International Journal of Health and Clinical Research

Coronary Angiographic Pattern in Patients Aged >45 Years: A Prospective Study

Shubham Upadhyay — 2023-07-03

Background: Cardiovascular Diseases (CVD’s) remain the biggest cause of death worldwide. Recent trends suggest that disease incidence has escalated and has started affecting younger age group also. Aims and objectives: This study was conducted to study the coronary angiographic pattern in patients aged >45 years.Materials and Methods: All patients >45 years who underwent coronary angiography and angioplasty were included in the study. Subjects meeting the inclusion criteria were selected. Detailed history, clinical examination, electrocardiography findings, echocardiography findings were studied. Angiographic findings were then correlated with the risk factors, demography and electrocardiographic findings.Results: A total of 100 patients were included in the study. Majority were in the age group 55-64 years (n=50) with a mean age of 60.59±7.16 (mean±SD). There was a male preponderance (83, 83%). Most common angiographic finding was double vessel disease in 25% followed by triple vessel disease in 23%, followed by single vessel disease in 22%. Most common angiographic pattern among the males was Triple vessel disease & Double vessel disease (26.5%) while in females, it was non-critical CAD(47.1%). The most common abnormal ECG finding was ST elevation MI in 35% participants.Conclusion: DVD was the most common angiographic abnormality which was followed by TVD and SVD.RCA was the most common culprit vessel in the majority of patients, followed by LAD and LCX.

Review on Microspheres

Shallu — 2023-07-03

Microspheres can be employed to deliver medication in a rate-controlled and sometimes targeted manner. Medication is released from a microsphere by drug leaching from the polymer or by degradation of the polymer matrix. The current review provides an in-depth discussion of therapeutic aspects of microsphere drug delivery including consideration of the prerequisite area for micro particulate, types of polymers used, method of preparation, method of release & kinetics, type of microspheres in brief, characterization & targeting of microspheres & practical aspects of microspheres

Efficacy of Oral Eplerenone for the Treatment of Chronic Central Serous

Anand Sharan — 2023-07-03

Background: Central serous chorioretinopathy is a sight threatening disease characterized by accumulation of serous sub retinal fluid occurs due to serous detachment of neurosensory retina and retinal pigment epithelium.Purpose: To evaluate the efficacy of oral Eplerenone in patients with chronic CSCR. Methods: In a tertiary care hospital, a prospective analysis of all the patients with chronic CSCR treated with oral Eplerenone who had been seen for at least three months were prospectively analyzed in a tertiary care hospital. Changes in CMT as measured by spectral-domain OCT served as the primary outcome. Changes in BCVA as measured by log MAR and the number of patients obtaining full resolution of SRF served as the secondary outcomes.Results: In 25 patients (15M /10F) treated with 25mg and 50mg of oral Eplerenone were included. The mean age of follow up was 21±17.6 wks. Mean CMT decreased from 401±133 to 317±75μm at 6 wks& to 285±68μm at 3 months. Mean height of SRF decreased from 157±113 to 78±89μm at 6 wks& to 51±79μm at 3 months. Complete resolution of SRF was found in 15 pts after 3 months. BCVA (log MAR) improved from 0.2±0.18 to 0.14±0.16 at 6 wks & to 0.07±0.13 in 3 months.
Conclusion: Eplerenone therapy may improve BCVA & decrease CMT and SRF height in pts with chronic CSCR.

A Review on Microspheres: Preparation, Characterisation, Evaluation and Applications

Croxy Rajoria — 2023-07-03

Now a day the recent development in new drug delivery systems plays a vital role in pharmaceutical industries. The drug delivery practice has been modified in the last decades and even many advanced innovations happened in recent times. Newer drug delivery systems are largely influencing the current medical practice. The idea of targeted drug delivery is to concentrate the treatment in the target tissues while lowering the relative concentration of the drug in the non-target tissues. As a result, the medication is concentrated at the desired location. As a result, the medication has no effect on the tissues nearby. Therefore, by combining the drug with a carrier particle like microspheres, nanoparticles, liposomes, niosomes, etc. that regulates the release and absorption characteristics of the drug, carrier technology offers an intelligent way for drug delivery. Microspheres attracted a lot of interest for their sustained release as well as their ability to direct anti-cancer medications to the tumour. Microspheres will play a key role in novel drug delivery in the future by fusing together a variety of other strategies, especially in diseased cell sorting, diagnostics, gene & genetic materials, safe, targeted, and efficient in vivo delivery, and supplements as miniature representations of diseased organs and tissues in the body.

Comparative Study on Laparoscopic vs Open Appendicectomy in the Treatment of Perforated Appendicitis

Keerthana Duraisamy — 2023-07-04

Background: Acute appendicitis is one of the most common causes of surgical emergency and perforated appendicitis is associated with higher morbidity and longer hospital stays. In recent times considering the overall benefits of laparoscopic surgeries, it has been widely preferred in the treatment of complicated appendicitis.Aim: To compare the outcome of laparoscopic appendicectomy (LA) vs open appendicectomy (OA) in the treatment of perforated appendicitis.Materials and Methods: 62 patients presenting with perforated appendicitis and undergoing surgical intervention in the Department of General Surgery, Kozhikode. Patients were monitored immediate postoperative period for 4 weeks for the development of complications.Results: Out of 31 patients who underwent laparoscopic none of the patients developed wound infection with a mean duration of hospital stay of 3.5 days. In open appendicectomy 7 patients developed wound infection with a mean duration of hospital stay of 5.3 days.Conclusion: Laparoscopic procedure for perforated appendicitis is a safe and feasible procedure which can be performed with a low incidence of infectious complications, possibly offering patients faster recovery and better cosmetic benefits than the open procedure. It has a clinically significant advantage. The patient’s factor and the experience of the surgeon both are deciding factors in the decision-making for the treatment approach.

Prevalence of Depression in Diabetes Mellitus: A hospital based Cross sectional study

K Sunil Kumar — 2023-07-04

Introduction: Diabetes is a metabolic disorder that has life-changing consequences for individuals affected by it. Diabetes may be diagnosed and treated, but the depression in these patients often goes unnoticed. Most of the time depression is not considered as an important factor and often ignored and left untreated. Depression is associated with poor health behaviors (i.e., smoking, physical inactivity, caloric intake) that increase risk of type 2 diabetes .Depression is also associated to central obesity and potentially to impaired glucose tolerance and may worsen diabetes.Objectives of the study: The primary aim is to study the prevalence of depression in type 2 diabetes mellitus patients.Materials & Methods: A hospital based observational study was carried out on diabetic patients attending the general medicine OPD in a tertiary care hospital during the period June-October2018. Results: The prevalence of depression in diabetic patients is 56% in the current study which is in par with earlier studies. In the present study, among depressed patients 38.39% had mild depression, 34.82% has moderate symptoms, 19.64% had moderately severe depression, 7.14% had very severe symptoms. On evaluation of various parameters of diabetes, the parameters that are significantly associated with depression are glycated hemoglobin ( p=0.028),Fasting blood sugar(p=0.019),Body mass index(p=0.004),Duration of diabetes(p-0.002).Depression is mostly observed in patients with diabetes duration of 7-9 years. Among the parameters evaluated in the present study, number of complications and treatment regimen (p=0.000) have showed the most significant association with severity of depression.Conclusion: Higher glycated hemoglobin value, fasting blood sugar levels and duration of diabetes, higher BMI all are significantly associated with severity of depression. The number of complications and treatment regimen in diabetes are also significantly associated with depression. As the disease burden of depression increases in terms of duration of illness or poor control or complications, the severity of depression also seems to increase. Therefore adequate screening and intervention of depression is necessary for better outcome on both diabetes and depression especially in diabetic patients with higher morbidity and longstanding illness.

Study of Cytopathological Spectrum of Lymphadenopathy at Tertiary Care Hospital, Gujarat, India

Nikita Modh — 2023-07-04

Lymph nodes are most widely distributed and easily accessible component of lymphoid tissue. Lymphadenopathy is a commonly encountered clinical problem which has multitude of causes varying from non-neoplastic to neoplastic conditions like inflammation, infection, primary or metastatic tumors. Fine needle aspiration cytology (FNAC) is a very simple, quick, and cost-effective method of sampling of superficial masses. This technique is an outpatient department (OPD) procedure and causes minimal trauma to the patient and carries virtually no risk of complication. The main goal of FNA is to determine the presence or absence of neoplasm, assure the clinical benign impression of the mass, and if malignant, to determine the type of malignancy. Aim: To evaluate and diagnose the causes of lymph node swelling for early and prompt treatment as FNAC is the minimally invasive procedure and report can be issued within 2 to 3 hours. Materials and method: Total 110 cases of FNAC of lymph node was studied at the Department of Pathology, GAIMS, Bhuj during period from July 2022 to March 2023. Patients were explained about the procedure and consent was taken. FNAC was done, smears were prepared and subsequently stained using H&E, PAP, Giemsa satin and ZN stain for AFB. Observation and Result: Out of total 110 cases, 61 (55.45%) were male and 49 (44.54%) were female patient. Age ranges from first year of life to 78 years of life, with maximum cases 32 (29.09%) were in age group of >40 years. Based on anatomical site, cervical lymphadenopathy was found to be more common, seen in 85(77.27%) cases out of 110 cases. The non-neoplastic lesions were predominated, diagnosed in 85 (77.27%) patients as compared to neoplastic lesions diagnosed in 25 (22.73%) cases. In non-neoplastic lesions, non-specific reactive lymphadenitis was the most frequent diagnosis with 43 (39.09%) cases followed by tuberculous lymphadenitis diagnosed in 22 (20.00%) case. In neoplastic lesions, metastatic squamous cell carcinoma was common in 18(16.36%) cases, whereas, the primary neoplastic lesions of lymph node (lymphoproliferative disease) constituted only about 07(6.36%) cases. Conclusion: FNAC is less invasive and less time consuming procedure yielding result in 1 to 3 hours of procedure. That’s why FNAC must be first line of investigation in lymphadenopathy to differentiate neoplastic from non-neoplastic lesion and guide the surgeon for line of treatment.

Analysis of Ascitic Fluid Cytology by Cell Block in the Evaluation & Grading of Malignancy with Ki 67 Marker Study in a Tertiary Care Centre

G Jeyanthi — 2023-07-04

Background: The cell block technique is one of the oldest methods, which is used for the evaluation of body cavity fluids. This method usually increases the yield of cellularity, gives better morphological details, and helps in improving the sensitivity of the diagnosis and grading of malignancy. Multiple sections were obtained from the prepared cell block for special stains and immunohistochemistry studies. Aim: Preparation of cell blocks of ascitic fluid in suspicious or confirmed cases of malignancy. Evaluation and grading of visceral malignancy in cell block using Ki 67 immunohistochemical marker by MIB index scoring system. Method: Cell blocks were prepared by the plasma thromboplastin method. Sections from the blocks were stained with H&E. Immunohistochemical staining with ki67 was done for selected cases and grading was done. Results: Out of 100 samples of ascitic fluid, 14 cases were malignant. The malignancy was graded by applying the ki67 marker by the MIB index scoring system. Conclusion: Cell block method is useful for the detection and grading of malignancy by applying immunohistochemistry.

To Study the Spectrum of Clinical Features, Prevalence, Risk Factors, Type of Management and Clinical Outcome in Relation to the Type of Management in Patients with Peripheral Arterial Disease

Surabhi Matta — 2023-07-09

Background: Peripheral artery stenosis or blockage is frequently one of the manifestations of systemic atherosclerosis. The most frequent causes of Peripheral arterial disease (PAD) are atherosclerosis and/or thromboembolic disease. The patient may display a variety of clinical manifestations and symptoms, which can be categorized into the following groups: loss of sensation, changes in colour, temperature, pulsations of the arteries, movement, ulceration, gangrene. Digital subtraction angiography (DSA) still yields the sharpest images, even though CT angiography and magnetic resonance (MR) angiography are more recent techniques that are gaining favor. Risk Factors. Cigarette smoking, Diabetes Mellitus (DM), High blood pressure and abnormal lipid levels, Insufficiency of the kidneys and raised inflamatory markers. Imaging, Duplex Ultrasound, Angiography Done Through a Catheter, Non-operative management, Operative Procedures Surgical revascularization plays a predominant role in the management of patients who have vascular disease; however, the modern treatment paradigms have evolved significantly with an increased emphasis on catheter-based percutaneous interventions over the past two decades. Aims and Objective: To study the spectrum of clinical features, prevalence, risk factors, type of management and clinical outcome in relation to the type of management in patients with peripheral arterial disease. Conclusion: Prevalence of total peripheral arterial disease patient as compared to patients presenting with either unilateral or bilateral lower limb pain is 24.5%. It can be seen that 82% population is male and the rest is female. 57% of the population that was analyzed in this research project had diabetes mellitus. The population had 33% people who were known hypertensives who were suffering from peripheral arterial disease. Tobacco is another risk factor that goes hand in hand with smoking, where males are mostly known to be smokers.

The Use of Mini Mental Status Examination For The Diagnosis of HIV Associated Neurocognitive Disorder with Special Reference To The Duration of HIV Infection And Antiretroviral Therapy

Aishwarya Menon — 2023-07-09

Background: Mini Mental Status Examination can be used as a tool to detect cognitive, motor and behavioural changes seen in HIV associated neurocognitive disorders with special reference to the duration of symptoms and duration of antiretroviral therapy.Aims and objectives: To describe the prevalence of HIV associated neurocognitive impairment by using Mini Mental Score. To correlate the prevalence of HIV associated neurocognitive impairment with the duration of HIV. To assess the effect of antiretroviral drug therapy on neurocognitive decline seen in HIV patients. Material and methods: 100 HIV positive patients visiting the ART outpatient department were included, Mini Mental Status Examination was conducted, the scores were correlated with the duration of symptoms and the duration of antiretroviral therapy.Results and Conclusion: In our study, out of 100 patients, 77.2% of study participants did not have any cognitive impairment (MMSE Score ≥24) while 22.8% of participants had mild cognitive impairment (MMSE Score 18-23). A significant decline in the mini mental status examination score was found as the duration of symptoms. It also declined with the duration of antiretroviral therapy but this could be a confounding factor. A decline in the MMSE scores was also observed with a lag in starting antiretroviral therapy, from the onset of symptoms.

Correlation of Neutrophil to Lymphocyte and Monocyte to Lymphocyte Ratio with Acute Phase Reactant in Septicemia: A Prospective Study. NLR and MLR as Alternative in Sepsis

Navya Jaiswal — 2023-07-18

Introduction: Acute phase reactants (Procalcitonin, C-Reactive Protein) are important parameters in diagnosing and prognosticating sepsis. Despite availability of these, all the laboratories and hospitals are not equipped with the high end diagnostic capabilities in developing nations. Using alternative available markers in such conditions is preferable. We correlated the ratios from complete blood count with parameters procalcitonin and CRP.Material and Methods: This was a prospective study conducted in tertiary care hospital. All the patients admitted with diagnosis of sepsis who fulfilled the inclusion and exclusion criteria were included in this study. Venous sample were collected from all the patients. Complete blood count, procalcitonin and C reactive protein was done. Ratio of neutrophil to lymphocyte and monocyte to lymphocyte was calculated and correlated.Results: A total of 102 patients were included in this study. 49 were males and 53 females with an average age of 48.72 ± 11.21. The mean NLR was 14.09 ± 3.31 while mean MLR was 0.71 ± 0.15. Average procalcitonin was 25.38 ± 9.34 and the mean CRP was 142.97 ± 32.20. the correlation was checked using pearson’s coefficient. There was a strong correlation between NLR with procalcitonin and CRP which was statistically significant (<0.001). MLR had a strong to moderate correlation with both the parameters and was statistically significant.Conclusion: Calculating the ratio of blood parameters from the complete blood count is the easy and cheap way to diagnose the sepsis in hospitals where high end clinical investigations are not available.

Breast Cancer Survival Rate of Luminal vs Non-Luminal Subtype at Prof. Dr. Margono Soekarjo Regional General Hospital Purwokerto in 2021-2023

Muhammad Yamsun — 2023-08-15

Introduction: Breast cancer is a malignancy that originates from breast tissue such as epithelium, ducts and breast lobules. Breast cancer often occurs at a young age, due to many risk factors including alcohol consumption, diet, radiation and family history. Based on receptor gene expression in tissues, breast cancer is classified into two, namely luminal subtypes in the form of Luminal A and Luminal B, and non luminal subtypes in the form of Positive Human Epidermal Growth Factor Receptor 2 and Triple Negative Breast Cancer (TNBC). The survival rate for each subtype has a different time, so further understanding is needed to determine the right treatment for patients. This study aims to determine the relationship between survival rate and luminal and non luminal breast cancer subtypes. Methods: This study uses secondary data, namely the medical records of breast cancer patients at Prof. Hospital. Dr. Margono Soekarjo Purwokerto. The sample in this study were breast cancer patients at RSMS for the 2021-2023 period who fit the inclusion and exclusion criteria. Results: Of the 84 samples that complied, the survival rate for patients with the luminal subtype was 52.9%, while the survival rate for the non luminal subtype was 42.4%. Conclusion: The survival rate of breast cancer patients with luminal subtype is higher than that of non luminal breast cancer patients, and there is a relationship between survival rate with luminal and non luminal subtypes.

Evaluation of using temporalis fascia and cartilage graft in type I tympanoplasty among the patient from district Nainital

Alka Negi — 2023-08-16

The tympanic membrane which is pearly greyish in colour has a function to amplify and transmit sound waves and perforation could be caused due to recurrent middle ear infection or trauma results in symptoms like discharging ear, hearing impairment and otalgia. A total of 120 patients were enrolled for the present study and Pure tone audiometry test along with other tests were performed to evaluate improvement in hearing and closure of the perforation. The mean age of the study population was 29.33±10.77 years, the mean Preop PTA was 39.22±6.39, the mean preop air bone gap was 29.78±4.73 and the post op PTA and air bone gap was 32.91±7.001 and 23.54±6.29 respectively.In preoperative cartilage group, Ab gap was 29.04±4.915, the postoperative AB gap was 23.85±6.65 and 23.07±5.94 for temporal fascia and cartilage respectively. No significant difference was observed among grouped variables among both the groups. It was observed thatpreop PTA (38.53±5.85), preop air bone gap (29.43±4.64), post op PTA (31.45±5.28) and postop air bone gap (22.43±5.51) was significantly less than in patients in whom healing was not present. The mean surface area (%) was greater in patients in whom healing was not present (53.85±17.22 vs 45.56±14.90). Thus, we found that Type I tympanoplasty is an effective and safe procedure with a high anatomical success rate in the treatment of mucosal COM. Tympanoplasty with cartilage graft had a hearing outcome comparable to temporalis fascia graft. We found that factors like age, gender, side of involvement of ear, size and site of perforation and grafting techniques did not affect the success rate of tympanoplasty.

Medicinal Plants: Nature’s Prodigy for Hyperuricemia and its related Upshot

Meenakshi Mehra — 2023-08-16

Uric acid formation occurs both endogenously and exogenously in the liver, intestines, and blood vessel endothelium when injured, dying, and dead cells transform the nucleic acids adenine and guanine into uric acid. Atypically high levels of uric acid in the blood, or Hyperuricemia, can cause gout and arthritis. Over the past few years, hyperuricemia has become increasingly prevalent. Various studies reported that the increased level of uric acid in blood is not only associated with gout but also may contributory factor for cardiovascular diseases such as hypertension, atrial fibrillation, chronic kidney disease, heart failure, coronary artery disease, and cardiovascular death. There has been an emergent attention in uric acid because of the increased prevalence of hyperuricemia worldwide and its induced metabolic disorders. This review article summarizes various traditional plants and their chemical constituents utilized in the cure and treatment of elevated levels of uric acid and its repairable risk factors.