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Background: Multiple myeloma is the second most frequent malignancy which constitute 13% of hematologic cancers. Thrombotic and hemorrhagic complications have been frequently observed in multiple myeloma patients. Methods: The study was conducted in the department of pathology, Government medical college Srinagar. A total of fifty (50) patients were recruited for the study. The patients were advised coagulation profile and complete myeloma profile. Results: Our findings indicate that prolonged PT is associated with high serum IgG levels. A mild to moderate correlation was seen with kappa-free light chains and an inverse correlation was seen between PT and lmbda-free light chains. Conclusions: Screening of multiple myeloma for hemostatic abnormalities at the diagnosis should improve prognosis in such cases.
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This systematic review critically investigates the administration of the Bacillus Calmette-Guérin (BCG) vaccine in neonates with severe combined immunodeficiency (SCID). The BCG vaccine, derived from Mycobacterium bovis, is a live attenuated vaccine recognized for its significant role in mitigating the impacts of tuberculosis (TB) in endemic areas. Despite its beneficial effects in controlling TB, safety and efficacy concerns have been raised when the vaccine is administered to SCID patients, who have a severe dysfunction or absence of the immune system. The potential for the vaccine to lead to severe complications due to the immunocompromised state of SCID patients necessitates a comprehensive investigation. To better understand these issues, a thorough literature review was carried out, integrating data from clinical trials and observational studies available on the PubMed database. An extensive review and analysis of 32 relevant articles revealed substantial evidence of complications from BCG vaccination in SCID patients. These findings emphasize the urgency for a more effective pre-vaccination screening process to circumvent potential adverse effects. Given the crucial role of the BCG vaccine in controlling TB, its potential to induce severe complications in SCID patients warrants careful consideration. Therefore, this review proposes an in-depth screening algorithm for newborns before BCG vaccination administration. The goal is to prevent these adverse events, offering critical insights to health policymakers, researchers, and clinicians in the field.
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Mesoamerican nephropathy (MeN) also known as chronic kidney disease of unknown etiology (CKDu) is prevalent in agriculturally rich areas. The most widely accepted pathophysiological explanation for MeN is chronic dehydration caused by prolonged exposure to the sun. Other theories include oxidative stress, chronic inflammation, infection and tubulointerstitial fibrosis. The clinical presentation is quite vague and is diagnosed similar to CKD from any cause using blood, urine analysis and ultrasound. The study highlights the need for interdisciplinary cooperation among physicians, epidemiologists, toxicologists, and geneticists while identifying significant research gaps and future objectives. Occupational health related to agriculture is not emphasised enough especially in third world countries where a large chunk of population heavily depend on farming. To safeguard the population at risk, the significance of community-based initiatives, occupational health measures, and regulatory changes is emphasised.
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Background and Objective: Cardiovascular disease (CVD) is a significant cause of morbidity and mortality worldwide, with high-risk patients requiring effective management to reduce their risk of cardiovascular events. Bempedoic acid is a novel therapeutic agent recently approved as an add-on therapy to statins in patients with uncontrolled LDL-c. Bempedoic acid inhibits cholesterol synthesis in the liver, which ultimately reduces the risk of cardiovascular events. Therefore, the present study aims to assess the efficacy and safety of bempedoic acid in patients with uncontrolled LDL-c (Previously on moderate or high-intensity statins) with a high risk of CVD in real-world settings. Methods: This is a multicenter, retrospective, observational study on the data of high-risk-CVD patients collected from Bempedoic Acid on Efficacy and Safety in patients (BEST) Registry. The clinical data of 140 patients who were already on statin therapy and were receiving Bempedoic acid at a dose of 180 mg, along with measurements of the level of LDL-c, HbA1c, HDL, TG, TC, PPPG, FPG, AST, ALT, serum creatinine was taken into consideration. The primary outcome includes a change in LDL-c level, and secondary outcomes involve a change in the level of HbA1c, HDL, TG, TC, PPPG, FPG, AST, ALT, and serum creatinine at week 12 and 24. Adverse events were reported at both time points. Results: A total of 140 patients were included in the present study with a mean age of 51.8 ± 9.2 years and had primary confirmed diagnosis of dyslipidemia with uncontrolled LDL-c. The mean levels of LDL-c decreased from the mean baseline value of 142.67 ± 46.49 mg/dL, to 106.78 ±33.92 mg/d; a statistically significant reduction by 23.23% (p < 0.01) at week 12. Similarly, at week 24, the mean LDL-c value reduced to 90.39 ± 38.89 mg/dL. A 33.38 % decrease was observed (p < 0.01). Other parameters such as non-HDL, FPG, PPPG, AST and serum creatinine also showed statistically significant reduction at week 12 and week 24. Conclusion: The present study demonstrates that bempedoic acid is an effective add-on medication in lowering LDL-c levels in high-risk CVD patients with uncontrolled LDL-c.
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Renal artery stenosis (RAS) is a major contributor to the prevalence of secondary hypertension. Fibromuscular dysplasia and atherosclerosis are commonly responsible for the occurrence of the disease. Medical therapy is the primary means of treatment for RAS. However, surgical interventions for revascularization are also considered, in selected group of patients, which can effectively cure hypertension and chronic kidney disease. An older man presented at Venus hospital, Surat, Gujarat with the complaints of severe dyspnea, edema, uncontrolled hypertension and renal insufficiency. He was diagnosed RAS and was operatively managed with percutaneous transluminal renal angioplasty. Written consent was taken from the patient mentioned in the study. During the procedure, the renal artery got ruptured, which was managed by placing a covered stent. The patient was successfully treated for RAS, in spite of comorbidities and intraoperative complication. In the subsequent clinical follow-up, the patient was asymptomatic. There was marked reduction in serum creatinine levels and even the blood pressure improved significantly. Absence of post-operative complications and positive recovery of the patient signifies the fact that management of renal artery rupture with a covered stent is a convenient approach in acquiring effective haemostasis. This approach can be useful in managing any sort of vessel rupture, related to revascularization procedures.
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Renal artery stenosis (RAS) is a major contributor to the prevalence of secondary hypertension. Fibromuscular dysplasia and atherosclerosis are commonly responsible for the occurrence of the disease. Medical therapy is the primary means of treatment for RAS. However, surgical interventions for revascularization are also considered, in selected group of patients, which can effectively cure hypertension and chronic kidney disease. An older man presented at Venus hospital, Surat, Gujarat with the complaints of severe dyspnea, edema, uncontrolled hypertension and renal insufficiency. He was diagnosed RAS and was operatively managed with percutaneous transluminal renal angioplasty. Written consent was taken from the patient mentioned in the study. During the procedure, the renal artery got ruptured, which was managed by placing a covered stent. The patient was successfully treated for RAS, in spite of comorbidities and intraoperative complication. In the subsequent clinical follow-up, the patient was asymptomatic. There was marked reduction in serum creatinine levels and even the blood pressure improved significantly. Absence of post-operative complications and positive recovery of the patient signifies the fact that management of renal artery rupture with a covered stent is a convenient approach in acquiring effective haemostasis. This approach can be useful in managing any sort of vessel rupture, related to revascularization procedures.
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Background: Laboratory diagnosis in Indian health-care setup is usually the mainstay of screening and diagnosis of diseases. Accreditation is a process of approval by establishing adherence of pre-defined quality standards to the existing system which can bring about utmost quality in service delivery by increasing accuracy and reliability and minimizing errors. Need for accreditation is ever-increasing in public sector health-care centers. Aim and Objectives: To ascertain and to quantify the impact of accreditation via training and exposure in the cadre of laboratory technicians in tertiary care public sector hospital. Materials and Methods: It was an interventional study to check competency of laboratory technicians in various domains of NABL standards, before and after training and exposure to accreditation process. It was carried out amongst MLT students and employed laboratory technicians in the clinical biochemistry department of a public sector, tertiary care, teaching hospital and lasted for 2 months. Preformed questionnaire was used. Difference between pre- and post-test results was compared with appropriate statistical analysis. Results: Marked difference was seen in the performance of study subjects before (27.6 ± 9.9) and after (56.7 ± 6.2) exposure to training and accreditation process (Max. score of 80). Average gain was 37.5%. The difference was highly significant for each domain. Domains of pre-analytical, analytical, and post-analytical procedures saw the highest difference. There was a significant difference in competence gain between student lab. techs. and employed lab. techs. Conclusion: Benefits of accreditation are immense, yet it is a voluntary process in our country. Strict adherence to already laid out standards and protocols at national level can be achieved by continuous sensitization and capacity building. Public sector laboratories need to gear up and embrace this need. The same should also be incorporated effectively in the curriculum of laboratory technician students.
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Background: One of the major challenges for pharmacology teachers is how to capture students’ interests and engage them in the subject, to create an engaging and enjoyable learning process. “Creative study guide posters” is one such novel educational tool that can help achieve these goals. Aims and Objectives: The authors tried to recreate visual artwork in the subject of pharmacology to engage students and at the same time make learning easy and fun-filled. Materials and Methods: In this study, 2nd year medical students participated and prepared creative study guide posters on antimicrobials and microbes in the form of two armies. On the one hand, antimicrobial drugs depicted the good army, consisting of the name of the drug, drug group, and mechanism of action, while on the other hand, the microorganisms depicted the evil army, consisting of the names of the common microbes, representing the battle of Kurukshetra as in the Indian epic of Mahabharata. Results: The majority of the students found this model interesting and useful for revising antimicrobials. About 82.3% of students agreed that their concepts of antimicrobials improved after this activity. About 86.46% of students believed that this model would foster interactive learning. Only 65.63% of students felt that the traditional methods of revising topics were better than this activity. Conclusion: Creative instruction encourages students to think independently, paricipate actively, and express themselves freely. Creative study guide poster activities help with better student engagement, reinforcing concepts, and better retention than just passing information passively in classrooms.
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Introduction: In Western population, a threshold of 5 drinks per day may exist for alcohol to increase pancreatitis risk. Given ethnic differences in alcohol metabolism, we examined the associations between smoking, alcohol, and pancreatitis in Western Indians. Methods: A case control study was conducted in a surgery department of a hospital in western India. In-formation on drinking was collected by in-person interview. Baseline characteristics and alcohol con-sumption was compared between cases of pancreatitis and control (without pancreatitis). Results: Baseline characteristics of cases and control are Among 4% of the cases and 2% of the control, bile stone was found to be present and this difference was also statistically not significant. Alcohol use was associated with pancreatitis in a dose-dependent way. Those who were taking heavy amount of al-cohol had more than five and half-time risk of developing pancreatitis compared to those who are not taking alcohol. Conclusions: Indians are more prone to alcohol-related pancreatitis than Westerners, and alcohol con-sumption is the leading cause of pancreatitis in India.
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Background:Ischemic heart diseases are the leading cause of death due to non-communicable diseases in India. Tobacco consumption is well proven risk factor for ischemic heart disease. Tobacco chewing is a very common practice done in Gujarat as well as other regions of India. Nicotine is the active ingredient in tobacco which causes alteration in lipid profile over long term consumption. According to “global adult tobacco survey (2016-2017)” over 21.4% of Indian adults consume smokeless/chewable tobacco. Present study was conducted to compare the lipid profile of non-tobacco consumers vs. chronic smokeless/chewable tobacco consumers.Material And Methods:The study was conducted after taking approval of Institutional Ethics Committee. A total of 100 selected study participants (non-obese male without any history of cardiovascular diseases and diabetes and not on any lipid altering medications) were divided in to case and control arm based on the history of consumption of CSLT(chronic smokeless tobacco)for 8 years or not. After overnight fasting,blood samples of both group individuals were taken for estimation of lipid profile. Details of lipid profile along with other demographic data were recorded in predesigned case record form. Result:A significant increase in lipid profile parameters such as TC, LDL, and TG were seen in chronic tobacco chewers compared to control group. Mean total cholesterol (TC), low density lipoprotein(LDL)and serum triglycerides levels in CSLT consumers were 222 mg/dl, 148 mg/dl and 171 mg/dl respectively. These parameters were higher in CSLT consumers as compared to control group by 68mg/dl (TC), 53 mg/dl (LDL) and 66 mg/dl (TG).Conclusion:Chr onic tobacco chewing was found to be associated with alteration in all the lipid profile parameters. Altered lipid profile is the proven risk for cardiovascular ailments. Hence ahypothesis can be generated from the study that CSLT consumption is the responsible factor for cardiovascular diseases. This can be tested further on large scale studies along with differences in the type of CSLT consumption and development of cardiovascular diseases can be evaluated.
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Background:Gingival recession is the one of the widespread mucogingival deformity and should be treated at its most primitive recognition. Exposed root surfaces are more likely to develop root sensitivity, root caries, cervical abrasions and post esthetic problems. Amid innumerable procedures, laterally positioned pedicle graft (LPG) is extensively used efficaciously to conceal recession defects. The main advantages of thelaterally positioned pedicle graft is, it produces excellent esthetic results as it has good vascularity of the flap and ability to cover the denuded surfaces. Thus,the present case report describes the use of lateral pedicle graft technique in an isolated gingival recession on mandibular incisor.
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Background:Traditional complete dentures were the most common treatment option for patients with edentulous arches. However, the initiation of implant-supported overdentures has substitutedorthodox dentures as animproved standard for restoration. Careful case selection is important criteria for improving success rate of implant supported over denture. Lower arch implant-supported overdentures have a better success percentage than upper arch implant-supported overdentures. Upper arch implant-supported overdentures are simulating a form of “salvage treatment,” rather than being the primary modality of treatment for patients with completely edentulous upper arch.
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Background:In the last decade, the use of lasers (lightamplification by stimulated emission of radiation) has occupied part of the dialogue within periodontology and oral surgery because of several proposed advantages. Laser uses produces less postoperative swelling, reduces inflammation and is also relatively painless. In the arena of periodontology, laser use as an adjunct to non-surgical therapy was demonstrated to enhance periodontal health. The present study was done to highlight these facts and to add over the previous researches. Material And Methods:Atotal of 50 patients with generalized chronic moderate to severe periodontitis with pocket probing depth (PD) ?5 mm were selected for a split-mouth study. Flap surgery with adjunctive diode laser irradiation was performed in the test quadrant while routine OFD was done in the control quadrant. Clinical parameters including PD, plaque index, and gingival index were recorded at baseline, 3 months and 6 months following treatment. Result:All clinical parameters significantly improved after therapy without any statistically significant difference between the two groups for any of the parameters. The results of the present study indicate that diode laser used as an adjunct to in OFD did not significantly e nhance the treatment outcome. Conclusion: Sincethere was a significant clinical improvement in case of gingival inflammation, it can be safely and effectively used to achieve the same and can aid in tissue healing.
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Background: Anterior shoulder dislocation is a common injury, accounting for 95% of all shoulder injuries. However, many doctors and hospitals do not have a fixed protocol for the treatment of dislocations. The current study have compared 8 different techniques for shoulder dislocation reduction in this study. Methods: Eight different methods namely the Scapular Manipulation, Matsen’s Traction-Countertraction, Kocher’s, Spaso, External Rotation, Cunningham, Modified Milch, and the FARES methods were compared on the basis of efficacy, pain experienced during reduction (VAS score), and time taken for reduction. Results: The Matsen’s Traction-Countertraction method had the highest efficacy, while the Scapular Manipulation method had the least VAS scoring. The FARES Method had the fastest reduction time on average. Interpretation and Conclusions: As per the data analyzed, the FARES and Scapular Manipulation method appear to be the most effective in reducing anterior dislocations, having consistently high success rates, and low VAS scores and reduction times. These 2 methods may be recommended to new practitioners to treat acute shoulder dislocations.
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INTRODUCTION:Breast carcinoma is the leading most common malignant tumor and leading cause of carcinoma death with more than 1000000 cases occurring world wide annually 1. FNAC (Fine Needle Aspiration Cytology) has become widely accepted as a reliable diagnostic tool for diagnosis of breast masses3.The aim of the study was to classify Breast lesions & correlate with histopathology Report.MATERIALS & METHOD:This was a retrospective observational study done over a period of one year (Jan. 17-Dec. 17) in Cytology Division of Department of Pathology of AMC MET Medical College at L.G.Hospital Campus ,a tertiary Health Care located in Maninagar Ahmedabad .Of total 1104 FNAC were done in the department among these 215 were Breast Lesions.Breast lesions were categorized into Inflammatory,Benign with No Risk, Benign with moderate Risk,Suspicious & Malignant.RESULTS:The Maximum number of cases was in the age group of 18-30 in Benign Breast Lesion. Malignant Breast Lesion was found in the age group of above 41.
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OBJECTIVES: Mobile health (m-Health) technologies may provide an appropriate follow-up support service for patient groups with post-treatment conditions. While previous studies have introduced m-Health methods for patient care, a smart system that may provide follow-up communication and decision support remains limited to the management of a few specific types of diseases. This paper introduces an m-Health solution in the current climate of increased demand for electronic information exchange. METHODS: Adopting a novel design science research approach, we developed an innovative solution model for post-treatment follow-up decision support interaction for use by patients and physicians and then evaluated it by using convergent interviewing and focus group methods. RESULTS: The cloud-based solution was positively evaluated as supporting physicians and service providers in providing post-treatment follow-up services. Our framework provides a model as an artifact for extending care service systems to inform better follow-up interaction and decision-making. CONCLUSIONS: The study confirmed the perceived value and utility of the proposed Clinical Decision Support artifact indicating that it is promising and has potential to contribute and facilitate appropriate interactions and support for healthcare professionals for future follow-up operationalization. While the prototype was developed and tested in a developing country context, where the availability of doctors is limited for public healthcare, it was anticipated that the prototype would be user-friendly, easy to use, and suitable for post-treatment follow-up through mobility in remote locations.
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Humanos , Artefactos , Clima , Sistemas de Apoyo a Decisiones Clínicas , Atención a la Salud , Países en Desarrollo , Grupos Focales , Estudios de Seguimiento , Atención al Paciente , TelemedicinaRESUMEN
INTRODUCTION: Haemovigilance is defined as a set of surveillance procedures covering whole transfusion chain from the collection of blood and its components to the follow up of its recipients, intended to collect and access information on unexpected or undesirable effects resulting from the therapeutic use of labile blood products, and to prevent their occurrence and recurrence.(1) AIMS AND OBJECTIVES: An effective effort towards the study of haemovigilance programme by evaluating the different adverse reactions occurring due to blood transfusion in patient receiving regular or temporary blood transfusion.The ultimate goal of a haemovigilance system is to improve the safety of blood transfusion. METHODS & MATERIALS: The current study was done at Blood bank AMC MET Medical College & LG Hospital, Ahmedabad. All the adverse reactions related to transfusion of blood components between April-2014 to March-2016 issued were studied.RESULT: In this study, total 17264 blood component (PCV, PRC, FFP, CRYO) were issued. From total 20 BTR, 18 BTR due to PCV, and 02 BTR due to PRC. In which 08 patients have febrile reaction, 07 patients have allergic reaction, 02 patients have non TRALI associated dyspnea and 01 patient has uneasiness-giddiness due to the PCV. 02 patients have allergic reaction which occurred due to PRC.CONCLUSION: Haemovigilance is an essential component of quality management in a blood system and is needed for the continual enhancement of quality and safety of blood products and transfusion process by monitoring and safeguarding the adverse events associated with the use of blood products.
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Background: Acute disseminated encephalomyelitis is an acute demyelinating disorder of the central nervous system and is characterised by multifocal white matter involvement. Diffuse neurological signs with multifocal lesions in brain and spinal cord characterise the disease. It do not invade central nervous system. Aim: To evaluate role of MRI in acute disseminated encephalomyelitis. Materials and methods: A prospective study of 10 cases which was conducted in the pediatric department in Dhiraj hospital. MRI brain was done on 1.5 Tesla MRI machine. Results: ADEM can be distinguished from acute viral encephalitis because the disease is not the result of primary tissue invasion by an infectious organism. It was thought to be immune-mediated and is characterized neuropathologically by perivenular inflammation and demyelination. Conclusion: ADEM is more common in female and more associated with previous infection as compared to previous vaccination. Neurological deficit is mostly associated with it. CSF showed raised protein in almost cases. It showed hyperintense lesion on T2W and FLAIR sequences. Periventricular area of brain is commonly associated.
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Background: Shoulder pain is the third most common musculo-skeletal complaint after low back pain and knee pain. The most common cause of shoulder pain is rotator cuff disease. For the evaluation of shoulder joint, MRI is the modality of choice and is considered over USG. MR imaging is the global assessment of all shoulder structures. Materials and methods: A prospective study of 65 patients were conducted, who were referred to the Department of Radiodiagnosis, Dhiraj General Hospital with shoulder pain. All the scans were done on Philps MR systems Achieva 1.5 tesla. T1 and T2 weighted images in the sagittal, coronal, axial planes were obtained in each patient. Results: In a retrospective review, 50 patients referred to our institution for diagnostic workup for shoulder complaints from June 2016 to December 2016. Out of these, only 7 had no visible pathology. Rotator cuff tendinopathy accounts maximum in which supraspinatus tendinopathy was found in 60% cases (26 patients), subscapularis tendinopathy were in 10% (4 patients), infraspinatus tendinopathy and rotator cuff tendinopathy was not found in any patient. Rest of the pathologies included soft tissue pathology, subacromial-subdeltoid bursitis. Conclusion: MRI provides elaborate diagnosis thus it replaces other investigations. Thus MR imaging is the standard among the imaging methods for optimal depiction of almost all shoulder pathology.
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Granulomatous lesions of the skin and subcutaneous tissue are common in India. They are known as “Dermal Granulomas”. In present study following types of Dermal Granulomas were included – Leprosy, Cutaneous Tuberculosis, Syphilis, Fungal, Actinomycosis, Foreign body Granuloma, Granuloma annulare and Sarcoidosis. Histopathology remains a time tested tool for establishing a correct diagnosis. Clinical lesions often reveal surprising underlying pathology. Hence carrying out skin biopsies and microscopic study with routine haematoxylin and eosin (H&E) as well as special stains are must in these disorders so that the type and aetiological agent of the granuloma are properly identified. Besides, follow-up biopsies after the commencement of treatment help in evaluation of the response to therapy. Methods: 52 cases were studied over a period of 2 and a half years. Specimens were collected from the patients of skin, surgery and ENT department. A brief clinical history with age presenting symptoms and signs were recorded. Routine investigations like ESR were performed. Comparison of our study was done with others around the country. Results: Most common type of dermal granuloma was leprosy (59.6%) followed by cutaneous tuberculosis (21.1%), Foreign Body (5.7%), Granuloma Annulare (5.7%), Fungal (5.7%), Actinomycosis (1.9%) and Sarcoidosis (1.9%). Dermal granulomas were most common between the age group of 31 – 50 years. In leprosy and cutaneous tuberculosis, males were affected more as compared to females. Conclusion: Leprosywas most common than other dermal granuloma. Most common type of leprosy and tuberculosis were lepromatous leprosy and lupus vulgaris respectively.