Seetaram N.K., Gayatri B.H., Chandrashekhar Kachapur, S. Kulkarni
BACKGROUND Platelet size, measured as mean platelet volume (MPV), is a marker of platelet function and is positively associated with indicators of platelet activity, including aggregation and release of thromboxane A2, platelet factor 4, and thromboglobulin.1 Larger platelets are metabolically more active, produce more prothrombotic factors, aggregate more easily & act as index of homeostasis and its dysfunction thrombosis.2 The purpose of this study was to examine the relationship between platelet indices and stroke, as well as its severity and outcome. METHODS This was a prospective observational case control study. This study was conducted with 105 non-diabetic, non-hypertensive ischemic stroke patients who had no history of previous thrombotic events and who had not previously taken any antiplatelet medications. These patients were examined within 24 hours of onset of symptoms and severity of stroke was calculated by Canadian neurological scale (CNS). The results were compared with 105 age and sex match controls. RESULTS Mean age of patients was 61.72 ± 12 and of controls was 62.85 ± 10.68. Based on the CNS score, participants were allocated into two groups; the first group were those who had a comprehension deficit (1st group, 43 patients) and the second group were those without a comprehension deficit (2nd group, 62 patients). Mean values for platelet distribution width (PDW) & MPV in 1st group was 18.329 and 12.55 respectively and in 2nd group was 16.98 and 11.48 respectively. The mean value of PDW and MPV for stroke patients was 17.53 ± 0.76 and 11.92 ± 0.58 and was significantly higher than mean value of PDW & MPV respectively in controls, which were 15.47 ± 0.26 and 10.43 ± 0.23. PDW & MPV was found to be significantly associated with severity of motor deficit. CONCLUSIONS Larger studies may be required to determine its utility in day-to-day clinical practice. However, platelet indices can be used for predicting the severity of deficit in patients of acute ischemic stroke. KEYWORDS Platelet Indices, Stroke
{"title":"Correlation of Platelet Indices with Severity of Acute Ischemic Stroke in Non-Diabetic and NonHypertensive Patients in Hubli, Karnataka","authors":"Seetaram N.K., Gayatri B.H., Chandrashekhar Kachapur, S. Kulkarni","doi":"10.18410/jebmh/2021/561","DOIUrl":"https://doi.org/10.18410/jebmh/2021/561","url":null,"abstract":"BACKGROUND Platelet size, measured as mean platelet volume (MPV), is a marker of platelet function and is positively associated with indicators of platelet activity, including aggregation and release of thromboxane A2, platelet factor 4, and thromboglobulin.1 Larger platelets are metabolically more active, produce more prothrombotic factors, aggregate more easily & act as index of homeostasis and its dysfunction thrombosis.2 The purpose of this study was to examine the relationship between platelet indices and stroke, as well as its severity and outcome. METHODS This was a prospective observational case control study. This study was conducted with 105 non-diabetic, non-hypertensive ischemic stroke patients who had no history of previous thrombotic events and who had not previously taken any antiplatelet medications. These patients were examined within 24 hours of onset of symptoms and severity of stroke was calculated by Canadian neurological scale (CNS). The results were compared with 105 age and sex match controls. RESULTS Mean age of patients was 61.72 ± 12 and of controls was 62.85 ± 10.68. Based on the CNS score, participants were allocated into two groups; the first group were those who had a comprehension deficit (1st group, 43 patients) and the second group were those without a comprehension deficit (2nd group, 62 patients). Mean values for platelet distribution width (PDW) & MPV in 1st group was 18.329 and 12.55 respectively and in 2nd group was 16.98 and 11.48 respectively. The mean value of PDW and MPV for stroke patients was 17.53 ± 0.76 and 11.92 ± 0.58 and was significantly higher than mean value of PDW & MPV respectively in controls, which were 15.47 ± 0.26 and 10.43 ± 0.23. PDW & MPV was found to be significantly associated with severity of motor deficit. CONCLUSIONS Larger studies may be required to determine its utility in day-to-day clinical practice. However, platelet indices can be used for predicting the severity of deficit in patients of acute ischemic stroke. KEYWORDS Platelet Indices, Stroke","PeriodicalId":15779,"journal":{"name":"Journal of Evidence Based Medicine and Healthcare","volume":"182 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77101469","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}
D. Christian, R. Shukla, H. J. Sutariya, Y. R. Patel
BACKGROUND Public health emergencies including a disaster are inevitable. Moreover, the vulnerability and health impacts are more profound in urban densely populated dwellings. Household preparedness for public health emergencies need to be focused to minimize the morbidity and mortality associated with such situations. METHODS An urban community, situated in field practice area of a tertiary care teaching institute of Ahmedabad, Gujarat was approached for a cross-sectional study through door to door structured interviews. A pre-designed questionnaire was administered to assess the knowledge as well as preparedness for public health emergencies among the respondents. The adult representative family member from each of the selected households formed the sampling unit. Statistical tests of association and logistic regression analysis were used to find our relationship between household preparedness and some of the independent factors. RESULTS From a total of 405 households, majority of the respondents were male (65.7 %), married (92.1 %), having secondary level education (43.7 %) and belonged to socio-economic class IV (37.8 %). Only 44 % of the respondents had experienced any form of public health emergency in the past and only 14.6 % had an experience of relief work. “Flash floods following heavy rains” and “earthquake” were the commonest disaster experienced by the respondents. None of the surveyed households had first aid kit or a fire-extinguisher. Majority of the respondents (N = 280, 69.1 %) were aware of emergency contact numbers in case of public health emergencies. The overall household level preparedness was only 12.59 %. Perceived susceptibility to public health emergencies and household preparedness had significant statistical associations with education, occupation, type of house and socio-economic class. CONCLUSIONS Education, occupation, and social class play roles in both perception as well as household preparedness for public health emergencies. A very low level of preparedness and their possible factors should be addressed through adequate channels so that the damage due to such emergencies could be minimized. KEYWORDS Disaster, Household Preparedness, Public Health Emergency, Urban Community
{"title":"Household Preparedness for Public Health Emergencies among Urban Communities of Ahmedabad, Gujarat, India - A Community Based Cross-Sectional Study","authors":"D. Christian, R. Shukla, H. J. Sutariya, Y. R. Patel","doi":"10.18410/jebmh/2021/559","DOIUrl":"https://doi.org/10.18410/jebmh/2021/559","url":null,"abstract":"BACKGROUND Public health emergencies including a disaster are inevitable. Moreover, the vulnerability and health impacts are more profound in urban densely populated dwellings. Household preparedness for public health emergencies need to be focused to minimize the morbidity and mortality associated with such situations. METHODS An urban community, situated in field practice area of a tertiary care teaching institute of Ahmedabad, Gujarat was approached for a cross-sectional study through door to door structured interviews. A pre-designed questionnaire was administered to assess the knowledge as well as preparedness for public health emergencies among the respondents. The adult representative family member from each of the selected households formed the sampling unit. Statistical tests of association and logistic regression analysis were used to find our relationship between household preparedness and some of the independent factors. RESULTS From a total of 405 households, majority of the respondents were male (65.7 %), married (92.1 %), having secondary level education (43.7 %) and belonged to socio-economic class IV (37.8 %). Only 44 % of the respondents had experienced any form of public health emergency in the past and only 14.6 % had an experience of relief work. “Flash floods following heavy rains” and “earthquake” were the commonest disaster experienced by the respondents. None of the surveyed households had first aid kit or a fire-extinguisher. Majority of the respondents (N = 280, 69.1 %) were aware of emergency contact numbers in case of public health emergencies. The overall household level preparedness was only 12.59 %. Perceived susceptibility to public health emergencies and household preparedness had significant statistical associations with education, occupation, type of house and socio-economic class. CONCLUSIONS Education, occupation, and social class play roles in both perception as well as household preparedness for public health emergencies. A very low level of preparedness and their possible factors should be addressed through adequate channels so that the damage due to such emergencies could be minimized. KEYWORDS Disaster, Household Preparedness, Public Health Emergency, Urban Community","PeriodicalId":15779,"journal":{"name":"Journal of Evidence Based Medicine and Healthcare","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84849629","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 The head and neck region is an anatomic site having lymph nodes, nerves, veins, arteries, muscles, mucosal epithelium to salivary glands, thyroid, and a host of developmental tissues. Any of these tissues can become pathological, resulting in a mass. Fine needle aspiration cytology (FNAC) is regarded as a reliable method of investigation in diagnosis of head and neck lesions. However, histopathology is the gold standard of diagnosis. The purpose of this study was to assess the frequency of head and neck tumours according to the sites of their occurrence and to find out the correlation of cytopathological findings by FNAC and histopathological findings by biopsy. METHODS This prospective study undertaken from June 2012 to June 2014 in the Department of Pathology, IMS and SUM Hospital, Bhubaneswar, a tertiary care center. All the patients attending different outdoor of IMS & SUM Hospital, Bhubaneswar with head & neck lesions referred for FNAC were included in the study. The results of FNAC were compared with that of histopathological findings by tissue biopsy. Data collected was entered in MS Excel and analysed using the same software. Descriptive statistical measures like frequency and percentage. Data was presented in tabular form. RESULTS The commonest site of lesion was in the lymph node followed by thyroid gland. There was preponderance of female sex in thyroid lesions whereas males were commonest in other sites. The accuracy in cyto-histopathology correlation between benign and malignant lesion was 96.36 % and 88.89 % respectively and was most corroborated in the thyroid lesions (50.6 %). CONCLUSIONS Cyto-histo correlation of head and neck lesions provides an important, quick, excellent, and sensitive diagnostic tool to exclude non-neoplastic lesions from neoplastic lesions. KEYWORDS Head and Neck Lesions, FNAC, Histopathology
{"title":"A Study on Cytomorphological and Histopathological Correlation of Head and Neck Lesions in a Tertiary Care Centre, Bhubaneswar, Odisha","authors":"Anima Hota, Pranita Mohanty, Mitu Mohanty","doi":"10.18410/jebmh/2021/565","DOIUrl":"https://doi.org/10.18410/jebmh/2021/565","url":null,"abstract":"BACKGROUND The head and neck region is an anatomic site having lymph nodes, nerves, veins, arteries, muscles, mucosal epithelium to salivary glands, thyroid, and a host of developmental tissues. Any of these tissues can become pathological, resulting in a mass. Fine needle aspiration cytology (FNAC) is regarded as a reliable method of investigation in diagnosis of head and neck lesions. However, histopathology is the gold standard of diagnosis. The purpose of this study was to assess the frequency of head and neck tumours according to the sites of their occurrence and to find out the correlation of cytopathological findings by FNAC and histopathological findings by biopsy. METHODS This prospective study undertaken from June 2012 to June 2014 in the Department of Pathology, IMS and SUM Hospital, Bhubaneswar, a tertiary care center. All the patients attending different outdoor of IMS & SUM Hospital, Bhubaneswar with head & neck lesions referred for FNAC were included in the study. The results of FNAC were compared with that of histopathological findings by tissue biopsy. Data collected was entered in MS Excel and analysed using the same software. Descriptive statistical measures like frequency and percentage. Data was presented in tabular form. RESULTS The commonest site of lesion was in the lymph node followed by thyroid gland. There was preponderance of female sex in thyroid lesions whereas males were commonest in other sites. The accuracy in cyto-histopathology correlation between benign and malignant lesion was 96.36 % and 88.89 % respectively and was most corroborated in the thyroid lesions (50.6 %). CONCLUSIONS Cyto-histo correlation of head and neck lesions provides an important, quick, excellent, and sensitive diagnostic tool to exclude non-neoplastic lesions from neoplastic lesions. KEYWORDS Head and Neck Lesions, FNAC, Histopathology","PeriodicalId":15779,"journal":{"name":"Journal of Evidence Based Medicine and Healthcare","volume":"65 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73737333","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}
Sunnapu Uma Maheswara Rao, Lakhineni Lakshmi Sailaja, M. S. Rao, Sakura Ravindra Kishore
BACKGROUND Talus is a very important bone among the skeleton of foot. Talus is a very common bone which undergoes some structural modifications due to prolonged habitual squatting postures. Structural alterations like squatting facets, trochlear extensions are observed over the dorsal aspect of the neck of the talus common type of squatting facets observed are medial squatting facets, lateral squatting facets, combined type of squatting facets .These are observed in specific group of people. METHODS Present study was conducted in 100 talus bones, which are procured from department of Anatomy, Andhra medical college, Visakhapatnam. Structural modifications like squatting facets, trochlear extensions are studied in all the bones. RESULTS Squatting facets are observed in most of the talus .but trochlear extensions are not observed in any of the talus .out of 100 talus, 54 tali are having lateral squatting facet, 4tali are having a medial squatting facet, 16 tali showing combined type of squatting facet, 26 tali are not having any type of squatting facets. Out of 54 right sided taluses, 24 tali are having a lateral squatting facet, 3 tali are having medial squatting facet, 10 tali are having combined type of squatting facet, 17tali are not having any type of squatting facet. Out of 46 left sided taluses, 30tali are having lateral squatting facet, 1 talus is having a medial squatting facet, 6 tali are having combined type of squatting facets, 9tali are not having any type of squatting facet. CONCLUSIONS Incidence of modifications over the neck of talus is very common in people who are having a rural background, those people are having a habitual squatting position. And these alterations may be due to genetic inheritance and several unexplainable reasons. KEYWORDS Talus, Squatting Facet, Habitual Squatting Posture, Lateral Squatting Facet, Medial Squatting Facet
{"title":"Morphometric Study of Modifications over the Neck of Talus in Visakhapatnam Region of Andhra Pradesh State","authors":"Sunnapu Uma Maheswara Rao, Lakhineni Lakshmi Sailaja, M. S. Rao, Sakura Ravindra Kishore","doi":"10.18410/jebmh/2021/555","DOIUrl":"https://doi.org/10.18410/jebmh/2021/555","url":null,"abstract":"BACKGROUND Talus is a very important bone among the skeleton of foot. Talus is a very common bone which undergoes some structural modifications due to prolonged habitual squatting postures. Structural alterations like squatting facets, trochlear extensions are observed over the dorsal aspect of the neck of the talus common type of squatting facets observed are medial squatting facets, lateral squatting facets, combined type of squatting facets .These are observed in specific group of people. METHODS Present study was conducted in 100 talus bones, which are procured from department of Anatomy, Andhra medical college, Visakhapatnam. Structural modifications like squatting facets, trochlear extensions are studied in all the bones. RESULTS Squatting facets are observed in most of the talus .but trochlear extensions are not observed in any of the talus .out of 100 talus, 54 tali are having lateral squatting facet, 4tali are having a medial squatting facet, 16 tali showing combined type of squatting facet, 26 tali are not having any type of squatting facets. Out of 54 right sided taluses, 24 tali are having a lateral squatting facet, 3 tali are having medial squatting facet, 10 tali are having combined type of squatting facet, 17tali are not having any type of squatting facet. Out of 46 left sided taluses, 30tali are having lateral squatting facet, 1 talus is having a medial squatting facet, 6 tali are having combined type of squatting facets, 9tali are not having any type of squatting facet. CONCLUSIONS Incidence of modifications over the neck of talus is very common in people who are having a rural background, those people are having a habitual squatting position. And these alterations may be due to genetic inheritance and several unexplainable reasons. KEYWORDS Talus, Squatting Facet, Habitual Squatting Posture, Lateral Squatting Facet, Medial Squatting Facet","PeriodicalId":15779,"journal":{"name":"Journal of Evidence Based Medicine and Healthcare","volume":"101 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79563809","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 A variety of non - neoplastic and neoplastic conditions involve the nasal cavity, paranasal sinuses and nasopharynx and these are very common lesions encountered in clinical practice. Histopathological examination of these lesions is the gold standard for diagnosis because management and prognosis vary among different lesions. The aim of the present study was to evaluate the histopathological study of the lesions of the nasal cavity, paranasal sinuses and nasopharynx in relation to their incidence, age, gender and site wise distribution and to compare the results with the available data. METHODS A study of 88 cases was conducted for a period of 2 years from August 2017 to July 2019. After fixation, Processing and Haematoxylin and Eosin staining and special stains histopathological diagnosis was made. RESULTS Among 88 total cases, 58 were males and 30 were females. A male predominance was observed with a male to female ratio of 1.93 : 1. They were more common in third, fourth and fifth decade of life. Malignant nasal lesions were seen after fourth decade of life. Nasal lesions were more common in nasal cavity (67.05 %), followed by paranasal sinuses (18.18 %) and nasopharynx (14.75). Out of 88 total cases, 39 (44.32 %) were non - neoplastic, 30 (34.09 %) were benign and 19 (21.59 %) were malignant nasal lesions. CONCLUSIONS Sinonasal lesions and nasopharyngeal lesions can have various differential diagnoses. A complete clinical, radiological and histopathological correlation helps to categorize these sinonasal lesions into various non - neoplastic and neoplastic types. But histopathological examination remains the mainstay of definitive diagnosis. KEYWORDS Nasal Cavity, Paranasal Sinuses, Nasopharynx, Benign Tumours, Malignant Tumours, Histopathological Examination
{"title":"Histopathological Study of Lesions of the Nasal Cavity, Paranasal Sinuses and Nasopharynx in a Tertiary Care Centre, Visakhapatnam over a Period of 2 Years","authors":"Rajendra Prasad Jagannadham, Lakshmi Latchupatula, S. Ponnada, Neelima Lalam, Raghunadhababu Gudipudi, Bhagyalakshmi Atla","doi":"10.18410/jebmh/2021/557","DOIUrl":"https://doi.org/10.18410/jebmh/2021/557","url":null,"abstract":"BACKGROUND A variety of non - neoplastic and neoplastic conditions involve the nasal cavity, paranasal sinuses and nasopharynx and these are very common lesions encountered in clinical practice. Histopathological examination of these lesions is the gold standard for diagnosis because management and prognosis vary among different lesions. The aim of the present study was to evaluate the histopathological study of the lesions of the nasal cavity, paranasal sinuses and nasopharynx in relation to their incidence, age, gender and site wise distribution and to compare the results with the available data. METHODS A study of 88 cases was conducted for a period of 2 years from August 2017 to July 2019. After fixation, Processing and Haematoxylin and Eosin staining and special stains histopathological diagnosis was made. RESULTS Among 88 total cases, 58 were males and 30 were females. A male predominance was observed with a male to female ratio of 1.93 : 1. They were more common in third, fourth and fifth decade of life. Malignant nasal lesions were seen after fourth decade of life. Nasal lesions were more common in nasal cavity (67.05 %), followed by paranasal sinuses (18.18 %) and nasopharynx (14.75). Out of 88 total cases, 39 (44.32 %) were non - neoplastic, 30 (34.09 %) were benign and 19 (21.59 %) were malignant nasal lesions. CONCLUSIONS Sinonasal lesions and nasopharyngeal lesions can have various differential diagnoses. A complete clinical, radiological and histopathological correlation helps to categorize these sinonasal lesions into various non - neoplastic and neoplastic types. But histopathological examination remains the mainstay of definitive diagnosis. KEYWORDS Nasal Cavity, Paranasal Sinuses, Nasopharynx, Benign Tumours, Malignant Tumours, Histopathological Examination","PeriodicalId":15779,"journal":{"name":"Journal of Evidence Based Medicine and Healthcare","volume":"85 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80501984","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}
N. Ramanaiah, G. Prakash, Kumbha Roja Ramani, S. Heena, D. Mythri, Udayagiri Shanmukha Srinivasulu
BACKGROUND Diabetic foot is the most common and most feared complication of diabetes and is more significant than nephropathy, retinopathy, heart attack, and stroke combined. Diabetes-associated problems are the second common cause of lowerlimb amputations in India. Foot disorders like ulcerations, infection, Gangrene are the leading causes of hospitalization in patients with diabetes mellitus in India.1 METHODS A prospective study, carried out on 100 diabetic patients with foot ulcers over a period of one year from April 2019 to March 2020 at Sri Venkateswara Medical College hospital. The extent of foot infection was assessed based on Wagner’s classification and were studied based on the culture and sensitivity obtained and the efficacy of the antibiotic used. RESULTS The data analysis of 100 patients has given the following results. 70 % (70 patients) of them were culture positive, and 30 % (30 patients) were culture negative. Culture positive patients were divided into two groups with 35 patients each. Group A started on empirical therapy, Group B on sensitive antibiotic therapy. Repeat swab taken on day 7 from the previously culture-positive patients (70 patients), it was found that 30 out of 35 patients of group-A (empirical therapy) were still culture positive with a similar or newer organism, only 5 patients were culture negative, whereas in 35 patients of Group-B (sensitive antibiotic therapy) only 5 patients were culture positive with a similar or newer organism, remaining 30 patients were culture negative. Sensitive antibiotic therapy was found to be effective than empirical therapy in treatment of diabetic foot ulcers. CONCLUSIONS Culture and sensitivity from the wounds play a critical role in prescribing appropriate antibiotic at the time of admission itself rather than starting the empirical treatment. KEYWORDS Diabetic Foot, Culture and Sensitivity, Empirical Antibiotic Therapy
{"title":"A Prospective Study on Clinico-Bacteriological Study of Diabetic Foot and the Efficacy of Antibiotic Therapy in a Tertiary Care Hospital in Tirupati","authors":"N. Ramanaiah, G. Prakash, Kumbha Roja Ramani, S. Heena, D. Mythri, Udayagiri Shanmukha Srinivasulu","doi":"10.18410/jebmh/2021/572","DOIUrl":"https://doi.org/10.18410/jebmh/2021/572","url":null,"abstract":"BACKGROUND Diabetic foot is the most common and most feared complication of diabetes and is more significant than nephropathy, retinopathy, heart attack, and stroke combined. Diabetes-associated problems are the second common cause of lowerlimb amputations in India. Foot disorders like ulcerations, infection, Gangrene are the leading causes of hospitalization in patients with diabetes mellitus in India.1 METHODS A prospective study, carried out on 100 diabetic patients with foot ulcers over a period of one year from April 2019 to March 2020 at Sri Venkateswara Medical College hospital. The extent of foot infection was assessed based on Wagner’s classification and were studied based on the culture and sensitivity obtained and the efficacy of the antibiotic used. RESULTS The data analysis of 100 patients has given the following results. 70 % (70 patients) of them were culture positive, and 30 % (30 patients) were culture negative. Culture positive patients were divided into two groups with 35 patients each. Group A started on empirical therapy, Group B on sensitive antibiotic therapy. Repeat swab taken on day 7 from the previously culture-positive patients (70 patients), it was found that 30 out of 35 patients of group-A (empirical therapy) were still culture positive with a similar or newer organism, only 5 patients were culture negative, whereas in 35 patients of Group-B (sensitive antibiotic therapy) only 5 patients were culture positive with a similar or newer organism, remaining 30 patients were culture negative. Sensitive antibiotic therapy was found to be effective than empirical therapy in treatment of diabetic foot ulcers. CONCLUSIONS Culture and sensitivity from the wounds play a critical role in prescribing appropriate antibiotic at the time of admission itself rather than starting the empirical treatment. KEYWORDS Diabetic Foot, Culture and Sensitivity, Empirical Antibiotic Therapy","PeriodicalId":15779,"journal":{"name":"Journal of Evidence Based Medicine and Healthcare","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87990271","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}
Sajna Gamaly Leela, M. Sunilkumar, Ramaraj Subbiah
BACKGROUND Bronchial asthma is a major public health concern especially in the paediatric population. An elevated immunoglobulin E (IgE) level is considered as an objective marker of allergy. Because IgE is a mediator of allergic response, quantitative measurement of IgE together with other clinical markers, can provide useful information for the differentiation between atopic and non-atopic diseases. In this study, we wanted to determine serum IgE and absolute eosinophil count (AEC) levels and correlate both levels with severity of asthma in children in the age group of 2 - 15 years admitted in the paediatric department. METHODS This is a descriptive cross-sectional study. After taking the informed consent from the parent or guardian, relevant information on asthmatic symptoms and severity, other associated manifestations, precipitating factors, and family history of asthma were recorded in a pre-designed proforma. A total of 65 children (age group 2 – 15 years old) with bronchial asthma were studied. Investigations such as hemogram and serum IgE levels were determined. Asthma severity was assessed according to global initiative for asthma (GINA) guidelines. RESULTS Among 65 children, 69.2 % were boys. Receiver operating characteristic curve (ROC) analysis showed that total IgE cut-off concentration of 168 IU/ml, distinguishes children with intermittent asthma from those with mild persistent disease. IgE cut-off concentration of 989 IU/ml distinguishes mild persistent from those with moderate persistent asthma. Both showed adequate or good diagnostic efficacy. Cut off value of 168 IU/ml may prove useful in practice, indicating that 75 % of children in intermittent group will have serum concentration of total IgE < 168 IU/ml. No association was observed between AEC and increasing severity of asthma. Only atopic dermatitis with asthma showed increasing trend of IgE levels. CONCLUSIONS Asthmatic children with higher asthma severity have a higher serum total IgE concentration (168 IU/ml and 989 IU/ml are the cut off values for differentiating intermittent from mild persistent and mild persistent from moderate persistent). KEYWORDS Serum IgE, Absolute Eosinophil Count, Childhood Asthma, Asthma Severity
{"title":"A Descriptive Study on Serum IgE and Absolute Eosinophil Count in Children with Bronchial Asthma Attending the Paediatric Department of a Medical College in Central Kerala","authors":"Sajna Gamaly Leela, M. Sunilkumar, Ramaraj Subbiah","doi":"10.18410/jebmh/2021/564","DOIUrl":"https://doi.org/10.18410/jebmh/2021/564","url":null,"abstract":"BACKGROUND Bronchial asthma is a major public health concern especially in the paediatric population. An elevated immunoglobulin E (IgE) level is considered as an objective marker of allergy. Because IgE is a mediator of allergic response, quantitative measurement of IgE together with other clinical markers, can provide useful information for the differentiation between atopic and non-atopic diseases. In this study, we wanted to determine serum IgE and absolute eosinophil count (AEC) levels and correlate both levels with severity of asthma in children in the age group of 2 - 15 years admitted in the paediatric department. METHODS This is a descriptive cross-sectional study. After taking the informed consent from the parent or guardian, relevant information on asthmatic symptoms and severity, other associated manifestations, precipitating factors, and family history of asthma were recorded in a pre-designed proforma. A total of 65 children (age group 2 – 15 years old) with bronchial asthma were studied. Investigations such as hemogram and serum IgE levels were determined. Asthma severity was assessed according to global initiative for asthma (GINA) guidelines. RESULTS Among 65 children, 69.2 % were boys. Receiver operating characteristic curve (ROC) analysis showed that total IgE cut-off concentration of 168 IU/ml, distinguishes children with intermittent asthma from those with mild persistent disease. IgE cut-off concentration of 989 IU/ml distinguishes mild persistent from those with moderate persistent asthma. Both showed adequate or good diagnostic efficacy. Cut off value of 168 IU/ml may prove useful in practice, indicating that 75 % of children in intermittent group will have serum concentration of total IgE < 168 IU/ml. No association was observed between AEC and increasing severity of asthma. Only atopic dermatitis with asthma showed increasing trend of IgE levels. CONCLUSIONS Asthmatic children with higher asthma severity have a higher serum total IgE concentration (168 IU/ml and 989 IU/ml are the cut off values for differentiating intermittent from mild persistent and mild persistent from moderate persistent). KEYWORDS Serum IgE, Absolute Eosinophil Count, Childhood Asthma, Asthma Severity","PeriodicalId":15779,"journal":{"name":"Journal of Evidence Based Medicine and Healthcare","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76120999","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}
Guillain-Barre syndrome is an immune mediated acute demyelinating polyradiculopathy, linked to various infectious agent. GBS has a very low incidence during pregnancy, estimated population incidence ranged from 0.62 to 2.66 cases per 100,000 person-years across all age groups.1 It is usually preceded by a bacterial or viral infection. Infections like CMV, EB, HIV-1, Hepatitis virus and campylobacter jejuni has been implicated as etiologic agents. Most common infectious agent associated with GBS is campylobacter jejuni.2 GBS classically presents with pain, numbness, paraesthesia, or weakness of the limbs, areflexia. Ascending paralysis with weakness beginning in the feet and migrating towards the trunk is the most typical symptoms. Life threatening complications particularly occurs if there is involvement of respiratory muscles. Increased incidence of respiratory complications is mostly due to gravid uterus. However, GBS is more common in the third trimester and the first 2 weeks of postpartum. 3 GBS is known to worsen in postpartum period due to an increase in delayed type IV of hypersensitivity response. Delayed diagnosis is common in pregnancy or immediate postpartum period because the initial nonspecific symptoms may mimic changes in pregnancy. GBS in pregnancy associated with high maternal mortality. A third of pregnant women required ventilator support with a mortality rate of 13 %.4 Diagnosis is based on the clinical presentation, laboratory and electrophysical investigations. Nerve conduction studies and EMG show an evolving multifocal demyelinating polyneuropathy. Management of GBS in pregnancy is a multidisciplinary approach. IVIG injection in high dose or plasmapheresis is beneficial if given within 1 to 2 weeks of motor syndrome.3 Maternal GBS is not an indication for caesarean section and operative delivery should be reserved for obstetrics indications only. A 25 years old, primigravida patient was relatively alright 9 days back, when she started complaining of weakness in right hand it was acute in onset and progressing gradually with time. The next day patient started having difficulty in standing up. On 29 / 07 / 2019 she was unable to move all four limbs. Patient was taken to private hospital where she was investigated. Her NCV was suggestive of severe acute onset polyneuropathy. She received IVIG at private hospital where her tracheostomy was done. She was brought by relatives to Indira Gandhi Government Medical College, Nagpur on 04 / 08 / 2019. On examination her general condition was not satisfactory, afebrile, pulse rate was 120/min, BP was 110 / 80 mm Hg, RBS 186 mg %. On CNS examination she was conscious oriented with time, place and person, bilateral planters absent, DTR absent, Power in all four limbs was zero.
格林-巴利综合征是一种免疫介导的急性脱髓鞘性多神经根病，与多种感染因子有关。妊娠期GBS发病率非常低，在所有年龄组中，估计人群发病率为每10万人年0.62至2.66例它通常在细菌或病毒感染之前发生。CMV、EB、HIV-1、肝炎病毒和空肠弯曲杆菌等感染已被认为是致病因子。与GBS相关的最常见的感染源是空肠弯曲杆菌GBS典型表现为疼痛、麻木、感觉异常或四肢无力、反射。最典型的症状是上升性麻痹，虚弱从足部开始，向躯干转移。危及生命的并发症尤其发生在呼吸肌受累的情况下。呼吸系统并发症的发生率增加主要是由于妊娠子宫。然而，GBS在妊娠晚期和产后前两周更为常见。由于迟发性IV型超敏反应的增加，GBS在产后会恶化。延迟诊断常见于妊娠期或产后，因为最初的非特异性症状可能模仿妊娠期的变化。妊娠期GBS与高孕产妇死亡率相关。三分之一的孕妇需要呼吸机支持，死亡率为13%诊断是基于临床表现，实验室和电物理检查。神经传导研究和肌电图显示一种不断发展的多灶性脱髓鞘性多神经病变。妊娠期GBS的管理是一个多学科的方法。如果在运动综合征的1 - 2周内给予高剂量IVIG注射或血浆置换，则有益产妇GBS不是剖宫产的指征，手术分娩应仅用于产科指征。一名25岁的原发患者9天前还比较好，当她开始抱怨右手无力时，开始是急性的，随着时间的推移逐渐进展。第二天，病人开始站不起来。2019年7月29日，她四肢无法移动。病人被送往私立医院接受调查。NCV提示严重急性多神经病变。她在进行气管切开术的私立医院接受了静脉注射。她于2019年8月4日被亲戚带到那格浦尔的英迪拉·甘地政府医学院。经检查，患者一般情况不佳，无发热，脉搏120次/min，血压110 / 80 mm Hg, RBS 186mg %。中枢神经系统检查患者有时间、地点和人的意识定向，双侧种植体缺失，DTR缺失，四肢无力。
{"title":"Guillain Barre Syndrome in Pregnancy - A Rare Case","authors":"M. Patil, Trupti M. Wankhede","doi":"10.18410/jebmh/2021/577","DOIUrl":"https://doi.org/10.18410/jebmh/2021/577","url":null,"abstract":"Guillain-Barre syndrome is an immune mediated acute demyelinating polyradiculopathy, linked to various infectious agent. GBS has a very low incidence during pregnancy, estimated population incidence ranged from 0.62 to 2.66 cases per 100,000 person-years across all age groups.1 It is usually preceded by a bacterial or viral infection. Infections like CMV, EB, HIV-1, Hepatitis virus and campylobacter jejuni has been implicated as etiologic agents. Most common infectious agent associated with GBS is campylobacter jejuni.2 GBS classically presents with pain, numbness, paraesthesia, or weakness of the limbs, areflexia. Ascending paralysis with weakness beginning in the feet and migrating towards the trunk is the most typical symptoms. Life threatening complications particularly occurs if there is involvement of respiratory muscles. Increased incidence of respiratory complications is mostly due to gravid uterus. However, GBS is more common in the third trimester and the first 2 weeks of postpartum. 3 GBS is known to worsen in postpartum period due to an increase in delayed type IV of hypersensitivity response. Delayed diagnosis is common in pregnancy or immediate postpartum period because the initial nonspecific symptoms may mimic changes in pregnancy. GBS in pregnancy associated with high maternal mortality. A third of pregnant women required ventilator support with a mortality rate of 13 %.4 Diagnosis is based on the clinical presentation, laboratory and electrophysical investigations. Nerve conduction studies and EMG show an evolving multifocal demyelinating polyneuropathy. Management of GBS in pregnancy is a multidisciplinary approach. IVIG injection in high dose or plasmapheresis is beneficial if given within 1 to 2 weeks of motor syndrome.3 Maternal GBS is not an indication for caesarean section and operative delivery should be reserved for obstetrics indications only. A 25 years old, primigravida patient was relatively alright 9 days back, when she started complaining of weakness in right hand it was acute in onset and progressing gradually with time. The next day patient started having difficulty in standing up. On 29 / 07 / 2019 she was unable to move all four limbs. Patient was taken to private hospital where she was investigated. Her NCV was suggestive of severe acute onset polyneuropathy. She received IVIG at private hospital where her tracheostomy was done. She was brought by relatives to Indira Gandhi Government Medical College, Nagpur on 04 / 08 / 2019. On examination her general condition was not satisfactory, afebrile, pulse rate was 120/min, BP was 110 / 80 mm Hg, RBS 186 mg %. On CNS examination she was conscious oriented with time, place and person, bilateral planters absent, DTR absent, Power in all four limbs was zero.","PeriodicalId":15779,"journal":{"name":"Journal of Evidence Based Medicine and Healthcare","volume":"424 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76627290","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 Infertility is defined as the inability to conceive after at 1 year of regular unprotected intercourse. Male contributes to almost half of infertility cases and in almost 30 % of cases, no definite aetiology is identified, and hence, male infertility is labelled idiopathic in these cases. Oxidative energy production mechanisms are almost always accompanied by reactive oxygen species (ROS), generation whose too much concentrations can lead to extensive protein damage and cytoskeletal modifications and inhibit cellular mechanisms. A number of laboratory techniques have been developed to evaluate oxidative stress by measuring ROS level in the semen. In recent times antioxidant supplements have been proposed as useful agents to increase the scavenging capacity of seminal plasma, controversy still surrounds their actual clinical utility. METHODS 34 male patients were included in this study. Reactive oxygen species detection was done by Flowcytometry using dichloroflurosecindiacetate (DCFH-DA). RESULTS The ROS in the patient group was found to be significantly higher 29.821 (5.6300 than the control group 22.162 (1.6331 having p value < 0.001). The ROS (29.821 ± 5.6300) was found to be significantly reduced after 3 months of antioxidant therapy which got reduced to 19.893 ± 4.2299 respectively. CONCLUSIONS Our study demonstrates that infertile men have significantly higher level of ROS (as measured by flowcytometry) & lower sperm count (oligospermia), decreased progressive & total motility and increased immotile sperms as compared to healthy fertile men. This study further proves that antioxidant therapy based on a combination of carnitine, zinc, coq10, lycopene and vitamin C & E for 3 months is associated with a decrease of ROS as measured by flowcytometry & a variable degree of improvement in above mentioned semen parameters. KEYWORDS Reactive Oxygen Species, Male Infertility
{"title":"A Study of Role of Reactive Oxygen Species in Idiopathic Male Infertility & Its Management by Antioxidant Therapy in Uttar Pradesh (U.P.)","authors":"Namrata Shrivastava, V. Shrivastava, M. Pandey","doi":"10.18410/jebmh/2021/551","DOIUrl":"https://doi.org/10.18410/jebmh/2021/551","url":null,"abstract":"BACKGROUND Infertility is defined as the inability to conceive after at 1 year of regular unprotected intercourse. Male contributes to almost half of infertility cases and in almost 30 % of cases, no definite aetiology is identified, and hence, male infertility is labelled idiopathic in these cases. Oxidative energy production mechanisms are almost always accompanied by reactive oxygen species (ROS), generation whose too much concentrations can lead to extensive protein damage and cytoskeletal modifications and inhibit cellular mechanisms. A number of laboratory techniques have been developed to evaluate oxidative stress by measuring ROS level in the semen. In recent times antioxidant supplements have been proposed as useful agents to increase the scavenging capacity of seminal plasma, controversy still surrounds their actual clinical utility. METHODS 34 male patients were included in this study. Reactive oxygen species detection was done by Flowcytometry using dichloroflurosecindiacetate (DCFH-DA). RESULTS The ROS in the patient group was found to be significantly higher 29.821 (5.6300 than the control group 22.162 (1.6331 having p value < 0.001). The ROS (29.821 ± 5.6300) was found to be significantly reduced after 3 months of antioxidant therapy which got reduced to 19.893 ± 4.2299 respectively. CONCLUSIONS Our study demonstrates that infertile men have significantly higher level of ROS (as measured by flowcytometry) & lower sperm count (oligospermia), decreased progressive & total motility and increased immotile sperms as compared to healthy fertile men. This study further proves that antioxidant therapy based on a combination of carnitine, zinc, coq10, lycopene and vitamin C & E for 3 months is associated with a decrease of ROS as measured by flowcytometry & a variable degree of improvement in above mentioned semen parameters. KEYWORDS Reactive Oxygen Species, Male Infertility","PeriodicalId":15779,"journal":{"name":"Journal of Evidence Based Medicine and Healthcare","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76341598","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}
Sajeev George Pulickal, R. Bhaskaran, Aparna Perumangat, Harikrishna Reghu, Girish Babu Moolath
BACKGROUND Acute esophagitis (AE) is a common toxicity seen in patients undergoing radiotherapy (RT) for breast cancer, which can affect their quality of life. Thus, majority of our patients receiving hypo fractionated dose of 40 Gy in 15 fractions were having AE. We conducted this study to evaluate the dosimetric parameters of oesophagus and correlate with published literature. METHODS Treatment plans of 80 post mastectomy patients who underwent radiotherapy for carcinoma of breast (Ca breast) with a dose of 40 Gy in 15 fractions to the chest wall along with supra clavicular fossa (SCF) were selected. Out of these, 44 patients (22 each in right and left side) were simulated in neck straight position and 36 in neck tilted position (18 each in right and left side). The oesophageal volume was contoured in already executed plans from the inferior border of cricoid cartilage to the inferior border of the SCF planning target volume (PTV). No plan modification was done after contouring the oesophagus. Dosimetric parameters like the maximum dose (Dmax) and mean dose (Dmean) to oesophagus, volume of oesophagus receiving ≥ 5 Gy (V5), ≥ 10 Gy (V10), ≥ 15 Gy (V15), ≥ 20 Gy (V20), ≥ 25 Gy (V25), ≥ 30 Gy (V30) were derived from dose volume histogram (DVH) data and analysed. RESULTS Dmean in straight neck group irrespective of side was 18.57 (± 7.30) Gy and in tilted neck 22.94 (± 9.53,) Gy, P = 0.023. Subgroup analysis shows Dmean was significantly high in patients with left sided disease than those with right sided disease (24.10 vs. 13.03, P = 0.00) in the straight neck cases. In the neck tilted group there was a nonsignificant increase in Dmean in left sided cases (25.36 vs. 20.53, P = 0.13). CONCLUSIONS Evaluation of oesophageal dosimetric parameters in hypofractionated dose showed that DmeanEQD2 was within the values of published studies in conventional fractionation. KEYWORDS Oesophageal Dosimetric Parameters, Breast Cancer
{"title":"Dosimetric Evaluation of Oesophagus in Hypofractionated Supraclavicular Nodal Irradiation in Breast Cancer - A Retrospective Observational Study in a Tertiary Care Cancer Centre in Alappuzha, Kerala","authors":"Sajeev George Pulickal, R. Bhaskaran, Aparna Perumangat, Harikrishna Reghu, Girish Babu Moolath","doi":"10.18410/jebmh/2021/543","DOIUrl":"https://doi.org/10.18410/jebmh/2021/543","url":null,"abstract":"BACKGROUND Acute esophagitis (AE) is a common toxicity seen in patients undergoing radiotherapy (RT) for breast cancer, which can affect their quality of life. Thus, majority of our patients receiving hypo fractionated dose of 40 Gy in 15 fractions were having AE. We conducted this study to evaluate the dosimetric parameters of oesophagus and correlate with published literature. METHODS Treatment plans of 80 post mastectomy patients who underwent radiotherapy for carcinoma of breast (Ca breast) with a dose of 40 Gy in 15 fractions to the chest wall along with supra clavicular fossa (SCF) were selected. Out of these, 44 patients (22 each in right and left side) were simulated in neck straight position and 36 in neck tilted position (18 each in right and left side). The oesophageal volume was contoured in already executed plans from the inferior border of cricoid cartilage to the inferior border of the SCF planning target volume (PTV). No plan modification was done after contouring the oesophagus. Dosimetric parameters like the maximum dose (Dmax) and mean dose (Dmean) to oesophagus, volume of oesophagus receiving ≥ 5 Gy (V5), ≥ 10 Gy (V10), ≥ 15 Gy (V15), ≥ 20 Gy (V20), ≥ 25 Gy (V25), ≥ 30 Gy (V30) were derived from dose volume histogram (DVH) data and analysed. RESULTS Dmean in straight neck group irrespective of side was 18.57 (± 7.30) Gy and in tilted neck 22.94 (± 9.53,) Gy, P = 0.023. Subgroup analysis shows Dmean was significantly high in patients with left sided disease than those with right sided disease (24.10 vs. 13.03, P = 0.00) in the straight neck cases. In the neck tilted group there was a nonsignificant increase in Dmean in left sided cases (25.36 vs. 20.53, P = 0.13). CONCLUSIONS Evaluation of oesophageal dosimetric parameters in hypofractionated dose showed that DmeanEQD2 was within the values of published studies in conventional fractionation. KEYWORDS Oesophageal Dosimetric Parameters, Breast Cancer","PeriodicalId":15779,"journal":{"name":"Journal of Evidence Based Medicine and Healthcare","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84822007","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}
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