Utilization of Nerve Conduction Study for the Detection of Diabetic Polyneuropathy in a Tertiary Care Center in Madhya Pradesh

Introduction: Diabetes mellitus is a group of metabolic disorders that share the phenotype of hyperglycemia. The clinical and economic burden of diabetic polyneuropathy (DPN) stems from its central role in the pathophysiology of foot ulceration and lower limb amputation, reduction in quality of life. Simple screening methods are of limited value in early neuropathy. Nerve conduction studies (NCSs) are the most sensitive and specific DPN detection method. Material and Method: This study was conducted to detect the sensory-motor neuropathy in type 2 diabetes mellitus by clinical examination and nerve conduction study. In this study, 50 cases of type 2 diabetes were taken. Results: Majority of patients presented with tingling sensation and followed by burning feet. In 50 patients of type 2 diabetes mellitus on clinical examination, most of the patients had involvement of both upper and lower limbs followed by only lower limb involvement, whereas on NCS, there were more patients with both upper and lower limbs involvement as compared to clinical studies. Maximum patients had symmetrical limb involvement clinically, but on NCS, the number of patients with symmetrical limb involvement was even more. Conclusion: It was found that patients with diabetes mellitus, diabetic peripheral neuropathy is highly prevalent, but in the majority of patients, it is subclinical. Sensitivity and negative predictive values of the neurological examination are low. Therefore, routine nerve conduction velocity measurement for the assessment of diabetic peripheral neuropathy appears to be warranted in these patients. Thus, the author concluded in this study, detection of neuropathy is earlier and significant with NCS compared to clinical.

Predictors of Post-operative Pulmonary Complications Following Emergency Laparotomy

Background: Post-operative respiratory complications are a major threat following emergency abdominal surgeries. It significantlyincreases post-operative morbidity and mortality. The aim of this study was to determine the incidence and factors affectingpost-operative pulmonary complications (PPCs).Materials and Methods: This is a prospective observational study conducted in 270 patients who got admitted through SOPD,casualty or transferred from other department, and undergoing emergency laparotomy over a period of 1 year (June 1, 2018–May 31, 2019). Patients were included in the study irrespective of age, sex, and occupation. Pre- and post-operative datawere collected through interview and postoperatively patients were monitored clinically and various investigations were doneto record post-operative respiratory complications. Then, their association was analyzed.Results: Two hundred seventy patients were included in the present study and 55 (20.4%) developed PPCs. Pneumonia (20)was the most common PPC followed by atelectasis (15). Elderly patients had more risk. PPCs were more in current smokers(30.98%), patients with pre-existing respiratory diseases (47.1%), duration of surgery more than 3 h. PPCs significantly increasethe duration of hospital stay and mortality.Conclusion: Pulmonary complications are significant among patients undergoing emergency laparotomy that leads to increasedmorbidity and mortality. Predictors of PPCs are smoking, pre-existing respiratory diseases, prolonged duration of surgery, andprolonged intubation.

A Prospective Study of Common Surgical Problems in Geriatric Patient with Special Reference to Gastrointestinal Tract Diseases in Vindhya Region

Background: Aging is a continuous process which begins with conception and ends with death. It is said that nobody grows oldmerely by living a certain number of years, while aging merely stands for growing. The health problems to be considered shouldinclude – physical, mental, emotional, and socioeconomical. Old age is not a disease but the aged people are often vulnerableto long-term diseases such as cardiovascular, cerebrovascular, respiratory, gastrointestinal, cancers, mental derangement,hearing and visual loss, and conditions affecting the locomotor system. Aim of this study is to analyze the common surgicalproblems in geriatric patient with special reference to gastrointestinal tract (GIT) diseases in Vindhya region.Materials and Methods: A total of 1585 cases were studied with common surgical geriatrics problems admitted in the surgicalwards in Sanjay Gandhi Memorial Hospital associated with Shyam Shah Medical College, Rewa (MP), India, in the periodfrom 1 June 2018 to 31 May 2019. The proposed study includes patients with age 60 years and above who will be admittedthrough surgical outpatient department, casualty and/or will be transferred from other departments. After admission of patients,particular will be recorded and they will be also inquired for chief complaints with duration, history, drug history, personal history,and family history. Their findings will be recorded in a pro forma.Results: Of 10,887 patients admitted in Sanjay Gandhi Memorial Hospital associated with Shyam Shah Medical College, Rewa(MP), India, during the period of 1 June 2018–31 May 2019, in which common surgical problems were diagnosed in 1585 patients(14.55%), among which most of the patients were males (1137) and rest were females (448). Most of the patients belonged to 60–64years of age group. From this study, intestinal obstruction among GIT diseases was found to be the most common surgical problem.Conclusion: Majority of elderly patients admitted with GIT disorders were having intestinal obstruction (22.17%), followedby PUD (21.47%), peritonitis (17.09%), malignant lesions and hemorrhoids (9.23%), and colitis (6.92%). Of sex-wise totaladmission. The incidence of intestinal obstruction (26.11% vs. 20.40%) and colitis (14.92% vs. 3.34%) was more common infemale than male. Whereas PUD (23.41% vs. 17.16%) and perforation peritonitis (19.06% vs.12.68%), hemorrhoids were morecommon in male than female.

Study of Peripheral Vascular Disease in Patients with Diabetic Foot using Doppler Ultrasound

Objective: The objective of the study was to determine the extent of vasculopathy in patients with diabetic foot using Dopplerultrasound scanning.Methodology: This descriptive study was carried out in surgical wards SS Medical College and SGMH Rewa from June 1,2017, to May 31, 2018. All patients having diabetic foot complications including abscess formation, cellulitis, ulceration, andgangrene were included in the study after taking informed consent. Peripheral pulses such as posterior tibial, dorsalis pedis,and popliteal arteries were checked. The presence of vasculopathy was checked with Doppler scanning of dorsalis pedis artery,posterior tibial artery, and popliteal artery. The data were collected on a pro forma that was especially designed for this study.Results: A total of 115 patients were included in this study. Out of total cases of the diabetic foot, 21% of cases peripheralpulses were not palpable, 30% of cases were weakly palpable, and in 50% of cases were palpable. In right affected limb outof 66 affected limb, peripheral pulses were palpable in 45% of cases, weakly palpable in 32% of cases, and absent in 23% ofcases and left affected limb out of 49 affected limb peripheral pulses were palpable in 55% of cases, weakly palpable in 26%of cases, and absent in 19% of cases, with a male preponderance.Conclusion: This study shows that vasculopathy is a strong independent risk factor in the development of diabetic foot lesions.The usual symptoms and signs of lower limb ischemia may not be present and indeed may be misleading in diabetic foot disease.

Study of association between the serum lipid profile and age-related macular degeneration in a tertiary care centre of Central UP

Background: Age-related macular degeneration (ARMD) is the major challenge in the new millennium in the developing countries as the size of elderly population continues to rise due to betterment of medical facilities and increased life expectancy. Lipids are implicated in the pathogenesis of ARMD. The relationship between systemic lipids and ARMD has not been well characterized, especially in rural population. The objective was to investigate the relationship between serum lipids and ARMD in older adults.Methods: In this case-control study, 300 adults, aged ≥50 years, 150 each among cases and controls were included in the study. Mean lipids values between cases and controls were compared.Results: Mean age of cases was 62.45±8.472 years and mean age of controls was 61.89±8.51 years. Among 150 cases, 124 (82.66%) cases were of dry ARMD while 26 (17.33%) cases were Wet ARMD. Author found that 38 cases among total cases (25.33%) and 15 individuals (10%) among controls had altered lipid profile. All mean lipid values were higher among cases compare to controls (p>0.05), while the mean of VLDL, TG and TG/HDL were significantly raised showing positive association (p<0.05).Conclusions: Present study showed that high levels of serum lipid values especially VLDL, TG and TG/HDL positive association with an increased risk for development of ARMD, implying that strategies reducing serum lipid levels may be useful to prevent the development of the disease.

Study of Incidence of Helicobacter pylori Infection in Patients of Peptic Ulcer Perforation

Background: Peptic ulcer disease (PUD) is a common disorder that affects millions of individuals each year. PUD has a major impact on our health-care system by accounting for roughly 10% of medical costs for gastrointestinal diseases. Helicobacter pylori infection and the use of nonsteroidal anti-inflammatory drugs are the predominant causes of PUD overall, PU mortality and hospitalization rates have declined for the past two decades, but complications such as PU perforation and bleeding remain a substantial health-care problem. Materials and Methods: A prospective 1-year study conducted in 116 cases of peptic perforation admitted in surgical wards of Sanjay Gandhi Memorial Hospital, Rewa, M.P., during the study period June 2016–May 2017. All patients suspected of peptic perforation were admitted to surgery ward and underwent emergency exploratory laparotomy. Post-operatively, H. pylori serological test to detect IgG antibody was done with patients’ blood serum. Their findings were recorded in a pro forma and master chart. The information obtained was tabulated and analyzed. Results: The incidence of H. pylori infection in our study was found to be 31.03%, i.e., 36 cases of 116 cases. Conclusion: Tobacco chewing, smoking, alcohol, inadvertent use of analgesics, and H. pylori infection are the most common predisposing factors for PUD, and patients’ inability to get proper and complete treatment is responsible for peptic perforation. Early hospitalization and urgent surgical intervention can significantly reduce the post operative morbidity and mortality in peptic ulcer perforation patients. Post-operative H. pylori eradication therapy and follow-up endoscopic facilities in patients found positive for H. pylori can reduce recurrence rates and subsequently the burden of this disease

Hydrophilic Matrix Based Oral Controlled Release Tablets of Melt Sonocrystallized Simvastatin.

The major drawback of Simvastatin to formulate a dosage form is its poor aqueous solubility. In this study a solvent and carrier less technique called Melt sonocrystallization was utilized to form tiny crystals of Simvastatin with enhanced solubility in distilled water and Phosphate buffer pH 7.4, with an insignificant (p > 0.05) change in partition behaviour. The Melt sonocrystallized Simvastatin (MSCSIM) was characterized by FT-IR, DSC and SEM. The flow property was characterized and compared with pure Simvastatin. The MSCSIM was incorporated in directly compressed matrix tablets formed with varying proportion of HPMC K100 LV and starch. The formed tablets were evaluated for pharmacotechnical parameters along with drug release study. After melt sonocrystallization the chemical integrity of drug was unchanged and showed a sound flow property. The pharmacotechnical features of the tablets were noted to be within pharmacopoeial limit. The formulation F5 displayed a comparatively more controlled release of drug (96.45%) over 12 hours. The major release mechanism was found to be anomalous diffusion, with n value of 0.58 from the Korsmeyer-Peppas model, suggesting the drug release driven by swelling of matrix and diffusion. This technique may prove to be beneficial for poorly water soluble drugs and the melt sonocrystallized drugs can lend themselves for developing controlled release formulations.

Clinicopathological Study of Peptic Perforation was Carried Out in 150 Cases Admitted in Surgical Wards of Sanjay Gandhi Memorial Hospital Associated with Shyam Shah Medical College, Rewa (Madhya Pradesh).

Background: Peptic ulcer disease (PUD) is a common disorder that affects millions of individuals each year. PUD has a major impact on our health-care system by accounting for roughly 10% of medical costs for digestive diseases. Overall, peptic ulcer mortality and hospitalization rates have declined for the past two decades, but complications such as peptic ulcer perforation and bleeding remain a substantial health-care problem. Materials and Methods: It was a prospective 1-year study conducted in all cases of peptic perforation admitted in surgical wards during the study period August 2013-July 2014. On admission, every patient was interrogated about name, age, sex, address, occupation, religion, and residence. All patients suspected of peptic perforation with symptoms of the sudden onset of epigastric pain in abdomen, distention of abdomen, constipation, and vomiting were admitted to surgery ward from the outpatient department or transferred from other wards. Their findings were recorded in a pro forma and master chart. The information obtained was tabulated and analyzed. Results: Incidence of peptic perforation was 1.65% of all surgical admissions. It was 6.63% of total case of acute abdomen and 50.17% of total case of perforation peritonitis. A maximum number of peptic perforation cases was found in age group 51-60 years (24.67%). Conclusion: Perforation of the peptic ulcer is due to the persistence of causative factors of peptic ulceration with a decrease in mucosal resistance due to injudicious use of corticosteroids, decreased immunity, malnutrition, delay in hospitalization due to initial treatment by homemade medicines and abdominal massage further complicates the perforation in this region. Peptic perforation is diagnosed on clinical grounds and abdominal X-ray easily, yet due to delayed hospitalization and time consumed in resuscitation of the patient affects the outcome of standard surgical procedure.

Neurocysticercosis with initial clinical presentation of acute cysticercal meningitis coexisting with anterior chamber intraocular cysticercosis: a case report from a rural institute in India.

Acute cysticercal meningitis coexisting with intraocular cysticercosis is an extremely infrequent clinical presentation of neurocysticercosis. We report a 26 year old male, who presented with signs and symptoms of acute eosinophilic cysticercal meningitis with intraocular cysticercosis in the anterior chamber of left eye. Diagnosis was confirmed with demonstration of cerebrospinal fluid (CSF) eosinophilia, cysticercus specific IgG antibodies by CSF ELISA, sterile bacterial, mycobacterial and fungal CSF cultures, cystic lesions containing characteristic scolices consistent with neurocysticercosis on neuroimaging and histopathological demonstration of cysticercus cellulosae larva viscoexpressed from the eye. The importance of having high index of clinical suspicion highlighted along with need of examining cerebrospinal fluid with Wright-Giemsa stain so as not to miss cerebrospinal fluid eosinophilia and diagnosis of this extremely under-reported clinical entity, when there is concurrent presence of brain and other extracerebral lesions consistent with cysticercosis.