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Background: Recent advancements in diagnostic modalities for microalbuminuria have shown that urinaryexcretion of albumin is more in hypertensive patients as compared to subjects with normal blood pressure.Microalbuminuria is known to be associated with certain complications like dyslipidemia, cardiac complications,atherosclerosis and kidney disease. Purpose: To analyze the prevalence of microalbuminuria and its clinicalcorrelation with essential hypertension. Material and Methods: The study was of cross-sectional design,which was carried out in outpatient and inpatient departments of Medicine in DY Patil Medical School andHospital, Nerul, Navi Mumbai. Results: Out of total 190 study participants 96 were normotensive controls,while 94 were hypertensive patients. Mean age in control group was 48 ± 9.4 years, while that in hypertensivegroup, it was 49.2 ± 10.2 years. The 24 hours mean urinary excretion of albumin in hypertensive patients withmicroalbuminuria was found to be 80.21, while it was 12.91 and 7.89 in hypertensive patients withoutmicroalbuminuria and control groups, respectively. Conclusion: Early screening to detect microalbuminuriain early stages will help to initiate appropriate treatment regimen and prevent the risk of complications and thusimprovement in prognosis.
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Aims:The etiological spectrum and clinical profile of admitted patients presenting with pancytopeniawere studied. Study Design:This was a prospective study conducted on 200 patients presenting to the Department of Medicine, Department of Oncology and the Allied Specialities of Medicine, Dayanand Medical College and Hospital, Ludhiana and were found to have pancytopenia during hospital stay.Results:Mean age of the patients was 45.69 ± 17.05 years with maximum number of patients (23%) in the age group of 51-60 yearsand 119 patients were males and 81 patients were females.Most common physical finding was pallor (95%), followed by splenomegaly (22%) and hepatomegaly (17%). Total of107 patients were vegetarians (53.5%) and 93 patients (46.5%) were non-vegetarians. Mean hemoglobin was 7.16 ± 2.04 g/dl, mean total leucocyte count was 2.51 ± 1.02 x 103/cu.mm, mean platelet count was 54885.37 x 103/ul ± 40320.96 and mean the absolute neutrophil count was 1.59 x 103 /cu.mm ± 0.84. Ten patients of pancytopenia were because of tropical fever which included 4 cases of dengue, 3 cases of malaria, 2 cases of enteric fever and 1case of mixed infection (malaria + scrub typhus).Viral markers were positive in 14 out of the 63 patients tested. Out of these 14 patients, 4 were HBsAg reactive, 7 were HCV +ve and 3 were HIV +ve. Most common red blood cell picture on peripheral blood film was normocytic normochromic (34.5%), followed by mixed morphology (33.5%). Macrocytic and microcytic morphology was seen in 19.5% and 12.5% of the patients respectively. Hypercellular marrow was seen in 82 patients (42.9%), normocellular marrow was seen in 58 patients (30.3%) and hypocellular marrow was seen in 51 patients (26.7%). The most common cause of pancytopenia in this study was megaloblastic anemia in 59 patients (29.5%), the 2nd common cause was leukemias in 28 patients (14%) and the 3rdcause was aplastic anemia in 22 patients (11%). Drug induced pancytopeniawas seen in 21 patients (10.5%) and hypersplenism in 9 cases (4.5%).Conclusion:This study has helped us in knowing the various etiologies of pancytopeniain this hospital. Megaloblastic anemia was the most common etiology in this study followed by leukemiasand aplastic anemia. The study helped us in understanding of the age and gender distribution, the hematological parameters, the peripheral blood film in pancytopenia and the bone marrow picture in these patients.
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Background: A group of metabolic diseases is ‘diabetes’ which has become a major global concern is characterized by high blood sugar. In the world about 347 million people have diabetes. Untreated long standing hyperglycemia leads to microvascular complications in newly diagnosed DM. The objective of the study was to find out prevalence of microvascular complications in newly diagnosed Type-2 diabetes mellitus.Methods: The present cross-sectional study was conducted over a period of 6 months involved 200 patients who were diagnosed with T2DM having ≤6 months duration was conducted in the out-patient department of medicine and ophthalmology at a tertiary care hospital. Informed consent was taken from all the participants who were willing to participate. Detailed history, clinical examination and relevant investigations were done to diagnose microvascular complications.Results: Maximum number of studied subjects i.e. 54% were seen in age group of 41-50 yrs. Males were 56% whereas females comprised 44%. Total of 52% of subjects were from rural background. Nephropathy was the most common microvascular complication present in 54% patients followed by neuropathy in 30% and retinopathy in 8% (NPDR in 7% and PDR in 1%) of patients.Conclusions: From the present study it has been concluded that nephropathy is the most common microvascular complication in newly diagnosed T2DM followed by neuropathy and retinopathy. Authors recommend that education of high-risk group regarding diabetes and its complications by electronic and print media is required so that they seek medical consultation at the earliest. Screening for diabetes at a younger age in view of lower average age at presentation and high prevalence of microvascular complications.
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Congenital obstruction of nasolacrimal duct is a very common cause of epiphora in new born children.Controversy exists regarding the natural course and management of children with congenital nasolacrimalduct obstruction. The present study was undertaken on 80 children of congenital nasolacrimal duct obstructionwith no previous intervention. They were divided into two groups of 40 each. Group 1 had children aged lessthan 1 year and Group 2 comprised of children older than 1 year. Probing was done under general anesthesia.The mean age of the patients in Group 1was 8.35±2.65 months and that of the children in Group 2 was27.5±11.98 months. The overall success rate of probing was 78.75%. Success rates in Group 1 and Group2 were 85% and 72.5%, respectively. The difference between the two groups was statistically insignificant.However, there was a significant difference in the success rate of probing depending on the type of obstruction(p<0.05). Membranous obstruction of NLD was associated with increased success rates of probing ascompared to firm obstruction of NLD (p=0.001230, Yates corrected Chi square =0.0009578). Probing is asafe option of treating congenital nasolacrimal duct obstruction. Probing is beneficial in older children althoughthe success rate of probing tends to decline with increasing age. Firm anatomical obstruction in nasolacrimalduct is associated with a decline in the success rate of probing.
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Background: One of the delicate structure in the human body is eye and trauma to the eye is essentially a very grave matter. Major cause of preventable monocular blindness and visual impairment in the world is ocular trauma. So any injury to the eye must be deemed to be an ocular emergency and should be handled with utmost care. Despite its public health importance, there is relatively less population based data on the magnitude and risk factors for ocular trauma specially from developing countries. The objective of the study was to find out the epidemiological pattern of ocular trauma.Methods: The present study was 5 year retrospective study of all the patients who reported directly with ocular injury or referred from the casualty to the department of ophthalmology from January 2013 to January 2018. Various parameters like age, sex, mode of injury, type of injury etc. of all patients seen during this period were analyzed.Results: Total of 4192 ocular trauma patients were seen during study period. Maximum number of ocular trauma patients i.e. 1146 were seen in age group of 21-30 years. Males i.e. 3490 outnumbered females in the present study. Road traffic accidents were the most common cause of ocular trauma and accounts for 1760 cases. Most common reported ocular trauma was periorbital oedema/ecchymosis followed by laceration. Surgical intervention was done in 1660 cases whereas 2532 were managed medically.Conclusions: From present study, we may conclude that the maximum number of ocular trauma patients were seen in the age group of 21-30 years with more preponderance in males. Road traffic accidents were the most common cause of ocular trauma. The fact that the lifetime prevalence of ocular trauma is higher than that of eye diseases, which can be decreased by implementing the traffic rules with strict force and imposing heavy fine and license cancellation for drunken driving.
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Background: The purpose of this study was to introduce modified form of conventional problem-based learning (PBL) i.e. “Tutor less PBL” in educating medical students about type 2 diabetes mellitus (T2DM). Medical students are future physicians and can be effective healthcare professionals to screen and manage diabetes at community level. Poor levels of awareness as well as lacunae in teaching diabetes have been reported among medical students. The study aimed to assess the knowledge of undergraduate medical students about T2DM by using “Tutorless PBL” method.Methods: Sixty-two 8th semester medical students from one of the private medical colleges in Mumbai city attained knowledge about T2DM through “Tutorless PBL” and “conventional PBL”. “A structured set of engagements triggers” (SET) was used in Tutorless PBL. Students responded through pre and post-test questionnaires and ‘student’s unpaired t test’ compared their test scores. Fourteen item questionnaires with Likert scale evaluated students’ feedback about both methods.Results: The post test scores were more for students in “Tutor less group” than in “tutored group” (15.37 vs. 14.01). The difference was statistically significant (t=5.87, p<0.001). All (100%) students appreciated both methods for enhancing their knowledge about T2DM. “Tutor less PBL” was found to be more effective than “conventional PBL” in promoting self-learning and critical thinking abilities.Conclusions: Both methods were beneficial to students in terms of clarifying the topic, improving group interaction and yielding self-directed learning. Tutorless problem-based learning can be an effective option especially in resource (faculty) limited setting
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Background: Pterygium is a triangular wing shaped fiovascular growth of subconjunctival tissue on to the cornea. Surgical removal is the treatment of choice but no single technique is successful due to high recurrence rate. Aim: To evaluate the success and complications of sutureless glue–free conjunctival–limbal autografting in management of primary pterygium. Materials and Methods: A prospective interventional study was carried out in 60 patients to analyse the outcome of sutureless and glue–free conjunctival–limbal autograft for the management of primary nasal pterygium. The patients were followed up after 1 week, 3 weeks, 6 weeks and at 3 months postoperatively. The mean age of the patients was 38.28± 13.77 years (range 21–67), 55% of which were females. Graft retraction occurred in 3(5%) eyes. Haemorrhage was seen in 20(33.33%) eyes at 24 hours, which persisted in only 8(13.33%) eyes at 3 weeks and resolved completely in 100% of eyes at 6 weeks. Oedema was noted in 5(8.33%) eyes at 24 hours, and resolved completely by 1 week. Recurrence of pterygium was observed in 2(3.33%) eyes at three months of follow–up. Conclusion: Sutureless and glue–free conjunctival–limbal autograft following pterygium excision is an easy, quick, safe, effective, and economical option for the management of primary pterygium.
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Corticosteroid induced complications like cataract are well reported with varied manifestation. Manyhypothesis to explain the mechanisms and etiology of corticosteroid induced cataracts have beenreported. To best of our knowledge, this is one of a case reports establishing corticosteroid systemicuse as a possible cause for mature white cataract (bilateral), warranting clinician's attention as thecondition is important, in relation to indiscriminate systemic use of steroids in relation to ophthalmologicalcomplications.
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Introduction: One of the documented leading cause ofblindness in India is cataract as many patients with cataract donot have access to hospitals and surgery and to avoid blindnessdue to cataract, the only remedy is to perform hospital basedcataract surgery on a large scale. There is an increase in anumber of cataract patients due to improved quality of life,health indices and increased life expectancy. Study aimedto see the visual outcome and complications among patientsundergone manual SICS with PC-IOL implantation.Material and Methods: The present prospectiveobservational study was conducted on 72 patients who wereselected in various screening eye camps to undergo cataractextraction surgery by manual small incision cataract surgerytechnique with posterior chamber IOL implantation (MSICSwith PC-IOL).Results: Total of 72 eyes of patients who underwent manualsmall incision cataract surgery were studied. Best correctedpreoperative visual acuity of ≥ 6/60 was found in 13 patientswhile postoperatively on day1 total of 60 patients had visualacuity of ≥ 6/60. The final 6th week postoperative bestcorrected visual acuity of 6/12-6/9 was found in 65 patients.Iris prolapse was seen in 3 patients followed by posteriorcapsule rent which was seen in 2 patients. Mild postoperativeuveitis was seen in 20 followed by striate keratopathy in 8patients while hyphaema was seen in 2 patients.Conclusion: MSICS is a safe and effective procedure, due toits low rates of intraoperative and postoperative complicationswhich are easily treatable. Visual acuity is only one measureof the functional success of cataract surgery and the goodpostoperative visual outcomes achieved by our patientsfurther adds on to its benefits as a good surgical technique.MSICS can be performed as procedure of choice for largevolume cataract surgeries
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Background: Pilonidal sinus disease (PSD) is an acquired chronic disorder located in the natal cleft, with its etiology based on the presence of hair follicles in the gluteal crease. The objectives for treating PS disease are minimal tissue loss, minimal postoperative morbidity, rapid return to daily activities and work, acceptable cosmetic results, minimal recurrence rate, and low cost. Aim of the study: To retrospective analyze surgical management of pilonidal sinus disease among patients visited in tertiary healthcare center. Methods: The study was conducted in the Department of General Surgery, Mahatma Gandhi Hospital Bhilwara, Rajasthan, India. For the study we analyzed the records of 50 patients treated at the Surgical Department. Postoperative follow-up of all patients were done. The surgical treatment options, complication rates, hospitalization, and work-off periods were analyzed. Results: A total of 50 patients were included in the study.Marsupialization was done in 23 patients, unroofing done in 8 patients, primary closure in 7 patients and Limberg flap transposition in 12 patients. Table 1 shows mean hospitalization periods and mean work off day period in different surgical procedures. Maximum mean hospitalization period was seen with Limberg flap transposition (4.12 days) followed by Unroofing (3.02). Conclusion: Physicians treating pilonidal disease should have adequate knowledge of the advantages and disadvantages of the different surgical techniques. Preoperative decision making should be based on the patient’s expectations, and cooperation with the patient about possible postoperative complications, and outcomes.
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We report a case of a 30 year old female who presented with features of septic abortion with peritonitis 2 days after unsafe abortion of a 20 week pregnancy with uterine perforation with intrabdominal fetus with mesenteric and bowel injury that required bowel resection.
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BACKGROUND: Constipation is a common problem, which may be due to slow transit or faecal evacuation disorders. Though the screening test of colonic transit study using radio-opaque markers given at 0, 24 and 48 hours followed by abdominal X-ray at 72 hours is a good protocol in the West, it is not suitable for Indians who have a rapid gut transit. METHODS: Nine patients with adult Hirschsprung disease, 11 with chronic intestinal pseudo-obstruction diagnosed using standard investigations and 11 healthy subjects were evaluated by colonic transit study using radio-opaque markers (SGmark), 20 each at O, 12 and 24 hours followed by an abdominal X-ray at 36 and 60 hours. The cut-off was determined by using receiver operating characteristic (ROC) curves, and sensitivity, specificity, positive and negative predictive values and diagnostic accuracy were determined. RESULTS: The total number of markers retained in the abdomen and those in the right segment at 36 hours in patients with Hirschsprung disease and chronic intestinal pseudo-obstruction was higher than that in healthy subjects though the number in the left and rectosigmoid segments were comparable. The abdominal X-ray at 60 hours, total number of markers and number in all segments were higher in patients with Hirschsprung disease and chronic intestinal pseudoobstruction than in healthy subjects. The best cut-off by ROC curves at 36 and 60 hours was 30 and 14 markers, respectively. The sensitivity, specificity, positive and negative predictive values, diagnostic accuracy and area under the ROC curve at 36 hours were 90%, 82%, 90%, 82%, 87% and 0.9, respectively; the corresponding values at 60 hours were 95%, 100%, 100%, 92%, 97% and 0.99, respectively. CONCLUSION: Using the proposed protocol, the colonic transit study is able to distinguish patients with specific motility disorders causing constipation such as Hirschsprung disease and chronic intestinal pseudo-obstruction from healthy subjects with reasonable sensitivity and specificity, and shows that an abdominal X-ray at 60 hours is better than one at 36 hours.
Subject(s)
Adolescent , Adult , Biomarkers , Case-Control Studies , Chronic Disease , Constipation/diagnosis , Contrast Media , Female , Gastrointestinal Motility , Gastrointestinal Transit , Hirschsprung Disease/physiopathology , Humans , Intestinal Pseudo-Obstruction/physiopathology , Male , Mass Screening , Middle Aged , Time FactorsABSTRACT
Tumor-associated gastroparesis, though reported in association with various malignancies, is rare in patients with cholangiocarcinoma. We report a 55-year-old woman who presented with dysphagia and recurrent vomiting. Esophagogastroduodenoscopy revealed dilated stomach and excess residue without organic obstruction. 99mTc sulfur colloid solid gastric emptying study, radio-opaque marker gut transit study, and esophageal manometry showed features suggestive of gastroparesis and achalasia cardia; electrogastrography revealed bradygastria. Cholangiocarcinoma was detected on CT scan performed after the patient developed jaundice two months later. The lesion was deemed surgically unresectable. She died four months later.