ABSTRACT
Background: Orthopedic implant site infection is major component of surgical site infection associated with high morbidity and mortality. Implants are foreign to the body so that orthopedic surgery is at risk of microbiological contamination .The changes in pathogenic flora has lead to emergence of antibiotic resistance creating problems in the management of orthopedic diseases. The aim of this study was to determine the type of bacterial pathogens isolated from surgical site infection (SSI) in Guru Nanak Dev Hospital attached to Govt. Medical College, Amritsar and their antibiotic sensitivity profile. Methods: During this period of study from August 2018 to July 2019, 509 pus samples were sent to microbiology department suspected as surgical site infection, from orthopaedic department of Government Medical College, Amritsar. Standard microbiological techniques were used to identify the organisms and determine the antibiotic susceptibility pattern as per CLSI guidelines. Results: In the study, out of 397 (77.6%) positive cultures, 109 (27.45%) Gram positive organisms were isolated among whom Staphylococcus aureus 92 (23.17%) was most common and 288 (72.54%) Gram negative organisms were isolated among whom Klebsiella species 90 (22.67 %) was most common isolate. Conclusion: S. aureus is the most common organism responsible for SSIs. Antibiotic preference should be made according to local sensitivity pattern of the hospital.
ABSTRACT
Mastalgia or Breast pain, is a common symptom which women may experience at different time in their lives. Many women worry that pain in their breasts is caused by breast cancer. Breast cancer rarely causes breast pain, however a thorough history and clinical examination by clinician appreciates it. Methods: A descriptive study was carried out in department of general surgery, Govt. Medical College in Guru Nanak Dev Hospital, Amritsar. there is 500 cases of mastalgia collected in Guru Nanak Dev Hospital and diagnosis was made on basis of clinical history and local examination of both breasts. All the quadrants of the breast were examined. Treatment of each patient was done as per the diagnosis. Results: Among 500 Patients 449 patients had cyclical mastalgia were as 51 patients has non cyclical mastalgia. Conclusion: In our study 89.8% of the patients experienced cyclical mastalgia and 10.2% non cyclical mastalgia.
ABSTRACT
Cases of carcinoma breast with TNM stage 3 are considered as locally advanced breast cancer. This study was done to demonstrate the effect of multimodal treatment approach in cases of stage 3 technically inoperable breast cancer. Its effect on clinical response was studied. Methods: This prospective study was carried out in department of general surgery, government Medical College, Amritsar, Punjab. Main part of multimodal approach is neoadjuvant chemotherapy, so in collaboration with department of radiotherapy, relevant data was collected. 25 cases of locally advanced breast carcinoma were studied. These patients were studied on treatment with FAC regimen (as neoadjuvant chemotherapy), then underwent surgical excision (MRM) followed by chemotherapy, radiotherapy and hormonal therapy wherever indicated, and response was assessed. Results: Initially assessment of lump was done after 3 cycle of chemotherapy. 2 patients (8%) have reduction <50%, 22 patients (88%) have reduction in size which ranges between 51- 75% of the initial, remaining 1 patient (4%) has reduction >75% of the initial. Thus making them operable therefore after this they all had undergone modified radical mastectomy. During follow up period no lump was detected clinically, ultrasonographically or radiologically. There was no any loco-regional recurrence in any case. Conclusion: The study demonstrated the effectiveness of neoadjuvant chemotherapy in down staging the tumor enabling definitive surgery with less morbidity.
ABSTRACT
Detecting and characterization of hepatobiliary masses is one of the most confusing and controversial challenges in imaging today. Aims and objectives: To evaluate the role of Ultrasound and Computed Tomography in hepatobiliary masses and know the exact site of origin of lesion and its extension into surrounding structures. Methods: In this study, 100 cases of hepatobiliary masses were subjected to with USG and CECT abdomen. Imaging findings were evaluated and tabulated and correlated with the histopathological findings, surgical findings and follow up. The findings were checked and statistically tabulated. Results: Out of a total 100 patients included for study, most patients were in age range of 51 – 60 years. Males : Females ratio was 55 : 45. Out of 100 cases 73% were hepatic masses, 18% gall bladder masses and 8% common bile duct masses. 51 being true benign and 49 lesions being true malignant. Sensitivity (%) and Specificity (%) of diagnosing these lesions on USG was 84.5% and on 86.6% respectively. Sensitivity (%) and Specificity (%) of diagnosing these lesions on CT was 92.2% and on 94.8% respectively. Conclusion: Hepatobiliary masses remain a diagnostic challenge. These lesions are frequently caused by benign, malignant and metastatic etiologies. We conclude that USG plays an important role as an initial screening modality and as an adjunct to CECT and Triphasic CT in the evaluation of hepatobiliary masses.
ABSTRACT
Epilepsy is treated with anti-epileptic drugs (AEDs) mainly in most of the patients. AEDs are to be initiated after having 2 seizures within a 6-month period. These have been observed to be associated with an increased frequency of hypocalcemia, hypophosphataemia, elevated serum alkaline phosphatase activity, reduced 25-hydroxy Vitamin-D concentrations, and decreased bone mass in patients receiving long term therapy. It is also observed that duration of AED therapy was the most important contributing factor for the alterations of these biochemical parameters. Objective: To study the effect of antiepileptic drugs on serum alkaline phosphatase levels in epileptic patients and to compare the relationship of change with duration of drug intake. Study Design: A Case Control Prospective Study. Methods: A total number of 100 subjects presenting with epilepsy in the OPD of Neurology department of Guru Nanak Dev Hospital, attached to Government Medical College Amritsar, were selected. Results: 50 epileptic patients taking Antiepileptic Drugs for more than 6 months constituted case group and 50 epileptic patients not taking Antiepileptic Drugs constituted control group. The study group patients were further divided according to duration of drug intake. Conclusion: AEDs causes significant increase in Alkaline phosphatase levels and this increase is further related to duration of drug intake.
ABSTRACT
The unhealthy effects of indoor air pollution by cooking fuels is great concern for good respiratory health. Present study was conducted to study and compare the effects of two major fuels used in developing countries like India, Kerosene and Liquefied Petroleum Gas (LPG) in rural women of Amritsar, India. Methods: Study was conducted on 800 rural women out of which 400 using Kerosene as cooking fuel and rest 400 using LPG. Subjects of chronic and recent respiratory illness even if treated were excluded Ventilatory functions of lungs were done on computerized spirometer, MED-SPIRER. Results: There was statistically significant decline in FEV1 in Kerosene using women (0.98±0.47) when compared with LPG using women (1.86±0.37). Other parameters FEV3, PEFR, FEF 25-75%, FEF2-12, FEF 25%, FEF 50% FEF 75% and MVV showed similar significant decline in women using Kerosene as fuel. Conclusion: There is significant decline in ventilator function od lungs in women using Kerosene as cooking fuel, which is still used in developing country like India. Reduced values indicate small airway obstruction.
ABSTRACT
Antiepilectic drug is the main stay of treatment for most patients with epilepsy. These may cause Patients with epilepsy are often required to take antiepileptic drugs (AEDs) for a long period of time. However, prolonged use of AEDs is known to be associated with adverse effects such as metabolic and organ toxicity, endocrine disturbance, negative cognitive effects, and psychiatric problems; particularly with alterations in thyroid function in patients with epilepsy and is thought to correlate with type of AED taken. Objective: To study the effect of antiepileptic drugs on serum thyroid profile in epileptic patients and to compare the relationship of change with type of drug intake. Study Design: A Case Control Prospective Study. Methods: A total number of 80 subjects presenting with epilepsy in the OPD of Medicine of Guru Nanak Dev Hospital, attached to Government Medical College Amritsar, were selected. 40 epileptic patients taking Antiepileptic Drugs for a minimum period of 1 year constituted case group and 40 normal healthy individuals constituted control group. They were again divided according to type of drug intake. Results: AEDs causes significant increase in TSH levels and this increase is further related to type of drug intake. Conclusion: ?
ABSTRACT
Seizure disorder is highly prevalent disorder particularly in developing countries. This study was undertaken to determine the prevalence of seizure disorder of school going children (6-16) years of age in all the six districts of Kashmir. Methods: The selection of schools was done by PPS (proportionate to population size) used in cluster survey. Questioner Performa was given to 60 randomly selected children from each selected school, 30 boys and 30 girls were screened to find out the prevalence of seizure disorder. To give adequate representation to all individuals of various strata both Govt and Private run schools from rural as well as urban areas were selected. Results: A total of 19 positive cases of epilepsy were detected during the survey period, After screening of 5760 children (rural and urban) the crude prevalence of epilepsy was found to be 3.3/ 1000 which is comparable to the other studies in the world. The Male prevalence in school going children was 3.8/1000 while female prevalence of epilepsy was 2.77/1000. Commonest type of seizure was generalized tonic clonic (GTC) 78.9%. Conclusion: The prevalence of seizure disorder in children of lower socio economic class was 3.5/1000.
ABSTRACT
Atopic Dermatitis is a chronic disease that improves and remits with time. It may affect parental life style and parent-child relationship. Psychologically, individuals suffering from atopic dermatitis either children or adults have been shown to suffer a higher level of anxiety and lower quality of life. Objectives: To assess the Severity of AD in the children and quality of life in parents of children with AD. To analyse the relationship of severity and treatment of the disease on the quality of life in parents. Methods: The study comprised50 children diagnosed with AD ranging in age from 6 months to 12 years as well as parents of these patients attending Paediatric Dermatology Clinic at Dermatology department, GGS Medical College,Faridkot from February 2017 to February 2018. The quality of life was quantified by the Dermatitis Family Impact (DFI) Questionnaire. Eczema Severity was assessed using SCORAD Index. These two parameters were evaluated on two occasions 12 weeks apart, meanwhile the patients were managed accordingly. Results & Conclusion: The mean SCORAD and mean DFI Score at the baseline was 32.016 ± 10.78 and 15.14 ± 4.0 respectively. These values decreased to 16.494 ± 6.62 and 12.08 ± 3.34 respectively, at the end of 12 weeks. SCORAD and DFI scores, showed positive correlation which was statistically significant (p=0.04 at both visits), implying that quality of parental life is significantly correlated to severity of AD in the child. Hence, proper management of dermatological illnesses often requires combined evaluation and management of emotional factors as well.
ABSTRACT
Nearly 18 % tuberculosis patients have only extrapulmonary manifestations. Tuberculosis of the breast is an uncommon disease even in countries where the incidence of pulmonary and extrapulmonary tuberculosis is high. It accounts for less than 0.1% of breast conditions in developed countries, but reaches 3–4% in regions where the disease presents with high incidence (India, Africa). The significance of mammary tuberculosis is due to very rare occurrence and usually mistaken identity with breast cancer and pyogenic breast abscess. Radiological imaging is not diagnostic. Diagnosis is based on identification of typical histological features or the tubercle bacilli under microscopy or culture. This disease can present a diagnostic problem on radiological and microbiological investigations, and thus a high index of suspicion is needed. This review is based on the discussion on the important issues relating to the diagnosis, clinical features, and management of breast tuberculosis.
ABSTRACT
Echinococcosis or hydatid disease is caused by larvae of the tapeworm Echinococcus. In cystic echinococcosis, humans are an accidental host and are usually infected by handling an infected dog. The liver and lungs are the most frequently involved organs. Pulmonary disease appears to be more common in younger individuals. Although most patients are asymptomatic, some may occasionally expectorate the contents of the cystor develop symptoms related to compression of the surrounding structures. Other symptoms of hydatid disease can result from the release of antigenic material andsecondary immunological reactions that develop from cyst rupture.
ABSTRACT
Asthma and COPD are the pulmonary diseases most frequently encountered in clinical practice. Usually, each disease is caused by a different etiology and shows a different clinical picture and course. However, these two diseases sometime present within the same patient, and it is now recognized that asthma and COPD can coexist as asthma COPD overlap (ACO), which is clinically important for several reasons. First, it is estimated that the number of patients with ACO will increase significantly together with the recent increase in numbers of patients with asthma and COPD. Secondly, patients with ACO are prone to experience more frequent and severe exacerbations. Patients who have asthma with a COPD component tend to present with severe hypoxia because of Irreversible/fixed airway obstruction and impairment of the alveolar diffusion capacity by emphysematous changes. In contrast, patients with COPD who have an asthma component not only have exertional dyspnea but also develop paroxysmal wheezing or dyspnea at night or in the early morning. Here we report a case of 60 yr old male diagnosed as a case of asthma COPD overlap.
ABSTRACT
Drug resistance is a threat to TB control program worldwide. Patient infected with multiple drug resistant strains are less likely to become cured. Management of resistant cases is complex and presents therapeutic limitations. Patients with multidrug resistant strains are more prone to treatment failure, progresses to more chronic forms of the disease and death. In most areas of the world, the routine use of drug susceptibility tests, let alone cultures to diagnose tuberculosis or multidrug resistant tuberculosis is beyond the scope of health care resources. According to Global Tuberculosis Report 2015, about 3.3% of newly diagnosed patients had multidrug resistant tuberculosis and 20% of previously treated Tuberculosis cases were estimated to have Multidrug resistant Tuberculosis (MDR-TB). This present study was conducted in the department of chest and TB, Government medical college, Amritsar, with an aim to study the clinico-radiological profile of patients with multidrug resistant tuberculosis. Methods: A prospective study was conducted at the Chest and TB hospital, Amritsar which included 100 diagnosed patients of Multidrug Resistant Tuberculosis. Clinicoradiological profile of these patients was determined. Results: Out of 100 study population, maximum number of patients belonged to the age group of 21-30 years i.e. 26% followed by 22% in the age group of <20 years. Most common symptom was cough with expectoration which was present in 94 (94%) patients. 97 (97%) patients were having previous history of ATT, 3 (3%) patients were not having any previous history of ATT. On radiology unilateral disease was present in 48 (48%) patients, bilateral disease present in 52 (52%) patients. Parenchymal infiltration was present in 79 (79%) patients. Cavitation was present in 23 (23%), Fibrocavitary disease was present in 37 (37%) study subjects. Previous history of ATT had significant association with extent of lesion on chest x- ray (p < 0.05). Conclusion: clinico-radiological characteristics should always be determined where appropriately administered drugs have not achieved necessary drug levels to deal with all the population of mycobacteria, to timely modify and strengthen the national programs, and evaluation of trends in drug resistance pattern.
ABSTRACT
Drug resistance is a threat to TB control program worldwide. Patient infected with multiple drug resistant strains are less likely to become cured. Multidrug – resistant and extensively drug -resistant tuberculosis continues to emerge in high HIV prevalence settings, and their mortality in HIV co-infected patients remain high. Methods: This retrospective study was carried out at DR-TB centre, Amritsar. This study included drug resistant TB cases registered over the period of 2012 to 2018 at DR-TB centre, Amritsar. Results: A total of 1163 patients of Drug resistant tuberculosis were registered during the period of 7 years , among these 1027, 39 and 97 patients were of MDR, XDR and isoniazid monoresistance respectively. The prevalence of HIV seropositivity was 2.7%, 2.9% and 2.6% in total drug resistant cases, MDR and XDR cases respectively. No case of isoniazid mono-resistance was found positive for HIV. And only one case with primary MDR tuberculosis was HIV positive. Conclusion: In this high drug-resistant TB settings, previous TB treatment failure was strong risk factor for both MDR and XDR-TB in HIV seropositive patients. And HIV seropositivity was more prevalent in MDR-TB cases.
ABSTRACT
Tuberculosis is the commonest opportunistic infection and the leading cause of death in HIV patients in developing countries and accounts for about 40% of all manifestations seen in HIV patients. Correct diagnosis and treatment of tuberculosis helps to reduce burden of TB. However there are difficulties in achieving this goal such as difficulties in diagnosing tuberculosis in HIV infected patients due to unusual clinical picture with increase in smear negative AFB pulmonary tuberculosis and atypical findings on chest radiography. There is a paucity of literature regarding determination of percentage of HIV seropositivity in smear positive tuberculosis cases in Northern India. Hence, this study was planned to study the correlation and burden of HIV seropositivity in smear positive tuberculosis cases. Methods: A prospective study was conducted at the Chest and TB hospital, Amritsar which included 150 smear positive tuberculosis cases. HIV seropositivity was determined in all the patients. Results: In our study, the HIV seropositivity detected in 150 smear positive tubercular cases was 3.33% which is more than the prevalence seen in most of the northern states and lower than the southern and north eastern states of India. Conclusion: The HIV seropositivity detected in 150 smear positive tubercular cases was 3.33% which is more than the prevalence seen in most of the northern states and lower than the southern and north eastern states of India.
ABSTRACT
Some important challenges for TB control strategies include the increasing prevalence and rapid distribution of drug-resistant TB. Recently, this concern has been further intensified by reports of multi drug resistant (MDR) and extensively drug resistant-TB (XDR-TB). Although resistance to first and second line drugs poses the important risk to patients, resistance to isoniazid (INH) alone is also important. INH is the most potent anti-TB drug and is the main part of any first-line treatment regimen for TB. Our objective is to determine the percentage of isoniazid monoresistance mutations via Kat G v/s Inh A gene. Methods: We conducted a retrospective record review of 100 INH monoresistant TB patients without rifampicin resistance registered during Feb 2017 - March 2018. Results: Of the 100 INH monoresistant patients taken in a year, 82% were found to be resistant via Kat G gene and only 18% were found to be resistant for Inh A gene. Conclusion: In conclusion, our study showed increased prevalence of isoniazid resistance via Kat G gene mutation than with Inh A gene.
ABSTRACT
Blunt injury to abdomen is one of the most common injury caused by road traffic accidents. The advent of newer imaging techniques with high resolution computed tomography scanners (CT scan) has enabled the clinicians to exactly diagnose the extent of the intra abdominal injuries. High grade injuries are commonly managed by surgery but the shift to selective non operative management (NOM) of blunt injuries to abdominal solid organs are one of the most notable trends in the case of trauma. Methods: This study was conducted on 50 patients of blunt abdominal trauma admitted in Guru Nanak Dev Hospital, attached to Govt. Medical College, Amritsar. Patients of all age groups with blunt trauma abdomen were admitted in hospital. Results: In the present study, most common age group affected was 21-40 years (70%); out of which males were more commonly affected (90%); most common mode of injury was road traffic accident accounting for 76% of patients of all age groups. In this study, 2 out of 13 patients expired who were kept on NOM due to liver injuries. Failure to resuscitate these patients was the main cause of mortality. 4 out of 12 operative cases expired. Most common organ injured was liver (50%) followed by spleen (36%). Other organs injured were pancreas and kidney, 6% each. Mortality rate in patients who were receiving NOM was 5.26% while patients who received operative management had mortality rate of 33.3%. Conclusion: Morbidity and mortality can be prevented by timely initial resuscitation and correct diagnosis as well as management (non operative or operative) which depends on patient’s hemodynamic stability and findings of imaging studies.
ABSTRACT
Cholecystectomy is currently a frequent performed operation. The presence of gallstones within either the gallbladder or biliary tree is associated with the bacterial colonization of the bile. Acute cholangitis spans a continuous clinical spectrum and can progress from a local biliary infection to advanced disease with sepsis and multiple organ dysfunction syndrome. Therefore, it is important to know the microbiological flora of the gallbladder before prophylactic antibiotics are given. Aim and objectives: 1.To evaluate the bacteriological profile of bile in patients undergoing cholecystectomy. 2. To determine the appropriate antibiotics for prophylaxis in cholecystectomy patients based on the bacteriological profile of bile in our study. Methods: The study was a prospective study carried out in Guru Nanak Dev Hospital, Amritsar. A total of 100 patients undergone cholecystectomy who met the inclusion criteria were included in the study. Bile was aspirated from all patients, this collected bile from gallbladder was transported to the Microbiology Department in 5cc sterile syringe. The specimen was evaluated to find out whether it is sterile or has any bacteria present. Sensitivity of isolated organisms was done against antibiotics. Results: 25 patients showed positive bile culture (25%), whereas bile was sterile in 75 patients (75%). E.Coli was the most common isolated bacteria (60%) followed by Enterococcus (20%), Staph Aureus (8%), Salmonella (8%) and Pseudomonas (4%). Postoperative wound infection was more common (20%) in group of patients with isolated organisms from bile. Conclusion: 25% of bile samples were culture positive. E coli was the most common aerobic bacteria to be isolated from the bile culture . E. coli, salmonella and pseudomonas were most sensitive to piperacillin + tazobactum and imipenum (100%). E. coli also showed sensitivity to amikacin and gentamicin (73.33% each). Enterococcus was most sensitive to linezolid and ampicillin + salbactum (100%) followed by gentamicin and amoxicillin + clavulanate (80% each). Staphylococcus was most sensitive to linezolid (100%). Antimicrobial susceptibility of potential causative organisms and the local susceptibility pattern must be taken into consideration when prescribing drugs to patients with biliary disease.
ABSTRACT
Aim: Comparing the role and finding sensitivity and specificity of ultrasonography with that of conventional MRI techniques in patients presenting with rotator cuff injury. Methods: 50 patients who presented with shoulder pain and/or disability and clinically suspected rotator cuff tears in orthopedic out patient department (OPD) of Guru Nanak Dev Hospital, Amritsar, referred to department of Radiodiagnosis and imaging for ultrasonography and magnetic resonance imaging. Results: USG shows sensitivity of 83.7%,specificity of 100%,PPV of 100% and NPV of 68.4% for partial thickness tear and 100% sensitivity,specificity ,PPV and NPV in complete thickness tear. The strength of agreement between USG and MRI for diagnosis of rotator cuff tear was found to be (k= 1.0) for full thickness tears (very good agreement) and good agreement for partial thickness tears. Conclusions: From our study, USG is proven to be an effective imaging modality with results comparable with MRI in patients presenting with shoulder pain and /or disability and clinically suspected case of rotator cuff tendon tears.ultrasound by an experienced radiologist should be considered as a primary diagnostic tool for imaging the rotator cuff pathologies. At present, MRI can be reserved for patients with suspicious USG results.
ABSTRACT
Immunophenotyping, although has emerged indispensable in the diagnosis and classification of lymphoid neoplasms, has to be used cautiously with knowledge of the antibodies used. No antigen is totally lineage or lymphoma specific, and for this reason, immunostaining must be performed in the context of a panel. In addition, familiarity with the diagnostic criteria and differential diagnosis of each lymphoid tumor and ultimately correlation with morphology, and clinical history are essential to enhance the diagnostic accuracy and reproducibility. AIM: The present retrospective study aimed to analyse the differentiation and grading of Non-Hodgkin’s lymphoma by immunohistochemical expression of CD20, CD3 and Ki-67 in lymph node. Methods: A total of 50 samples of NHL were included in the study. Written informed consent of the patient was taken where ever required in the vernacular. Relevant history of the patient was also taken as per the proforma attached along with. The tissues were stained with H and E staining, CD20, CD 3 and Ki-67 immunostaining. The positive immunostained slides were then evaluated and scored both qualitatively and quantitatively. Results: In the present study a total of 50 samples of NHL were included with an age range from 12 to 72 years and a mean age of 46.54 years and male predominance.45 cases showed immunopositivity for CD 20, showing that they belong to B cell phenotype and only 5 cases showed immunopositivity for CD 3, thus showing T cell phenotype. The mean Ki-67 for B cell lymphoma patients was 47.86 ±28.04,with a minimum score of 2 and a max score of 92 and for T cell lymphoma patients was 61.4±18.02, with a minimum score of 40 and a max score of 81, but there was no significant correlation between them (P=0.382). Conclusion: Ki-67 expression in NHL can help in monitoring of patients at risk and can to some extent also aid in detecting the degree of aggressiveness of the disease to give suitable treatment but Ki-67 alone cannot be a risk factor in NHL patients and other factors such as age, sex and type of NHL can be affective, too. The outcome of further analyzing the association between Ki-67 expression and the prognosis of various subtypes of lymphoma should be supported.