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Pneumonia has accounted for approximately 15 percent of all hospital-associated infections and 27 percent and 24 percent of all infections acquired in the medical intensive-care unit (ICU) and coronary care unit, respectively. It has been the second most common hospital-associated infection after that of the urinary tract. Because of this tremendous risk, in the last two decades, most of the research on hospital-associated pneumonia has focused on ventilator-associated pneumonia. This study was aimed to assess effi ciency of nursing care package on expected outcome regarding prevention of ventilator associated pneumonia among ventilated clients. A quantitative research approach with quasi experimental research design with pre-and post-test with equivalent control group design was used to carry out the study. Ventilated clients from selected hospitals who were fulfi lling the inclusion criteria were selected by using non-probability convenient sampling technique. Total 40 (20 experimental and 20 control group) size sample was included in the study. In experimental group, majority (50%) had mild infection and only 15 percent had no infection in pre-test; in post-test majority (75%) had no infection and only 25 percent had mild infection and no patient had severe infection. It showed that delivery of nursing care package is effective in decreasing ventilator associated pneumonia. In control group, majority (50%) had mild infection and only 10 percent had no infection in pre-test and in post-test majority (40%) had mild infection and 60 percent had severe infection and no patient had severe infection. As nursing care package was not delivered, the infected cases increased. The effi ciency of nursing care package on expected outcome regarding prevention of ventilator-associated pneumonia between experimental groups was statistically signifi cant and in control group it was not signifi cant. The delivered nursing care package on ventilator-associated pneumonia among ventilated clients proved its benefi cial effects in controlling infection level and preventing ventilator-associated pneumonia at intensive care units. This study confi rmed that nursing care package for ventilated clients can prevent infection and cut short long stay in intensive care units.
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The purpose of the study is to compare the gross anatomy of umbilical cord in normal placentas and IUGR placentas. MethodsThis is a case control study, conducted in the Department of Anatomy, R.N.T. Medical College, Udaipur among 100 control and 100 IUGR placentas. Placenta was collected as soon as possible after delivery and was examined for gross changes. Then it was fixed in 10% formalin for sections for staining. ResultsIn our study, the marginal attachment of umbilical cord with 0.25 insertion percentage was seen in 35 cases. The association between marginal attachment of the cord and low birth weight is statistically significant. ConclusionsIncreased incidence of marginal cord insertion was associated with low foetal weight. The mean length of umbilical cord varied in the present study between 30 cms and 60 cms in control and IUGR group. No significant difference was seen in the cord length according to type of pregnancy, normal or abnormal. From the literature review, it was anticipated that there would be a wide range of umbilical cord lengths. The umbilical cord may have a central, lateral, marginal or medial insertion. Central and lateral insertions have no clinical importance. Marginal insertions may be more susceptible to vessel rupture and have been associated with foetal growth retardation, stillbirth and neonatal death.
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Background: Dengue remains major public health concern because of the expanding geographic distribution of both the virus and the mosquito vector. Aims and objectives was to determine the incidence of dengue fever in paediatric age group presenting to a tertiary care centre in Western Rajasthan and to evaluate the clinico-epidemiologic profile of these children.Methods: This is observational epidemiological study on patients of pediatric age group, over a period of one year.Results: A total of 210 ELISA positive cases, comprising of 55% males and 45% female (Male to female ratio of 1.2:1) were enrolled. In this study most (44.7%) were age group of 10-18 years, 80% patients from urban area, 93.8%. admitted between the months of September to December, 70.95% presented between 3rd to 5th days of their illness, 48 (22.86%) were tourniquet test positive at the time of admission with fever being most common (95.23%) presenting symptom, followed by headache (60%) and vomiting (55%). Almost all (99.52%) had thrombocytopenia (34.2% of them had severe thrombocytopenia), most (85%) had a hospital stay of less than a week, 98.10% patients required fluid therapy for less than 5 days. and a mean of 3.41'2.60 days were required by these patients to recover from significant thrombocytopenia. Here 22% (46) patient's required ICU care, with shock being main indication for ICU admission, followed by requirement of blood product transfusion (73%). Bleeding manifestations were seen in '73(34%) patients, commonest being the epistaxis in 40 patients (55%).Conclusions: Incidence of dengue was 0.42% with 32.38%patients were IgG ELISA positive also.
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Background: Chromium, an essential trace mineral plays an important role in the metabolism of carbohydrate, fat and proteins. Chromium picolinate (Cr.Pic) is used in alternative medicine to treat chromium deficiency. Though Cr.Pic is increasingly used to treat diabetes and obesity, studies on its safety profile is limited.Methods: Acute toxicity study was conducted by oral administration of Cr.Pic (2000 mg/kg body weight). The animals were maintained another 14 days with once a day observation. For sub-chronic studies, test groups were treated with Cr.Pic 10 mg/kg/day for 90 days. Tests for hepatic and renal function were conducted. Effect of Cr.Pic on behavioural changes and motor co-ordination was done on every week. Histopathological studies were conducted on day 90 at the end of the experiment.Results: Acute toxicity study of Cr.Pic showed no signs of toxicity and mortality. Absence of any behavioural alteration or mortality during the period of 14 days indicates that Cr.Pic has no latent effect. Similar results were obtained with sub-chronic studies suggesting safety of Cr.Pic. Cr.Pic treated groups showed no changes in learning and motor co-ordination compared to the untreated group. No gross histopathological changes were seen in any group indicating safety of Cr.Pic.Conclusions: The present study conferred safety profile of Cr.Pic from normal results obtained in hepatic function, renal function, behavioural and histopathological studies, suggesting its safety.
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The objective of the work is to develop and validate a new reverse phased ultra-performance chromatography method and its stability studies for the simultaneous estimation of alogliptin and pioglitazone in bulk and tablet dosage form. The column of the method was BEH C18 (2.1× 50 mm, 1.7 µ) used as a stationary phase and the mobile phase was 45:55 v/v of phosphate buffer (pH 3) and methanol, respectively. The injection volume was 2 µl and flow rate was maintained at 0.3 ml/minute. The wavelength was 280 nm and the runtime was 3 minutes. The retention time of alogliptin was 0.4 minutes and pioglitazone was 0.529 minutes. The Linearity of the alogliptin was 6.25–37.5 µg/ml and pioglitazone was 15–90 µg/ml. The newly developed method could be used for the routine analysis of pure drug and its formulations in accordance with the ICH Q2 (R1) guidelines.
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Background: Assessment of fetal gestational age (GA) is an essential part of obstetric USG. Accurate knowledge of fetal GA is important to facilitate the best possible prenatal care and successful pregnancy outcome. For the estimation of GA the commonly used parameters in third trimester are:- BPD, HC, AC and FL. As all these parameters are affected by fetal growth disorders and fetal position. TCD can be used as another parameter for the estimation of GA in growth restricted fetuses.Methods: This study was conducted at Mahila Chikitsalaya Sanganeri Gate; SMS Medical College Jaipur from July 2005 to September 2006. A total of 80 pregnant women in third trimester with singleton pregnancy including 40 pregnant women with known cases of IUGR and 40 AGA fetuses were studied for TCD measure.Results: Correlation coefficient between TCD and gestational age was highly significant and no significant difference was found in TCD of AGA and IUGR fetuses.Conclusions: TCD measurement can be used as more reliable parameter for accurate estimation of gestational age in IUGR fetuses in third trimester.
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An Internal hernia is a protrusion of abdominal viscera through the opening in the peritoneum or mesentery. We report the case of a left paraduodenal hernia (LPDH) combined with a small bowel obstruction in a 50-years-old male with pain abdomen and vomiting and no previous abdominal surgeries. An anteroposterior abdominal radiograph showed a clustered small bowel loops towards the left side of the abdomen and few air-fluid levels suggestive of obstruction. CECT abdomen showed a focal crowding of small bowel loops noted in the left anterior pararenal space with crowding of mesenteric vasculature and displacement of ascending left colic artery and inferior mesenteric vein anteriorly. The surgical intervention provided definitive diagnosis and treatment for LPDH. A paraduodenal hernia is a relatively rare cause of acute abdomen, and its diagnosis is often incorrect or delayed owing to its variable clinical manifestations. Therefore, it is important for the clinicians to recognize this condition, diagnose it early, and avoid making a wrong diagnosisowing to its high overall mortality rate
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Rectus sheath hematoma has been described in the past due to various etiologies with varying degrees of severity. It is a rare cause of acute abdomen. Clinical presentation may vary from person to person and based on site of collection and source of bleeding. Various management options including surgical and non-surgical measures have been described and generally present with tenderness with a mass of varying size based on the duration and amount of bleeding. Here, we present the case of a 72-year-old female with acute abdomen on presentation, unstable vitals, and severe pallor. A tender mass over the left lower part of the abdomen was found, and on further evaluation with imaging, the patient was found to have a rectus sheath hematoma. The hematoma was successfully treated with the evacuation of the hematoma and ligation of the bleeding vessel
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Alveolar soft part sarcoma (ASPS) is a rare tumor (0.5–1% of sarcomas) of unknown etiology with a highly characteristic morphology. It tends to occur more often in the younger age group with a predilection for the female sex. Prognosis is generally poor and it often presents with late metastases. Here, we report the case of a 48-year-old female, who presented to the emergency department with a complaint of giddiness and melena. She was a known case of sarcoma ASPS left thigh with pulmonary secondaries. On evaluation, a bleeding tumor in the upper jejunum was found on upper GI endoscopy. As the patient’s hemodynamics were unstable, she had to be operated without further imaging. Post-operative period was uneventful
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Mixed adenoneuroendocrine carcinoma (MANEC) is a rare and relatively newer entity and classified into a separate category by the WHO 2010 Classification of Tumors. Accordingly, due to its rarity of diagnosis, further oncologic management is a challenge. They contain an adenocarcinoma part and a neuroendocrine part and are further classified based on grades. We present case series with a histological diagnosis of MANEC, its management, and clinical behavior in the follow-up period. Optimum mode of the management of these tumors is yet to be proposed, as these groups of tumors are highly aggressive and associated with poor prognosis.
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Background: Acute myocardial infarction has reached enormous proportion in the developing countries and it is speculated that atherosclerotic heart disease will replace infectious disease as the leading cause of death in India. It has been shown that the thrombolytic therapy is underutilized. So, the study was taken to study the clinical manifestations and outcome of thrombolytic therapy in STEMI.Methods: The study was conducted for a period of 18 months in a tertiary care centre during which 100 cases of STEMI admitted to ICCU were included in the study, after fulfilling the inclusion criteria for thrombolysis, data related to clinical profile and outcome of thrombolysis was collected. SPSS 16 was used to analyse the data. Descriptive statistics like proportions mean and SD were computed.Results: Incidence of STEMI was high among subjects in the age group 51-60 years. Males were more affected (72%). Smoking, hypertension, hyperlipidemia and diabetes mellitus were the most common risk factors. Chest pain (92%) was the most common symptom. Majority (56%) were admitted within 6 hours of onset of symptoms. Anterior wall infarction was most common type of myocardial infarction. Majority (82%) were admitted in either Killips I/II class. Left Ventricular failure and Arrhythmias were most common complication. 64% patients had objective evidence in a form of ECG with ST-T resolution (>50%) between 1-6 hours, 18% between 6-24 hours and 18% patients had no significant resolution even after 24 hours. Echocardiography showed good left ventricle function (LVEF >45%) in 70% and 30% of the patients showed reduced ejection fraction (LVEF<45%). Mortality was seen in 8% of cases.Conclusions: Smoking, hyperlipidemia, diabetes mellitus and hypertension were most important risk factors for MI in the study. Coronary pain relief was most frequent and early marker of reperfusion. The ST segment elevation resolution has been widely accepted as most reliable objective criteria of coronary reperfusion. Hence ST segment resolution is regarded as a marker of salvaged myocardium by post-thrombolytic reperfusion. Early reperfusion of the ischaemic myocardial tissue with thrombolytic therapy decreases the morbidity and mortality.
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Objective: To determine the frequency of Acute kidney injury secondary to snake bite in patients presenting to a tertiary care hospital
Subject and Methods: This was a descriptive cross-sectional study conducted at the department of General Medicine, Jinnah postgraduate medical center, Karachi, from 10th June 2015 to 10th Jan 2016. Patients with diagnosis of snake bite were enrolled. Detailed history, physical examination and biochemical measurements were recorded. Patients underwent serum creatinine levels for diagnosis of AKI
Results: One hundred and twelve patients fulfilling the inclusion criteria were included in this study.There were 90 [83.36%] males and 22 [19.64%] females. The mean +/- standard deviation age of study population was 28+/-0.151 years. On analysis of risk factors it was observed that 33 [29.46%] patients were obese. On analysis of outcome variable, it was observed that 33 [29.46%] had AKI
Conclusion: Around 30% of patients who developed AKI were presented with history of snake bite. However, factors such as age, gender, duration and obesity were not related with the AKI
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The experiment was conducted during rabi season in medium black soil at College Farm, College of Agriculture, Rajendranagar, ANGRAU, Hyderabad, Andhra Pradesh to study the influence of biofertilizers, vermicompost and chemical fertilizers on growth, nodulation, nutrient uptake, seed yield and economics of Black gram. From the data, it was observed that 50%RDF + Vermicompost + Rhizobium + Pseudomonas significantly increased the plant height, root length, leaf area index and leaf chlorophyll content at 25 and 50 DAS over the other treatments including control. The same treatment recorded highest seed yield (707 kg ha-1) and haulm yield (7067 kg ha-1) as compared to the control. Nutrient uptake recorded significantly highest in the treatment supplied with biofertilizers along with Vermicompost and 50%RDF. Treatment supplied with 50%RDF + Vermicompost + Rhizobium + Pseudomonas recorded highest net return (17784 Rs ha-1) but highest B: C ratio (2.11) was recorded in the treatment supplied with 50%RDF + Rhizobium + Pseudomonas.
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A 50 year female presented with dysphagia for 2 months and she denied pain during swallowing, retrosternal pain, drooling of saliva, nasal regurgitation, cough, breathlessness, hoarseness of voice abdominal pain, vomiting, loss of weight or loss of appetite. Upper gastrointestinal (UGI) endoscopy revealed a web at 17 cm from incisors. Post endoscopy patient developed pain over the upper abdomen which worsened during swallowing and breathing. Because of rapid development of these symptoms we suspected esophageal perforation/dissection. Complete blood picture suggestive of neutrophilic leukocytosis and other parameters were normal. Thin barium study showed pseudo lumen in esophagus and confirmed the diagnosis of esophageal web with esophageal dissection. Patient was treated conservatively with nil per oral and parenteral fluids and antibiotics. Web was dilated after 2 weeks with Salivary-Gilliard dilators and procedure was uneventful and oral feeding was initiated.
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<p><b>PURPOSE</b>Ilizarov ring fixator and limb reconstruction system (LRS) fixators have been used in the management of complex tibial fractures with severe soft tissue injuries, compound tibial fractures, and infected tibial nonunion for which conventional internal fixation cannot be contemplated. Fracture union and distraction osteogenesis can be done simultaneously with these external fixators, allowing early weight bearing. Several previous studies have shown almost equal results of rail and ring fixators for the compound tibial shaft fractures. Thus we performed a prospective study to evaluate the union rate, functional outcome and amount of limb lengthening after the treatment of compound tibial shaft fractures with or without infected nonunion by ring or LRS fixators.</p><p><b>METHODS</b>This prospective study was done at Sarojini Naidu Medical College and Hospital, Agra, India and included 32 patients of compound tibial shaft fractures with or without infected nonunion. There were 26 males and 6 females and the average age was 40 years. Patients were randomly divided into two groups (n=16 for each): one underwent Ilizarov fixation and the other received LRS fixation. Cases were followed up for 3-24 months, 6 months on average from September 2012 to October 2014. Functional and radiological outcomes were assessed using the Association for the Study and Application of Methods of Ilizarov (ASAMI) criteria for both rail and ring fixators.</p><p><b>RESULTS</b>Union was achieved in all cases. Radiological outcome was found excellent in 68.75%, good in 18.75% and fair in 12.50% of cases treated by rail fixators whereas it was excellent in 56.25%, good in 18.75%, fair in 12.50% and poor in 12.50% of cases treated by ring fixators. Functional result was satis- factory in 75.00% of cases treated by rail fixator and 68.75% of cases treated by ring fixators whereas the corresponding rate of unsatisfactory was 25.00% vs. 31.25%.</p><p><b>CONCLUSION</b>In our short-term assessment, LRS fixators show a better result than Ilizarov fixators in terms of fracture union and functional outcome with soft tissue care and limb length.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , External Fixators , Fracture Fixation, Internal , Ilizarov Technique , Prospective Studies , Tibial Fractures , Diagnostic Imaging , General Surgery , Treatment OutcomeABSTRACT
Decalcification and its effect on microhardness of root canal dentin by an aqueous solution of 17% EDTA at different time intervals were studied.Single rooted forty extracted human premolar teeth after adequate processing and embedded with acrylic resin were randomly divided into 8 groups based on different time intervals. Each sample group was assessed for Ca<sup>2+</sup> release into the test solution by Atomic Absorption Spectrophotometer, respectively and then were subjected for microhardness testing.17% EDTA and 0.9% Saline, test solutions were used; EDTA was adjusted to 7.5 pH. Data analysis was done by One Way analysis of variance (ANOVA) and the comparison of means was done by using Tukey’s multiple comparison tests. The decalcifying activity of 17% EDTA solution was time dependent and increased immersion time showing very high significant influence on the amount of calcium extracted (<strong>F=154.304, p). The reduction in microhardness for 17% EDTA solution was time dependent and increased immersion time showing very high significant decrease in the microhardness among the different time intervals tested (<strong>F=249.925, p < 0.0005</strong>).Effect of 17 % EDTA solution as root canal irrigant is time dependent as evidenced by dentin microhardness reduction.
Subject(s)
Calcium , Dental Pulp Cavity/drug effects , Dental Pulp Cavity/pharmacology , Dentin/drug effects , Dentin/pharmacology , Edetic Acid/analogs & derivatives , Edetic Acid/therapeutic use , Hardness , Hardness Tests , Humans , Spectrum Analysis , Time FactorsABSTRACT
Background: Quality of life assessment is considered as important measure of outcome in chronic disease management. With increase in prevalence of Diabetes in India it becomes important to assess the quality of life for better care and control. Aims & Objective: Hence this study was conducted with the objectives to assess the Quality of life (QoL) among diabetic patients with respect to anthropometry and blood investigations and assess the influence of risk factors on Quality of Life among Diabetic patients. Materials and Methods: Cross-sectional study was conducted for a period of 2 months among 180 type 2 diabetes mellitus patients attending rural tertiary care centre. A pretested and structured questionnaire was used to obtain the information on socio- demographic profile, diabetic history. Quality of life was assessed by WHOQOL-BREF. Statistical analysis was carried out by using EPI Info 7 software. Correlations, Students t test and logistic regression analysis are the statistical tests. Results: The mean age of males was 59.56 ± 9.64 and females was 60.90 ± 7.51. Mean scores of Quality of life with respect to physical, psychological, social and environmental domains were significantly higher among females compared to males (p<0.01). Quality of life domains and other continuous variables showed that there is significant positive correlation between age and physical, psychological, social and environmental domains (r = 0.864, 0.396, 0.549, 0.420 respectively and p<0.001). Logistic regression showed that increase in age and HbA1c acts as independent factors to assess the Quality of life. Conclusion: Quality of life among diabetics needs improvement with proper treatment regimens ensuring good glycemic control.
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Aim: The aim of this study was to evaluate the sealing ability of white and gray mineral trioxide aggregate (MTA) mixed with distilled water and 0.12% chlorhexidine (CHX) gluconate when used as a root-end filling material using the dye-penetration technique. Materials and Methods: A total of 48 single-rooted human teeth were cleaned, shaped, and obturated with gutta-percha and AH Plus sealer. The apical 3 mm of each root was resected, and 3-mm deep root-end cavity preparations were made. The teeth were randomly divided into 4 experimental groups, each containing 8 teeth, and 2 negative and positive control groups, each containing 8 teeth. Root-end cavities in the experimental groups were filled with the experimental materials. After application of nail polish, the teeth were exposed to India ink for 72 h and longitudinally sectioned, and the extent of dye penetration was measured with a stereomicroscope. Results : No statistically significant differences were observed in the sealing ability of gray and white MTA mixed with distilled water and 0.12% CHX. Conclusion : CHX appears to be a good alternative to replace distilled water, as a solution to be mixed with MTA.
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Since a very long time the usefulness and great therapeutic value of pyrazole nucleus has been recognized and the wide range of activities of this nucleus evaluated. However antipyrine was the first synthetic organic compound having pyrazolin-5-one nucleus, to find use as an important drug. Phenylbutazone a prototype of pyrazolidinedione is very potent anti-inflammatory agent but its use is now banned in some countries. Later on many modifications of pyrazole nucleus were attempted and several compounds have been synthesized which serve as basis for treatment of different diseases, like-inflammation, pain, cancer, tuberculosis and disease caused by bacteria. COX-2 inhibitory activities of pyrazoles are well proved and many compounds containing pyrazole nucleus like Celecoxib, Sulphenazole, Sulphinpyrazole and Analgin are well established in the market. The discovery of natural 4-Hydroxy Pyrazole C-glycoside antibiotic pyrazofurin; 4-hydroxy-3beta-D-ribofuronasyl-IH-pyrazole-5-carboxamide; has provided a basis for more rational design and synthesis of new pyrazoles as potential antimicrobial, antiviral, anticancer agents