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Introduction: Asthma is a chronic lung disease characterised by reversible airway obstruction, cellular infiltration, and airway inflammation. The reaction is characterised by the interaction of genetic and environmental variables, as well as the activation of cells in the innate and adaptive immune systems. Method: The study was conducted in the Department of General medicine, in Tertiary Care Center, to study association of serum level of Vitamin D3 and pulmonary function in bronchial asthma patients. As per inclusion and exclusion criteria ,137 patients of bronchial asthma were included in the study. Result: In cases having serum vitamin D3 level <20 ng/ml mean value of FVC, FEV1, FEV1/FVC ratio, was 108.10�.89, 68.56�.40, and 62.35�17. In cases having serum vitamin D3 20-29 ng/ml, mean value of FVC, FEV1, and FEV1/FVC ratio was 109.72�.22, 72.34�.48, and 64.39�97. In cases having serum vitamin D3 >30 ng/ml mean value of FVC, FEV1, and FEV1/FVC ratio, was 115.0�27, 81.0�09, and 70.52�00. Conclusion: Vitamin D3 deficiency was highly prevalent in asthmatic patients, there was a strong correlation between asthma severity and vitamin D3 concentrations and there was a direct and a positive significant correlation between vitamin D3 levels and pulmonary function test in asthmatic patients.
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Background: Three or more waves of COVID 19 pandemic have hit the different parts of world including India very hard, taking toll on the lives of people both in terms of morbidity and mortality. Keeping this in mind, the present study was conducted with an aim to determine the socio-demographic and clinical profile of laboratory confirmed COVID 19 cases and to determine their association with oxygen requirement and outcome of disease at the time of discharge. Methods: The present cross-sectional study was conducted on lab confirmed COVID 19 cases admitted in tertiary care hospital in Jammu from June-July 2021.Data was collected using convenient sampling method. The self-designed questionnaire used for data collection obtained information regarding socio-demographic characteristics of patients as well as clinical features of the disease. Results: Out of total 161 patients studied, 60.8% were males and 39.2% were females. Mean age was 51.2 ± 17.5 years. Comorbid conditions were present in 37.8% patients, with hypertension being the most common ( 36%). Cough, Fever, breathlessness and myalgia were the main presenting symptoms (90%, 81%, 57.7% and 56% respectively). The variables which were found to have statistically significant association with oxygen requirement and the outcome of disease at the time of discharge were age, gender and presence of co-morbidity (p <0.05). Conclusions: Advancing age, male gender and presence of underlying co-morbidity were found to be significant risk factors for the requirement of oxygen and poor outcome of the disease.
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Introduction : The Coronavirus disease 2019 (COVID-19) primarily involves respiratory system but may also affect the Cardiovascular System leading to abnormal ECGs. Its early recognition is crucial as it may be associated with increased mortality. Hence we aimed to find out various Electrocardiographic (ECG) manifestations of COVID19 patients admitted in a Tertiary Care Hospital and its relation to disease severity. Methods : We performed a hospital-based retrospective observational study between April, 2021 to November 2021 and analyzed the ECG changes at admission by three Cardiologists according to standard definitions and diagnostic criteria. Results : Out of 579 patients, ECG of 473 was available for analysis. ECG was normal in 227 (48%) and abnormal in 246 (52%) patients. Most common abnormal ECG finding in COVID19 patients was Sinus Tachycardia(19.5%) and less common findings were Sinus Bradycardia (5.3%), Incomplete Right Bundle Branch Block (RBBB) (3.2%), atrial fibrillation (2.5%), complete RBBB (2.3%), atrial premature complexes (2.3%), S1Q1T3 pattern (2.1%), first degree AV block (1.5%), ST-T wave changes (1.3%), Atrial flutter (1.1%). In mechanically ventilated patients, incidence of acute Right Ventricular Pressure Overload (RVPO) related ECG findings were more frequent. Conclusion : There is a wide spectrum of ECG manifestations in COVID-19 patients which varies depending upon the severity of COVID as well as prior Cardiovascular status, associated comorbidities and need for ventilatory support. Knowledge of ECG changes might help in risk stratification and triaging of COVID-19 patients.
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Background: Each year in India, roughly 28 million women experience pregnancy and 26 million have a live birth. Of these, an estimated 67,000 maternal deaths and one million new-born deaths occur each year. A woman dies as a result of complication arising during pregnancy and childbirth every 90 seconds in the world, and every 7 minutes in India. The three delay model can be used to find the causes of delays in relation to maternal deaths.Methods: A retrospective study was carried out in a tertiary care centre. All cases of maternal mortality between July 2010 to June 2016 were included in the study. Then data analysis was done.Results: Out of the total 382 maternal deaths, Majority of maternal deaths 43% were due to type 1 delay. 150 patients had delay in seeking help, 9 patients refused treatment and 5 patients refused admission to health care centre. 13% maternal deaths were due to type 3 delay which include delay in receiving adequate treatment, Delay in diagnosis and intervention, Lack of facilities etc.Conclusions: Type-1 delay was major contributors of maternal deaths in the study region. Therefore, to prevent the preventable maternal deaths effective action should be taken.
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Background: Indicators showing levels of nutritional status in children are often regarded as representative of the health and general well-being of a society at large. Malnutrition stands as a consequence of several key social and economic factors such as lack of education, inadequate health care services and ill-informed cultural behaviors.' In order to holistically address the issues surrounding malnutrition, a comprehensive understanding of the multi-dimensional complexities at play in society is crucial. Objective was to identify determinants of severe acute malnutrition among children with severe acute malnutrition under 5 years (between 6 months to 60 months) of age. Methods: A cross sectional study design involving 64 patients with severe acute malnutrition between 6 to 60 month of age was employed to identify the risk factors of severe acute malnutrition among children admitted in pediatric wards and nutritional rehabilitation centers, Civil hospital Ahmedabad, from April 2018 to march 2019. A detailed history of all the patients were taken and data collected using structured interviewer-administered questionnaire.Results: Thus, from the above study, it is clear' that age of the child <2 years, female gender, bigger family size, poverty, illiteracy in mother, poor feeding practices, improper complementary feed introduction, poor nutritional status of mother whose child were breastfed, acute or chronic illness in child and narrow birth spacing were the chief determinants of SAM in under five children.Conclusions: Socio demographic characters, nutrition and child caring practices, infection and other childhood illness as well as obstetric history of mother are important determinants of severe acute malnutrition in children under five years of age. As a result, collaborative efforts should be organized to improve promotion of better child caring practices through appropriate age specific child and maternal feeding practices, prevention and early treatment of acute childhood illnesses and promotion of family planning.
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Background: Obstetric hysterectomy is an important procedure in modern obstetrics and its proper indications, risks and complications need to be studied for judicious usage and improvement in outcome.Methods: A retrospective, record-based study was carried out over one and a half years at a tertiary care government hospital. All the patients who underwent emergency obstetric hysterectomy at the study centre during study period were studied. Labour room register, operation room register for emergency and elective cases, case records, referral slips and mortality register data were reviewed for the same and outcomes analysed.Results: Total 33 patients underwent emergency obstetric hysterectomy, with the incidence observed at 0.21%. The most common indications were atonic post-partum hemorrhage (42.4%), uterine rupture (33.3%) and morbidly adherent placenta (18.1%). Prior cesarean section (36.4%) and placenta previa (15.1%) were the commonest predisposing factors associated with PPH and uterine rupture. Subtotal hysterectomy (66.7%) was observed to be the preferred type of surgery. Out of total 7 maternal deaths that occurred, 4 (57%) were because of disseminated intravascular coagulation.Conclusions: There is increasing trend in the rate of obstetric hysterectomy along with rise in rate of previous LSCS, emphasizing the importance of the mode of delivery. Measures to reduce the rate of primary cesarean section are advisable.
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Background: Adverse drug reaction, usually reported by pharmacovigilance, either through health care professionals or the patients themselves is of utmost importance to give an accurate estimate of the severity of the drug and also if the ADRs are casual, preventable or severe.Methods: A total of 42 patients satisfied the WHO definition of ‘adverse drug reactions’ were included in the study. The demographic details were taken, and the regular physical examination and clinical examination was done for all the patients. The latest drug they were on and the dosage were analyzed and the type of reaction was assessed. The causality, severity and preventability were also assessed.Results: Majority of the ADRs were found in the medicine department, followed pulmonology, obstetrics-gynecology and paediatrics. B-lactams were the major cause of ADRs with 42.2%, followed by NSAIDs with 23.8%, fluoroquinolones with 19% and 9.5% due to antitubercular drugs. 66.7% of the ADRs were mild, 28.6% were moderate and 4.8% were severe. The most common type of ADR were skin rashes (40.5%), urticara (16.7%), headaches (26.2%), insomnia (21.4%), diarrhoea (21.4%), abdominal pain (14.3%) and vomiting (4.8%). Most of the ADRs were evaluated as probably preventable (69%), definitely preventable (26.2%), non preventable (4.8%).Conclusions: Most of the drug reactions are mild and preventable. More health care professionals as well as patients need to be aware of the drug reactions at much early age so as to prevent the condition before it becomes serious.
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Background: Urolithiasis is a common disease entity seen in medical practice. Various studies from different areas of the world indicates higher male preponderance. Our study was done to find out the gender, age and area of distribution of Urolithiasis in a tertiary urology centre in upper Assam.Methods: Our study was a retrospective study done between January 2018 to June 2018. Data was collected from the records. A total of 1041 patients were examined during this period, out of which 307 patients were diagnosed and treated for urolithiasis.Results: Out of 307 patients, 228 were males and 79 were females. Male to female ratio was 2.9:1. The maximum number of patients in the age group was between 30-39 years. Majority of the patients were from the Dibrugarh district of upper Assam. Most of the positive urolithiasis cases was fund in patients consuming a non-vegetarian diet.Conclusions: Urolithiasis is a disease with preponderance in adult males. Geographical distribution, age and diet are factors that affect the occurrence of the disease.
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Leprosy is a major public-health problem in developing countries like India. Studies pertaining to proportion and characteristics of pediatric cases are few in number. As these reflect indirectly the effectiveness of programme, this study has been carried out to know the clinical, bacteriological and histopathological characteristics of childhood leprosy cases who came to Dermatology Venerology Leprology (DVL) Outpatient Department of a Tertiary Care Centre in South India over a period of 2 years (from January 2015 to December 2016). This prospective observational study had 26 (23%) pediatric cases of leprosy out of 113 who attended DVL OPD. The age of childhood leprosy cases ranged from 10 to 18 years with mean of 14 years. 76% cases were males and 24% cases were females. 84% cases presented with hypopigmented, anaesthetic patches, 11% cases with grade 3 disabilities and 3% with tingling and numbness of both feet. 80% cases were MB and 20% were PB. 76% of children had multiple skin lesions and 24% had single skin lesion (SSL). Of the 20 multiple skin lesions cases examined histopathologically, 11 showed features of BT, BL and LL with overall concordance of 55% (11/20). Among cases clinically classified as MB, 33 % cases were smear positive. Overall 7/26 ( 26%) of child cases in our study were bacteriologically positive. Only 19% of patients had history of contact within the household. 8% cases developed LR. Six cases had deformities. The mean duration of symptoms was around six months. All the patients were treated with MDT. The present study though small and may/may not be representative of distribution/profile of leprosy in children at population level indicates the severity of childhood leprosy in society as evidenced by MB nature, high bacteriological positivity and unacceptable disability rate. After in depth studies at community level, strategy need to be improved to ensure early diagnosis and treatment.
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Study of profile of leprosy in a Tertiary care Centre in an Urban Metropolitan settings has important epidemiologically relevant messages. This study has been carried out to find out the profile of leprosy patients attending a Tertiary Care Centre at Kolkata and to interpret data in respect to different epidemiological variables. The cases attending R.G. Kar Medical College for the year 2014-2017 and who were referred to Microbiology Department for slit skin smear examination were studied. Their profile analyzed according to age, sex, type of disease, past treatment, presentation of disease, deformity status, presence of reactions, bacteriological status of the patients and treatment history. Diagnosis was based on the clinical assessment and slit skin smear for Bacteriological Index (BI) as well as Morphological index (MI). Among 2380 cases 720 (30.25%) were females and 1660 (69.75%) were males. Maximum patients (74%) belong to upper lower (Class IV) socio-economic class. 20-40 years age group was reported as peak age of onset with average onset of age as 35 years, 7.56% were children below 15 years of age. Maximum patients (63.87%) were in reproductive age group. Multibacillary (BL/LL) cases are more prevalent (71.47%). 21% of cases were bacteriologically positive with 10.9% having >3+ BI. MI upto 25% was observed in 92% of 360 smears examined for this purpose. Proportion of type 1 reaction was more than type 2 in both males and females. 440 (18.5%) had reactions, 12.6% had type 1 and 5.9% type 2 reactions. Reactions in females were more associated with pregnancy/ lactation. 24% of cases had grade I disability whereas grade II disability was present in 14% of cases which indicates delayed diagnosis and inadequate management or both. Both grade 1 and grade 2 were more in males. Leprosy was found to be more prevalent in males, more prevalent in upper lower (Class IV) socioeconomic class and more commonly of borderline type. Strategy need to be fine tuned to improve early detection, more focus on females during the reproductive years and appropriate intervention to reduce overall morbidity and deformity/disability
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Background: Spinal dysraphism refers to a spectrum of congenital anomalies of the spine resulting in a defective neural arch through which meninges and / or neural elements herniated leading to a variety of clinical manifestations. Aim: This study aimed to evaluate the incidence, clinical presentations, and surgical outcome in spinal dysraphism patients. Materials and methods: This study was a retrospective study which consisted of 32 patients conducted in Academy of Medical Sciences, Pariyaram over a period of March 2015 to March 2017. All the patients were admitted in Department of Gynecology and Pediatrics. Results: The incidence was high in females 54.29% than males 45.71%. Spina bifida aperta (open type) was present in 44 patients (62.86%) and more common than Spina bifida occulta (closed) which was present in only in 26 patients which constituted 37.14%. The commonest site of occurrence of spinal dysraphism was the lumbo sacral region in 32 patients which constituted to 45.7%. Most common finding was myelomeningocele in 41 (58.6%) cases; myelocele was seen in 6 cases (8.6%). Lipomyelomeningocele was seen in 8 cases which was most common finding in closed type. The most common associated anomaly was hydrocephalus in 25 patients and next common was Arnold Chairi malformation type 11 in 20 cases. Motor weakness in the form of paraparesis or paraplegia present in25 patients preoperatively, out of which only 14 improved. Major cases of sensory deficits did not improved and remained static. In the majority of cases of 11 sphincter function, 6 cases remained status quo same as in the preoperative period. Conclusion: The most common congenital cause of disability in children is spinal dysraphism encountered by paediatric neurosurgeon. Open type spina bifida is more common than closed one .At Premlal KV. A Retrospective Analysis of Clinical Profile and Surgical Outcome in Patients with Spinal Dysraphism at Tertiary Care Center. IAIM, 2018; 5(5): 63-68. Page 64 peripheral centres, inadequatetreatmentshouldbeavoided.Spinaldysraphismpatientsshould be referred to higher tertiary centre where all the facilities are provided to the patients.
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Background: Surgical site infection is a common cause of morbidity for the operated patients. Hence a cost effective and simple method was formulated and studied on cases of laparotomy and appendicectomy patients which can be categorized as dirty and contaminated wounds. Materials and methods: 25 cases and adequately matched controls were selected from patients who underwent laparotomy or appendicectomy which can be categorized as dirty or contaminated wounds. Cases were given local application Inj. Amikacin over the subcutaneous plane preoperatively and for the subsequent three post-operative days through a subcutaneously placed feeding tube along with systemic iv antibiotics. The control patients only received systemic IV antibiotics. ASEPSIS scoring was used to grade the post-operative surgical site infection in the cases and the corresponding controls, at the end of the first and second week after surgery. Various criterions were specifically evaluated such as the isolation of microbe from the wound site or the requirement of change of antibiotic at the end of the 1st or 2nd week and the tendency of prolonged stay in the hospital for more than 2 weeks. Results: It was observed that the cases that received the local Amikacin application as an adjuvant to systemic antibiotic showed significantly lesser incidence and/ or grading of SSIs in the first week and A.K. Rajendran, C. Arun Babu, Gnana Sezhian. To evaluate efficacy of local Amikacin therapy as an adjuvant to parenteral antibiotics in control of surgical site infection compared to parenteral antibiotic alone in a tertiary care centre. IAIM, 2018; 5(2): 64-71. Page 65 also lesser, but not statistically significant reduction of SSIs in the second week. The incidence of antibiotic change, hospital stay and isolation of microbe from the wound site was statistically found be to lesser in the study group compared to their controls. Conclusion: It is observed that the local therapy as an adjuvant is cost effective and without any significant local or systemic adverse effects in the prevention of SSIs in dirty and contaminated patients. But it was also observed that it did not have sustained effect for prolonged period beyond its time of administration (as evidenced by its lesser effect in the second week after surgery). It may be suggested that a further combination of suction drainage of the subcutaneous DT along with local antibiotic treatment may have added advantage in further preventing SSIs.
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Abstract: Background and Objectives: Pemphigus vulgaris is a chronic autoimmune disease characterized by the formation of intraepithelial blisters in skin and mucosa. In majority of the patients the initial manifestations of pemphigus vulgaris appears in the oral mucosa followed at a later date by cutaneous lesions. Detection of the oral lesions can result in an earlier diagnosis and early treatment thereby decreasing the hospital stay of the patients. Objective: We review the clinical and epidemiological aspects of oral pemphigus vulgaris in patients attending tertiary care centre. Methodology: All patients diagnosed as having Pemphigus in the department of skin during last 6 years were included in the study and data analysed. Results : Out of 91 patients diagnosed as having pemphigus during the period of 6 years, pemphigus vulgaris was the most common type ( 91.2 % ) . The mean age of onset was 45 years . Male to female ratio in the patients with pemphigus vulgaris was 1:1.5 . Oral lesions were found in 84 % of patients and it was the first manifestation in 66% of cases. Results & Conclusion: Pemphigus vulgaris was the most common condition seen, oral cavity being the initial site of disease presentation.
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Background & objectives: Although depression is a significant co-morbid condition in chronic illnesses, little is known about the prevalence or risk factors for depressive symptoms in patients with chronic obstructive pulmonary disease (COPD) in India. This study was undertaken to investigate the presence and risk factors of depression in the COPD patients attending a tertiary care health facility in north India. Methods: COPD was classified according to GOLD stages based on forced expiratory volume in one second (FEV1) in 126 stable patients. Depression was examined by administering the nine-item Hindi version of Patient Health Questionnaire-9 (PHQ-9). Linear regression model was used to examine association between predictor variables and risk of depression with adjustment of age and sex. Cronbach alpha was calculated to assess internal consistency of PHQ-9. Results: In the study population as whole, 33.3 per cent patients showed moderate to severe depressive symptoms whereas 20.6 per cent patients had major depressive disorder on PHQ-9 Scale. Educational and occupational status, body mass index, FEV1, respiratory symptoms, physical impairment and dyspnoea were found to be potential predictors of depression in COPD patients. Interpretation & conclusions: One fifth of the patients with COPD had severe symptoms of related to depression, which was especially higher with severity of COPD. Hence, the patients with COPD should focus on management of these two conditions. Further, future studies should be conducted to assess the role of depression management and timely treatment of it in patients with COPD.
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Background & objectives: Although depression is a significant co-morbid condition in chronic illnesses, little is known about the prevalence or risk factors for depressive symptoms in patients with chronic obstructive pulmonary disease (COPD) in India. This study was undertaken to investigate the presence and risk factors of depression in the COPD patients attending a tertiary care health facility in north India. Methods: COPD was classified according to GOLD stages based on forced expiratory volume in one second (FEV1) in 126 stable patients. Depression was examined by administering the nine-item Hindi version of Patient Health Questionnaire-9 (PHQ-9). Linear regression model was used to examine association between predictor variables and risk of depression with adjustment of age and sex. Cronbach alpha was calculated to assess internal consistency of PHQ-9. Results: In the study population as whole, 33.3 per cent patients showed moderate to severe depressive symptoms whereas 20.6 per cent patients had major depressive disorder on PHQ-9 Scale. Educational and occupational status, body mass index, FEV1, respiratory symptoms, physical impairment and dyspnoea were found to be potential predictors of depression in COPD patients. Interpretation & conclusions: One fifth of the patients with COPD had severe symptoms of related to depression, which was especially higher with severity of COPD. Hence, the patients with COPD should focus on management of these two conditions. Further, future studies should be conducted to assess the role of depression management and timely treatment of it in patients with COPD.
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Good knowledge and practice regarding diabetic foot care will reduce the risk of diabetic foot complications and ultimately amputation. This study is conducted to assess patients’ knowledge and compliance of diabetic foot care. A cross sectional study performed on patients who were admitted to HSNZ from the 1st September 2013 to 30th April 2014 for diabetic foot infections. They were interviewed with a questionnaire of 15 ‘yes’ or ‘no’ questions on foot care knowledge and practice. Score of 1 was given for each ‘yes’ answer. The level of knowledge and practice, whether good or poor, was determined based on the median score of each category. The result was tested using a chi-square test in SPSS version 17. A total of 157 patients were included in this study with a mean age of 56.33 years (31-77). There were 72 male (45.9%) and 85 female (54.1%) patients with the majority of them being Malays (154 patients, 98.1%). Majority of the patients (58%) had poor foot care knowledge while 97 patients (61.8%) had poor diabetic foot care practice as compared to the median score. Based on the chi square test of relatedness, there was no significant association between knowledge and practice with any of the variables. In conclusion, the majority of patients admitted for diabetic foot infections had poor knowledge and practice of diabetic foot care. Education regarding foot care strategies should be emphasized and empowered within the diabetic population.
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Diabetic FootABSTRACT
Aim: Human Immunodeficiency Virus (HIV), Hepatitis B (HBV) and Hepatitis C (HCV) viruses are the major causes of chronic viral infections globally and their prevalence has been extensively reported in the literature in various study groups including general population, health care workers, sex workers, homosexuals, pregnant woman. There are only fewer reports of Seroprevalence in tertiary care centers. We aim to study the trends of such infections in a tertiary care teaching hospital located at South India. Study Design: This is a prospective study conducted over a 5 year period (2008-2012). Place and Duration of Study: Department of Microbiology, Prathima Institute of Medical Sciences, Karimnagar, Andhrapradesh, India from 2008-2012. Methodology: We performed a prospective study of patients presenting at the Prathima institute of medical Sciences, a rural tertiary care teaching hospital over a period of 5- years (Jan 2008 to Dec 2012). Screening for anti-HIV I and 2, HBsAg detection and anti- HCV antibodies test were carried out by commercially available enzyme linked immunosorbent assay (ELISA). Results: Of the 16796 individuals tested a total of 570 (3.3%) showed seropositivity to one of the three viral infections tested. Among the population tested 258(1.5%) were seropositive for antibodies against HIV-1, and none showed HIV-2 seroprevalence (0%). Prevalence of Hepatitis B and Hepatitis C were found as 305(1.8%) and 7(0.04%) respectively. Co-infection of HIV-1 with Hepatitis B was observed only in 10(0.06%) cases. Conclusion: The present study revealed that there was a slight increasing trend for Seroprevalence of HIV- 1 antibodies among the tested population. Hepatitis B surface antigen Seroprevalence has shown a gradual increase during the last five years. Seroprevalence rates of Hepatitis C viral infection also showed an increasing trend through a five year period.