolic dimensions, 6 min walk test and Kansas City Cardiomyopathy Questionnaires (KCCQ) showed p values < 0.05 between the groups. Conclusion: The ARNI study group showed better safety and efficacy outcomes at the end of 6 months follow-up compared to ACEI group
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Introduction: Nonunion of humeral fractures afterconservative or surgical treatment represents a disablingcondition for the patient and a challenge for the surgeon. Studyaimed to evaluate the outcome of treatment of humeral shaftnonunions with dynamic compression plate and cancellousbone graft.Material and Methods: This study was conducted atDepartment of Orthopaedics, GMC Srinagar from June 2016to December 2019. Twenty patients were operated over thisperiod. Trauma was the cause of injury in majority of thepatients. Nonunion was atrophic in 80% and hypertrophic in20% of the individuals. All the patients had closed fractureat presentation, and 70% had received previous treatmentfrom traditional bone setters and 30% had failure of theconservative cast management.Results: The average time to union was 18 weeks. Treatmentpreviously from traditional bone setters significantly affectedthe time to fracture union (p<0.05). All fractures unitedsuccessfully.Conclusion: we concluded that treatment with dynamiccompression plating and cancellous bone grafting remains aneffective treatment option for nonunion of humeral shaft.
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Background: One of the treatment modalities of mandibular and midface fracture is closed reduction with the use of intermaxillary fixation (IMF), in which the fractured segments are immobilized adjacent to each other and this procedure results in the reunion of the separated segments. It has been shown that there is a direct relation between nutrition and the healing process of the body therefore treatment with IMF could possibly affect the healing process. In this study, we evaluated the effects of IMF on paraclinical factors like protein profile and lipid profile which are markers for malnutrition condition, so further thoughts can be given to prevent malnutrition by using different supplements. Methods:30 Patients having mandibular fracture which needed closed treatment was selected for this study. All patients were treated with a 4 weeks period of IMF. Lipid profile factors [total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglyceride (TG)] and protein profile factors [hemoglobin (Hb), albumin (Alb)] were measured before the start of IMF and after the 4 weeks period of IMF. Results: there occur decrease in the level of Alb and the reduction was statistically significant. There occur slight increase in Hb level at the end of treatment however the result was statistically insignificant. also there occur decrease in the level of TC, HDL, LDL and TG after the treatment but the result was statistically insignificant. Conclusion: it was concluded that treatment with IMF can result in malnutrition conditions although not severe. so when close reduction techniques are used as the treatment plan in maxillofacial region, a supplemental nutrition planning is very thoughtful thing to do.
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Background: The menace of substance abuse is not only a socially unacceptable reality, but in its entirety is a disease and emerging as a major public health challenge. Objective: To study the socio-demographic and clinical profile of patients attending the drug de-addiction centre. Methods: A descriptive study was undertaken in a drug de-addiction centre at the Police Hospital in Srinagar, and all patients (198) who were admitted during this period were interviewed. Results: The mean (SD) age of patients was 26.8 years (SD 7.37), and over half (56%) belonged to the lower-middle social class. Poly-substance abuse was seen in 91.9%; medicinal opioids and cannabis were the most common substances abused. Most common age of initiation was 11–20 years (76.8%), with peer pressure and relief from a negative mood state being the most common reasons given for starting the drug(s). Prevalence of a co-morbid psychiatric disorder was high, on the order of 49.5%. A high rate of volatile substance use was observed among adolescents (54.5%). Conclusion: A pattern of poly-substance abuse was found to be quite common in patients, and use of volatile substances at a very young age emerged as a new trend. The dreadful repercussions of substance abuse justify the urgency to evolve a comprehensive strategy.
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Substance-Related Disorders , Heroin Dependence , Social Problems , IndiaABSTRACT
Background: Coronary heart disease is a leading cause of death and a major cause of disability worldwide. Aims: This study was conducted to see whether there are certain specific personality pattern of coronary heart disease patients and the coping strategies they use to deal with these stressful situations. Methodology: A sample of 30 male patients diagnosed as having coronary heart disease were selected from the outdoor and indoor patient cardiology departments of Ramkrishna Care Hospital and Modern Medical Hospital, Raipur, Chhattisgarh. Results and Conclusions: It was found that CHD patients have certain specific personality traits which reflect that these persons have low frustration tolerance for unsatisfactory conditions, are neurotically fatigued, easily annoyed and emotional (Factor C). They are suspicious and are often involved in their own ego and are self-opinionated and interested in internal mental life.
Subject(s)
Adaptation, Psychological , Coronary Disease/epidemiology , Coronary Disease/psychology , Humans , India , Male , Personality/psychology , Personality Disorders/epidemiology , Personality Disorders/etiologyABSTRACT
This study was designed to evaluate the pattern of clinical presentation, risk factors and angiographic findings in young males representing with acute myocardial infarction [AMI]. This cross-sectional descriptive study was conducted at the Cardiology Department, Punjab Institute of Cardiology, Lahore from May 2005 till February 2006. After fulfilling the inclusion criteria 200 male patients
Subject(s)
Humans , Male , Angiography , Coronary Angiography , Risk Factors , Myocardial Infarction , Cross-Sectional Studies , Smoking , Hypertension , Myocardial Ischemia , Diabetes Mellitus , Hyperlipidemias , Coronary Vessels/anatomy & histology , Ventricular Function, LeftABSTRACT
To compare the clinical, echocardiographic and angiographic variables after PTMC in patients of mitral stenosis having echo score < 8 and >/= 8. Cardiology ward and echocardiography department of the Punjab Institute of Cardiology, Lahore. The study was conducted from 15[th] of January 2006 till 30[th] of July 2006. It was a comparative study. Two hundred consecutive patients of mitral stenosis undergoing PTMC were studied. Patients were divided in to two groups. Group I consisted of patient having echo score <8, while Group II contained patients having echo score >=8. The immediate clinical follow-up of 200 patients who underwent PTMC procedure was studied. Patients were divided into 2 groups, Echo-Sc <8 [n=136] and Echo-Sc >/= 8 [n=64]. PTMC resulted in an increase in mitral valve area from 1.0 +/- 0.3 to 2.0 +/- 0.6 cm[2] in patients with Echo-Sc<8 and from 0.8 +/- 0.3 to 1.6 +/- 0.6 cm[2] in patients with Echo-Sc >/= 8 [P<0.0001]. Procedural success was 83.5% for the overall group, with patients with Echo-Sc <8 having a higher procedural success [93.4% versus 62.5%; P<0.0001]. Thirty three [16.5%] patients had unsuccessful procedures. There was 1 [0.5%] in-hospital death. Severe post- PTMC MR [>/= 3 grade] occurred in 19 [9.4%] patients, with grade III in 12 [6%] and grade IV in 7 [3.5%]. Emergent MVR was required in 3 [1.5%] of 200 patients. Pericardial tamponade occurred in 2 [1%] patients. Thromboembolic events [stroke] occurred in 2 [1%] patients in the overall population. Finally 1 [0.5%] patient developed complete atrioventricular block. Patients with echo score less than 8 have a favourable outcome in terms of procedural success and post procedure complications as compared to patients with echo score >/= 8