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Objective: To study the prognostic role of right ventricular systolic pressure (RVSP) in patients with heart failure (HF). Background: Although RVSP is a readily available echocardiographic parameter, it is often underused. Its prognostic role in patients with heart failure is not well established compared with pulmonary artery pressure measured by right heart catheterization. Methods: This single-center retrospective cohort study included patients with acute heart failure hospitalization admitted to the hospital from January 2005 to December 2018. The primary predictor was right ventricular systolic pressure (RVSP) obtained from bedside transthoracic echocardiography at admission. We divided RVSP into two groups, RVSP <40 mm Hg (reference group) and RVSP 40 mm Hg. Primary outcome was all-cause mortality. Secondary outcomes were all-cause readmission and cardiac readmission. We conducted propensity-score matching and applied cox-proportional hazard model to compute hazard ratio (HR) with 95% confidence interval (CI). Results: Out of 972 HF patients, 534 patients had RVSP <40 mm Hg and 438 patients had RVSP 40 mm Hg. Patients with RVSP 40 mm Hg compared with RVSP <40 mm Hg were associated with higher rates of death [HR: 1.60, 95% CI: 1.22e2.09, P-value ¼ 0.001], all-cause readmissions [HR: 1.37, 95% CI: 1.09 e1.73, P-value ¼ 0.008] and cardiac readmissions [HR: 1.41, 95% CI: 1.07e1.85, P-value ¼ 0.014]. Conclusion: Higher RVSP (40 mm Hg) in HF patients was associated with higher rates of death, allcause readmissions, and cardiac readmissions. RVSP can be considered as a prognostic marker for mortality and readmission.P
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Chronic Renal Disease is a Global Health Problem which has multiple clinical features which are problematic to the patient, reduces their life expectancy and changes their way of living. It is mainly comprised of hematuria, proteinuria and progressive loss of kidney function. If it reaches end-stage that means there is 90% loss of the kidney function. At times, it also gives rise to oral manifestations which are misdiagnosed and as a result go untreated. This review article deals with the oral manifestations of Chronic Renal Disease so that proper awareness of this problem can be met among Dentists as well.
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Inflammatory bowel disease (IBD), once considered a disease of the Western hemisphere, has emerged as a global disease. As the disease prevalence is on a steady rise, management of IBD has come under the spotlight. 5-Aminosalicylates, corticosteroids, immunosuppressive agents and biologics are the backbone of treatment of IBD. With the advent of biologics and small molecules, the need for surgery and hospitalization has decreased. However, economic viability and acceptability is an important determinant of local prescription patterns. Nearly one-third of the patients in West receive biologics as the first/initial therapy. The scenario is different in developing countries where biologics are used only in a small proportion of patients with IBD. Increased risk of reactivation of tuberculosis and high cost of the therapy are limitations to their use. Thiopurines hence become critical for optimal management of patients with IBD in these regions. However, approximately one-third of patients are intolerant or develop adverse effects with their use. This has led to suboptimal use of thiopurines in clinical practice. This review article discusses the clinical aspects of thiopurine use in patients with IBD with the aim of optimizing their use to full therapeutic potential.
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Background@#Surgical treatment of empyema thoracis in patients with chronic kidney disease is challenging, and few studies in the literature have evaluated this issue. In this study, we aim to report the surgical outcomes of empyema and to analyze factors predicting perioperative mortality in patients with chronic kidney disease. @*Methods@#This retrospective study included data from 34 patients with chronic kidney disease (estimated glomerular filtration rate 2) (p=0.03), ESRD (p=0.02), and late referral (>8 weeks) (p<0.001) significantly affected mortality. @*Conclusion@#ESRD, late referral, and poor functional status were poor prognostic factors predicting postoperative mortality. The decision of surgery should be cautiously assessed given the very high risk of perioperative morbidity and mortality in these patients.
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Introduction: Post-operative sore throat (POST) andhoarseness of voice are common complaints from patientsreceiving tracheal intubation. Budesonide is used to reduceall these complications and metered dose delivery of drugis considered as simple and less time consuming with highpatient acceptability. The present study was study was plannedto assess the effect of use of preoperative inhaled budesonideto reduce postoperative sorethroat incidence after endotrachealintubation.Material and methods: All the patients scheduled to undergoshort elective laproscopic surgeries, lasting <2hrs undergeneral anaesthesia with endotracheal intubation will beincluded in this study. The patients were selected randomlyinto two equal groups as follows: Group A- 20 patientsreceived 200μg budesonide inhalation suspension, using ametered dose inhaler 10 min before intubation, which wasrepeated 6hrs after extubation. Group B- 20 patients with nosuch interventions was performed before intubation or afterextubation. Post-operative sore throat was assessed at 2,6,12and 24hrs. All the results were categorized and summarized.Results: Incidence of POST was significantly higher amongsubjects of Group B in comparison to subjects of group A atdifferent time intervals.Conclusion: Administration of budesonide significantlyreduced the incidence of postoperative cough hoarseness ofvoice and POST among subjects undergoing laparoscopiccholecystectomy
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Background: This study has been performed to compare the pulmonary functions of healthy adolescents studying in schools situated in highly polluted areas with those studying in schools of low polluted areas of south western Punjab.Methods: This study was conducted in various schools located at Faridkot and Bathinda city. These places had been identified by the Punjab Pollution Control Board (PPCB) as having low and high air pollution levels respectively. Study Population divided into two groups that is Group A: 300 children from schools situated in Bathinda city. Group B:' 301 children from schools situated in Faridkot city. Spiro Excel spirometer was used, and following parameters were obtained: FVC, FEV?, FEV?% (relation of FEV? to FVC), PEFR, FEF25-75%. Results: FVC was low in males and females in the high polluted group as compared in the low polluted group (p = 0.042; significant; males) (p = 0.039; significant; females). FEV? was low in males and females in high polluted group as compared in low polluted group (p = 0.003; significant; males) (p = 0.026; significant; females). In this study only, males showed a significant fall in mean percentage of FEF25-75%. PEFR was low in males in high polluted group as compared to that in low polluted group (p = 0.007; significant) while in females it was insignificant.Conclusions: It is concluded that in South Western Punjab, air pollution has detrimental effect on pulmonary functions (FVC, FEV?, FEV?%, FEF25-75% and PEFR) in healthy adolescents.
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Background: For middle ear surgery, familiarity with theinterrelationships of the anatomical structures is as essential asknowledge of their individual morphology, as surgery isstrongly influenced by the close spatial relations between thedifferent components. In the present study, we assessed andcompared the efficacy of nalbuphine and dexmedetomidineversus nalbuphine and propofol in middle ear surgeries undermonitored anaesthesia care.Materials & Methods: A total of 40 patients scheduled toundergo MESs were included in the present study and werebroadly divided into two categories as follows: Group 1:Included patients who received injection dexmedetomidinealong with nalbuphine (intravenously), Group 2: Includedpatients who received injection propofol along with nalbuphine(intravenously). Visual analogue score (VAS) was used forassessing the intraoperative and postoperative pain. Recoveryto be assessed using Modified Aldrete scoring system (scoreranging from 0 to 10) in the recovery room every 5 min, tillscore of 10 was achieved. Adverse events were recorded. Bothpatient satisfaction score (PSS) and surgeon satisfaction score(SSS) were recorded on a scale on 1 to 7; with 1 indicatingextremely dissatisfied and 7 indicating extremely satisfied.Results: Significant results were obtained while comparing themean VAS, number of patients with PSS of 5 to 7 and numberof patients with SSS of 5 to 7 in between the two study groups.Non-significant results were obtained while comparing theincidence of complications between the two study groups.Conclusion: In patients undergoing middle ear surgeries,Nalbuphine/ dexmedetomidine appeared to be significantlymore effective combination in comparison to the nalbuphine/propofol combination.
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Background: COPD is characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases. It leads to cor pulmonale causing right ventricular failure. Present study compares the serum level of CA-125 and 2 D Echo for detection of right ventricular failure in COPD patients.Methods: In this study 178 patients suffering from COPD has been taken after following inclusion and exclusion criteria and informed consent. Serum CA 125 levels are evaluated in all patients and compared with the right ventricular functions.Results: The mean CA125 was higher in subjects with RV failure (96.32) as compared to those subjects with RV normal (37.17). The result was statistically significant. (p<0.001). The mean duration of illness was higher in subjects with raised CA125 (8.71 years) as compared to those with normal CA 125 (6.67 years) and the difference was also statistically significant (P<0.001).Conclusions: CA-125 levels have a good sensitivity and specificity for predicting right ventricular failure in COPD patients. Diagnostic accuracy, high positive and negative predictive value makes CA-125 a good predictor of right ventricular failure in COPD patients.
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Introduction: Concurrent chemo-radiation is the main treatment in locally advanced cervical cancer. The change of bladder and rectum volume may lead to change in the positions of these structures and target volume during MUPIT implant which may lead to variation in dose to the organ at risk and target. Materials and Methods: Ten patients of gynecological malignancy were included. MUPIT template was positioned under anesthesia. CT scan was done for the contouring of bladder, rectum, and target and for planning purpose which generates plan (P1). CT scan was repeated before the third fraction of the treatment (CT2). The resultant plan (P2) was analyzed qualitatively and quantitatively. Results: Bladder volume variations of 88.18% to -68.15% were noted. This change in volume lead to differences in the maximum dose in bladder between fractions. The maximum dose variation ranged from 62.53% to -21.49%. The rectal volume variation ranges 11.71% to -46.20% due to the rectal filling. High variation in maximum dose to the rectum were observed which might be due to rectal filling. CTV volume is increased by 19.48% while in other by 19.05% and in all other patients the volume is decreased. CTV volume maximum decreased by 30.54% which might be due to decrease in edema developed during procedure. The volume variation in CTV is in range of19.48% to -30.54%. Conclusion: It is proposed that re-planning using repeat CT scan is required before third fraction implementation.
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HPTLC and HPLC are two most widely accepted methods for determination of natural products. Present research work envisages microwave assisted extraction of quercetin from hydroethanolic extract of Cuscuta reflexa Roxb. (Cuscutaceae), an unusual parasitic vine. Further, chromatographic characterization of hydroethanolic extract of C. reflexa was carried out in terms of quercetin content using two validated methods (HPTLC and RP-HPLC). Confirmation of the presence of quercetin in the samples was carried out using Mass Spectrometry. HPTLC separation of quercetin was achieved on an aluminum-backed layer of silica gel 60 F254 using Toluene: ethyl acetate and formic acid as mobile phase while RP-HPLC was performed on Cosmosil C18-column (150 mm x 4.6 mm, 5 μm) using mobile phase comprising of 0.025 M NaH2PO4 buffer – ACN (pH - 2.6) at a flow rate of 1.2 mL/min. ICH guidelines were followed for validation of both the the chromatographic methods. Samples of C. reflexa collected from different regions of India and growing on different hosts were also screened for their quercetin content. The developed chromatographic methods described here were found to be simple, rapid, accurate and sensitive.
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Aim: The aim of the study was to determine the prevalence of anterior teeth fracture among visually impaired individuals. Materials and Methods: A cross‑sectional study was carried out among 103 blind individuals (70 males and 33 females), with age ranges from 10 years to 29 years, the survey was carried out according to World Health Organization (WHO) criteria and by using WHO classification for teeth fracture. All subjects were divided into two groups on the basis of whether they are partially sighted or totally blind. Data were analyzed using Chi‑square test, with keeping the level of significance at P < 0.05. Results: Overall prevalence of 34.95% of traumatic injuries to anterior teeth was found in the study population with no significant difference between both groups (P < 0.05). Female were having significantly more fracture than males (P < 0.005). Fall being indoor was the most common cause. Permanent maxillary central incisors were most commonly injured with injuries involving enamel and dentin being the most frequently observed. Increased overjet and inadequate lip coverage were significantly associated with the occurrence of trauma (P = 0.0001). Conclusion: The prevalence of dental injuries in a group of individuals with blind. This should alert caregivers to carry out a profound investigation of the events and suggest methods to reduce this type of morbidity.
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In regard to arthroscopic treatment of popliteal cysts, we explored the refuted pathology for popliteal cysts proposed by others. Here we introduce an arthroscopic technique using posterior portals to treat a popliteal cyst based on our observation that the opening of the cyst in the joint is a slit-like structure in the posterior wall of the capsule. By disrupting this slit-like structure with our procedure, the popliteal cyst ceased to be palpable and was no longer symptomatic. This technique also provides excellent arthroscopic visualization of the cavity of the popliteal cyst through the knee joint approach. After completion of the resection of the opening, we can easily insert an arthroscope into the cavity of the popliteal cyst from the posteromedial portal through the resected opening. Arthroscopic visualization of the cavity of the cyst showed that the inside wall of the cavity was smooth and had no synovitis. We believe that to disrupt this slit structure is the most pathologically reasonable procedure to treat popliteal cysts surgically.
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During the last two decades there has been a tremendous progress in development of synthetic as well as semi-synthetic drugs which possess antibacterial activity. Although much attention has been paid to develop the potent antibacterial drugs with fewer side effects and adverse reactions, relatively a few of them are really free from adverse effects. Several medicinal plants have been observed to possess antimicrobial activity. This review deals with such medicinal plants as a means to contribute towards the development of effective and safe antimicrobial agents