Mayuri K S, VinodKumar C S, Arun Kumar A, Jayasimha V L, Basavarajappa K G
Background: Ventilator associated pneumonia (VAP) is one of the most important form of hospital acquired infections which is associated with increased mortality and morbidity. VAP occurs in about 9 to 27% of all intubated patients. Intubation is associated with 3 to 10 fold increase in the incidence of VAP among all patients receiving mechanical ventilation. In contrast to other nosocomial infections, the crude mortality rate occurring due to VAP ranges from 24% to 76%. ICU patients with VAP have a 2 to 10-fold higher risk of death when compared with patients without pneumonia. Aim: The present study is undertaken to find out the frequency of occurrence of VAP in clinically suspected patients who are mechanically ventilated for more than 48 hours and the major pathogens causing VAP and their antibiotic sensitivity pattern. Methods: A total of 392 patients who are mechanically ventilated for more than 48 hours with clinical suspicion of VAP were included in the study. Endotracheal aspirate was collected and subjected to Grams stain and culture. Culture was performed by quantitative culture technique. Growth on the culture plate was identified by standard microbiological techniques and subjected to antibiotic sensitivity testing by Kirby Bauer disc diffusion method and CLSI guidelines. Results: Among the 392 clinically suspected VAP patients enrolled in the study 52.8% patients were diagnosed with VAP as per the CPIS score. The most common age group affected was 28- 40 years with male preponderance. 18% of the infections were categorized as early onset VAP while 72% as late onset VAP. Pseudomonas aeruginosa, Staphylococcus aureus and Acinetobacter baumannii were the most common isolates.78.5% of Gram negative bacteria were β lactamase producers.89.6% of the Pseudomonas aeruginosa and 96.2 % of Acinetobacter baumannii were meropenem and 84.6% of Staphylococcus aureus strains were methicillin resistant. Conclusion: Staphylococcus aureus was the most common organism causing early onset and Pseudomonas aeruginosa in late onset VAP.
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Jawahar Krishnaswamy, Deivanayagam Shanmugam, Vijay Kalimuthu, Sanjai Venkatesh Somasukumar
We report the case of a 50-year-old woman with occult breast cancer who presented with a hard metastatic nodule in the left axilla. Histology identified a metastatic ductal carcinoma deposits in the lymph nodes, but mammography of left breast showed only diffuse thickening of skin and subcutaneous tissue.Left modified radical mastectomy was performed and histopathology revealed invasive ductal carcinoma 1mm x 1mm size with multiple axillary node metastasis.
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Sanjana Vinod, Maya Rose Jose
Peri-operative hemodynamic stability in patients undergoing laparoscopic procedures using dexmedetomidine
Peri-operative hemodynamic stability in patients undergoing laparoscopic procedures using dexmedetomidine
N V Naren, P Giridhar, K P Rashmi, S N Sadia
Polycythemia vera (PV) is a chronic myeloproliferative disorder characterised by panmyelosis, splenomegaly, and predisposition to venous and arterial thrombosis. Our case was a 54 year male patient who presented with massive splenomegaly, eryhtrocytosis and bone marrow panmyelosis and positive JAK2V617F mutation. Sensitive and relatively cost effective test of JAK2V617F mutation helped in early diagnosis and treatment of PV with certainity. Patient responded well with phlebotomy. Polycythemia vera is a uncommon myeloproliferative neoplasm which is asymptomatic in majority of patients thus needs early identification and treatment to prevent serious complications of haemorrhage and thrombosis.
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Kalyan Munde, Nagesh Waghmare, Ashish Amaldi, Anil Kumar
Persistent Truncus arteriosus is congenital cyanotic heart disease characterised by a single great artery that leaves the base of heart and gives rise to coronary, pulmonary and systemic arteries. Majority of patients die of congestive heart failure before their first birthday .Only occasional patients survive in adulthood. We are presenting such a case
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Background: The widespread adoption of family planning, in a society, is an integral component of modern development and is essential for the integration of women into social and economic life. Objectives: To assess the knowledge, attitude and practice regarding usage of contraceptive methods among women attending family planning clinic Material and Method: A cross sectional study was conducted in 100 urban women. They were allotted to two groups – Group A of 76 women consisted of those who came for Medical termination of pregnancy (MTP) and Group B of 24 women who came with incomplete abortion following induced abortion. A pretested semi structure questionnaire was used as study tool to assess the contraceptive knowledge, attitude and practices. The data was analyzed using appropriate statistical methods (SPSS ver. 20). Result: Though 82% women were aware of the existence of a contraceptive method, only 44% ever used one. The most commonly used contraceptive was condom (34%). 82% were willing to undergo tubectomy in future whereas only 20% were willing to accept an intrauterine contraceptive device. Conclusion(S): The study highlights that although there is high level of awareness, contraceptive use is not very high. New ways of motivating people to adopt contraceptives should be considered.
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A V Salunkhe, N R Mudiraj
Introduction: Dermatoglyhics is the scientific study of skin creases and lines and has formed an important part of surface anatomy. The development of dermatoglyphics occurs at much earlier embryonic stage. This is the same period when most of the organs and systems develop including the cardiovascular system. Hence in this study we evaluated the dermatoglyphics in patients of Myocardial Infarction as compared to normal counterparts. Materials and Methods: Study was carried out in Department of Anatomy, in D. Y. Patil medical college during January 2011 to June 2012. Finger prints and palm prints of 150 diagnosed cases of Myocardial Infarction 120 males (M) and 30 females (F) and 150 Control group120 males and 50 females were obtained. Materials required for standard ink method was collected and used for data collection of both the hands. Written consent of the patients was obtained. Results: It was observed in our present study that there was significant increase in whorls and decrease in percentage loops and arches in Myocardial Infarction as compared to controls. The frequency of total palmar pattern in Myocardial Infarction Group is decreased in both sexes and both sides as compared to the controls. There was increase in frequency of position of axial triradii at t’ and t’’ in both hands of myocardial Infarction group in both sexes. Conclusion: Dermatoglyphics in Myocardial Infarction showed significant variation as compare to normal. Presence of above dermatoglyphic features will help us to predict that these individuals may be susceptible for myocardial infarction. It warrants further research in the same direction.
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Pankaj Palange, Ravikant Patil, R B Kulkarni, Atul Jankar
Introduction: Cardiovascular diseases are account for approximately 12 million deaths annually and are commonest cause of death globally. The progressive evolution in cardiac catheterization technique coupled with the development of effective treatment options for coronary artery disease, diagnostic coronary angiography has become one of the primary components of cardiac catheterization. Objective: To study correlation between clinical and angiographic findings in patient underwent angiography. Material and Methods: A cross sectional study was carried out for the period of one Year in Department of Cardiology, Bharati Vidyapeeth Medical College and Hospital, Sangli. 100 patients above 20 years of age, symptomatic patient, asymptomatic patient with electrocardiogram changes, patients who are willfully opting for coronary angiography were included in the study. Patients with previously diagnosed ischemic heart disease and underwent PTCA or CABG are excluded. Coronary angiography either from femoral or radial artery was done. The results of coronary angiography were carefully interpreted. Patients were grouped as Single Vessels Disease (SVD), Double Vessel Disease (DVD) or Triple Vessel Disease (TVD). According to the percentage of stenosis; the patients were expressed as <50% and >50% stenosis. Statistical analysis was done using Microsoft excel and necessary statistical analysis software was used where necessary. Results: The majority of patients were male with mean age was 60.19± 11.73 years and 57.70± 9.19 years in females. The clinical characteristics showed that chest pain was common clinical feature (96%). The coronary angiography revealed that majority of patients were having SVD (36%) with involvement of LAD artery (82%). 15% showed normal coronary arteries. The correlation between clinical presentation and stenosis of coronary artery showed no statistical significant. Conclusion: The clinical assessment is a good predictor for CAD but it can’t be correlated directly to the coronary angiography findings.
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Unilateral enlargement of the breast can occur due to various diffuse infiltrative breast lesions, including normal physiological changes, infective, inflammatory, benign etiology and malignant tumors. In this article we present a series of cases with history of unilateral enlargement of breast and appearing as diffuse dense mass on x ray mammogram. Ultrasound findings made appropriate diagnoses which are confirmed on histopathology further.
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Prashant Lomate, Divakar Patil, Vasudha Jadhav, Trupti Deshpande, Manisha Patil
Background and Objectives: The infraclavicular brachial plexus block is a safe and reliable approach to provide intraoperative and postoperative analgesia of upper limb. We evaluated the efficacy of dexmedetomidine added to local anaesthetics in infraclavicular brachial plexus block to hasten the onset of sensory and motor block and to prolong the postoperative analgesia. Methods: A prospective randomized double-blind study was carried out in 60 patients aged 18-60 years of ASA grade I and II, who were scheduled for various upper limb surgeries in orthopedics. The patients were divided into two groups of 30 each i.e. Control Group (group C) received 20 ml of inj. Bupivacaine + 10 ml of inj. Xylocaine + 10 ml of Normal Saline and Dexmedetomidine Group (group D) received 20 ml of inj. Bupivacaine + 10 ml of inj. Xylocaine + 10 ml of Normal Saline + 1 µg/kg of inj. Dexmedetomidine. Both groups were compared for the time of onset of sensory and motor blocks, postoperative analgesia and haemodynamic changes. Results: The onset of sensory and motor blockade (2.9 ± 1.0 Vs 8.8 ± 2.22 min and 5.23 ± 1.14 Vs 10.86 ± 2.41 min, respectively) were significantly more rapid in the D group than in the C group (p = 0.0001). The duration of sensory and motor blockade (825 ± 133.83 Vs 412 min ± 74.17 and 878.33 ± 166.23 Vs 409.33 ± 72.01 min respectively) were significantly longer in the D group than in the C group (p = 0.0001). The duration of analgesia (1448.66 ± 288.33 Vs 499 ± 78.79 min) was significantly longer in D group than in the C group (p = 0.0001). Systolic and diastolic blood pressure were lower in D group than C group during the period of anaesthesia from 30 to 120 minutes (in this period patients can be closely monitored and managed) (p < 0.05). Heart rate levels were also low in D group than C group during the period of anaesthesia from 15 to 120 minutes (p < 0.05). Conclusion: We conclude that the addition of dexmedetomidine to local anaesthetic mixture in infraclavicular brachial plexus block hastens the onset and prolong the duration of sensory and motor blocks, as well as the duration of postoperative analgesia.
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Jawahar Krishnaswamy, Deivanayagam Shanmugam, Vijay Kalimuthu, Vinod Balaji Baskar
Leiomyosarcoma of soft tissue is thought to arise from the smooth muscle cells lining small blood vessels. Most common site of involvement is retroperitoneum, accounting for approximately 50% of occurrences. Leiomyosarcoma of somatic soft tissues presents as an enlarging, painless mass. Although these tumours are generally associated with small blood vessels they usually do not present with signs or symptoms of vascular compression. However, when leiomyosarcoma arises from a major blood vessel, symptoms of vascular compromise or leg edema may be present, as well as neurologic symptoms such as numbness from compression of an adjacent nerve. We report a case of leiomyosarcoma of somatic soft tissue of the leg of a young male presented to us with swelling in the upper one-third of left leg which was associated with severe pain on extension of the joint. Patient was diagnosed as leiomyosarcoma of the somatic soft tissue origin by clinical, pathological and immunohistochemistry methods.
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Satish Prasad B S, Lakshmi Paragannavar
Acrania is a rare lethal congenital anomaly characterised by an absence of the calvarium. Ultrasound allows early diagnosis of this anomaly. Although acrania associated with anencephaly is a well recognized entity with an incidence of about 10:10,000 births, isolated acrania is a rare anomaly, and its incidence is unknown. We report a 25 year old female patient referred to our ultrasound department for antenatal scan. The fetus was found to have a completely formed brain, base of the skull and facial structures but lacking a cranium.
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Shivakumar K T, Deepak P
A study of profile of poisoning cases in and around Hassan district, Karnataka
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Virendra K Meshram
Patients with COPD have reduced functional capacity due to deconditioning. Various studies have found that endurance exercise training is single most important aspect of rehabilitation for patients with chronic pulmonary disease. However, there are conflicting views about the intensity for exercise prescription in stable COPD patients. The optimal specific exercise prescription guidelines in terms of intensity prescription have not been well documented. The purpose of this study was to compare the effect of two training intensities in stable COPD patients, which would help in formulating a comfortable and efficient exercise program in this population. 60 male subjects with moderate COPD were selected through purposive sampling and randomly allocated into two groups, group A and group B, each group having 30 subjects (n=30). Group A subjects were trained with moderate intensity and Group B subjects with heavy intensity exercise. Subjects were trained with the prescribed intensity exercise for respective groups for 10 min per day, 4 times a week for 4 weeks of duration. Outcome of interest include Resting Heart rate, Respiratory rate, Distance covered in 6-min walk test, % predicted FEV1 value, % predicted FEV1/FVC ratio. Data were analysed using paired and unpaired t test. Group B showed significant improvement in RHR, RR. Improvement is found in both groups for 6-MWD, whereas group B subjects showed more significant improvement. However, there was no improvement found in FEV1 and FEV1/FVC ratio in either group. The result of this study revealed that heavy intensity exercise training provides benefits to patients with moderate COPD than moderate intensity exercise training in terms of improvements in functional status if done with permissible interval training during the training. There was 18% of improvement in 6-MWD in group B.
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Shalini N Maksane, Sucheta P Dandekar
This prospective study was conducted to assess the effect of demographic and clinical parameters on liver enzymes in apparently healthy western Indian male population. The study population consisted of 669 males attending blood donation camps during 2011 to 2013. Anthropometric measurement was taken and history for alcohol consumption and smoking was noted. Biochemical parameters including AST, ALT, and GGT activities were determined using auto analyzer (AU-400 by Olympus). Mann-Whitney Test and Kruskal-Wallis One Way ANOVA on Ranks Test applied. P value of < 0.05 was considered to be statistically significant. All analyses were conducted using the SPSS-13.0. According to alcohol habit, 97 (14.5%) were alcoholic and 572 (85.5%) were non-alcoholic. According to smoking habits, 171 (25.6 %) were smokers and 498 (74.4 %) were non-smokers. Median activity of serum AST, ALT and GGT were 27.00 IU/L, 17.00 IU/L and 18.80 IU/L respectively. By univariate analyses, there were significant associations between increasing AST, ALT, or GGT tertiles and age, body mass index, and waist and hip circumferences, Waist-Hip ratio (p < 0.05). AST and GGT activity were significantly higher in alcoholic men compared to non alcoholic (p < 0.05). BMI, AST, ALT and GGT were significantly higher in smokers compared to non-smokers (p < 0.05). These data suggest that slight to moderate increase in BMI and light alcohol intake and smoking affected liver enzymes levels in apparently healthy western Indian males. These factors should be considered in the definition of normal limits for liver enzymes.
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Introduction: Metabolism refers to biochemical processes that occur within any living organism - including humans - to maintain life. It is sum of all anabolic (synthesis) and catabolic (break down) reactions occurring in our body. Metabolism can also be aerobic (O2 dependent) or anaerobic (in absence of O2). These biochemical processes allow us to grow, reproduce, repair damage, and respond to our environment. Oxidants are formed as a normal product of aerobic metabolism. This aerobic metabolism does not come without cost. “Free radicals” are formed as a by product of this metabolism which is capable of attacking the healthy cells of the body. They are responsible for causation and progress of many diseases like Atherosclerosis, Cataract, Cancer, degenerative diseases, inflammatory diseases, etc. Antioxidants are the first line of defense for these free radicals and are vital in maintaining optimum health and well being. These anti oxidants can be obtained from natural dietary sources or can be taken as nutritional supplements.
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Bharati V Nalgirkar, Shubhangi S Pathak, Sanjeev Kale, Vivek V Nalgirkar
Total Serum Sialic acid has been suggested as a new marker of alcoholic liver disease. The synthesis and the catabolism of Sialic acid takes place in the liver and therefore the status of liver can influence the serum levels of Total Sialic acid (TSA). Increased capacity of transferrin deficient in SA to selectively deposit iron in the hepatocytes might be of significance for the development of hepatic siderosis observed in alcoholism. Estimation of serum sialic acid level may be of help in early diagnosis of alcoholic liver disease and prevents the progression of the disease to terminal stages and complications. However, the role of TSA as a marker of liver disease and its association with cognitive changes has not been clearly elucidated. Material and methods: A total of 68 cases and 50 age matched healthy controls were recruited. These patients were further categorized into 3 groups; fatty liver, alcoholic hepatitis and alcoholic cirrhosis. Enrolled patients were followed for 6 months. The study was approved by the institutional ethical committee. Global cognitive functions were assessed periodically with Mini Mental State Examination (MMSE).Serum TSA levels were determined by Biovision’s Sialic acid assay kit. Result: The serum TSA levels (34.74±11.25 nmol/µl) were significantly higher in the alcoholic liver disease than in the healthy controls (2.21±1.01 nmol/µl). Significantly higher TSA levels were observed in patients with alcoholic cirrhosis (36.46±7.66 nmol/µl, p<0.001) compared with alcoholic hepatitis (31.14±9.69 nmol/µl, p<0.001) and alcoholic fatty liver (35.17±10.9 nmol/µl, p<0.001). MMSE Scores were found to be lowest in alcoholic cirrhosis (10.60± 5.32) followed by hepatitis (12.36 ±5.48) and fatty liver (18.28±3.43). Conclusion: Serum TSA is significantly elevated in alcoholic cirrhosis. Serum TSA levels can be used as a marker of alcoholic liver disease and may correlate with cognitive dysfunction among ALD patients.
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Ewa Gruszewska, 1 Bogdan Cylwik, 2 Anatol Panasiuk, 3 Maciej Szmitkowski,1 Robert Flisiak,3 and Lech Chroste. Total and Free Serum Sialic Acid Concentration in Liver Diseases BioMed Research International 2014 (2014).5 pages
Ankita Sharma, G G Kaushik, Sonali Sharma, J S Broca
Objective: To evaluate acylated ghrelin and uric acid in prediabetic subjects and compare it with type 2 diabetics and healthy subjects and to examine the relationship between plasma acylated ghrelin and uric acid concentrations. Method: The study was conducted on 100 subjects: 50 subjects of prediabetes (Group - I) and 50 subjects of type 2 diabetes (Group - II). 50 healthy non-diabetic control subjects (Group-III) of same age of either sex were selected. All subjects with BMI > 30 kg/m2 were considered. Blood samples were analyzed for fasting blood glucose, insulin, HbA1c, uric acid and acylated ghrelin. Result: Acylated Ghrelin and uric acid increases in group -I when compared with group -III and decreases in group-II when compared to group –I. The strongest positive association of acylated ghrelin was observed between acylated ghrelin and Homa- β in prediabetic subjects while the strongest association of uric acid was observed between uric acid and acylated ghrelin in prediabetic subjects. Conclusion: Although the mean values of both acylated ghrelin and uric acid are high in prediabetic subjects as compared to obese control yet the mechanism related to prediabetes i.e. impaired insulin secretion has strong positive association with acylated ghrelin while it shows negative association with uric acid. Hence, acylated ghrelin and uric acid shows inverse relationship in prediabetic obese individuals.
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Vinita Belsare, Hrishikesh Belsare, Sandip Lambe
Children with thalassemia have various skeletal changes and effect on liver, lungs and kidneys. All these effect are due to ineffective erythropoiesis and hemochromatosis. All this leads to impairment of functions of various organs. The present study was conducted to assess the kidney functions with blood urea, serum creatinine, serum phosphates, serum sodium, serum potassium ,urinary total protein and urine specific gravity in children’s with beta thalassemia major.
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P V Kathane, Suryakant M Patil, K R Aher
Groundwater is a dynamic resource and it varies from place to place quantativaly and qualitatively. Its quantity is mostly depends on the rainfall data of that particular region, Geological terrain, Rock type i.e. Aquifer, Geomorphology and drainage pattern. In India especially in Maharashtra state drinking and irrigation water demand is rapidly increases last few years, to cope up this problem, it is necessary to evaluate the existing trend and availability of groundwater in time and space for proper planning in near future. Pre and post monsoon ground water record and its trend, rainfall pattern, and geological especially hydrological study is very useful technique for judicious future planning of groundwater utilization. Proper utilization of available surface water and Ground water quantity it is necessary to manage the watershed concept. For this manners, this paper discuss to analyze the long term (2002-2012) trend of pre- and post-monsoon water level of watershed PTW-1 of Malkapur and Motala Taluka of Buldhana district first time. Trend of Pre and Post Monsoon static Ground water level indicate that there is depletion of static ground water level with the passage of time.
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Vijay Kalimuthu, Jawahar Krishnaswamy, Anitha Samraj, Ravishankar Jayavelu
A diagnosis of large-bowel perforation, caused by a sharp or pointed foreign body, is rarely made preoperatively because the clinical symptoms are usually nonspecific and can mimic other surgical conditions, such as appendicitis and diverticulitis. Less than 1% of ingested foreign body results in perforation from mouth to anus mostly by sharp objects. Of these sharp objects, chicken bone and fishbone account for half of the reported perforations. The most common sites are the ileo-caecal junction and sigmoid colon. In our case the patient presented late with pericolic abscess following the perforation by a fish bone in proximal ascending colon and the fish bone found extramurally making it as first case for that site of large bowel perforation by a fish bone with localized late presentation.
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