A comparative study on the use of holmium laser and pneumatic lithotripser for intracorporeal lithotripsy of upper ureteric stones

Background: In the last decade different minimally invasive modalities for management of urolithiasis have been available requiring an intelligent decision by the urologist to choose one as per patients need and preferences.Methods: The present cross sectional study was conducted among patients who underwent ureterorenoscopic lithotripsy for proximal ureteric stones in the Department of Urology. Using consecutive sampling technique, patients were randomly allocated to two groups for treatment with either pneumatic lithotripser (group A) or Holmium laser lithotripser for fragmentation of calculi (group B) and the comparison of both these techniques was done.Results: 117 patients were included (57 and 60 in group A and group B respectively) in the study. The difference in age in the two groups was found to be statistically significant (p=0.03). The total operative time, length of stay in hospital and complications were more in group A patients. The difference in two groups for total operative time and length of stay in hospital was statistically significant (p=0.00 and 0.00 respectively).Conclusions: Holmium laser lithotripser has better safety profile when compared to pneumatic lithotripser especially in stone clearance rate and retropulsion rates and could be used as modality of choice in proximal ureteric stones.

LGIB & the Elderly: Perspective from the Developing World.

Aim: To ascertain the common causes of LGIB in the elderly and to evaluate sigmoidoscopy and colonoscopy as the initial investigation for diagnosing LGIB in the elderly in the developing world. Materials and Methods: The study was conducted over a period of two years at SMHS Hospital and Government Medical College Srinagar, a tertiary care centre, Jammu & Kashmir. All the patients above the age of 60 years, presenting with symptoms or complaints of LGIB to the OPD’s and casualty services of the said hospital were enrolled in the study. Exclusion Criteria: Cases presenting with LGIB which were proved by any diagnostic procedures or during laparotomy to originate from any source proximal to ligament of Treitz. Results: The commonest cause of LGIB in our study was local anal disease [haemorrhoids and anal fissures] followed by carcinoma colorectum, inflammatory bowel disease [IBD], solitary rectal ulcers [SRUS] and colonic polyps, in the order of decreasing frequency. Colonoscopy was able to detect the cause of LGIB in all our study subjects. Conclusion: Despite the small number of patients in our study group, it can be concluded that the cause of LGIB in the elderly in our part of the world differs from that of the developed world, although the reasons for this remain unexplained and require more research. As such, elderly patients with complaints of LGIB should be offered the benefits of colonoscopy unless contraindicated by their co-morbidities because of the fact that they may be harbouring a sinister cause of LGIB, i.e., colorectal malignancy.

Assessment of pulmonary function in patients with type 2 diabetes mellitus: a case-control study.

Background: As other microvascular complications, respiratory involvement is far less studied among patients with type-2 Diabetes Mellitus (DM). Objective: to study the extent of pulmonary function limitation among patients with type-2 DM. Methods: Hospital based matched case-control study. Results: Total of 90 cases and 90 controls matched for age, sex, height and weight were recruited. Patients with DM had neuropathy [63.3% (57; male=27: Female: 30)], retinopathy [44.4% (40; male=22: Female: 18)], nephropathy [41.1% (37; male=17: Female: 20)] and microalbuminuria [14.4% (13; male=5: Female: 8)]. All cases and 88 controls observed with FEV1:FVC ratio of >70.0%, further assessment for delineation of normal and restrictive pattern patients with high level of predicted values of FEV1 as compare to FVC showed that significantly (P = 0.00) more (Cases: 76.6%; Controls: 42.2%) cases had FEV1 >FVC predicted levels as compare to controls, means among diabetics odds of restrictive pattern of lung abnormality is four times (OR: 4.4; CI: 2.3-8.5) more as compare to non-diabetics. In addition a long duration of DM was significantly (r: 0.39; P = 0.00) positively correlated with lung dysfunction. Conclusion: Patients with type 2 DM patients as compare to its controls observed with restrictive pattern of lung dysfunction.

Study of LV functions in patients of subclinical hypothyroidism in patients coming to rural medical college of Sub-Himalayan region of India.

Background: Subclinical hypothyroidism (SCH) is a common disorder and has been implicated in increased cardiovascular morbidity and mortality. Therefore, it is important to study the effect of SCH on cardiac morphology and function. Thus, present study titled “Study of LV functions in patients of subclinical hypothyroidism in patients coming to rural medical of sub-Himalayan region of India” was conducted in the department of medicine, Rajinder Prasad government medical Tanda over a period of three years from December, 2010 to November, 2013 to study left ventricular function in subclinical hypothyroidism. Methods: The study was conducted in the department of medicine, Rajinder Prasad government medical Tanda over a period of three years from December, 2010 to November, 2013 to study left ventricular function in subclinical hypothyroidism. The data was analysed using computer software Epi-info version 6.0 and SPSS version 12.0 for Windows. Descriptive characteristics were presented as percentages for quantitative variables including measurement of thyroid hormones and ejection fraction. Mean and standard deviation were reported. Results: Diastolic parameters were markedly altered, mainly isovolumic relaxation time, which was increased and reduction of E/A wave ratio (<1). Systolic function parameters were within normal range. 155 patients had diastolic dysfunction with E/A wave <1.45 patients were not affected and they had E/A wave >1. Conclusions: Implication for echocardiography in SCH patients observed were that early recognition of silent diastolic dysfunction can be done. We can institute L-thyroxinee therapy which has been found to reverse diastolic dysfunction of heart along with improvement in lipid levels, decreased systemic vascular resistance, diastolic hypertension and coagulation profile. SCH, invariably affects heart and sooner or later and leads to diastolic dysfunction. Early recognition by echocardiography and then treatment with L-thyroxinee is indicated.

Hospital acquired acute renal failure.

Background: Acute renal failure has continued to attract interest and stimulate investigators .This is in part, a reflection of many clinical entities that can result in an acute renal failure. HAARF is an important cause of morbidity and mortality and is associated with the ten fold increase in the risk of death during the hospitalization.14 Despite advances in diagnosis and management it still carries a high mortality. HAARF is associated with grave consequences. Some of the clinical setting leading to HAARF can be limited by monitoring of renal function, better control of infection, avoiding nephrotoxic drugs and initiation of therapy at the earliest. Present study is proposed to evaluate the incidence, etiological factors and measures to reduce the incidence of HAARF. Methods: All patients were admitted to RPGMC from Dec. 2010 to APRIL 2014. They were screened for the development of the ARF during their hospital stay. The parameters of Prakash et al. were taken for the diagnosis of HAARF. Results: In our present study HAARF was diagnosed in 88 patients of 56904 admission during 40 month period, representing 0.15% of the admission. Predisposing factors were present in 64 % of the patients. They were elderly age >60 years (22.72%), DM (13.64%), pre-existing renal disease (13.64%) and HTN (4.54%). It was due to nephrotoxic dugs in 45.45%, decreased renal perfusion in 22.72%, infections in 13.64%, hepatorenal syndrome 9.09% surgery in 4.54% and Weil’s disease in 4.54 %. Among the nephrotoxic drugs antibiotics were the most common and NSAIDs were the second most common etiological factors. Decrease renal perfusion secondary to volume depletion and heart failure were equally responsible for HAARF in 9.09% each. Septicemia was responsible for 4.54% of cases. Oliguric renal failure was seen in the 31.82% where as nonoliguric renal failure was seen in 50% of cases. Great majority of non oliguric renal failure was due to nephrotoxic drugs. Oliguric patients have longer duration of hospital stay and high mortality as compared to the non oliguric renal failure. A high s. creatinine and high urea levels at the time of admission were associated with the earlier development of HAARF. Oliguria and anuric patients had a longer duration of hospital stay. Overall mortality of HAARF was 18.18% and nephrotoxic drugs responsible for one half of the total mortality. Conclusion: High risk group patients for HAARF needs meticulous monitoring during hospital stay. Hospitalized patients on nephrotoxic drugs should have frequent renal function tests. Proper fluid and electrolyte balance in hospitalized patients needs special emphasis to avoid HAARF.