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Background@#Many benefits are associated with early antenatal booking which include but are not limited to accurate dating, early detection of medical and obstetrical disorders that could make the pregnancy a high-risk pregnancy and affect its outcome, and objective assessment of maternal baselines such as identifying pre-existing risk factors, taking weight, blood pressure, blood sugar level and urinalysis. If done early, it may provide a picture of the pre-pregnancy condition of the woman. @*Aim@#In the time period and setting looked at in this research, it was found that majority of the mothers booked late, however reasons for booking late were not sought as this was only a quantitative retrospective cohort study. From the outcomes measured, it was seen that anaemia was the most significant outcome associated with late bookers. PPH was also found to be significant amongst late bookers however other statistical analysis deemed it insignificant.@*Results@#The results of this study found that majority of the women (76,58%) booked late. Of these, women who booked late fell in the 15 to 25 age range, were of I-taukei ethnicity, were married, did domestic duties, attended secondary level of education and were multiparous. The most significant pregnancy outcome that was associated with late booking was found to be anaemia. The remaining outcomes were found to be insignificant.
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Purpose: Age?related macular degeneration (AMD) is a common cause of blindness, residual damage to macular area in spite of treatment necessitates visual rehabilitation by means of low?vision aids (LVAs). Methods: Thirty patients suffering from different stages of AMD requiring LVAs were included in this prospective study. Patients with nonprogressive, adequately treated AMD were enrolled over a 12?month period, prescribed requisite LVAs and followed?up for a minimum 1?month period. Before and after provision of LVAs, near work efficiencies were evaluated by calculating reading speed as words per minute (wpm) under both photopic and mesopic light conditions, and impact of poor vision on activities of daily living (ADL) was quantified by modified standard questionnaire based on Nhung X et al. questionnaire. Results: Of the 30 patients mean studied with mean age of 68 ± 10 years, 20 patients (66.7%) had dry AMD in better eye and 10 (33.3%) had wet AMD. Post?LVA, near visual acuity improved significantly and all cases were able to read some letters on near vision chart with an average improvement of 2.4 ± 0.96 lines. The different LVAs prescribed were high plus reading spectacles (up to 10 D) in 23.3%, hand?held magnifiers in 53.3%, base in prisms in 10%, stand held magnifiers in 6.7%, and bar and dome magnifiers in 3.3%. Conclusion: LVAs are effective in visual rehabilitation in patients with AMD. Self?reported reduction in visual dependency and improvement in vision?related quality of life post use of aids corroborated perceived benefit.
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Background: Chronic Kidney disease is a major public health concern. In India, the burden of chronic Kidney disease cannot be assessed properly. In such case autopsy study becomes an indispensible part of Medicine. Aim: To explore the spectrum of changes seen in kidneys and correla?ng it with clinical findings. Material & Methods: A descrip?ve study of kidneys of Medico legal autopsies from January 2019 – December 2019 was conducted. A total of 665 Medico legal autopsies were received, in 73 cases kidneys were not received, while 23 kidneys had autoly?c change. A total of 569 Kidneys were included in the study. The Gross and Microscopic features along with special stains were studied and the cause of death was noted. Results: A total of 569 kidney autopsies were assessed. On Gross 26% were congested, 13% had contracted granular kidney. On Histopathological examina?on, Non specific changes were seen in 53.4%, specific nephropathological lesions noted were chronic pyelonephri?s (8.9%), acute tubular necrosis (5.6%), sickle cell nephropathy (4.7%), tubercular nephri?s (1.2%). Conclusion: Infec?ve e?ology was the commonest cause, along with sickle cell nephropathy. It has provided the spectrum of lesions seen in this area along with correla?on of cause of death. Screening for diabetes mellitus and hypertension would lead to early detec?on and ?mely management which would reduce chronic kidney diseases.
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Aim: To know organism most commonly found in bile, to study and compare the incidence of gall stone in culture negative versus culture positive bile. bile will be collected from removed gall bladder after the patientMethod: undergoes cholecystectomy and subjected to culture and sensitivity, and the result of the organism found will be tabulated and incidence of which organism is highest will be known in the study and which antibiotic was it most sensitive to will be noted. A total of 29 patients were included in the study. Out of 29 calculous cholelithiasisResults: patients only 10 of them had positive bile culture. More than 50 percent of patients had growth belonging to the Enterobacter family, and highest sensitivity was for imipenem antibiotic.
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Background: The clinical significance of serum sodium levels and its association with a higher rate of complications in cirrhosis is debatable. This study was done to study the serum sodium levels in chronic liver disease (CLD) patients and establish its association with the severity of disease in such patients.Methods: In this cross-sectional study, we included adult patients diagnosed with CLD and assessed their serum electrolytes. The severity of liver disease was assessed using Child Pugh score (CPS) and model for end stage liver disease (MELD). Those with serum sodium levels less than 130 mEq/lwere classified as group A, 131 to 135 mEq/las normal group B and greater or equal to 136 mEq/las Group C.Results:In the present study, hepatic encephalopathy (p<0.01), hepatorenal syndrome (p<0.01) and coagulopathy (p<0.01) were found to occur significantly more common among patients from Group A, as compared to those in patients from group B or C. Mean MELD, CPS score and mortality was significantly higher among group A patients.Conclusions: Patients with lower serum salt levels had a substantially higher MELD score and CPS. Low blood sodium levels were linked to more severe liver disease, greater complications, and increased death. As a result, we urge that serum salt levels be checked on a frequent basis in patients with chronic liver disease.
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Background: Autoimmune diseases are known to be the third leading cause of fatality and morbidity amongst the population of industrialized world. They account for 3-9% of health burden in general people, but information regarding prevalence of autoantibodies and autoimmune diseases in developing nations is scarce. To study the prevalence of Anti-nuclear antibodies, Aim: the total number and distribution of different tests used in the diagnosis of anti-nuclear antibody amongst Indian population, and correlate the findings from these tests with the clinical characteristics of the patients. Retrospective data was evaluated from a Global Reference Method: Diagnostic Laboratory in Mumbai, for a period of 6 years. This included a total of 285095 cases tested for ANA. ANA-IFA and ANA-ELISA were the screening tests used while ANA-ELISA Profile and ANA Blot were the confirmatory tests. ANA by IFA was the most preferred Results: screening test (88.73%) and ANA by Blot was the most preferred Confirmatory test (67.13%) based on their sensitivity and positive predictive value respectively. ANA-IFA showed positivity of 36.48% and ANA by ELISA test had positivity of 11.46%. In confirmatory testing, ANA Blot showed a positivity of 31.90% and ELISA Profile had 23.36% positivity. Females showed significantly higher positivity for both the screening test and Confirmatory tests than males (p<0.001). Screening by ANA IFA and Confirmatory by Conclusion: ANA Blot was the most preferred tests in our study population. These tests were found to be better for diagnosis, sub-syndrome categorization, prognosis, clinical follow-up and therapeutic strategies in various autoimmune disorders.
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A granular cell tumour is a tumour of neural origin and is mostly benign and rarely malignant and commonly found in the skin, oral cavity or digestive tract. This report describes a case of a 23 - year - old female with a palpable painless mass on the back near the left axilla with progressive growth. While her laboratory tests and radiological were within normal limits histopathological examination revealed round to polygonal PAS positive atypical cells with large vesicular nuclei and coarsely granular cytoplasm along with foci of spindling an d necrosis which on IHC were S - 100 and CD68 positive and negative for cytokeratin, desmin, EMA. Thus, rendering a diagnosis of a malignant granular tumour of primary origin. This case highlights the importance of accurate histopathological examination to r ecognise and further categorization of Granular cell tumours along with clinical and radiological correlation .
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Although acne is principally a disorder of adolescence, the prevalence of adult acne is increasing. Adult acne has been defined as the presence of acne beyond the age of 25 years. Acne in adult women may have different clinical features i.e., more involvement of lower face, association with hair loss, premenstrual flare, signs and symptoms of insulin resistance, dyslipidaemias. Various studies have shown that a significant percentage of adult women with acne failed to respond to treatment with systemic antibiotics and isotretinoin which indicates a need for treatment alternatives with improved effectiveness and acceptable side effects for resistant acne. This study aims to study the different clinicoepidemiological features of adult acne.
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Kashyapa Samhita is an ancient text having many benchmark contributions in the field of Kaumarbhritya. Lehaadhya is a major contribution of Kashyapa Samhita where Lehana Yoga (lickable-semisold forms of herbs) is given. Lehana are most palatable and easy to prepare yoga for pediatric practice. In this article i have presented my views on how a practitioner can utilize drug combination of Lehaadhya in day to day practices. Various combinations given in Lehadhyaya are mainly given as preventive measures. But if we think on indication of Lehana, and side by side we thought on pediatric cases we encounter in day to day practices, we can realize that Lehana combinations are also useful in many common ailments in children. In other words Lehana combinations are not just for Preventive purpose and enhancing immunity and intellectual purpose but also can be used in so many common ailment found in pediatric practices. The thing we should kept in mind while using Lehana is its contraindications. Once we are clear about where we should not use Lehana and directly move on the treatment of particular disease, it becomes much easier to decide in which cases Lehana can be used.
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Purpose: To compare the functional outcome of retropupillary iris claw lenses (RPIC?IOL) and scleral fixated intraocular lenses (SFIOL) in children with large lens subluxations. Methods: Sixty eyes of patients between 6 and 18 years of age having ?7 clock hour lens subluxation were included and equally divided into group A (RPIC?IOL implantation) and group B (Gore?Tex sutured SFIOL implantation). Cases with anterior and posterior segment abnormalities, trauma and glaucoma were excluded. Primary outcome was improvement in best?corrected visual acuity (BCVA) at 1.5 years. Secondary outcomes were assessment of intraocular lens (IOL) tilt, mean change in astigmatism at 1.5 years, and median operating time. All surgeries were performed by the same surgeon. Results: The mean improvement in BCVA in group A was 0.28 ± 0.41 logMAR and group B was 0.44 ± 0.45 logMAR (P = 0.3). Significant IOL tilt was seen in 4 eyes in group A (13.33%) and 5 eyes in group B (16.66%) (P = 0.120). Mean change in astigmatism was 4.38 ± 5.9D in group A and 4.91 ± 4.4D in group B (P = 0.299). The median operating time was 40 min in group A and 90 min in group B (P < 0.001). No significant posterior segment complications were seen in either technique. Conclusion: Both procedures had comparable visual outcomes. RPIC?IOL implantation was relatively quick and comparatively easier; it may be preferred in cases with high risk of retinal detachment.
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Background: Acute viral hepatitis causes high morbidity in children and young adults. Hepatitis A and E can lead to fulminant hepatitis in 0.1% -2%. Objective: To find prevalence of HAV and HEV among suspected cases of acute viral hepatitis and to co-relate the laboratory findings with clinical presentations, over a one year periodMaterial & Methods:A retrospective analysis of 396 suspected acute viral hepatitis cases, whose samples were received in the laboratory during over a period of 1 year was performed. All sera samples were tested for IgM anti HAV & IgM anti HEV using commercially available solid phase ELISA, in Microbiology laboratory, at our hospital.Results:Majority infected were male (69%) and young adults (98 %). Clinical presentations included fever (92%), jaundice/icterus (74%), nausea/vomiting (60%), hepatomegaly (45%), abdominal pain (40%), darkcoloredurine(15%), itching/rash (8.3%). ELISA revealed overall positivity :21.2% ; HAV: 38% ,HEV:62% and dual infection:5%. Increased serum bilirubin, AST and ALT occured in 68%.Conclusions:Awareness regarding sanitation and hygiene is imperative to curb the spread of acute viral hepatitis, especially in developing countries. Laboratory diagnosis is an essential supplementary tool in confirmation of suspected clinical cases and reduce transmission of this infection.
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Background:The angle subtended by the long axis of the arm and the long axis of forearm in the frontal plane when the elbow is fully extended and the forearm is supinated. Normal degree of Carrying angle is 5 ?-15 ? but in females it is varies on 5 ?-18 ?. The apparent difference in gender may be because of increased joint laxity in females permitting a greater degree of extension. Comparative study of carrying angle between dominant and non-dominant limb in normal young girls. This study aimed comparison of between dominant and non-dominant limb data obtained by clinical method in 18 –20 years normal young girls.Material And Methods:Carrying angle was measured in 141 students of girls in manual method with goniometer.Result:In girls carrying angle dominant limbwas greater than non-dominant limb in girls.Conclusion:The study we conducted there is no significance difference in carrying angle among females in both dominant and non-dominant limb in young girls.
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Purpose: To evaluate the retinal microvascular changes in patients, recovered from severe COVID?19 during the second wave of the pandemic in North India. Methods: In this observational cross?sectional study, 70 eyes of 35 patients who recovered from severe COVID?19 during the second wave underwent detailed ophthalmic evaluation 4–6 weeks after discharge. Twelve controls were also enrolled, and the difference in the findings between the case and control groups on optical coherence tomography (OCTA) were studied. Result: The ages of study participants ranged from 27 to 60 years with the male:female ratio being 1.05:1. The fundus changes suggestive of ischemia in the form of cotton wool spots and vascular tortuosity were seen in 25 eyes (35.71%). Increased venous tortuosity was the most common finding seen in 23 eyes (32.85%), of which 10 eyes (28.57%) had concurrent hypertensive retinopathy (HTR) changes. There was a significant reduction in the mean vascular density (VD) and perfusion density (PD) for both the superficial capillary plexus (SCP) and deep capillary plexus (DCP) at inner, outer ring, and whole (P < 0.05). Foveal avascular zone was significantly enlarged in both the SCP (P = 0.01) and the DCP (P = 0.03). The mean ganglion cell?inner plexiform layer (GC?IPL) was significantly reduced in comparison to controls (P < 0.001). Conclusion: Severe COVID?19 can result in microvascular changes at the macula in the form of reduction in vascular and perfusion density, which can be evaluated using OCTA. As structural changes precede functional changes, a close watch is recommended in patients showing compromise in retinal microvasculature
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Purpose: The purpose of this study was to assess change of contrast sensitivity (CS) in subjects having retinal diseases with yellow?amber no infrared (NoIR) glasses used as low vision aid (LVA). Methods: We examined CS in 82 low vision (LV) subjects having retinal diseases with Pelli Robson Chart at 1 m distance before and after wearing yellow?amber NoIR glasses. We also found type of retinal affection and macular optical coherence tomography (OCT) features. Results: The distance and near best?corrected visual acuity (BCVA) was, respectively, 0.68 ± 0.17 (median = 0.70) and 0.72 ± 0.25 (median = 0.70) logmar units. The pre?LVA CS was 0.52 ± 0.29 (median = 0.3) and post? LVA was 0.52 ± 0.28 (median = 0.45) logunits (mean reduction = ?0.002 ± 0.24; Median reduction = 0; P = 0.909). The pre?LVA and post?LVA CS showed a negative correlation with logmar distance BCVA [r = ?0.090; P = 0.317 and r = ?0.152; P = 0.090 respectively]. The pre?LVA and post?LVA CS showed a negative correlation with logmar near BCVA [r = ?0.114; P = 0.207 and r = ?0.054; P = 0.549 respectively]. The CS did not improve in subjects having macular degeneration, pathological myopia, hereditary maculopathy, and diabetic retinopathy. The macular OCT features like fluid, exudates, scars, drusens, traction, and hole did not significantly influence CS both at pre?LVA and post?LVA stage. Conclusion: This is the first study with yellow?amber NoIR glasses which blocks “both ultraviolet and infrared light.” The subjects having macular degeneration, pathological myopia, hereditary maculopathy, and diabetic retinopathy did not improve in CS with filters. The correlation values showed that filters may improve CS in subjects having good baseline BCVA.
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Cervical lesions are one of the most common cause of female morbidity, cervical cancer being the second most common malignancy only after breast in women in India as well as the world. The aim of this study was to analyse the spectrum of cervical lesions in Liquid based cytology and categorizing them according to the Bethesda System for Reporting Cervical cytology. This is a 3 year retrospective study . Total number of cases collected were 1228, of which majority were in the age group of 21-30 years comprising of 450 cases (36.6%) . The most common complain was whitish discharge followed by pain lower abdomen. Out of 1228 cases ,1131 (92.10%) were NILM, 11(0.89%) LSIL,10(0.80%) each of HSIL &ASCUS,5(0.42%) Atypical endocervical cells(NOS), 4(0.35%) SCC and 2(0.16%) Atypical glandular cells(NOS) .55 cases (4.48%) were inadequate. Out of 1131cases of Negative for intraepithelial lesion or Malignancy, 1048 were non -neoplastic and 83 were associated with speci?c infection. Premalignant and malignant lesions of the cervix are very common, therefore proper screening and categorization of cervical lesion is necessary for treatment and follow up,thereby reducing the mortality and morbidity.
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Mediastinal masses span a wide histopathological spectrum. Inflammatory pseudotumors are rare and most commonly described in the lungs but these are reported in almost all the organs in the body. Mediastinal involvement is rare and difficult to diagnose. Clinical manifestations and laboratory investigations and radiology are non-specific. Histomorphology and Immunohistochemistry provide a valuable aid. Complete resection usually provides definitive diagnosis and is treatment of choice.
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Purpose: To evaluate the impact of color vision deficiency (CVD) in medical undergraduates by a more clinically applicable test. Methods: Cross?sectional study of 31 students with CVD (Ishihara diagnosed) asked to identify subject?specific signs/tests requiring color identification on a customized medical multispecialty designed color album test (CAT). They were further subjected to Farnsworth D?15 testing. Results: The error score of CVD students (4 ± 3.2) on 39 plates of color album test was highly significant as compared to the error score of color normal (0.3 ± 0.6). The CAT depicted linear correlation with Farnsworth D?15 and emerged as a valid tool of assessment. Ishihara interpretation did not correlate with the clinical impact of CVD. Nature of error suggests that CVD students can anticipate problems in dermatology, pathology, hematology, microbiology, and biochemistry. Conclusion: Color album test is a more clinically relevant test for CVD doctors to identify specialties where they can anticipate difficulties
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ABSTRACT Background Fibrous hamartoma of infancy (FHI) is a rare soft tissue lesion arising as a subcutaneous mass involving the axilla, trunk, and upper arm in infants and children <2yrs. Sarcomatous transformation in FHI is described in anecdotal cases in the literature. Case Report We describe one such example arising as a mass in the lower back in a 3-month-old infant. On histology, the tumor contained classic triphasic morphology; however, brisk mitotic activity noted at multiple foci was diagnostically challenging to categorize. The tumor was evaluated for ETV6-NTRK3 fusion to exclude other common differentials. Conclusion While FHI may be frequently encountered in infants, rare sarcomatous transformation are known to occur and merits special attention as it can be misdiagnosed. Also, a close follow-up is warranted as the lesion is known to recur locally.
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Abstract We present a case of a late preterm intrauterine growth-restricted neonate with isolated and persistent severe thrombocytopenia. At birth, the neonate did not have a complete clinical spectrum of congenital rubella syndrome (CRS) but later developed peculiar findings that helped clinch the diagnosis. The neonate also had interstitial pneumonia and died secondary to superimposed acute viral infection leading to acute respiratory distress syndrome. The serology was positive for IgM antibodies against the rubella virus. The constellation of clinical manifestations of congenital rubella in the presence of positive IgM antibody against rubella and consistent histopathology confirmed the diagnosis of CRS.