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Background: Diabetes Mellitus is a complex disease with varying degree of systemic and oral complications. The prognosis is quite favorable if a disease is diagnosed in early stages. Since a large number of patients seek dental treatment routinely, screening procedures for early detection of subclinical cases can help in diagnosis of asymptomatic diabetes. Aim: The present study was undertaken to evaluate if gingival crevicular blood can be used for the estimation of blood glucose levels in periodontitis patients. Material and Methods: A prospective study was carried out comprising 150 patients Group A comprised of 75 subjects with gingivitis and group B comprised of 75 subjects with periodontitis. For gingival crevicular blood glucose (GCBG) level estimation, the blood was drawn onto the glucometer strip after gently probing the gingival sulcus and the readings were recorded. At the same time, blood Vijayendra Pandey, Akhilesh Chandra, Deepak Kumar, Anup Kumar Singh, Priyankesh, Alok Kumar Gupta. Estimation of gingival blood glucose using a sensitive self-monitoring device in periodontitis patients. IAIM, 2019; 6(6): 51-56. Page 52 was also collected from the index finger onto the glucometer strip for the capillary finger-prick blood glucose (CFBG) sample. Both the values were compared and statistical analysis of data was performed. Results: The mean GCBGL and CFBGL in group A was 98.43 mg/dl ± 18.62 and 103.48 mg/dl ± 13.90 respectively, while in group B it was 136.37 mg/dl ± 36.95 and 141.62 mg/dl ± 51.84, respectively. There was no statistically significant difference (p> 0.05) between the two values in both the groups. Conclusion: It can be concluded that GCBG levels are positively correlated with CFBG levels. Therefore, clearly indicating that gingival crevicular blood collected during diagnostic periodontal examination may be an excellent source of blood sample for glucometric analysis.
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Background: Management of spontaneous supratentorial hemorrhage via conservative management is controversial so our study aimed to compare between conservative and surgical treatment of spontaneous supratentorial hemorrhage. Methods: 90 patients were selected who were diagnosed with spontaneous supratentorial hemorrhage and had given written consent to participate in the study. Patients were randomly divided into two groups of early surgery group (n=45) and conservative group (n=45). Results: 90 patients with spontaneous supratentorial hemorrhage were analysed who fulfill the inclusion criteria . Both the groups were comparable with respect to age , sex, medical comorbidities, Glassgow coma score. The intraventricular hemorrhage were present in 31.1% in conservative group and 26.6% in surgical group (but no significant difference as p value 0.641). Outcome of patients was analyzed by Glasgow outcome score and modified Rankin score. There was also no significant difference in mRS of conservative and surgical group (p value -0.206). Mortality at 3 months was 31.1% in conservative group and 40% in surgical group (p value 0.378).For patients less than and equal to 55 years age group both the groups were comparable and there was no stastically significant difference between conservative and surgical groups as Glassgow outcome scale and Modified rankin score values were comparable. But for patients more than 55 years age group. Good outcome as measured by Glassgow outcome score(p value is 0.037) and Modified Rankin score(p value 0.038) was significantly more in conservative group as compare to surgical group. Conclusion: In our study, we found no significant difference in outcome between conservative and surgical management of primary spontaneous suprtentorial hemorrhage. But interestingly, for more than 55 age group, outcome of conservative management was better than surgical management. But there is no significant difference in mortality between conservative and surgical management for any age group.
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Background: Both General and Regional anaesthesia can be used for lower Lumbar Disc surgery but SPINAL ANAESTHESIA is also a better alternative as it is accompanies by less blood loss and haemodynamics instability. Materials & Methods: 60 patients were randomly assigned to receive either General Anaesthesia( GA group) or Spinal Anaesthesia(SA group). Patients were supplemented with i.v. Propofol sedation in Spinal anaesthesia group. The values were recorded preoperative, intraoperative & postoperative. HR, MAP, amount of blood less, surgeon Satisfaction were noted. The severity of nausea, vomiting, duration of recovery and total analgesic use was also recorded. Results: Total anaesthesia, surgical time and blood loss is less in spinal anaesthesia group as compared to general Anaesthesia group. Intraoperative hypertension and tachycardia is more in GA group. Surgeon satisfaction and cost effectiveness is more in SA group. Postoperative nausea ,vomiting is more in GA group. Conclusion: Spinal anaesthesia is better ,safe and economical alternative to general anaesthesia for lower spinal surgery
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Background: Brain Trauma Foundation recommends EDH volume of greater than 30 cm3 warrants surgical evacuation irrespective of Glasgow Coma Scale. Often it is observed that Not all cases of acute EDH require immediate surgical evacuation, cases with lesser than 5 mm midline shift, no focal neurological deficits and GCS>8 and can be managed conservatively provided the patients are closely observed for any deterioration in GCS. For EDH with a volume more or less than 30ml in the supratentorial space and, a midline shift 6-10 mm, with a GCS score > 10, was attempted non-surgical management, with close observation and serial CT scanning. Aim: The aim of this study was to discover the most important factors influencing the management strategy and outcome of EDH. Methods: 70 adult patients treated for EDH were included in this retrospective study, 26 cases (37%) underwent urgent surgery, 44 cases (62.8%) were managed conservatively out of which one third of patient required delayed surgery. Results: Our study showed that out of 62 % of the patients who were conservatively managed, 72 % had a favorable outcome despite the presence of a midline shift of 6- 10 mm and an EDH volume of >30 ml but having a good GCS score. Conservatively managed patients with GCS >10, 77% had Good Recovery. Those with high EDH volume, 61% had a good outcome. 84 % of the patients having a midline shift between 6-10 mm had a good recovery. Patients with GCS < 8 had a poorer outcome than patients in good neurological status, regardless of the therapy. Conclusions: Hence we conclude, EDH must be promptly diagnosed by CT scan and considered as an emergency lest misdiagnosed and should be admitted into a neurosurgical care unit. Close neurological monitoring, appropriate follow up CT scans in the setting of improved GCS score resulting in good outcome in patient on conservative management.
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Background: Portal vein size is a diagnostic index useful in measuring portal hypertension which is found in many disease conditions including cirrhosis where it occurs in > 60% of cases. Aims: The aim of this work is to determine the normal portal vein diameter in adult North Indian population. There is paucity of work describing the portal vein diameter in this population. Method: In this work we used a 2 D ultrasound- a non invasive method to assess the portal vein size in 400 adults aged 20-80 years of both sexes(146 males & 254 females). Results: The mean diameter of normal portal vein in the male subjects was 10.33 mm ± 1.004 & in female 9.41 mm ± 1.16. Conclusion: The portal vein diameter obtained in this work is comparable to that found in Caucasians. This information can be useful in diagnosing and treating portal hypertension in a variety of clinical situations.
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Aims: To elucidate if endothelial dysfunction is an early CV risk marker in obese men and women with prediabetes. Study Design: Cross-sectional study. Place and Duration of Study: Clinical Research Unit, Pennington Biomedical Research Center, Baton Rouge, LA. United States. Methodology: Overweight and obese status denotes an increasing adipose tissue burden which spills over into ectopic locations, including the visceral compartment, muscle and liver. Associated co-morbidities enhance cardiovascular (CV) risk. Endothelium which is the largest receptor-effector end-organ in our bodies, while responding to numerous physical and chemical stimuli maintains vascular homeostasis. Endothelial dysfunction (ED) is the initial perturbation, which precedes fatty streak known to initiate atherosclerosis: insidious process which often culminates as sudden catastrophic CV adverse event. Asymptomatic men and women; [n=42] coming in after an overnight fast had demographic, anthropometric, clinical chemistry and resting endothelial function [EF: increased test finger peripheral arterial tone (PAT) relative to control; expressed as relative hyperemia index (RHI)] assessments. Results: Adults with desirable weight [n=12] and overweight [n=8] state, had normal fasting plasma glucose [Mean(SD)]: FPG [91.1(4.5), 94.8(5.8) mg/dL], insulin [INS, 2.3(4.4), 3.1(4.8) μU/ml], insulin sensitivity by homeostasis model assessment [HOMA-IR, 0.62(1.2), 0.80(1.2)] and desirable resting clinic blood pressure [SBP/DBP, 118(12)/74(5), 118(13)/76(8) mmHg]. Obese adults [n=22] had prediabetes [FPG, 106.5(3.5) mg/dL], hyperinsulinemia [INS 18.0(5.2) μU/ml], insulin resistance [HOMA-IR 4.59(2.3)], prehypertension [PreHTN; SBP/DBP 127(13)/81(7) mmHg] and endothelial dysfunction [ED; reduced RHI 1.7(0.3) vs. 2.4(0.3); all p<0.05]. Age-adjusted RHI correlated with BMI [r=-0.53; p<0.001]; however, BMI-adjusted RHI was not correlated with age [r=-0.01; p=0.89]. Conclusion: Endothelial dysfunction reflective of cardiometabolic changes in obese adults can be an early risk marker for catastrophic CV events.
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Background and Aim Helicobacter pylori (H. pylori) bacteria convert urea to ammonia, which has been implicated in causation of hepatic encephalopathy in patients with liver cirrhosis. The role of H. pylori infection in causation of minimal hepatic encephalopathy (MHE) has not been well studied. We looked at the relationship of H. pylori infection with MHE and hyperammonemia in patients with liver cirrhosis and the effects of anti-H. pylori treatment in patients with MHE and H. pylori infection. Methods Patients with liver cirrhosis underwent psychometric tests for detection ofMHE, rapid urease test to look for evidence of H. pylori infection and measurement of fasting blood ammonia levels. Patients with MHE were treated with triple-drug anti-H. pylori treatment for one week. Rapid urease test, blood ammonia levels, and psychometric tests were repeated four weeks after treatment. Results H. pylori infection was found more often in patients with MHE (63%) than in those without MHE (37%). Blood ammonia levels were significantly higher in patients with MHE than those without. After H. pylori treatment in patients with MHE, blood ammonia levels showed a significant decline and psychometric test results returned towards normal. Conclusion In patients with liver cirrhosis, there is a significant association between H. pylori infection and MHE. Anti-H. pylori therapy results in reduction in blood ammonia levels and improvement in MHE.
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The present study was conducted to find out a correlation between protein to creatinine (PC) ratio in random sample and 24 hr. urinary protein (UP) in patients with proteinuria with normal renal functions (serum cretinine<1.5 mg %) -group-I, with impaired renal functions, mild to moderate (s.cretinine 1.5-4.0mg%) group-II and advance renal failure (s.cretinine >4.0mg%) -group-III. 24 hr. and a random urine sample was taken for each patient and was tested for protein and creatinine. PC ratio was found in each random sample. The mean 24 hr.UP (g/24 hr.) estimated by 24 hr. urine collection was 1.15± 0.97, 3.26 ±1.34 and 7.39±2.19 in group I, II and III respectively. However, the mean UP estimated by random sample was 1.35±1.09, 3.94±1.93 and 10.38±3.70 in group-1, group-II and group-III respectively. P value was statistically insignificant in group 1 & II. However, there was significant difference in values in group-III (P=0.012). Coefficient of correlation on univariate analysis was r=0.889 in group-I, 0.788 in group-II and 0.375 in group-III indicating a significant correlation in results in groupI and II and not in group-III. The results in the study have shown that single voided urine method of estimating quantitative proteinuria holds its value in patients with normal, as well as in mild to moderately impaired renal functions. However, this method does not hold good for patients with severely impaired renal functions.