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Introduction: Atrial Septal Defect by virtue of its left to right shunt induces geometric and electrical remodeling of the right sided chambers of the heart which produces prototypical changes in the Electrocardiogram. Various patterns produced by ASD in the ECG can give a clue in diagnosing the defect. Reversal of remodeling after the shunt closure and its accompanying changes in ECG are also helpful in follow up of these patients Methodology: This is a retrospective cohort analysis, wherein, ECG of the patients who have undergone ASD closure by percutaneous device closure or surgical closure during the study period,were obtained from hospital records and they were followed up. After screening, 60 patients met the inclusion criteria and were included in the study. ECG of the patients before closure of ASD and on immediate post procedure day, 2 weeks, 1month, 3 months, 6 months and 1year were obtained and analyzed. Results: Mean age of the study population was 28.4 ± 09 years. In analysis of ECG after closure of ASD, the mean QRS axis reduced from 108 ± 10 to 70 ±12 degrees (P = 0.016), mean QRS duration reduced from 123 ± 30 ms to 80 ± 27 ms (P= 0.28). Mean PR interval reduced from 188 ± 30 ms to 123 ± 24 ms (P value= 0.09). The Crochetage Sign disappeared in the 2 patients who had it before closure of the defect. The amplitude of R’ wave in rSR’ in right precordial leads reduced over 2 years. rR’ and qR pattern in right precordial leads reverted to rSr’ pattern in 10 out of 12 patients. The other 2 patients who did not show reversal had residual shunt. No clinically significant complete heart block was observed in any patient. Conclusion: ECG forms as an easily available tool for diagnosis of ASD as well as in assessing the success of closure in the follow up after the closure of ASD by surgical or percutaneous device therapy. Failure of reversal of electrocardiographic signs of ASD after the closure should prompt search for residual shunt or pulmonary complications.
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Background: Globally, chronic kidney disease (CKD) is a major public health problem. Fibroblast growth factor (FGF)-23 is a newly recognized phosphatonin secreted by the osteocytes which acts as a key regulator of serum phosphate levels in CKD. In the present study, we aimed to estimate the levels of serum FGF-23 in patients with CKD and to compare them with healthy controls. Also, we aimed to compare the levels of FGF-23 levels with creatinine clearance and kidney size in various stages of CKD.Methods: A cross sectional comparative study was conducted at Thiruvarur Government Medical College hospital in Tamil Nadu. Patients aged between 20 and 65 years with an established diagnosis of CKD and healthy controls were included in the study. Enzyme Immuno-Assay method was followed for the estimation of FGF-23. Spot Urine sample was collected to determine the presence of albumin. Serum levels of glucose, Urea, Creatinine, Electrolytes (Sodium, Potassium), Albumin, Calcium, Phosphorus and Alkaline Phosphatase were measured. Information on kidney size, cortical echogenicity, parenchymal thickness and cortico-medullary differentiation were assessed based on ultrasound abdomen.Results: A total of 45 CKD cases and 45 healthy controls were studied. Mean (SD) age of CKD cases was 54(11) years and that of controls was 46(9.6) years. The mean value of FGF23 in cases was 730.7±492.7 pg/ml and this was higher than that of the control group whose mean value was 39.49±12.47 pg/ml (P<0.05). Mean GFR levels in cases and controls were 23.8 and 113.8 and this difference was statistically significant (P value<0.0001). Among cases, Pearson correlation between serum FGF-23 levels and eGFR, serum albumin was statistically significant and had a negative inverse correlation.Conclusions: The present study demonstrated that serum FGF23 levels were significantly increased in patients with CKD. This increase in serum FGF23 levels were progressive from the early stages to the late stages of CKD.
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Chronic obstructive pulmonary disease (COPD) is a group of symptoms, which defined as persistent airflow limitation due to alveolar and airway abnormality which caused by chronic inflammation of airway and lung parenchyma. It is stated that it has leading cause of mortality and morbidity. It is projected to rank third among all causes of death by 2020. It has complex pathology with marked heterogeneity all over India. Now days it is markedly increasing in India due to biomass, occupational and household exposures. COPD leads to variety of intra and extra-pulmonary component and considerable effect of public health incidence are increasing in India mainly Uttar Pradesh and Bihar due to increase dependence to biomass and conventional exposure to noxious agents (Smoke, Biomass fuel, Dust particles).
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Background: Extra pulmonary TB accounts for 15% of all TB cases. Its incidence is much higher about 50% in HIV positive patients. Tuberculous pleurisy is present in around 4% of all TB cases2. Tuberculosis is always the leading etiology of pleural effusions in the developing countries3. Aims and Objectives: We have lot of investigations to diagnose pulmonary tuberculosis like sputum AFB, CBNAAT, LPA. These tests have some limitations in pleural fluid. So we are in need of a better test for diagnosis of tuberculous pleural effusion especially in high burden countries like India. Methods: In this study we have evaluated the usefulness of ADA level in pleural fluid for diagnosis of tuberculous pleural effusion. This study conducted from May 2017 to June 2018. Conclusion: This is a case control study done in a tertiary care center in Varanasi included 100 cases (Tuberculous pleural effusion) and 100 controls (Non Tuberculous pleural effusion).
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Background: Thyroidectomy remains to be one of the most common surgeries done and has been associated with few specific complications. One major complication of thyroidectomy is hypocalcemia, which often occurs as a result of inadvertent intra-operative injury to parathyroid glands. Transient hypocalcaemia, which is usually noticed after surgery, resolves well most of the times as it respond to replacement therapy in few days. Aim of the study: To study the incidence of transient hypocalcemia occurring in patients undergoing total thyroidectomy Materials and methods: The methods for the study included screening of patients who presented with thyroid swelling alone or along with pain, hoarseness of voice and dysphagia symptoms. Such patients were studied in detail clinically and investigated as per proforma detailed below. Hematologic and biochemical investigations were done. All patients were subjected to ultrasonographic evaluation and thyroid function tests initially. Following which they had undergone a fine needle aspiration biopsy for histological diagnosis. Patients who were suspected to have malignancy were made to undergo other imaging modalities as CT. Results: 28% of cases developed hypocalcaemia by 6 hours while 24% of cases had hypocalcemia after 72 hours. Post-operatively only 5 patients had developed symptoms of hypoparathyroidism. These were found to have reduced calcium levels at both 6hrs and 72 hours of surgery and hypocalcemia had resolved in 5 patients by 72 hours who had drop in 6 hours post-operatively. Conclusion: The maximum incidence of clinically symptomatic hypocalcemia was found in the age group of more than 35 to 65 and those cases had reduced serum calcium levels measured at both 6 hours and 72 hours.
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Background: A fistula-in-ano is an abnormal hollow tract lined with granulation tissue connecting a primary opening inside the anal canal to a secondary opening in the perianal skin. Treatment of fistula-in-ano remains challenging. Surgery is the treatment of choice, with the goals of draining infection, eradicating the fistulous tract, and avoiding persistent or recurrent disease. Aim: This study was intended to investigate the factors determining the course of fistula in ano and its recurrence of patients with fistula in ano came to Govt. Stanley Hospital for 1 year. Materials and methods: 45 patients were selected who were diagnosed as fistula in ano admitted in Govt. Stanley Hospital during June 2015 to May 2016. The anatomy and type of fistula was detected by MRI. Patients underwent definitive treatment. Data regarding the objectives of the study were collected and outcomes of the treatment evaluated by following up the patient for 6 months. Results: Majority of patients (82%) belonged to 31 -60 years of age. Male: Female ratio was 4:1. Most of the fistulas were low anal 41 (91%). About 34 (76%) of external openings were posterior. Fistulectomy was performed in 31 cases, fistulotomy for 10 cases, seton for 4 cases and the operated wound healed in a range of 2 weeks to 8 weeks. Delayed healing was associated with complex fistulas, intersphincteric and transphincteric fistula takes longer time to heal about 4 to 5 weeks (P = 0.007). Fistula of tubercular etiology took minimum 3 weeks to heal (P =0.047). 13 % of cases showed recurrence. Transphincteric fistulas had recurrence rate of 33%. Fistulas with lateral openings had recurrence rate of 67%. Conclusion: Fistulectomy is the commonest and best procedure to get rid of the infective pathology. Fistula in ano has a well recognised incidence of recurrence after surgical treatment
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Aim: This study was an attempt at investigating the variation in growth and morphology of primary avian chondrocyte and neural cell cultures established under standard laboratory conditions. Methods: For establishing chondrocyte cultures, the tibia were dissected from chick embryos that were 12 (E12), 14 (E14) and 15 (E15) days old. For the neural cell culture initiation, the two lobes of the forebrain were dissected from chick embryos that were 4 (E4), 8 (E8) and 12 (E12) days old. The final characterization of the cells was performed by H&E and CFV staining. Results: In the chondrocyte cultures, two forms of morphology were observed which is reversible in process.The primary variation evaluated in chondrocytes cultures was the effect of the media on the state of the cells. Based on whether the cells were cultured in DMEM or MEM, there was a difference in the transformation of the attached cells from the differentiated to de-differentiated forms. The primary variation examined in neuron cultures was the embryonic age of the tissue and the effect that it had on the proliferation and neurite formation of the cells. E8 embryo neural cells cultures result in well-developed cells with neurite formation along with axonal and dendritic outgrowths with highly complex interconnections between them. Conclusion: Ultimately, this study demonstrated the composition of culture media had an effect on the morphological appearance of the chondrocytes, as well as, confirmed that the culture of primary neurons is best performed using cells from an E8 embryo.
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Allograft vasculopathy in cardiac transplant recipients occurs commonly at 5 years post transplantation. We report a case of post-transplant right coronary discrete stenosis which was treated with balloon angioplasty and stent implantation under intravascular ultrasound guidance.