Septate gall bladder: a surgical surprise with review of literature

Septate gallbladder is a rare congenital anomaly, which can present a challenge for the surgeon who performs laparoscopic cholecystectomy. The common first line modality for screening in symptomatic gallbladder pathology is still ultrasonography. Preoperative diagnosis of this anomaly is not common. Pre- operative diagnosis and being acquainted with this anomaly decreases the possibility of injury to the biliary tract, the number of postoperative complications and the possible need for further surgical procedures. We present a case of septate gallbladder, which was diagnosed during the operative procedure. Despite the finding of a septate gallbladder, the performance of laparoscopic cholecystectomy was uneventful.

High Sensitivity C- Reactive Protein Level in Acute Cerebrovascular Accident (Stroke) at a Tertiary Care Centre.

Stroke is the leading cause of death worldwide and one of the main causes of long term disability. According to WHO, 15 million suffer from stroke each year. Studies have shown that levels of hsCRP measured shortly after stroke predicted complimentary aspects of prognosis. There is possibility that elevated hsCRP levels has direct relation to extent of cerebral tissue injury. We wanted to measure the levels of hsCRP in acute cerebrovascular accident. To correlate the level of hsCRP with severity of stroke and outcome.METHODSStudy was conducted in patients admitted in medical ward and medical ICU in tertiary care hospital (Grant Government Medical College and Sir JJ Group of Hospitals). It was a cross sectional study. A total of 150 patients who presented with stroke and fulfilled inclusion and exclusion criteria were enrolled in the study. In all patients hsCRP levels were measured within 48 hours of admission. Data was collected prospectively in a Microsoft Excel database. Statistical analysis was done using non-parametric ANOVA (Kruskal Wallis test) and Mann Whitney test.RESULTSMean age of patients was 59 ± 12 years. hsCRP levels were raised in stroke patients. Also values were found to be more in haemorrhagic stroke (value) than in ischemic stroke (value) and the difference was found to be significant. Significant correlation was also found between hsCRP levels and GCS with lower GCS scores associated with higher hsCRP levels in both types of stroke. Mean hsCRP level in survivors was 21.83 ± 23.17 mg/L and in non survivors was 82.07 ± 25.83 mg/L and the difference was statistically significant (p <0.0001)CONCLUSIONSWe concluded that hsCRP level is increased in cases of stroke (both ischemic and haemorrhagic) suggesting an inflammatory response in acute stroke. Increased levels of hsCRP correlated with severity of neurological deficit and worse outcome.

Clinical Study of Urine Albumin Creatinine Ratio as an Earlier Predictor of Diabetic Nephropathy.

Diabetic nephropathy (DN) is a chronic microvascular complication of diabetes mellitus (DM). Microalbuminuria is an earliest marker of DN. Effective screening measures are required for early diagnosis and management to halt the progression of diabetic nephropathy. We wanted to evaluate urine Albumin Creatinine Ratio (ACR) as an earlier predictor of diabetic nephropathy in comparison to the gold standard test 24-hours urine protein.METHODSThis is a cross sectional study conducted among 210 patients of type-2 DM admitted in the medical ward of a tertiary care hospital, who fulfilled the inclusion and exclusion criteria. Relevant history including duration of DM, and other comorbidities was taken from the patients. Vital parameters such as heart rate, systolic and diastolic blood pressure were recorded. CBC, RFT, FBS, PPBS, HbA1c, Fundoscopy were done in all patients. Urine analysis for ACR from random urine sample and 24-hours urine protein from 24-hour urine sample were done.RESULTSProteinuria was present in 80.95% of patients and that with 24-hour urinary protein, in 59.04% patients. ACR showed sensitivity of 100%, specificity of 46.51% with PPV of 72.94% and NPV of 100%. ACR has strong positive correlation with 24-hours urinary protein. Positive correlation of urine ACR was seen with serum creatinine, blood urea, HbA1c, anaemia, duration of diabetes and the presence of diabetic retinopathy.CONCLUSIONSACR shows high sensitivity in the detection of proteinuria, especially microalbuminuria and hence can be considered as an alternative to 24-hour urine protein in an early screening for DN.

Health and wellness centers: a paradigm shift in health care system of India?

An ambitious attempt to achieve the goal of universal ‘comprehensive’ primary care through health and wellness centres under the Ayushmann Bharat Scheme (ABS) has been made by the Ministry of Health and Family Welfare, Government of India. The scheme has widened the package of services available to beneficiaries and it also envisages continuum of care. However, there are pre-existing weaknesses in the three tired public health system in India which may threaten the success of this scheme. In this article we describe and analyze the newer services or initiatives at the health and wellness centres under the ABS. We also attempt to identify the Strengths, weaknesses, threats and opportunities associated with this initiative.

Perioperative duloxetine as part of a multimodal analgesia regime reduces postoperative pain in lumbar canal stenosis surgery: a randomized, triple blind, and placebo-controlled trial

Background@#Duloxetine is an antidepressant that is also useful in chronic neuropathic and central origin pain. In this study, the role of duloxetine in decreasing acute postoperative pain after lumbar canal stenosis surgery is explored. @*Methods@#In this single center, triple blinded, and placebo-controlled trial, 96 patients were randomized for statistical analysis. The intervention group received oral duloxetine 30 mg once a day (OD) for 2 days before surgery, 60 mg OD from the day of surgery to the postoperative second day and 30 mg OD for the next 2 days (a total duration of 7 days). A placebo capsule was given in the other group for a similar time and schedule. The same standard perioperative analgesia protocols were followed in both groups. @*Results@#Total morphine consumption up to 24 hours was significantly decreased in the duloxetine group (p < 0.01). The time to the first analgesia requirement was similar in both groups but the time to the second and third dose of rescue analgesia increased significantly in the duloxetine group. The time to ambulation was decreased significantly (p < 0.01) in the duloxetine group as compared to the placebo group. Pain scores remained similar during most of the time interval. No significant difference was observed in the complication rate and patient satisfaction score recorded. @*Conclusions@#Duloxetine reduces postoperative pain after lumbar canal stenosis surgery with no increase in adverse effects.

An FGD Report on Vitamin B12 Deficiency in Medical Professionals.

Introduction: Vitamin B12 Deficiency has become animportant health concern in the recent times. Acknowledgingthe health of medical professionals shall improve the healthstatus of the community as they form a classified population ofthe society. The present study was done with an aim to assessthe treatment seeking behavior of the doctors in RNT MedicalCollege, Udaipur who were found deficient in Vitamin B12levels.Material and methods: Two focused group discussionswere conducted in the department of Community Medicinewith a strength of 13 and 17 each, few pre-decided questionswere asked to the groups by the moderator and answers werereported by the recorder in the form of tally sheets.Results: Maximum doctors were interested in taking Oraltreatment by self, most of them were consuming ReverseOsmosis water and most common clinical feature theyexpressed were weakness and fatigue.Conclusion: Vitamin B12 deficiency is becoming a silentepidemic which needs to be addressed as it is affecting all thegroups of the society and thus further large scale multicentricstudies are needed to address this issue at the global level.

A Study Of Prognosis Of Stroke With Special Reference To Electrocardiographic Changes And 2d-Echo.

Introduction: Stroke is the second most common cause of death and major cause of disability worldwide. Approximately 20 million people each year suffer from stroke of which 5 million do not survive. Cerebral infarction is responsible for about 80% of all rst ever in a lifetime strokes. There are many risk factors for cerebrovascular accidents like hypertension, diabetes, aneurysm & coagulopathy . This study was undertaken to determine ECG changes in stroke with diabetic and its prognostic signicance. Aims & Objectives: The present study aims to determine the 2D ECHO and ST-T changes among stroke patients and its implication in assessing prognosis. Material and Methods: The present study was carried out in100 patients admitted in department of medicine, S.S. medical college and associated S.G.M.H hospital, Rewa (M.P.) from july 2014 to Jun. 2015. Inclusion Criteria: The stroke patients of both sexes aged >16 years admitted to SGMH, Rewa. Neurodecit lasting >24 hours. Detailed neurological examination including fundoscopy and cardiovascular examination was carried out in all the cases. A12 lead ECG was done within 24 hours of admission. Result: th th Stroke was most common in 5 and 6 decade (55%). Males had higher preponderance among stroke patients (Male-female ratio 1.5:1). Hypertension was the most common risk factor in 45% of patients. In infarct the most common presenting complaints were headache(25%), Vomiting(19.11%) & Convulsion(8.82%). Such complaints were signicantly higher in hemorrhage Headache(65.62%), vomiting(78.12%) & convulsion(12.50%). Abnormal ECG changes were more common among hemorrhagic patients (78.12%) compared to infarct patients (67.64%). LVdysfunction was the most common abnormality noted in both groups i.e., infarct (23.53%) and hemorrhage (56.26%). Conclusion: ST segment depression in infarct(30%),hemorrhage(53.33%), QTc prolongation infarct(35.71),hemorrhage(46.66%) and prominent U wave infarct(50%),hemorrhage(53.33%) are the common ECG abnormalities in strokes. ECG abnormalities in stroke patients do not have any prognostic signicance. 2D echo abnormalities were more common among hemorrhage group (75%) than in infarct (44.12%). LV dysfunction showed signicant mortality in stroke patients and was statistically signicant (p<0.001).

A Comparative Study of High Sensitive C-Reactive Protein (hs-CRP) and Urinary Calcium/Creatinine Ratio in Normal Pregnancy and Pregnancy Induced Hypertension in Gujarat, India

Background:Pregnancy-induced hypertension (PIH) is a condition characterized by high blood pressure during pregnancy.It is the most common leading cause of maternal and perinatalmorbidity and mortality in females. Serum high sensitive C-reactive protein (hs-CRP) is one of the suitablemarkers for low grade inflammation evaluation.Urinary calcium-creatinine ratio (UCa/Cr) is a valuable marker for prediction of PIH Aim:To measure & correlate serum hs-CRP and urinary calcium-creatinine ratio in between pregnancy-induced hypertension and normal pregnancy.Material & Methods:In present study total 150 subjects attending Department of Obstetrics & Gynecology at Sir Takhtsinhji Hospital, Bhavnagar, Gujarat, were included which were categorized in two groups. Group A: 75 patients of pregnancy-induced hypertension; Group B: 75 normal pregnant women as a control group. They were primarily diagnosed based on measurement of bloodpressure, clinical examination followed by biochemical investigations like hs-CRP, urinary calcium & creatinine, RBS, urea, creatinine, uric acid, CK-MB. Written informed consent was obtained from all participants before enrolling in the study.Results:No significant change in the levels of biological parameters like RBS, urea, creatinine and CK-MB was observed in both the study groups (p>0.05) except serum uric acid shows a significant difference (p<0.001). The levels of hs-CRP were found to be significantly higher in patients of pregnancy-induced hypertension (7.81±3.681)as compared to the normal pregnant women (3.11±1.972)(p<0.0001) .UCa/Cr ratio had more sensitivity and specificity than hs-CRP for prediction of pregnancy-induced hypertension compared to normal pregnancy.Conclusion:UCa/Cr ratio can be used as a more sensitive and specific test to detect pregnancy induced hypertension

Microbial contamination of mobile phones of health care providers at a teaching hospital in a hilly North Indian State

Mobile phone is a ubiquitous device used in health care settings as well. Its frequent handling, closeness to the body and heat generated during functioning provides a favourable environment for microbial contamination and growth; as well as opportunities for their transfer from one person to another through health care provider. Objective: To investigate whether health care workers mobile phones carry microbes and to identify areas or health personals where this was more common. Material and methods: A cross sectional study was conducted at a medical college and its associated hospital in a northern hilly state of India to determine the prevalence of microbial contamination of mobile phones used by health care providers. Doctors, Nurses, Laboratory Technicians and Medical Interns were contacted at their place of work to collect swab samples from their mobile phones. Sample collection sites included out-patient clinics as well as in-patient wards, emergency department and intensive care unit. All health care providers available at the time of visit to these departments were included in the study. Swab samples collected were immediately transferred to microbiology department where overnight incubation in peptone water at 37°C followed by culture and appropriate testing to identify organisms was done. Result: A total of 100 swab samples were collected, 28 from doctors, 20 from nurses, 25 from technicians and 27 from medical interns. All of them except one showed growth. Single growth were 56 while 43 cultures had multiple growths. Organism of medical importance isolated included Coagulase Negative Staphylococci (CoNS), Methicillin Resistant CoNS, Methicillin Resistant Staphylococcus aureus (MRSA), Klebsiella, S. aureus, E.coli among others. Conclusion: Almost all mobile phones were contaminated, more than half of whom were harbouring pathogenic micro-organisms. It could be a major threat to the health care providers as well as patients in form of nosocomial infections.

Correlation between serum ferritin and glycaemic control in patients of type 2 diabetes mellitus: a case control study.

Background: Diabetes Mellitus (DM) is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. Ferritin is a ubiquitous intracellular protein complex that reflectes the iron stores of the body. Many cross-sectional studies indicate that increased body iron stores have been associated with the development of glucose intolerance, type 2 diabetes, metabolic syndrome. This study was carried out to find out the relationship between serum ferritin and type 2 diabetes and to see the influence of body iron stores on HbA1c and blood glucose. Methods: This study includes 50 patients suffering from type 2 diabetes and compared with controls at Sir T hospital, Bhavnagar. S. ferritin, Fasting Blood Sugar (FBS), Post Prandial Blood Sugar (PPBS) and HbA1c were measured. Results: Serum ferritin was significantly higher (p<0.0001) in the patients suffering from type 2 diabetes and the correlation between serum ferritin and HbA1c was positive. Patients with type 2 diabetes with increased level of serum ferritin had poor glycemic control reflected by increased levels of HBA1c (r=0.701, p<0.0001) Conclusions: There is a positive association between elevated iron stores measured by serum ferritin levels and type 2 diabetes mellitus. Ferritin levels also correlated FBS, PP2BS and HbA1c.

Needle tract seeding following percutaneous biopsy of renal cell carcinoma

A 66-year-old man underwent computed tomography-guided needle biopsy of a suspicious renal mass. Two months later he underwent partial nephrectomy. Histology revealed a 30-mm clear cell renal cell carcinoma, up to Fuhrman grade 3. An area of the capsule was interrupted, which corresponded to a hemorrhagic area on the cortical surface. Under microscopy, this area showed a tongue of tumor tissue protruding through the renal capsule. A tumor deposit was found in the perinephric fat. These features suggest that tumor seeding may have occurred during the needle biopsy.

Internet resources for diabetes.

Internet is transforming lives of many people in the world. Nowadays Internet has become one of the most common media to extract information of interest to researchers. The Internet is composed of a large number of smaller interconnected networks called Intranets. These Intranets connect thousands computers enabling them to share information with each other and to share various resources such as powerful super computers, software and databases of information. It has made it possible for people all over the world to effectively and inexpensively communicate with each other. The Internet has become world's biggest library where retrieval of scientific resources is only a mouse click away. The geometric growth in Internet usage is mainly due to the great success of "World Wide Web". Various useful databases on diabetes are already on 'the Net' and many more being added regularly. The present article is an attempt to provide a review of several sites that may be of great significance to the diabetes researchers before execution for new assignment/project.