Original Research Article
Jan. 8, 2020
Outcome of Single Level Instrumented Posterior Lumber Interbody Fusion (PLIF) Using Corticocancellous Bone Chips and Cages in Spondylolisthesis
Mohammed Mohsin Reza, Abdullah Al Mamun Choudhury, Md. Hossain Rasel, Abul Kalam Azad, Humayun Kabir Reza
Sch J App Med Sci | 1-9
DOI : 10.36347/sjams.2020.v08i01.001
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Background: A Posterior Lumbar Interbody Fusion (PLIF) procedure allows the surgeon to insert bone graft and cage into the disc space from a unilateral approach. PLIF fuses the anterior (front) and posterior (back) columns of the spine through a single posterior approach. By using cage, restoration of disc height and indirectly foraminal height can occur. Pedicle screws and rods give immediate stability. Objective: To determine the clinical outcomes of posterior lumbar interbody fusion (PLIF) using cage combined with decompression and stabilization of lumbar spine for spondylolisthesis. Methods: This prospective observational study was conducted in the National Institute of Traumatology Orthopedic and Rehabilitation from July 2015 to June 2017. All spondylolisthetic patients of both sexes age above 18 years were included in this study. A total number of 20 patients were enrolled as per inclusion and exclusion criteria. Diagnosis of spondylolisthesis and instability was made by history, clinical examination and X-ray. Magnetic resonance imaging (MRI) of the lumbosacral spine was done routinely to delineate the intra-spinal pathoanatomy. Surgery was done by posterior lumbar interbody fusion using cage, bone graft and stabilization by pedicle screws and rods. Preoperative and postoperative pain status was recorded by self-evaluated Visual Analog Score (VAS) and disability by Oswestry Disability Index (ODI).
Original Research Article
Jan. 11, 2020
A Retrospective Pilot Study on the Effect of Volume Gurarantee on High Frequency Oscillatory Ventilation in Neonates
Jomily U V, Manoj V C
Sch J App Med Sci | 10-13
DOI : 10.36347/sjams.2020.v08i01.002
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Because of improved survival rate of low birth weight infants (LBW), there is increasing need of safe ventilation. Conventional ventilation is associated with ventilation induced lung injury (VILI). High frequency oscillatory ventilation (HFO) reduces VILI as it uses subphysiological tidal volume. Preclinical studies have shown that more effective stabilization of DCO2 can be achieved by combining volume guarantee to high frequency ventilation, as in HFO VG tidal volume can be directly controlled. This study is done to evaluate the clinical applicability of this finding of preclinical studies by analyzing the ventilation parameters and physiological parameters of those newborns who are ventilated on HFO or on HFO VG. In this retrospective study neonates ventilated on HFO or HFO VG in the year 2018 were identified and data collected from medical records. Twelve neonates were included in the study. Six of them received high frequency ventilation and other 6 were ventilated on HFO VG mode. VThf (tidal volume in high frequency) were almost same in both groups (1.94 in HFO and 1.9 in HFO VG). It is found that fluctuations in DCO2 (diffusion coefficient of CO2) was less in HFO VG group (SD 43.44 & 92.58 P value0.015). Also babies on HFO VG had better SpO2 values (95.67, 85.83 p value 0.05) and lesser fluctuations in SpO2 (SD 7.0 & 13.64) indicating better oxygenation and lesser hypoxia in HFO VG group. This pilot study suggests VG combined with HFO reduces fluctuations in DCO2 and SpO2.
Original Research Article
Jan. 9, 2020
Ambulatory Blood Pressure Monitoring in Young Hypertensive Patients
Dr. D.Swaroopa, Dr.P.Ganesh, Dr.D.D.S.Anudeep, Dr.Y.S.N.Raju
Sch J App Med Sci | 14-19
DOI : 10.36347/sjams.2020.v08i01.003
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Background: Hypertension is one of the leading causes of the global burden of disease and is a major risk factor for cardiovascular disease, stroke and renal failure. Since younger patients are easily susceptible to reactive hypertension and may have low pre-test probability of hypertension, in this context we aimed at measuring Ambulatory blood pressure monitoring(ABPM) to differentiate true from white coat hypertension and to identify dippers and nondippers . Methods: A total of forty six newly diagnosed hypertensive patients based on clinic BP measurement from out-patient department with age ranging from 18-40years were included. All were subjected to ABPM by using ABPM-05 machine from Meditech Ltd. and Easy ABPM 1.1.1.0 as program. Results: The mean age of the subjects was 31.67±5.43 yrs, among them 35 were males and 11 were females. Out of total 46, 38 patients had true hypertension and 8 had white coat hypertension. Dipping was the most common (30) finding followed by non-dipping (16). Non dipping pattern is seen more in females (7 out of 11) than males. It is observed that the Haemoglobin levels in dippers was significantly higher as compared to subjects with non-dipping pattern (14.4 vs 12.2, p=0.001). Serum albumin were also higher in dippers when compared to non-dippers (4.33g/dl vs 3.84 g/dl, p=0.04). Conclusion: Ambulatory blood pressure monitoring is a very important tool to identify white coat hypertension, where they may not benefit from immediate antihypertensive treatment so as to avoid overtreatment and also identify non dippers which was sought to be a cardio-vascular risk factor.
Osteosarcoma in a 20 Year Old Male Posted for Tumor Excision and Total Knee Replacement: Anaesthetic Concerns with Review of Literature
Barnali Kakati, Anupam Das, Minoti Baruah, Marie Ninu, Dokne Chintey, Tridip Jyoti Borah
Sch J App Med Sci | 20-22
DOI : 10.36347/sjams.2020.v08i01.004
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Osteosarcoma is the most common bone sarcoma having an incidence of 4.6 per million occurring more commonly in the adolescent age group. Treatment of osteosarcoma consists of neoadjuvant chemotherapy for about 10 weeks before and after the reconstructive surgery carried out to salvage the affected limb. The limb saving surgical treatment of osteosarcoma consists of tumour resection and limb reconstruction with a bone graft or endoprosthesis. We hereby discuss the anaesthetic management of a young adult with distal femur osteosarcoma posted for tumour resection and implant of an endoprosthesis with the help of general anaesthesia with adequate perioperative pain management with systemic opioids, paracetamol and epidural analgesia. Optimal haemodynamic management with the help of invasive monitoring helped us not only to manage the perioperative fluid requirements but also kept us vigilant against any untoward side effects of bone cement implantation syndrome. Use of low molecular weight heparin also helped us achieve adequate thrombophrophylaxis in the post-operative period.
Original Research Article
Jan. 11, 2020
Effectiveness of Nutritional Counseling in Improving the Nutritional Status of Head and Neck Cancer Patients undergoing Concurrent Chemotherapy and Radiotherapy through continuous Guidance on Nutrition
Manasij Mitra, Maitraye Basu, Babita Hazarika, Swati Modak Das
Sch J App Med Sci | 23-28
DOI : 10.36347/sjams.2020.v08i01.005
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Background: Though nutrition plays a vital role during all phases of cancer treatment, in patients suffering from head and neck cancer, it is particularly important. Studies have reported the malnutrition prevalence rate of head-neck cancer patients as high as 74.2%. Studies have shown that early intervention and counselling by a dietician; with proper evaluation and guidance for nutritional management is of paramount importance is improving the nutritional status of patients in head and neck cancer. Materials and Methodology: A retrospective data from 1st October 2018 to 31st March 2019 for 50 head and neck cancer patients on concurrent chemotherapy and radiotherapy before initiation of the dietary counseling initiative henceforth referred as Non Counseling Group (NCG) was compared with retrospective data from 1st May 2019 30th October 2019 of 50 head and neck cancer patients on concurrent chemotherapy and radiotherapy who received the diet counselling services henceforth referred as Regular Counseling Group (RCG).
Original Research Article
Jan. 13, 2020
The Unusual Tales of Arch & Nape
Khetrapal Shaan, Rana Safia, Jairajpuri S Zeeba, Jetley Sujata, Sabina Khan, Mohd. Jaseem Hassan, Nehal Ahmad
Sch J App Med Sci | 29-39
DOI : 10.36347/sjams.2020.v08i01.006
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Introduction: Cancer is among the ten leading causes of death in India, and head and neck neoplasia in India accounts for 23% of cancers in males and 6% in females. They encompass a diverse group of uncommon tumors that frequently are aggressive in their biologic behavior. Aims & Objectives: Considering the magnitude of the problem in India and the associated high morbidity and mortality we undertook this study to focus on the rare and unusual head and neck malignancies. Material and methods: A retrospective observational study of unusual malignancies diagnosed in head and neck swellings. Result: A spectrum of rare malignancies was encountered including chondrosarcoma of the maxillary sinus and ocular surface squamous cell neoplasia. Anaplastic large cell lymphoma presenting as an infra clavicular swelling, polymorphous low grade adenocarcinoma of the hard palate and clear cell carcinoma of minor salivary gland were some of the other rare tumors reported. Rare thyroid malignancies included poorly differentiated carcinoma and extramedullary plasmacytoma of thyroid. Few uncommon benign tumors were also reported including schwannoma of left side neck and plexiform neurofibroma of the lip. Conclusion: The need of the hour is to prioritize control and early detection of head and neck cancer in India with special emphasis on the uncommon entities. An awareness of rare entities is important to implement cancer control activities and fast track the diagnosis and management so as to deliver utmost benefit to patients.
Original Research Article
Jan. 13, 2020
A Study to Assess the Knowledge and Practice of The Primi Mothers Related to Breast-Feeding in Post Natal Ward in Selected Tertiary Care Hospital.
S. Bhaktiswarupa, Niyati Das, Purnima Sahoo, Rasmiranjita Parhi, Debasruti Bhunia
Sch J App Med Sci | 40-42
DOI : 10.36347/sjams.2020.v08i01.007
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A Quasi Experimental research was conducted among primi mothers to assess the knowledge and practice on breastfeeding. One-shot Case Design was used in this study. 30 samples were selected through purposive random sampling and data were obtained by using self structured questionnaire and checklist .The study was conducted at Pradyumna BAL Memorial Hospital, Bhubaneswar. The data were analyzed by using descriptive and inferential statistics.67% mothers have good knowledge about breastfeeding and 26% mothers have average knowledge about breast feeding, 66.6% mothers have good practice and the value of r is 0.64 shows that there is a positive co-relation between the knowledge and practice.
Original Research Article
Jan. 13, 2020
An Identification of Suspicious Ovarian Masses Using USG & CT Techniques: A Study in a Tertiary Care Hospital, Jamalpur, Bangladesh
Gulnar Begum, Selina Afroze Ansary, Ismail Hossain, SM Akhter-ul-Alam, Shakina Khatun
Sch J App Med Sci | 43-47
DOI : 10.36347/sjams.2020.v08i01.008
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Radiological checking for pelvic masses in women are very conflicting in different age groups. A pelvic mass may have gynaecologic origin or arise from urinary tract or intestines and since pelvic and ovarian masses with benign or malignant types might occur with different percentages at different ages. The importance of primary diagnosis and choosing proper surgical procedure is highly emphasized. The present study was conducted in several private clinics in Jamalpur District, Bangladesh during the period from June 2018 to May 2019. Sixty (60) patients of Histopathology confirmed cases of malignancies of nose and Para nasal sinuses are studied with regard to their clinical presentation, radiology, histopathology and treatment protocols. All the selected patients were subjected to detailed history, physical examination, ultrasonography and CT scan. Patients with ovarian masses and scheduled for surgery were included in this study, and patients with ovarian masses managed conservatively were excluded. Detailed history of allergy and renal function tests were taken before doing CT scan.
Original Research Article
Jan. 13, 2020
Clinical Profile of Right Ventricular Infarction in Patients with Inferior Wall MI
Arun. V, Pradeep Prajapati
Sch J App Med Sci | 48-50
DOI : 10.36347/sjams.2020.v08i01.009
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Introduction: Inferior wall MI is complicated by right ventricular function in about 50% of cases and associated with 20% of mortality the hospital death rate and complications are very high and associated with major complications. Method: Observational cross sectional study Result: There is a significant association between IWMI and RVMI and RVMI is seen in about 20% of cases and most common complication encountered was hypotension followed by complete heart block. Conclusion: Involvement of the right ventricle in inferior wall myocardial infarction significantly affects the mortality and morbidity and complications.
Ulcerative Colitis and Systemic Lupus Erythematosus: An Unusual Association with Diagnostic and Therapeutic Difficulties
Nacir Oussama, Aboutarik FatimaEzzahra, AitErrami Adil, Samlani Zouhour, Krati Khadija, Oubaha Sofia
Sch J App Med Sci | 51-56
DOI : 10.36347/sjams.2020.v08i01.010
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Background: Although patients with systemic lupus erythematosus (SLE) may experience various gastrointestinal disorders, SLE and ulcerative colitis (UC) rarely coexist. The gastrointestinal (GI) manifestations of these two diseases may be quite similar. Without a definite diagnosis, the physician may confuse the two diseases. We present the case of a patient with SLE and UC who developed abdominal pain and recurrent bloody diarrhea that was initially treated as SLE-related colitis to little effect. Case Presentation: A 33-year-old Moroccan woman with systemic lupus erythematosus (SLE) developed abdominal pain and diarrhea mixed with blood and mucus since the patient was aged 28 years that was initially treated as SLE-related colitis. Although a diffuse erythema and two superficial ulcerations in the descending colon were observed every examination, biopsy revelated only mild inflammation with no signs of specificity. Colonoscopy was performed again when the patient was 30 years because of the persistence of the bloody diarrhea with tenesmus. The transverse and descending colon and rectum showed diffusely Inflamed hyperemic colonic mucosa with multiple active ulcers. Macroscopic examination highly suggestive for UC. Histopathological examination revealed an aspect consistent with UC and no evidence of vasculitis. Introduction of specific treatment of the UC has considerably relieved the patient’s symptoms. Conclusion: Diagnostic criteria for UC and SLE overlap, making them difficult to diagnose correctly. It is important to consider UC for patients who have SLE with gastrointestinal.
Original Research Article
Jan. 13, 2020
Extramedullary Plasmacytoma of Aero-Digestive Tract: About 3 Cases
Sefrioui Taha Ismail, Lassikri Omar, Mahiou Nourredine, Nitassi Sophia, Bencheikh Razika, Benbouzid Mohamed Anas, Oujilal Abdelilah, Essakalli Leila
Sch J App Med Sci | 57-60
DOI : 10.36347/sjams.2020.v08i01.011
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Extra-medullary plasmacytoma is a rare tumor, resulting from the malignant proliferation of particular B lymphocytes, the plasma cells. However, there are localized forms, divided into solitary bone plasmocytoma (POS) and extramedullary plasmocytoma (EMP). The incidence is about 3-4% of all plasmocytic neoplasms. The median age of EMP presentation is 55 years with male predominance (75% of cases). The majority of cases of EMP (80% of cases) reported in the literature are in the head and neck [3], particularly in the upper aero-digestive tract and nasosinus. His treatment is based on chemotherapy, radiotherapy or surgery for some locations. His prognosis depends essentially on the risk of progression to multiple myeloma.
Original Research Article
Jan. 13, 2020
Intra-Abdominal Pressure and Renal Functions in Critically Ill Children
Ajay M. Naik, Ajinkya S. Kale
Sch J App Med Sci | 61-64
DOI : 10.36347/sjams.2020.v08i01.012
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Background: Intra-abdominal pressure is neglected entity in clinical practice. Intra abdominal hypertension affects various systems of the body. Objective of this study was to evaluate intra abdominal pressure and renal functions in critically ill children. Methods: This prospective study was carried out in the months of October and November 2019. Consecutive 30 critically ill children admitted in pediatric intensive care unit who required urinary catheterization were included in our study. Intra abdominal pressure was measured by intra vesical technique and renal functions were evaluated by using pediatric risk, injury, failure, loss of function and end stage kidney disease classification (pRIFLE classification). SPSS version 25 was used for statistical analysis. Results: Nine (30%) critically ill children had raised intra abdominal pressure. None of the patient had abdominal compartment syndrome. Increased intra abdominal pressure was significantly associated with worsening of pRIFLE class. Conclusion: Intra abdominal pressure and renal functions play important role in the management of critically ill children.
Recurrent Synovial Sarcoma of Scalp - A Rare Presentation
Panabaka Sindhuja, Ramana Reddy Naru
Sch J App Med Sci | 65-66
DOI : 10.36347/sjams.2020.v08i01.013
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Synovial sarcoma is a soft tissue sarcoma, which is rarely seen, affecting 1-3 per million populations per year, more common among teenagers and young adults but can also be seen in old age. Despite the name, synovial sarcoma, it is not related to the synovial tissues of the joints. Most commonly seen in the legs and arms, but can appear in any part of the body. It is a high grade tumor with distant spread seen in up to 50% of cases. Here is a 51 year old female presented with complaints of swelling over the right side of scalp since 3 months, insidious onset and gradually progressive. History of similar swelling in the scalp 6 months ago, for which she underwent excision. On examination 5x4 cm solitary swelling in right posterior parietal region of scalp, scar noted over the swelling, surface is nodular, with engorged veins, no visible pulsations, non-tender, firm in consistency, with restricted mobility, skin is free over swelling. Enlarged level II right cervical group of lymph nodes noted. No neurological deficits noted. CT showed features of lobulated hetero-genous mass in right parietal scalp area of size 5.2x3.7x5.5cm. No involvement of underlying cranium with normal brain parenchyma. FNAC has been reported as? Monophasic synovial sarcoma and suggested IHC S100, CD99, BCL2, CD34 markers.
Original Research Article
Jan. 13, 2020
A study on Premarital Screening for β Thalassemia Trait in Hilly Areas Around Salem
Priyadharshini U. N, Senthil Kumari S
Sch J App Med Sci | 67-71
DOI : 10.36347/sjams.2020.v08i01.014
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Hemoglobinopathies are heterogeneous group of inherited disorders of hemoglobin (Hb). Thalassemia is characterized by reduced or absent production of globin chains. This study aims at estimating the prevalence of Beta Thalassemia trait in hilly areas around salem and to validate the screening test for Beta Thalassemia trait. As a part of the ongoing school screening programme, blood samples are collected from 10th and 12th school children in 30 selected tribal blocks in Tamil Nadu. Our Medical College Hospital receives samples from three tribal blocks around Salem namely Yercaud hills, Kolli hills and Kalrayan hills. The HPLC results of samples collected from the three hilly areas around salem for period of one academic year was analysed and blockwise prevalence was worked out. Sensitivity and specificity of NESTROFT test was also calculated with the datas available in our Department. This study shows that the prevalence of beta thalassemia trait in hilly areas around salem was as high as 5.2%. Among the three hilly areas around salem, Kalrayan hills shows the highest prevalence of about 6.9%. Second highest prevalence of about 4.9% was found in Yercaud hills and Kolli hills showed a prevalence of 3.8%. NESTROFT test shows 100% sensitivity and 100% negative predictive value. Specificity was only 25%. The most cost-effective and feasible approaches are preventive genetic strategies which requires proper health education and adequate sensitization of the community.
Original Research Article
Jan. 13, 2020
Study of Maternal Mortality in a Tertiary Health Care Centre in Akola District of Maharashtra (India)
Kale Kalpana M, Aswar Nandkeshav R, Wahane Aparna R
Sch J App Med Sci | 72-76
DOI : 10.36347/sjams.2020.v08i01.015
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Background: Maternal mortality reflects the quality of obstetric care given to pregnant women in the community. Maternal mortality in India continues to be unacceptably high. This study was conducted to find the maternal mortality ratio in the hospital and to assess some epidemiological aspects and causes of maternal mortality. Material and methods: The present retrospective record based study was conducted in Community Medicine department in collaboration with Obstetrics and Gynaecology department of Government Medical College and hospital, Akola, Maharashtra. Data regarding maternal mortality for year 2018 was collected from Maternal Mortality register. Information regarding age, residence, religion, gestational age, parity, causes of maternal deaths, time interval between admission and death, time of death in relation to pregnancy, etc. was recorded in pre coded proforma. Results: During the study period there occurred 5689 live births and 30 maternal deaths in the hospital. Thus maternal mortality ratio in this hospital was 527.3 per 100000 live births. 86.6% maternal deaths occurred above 20 years of age. Most of these women were from urban area (86.6%). 80% maternal deaths occurred in third trimester or during postpartum period. 53.3% deaths occurred in primipara while 46.7% in multipara. Direct causes of maternal deaths were –haemorrhage (16.7%), Eclampsia (16.7%), sepsis (13.3%) and Rupture ectopic (3.3%). Indirect causes contributing for maternal mortality were severe anaemia (6.6%), hepatitis (16.7%), ARDS (16.7%) and heart disease (10.0%). 56.7% maternal deaths occurred within 24 hours of admission to the hospital. Of these 36.78% deaths occurred within 12 hours of admission
Original Research Article
Jan. 13, 2020
Evaluation of 0.5 % Hyberbaric Ropivacaine Versus 0.5 % Hyperbaric Bupivacaine for Elective Surgery under Spinal Anaesthesia - A Comparative Study
A. Shafudeen, Santhana Krishnan C, Murugesan K, Sridhar P
Sch J App Med Sci | 77-83
DOI : 10.36347/sjams.2020.v08i01.016
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In this prospective randomized control study, we compared the clinical efficacy and safety of equal doses (15 mg) of 0.5% Hyperbaric Ropivacaine with 0.5 % Hyperbaric Bupivacaine for lower torso surgeries under Spinal Anaeasthesia. After Ethical Committee clearance and obtaining informed written consent from the patient, 80 patients of ASA 1 and 2 of age group 25-50 years posted for lower torso surgeries in Government. Mohan Kumaramangalam Medical College were included. Study population was divided into 2 groups- GROUP B(Patients in this group received intrathecal 15 mg (3 ml) of 0.5% Hyperbaric Bupivacaine) GROUP R(Patients in this group received intrathecal 15 mg (3 ml) of 0.5% Hyperbaric Ropivacaine which is prepared aseptically immediately before injection by adding 1 ml (250 mg) of autoclaved 25% dextrose ampoule (10 ml) to 2 ml of commercially available sterile preservative free isobaric solution of 0.75% Ropivacaine).From our study we conclude that the duration of sensory block and motor block in patients receiving 0.5 % hyperbaric Ropivacaine was less when compared to the patients receiving 0.5 % hyperbaric bupivacaine
Original Research Article
Jan. 14, 2020
Study of Ophthalmic Lesions: Diagnostic Utility of Histopathology and Clinopathological Correlation
Riddhi Patel, Nisha Raval, T.S.Chokshi
Sch J App Med Sci | 84-88
DOI : 10.36347/sjams.2020.v08i01.017
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Background: Ophthalmic pathology is subspeciality of pathology and ophthalmology that focuses on diseases of eye and its neighbouring tissue that ranges from benign to precancerous and malignant lesion. Aims and objective: To study morphological and clinico-pathological correlation of ophthalmic lesions and to enhance the commuinication between ophthalmic surgeon and histopathologist to get detailed information regarding patients’clinical history,signsymptoms and associated features so that we could correlate with histopathological features. Methods: This study was conducted in C. U. Shah Medical College, Surendranagar during year 2016-17. Total 50 specimens were received from ophthalmology department and studied for histopathology. Result: Out of 50 cases, 48.8% were benign, 14.89 % were malignant, 18.76% were inflammatory and 17.45 % were non-catagorised. Eyelid was the most common site (53.19%). Clinico-histopathological concordance was in approximate 69% cases and discordance was in 31% of cases. Out of these cases of discordance, 43% cases were found to be malignant and diagnosed by clinico-pathological correlation as malignancy was not evident clinically. Conclusion: All ophthalmic lesions removed surgically should always be subjected to histopathological examination to establish correct diagnosis and greatest benefit to ongoing patient care.
Original Research Article
Jan. 14, 2020
Microbiological Pattern in Acute Exacerbation of COPD- A Retrospective Study at MIMS, Mandya
Chethan Kumar K L, Shivakumar K M
Sch J App Med Sci | 89-91
DOI : 10.36347/sjams.2020.v08i01.018
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Background: Chronic Obstructive Pulmonary Disease (COPD) is a chronic disease which is characterized by persistent respiratory symptoms and airflow limitation that is not fully reversible. COPD is a major cause of morbidity and mortality throughout world including in India. Major reason for hospital admissions in these patients is exacerbation. An exacerbation of COPD is an acute event characterized by a worsening of the patient’s respiratory symptoms that is beyond normal day-to-day variations. Bacterial infections are the most common cause of acute exacerbation of COPD. Objective: To identify the common bacterial pathogens responsible in patients admitted with acute exacerbation of COPD to our hospital. Material and Methods: This is a retrospective study done at Department of General Medicine, MIMS, Mandya among patients admitted with acute exacerbation of COPD. 60 patients admitted with acute exacerbation are included in this study. Sputum culture reports obtained from case sheets, data entered into MS Excel sheet and analysed. Results: 60 patients were included in the study, of the 60 patients microbial isolates were seen in 43.3% (26) cases. Among positive culture, Streptococcus pneumonia is the most common pathogen isolated in 38.46% cases followed by pseudomonas aeuroginosa (23.07%), klebsiella pneumonia (15.38%), staphylococcus aureus (7.6%), H. influenza (3.84%), E. coli (3.84%), and Acinetobacter (3.84%). Sputum AFB was positive in 3.84% (1 patient).
Original Research Article
Jan. 16, 2020
Analytical Study for Pterygium in Syria
Hamsa Majed Mohamed, Sulaiman Madad, Maymoun Abbad
Sch J App Med Sci | 92-99
DOI : 10.36347/sjams.2020.v08i01.019
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Purpose: To majoring pterygium in the society and put suitable treatment and Prevention of Pterygium Recurrence after Surgical Removal. Material and Methods: 60 eyes with primary Pterygium and follow up after surgery. The Study Was Performed Between October 2014 and January 2015, to study patients with pterygium and who presented the Department of the ophthalmology in the Alipo University hospital and Damascus eye surgical and follow up was performed for 6 months postoperatively. Differences between frequencies in both groups were compared by the chisquare test P<0.05was considered significant and analysis the causative organisms susceptibility patterns of pterygium patients on Syria during 2014 -2015. Result: The Recurrence is conjunctival tissue going or passed 1 mm after lumps we analyzed the data with SPSS version 10 programs. Postoperative complications by Chi-2 and P value test where the value was considered less than 0.05 statistically significant. After 6 months from surgery the percentage of Recurrence. Tables for follow up patients after surgery (3-4- 5- 6 -7- 8). Conclusion: The pterygium on of common diseases in the eye, and expressed the ophthalmologist from the most important reduced of the pterygium recurrence suggested many treatments (injection in the head of the pterygium - a conjunctival flap)
Original Research Article
Jan. 16, 2020
A Comparative Study of Role of Flupirtine and Pregabalin as Pre-emptive Analgesic in Patients Undergoing Laparoscopic Cholecystectomy a Prospective, Randomised, Double Blind, Clinical Study
Neha Singh, Sanjeev Kumar, Ajit Gupta
Sch J App Med Sci | 100-108
DOI : 10.36347/sjams.2020.v08i01.020
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Introduction: Pain shares its etymological origin with words punishment and penalty and is the most miserable symptom of disease presentation. Pre-emptive analgesia is used as a treatment that is initiated before surgery in order to prevent the establishment of central sensitization evoked by the incision and inflammatory injuries occurring during surgery and in the early postoperative period. Role of Pregabalin and Flupirtine as pre emptive analgesia has been documented. The present study was undertaken to compare the role of Flupirtine and Pregabalin as pre-emptive analgesic in patients undergoing laparoscopic cholecystectomy because of their documented efficacy, cost effectiveness, pharmacokinetics and minimal side effects or complication. Material and Method: The randomised, double blind, prospective study was carried out in 100 patients scheduled for laparoscopic cholecystectomy and fulfilling the inclusion criteria at Indira Gandhi Institute of Medical Sciences, Patna. Two randomised groups were administered Flupirtine and Pregabalin as pre emptive analgesia and the postoperative outcome were compared and analysed.
Original Research Article
Jan. 17, 2020
Short Term Outcome of Fixation of Paediatric Femoral Shaft Fracture by Titanium Elastic Nail - A Prospective Study
Tapas Kumer Talukder,Mohiuddin Aslam, Mahbub Hasan
Sch J App Med Sci | 109-113
DOI : 10.36347/sjams.2020.v08i01.021
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Introduction: Femoral shaft fractures are most common fractures in paediatric age group having different options to treat them. Elastic stable intramedullary nailing is one for treating these fractures and has a reliable methodology. Objective: The aim of this study is to evaluate the short term clinical, functional and radiological outcome of intramedullary fixation of displaced femoral shaft fractures in skeletally immature children using titanium elastic nails. Material and Methods: 36 femoral shaft fractures in 36 children aged 6-14 years were fixed with titanium intramedullary elastic nail between July 2017 and December 2018 in the department of Orthopaedics, Shaheed Ziaur Rahman Medical College Hospital, Bogura, and in some private hospitals in Bogura, Bangladesh. Two nails of proper and equal diameter were used for fracture fixation. No external splint was used after surgery. Outcomes assessed on the basis of Flynn et al. scoring criterion. Results: All patients achieved complete healing at a mean of 9.1 (Range 8- 10) weeks. 31 fractures were reduced by closed means but 5 needed open reduction. No major complication was recorded. Most common minor complication was entry site skin irritation recorded in 4 patients. 86% had excellent result and 14% had satisfactory. Conclusion: Elastic stable intramedullary nailing is the method of choice for the femoral shaft fractures in paediatric patients, because it is minimally invasive and shows very good functional and cosmetic result. It allows early ambulation and shorter hospital stay and higher parent satisfaction. It also provides flexural, translational and rotational stability as well.
Original Research Article
Jan. 17, 2020
An assessment of Chromogenic Agar Medium and Conventional Culture System for the Isolation of Uropathogens
S Gul Nahar, Bulbul Hasan, Rozina Aktar, Mahmuda Naznin
Sch J App Med Sci | 114-119
DOI : 10.36347/sjams.2020.v08i01.022
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Introduction: Urinary tract infections (UTI) account for significant health burden among all age groups. Isolation and identification of the uropathogens by bacterial culture and selection of appropriate antimicrobial drugs through susceptibility testing is the mainstay in management of UTI cases. Material & Methods: This was a cross-sectional study which was carried out in the Department of Microbiology, Rajshahi Medical College (RMC) to evaluate the performance of a Chromogenic agar medium (commercially named as HiCrome UTI agar) and conventional culture system like Blood agar (BA) and MacConkey (MAC) agar for isolation and presumptive identification of the uropathogens. Results: Slightly higher bacterial growth was noted among female (29.33%) than male (17.00%) patients as a whole and 15-45 years was the leading age group with higher number of culture positive cases. Out of 300 urine samples cultured, a total of 139 (46.33%) yielded bacterial growth and 161 (53.67%) were negative for bacterial growth. Bacterial isolates included E. coli 91(62.75%), Klebsiella spp. 18(12.41%), Enterococcus spp. 16(11.03%), Pseudomonas spp. 09(06.28%), Staph. saprophyticus 05(3.44%), Enterobactor spp. 04(2.75%) and Proteus spp. 02(1.37%). It is evident from the present study that both HiCrome UTI agar and BA media supported growth of all 145 bacteria, while MAC agar yielded 133(91.72%) bacterial growths. The rate of presumptive identification of the isolates was found significantly higher (97.24%) on HiCrome UTI agar when compared with the MacConkey agar (80.68%) and Blood agar (27.58%) media.
Original Research Article
Jan. 17, 2020
Socio-demographic and Occupational Characteristics of Auto Rickshaw Drivers with Low Back Pain
Kazi Rakibul Islam, Shafiur Rahman, Janntul Baki, Shukur Ali, Kariul Islam
Sch J App Med Sci | 120-125
DOI : 10.36347/sjams.2020.v08i01.023
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Introduction: Work-related musculoskeletal disorders, especially low back pain, cause substantial economic losses to individuals as well as to the community. Aim and objective: To determine socio-demographic characteristic of the proportion of auto rickshaw drivers having low back pain. Material & Methods: This study was a descriptive type of cross-sectional study. Study was done in four C.N.G stand (Mirpur-11 stand, Banani-11 stand, Tongi station road, Mirpur-10 stand) and two garages (Ibrahimpur garage and Khilgaon garage) in Dhaka city. The study period extends from January 1st to December 31st of 2014. C.N.G based Auto rickshaw drivers not less than 25 years of age were selected as a study population of this study. Sampling was done purposively. Purposively 220 Auto rickshaw drivers from four C.N.G stands and two garages were included in the study with fulfilling the above-mentioned enrollment criteria were included in the study. The data entry was started immediately after completion of data collection. Data processing and analyses were done using SPSS (Statistical Package for Social Sciences) version 19. Data were analyzed according to the objectives of the study.
Original Research Article
Jan. 17, 2020
The Outcome of the Efficiency of the Condylar Plate for the Treatment of Intercondylar Fracture of Femur
Shafiqul Islam, Zillur Rahman Siddique, Mizanur Rahman1, Abdus Sobhan, Naseem Begam, A. B. M. Zakir Uddin, Abul Hasnat, Abu Bakar Siddique
Sch J App Med Sci | 126-129
DOI : 10.36347/sjams.2020.v08i01.024
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Objective: In this study our main goal is to evaluate the outcome of the efficiency of the Condylar plate for the treatment of intercondylar fracture of femur. Method: This clinical trial was carried out at the National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka over a period of two years between January 2017 to December 2018.A total of 15 patients of intercondylar fractures of femur meeting the selection criteria were consecutively included in the sample. Result: Muller type C2 was predominant and muller type C1 and C3 each was 20%. Over half (53.3%) of the patients were operated after 1 -2 weeks of receiving the injury, 26.7% before 1 week and 20% after 2-3 weeks of injury. Two-thirds (66.7%) of the patients stayed in the hospital for 2-3 weeks and the rest > 3-4 weeks.40% of the patients had excellent outcome (Insal score > 85), 46.7% good outcome (Insal score between 70-84), and 13.3% fair outcome (Insal score 60- 69). Conclusion: The outcome of intercondylar fractures of the femur treated by condylar plate demonstrated excellent to good result in majority of the cases. Sixty percent of the cases returned to routine preinjury activities without limitations and one-quarter with mild limitations, in terms of subjective evaluation as well most of the patients had good to excellent outcome.
Original Research Article
Jan. 18, 2020
Incidence of Burning Mouth Syndrome: A Single Centre Study
V. Paramasivam, N. Suresh, Ramya Ganesh
Sch J App Med Sci | 130-132
DOI : 10.36347/sjams.2020.v08i01.025
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Objective: To calculate the incidence of burning mouth syndrome (BMS) diagnosed in the Department of Medicine, Medical College of Theni. Material and Methods: Diagnoses of BMS were confirmed through the presence of burning pain symptoms of the oral mucosa with normal oral examination findings and no associated clinical signs. Results: Eighty five incident cases were confirmed, majority of the 69 patients were female (81.1%). The mean age at diagnosis was 62.6 years (range, 19–96 years). At diagnosis, 9.4 % of patients were current smokers and 22.3% were prior smokers. The tongue was the most frequently involved anatomic. Intensity of reported pain had a broad range, but most of them had mild pain (57.6%) followed by moderate pain (30.5%). Disease was commonly symmetrical on both the mediolateral (95.2%) and anteroposterior (80.0%) axes. Pain was typically continuous (94.1%) and present throughout the day (81.1%). Conclusion: The results of our study show BMS is an uncommon disease, highly associated with both advancing age and female sex. Typical symptom characteristics show mild, symmetrical, bilateral burning pain of the tongue that is continuous throughout ......................
Original Research Article
Jan. 18, 2020
Assessment of Immunization Coverage in Children Aged 1 Year To 2 Years From Rural, Urban and Tribal Areas After Launching Mission Indradhanush
P S S Aparna, V V Vijayalakshmi, N Madhavi, M N V Poushya Sai, D Manikyamba, A Krishna Prasad, A Satyavani
Sch J App Med Sci | 133-138
DOI : 10.36347/sjams.2020.v08i01.026
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Vaccination has saved more lives worldwide than any other medical products or procedures. To accelerate immunization coverage, Mission Indradhanush was launched by Ministry of Health and Family Welfare in 2014. Under Mission Indradhanush, the immunization programme was strengthened and also newer vaccines like pentavalent, rotavirus and f-IPV vaccines were sequentially introduced. Mission Indradhanush was intensified in 2017 to further accelerate full immunization coverage. The present study was done for a period of 2 months in 2 urban areas, 2 rural areas and 2 tribal areas of East Godavari district of Andhra Pradesh with the objective to know the immunization coverage in children aged 1-2 years after launching Mission Indradhanush with the aim to evaluate the primary immunization coverage, coverage of newer vaccines after launching MI , assess the knowledge of mothers on routine vaccination with a special focus on newer vaccines and the reasons for delay or dropouts in vaccination. In the present study, the overall coverage of primary immunization was 94.8%. Overall immunization coverage is less in urban areas compared to rural and tribal areas. Literacy of mother, parity and place of delivery had significant association with complete immunization coverage. The main reason for high dropout rate of newer vaccines was nonavailability of vaccine. This study showed that Mission Indradhanush was successful in accelerating the overall primary immunization coverage in this area to a significant extent.
Original Research Article
Jan. 22, 2020
Comparitive Study of Anatomical Repair and Lichen steins Tension Free Meshplasty
Shirishkumar Panhale, Amit Ojha
Sch J App Med Sci | 139-145
DOI : 10.36347/sjams.2020.v08i01.027
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Introduction: Inguinal hernias are very common and their repair is one of the commonest surgeries performed in all hospitals. Since the description of anatomical repairs of inguinal hernia of Bassini’s and Shouldice, many new techniques for hernia repair have been introduced including Prolene mesh repair and Laparoscopic hernia repair. It is with the intent of comparing anatomical repairs of Bassini’s and Shouldice with Prolene mesh repair, this study had been done. Comparision was done with respect to post-operative pain, infection, demographic profile, feasibility in selective group, type of inguinal hernia, duration of operation, hospital stay and expenditure. Materials and methods: The present study was carried out in the Department of General Surgery in G R Medical College, Gwalior, Madhya-Pradesh. This was prospective study that collected information from 100 patients from interview. All the patients between 2 – 80 years undergoing hernia surgery from July 2006 to October 2007 were included in the study. Those patients more than 80 years age, medical comorbidities, abdominal wall infection and contraindications to anaesthesia (General and or Spinal) were excluded from the present study. Result: In our study, there was male predominance of inguinal hernia. Most hernias were of indirect type (60%) compared to Direct hernia (39%) and pantaloons hernia (1%). Direct hernia was more evident in old age group (45-60 years) than indirect hernia (30-45 years). Lichtenstein’s tension free meshplasty was comparatively costly and 7 % patients had persistent pain at operated site. The rates of infective complications were not significantly different. There were no recurrences in our study. Mean operative time was 85, 90 and 100 minutes respectively for Lichtenstein’s tension free meshplasty, Bassini’s repair and Shouldice repair. Conclusion: Our results suggest that a general hospital with high patient volume, good training and proper aseptic precautions, anatomical .......
Original Research Article
Jan. 22, 2020
Intrapleural Fibrinolytic Instillation for the Treatment of Complicated Pleural Effusion: Our Experience at King Hussein Medical Centre
Jamal Alaydi, Alaa Qayet, Mutaz Haddadin, Kasem Kaisy, Hani Alhadidi
Sch J App Med Sci | 146-148
DOI : 10.36347/sjams.2020.v08i01.028
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Background: management of empyema had evolved greatly since the administration of streptokinase which had resulted in improved outcome and great reduction in surgery rate. Methods: 57 patients were enrolled in a 2 year study, held in King Hussein Medical Centre, evaluating the efficacy of streptokinase instillation in multiloculated pleural empyema. Results: 36 male and 21 females were included in the study with median age of 32 years. Streptococcus pneumonia was the major pathogen followed by Staphylococcus aureus with 49% and 33% respectively. Drainage of empyema was between 50-750, 500-1000 and 250-600 ml for the first, second and third dose respectively. Chest pain and discomfort was the major complication (56.1%). Conclusion: streptokinase administration helps in resolving multiloculated empyema and can reduce the decortication surgery.
Original Research Article
Jan. 22, 2020
Comparison of Intraocular Pressure Measurements with Icare® Rebound Tonometer and Goldmann Applanation Tonometer in Normal Pediatric Population
Vinay, Sunayana Bhat, Norman Mendonca
Sch J App Med Sci | 149-154
DOI : 10.36347/sjams.2020.v08i01.029
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Accurate measurement of intraocular pressure (IOP) is vital in screening, diagnosis and management of paediatric glaucoma. This study compares the agreement in IOP taken with GAT (Goldman applanation) and ICare in a normal paediatric cohort. Methods: This was an observational, prospective, cross-sectional study conducted on children of age group 7-14 years presenting to ophthalmology clinics in a tertiary care hospital. The subject underwent IOP measurement by two ophthalmologists blinded to the results of the other. Differences in IOP means between the tonometers were calculated and analysed. Results: 60 eyes of 30 subjects were enrolled in this study. The mean difference between the Icare and GAT was 2.31 mmHg, with a standard deviation (SD) of ±3.17 mmHg which was statistically significant (p < 0.001) using Mann–Whitney U test, showing that Icare tonometer significantly overestimates IOP values when compared to GAT by around 2.3 mmHg. There was only a weak positive correlation between the IOP values obtained with GAT and ICT as indicated by Pearson’s correlation coefficient r=0.258; p<0.05. The results also show poor inter-observer reliability with an intraclass correlation coefficient of 0.286 (95% CI -0.111, 0.554) Agreement between tonometers was evaluated using the Bland-Altman method. Conclusion: Our study found poor correlation and agreement between ICT and GAT. Based on our study results and previous publications, we can recommend that when normal readings are obtained by Icare tonometer, the IOP is most likely to be within the normal range. When higher readings are obtained, confirmation may be required by more accurate methods.
Original Research Article
Jan. 22, 2020
Post-Allograft Anti-Phospholipid Antibody (APLA) Syndrome – A Case Report
Beddou G, Skalli H, Raissi A, Yahyaoui H, Benjelloun I, Ait Ameur M, Chakour M
Sch J App Med Sci | 155-157
DOI : 10.36347/sjams.2020.v08i01.030
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The production of autoantibodies after a hematopoietic stem cell allograft is a fact observed in hematology and often observed during graft versus host disease (GVHD) following an immune disturbance, however studies have shown the possibility of transferring B cells memory from a donor to the recipient and be responsible for autoimmune manifestations similar to that observed in the donor. We present here an extremely rare case of a manifestation of an isolated anti-phospholipid syndrome, 7 years after allograft in a patient whose donor is always asymptomatic. The appearance of autoantibodies was preceded by the appearance of chronic GVHD and the patient posed a management problem in the face of her persistent thrombocytopenia. The distinction between the manifestation of chronic GVHD and adoptive immunity is necessary due to the prognostic and therapeutic differences between these two entities.
Original Research Article
Jan. 22, 2020
Low Dose Intrathecal Morphine versus Multimodal Analgesia in Patients Undergoing Abdominal Surgeries under General Anaesthesia
Pankaj Kumar Mohanta, Zahidul Islam
Sch J App Med Sci | 158-165
DOI : 10.36347/sjams.2020.v08i01.031
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Introduction: Opium means juice, from Greek word. Morphine is named after Greek god of dreams, Morpheus Opioid refers to drugs derived from opium both natural and synthetics. Narcotic refers to morphine and like analgesics. Aim of the Study: To evaluate the effect of preservative free morphine 0.5mg administered intrathecally, on intraoperative anesthetic requirement and post operative analgesia in patients undergoing laparotomies under general anesthesia compared with multimodal analgesia during the 1st 24 hours of postoperative period. Materials And Methods: This study was conducted at Sheikh Sayera Khatun Medical College & Hospital, Gopalganj, Bangladesh during from Jun to December 2019, in the general surgical operation theater.50 patients of ASA physical status I,II and III undergoing both upper and lower abdominal surgeries under general anesthesia are categorized into one of two groups, Group M – Morphine study group and Group C–Control group. In both study and control Group routine General anesthesia was administered. In Group M, 0.5mg morphine given intrathecally before general anaesthesia. The parameters studied were intraoperative hemodynamics, post operative pain score and analgesic requirement, post-operative hemodynamics, intra operative and post-operative complications.
Original Research Article
Jan. 23, 2020
Microbiological Profile of Diabetic Foot Infections in a Tertiary Care Hospital in Navi Mumbai
Rahila Khan, Shrikrishna A Joshi, Abhay Chowdhary
Sch J App Med Sci | 166-170
DOI : 10.36347/sjams.2020.v08i01.032
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Diabetic foot ulcers are most common serious consequences of diabetes. The proper management of diabetic foot infection (DFI) requires a detailed knowledge about the microbial spectrum and their antibiogram. In this study, 123 cases with DFI were studied. Pus swabs and deep tissue/ bone samples were collected. We observed 74.8% & 16.2% cases were monomicrobial and polymicrobial in nature, respectively. Pseudomonas aeruginosa (29.5%) was the most commonly isolated organism followed by Staphylococcus aureus (16.6%) and Escherichia coli (12.8%). We observed 27.27% strains of Methicillin Resistant Staphylococcus aureus (MRSA) & 100% Extended Spectrum Beta Lactamases (ESBLs) strains of enterobacteriacae. All the gram positive organisms, Staphylococcus aureus, Enterococcus faecalis and Coagulase negative Staphylococcus were sensitive to vancomycin (100%) and Linezolid (100%). Pseudomonas aeruginosa isolates were 100% sensitive to Amikacin and Tobramicin, Piperacillin-Tazobactm and Ciprofloxacin. Klebsiella pneumoniae showed high resistance to Cefepime (87.5%) and Piperacillin-Tazobactm (75%). Escherichea coli isolate showed 100% sensitivity towards Gentamicin. Acinetobacter baumanni showed 100% sensitivity for Imipenem and Meropenem.
Refractory Myasthenia Gravis: Clinical Description and Literature Review
Leye PA, Malissin I, Mora P, Voicu S, Elgharbi F, Megarbane B
Sch J App Med Sci | 171-173
DOI : 10.36347/sjams.2020.v08i01.033
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Myasthenia is an autoimmune disease due to the presence of auto-antibodies leading to a blockage of the neuromuscular junction. The anti-MuSK form is rarely observed and can lead to an acute respiratory failure requiring care in intensive care unit. It can be refractory to the immunosuppressant first-line treatment. In this case, plasmatic exchanges can lead to a better clinical evolution. We report a case of favorable evolution.
Original Research Article
Jan. 22, 2020
“Effectiveness of Magnesium Sulphate in Term Neonate with Perinatal Asphyxia: An Experience from Tertiary Hospital of Central India”
Arvind Kankane, Aradhana Kankane, Vijay Singh
Sch J App Med Sci | 174-177
DOI : 10.36347/sjams.2020.v08i01.034
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Objective: To determine effectiveness of Magnesium Sulphate infusion in full term neonate suffering from moderate and severe perinatal asphyxia. Methods: Full term neonates with perinatal asphyxia were selected and classified according to criteria laid by Sarnat and Sarnat. After recording baseline characteristics they were randomly assigned to receive either 3 doses of magnesium sulfate infusion at 250 mg/kg/dose 24 hours apart (treatment group) or 3 doses of normal saline infusion at 1 ml/kg/dose 24 hours apart (placebo group). Neurological assessment was performed at time of admission and at fourteenth day. Distributions of perinatal factors, neonatal baseline characteristics, and mean time for initial infusions were noted in pre designed proforma and analyzed statistically. Results: Distribution of neonatal baseline characteristics and severity of hypoxic- ischemic encephalopathy were similar in treatment and placebo groups. In our study, postnatal magnesium sulfate infusion was found neuroprotective in moderate encephalopathy, which was reflected by early control of seizures (p=0.04), early appearance of normal cry (p=0.02), early appearance of normal activity (p=0.02), early acceptance of full oral feed by sucking (p=0.04). Postnatal magnesium sulfate infusion was not found neuroprotective in severe encephalopathy (p=>0.05). No significant differences were observed in the cranial sonography and electroencephalography between treated and placebo groups (p=>0.05). No significant differences were observed in blood pressure, heart rate and respiratory rate between both the groups. Conclusion: Postnatal magnesium sulfate therapy may result in early recovery and favorable neurological outcome in term neonates with moderate encephalopathy.
Original Research Article
Jan. 22, 2020
A Prospective Study of Deteriorating Acute Ischemic Stroke in NonThrombolysed Patients
Srikumar B, Dileep R, Jayasree L, Ram Mohan, Deepthi S
Sch J App Med Sci | 178-190
DOI : 0.36347/sjams.2020.v08i01.035
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Context: Progression of stroke is likely multifactorial; however, risk of deterioration in acute ischemic stroke can be predicted in great majority of cases at admission by careful close observation. Aims: To study the causes of neurological deterioration of non-thrombolysed stroke patients. Settings and Design: This was a prospective observational study of non-thrombolysed stroke patients admitted at the Stroke ICU of a teaching hospital in Kerala, India for a period of one year from between January 2017 to January 2018. Methods and Material: All stroke patients with first episode of acute ischemic stroke were admitted and evaluated forneurologic deterioration (defined as an increase in National Institute of Health Stroke Scale Score (NIHSS score) by 2 or more points, after admission during the first week). Results: 80 out of 320 patients with acute stroke patients developed neurological deterioration and were analyzed for clinical, biochemical and radiological features associated with deterioration. Clinical features - Stroke severity (high NIHSS Score), altered consciousness at admission, persistent gaze deviation, bulbar dysfunction, atrial fibrillation, recent myocardial infarction, systemic diseases (hypertension, hepatic and renal dysfunction) and deep vein thrombosis were associated with deterioration. Biochemical features - Uncontrolled blood sugar and hyponatremia were associated with deterioration. Imaging features - ASPECT score less than 7, large infarct at admission, dense MCA sign, hemorrhagic transformation, proximal large vessel occlusion and lack of correlation between clinical deficits with initial CT picture were associated with higher risk of deterioration. Conclusion: Each stroke case needs prompt individualized evaluation and management. Interventions based on pathophysiology identified by imaging features and patient’s clinical condition and management of systemic diseases and complications will improve the outcome.
Megaoesophagus and Esophageal Cancer
Rahaoui A, Benelbarhdadi I, Abdelwaly K, Lagdali N, Berhili C, Borahma M, Ajana FZ
Sch J App Med Sci | 191-196
DOI : 10.36347/sjams.2020.v08i01.036
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Achalasia or megaesophagus is a pathology predisposing to the occurrence of squamous cell carcinoma and adenocarcinoma of the esophagus. The diagnosis is often made late. The first-line paraclinical workup should include esogastroduodenal fibroscopy with biopsies to confirm the diagnosis. Materials and methods: Retrospective study over a period of 18 years collecting all the patients followed in our departement. The diagnosis of megaesophagus was made by esophageal manometry. Results: Among 104 patients followed for megaesophagus, only one patient developed an squamous cell carcinoma on achalasia, that is a prevalence of 0.96%. This is a 44-year-old patient who is non smoker, or who consumes alcohol and who has had functional dysphagia since the age of 5 and in whom esophageal manometry had demonstrated an aperistalsis of the esophageal body with hypertonia and lack of relaxation of the LES. This dysphagia became 39 years later marked with solids and semi-liquids, a constant progressive associated with odynophagia and weight loss of 07 kg in 2 months.The clinical examination was without particularities. Esogastroduodenal fibroscopy objectified ulcerative stenosing cauliflower mass of the lower esophagus. The anatomopathological study of the biopsies revealed a well differentiated, mature and infiltrating squamous cell carcinoma of the lower esophagus.
Original Research Article
Jan. 23, 2020
Prospective Clinical Study on Incidence, Risk Factors and Management of Retinopathy of Prematurity in Preterm Babies Admitted in NICU, GGH, Kakinada
N Madhavi, V V Vijayalakshmi, P Shanthi Priya, M N V Poushya SAI, D Manikyamba, A Krishna Prasad, P S S Aparna
Sch J App Med Sci | 197-201
DOI : 10.36347/sjams.2020.v08i01.037
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This study was done to study the incidence, risk factors, severity and interventions done for ROP in preterm babies. This was a Hospital based prospective study done in Neonatal intensive care unit for a period of 18 months. Inclusion criteria, exclusion criteria and timing of screening were taken according to NNF guidelines. ROP screening was done using RETCAM and timely intervention was done whenever needed with laser and/or intravitreal bevacizumab. Out of 576 screened preterm babies, 124 (21.4%) had ROP and among them 64 (51%) babies had type1 ROP, 48 (38%) had type2, 12(9.6%) had Aggressive posterior ROP. ROP incidence was higher in babies with birth weight <1000gms (75%), 1001-1250gms (63%),1250-1500gms (35%) with mean weight being 1310gms. 90% of babies with ROP were of < 34 weeks of gestation with mean GA of 31weeks. Most common risk factors identified on univariate analysis apart from birth weight and gestational age were oxygen therapy, CPAP, RDS, sepsis, duration of stay, apnea and hyperbilirubinemia (with p values < 0.0001). Multivariate analysis showed oxygen therapy, CPAP, RDS, sepsis and hyperbilirubinemia were significantly associated with ROP. Among 29 babies with blood transfusion, 44. 8 % had ROP and of which 77% had severe ROP (type 1 ROP or APROP). Laser treatment was given for 43 (56.6%) babies and intravitreal bevacizumab for 28 (36.8%) babies and 5(6.6%) babies received both. This study identified increased incidence of APROP. Severe ROP higher among babies who received blood transfusion.
Original Research Article
Jan. 25, 2020
“Assessment of Women's Risk Factors and Preventive Measures toward Cervical Cancer: A study in Enam Medical College & Hospital, Dhaka, Bangladesh”
H. N. Ashikur Rahaman, Shravana Kumar Chinnikatti, Al Miraj AK, Magfur Rahman, Saif Ullah Khan
Sch J App Med Sci | 202-209
DOI : 10.36347/sjams.2020.v08i01.038
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The current study aims at assessing the risk factors and preventive measures of cervical cancer for women attending primary health care centers and identifying the relationship between those risk factors and preventive measures and women's socio-demographic characteristics. A descriptive design is carried out on purposive sample of (150) women attending at Enam Medical College & Hospital, Savar, Dhaka, Bangladesh from January 2019 to Jun 2019. A questionnaire constructed for the purpose of the study. Content validity and internal consistency reliability for the study's questionnaire are determined through a pilot study. Data is collected through the study instrument using the interview technique as means of data collection. Data were analyzed through the application of descriptive and inferential statistical analysis approaches. Data analysis reveal that women, who are obese, exposed to genital infections and use oral contraceptive drug are at risk for cervical cancer and the risk increases due to their lack of commitment toward screening test, HPV vaccine and access to educational resources for increasing their awareness toward the problem. However, fortunately it appears that whenever they are under the risk they do follow the preventive measures more.
Original Research Article
Jan. 26, 2020
A Hospital-Based Cross-Sectional Study on Cardiovascular Changes in Newly Diagnosed Hypothyroid Patients
S. Muthuchellakumar, S. Jaya Kumar, R. Vijaya Kumar
Sch J App Med Sci | 210-211
DOI : 10.36347/sjams.2020.v08i01.039
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Objective: Hypothyroidism is the most common pathological hormone deficiency. This clinical state is due to either the decreased secretion or decreased action of thyroid hormones. These hormones have a profound effect on multiple organ systems, with the heart being particularly sensitive to this effect. Hence it is important to identify any clinical or sub clinical hypothyroidism at the earliest to blunt its cardiovascular effects. Aim: To assess the cardiovascular changes in newly diagnosed hypothyroid patients. Methods: Among the patients attending the Medicine OPD at Venkataeswara Hospital, Chennai-35. Newly detected hypothyroid patients were diagnosed based on their symptoms, clinical examination and hormone assays. These study subjects were subjected to detailed cardiovascular examination, ECG and echocardiography. Results: Out of 44 patients, who participated in the study, 27.3% patients had bradycardia; 22.7% had low voltage complexes; 20.5% had pericardial effusion; 11.3% had diastolic dysfunction. Systolic function was normal for all study subjects. Conclusion: This study provides a clinical profile on the cardiovascular effects of newly diagnosed hypothyroid patients. Early diagnosis and treatment of hypothyroidism with thyroxine helps to reduce these cardiovascular risks.
Original Research Article
Jan. 26, 2020
A Study on Elevated Level of Cardiac Troponin in Patients of Chronic Kidney Disease Stage 3 to above, on and off Haemodialysis
Pradeep Nigam, B. B Singh, Manoj Indurkar, Vaibhav Meshram
Sch J App Med Sci | 212-215
DOI : 10.36347/sjams.2020.v08i01.040
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The Kidney Disease Outcomes Quality Initiative (KDOQI) of the National Kidney Foundation (NKF) established a definition and classification of CKD in 2002. Kidney disease is the ninth leading cause of death in the United States. Coronary artery disease (CAD) is the major cause of death in patients with chronic kidney disease (CKD), responsible for up to 45% of overall mortality. The biochemical diagnosis of myocardial infarction in patients with CKD is always complicated by the fact that serum markers of myocardial necrosis such as creatine kinase, MB-fraction of creatine kinase. (CK-MB) are commonly increased in end stage CKD patients, even in the absence of clinically suspected myocardial infarction. Cardiac troponin (cTn) is a component of the contractile apparatus of the cardiac muscle. Because of its high tissue specificity, cTn is a cardio-specific, highly sensitive marker of myocardial damage. However, increases in serum cTn concentration have been reported in patients with CKD in the absence of acute myocardial infarction. Various study suggest that Elevations of cTnI not associated with ACS were common in patients with CKD stage 3 to 5, and there was an increase in mortality with higher concentrations of cTnI. Objective: To assess the elevated level of cardiac troponin in patients of Chronic kidney Disease stage 3 to above, on and off Haemodialysis
Original Research Article
Jan. 26, 2020
Arthroscopic Rotator Cuff Repair: Double Row Suture Bridge Technique (About 50 Cases)
K. Chmali, R. Jarbouh, W. Boughzala, A. Barry, A. Elmrini, O. Kada
Sch J App Med Sci | 216-220
DOI : 10.36347/sjams.2020.v08i01.041
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Rotator cuff tear occurs in young adults as a result of degenerative and/or traumatic tendon pathology. This retrospective study presents outcomes in 50 patients who had undergone arthroscopic rotator cuff repair. This work has shown that the double row suture bridge technique seems to be more anatomical. By applying the tendon on the previously prepared footprint which is located in the greater tuberosity and thus restoring the tendons to their approximate premorbid positions, which significantly improves the patient’s quality of life.
Original Research Article
Jan. 26, 2020
Correlation between IGT and Microalbuminuria in Type-2 Diabetes Mellitus Patients
S. Muthuchellakumar, S. Jaya Kumar, G. Bupesh
Sch J App Med Sci | 221-223
DOI : 10.36347/sjams.2020.v08i01.42
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Impaired glucose tolerance (IGT) is one of the metabolic diseases caused by uncontrolled carbohydrate metabolisms in type-2 diabetes mellitus. The study population was selected based on the results of glucose tolerance test (GTT, 75G), IGT was defined between 140-199mg/dl of serum glucose after two hour Oral 75g glucose consumption. The results inferred that the urinary albumin secretion in both samples was significantly found in twenty subjects (20) with IGT with microalbuminuria and 18 patients from this group developed diabetes mellitus within a year follow up period. Moreover, 4 patients with IGT without microalbuminuria also developed diabetes mellitus during the one year study period. According to ADA, IGT patients with albuminuria were at risk of progression to diabetes mellitus than subjects without albuminuria.
Original Research Article
Jan. 26, 2020
Macular Thickness in Relation to Duration and Severity of Diabetes
Macular Thickness in Relation to Duration and Severity of Diabetes
Sch J App Med Sci | 224-232
DOI : 10.36347/sjams.2020.v08i01.043
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Diabetes mellitus is the leading cause of blindness in the working age group; retinal neuronal abnormalities are present in early stages of Diabetes mellitus, even before the development of clinically detectable microvascular damage. With the increasing duration of DM, these abnormalities might increase leading to alteration in retinal thickness. The study was undertaken to test the hypothesis that duration and severity of diabetes affects macular thickness even in the absence of clinically apparent macular edema. We recruited 50 diagnosed patients of type-II Diabetes mellitus (NIDDM) as cases and 100 age and sex matched non-diabetic subjects attending outpatient services of department of Ophthalmology as the control group. Complete ophthalmological examination was done and measurement of retinal thickness was obtained in nine EDTRS subfields within 3 concentric circles centered on fovea making use of spectral domain Optical coherence tomography (SD-OCT). Corresponding quantitative data (µ±SD) was compared using chi square test and one-way analysis of variance. Significantly decreased macular thickness and volume was found in diabetics in comparison to the control group in outer and inner nasal and superior quadrant. This decrease in macular thickness in the specific quadrant also significantly increased with decrease in control of disease i.e. increase in HbA1c value more than 7%. Duration of disease more than 10 years was the only factor which resulted in decreased thickness of the central fovea. Our study detected morphological changes in NIDDM patients with the help of SD-OCT signifying that neural tissue loss begins in the early stages of diabetes and warrants early neuroprotective measures to prevent the damage. SD-OCT may represent an effective tool for identifying early signs of neurodegeneration in diabetic patients.
Original Research Article
Jan. 29, 2020
“An Analytical Study of Causes, Clinical Presentation and Prognosis of Intestinal Obstruction in Tertiary Care Hospital”
“An Analytical Study of Causes, Clinical Presentation and Prognosis of Intestinal Obstruction in Tertiary Care Hospital”
Sch J App Med Sci | 233-243
DOI : 10.36347/sjams.2020.v08i01.044
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Introduction: Intestinal obstruction is one of the common acute abdominal emergencies in surgical practice. Early recognition and prompt intervention can prevent irreversible ischemia and thereby decrease the mortality and longterm morbidity. The most common causes of intestinal obstruction are obstructed hernia, post-operative adhesions and tumors in rural population: Aims and objectives: To study the causes and clinical presentations of intestinal obstruction. To study the prognosis of surgery for intestinal obstruction including procedure, complications, morbidity and mortality. Materials this is a prospective observational study of 100 cases of intestinal obstruction who are admitted in surgical wards at PESIMSR Hospital, kuppam between August 2017 to November 2018. Inclusion Criteria: All patients between the age of 18-80 years admitted in department of general surgery with signs and symptoms of intestinal obstruction. Exclusion Criteria: Patients who are not willing to be a part of this study. Patients with pseudo obstruction, paralytic ileus are excluded. Results: In our study, obstructed hernia (39%) was the most common cause of intestinal obstruction followed by adhesions and bands (36%). Conclusion: Obstructed hernias are the common cause of intestinal obstruction in our study due to lack of awareness among rural population followed by adhesions and bands with pain abdomen as the most common presenting symptom. Majority of patients with intestinal obstruction needs surgical relief of obstruction.
Original Research Article
Jan. 29, 2020
“Bronchoscopy and Hrct Chest in Evaluation of Patients with Haemoptysis Having Normal Chest X-Ray”
Vislavath Sumalatha, Ranganath Deshpande, K. Ramesh Kumar, K.Lakshmi Prasanna
Sch J App Med Sci | 244-253
DOI : 10.36347/sjams.2020.v08i01.045
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Hemoptysis is a condition where there is expectoration of blood from the lower respiratory tract and has various causes. Depending upon the underlying cause and the amount of blood lost, its clinical presentation may vary from mild form with streaks of blood to massive blood loss requiring urgent medical attention. In many cases the underlying cause is straight forward on initial chest radiograph, but, at times it becomes difficult to identify the cause with initial evaluation. In such a situation, bronchoscopy and high resolution CT scan have been proposed to be of diagnostic utility, and we, here present our study on the role of bronchoscopy and HRCT chest in the evaluation of hemoptysis in patients with normal chest radiograph.
Original Research Article
Jan. 29, 2020
Pulmonary Function Test Disorders in Rheumatoid Arthritis Patients – A Hospital Based Study
Iqra Jan, Parvaiz A Koul, Mohd I dar, Fayaz A Sofi
Sch J App Med Sci | 254-257
DOI : 10.36347/sjams.2020.v08i01.046
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In a hospital based case control study, in which 50 patients of RA and 50 healthy controls were studied with respect to their demography, disease activity, disease duration and PFT. Mean age of Rheumatoid arthritis (RA) patients and controls was 46.86±10.51 and 46.68±10.65 years respectively. Patients and controls were in the age group of 40-49 and 50-59. RA group constituted 16(32%) and control group constituted 6(12%) of smokers (p=0.0016). Mean BMI in the RA patients was significantly lower compared to controls (p=0.027). RA patients had significantly lower mean FVC% compared to controls (p<0.001). Mean FEV1% was also significantly lower in RA patients compared to the controls (p<0.001). Mean FEV1/FVC in RA patients was significantly reduced than in controls (p=0.012). However mean disease duration 5.98±4.3 years showed no significance with PFT abnormality. Also mean DAS28 showed no relation with PFT abnormality. Obstructive and Restrictive pulmonary dysfunction was found in 14(28%) and 19(38%) in RA patients respectively compared to that of 0% and 2(4%) in healthy controls respectively (p<0.001). However use of drugs like Methotrexate, Leflunomide and others in RA patients showed less significance with lung function abnormality.
Original Research Article
Jan. 30, 2020
The Effect of Alcohol on Low Density Lipoprotein Level
Joice Nancy Ansye Engka, Sylvia Ritta Marunduh, Aaltje Ellen Manampiring
Sch J App Med Sci | 258-260
DOI : 10.36347/sjams.2020.v08i01.047
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Cardiovascular disease according to World Health Organization (WHO, 2012) is a major cause of death worldwide (31%). The prevalence of coronary heart disease on age > 15 year old in Indonesia in 2013 is 0.5% and the prevalence in North Sulawesi based on diagnosis is 0.7% and based on symptoms 1.7%. In 2018 based on doctor diagnosis the prevalence increased to 1.8% and became a tenth rank in Indonesia. The main Lipoproteins circulated in blood are chylomicrons, Very Low Density Lipoprotein (VLDL), Low Density Lipoprotein (LDL) and High Density Lipoprotein (HDL). Intermediate Density Lipoprotein is derived from VLDL in the formation of LDL. High level of LDL will form a plaque that builds up in arteries, a condition called atherosclerosis. LDL level can be affected by several factors such as genetics, diet, weight, physical activity, smoking and alcohol consumption. Objective: The objective of this study is to determine the effect of alcohol consumption on blood LDL level. Methods: This is an observational study with a cross-sectional design on 60 male university students (Faculty of Economy and Business, University of Sam Ratulangi) aged 20 - 24 year old who consumed alcohol drink regularly. Primary and secondary data were collected using questionnaire and interview. Blood samples were analyzed in clinical laboratory with reference value of normal LDL levels <100 mg/dL: Result: Using Chi square there is significant correlation between the duration of alcohol intake and LDL levels (p<0.05), between the amount of alcohol intake and LDL levels (p<0.05) and between daily amount of alcohol intake with LDL levels. Conclusion: Alcohol consumption can influence blood LDL levels.
Original Research Article
Jan. 29, 2020
Cardiac Remodelling and Fetal Adaptive Changes Related to Intrauterine Growth Restriction: A Comparative Study
Sharma Bhoomika, Verma Asha, Gurjar Anil
Sch J App Med Sci | 261-263
DOI : 10.36347/sjams.2020.v08i01.048
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In the modern world, cardiovascular disorders are the leading cause of morbidity and mortality, which in most cases undergo a long subclinical phase that can last decades before the first clinical symptoms appear. The aim of the present study was to evaluate whether reduced fetal growth is associated with fetal cardiac dysfunction. Methods and results: This study was prospective cohort study starting in early fetal life. A prospective study was conducted in S.M.S Medical College Jaipur, involving 72 singleton foetuses ≥28 weeks of gestation divided into two groups 36 intrauterine growth restricted foetuses and 36 appropriate for gestational age foetuses. Isovolumetric relaxation time was obtained by fetal echocardiography. The mean Isovolumetric relaxation time in the IUGR foetuses and AGA foetuses was statistically significant and that was 57 3.20msec and 42.11 1.45msec respectively, respectively; (p value: <0.0001). These findings suggest that IUGR induces primary cardiac changes, which could explain the increased predisposition to cardiovascular disease in adult life [13]. Fetal echocardiographic parameters (IVRT) identify a high risk group within the IUGR fetuses, which could be targeted for early screening of blood pressure and other cardiovascular risk factors, as well as for promoting a healthy diet and exercise.
Original Research Article
Jan. 30, 2020
Assessment of Some Haematological Parameters of Male Wistar Rats Treated with Leaf Extract of Momordica Charantia
Chibuike Obiandu, Karibo Okari, Adesua C. Obiandu
Sch J App Med Sci | 264-267
DOI : 10.36347/sjams.2020.v08i01.049
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Momordica charantia is a medicinal plant found mainly in East Africa and Asia. It is applied in folklore remedies in the treatment of diabetes, cough etc. The plant has been reported to contain important substances especially necessary for erythropoiesis. This study investigated the effects of the leaves of Momordica charantia on haematological parameters of male wistar rats. The animals were divided into three (3) groups of six (6) rats each. Group one (1) served as control and received distilled water. Group two (2) and group three (3) rats were treated with 200mg/kg bw and 400mg/kg bw of the hydromethanolic extract of the leaves of Momordica charantia respectively, for a period of 30 days. The results indicated that the extract did not significantly (p<0.05) affect the red blood cell count, packed cell volume and haemoglobin concentration. The white blood cell (WBC) count and platelet count were significantly increased following extract administration. This study has shown that the extract may be useful in promoting haemostasis due to observed increase in platelets counts, in male wistar rats.
Original Research Article
Jan. 30, 2020
Reduction in Some Reproductive Indices of Momordica Charantia Treated Male Wistar Rats
Chibuike Obiandu, Amara G. Nnadozie, Bright S. Azubuike, Prince N. Achinike, Karibo Okari, Adesua C. Obiandu
Sch J App Med Sci | 268-273
DOI : 10.36347/sjams.2020.v08i01.050
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The effect of Momordica charantia leaf extract was evaluated by determining blood follicle stimulating hormone (FSH), Interstitial cell stimulating hormone (ICSH) and testosterone (TET) levels as well as sperm quality and organ weight in male wistar rats, after 30 days of oral administration. The animals were randomly assigned into three (3) groups of six (6) rats each. Group one (1) served as control and received distilled water. Group two (2) and group three (3) received 200mg/kg and 400mg/kg of the hydromethanol (20%:80%) extract respectively. Results obtained showed that the extract caused no significant (P<0.05) alteration in the levels of FSH and ICSH. But there was a significant decrease in plasma TET level. There were no significant effects on testicular and epidydimal weights. There was significant impairment of sperm quality evidenced by a reduction in percentages of viable sperms, sperms with normal morphology and actively motile sperm as well as sperm count. The decrease in plasma testosterone and abnormal sperm parameters may suggest the ability of the plant extract to cause a direct toxic effect on the seminiferous tubule which may damage testosterone secreting cells thereby affecting testosterone synthesis and the production of healthy sperm. This study proved that, the leaf extract of Momordica charantia caused anti fertility effects in male wistar rats.
Original Research Article
Jan. 21, 2020
To Study the Pattern of Eyelid Injuries in a Tertiary Care Hospital in Mewat Region
Amit Jain, Nishtha Saini, Sonia Hasija, Gautam Gole, Yamini, Manish Malhotra, Sunil Kumar, Sandeep Kumar
Sch J App Med Sci | 274-277
DOI : 10.36347/sjams.2020.v08i01.051
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Trauma to eyelid is a major volume of ocular trauma regularly seen in our emergency. It can be a manifestation that can occur following trauma, maybe roadside accidents, falls, blasts and assault cases. Repairing of eyelid injuries requires good knowledge of anatomy of the lids. Good repair also requires fine and meticulous surgical approach to prevent complications. This study was planned to see the pattern of eyelid injury in a rural tertiary care hospital reporting in the emergency so that timely diagnosis and management will prevent the vision loss.
Original Research Article
Jan. 22, 2020
To Study the Management and Outcome of Eyelid Injuries in a Tertiary Care Hospital in Mewat Region
Amit Jain, Nishtha Saini, Sonia Hasija, Gautam Gole, Yamini, Manish Malhotra, Sunil Kumar, Ashutosh Mangla
Sch J App Med Sci | 278-281
DOI : 10.36347/sjams.2020.v08i01.052
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Eyelid trauma is routinely seen in the emergency departments worldwide. There are numerous causes which can lead to eyelid injuries. The cause of eyelid injury can be road side accidents, penetrating injuries. These injuries can cause functional and aesthetical loss like ectropion, entropion, excessive scarring etc. This study was planned to see management and outcome of eyelid injuries in a rural hospital of Mewat reporting in the emergency so that timely diagnosis can be done and complications can be prevented.
Original Research Article
Jan. 30, 2020
Splenectomy versus Splenic Preservation in Cases of Blunt Splenic Trauma: A Retrospective Study
Arun Bhargava, Abhishek Kumar, S. P. Singh
Sch J App Med Sci | 282-286
DOI : 10.36347/sjams.2020.v08i01.053
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The aim of the study was to study the per-operative indications of splenic preservation with the criteria and various modes of splenic preservation. It was a retrospective study conducted on 50 patients of splenic trauma from 2016 to 2019. The mean age of patients was 38.48 years with male to female ratio of 4:1. Majority of the patients presented with pain abdomen, shock and abdominal tenderness. USG was able to identify the splenic injury in most of the patients. Laparotomy was done in 25 cases (50%), splenectomy was done in 16 cases (32%), while in 9 cases (18% 0 splenorrhaphy was done. 23 cases were managed conservatively. Spleen preservation was done in 32 cases while 16 cases had splenectomy. Spleen preservation was possible in 64% of cases by operative or non-operative methods.
Original Research Article
Jan. 30, 2020
QT Dispersion & Insulin Resistance: Effective Markers to Assess Cardiovascular Risk in Type 2 Diabetes Mellitus
Sangeeta M Gawali, Sweta Sharm
Sch J App Med Sci | 287-292
DOI : 10.36347/sjams.2020.v08i01.054
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Background: Most recent trials revealed that insulin resistance could be an only risk factor for cardiovascular diseases in type 2 diabetics. Increased insulin resistance involved in a series of poorly investigated outcome, one of them is ventricular instability, manifested by increase in ventricular repolarization. Current study was undertaken to evaluate the QT Dispersion in type II diabetic subjects as it is cost effective and to assess its correlation with insulin resistance. Methods: 100 diabetics were screened for insulin resistance & QT dispersion & compared with 100 ages & sex matched non diabetics. HOMA -IR for insulin resistance & ECG derived indices QT interval QTi, Corrected QT interval QTc by Bazzet’s formula & QT dispersion QTd were calculated by 12 lead ECG. Insulin resistance calculated from HOMA-IR was correlated with various parameters like abdominal circumference, HBA1c, QTi, QTc, & QTd. Results: QTd was significantly increased in diabetics than nondiabetics. HOMA -IR shows strong positive correlation with abdominal circumference, HBA1c, QT interval & QT dispersion. Conclusion: Raised insulin resistance is associated with increased sympathetic nerve activity which enhances myocardial cell membrane refractoriness and thus leads to prolongation of QT interval. We conclude that QTd as significant prognostic marker for early detection of cardiovascular mortality & can be used as screening tool to prompt further investigation.
A Rare Case of Extensive Lichen Planus Eruption during Fixed Dosed Regimen of Anti Tubercular Therapy
Paladugu Swetha, Ananthalaxmi, Hima Bindhu, V.Aruna Sree
Sch J App Med Sci | 293-295
DOI : 10.36347/sjams.2020.v08i01.055
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Introduction: Lichen Planus is a mucocutaneous disease with idiopathic etiology. Lichenoid drug eruption/Drug induced lichen planus an uncommon adverse effect of several drugs. Lichen planus can be distinguished from Lichenoid drug eruption by clinical and microscopic features. Case report: 62 year old male presented with left lung consolidation with effusion .Analysis of pleural fluid was consistent with koch’s etiology. Patient was started on fixed dose regimen of anti-tubercular therapy .Patient developed rash all over the body initially over legs and later on progressed to entire body involving oral mucosa, lips and scalp. On examination purplish to blakish plaques mostly over extremities, and also scalp, buccal mucosa, lips involved. A differential diagnosis of Psoriasiform lichen planuS/Psoriasis/Prurigo nodularis was made and skin biopsy was sent for histopathological examination which showed lichen planus. Dermatologist consultation was taken and patient was started on topical steroids and antihistamines .Anti tubercular therapy was continued and completed the course for 6months.patient is in a verge of relief of symptoms and hyperpigmentation.
Original Research Article
Jan. 30, 2020
Comparative Study of Intravenous Clonidine and Dexmedetomidine for Blunting Pressor Response during Endotracheal Intubation
Faiza Ahmed Talukdar, Biswajit Mahanta
Sch J App Med Sci | 296-303
DOI : 10.36347/sjams.2020.v08i01.056
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Background and Aims: Laryngoscopy and tracheal intubation stimulates the sympathetic nervous system. Dexmedetomidine has an affinity for alpha2 receptors 8 times greater than that of clonidine. The study aimed to compare the effects of intravenous (IV) dexmedetomidine and clonidine on the pressor response among patients undergoing tracheal intubation in elective surgeries under general anaesthesia. Methods: After ethical clearance, this randomised double blinded study including 116 patients, aged between 18 to 55 years, belonging to American Society of Anesthesiologist (ASA) classes I and II scheduled for elective surgeries under general anaesthesia were randomly allocated into Groups A (n=58) and B(n=57). Group A received dexmedetomidine 0.5mcg/kg and Group B received clonidine 3mcg/kg, both diluted in 0.9% 100 ml saline and were infused over a period of 10 minutes. Heart rate (HR), Systolic blood pressure (SBP), Diastolic blood pressure (DBP), Mean arterial pressure (MAP) were recorded before administration of the drugs, after induction, immediately after intubation and 2, 4, 6, 8 and 10 minutes after intubation. Adverse effects if any were noted. Results: Demographic characteristics in both the groups were comparable. Mean of SBP (Group A124±14.70 vs Group B 135±24.66mmHg, p=0.003), DBP (Group A 84.02±11.71 vs Group B 9.63±17.09mmHg, p=0.042), MAP (Group A 97.34±12.75 vs Group B 104.68±18.98mmHg, p=0.016) and HR (Group A 79.95±10.22 vs Group B 85.07±16.06bpm, p=0.043) immediately after intubation was lower in Group A. Conclusion: Dexmedetomidine 0.5mcg/kg infusion over 10 minutes before induction blunts haemodynamic response to laryngoscopy and intubation more effectively than clonidine 3mcg/kg without any significant adverse effect.
Original Research Article
Jan. 30, 2020
Acute Coronary Syndromes and Diabetes Mellitus in Morocco: Study of 430 Patients
Rida Chniber, Laila Bendriss, Ali Khatour
Sch J App Med Sci | 304-307
DOI : 10.36347/sjams.2020.v08i01.057
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In diabetic patients, coronary artery disease (CAD) is the mean cause of morbidity and mortality. To evaluate CAD among diabetic patients, we conducted retrospective study concerning 430 patients hospitalized for CAD in the cardiology department of the Avicenne Military Hospital of Marrakesh from January1, 2008 to December 31, 2016. Our patients were divided into 2 groups: 230 were diabetics (GI) and 200 were non-diabetics (GII). The average age of patients in group I was 58 years versus 60 years in group II (p = 0.043). The statistical analysis did not show any significant difference between the two groups regarding sex. Diabetic patients had more co-morbid factors with a higher frequency of hypertension, dyslipidaemia, while non-diabetics are more likely to be smoking. LV systolic and diastolic dysfunction was higher in group I. Coronary angiography showed damage in three arteries was more common in the group I, while single artery damage was more frequent in the non-diabetic group. Our study focuses on the severity of CAD among diabetic patients and its prevalence, prompting to draw the attention of health professional on the epidemiological situation of this phenomenon in our country.
Original Research Article
Jan. 30, 2020
Correlation of Serum Triglyceride level with Carotid Intima Media Thickness in Type-2 Diabetes Mellitus patients
JL Wadhwani, Anil Sejwar, K Deopujari, Manuj Sharma
Sch J App Med Sci | 308-311
DOI : 10.36347/sjams.2020.v08i01.058
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Background: Type-2 Diabetes Mellitus (T2DM) with cardiometabolic risk factors poses the high risk of atherosclerosis. The Intima-Media Thickness (IMT) of carotid artery is reliable indicator of cardiovascular diseases. Aims and objectives: To study the Correlation of Serum Triglyceride level with Carotid Intima-Media Thickness (CIMT) in Type-2 Diabetes Mellitus patients. Materials and Methods: Presentretrospective study was performed on 250 T2DM patients at Department of Medicine, Gandhi Medical College and associated Hamidia Hospital from January 2018 to March 2019. T2DM patients having age 25-65 were enrolled. CIMT was measured with ultrasonography and its correlation was checked with triglyceride serum level. Results: Out of 250, 152 were male and 98 were females. Mean age of cohorts was 53.03 years. out of 250 subjects only 79 has normal fasting triglyceride (FTG) and post prandial triglyceride (PPTG) (mean CIMT was 0.95±0.27), 88 subjects has abnormal PPTG and normal FTG with (mean CIMT 1.63±0.40 mm) and 83 subjects had abnormal FTG and PPTG i.e. ≥150 mg/dl and significantly high CIMT as 1.96±0.61 mm. Conclusion: FTG and PPTG levels are significantly correlated with the carotid intima media thickness. PPTG is indecently and strongly associated with CIMT.
Original Research Article
Jan. 30, 2020
Association between Diabetic Neuropathy and Neutrophil Lymphocyte Ratio amongst Type 2 Diabetics
JL Wadhwani, Sachin chittawar, Upendra Gedam, Sagar Khandare
Sch J App Med Sci | 312-315
DOI : 10.36347/sjams.2020.v08i01.059
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Background: The study aimed to evaluate the relationship between Diabetic neuropathy and neutrophil lymphocyte ratio amongst patients with type 2 diabetes. Methodology: The study was conducted as a cross sectional study in outpatient Department of Medicine, Hamidia Hospital Bhopal for a period of 6 months. All the 100 known cases of type 2 diabetes belonging to age group of 18 to 80 years and giving consent were included in the study. Detailed data regarding sociodemographic variables, diabetes duration and treatment was obtained and entered in questionnaire. Height, weight, BMI was recorded. CBC, FBS, PPBS and HbA1c was also conducted. Results: The present study observed no statistically significant association between various baseline variables and Neutrophil to lymphocyte ratio (p>0.05).Neutrophil to lymphocyte ratio were significantly associated with duration of diabetes and presence of neuropathy i.e. NLR were significantly higher in patients with neuropathy and patients with longer duration of diabetes (p<0.05). Diabetic neuropathy was observed to be significantly correlated with neutrophil to lymphocyte ratio and duration of diabetes (p<0.01). Conclusion: Higher neutrophil to lymphocyte ratio may be considered as a prognostic indicator of diabetic neuropathy. This is a cost effective marker that is easily available and can be used in community settings as well as resource poor settings.
Original Research Article
Jan. 30, 2020
Management of Nonpalpable Testes in Children Bangladesh
Mahabur Rahman Sarker, Abdul Aziz, A. R. Khan, Mohammad Golam Mostafa
Sch J App Med Sci | 316-319
DOI : 10.36347/sjams.2020.v08i01.060
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Objectives: In this study our main goal is to evaluate the management of nonpalpable testes in children Bangladesh. Methods: This cross-sectional observational study was done in the department Pediatric Surgery, Dhaka Shisu (children) Hospital (DSH), Dhaka, from March 2012 to September 2013.The study included 30 children with nonpalpable testis either unilateral or bilateral.A descriptive analysis was performed for clinical features and results were presented as mean ± standard deviation for quantitative variables and numbers (percentages) for qualitative variables. Results: During the study(45%) cases primary orchiopexy done and in (5%) cases decided for stages procedure.in 22 impalpable testes (50%), vas deferens and testicular vessels were through the internal inguinal ring, of which 3(6.8%) found only testicular remnants that were excised. 20 (45%) testes found intra abdominally within <3cm. 2 (5%) testes in high (>3cm) intra-abdominal position. Conclusion: From our study we can conclude that, Laparoscopic procedure presents excellent results in terms of diagnosis and therapy of the impalpable testis in children, so this technique has been routinely incorporated in Bangladesh.
Original Research Article
Jan. 30, 2020
Study of ER, PR and VEGF Expression in Endometrial Epithelial Neoplasms and its Correlation with Histological Stage and Grade of Endometrial Carcinoma
Rathin Hazra, SK Samim Rahaman, Debasish Guha
Sch J App Med Sci | 320-326
DOI : 10.36347/sjams.2020.v08i01.061
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Endometrium is a one of the dynamic tissue of the female genital tract. Carcinoma of endometrium is one of the leading causes of mortality in aged women.The important precursor lesions are hyperplasia with or without atypia, all are mainly influenced by unchecked hormonal imbalance between Estrogen Receptor (ER) and Progesteron Receptor (PR).As the diseases advances from hyperplasia to carcinoma there is change of expression of ER, PR and VEGF leading to changes in treatment protocol. The study was conducted in the Department of Pathology in collaboration with the Department of Obstetrics and Gynaecology, Nilratan Sircar Medical College and Hospital, Kolkata from 1st January 2018 to 30th June 2019. The study included patients attending the Department of Gynaecology and Obstetrics, with clinical and/or radiological suspicion of endometrial pathologies. Total 51 cases were included in our study. The results of ER, PR and VEGF on endometrial carcinoma and its precursor lesions have been discussed below.
Original Research Article
Jan. 30, 2020
“Ultrasonographic Assessment of Polycystic Ovaries: Ovarian Morphology versus Ovarian Volume in Diagnosis of Polycystic Ovaries.”
Gulnar Begum, Selina Afroze Ansary, Ismail Hossain, Shaida Akhter, Shakina Khatun
Sch J App Med Sci | 327-330
DOI : 10.36347/sjams.2020.v08i01.062
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Hyperandrogenism. It is the killer of the womanhood. Women of any ethnic background can present with PCOS. Polycystic ovaries (PCO) are a common problem among females. As ultrasound examination of such cases is easy, available, cheap and less invasive than hormonal assessments. In practice, ultrasound findings are sometimes equivocal when some patients have normal ovarian volume but with abnormal ovarian morphology. Herein, the study aimed to compare ovarian volume in patients with PCO versus the ovarian morphology and whether one finding alone could make the diagnosis. Ninety(90) patients (women) with clinically and laboratory diagnosed PCO were selected from OPD of Obstetrics and Gynaecology in 250 Beded General Hospital , Jamalpur and other private clinic or hospitals in Jamalpur during the period of August 2017 to July 2019.Transabdominal & Transvagina ultrasound was done for assessment of ovarian volume and morphology. In patients, 16(8.8%) ovaries showed normal morphological appearance while the rest (91.1%) showed morphological picture of PCO in the form of detection of 10 or more cysts of 2-8 mm in diameter. Peripherally arranged around on ecodense stroma (redulla). Ovarian morphological feature is more reliable than ovarian volume in diagnosing patients with polycystic ovarian syndrome in polycystic ovaries (PCO) women.
Original Research Article
Jan. 30, 2020
Identifying Risk Factors of Hypothyroidism: A Study in a Tertiary Care Hospital, Rajshashi, Bangladesh
Ashik Ikbal, Milon Chowdhury, Subrata Ghosh, MA Matin
Sch J App Med Sci | 331-336
DOI : 10.36347/sjams.2020.v08i01.063
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This was a study cross sectional prospective study. This study was done in the Department of otolaryngology and Head Neck Surgery, Rajshahi Medical College Hospital. Rajshshi, Bangladesh during the period from 2015 January to 2015 December. Our aim was to identify risk factors of Hypothyroidism in adult patients. All patients were evaluated for age, sex, pre-operative and post-operative TSH levels, histopathology and follow up. Time of diagnosis and therapeutic dose of thyroid hormone were determined for patients with hypothyroidism. Out of 50 patients 11(22%) patients had become hypothyroid after surgery (9 females and 2 males). Female & male ratio is 5.25:1. The remaining 39 patients (33 females & 6 males) were euthyroid. The mean preoperative serum thyroid stimulating hormone (TSH) levels in hypothyroid and euthyroid groups were 3.14µIU/L & 2.008 µIU/L respectively. A tissue diagnosis consistent with multi-nodular goitre (27%), lymphocytic infiltration or hashimoto thyroiditis (18%) compared with euthyroid patients (30% & 2%).Approximately 15-30% of patients who undergo hemithyroidectomy may have this complication, and some may need thyroid hormone replacement therapy. Patients at increased risk for postoperative hypothyroidism should be made aware of their risk factors and undergo more intensive follow-up. Maximum incidence of hypothyroidism following hemithyroidectomy in 3rd and 4th decade. Compared with those who were euthyroid, there was no significance difference in age, family history of goiter.
Original Research Article
Jan. 30, 2020
“A Comparative Study on Postoperative Complications in Using Total Intravenous Anesthesia with Propofol and Sevoflurane Inhalation Anesthesia”
Mohammad Abdul Mannan, Minhazur Rahman Chowdhury, Purabi Bardhan
Sch J App Med Sci | 337-341
DOI : 10.36347/sjams.2020.v08i01.064
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Introduction: Propofol is a short-acting medication that results in a loss of consciousness and lack of memory for events. Sevoflurane is a sweet-smelling, nonflammable, highly fluorinated methyl isopropyl ether used as an inhalational anaesthetic for induction and maintenance of general anesthesia. We have a very few comparative data regarding these two anaesthetic agents. Aim of the study: The aim of this study was to compare the postoperative complications between „total intravenous anesthesia with propofol‟ and „sevoflurane inhalation anesthesia‟. Methods: This retrospective study was conducted in Pioneer Hospital, Chattogram, Bangladesh. During the period from January 2018 to December 2018. In total 94 patients who had ENT surgeries previously were finalized as the total study population. Total patients were divided into 2 groups. In Group I there were 43 patients to whom total intravenous anesthesia with propofol (TIVA) had been used and in Group II there were 51 patients to whom sevoflurane inhalation anesthesia (SIA) had been used. Postoperative complications and recovery period were determined as tachycardia, bradycardia, hypertension, hypotension, recovery time, additional analgesia and nausea-vomiting.
Original Research Article
Jan. 30, 2020
Skull Base Osteomyelitis - Extent, Clinical Impact and Medical Management
Rashmi Prasad, Saket Ballabh, Anagha Joshi
Sch J App Med Sci | 342-351
DOI : 10.36347/sjams.2020.v08i01.065
Abstract
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Skull base osteomyelitis is a complex and fatal clinical entity that is often misdiagnosed for malignancy. Typical SBO are initiated by ear infection with Pseudomonas Aeruginosa as the usual pathogen, whereas atypical SBO centred on the sphenoid and occipital bones rather than temporal bone. Culture sensitivities will guide the choice of antibiotics, influenced by local prescribing policies. Infective causes must be included in the differential diagnosis of all patients with skull base masses, not just diabetic and immunocompromised patients, especially in the setting of headache, raised ESR and CRP, and multiple lower CNP. Accurate diagnosis and evaluation of the disease depends on appropriate physical examination and radiological assessment including both CT and MRI scans. Treatment with quinolones – especially Ciprofloxacin is the first line treatment for skull base osteomyelitis. If the diagnosis is made and aggressive treatment started early as per culture and sensitivity or empirical based treatment, for appropriate period of time, outcome has improved without any surgical intervention, neural deficit improves, although full recovery of cranial nerve function may not occur.
Original Research Article
Jan. 30, 2020
Usefulness of Ultrasonography in the Treatment of Thyroid Disorders
Gulnar Begum, Selina Afroze Ansary, Ismail Hossain, SM Akhter-ul-Alam, Shakina Khatun
Sch J App Med Sci | 352-354
DOI : 10.36347/sjams.2020.v08i01.066
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Introduction: Thyroid gland plays a fundamental role in the development of tissue metabolism and it affects various organs systems. An assessable amount of non TSH reliant on T4 secretion also happens typically. Mostly, two major group of thyroid disorders are familiar: a) hyperthyroidism b) hypothyroidism. Material & Methods: This was a comparative cross-sectional study and was conducted in the Department of Obstetrics and Gynaecology at 250 Bed Jamalpur General Hospital, Jamalpur, Bangladesh during the period from 1st June 2019 to 31st December 2019. A total number of 50 patients had been selected for this study and they were divided equally in two major groups: subclinical hypothyroidism group and subclinical hyperthyroidism group. Complete physical examination routine lab test, liver function test, renal function test, ECG, fasting blood glucose, thyroid profile, ultrasonography of thyroid gland and thyroid function test was done to all these patients. TSH was done in a fasting state by Enzyme Immunoassay.
Original Research Article
Jan. 30, 2020
Antibiotic Sensitivity Pattern of Bacterial Isolates in Neonatal Septicemia in Bangladesh
A.T.M Shahid, Ibrahim Khalil, Shamim Parvej Ibne Halim, Shahina Akhter Mita, Habibur Rahman, Sirajul Islam Bhuiyan, Mohammad Akhteruzzan, Mohammad Abul Khayer, Md. Salim, Monimul Haque
Sch J App Med Sci | 355-358
DOI : 10.36347/sjams.2020.v08i01.067
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Objective: In this study our main goal is to evaluate the Antibiotic sensitivity pattern of Bacterial Isolates in Neonatal Septicemia in Bangladesh. Methods: This cross sectional study is conducted at Neonatal unit of the department of paediatrics, Sir Salimullah Medical College and Mitford Hospital, Dhaka, From July 2007 to June 2008.Among 90 clinically diagnosed septicemic neonates, 30 were blood culture positive. Results: During the study, 30 samples showed growth of different organisms, 12(40%) samples showed growth of klebsiella, 6 samples (20%) growth of coagulase negative staphylococcus, 5 samples (17%) were pseudomonas positive. 4 samples (13%) showed growth of E. coli. Here 18(60%) neonates developed late onset and 12(40%) early onset infection with various organisms. Ciprofloxacin was the most sensitive antibiotics against all organisms ranging from (4.0-100%) then was the chloramphenicol 20-83%. Ceftriaxone was (40-80%) sensitive against almost all organisms but E. coli were resistant to ceftriaxone. Gentamicin and Cotrimoxazole were sensitive to organisms from 0-66% and 0-40% respectively. Conclusion: From our result, we can conclude that, gram negative organisms remain as the main pathogens causing neonatal septicaemia with predominance of klebsiella. The emergence of kelbsiella species is a new one in this institution. Further study should be carried out to find out the source of this organism.
Original Research Article
Jan. 30, 2020
Accumulative Study of the Value of Conservative Treatment in Selected Cases of Peptic Ulcer Perforation
Dizen Chandra Barman, Shiladitya Shil, Sandipan Chakrabarty, B. K. M. Tarik Hossain, Sarwar Murshed Alam
Sch J App Med Sci | 359-362
DOI : 10.36347/sjams.2020.v08i01.068
Abstract
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Background: Conservative treatment is an alternative method of surgical treatment for the management of perforated peptic ulcer diseases. Objective: The objective of the study is to recommend safe and effective treatment in selected cases of peptic ulcer perforation under strict supervision as an alternative to surgery. Method: This prospective study was conducted at Surgery Department of M. Abdur Rahim Medical College Hospital, Dinajpur, Bangladesh for a period of July 2008 to July 2009. Hundred cases were selected by special inclusion and exclusion criteria. Results: All patients were presented with acute upper abdominal pain, most were in their fourth decade and came to the hospital around twenty four hours of their onset of pain. Diagnosis was made on clinical grounds and confirmed by radiological and imaging examinations. Resuscitative measures were taken in all cases in the form of IV fluid, nasogastric suction, antibiotics and analgesics. The study was designed to treat all the patients conservatively and accordingly all were given conservative regimen up to 24 hours. There after they were assessed clinically. Great deterioration was found in 12 patients and 18 patients showed no improvement who were operated immediately. Conservative measures were continued for 70 patients who responded smoothly with few minor complications. The mortality was 6.33% in the cases treated operatively after failing conservative management. No mortality was found in conservatively treated group.
