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Background: This study aims to assess the relationship between appendiceal perforation peritonitis and serum bilirubin levels, as has been reported previously in the literature.Methods: A retrospective observational study was conducted at tertiary care hospital of India, namely Government Medical College-Srinagar, Maulana Azad Medical College-Delhi and Government Medical College-Jammu over a period of five years (January 2014 to December 2018). Authors collected and analysed the data of 306 patients, who had reported to the surgery emergency of the afore mentioned hospitals with complaints of acute abdominal pain and were later confirmed and managed as appendiceal perforation peritonitis (localized or generalized). Also, liver function tests of these 306 patients had been sent at the time of admission.Results: Authors had 202 males and 104 females with an average age of 35 years in this study group. Hyperbilirubinemia was noted in 226 patients, with an average serum bilirubin level 1.8 mg/dl. In patients having total leucocyte counts higher than 11000 cells/cumm, the average serum bilirubin level was 2 mg/dl.Conclusions: It may be safely concluded that a pre-operative evaluation of serum bilirubin levels may help us in better diagnosing appendiceal perforation when used in conjunction with other routine and advanced diagnostic modalities.
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Background: Acute appendicitis is one of the commonest surgical emergencies. Authors undertook this study to evaluate serum bilirubin levels in acute appendicitis and appendiceal perforation.Methods: A retrospective study evaluating the serum bilirubin levels in acute appendicitis and appendiceal perforation was carried out for 6 years at three tertiary care hospitals at India from 2014 to 2019. Patients having acute appendicitis and appendiceal perforation, confirmed on histopathology, with no other medical or surgical comorbidity were included in the study.Results: The total number of our study subjects was 927. 306 patients had appendiceal perforation, amongst these, 226 (74%) had hyperbilirubinemia. Out of the 621 patients having acute appendicitis only 186 (30%) had hyperbilirubinemia. The lowest and the highest serum bilirubin levels of this study group were 0.6 and 3.1 mg/dl, respectively, with an average of 1.6 mg/dl. In patients diagnosed to be having acute appendicitis, the lowest and highest serum bilirubin levels were 0.6 and 2.4 mg/dl, respectively, with an average of 1.3 mg/dl. As for the patients having appendiceal perforation the lowest and highest serum bilirubin levels were 0.8 and 3.1 mg/dl, respectively, with an average of 1.8 mg/dl.Conclusions: Hyperbilirubinemia is seen in acute appendicitis but predominantly in appendiceal perforation, so serum bilirubin estimation may help us in diagnosing appendiceal perforation pre-operatively if and when used in conjunction with other available diagnostic modalities.
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Background: Pyogenic Liver abscesses are potentially life threatening if left untreated. They pose a major Diagnostic and therapeutic challenge to modern world. Interventional radiology is becoming standard of care for liver Abscesses.Methods: All patients of pyogenic liver abscess admitted to Government Medical College and hospital Jammu, J and K, India from October 2018 to November 2019 were prospectively studied. Demographics, presentation, lab reports and management strategies were evaluated.Results: Total of 60 patients of pyogenic liver abscesses were studied with 81.7% males. Alcohol was found to be most common risk factor with 55% of patients being alcoholic. Right lobe of liver was involved in 66.7% of patients. Segment VI and VII were involved in 50% of patients. The most common clinical symptom was right upper quadrant pain (98.3%), followed by fever (91.7%). The most common clinical sign was right upper quadrant tenderness (91.7%). Percutaneous drainage with catheter placement was the most common and successful modality of management associated with least hospital stay.Conclusions: Pyogenic liver abscess is a rare but serious problem. Early diagnosis and treatment are necessary to avoid mortality. Percutaneous drainage along with I.V antibiotics is the best form of management.
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Background: Reindeer lichen, Lichen rangiferinus syn. or Cladonia rangiferina (L.) F. H. Wigg. (Cladoniaceae) has been traditionally reported as a remedy to treat fever, colds, arthritis as well as convulsions,liver infections, coughs, constipation, and tuberculosis. The current study is aimed at rectification ofalcohol induced liver damage by the use of L. rangiferinus extract.Objectives: The aim of the study was to compare some biochemical markers for liver injury and hematological indices in normal untreated rats and treated rats.Material and Methods: The study was performed using male Wistar rats. Animals were categorized intofive groups, negative control group (normal diet only), treated groups (2 groups were lichen treatedalong with 10% ethanol & 1 group was only ethanol treated) and positive control group (Silymarin + 10%ethanol) of six animals in each group. Biochemical markers for liver injury and hematological indices ofall animals were measured using standard diagnostic tools. The animals were then sacrificed and liverswere sent to the pathology lab for histopathological analysis.Results: Lichen extract showed a significant restoration of altered biochemical parameters towardsnormal in both in vitro and in vivo conditions. The total phenolic and flavonoid content of the LRE wasfound to be 21.78 mg PE/mg of extract and 5.13 mg RE/mg of extract respectively. The IC50 values foratranorin and fumarprotocetraric acid were found to be 128.48 and 218.46 mg/mL respectively.Reducing power of the extract was found to be quite significant. After administration of lichen extract,endothelial cells were less injured around central vein and number of fat vacuoles was also lesser inhepatocytes.Conclusion: Conclusively, treatment with lichen extract assuages alcohol-related damage and guardshepatic tissue from alcohol-induced toxicity.© 2017 Transdisciplinary University, Bangalore and World Ayurveda Foundation. Publishing Services byElsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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Background: Perceived health (PH) is a subjective assessment of the health and it is a strong, independent and reliable predictor of morbidity, mortality. It includes so many aspects that are difficult to capture clinically such as incipient disease, physiological, psychological reserves. We assessed the impact of diabetes mellitus (DM), hypertension (HTN), co-morbidity and other associated factors on the general health (GH) dimension of the PH of the patients attending the outpatient department (OPD), Inpatient department (IPD), rural health training centre (RHTC) and urban health training centre (UHTC) of Shri Ram Murti Smarak Institute of Medical Sciences (SRMS, IMS), Bareilly.Methods: PH status of the patients was assessed by the GH dimension of the physical component summary of PH using the 36-Items short form health survey (SF-36).Results: The impact of morbidity deteriorate the GH score but hypertensive patients scored poor results as compared to those with DM and comorbid patients (p>0.05). Age was inversely related with GH scores but male gender, higher education (p<0.05) and good occupation were all associated with higher GH score. There was not much influence of geographical area on the GH scores but urban score slightly better and the association was insignificant (p>0.05).Conclusions: Male young patients from urban area, educated and good job performed better score for GH and association was significant for education and occupation. The presence of morbidity and co-morbid condition deteriorate the GH of the patients. The impact of various socio-demographic factors on the PH status was also evident in the study.
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Background and Objectives: Cervical cancer is very common type of cancer in women globally. The objective of this study was to compare the cytopathological findings of the cervical pap smears using the revised 2001 Bethesda system and to compare the cytopathological findings with the clinical features.Material and Methods: A total of 1016 pap smear sent to the Department of Cytopathology at Peoples Dental college general hospital (PDCH), Kathmandu over a period of three years were studied. Relevant history and clinical findings were retrieved for the study. The age, caste, location, gravida of the patient, the nature of complaint of patient to the doctor along with the per speculum findings, per vaginal examination findings of the patient and their relation to the cytopathological findings of pap smears were evaluated.Results: No significant relationship was observed between the (30-39 years) aged women and the available outcome of pap smear (p=0.404). Most of the females were Brahmin and Newars. The statistical analysis showed no significant relationship (p>0.05) between the ethnicity and pap smear result. The number of asymptomatic women in this study was found 22.9%. This study found 20.37% of intraepithelial lesion or malignancy. Trichomonas vaginalis and bacterial vaginosis combinely contributed to 0.7% of the total cases in this study. Three smear cases were detected having malignant epithelial cell which were diagnosed with adenocarcinoma, squamous cell carcinoma.Conclusion: In this study cervical pap smear was able to differentiate inflammatory, benign precursors and malignant cases. So, it is desirable to conduct routine Pap smear screening in women of all reproductive age regardless of race, ethnic background and socioeconomic status.
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Aim: The present study was undertaken to establish the potential role of Achyranthes aspera Linn for cure of skin diseases. Study Design: The plant is traditionally used by various tribes for curing a wide range of diseases. A 50% ethanolic extract of the leaves was subjected to phytochemical studies and further investigated for in vitro antioxidant and antibacterial activities. Place and Duration of Study: CSIR-National Botanical Research Institute (NBRI), Lucknow, between December 2012 and November 2013. Methodology: In vitro antioxidant activity was determined by DPPH free radical scavenging assay, hydroxyl radical scavenging activity, β-Carotene-linoleic acid assay and reducing power assay. Antibacterial activity was studied by agar well diffusion method. Results: The total phenol and flavonoid content was estimated to be 3.363% and 6.36% respectively. The HPTLC analysis showed the presence of oleanolic acid, lupeol and β- sitosterol. The free radical scavenging activity of the extract was concentration dependent and IC50 was observed at a concentration of 62.24μg/ml for DPPH free radical scavenging activity and 68.32μg/ml for hydroxyl radical scavenging activity. The extract showed significant total antioxidant activity and reducing power. Antibacterial activity was studied by well diffusion method and the MIC was recorded at 0.75 mg/ml for S. aureus, 0.8 mg/ml for M. luteus, 2.75 mg/ml for E. coli and 0.8 mg/ml for P. aeruginosa. Conclusion: The results obtained from current study demonstrate that the leaf extract of Achyranthes aspera L possess significant antioxidant and antibacterial properties. Presence of various classes of phytocompounds e.g. Phenols, flavonoids, saponins, alkaloids etc. contribute highly to its medicinal values, thus indicating its potential for cure of skin diseases.
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Aims: The study aims to understand the wound healing potentials of a 50% aqueous ethanolic extract of Premna latifolia stem using excision wound model. Study Design: The wound healing potentials were simultaneously supported by observing the bacterial functional diversity of wound swabs using Biolog Eco plates. The antioxidant activity was performed using In vitro DPPH free radical scavenging assay. Place and Duration of Study: CSIR-National Botanical Research Institute (NBRI), Lucknow, between May 2013 and November 2013. Methodology: Wound healing activity of the plant was studied using excision wound model. Animals were divided into three groups of six male rats each as control group (GI) dressed with compound free simple ointment. Test group (GII) treated with 50% aqueous ethanolic extract of P. latifolia stem (10% w/w) in ointment vehicle and standard group (GIII) group treated Nitrofurazone ointment, Himedia (0.2%w/w). The wound healing potential was further supported by the DPPH free radical scavenging and antibacterial activity of the plant. The phytochemical estimations were done using standard methods. Results: Sugar and starch content in the plant was 3.55% and 5.54% respectively. Total tannins, phenol and flavonoid content were estimated to be 0.18%, 0.54% and 2.73%. The 50% ethanolic extract of the plant showed moderate DPPH free radical scavenging activity with an IC50 of 188.02μg/ml. A 69.15% of wound closure was observed on 10th day post wounding of the rats treated with 200 mg/kg of extract. The results also indicated significant antibacterial activity of the extract. Conclusion: The 50% aqueous ethanolic extract of P. latifolia shows significant wound healing activity.
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Aims: Objective of the study was to investigate the wound contraction and antiinflammatory activity of the 50% ethanolic extract of Fumaria indica (Hausskn.) Pugsley (Fumariaceae) by excision wound model and estimation of pro-inflammatory and antiinflammatory cytokines. Study Design: Prospective. Place and Duration of Study: Department of Pharmacognosy and Ethnopharmacology, CSIR-National Botanical Research Institute, Lucknow, India. December 2012 to May 2013. Methodology: Dried powdered whole plant of Fumaria indica was extracted with 50% ethanolic extract. The extract was subjected to HPTLC fingerprinting, DPPH free radical scavenging and antibacterial activities. Further, 10% F. indica ointment was tested for its wound contraction, pro-inflammatory and anti-inflammatory potentials. Results: The 50% ethanolic extract showed presence of ellagic acid, ferulic acid andquercetin. The IC50 was 0.11mg/mL and significant antibacterial activity was observed against S. aureus and E. coli. The 10% F. indica ointment applied topically to the wound area reducedits size from 500 mm2 to 40 mm2 by the end of 9th day. These results were comparable to the effect of 0.2% nitrofurazone. The extract further showed a reduction in the release of pro-inflammatory cytokines (TNFα and IL-6) and an increase in antiinflammatory cytokine IL-10.
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Aims: The aim of the study was to evaluate the effect of the standardized ethanolic extract of Andrographis serpyllifolia leaves on experimentally induced typhoid. Study Design: Single dose of 1 ml Salmonella Typhi (106 CFU/mL) was administered orally to rats to induce typhoid in rats. Blood culture test confirmed typhoid infectioned rats received orally the ethanolic extract of Andrographis serpyllifolia at dose levels of 200 and 400 mg/kg twice daily for 10 days, respectively and control animals received physiological saline. Place and Duration of Study: CSIR-National Botanical Research Institute (NBRI), Lucknow, between December 2011 and June 2013. Methodology: Leaves of Andrographis serpyllifolia was extracted with ethanol and concentrated on rotavapour. Single dose of 1 ml S. Typhi (106 CFU/mL) was administered orally to rats with the help of orogastric tube to induce typhoid in rats. After seven days, typhoid confirmed rats received the standardized extract subsequently subjected to in vitro antimicrobial susceptibility test. Results: The treatment with ethanolic extract of Andrographis serpyllifolia at dose level of 200 mg/kg showed 75.0% to 87.5% protection and 100% protection observed at higher dose of 400 mg/kg on widal, blood culture and typhidot test respectively. Biochemical test carried out on blood culture isolates confirmed the presence or absence of S. Typhi. A. serpyllifolia extract at a concentration of 1.50 mg/disc showed antimicrobial activity susceptibility against S. Typhi. Conclusion: Andrographis serpyllifolia leaves extract showed antimicrobial activity against S. Typhi and accomplished the extract of A. serpyllifolia is recommended for clinical applications in the treatment of typhoid.
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Four hundred patients who presented in the emergency of GMC Jammu as a case of perforation peritonitis over a period of two years were studied. In most of the cases diagnosis was made by clinical examination supplemented by investigations in the form of standing X-ray chest PA view with domes of diaphragm, Ultrasound abdomen and abdominal paracentesis. Contrast enhanced CT scans of abdomen were conducted on patients where the diagnosis of perforation peritonitis was doubtful. After resuscitation, Laparotomy was done in all the patients and thorough peritoneal lavage was done. A note of the site, size, type, number of perforations was made and biopsy was taken from the edge of the perforation whenever indicated. The most common cause of gastrointestinal perforation in our study was duodenal ulcer perforation, followed by appendicitis, typhoid perforation, blunt/penetrating trauma, gastric perforation, obstruction, iatrogenic, malignancy, and recurrent perforation. Primary closure of the perforation was most commonly done procedure, followed by appendectomy, resection anastomosis of the gut and exteriorization of the gut. The overall mortality was 6 % and morbidity in the form of wound infection, fever, respiratory complications, residual abscess, dyselectrolytemia, burst abdomen, jaundice, sepsis, cardiac complications, anastomotic disruption was present
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We report a case of a 30 year old female who presented with features of septic abortion with peritonitis 2 days after unsafe abortion of a 20 week pregnancy with uterine perforation with intrabdominal fetus with mesenteric and bowel injury that required bowel resection.
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This is a prospective study to assess the accuracy of the Alvarado Scoring System in predicting acute appendicitis in our set up.100 consecutive patients with suspected acute appendicitis were included in the study. They were given specific scores according to variables of Alvarado scoring system and then divided into 3 groups. Group A included patients with score of 7 or more and they underwent surgery, Group B included patients with score of 5-6 and they were admitted for observation and Group C included patients with score of 4 or less and they were discharged after symptomatic treatment. Patients from group B with increased symptom intensity (score 7 or more) in re-evaluation underwent surgery. Diagnosis was confirmed by histopathological examination. Reliability of scoring system was assessed by calculating negative appendectomy rate and positive predictive value .Out of a total of 100 patients 74 underwent surgery and appendicitis was confirmed by histopathological examination in 62 patients, thus giving negative appendectomy rate of 16.21% and positive predictive value of 83.79%.Alvarado Scoring System is a simple, easy and reliable tool in the diagnosis of acute appendicitis.