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Background: Hypertension is the commonest cardiovascular disorder posing a challenge to the societies in socioeconomic and epidemiologic transition. In India, Cardiovascular Diseases (CVDs) are estimated to be responsible for 1.5 million deaths annually. Indeed, it is estimated that by 2020, CVDs will be the largest cause of mortality and morbidity in India. To present study is designed to evaluate the variation of blood pressure and ECG wave forms among people hypertension with co morbidities (study group) and controls.Methods: The study included 50 people comorbidities with hypertension and 50 controls, each between ages 30-40 years from general population, and also from Medicine outpatient department, KIMS and RF Amalapuram. Detailed history from subjects, blood pressure (sitting position) and electrocardiogram was recorded during resting state in supine position. The ECG results were evaluated for various parameters like heart rate, P wave, PR interval, QRS complex etc.Results: There was significant increase in heart rate, systolic blood pressure as well as diastolic blood pressure in study group when compared to controls. Decrease in PR interval, decrease in QT interval, decrease in QTc interval, decrease in QRS axis in smokers when compared to controls.Conclusions: There was significant increase in heart rate in study group (smokers, diabetic) when compared to controls. There was significant increase in systolic blood pressure as well as diastolic blood pressure in study group (smokers, diabetics) when compared to controls. There was significant decrease in PR interval in smokers when compared to controls. There was significant decrease in QT and QTc interval in smokers when compared to controls.
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Background: Dyslipidemia and hypertension are a major, common and modifiable risk factor for diseases like a stroke; coronary artery disease etc. which are common causes for mortality in India. Dyslipidemia and hypertension are usually found co-exist, which accelerates the process of atherosclerosis.Methods: It is a cross-sectional study conducted on the patients who are newly diagnosed hypertensive visited Medical OPD in Konaseema institute of medical sciences between January 2018 to June 2019. All were investigated for various clinical parameters on lipid profile abnormalities. Results were compared among cases and controls.Results: A total number of patients included in the study were 167,107 are cases and 60 controls. Significant higher levels of total cholesterol, triglycerides, LDL-c and lower levels of HDL-c were observed in hypertensive patients with p-value significant <0.0001.Conclusions: Hypertensive patients have significantly elevated levels of all forms of cholesterol and a higher percentage of individuals in the dyslipidemic state when compared with normotensive patients. Pre-diabetic state significantly increases the total cholesterol in hypertensive patients.
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Background:Endotracheal extubation is one of the frequently performed procedure in the practice of anaesthesia.This study was done to observe the haemodynamic responses during tracheal extubation and to compare the efficacy of IV diltiazem 0.2mg/kg versusIV lidocaine 1mg/kg in attenuating the hemodynamic response to tracheal extubation.Methods:90 patients aged 20 to 60 yrs, belonging to ASA I and II, normotensive were included in the study and they were randomly allocated into 3 groups of 30each. Group I received normal saline and served as control. Group II received0.2mg/kg of IV diltiazem 2 min before extubation. Group III received 1mg/kg of lidocaine IV 2 min before extubation. At the end of the surgery, heart rate (HR), systolic blood pressure (SBP)and diastolic blood pressure(DBP)were recorded served as base line values.Results:After tracheal extubation, all the haemodynamic parameters increase from the basal level in the control group and decreased in the study group. The change in HR, SBP and DBP were significantly less in group II and group III compared to group I. The change in HR, SBP and DBP were significantly less in group II compared to group III. Conclusions: Diltiazem hydrochloride, a calcium channel blocker belongs to the benzothiazepine group given in dose of 0.2mg/kg IV 2 min before tracheal extubation in ASA grade I andgrade II patients is a simple, effective and practical method of blunting cardiovascular responses to tracheal extubation. This suppressive effect of diltiazem was comparable to or even more potent than that of lignocaine 1mg/kg IV 2 min before tracheal extubation
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Background: Organophosphorus compounds are anticholinesterases by inhibiting cholinesterase it protects acetyl chorine from hydrolysis. So, acetylcholine accumulates at the synapses, and all the clinical manifestation are due to that. So, this study has been designed to establish the reactive between level of serum and prognosis of op poisoning patients.Methods: Patient with history of organophosphorus poisoning admitted into the emergency department with following exclusion and inclusion criteria were included in this study. All patients were managed as per standard treatment protocol of op poisoning. Various parameters like demography of the patients, sign and symptoms, severity of intoxication, clinical and lab parameter manoring, Serum cholinesterase was measured every alternate day.Results: 22(47.84%) patients have mild symptom out of that 20 patient抯 serum cholinesterase was more than 2000 IU/L, and 2(4.3%) patients serum cholinesterase was between 1000-2000 IU/L. In eighteen patient抯 severity as per POP scale was moderate, out of that 2(4.3%) patients have serum cholinesterase was below 1000 IU/L, 8 having serum cholinesterase between 1000 to 2000 IU/L, and remaining eight having serum cholinesterase above 2000 IU/L.Conclusions: Serum cholinesterase was less in patient with high severity score or low serum concentration of cholinesterase was associated with high severity score. Serum cholinesterase was improved as days passes.
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Background: All these metabolic derangements exist for many years in the asymptomatic phase of type 2 diabetes and they predispose to development of complications even before clinical diagnosis. Metabolic syndrome is considered to be a precursor of type 2 diabetes. Present study is primarily aimed to study the prevalence of micro vascular complications and metabolic syndrome in newly diagnosed type 2 diabetes mellitus patients of low socio-economic group.Methods: This is a cross sectional prospective study conducted in the dept. of general medicine Konaseema institute of medical science Amalapuram, Andhra Pradesh, India from November 2016 to October 2018. Based on exclusion and inclusion criteria 103 patients were enrolled for this study. Various parameters like age, sex, body mass index, waist circumference, lipid profile, systolic and diastolic blood pressure, neuropathy, nephropathy and retinopathy was measured.Results: The mean age of the patient was 48±10.0 years. Fasting and 2 hours OGTT was 174.6±46.8 mg/dl and 255.6±75.6 mg/dl. The mean of total cholesterol was 204.7±41.9 (mg/dl), Triglycerides was 218±83.4 (mg/dl) and HDL was 44±5.3 (mg/dl). Symptomatic neuropathy constituted 35.6% in 51-60 age group and 27.1% in 31-40 and 41-50 age groups. Objective neuropathy constituted highest (36.6%) in 51-60 age group. Retinopathy constituted highest (60%) in 51-60 age group and nephropathy constituted 26.3 % in 21-30 and 51-60 age groups.Conclusions: Prevalence of microvascular complications in newly diagnosed diabetics of low socioeconomic group were as follows: symptomatic neuropathy-57.3%, objective neuropathy-39.8%, retinopathy-4.9%, nephropathy-18.4%. These were similar to published studies from general population from the same geographical area.
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Background: Venomous snake bite is an acute medical emergency, and children are more quickly and severely affected than adult. Venomous snake bite is responsible for 28.5 deaths per 1000 snake bite death among 5-15years old children. Most of them used to be from rural India and is more common in school going children. But there is no study regarding clinic epidemiology and treatment outcome among pediatric age group in this part of Andhra Pradesh. This retrospective descriptive has been conducted to evaluate the clinic epidemiology, clinical presentation, complication and treatment outcome in snake bite in pediatric patients in our set up.Methods: Present study is a retrospective, descriptive study conducted in the department of paediatrics Konaseema institute of medical science Amalapuram Andhra Pradesh, between 2006 to September 2018. This study protocol is approved by the institutional ethics committee. All the clinical parameters like, age, sex, season of bite, time of bite, socio economic statue, region, site, common clinical presentation, complications, reaction to ASV outcome of treatment were obtained from patient's case record and was analysed.Results: In present study total 166 snake bite patient case records were evaluated, out of this 166 snake bite cases, 28 bites were by unknown snakes. Demographic profile of patient shows that out of 70 cases, 49 cases were in male child and 21 cases were in female child. Regarding clinical profile of the children with snake bite as mentioned in Table 3, local pain was present in (n=70) 100 % patients. Local blending was presenting symptom in 64.28 %(n=45) patients.Conclusions: From present study authors conclude that snake bite in children is more common among school going children, during monsoon and post monsoon, and in rural area. In our region vasculotoxic snake envanomation is more common and presented with cellulitis which required surgical intervention in most of circumstances. In neurotoxic envenomation some patient developed respiratory paralysis which required ventilatory support.
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Background: Konaseema region of Andhra Pradesh is a rural area having well irrigated lands and rice fields. Agriculture is the major some of income, and pesticide use is high.' As per one report of deccan chronicle (a daily newspaper) Andhra Pradesh and Telangana accounts for 24% share of pesticide consumption in the country. Pediatric pesticide poisoning is under reported in India as well. In this background resent study has been designed to study clinic-epidemiology, profile, complication and treatment outcome of pesticide poisoning in Konaseema region of Andhra Pradesh.Methods: In present study clinico-epidemiology, clinical profile, complication and outcome of the patient admitted in the Department of Emergency medicine and Paediatric were evaluated over a period of 12years.Results: Most of the children were above 5years of age that is 74.0% (n=40), rest were below 5years of age. Male children out numbered female children and accounted for 77.78% (n=42). Accidental poisoning was more than suicidal poisoning that is 94.59% of the patients. 9.35% patient (n=5) developed respiratory failure and required ventilator support. Non-carcinogenic pulmonary edema was present in 8 (14.81%) patients. Four patients have atropine toxicity, electrolyte in balance was found in 7.4% (n=4) patients. Acute kidney injury was present in two patients, 5.5% (n=3) patients developed cardiac arrhythmia.Conclusions: Chlorpyrifos was common agent which is responsible for poisoning most common complication in our patients were respiratory complications which required ventilatory support. Lack of information, improper disposal of container, non-existence of training and regulation is supported to the cause of accidental exposure of pesticide to paediatric patients.
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Background:Public awareness about the importance of clinical research (CR) is crucial for patient’s participation in clinical trials. Their enrollmentmay be impacted by their levels of awareness and attitudes toward participation. Our study aimed to assess the Saudi cancer patient’s knowledge and perception about CR, and determine the influencing factors and barriers affecting participation.Methods:A cross-sectional study was conducted in 300 cancer patients attending the Oncology Department at King AbdulAziz Medical City (KAMC) Riyadh between February2011 and February2012 using a survey covering the demographic data, knowledge of clinical research, and attitude toward participation; followed by statistical analysis.Results:A total of 300 patients were enrolled in the study with a median age of 53.6 (42.2-64.01); 62.67% of which were females. The majority of patients (97.31%) were not aware of Institutional Review Board (IRB). However, (75.33%) showed interest in CR participation, if offered. The advanced disease (86.67%), and the lack of other treatment options (85.33%) were the top two encouraging factors, while fear of adverse side effects (58.33%), and the unknown efficacy of treatment (58.32%) were the top two barriers against participation. Respondents younger than 45 years, and educated ones were significantly more interested in participation in CR with Pvalues P=0.0136 and P=0.0239 respectively. Conclusions: There is an apparent gap in cancer patient’s awareness about CR. However, there is an obvious interest in participation in CR especially in younger and educated patients. Enhancing public awareness is crucial to improve participation in CR
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Background:There are clinical evidences for efficacy of dexmedetomidine as an adjuvant to local anaesthetic for peripheral nerve block, but very few published study are available on continuation of dexmedetomidine, with ropivacaine for ultrasound guided supraclavicular block. The present study has been designed to elucidate the effect of dexmedetomidine, in combination ropivacaine on various parameters.Methods:During period of 2 year and 3 months 84 patients were enrolled for thisstudy. Patient in Group A were received 15 ml of 0.5% ropivacaine with 100 microgram one ml dexmedetomidine and Group B were received 15ml of 0.5% of ropivacaine with 1 ml of normal saline. Drug solution was prepared by same individual and was not part ofstudy.Results:Both the group were comparable to each other regarding demography profile. The duration of sensory block 644.96±72.4 min in group A and the duration of sensory block in Group B was 731.53±131.54 min with p value0.00354.The duration of motor block was 661.5±29.25 in group A and 559.77±29.25 in Group B with P value 0.0001. Duration of analgesia in Group A was 457.06±34.47 min and it was 345.70±38.032min in Group B.The supplementation of intravenous opioid was required in 3 patients in Group A and 10 patients in group B with P value 0.037. Conclusions: When 100 microgram of dexmedetomidine was added as an adjuvant to ropivacaineis associated with early onset of sensory and motor block, prolongation of sensory and motor block and duration of analgesia in comparison with ropivacaine alone
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Background: DENV (dengue viral infection) is a non-hepatotropic RNA virus, but hepatic involvement is common. High level of viremia is associated with involvement liver and other organs. Present study is a prospective study which is aimed to know about the, pattern of hepatic involvement in dengue patients admitted in General Medicine Dept Konaseema Institute of Medical Science.Methods: This is a prospective hospital-based study conducted in the Department of General Medicine Konaseema Institute of Medical Science Amalapuram Andhra Pradesh, from December 2015 to December 2017. During two year of study period 126 clinically and serologically positive patients of Dengue fever, Dengue haemorrhagic fever and Dengue shock syndrome, classified as per the, definition of national vector borne disease control programme Govt. of India.Results: Mean value of total bilirubin was 0.8 mg/dl in DF patients, 0.96mg/dl in DHF patients and 1.08mg/dl in DSS patients. Mean value of AST was 77.44(IU/L) in DF group, 112.32 IU/L in DHF group and 486.28 in DSS group. In DF group mean ALT in DHF group was 94.36 (IU/L) and it was 386.42 IU/L in DSS group. Mean value of serum albumin was 3.97 gm/dl in DF group, 3.65 gm/dl in DHF group and 3.49 gm/dl in DSS group. Serum globulin mean value was 2.98mg/dl in DF group, 2.86 gm/dl in DHF group and 2.69 gm/dl in DSS group. Serum alkaline phosphate level was also increased in all the groups, mean value of ALP was 118.46 IU/L in DF group, 164.32 IU/L in DF group, 164.32 IU/L in DHF patients and 342.42 IU/L in DSS group.Conclusions: The pattern of hepatic involvement of liver in dengue fever varies as per the severity of disease. In milder case of dengue fever liver function test was normal but there was hepatomegaly was present commonly but in severe form of disease pattern of hepatic involvement varies from tender hepatomegaly to significant increase in liver enzyme.
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Background: Plasma cell dyscrasia (PCD) is the term used to describe the disorders characterized by neoplastic proliferation of plasma cells with the abnormal production of immunoglobulins (Ig). Patients with multiple myeloma frequently have abnormal coagulation tests. Aim of the present study were to correlate prothrombin time (PT) and Activated Partial Thromboplastin time (aPTT) with Ig concentrations in patients with newly diagnosed with PCD and to compare PT and aPTT values in untreated and treated patients diagnosed with PCDMethods: This study was conducted in the department of clinical hematology of SKIMS, a tertiary care hospital in northern India from 2015 to 2016. Patients diagnosed with PCD were advised for coagulogram (PT, aPTT) as a base line investigation. A total of 72 patients were included in the study.Results: 37% of multiple myeloma cases (newly diagnosed) and 22% of light chain disease patients presented with prolonged PT whereas none of the patients in treated cases of PCD had prolonged PT. The mean Ig concentration was significantly higher in patients with prolonged PT and aPTT compared to that of patients with normal PT and aPTT values. In IgA myeloma, the mean immunoglobulin concentration was 3643 mg/dL with a mean PT and aPTT values of 18.8s and 36.6 (p value: 0.006). The mean free light chain concentration in kappa (k) light chain myeloma was 1727 mg/L with a mean PT value of 20.5 s, mean aPTT value of 37.4 s (p-value: 0.026).Conclusions: Patients with newly diagnosed myeloma presented with prolonged PT as compared to the treated cases. Also, mean Ig concentration was significantly higher in patients with prolonged PT and aPTT compared to that of patients with normal PT and aPTT values.
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ABSTRACT Purpose To study the intraoperative findings in case of early and delayed decompression of facial nerve paralysis and compare their results. Methods Retrospective data analysis of 23 cases of longitudinal temporal bone fracture with House-Brackmann grade V and VI facial nerve paralysis. All cases were thoroughly evaluated and underwent facial nerve decompression through the transmastoid approach. All cases were under regular follow-up till the date of manuscript submission. Results Clinical improvement of the facial nerve function was observed for early vs. delayed facial nerve decompression. In the early decompression group, facial nerve function improved to grade II in eight cases (80%) and grade III in two cases (20%), whereas in the delayed decompression group it improved to grade II in one case (7.70%), grade III in four cases (30.76%), grade IV in seven cases (53.84%), and grade V in one case (7.70%). Conclusions Early decompression of facial nerve provides better results than delayed decompression because it enables early expansion of the nerve.