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Background: The data on clinical characteristics, treatment practices and out comes in patients with Nonischemic Systolic Heart Failure (NISHF) is limited. We report clinical characteristics, treatment and outcomes in patients with NISHF. Methods: 1004 patients with NISHF were prospectively enrolled and their demographics, clinical characteristics, and treatment were recorded systematically. Patients were followed annually for a median of 3 years (1 year to 8 years) for allcause death, major adverse cardiovascular events (MACE); composite of all-cause death, hospitalization of heart failure, and or for stroke. Results: Patients of NISHF were middle-aged (58.8±16.2 years) population with severely depressed left ventricular ejection fraction (29.3±7.02%) and 31.1% had symptoms of advanced Heart failure. Hypertension (43.6%), obesity and or overweight (28.0%), Diabetes (15.0%), and valvular heart disease (11.8%) were the common risk factors. The guideline directed medical treatment was prescribed in more than 80% of the study cohort. Incidence of all cause death and MACE was 7 (6.8, 8.8) per 100 person years and 11(10, 13) per 100 person years respectively. The cumulative incidence of deaths and MACE was 35% (30%, 40%) and 49% (44%, 53%) at 8 years of follow-up. Conclusions: Patients of NISHF were middle-aged population with severely depressed LV systolic function with significant incident morbidity and mortality. Early detection of risk factors and their risk management and enhancing the use of guideline directed treatment may improve the outcomes. Keywords: Non-ischemic systolic heart failure, risk factors, outcomes, guideline directed treatment
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Background: The data on incidence of recovered Left Ventricular Ejection Fraction (LVEF) and outcome in patients with non ischemic systolic heart failure is limited. We report the incidence, determinants and mortality in patients with recovered LVEF. Methods: The 369 patients with HFrEF with LVEF of less than 40% of non ischemic etiology with available follow up echocardiography study at one year were enrolled. The baseline data of clinical characteristics and treatment was recorded prospectively and were followed up annually for mean of 3.6 years (range 2 to 5 years) to record all cause death and LVEF measured echocardiographically. The recovered, partially recovered and no recovery of LVEF was defined based on increase in LVEF to 50% and more, 41% to 49% and to persistently depressed LVEF to 40% or lower respectively. Results: The LVEF recovered in 36.5%% of the cohort at 5 years. The rate of recovery of LVEF was slower in patients with no recovery of LVEF at one year compared to cohort with partially recovered LVEF (18% vs.53%) at five year. The Baseline LVEF was significantly associated with recovered LVEF, odd ratio (95% C.I.) 1.09(1.04, 1.14). The cumulative mortality at five years was significantly lower in cohort with recovered LVEF (18.1% vs. 57.1%). Conclusions: One third of the patients had recovered LVEF and was significantly associated with baseline LVEF and lower mortality rate.
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We report a case of isolated duodenal tuberculosis (TB) in a patient who presented with features of gastric outlet obstruction. The diagnosis was made on repeat endoscopic duodenal biopsy after initial histopathology failed to reveal the diagnosis. The patient recovered with antitubercular therapy. The index of suspicion has to be high in TB endemic countries as clinical, radiological, and endoscopic features are nonspecific.
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Valeriana wallichii referred to as Indian Valeriana has a family circle Valerianaceae commonly known as "Tagara". India, Nepal, and China are home to the important variety of the Valeriana genus. It is indigenous to India and can be found between 8000-10000 feet altitudes in the Himalayan region. Valeriana is a popular ethnobotanical remedy throughout Europe for relieving stress and improving sleep. Vital Central nervous system (CNS) activity is mirrored in the genuine Ayurvedic text-based content and declared as one of the handiest treatments with inside the remedy of neurosis and is powerful in pacifying the body ache (Vedanasathpana), chills (Sheetprashmana), and headaches (Shirah shoolprshmana). Additionally, it has been addressed in the Charaka Samhita as a remedy for snake poisoning. The rhizome and supporting tissues of valerian are used to treat insomnia, epilepsy, hypertension, and psychosomatic disorders. Important phytochemicals can reduce pain, manage stress, protect the brain from radiation, and fight off microbes. Hesperidin, the statutory potent flavonoid, 6-methylapigenin, and four new varieties of the iridoids Valeriotetrates B and C, 8-methylvalepotriate, and 1,5-dihydroxy-3,8-epoxyvalechlorine A are just a few of the naturally occurring active phytochemicals in the Valeriana wallichii.
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Isolated Jejunal peroration in a case of blunt trauma abdomen is less encountered and variably dealt with. Being rare, its diagnosis itself is very late clinically and hence carries very high rate of morbidity & mortality. Here we attempted a novel technique to manage the dreaded proximal intestinal leak and avoid stoma at a very proximal site. High output proximal fistula that follows leak is still a nightmare for the resident.Isolated Jejunal blowout injuries are easily missed and diagnosed late. The management involves a primary repair which has a very high risk of leak. This further increases the financial burden and emotional trauma, to the patient & family, as it involves multiple surgeries and prolonged hospital stay following leak and / or high output proximal fistula. This can be avoided by addition of a retrograde duodenostomy to secure the anastomosis without much expense. This reduces the overall stay and expense. Bile collected from the Retrograde Duodenostomy tube was further utilized and replaced to the patient, thus alleviating the need for total parenteral nutrition also. Here we present our technique.
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Introduction: The diagnosis of acute appendicitis has essentially been clinical, but USG abdomen has been said to be highly accurate in diagnosing AA. The surgeon’s perspective may not always be the same. Materialsand methods: Appendectomy data of 106 patients from two hospitals of Kangra region was retrospectively analysed. The data was collected for age, sex, initial pre-operative diagnosis, USG findings, intra-operative findings, Histo-pathological examination (HPE) report, post operative hospital stay. Observations:It revealed a sensitivity of about 54% and specificity of 100% for diagnosing AA with the help of USG abdomen. AA was seen most commonly in males as compared to females. Mean age of presentation was 29.34 +/-14.4 years. Mean hospital stay was 3.68 +/-2.25 days. Most common initial preoperative diagnosis was AA (84%). Most common position of the appendix during surgery was retrocecal (53.7%). HPE report revealed AA in 105 patients. Conclusion:USG abdomen is often falsely assuring, leading to unnecessary delay in effectively managing a patient of AA further leading to increased complications. Only the clinically equivocal cases require further radiological investigations where CECT abdomen is the preferred investigation, but it should be used judiciously.
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CT guided FNAC is a simple and safe procedure of diagnostic value in patients with lung lesionssuspected to have lung malignancy. We undertook a study on 41 patients and were able to diagnose/rule out malignancy in 85.37% of these patients, while in 14.63 % of patients the smears were nondiagnostic. Once malignancy was diagnosed in these patients, then the next most important step wasto categorize the lesions. 44% of patients had squamous cell carcinoma, 12.12 % had adenocarcinoma,9.75% had small cell carcinoma, 7.31 % had poorly differentiated carcinoma, 4.87% each hadmetastasis & tuberculosis and 2.43% had aspergillosis. Squamous cell carcinoma was the commonestsubtype in our study, which is contrary to changing trends in incidence of lung carcinoma whereadenocarcinoma has replaced squamous cell carcinoma as the commonest lung malignancy. Threeof our patients had minor complication in the form of mild pneumothorax, and it resolved in all patientswithin 24 hours.
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Gallbladder carcinoma is the most common biliary tract malignancy in the world. Radiologicalinvestigations are helpful in diagnosing the gallbladder diseases especially carcinoma in most of thecases, but confirmation of diagnosis requires cytopathological correlation. We have undertaken astudy on 29 patients, who underwent ultrasound guided FNAC for evaluation of gallbladder lesionssuspected to be carcinoma gallbladder. 82.75% of patients had malignancy or suspicion of malignancyand 10.34% patients had abscesses, while in 6.9 % patients FNAC was inconclusive. Adenocarcinoma(NOS) was the most common diagnosis and was found in 62.6 % of patients. Poorly differentiatedcarcinoma, cytology suspicious of malignancy and abscesses were present in 7 % of patients each.Papillary carcinoma and squamous cell carcinoma were only seen in 3.44 % patients each. None ofthe patients in our study developed any minor or major complications during the procedure. A precisecytological examination is required not only to diagnose or rule out gallbladder malignancy, but alsofor prognostication of these carcinomas.
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ustification: A number of guidelines are available for management of congenital heart diseases from infancy to adult life. However,these guidelines are for patients living in high income countries. Separate guidelines, applicable to Indian children, are required whenrecommending an intervention for congenital heart diseases, as often these patients present late in the course of the disease and mayhave co-existing morbidities and malnutrition. Process: Guidelines emerged following expert deliberations at the National ConsensusMeeting on Management of Congenital Heart Diseases in India, held on 10th and 11th of August 2018 at the All India Institute of MedicalSciences, New Delhi. The meeting was supported by Children’s HeartLink, a non-governmental organization based in Minnesota, USA.Objectives: To frame evidence based guidelines for (i) indications and optimal timing of intervention in common congenital heartdiseases; (ii) follow-up protocols for patients who have undergone cardiac surgery/catheter interventions for congenital heart diseases.Recommendations: Evidence based recommendations are provided for indications and timing of intervention in common congenitalheart diseases, including left-to-right shunts (atrial septal defect, ventricular septal defect, atrioventricular septal defect, patent ductusarteriosus and others), obstructive lesions (pulmonary stenosis, aortic stenosis and coarctation of aorta) and cyanotic congenital heartdiseases (tetralogy of Fallot, transposition of great arteries, univentricular hearts, total anomalous pulmonary venous connection, Ebsteinanomaly and others). In addition, protocols for follow-up of post surgical patients are also described, disease wise.
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The epidermoid cysts are the most common cutaneous cysts and may develop from any parts of the human body. Primary epidermoid cyst with hypospadias in the penis is very rare. Here, we present the case of a slow growing, mobilized; non-tender frenulum of the penis mass in a 44-year-old male patient. Complete excision of the cyst was performed under spinal anesthesia. Histopathological examination confirmed the mass to be an epidermoid cyst. Care must be given during examination to rule out another entity. If there is any indication, complete excision and hypospadias repair is the best treatment
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Background: Jaundice is a common problem in both medical and surgical practice. For best line of management, it is very essential to differentiate all types of jaundice. The cause can often be correctly anticipated clinically but usually biochemical and radiological imaging investigations are required for confirmation. Here we present a study on clinical and biochemical profile of jaundice patients admitted in a tertiary care hospital.Methods: It was an observational study and all patients admitted with jaundice in the department of medicine meeting inclusion/exclusion criteria were enrolled. Data was collected on a self-designed, pretested and structured format.Results: Out of 100 patients, 77 were males, and median age of 47.5 years. Apart from jaundice, anorexia was the most common presenting complaint (90%), while ascites was the most common finding. Cirrhosis (60%) was the most common cause of jaundice. The mean total bilirubin was 7.9 mg%. Mean Hemoglobin in patients with cirrhosis was 9.7gm/dL. 78% patients of cirrhosis revealed esophageal varices. Majority (80%) showed hypoproteinemia. PT was prolonged >3sec in 87% of cases. On USG shrunken liver was noted in all patients with cirrhosis, enlarged liver was found in two patients of liver abscess while altered echotexture was seen in 66% cases. 90 patients improved, 9 died and only one was referred.Conclusions: Alcoholic liver disease was the leading cause of cirrhosis (92%). Jaundice in general and alcoholic cirrhosis in particular affects mostly the productive age group of the male population and has a high economic burden on our society.
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Context: Radiotherapy is a very effective treatment modality for pelvic malignancies such as carcinoma of the cervix. However, it is quite common for chronic radiation proctitis (CRP) to manifest after radical radiotherapy. CRP is a source of significant morbidity, and there is a lack of effective treatment modalities. There also exists a general lack of guidelines on management of CRP. Aims: To assess the benefit from 4% formalin application for the treatment of Grade >2 CRP among patients previously treated with radical radiotherapy for cervical carcinoma. Settings and Design: This retrospective descriptive study involved 29 eligible patients who were treated from November 2010 - November 2015 for CRP with 4% formalin application. Materials and Methods: Of the 1864 patients of carcinoma cervix treated during the said patients, 29 patients fulfilled the eligibility criteria. Eligible patients were invited telephonically for follow-up and were assessed for response and complications of the procedure. Results: The treatment of hemorrhagic radiation proctitis with local formalin instillation is effective, well tolerated and safe procedure. The procedure is inexpensive, technically simple and can be done on an outpatient basis. 62% patients had complete freedom from rectal bleed, while 34.5% patients had partial benefit. Only one patient required diversion colostomy for persistent bleeding.
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To compare and find diagnostic accuracy of Transvaginal sonography (TVS) over Transabdominalsonography (TAS) in evaluation of adnexal lesions. A cross sectional comparative study of 50 patientsincluding both pre and postmenopausal women who were clinically suspected to have adnexal masswere scanned on Logiq GE C5 Premium ultrasonography unit. TAS was performed with 3.5MHzelectronic macro convex probe followed by TVS with 6.5 MHz end firing electronic TVS probe. TVSwas found to be superior in diagnosing adnexal lesions. In comparison with TAS, TVS diagnosedbenign cystic teratomas (100% versus 40%), endometriomas (90% versus 57.1%), haemorrhagic ovarian cysts (85.7% versus 50%, hydrosalpinx (75% versus 25%), pyosalpinx/tubo-ovarian mass (75%versus 75%), and ectopic pregnancy (100% versus 77.7%). In our study ovarian cancers were betterdetected by TAS due to their large size. TVS was found to be superior in diagnosing adnexal masses ascompared to TAS with more accurate delineation of internal architectural features as wall thicknessand complexity, nodules, septae, papillary projections, internal echoes thereby narrowing the differentials.
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Background: Acute gallstone pancreatitis is the common condition marked by pancreatic inflammation. In general, patients with gallstone induced mild pancreatitis should undergo definitive treatment in the form of LC before discharge from hospital, during first admission itself. This is more important to prevent a further attack of acute pancreatitis, seen in as many as 30-50%, during the waiting period of LC. Our study analyzes various parameters in patients which were treated by early and delayed laparoscopic cholecystectomy who presented with mild acute biliary pancreatitis. Methods: A prospective study was conducted for one year, where 25 cases were operated early (within 8 days of pain abdomen) and another 25 cases were operated by delayed laparoscopic cholecystectomy for diagnosed mild acute biliary pancreatitis. Various parameters were assessed and compared which included both intra operative and postoperative events. Haemodynamically unstable, associated choledocholithiasis, severe AP and patients with malignancy were excluded from this study. Results: Twelve cases presented with recurrent attacks in waiting period which were delayed for surgery. In early group, operative time ranged from 19-40 minutes, operative blood loss about 10-50 ml, 3 patients were converted from LC to OC, 6 patients needed a drain and hospital stay ranged from 2-6 days. In delayed group, operative time ranged from 18-36 minutes, operative blood loss about 10-40 ml, 2 patients converted from LC to OC, 3 patients needed a drain and hospital stay ranged from 1-5 days. Post operative analgesia dose was also comparable. Conclusion: In new era of sophisticated technology, improved operative techniques and better post operative management; early LC is gold standard approach in patients with mild to moderate gall stone induced AP. It protects against further attacks of biliary pancreatitis, with no increase in complications or morbidity. Therefore, LC in the early period is safe, effective and feasible in patients of gallstone induced AP, preventing recurrent attacks, which otherwise cause significant morbidity and even mortality in patients.
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Enteroliths are a rare cause of intestinal obstruction. Patients can present with repeated episodes of intestinal obstruction as long as an enterolith is able to pass through the gut and then suddenly, they get stuck at the terminal ileum or present with the perforation peritonitis, as may happen in case of a diverticular disease. Here, we report the case of a young male presented to the emergency room with acute intestinal obstruction. During the explorative laparotomy, an enterolith was found stuck inside the proximal jejunum which was removed through an enterotomy. This was an interesting case, as the patient did not have any predisposing factors nor did we find any evidence of other pathologies intraoperatively. Moreover, the enterolith was stuck in jejunum, contrary to the belief that terminal part of the ileum is a most common site for the enteroliths to get stuck.
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Abstract Macrodystrophia lipomatosa is a rare entity that is mostly diagnosed in children. It has been very rarely reported in adults. Here, we describe the X-ray and computed tomography findings in a case of macrodystrophia lipomatosa in an elderly female presenting with an enlarged second toe since birth and bony outgrowths causing pressure effects and cosmetic problems.
Resumo A macrodistrofia lipomatosa é uma entidade rara, principalmente diagnosticada em crianças, e pouquíssimo relatada em adultos. Descrevemos os achados de radiografia e tomografia computadorizada em um caso de macrodistrofia lipomatosa em uma mulher idosa que apresentava um segundo dedo do pé aumentado desde o nascimento e crescimentos ósseos que causavam efeitos de pressão e problemas cosméticos.
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Abstract Intradiploic arachnoid cysts have scarcely been reported in the literature, most reported cases being secondary to trauma. Nontraumatic arachnoid cysts are quite rare and have been reported mostly in adults. Here, we report the case of a 16-year-old male presenting with a slowly growing mass in the occipital region and intermittent headaches. On the basis of the findings of X-rays, computed tomography scans, and magnetic resonance imaging scans of the head, the mass was diagnosed as a giant intradiploic arachnoid cyst.
Resumo Cistos aracnóideos intradiploicos foram raramente relatados na literatura, sendo a maior parte desses casos decorrente de traumas. Cistos aracnóideos não traumáticos são muito raros e têm sido relatados principalmente em adultos. Aqui, relatamos o caso de um jovem de 16 anos de idade apresentando uma massa de crescimento lento na região occipital e dores de cabeça intermitentes. Com base nos resultados de radiografia, tomografia computadorizada e ressonância magnética da cabeça, a massa foi diagnosticada como um cisto aracnóideo intradiploico gigante.
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Aerobic exercise is a proven measure to enhance the cardio-respiratory efficiency. This improvement is primarily due to improvement in autonomic function where in there is increase in the parasympathetic function and decrease in sympathetic function. Exercise also affects many metabolic activities in our body and may be one of the factors which reduce the oxidative stress. The aim of the present study was to see the effect of moderate aerobic exercise training on autonomic function and its correlation with antioxidant status. 30 healthy volunteers in the age group of 18-22 years were screened. Autonomic function tests included activity (tone) and reactivity parameters. Antioxidant status was assessed by the level of malondialdehyde in plasma. We observed a significant change in SBP, DBP, LF nu, HF nu, delta value of DBP in CPT and MDA. Our findings are consistent with earlier findings that short duration physical training is known to reduce blood pressure and that there is a relationship between HF (in HRV) and training response Physical exercise also provides a favorable change in the biochemical parameters such as MDA.
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The current observational study was conducted to evaluate the morphology of extracranial parts of carotid arteries by colour doppler in patients of stroke and to assess the peak systolic velocity ratio of internal carotid artery/common carotid artery and its utility in diagnosis of the carotid arterial disease. Duplex ultrasound is an inexpensive, non-invasive method that can provide functional and anatomical information about vessel stenosis and plaque morphology. It is a sensitive method for detection of atherosclerotic plaque and provides considerable information about the extent and severityof plaque as well as the resulting diminution of arterial lumen.The study of Colour Doppler of carotid arteries was carried on 35 patients presenting with stroke. The data gathered included grey scale and Doppler findings of common carotid, internal carotid and external carotid arteries. In this study, the commonest lesion found was the atherosclerotic plaque. Most common risk factor for increased intima -media thickness of carotid vessel is found in patients with history of smoking > 10 years. Atheromatous plaque was most commonly found in the left carotid and bilateral system (41.1%). Most common site for atheromatous plaque was found to be carotid bifurcation (48.5%). Significant stenosis (i.e. >40%) was found in 24(64%) of the cases. Peak systolic velocity ratio showed significant stenosis in 24 (68.5%) of patients. The role of carotid Doppler in detecting the site and morphology of atherosclerotic plaque with quantifying the amount of stenosis is very welljustified. In addition carotid Doppler can also be used to assess the prognosis in potential symptomatic and asymptomatic patients with one or the other risk factors for cerebrovascular disease.