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Background: This aim of study was to evaluate the ability of consecutive measurements of serum calcium levels to predict clinically relevant post-thyroidectomy hypocalcaemia and to assess risk factors for post-thyroidectomy hypocalcaemia.Methods: The study design was a prospective observational study, total 65 patients who undergoing completion or total thyroidectomy. Serum calcium level was measured at the time of first follow up (nearly 20th postoperative day) and patient was examined for signs of hypocalcemia.Results: In this study, 65 patients of all age group included from 19 years to 78 years. The mean (±SD) age of the patients was 47.65±12.35 years with range from 19 to 78 years. The mean difference of calcium values after 6 hours, 12 hours, 24 hours and 48 hours post-operative period were statistically significant (p<0.001) between patients with hypocalcaemia and patient with normokalaemia in unpaired t-test.Conclusions: There was no significant increase in morbidity (including postoperative hypocalcaemia) in completion thyroidectomy compared to primary total thyroidectomy.
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Aims and Objectives: The aims of the study were to find out the correlation between three methods of blood pressure (BP) measurement with impedance cardiography (ICG) device, conventional non-invasive sphygmomanometer, and cath lab-based invasive arterial pressure (AP) study. Patients Materials and Methods: Patients who had definite indications for coronary angiography (CAG) or coronary intervention due to cardiac reasons were selected for the measurement of BP by three methods, namely, by transducer-based invasive central aortic pressure study, by ICG, and by conventional sphygmomanometry. One hundred patients of acute myocardial infarction having chest pain, ST elevation in two or more contiguous leads of electrocardiogram (ECG), biomarker positivity, and echocardiographic evidence of regional wall motion abnormality were selected. Transfemoral or radial access of the ascending aorta allowed the measurement of central aortic pressure during invasive procedure. CAG was done in the cath lab having “Siemens™ Axiom Artis Zee (floor)” equipment. The subjects who were unwilling to participate, who were moribund, critically ill subjects, and patients with concomitant heart failure, arrhythmia, and valvular lesions were excluded from the study. GE™ Vivid 7 Dimension machine was used for ECG-gated echo-Doppler studies. ICG-derived BP values (systolic BP [SBP], diastolic BP [DBP], mean AP [MAP], and pulse pressure) were recorded for comparison with similar pressure data obtained from two other methods. Results and Analysis: Analysis of results show a comparison of data on SBP, DBP, and MAP measured by three methods by sphygmomanometry, invasive, and ICG methods. The analysis also shows the values of correlation coefficients – all of which are significantly positive correlations. ICG has been found to have positive correlation with both sphygmomanometric and invasive methods of BP measurement. It also shows a graphical presentation of the correlation between SBP, DBP, and MAP measured by three methods by sphygmomanometry, invasive, and ICG methods. Conclusion: There is a significant correlation between three methods of BP measurement with ICG device, conventional noninvasive sphygmomanometer-based method, and cath lab-based invasive AP study
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Aims and Objectives: The aims of the study were to find out the correlation between coronary angiographic findings and hemodynamic parameters derived from impedance cardiography (ICG) and echo-Doppler study. Patients, Materials and Methods: A total of 200 patients of acute myocardial infarction having chest pain, ST elevation in two or more contiguous leads of electrocardiogram (ECG), biomarker positivity, echocardiographic evidence of regional wall motion abnormality (RWMA), and coronary angiographic evidence of coronary lesions were recruited. Subjects unwilling to participate, moribund, critically ill subjects, and patients with concomitant heart failure, arrhythmia, and valvular lesions were excluded from the study. GE™ Vivid 7 Dimension machine was used for ECG-gated echo-Doppler studies. The left ventricular ejection fraction (LVEF), stroke volume (SV), RWMA, diastolic function, etc., were observed. ICG measured LVEDV, LVESV, LVEF, and other parameters particularly amplitudes of the different waves. Coronary angiography (CAG) was done in the Cath Lab having “Siemens™ Axiom Artis Zee (floor)” equipment. Results and Analysis: Results-analysis revealed there is negative correlation (Pearson’s correlation coefficient, r = −0.8) between augmentation pressure and coronary angiographic stenosis percentage and P value is also significant (P = 0.034). Pulse pressure (PP) also is positively correlated (r = −0.78) with coronary angiographic stenosis percentage and P value is also significant (P = 0.027). There is a negative correlation (r = −0.259) between augmentation index (AIx) and coronary angiographic lesions and that is statistically significant (P = 0.03). Conclusion: There is a positive correlation between ICG -derived hemodynamic parameters and the percentage stenosis of coronary arteries. Rise of augmentation pressure and PP in the ICG waveform is associated with coronary artery disease severity. AIx is negatively correlated with severity of coronary arterial stenosis
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Introduction: Acute Myocardial Infarction(AMI) is quitecommon and despite lack of adequate infrastructure it isa compulsion for doctors in India to treat patients of AMIeven in the rural hospitals due to lack of transportation andcommunication facilities on round the clock basis. In ruralsetup usually ECG and Troponin biomarker kits are available.Aim and objective of the present study was to validateimpedance cardiography derived haemodynamic parametersagainst echo-doppler study.Material and methods: 200 patients of AMI were subjectedto impedance cardiography and echodoppler study.Results: Echocardiographic Mean±S.D values of LVEDV,LVESV , LVEF, IVCT, IVRT, LVET, Total Diastolic Time,Total Systolic Time & MPI were as follows 80.78±25.554,40.62±13.062, 41.18±15.669, 46.13±8.5, 50±8.907,65.93±12.103, 334.11±38.668, 482.97±83.164, 318.4±32.715& 0.4311±0.0732 respectively. Similarly impedancecardiographic Mean±S.D. values of LVEDV, LVESV , LVEF,IVCT, IVRT, LVET, Total Diastolic Time, Total Systolic Timeand MPI are as follows: 102.813±26.006, 53.048±14.773,39.646±18.095, 40.4786±10.820, 56.953±13.69,67.153±20.0375, 327.2035±23.91123, 449.4202±91.3202,349.8660±56.011 and 0.4106±0.08682 respectively.Conclusion: There was strong positive correlation among allthe haemodynamic parameters of echocardiography and ICGand the P values were significant in all the parameters studied(<0.001). It can be used for haemodynamic assessment ofpatients in rural setup where the facility of echo-doppler studyor invasive haemodynamic monitoring is not available.
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Introduction: The subtrochanteric fractures are one of thecommon fractures that every trauma surgeon come acrosson daily basis. The most of these fractures are treated eitherintramedullary device or a side plate. Among side plates, thechoice between the implants like DCS and DHS is variedamong the different surgeons. We made an analysis of resultsof Dynamic Condylar Screw with the aim to find out the useof that implant in selective fracture types.Material and Methods: A prospective study during 2014 to2015 was done in our institute. The study period is 1 year. Thepatients who opted for surgical treatment only were chosen.They were undergoing surgery under spinal anaesthesia, usingfracture table under image intensifier. The position of fracturereduction was checked in anterior posterior and lateral imageintensifier views. The post-operative assessment was doneat 3weeks, 6 weeks and 3months intervals with regard toradiological union and clinical outcomes. Data was analysedand expressed in terms of percentages.Result: the female to male ratio was 1:1.55. The average ageamong males is 58years and of females is 54 years. The rightside and left side were involved equally (n=28). Most of thepatients were injured by fall at home 39.2% (n=11), due toRTA 32.1% (n=9) and 28.5% (n=8) subjects were injureddue to self-inflicted road accidents. Limb shortening is mostcommon complication, which is there for 17.85% (n=5) ofpatientsConclusion: Dynamic Condylar Screw (DCS) provide goodfixation for subtrochanteric fractures with better results interms of stability and fracture union. Procedure has a fewercomplication rates if cases were selected carefully.
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STUDY DESIGN: Observational comparative study. PURPOSE: To compare fractional anisotropy (FA) maps with T2 values of the nucleus pulposus (NP) and annulus fibrosus (AF) of intervertebral discs in healthy volunteers and patients to develop a predictive disc health scale. OVERVIEW OF LITERATURE: T2-weighted magnetic resonance imaging (MRI) is not sensitive to early morphological changes and provides no quantitative biomarker profile for early degeneration. METHODS: We examined 59 healthy controls and 59 patients with back pain by MRI using T2 relaxometry and diffusion tensor imaging (DTI). Each group was divided into three age subgroups: A (50 years, n=21). We obtained FA values for AF and NP and T2 values for NP for each intervertebral disc. Furthermore, we calculated the FA (AF/NP) ratios. RESULTS: We categorized 590 intervertebral discs from 118 participants, 566 of which were analyzed with T2 relaxometry and DTI. The T2 values were as follows: subgroup A, 55.8±4.4 ms; B, 48.5±6.9 ms; C, 45.8±8.7 ms (p120 ms, 90–100 ms, and 70 ms, respectively (p<0.001). Control subgroup A had higher T2 values and AF/NP ratios than subgroups B and C; the AF values were not significantly different. Control subgroup B had higher T2 values and AF/NP ratios than subgroup C but lower FA (NP). CONCLUSIONS: FA maps of the AF/NP ratio and T2 values of NP are potential microstructure biomarkers of normal and degenerating discs and can help detect early degeneration using a predictive disc health score on a continuous scale.
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Humans , Anisotropy , Back Pain , Biomarkers , Diffusion Tensor Imaging , Healthy Volunteers , Intervertebral Disc Degeneration , Intervertebral Disc , Magnetic Resonance ImagingABSTRACT
Background: Dengue fever is a mosquito borne viral infection which has become a global health hazard, especially in tropical and subtropical areas. Children have higher risk of developing severe forms of dengue fever, however, studies show that paediatric complications/fatalities from dengue fever are potentially avoidable by proper management. Data about drug usage patterns for dengue are particularly lacking, especially in the paediatric age group, therefore this study will help facilitate the rational use of drugs and aid in establishing a more specific management for dengue fever. The objective of the present study was to identify the prescribing pattern of dengue fever in paediatric inpatients admitted to RajaRajeswari Medical College and Hospital and assess according to the WHO core prescribing indicatorsMethods: This prospective observational study took place from March 2017 to September 2017 in the paediatric general wards. Data was collected from case files of NS1 positive patients of both genders between 1-18years. Data was analysed using descriptive statistics and expressed as percentages, means and standard deviations. The prescription pattern was analysed using the prescribing indicators mentioned in the World Health Organization core drug use indicators.Results: Total of 300 drugs were prescribed for 110 prescriptions that were analysed excluding IV fluids and blood products. Mean number of drugs prescribed was 2.7±0.8. Drugs prescribed by a generic name was 7.33%. Patients prescribed an antibiotic was 12.73%. Patients prescribed with an injection was 62.72% Majority of drugs prescribed in this study come from essential medicines list created by regulatory bodies. Intravenous fluids were administered to all patients with majority receiving normal saline (60.9%).Conclusions: Mainstay of treatment of dengue fever for paediatric patients is symptomatic along with focus on fluid management. Majority of drugs prescribed are from essential medicines lists formed by regulatory bodies. With dengue infections being a worldwide health hazard, more studies are needed to facilitate rational use of drugs in this disease.
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Background: Tzanck smear named after Arnault Tzanck (1886-1954), to evaluate Cytopathology as a quick less invasive method for early diagnosis of bullous lesions. Aim: To determine the diagnostic value of Tzanck smear in vesiculobullous skin lesions, to evaluate the vesiculobullous lesions and correlating the diagnosis with Tzanck smears and histopathological findings and when required with Immmunoflourescence. Materials and methods: 565 patients clinically diagnosed as vesico-bullous skin lesions were included in the present study from July 2011 to July 2018 for a period of 7 years. Tzanck smear preparation and biopsy as well as immunoflouresence tests were done in all 565 patients. Results: Out of the 565 patients with vesiculo bullous lesions, 297 were males, and 268 were females. The concordant results between cytology and histopathology was observed in majority (92.7%) direct immunoflouresence test was done in some which also confirmed the diagnosis. Conclusion: The Tzanck smear test is an inexpensive, useful, and an easy diagnostic tool for vesiculo-bullous lesions of skin diseases and can be recommended as a bedside first line investigation.
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Background: Tetanus is a major health problem in many developing countries, including India, with significant morbidity and mortality due to lack of environmental hygiene and health education, incomplete vaccination, high case prevalence and inadequate intensive care facilities. Objectives: To observe the demography, clinical profile and outcomes of tetanus patients. Materials and methods: A total of 282 tetanus patients were screened and closely observed prospectively from January 2010 to December 2011. Results: The mean age of the study patients was 31.15 years (± 14.26) and the majority were unvaccinated or incompletely vaccinated against tetanus. Patients were mainly farmers (140, 49.64%) and children (102, 36.17%). The sources of infection identified were mainly thorn/pin prick in 129 cases (45.7%), cut/lacerated injury in 83 cases (29.4%) and ear infection in 47 cases (16.7%), while definite injury was not detected/remembered in 42 cases (14.8%). The average duration of hospital stay was 17.2 ± (4.7) days and autonomic nervous system dysfunction was the most common complication observed in this study. Death was the outcome in a total of 58 patients (20.6%) mostly due to aspiration pneumonia-induced sepsis, respiratory failure or cardiac complications. Conclusion: Environmental hygiene, basic health education, increased in immunization coverage, proper wound care – even following minor injuries – and more facilities for intensive care units, may reduce the overall incidence of tetanus and mortality following onset of the disease.
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The stage of Skeletal Maturation of an individual is essential for assessing the growth potential of an individual. This helps in formulating Diagnosis and Treatment Planning which may affect the final prognosis of the orthodontic treatment. The course of orthodontic treatment often depends upon the intensity of facial growth. Thus the knowledge of the timing of these growth velocity variations in craniofacial complex is important in clinical orthodontics. There are different methods of assessing skeletal maturity for orthodontic treatment purpose. The main source is Hand Wrist X-rays, Cephalograms and Radiographs for assessing the status of dental development. Review of Literature reveals a wide data on this aspect related to methods and the correlation between different methods. Most of them are academically oriented. The purpose of this article is to present a simplified method for clinical reference during treatment.
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Vanadium is considered as an essential trace element in some animals. In human’s classification of vanadium as an essential nutrient is still a topic of debate among various research groups. Nutritionally vanadium is thought to be a cofactor in various enzymatic reactions. Increased levels of insulin in blood (hyperinsulinemia) associated with type-2 diabetes mellitus. Increase intake of fat induces hyperinsulinemia which may leads development of type-2 diabetes mellitus. The present study aimed to know the effect of vanadium supplementation on high fat diet induced hyperlipidemia, hyperinsulinemia and hyperglycemia. In this study New Zealand white breed male rabbits divided into three groups. Group-I: rabbits fed with standard diet Group-II: fed with group-I diet and egg yolk, Group-III: rabbits fed with group-II diet and supplemented with 0.5mg/kg of elemental vanadium as sodium meta vanadate. Total cholesterol, LDL-cholesterol and Triglycerides were significantly decreased in G-III when compared to G-II after the experiment. HDL-cholesterol levels are similar in G-II & G-III. Plasma glucose and insulin levels were significantly decreases in G-III than G-II. The present study shows the antidiabetic and antilipidemic role of vanadium in the experimental rabbits. Supplementation of vanadium may prevents hyperglycemia and cardiovascular risk factors like, insulin resistance and hyperlipidemia in diabetes mellitus.
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OBJECTIVE@#To determine health systems-related, familial, and cultural factors which influence the delivery and uptake of measles vaccination in Indonesia.@*METHODS@#Logistic regression analysis of data collected during the 2007 Indonesian Demographic and Health Survey was undertaken by the authors to investigate these factors. The 2007 Indonesian Demographic and Health Survey dataset is a nationally representative, randomly sampled survey containing 15 065 children aged between 9 and 59 months.@*RESULTS@#72.8% of children had received the measles vaccine. Vaccination coverage was similar for males and females; however, coverage was higher amongst urban children, 80.1%, compared to 68.5% in rural areas. The key findings of the regression analysis were congruent with the results of previous research targeting vaccination coverage. After controlling for all other factors, maternal age, maternal education, wealth, the use of a skilled birth attendant, and postnatal check-ups were positively and significantly (P< 0.01) correlated with measles vaccination. The number of children per household was negatively correlated (P<0.01).@*CONCLUSIONS@#In order to enhance measles vaccination coverage in Indonesia, delivery to, and uptake by, rural and low socio-economic populations require substantial improvements. Mass health education and health systems improvements are also required.
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Adolescent , Adult , Child, Preschool , Female , Humans , Infant , Male , Middle Aged , Pregnancy , Young Adult , Antibodies, Viral , Blood , Cross-Sectional Studies , Indonesia , Measles , Measles Vaccine , Allergy and Immunology , Vaccination , MethodsABSTRACT
Thirty patients with complete atrioventricular septal defect were operated upon between 1989 and 1996 at our institute. Their ages ranged from two months to 24 years (mean age 2.81 years). All patients had severe pulmonary arterial hypertension except one who had associated pulmonic stenosis. Four patients had severe atrioventricular valve regurgitation and another six had moderate regurgitation. Five patients had Down's syndrome. The cleft in the left atrioventricular valve was closed in all but seven patients. There were five (16.66%) in-hospital deaths which included two patients in whom the cleft was left open. Follow-up ranged from three months to eight years. All patients were evaluated by 2D echocardiography in the immediate post-operative period and three to six monthly subsequently. One patient progressed to moderate and another to severe left atrioventricular valve regurgitation during follow-up. In both the patients the cleft had been left open. All other patients continue to have stable left atrioventricular valve status, that is, none or trivial to mild regurgitation. In view of late deterioration of the left atrioventricular valve regurgitation only in those patients where the cleft was left open, we suggest complete closure of the cleft in all complete atrioventricular canal defects.