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Background: Diabetes mellitus (DM) and anemia are both prevalent in India. Glycated hemoglobin (HbA1c) is the gold standard test for the diagnosis of DM and monitoring of glycemic status. Hemoglobin (Hb) being the integral component of HbA1c, there is a possibility that anemia can also affect the level of HbA1c apart from the various other factors. Objectives: To study the prevalence, type of anemia, and correlation between HbA1c and anemia, including red blood cell (RBC) indices in euglycemic type 2 DM patients. The study was conducted with the objective of studying the correlation between HbA1c and anemia in euglycemic diabetic patients having controlled blood glucose over a period of 3 months. Methodology: This cross-sectional study was conducted between May 2020 and May 2021 at the Department of General Medicine, Government Medical College, Kota, Rajasthan, India. All euglycemic diabetic patients with controlled blood glucose over a period of 3 months attending the outpatient department and fulfilling inclusion and exclusion criteria were enrolled in the study. Inclusion criteria: All euglycemic type 2 DM patients with controlled blood glucose having three consecutive normal blood glucose levels [fasting blood sugar (FBS)—80–130 mg/dL and postprandial blood sugar (PP2BS) test—<180 mg/dL] over a period of 3 months from the outpatient department. Exclusion criteria: Type 1 DM and latent autoimmune diabetes of adults, patients with hemolytic anemia, pregnancy, chronic alcoholism, chronic kidney disease, chronic liver disease, combined deficiency anemia, patients with increased FBS and PP2BS, acute and chronic inflammatory state, malignancy, anemia of chronic disease, and vitamin B12 deficiency were excluded from our study. Detailed investigations of diabetes and anemia were conducted. The effect of anemia on HbA1c was assessed, and the correlation of anemia with mean HbA1c was analyzed statistically Results: The prevalence of anemia in diabetic patients is 56.8%. Normocytic normochromic anemia is the most common, which was observed among 48.86% of diabetic patients. The median HbA1c of anemic patients is higher than nonanemic patients (p < 0.01). There is a negative correlation between Hb and HbA1c (p < 0.01). The correlation of RBC indices, that is, mean corpuscular Hb (MCH), mean corpuscular volume (MCV), and MCH with HbA1c, is also negative (p < 0.01). There is a negative correlation between HbA1c and serum ferritin level, as indicated by the Pearson correlation test (p-value of <0.01). Conclusion: Anemia is prevalent in type 2 DM patients without renal involvement, and also normocytic normochromic type is the most common, followed by iron deficiency anemia (IDA). HbA1c levels are significantly affected by the presence of moderate anemia in spite of controlled glycemia.
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Background: Heart failure (HF) is a complex clinical syndrome that results from any structural or functional impairment of ventricular filling or ejection of blood. There are range of factors that predict the mortality, morbidity, and outcome in congestive HF (CHF) patients. Objectives: The objective was to study the clinico‑epidemiological characteristics and predictors of inhospital mortality of elderly patients ≥60 years hospitalized for HF. Subjects and Methods: A complete medical history of enrolled patients and physical examination inclusive of etiology, New York Heart Association (NYHA) grade, heart rate (HR), and systolic blood pressure (SBP) were noted. Complete blood count, blood urea, serum creatinine, serum sodium, serum potassium, 12-lead electrocardiogram, X-ray of the chest, and echo were obtained in all patients. Outcomes were analyzed till the study endpoints. Results: Compared to normal comparators, a higher mortality was observed in patients with age >75 years (33.3%), HR >100 beats per min (27.14%), SBP <80 mmHg (60%), NYHA IV HF (37.1%), hemoglobin (Hb) <12 mg/dl (31.25%), blood urea ≥40 mg/dl (26.39%), serum creatinine >1.30 mg/dl (29.17%), serum sodium <135 meq/L (26.69%), and ejection fraction (EF) <50% (26.39%). Conclusion: Increasing age, prior history of CHF on admission, higher NYHA grade on admission, higher HR, lower SBP, lower EF, low Hb, higher blood urea, serum creatinine, and low serum sodium levels are statistically significant predictors of inhospital mortality of elderly CHF patients
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Introduction – Circumcision is one of the oldestsurgical procedure practiced to remove shaft skinand inner foreskin to uncover the glans.Among various techniques for the circumcision, wehave described Plastibell method which has becomepopular and more preferable for its advantages suchas minimal tissue trauma and better cosmesis.Aim - This article aims to analyse the safety, efficacyand outcome of plastibell circumcision in paediatricpatients.Material & Methods – This study includes 30inpatient cases who satisfied the inclusion criteriaand underwent circumcision using plastibell device atsheth L.G. hospital, AMC MET Medical college,Ahmedabad. Data on operative time, intra op andpost op complications, post operative hospital stay,cosmetic outcome and parent satisfaction wasobtained and analysed.Results – Total of 30 patients were circumcised withplastibell device with average operative time of 9±3mins. Most common post-operative complication waspain which was observed in 8 patients (26.67%).Post-op bleeding was seen in 1 patient (3.33%) dueto detachment of ring. 28 out of 30 parents weresatisfied with the cosmetic outcome.Conclusion – Based on our study, plastibellcircumcision is effective technique for circumcisionoffering lesser operating time, post-operative pain,
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Background: Intravenous calcium channel blockers or beta-blockers are the preferred rate control medications for hemodynamically stable patients with atrial fibrillation with rapid ventricular rate (AFRVR) in the emergency department. Objectives: To compare the efficacy of intravenous diltiazem and metoprolol for rate control and safety with respect to development of hypotension and bradycardia in patients with AF-RVR. Methods: For this systematic review and meta-analysis, we searched PubMed, Embase, Cochrane databases, and the clinicaltrials.gov registry between database inception and 30th May 2021. Articles were included if they compared efficacy and safety of diltiazem versus metoprolol in critically ill adult patients hospitalized with AF-RVR. Outcome measures were achievement of rate control, development of new hypotension, and bradycardia after drug administration. Results: Of 86 records identified, 14 were eligible, all of which had a low to moderate risk of overall bias. The meta-analysis (Mantel-Haenszel, random-effects model) showed that diltiazem use was associated with increased achievement of rate control target compared to metoprolol [14 studies, n ¼ 1732, Odds Ratio (OR): 1.92; 95% Confidence Intervals (CI):1.26 to 2.90; I2 ¼ 61%]. In the pooled analysis, no differences were seen in hypotension using diltiazem vs metoprolol [12 studies, n ¼ 1477, OR: 0.96; 95% CI:0.61 to 1.52; I2 ¼ 35%] or bradycardia [9 studies, n ¼ 1203, OR: 2.44; 95% CI: 0.82 to 7.31; I2 ¼ 48%]. Conclusions: Intravenous diltiazem is associated with increased achievement of rate control target in patients with AF-RVR compared to metoprolol, while both medications are associated with similar incidence of hypotension and bradycardia.
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Background: Vesiculobullous disorders (VBDs) are extant with diverse clinical manifestations. Vesicles and bullae are fluid-filled cavities present within or beneath the epidermis. They are autoimmune blistering disorders in which autoantibodies are directed against target antigens present in the epidermis and dermo-epidermal junction. Objective: Evaluation of the various clinicodemographic profile of patients with a pattern of distribution (subtypes) of VBDs of the skin and assess the association between clinical aspects and histological changes in vesiculobullous lesions of the skin. Materials and Methods: The study material constituted 93 cases of VBDs out of 936 skin biopsies reported over two and a half years (January 2016 to June 2018) from the tertiary care center. A detailed history of the patients was taken, and a complete physical and dermatological examination with findings including clinical diagnosis was recorded. Histopathological examination (incisional/excisional/punch biopsy) was done in each case. The clinico-demographic evaluation was done and the results were correlated with histopathological findings. Results: Vesiculobullous lesions constituted 10.06% of all skin biopsies. The majority of cases were of pemphigus vulgaris (PV) 30 (32.25%) followed by 16 (17.2%) of bullous pemphigoid. In 83 cases (89.24%) histopathology findings were consistent with clinical diagnosis. Out of 34 cases that were diagnosed clinically as PV , the histopathological study proved 30 cases (88.23%) as PV. Conclusion: Vesiculobullous lesions of the skin are a heterogeneous group of disorders. It is essential to differentiate each pattern of subtype based on clinical examination and histopathological findings. Histopathological diagnosis with clinical correlation plays a major role in arriving at the diagnosis.
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Background & objectives: During the COVID-19 pandemic it was important to assess the antibody profile in individuals vaccinated with Covaxin (BBV152) and Covishield (ChAdOx1 nCoV-19) with both 28 and 84 days gaps between two doses, those infected with SARS-CoV-2 and post-COVID-19-infected individuals vaccinated with only one dose of either of the vaccines. The present study was aimed to assess these objectives. Methods: Fifty real time reverse transcription–polymerase chain reaction (qRT-PCR)-confirmed COVID-19-infected individuals, along with 90 COVID-19-naïve (BBV152 and ChAdOx1 nCov-19)–vaccinated individuals, were included in the study. Individuals who received a single dose of either vaccine with a confirmed past diagnosis of SARS-CoV-2 infection (n=15) were also included. Blood samples were collected strictly between the 4th and 5th wk after development of symptoms for SARS-CoV-2 infected individuals and after the first/second vaccination dose. Antibody profile assessment was done using whole-virus, spike-receptor binding domain (RBD) and nucleocapsid-specific ELISA kits along with neutralizing antibody kit. Results: There was an overall 97.7 per cent seropositivity rate in vaccinated individuals, and a strong correlation (R2=0.8, P<0.001) between neutralizing and spike-RBD antibodies. Among individuals who received two standard doses of ChAdOx1 nCoV-19 vaccine, the spike antibody levels developed were of higher titre with a longer prime boost interval than in those with shorter intervals (P<0.01). Individuals vaccinated with two doses as well as only one dose post-SARS-CoV-2 infection had high neutralizing and spike-specific antibodies. Interpretation & conclusions: High neutralizing and spike-specific antibodies were developed in individuals vaccinated only with one dose of either vaccine post-SARS-CoV-2 infection. With the main priority being vaccinating majority of the population in our country, single-dose administration to such individuals would be a sensible way to make the most of the limited supplies. Furthermore, neutralizing antibody levels observed in COVID-19-naïve vaccinees imply the need for booster vaccination.
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Background: Nerve Conduction Studies were performed in asymptomatic HIV positive persons and corresponding controls to detect subclinical peripheral nervous system involvement in early stage of HIV. Aims & Objective: To perform Nerve Conduction Studies in asymptomatic HIV positive persons and corresponding controls. Material and Methods: In this study,100 participants in the age group 25-45 years were selected. In study group, 50 3 participants who were HIV positive and asymptomatic (CD4 count > 350 cells/mm ) and were not on Anti Retro Viral Treatment (ART), were included. In control group 50 healthy age matched HIV negative participants were included. We performed Nerve Conduction Studies in these participants. For motor nerves, Distal Latency (DL), Motor Nerve Conduction Velocity (MNCV), Compound Muscle Action Potential (CMAP) amplitude were measured and for sensory nerves Onset Latency (OL), Sensory Nerve Conduction Velocity (SNCV) and Sensory Nerve Action Potential (SNAP) amplitude were measured. Results: Nerve Conduction Studies in asymptomatic HIV revealed that, MNCV was significantly decreased for median motor nerve and tibial motor nerve in study group compared to control group, SNAP was significantly reduced for median sensory nerve in study group compared to control group, OL was significantly prolonged for sural nerve in study group than control group and SNCV was significantly decreased for sural nerve in study group than control group. Conclusion: Nerve Conduction Studies in asymptomatic HIV positive persons suggests subclinical peripheral nervous system involvement in early stages of HIV. Hence Nerve Conduction Studies can be important to detect subclinical peripheral nervous system involvement in the early stages of HIV.
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Background: To decrease morbidity in patients undergoing hysterectomy for benign lesions, oophorectomy should not be done. Aims and Objectives: This study aims to compare the effects of surgical and natural menopause on menopausal symptoms and musculoskeletal complaints in menopausal women. Materials and Methods: This study was conducted in gynecology outpatient department from June 2019 to June 2020. A total of 200 postmenopausal women were selected between the age group of 40 and 55 years and then divided into two main groups – Group A (100), that is, natural menopause and Group B (100), that is, surgical menopause. Interviews were conducted about menopausal symptoms, using a standard questionnaire and were modified for yes or no response. The women were asked about symptoms such as hot flashes, sweating, vaginal dryness, dryness of skin, decreased libido, poor memory, depression, and musculoskeletal pain. Results: The study showed that menopausal symptoms and musculoskeletal pain were more common in women with surgical menopause as compared to women with natural menopause. The rate of hot flashes and sweating was more in surgical menopause group, that is, 81% and 82%, respectively, as compared to 52% and 50%, respectively, in natural menopause group. The musculoskeletal pain was more significant in Group B as compared to Group A, especially low back and upper back which were present in 55% and 42%, respectively, in Group B as compared to 43% and 41%, respectively, in Group A. Conclusion: As the menopausal symptoms and musculoskeletal pain are more common in patients with surgical menopause thereby increasing the morbidity, so oophorectomy should not be done in patients who are undergoing hysterectomy for benign lesions. Therefore, treatment of osteoporosis and hormone replacement therapy is recommended after surgery to decrease the menopausal and musculoskeletal symptoms within the 1st year of menopause.
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Globally, hypertension is a common problem in the elderly, and its prevalence increases with increasing age. Isolated systolic hypertension (ISH) subset is more common in the very elderly population, and as the population ages, its prevalence will rise more and more. In the past, treatment of hypertension (HT) in the very elderly was controversial and either no treatment or complications of treatment risk overweigh the benefits observed. The inclusion of elders in various clinical trials has demonstrated a better understanding and rational approach toward optimal management of HT. Systolic blood pressure (BP) is more important in predicting adverse cerebrovascular outcomes and decline in renal function in elderly patients with ISH. Early detection, protection of target organs, correction of high BP will develop, promote, and corroborate healthy aging.
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Objective: To study the spectrum and outcome of severe scrub typhus in adult patients and to predict the hospital mortality by organ failure on admission. Methods: This was a prospective observational cohort study conducted between July 2017 and October 2020 at the medical emergency centre of PGIMER, Chandigarh, India. One hundred and twenty-six patients aged =13 years were diagnosed with scrub typhus. Severe disease was defined as the presence of organ failure based on the Sequential Organ Failure Assessment (SOFA) score on admission. Results: About two-thirds of the patients were from geographic regions outside the endemic sub-Himalayan belt. Fever (99.21%) and dyspnea (79.36%) were the most frequent complaints. Respiratory failure (81.75%) was the most common organ failure, followed by hepatic (52.38%), coagulative (47.62%), circulatory (33.33%), renal (21.43%), and cerebral dysfunction (13.49%). The median (Q1, Q3) SOFA score was 8 (6, 9), and 48.41% of the patients had a quick-SOFA score =2. Organ supports with invasive ventilation (40.48%), vasopressors (36.51%), and renal replacement therapy (7.14%) were frequently required. The in-hospital mortality was 11.90% and was independently predicted by circulatory and hepatic failures on multivariate logistic regression (OR 11.12, 95% CI 1.73-71.31 and OR 8.49, 95% CI 1.18-61.41, respectively). Conclusions: Most patients had pulmonary dysfunction; circulatory or hepatic failure on admission strongly predicts death.
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Background: The objective of this study was to determine the significance of meconium staining of the amniotic fluid and find out an appropriate mode of delivery in women with MSL.Methods: A retrospective study was carried out in Lady Hardinge Medical College and Smt Sucheta Kriplani Hospital, a tertiary government hospital, New Delhi over a time period of 1 year between 2009 to 2010 on 1425 consecutive women of which 142 women were diagnosed as having meconium staining of the amniotic fluid during labour. All cases were critically analysed and maternal and fetal outcomes were studied in these women.Results: The incidence of MSL was 10% (142/1425), 45% had thin MSL and 55% had thick MSL. In women with thick MSL, 85% had early thick MSL and 15% had late thick MSL. In women who had early thick MSL (n=66), 55 (83.3%) delivered by LSCS and 11 (16.7%) delivered vaginally. On correlating the perinatal outcome with mode of delivery irrespective of fetal heart rate abnormality in early thick MSL, it was seen that the perinatal outcome was significantly affected by mode of delivery. The rates of respiratory distress and MAS was significantly higher in babies who delivered vaginally compared to those by LSCS (18% & 100% vs 9% & 40%, p=0.012, RR- 5.2 [95% CI: 1.8-3.42]. There were no perinatal mortality in early thick MSL.Conclusions: In distinguishing between thick and thin meconium, it was noted that finding of thick meconium in the latent phase of labour (i.e. early thick MSL) is ominous and demands an urgent caesarean delivery.
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Introduction:Sepsis is defined as life threatening organ dysfunction caused by the dysregulated host response to infection with high mortality. Methods:We studied 2031 patients presenting to an emergency department with fever or suspected infection to find the correlation between q SOFA SCORE and procalcitonin level swith mortality.
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Background: Benign breast diseases are a common problem presenting in a day to day surgical practice. A combination of three tests i.e. clinical examination, radiological imaging and pathological examination is commonly used to accurately diagnose breast diseases. This study was aimed to know the clinico-pathological correlation in diagnosing benign breast diseases in women.Methods: A study of 30 female patients of benign breast disease was conducted by clinical examination and comparing its accuracy with the pathological findings.Results: The highest incidence of benign breast diseases was in the age group of 30-39 years (33.3%). The most common presenting symptom was lump (53.3%) in the breast. The most common quadrant involved was the upper outer quadrant (60%). Fibroadenoma (53.3%) was the most common lesion in this study. The clinical examination in cases of fibroadenoma had sensitivity and specificity of 87.5 % and 92.8% respectively. In cases of fibrocystic disease, clinical examination had sensitivity and specificity of 85.7 % and 91.3% respectively.Conclusions: Overall clinical breast examination had a sensitivity of 90% and specificity of 98% in this study. Hence, combination of all three diagnostic modalities i.e. clinical, radiological and pathological examination should be used. But in rural areas where radiological and pathological facilities are not available, clinical examination can also give us a fair amount of idea in diagnosing benign breast diseases.
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Background: A pterygium is a wing-shaped growth of conjunctiva and fibrovascular tissue on the superficial cornea. The pathogenesis of pterygia is strongly correlated with UV light exposure and environmental factors. The prevalence of pterygia increases steadily with proximity to the equator, and the condition is more common in men than women. It is well established fact that before entering the optical zone pterygium causes flattening of the cornea in horizontal meridian with the more normal side of the cornea usually temporally, resulting in with-the-rule astigmatism.Methods: The study included 80 patients of primary pterygium who underwent pterygium excision with conjunctival autograft adhered by autologous blood surgery. After performing routine ocular examination which includes visual acuity without and with pinhole and pre-operative keratomery was assessed by autokeratorefractometer. Repeat examination was performed after 6 weeks of surgery. Patients with recurrent pterygium, pseudo-pterygium, and history of previous ocular surgery were excluded.Results: The pre‑ and postoperative corneal astigmatism were compared after 6 weeks of surgery. The changes in corneal astigmatism were statistically significant p value <0.001. The preoperative mean corneal astigmatism of 3.41 D was reduced to 1.59 D (p value <0.001) 6 weeks after surgery, but maximum change in astigmatism was seen in Grade IV >Grade III >Grade II >Grade I.Conclusions: Primary pterygium of all grades treated with well accepted technique pterygium excision with conjunctival autograft with autologous blood gives promising results in terms of improvement in corneal astigmatism and hence visual acuity as well.
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COVID-19 pandemic has brought the whole world stand still, locked down in their homes, infecting more than 8 million people, and many thousands (449,182) -have lost their lives across the globe. Due to lack of any definitive medicine or vaccine, treatment options are supportive of oxygenation, antiviral, antiretroviral drugs, antibiotics, fluid/electrolyte, mechanical ventilation with ICU (Intensive Care Unit) support, and hloroquine/hydroxychloroquine have been tried to fight this infection. However, mortality due to severe pneumonia, ARDS (Acute Respiratory Distress Syndrome), and multiorgan failure arising from the overactive immune response (storm) mediated by cytokines remains a treatment challenge in elderly and patients with severe medical comorbidities. Recently, anti-inflammatory, angiogenic, immune-modular, and healing properties of intravenous injections of culture derived stem cells have been proposed and shown to benefits in a small number of patients with severe COVID-19 infections. Based on previous experience with other viral infections, convalescent plasma, and serum transfusion are being used as a source of neutralizing antibody/factors to minimize the effects of inflammatory cytokines in this infection. Immunotherapy with purified monoclonal antibodies and conditioned serum with a mixture of unique cytokines are also being developed. Regenerative Medicine has emerged as a crucial adjuvant tool in promoting healing and early recovery in severe COVID-19 infections and other supportive treatments.
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Hamartomas are uncommon benign tumours of axilla and breast. They show varied imaging appearances depending upon the proportion of various tissue elements present. The mammographic, ultrasound and elastographic appearances of a case of left axillary hamartoma is described in a 49 years old Indian patient.
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Background: Ujjain is holy city of Lord Mahankal. It is an ancient city on the eastern bank of the Kshipra River. There were total 2508 students studying in 11th and 12th standards in various higher secondary schools of Ujjain city. Reproductive health is a crucial part of general health and a central feature of human development. It is a reflection of health during childhood and crucial during adolescence and adulthood, sets the stage for health beyond the reproductive years. Adolescence is a complex period of myriad of physiological as well psychological changes. This is a time for them to prepare for making responsibilities, a time of exploration and widening horizons and a time to ensure healthy all-around development. Adolescents lack knowledge regarding reproductive health problems. The present study is conducted to assess the knowledge, attitude and practices regarding selected aspects of reproductive health with special reference to knowledge of Reproductive tract infections (RTI) among adolescent school students.Methods: This was a cross sectional study carried out among randomly selected school students of Ujjain city.Results: It was observed that 86% of the students had adequate knowledge in the area of pregnancy and care during pregnancy. The mean score percentage of reproductive tract infection was found to be 56.92%. 90.50% students agreed that Menstruation is normal phenomenon.Conclusions: There is need of imparting sex education in schools across the country with the help of specially trained teachers and peer educators.
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BBackground: A postoperative patient suffers from pain the best relief of which is a clinician’s duty. Till date very few studies have been conducted for comparison of paracetamol and diclofenac as analgesics. As a result a comparative study between Paracetamol and Diclofenac was carried out. The aim of the study was to compare the efficacy and side effects of intravenous Paracetamol and intravenous Diclofenac in patients undergoing major abdominal open surgeries in obstetrics and gynaecology. The study was conducted to assess the postoperative visual analogue pain scores (VAS) and total analgesic requirement in the first 24 hours and also to study the total requirement of additional analgesics despite administration of either Paracetamol or Diclofenac in postoperative period.Methods: 100 patients satisfying the inclusion/exclusion criteria were recruited for the study. They were divided into two groups of 50 each. Group A was given IV Paracetamol 6 hourly for 48 hours starting 2 hours after surgery. Group B was given IV Diclofenac 8 hourly for 48 hours starting 2 hours after surgery. Patients were assessed for pain relief by visual analogue scale (VAS) of zero to ten after 6 hours, 12 hours, 24 hours and 48 hours of surgery by asking the patient to point the position on the 100 mm scale.Results: The results revealed that when we compared the VAS scores between the 2 Groups at different time intervals, it showed that at 24 hours and 48 hours VAS score in the Diclofenac Group was significantly less than the Paracetamol Group. The main side effects were nausea and vomiting in both the groups. There was more nausea and vomiting in Diclofenac group compared to Paracetamol group.Conclusions: It was concluded that at 24 hour and 48 hour pain reduction was more in the Diclofenac group as compared to Paracetamol group, but the side effects were more in the Diclofenac group compared to Paracetamol group.