Significance of Abnormal T Waves in Acute Coronary Syndrome without ST Changes in ECG

T-wave abnormalities are common electrocardiographic occurrences in patients with acute coronary syndromes. The clinical and electrocardiographic course and angiographic findings in patients with evolving inverted or biphasic T waves have not been fully elucidated. Patients with abnormal T waves associated with unstable angina represent a subgroup with a high probability of near total obstruction of coronary artery and myocardial dysfunction. In the present study we describe a subgroup of patients with myocardial ischemia who during the acute Ischemic phase did not develop elevation but only biphasic or inverted T waves in the ECG and had >90% stenosis of 1 or more coronary arteries. Methods: The study comprised 125 patients presented with unstable angina pectoris. Patients’ characteristics, Electrocardiographic Data, Cardiac enzymes and Coronary angiography findings were obtained. Collected data was analyzed and sensitivity, specificity, positive predictive value, significance of test (p value) were calculated using appropriate statistical method. Results: Of the 125 patients deep symmetrical and sustained T-wave inversions were present in 72 patients & biphasic T-waves in 28 patients. 125 patients underwent coronary angiography, 92(74%) patients had >90% stenosis of 1 or more coronary arteries; sensitivity of abnormal T waves for significant stenosis was 90%, specificity 92%, positive predictive value 97.83 % and p value <0.001. Conclusion: We have identified a subgroup of patients with critical obstruction of coronary artery in patients with unstable angina and non diagnostic ECG T-wave abnormalities are significant electrocardiographic occurrences in patients with acute coronary syndromes and frequently associated with coronary artery obstruction

A Study To Correlate Vss And Vhq In Patients With Vertigo Due To Peripheral Vestibular Disorders

There are ample of studies on use of VSS in order to find out the severity of vertigo symptoms, also studies portray the usefulness of VHQ to study the impact of vertigo on lifestyle; however, there is dearth of information on whether there is any correlation between the vertigo symptoms and affection on quality of life (QOL). Hence, the need arises to find out the correlation between VSS and VHQ for the better, documentation of symptoms and affection on QOL, as it will benefit treatment efficacy. METHODS: Sample size was 40. All the patients were given two questionnaires VSS and VHQ, which are self-administered. RESULTS: Correlation was found between total VSS and its dimensions with VHQ using Karl Pearson correlation coefficient method. Thus, we concluded that increase or decrease in the scores of VSS has an effect on the scores of VHQ.

Do our medical undergraduates need to develop research skills? Assessing perceptions, attitudes and skills of medical undergraduates

Background: The development of research capacity at undergraduate level is essential to produce good quality researchers in the long run. The core curriculum must ensure that relevant and appropriate research expertise is attained by all graduates who are then provided with a suitable foundation from which they can develop such specialized research skills as may be required in their careers.Methods: A cross sectional study was conducted in Terna Medical College, Nerul, Navi Mumbai from May 2016- September 2016. All students of second and third year who willingly participated were included in the study. Preformed pretested and validated proforma was used. For checking attitudes a standard attitudes towards research scale was been used which contained 32 questions.Results: 74.9% said that research methodology should be the part of curriculum. 37.7% said that they would like to opt a carrier as a researcher. 70.6% students either identified no opportunities, gave no response or didn’t know about opportunities. Biggest barriers identified were lack of knowledge (36.5%), lack of time (34.7%), lack of infrastructure (25.1%). Correlation coefficients between ATR sub-scales were also calculated.Conclusions: Students’ want to conduct research at undergraduate level and want incorporation of research methodology in curriculum. Lack of knowledge, time and resources are common barriers while opportunities, majority are not aware about it. Though students find research difficult and are anxious about it, they have positive attitude towards conducting research.

Evaluation of "rapid urease test performed on broth of blood culture bottles indicated positive by automated blood culture system" - as a tool for early diagnosis of brucellosis

Brucellosis is a major zoonotic disease, the incidence of which is usually underestimated. The early diagnosis of human brucellosis continues to challenge clinicians because of its non-specific clinical features, slow growth rate in the blood culture, and the complexity of its serodiagnosis. Although the growth rate is slow, culture detection of circulating Brucella organisms remains a diagnostic cornerstone. The unique property of Brucella is to give urease test positive within 4 hours. So, we aimed our study to judge applicability of standard urease test done directly from blood culture bottles indicated positive by BACTEC 9050 for early diagnosis of brucellosis. Materials & Methods: The blood cultures indicated positive by BACTEC 9050 & having suspicion of Brucella infection were subjected to urease test. All the bottles were also sub-cultured over solid media for isolation & identification of bacteria. Result & Discussion : Out of total 50 bottles, 10 were found urease test positive within 4 hours of incubation (mean time 48 min) & all of these 10 bottles also revealed growth of Brucella spp. on subsequent subculture. Remaining 40 bottles, which were negative for urease test, revealed growth of other bacteria or didn't reveal any growth. The overall mean time for diagnosis of Brucellosis by blood culture & subsequent urease test was 74 hours with 100 % Positive predictive value. Conclusion : The rapid urease reaction was found to be the best and cost effective option to identify the Brucella spp. It can give positive reaction from the direct inoculation of blood from the blood culture bottle within 4 hours after indication of blood culture positivity by automated blood culture system; & thus it significantly reduces the time for preliminary identification of Brucella infection. This might also help to increase the rate of diagnosis for the Brucella spp

A Worm in Gall bladder - Victorious or Vanquished? : Diagnostic Dilemma Prevails

Parasites in India are a run-of-the-mill phenomenon. Protozoa, sporozoa, cestodes, nematodes and even trematodes – all have discovered a comfortable niche in the Indian soils. Literature spills with cases of all these parasites in varying degrees of their occurrence in the Indian subcontinent. The case being reported here, is out of the aforementioned league. The uncustomary nature of the parasite recovered from the gall bladder of a patient mandates its discussion here. An adult male with jaundice, cholangitis, cholecystitis, gall bladder calculi and, a worm ….Ascaris ?, Fasciola ?, ….let us unfold the diagnostic dilemma.

Recurrent Pyrexia, Brucellosis, Underdiagnosis: The Puzzle Triad Untangled By Blood Cultures - The Benchmark Tool Coming To Aid

Introduction: Human brucellosis, a zoonotic disease is common in India. In spite of high prevalence, the disease usually remains under diagnosed or misdiagnosed.Aim: To evaluate & establish the significance of blood culture for diagnosis of brucellosis.Materials & Method: A study of 10 patients of brucellosis diagnosed by blood culture were evaluated retrospectively, for the various clinical & laboratory profiles, during the period of 2014-17. Results: All the ten patients, positive for brucellosis by blood culture were having history of fever. Other clinical presentations were - abdominal pain (n=6,60%), vomiting (n=5,50%), headache (n=1,10 %), generalized body ache (n=1,10%), anorexia (n=1,10%), joint pain (n=1,10%), cough (n= 1,10%), mild splenomegaly (n=2,20%), mild hepatomegaly (n=1,10%), mild to gross hepatosplenomegaly (n=3,30%). In all the cases, Brucella spp. were recovered from patient's blood culture & identified within 7 days of sample collection. The time-to- detection of BACTEC blood culture system (positive indication) was 3-5 days. Conclusion: A high level of clinical suspicion & proper blood culture remains the gold standard for early diagnosis of brucellosis.

Analysis of Intestinal Parasitic Infections in a Tertiary Care Hospital of Ahmadabad.

Background & Objectives: Microscopic evidence of Intestinal parasitic infections (IPIs) becomes evident only when the parasites are heavily populated in the intestine. Immunological tests can diagnose IPIs even at earlier stage of a disease but the tests are costly, not easily available and lots of research is yet to be done in that field. So even today we have to rely upon microscopic evidence only & microscopically detected infections may be a tip of iceberg only. The purpose of this study was to determine the distribution of Intestinal parasitic infections in patients attending a tertiary care hospital. Material and Methods: A total of 847 stool sampleswere examined macroscopically & microscopically for the presence of parasite eggs, larva, cysts and trophozoites. Results: Out of 847 stool samples, parasites were detected from 72 (8.5%) samples. The distribution of intestinal parasites was as follows: Entamoeba histolytica (44%), Giardia intestinalis (30%), Trichomonas intestinalis (10%), Ascaris lumbricoides (6%), Hymenolepis nana (4%), Strongyloides stercoralis (2%), Ancylostoma duodenale (2%), and Isospora belli (1%). Conclusion: It is concluded that protozoal infections are more common in our region than helminthic infections. Constant surveillance of the infected patients, their treatment as well as improving sanitary condition will help to prevent the spread of IPIs.

Low dose ketamine for painless labour- A comparative study of 100 patients.

Background: The phencyclidine derivative Ketamine is widely used as intramuscular and intravenous anaesthetic agent. In contrast to other anaesthetics, ketamine has potent analgesic properties in sub-anaesthetic doses. Recent studies indicate that analgesia produced by ketamine is mediated through opiate receptors and N-methyl D aspartate receptors. As systematically administered ketamine is unlikely to produce the respiratory depression, it seemed to offer an obvious advantage over the narcotics in which major drawback is respiratory depression. Aims & Objective: (1) To study the following parameters in pregnant women given ketamine v/s pregnant women not given analgesic - (a) Maternal outcome in form of duration of labour, mode of delivery, complication of third stage of labour. (b) Foetal outcome in form of Apgar score at 1 min and 5 min. (2) To study pharmacological effect of ketamine on mother (3) To evaluate patient’s satisfaction about this method. Material and Methods: The present study was Randomized controlled trial, conducted in Department of Obstetrics and Gynaecology at Smt. SCL Municipal General Hospital affiliated to NHL Medical College Ahmedabad over a span of 3 yrs. from 2010 to 2012. Study included primigravida and multigravida. 100 women fulfilling the inclusion and exclusion criteria were taken for the study. Study population divided into Control Group (no drug administered) and Study group (intravenous ketamine administered). Results: The duration of 1st and 2nd stage was remarkably shortened in study group. 64% of parturient in study group delivered within 3 hours of entering the active phase of labour compared to only 10% in control group. In study group 98% delivered vaginally only 2% required instrumental delivery. There was no inhibition of bearing down reflex by ketamine, no maternal exhaustion in study group. In present study ketamine had no effect on APGAR score at 1 min & at 5 min. 30% had marginal rise in pulse rate with range of 10-15 beats /min. 16% had risen in B.P. not beyond 15-20 mm of Hg. 10% cases had nausea but no vomiting. 90% of cases had excellent pain relief & 8% had satisfactory pain relief, while 2% had no pain at all. Conclusion: The low dose intravenous ketamine suits best to this situation as it provides effective analgesia in low doses, safe without significant maternal and foetal complications, does not prolong duration of labour and there is no increase in rate of instrumental delivery or caesarean section rate. Since it reduces maternal pain thereby reducing the maternal exhaustion the patients on ketamine are very co-operative during labour, easy to administer and monitor without the help of an expertise and cost effective. KEY-WORDS: Normal Labour; Intravenous Ketamine; Study Group; Control Group