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Results in Journal International Journal of Research in Medical Sciences: 6,980

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Sandhya S., Mohanraj P.
International Journal of Research in Medical Sciences, Volume 5; https://doi.org/10.18203/2320-6012.ijrms20174669

Abstract:
Background: Myocardial Infarction is one of the most common causes of mortality and morbidity among the elderly patients. Also, it is known for wide range of clinical presentations other than chest pain. This article enlightens the clinical features, risk factors, complications, prognosis and outcome of Acute myocardial infarction in elderly patients. The objective of this study was to assess the risk factors, various symptoms, complications, prognosis and outcome of elderly patients with Acute myocardial Infarction (AMI). Methods: This is a prospective study done over a period of two years in a tertiary care hospital in South India. 80 elderly patients who were diagnosed as AMI were included in the study.Results: Among the eighty patients the majority of the patients belonged to the age group 60-69 years. Twenty percent of the patients presented without chest pain. The atypical presentations included dyspnoea, giddiness, vomiting, sweating and epigastric pain. Mortality rate was 20%.Conclusions: This study showed that even though chest pain was the most common presentation in elderly AMI patients, they were also found to have atypical presentations like shortness of breath, giddiness, vomiting, sweating and epigastric pain. This signifies the need of examining physicians to meticulously identify acute myocardial infarction in elderly though they may not present typically.
Simanchala Dakua, , Jayant Kumar Panda, Prabhat Kumar Padhi
International Journal of Research in Medical Sciences, Volume 5; https://doi.org/10.18203/2320-6012.ijrms20174667

Abstract:
Background: Dyslipidemia is an independent modifiable risk factor for coronary artery disease. Patients with systemic lupus erythematosus (SLE) have dyslipidemia and accelerated atherosclerosis; however, there is paucity of published data on the lipid profile in patients with SLE in Eastern India. This study was done to assess the prevalence and abnormality of lipid profile in patients with SLE admitted to a tertiary care teaching hospital in Eastern India.Methods: This was a hospital based prospective study evaluating SLE patients admitted to a tertiary care institution in Eastern India. 101 patients with SLE admitted consecutively and 100 age and sex matched controls were enrolled for study. Fasting total cholesterol (TC), triglycerides (TG), high density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) were measured in plasma whereas very low-density lipoprotein cholesterol (VLDL-C) was calculated. Statistical analysis was done using the standard statistical techniques.Results: Out of 101 patients of SLE, 97 were female and 4 were of male gender. The age of the patients ranged from 15 to 47 years with a mean of 27.17 (±8.4) years. Dyslipidemia was found in 58(57.4%) patients. Hypercholesterolemia was found in 23 (22.7%), hypertriglyceridemia in 55 (54.4%), raised LDL-C in 24 (23.7%) cases. Raised TC, TG, and LDL-C was found in 18 (17.8%), and raised TC, TG, LDL-C and low HDL-C was found in 9 (8.9%) cases. There was significant increase in serum cholesterol, triglyceride and VLDL-C while decrease in HDL-C in SLE patients than controls (p <0.001). Statistically no difference in lipid profile was found in between groups of SLE receiving steroid and without steroid.Conclusions: Abnormal lipid profiles are very common in patients with SLE, though the patients are very young. Control of dyslipidemia can favourably affect cardiovascular related morbidity and mortality.
Mamata Soren, Ranjita Patnaik, Bismoy Kumar Sarangi
International Journal of Research in Medical Sciences, Volume 5; https://doi.org/10.18203/2320-6012.ijrms20174671

Abstract:
Background: Ruptured ectopic pregnancy is a medical emergency; therefore, it is imperative to diagnose the unruptured ectopic pregnancy such that timely intervention will prevent morbidity and mortality Today with availability of monoclonal β-HCG, high resolution transvaginal scan and laparoscopy it is possible to make early diagnosis even before rupture.Methods: Prospective study of two years duration with sample of 72 cases of suspected ectopic pregnancy observed and treated out of total 20193 pregnant women admitted were included in this study.Results: The incidence was 0.36%, maximum between the age group of 26-30 years (33.3%). Risk factors were tubectomy (30.56%), D and C (6.94%), PID (5.6%), previous ectopic (1.39%), IUCD (2.78%). The typical triad of amenorrhoea, pain abdomen and bleeding was observed in 54.2% of cases. 19 patients were brought in shock (26.4%). Ultrasonography done in 56 cases.Conclusions: There is an increase in the incidence of ectopic pregnancy but a decrease in maternal mortality during the past two decades. Although the early diagnostic tools were available, we had to manage most of our patients as surgical emergencies, as they were brought late in the trial, with established diagnosis of ruptured ectopic pregnancy. Physicians should be sensitive to the fact that in the reproductive age group any women presenting with pain in the lower abdomen, diagnosis of ectopic pregnancy should be entertained irrespective of the presence or absence of amenorrhoea, whether or not she has undergone sterilization.
Bijaya K. Behera, Sanjay M.
International Journal of Research in Medical Sciences, Volume 5; https://doi.org/10.18203/2320-6012.ijrms20174672

Abstract:
Background: Present study was conducted with an objective to study the prevalence of left ventricular hyper trophy (LVH) by echocardiography in patients with chronic kidney disease (CKD) and to find out correlation of left ventricular hypertrophy with severity of chronic kidney disease.Methods: From November 2012 to September 2014, 100 chronic kidney disease patients who were admitted in hospital or attended on OPD basis for dialysis were taken for study. Detailed history, clinical evaluation, laboratory investigations and echocardiography was carried out. The diagnosis of CKD was made on basis of serum creatinine more than 1.5 mg/dl which remained constantly for more than 3 months. Patients with mild, moderate and severe CKD were having serum creatinine level 1.5-3mg/dl, 3-6mg/dl and > 6mg/dl respectively. Glomerular filtration rate (GFR) was calculated by modification of diet in renal disease (MDRD) equation. Cut-off for CKD was taken to be
International Journal of Research in Medical Sciences, Volume 5; https://doi.org/10.18203/2320-6012.ijrms20174670

Abstract:
Background: There is reduction of childhood under nutrition and at the same time a gradual increase in childhood obesity especially urban area is seen due to rapid urbanization, economic and food transition and changes in lifestyle. On this backdrop present study is taken up to find out the prevalence of overweight and obesity among adolescent school children of urban Sambalpur and its association with lifestyle behaviour.Methods: A comparative, cross-sectional study was conducted from December, 2016 to April 2017 among 600 children of class VI to X of two government and two private schools. Thirty students were chosen in each class using systematic sampling method. Pre-designed and pre-tested questionnaire was used to elicit the information on demographic variables and lifestyle behaviours. The risk factors were assessed by using the Chi-square test. For all the statistical tests, a p- value of<0.05 was considered as statistically significantResults: Prevalence of overweight and obesity were 8.9% and 3.4% respectively. Obesity was found more among girls (3.8%) and more children from private school were obese. Association of fast food, physical inactivity with obesity was significant.Conclusions: Overall combined prevalence of childhood overweight and obesity was 12.3 per cent. Percentage of overweight and obese children studying in private schools was more as compared to government school children. School health program should incorporate health education of teachers, students, parents and a convergence of education and health sector can reduce the modifiable lifestyle behaviours.
Pravin M. Meshram, Hemant R. Kokandakar, Rajan S. Bindu
International Journal of Research in Medical Sciences, Volume 5; https://doi.org/10.18203/2320-6012.ijrms20174666

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Background: Iron deficiency anemia (IDA) and beta thalassaemia trait (BTT) are two of the most common causes of microcytic anemia.It is essential to differentiate between the two, so as to avoid unnecessary iron therapy which is contraindicated in beta thalassaemia .We retrospectively evaluated the reliability of various indices for differential diagnosis of microcytosis and
Mayank Kapur, Atul Luhadia
International Journal of Research in Medical Sciences, Volume 5; https://doi.org/10.18203/2320-6012.ijrms20174668

Abstract:
Background: Pulmonary Tuberculosis is one of the common infections in the world, especially in developing countries like India and is a leading cause of morbidity and mortality worldwide. Therefore, early diagnosis and microbiological confirmation of pulmonary TB is important. This study was done to assess the role of induced sputum with hypertonic saline in suspected pulmonary TB patients who produce no or inadequate sputum or who are sputum for AFB smear negative.Methods: 100 patients with clinical and radiological evidence of pulmonary TB with no or inadequate sputum or who are smear negative with spontaneous sputum were included in the study. Sputum was induced with 5ml of 3% hypertonic saline delivered through nebulizer and then was sent for Ziehl Neelsen staining examination.Results: 96 patients could produce adequate sputum after sputum induction. In 47 patients, sputum for AFB smear was found positive after induction.Conclusions: Sputum induction is a safe, cheap and non-invasive procedure and offers an alternative or additional approach in the diagnosis of sputum smear-negative suspected pulmonary tuberculosis patients and would enhance sensitivity for the diagnosis of tuberculosis.
Sushant Khanduri, Sonika Katiyar, Nand Kishore, Rakhee Sodhi, Ankit Aggarwal
International Journal of Research in Medical Sciences, Volume 5; https://doi.org/10.18203/2320-6012.ijrms20174642

Abstract:
Background: An Intensive care unit (ICU) is an area where highest level of care is given with close invasive and non-invasive monitoring to a critically ill patient. Medical audit is must to assess the quality care provided and lay down policies for future. Objectives: To review retrospectively the profile of patients admitted to ICU and assess their outcome.Methods: From January 2016 to December 2016, ICU records of all admissions, referred, discharges, and deaths were utilized for the purpose of this study. Data extracted from the records included age, sex, diagnosis and outcome.Results: A total of 2316 patients were admitted to ICU. Males were 1489 (64.3%) and females were 827 (35.7%). Most of the patients (42.8%) were between 46-70 years. Most of the patients were shifted from emergency (48.5%) and it was associated with better outcome. A total of 49.6% patients were shifted out of ICU in stable condition while mortality was 28.6%. Around 21.8% patients left ICU against Medical advice.Conclusions: Majority patients admitted to ICU were of general medicine and neurosurgery. Survival was inversely related to age. Mortality was not associated with sex. Outcome was also related to the source from where patient was admitted.
Upneet Bedi, Bavneet Kaur Dang
International Journal of Research in Medical Sciences, Volume 5; https://doi.org/10.18203/2320-6012.ijrms20174643

Abstract:
Background: Type 2 diabetes mellitus has deleterious effects on brain resulting in loss of short term memory and working memory in elderly and poorly controlled diabetic patients. Less attention has been given to the effect of diabetes on cognitive functions. Hence, the study was undertaken to study the status of short term and working memory in type 2 diabetes mellitus and to correlate it with the duration of diabetes.Methods: Study was conducted in Punjab Institute of Medical Sciences, Jalandhar, India, on 100 diabetic patients in the age group of 40-60 years. Short term memory and working memory was assessed using 4 memory tests. AVLT and VFT for short term memory and WDST and VST for working memory. The results expressed in average of total scores. One-way ANOVA followed by post hoc (t) test were used for statistical analysis.Results: Short term memory and working memory status was negatively correlated with duration of diabetes. Diabetics more than 55 years showed greater cognitive decline compared to younger age group.Conclusions: The short term and the working memory status decreased significantly in diabetic patients, which may be due to age of onset, duration, vascular dementia, hyperglycemia or hypoglycemia. These effects observed that duration, sex, age and blood glucose levels are of clinical importance as short term and working memory loss could have important practical implications for daily activities.
G. Madhulatha, N. Venkateswarlu, Satrupa Das
International Journal of Research in Medical Sciences, Volume 5, pp 4743-4748; https://doi.org/10.18203/2320-6012.ijrms20174645

Abstract:
Background: Oral cancer is one of the most fatal health problems faced by the mankind today. Oral cancer ranks as the eighth most common cancer in developing countries. A high incidence of oral cancer is observed in the Indian sub-continent which accounts for one third of the world burden. In India, because of cultural, ethnic, geographic factors and the popularity of addictive habits, the frequency of oral cancer is high. It is estimated that about 56 thousand new cases are reported each year in India resulting in about one lakh individuals suffering from the disease at any given time. Cancer or precancer states can be found in individuals who are non-smokers and quid chewers. The possibility of alteration of various antioxidant levels due to presence of carcinogens in the blood plays a key role in the development of malignant states. Methods: The material for the present study comprise of 50 subjects selected at randomly. After recording history regarding habits, thorough clinical examination the patients clinically diagnosed as oral cancer underwent biopsy to confirm histopathologically. A total of 2.5ml ml of blood was drawn from the mid-cubital vein with necessary aseptic precautions and transferred to sterile vacutainers. Serum was separated immediately by centrifugation at 2000rpm for 15mins for the estimation of antioxidants namely ceruloplasmin, malondialdehyde, glutathione using photometric method. Results: The mean values of Ceruloplasmin (the mean values for controls 32.87, oral cancer 40.49), Glutathione (controls 4.46 oral cancer 5.55), malondialdehyde (controls 2.97, oral cancer 4.34) were compared using students t-test. The mean values of antioxidants were significantly increased in cancer compared to controls (pvalue < 0.05), It can be observed from the results that values of enzyme increased from controls to Oral cancer. Conclusions: It can be stated with our study that the antioxidant defence mechanism constitute a very important defence system against the free radical injury of the cells. The antioxidants come into play not only during minor free radical injurious process but also when the malignancy develops. Hence the antioxidants play a vital role as valuable markers in diagnosing oral cancer.
G. Madhulatha, N. Vijayalaxmi, T. Harshavardhan
International Journal of Research in Medical Sciences, Volume 5; https://doi.org/10.18203/2320-6012.ijrms20174644

Abstract:
Background: Plants are a good source of drugs in traditional and modern medicine. One among these plants is “tulasi” The queen of herbs” which is used in ayurveda for its diverse properties like antioxidant, analgesic, anti-inflammatory, antidiabetic, and others. It belongs to labiate family and is the most sacred and valued in traditional culture of India. AIMS of the study was to evaluate the efficacy of Tulasi in the treatment of OSMF.Methods: The study included 20 individuals, females and males of age group 20-50yrs who visited the outpatient department who were diagnosed clinically as having OSMF, categorized according to pindborg’s classification. Patients were asked to apply 500mg of Tulasi medicine paste (Tulasi powder mixed with glycerine) twice daily for 1month and were recalled for follow up every week for 1month. All the clinical parameters - mouth opening, burning sensation, pain with the lesion and others were evaluated and recorded in specially designed proforma.Results: Friedman test and wilcoxon signed rank test was used for statistical evaluation. Significant improvement with P value
Sushil Sharma, Ajay Kumar Gupta, G. Jyothi Reddy
International Journal of Research in Medical Sciences, Volume 5; https://doi.org/10.18203/2320-6012.ijrms20174564

Abstract:
Background: The causality assessment system proposed by the WHO collaborating centre for international drug monitoring, the Uppsala monitoring centre (WHO-UMC) and the Naranjo probability scale are the generally accepted and most widely used methods for causality assessment. Both these scales are structured, transparent, consistent, and easy to apply with distinct advantages. The PvPI recommends use of WHO-UMC scale while many clinicians prefer Naranjo scale for its simplicity. As both these scales are used very widely in practise, it is important to study the level of agreement among them, to ensure proper interpretation of the causality assessment of the drugs. Objective was to study the inter-rater and intra-rater agreement in causality assessment of adverse drug reactions between WHO-UMC and Naranjo scale.Methods: A total of 200 cases were analyzed by three raters. Each ADR reporting form was analyzed by the raters independently using both the Naranjo scale and the WHO-UMC scale. The inter-rater and Intra-rater agreement of all the three raters was analyzed using kappa statistics.Results: The most common category of causality assessment was ‘possible’ which was around 73%, while the probable, definite and unlikely accounted for 23%, 3% and 1% respectively. The inter-rater agreement for the various categories of causality assessment when using Naranjo scale ranged from “very good to excellent” (Kappa value 0.95) while the same ranged from “good to very good” when the WHO-UMC scale was used (Kappa value 0.89) while the Intra-rater agreement for the three raters ranged from good to very good. The mean time (in minutes) taken for assessing the suspected adverse drug an ADR was 8. 26±2.53 for WHO-UMC scale while it was 14.18±3.44 when Naranjo scale was used.Conclusions: Both the WHO-UMC scale and Naranjo scale are reliable and valid tools for causality assessment but the Inter-rater agreement was slightly better with Naranjo as compared to WHO-UMC scale.
Arshad Imam, Sabir Hasnat
International Journal of Research in Medical Sciences, Volume 5; https://doi.org/10.18203/2320-6012.ijrms20174558

Abstract:
Background: This study aims to compare the anaesthetic potency of intrathecally administered levobupivacaine with racemic bupivacaine in lower limb surgeries.Methods: 60 adult cases ranging in age from 18 to 60 years with ASA Grade I and II, presenting for elective lower limb surgery were randomly allocated into two groups containing 30 cases each. Cases in Group L received 3ml of 0.5% levobupivacaine and those in Group R received 3ml of 0.5% levobupivacaine.Results: Cases in both groups showed similarity and no statistically significant differences were observed. Cardiovascular parameters were stable and similar between both groups.Conclusions: Levobupivacaine and racemic bupivacaine show equally effective potencies for spinal anaesthesia in lower limb surgeries.
Suchita V. Ingale, Milind P. Ullewar, Vikas C. Ingale, Jayshree J. Upadhye
International Journal of Research in Medical Sciences, Volume 5; https://doi.org/10.18203/2320-6012.ijrms20174581

Abstract:
Background: Often, the first test used to diagnose anemia is a complete blood count (CBC). It determines the number, size, volume, and hemoglobin content of red blood cells. Peripheral smear is done for typing of anaemia. Such evaluation is necessary for proper treatment.Methods: A retrospective study was done in 300 anaemic patients at Shakuntala pathology laboratory, Nagpur. Patients were randomly selected including males and females. CBC and peripheral smear were analyzed.Results: Out of total 300 patients evaluated, the prevalence of anaemia was quite significant in females 225 (75%) than males 75 (25%). 66 females (22%) had mild anemia while 129 females (43%) had moderate anemia and 30 females (10%) had severe anaemia 36 males (12%) had mild anaemia, 30 males (10%) had moderate anaemia while 9 males (3%) had severe anaemia. In morphology of red blood cells, normocytic normochromic anaemia was seen in 132 (44%) females and in 45 (15%) of males. Microcytic hypochromic anaemia was seen in 90 (30%) females and 27 (9%) males. Macrocytic anaemia was seen in 3 (1%) females and 3 (1%) males.Conclusions: Prevalence of anaemia is quite high in females than males. Also, the severity of anaemia is more in females than males. So, heath programmes should be directed more towards females since adolescent age.
Rajiv Kumar Gupta, Parveen Singh, Rashmi Kumari, Bhavna Langer
International Journal of Research in Medical Sciences, Volume 5, pp 4450-4454; https://doi.org/10.18203/2320-6012.ijrms20174576

Abstract:
Background: Emergency contraception (EC) is indicated after unprotected sexual intercourse to prevent unintended pregnancy and its harmful consequences. Its optimum use can avoid unintended child birth or unsafe abortion which can in turn lower maternal mortality. So, the present study aimed to study the knowledge, attitude and practices of recently married females towards EC in a rural area of Jammu.Methods: The present cross-sectional study was conducted among recently married females visiting the OPD in CHC RS Pura during the course of the three months and were willing to participate. Information was obtained using a questionnaire and results were presented as proportions.Results: 90% respondents had ever heard of EC with media being the main source of information. 91% knew oral pills being used as EC and 81% had correct knowledge of time regarding its usage. 85% would recommend it to friend/relative if required and 73% were willing to use EC themselves in case of unprotected sex. 70% of the respondents had ever used EC.Conclusions: High awareness, positive attitude and adequate usage of EC among currently married females is a good sign which is probably due to high literacy among them. But it should not make the authorities complacent, rather interventions intended to combat maternal mortality through use of regular contraceptives besides EC need to be promoted among the target groups.
Sandesh Deolekar, Bibekananda Mahapatra, Sridevi Murali, Karna Chheda, Naseem Khan
International Journal of Research in Medical Sciences, Volume 5; https://doi.org/10.18203/2320-6012.ijrms20174608

Abstract:
A peritoneal cystic mesothelioma is a very rare mesenteric cyst of mesothelial origin. The size of this lesion usually ranges between a few centimetres and 10 cm. It is usually asymptomatic, but occasionally presents with various, non-specific symptoms. We present a 24-years-old woman with vague abdominal discomfort and associated distension for 6 months, with generalized weakness with no significant past medical history. This is an unusual case of a giant peritoneal mesothelioma which is hemorrhagic nature which could be the first such case reported.
Ravi Dosi, Ashwin Songara, Prakash Joshi, Arpit Jain, Awadesh P.S. Solanki
International Journal of Research in Medical Sciences, Volume 5; https://doi.org/10.18203/2320-6012.ijrms20174570

Abstract:
Background: The six-minute walk test is one of the most powerful test used to measure the functional capacity in various chronic conditions such as in Obesity. There are very few reported studies on SMWT on Obese population all over the world, and there is no reference equation for SMWD. The aim of present study is to propose a Reference equation which could predict the distance walked in SMWT by obese individuals.Methods: 150 obese individuals free from any cardiorespiratory disease were randomized into 2 groups. SMWT data from group A was used to propose the reference equation and SMWD for Group B was predicted. Significance of difference between predicted and original values for group B was found.Results: Mean SMWD for Group A was 304.56 (SD= 68.28) which significantly correlated to (by using linear regression method) age (r = -0.32, p <0.001), BMI (r = -0.43, p <0.001) SpO2* (r=-0.35, p<0.001). These could explain 56% of the total variance in 6MWT. Though the difference between predicted and original values for group B wasn’t found to be statistically significant. The proposed Reference equation is:6MWT distance = (6.8) O2 saturation-(4.3) BMI-(0.6) age-170.64.Conclusions: SMWT is a simple, safe and powerful test to assess the functional status. The standardized SMWD values for Indian obese population would serve as benchmark to assess baseline functional capacity, prescribe proper and safe exercise intensity and monitor changes after rehabilitation interventions.
Yousif Abdulla Albany, Reem Qasim Mohammed, Nagham Mohammed Azzo, Mohammad Ismail Al-Berfkani
International Journal of Research in Medical Sciences, Volume 5; https://doi.org/10.18203/2320-6012.ijrms20174554

Abstract:
Background: Foodborne illness are caused by the consumption of food that is contaminated with either bacteria or their toxins and the most common causes are psychotropic bacteria which cause major public health problem. The aim was to detect and enumerate pathogenic bacteria in locally made ice cream.Methods: 250 locally made ice cream samples were randomly collected from automatic soft machines and dipping cabinets in the markets of Zakho city over a period of ten months starting in July 2016 to May 2017. All collected samples were transported to the microbiology laboratory. The most probable number methods used for detection and enumeration of pathogenic psychotropic bacteria.Results: In general, both types of ice cream samples were showed heavy contamination with aerobic bacteria. The Staphylococcus aureus (MRSA) counts exceeded the standard limits in all samples; the count in dipping cabinets' samples was higher than automatic soft machines samples whereas Coliform count in automatic soft machines samples was higher than dipping cabinets' samples. High incidence of Salmonella and Listeria monocytogenes had been detected in all ice cream samples and the range in samples from automatic soft machines were higher than samples obtained from dipping cabinets.Conclusions: This study indicates a high prevalence of pathogenic psychrotrophs in unpacked ice cream and poor hygiene during production, which make local ice cream unsuitable for consumption and it is indicating the need to monitor the hygienic quality of markets and the health authorities must be informed about such cases to avoid food poisoning.
Neha Bhave, Dinesh Gupta, Prashant Kashyap
International Journal of Research in Medical Sciences, Volume 5; https://doi.org/10.18203/2320-6012.ijrms20174615

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Adult onset still’s disease is a rare systemic inflammatory disorder of unknown etiology that is responsible for a significant number of cases of fever of unknown origin (FUO) and musculoskeletal diseases. The diagnosis in adult onset still’s disease is mainly clinical and requires exclusion of other infections. Laboratory tests are nonspecific and treatment mainly comprises of corticosteroids, NSAIDS, immunosuppressive drugs, iv gamma globulin, anti-tumour necrosis factor, anti-interleukin. AOSD (adult onset stills disease) is a diagnostic challenge. Discovery of new serological tests and a specific diagnostic criterion may help the clinician in faster diagnosis and better management of the disease.
Sneha V. Khante, Sharmila S. Raut
International Journal of Research in Medical Sciences, Volume 5; https://doi.org/10.18203/2320-6012.ijrms20174577

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Background: Neonatal sepsis is a clinical syndrome of bacteraemia characterized by systemic signs and symptoms in the first month of life. It is the leading causes of neonatal mortality and morbidity. Early diagnosis and treatment with appropriate antibiotics is important to improve the prognosis of neonatal sepsis. Our objectives were to study the organisms causing neonatal septicaemia, associated risk factors, to correlate CRP with blood culture and to study mortality rate in neonatal septicaemia.Methods: The study of 2 years included clinically suspected cases of neonatal septicaemia admitted in NICU. 566 blood samples were collected, processed and isolates were identified. Maternal and neonatal risk factors were studied. CRP test was done by slide agglutination test.Results: Blood culture was positive in 205 (36.22%) cases. Among the culture positive cases, 128 (62.44%) were males and 77 (37.56%) females with male to female ratio of 1.66:1. Early onset sepsis was present in 137 (66.83%) and late onset sepsis in 68 (33.17%) cases. 107 (52.20%) were low birth weight babies. The most common neonatal risk factor was prematurity 75 (36.58%) and maternal risk factor was prolonged rupture of membrane 65 (31.71%). gram negative bacilli 144 (70.24%) were found to be common cause of sepsis than gram positive cocci 61 (29.76%), Klebsiella pneumoniae 54 (26.34%) being most common pathogen. Out of 566, CRP test was positive in 244 (43.10%) cases. Mortality rate was 23.41%.Conclusions: Neonatal septicaemia is a life-threatening emergency. The study of etiological profile and CRP test plays a significant role.
Vinodkumar C. S., Satish S. Patil, Arun Kumar A., B. S. Prasad, N. K. Kalappanavar, Niranjan K., Shama Taj K. R., Raghu Kumar K. G., Jayasimha V. L., Basavarajappa K. G.
International Journal of Research in Medical Sciences, Volume 5; https://doi.org/10.18203/2320-6012.ijrms20174571

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Background: Ventilator associated pneumonia contributes nearly half of all cases of hospital-acquired pneumonia. Drug resistance among ventilator associated pneumonia has obligation of device withdrawal in order to achieve clinical and microbiological cure. Aim of the study was to determine the relationship between antibiotic resistance of Endotracheal tube biofilm and pulmonary pathogens in ventilator-associated pneumonia.Methods: A descriptive analytical study of 100 clinically suspected VAP patients was done. Patients were divided into group-I and Group-II based on intubation duration for 1-5 days and 6-10 days respectively. Endotracheal aspirate (ETA) was collected from clinically diagnosed cases and processed as per standard microbiological techniques. Bacterial counts ≥106 CFU/ml for quantitative cultures was considered significant. Biofilm production was detected by tissue culture plate, tube method and Congo red method. Multi-variant analysis was done to find out the association of the various factors.Results: Klebsiella pneumoniae was the predominant bacteria isolated followed by Acinetobacter baumannii. 45% of Gram negative bacteria were β lactamase producers. In Biofilm production by tissue culture method, 72% of the isolates showed either strong or moderate biofilm formation. Multivariate analysis revealed that bacteria isolated from VAP occurring after 5 days of mechanical ventilation among prior antibiotic-treated patients were resistant to all the antibiotics tested.Conclusions: Bacterial aetiology, biofilm formation and drug resistance has ramification on outcome of ventilator associated pneumonia. Hence, advised that it is crucial to remove ET tube in regular interval to prevent biofilm formation and sequential cultures to obtain the microbiological information which enables better patient care.
Rijit Kannan, Anoop George Alex, K. Sudeep
International Journal of Research in Medical Sciences, Volume 5; https://doi.org/10.18203/2320-6012.ijrms20174555

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Background: Stroke is the second most common cause of death and third most common cause of disability in the world. Knowledge of prognostic factors is necessary for the clinician to make a reasonable prediction of outcome for individual patients, to provide rational approach to management and to help patients and their families understand course of the disease. Hence, this study to determine the prognostic factors in acute ischemic stroke with special emphasis on atrial fibrillation, hyperglycemia and fever was undertaken.Methods: This is a prospective and hospital based observational study of 70 patients with acute ischemic stroke. The diagnosis of acute ischemic stroke was based on history, physical examination and CT imaging. The severity was assessed based on Scandinavian Stroke Scale (SSS). The prognostic factors with special emphasis on atrial fibrillation, hyperglycemia and fever were studied based on the standard diagnostic criteria.Results: Prevalence of Atrial Fibrillation was 20% in present study. Mortality and dependency rates were significantly higher in AF group. Fever during the first few days of acute ischemic stroke was a statistically significant predictor of poor outcome. Neuronal damage in brain is directly proportional to its temperature. The results of the study confirm that hyperglycemia at stroke onset is an adverse prognostic factor with 33.33% mortality in hyperglycemic stroke.Conclusions: Atrial fibrillation, hyperglycemia and fever were found to be poor prognostic factors in acute ischemic stroke. Prompt recognition and correction of these poor prognostic factors improve the outcome for such patients.
Prangya Panda, Bijaya Kumar Sadangi, Dhaneswari Jena, Sarita Panda
International Journal of Research in Medical Sciences, Volume 5; https://doi.org/10.18203/2320-6012.ijrms20174588

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Background: Rhinosporidiosis is a chronic granulomatous disease. Aim of the study was to do a clinicopathological evaluation of the cases of rhinosporidiosis. Study design was longitudinal.Methods: The study was undertaken in MKCG medical college. 151 cases of rhinosporidiosis were taken. Pedunculated or sessile, fleshy, polypoidal, reddish looking mass with spores on the surface were clinically diagnosed as rhinosporidiosis. Age, sex distribution, site of presentation and socioeconomic status was studied. The swellings of lacrimal sac were doughy in consistency. The conjunctival mass was excised and thermocautery applied. For the cases of lacrimal sac dacryocystectomy was done.Results: The cases were more common in male children of low socioeconomic status. Palpebral conjunctiva is the common site of involvement. History of pond bath was present in almost all the cases. History of bleeding from nose and eye was present in many cases.Conclusions: Rhinosporidiosis is a common condition of our locality. Treatment is simple by excising the growth and cauterising the site. Taking bath in pond water is supposed to be the cause of the disease. The disease can be prevented by avoiding pond bath.
Rajendra Prasad Takhar, Prateek Kothari, Shanti K. Luhadiya, Narendra K. Gupta
International Journal of Research in Medical Sciences, Volume 5; https://doi.org/10.18203/2320-6012.ijrms20174600

Abstract:
Background: Treatment of tubercular lymphadenopathy consists of at least 6 months of therapy with antitubercular drugs as DOTS in India. Some studies recommend that extension of therapy for some time may lead to lesser recurrence and relapse. This study was planned to assess the outcome of DOTS therapy in lymph node tuberculosis (TB) cases treated under RNTCP and to find out the prevalence of relapse in these patients in southern Rajasthan.Methods: This was a retrospective analysis of 275 cases of lymph node tuberculosis treated with DOTS under RNTCP. An immediate outcome of these cases was recorded and further traceable 81 patients were interviewed for long term outcome.Results: In our study population, treatment completion rate was 93.09%, defaulter rate was 4% and death reported in 3.7% (3/81) cases. We observed relapse rate of 9.1% after treatment completion. A total of 7.04% patients received extended treatment and none of them had relapsed during our follow up.Conclusions: Our study confirms that the efficacy of DOTS treatment is quite good in cases of tubercular lymphadenopathy but still requires review of programmatic strategy. An extension of antitubercular therapy is recommended because patients treated with DOTS had a little higher relapse rate in comparison to whom the treatment extended who had no recurrence and relapse.
Bhavnaben A. Vora, Rajan S. Bindu
International Journal of Research in Medical Sciences, Volume 5; https://doi.org/10.18203/2320-6012.ijrms20174591

Abstract:
Background: Malaria is common, life threatening infection in endemic area and presents diagnostic challenge to laboratories in most endemic areas. A rapid and accurate diagnosis is a pre requisite for effective treatment, especially for potentially fatal cases of falciparum infection.Methods: Total 200 patients presented with fever and chills, were taken for study and performances of peripheral blood and centrifuged buffy coat smear were compared against the result of rapid antigen detection test (standard method).Results: out of 200 cases, 55 were positive by rapid detection test.30 of P. vivax, 24 of P. falci and 1 was mixed infection. Peripheral smear had 85.5% sensitive and 100% specific compared to RDT which was 100 % sensitive and specific whereas centrifuged buffy coat was 92.7% sensitive and 99.3% specific.Conclusions: Easy, rapid, most sensitive and specific diagnostic method will help in early diagnosis and lead to decrease in morbidity and mortality.
, Pradeep K. Maurya, Rohit Chhirolya, Ajai K. Singh, Anup K. Thacker
International Journal of Research in Medical Sciences, Volume 5; https://doi.org/10.18203/2320-6012.ijrms20174609

Abstract:
The artery of Percheron is a rare anatomic variant supplying the thalamus and the rostral midbrain. Infarct in this territory results in a wide array of neurological signs and symptoms causing diagnostic dilemma and management issues. We describe the clinical presentations in three cases admitted and evaluated for neurological symptoms and diagnosed as artery of percheron infarct after brain imaging. In one patient, the etiology turned out to be infective while the other two patients had cerebrovascular accident secondary to dilated cardiomyopathy and hyper homcystinimea respectively. Artery of percheron infarction is a rare entity and should be considered in patients with altered sensorium and behavioral manifestations with associated eye abnormalities. MRI brain is the investigation of choice to detect this rare variant of thalamic circulation.
, Pulin K. Gupta, Sahil Sareen, Arjun M. Balakrishna, Sumit K. Suman
International Journal of Research in Medical Sciences, Volume 5; https://doi.org/10.18203/2320-6012.ijrms20174611

Abstract:
Histoplasmosis is a rare entity in India and very few cases have been reported from eastern region of India like West Bengal and rarely cases from southern India as well. We hereby report a case of progressive disseminated histoplasmosis (PDH) from a non-endemic region of India (Eastern Utter Pradesh) and that too in an immunocompetent individual.
Rituparna Banerjee, Smita Patil, Manish Pendse, Anannya Mukherji, Prashant Kashyap
International Journal of Research in Medical Sciences, Volume 5, pp 4645-4648; https://doi.org/10.18203/2320-6012.ijrms20174614

Abstract:
Here’s presenting a case of disseminated invasive aspergillosis in a young female patient with pulmonary and CNS complications and the difficulty one faces while diagnosing such a case due to variable presentation of symptoms with no prior history of any underlying immunodeficiency. It also focuses on how diagnosing such a case can be further delayed due to clinical and radiological miss-match. Thus, it is important to have a high index of suspicion in such patients as prolonged antibiotics and systemic steroids worsens the course of illness.
C. Suvarna Devi, H. A. Nadiger, T. Sharmila Krishna, J. N. Naidu
International Journal of Research in Medical Sciences, Volume 5, pp 4400-4402; https://doi.org/10.18203/2320-6012.ijrms20174566

Abstract:
Background: Malaria is endemic throughout most of the tropics. Technically, detection of malaria parasite may be missed due to low parasite density at sampling time and poor blood film preparation. The study was aimed to evaluate the serum acid phosphatase levels as a possible diagnostic marker for malarial infections.Methods: This study was conducted on a total of 100 subjects (40 malaria cases, 30 non-malarial cases and 30 sex and age matched healthy controls attending the department of medicine, PESIMSR, Kuppam. Venous blood sample was collected and serum acid phosphatase (ACP) level estimation was be done by enzymatic method using commercial kit (Raichem diagnostics kit).Results: Serum ACP level was highly significantly elevated in malarial group (Mean±SD) (3.14±1.22) when compared with control (1.33±0.72) and non-malarial (1.81±0.30) groups (P value
Jayant B. Chauhan, Tehzeeb Faruqui, Pankaj Panchal
International Journal of Research in Medical Sciences, Volume 5; https://doi.org/10.18203/2320-6012.ijrms20174599

Abstract:
Background: The study aims to identify the diagnostic yield of bronchoscopy along with clinico-pathological profile of 30 confirmed cases of lung cancer during a 6-months period.Methods: A retrospective analysis was conducted on the diagnostic yield bronchial brushing (BB), bronchoalveolar lavage (BAL) and brush biopsy specimens obtained at fibre-optic bronchoscopy for patients with lung cancer and their clinico-pathological characteristics studied.Results: Of 30 patients who underwent fibre-optic bronchoscopy examination brush cytology was diagnostic in 17 patients (68%) brush biopsy in 5 patients (20%) and BAL cytology in 4 patients (16%) with adenocarcinoma in 13 patients (43%), non-small cell carcinoma in 1 (3%), large cell carcinoma in 1 (3%), squamous cell carcinoma in 5 (16%), small cell carcinoma in 5 (16%). The most common Symptom was cough in 25 (83%) followed by chest pain in 22 (73.3%), breathlessness in 14 (46.6%), fever in 13 (43.3%), anorexia in 11 (36.6%), weight loss in 10 (33.3%), hoarseness of voice and haemoptysis in 5 (16.6%) and dysphagia in 1 (3.3%).Conclusions: In bronchoscopic procedure the highest yield is of brush cytology with adenocarcinoma being the most common type with presenting complaint of cough and chest pain. The prevalence of lung cancer is more common among males and commonly being located in right upper lobe.
Manjula Thulasi S.
International Journal of Research in Medical Sciences, Volume 5, pp 4348-4354; https://doi.org/10.18203/2320-6012.ijrms20174556

Abstract:
Background: Fragile X Syndrome (FXS) is the most common single gene cause of Learning (intellectual) Disability (LD). FMR1 gene mutation is the commonest cause for this syndrome. The present study aims to analyze the incidence of the syndrome in Kerala population.Methods: Study was conducted among 86 children belonging to different places of Kerala. Children were selected on the basis of IQ scores and typical features of FXS. Blood samples were taken and routine karyotype was performed. PCR analyses were also conducted.Results: Majority of the children showed typical features of FXS. Out of 86 samples, six showed chromosomal aberrations were excluded. PCR analyses in 55 samples, screened 35 samples with FMR1 mutation, in which 26 samples having pre- mutation and 9 samples with full mutation.Conclusions: Through this genetic study, differential diagnosis of LD children with FXS, LD children with constitutional chromosome abnormalities, and LD children without any apparent genetic abnormalities could be established.
Sapna Ramani Sardana, Shakti Kumar Gupta, D. K. Sharma, Aarti Vij, S. S. Kale
International Journal of Research in Medical Sciences, Volume 5; https://doi.org/10.18203/2320-6012.ijrms20174592

Abstract:
Background: Reported increases in waiting times for publicly-funded elective surgeries have intensified the need to decrease wait by healthcare providers and hence the study.Methods: Descriptive study done in neurosurgery department, to ascertain waiting times for its elective surgeries, included a retrospective analysis of admitted post-surgical patients and a prospective study using interviews with relevant stakeholders to do a process mapping.Results: Median time from decision of surgery to actual date of surgery was found to be 110.5 days. It was calculated that for optimum utilization of present available OTs, 19 extra beds are required and to address the existing load of patients waiting for their respective surgeries there is a need of 63 additional beds with 2 additional OTs functioning per day.Conclusions: The most common cause of waiting time was unavailability of vacant beds due to mismatch in demand-supply. The reason for postponement of surgery after admission was found to be lack of availability of theatre time followed by patient not being fit for surgery. Shortage of operating time was due to delayed start of operation theatre time. The study recommends improving admission process, restricting OPD time, standardized patient prioritization depending on relevant clinical criteria.
Debahuti Sabhapandit, Plabon Hazarika, Anil C. Phukan, K. G. Lynrah, Elantamilan D.
International Journal of Research in Medical Sciences, Volume 5; https://doi.org/10.18203/2320-6012.ijrms20174598

Abstract:
Background: There is an equivocal contention that Tuberculosis may be a cause of non-HIV-associated CD4+ T cell lymphopenia. In HIV negative patients, CD4+ and CD8+ T cell count suppression has been associated with TB infection. Prediction of HIV coinfection in newly diagnosed pulmonary TB patients with negative HIV status by estimation of CD4, CD8 count and CD4:CD8 ratio.Methods: Newly diagnosed pulmonary TB patients comprising of 30 numbers with negative HIV status were subjected for estimation of CD4, CD8 counts and ratio for prediction of HIV coinfection. Equal number of healthy controls was also included in the study for comparison of the values.Results: Significantly lower CD4 and CD8 counts among pulmonary TB infected HIV negative patients as compared with healthy controls was found. The CD4:CD8 ratio was normal when compared with healthy controls.Conclusions: The present study highlights the importance of estimation of CD4+ and CD8+ T cell counts and ratio in newly diagnosed pulmonary TB patients with negative HIV status. Prediction ability in combination with early detection and appropriate management play major role in evading emergence of drug resistance among the HIV-TB coinfected patients.
, , Frederick Yaw Opare, Samira Ali
International Journal of Research in Medical Sciences, Volume 5; https://doi.org/10.18203/2320-6012.ijrms20174552

Abstract:
Background: Despite the advancement in malaria treatments and management; malaria morbidity and mortality is still on the increase. This phenomenon has been mostly attributed to the emergence and transmission resistance of the plasmodium parasite to drugs; which is as a result of non-adherence to anti-malaria medication. Therefore, the purpose of this study was to assess patients’ adherence to anti-malarial medications and the factors influencing their adherence in the Volta regional hospital.Methods: A descriptive cross-sectional study was employed. Convenience sampling technique was used in recruiting respondents. Data were collected within a period of 8 weeks from April to May 2017. Data were analyzed using descriptive statistics in the form of frequencies, percentages, mean and standard deviations which was generated by the use of IBM statistical package for social sciences version 23.Results: The average age of respondents surveyed for this study was 32.27±11.09 ranging from of 19 to 68 years. Majority (51.7%) of respondents were females and 76.7% of them being Christians. The study findings revealed that 36.6% of patient were completely adherent to anti-malarial medication. Over 90% of respondents agreed that the malarial medication had bad taste and it was an unpleasant feeling for them taking it.Conclusions: Poor adherence to antimalaria medications could play a role in the future development of drug resistance. As such, identifying ways to improve anti-malarial compliance will help mitigate drug resistance. Therefore, further studies should be carried out on ways to improve patients’ adherence to antimalarial medication.
George Koshy, Vandana Gangadharan, Anullekha Naidu
International Journal of Research in Medical Sciences, Volume 5; https://doi.org/10.18203/2320-6012.ijrms20174593

Abstract:
Background: Cervical cancer is one of the most common cancers in women with an average of 468,000 new cases per year. Out of these 80% occur in developing and underdeveloped countries. World Health Organisation statistics show that Indian carries one fifths of world burden of the disease with 72,600 deaths annually. Key to the success of cervical cancer screening and prevention is the knowledge and awareness possessed by women in general. This requires the honing of knowledge at an impressionable and younger age group.Methods: It is a questionnaire based cross sectional study and was conducted amongst 4 study groups comprising Medical students, engineering students, nursing students and general graduate students between the age group 18 and 25 years.Results: According to present study, 93% of medical, 75% of nursing and only 29% of engineering students and 9 % of other students were actually even aware of the term cervical cancer. Assessment of knowledge regarding the risk factors of cervical cancer revealed that 13 medical, 9 nursing, 75 of engineering and 85 of Other Graduates weren’t aware of any risk factor that causes cervical cancer. As regards to attitude of the students towards cancer, present study revealed 4 medical, 23 nursing, 10 engineering and 9 general public women think that it is incurable and leads to death.Conclusions: This study highlights unawareness of various aspects of cervical cancer among young women and the burning need for continuing educational intervention at institute level to emphasise the importance and increase the awareness regarding cervical cancer.
Riyaz Mohammed, Mohammed Azfar Ali
International Journal of Research in Medical Sciences, Volume 5; https://doi.org/10.18203/2320-6012.ijrms20174567

Abstract:
Background: DPP-4 is widely distributed in endothelial cells, pancreas, uterus, liver, salivary glands, lymph node, spleen, and thymus. DPP-4 regulates glucagon-like peptide (GLP)-1, and glucose-dependent insulin tropic peptide (GIP) which leads to glucose homeostasis via enhancing insulin secretion and suppression of glucagon, which results in control of post-prandial and fasting hyperglycemia.Methods: These 40 patients who were enrolled as per the inclusion criteria of receiving metformin dosage of 2 gram per day in established type 2 diabetes mellitus patients with no comorbidities. these patients were divided randomly into two groups comprising of 20 patients each, group A received linagliptin 5 mg per day in addition to metformin 1gm twice daily whereas group B received linagliptin 5 mg per day in a fixed dose (Linagliptin + metformin) of 2.5/1000 twice daily.Results: In the present observational study, the mean age in group A was 46.7±9.4 compared to 51.65±9.9 in group B, p >0.05, mean BMI in group A was 27.8±1.1 compared to 27.28±0.93 in group B p >0.05, Mean FBS in group A was 157.9±24.1 compared to 146.2±21.8 in group B p >0.05, Mean PPBS in group A was 245.8±32.7 compared to 246.2±39.3 in group B p >0.05 and Mean HbA1c in group A was 7.67±0.58 compared to 7.6±0.5 in group B p >0.05. Group A patients were initiated on once daily linagliptin, there was a significant reduction in FBS, PPBS and HbA1c at the end of 6 months p 100 hours), related to the saturable binding of linagliptin to DPP-4. The prolonged elimination phase does not contribute to the accumulation of the drug. Addition of linagliptin to metformin has shown a significant reduction in FBS, PPBS and HbA1c.
Mrunal S. Phatak, Tara G. Chawla
International Journal of Research in Medical Sciences, Volume 5; https://doi.org/10.18203/2320-6012.ijrms20174563

Abstract:
Background: In this modern era stress is a commonly seen phenomenon. Stress affects physiological equilibrium leading to many pathologic conditions including endocrine disorders like diabetes mellitus. Physiological responses to stress including increased glucose production, glucose mobilisation and insulin resistance could partially mediate this risk. Meditation is a behavioural phenomenon which can be used to cause autonomic nervous system alterations and help in reducing stress and its effects.Methods: In this cross-sectional study 60 patients of type 2 diabetes mellitus (T2DM) were divided into 2 groups, 30 patients who are practicing Raja yoga meditation for more than 5 years and their glycemic status was compared with the glycemic status of 30 patients of T2DM who did not practice any form of yogic meditation.Results: Blood glucose level and glycated haemoglobin levels were significantly lower in yoga practitioners. Lipid profile showed significant reduction in total cholesterol and serum triglycerides.Conclusions: Thus, a better glycaemic control is achieved with regular practice of Raja yoga meditation which helps in maintaining optimal level of autonomic equilibrium at rest as well as during exposure to stress.
Aditi Chandrakar, Prem Sagar Panda, Gopal Prasad Soni, Srishti Dixit
International Journal of Research in Medical Sciences, Volume 5; https://doi.org/10.18203/2320-6012.ijrms20174561

Abstract:
Background: In order to increase accessibility of health care services for pregnant women and sick infants and to reduce out-of-pocket expenditure, Ministry of Health and Family welfare, Government of India has launched a nationwide initiative- Janani Shishu Suraksha Karyakram on June 01, 2011. The objective of the study was to find out the awareness level about the entitlements of JSSK among mothers with child less than one year and its association with different socio-demographic variables.Methods: A community based cross-sectional study was conducted in rural block of Raipur district, Chhattisgarh, India, among 352 mothers having child less than one year using multistage random sampling using predesigned, pretested proforma from July 2015 to June 2016. Chi-square test was applied to find out the association between awareness level and different socio-demographic variables. P <0.05 was considered significant.Results: Among 352 mothers, good awareness were found in only 207 mothers (58.80%). Maximum awareness (89.20%) regarding entitlements among mothers was seen for free transport services from home to health institution followed by the drop back transport facility from hospital to home (85.22%). None of the mothers know about free diagnostic services for mothers and for sick infants and for free provision of blood for sick infants. Increasing parity was significantly associated with good awareness regarding JSSK.Conclusions: Level of awareness regarding JSSK entitlements for pregnant mothers and sick infants was found to be low. Extensive IEC needed to further increase the awareness regarding JSSK entitlements to increase utilization among beneficiaries.
Siddharth Goel, Abhay Elhence
International Journal of Research in Medical Sciences, Volume 5, pp 4355-4359; https://doi.org/10.18203/2320-6012.ijrms20174557

Abstract:
Background: Fractures of the distal tibia are among the most difficult fractures to treat. The short distal segment presents difficulty in choosing the appropriate fixation method. The greatest challenge lies in the relatively tight soft tissue around the ankle. As a result, it has been a recent interest in treating these fractures with external fixation and limited internal fixation. The external stable fixation methods used are tubular or ring fixators, with or without immobilising the ankle. This minimally invasive nature of the surgery can avoid catastrophic wound complications like dehiscence, implant exposure and infection.Methods: 18 patients with extra-articular distal tibial fractures (AO Type 43A) were treated with the technique of ankle spanning external fixation. Lag screws or K-wires were supplemented for limited internal fixation when required. Fibula was stabilised in all cases. Intra- articular and Compound fractures were excluded. In addition to union at fracture site, ankle pain and motion was noted in each follow-up.Results: The mean follow-up was 25 months. Of the 18 patients included all but one fractures united with an average healing time of 16 to 18 weeks. Ankle pain and motion was graded according to Mazur modified by Teeny and Wiss clinical scoring system. 15 of them had excellent or good results, 2 had fair results. One patient had poor result. Five pin tract infections occurred. 17 patients had no evidence of osteoarthritis after completing follow up of at least 2 years.Conclusions: Distal tibial fractures are complex injuries, not only regarding the bony component, but also in terms of the management of the soft tissue problem. Ankle Spanning External Fixator with Limited Internal fixation is a relatively simple and cost-effective method for treating these fractures, achieving union and also maintaining ankle function.
Liji Menon, Soman Mani,
International Journal of Research in Medical Sciences, Volume 5; https://doi.org/10.18203/2320-6012.ijrms20174562

Abstract:
Background: Ocular injuries following road traffic accidents (RTA) is one of the common causes of ophthalmological morbidity and unilateral blindness. The aim of this study was to document the epidemiological pattern of ocular injures caused by RTA in a cross-sectional population brought to a tertiary care centre in rural southern India.Methods: After receiving institutional ethics committee approval, all patients over the age of 10 years, who came to the emergency department (ED) of this rural tertiary care centre with alleged history of RTA, during the period, July-December 2015 were serially enrolled to participate in the study after obtaining written informed consent. The sample size for 95% confidence level and precision of 5% was calculated to be 191.Results: Out of the 832 cases of RTA presenting to the ED, 191 (23%) had ocular injuries. There were 186 (97.38%) closed globe injuries and 5 (2.6%) open globe injuries. Eight (4.1%) patients with ocular injuries had no perception of light in the affected eye after the accident. The commonest injury was periorbital edema and ecchymosis (68.6%) followed closely by eyebrow laceration (63.9%) and lid laceration (48.2 %). The commonest anterior and posterior segment injuries were traumatic optic neuritis (6.3%) and vitreous or retinal haemorrhage 4 (2.09%) respectively.Conclusions: In this study, the prevalence of ocular involvement in RTA was is 23%. Most of the injuries were closed globe injuries and periorbital edema and ecchymosis were the commonest type of injury occurring followed by eyebrow and lid laceration.
Mukta Pujani, , , Deepshikha Rana, Kanika Singh, Shivam Dixit
International Journal of Research in Medical Sciences, Volume 5, pp 4470-4477; https://doi.org/10.18203/2320-6012.ijrms20174579

Abstract:
Background: Thalassemia can easily be prevented by awareness, education, screening, premarital genetic counselling and prenatal diagnosis. There are only a handful of articles on knowledge and awareness about thalassemia among general population or parents of thalassaemic children. Aims and objectives was to evaluate the level of awareness, knowledge and attitudes of medical students towards thalassemia as well as to analyse the differences if any between the first year and second year MBBS students and their correlation with various socio-demographic parameters.Methods: This was an institutional based cross sectional observational descriptive study regarding knowledge and attitude of first and second year MBBS students about thalassemia using a pre-designed, structured, self-administered questionnaire. Data was analyzed using SPSS software version 17. Values of p
International Journal of Research in Medical Sciences, Volume 5, pp 4214-4222; https://doi.org/10.18203/2320-6012.ijrms20174549

Abstract:
The AMELX gene provides instructions for making a protein called amelogenin, which is essential for normal tooth development. Amelogenin is involved in the formation of enamel, which is the hard, white material that forms the protective outer layer of each tooth. Using molecular genetic techniques, we have shown that there is no evidence that the AMGX gene is deleted in this case of the Nance-Horan syndrome. In affected members of a Michigan kindred of Eastern European ancestry segregating X-linked amelogenesis imperfecta with a characteristic snow-capped enamel phenotype.
, Nihida Akhter, Tufail Ahmad Sheikh
International Journal of Research in Medical Sciences, Volume 5; https://doi.org/10.18203/2320-6012.ijrms20174603

Abstract:
Background: It is now possible to identify acquired and hereditary risk factors in a substantial percentage of patients presenting with a venous thrombotic event. The objective of the study was to study the clinical and etiological profile of patients with unprovoked thrombosis in young patients.Methods: Twenty-one patients 09 males (42.8%) and 12 females (57.14%) with a mean age of 29.67±5.21 were studied, who presented with unprovoked thrombosis.Results: Among 21 patients studied most common presentation was deep venous thrombosis of lower limbs (38.09%) followed by recurrent abortions with deep venous thrombosis (14.28%) and cerebellar infarction (14.28%). In etiological profile, the most common thrombophilla was factor V Leiden mutation (28.57%) followed by antiphospholipid antibody syndrome (23.8%), protein C deficiency (19.04%), methylene tetrahydrofolate reductase (9.52%) and antithrombin, prothrombin gene mutation, hyperhomocystenemia and janus kinase 2 mutations (4.76%). Among 6 patients of factor V Leiden mutation 3 presented with deep venous thrombosis of lower limbs, 1 patient each with middle cerebral artery infarct, juglar vein thrombosis and subclavian vein thrombosis respectively.Conclusions: Factor V Leiden mutation is the most common inherited thrombophillias which has been "substantiated from various studies.
, Manisha Shastri, Rupalee Desai, Khushnood Sheikh
International Journal of Research in Medical Sciences, Volume 5; https://doi.org/10.18203/2320-6012.ijrms20174607

Abstract:
Study report a case of a 22-years-old female with history of vegetative trauma in right eye with 7th running months of amenorrhoea (RMOA). She came after 10 days of trauma, with chief complaint of pain, watering and diminution of vision in right eye. Her visual acuity was PLPR4 in affected eye and 6/9 in other. Central corneal ulcer with abscess and hypopyon was noted with inability to see fundal glow. To study response of fungal keratitis to voriconazole and natamycin eye drop. Corneal tissue obtained by a corneal scrape was plated on Sabouraud’s agar, KOH mount, gram and giemsa staining was performed. SDA shows a filamentous colony of fungus is grown upon aerobic incubation at 37◦C for 5-7 days. Patient was treated with combination therapy of voriconazole and natamycin eye drop. Patient responded well to combination therapy of voriconazole and natamycin eye drop. Patient developed corneal healing with little amount of fibrosis. We lost patient on follow up after that. Patient responded well to combination therapy of voriconazole and natamycin eye drop. The most common risk factors for acremonium fungal keratitis is ocular trauma, and acremonium fungal keratitis might be treated better with natamycin and voriconazole than other alternatives. our results are clinically significant and may provide some useful information on the diagnosis and management of acremonium fungal keratitis.
Samer N. Samarh, Najm A. Khalaf, Mohammed M. Hajhamad
International Journal of Research in Medical Sciences, Volume 5; https://doi.org/10.18203/2320-6012.ijrms20174547

Abstract:
The use of aloe vera is being promoted for a large variety of conditions. The aim of this review was to summarize all available research papers on aloe vera preparations with a view to providing evidence for or against its clinical effectiveness. Independent literature searches were conducted in PubMed. All studies of controlled clinical trials, observational studies and case series were included. There were no restrictions on the language of publication. All studies were read by all authors and data were extracted in a standardized, pre-defined manner. Even though there are some promising results, clinical effectiveness of oral or topical aloe vera is not sufficiently defined at present.
Sunil Prasobh Prabhakaran, Abhilash Kannan
International Journal of Research in Medical Sciences, Volume 5; https://doi.org/10.18203/2320-6012.ijrms20174559

Abstract:
Background: Cardiac markers traditionally have been used only to establish the diagnosis in patients with acute coronary syndromes. In those with suspected acute STEMI, markers have been deemed to have little value, although smaller studies have suggested that troponin T may be valuable for risk stratification. Study aim was to study the prognostic significance of admission Troponin T in acute STEMI and also the relation between Troponin positivity and ST segment resolution after thrombolysis and also relationship with ejection fraction by echocardiogram.Methods: This was a descriptive study conducted in 50 patients admitted with acute STEMI within eight hours in the department of medicine in a tertiary care centre in South Kerala. A blood sample was sent for assessing troponin T. All Patients underwent thorough clinical examination and investigations including echocardiogram was done and were managed with thrombolysis. They were closely followed up for in hospital and 30 days mortality and complications. ST segment resolution after thrombolysis with streptokinase was also assessed.Results: In present study 48% of the patients were troponin T positive. Total six patients died of which all were Troponin T positive. There was a significant increase in the complications in troponin T positive group (46% vs 16%). 44% of the patients had an anterior wall myocardial infarction of which 46% had complications. ST segment resolution after thrombolysis was below 30% in 66.7% of the troponin T positive patients. Ejection fraction was below 50% in 80% of troponin T positive patients.Conclusions: There was a statistically significant correlation between admission troponin T levels and in hospital complications and also mortality rates at 30 days. Troponin T positivity at admission was significantly associated with lower rates of reperfusion after thrombolysis with streptokinase and also lower rate of ejection fraction on echocardiogram. Troponin T positive anterior wall myocardial infarction was associated with more complications than non-anterior wall myocardial infarction.
Subodh K. Mahto, Pulin K. Gupta, Sahil Sareen, Arjun M. Balakrishnaa, Sumit K. Suman
International Journal of Research in Medical Sciences, Volume 5; https://doi.org/10.18203/2320-6012.ijrms20174618

Abstract:
Rocky mountain spotted fever (RMSF) is a rickettsia disease frequently reported from North America and Europe and transmitted by tick bite. This disease is very rare in India and other parts of South East Asia. Fever with rash and thrombocytopenia are the hallmark clinical presentations of viral hemorrhagic fever but other diseases like malaria, typhoid, Leptospira and rickettsia diseases should also be considered in differential diagnosis. Knowledge of geographical distribution, evidence of exposure to the vector and a high degree of clinical suspicion of rickettsia diseases are very important for early differentiation from other diseases to prevent lethal complications and institute initial treatment. We report a rare case of rocky mountain spotted fever (RMSF) from New Delhi, which was confirmed by specific indirect immunofluorescence assay (IIF).
Kiran Yadav, Geeta Parihar, Suresh Kumar Yadav
International Journal of Research in Medical Sciences, Volume 5; https://doi.org/10.18203/2320-6012.ijrms20174568

Abstract:
Background: Typhoid fever is a major public health problem associated with significant morbidity and mortality in many countries. The Widal slide agglutination test is a commonly used test for diagnosing enteric fever. Limited literature is available on its diagnostic ability in comparison to the tube agglutination test. Aim of this study was carried out to evaluate the efficacy of the Widal slide agglutination test for the diagnosis of enteric fever.Methods: This cross-sectional study was done in department of microbiology in Jawahar Lal Nehru medical college and hospital, Ajmer over a period of six months from September 2013 to March 2014. A total of 640 serum samples received in the microbiology department were processed for detecting the presence of anti O and anti H agglutinins against S. typhi, S. Paratyphi A and S. Paratyphi B by slide and tube Widal agglutination tests as per standard protocols. The significant titre for O and H agglutinin, 1:160 was taken as positive.Results: Of the 154 slide Widal positive samples, 115 (18%) samples tested negative by the tube agglutination test whereas only 39 (6%) samples were positive by both slide and tube agglutination.Conclusions: Slide Widal test has high sensitivity and NPV (100%) can be used as a screening tool but due to low specificity (83.93%) any positive sample should be confirmed by tube Widal test.
Adedokun I. Adegoke
International Journal of Research in Medical Sciences, Volume 5, pp 4242-4246; https://doi.org/10.18203/2320-6012.ijrms20174553

Abstract:
Background: Ectopic gestation is still the leading cause of pregnancy related death in the first trimester. Not much has changed in the area of management in the developing world due to the pattern of patients’ presentation and paucity of laparoscopic facilities. The study aims to assess the current pattern of presentation and approach to the management of ectopic gestation in a secondary health facility in sub-Saharan Africa. Methods: A retrospective study was carried out to assess the current pattern of patients’ presentation and approach to management of ectopic gestation in State Specialist Hospital, Ondo, Nigeria. All the data were retrieved from the case record of patients and analysed using SPSS version 20. Result: The commonest symptoms patients presented with were abdominal pain, amenorrhoea and vaginal bleeding with figures 63 (96.92%), 47 (72.31%) and 34 (52.31%) respectively. Tubal ectopic gestation was the commonest type found in 60 (92.31%) patients and was more on the right (56.92%). Fifty-nine (90.77%) of the tubal ectopic gestations were ruptured while only one was unruptured. All the patients had exploratory laparotomy. No mortality was recorded during the period under review. Conclusion: All the patients reviewed had exploratory laparotomy mainly due to the non-availability of laparoscopy in our centre, the nature of presentation and the financial capability of the patients and their relations. These factors still remain the determinants of clinician’s choice of patients’ management in low resource settings of the world.
Husameldeen Hameed Shalal, Najdat Shukur Mahmood, Muahammad Abdul Qader Alchalabi
International Journal of Research in Medical Sciences, Volume 5; https://doi.org/10.18203/2320-6012.ijrms20174551

Abstract:
Background: To show the initial presenting features the children of acute lymphoblastic leukemia presented till the diagnosis at oncology Center/ Diyala/ Iraq.Methods: A retrospective study, carried out during 2016-2017. The data include constitutional, hematological, and infiltrative features with laboratory findings registered at patient’s files until the diagnosis. Data were analyzed by Statistical Package of Social Sciences v. 20.Results: The total patients were 55, distributed into: T- cell (10.9%) and B- cell leukemia (89.1%), FAB classification include L1 (11%), L 2 (89%) and L3 (0%). Most of patients presented at 1- 10 years of age (p value= 0.000); M: F= 1.3:1 (p value= 0.345). Fever and pallor were the most common features, 81.8% (p value=0.000) and 67.3% (p value=0.010), respectively. Other features were bone pain (40%), anorexia (36.4%), fatigability (30.9%), muco-cutaneous bleeding (27.3%), hepatosplenomegaly (56.4%), lymphadenopathy (49.1%), and facial palsy (1.8%). Hemoglobin was < 8 gm/ dl in 70.9 %, white cell count was < 50×109 cells/L in 70.9 %; 12.3% has severe leukocytosis, and platelets' count was between 20- 100 × 109 cells/L in 49%. Mediastinal infiltration (7.2%), pleural effusion (1.8%), pericardial effusion (1.8%), and positive cytospin (5.4%).Conclusions: L2 subtype was the dominant subtype; this contrary to all other studies and may be related to the prognosis. Most of the initial features were general and may indicate more common illnesses, but their constellation with complete blood picture should rise the possibility of leukemia. A rare complication, pleural effusion, was detected as initial feature.
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