Risk factors of type 2 diabetes mellitus in rural population of Karad, Maharashtra, India: an observational study

Background: Non-communicable diseases like DM2, cardiac diseases, chronic respiratory disorders, brain disorders like stroke have created a havoc in developing countries, especially India which harbors 2nd largest population in the world. The present study was planned in this area to capture the data regarding epidemiology, risk factors of DM2, and use this information to plan health program to formulate effective preventive measures, including raising general awareness about the disease in that geographical area.Methods: The present cross sectional study was carried out in population of Karad area of Satara district in Maharashtra state. The study duration was of 1 year, from 1st February 2018 to 1st February 2019.Results: Out of total 1100 study population in the present study, 99 (9%) were diagnosed as diabetics (DM2) while 1001 were normal/non-diabetics. Majority of the diabetic patients were of the age group 41 to 50 years. Females (47%) showed slightly more prevalence of diabetes as compared to males (53%). Majority of the diabetic patients were having sedentary lifestyle, which consisted of 69 patients (70%), which was statistically significant, as compared to non-diabetic group.Conclusion: Thus, findings of the present study amply clarifies that DM2 is on longer a disease of urban population. Its prevalence is increasing in rural population, as well. Lack of awareness, sedentary lifestyle, faulty dietary habits, etc. are some of the reasons for such high prevalence.

Derangements in thyroid hormone status in seriously ill patients: does it matter?

Background: Derangements in stress hormone levels i.e. steroids, thyroid hormones is routinely encountered in almost all the seriously ill patients, which have been found to be associated with morbidity and mortality. The present study was planned to assess the thyroid hormone derangements in seriously ill patients, with respect to mortality.Methods: The present study was a retrospective, observational, record-based study done at Krishna Institute of Medical Sciences, Karad, Maharashtra, India.Results: Out of total 170 patients, 108 were females (63.5%) and 62 (36.4%) were males. On age wise analysis, it was found that majority of the patients were in the age group >50 years comprising of 78 (45.8%) patients. Thyroid hormonal status was deranged in 94 patients (55%), out of which 53 (31%) died and 41 patients (24%) were alive. Most common derangement was seen in free T3 (triiodothyronine), with 60% of the patients showing lowered values, 35% showing raised values and 5% showing normal values. T4 (thyroxine) levels were normal in major bulk of the patients.Conclusions: Serum T3 levels should be routinely done in critically ill patients, to detect any thyroid disorders, which might go undetected until it is too late.

A clinico-epidemiological analysis of subclinical hypothyroidism in a tertiary care health center

Background: Subclinical hypothyroidism (SCH) is defined by increase in serum thyroid stimulating hormone (TSH) and free thyroxine (FT4) and free triiodothyronine (FT3) levels within normal range, coupled with absence of typical clinical symptoms. The present study was undertaken to analyse the SCH associated comorbidities, especially lipid disturbances, thyroid autoantibodies, etc.Methods: The present study was retrospective observational study, which was carried out at a tertiary health care center.Results: Out of the 100 patients, majority were in the age group 21 to 30 years (31 patients), followed by 26 patients in age group >51 years and least in age group 41 to 50 years. Prevalence showed female predilection, with female: male ratio of 1.9:1. Most common symptom reported was general fatigue, which was encountered in 40 patients, followed by weight gain, menstrual abnormalities, and constipation. 10 patients were asymptomatic. Serum TSH range in the patients was 5 to 21.1 µIU/l, while mean TSH was 10.9 µIU/l. 20 patients were found to have serum TSH>10.Conclusions: Despite high prevalence, detection rate of subclinical hypothyroidism is very low. Carrying out epidemiological study on national scale is need of the hour, as lack of typical clinical features makes the detection less likely and it has numerous complications, if untreated

Clinical profile and outcome of respiratory distress in newborns admitted in rural tertiary health care centre of Maharashtra, India

Background: Respiratory distress is most common symptom complexes seen in newborn infants lead to high mortality. The objectives were to study various etiological factors, maternal and neonatal risk factors for development of respiratory distress along with need for CPAP, mechanical ventilation and surfactant to assess the immediate clinical outcome in newborns.Methods: The study was conducted at Krishna Hospital and Medical Research Centre, Karad in period of January to August 2018. A total of 100 neonates who were admitted in NICU within 72 hours of life were studied by clinical examination and relevant investigations. The severity of distress was assessed by Silverman-Anderson scoring, Downe's scoring and APGAR scoring respectively for neonates.Results: It was observed that max, 90% of the distress cases were of respiratory in origin and high severity of distress was observed among 27% newborns. The proportion of respiratory distress was higher, 51% in males and low APGAR score was reported in 14% cases. Among respiratory etiology of respiratory distress, high proportion was of TTNB 35.55%. The maternal and new born factors like maternal age >30 years (32%), gestational age 28-30 weeks (87.5%), gravid 2 and 3 mothers (35%), female gender (32.6%), low birth weight (70%) developed severe distress respectively. The recovery rate of respiratory distress due to respiratory etiology was of 88.8%.Conclusions: Transient tachypnoea of new-born is the most common cause among new-borns with respiratory distress. New-borns with low gestational age, low birth weight baby, low APGAR score is more prone to develop severe respiratory distress.

Single Port Laparoscopic Appendicectomy versus Open Appendicectomy in Cases of Appendicitis.

Background: Appendicectomy is the treatment for appendicitis. A recent development in Appendicectomy has been the introduction of less invasive single incision laparoscopic surgery. There are still many unanswered questions regarding efficiency of this new technique in terms of benefits, cosmetic outcome, complications, etc. To study and compare the outcome, effectiveness and safety of single port laparoscopic Appendicectomy with that of open appendectomy. Methods: This comparative study was carried out to analyze and evaluate the advantages and disadvantages of single port laparoscopic appendicectomy over open appendicectomy. The patient Age, sex, time of surgery, start up time, anesthesia given, Post-operative pain, Period of Nil by Mouth, Hospital stay and Post-operative complications were studied and compared. Results: The study of 137 patient revealed Single port laparoscopic appendicectomy better over open appendicectomy in terms of early resumption of oral feeds, shorter duration of stay, early resumption of daily activities and excellent cosmetic results. All these advantages are at a cost of slightly increased duration of surgery, steep learning curve and higher overall cost. Conclusion: Going by our study we definitely find an overall advantage of single port laparoscopic appendicectomy over Open appendicectomy.

High-grade myxofibrosarcoma-presented as a large mass of right upper arm.

Myxofi brosarcoma is one of the rare soft tissue sarcomas. We present a case of a 65-year-old male having large soft tissue mass over right upper arm associated with surface ulceration. On histopathological study tumor was diagnosed as myxofi brosarcoma – high grade according to modifi ed FNCLCC grading system. Like many other tumors of connective tissue, soft tissue sarcoma exhibits high recurrence. In our case, tumor showed features of high grade with local recurrence, large size; however, no evidence of metastasis was noted. For this unpredictable clinical behavior, we are presenting this case.

Metastatic primitive neuroectodermal tumor involving testis.

A 40-year-old male patient presented with enlarging mass over left leg region. Incisional biopsy report revealed an undifferentiated malignant round cell sarcoma, for which above-knee amputation was done. One year later, the same patient presented with left testicular swelling which appeared to be malignant. A left high orchiedectomy was done. Biopsy report showed metastatic round cell tumor, which was confirmed by immunohistochemistry as primitive neuroectodermal tumor. Metastasis to testis is very uncommon.

Pseudohermaphrodite presented as an irreducible inguinal hernia.

Absence of antimuellerian hormone or defective functioning of antimullerian hormone type II receptors give rise to a type of male pseudohermaphroditism known as 'persistent muellerian duct syndrome'. Such patients are phenotypically male with 46 XY karyotype and well developed muellerian duct derivatives which may be intra-abdominal or may herniate in inguinal region giving rise to a condition called as 'hernia uterine inguinale'. Cryptorchidism, transverse testicular ectopia and hypospadias are few anomalies associated with this syndrome. Though orchidopexy while leaving the uterus and fallopian tube in situ is an accepted surgical management, compromisation of blood surply to the testes or the vas may occur as vasa efferentia are embedded in the wall of uterus.

Fine needle aspiration cytology diagnosis of aneurysmal bone cyst: a case report.

Aneurysmal bone cyst is a relatively rare tumour accounting 1 to 6% of all primary bone tumours. The involvement of clavicle is even rare with incidence of only 3% of all cases of aneurysmal bone cyst. Aneurysmal bone cyst is an expanding osteolytic lesion occurring mostly at metaphyseal ends of the long bones. Although excisional biopsy is diagnostic for aneurysmal bone cyst and FNAC (fine needle aspiration cytology) is mostly inconclusive. Still FNAC can be helpful in pre-operative diagnosis of aneurysmal bone cyst.

FNAC diagnosis of MPNST--a case report.

Malignant peripheral nerve sheath tumour (MPNST) is a relatively rare tumour arisingfrequently in patients with neurofibromatosis, type I (NF1). It is usually a high grade sarcoma. A 65 year old female patient presented with a swelling in left popliteal fossa of two months duration. She had multiple nodular lesions all over the body since childhood. She was subjected to fine needle aspiration for the popliteal mass and was reported as MPNST which was confirmed on histopathology. She developed recurrence within four months time. The prognosis of MPNST is poor. Fine needle aspiration cytology is a very useful, rapid sensitive and inexpensive investigative procedure for the diagnosis of soft tissue tumours and can replace an open biopsy for the diagnosis of MPNST in patients with neurofibromatosis-1.

Schwannomatosis presenting as a painful gluteal swelling--a case report.

A 58 years old male came with a painful swelling in right gluteal region. On examination a small mass was found which was subsequently excised. Histopathological study reported presence of presumptive schwannomatosis, as there were 4 tumours composed of Antoni A and Antoni B areas along with Verocay bodies. As post-operative MRI scan of base of brain and ophthalmological examination of patient failed to reveal vestibular schwannomas and ocular stigmata of neurofibromatosis type 2 (NF-2) respectively, a final diagnosis of definite schwannomatosis was made.