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Background: The importance of prostatic carcinoma and its detection has increased manifold over the last few decades. Total serum acid phosphatase (ACP) was the world’s first emerged clinically useful tumor marker in the 1940s and 1950s in patients with prostatic diseases. With the introduction of the prostatic specific antigen (PSA) test in the 1980s, which performed significantly better in screening and treatment programs bringing disfavor to the advent of ACP. Aims and Objectives: To determine serum PSA and total serum ACP in patients with prostatic cancer and benign prostatic diseases, followed by evaluation of these tumor markers. Materials and Methods: This study was conducted on 30 patients with histologically proven cases of prostatic carcinoma and compared against 30 patients as control with benign prostatic pathology, residing in Punjab who were admitted and treated with symptoms complex of prostatism or retention urine or other urinary complaints as the primary symptoms. PSA and ACP in serum were determined using ELISA test kit and King and Kind method, respectively. Results: The mean level of serum PSA was 81.19 ± 49.02 for cancer prostate and 4.975 for benign prostatic diseases, while the mean level of serum ACP was 5.22 ± 1.70 and 2.52 ± 2.27, respectively, for the cancer prostate and benign prostatic diseases showing statistically difference between study and control groups was highly significant as P < 0.0001. Conclusion: Statistical analysis and results of the present study indicated that although serum ACP has better specificity to PSA, yet later is a very sensitive tumor marker in prostate diseases for screening, diagnosis, and post-treatment follow-up.
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Background: Rabies is one of zoonotic viral disease, estimated to cause 59000 human deaths annually in over 150 countries, of which 20,000 are from India alone; about 40% of which are in children under the age of 15. Rabies though 100% fatal is preventable with post-exposure prophylaxis which includes wound washing, anti-rabies vaccination and rabies immunoglobulin. Objective: To describe the clinico-social profile of animal bite patients attending the anti-rabies clinic of BRD Medical College, Gorakhpur. Methodology: A cross-sectional study was conducted in the anti-rabies clinic of Nehru hospital, BRD Medical College, Gorakhpur from January 2022 to May 2022. Study participants were interviewed by using a pre-phrased, pre-designed and pre-tested questionnaire. Data regarding socio-demographic and clinical profile of the study participants following animal bite exposure was collected. Results: The total number of animal bite victims were 250, in which majority of them were males (76.77%) and highest percentage was of adult population (20-59 years). Maximum number of victims were from rural area (78.70%). 19.35% were working and 39.35% were students. 77.43% were category III bites and in 50.96% cases lower limb was the site of bite and dogs were responsible for 89.67% of the bites. 60.64% victims did not wash the wound properly before reaching the anti-rabies clinic. Conclusion: This study concludes that as majority of the animal bite victims were students and majority of victims were unaware about the importance of wound care, therefore a step can be taken to create awareness in various schools.
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Background: COVID-19 infection is a disease that remains the main concern globally due to high admissions and fatality rates among patients. Clinical manifestation and choice of treatment are various. Therefore, this study was developed to explore the physicians’ perceptions in this regard in a semi-governmental hospital in Sharjah. Aims and Objectives: The objective of this research is to (1) to outline physicians’ descriptions of the clinical presentation of COVID-19, (2) to explore the physicians’ perceptions regarding the different aspects of COVID-19 and its complications, and (3) explore the physicians’ experiences regarding the treatment of COVID-19 cases. Materials and Methods: A descriptive qualitative design was approached. A semi-structured interview guide was developed, validated and used for data collection. Ten in-depth individual interviews with physicians were conducted. Interviews were recorded, transcribed, and thematically analyzed. Results: After analysis, three main themes with their sub-themes emerged to describe physicians’ experience regarding COVID-19’s clinical presentation, complications, and management. Sub-themes cleared-up COVID-19’s signs, symptoms, and risk factors along with admission’s requirements. Furthermore, it showed COVID-19’s complication in main organs. Moreover, COVID-19’s treatment was clarified for both home-quarantine and admitted patients along with instructions for discharged patients. Conclusion: Cases varied in severity and classified from asymptomatic to severe. It showed the requirements for hospitalization and risk factors associated with severity. The management of COVID-19 disease followed by MOHAP protocol and provided adequate outcomes from physicians. Vaccination was one of physicians’ recommendations.
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@#A chronic expanding hematoma (CEH) is a rare clinicopathologic entity that may simulate the clinical and radiologic presentation of soft tissue sarcomas. Etiology has been attributed to repeated exudation and bleeding from capillaries in granulation tissue, resulting in a gradually enlarging mass. A 51-year-old male presented with a large thigh mass following a gunshot wound one year prior. Diagnostic imaging revealed a large complex mass with cystic areas overlying cortical erosions in the femoral diaphysis suggestive of osteomyelitis versus a primary aggressive new growth. Biopsy confirmed CEH and the absence of malignant cells. Hip disarticulation was performed after noting massive necrosis of the thigh compartments and neurovascular compromise. CEH is an important differential diagnosis to be considered in a patient with a slow-growing soft tissue mass and history of significant trauma. Its similar clinical presentation with a soft tissue sarcoma necessitates a high index of suspicion, diagnostic imaging, and biopsy prior to performing definitive surgery.
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Background: Early-onset atherosclerosis is a marker of future cardiovascular diseases. However, indicators of early dyslipidemia for primary prevention are generally lacking in sub-Saharan Africa. This study aimed at describing the cord blood lipid profile among apparently healthy newborns in a tertiary hospital in Southeast Nigeria, and its relationship with gestational age and birth weight.Methods: Cross-sectional study of 167 consecutively recruited apparently well newborns in a tertiary hospital whose cord blood lipid profile parameters (total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL C), low-density lipoprotein cholesterol (LDL C) and very low-density lipoprotein cholesterol (VLDL C)) were assessed using an autoanalyzer (BiOLis 24i). Lipid variables were presented with descriptive statistics whereas their relationship with gestational age and birth weight was highlighted using Spearman's rank correlation analysis. Dunnett's T3 Post Hoc analysis was used for pairwise comparisons.Results: The 167 newborns recruited included 15 (9%) moderate preterm, 46 (27.5%) late preterm and 106 (63.5%) term babies of which 79 (47.3%) were males and 88 (52.7%) were females. The number of recruited SGA, AGA and LGA were respectively 13 (7.8%), 142 (85%), 12 (7.2%). Mode of delivery was majorly vaginal delivery (69.5%) while the rest (30.5%) was by caesarean section. The median values (in mg/dL) of TC, TG, HDL C, LDL C and VLDL C were 60.0, 30.5, 29.0, 25.8 and 6.1 respectively, all within the normal international ranges. Triglycerides and VLDL-C had a moderate positive correlation with gestational age (rs = 0.4;p < 0.001) and were significantly higher in small-for-gestational-age newborns. Total cholesterol, HDL C, and LDL-C had a weak negative correlation with gestational age and birth weight (spearman rsË-0.3). Birth weight, gestational age, and paternal age were the common predictors of lipid profile variability.Conclusion: The finding of a significant relationship between lipid variables with gestational age and birth weight underscores the need to clinically interpret these given the relationship. The relationship with paternal age is another interesting finding which needs to be replicated and the mechanism(s) elucidated.
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Birth Weight , Fetal Blood , Gestational Age , AtherosclerosisABSTRACT
This article aims to evaluate the possible antidepressant effect of the Ghrita prepared from the combination of these plants and to provide probable scientific explanations for using medicated Ghrita (ghee) in Ayurvedic system of medicine. Herbs for Ghrita like Marsilea quadrifolia, Lawsonia inermis, Mimosa pudica, Piper betle were collected freshly during the month of June. One part Kalka (herb bolus), 4 parts pure cow ghee, and 16 parts Dravadravya were used to make Ghrita (Swarasa). Anti-depressant potential of the Ghrita was evaluated by forced swimming, tail suspension, locomotor activity, rota-rod test (motor co-ordination), elevated plus maze (EPM) model, and hole board test were used to assess the Ghrita's anti-depressant potential. According to the Irwin schedule, Gritha medication reduces alertness but has no effect on other parameters, but imipramine treatment reduces responsiveness, alertness, grooming, and writing reflexes to some extent. Following 14 days of therapy with medicinal Ghrita, the immobility time in the forced swim test and the tail suspension test were reduced by 29% and 42%, respectively. In the rotarod test, it had no significant effect on muscle gripping ability when compared to control animals, whereas imipramine produced a significant result. It was observed that the medicinal Gritha significantly (p<0.05) decreases the locomotor activity in actophotometer test and head dips counts in hole board test as compared to control at the end of 14 days study in a 5 minute observation. Ghrita increased the number of entries in the elevated plus maze by 50% and the time spent in the open arm by 72%. The results of this investigation suggest the possible antidepressant potential of medicinal Ghrita.
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Context: COVID-19 caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is an emerging pandemic that is rapidly spreading with more than 114 million confirmed cases and 2.5 million deaths by far. Nasopharyngeal swab (NPS) in VTM has been used as the gold standard respiratory specimen for SARS-CoV-2 reverse-transcriptase real-time PCR (rRT-PCR) tests. But now the virus can also be detected in other clinical specimens like bronchoalveolar lavage, sputum, saliva, throat swab, blood, and stool specimens. Aims: The aim of this study was to determine the diagnostic potential of saliva as a sample in comparison to NPS for detection of SARS-CoV-2 by rRT-PCR. Settings and Design: A cross-sectional study was conducted among 256 paired samples (NPS and Saliva) received in the Department of Microbiology, SMS Medical College, Jaipur over a period of 2 months Methods and Material: NPS from individuals were collected in a sterile tube containing Viral Transport Medium™. Before swab collection, whole saliva was collected by spitting from the suspected patient into a sterile container. Both were stored at room temperature and transferred to the diagnostic laboratory within four hours of collection where extraction was done using Perkin Elmer chemagic extractor and rRT- PCR was performed using NIV, Pune mastermix. Results: Sensitivity, specificity, PPV, and NPV of RT-PCR for the diagnosis of COVID-19 in saliva were 84.26%, 100%, 100%, and 54.05%, respectively. The accuracy of detection of COVID-19 by saliva samples compared to the routinely used NPS samples (considered as the standard reference) for RT PCR was 86.72%. Conclusions: Our results show that saliva as a reliable sample type for SARS-CoV-2 detection.
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Background: The treatment of Type 2 diabetes mellitus (T2DM) requires many classes of drugs, combination of old and new drugs is usually recommended for intensification of therapies. Antidiabetic drug (ADD) utilization study promotes rational use of ADDs and reveals the recent trends in use. Aims and Objectives: The objective of the study was to analyze drug utilization pattern with particular attention to initiation and intensification of the treatment options in T2DM patients of a diabetes clinic run by endocrinology department of a tertiary care teaching hospital in Eastern India. Materials and Methods: This was a cross-sectional and observational study conducted at the diabetes clinic of a tertiary care Medical College and Hospital of West Bengal over a period of 12 months. After obtaining informed consent, diagnosed adult Type 2 diabetes patients receiving any ADD were included in the study. Demographic, clinical, and laboratory data, proportion of each class of ADDs, and WHO core drug use indicators were analyzed. Results: A total of 298 patients ([167, 56%] males and [131, 44%] females) were enrolled. The mean age of the patients was 52.33 ± 9.91. Metformin (287/298, 96%) was the most commonly prescribed drug, followed by glimepiride (168/298, 56.38%), insulins (116/298, 38.93%), DPP4 inhibitors (108/298, 36.24%), and pioglitazone (99/298, 33.22%). Metformin, glimepiride (53/109, 48.62%) and metformin, glimepiride, and pioglitazone (36/113, 31.86%) were the common dual and triple drug combinations. Conclusion: In Type 2 diabetes, metformin was the preferred agent for initiation of the treatment; glimepiride, insulin, DPP-4is, and pioglitazone were used in combination of metformin for intensification of therapy, consistent with current clinical practice guidelines.
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Background: Appendix is a blind muscular tube derived from the midgut. During the embryogenic development, in the 6th week appendix and cecum appear as out pouching from midguts caudal limb. Acute appendicitis is one the most common diagnosis made whenever patient presents with right illac fossa pain and mostly encountered in young and middle-aged individuals. The diagnosis and management of acute appendicitis depend on clinical presentation, that is, clinical signs and symptoms. The most common presentations in these cases have abdominal pain along with fever, anorexia, nausea, and vomiting. Various Scoring systems are developed to diagnose acute appendicitis based mainly on the presenting signs and symptoms, but widely none of them are used as an uniform scoring system. Aims and Objectives: The purpose of this study was to assess effectiveness and comparison of modified Alvarado score and Tzanaki’s Score in the early diagnosis of acute appendicitis. Materials and Methods: A prospective observational study was done in department of General Surgery JLN Medical College Hospital, Ajmer which included 200 patients presenting with the signs and symptoms of acute appendicitis, clinically. During admission the patients were evaluated by Modified Alvarado score and Tzanaki’s Score and final surgical decision was taken by the treating surgeon. Finally, the scores were compared with the histopathological examination of the surgically operated specimen. Results: The sensitivity and specificity of Modified Alvarado Score was 84.26% and 72.7%, respectively, with a positive predictive value of 96.15% and negative predictive value of 36.3%. The sensitivity and specificity of Tzanaki’s score was 88.2% and 72.7%, respectively, with a positive predictive value of 96.31% and negative predictive value of 43.24%. The diagnostic accuracy of Alvarado score was 83% and that of Tzanaki’s score was 86.5%. Conclusions: Our study showed that Modified Alvarado scoring system is a simple tool with limited features for bedside diagnosis of acute appendicitis, but its effectiveness is not as good as that of Tzanaki’s scoring system.
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Background: Intestinal obstruction is a common clinical entity in surgeons practice. In a large number of patient, therapeutic options are surgery versus conservative treatment; the choice of the treatment, that is, surgical versus conservative depends mainly on the surgeon’s assessment and therefore, is a clinical challenge to decide. Aims and Objectives: The purpose of our study is early detection of strangulated bowel obstruction based on a clinical, laboratory, and radiological parameters, a severity indicator score developed by combining these parameters. Materials and Methods: It was a hospital-based prospective observational study of 100 patients between April 2019 and October 2020 who presented with intestinal obstruction. Clinical, laboratory, and radiological parameters were noted and scoring was done as per severity scores. Results: Common cause of obstruction in this study was adhesions 41%, tuberculosis 13%, malignance 8%, and mesenteric ischemia 6% followed by intussusception and volvulus. Patients who had score <3 were managed conservatively, while 90.9% of patients having a score of three or more where operated on, which was statistically significant. Conclusion: Evaluation of the patient is not only to confirm the diagnosis but also timely management of strangulation and prevention of ischemia of gut to improve morbidity and mortality. This study used a severity scoring system of clinical parameters, laboratory and radiological investigation to help in the decision-making of treatment in a case of intestinal obstruction.
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Hematohidrosis is an uncommon pathophysiological condition of sweating blood. A young lady with abrupt bleeding from the skin (since January 2017) was brought to the emergency. The bleeding was vanished after mopping with no site of injury, but it reappeared soon enough confirming its nature. Bleeding time (BT), clotting time (CT), and the prothrombin time (PT) was within normal limit. This patient is confirmed as a case of hematohidrosis by the method of exclusion and the presence of blood was finalized by benzidine test as well as biochemical and microscopic examination of it. Now, no treatment is available as per the latest pieces of evidence. Also, the cause of it is not known till date. Psychological anxiety is a predisposing cause for hematohidrosis.
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The novel coronavirus disease (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 has led to an increased incidence of fungal infections. However, pulmonary infections are rare. COVID-associated pulmonary aspergillosis has been reported; however, there is no prior report of tracheobronchial aspergillosis with endobronchial aspergilloma as per the authors' literature search. We report such a case of a 65-year-old male with radiology and biopsy-proven endobronchial aspergilloma upon a background of tracheobronchial and pulmonary aspergillosis after having recovered clinically from severe COVID-19 disease.
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Adrenal myelolipoma is a benign tumor-like growth, composed of mature fat cells and bone marrow elements. We report a case of a 44-year lady who presented with a complaint of pain in the abdomen. The only positive finding was contrast-enhanced computed tomography (CECT) whole abdomen, which was suggestive of heterogeneously enhancing hypodense lesion of size 130 mm × 105 mm with few calcifications and 103 mm × 75 mm with intralesional fat attenuation in right and left adrenals. Rest laboratory parameters were normal. Only a few cases so far have been reported for bilateral adrenal myelolipoma but what stands out in our case is its giant size and bilaterality, managed surgically without any complications.
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Histoid leprosy is a rare variant of lepromatous leprosy, may occur de novo or may occur in cases earlier treated with dapsone monotherapy. Demographic, clinico-histopathological and treatment details of biopsy proven cases of histoid leprosy, collected retrospectively from the leprosy clinic of tertiary care hospital of SMS Medical College, Jaipur. During the study period of 5 years (2011-2016), 28 (2.98 %), patients had histoid leprosy among total 937 patients of leprosy. Most were in 21 – 40 years of age group with M: F ratio 2.5: 1. Histoid lesions developed with primary diagnosis of lepromatous leprosy in (71.4%) and de novo in (28.6%). Predominant site of involvement was upper extremity (85.7%) and most common presentation was subcutaneous nodules, Nerve thickening seen in (85.7%), and ulnar nerve being most common. Neuritis and disabilities were present in 6 and 16 patients respectively. Type 2 reaction seen in17.9% (5/28) patients. Biopsy and slit skin smear of all cases were done. Most (25/28) cases responded well to standard one-year multibacillary drug therapy (MDT), it had to be extended in three cases up to 2 years. Histoid leprosy may occur de novo or may be due to inadequate therapy, resistant strains, earlier dapsone monotherapy. Although India as whole has achieved leprosy elimination in January 2006, however new cases continue to be reported. Occurrence of histoid leprosy specially with changed morphology of the lesions and poor histopathological correlation needs to be investigated as these cases may be important source of infection even in low endemic situations.
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Background: Breast cancer is the most common cancer among women and a leading cause of death worldwide, including in India. Breast cancer usually shows a slow development rate, and when recognized in the early stages, successful treatment results can be achieved. Breast self-examination is a screening option for young women. Objective: To assess the impact of health education on knowledge and attitude of self-breast examination among nursing students. Study Design: The present interventional study was conducted between September and October 2019. Setting: This study was done among 79 nursing students of a tertiary care hospital situated in a central district of Uttar Pradesh. Main Outcome Measures: The self-reported pre-designed and structured questionnaire was used. It included three sections Sociodemographic profile Knowledge regarding self-breast examination (SBE) 3. Attitude regarding self-breast examination (SBE). Knowledge and attitude scores were calculated and divided into the poor, average, and good categories. Results: There were 87.3% of girls had prior knowledge of the self-breast examination, while 12.7% of girls were not aware of the self-breast examination. Postintervention, there was a significant increase (p<0.05) in their knowledge about self-breast examination. Conclusion: Planned teaching intervention had a significant impact on the knowledge and attitude of self-breast examination.
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Background:During hemodialysis there is decrease in both systolic blood pressure (SBP) and diastolic blood pressure (DBP) and hence Mean Arterial Pressure (MAP) due to decrease in body fluid volume. Due to reduc?on in MAP there is decrease in Mean Ocular Perfusion Pressure (MOPP) and also there is increase in IOP during dialysis. Objec?ve:To study changes in MOPP and IOP among pa?ents undergoing hemodialysis Methods:An observa?onal study was carried out among 100 pa?ents undergoing hemodialysis Under asep?c condi?on, Proparacaine eye drops were ins?lled in both eyes, IOP was measured by Schiotz Indenta?on Tonometer 30 min before, during hemodialysis and 30 min a?er hemodialysis in supine posi?on. Tonometer was sterilized by Isopropyl alcohol and was washed with normal saline before using on next pa?ent. Systolic and diastolic blood pressure were measured by using sphygmomanometer 30 min before, during and 30 min a?er hemodialysis. Results:The varia?ons in the SBP, DBP and MAP before, during and a?er hemodialysis were not sta?s?cally significant (p>0.05). There was significant differences for IOP between before, during and a?er hemodialysis and same for MOPP except before and 30 min a?er hemodialysis (p < 0.0001). Conclusion:Significant fluctua?ons were seen from the present study in the intra-ocular pressure and mean ocular perfusion pressure during, before and a?er hemodialysis.
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BACKGROUND Planned elective surgery had to be postponed for a large number of patients who tested positive for Covid-19 in the preoperative period. We aimed to assess the postoperative outcomes of patients who were operated on for elective indications, following recovery from Covid-19 infection. METHODS We did a retrospective study of patients who underwent elective general surgery between 1 April 2020 and 31 March 2021, following recovery from Covid-19. The 30-day postoperative morbidity and mortality were analysed. The data relevant for the study were retrieved from the hospital’s electronic medical records. RESULTS Of the 109 patients included, 54.1% were women and the median (range) age was 49 (16–76) years; 53.2% of operations were performed for benign indications and the rest were for malignancies. Eighty-five (78%) patients underwent surgery following recovery from an asymptomatic Covid-19 infection and 23 (21.1%) patients following recovery from mild Covid-19 infection; 73.3% of the operations were performed following a planned delay of 2– 5 weeks from the diagnosis of Covid-19. The 30-day major postoperative morbidity (Clavien–Dindo grade ?3) was 6.4%, the postoperative pulmonary morbidity was 0.9%, and there was no 30-day mortality. CONCLUSIONS Elective general surgical procedures can be done safely in patients who have recovered from asymptomatic and mild Covid-19 infection, following a minimum wait period of 2 weeks.
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Background: Ocular surface squamous neoplasia (OSSN) comprises neoplasm arising from the ocular surface, which includes conjunctiva, cornea, and limbus and ranges from mild dysplasia to invasive squamous cell carcinoma. Purpose: The aim of this work was to study the spectrum of OSSN based on histopathological analysis. Materials and Methods: This was a retrospective cross-sectional study comprising 776 histopathologically diagnosed cases of OSSN from January 2004 to December 2014. Results: The mean age of presentation of OSSN was 45 years (median, 45 years; 2 to 87 years) with male preponderance (74%). The most common age group of presentation was 41–60 years (n = 299; 39%). The most common type of OSSN was invasive squamous cell carcinoma seen in 50% (n = 383) eyes followed by severe dysplasia/carcinoma in situ in 31% (n = 250) eyes. Tumor infiltration at base was seen in 16% (n = 124), positive margins in 32% (n = 248), scleral infiltration in 14% (n = 109), intraocular extension in 3% (n = 23), and orbital extension in 4% (n = 26) eyes. OSSN was associated with actinic keratosis in 21% (n = 165) cases. Conclusion: Based on histopathology, invasive squamous cell carcinoma is the most common form of OSSN in the Asian Indian population.
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Background: Worldwide stroke is accounted as the second leading cause of death and third cause of disability. Changes in physiological variables such as temperature, blood pressure, blood glucose levels, and their deleterious effect in terms of mortality and morbidity are of major concerns for the treating physicians. Aim and Objectives: The aim of the study was to study changes in temperature and its relation to 7th day outcome in acute stroke patient. Materials and Methods: A prospective hospital-based study was conducted, after approval of Institutional Ethical committee, recruiting 150 acute stroke patients presenting within 6 h of developing symptoms. Temperature was recorded every 8 h for 48 h and stroke severity was assessed using modified Rankin scale on admission and on the 7th day after admission. Results: Categorical variables were analyzed using Chi-square analysis and means of continuous variables were compared using analysis of variance. For any significant difference in mean temperature at two consecutive readings, paired sample t-test was used. Multinomial logistic regression analysis was done to predict outcome in acute stroke patients. The difference in the mean temperature at 8 h, 16 h and 40 h after admission was significant between male and female patients. Temperature at 16th h of admission was found to be significant for improved, status quo, and worsened comparison. Temperature at 24th h of admission was also found to have significant value but only for status quo and worsened outcome. Conclusion: The authors conclude that the mean temperature of the patients remained within the normal range in the first 48 h. The temperature at various intervals may not consistently predict the 7th day outcome in acute stroke patients.