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Objective@#To evaluate the preliminary surgical results of Endoscopic Type I Tympanoplasty among patients with inactive chronic otitis media without ossicular pathology. @*Methods@#Design: Prospective Series. Setting: Tertiary Government Hospital. @*Participants@#Seventy patients with inactive mucosal chronic otitis media (COM) with air bone gap (ABG) of ≤ 40 dB on the preoperative audiogram scheduled to undergo Type I Tympanoplasty between July 2018 and December 2020 were enrolled. @*Results@#Seventy-three (73) ears were evaluated. The overall rate of graft uptake was 95.9% at 12 weeks. There was a statistically significant (p<.001) improvement in hearing on comparison of pre-operative (25.74 ± 7.34 dB) and post-operative (14.82 ± 6.55 dB) air bone gap. The duration of surgery was less than one hour in 76.7% and 77.2 % patients experienced only mild post[1]operative pain. @*Conclusion@#Endoscopic tympanoplasty can provide good results with respect to graft uptake and hearing gain with short surgical duration and minimum postoperative morbidity. Longer follow up of at least 6 months (for graft uptake) and preferably not less than 12 months (for hearing results) may confirm our preliminary findings.
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Pain, Postoperative , Tympanic Membrane Perforation , Hearing , MorbidityABSTRACT
Background: Necrotizing soft tissue infection (NSTI) is a serious condition that can be diagnosed on a high index of suspicion and require urgent surgical treatment. NSTI involved epidermis and dermis but more frequently it affects the deeper layer of adipose tissue, fascia, and muscle. NSTI diagnosis and its treatment include emergent surgical intervention and the use of appropriate antibiotics. In this study, we have been evaluated the laboratory risk indicator for necrotizing fasciitis (LRINEC) score in predicting the outcomes in patients of NSTI.Methods: We have conducted a prospective study of 36 patients with NSTI. The LRINEC score, predisposing factors, etiology, risk factors, causative microbiological organisms have been studied.Results: LRINEC score >8 is associated with NSTI in all cases. The mortality and morbidity, length of stay including ICU stay increases with an increase in LRINEC score. The most common microorganism was found to be E. coli followed by Klebsiella.Conclusions: Although, we used the emergent and liberal debridement and appropriate antibiotic and resuscitation. In this study, morbidity, mortality, and length of hospital stay all are increased with respect to the increase in LRINEC score.
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Background: Diabetes mellitus refers to group of metabolic disorders characterized by hyperglycemia due to an absolute or relative deficit in insulin production or action. Diabetes mellitus produces pathological changes in most organs of the body including heart, blood vessels, kidneys, nerves and eyes. Cardiovascular autonomic neuropathy (CAN) is a severely debilitating yet underdiagnosed complication of diabetes. Diabetes-associated cardiovascular autonomic neuropathy damages autonomic nerve fibers that innervate the heart and blood vessels causing abnormalities in heart rate and vascular dynamics.Methods: Total 80 cases of diabetes mellitus were selected. Cardiac autonomic neuropathy in them was diagnosed by a series of tests recommended by Ewing et al, which include - Valsalva ratio, Deep Breath Test, Heart rate response to standing, Postural Hypotension, SHGT Increase in diastolic BP on sustained hand grip. They were divided into 2 groups A and B depending on presence or absence of cardiac autonomic neuropathy. ECG was done to calculate QTc and QTd.Results: In group A mean QTc was 0.344 sec and in group B in patients with mild CAN mean QTc was 0.432, moderate CAN mean QTc was 0.444, and in patients of severe CAN mean QTc was 0.481. p value was 0.001 that it is highly significant. Means more was degree of CAN more was prolongation of QT and similarly more the degree of CAN more was QTd.Conclusions: Diagnosis of cardiac autonomic neuropathy by battery of cardiac autonomic function tests is a comlex procedure. The prolongation of QTc interval and more specifically QTd interval on ECG is a marker in diagnosis of cardiac autonomic neuropathy which can be easily evaluated.
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Background: Following Myocardial Infarction some proteins and enzymes, CPK-MB/ Troponin-I, T, are released into the blood from the necrotic heart muscle. Serum Uric Acid (SUA) may be a risk factor and negative prognostic marker for cardiovascular diseases. Aim of the study was to study serum uric acid levels in patients of acute Myocardial infarction with congestive heart failure, its relation with stages of congestive heart failure as per Killip classification and the role of serum uric acid levels as a marker of mortality.Methods: The case control study was conducted on 120 patients divided into two groups. Group A included 60 patients of acute Myocardial infarction. Group A was further divided into two categories. One includes 30 patients of with congestive heart failure and another includes 30 patients without congestive heart failure. Group B consists of 60 control patients. Serum uric acid levels were measured in Group A on 1st, 3rd and 7th day of hospital admission and in Group B on 1st day.Results: The study showed females have higher degree of hyperuricemia than males. SUA was significantly higher in patients of acute myocardial infarction than control group patients. SUA were also higher in patients with history of IHD, in patients with BNP >100 and it correlates with Killip class and mortality rates. Patients of acute myocardial infarction with diabetes mellitus had higher degree of hyperuricemia than nondiabetic and control group. No significant difference in SUA levels were observed with regard to age, alcohol intake, lipid profile, ejection fraction and hypertension.Conclusions: In acute myocardial infarction, patients with hyperuricemia had higher mortality and may be considered as poor prognostic biomarker.
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Background: Currently about 35 million Indians are reported to suffer from diabetes mellitus, a significant proportion of whom are either undiagnosed or diagnosed but undertreated leading to poor glycemic control. This leads to accelerated development of macrovascular complications like Peripheral Vascular Disease (PVD). As most of the patients are asymptomatic, hence, early detection and treatment of PVD in patients with diabetes mellitus carries utmost importance.Methods: The present study was undertaken in SGRDIMSAR, Amritsar on 100 patients of type 2 Diabetes Mellitus with asymptomatic PVD. The diagnostic accuracy of Ankle-Brachial Index (ABI) and pulse oximetry as a screening tool was compared against Color Doppler ultrasonography as the reference standard.Results: The sensitivity, specificity, positive predictive value and negative predicted value of pulse oximetry to diagnose asymptomatic PVD in diabetics was found to be 98.31% (95% CI: 90.91-99.96), 41.46% (95% CI: 26.32- 57.89), 70.73% (95% CI: 65.08-75.81) and 94.44% (95%CI: 70.19-99.19) respectively. The sensitivity, specificity, positive predictive value and negative predicted value of ABI to diagnose asymptomatic PVD in diabetics was found to be 77.97% (95% CI: 65.27-87.71), 97.56% (95% CI: 87.14-99.94), 97.87% (95% CI: 86.85-99.69) and 75.47% (95% CI: 65.51-83.29) respectively.Conclusions: Pulse oximetry is better than ABI for the screening for asymptomatic PVD among diabetics. However, ABI is more accurate as compared to pulse oximetry in diagnosing asymptomatic PVD in diabetics.
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Background: Obesity and Diabetes mellitus are well knownrisk factors for cardiovascular diseases (CVD). Though bodyfat appears to play important role in insulin resistance, the waybody fat is distributed is also significant. Waist circumference(WC), calf circumference (CC), and wait to calf ratio (WCR)can be used as predictors of risk of CVD. This study aims toevaluate the utility of WCR as a simple non-invasive, cheaper,easy to use and non-instrumental modality which can be usedas screening tool and as an indicator of coronaryatherosclerosis and resulting cardiovascular risk in patients(OPD as well as Inpatients) with Diabetes mellitus bycorrelating WCR with Carotid Intima Media Thickness (CIMT)which itself is an established indicator for risk of CVD.Methods: 100 adult patients with Type-2 diabetes werediagnosed on the basis of latest ADA criteria. Detailed history,clinical examination, anthropometric measurements,biochemical indices were assessed for all the selectedpatients. Carotid atherosclerosis was measured by scanningthe bilateral common carotid arteries using a high resolutionUSG system with 10 MHz linear transducer. The carotid intimamedia thickness (CIMT) was measured at three points on farwall of mid and distal CCA and 1 cm proximal to dilation ofcarotid bulb. Mean value of six measurements from right andleft CCA were used.Results: There is an expected negative correlationbetween calf circumference and prevalence of abnormal CIMT(p<0.011). WCR correlated with CIMT more strongly than theindependent measures with (p<0.001) and is a good predictorof CIMT abnormality as AUC (area under the curve) is 97.7%Conclusion: Waist to calf circumference ratio is a simple noninvasive, cheaper, easy to use and non-instrumental modalitywhich can be used as screening tool in assessment ofatherosclerotic burden of the vasculature at an early stage intype 2 diabetic OPD as well as in patients. WCR will serve assurrogate marker of coronary artery disease.
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Despite global support for immunization as a core component of the human right to health and the maturity of immunization programs in low- and middle-income countries throughout the world, there is no comprehensive description of the standardized competencies needed for immunization programs at the national, multiple sub-national, and community levels. The lack of defined and standardized competencies means countries have few guidelines to help them address immunization workforce planning, program management, and performance monitoring. Potential consequences resulting from the lack of defined competencies include inadequate or inefficient distribution of resources to support the required functions and difficulties in adequately managing the health workforce. In 2015, an international multi-agency working group convened to define standardized competencies that national immunization programs could adapt for their own workforce planning needs. The working group used a stepwise approach to ensure that the competencies would align with immunization programs' objectives. The first step defined the attributes of a successful immunization program. The group then defined the work functions needed to achieve those attributes. Based on the work functions, the working group defined specific competencies. This process resulted in three products: (1) Attributes of an immunization program described within eight technical domains at four levels within a health system: National, Provincial, District/Local, and Community; (2) 229 distinct functions within those eight domains at each of the four levels; and (3) 242 competencies, representing eight technical domains and two foundational domains (Management and Leadership and Vaccine Preventable Diseases and Program). Currently available as a working draft and being tested with immunization projects in several countries, the final document will be published by WHO as normative guidelines. Vertical immunization programs as well as integrated systems can customize the framework to suit their needs. Standardized competencies can support immunization program improvements and help strengthen effective health systems.
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Humans , Immunization/standards , International Cooperation , Immunization , Clinical Competence , PlanningABSTRACT
Rationale: Disseminated cysticercosis is characterized by presence of cysts in multiple body organs, like brain, skin, eyes, muscles and rarely heart and lungs. Patient concerns: A 22-year-old man presented with bilateral proptosis of 1-year duration. He also had two episodes of cysticercosis encephalitis. In the second episode of encephalopathy, the patient died. Diagnosis: Disseminated cysticercosis. Interventions: Corticosteroids (Initially intravenous dexamethasone 0.4 mg/kg/day for 2 weeks, followed by oral prednisolone 1.0 mg/kg/day). Outcomes: The patient died of cysticercosis encephalitis approximately 2 months later. Lessons: Disseminated cysticercosis in our case presented only with proptosis as he had very heavy infestation of the brain and eyes. Heavy larval infestation in a patient with disseminated cysticercosis can be life-threatening.
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The liver and skin are the organs most commonly involved in serious adverse drug reactions. Rarely a drug reaction can affect both organs concurrently. The association of drug induced liver injury (DILI) and toxic epidermal necrolysis (TEN) is even rarer and may be rarely reported. This is a case report on development of both TEN and DILI following use of piperacillin / tazobactam. We describe our experience of DILI occurring in association with TEN including the etiological agent responsible, its clinical/ biochemical characteristics and ultimate outcome.
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Background: Liver plays a central role in glucose homeostasis. Chronic liver disease is associated with an increased incidence of insulin resistance (IR) and Diabetes Mellitus. Diabetes that develops as a complication of cirrhosis of liver is known as 慔epatogenous diabetes (HD)�. This study was conducted to study the prevalence of insulin resistance in liver cirrhosis.Methods: One Hundered (100) non-diabetic patients of liver cirrhosis considering the inclusion and exclusion criteria and visiting both indoor and outpatient department of medicine, SGRDIMSAR were included in the study. All cirrhotic patients irrespective of etiology were subjected to fasting plasma glucose level and fasting plasma insulin levels and insulin resistance was calculated by HOMA-IR method. Study was statistically analyzed.Results: 79 out of 100 patients were found to have insulin resistance and increase in prevalence with grades of child pugh score were noted.Conclusions: Keeping in view the results of the study, we conclude that FPG and HbA1c are not sufficient in detecting glucose metabolism disorders in cirrhosis. As insulin resistance can be used as an important prognostic marker in patients with cirrhosis of liver, serum insulin levels can be recommended as routine investigation in these patients. Diabetes mellitus increases the risk of HCC in cirrhosis patients. So, by early detection of diabetes mellitus by calculating insulin resistance with HOMA-IR method we can prevent progression of disease to development into HCC.
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Background: In the present study we have done a retrospective as well as prospective studies of patients with carcinoma anorectum undergoing abdominoperineal resection with special emphasis on the role of adjuvant treatment regimens as a complement to surgery. Methods: 75 patients operated for APR were studied retrospectively and 25 patients operated for the same were studied prospectively. Results: It was observed that colorectal cancer is the most common malignancy of the gastrointestinal tract. Rectum remains the most common site affected by it. Carcinoma anal canal is about one tenth as common as rectal cancer. Adjuvant treatment after surgery was studied with respect to the indications, the schedules followed and the subsequent complications. Conclusion: It was concluded that adjuvant treatment, in the form of Radiotherapy and Chemotherapy, has a definitive role in, both locally advanced Carcinoma Anorectum and for Dukes' C stage but it has its own complications which need to be addressed. Nigro's chemoradiation regimen has become the first choice for carcinoma anal canal, ahead of APR.
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The aim of the present work was to study a simple colorimetric and potentiometric biosensor based on urease inhibition by Pb (II) ions for its estimation in milk samples. Urease immobilized on nylon membrane by hydrosol gel method was used as the biocomponent to demonstrate the metal effect on the enzyme activity using phenol red as the pH indicator. A lower limit detection of 38.6µm was achieved in the milk and the enzyme membranes were stable for more than two months at 4ºC. In potentiometric approach, response of an ion selective electrode (ISE) to changing ammonium ion concentration as a consequence of urease inhibition by Pb (II) ions was explored to achieve a detection limit of 9.66 µm. Lead specificity was attained by means of masking agents 1,10 - phenanthroline and sodium potassium tartarate. Validation of the developed biosensors was carried out with spiked milk samples.
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We describe a case of primary hypertensive iridocyclitis with biopsy-proven Cytomegaloviral retinitis. It is an observational case report of a 69-year-old diabetic gentleman on azathioprine for Crohn’s disease who presented with recurrent episodes of hypertensive iridocyclitis. On the 4th a endance in 5 months, a granular white lesion was noted in the temporal periphery of the mid-peripheral fundus and a chorioretinal and vitreous biopsy performed. Vitreous PCR was positive for Cytomegalovirus (CMV). Hematoxylin and eosin staining revealed cytomegaliclike inclusions within necrotic neural retina. Transmission electron microscopy revealed herpes family virus particles and immunohistochemistry demonstrated CMV protein. This case provides further evidence implicating CMV infection in the etiology of hypertensive iridocyclitis. With hindsight, the cumulative eff ect of diabetes and azathioprine on the immune surveillance system proved sufficient to render the patient susceptible to CMV retinitis.
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Pleomorphic adenoma is the most common benign tumor of the major or minor salivary glands. The incidence in the other parts of the head and neck region is very low and in most of the cases, the lesion is located in the upper aerodigestive tract, namely, the oral and pharyngeal and occasionally, in the nasal cavity. Cases involving regions where minor salivary glands are not normally present are extremely rare. We report a 35-year-old female who presented with progressive swelling at nasal vestibule of 9 months duration. The mass was excised and the histopathological report revealed it to be pleomorphic adenoma.
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A 67‑year‑old former gold miner with rheumatoid arthritis, treated with steroids and methotrexate, presented to eye casualty with a painful right eye. Examination revealed an anterior uveitis and despite an initial response to topical steroids, the intraocular inflammation worsened with anterior and posterior uveitis development. Re‑examination showed a white mass in the peripheral nasal retina initially suspected of being active Toxoplasmosis infection and anti‑toxoplasmosis treatment commenced. After improvement and tapering of this treatment, the intraocular inflammation reoccurred. Cytopathological examination of a pars plana vitrectomy obtained vitreous sample that showed a non‑diagnostic non‑infectious chronic vitritis. The vitreoretinal surgeons elected to do a direct biopsy of the white subretinal mass in the peripheral nasal area. This revealed, quite unexpectedly, an abscess containing pigmented phaeohyphomycosis fungi. This case report documents the multidisciplinary approach that assisted in clinching a final diagnosis and the role of sub‑retinal biopsy in this unprecedented scenario.
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Child , Humans , Electronic Health Records/standards , Patient Rights , Pediatrics , Social ResponsibilityABSTRACT
The contamination from heavy metals has risen during the last decade due to increase in Industrialization. This has led to a significant increase in health problems. Many of the known remediation techniques to remove heavy metal from soil are expensive, time consuming and environmentally destructive. Phytoremediation is an emerging technology for removal of heavy metals which is cost effective, and has aesthetic advantages and long term applicability. The present study aims at efficiently utilizing Brassica juncea L. to remove lead (Pb). The result of our study indicate that amount of lead in Indian mustard is increased with the amount of EDTA applied to the soil and maximum accumulation was achieved with 5mmol/kg of EDTA. On further increase in EDTA resulted in leaf necrosis and early shedding of leaves. Therefore EDTA at a concentration of 5mmol/kg was considered optimum for lead accumulation by Brassica juncea L.
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Sarcoidosis is a rare and potentially disabling disease in the paediatric age group. Clinical management of such cases is difficult and requires long-term monitoring. We report a case of a 9 years old Caucasian girl who presented initially with bilateral chronic anterior uveitis, cataracts and glaucoma secondary to sarcoidosis. She was treated with Guttae Levobunolol, topical and systemic steroids over the last 2 years but subsequently required cataract extractions with foldable intraocular lens uveitis was well controlled with both topical steroids and low dose methotrexate over the last 2 months following cataract surgery. Her full blood counts and renal functions are monitored regularly. There was no adverse effect from the methotrexate reported so far. Sarcoidosis is a multisystem disease and requires multi-disciplinary input from ophthalmologists, neurologists and paediatricians. Medical and surgical treatment of such ocular manifestations is challenging. This case highlights both the safety of low dose methotrexate in the management of childhood chronic uveitis and the need for prompt treatment in such cases to avert significant morbidity from this disease.
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Bilateral carotid artery occlusion followed by reperfusion produced significant cerebral infarction and impaired short-term memory, motor co-ordination and lateral push response. Individual pretreatments with chlorophyll and aqueous extracts of B. monniera and V. wallichii markedly attenuated ischaemia-reperfusion induced cerebral injury in terms of decreased infarct size, increase in short-term memory, motor in coordination and lateral push response. The results suggest that chlorophyll and aqueous extracts of B. monniera and V. wallichii prevent ischaemia-reperfusion induced cerebral injury with comparable potency.