Relative Risk Analysis of Patient Return Within 72 Hours to Emergency Department.

Introduction: Transparency in patient care in an emergency department can be projected by capturing data from the medical records of patients. Policy makers envision that transparency in this data will allow the patient to choose the right hospital of his choice. Relative risk is a ratio of the probability of an event occurring in the exposed group versus the probability of the event occurring in the non-exposed group. It is usually used in the scenario of clinical events. In this study we have used it to analyse one of the key performance indicators used in Emergency Department, as per Emerald standards. The problem statement identified in the study is the returning of patients to the Emergency department of a private, tertiary care hospital within 72 hours after the initial visit. A revisit in this study is assumed as an unplanned visit done by the patient within 72 hours with similar presenting complaints. Methodology: A retrospective cohort study for all emergency visits between January to June 2021. People who returned to EMD within 72 hours were compared to other non-re attending patients based on medical diagnosis, patient demographics, mode of arrival, triage category and qualification of doctors in charge. Multivariate analysis using the generalized linear model was conducted on variables associated with 72-hour ED re-attendance. Result: Among 18,355 patients, 128 (0.69%) were in the 72-hour re-attendees’ group. Multivariate analysis showed female gender as more, above 60 years of age, arrival by ambulance, triaged as yellow. Among the ICD-10 diagnosis for the patients who returned, it was not possible to identify one specific condition. But abdominal pain was one reason for the re-visit of a few patients. There was also a significant difference in the seniority ranking of the doctor-in-charge between both groups. Conclusion: Identification of characteristics of patients lead to improved care by surgeons and gastroenterology.

Study of morphine with ropivacaine and ropivacaine alone for caudal epidural analgesia in children

Background: Caudal epidural analgesia is one of the most popular and commonly performed regional blocks in pediatric anesthesia. It is reliable and safe technique that can be used with general anesthesia for intraoperative and postoperative analgesia. The aim of this research is to study the effect of morphine (15 µg/kg) with ropivacaine (0.2%) and ropivacaine (0.2%) alone through caudal epidural route on duration of analgesia in children.Methods: The study was performed on 60 ASA grade I and II patients, aged 1 to 7 years scheduled for elective infraumbilical surgeries. After induction of general anesthesia, caudal epidural block was performed. Each group consisted of 30 pediatric patients: group I-caudal epidural 0.2% ropivacaine (1 ml/kg) and group II- caudal epidural 0.2% ropivacaine (1 ml/kg) with morphine 15 µg/kg. Intra-operatively heart rate, blood pressure was recorded at pre-induction, immediately after induction, 5 minutes after administration of caudal block and thereafter every 10 minutes till the completion of surgery. Postoperative heart rate, blood pressure, pain score was assessed periodically till 24th hour.Results: The duration of analgesia was more in group II (7.30±1.78 hour) in comparison to group I (3.93±0.83 hour). The fall in mean arterial pressure and heart rate were not significant in group II as compared to group I.Conclusions: Addition of low dose morphine to ropivacaine resulted in prolonging the duration of analgesia by almost double the duration as compared to ropivacaine alone.

Prevalence of Blindness in Patients with Uveitis.

Introduction: The uvea plays an important role in ocularimmunological defense mechanism. Immunologicallyspeaking, the eye has a deviant and privileged position becauseof the blood retina barriers, absence of lymphatic drainageand a special feature called anterior chamber associateddeviation. This special defense mechanism contributed to thepreservation of vision. If these mechanism fail, intraocularinflammation will arise, which may lead to blindness. The aimof this research is to find out the incidence of blindness inpatients with uveitis.Material and methods: In this study, 50 cases of uveitisattending ophthalmic out patients and those who are admittedin department of ophthalmology, Regional Institute of MedicalSciences, Imphal were studied to find out clinical incidence ofblindness. All the patients were subjected to detailed ocularexamination including visual acuity, slit lamp biomicroscopy,direct/indirect ophthalmoscopy and intraocular pressure wasrecorded.Results: Out of 50 patients examined, 20 cases (40%)developed blindness or visual impairment. Bilateral loss ofvision developed in 5 cases (10%) and unilateral loss of visionoccurred in 11 cases (22%).Conclusion: Uveitis was found to be more common in the agegroup of 21 – 30 years with male preponderance. The maincause of visual loss were secondary glaucoma and cataract.Patients with panuveitis had the worst visual prognosis.

Prevalence of Diabetic Nephropathy in Type II Diabetes Mellitus Patients Admitted to a Tertiary Care Centre in Mizoram

Diabetic Nephropathy is a microvascular complication leading to impairment of renal function which occurs in the patient with long standing diabetes mellitus. Diabetic nephropathy is the leading cause of chronic kidney disease (CKD), end stage renal disease (ESRD) and CKD requiring renal replacement therapy. Furthermore, the prognosis of diabetic patients on dialysis is poor, with survival comparable to many forms of cancer. Fortunately, in the recent years, apart from better metabolic control of diabetes, specific nephro-protective interventions have become available. The true prevalence of diabetic nephropathy is underestimated because proteinuric patients are usually asymptomatic. The aim of this research is to find out the prevalence of microalbuminuria, overt proteinuria and ESRD in diabetic patients. Methods: The study was conducted in the Department of General Medicine, Civil Hospital, Aizawl. Type II Diabetes Mellitus patients admitted in the General Medicine ward were included in the study. 117 cases of type 2 diabetes were subjected to detailed clinical examination and investigations. Blood glucose estimation, urinary albumin excretion rate, 24 hours urinary protein excretion and renal function tests were performed. Based on the results of these tests, patients were classified into four groups: Normoalbuminuria-54 cases, Microalbuminuria-38 cases, Macroalbuminuria-15 cases & ESRD-10 cases. Results: The prevalence of microalbuminuria was 32.5% and prevalence of macroalbuminuria was 21.4%. 8.5% patients had ESRD. 40% of macroalbuminuria patients had end stage renal disease. Conclusion: Age of the patients who had microalbuminuria, macroalbuminuria and ESRD were significantly higher when compared to normoalbuminuric patients. The glycemic control was poorer in patients having microalbuminuria, macroalbuminuria and ESRD group as compared to patients having normoalbuminuria.

Rural population at risk of development of diabetes mellitus: a cross sectional study using Indian Diabetic Risk Score in Bengaluru

Background: Prevalence of diabetes mellitus is increasing in an alarming way throughout the world. More than 50% of the diabetic subjects in India remain unaware of their diabetes status and screening for risk factors of diabetes mellitus enable us to initiate appropriate control measures. This study was undertaken to identify the people who are at risk of diabetes mellitus in rural area of Bengaluru.Methods: It was a community based cross sectional study in which 1750 study subjects were randomly selected using multi stage random sampling method. Selected individuals were examined and interviewed using a semi structured questionnaire. Indian diabetic risk score was used to assess risk of developing diabetes. Data entry and analysis was done using SPSS version 20.0.Results: According to IDRS, 46.2% of respondents were in the moderate risk group and 33.1% were in the high risk group. Family history of diabetes, low physical activity and abdominal obesity were found to associate with high risk group.Conclusions: The prevalence of high risk for diabetes according to IRDS was 33%. Primordial and primary preventive actions are very much necessary.

Comparative study of anthropometric measurements, liver function tests, hemoglobin and plasma glucose levels between individuals with alcohol abuse and controls

Background: Alcohol abuse is global burden to families as well as society. On the ‘years of life lost scale’, which is based on alcohol attributable years of life lost, India has been rated 4 on a scale of 1 to 5. This implies that the alcohol consuming population of our country loses most of the years of their life because of drinking and its consequences. The aim of this research is to compare anthropometric measurements, liver function tests, haemoglobin and plasma glucose levels in individuals with alcohol abuse and normal population.Methods: The study was conducted in the Department of General Medicine, Civil Hospital, Aizawl. 84 cases of individuals with alcohol abuse (as per DSM-IV criteria) within the age group of 18-70 years and 70 age, sex, height and weight matched lifetime abstainers, healthy individuals were taken as controls from medicine department. They underwent a detailed clinical examination, anthropometric measurements, liver function tests, haemoglobin and plasma glucose levels.Results: 15.5% of the individuals with alcohol abuse had hypertension. The mean post prandial glucose among the individuals with alcohol abuse was 116.8±12.3 mg/dl and among the controls was 121.1±11.0 mg/dl. Mean serum bilirubin 1.1 mg/dl, AST 79 IU/l & ALT was 79.6 in alcoholics. The mean serum bilirubin 0.8 mg/dl, AST 27.2 IU/l and ALT was 29.4 in non-alcoholics.Conclusions: The individuals with alcohol abuse have raised serum bilirubin, AST and ALT levels compared to the non-alcoholics. Prevalence of hypertension is higher in the individuals with alcohol abuse compared to normal population.

Effect of antiretroviral therapy on progression of endothelial dysfunction in acquired immune deficiency syndrome patients

Background: Though the natural history of Human Immunodeficiency Virus (HIV) infection in many patients has been dramatically altered through the use of antiretroviral therapy, this treatment paradigm of chronic chemotherapy may not be sustainable given the short and long-term toxicities of these medications. Currently, there is lack of data in the Indian literature regarding study of endothelial dysfunction in HIV patients. The purpose of our research was to study the effect of anti-retroviral therapy on the progression of endothelial dysfunction in HIV/AIDS patients.Methods: The study comprises a total number of 30 adult HIV positive patients of both sex with confirmed HIV seropositivity and CD 4+T cell count < 200/µl. None of these patients had ever received anti retroviral therapy (ART). These patients were subjected to detailed clinical examination and markers of endothelial dysfunction - Flow mediated vasodilatation (FMD) of brachial artery, S. Nitrite and C-reactive protein (CRP) were performed before starting ART. Study group patients were started on ART, they received triple drug ART (Lamivudine 150 mg BD, Stavudine 30 mg BD, Nevirapine 200 mg BD). In patients on ART after a period of 6 months, markers of endothelial dysfunction - FMD, S. Nitrite and CRP tests were reassessed.Results: FMD (4.08±3.58) and S. Nitrite (20.83±13.75) were also depressed after six months of anti retroviral therapy. Also, patients showed more CRP positivity and higher titres after ART. CD 4+T cell count before ART (124.16±84.46) and after ART (186.63±70.96). This rise in count was statistically significant.Conclusions: HIV patients who are receiving ART demonstrate a number of metabolic abnormalities with more severe depression in markers of endothelial function.

Study of C-Reactive Protein Significance in Chronic Kidney Disease

Introduction: Chronic kidney disease (CKD) is a worldwide major disease, both for the number of patients and cost of treatment involved. Screening for CKD at an early stage helps to initiate specific therapy to reduce the progression of renal disease and burden of end stage renal disease (ESRD). Patients with CKD and ESRD show elevated acute phase C-reactive protein (CRP) levels as a consequence of chronic inflammatory states. The aim of this research was to study the significance of CRP with objective of finding an association between the CRP and parameters of other co-morbidities. Material and methods: The study was conducted in the Department of General Medicine, Civil Hospital, Aizawl. Chronic kidney disease patients admitted in the General Medicine ward were included in the study. 140 CKD patients fulfilling the inclusion and exclusion criteria were included to study the significance of CRP in CKD. CKD is defined as kidney damage or GFR < 60 ml/min/1.73 m2 for 3 months or more. All the patients selected for the study was investigated for serum CRP, Albumin, Creatinine, eGFR and ankle brachial index. Results: Most common past history of CKD patients was hypertension (29.3%) and diabetes mellitus (21.4%). >10 mg/L CRP patients serum albumin range (3.43±0.982 gm/dl) was significantly lower than <10 mg/L CRP patients (5.40±1.169 gm/dl). >10 mg/L CRP group eGFR range (35.74±7.54 ml/ min/1.73 m2 ) was significantly lower than <10 mg/L CRP group (42.39±11.47 ml/min/1.73 m2 ). Conclusion: This study shows a high rate of inflammation in CKD patients as seen by high CRP levels. High CRP levels are associated with lower eGFR and lower serum albumin levels

A cross sectional study to assess the morbidity pattern among under five year old children in urban Chitradurga, South India

Background: Children under 5 years of age constitute approximately 15% of the country’s total population. First 1000 days of life is the most crucial period, as this age is known for high growth rate and development. They constitute most vulnerable section of the society and suffer from highest morbidity. Good personal hygiene and sanitary condition of living now forms a part of primary health prevention strategy and it is found to be effective for reducing morbidity and mortality in children.Methods: It’s a community based cross sectional study among 150 children of less than five years of age for a period of 4 months from November 2018 to February 2019 in the urban field practice area of Basaveshwara Medical College and Hospital, Chitradurga.Results: In our present study we found respiratory tract infection is the predominant ailment followed by gastrointestinal clinical features accounting for 39% and 33% respectively. Though the factors like birth weight, immunisation of majority of population were fair but in later years of life found that weight for height was not achieved as per standard protocol among major of the study population.Conclusions: By health education for the caretaker regarding mother-crafting and satisfactory environmental condition can reduce the prevalence of morbidity.

Prevalence of endothelial dysfunction in acquired immune deficiency syndrome patients and its correlation with degree of immunodeficiency

Background: Number of factors play a role in endothelial dysfunction observed in AIDS patients, which can lead to atherosclerosis along with cardiovascular mortality and morbidity. Human immunodeficiency virus (HIV), the etiologic agent of AIDS causes several vascular disorders characterized by an evident activation and perturbation of endothelial cells. Currently, there is lack of data in the Indian literature regarding study of endothelial dysfunction in HIV patients. The purpose of our research was to study the prevalence of endothelial dysfunction in HIV/AIDS patients.Methods: The study comprises a total number of 60 adult HIV positive patients of both sex (male and female) with confirmed HIV seropositivity. The patients were divided into two groups of 30 each, depending on the degree of immune dysfunction (CD 4 cell counts). Group I- patients with CD 4+T cell count>200/µl and group II-patients with CD 4+T cell count<200/µl. These patients were subjected to detailed clinical examination and markers of endothelial dysfunction-flow mediated vasodilatation (FMD) of brachial artery, S. nitrite and C-reactive protein (CRP) were performed.Results: The defect in endothelial function was most prevalent in patients with more severe immunosuppression. FMD of brachial artery was decreased in patients with CD 4+T cell count < 200/µl (7.07±2.89, p=0.00). S. nitrite was also significantly lower in group II patients (26.43±15.38), and these patients also showed more CRP positivity and higher CRP titres ranging from 1.2 mg/dl to 9.6 mg/dl.Conclusions: The defect in endothelial function was most prevalent in patients with more severe immunosuppression. FMD of brachial artery was decreased in patients with CD 4+T cell count <200/µl (7.07±2.89, p=0.00). S. nitrite was also significantly lower in group II patients (26.43±15.38), and these patients also showed more CRP positivity and higher CRP titres ranging from 1.2 mg/dl to 9.6 mg/dl.

Study on absolute eosinophil count correlation with severity of bronchial asthma

Background: Bronchial asthma is defined as chronic inflammatory disease of the airways that is characterized by increased responsiveness of the tracheobronchial tree to a multiplicity of stimuli. Eosinophil infiltration is a characteristic feature of asthmatic airways. It presents as an obstructive type of ventilator defect usually diagnosed from a reduced FEV1% (Forced Expiratory Volume) or from a reduced peak expiratory flow (PEF) associated with reduced airway caliber during expiration. Allergen inhalation results in a marked increase in activated eosinophils in the airways. Correlation between the degree of bronchial hyperresponsiveness (a cardinal feature of asthma) and peripheral blood eosinophilia has been observed in patients with dual response following allergen challenge.Methods: The study comprises a total number of 50 bronchial asthma patients of both sexes (male and female) between the age groups of 13-65 years. Based on severity, asthma patients were classified into mild, moderate and severe asthmatics, assessed by FEV1% computerized Spirometry Helios model number 701, recorders and medicare system. Peripheral blood sample was collected from each patient for absolute eosinophil count, the count was done on the same day.Results: The mean±SD absolute eosinophil count of 50 patients is 330±88.64 which is slightly above normal (300 cells/mm3). Author found that the mean±SD absolute eosinophil count of 405±83.16 in severe asthma patients is quite high, corresponding with a steep decline in the FEV1% 45.3±12.6.Conclusions: Absolute eosinophil count and FEV1% are important indicators of bronchial asthma severity and can even be used to predict disease progression.

Prevalence and risk factors associated with severe acute malnutrition (SAM) in ICDS block of rural Hubli, Karnataka, India

Background: Malnutrition is one of the leading causes of morbidity and mortality in children under the age of five years in developing countries. Despite economic growth of nearly 10% per annum, in India in 2006 the NFHS-3 indicated that 6.4% of children below 60 months of age were suffering from severe acute malnutrition. This study was undertaken to know the prevalence and the risk factors associated with SAM in ICDS block of rural Hubli.Methods: This was a cross sectional observational community based study conducted in the ICDS block of rural Hubli. All children in the age group of 0- 59 months were included in the study. The study is conducted by the department and it is self-funded by the authors, no monetary benefit either from the institute or from the government or its organization.Results: Among 1796 children who were examined in present study, the prevalence of SAM children was 5.79% (104 children). 48% were in the age group of 37 months to 59 months. Male: female ratio was 2:3. 51% of the mothers and 47.1% of fathers were illiterate. 82.7% of the parents had per capita income belonged to class 5 of the modified B.G. Prasad classification. 60% of the SAM children were seen in families who had 3 or 4 children. Maternal anemia, IUGR and PIH were seen in 53.6%, 21.6% and 18% respectively. Low birth weight (<2.5kg) and Birth asphyxia were seen in 80.6% and 11.1%.Conclusions: The risk factors for SAM were illiteracy, low per capita income, high order births, maternal anemia, IUGR, PIH, low birth weight and Birth asphyxia. Due emphasis should be given in improving the knowledge and practices of the parents on appropriate infant and young child feeding practices.

Study on antipyretic property of the leaves of Ligustrum robustum

Background: Thorough pharmacological experiments on various plants used in traditional medicines are in progress in order to establish their effectiveness and safety. But modern drugs or conventional medicines are often viewed as impersonal, emphasizing crisis intervention. Keeping in view the above idea, the present study is undertaken on the plant Ligustrum robustum to explore its antipyretic property in albino rats.Methods: Healthy young albino rats weighing between 100-250gm were obtained for the study. The animals were divided into five groups with six animals in each group. Pyrexia was induced by subcutaneous injection of dried yeast in 2% gum acacia in normal saline at a dose of 20ml/kg body weight below the nape of the neck in albino rats. The antipyretic activity of the aqueous extract of Ligustrum robustum was tested by yeast induced method. The data were subjected to ANOVA followed by Dunnett’s ‘t’ test for statistical significance between different groups.Results: Ligustrum robustum in doses of 100mg/kg, 200mg/kg and 400mg/kg significantly reduced the temperature (p<0.05 to 0.01) in the 3rd and 4th hour after drug administration.Conclusions: Present study concludes that the aqueous extract of the leaves of Ligustrum robustum showed significant antipyretic property in the standard experimental animal models.

An Unusual Termination of Facial Vein and Anterior Division of Retromandibular Vein into External Jugular Vein: A Case Report

Facial vein, being the largest vein of the face forms the common facial vein after joining with the anterior division of retromandibular vein below the angle of the mandible. Usually, it drains into the internal jugular vein. During routine dissection of head and neck region of a male cadaver, aged approximately 50 years, an unusual pattern in the termination of veins on the left side of the neck was observed. The formation, course and termination of external jugular vein were normal. The anterior division of retromandibular vein joined with external jugular vein about 5 cm above the clavicle and the facial vein opened into the external jugular vein about 2.5 cm above the clavicle. In addition, there was a thin venous communication between anterior division of retromandibular vein and external jugular vein. The superficial veins of the neck are often used for cannulation; either for intravenous infusion or for central venous pressure monitoring. Furthermore, these venous segments are used as a patch for carotid endarterectomies. Hence, a thorough knowledge of the normal anatomy and their variations may be useful for performing these procedures.