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Purpose:The purpose of this study was to review the effect of the pre?operative use of clopidogrel and aspirin on peri?operative bleeding, blood product transfusion, and resource utilization after coronary artery bypass grafting (CABG). Materials and Methods: A total of 1200 patients who underwent off?pump CABG (OPCABG) between 2010 and 2012 were retrospectively studied. Patients were divided into three groups: group 1: discontinued aspirin and clopidogrel 6 days prior to surgery (n = 468), group 2: discontinued both drugs 3 to 5 days prior to surgery (n = 621), and group 3: discontinued both drugs 2 days prior to surgery (n = 111). The bleeding pattern and blood product transfusion were studied and compared between the groups. Patients having history of other drugs affecting the coagulation profile, other organ dysfunction, on?pump CABG, and the combined procedure were excluded from the study. Results: Group 2 patients had a higher rate of bleeding and a reduced mean value of hemoglobin (Hb) as compared to other groups. The same results were seen in blood and blood product transfusion. Patients of group 2 and group 3 were associated with higher blood loss in terms of drainage at 12 and 24 hours. Post?operatively, this was statistically significant. Re?exploration was statisitically significant in group 3 patients (9.01%) than in group 2 (2.58%) and group 1 (1.07%) patients. Conclusion: The pre?operative use of clopidogrel and aspirin in patients undergoing OPCABG showed limited clinical benefits; however, its use significantly increased the risk of bleeding and blood transfusion, thus increasing morbidity and resource utilization. Hence, clopidogrel and aspirin should be stopped at least 6 days prior to surgery.
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Introduction:Veno-arterial extracorporeal membrane oxygenation (ECMO) is well-recognized treatment modality for patients with refractory cardiogenic shock. Uncomplicated cannulation is a prerequisite and basis for achieving a successful outcome in ECMO. Vascular access is obtained either by surgical cut-down. Common vascular access complications are bleeding and limb ischemia. Objective: To evaluate cannulation technique, the incidence of vascular complications, and their impact on the outcome. Methods: A retrospective data analysis conducted on 95 patients receiving ECMO from 2013 to 2020 was done. The patients were divided into two groups: no vascular access complications (non-VAC group) and vascular access complications (VAC group). The groups were compared related to the hospital and ICU stays and blood transfusion. Results: The patients in both groups were demographically and clinically comparable. The Non-VAC group had 75 patients, whereas the VAC group had a total of 20 patients. The main complication observed in the VAC group was bleeding from the cannulation site which required more blood transfusion than the non-VAC group (6.8 ± 1.02 vs 4.2 ± 1.26). Limb ischemia was another complication seen in the VAC group (4.2%, n = 4). Two patients had delayed bleeding after decannulation. The overall average length of stay in the hospital was statistically similar in both the groups (22 days in the VAC group vs 18 days in the non-VAC group), but the average ICU stay was more in the VAC group compared to the non-VAC group (18 days vs 12.06 days). Conclusion: Bleeding and limb ischemia are the important vascular access site complications, which increase blood transfusion requirements, ICU stay, and overall hospital stay.
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Introduction: The most common functional abnormality ofthe infant’s lacrimal apparatus is the congenital blockage ofthe nasolacrimal duct. Non-canalisation of the duct, presenceof epithelial debris, mucous plug and bony occlusion are someof the possible causes of blockage. This was a prospectivestudy to identify the etiological agents, predisposing factorsand clinical profile of patients with congenital dacryocystitis.Material and Methods: A prospective observationalhospital based study was conducted on 72 eyes of 61 childrenpresenting with congenital dacryocystitis, in the age group 0-4years, attending the ophthalmology outpatient department in atertiary care teaching hospital.Results: Congenital dacryocystitis was common in agegroup of 0-3 months (31.15%). The incidence of disease inage group 4-6 months was 24.59% and 7-12 months was13.11%. 55.74% of males were affected. 83.61% of patientshad unilateral congenital dacryocystitis. 80.33% of thechildren had a normal delivery. 66.66% of cases presentedwith epiphora and discharge. 31.95% of cases presented withepiphora only. Epiphora with mucopurulent discharge was themost common presentation. Regurgitation test was positive in88.89% of cases. The nature of regurgitate was mucopurulentin 42.19% of cases.Conclusion: Congenital dacryocystitis usually presents at anearly age with epiphora and mucopurulent discharge. Earlydiagnosis helps in management.
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Background: Positive attitude towards menopause is believed to be associated with positive menopausal experience and vice versa. In order to improve women’s menopausal experience, thereby improving quality of life, it is important to understand their attitude towards menopause. The objectives of the research were to explore the attitude towards menopause and its relationship with various socio-demographic and life style factors among postmenopausal woman in the rural setting.Methods: This community-based cross sectional study was conducted using non probability sampling and house-to-house visit in randomly selected villages falling under rural health block Kot-Bhalwal, Jammu. 245 postmenopausal women were interviewed using modified attitude towards menopause checklist. The data so collected was analyzed using Open Epi version 3.1. For finding statistical significance, unpaired t-test and analysis of variance were used wherever needed. A p value of less than 0.05 was considered statistically significant.Results: The highest percentage of agreement with the positive item was for “a woman gets more confidence in herself after menopause” (77%). The lowest percentage of agreement with the positive item was for “going through menopause really does not change a woman in any important way,” (42.5%). There was a statistically significant mean difference between mean attitude score and religion, and no. of living children (F value=3.14, p value=0.002). No significant association was found between other sociodemographic variables and attitude towards menopause scores.Conclusions: There is a large scope of counseling and health education for improving and enhancing quality of life of postmenopausal women in rural setting of our country.
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Background: Tobacco use is a major preventable cause of morbidity as well as mortality worldwide. To combat the increasing trend of this problem, Government of India formulated the COTPA (Cigarettes and Other Tobacco Products Act) in 2003. The study aimed to assess the awareness about COTPA and impact of pictorial warnings among smokers attending outpatient services in a tertiary care hospital in Jammu.Method: The present study was conducted among 320 patients attending the outpatient department of Internal Medicine, Government Medical College, Jammu who happened to be cigarette smokers. The questionnaire was developed by authors with the help of literature review and pilot tested before its final use. Information was elicited about demographic details, awareness about COTPA and impact of pictorial warnings on quitting of smoking.Results: More than half of the respondents were in 30-50-year age group and were urban residents. Awareness about COTPA was good on some parameters but was relatively low on other parameters. Despite all, the respondents noticing pictorial warnings on tobacco packages, only 69.37% of them were contemplating to quit. About half of them were of the view that warning statements preferably be written in local languages.Conclusion: Health and pictorial warnings on tobacco packages remain an important pillar in filling the gap of knowledge and communicating the health risks of tobacco use to the consumers. Only 69.3% of the respondents were planning to quit and awareness levels about COTPA were mixed.
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Background: Marfan syndrome (MS) is inherited autosomal dominant connective tissue disorder caused by mutations in the FBN1 gene encoding fibrillin-1. Aortic dilatation is present in about 80% patients with MS and is the major cause of premature mortality. The objective of our study was to determine the effect of beta-blockers on aortic root growth rate in patients with MS. Methods: We performed a systematic review of all randomized controlled trials and prospective cohort studies that evaluated the efficacy of beta-blockers in patients with MS. The primary outcome of the study was aortic root growth rate. Secondary outcome was composite of death, aortic regurgitation, congestive heart failure, aortic dissection or cardiovascular surgery. Results: Five prospective trials were identified with similar comparable groups, with a total of 243 patients. In our study mean patient age was 12 years with a mean follow-up 86.5 months. There was a significant reduction in aortic root growth rate (SMD -0.86, 95% CI -1.23 to -0.48, p <0.001) with the use of beta-blockers. No significant difference was observed in secondary outcomes in the beta-blocker group as compared to placebo (OR = 1.80, 95% CI 0.21-15.53). Conclusion: Beta-blockers were associated with a significant reduction in aortic root growth rate with reduction in morbidity and mortality.
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Background: Role of immunosuppression treatment in patients with inflammatory dilated cardiomyopathy is controversial. The aim of this review is to summarize current evidence for immunosuppressive therapy in inflammatory cardiomyopathy. Methods: A systematic literature search was performed using PubMed, Embase and MELDINE to identify trials comparing immunosuppressive therapy with either placebo or conventional medical therapy in adult patients with inflammatory cardiomyopathy. Combined primary outcome in our study was all cause mortality and heart transplantation. Secondary outcomes included improvement in left ventricular ejection fraction (LVEF) and left ventricular end diastolic dimension (LVEDD). Results: Five randomized controlled trials (RCTs) were identified and four trials with similar comparable groups, with a total of 359 adult patients were included for analysis. Pooled data demonstrated no reduction in all-cause mortality and heart transplantation amongst the immunosuppression or the placebo arm (OR 0.98, 95% CI 0.48-1.98). There was a significant improvement in LVEF (1.34%, 95% CI 0.37-2.30) in patients treated with immunosuppressive medications, however no difference was observed in LVEDD [-0.11mm (95% CI -1.92 – 1.71)] in the treatment arm. Conclusion: There was no survival benefit or reduction in heart transplantation events with a significant improvement in LVEF in inflammatory cardiomyopathy patients treated with immunosuppression therapy.
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The field of cancer immunobiology has been fast expanding.The realms of cervical cancer and immunodeficiency interactingat the molecular level has been actively investigated. The roleof the Human papillomavirus and developement of cervicalcancer admist a background of immunodeficiency is reviewedfor the novelty of the interaction between the HPV inducedoncogenesis and the host cellular responses in HIV positivewomen.The review aims to revisit the subject and generateinterest and research on HPV induced oncogenesis with anultimate aim to prevent cervical cancer. Greater understandingof the molecular pathways that underlie progression of highgrade IN to invasive cancer would be of great importancein the identification of the genetic markers that are able toidentify the women who have a high risk of progression tocancer, and therefore in need of aggressive monitoring andtherapy to prevent the development of cervical cancer.
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The scientific literature regarding use of reptiles for purpose getting high are sparse, and mainly from developing countries.Duringconditions like non-availability of drugs or other substances of abuse, there can be propensity for using alternative forms ofsubstances like reptiles or insects, which is determined by a milieu of factors, like personality profiles, socio-cultural milieus,availability and accessibility of substance and co-morbid psychopathology. We present a case of alcohol and cannabinoiddependence syndrome with dissocial traits admitted in a state drug-deaddictioncenter, PGIMS Rohtak describing the use of tail ofIndian lizard to get high when there was non-availability of cannabis and alcohol in jail.
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Introduction: Cataract is a major cause of impaired vision andblindness. Study aimed to find out if there is any associationbetween dyslipidemia and cataract.Material and methods: This cross sectional hospital basedstudy was performed in a tertiary care center of Jharkhandbetween June 2017 to March 2018. Total 223 patients whowere diagnosed with senile cataract were included in the study.Detailed history, ophthalmologic and systemic examinationwas done. Dyslipidemia is defined as:Hypercholesterolemia(total cholesterol > 220 mg/dl), or Hypertriglyceridemia (totaltriglyceride > 150 mg/dl), or Low density lipoprotein > 130mg/dl.Results: Out of total 223 patients 134 were men and 89were women. 70% patients had dyslipidemia. Prevalenceof dyslipidemia was associated significantly (< 0.05) withnuclear and cortical cataract but not significant (> 0.05) forposterior sub capsular cataract.Conclusion: Dyslipidemia maybe considered having anassociation with nuclear and cortical cataract directly orindirectly.
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Breast cancer is the most common cancer in females in the world. Breast aspiration cytology, histopathology and radiology have become important diagnostic tools in diagnosis of breast cancers. Objectives: Our aim was to conduct a combined diagnostic approach comprising of clinical examination, mammography, fine needle aspiration cytology and histopathology study in breast cancers correlate with individual diagnostic modality. Methods: A prospective study was done on 100 patients suspected of breast cancer. Various investigations including radiological investigations, FNAC, biopsy of the lesion was done. Clinical diagnosis, radiological, cytological and histopathology results were combined and compared with individual diagnostic modality. Results: Most common presenting symptom was breast lump seen in 95 cases. Out of 100 cases 47% were diagnosed malignant on radiology, 71% were malignant on Fine Needle Aspiration Cytology and 85% were diagnosed malignant on biopsy. On comparing all the three diagnostic procedures (radiology, FNAC and biopsy), the correlation came out to be highly significant. Conclusion: Though histopathological examination remains the gold standard for the diagnosis of these lesions, but an accurate clinical, radiological and cytological combined approach along with the histopathological examination aids in improving the diagnostic accuracy and reduce morbidity and mortality.
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Background: Climate change has emerged as one of the greatest challenges of the present century. The current study explores the knowledge, attitudes and practices about climate change of the adults aged 18 years and above in Jammu city of North India.Methods: A cross-sectional study was conducted among attendants of the patients visiting medical OPD of a tertiary care teaching hospital. A pilot tested questionnaire eliciting information on knowledge, attitudes and practices about climate change was administered to those who were willing to participate. The data collected was presented in proportions.Results: Majority (95%) of the respondents had heard of the term climate change, and 43.9% of them related it to changes in the weather pattern. Plastic use as a major cause of climate change was agreed upon by 95% of the respondents. About half of the respondents were very much concerned about climate change and 80% of them were very much interested in knowing more about climate change and its impact. Only 24.8% of the respondents read/watch stories on climate change.Conclusions: Knowledge levels of the respondents were found to be reasonably good but the same cannot be said about their attitude and practices. Role of NGOs, social communities and media is of utmost importance to make people aware of the harmful effects of climate change on both the environment as well as the health of the people.
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Background: Fired clay bricks, an important construction material, are manufactured in non-mechanized, labour intensive brick kilns which mostly employ unskilled men and women. The workers, as an occupational hazard, are exposed to dust and air pollution leading to respiratory diseases.Methods: This cross sectional study was conducted among brick kiln workers in RS Pura block of Jammu district. The workers were assessed regarding respiratory symptoms and illnesses using translated version of American Thoracic Society Division of Lung Disease questionnaire (ATS-DLD-78A).Results: 692 brick kiln workers were interviewed during the course of survey and 58.8%of them were males. 45% of the respondents were working since last less than three years. Among the respiratory symptoms chronic cough, was present in 23.55% and phlegm in 22.83% of the respondents. Chronic bronchitis was present in 20.52% of the respondents. Association of respiratory symptoms in relation to sex of the respondents was found to be statistically significant (p<0.05).Conclusions: Respiratory symptoms and illness were found to be quite prevalent in the brick kiln workers. More research needs to be conducted to assess other health risks besides respiratory morbidity. Health planners need to plan for their basic sanitation facilities and periodic check ups.
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Chronic respiratory diseases(CRD) remain a formidable challenge for public health experts acrossthe world due to their ever increasing morbidity and mortality. This study investigated various riskfactors for CRD among rural adults aged 20 years and above. The study was conducted in fourvillages under sub-health centre Domana in Kot Balwal health block and these villages wereselected randomly. For this cross-sectional population based study, a pre-tested respiratory healthquestionnaire was used. Those respondents who were found to be diagnosed cases of CRD werefurther enquired in detail about various risk factors for CRD. Out of 2018 respondents surveyed,177confirmed cases of CRD were detected.Various risk factors like being male, smoking, overcrowding,recurrent chest infections and use of non-clean fuel (wood, cow dung) were found to bestatistically significant. Among other risk factors, ventilation and history of allergy were found tobe highly significant statistically (p< 0.000). Smoking, recurrent chest infections, use of biomass fuel,ventilation and history of allergy were risk factors for CRD in rural adults aged 20 years andabove.
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Background: Cervical cancer is known for its late detection due to a variety of reasons chiefly lack of knowledge, undesirable attitudes and poor practices. Early screening and adequate knowledge about the disease remains the important safe guards against this disease. The study aimed to assess the knowledge, attitudes and practices of the women aged 18 years and above regarding cervical cancer visiting a tertiary care teaching hospital.Methods: The present cross sectional hospital based study was conducted in Jammu city, Jammu and Kashmir, India. All the women aged 18 years and above visiting OPD of gynaecology-obstetrics department of Government Medical College Jammu and willing to participate were administered a pretested questionnaire to collect the relevant data.Results: It was found that 91.56% of the respondents had heard of cervical cancer with 83% reporting that it was both preventable as well as curable. Multiple sex partners were the most important risk factor identified. Among the attitudes, 62% agreed that screening was harmless to the client. Only one third knew about the availability of preventive vaccine. About 83.6% of them had never been screened by Pap smear. However willingness to get HPV vaccination was found to be high.Conclusions: Though knowledge among the respondents was found to be adequate but it lacked transformation into attitudes and practices. In this connection, authors recommend health promotion campaigns to educate women and the community about cervical cancer and its preventability through screening.
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Violence against women a social evil in the society despite a lot of talk of women empowerment. Assessmentof burden in terms of prevalence will go a long way in planning the services for those affected bydomestic violence. To find the prevalence of domestic violence and associated risk factors among marriedfemales in a rural area of Jammu. This community based cross-sectional study was conducted amongrural married females using a structured and pretested questionnaire. Data was analysed using simpleproportions, chi-square test and logistic regression. 171/301(56.6%) of the respondents reported someform of the domestic violence. Psychological, physical and sexual violence rates were found to be32.16%, 9.9% and 2.33% respectively. A statistically significant association was found with variables likeliteracy, type of family, family income, sex of children etc. Relatively high levels of domestic violence inthis rural setting calls for a multidisciplinary approach involving improvement of literacy levels amongfemales, creating awareness about legal aid and screening the victims at primary health centres to mitigatethis problem.
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Background: Women worldwide suffer from various gynaecological disorders that require hysterectomy as a treatment option. Objectives: Our aim was to conduct a histopathological study of various uterine lesions in hysterectomy specimens and to correlate the findings with clinical indications. Methods: A prospective study was done on 200 hysterectomy specimens. The specimens were fixed in formalin and the tissue was adequately processed. The sections were stained with routine Haematoxylin and Eosin stain. Results: In this study the most common clinical indication for hysterectomy was leiomyoma (57.0%) followed by utero-vaginal prolapse (28.5%). Clinical indication of leiomyoma was confirmed by histopathology in 96.5% cases, whereas that of cervical dysplasia, cervical polyp, squamous cell carcinoma cervix, chronic pelvic inflammatory disease, adenomyosis and endometrial carcinoma was confirmed in 100% cases. Conclusion: The ultimate diagnosis and prognosis depends on the histopathological examination; therefore every operated specimen must be subjected to histopathology.
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Scindapsus officinalis (S. officinalis) holds a reputed position in Ayurvedic system of medicine. It has been ethanobotanically used to treat diarrhea (“atisara”), worm infes-tation (“krmiroga”), and as antipyretic. Literature survey on S. officinalis was carried out via electronic search in PubMed, SciFinder, Scirus, Google Scholar, Agricola and Web of Science and a library search. Results revealed that a very specific botanical description of the plant is still not available. The plant is mistaken within the hybrids and other plants of genus Scindapsus and family Araceae. Since ethnobotanically the plant is of much importance, chemistry of the plant yet needs to be fully explored. Thus the need of the hour is to comprehend the fragmented information available on the botany, traditional uses, phytochemistry and pharmacology of S. officinalis which could help in the correct identification of the sample and avoid adulteration due to mistaken identity.