Effect of Anti?Platelet Therapy on Peri?Operative Blood Loss in Patients Undergoing Off?Pump Coronary Artery Bypass Grafting

Purpose:The purpose of this study was to review the effect of the pre?operative use of clopidogrel and aspirin on peri?operative bleeding, blood product transfusion, and resource utilization after coronary artery bypass grafting (CABG). Materials and Methods: A total of 1200 patients who underwent off?pump CABG (OPCABG) between 2010 and 2012 were retrospectively studied. Patients were divided into three groups: group 1: discontinued aspirin and clopidogrel 6 days prior to surgery (n = 468), group 2: discontinued both drugs 3 to 5 days prior to surgery (n = 621), and group 3: discontinued both drugs 2 days prior to surgery (n = 111). The bleeding pattern and blood product transfusion were studied and compared between the groups. Patients having history of other drugs affecting the coagulation profile, other organ dysfunction, on?pump CABG, and the combined procedure were excluded from the study. Results: Group 2 patients had a higher rate of bleeding and a reduced mean value of hemoglobin (Hb) as compared to other groups. The same results were seen in blood and blood product transfusion. Patients of group 2 and group 3 were associated with higher blood loss in terms of drainage at 12 and 24 hours. Post?operatively, this was statistically significant. Re?exploration was statisitically significant in group 3 patients (9.01%) than in group 2 (2.58%) and group 1 (1.07%) patients. Conclusion: The pre?operative use of clopidogrel and aspirin in patients undergoing OPCABG showed limited clinical benefits; however, its use significantly increased the risk of bleeding and blood transfusion, thus increasing morbidity and resource utilization. Hence, clopidogrel and aspirin should be stopped at least 6 days prior to surgery.

A Study of the Clinical and Epidemiological Profile of Patients with Congenital Dacryocystitis

Introduction: The most common functional abnormality ofthe infant’s lacrimal apparatus is the congenital blockage ofthe nasolacrimal duct. Non-canalisation of the duct, presenceof epithelial debris, mucous plug and bony occlusion are someof the possible causes of blockage. This was a prospectivestudy to identify the etiological agents, predisposing factorsand clinical profile of patients with congenital dacryocystitis.Material and Methods: A prospective observationalhospital based study was conducted on 72 eyes of 61 childrenpresenting with congenital dacryocystitis, in the age group 0-4years, attending the ophthalmology outpatient department in atertiary care teaching hospital.Results: Congenital dacryocystitis was common in agegroup of 0-3 months (31.15%). The incidence of disease inage group 4-6 months was 24.59% and 7-12 months was13.11%. 55.74% of males were affected. 83.61% of patientshad unilateral congenital dacryocystitis. 80.33% of thechildren had a normal delivery. 66.66% of cases presentedwith epiphora and discharge. 31.95% of cases presented withepiphora only. Epiphora with mucopurulent discharge was themost common presentation. Regurgitation test was positive in88.89% of cases. The nature of regurgitate was mucopurulentin 42.19% of cases.Conclusion: Congenital dacryocystitis usually presents at anearly age with epiphora and mucopurulent discharge. Earlydiagnosis helps in management.

Polycystic ovarian syndrome and insulin resistance: a South Indian study

Background: Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women of reproductive age. Some studies have characterized different aspects of women presenting with PCOS. In this study we characterise the association of insulin resistance (IR) in patients with PCOS in the southern Indian state of Andhra Pradesh.Methods: A total of 50 women diagnosed to have PCOS according to Rotterdam criteria were studied. IR was estimated using Homeostatic model assessment - insulin resistance (HOMA-IR) and clinical characteristics were recorded.Results: The prevalence of IR among the study population was 36%. All PCOS patients with IR were overweight or obese, and had impaired glycaemic status, 75% of PCOS patients with IR also had features of hirsutism.Conclusions: Considering the prevalence of IR, obesity and impaired fasting glucose in women with PCOS, early institution of treatment by lifestyle changes or medication would lead to improvement in reproductive and metabolic abnormalities.

Corneal ulcer: an epidemiological, microbiological and clinical study of cases attending Assam medical college and hospital, Dibrugarh, India

Background: Corneal ulcer is one of the important ophthalmic conditions causing significant morbidity especially in the developing countries. This study was carried out to evaluate the common etiological agents, predisposing factors, age, gender and occupational distribution and to study the clinical features and management of all corneal ulcers.Methods: A total of 50 cases of corneal ulcers who attended the Ophthalmology outpatient department (OPD) of Assam medical college and hospital, Assam, India, over a 6 months period were included in the study. A detailed history was taken and examination done as per the proforma. Microscopy and culture were performed on all corneal specimens obtained.Results: Corneal ulcers were common in 3rd to 5th decades of life with Male to Female ratio of 1.3:1. Majority of patients were farmers or hired agricultural workers. Ocular trauma was the major predisposing factor in majority of cases (32%). Out of 50 cases, 31 (62%) were culture positive. 19 were bacterial isolates and 12 were fungal isolates. All patients were treated according to standard treatment protocol and majority (95.5%) patients responded well to treatment.Conclusions: This study has revealed that suppurative corneal ulcers are caused by both bacterial and fungal agents with bacterial preponderance in this geographical area. Early and accurate diagnosis and intensive treatment is the need of hour for saving the eye and preventing the catastrophe of lifelong blindness.

Effectiveness of diabetes in pregnancy study group India diagnostic criterion in detecting gestational diabetes mellitus: a rural Bangalore study

Background: The oral glucose tolerance test (OGTT) is considered the current standard for diagnosis of gestational diabetes mellitus (GDM). International association of diabetes and pregnancy study groups (IADPSG) recommends OGTT, with fasting, one-hour and two-hour venous blood samples drawn after intake of 75g oral glucose. In the Indian context, diabetes in pregnancy study group in India (DIPSI) recommends glucose challenge test (GCT), where 75 g glucose is given irrespective of the fasting state, and a single venous sample is drawn after two-hour. Diagnosis of GDM is made, if any cut-off value is met or exceeded. This prospective study was conducted to compare the DIPSI and IADPSG criteria for diagnosis of GDM.Methods: Pregnant women between 24 to 28 weeks of gestation were subjected to non-fasting GCT. Capillary sample were also drawn simultaneously using Accu check active glucometer. These women were counselled to undergo a standard 75gram OGTT, within a week of recruitment.Results: According to IADPSG criteria, 17.6% (18/102) of our participants had GDM, as compared to 19.6% (20/102) by DIPSI criteria using venous samples, and 25.3% (25/99) by capillary sample method. Sensitivity and specificity of GCT using venous sample was 72.22% and 91.67%, and using capillary sample was 70.59% and 84.15% respectively. DIPSI criteria using venous samples wrongly labelled 8.3% women as GDM, and capillary samples wrongly labelled 15.9% women as GDM. More importantly DIPSI criteria using venous samples labelled 27.8% women as false-negative and capillary samples labelled 29.4% women as false-negative for GDM. Almost one quarter of women with GDM will be missed if DIPSI criteria is used as a universal screening modality.Conclusions: We suggest that the IADPSG criteria be used for diagnosis of GDM in antenatal women in India.

Awareness about cigarettes and other tobacco products act and impact of health warnings on smokers in a North Indian city

Background: Tobacco use is a major preventable cause of morbidity as well as mortality worldwide. To combat the increasing trend of this problem, Government of India formulated the COTPA (Cigarettes and Other Tobacco Products Act) in 2003. The study aimed to assess the awareness about COTPA and impact of pictorial warnings among smokers attending outpatient services in a tertiary care hospital in Jammu.Method: The present study was conducted among 320 patients attending the outpatient department of Internal Medicine, Government Medical College, Jammu who happened to be cigarette smokers. The questionnaire was developed by authors with the help of literature review and pilot tested before its final use. Information was elicited about demographic details, awareness about COTPA and impact of pictorial warnings on quitting of smoking.Results: More than half of the respondents were in 30-50-year age group and were urban residents. Awareness about COTPA was good on some parameters but was relatively low on other parameters. Despite all, the respondents noticing pictorial warnings on tobacco packages, only 69.37% of them were contemplating to quit. About half of them were of the view that warning statements preferably be written in local languages.Conclusion: Health and pictorial warnings on tobacco packages remain an important pillar in filling the gap of knowledge and communicating the health risks of tobacco use to the consumers. Only 69.3% of the respondents were planning to quit and awareness levels about COTPA were mixed.

To Find Out if There is any Association between Dyslipidemia and Cataract in Tribal Population

Introduction: Cataract is a major cause of impaired vision andblindness. Study aimed to find out if there is any associationbetween dyslipidemia and cataract.Material and methods: This cross sectional hospital basedstudy was performed in a tertiary care center of Jharkhandbetween June 2017 to March 2018. Total 223 patients whowere diagnosed with senile cataract were included in the study.Detailed history, ophthalmologic and systemic examinationwas done. Dyslipidemia is defined as:Hypercholesterolemia(total cholesterol > 220 mg/dl), or Hypertriglyceridemia (totaltriglyceride > 150 mg/dl), or Low density lipoprotein > 130mg/dl.Results: Out of total 223 patients 134 were men and 89were women. 70% patients had dyslipidemia. Prevalenceof dyslipidemia was associated significantly (< 0.05) withnuclear and cortical cataract but not significant (> 0.05) forposterior sub capsular cataract.Conclusion: Dyslipidemia maybe considered having anassociation with nuclear and cortical cataract directly orindirectly.

Climate change: what people living in Jammu city of India know?

Background: Climate change has emerged as one of the greatest challenges of the present century. The current study explores the knowledge, attitudes and practices about climate change of the adults aged 18 years and above in Jammu city of North India.Methods: A cross-sectional study was conducted among attendants of the patients visiting medical OPD of a tertiary care teaching hospital. A pilot tested questionnaire eliciting information on knowledge, attitudes and practices about climate change was administered to those who were willing to participate.  The data collected was presented in proportions.Results: Majority (95%) of the respondents had heard of the term climate change, and 43.9% of them related it to changes in the weather pattern. Plastic use as a major cause of climate change was agreed upon by 95% of the respondents. About half of the respondents were very much concerned about climate change and 80% of them were very much interested in knowing more about climate change and its impact. Only 24.8% of the respondents read/watch stories on climate change.Conclusions: Knowledge levels of the respondents were found to be reasonably good but the same cannot be said about their attitude and practices. Role of NGOs, social communities and media is of utmost importance to make people aware of the harmful effects of climate change on both the environment as well as the health of the people.

A clinical study of patients attending disability clinic in a tertiary care hospital of Assam, India

Background: The aim of the study was to determine the various types of congenital or acquired disorders causing permanent disability and their association with age, sex and visual acuity in patients attending disability clinic of department of ophthalmology, Jorhat medical college and hospital, Assam, from January 2018 to December 2018.Methods: A hospital-based cross-sectional study. 200 patients were enrolled in the duration of January 2018 to December 2018 and were analyzed for anomalies, etiology, sex and age at presentation.Results: Out of 200 cases analysed, 116 males and 84 females (Male: Female = 1.38:1) observed. The most common age group at presentation was 11-20 years (28.5%). 23% of cases were congenital. The most frequent ocular anomaly noted was microphthalmos (19%) followed by uveal coloboma (15%) and phthisis bulbi (14%).Conclusions: In a developing country like India, a large proportion of the childhood and adult blindness is avoidable. Action is needed to prevent blindness from vitamin A deficiency, measles, external ocular infections and chemical injuries. Specialist paediatric and optical services are required to manage cataract and glaucoma. Further work is indicated to elucidate the causes of anophthalmos, microphthalmos and coloboma. It would be useful to document the changing patterns in the causes of ocular disability to allow early action against emerging avoidable causes.

Cervical cancer: a hospital based KAP study among women aged 18 years and above in Northern India

Background: Cervical cancer is known for its late detection due to a variety of reasons chiefly lack of knowledge, undesirable attitudes and poor practices. Early screening and adequate knowledge about the disease remains the important safe guards against this disease. The study aimed to assess the knowledge, attitudes and practices of the women aged 18 years and above regarding cervical cancer visiting a tertiary care teaching hospital.Methods: The present cross sectional hospital based study was conducted in Jammu city, Jammu and Kashmir, India. All the women aged 18 years and above visiting OPD of gynaecology-obstetrics department of Government Medical College Jammu and willing to participate were administered a pretested questionnaire to collect the relevant data.Results: It was found that 91.56% of the respondents had heard of cervical cancer with 83% reporting that it was both preventable as well as curable. Multiple sex partners were the most important risk factor identified. Among the attitudes, 62% agreed that screening was harmless to the client. Only one third knew about the availability of preventive vaccine. About 83.6% of them had never been screened by Pap smear. However willingness to get HPV vaccination was found to be high.Conclusions: Though knowledge among the respondents was found to be adequate but it lacked transformation into attitudes and practices. In this connection, authors recommend health promotion campaigns to educate women and the community about cervical cancer and its preventability through screening.

Risk Factors For Chronic Respiratory Diseases Among Rural Adults in Northwest India

Chronic respiratory diseases(CRD) remain a formidable challenge for public health experts acrossthe world due to their ever increasing morbidity and mortality. This study investigated various riskfactors for CRD among rural adults aged 20 years and above. The study was conducted in fourvillages under sub-health centre Domana in Kot Balwal health block and these villages wereselected randomly. For this cross-sectional population based study, a pre-tested respiratory healthquestionnaire was used. Those respondents who were found to be diagnosed cases of CRD werefurther enquired in detail about various risk factors for CRD. Out of 2018 respondents surveyed,177confirmed cases of CRD were detected.Various risk factors like being male, smoking, overcrowding,recurrent chest infections and use of non-clean fuel (wood, cow dung) were found to bestatistically significant. Among other risk factors, ventilation and history of allergy were found tobe highly significant statistically (p< 0.000). Smoking, recurrent chest infections, use of biomass fuel,ventilation and history of allergy were risk factors for CRD in rural adults aged 20 years andabove.

Risk factor analysis among patients with stroke: a cross sectional study at a tertiary care hospital

Background: Study of risk factors of stroke is very important in different settings to confirm their existence and to take necessary steps to prevent them especially in elderly so that incidence of stroke can be brought down. The objective of the present study is to perform the risk factor analysis among patients with stroke.Methods: A hospital based cross sectional study was carried out at a tertiary care hospital from June 2015 to March 2016. A total of 40 patients diagnosed with stroke were included in the present study. Detailed information and all necessary investigations were carried out. Risk factor analysis was done, and categorization was done for certain risk factors.Results: The predominant age group was 6-60 years. The age ranged from 1 month to 67 years. The Male: Female ratio was 14:9. The common etiologies were congenital, post infective and intracranial bleed in 26.1% (n=6) each. Favourable outcome was seen in 82.6% of cases. The failure rate was 17.4%. Most no of cases with favourable outcome was seen in 6-60 years age group, whereas >60 years age group had the most no of cases with poor outcome. The overall mortality rate was 21.6% (n=5). Wound related complication was seen in 1 patient (4.3%). Two (8.7%) patients required VP shunt post ETV. The cause of mortality was aspiration pneumonitis in 3 cases, CSF metastasis and wound infection in 1 cases each.Conclusions: The leading cause as well as risk factor for stroke was found to be hypertension followed by alcohol and smoking.

A hospital based follow up study on predictors of mortality in patients with Intra cranial hemorrhage

Background: Intra-cerebral hemorrhages account for approximately 10-15 percent of all stroke cases and are associated with the highest mortality rate (30-40%). Study of predictors can modify the mortality rates. The objective of the present study the predictors of mortality in patients with intra cranial hemorrhage.Methods: Hospital based cross sectional study was carried out. Forty patients with CT scan evidence of intra cranial hemorrhage admitted to our hospital were randomly selected. All investigations were done. Patient characteristics were noted down.Results: In the present study among 40 patients, 16 patients died. The mortality was 40%. As the age increased, the mortality rate increased. But there was no difference between the mortality among males and females. Mortality was more than twice among those with SBP more than 180 mmHg i.e. 58.8% compared to only 26.1% among those with SBP less than 180 mmHg. Similar findings were noted for DBP and MAP. As the severity of motor weakness increased, the mortality increased. Patients with presence of bilateral plantar extensor response were found to be more at risk of death with a death rate of 66.7% compared to only 18.2% among those without presence of bilateral plantar extensor response. As the Glasgow coma scale increased, the mortality decreased from 100% in patients with a score of 3-4 to only 31.2% in patients with a score of 9-13. Intra-ventricular extension of haemorrhage, presence of hydrocephalus, volume of hematoma >30 ml, decreased consciousness level was important predictors.Conclusions: Bad prognosis i.e. death can be expected if the patient is older, low GCS, hematoma size > 30 ml, gaze palsy, severe motor neuron weakness, abnormal pupils, ataxic respiration etc. hence intensive care should be given to such patients to bring down the mortality.

Lysinuric Protein Intolerance Presenting with Recurrent Hyperammonemic Encephalopathy.

Background: Lysinuric protein intolerance is an inherited disorder of transport of cationic amino acids, causing amino aciduria. Case characteristics: A 3-year-old boy with 12 month history of episodic change in behavior (decreased sleep, poor interaction), stunted growth and hyperammonemia. Outcome: Genetic analysis revealed a homozygous mutation, c.158C>T (p.Ser53Leu) in exon 1 of SLC7A7 gene.With appropriate management of hyperammonemia episodes, his neurodevelopmental outcome is normal. Message: Lysinusic protein intolerance is a potentially treatable disorder and should not to be missed.

Morbidity Profile of Rural Geriatric Population in North India: A Community Based Cross-sectional Study.

The current cross-sectional study was conducted over a period of on eyear. Eight villages were chosen from Miran Sahib zone of R.S Pura block using simple random sampling. A pre-designed, pre-structured and validated questionnaire was applied to all persons aged ?60 Years. A total of 418 subjects (191 males and 227 females) comprised the study population.64.40% of the respondents belonged to 60-69 year age group. Among the morbidity distribution in the study population, visual impairment (54.06%) was the most common, followed by hypertension (35.89%), arthritis (34.21%), diabetes mellitus (12.92%) and chronic obstructive pulmonary disease (5.50%). COPD was higher in males and arthritis was higher in females and the gender disease association was found to be statistically significant (p<0.05). The results have shown high morbidity in the study population especially of visual impairment and cardio-vascular diseases. Respiratory diseases especially COPD morbidity was higher in males, while arthritis morbidity was more in females.

A randomised comparative study of the effect of Airtraq optical laryngoscope vs. Macintosh laryngoscope on intraocular pressure in non-ophthalmic surgery / Estudo comparativo randomizado do efeito do laringoscópio óptico Airtraq vs. laringoscópio Macintosh sobre a pressão intraocular em cirurgia não oftálmica

BACKGROUND: We compared intraocular pressure changes following laryngoscopy and intubation with conventional Macintosh blade and Airtraq optical laryngoscope. METHODS: Ninety adult patients were randomly assigned to study group or control group. Study group (n = 45) - Airtraq laryngoscope was used for laryngoscopy. Control group (n = 45) - conventional Macintosh laryngoscope was used for laryngoscopy. Preoperative baseline intraocular pressure was measured with Schiotz tonometer. Laryngoscopy was done as per group protocol. Intraocular pressure and haemodynamic parameters were recorded just before insertion of the device and subsequently three times at an interval of one minute after insertion of the device. RESULTS: Patient characteristics, baseline haemodynamic parameters and baseline intraocular pressure were comparable in the two groups. Following insertion of the endotracheal tube with Macintosh laryngoscope, there was statistically significant rise in heart rate and intraocular pressure compared to Airtraq group. There was no significant change in MAP. Eight patients in Macintosh group had tongue-lip-dental trauma during intubation, while only 2 patients received upper airway trauma in Airtraq group. CONCLUSION: We conclude that Airtraq laryngoscope in comparison to Macintosh laryngoscope results in significantly fewer rises in intraocular pressure and clinically less marked increase in haemodynamic response to laryngoscopy and intubation.

JUSTIFICATIVA: Comparar as alterações de pressão intraocular após laringoscopia e intubação com lâmina Macintosh convencional e laringoscópio óptico Airtraq. MÉTODOS: Noventa pacientes adultos foram randomicamente designados para os grupos estudo ou controle. No grupo estudo (n = 45) o laringoscópio Airtraq foi usado para laringoscopia e no grupo controle (n = 45) o laringoscópio Macintosh convencional foi usado para laringoscopia. A pressão intraocular foi mensurada no pré-operatório com tonômetro Schiotz. A laringoscopia foi feita de acordo com o protocolo de cada grupo. Pressão intraocular e parâmetros hemodinâmicos foram registrados logo antes da inserção do dispositivo e três vezes após a inserção do dispositivo, com intervalo de um minuto. RESULTADOS: As características dos pacientes, os parâmetros hemodinâmicos basais e a PIO basal foram comparáveis nos dois grupos. Após a inserção do tubo endotraqueal com o laringoscópio Macintosh, houve um aumento estatisticamente significativo da frequência cardíaca e da pressão intraocular em comparação com o grupo Airtraq. Não houve alteração significativa da PAM. Oito pacientes do grupo Macintosh sofreram trauma de língua-lábio-dental durante a intubação, enquanto apenas dois pacientes sofreram trauma das vias aéreas superiores no grupo Airtraq. CONCLUSÃO: Concluímos que o laringoscópio Airtraq, em comparação com o laringoscópio Macintosh, resultou em elevações significativamente menores da PIO e em aumentos clinicamente menos acentuados da resposta hemodinâmica à laringoscopia e intubação.

Pulmonary Thromboembolectomy in Chronic Thromboembolic Pulmonary Hypertension: A Case Report and Review of Literature.

Chronic thromboembolic pulmonary hypertension (CTEPH) is an important cause of severe pulmonary hypertention (PH) resulting in significant morbidity and mortality. Chronic thromboembolic PH occurs when a pulmonary embolism fails to undergo complete thrombolysis leading to vascular occlusion and pulmonary hypertension. Despite the fact that CTEPH is a potential consequence of pulmonary embolus, diagnosis requires a high degree of vigilance as many patients will not have a history of thromboembolic disease. The ventilation perfusion scan is used to evaluate for the possibility of CTEPH although right heart catheterization and pulmonary artery (PA) angiogram are needed to confirm the diagnosis. Pulmonary thromboendarterectomy is the first-line treatment for patients who are surgical candidates. This case report and review describes the pathophysiology, risk factors, diagnosis, and management of CTEPH. As it is a potentially curable cause of PH, its accurate diagnosis is vital. The gold standard and effective treatment for CTEPH is pulmonary endarterectomy (PEA). Pulmonary endarterectomy is an uncommon procedure with less than 50 years of experience worldwide. Research on the development of new surgical approaches is essential. In the present case, a new successful surgical technique for PEA was introduced. Conclusion: The surgical procedure used on the present patient was a unique technique. We do not claim that our technique is better than the original San Diego technique, but it is suggested as a modification that may improve patient survival. However, this procedure has its own limitations and cannot be used for clots that are located distally. Therefore, further experience should be obtained in order to overcome the limitations and improve the applicability of the technique.

Tertiary Prevention of Ischemic Heart Disease: Post Coronary Artery Bypass Surgery.

Coronary heart disease is more prevalent in Indian urban populations and there is a clear declining gradient in its prevalence from semi-urban to rural populations. Epidemiological studies show a sizeable burden of coronary heart disease in adult rural (3-5%) and urban (7-10%) populations. Thus, of the 30 million patients with coronary heart disease in India, there would be 14 million who are in urban and 16 million in rural areas. In India, about 50% of coronary heart disease-related deaths occur in people younger than 70 years compared with only 22% in the West. Extrapolation of these numbers estimates the burden of coronary heart disease in India to be more than 32 million patients. In India, there are large spectrums of patients who present at tertiary stage when first examined. These patients are left with very little margin of safety. Heart disease is one of the commonest causes of mortality and morbidity worldwide. Coronary artery bypass graft (CABG) surgery is a frequently used cardiothoracic revascularization to treat coronary artery disease (CAD). In addition to physical impairments and activity restrictions in the immediate postoperative period, patients encounter some obstacles to exhibit improvements in quality of life in the long run. Cardiac tertiary prevention programs generally consist of the prevention of disease progression and patient suffering. Aim of these interventions is to reduce the negative impact of disease by restoring function and reducing disease-related complications and therefore, include the rehabilitation of disabling conditions. Cardiac rehabilitation programs are interventions aimed to reduce mortality and morbidity of patients with ischemic heart diseases through promoting a healthier lifestyle among patients. These programs are used to restore, maintain, or improve both physiologic and psychosocial outcomes and finally the quality of life in patients through a combination of exercise, education and psychological support.