PROSPECTIVE STUDY ON ACUTE MESENTRIC ISCHEMIA AT A TERTIARY CARE CENTRE

PROSPECTIVE STUDY ON ACUTE MESENTRIC ISCHEMIA AT A TERTIARY CARE CENTRE Original Research Paper Dr Seema Math Assistant professor, Hepatopancreatico biliary Surgeon, Department of General Surgery, AMCH Vijayapur. X 1GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS Background: Mesenteric ischemia develops when your small intestine's blood supply is restricted by narrowed or blocked arteries. The small intestine might suffer severe damage from decreased blood supply. A blood clot that suddenly cuts off the small intestine's blood supply (acute mesenteric ischemia) necessitates emergency surgery. Angioplasty or open surgeries are options for treating chronic mesenteric ischemia. In this study, predictive factors for mesenteric vascular disorders are assessed, with a focus on mesenteric ischemia. All the consecutive Methods: cases of Acute abdomen who were diagnosed & treated for acute mesenteric ischemia in the Department of emergency & surgical gastroenterology at Al Ameen Medical Collage and Hospital from July 2021 to Jan 2023 were included in the study. NOMI and low ow / perfusion states were excluded from the study. There were 20 patients of acute mesenteric Results: ischemia, of which 17 were males and 3 were female. 12 patients had acute mesenteric ischemia who had under gone surgical management & follow up medication, 5 on medical management with follow up medication & 3 expired. 18 out of 20 patients had risk factors mesenteric thrombosis. 14 required ICU stay, 12 required surgical management, 8 out 20, had undergone stoma reversal after 6 to 8 weeks at the later date. 4 of them had re-admission for dehydration and dyselectrolytemia, TPN and ICU admission .2 patient had just D LAP & then explored where in segment of the bowel was dusky and congested settled with 100% O2 & warm saline but he was admitted with chest infection and ARF needing with ICU stay and dialysis. Duration of Hospital stay varied from 1 to 30 days with mean of 15 days in mesenteric vascular diseases. Average incidence of AMI is 18 out of 95 Patients over period of 18 months (8.2%in one year). AMI is an uncommon but life-threatening vascular Conclusions: emergency that requires immediate diagnosis and urgent treatment that is more surgical than medical, or in some circumstances, IR guided

PHARMACOVIGILANCE IN INDIA: PAST, PRESENT, AND FUTURE PERSPECTIVE

Its start a decade ago, pharmacovigilance (PV) experienced tremendous development. There have been significant attempts in recent years to transform the current pharmacovigilance systems to meet future expectations. Adverse drug reactions (ADRs) are increasing in frequency, severity, and complexity as novel medication therapies are coming to market more quickly as a result of better laws and regulations. India is the second most popular nation in the world, with around 1 billion active and prospective consumers of pharmaceuticals. Despite being a member of the Uppsala Monitoring Centre, our nation has almost little commitment to the database. This problem is brought on by the inadequate ADR (adverse drug reaction) monitoring system and lack of knowledge among pharmacy associates and medical professionals. The primary objectives of the PV program are patient care, patient safety, and monitoring of negative medication reactions. There is a need for additional clinical preliminary exams and clinical assessments in India to accurately practice PV. A fully functional PV system is essential for the safe and responsible administration of medicines. This review gives a systematic review of pharmacovigilance in India from its origin to its current scenario and also discusses the various strategies and proposals to build, maintain and implement a robust pharmacovigilance system for India in coming years.

MULTIDETECTOR COMPUTED TOMOGRAPHY IN BLUNT CHEST TRAUMA SINGLE TERTIARY CARE TRAUMA CENTRE EXPERIENCE.

Thoracic injuries are significant causes of morbidity and mortality in trauma patients, second only to head injuries. In addition to conventional radiography, multidetector computed tomography (CT) is increasingly being used, since it can quickly and accurately help diagnose a wide variety of injuries in trauma patients. Furthermore, multiplanar and MiNIP, volumetric reformatted CT images provide improved visualization of injuries, increased understanding of trauma-related diseases, and enhanced communication between the radiologist and the referring clinician. To identify and accurately a Aims: ssess variety of injuries in blunt thoracic trauma with multidetector Computed Tomography (MDCT). To find commonest pattern of intrathoracic injury related to blunt chest trauma. This Method: retrospective observational study included 50 patients who underwent Multidetector CT examination during the period from November 2020 to April 2021 at tertiary care trauma centre, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai. Blunt chest Conclusion: trauma injuries were classified into pleural injury, lung parenchymal injury, bony thorax, tracheobronchial and vascular injuries. The commonest injury detected was pleural (70%) followed by lung parenchymal injury (52%) and bony thorax injury in 50% cases. 50% of the pleural injury cases were associated with rib fractures. Multiple injuries were seen in the 47 patients, stating the importance of a detail evaluation of all chest components. No oesophageal and cardiac injury was detected in our CT studies' with its multiplanar, MinIP and volume reconstruction images increases the confidence in imaging diagnosis and play a critical role in understanding thoracic trauma related complications.

Analysis Of Applicability Of Tools Of Inventory Control And Knowledge Of Hospital Pharmacists On Methods Of Inventory In The Central Pharmacy Of A Tertiary Care Hospital

Objective: A study was conducted to analyse the applicability of the tools of inventory control of drugs, and the awareness of hospital pharmacists on the inventory tools in the central pharmacy of a tertiary care hospital. Methods: Always Better Control (ABC) and High Moderate Low (HML) analysis were carried out for 4057 drugs purchased in the central pharmacy during the financial year of 2017-2018. The drugs were classified as A, B and C category based on their annual usage value and as Category High (H), Moderate (M) and low (L) drugs based on their unit price respectively. The knowledge of the 80 hospital pharmacists on the tools of inventory control was assessed using a structured questionnaire. Results: Based on ABC analysis, of 4057 drugs, 330 drugs were classified under “A” category accounting to 8.13% of the total number of drugs purchased which was 70.91 % of total annual consumption in money value. The category “B” consisted of 667 drugs accounting to 16.44% of the total number of drugs which was 20.01% of total annual money consumption. Category “C” had 3060 drugs which accounted to 75.42% of the total number of drugs purchased which reflected on 9.01% of annual money consumption. Based on HML analysis, 440 drugs (10%) had a unit price above Rs. 500 and were classified under ‘H’ category. The drugs with unit price between Rs.500 and Rs.100 were grouped as ‘M’ items. There were 695 drugs (17.13%) in ‘M’ category. The ‘L’ category consisted of 2922 drugs (72.02%) with their unit price below Rs.100. Of 80 pharmacists, 84 % had good overall knowledge on the inventory control tools and 59 participants were willing to acquire additional training on inventory control techniques. Conclusion: The study explained the need for the application of ABC and HML analysis, and the involvement of hospital pharmacists in the regular implementation of inventory analysis towards effective management of Pharmacy stores in a hospital setting.

Clinicomicrobiological study of the removed intrauterine device

Background: Intrauterine contraceptive devices are one of the most efficient, cost effective long acting reversible contraceptives. But the worrying clinical symptoms, misconceptions and higher rates of genital tract infection have become a hurdle in its acceptance as the first choice of contraception. The objective of this study was to study the common reasons for removal of IUCD.Methods: An observational study was done involving 430 women who reported to the OBG Outpatient of the hospitals attached to Bangalore Medical College, over a period of 2 years, for IUCD removal. Socio-demographic details, clinical symptoms compelling IUCD removal were elicited. The removed IUCD was subjected to culture and sensitivity. Initial descriptive analysis was used and statistical tests of significance like chi-square were used to know the relation between genital infections and IUCD.  P value <0.05 was considered significant.Results: Of the 430 women, 46.9% were between 21-25 years of age, 49.3% were primipara, and 71% used IUCD for 1-3 years. Most common reason for removal in the first 2 years was heavy menstrual bleed followed by pain abdomen. 15.3% culture reports showed growth of bacteria, with maximum cultures positive in <5 years of usage, the association was statistically significant.Conclusions: Present study shows a lower risk of bacterial infections among IUCD users. Hence, effective counseling regarding the safety of IUCD over other spacing methods is essential to increase its acceptance.

Study of Morphometry and Elastic Fibre Distribution in Left and Right Coronary Arteries.

Background: Coronary artery disease also called asischemic heart disease which develops when majorblood vessels that supply blood to heart becomedamaged or diseased. It is also one of the leading causesof death. Morphometry and elastic fibre distribution incoronary arteries may help in using appropriate sizecatheters for diagnostic procedures. Aim andObjectives: To study the morphometry and elastic fibredistribution in left and right coronary artery. Materialand Methods: Segment of left and right coronaryarteries each having length of 0.5 cm were collectedfrom 30 adult human heart specimens fixed in 10%formalin. Outer and inner diameters were measured.Tissues were processed and stained by verhoeff's VanGeison stain. Stained slides were scanned by “IScapture software” under 10 × magnifications. Results:Outer diameter of left coronary artery is 4.225 ±0.6963mm and right coronary artery is 3.827 ±0.6869mm. Inner diameter of left coronary artery is3.338 ± 0.5853 and that of right coronary is 2.869 ±0.6104mm.Conclusion: Diameter, wall thickness,thickness of tunica intima, tunica media is more in leftcoronary artery than the right. Also left coronary arteryshows more number of elastic fibers than right coronaryartery.

Diagnostic utility of F waves in clinically diagnosed patients of carpal tunnel syndrome.

Sensory nerve conduction velocity (SNCV) of median nerve measured across the carpal tunnel, difference between distal sensory latencies (DSLs) of median and ulnar nerves and difference between distal motor latencies (DMLs) of median and ulnar nerves are commonly used nerve conduction parameters for diagnosis of carpal tunnel syndrome (CTS). These are having high degree of sensitivity and specificity. Study of median nerve F-wave minimal latency (FWML) and difference between F-wave minimal latencies (FWMLs) of median and ulnar nerves have also been reported to be useful parameters for diagnosis of CTS. However, there is controversy regarding superiority of F-wave study for diagnosis of CTS. So the aim of present study was to compare sensitivity and specificity of median FWML and difference between FWMLs of median and ulnar nerves with that of above mentioned electrophysiological parameters and to find out which parameters are having more sensitivity and specificity, for early diagnosis of CTS. Methods : Median and ulnar nerves sensory and motor conduction, median and ulnar nerves F-wave studies were carried out bilaterally in 125 clinically diagnosed patients of carpal tunnel syndrome. These parameters were also studied in 45 age matched controls. Results : Difference between DSLs of median and ulnar nerves, median SNCV and difference between DMLs of median and ulnar nerves were having highest sensitivity and specificity while median FWML and difference between FWMLs of median and ulnar nerves was having lowest sensitivity and specificity for diagnosis of CTS. So in conclusion F-wave study is not superior parameter for diagnosis of CTS.

Topography-guided custom ablation treatment for treatment of keratoconus.

Keratoconus is a progressive ectatic disorder of the cornea which often presents with fluctuating refraction and high irregular astigmatism. Correcting the vision of these patients is often a challenge because glasses are unable to correct the irregular astigmatism and regular contact lenses may not fit them very well. Topography-guided custom ablation treatment (T-CAT) is a procedure of limited ablation of the cornea using excimer laser with the aim of regularizing the cornea, improving the quality of vision and possibly contact lens fit. The aim of the procedure is not to give a complete refractive correction. It has been tried with a lot of success by various groups of refractive surgeons around the world but a meticulous and methodical planning of the procedure is essential to ensure optimum results. In this paper, we attempt to elucidate the planning for a T-CAT procedure for various types of cones and asphericities.

CD34 positive-microgranular variant of acute promyelocytic leukemia in a child.

Acute promyelocytic leukemia (APL) is a subtype of acute myeloid leukemia (AML) in which abnormal promyelocytes predominate. APL is rare in children (approximately 10% of childhood AML) and is characterized by a higher incidence of hyperleukocytosis, an increased incidence of microgranular morphology, the presence of balanced t(15;17)(q22;q11.2-12) translocation, and more frequent occurrence of the PML-RARα isoforms bcr 2 and bcr 3 compared to adults. The cytomorphology of microgranular variant blasts is obviously different from AML M3 blasts; these cells have a nongranular or hypogranular cytoplasm or contain fine dust-like cytoplasmic azurophil granules that may not be apparent by light microscopy. This case report emphasizes the importance of a high index of suspicion for the diagnosis of APL, the hypogranular variant in particular. They are responsive to differentiation therapy with all trans-retinoic acid and complete remission in seen in >80% cases.

An uncommon case of an adult with del(5)(q) in acute lymphoblastic leukemia.

Del(5)(q) is a common chromosomal abnormality with favourable prognosis in Myelodysplastic Syndrome (MDS) and Acute myeloid leukemia (AML). However, del(5)(q) is also seen rarely in Acute lymphoblastic leukemia (ALL) and its significance remains poorly understood. We present here, a case report of diagnosis of an adult 75 year old patient of ALL with a cytogenetic abnormality of del(5)(q32). His clinical features, morphology and immunophenotyping findings were suggestive of T-ALL. Relevant literature has been reviewed and discussed.

Supernumerary teeth: A case report.

Supernumerary teeth are the teeth present in addition to the normal set of teeth. They may be single, multiple, unilateral or bilateral erupted or unerupted and in one or both jaws. Multiple supernumerary teeth are rare in individuals with no other associated diseases or syndromes. Our case presents with 12 supernumerary teeth in permanent dentition, of which six were erupted and six unerupted and a history of extraction of three teeth with no associated syndrome.

Parental presence in the dental operatory-parent's point of view.

Parental presence in the dental operatory is considered a controversial issue and majority of dentists prefer mothers not to be present in the operatory while the child receives dental care. Very few studies have focussed on the parental' point of view. The present study was carried out to find out the attitudes of parents towards being present determine in the operatory during dental procedure and also to determine if willingness to be present was influenced by variables like age, sex, order of the child among siblings and previous dental behavior. Data was collected from 1350 parents using a questionnaire designed by the authors. In the present study, 78.3% of parents expressed their willingness to be present with the child during dental procedures. The study also showed that parents of younger children were more likely to be willing to be present in the operatory and as age advanced, the percentage of parents willing to be present in the operatory decreased.