Role of preoperative MR volumetry in patients with renal cell carcinoma for prediction of postoperative renal function after radical nephrectomy and nephron sparing surgery

ABSTRACT Purpose Preoperative computed tomography or magnetic resonance (MR) imaging are commonly used for radiological evaluation of renal cell carcinoma (RCC) before radical nephrectomy or nephron sparing surgery(NSS). This study aimed to assess the role of MRI for predicting postoperative renal function by preoperative estimation of renal parenchymal volume and correlation with glomerular filtration rate (GFR). Materials and Methods A prospective observational study was conducted from February 2015 to October 2016 at a tertiary care hospital in northern India. MR imaging was done on 3 Tesla MR scanner (Signa Hdxt General Electrics, Milwaukee, USA). MR volumetry was used to estimate the renal parenchymal volume. GFR was measured in all patients using Tc99m Diethyl-triamine-penta-acetic acid using Russell's algorithm. Such measurement was done preoperatively, and postoperatively 3 months after surgery. Results 30 patients with suspected RCC underwent NSS (n=10) and radical nephrectomy (n=20). Median tumour volume was 175.7cc (range: 4.8 to 631.8cc). The median volume of the residual parenchyma on the affected side was 84.25±41.97cc while that on the unaffected side was 112.25±26.35cc. There was good correlation among the unaffected kidney volume and postoperative GFR for the radical nephrectomy group (r=0.83) as well as unaffected kidney volume, total residual kidney volume and residual volume of affected kidney with postoperative GFR for the NSS group (r=0.71, r=0.73, r=0.79 respectively; P <0.05). Conclusion Preoperative residual parenchymal volume on MR renal volumetry correlates well with postoperative GFR in patients with RCC undergoing radical nephrectomy or NSS.

Correlation of Mean Platelet Volume in Type 2 Diabetes Mellitus

Diabetes mellitus is a major global health problem. It is classified as type 1 and type 2 diabetes. The disease and its complications also cause a heavy financial burden on diabetic patients, their families and the society. Mean platelet volume is a measurement of the average size of platelets and varies between 7.5 and 10.5 fl. We wanted to study the correlation of MPV and HbA1c.METHODSThe present study was conducted in the Department of Pathology, SSMC and SGMH, Rewa (MP) over a period of 18 months on 210 cases. Glucose was measured by GOD-POD method, MPV by cell counter and HbA1c by high performance liquid chromatography (HPLC) method. Unpaired t test is used to find out p value by using GraphPad software.RESULTSA total 210 cases were included. 60 cases were non-diabetic (Control Group) and 150 cases were of DMT2. The DMT2 group was further divided into DMT2 (controlled) and DMT2 (uncontrolled) on the basis of levels of HbA1c. MPV in DMT2 vs. non-diabetic was 10.80 ± 1.32 fl vs. 10.01 ± 1.12 fl respectively. MPV in DMT2 (uncontrolled) vs. DMT2 (controlled) was 11.07 ± 1.53 fl vs. 10.39 ± 0.75 fl respectively.CONCLUSIONSMPV in DMT2 patients was significantly higher than non-diabetic group. MPV in uncontrolled diabetic group (HbA1c >7%) was significantly higher than controlled diabetic group (HbA1c <7%). Hence MPV along with HbA1c can be a useful diagnostic test as well as prognostic marker of vascular complications in DMT2 patients.

Hepatic Steatosis, its Complication and Correlation with Risk Factor and Management

Liver detoxifies the various metabolic products inside thebody and converts toxic substance to less toxic by differentphases of detoxification reaction. It play broad-spectrumrole (synthetic, storage, metabolic, protective secretary andExcretory). Sedentary life style, Unhygienic food, adulteratedfood, high dose of alcohol, fatty diet adversely affect the normalfunctioning of liver. Fatty Liver Disease refers to a reversiblecondition in which there is accumulation of triglyceride fatinto intra-cytoplasmic Vacuole. If fatty liver is not treatable attime then it goes to various stages (NAFLD, NASH, Fibrosis,Cirrhosis and Hepatocellular Carcinoma). Diet and aerobicexercise plays an important role in management of Liverdisease. The present article focused on fatty liver disease ismanageable at earlier stage by spreading awareness programamong the individual.

Smart phones for medical undergraduates: friend or foe?

Background: Smart phones are truly a boon for us in all aspects of our life. It helps mankind to lead a faster and easier life, but the same devices used to get things done are now the gatekeepers of an infinite number of distractions and sources of instant gratification. Even though, there is an ocean full of information a click away, we fail to utilize it for something resourceful. Increased media consumption, multi screening and social media usage reduce the ability to focus on tasks and duties which have a much higher priority.Methods: A cross sectional study was conducted with a validated questionnaire among 200 undergraduate MBBS students of a deemed to be medical university.Results: Among the ninety-eight per cent of the students who own a smartphone, all have access to the internet. Seventy-seven per cent of the students use these gadgets on a very regular basis throughout the day and among them only forty-six per cent were found to be using it for academic purposes.Conclusions: Through this study, it has become more discernible that smart phones have paved its way for a reckless future, though if used wisely it would become a blessing in disguise. The ever-changing medical fraternity could really benefit from this discovery but alas, a tool made to make our lives easier is weighing us down with its addictive and time-consuming features.

Completeness and Appropriateness of Integrated Management of Neonatal & Childhood Illness (IMNCI) Forms filled by the Interns of Tertiary Care Hospital in Gujarat

Introduction: IMNCI is an important strategy being implemented across our country in order to improve health worker's performance and also aim to reduce infant & under-five mortality. Training of MBBS students in IMNCI is being carried out at PramukhSwami Medical College, Karamsad since more than 10 years. In present study, quality of forms filled by interns during their posting at Urban Health Training Centre is assessed in terms of completeness & appropriateness. Objectives: To assess & compare completeness & appropriateness of Upto 2 months IMNCI forms of interns of 2012-13 & 2013-14 batch. Method: This was a record based study in which analysis of filled forms of Two MBBS batches was done. Completeness criterion was based on completely filled forms & appropriateness criterion was based on criterion of completely filled correct forms. Results: All available 216 forms were analyzed. Completeness was found in 18.9% (n=20) & 7.3% (n=8) forms of 2012-13 & 2013-14 batch respectively. Appropriateness of forms was 17.9% (n=19) forms of 2012-13 batch & 7.3% (n=8) forms of 2013-14 batch. Conclusion: Completeness & appropriateness was found to be poor, however it was better in the batch who had received training in final year of MBBS.

Patterns of Injuries in Road Traffic Accidents in a Rural Tertiary Hospital.

Road traffic injuries are a major but neglected global public health problem, requiring concerted efforts for effective and sustainable prevention. Of all the systems that people have to deal with on a daily basis, road transport is the most complex and the most dangerous. Objectives: To study the patterns of injuries in the road traffic accidents and days of hospitalization. Materials and Methodology: The study was retrospective record based study and included cases reported and recorded from October 2007 to March 2008. Results: The present study was designed to study the patterns of injuries in RTA (Road Traffic Accidents) in Anand district of Gujarat. The results showed that out of total 423 RTA cases, 327(77.3%) of the victims were males and the rest 96(22.7%) were females. Two wheeler riders and pedestrians form twothird of the total victims. Total 232 fractures were noticed and of these maximum numbers occurred in the lower limb region (53.86%) followed by fractures in the upper limb (24.54%) and 10.77% fractures were in the skull. Abrasions were seen most commonly on lower limbs (34.31%), lacerations were seen mostly on head (41.07%) and internal injuries were noticed more in the head region (31.48%). 74.2% of the victims were hospitalized and the rest 25.8% took treatment at the trauma centre. 51.1% of RTA victims were hospitalized for 1-5 days while patients who did not require hospitalization were 109(25.8%).

Effectiveness of a program designed to expose medical student to the rural community and support system in healthcare, in a medical college.

Background: It is felt that medical training should largely be made in close proximity of public health & social environment compared to a tertiary care hospital. The package of training could include an exposure to the rural community because a fresh graduate doctor does not have concept of broad community healthcare needs. Aims & Objectives: The aim of the study was to assess the effectiveness of a program designed to expose medical student to the rural community and support system in health. Methods: The study was conducted in December 2008 among 96 medical student of 7th semester. This was a quasi- experimental design with before and after intervention assessment. Assessment was made based on presentations on comparisons of mock village scenario Vs real village experience. A structured questionnaire was used to assess change in knowledge. Results: The mean of the test scores in communication skill and knowledge (based on presentations) in average mock village scenario were 45.94 and improved to 53.56 after real village stay. There was an improvement of 7.62(16.6 %, p<0.001).The mean pre and post village stay score in knowledge based on questionnaire was 56.02 and 67.12 respectively with an improvement of 11.1 (19.81%, p<0.001). The programme was also found to be interesting to the students and villagers. Conclusions: A village stay programme to teach undergraduate student in a field setting to expose them to various parameters of practice of primary health care can help them understand the contextual needs of the society.

Pattern of injuries due to electric current.

A one year study, from October 2007 to September 2008, was under taken in an attempt to study the pattern of electrical injury, the cause of death, manner of death, and diagnosis by histopathological examination. The study was compromised of 62 cases brought with history of electrical shock. Of the total 62 cases, males were 57(91.93%) and females were 5(8.06%) the mean age is 26 .27 year. The peak age of victims are 21-30 years age group 24 cases (38.71%].In the age group of 1n 0-10 years age group victims 3. Most of cases were due to low tension and domestic circuit. The patterns of electrical injuries are noted, such as entry, exit and both entry, exit wounds, flash burns and no electrical signs. The maximum victims showed dermo-epidermal degree of electrical burns .The histopathological examination is an important aid in diagnosis of electrical injuries and recommendations about preventive safety measures to reduce the mortality.

The pattern of poisoning in khammam.

This study was undertaken to study the patterns of poisoning cases admitted at Mamata General Hospital Khammam, Andhra Pradesh from June 2005 to June 2010. The poisoning was common mode of suicide and one of the common causes of death in developing countries, particularly in agricultural workers. The emphasis was given on age, sex, socioeconomic status, etc. type and mode of poisoning. Organophosphate compounds were the most commonly 74.10% abused substance. The common motive of poisoning was suicidal 93.43% in both male 85.85% and female 14.14% with male to female ratio 6.07: 1%. Peak incidence was observed in the age group 21-30 years 50.59% and majority were from Hindu community 90.83% as compared to other community. The overall mortality of poisoning is 17.33%. Majority 366 (72.90%) were consumed the approximate amount of poison is 400-500 ml and maximum number of deaths 74 985.05%) are associated with highly toxic amount of 400-500ml of poison consumed. The study observed increasing trend of suicide by organophosphate compounds and rat poison ,whereas other poisons for committing suicide are less commonly used and here with–reflecting the pattern of poisoning in Khammam.