G. Prakash, G. Purushotham, K. AjayBabu, Mamgunta Sai Anugna
BACKGROUND Intestinal obstruction can be defined as the partial or complete blockage of either the small intestine or large intestine or both, causing failure of intestinal contents to pass beyond the point of obstruction. Subacute intestinal obstruction implies incomplete obstruction. It is characterized by continuous passage of flatus and /or feces beyond 6 -12 hours of the onset of symptoms. We wanted to study the conservative management of subacute intestinal obstruction and its outcome. METHODS Data was collected from patients presenting to outpatient Department of General Surgery, SVRRGGH, Tirupati and emergency with the features of subacute intestinal obstruction during the period of March 2019 to April 2020 were included in the study. RESULTS The incidence is high in patients of age group 41-50 years with Male: Female ratio is 2.1:1. The most common presenting symptom is pain abdomen (92 %), followed by vomiting (84 %). In our study, exaggerated bowel sounds (60 %) are the most common physical finding. The most common cause of obstruction is Postoperative adhesions (36 %), followed by obstructed hernias (22 %). Out of 50 cases, 72 % of cases were managed successfully by conservative management. In the patients who were managed conservatively, most of them are due to postoperative adhesions. In the patients who underwent emergency surgical intervention, 50 % of cases operated on the 2nd day of admission. Most commonly done Surgery include Adhesiolysis (28.6 %), Herniorrhaphy (28.6 %) and Resection and anastomosis (21.5 %). CONCLUSIONS Our study showed that conservative management is successful in about 72 % of patients with subacute intestinal obstruction. Not all the patients attending the emergency ward with features of intestinal obstruction need emergency surgical intervention. Conservative management can be tried in selective cases in patients with SAIO, thereby reducing the rate of negative laparotomies and morbidity and mortality. KEYWORDS Sub-Acute, Intestinal, Obstruction Conservative, Outcome
{"title":"A Descriptive study on Conservative Management of Subacute Intestinal Obstruction and Its Outcome in Tirupati","authors":"G. Prakash, G. Purushotham, K. AjayBabu, Mamgunta Sai Anugna","doi":"10.18410/jebmh/2021/573","DOIUrl":"https://doi.org/10.18410/jebmh/2021/573","url":null,"abstract":"BACKGROUND Intestinal obstruction can be defined as the partial or complete blockage of either the small intestine or large intestine or both, causing failure of intestinal contents to pass beyond the point of obstruction. Subacute intestinal obstruction implies incomplete obstruction. It is characterized by continuous passage of flatus and /or feces beyond 6 -12 hours of the onset of symptoms. We wanted to study the conservative management of subacute intestinal obstruction and its outcome. METHODS Data was collected from patients presenting to outpatient Department of General Surgery, SVRRGGH, Tirupati and emergency with the features of subacute intestinal obstruction during the period of March 2019 to April 2020 were included in the study. RESULTS The incidence is high in patients of age group 41-50 years with Male: Female ratio is 2.1:1. The most common presenting symptom is pain abdomen (92 %), followed by vomiting (84 %). In our study, exaggerated bowel sounds (60 %) are the most common physical finding. The most common cause of obstruction is Postoperative adhesions (36 %), followed by obstructed hernias (22 %). Out of 50 cases, 72 % of cases were managed successfully by conservative management. In the patients who were managed conservatively, most of them are due to postoperative adhesions. In the patients who underwent emergency surgical intervention, 50 % of cases operated on the 2nd day of admission. Most commonly done Surgery include Adhesiolysis (28.6 %), Herniorrhaphy (28.6 %) and Resection and anastomosis (21.5 %). CONCLUSIONS Our study showed that conservative management is successful in about 72 % of patients with subacute intestinal obstruction. Not all the patients attending the emergency ward with features of intestinal obstruction need emergency surgical intervention. Conservative management can be tried in selective cases in patients with SAIO, thereby reducing the rate of negative laparotomies and morbidity and mortality. KEYWORDS Sub-Acute, Intestinal, Obstruction Conservative, Outcome","PeriodicalId":15779,"journal":{"name":"Journal of Evidence Based Medicine and Healthcare","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83922727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUND Cirrhosis of liver and its extrahepatic manifestations like hepatic osteodystrophy has been linked to vitamin D deficiency, and has been proposed as a potential therapeutic target. Its metabolism to 25-hydroxylation, makes liver necessary for its activation. In this study sources of vitamin D, functions and its metabolism with a focus on its variation with severity of liver cirrhosis is discussed. METHODS This is an observational study conducted on 60 patients with liver cirrhosis. The severity of liver cirrhosis was assessed according to the Modified CPS. By technique of enhanced chemiluminscence values of vitamin D were obtained. The results were statistically analyzed using SPSS Statistics-20.0 version. Association among different variables were calculated using Chi-Square Test and One Way ANOVA. Results were considered significant if p value obtained was below 0.05 and highly significant if it was below 0.001. RESULTS Mean age group of study population was 54.83 ± 13.56 years. 27 patients had Alcoholic cirrhosis, 11 patients were HCV positive, 2 patients were HBsAg positive and 20 patients had cirrhosis due to other etiologies. Mean vitamin D level of the study population was 35.34 ± 22.4. 27 patients (45 %) had sufficient vitamin D, 18 patients (30 %) were deficient and 14 patients had insufficient vitamin D levels. 1 patient had vitamin D toxicity. There was no significant correlation between mean vitamin D and etiology of liver cirrhosis (P value = 0.457; Not Significant). There was significant correlation between vitamin D levels with severity of liver disease (p value < 0.001). CONCLUSIONS In conclusion, low concentrations of 25 (OH) D are correlated with severity of liver dysfunction irrespective of the etiology. KEYWORDS Child-Pugh Score, Liver cirrhosis, Serum Vitamin D
{"title":"To Compare Serum Vitamin D Levels with Severity of Liver Cirrhosis According to Child-Pugh Score in Amritsar, Punjab","authors":"J. Kaur, G. Mohan, Manish Chandey","doi":"10.18410/jebmh/2021/563","DOIUrl":"https://doi.org/10.18410/jebmh/2021/563","url":null,"abstract":"BACKGROUND Cirrhosis of liver and its extrahepatic manifestations like hepatic osteodystrophy has been linked to vitamin D deficiency, and has been proposed as a potential therapeutic target. Its metabolism to 25-hydroxylation, makes liver necessary for its activation. In this study sources of vitamin D, functions and its metabolism with a focus on its variation with severity of liver cirrhosis is discussed. METHODS This is an observational study conducted on 60 patients with liver cirrhosis. The severity of liver cirrhosis was assessed according to the Modified CPS. By technique of enhanced chemiluminscence values of vitamin D were obtained. The results were statistically analyzed using SPSS Statistics-20.0 version. Association among different variables were calculated using Chi-Square Test and One Way ANOVA. Results were considered significant if p value obtained was below 0.05 and highly significant if it was below 0.001. RESULTS Mean age group of study population was 54.83 ± 13.56 years. 27 patients had Alcoholic cirrhosis, 11 patients were HCV positive, 2 patients were HBsAg positive and 20 patients had cirrhosis due to other etiologies. Mean vitamin D level of the study population was 35.34 ± 22.4. 27 patients (45 %) had sufficient vitamin D, 18 patients (30 %) were deficient and 14 patients had insufficient vitamin D levels. 1 patient had vitamin D toxicity. There was no significant correlation between mean vitamin D and etiology of liver cirrhosis (P value = 0.457; Not Significant). There was significant correlation between vitamin D levels with severity of liver disease (p value < 0.001). CONCLUSIONS In conclusion, low concentrations of 25 (OH) D are correlated with severity of liver dysfunction irrespective of the etiology. KEYWORDS Child-Pugh Score, Liver cirrhosis, Serum Vitamin D","PeriodicalId":15779,"journal":{"name":"Journal of Evidence Based Medicine and Healthcare","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82865239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Makannavar, Srinivas Kalabavi, Revanasiddappa A Kanagali, Bhuvanesh Aradhya, Sangamnath Sangamnath
BACKGROUND Xanthogranulomatous pyelonephritis (XGP) is an uncommon form of chronic pyelonephritis that is characterized by extensive enlargement and destruction of the involved kidney which ultimately results in non-functioning kidney. It often mimics other inflammatory or neoplastic renal disorders. Unlike chronic pyelonephritis, it spreads to the perinephric space with formation of multiple abscesses and fistulas. It is now being recognized as an important cause of renal morbidity and mortality worldwide. METHODS This is a case series undertaken in a tertiary care center. Clinical data was collected from last 6 years. Clinical features, radiological findings, treatment, and its outcome were analysed and presented. RESULTS A total of 23 cases diagnosed clinically were included in our study. The disease is more prevalent in females than in males with ratio of 1.8 : 1, with mean age of 47.04 years. Most of the patients presented with flank pain and fever. 2 patients had unusual presentations that are nephrocutaneous fistula and necrotising fasciitis of flank region. In our study, disease was associated with urolithiasis in 43.47 % and diabetes mellitus (DM) in 60.8 %. E. coli was the most commonly grown organism in urine culture. Most of the patients underwent initial percutaneous nephrostomy (PCN) or double-J (DJ) stenting followed by definitive treatment that is nephrectomy (21 patients, 2 patients lost to follow up). Extraperitoneal flank approach was most commonly chosen compared to subcostal transperitoneal approach. Excess blood loss was the most common complication encountered during surgery; 8 patients required post-operative blood transfusion. 5 patients required intensive care unit (ICU) care with inotropic support postoperatively. 6 patients had post-operative superficial surgical site infection. CONCLUSIONS XGP is a rare form of chronic pyelonephritis resulting in enlarged non-functioning kidney. UTI (urinary tract infection) and urolithiasis are the most important factors involved in pathogenesis. Prompt diagnosis and treatment is essential. Initial antibiotic treatment with drainage procedure (PCN or DJ stenting) followed by nephrectomy is treatment of choice. Early diagnosis and treatment may limit the disease process and associated morbidity, thus leading to good outcome. KEYWORDS Xanthogranulomatous Pyelonephritis, UTI (Urinary Tract Infection), Urolithiasis, Nephrectomy
{"title":"A Retrospective Review of Xanthogranulomatous Pyelonephritis - Our Experience at a Tertiary Care Center Located in Dharwad District, Karnataka","authors":"P. Makannavar, Srinivas Kalabavi, Revanasiddappa A Kanagali, Bhuvanesh Aradhya, Sangamnath Sangamnath","doi":"10.18410/jebmh/2021/571","DOIUrl":"https://doi.org/10.18410/jebmh/2021/571","url":null,"abstract":"BACKGROUND Xanthogranulomatous pyelonephritis (XGP) is an uncommon form of chronic pyelonephritis that is characterized by extensive enlargement and destruction of the involved kidney which ultimately results in non-functioning kidney. It often mimics other inflammatory or neoplastic renal disorders. Unlike chronic pyelonephritis, it spreads to the perinephric space with formation of multiple abscesses and fistulas. It is now being recognized as an important cause of renal morbidity and mortality worldwide. METHODS This is a case series undertaken in a tertiary care center. Clinical data was collected from last 6 years. Clinical features, radiological findings, treatment, and its outcome were analysed and presented. RESULTS A total of 23 cases diagnosed clinically were included in our study. The disease is more prevalent in females than in males with ratio of 1.8 : 1, with mean age of 47.04 years. Most of the patients presented with flank pain and fever. 2 patients had unusual presentations that are nephrocutaneous fistula and necrotising fasciitis of flank region. In our study, disease was associated with urolithiasis in 43.47 % and diabetes mellitus (DM) in 60.8 %. E. coli was the most commonly grown organism in urine culture. Most of the patients underwent initial percutaneous nephrostomy (PCN) or double-J (DJ) stenting followed by definitive treatment that is nephrectomy (21 patients, 2 patients lost to follow up). Extraperitoneal flank approach was most commonly chosen compared to subcostal transperitoneal approach. Excess blood loss was the most common complication encountered during surgery; 8 patients required post-operative blood transfusion. 5 patients required intensive care unit (ICU) care with inotropic support postoperatively. 6 patients had post-operative superficial surgical site infection. CONCLUSIONS XGP is a rare form of chronic pyelonephritis resulting in enlarged non-functioning kidney. UTI (urinary tract infection) and urolithiasis are the most important factors involved in pathogenesis. Prompt diagnosis and treatment is essential. Initial antibiotic treatment with drainage procedure (PCN or DJ stenting) followed by nephrectomy is treatment of choice. Early diagnosis and treatment may limit the disease process and associated morbidity, thus leading to good outcome. KEYWORDS Xanthogranulomatous Pyelonephritis, UTI (Urinary Tract Infection), Urolithiasis, Nephrectomy","PeriodicalId":15779,"journal":{"name":"Journal of Evidence Based Medicine and Healthcare","volume":"39 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73491014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Madhavan, Rekha Mathew, J. Michael, Aravindan Karunakaran, G. G. Kaimal, Binu Abraham
BACKGROUND Suicide attempts in young adults in the age group 18 - 25 years have grown exponentially across the globe in the last three decades. Suicide is the third leading cause of death among young adults worldwide and is the second leading cause of death in 15 – 29-year-olds. The studies on the factors affecting suicidal intent among young adult suicide attempters are few from the Indian context and young adult group is of utmost importance. So, this study was done to estimate the suicidal intent among young adult suicide attempters and to assess the various factors associated with suicidal intent among young adults. METHODS The study was an analytical cross-sectional study, which was carried out at the Suicide Prevention Clinic of the Department of Psychiatry at a Tertiary Care Centre in Kerala, India over a period of 1 year from October 2015 to September 2016. The consecutive 160 young adult suicide attempters were interviewed. Beck’s suicide intent scale was used to assess the severity of suicide attempts. Statistical significance of socio-demographic factors and suicidal intent score was assessed by independent student t test and one way analysis of variance (ANOVA). RESULTS Out of the 160 participants, 50 (31.2 %) had low suicidal intent, 71 (44.4 %) had medium suicidal intent and 39 (24.4 %) had high suicidal intent. The study showed significant association between marital status (t = 2.515, P = 0.011), Occupation (F = 7.991, P < 0.001), previous suicide attempt (t = - 2.586, P = 0.011), mode of attempt (F = 7.228, P < 0.001) and psychiatric disorder (F = 11.218, P < 0.001) with the suicidal intent score. The study has found a significant association between the caregiver and suicidal intent score (F = 4.339, P = 0.006) which needs to be researched further. CONCLUSIONS Our study showed significant association between the socio-demographic variables like occupation, marital status, caregiver, mode of attempt, previous attempt and psychiatric diagnosis with the suicidal intent scores of young adult suicide attempters attending the suicide prevention clinic. This finding throws light to the factors contributing to high suicidal intent among young adults. The suicidal rates among the young adults are on the rise and we as the health professionals should be aware of these factors which will help in preventing young adult suicides. KEYWORDS Suicidal Intent, Young Adults, Suicide Prevention Clinic, Suicidal Behaviour, Kerala
背景:在过去的30年里，全球18 - 25岁年轻人的自杀企图呈指数级增长。自杀是全世界年轻人死亡的第三大原因，也是15 - 29岁人群死亡的第二大原因。关于影响青年自杀企图者自杀意图因素的研究很少有来自印度的研究，青年群体是最重要的。因此，本研究是为了估计年轻人自杀未遂者的自杀意图，并评估与年轻人自杀意图相关的各种因素。方法:该研究是一项分析性横断面研究，于2015年10月至2016年9月在印度喀拉拉邦一家三级护理中心精神科自杀预防诊所进行，为期一年。连续采访了160名年轻的自杀未遂者。贝克自杀意图量表用于评估自杀企图的严重程度。采用独立学生t检验和单因素方差分析(ANOVA)评估社会人口学因素与自杀意图评分的统计学意义。结果160名参与者中，50名(31.2%)有低自杀倾向，71名(44.4%)有中等自杀倾向，39名(24.4%)有高自杀倾向。婚姻状况(t = 2.515, P = 0.011)、职业(F = 7.991, P < 0.001)、自杀未遂史(t = - 2.586, P = 0.011)、自杀未遂方式(F = 7.228, P < 0.001)、精神障碍(F = 11.218, P < 0.001)与自杀意图得分有显著相关。本研究发现照顾者与自杀意图得分之间存在显著相关性(F = 4.339, P = 0.006)，有待进一步研究。结论职业、婚姻状况、照顾者、企图方式、既往企图和精神病学诊断等社会人口学变量与到自杀预防诊所就诊的青年自杀未遂者的自杀意图得分存在显著相关性。这一发现揭示了导致年轻人自杀倾向高的因素。年轻人的自杀率正在上升，我们作为卫生专业人员应该意识到这些因素，这将有助于预防年轻人自杀。关键词:自杀意图，年轻人，自杀预防诊所，自杀行为，喀拉拉邦
{"title":"Suicidal Intent in Young Adults Attending the Suicide Prevention Clinic at a Tertiary Care Centre in Kerala, India","authors":"R. Madhavan, Rekha Mathew, J. Michael, Aravindan Karunakaran, G. G. Kaimal, Binu Abraham","doi":"10.18410/jebmh/2021/566","DOIUrl":"https://doi.org/10.18410/jebmh/2021/566","url":null,"abstract":"BACKGROUND Suicide attempts in young adults in the age group 18 - 25 years have grown exponentially across the globe in the last three decades. Suicide is the third leading cause of death among young adults worldwide and is the second leading cause of death in 15 – 29-year-olds. The studies on the factors affecting suicidal intent among young adult suicide attempters are few from the Indian context and young adult group is of utmost importance. So, this study was done to estimate the suicidal intent among young adult suicide attempters and to assess the various factors associated with suicidal intent among young adults. METHODS The study was an analytical cross-sectional study, which was carried out at the Suicide Prevention Clinic of the Department of Psychiatry at a Tertiary Care Centre in Kerala, India over a period of 1 year from October 2015 to September 2016. The consecutive 160 young adult suicide attempters were interviewed. Beck’s suicide intent scale was used to assess the severity of suicide attempts. Statistical significance of socio-demographic factors and suicidal intent score was assessed by independent student t test and one way analysis of variance (ANOVA). RESULTS Out of the 160 participants, 50 (31.2 %) had low suicidal intent, 71 (44.4 %) had medium suicidal intent and 39 (24.4 %) had high suicidal intent. The study showed significant association between marital status (t = 2.515, P = 0.011), Occupation (F = 7.991, P < 0.001), previous suicide attempt (t = - 2.586, P = 0.011), mode of attempt (F = 7.228, P < 0.001) and psychiatric disorder (F = 11.218, P < 0.001) with the suicidal intent score. The study has found a significant association between the caregiver and suicidal intent score (F = 4.339, P = 0.006) which needs to be researched further. CONCLUSIONS Our study showed significant association between the socio-demographic variables like occupation, marital status, caregiver, mode of attempt, previous attempt and psychiatric diagnosis with the suicidal intent scores of young adult suicide attempters attending the suicide prevention clinic. This finding throws light to the factors contributing to high suicidal intent among young adults. The suicidal rates among the young adults are on the rise and we as the health professionals should be aware of these factors which will help in preventing young adult suicides. KEYWORDS Suicidal Intent, Young Adults, Suicide Prevention Clinic, Suicidal Behaviour, Kerala","PeriodicalId":15779,"journal":{"name":"Journal of Evidence Based Medicine and Healthcare","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89468513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Comprehensive Study of Relative Afferent Pupillary Defect in Kanyakumari Medical College, Tamil Nadu","authors":"R. Beena, T. Anuradha","doi":"10.18410/JEBMH/2021/569","DOIUrl":"https://doi.org/10.18410/JEBMH/2021/569","url":null,"abstract":"","PeriodicalId":15779,"journal":{"name":"Journal of Evidence Based Medicine and Healthcare","volume":"19 1","pages":"3128-3133"},"PeriodicalIF":0.0,"publicationDate":"2021-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77545431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A 28-year-old female patient presented at ENT OPD with complaints of a slowly growing mass over nasal tip since last 5 years. There were no complaints of pain, nasal obstruction, or epistaxis. There were no skin changes or ulceration over the swelling and sensation was preserved. There was no history of similar kind of swelling in other parts of the body. History of trauma or any form of surgical intervention were excluded. Family history was insignificant. The swelling did not respond to any medications. The patient attended for cosmetic reason solely. Clinical examination showed a soft non-tender 4 cm by 4 cm mass over nasal tip and supratip area. Mobility of the mass was restricted and fixed to the alar cartilages. There was no evidence of café au lait spots or any other skin lesions. Anterior rhinoscopy was unremarkable. Diagnostic nasal endoscopy was also performed but no abnormality was detected. CT scan showed non-specific infiltrative subcutaneous lesions. T1W MRI showed an ill-defined hypodense mass over the nasal tip which was abutting the alar cartilages which showed mild enhancement with contrast (figure 1). T2W MRI showed hyperintense and or hypodense central focus (target sign). FNAC was done and report was suggestive of neurogenic tumour, most probably neurofibroma.
{"title":"Isolated Plexiform Neurofibroma of the Nasal Tip - A Rare Case Report","authors":"S. Chowdhury, Tithi Debnath","doi":"10.18410/jebmh/2021/576","DOIUrl":"https://doi.org/10.18410/jebmh/2021/576","url":null,"abstract":"A 28-year-old female patient presented at ENT OPD with complaints of a slowly growing mass over nasal tip since last 5 years. There were no complaints of pain, nasal obstruction, or epistaxis. There were no skin changes or ulceration over the swelling and sensation was preserved. There was no history of similar kind of swelling in other parts of the body. History of trauma or any form of surgical intervention were excluded. Family history was insignificant. The swelling did not respond to any medications. The patient attended for cosmetic reason solely. Clinical examination showed a soft non-tender 4 cm by 4 cm mass over nasal tip and supratip area. Mobility of the mass was restricted and fixed to the alar cartilages. There was no evidence of café au lait spots or any other skin lesions. Anterior rhinoscopy was unremarkable. Diagnostic nasal endoscopy was also performed but no abnormality was detected. CT scan showed non-specific infiltrative subcutaneous lesions. T1W MRI showed an ill-defined hypodense mass over the nasal tip which was abutting the alar cartilages which showed mild enhancement with contrast (figure 1). T2W MRI showed hyperintense and or hypodense central focus (target sign). FNAC was done and report was suggestive of neurogenic tumour, most probably neurofibroma.","PeriodicalId":15779,"journal":{"name":"Journal of Evidence Based Medicine and Healthcare","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85936639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUND Acute appendicitis (AA) is one of the commonest causes of acute abdominal emergencies. Accurate diagnosis and earlier surgery is imperative in such cases. Ultrasonography (US), and computed tomography (CT), are main stays accurate diagnosis of this disease. This study was conducted to compare the accuracy of US and CT in the diagnosis of AA and reduce number of negative appendectomies. METHODS This prospective study was done after approval from institutional ethical committee and obtaining written consent. 164 patients with clinical features suggestive of AA, were selected from emergency department of Patna Medical College, Patna India during the period from January 2019 to December 2020. 98 were males and 66 females, mean age being 18.08 years. 142 patents (86.58 %) underwent surgery, and 22 patients (13.41 %) were kept on clinical observation in hospital after imaging. After detailed clinical workup and laboratory investigations, all patients were subjected to both US and CT examination. Each patient was reevaluated clinically, and a clinical correlation was done between both sets of results. Based on these, final decision was made. Accuracy was decided based on intra-operative findings in appendectomy group and were correlated with imaging findings later with histopathologic findings. RESULTS Males outnumbered females, abdominal pain was present in 100%. The sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of US in diagnosis of AA in our study were 92.6 %, 76.4 %, 95.3%, 71.0% and 88.9 % respectively. The sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of CT in diagnosis of AA were 99.1 %, 90.5 %, 98.6%, 87.8% and 97.8 % respectively. CONCLUSIONS US should be the first-line imaging modality as it is free from radiation. CT is recommended as additional imaging tool to raise accuracy in diagnosis except in pregnancy and selected pediatric patients. KEYWORDS Acute Appendicitis, Computed Tomography, Ultrasound
{"title":"Acute Appendicitis - Study of Role of Ultrasound and CT Scan in Decision Making for Surgery in a Tertiary Care Government Hospital in Eastern India","authors":"J. Kumar, Akriti Komal","doi":"10.18410/jebmh/2021/556","DOIUrl":"https://doi.org/10.18410/jebmh/2021/556","url":null,"abstract":"BACKGROUND Acute appendicitis (AA) is one of the commonest causes of acute abdominal emergencies. Accurate diagnosis and earlier surgery is imperative in such cases. Ultrasonography (US), and computed tomography (CT), are main stays accurate diagnosis of this disease. This study was conducted to compare the accuracy of US and CT in the diagnosis of AA and reduce number of negative appendectomies. METHODS This prospective study was done after approval from institutional ethical committee and obtaining written consent. 164 patients with clinical features suggestive of AA, were selected from emergency department of Patna Medical College, Patna India during the period from January 2019 to December 2020. 98 were males and 66 females, mean age being 18.08 years. 142 patents (86.58 %) underwent surgery, and 22 patients (13.41 %) were kept on clinical observation in hospital after imaging. After detailed clinical workup and laboratory investigations, all patients were subjected to both US and CT examination. Each patient was reevaluated clinically, and a clinical correlation was done between both sets of results. Based on these, final decision was made. Accuracy was decided based on intra-operative findings in appendectomy group and were correlated with imaging findings later with histopathologic findings. RESULTS Males outnumbered females, abdominal pain was present in 100%. The sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of US in diagnosis of AA in our study were 92.6 %, 76.4 %, 95.3%, 71.0% and 88.9 % respectively. The sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of CT in diagnosis of AA were 99.1 %, 90.5 %, 98.6%, 87.8% and 97.8 % respectively. CONCLUSIONS US should be the first-line imaging modality as it is free from radiation. CT is recommended as additional imaging tool to raise accuracy in diagnosis except in pregnancy and selected pediatric patients. KEYWORDS Acute Appendicitis, Computed Tomography, Ultrasound","PeriodicalId":15779,"journal":{"name":"Journal of Evidence Based Medicine and Healthcare","volume":"43 7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81172707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUND Perianal fistulas account for a substantial discomfort and morbidity to the patient thus affecting productive man hours and quality of life. Accurate pre-operative assessment of course of the primary fistulous track and secondary extension or abscesses is required for successful surgical management of anal fistulas. The purpose of this study was to diagnose and classify pre-operative perianal fistulas. METHODS This is a cross-sectional study at Department of Radiodiagnosis in a tertiary level hospital of southern Rajasthan from November 2018 to November 2020. The study included a total of 50 patients referred to department of radiology for magnetic resonance imaging (MRI). Statistical analysis was done using chi square test and student t test. RESULTS Out of these patients, 56 % were having secondary tract on MRI, 12 % patients were having abscess and 4 % were having horseshoe abscess on MRI. The commonest type of ano-rectal fistula encountered in the study was Grade -II seen in 32 %. CONCLUSIONS MRI is a highly accurate, rapid and non-invasive tool in pre-operative evaluation of the perianal and anal fistulas. MRI evaluation and classification of perianal fistulae has a high degree of diagnostic accuracy. The use of MRI for the diagnosis and classification of perianal fistula can provide reliable information which has both pre-operative and prognostic value. St James University Hospital classification, which is an MR imaging-based grading system for perianal fistula is very useful for effective radiological-surgical communication thus contributing to improved patient care and reduced rate of recurrence. KEYWORDS MR Fistulogram, Perianal Fistula, Anal Fistula, Fistula Classification, Fistulography
{"title":"Role of MRI in the Diagnosis and Pre-Operative Classification of Perianal and Anal Fistulas - A Cross-Sectional Study, Southern Rajasthan","authors":"H. Jat, Neel Patel, Sitaram Barath, P. Yadav","doi":"10.18410/jebmh/2021/574","DOIUrl":"https://doi.org/10.18410/jebmh/2021/574","url":null,"abstract":"BACKGROUND Perianal fistulas account for a substantial discomfort and morbidity to the patient thus affecting productive man hours and quality of life. Accurate pre-operative assessment of course of the primary fistulous track and secondary extension or abscesses is required for successful surgical management of anal fistulas. The purpose of this study was to diagnose and classify pre-operative perianal fistulas. METHODS This is a cross-sectional study at Department of Radiodiagnosis in a tertiary level hospital of southern Rajasthan from November 2018 to November 2020. The study included a total of 50 patients referred to department of radiology for magnetic resonance imaging (MRI). Statistical analysis was done using chi square test and student t test. RESULTS Out of these patients, 56 % were having secondary tract on MRI, 12 % patients were having abscess and 4 % were having horseshoe abscess on MRI. The commonest type of ano-rectal fistula encountered in the study was Grade -II seen in 32 %. CONCLUSIONS MRI is a highly accurate, rapid and non-invasive tool in pre-operative evaluation of the perianal and anal fistulas. MRI evaluation and classification of perianal fistulae has a high degree of diagnostic accuracy. The use of MRI for the diagnosis and classification of perianal fistula can provide reliable information which has both pre-operative and prognostic value. St James University Hospital classification, which is an MR imaging-based grading system for perianal fistula is very useful for effective radiological-surgical communication thus contributing to improved patient care and reduced rate of recurrence. KEYWORDS MR Fistulogram, Perianal Fistula, Anal Fistula, Fistula Classification, Fistulography","PeriodicalId":15779,"journal":{"name":"Journal of Evidence Based Medicine and Healthcare","volume":"300 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76269900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUND Otologists always yearn to improve the hearing outcome of their patients with chronic suppurative otitis media. There are different options for ossiculoplasty to choose from, depending on the extent of disease, condition of ossicular chain and availability of implant material and there has always been a quest to make appropriate decision with a predictable outcome. In this study, we have tried to analyse various factors which can affect hearing outcome after Ossiculoplasty. METHODS A retrospective study was done to study the effect of implant material, condition of ossicular chain and disease in the mastoid on post-operative hearing improvement on 200 patients, who underwent tympanoplasty or tympanomastoidectomy from January 2018 to January 2020, in Department of Otorhinolaryngology and Head and Neck Surgery, K.D. Medical College, Mathura. Decision of ossiculoplasty was made based on intra-operative findings. Autograft incus, Teflon TORP (total ossicular replacement prosthesis) and cartilage columella were used based on availability and feasibility. RESULTS Mean improvement in average air-bone gap of 200 patients was found to be 18.57 dB, with autograft incus, it was 19.99 dB, with Teflon TORP (total ossicular replacement prosthesis), 19.53 dB and with cartilage columella 16.73 dB (P = 0.023). Mean hearing improvement was 18.98 dB when handle of malleus was present and 15.59 dB when it was absent (P = 0.023). Mean hearing improvement was 19.42 dB when stapes superstructure was present and 16.92 dB when it was absent (P = 0.016). Even though the hearing outcome was better when mastoid was disease free (19.57 dB) compared to when it was diseased (18.30 dB), the difference was not statistically significant. (P = 0.177) CONCLUSIONS In our study, we found autograft incus to be the best material for ossiculoplasty and presence of handle of malleus and stapes superstructure improved postoperative hearing outcome significantly but involvement of mastoid by disease did not significantly affect the hearing outcome post-operatively. KEYWORDS Chronic Suppurative Otitis Media, Ossiculoplasty, Tympanoplasty, Ossicular Prosthesis, Autograft
耳科医生一直渴望改善慢性化脓性中耳炎患者的听力。听骨成形术有不同的选择，这取决于疾病的程度，听骨链的状况和植入材料的可用性，并且总是寻求做出适当的决定和可预测的结果。在本研究中，我们试图分析影响听骨成形术后听力结果的各种因素。方法回顾性分析马图拉K.D.医学院耳鼻喉头颈外科2018年1月至2020年1月200例行鼓室成形术或鼓室乳状突切除术的患者，研究植体材料、听骨链状况和乳突病变对术后听力改善的影响。听骨成形术的决定基于术中发现。基于可用性和可行性，采用自体移植物砧骨、全听骨置换假体(Teflon TORP)和软骨小柱。结果200例患者平均气骨间隙改善18.57 dB，自体植骨组改善19.99 dB，全听骨置换术组改善19.53 dB，软骨小柱组改善16.73 dB (P = 0.023)。镫骨柄存在时平均听力改善18.98 dB，无镫骨柄时平均听力改善15.59 dB (P = 0.023)。镫骨上部结构存在时平均听力改善19.42 dB，镫骨上部结构不存在时平均听力改善16.92 dB (P = 0.016)。尽管乳突无病时的听力结果(19.57 dB)优于病变时的听力结果(18.30 dB)，但差异无统计学意义。(P = 0.177)结论本研究发现自体砧骨是最佳的听骨成形术材料，镫骨及踝上结构柄的存在可显著改善术后听力，而疾病累及乳突对术后听力无显著影响。关键词:慢性化脓性中耳炎，听骨成形术，鼓室成形术，听骨假体，自体移植物
{"title":"An Analytical Study of the Factors Affecting Hearing Improvement after Ossiculoplasty – A Retrospective Study, Mathura, Uttar Pradesh","authors":"Piyush Singh, S. Saggu, Preeti Singh","doi":"10.18410/jebmh/2021/568","DOIUrl":"https://doi.org/10.18410/jebmh/2021/568","url":null,"abstract":"BACKGROUND Otologists always yearn to improve the hearing outcome of their patients with chronic suppurative otitis media. There are different options for ossiculoplasty to choose from, depending on the extent of disease, condition of ossicular chain and availability of implant material and there has always been a quest to make appropriate decision with a predictable outcome. In this study, we have tried to analyse various factors which can affect hearing outcome after Ossiculoplasty. METHODS A retrospective study was done to study the effect of implant material, condition of ossicular chain and disease in the mastoid on post-operative hearing improvement on 200 patients, who underwent tympanoplasty or tympanomastoidectomy from January 2018 to January 2020, in Department of Otorhinolaryngology and Head and Neck Surgery, K.D. Medical College, Mathura. Decision of ossiculoplasty was made based on intra-operative findings. Autograft incus, Teflon TORP (total ossicular replacement prosthesis) and cartilage columella were used based on availability and feasibility. RESULTS Mean improvement in average air-bone gap of 200 patients was found to be 18.57 dB, with autograft incus, it was 19.99 dB, with Teflon TORP (total ossicular replacement prosthesis), 19.53 dB and with cartilage columella 16.73 dB (P = 0.023). Mean hearing improvement was 18.98 dB when handle of malleus was present and 15.59 dB when it was absent (P = 0.023). Mean hearing improvement was 19.42 dB when stapes superstructure was present and 16.92 dB when it was absent (P = 0.016). Even though the hearing outcome was better when mastoid was disease free (19.57 dB) compared to when it was diseased (18.30 dB), the difference was not statistically significant. (P = 0.177) CONCLUSIONS In our study, we found autograft incus to be the best material for ossiculoplasty and presence of handle of malleus and stapes superstructure improved postoperative hearing outcome significantly but involvement of mastoid by disease did not significantly affect the hearing outcome post-operatively. KEYWORDS Chronic Suppurative Otitis Media, Ossiculoplasty, Tympanoplasty, Ossicular Prosthesis, Autograft","PeriodicalId":15779,"journal":{"name":"Journal of Evidence Based Medicine and Healthcare","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82822850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Jaiswal, R. S. Yadav, M. Ranjan, Dipti Wahi, Chiranji Rai
BACKGROUND Myopia is a complex trait including both genetic and environmental factors as well as gene-environment interactions. It has been recognized as a risk factor for development of glaucoma. Both Myopia and raised IOP are known to increase mechanical stress at optic nerve head leading to glaucomatous nerve damage. This study intends to evaluate the clinical profile of myopic subjects and its correlation with Primary open angle glaucoma (POAG). METHODS A prospective observational study done from November 2019 to December 2020 after taking proper informed consent and ethical clearance. 164 eyes of 96 patients studied were divided into three groups, Group 1: low myopia (< -3.00D), Group 2: moderate myopia (-3.00 D to -5.75 D), Group 3: high myopia (≥ -6.00 D). A complete ocular examination was performed. Intraocular pressure was measured using Goldmann applanation tonometer. Visual field analysis using Humphrey automated perimetry was done in patients with suspected primary open angle glaucoma (POAG). Angle parameters and central corneal thickness (CCT) were measured using anterior segment optical coherence tomography (AS-OCT). RESULTS 164 eyes of 96 Myopic subjects were studied with no dropout during study period. Mean age was 46.05 yr. (range: 25-75 yr.). The refraction ranged from -0.50 DS to -17.00 DS. There was no statistically significant difference between Intraocular pressure (IOP), Central corneal thickness (CCT), corrected IOP and Nasal and Temporal Trabecular-iris Angle (TIA) between male and female of same age group. Mean IOP and mean CCT were found to vary significantly with age and with higher degree of myopia. Corrected IOP, Nasal and Temporal TIA increase significantly with higher degree of myopia. Cup-disc ratio (CDR) was found to be significantly higher in patients with moderate to high degree of Myopia. CONCLUSIONS Myopia is an important risk factor for development of primary open angle glaucoma, with its incidence increasing in patients with moderate to high myopia. KEYWORDS Myopia, Primary Open Angle Glaucoma, Intraocular Pressure, Central Corneal Thickness, Trabecular Iris Angle
{"title":"Clinical Profile of Myopic Patients as a Risk Factor for Primary Open Angle Glaucoma - A Prospective Observational Study in Gorakhpur, Uttar Pradesh","authors":"R. Jaiswal, R. S. Yadav, M. Ranjan, Dipti Wahi, Chiranji Rai","doi":"10.18410/jebmh/2021/562","DOIUrl":"https://doi.org/10.18410/jebmh/2021/562","url":null,"abstract":"BACKGROUND Myopia is a complex trait including both genetic and environmental factors as well as gene-environment interactions. It has been recognized as a risk factor for development of glaucoma. Both Myopia and raised IOP are known to increase mechanical stress at optic nerve head leading to glaucomatous nerve damage. This study intends to evaluate the clinical profile of myopic subjects and its correlation with Primary open angle glaucoma (POAG). METHODS A prospective observational study done from November 2019 to December 2020 after taking proper informed consent and ethical clearance. 164 eyes of 96 patients studied were divided into three groups, Group 1: low myopia (< -3.00D), Group 2: moderate myopia (-3.00 D to -5.75 D), Group 3: high myopia (≥ -6.00 D). A complete ocular examination was performed. Intraocular pressure was measured using Goldmann applanation tonometer. Visual field analysis using Humphrey automated perimetry was done in patients with suspected primary open angle glaucoma (POAG). Angle parameters and central corneal thickness (CCT) were measured using anterior segment optical coherence tomography (AS-OCT). RESULTS 164 eyes of 96 Myopic subjects were studied with no dropout during study period. Mean age was 46.05 yr. (range: 25-75 yr.). The refraction ranged from -0.50 DS to -17.00 DS. There was no statistically significant difference between Intraocular pressure (IOP), Central corneal thickness (CCT), corrected IOP and Nasal and Temporal Trabecular-iris Angle (TIA) between male and female of same age group. Mean IOP and mean CCT were found to vary significantly with age and with higher degree of myopia. Corrected IOP, Nasal and Temporal TIA increase significantly with higher degree of myopia. Cup-disc ratio (CDR) was found to be significantly higher in patients with moderate to high degree of Myopia. CONCLUSIONS Myopia is an important risk factor for development of primary open angle glaucoma, with its incidence increasing in patients with moderate to high myopia. KEYWORDS Myopia, Primary Open Angle Glaucoma, Intraocular Pressure, Central Corneal Thickness, Trabecular Iris Angle","PeriodicalId":15779,"journal":{"name":"Journal of Evidence Based Medicine and Healthcare","volume":"263 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75107757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：