Asian Journal of Medical Research

Efficacy of Alpha-1 Adrenergic Blockers in the Management of Benign Prostatic Hyperplasia

Sudhir Sabharwal — 2019-06-13

Background: Benign prostatic hyperplasia (BPH), the most common benign tumour in men. The present study was planned to assess quantitatively the symptom improvement with Terazosin and with Prazosin in patients with symptomatic BPH. Subjects and Methods: The present study was conducted on 30 patients. The patients were studied under two subgroups, allotted at random, each had 15 patients. The sub group A patients received prazosin GITS tablet and sub group B patients received Terazosin. The urinary symptom scores were measured by using AUA symptom index, comprising seven equally weighted questions addressing the severity of urinary symptoms. Results: The pre drug therapy symptom score in group A & B were comparable and there was no significant difference between the two subgroup of patients (P > .05). On comparison of improvement in AUA score between Group A and Group B, no significant difference was found (P > .05). There was also no significant difference in improvement of obstructive and irritative subscores between the two sub groups. Group B patients had significant reduction of the post void residual urine following treatment. Conclusion: Prazosin GITS is an effective formulation of Prazosin, which ensures single daily use of this agent. Prazosin GITS and Terazosin are equally effective in improving the bothersome symptoms of BPH in symptomatic patients.

A Comparative Study of Early Cholecystectomy and Interval Cholecystectomy in Acute Cholecystitis in a Tertiary Care Center.

H. N Singh — 2019-05-15

Background: The incidence of acute cholecystitis is gradually increasing throughout the world and also in India. 90-95 % of acute cholecystitis is related to gall stones. Earlier the management of acute cholecystitis was conservative followed by interval cholecystectomy. But in last 25 years, there have been many reports recommending early surgery as a treatment of choice. Subjects and Methods: This study was conducted on 80 patients divided in two groups of 40 each with an idea to study the result of early surgery compared with delayed surgery. Results: Though the mean post-operative stay was almost equal in both groups. The total hospital stay in early surgery was 13.28 days and that in delayed surgery was 21.54. In early surgery group majority of cases there was no technical difficulty rather good delineation of cystic duct-CBD junction as edema provided a plane of cleavage. In delayed surgery operative difficulties were found in 18 cases due to much adhesion in calot’s triangle. Conclusion: So, early surgery was found to be more economical with less hospital stay with minimum morbidity than delayed surgery in acute cholecystitis.

Surgical Treatment of Cystic Swellings of Scrotum and its Management: A Clinico-Pathological Study

Jasvinder Singh — 2019-06-19

Background: The treatment of cystic swellings of scrotum are one among the common surgical problem in all age group. Objective of this study is to spot the cause, mode of presentation, various modalities of treatment and outcome of these with mimnimal complications. Subjects and Methods: A total of 110 cases of cystic swellings of scrotum fulfilling the methodology criteria’s were subjected to preformatted study. Final diagnosis was made with Clinical examination and Ultrasound. All 110 cases were treated surgically. Results: Most of the patients were in age group of 20-75 years , presenting feature being scrotal swelling as a main complaint in 60% of cases, majority of them were right sided (64%), majority of them presented with in a year, 40% presented with in first 6 months and 30% in next 6 months. Primary hydrocele was the commonest cystic swelling (60%), followed by epididymal cyst, sebaceous cyst, haematocoele, pyocoele. Lord’s plication was the procedure, which was associated with early discharge of the patient and least post-operative complications. Most of the patients were discharged around 8th Post-operative day. Conclusion: Primary hydrocoele was the commonest cystic swellings of scrotum. Most of the cystic swellings were treated surgically with good results. Lord’s plication procedure was the least to have post-operative complication.

Investigations of Chronic Kidney Disease Associations with Hip Fracture Incidence and Mortality in India.

Praveen Agarwal — 2019-06-19

Background: Hip fracture is very common in patients with ESRD. The risk has been estimated to be 4.4 to 14 times greater than that of the general population. KD and hip fracture are important public health problems that share multiple risk factors. Both are more common in older individuals and patients with diabetes. In addition, CKD and low bone mineral density (BMD), a major risk factor for hip fracture, are highly coincident. Therefore, the study aim was to clarify the association of CKD with hip fracture incidence and mortality. Subjects and Methods: Present study included 700 participants which were divided into two groups according to kidney disease. Out of 700 subjects, 100 subjects with CKD were included in group I whereas, 600 subjects without CKD were included in group II. We chose femoral neck BMD as the main measurement of hip BMD in our analysis because this region is most predictive for hip fracture. We chose to use the Modification of Diet in Renal Disease (MDRD) formula to calculate the estimated GFR (eGFR). Results: It is interesting that when the demographic characteristics of the hip fracture populations were evaluated, there was an association among age, history of hip fracture, and prevalence of CKD. In the participants (aged 50 to 74), the prevalence of CKD was approximately three-fold higher in the group with a history of hip fracture than in the group without a hip fracture (12% versus 4%; P<0.01). However, in older participants (older than 75 yr), the prevalence of CKD was the same regardless of hip fracture history. Conclusion: By using different measures of hip fracture incidence and mortality, we have demonstrated why other studies have shown mixed associations between CKD and hip fracture. Hip fracture incidence was higher in individuals with CKD compared with those with normal eGFR particularly where measured with admissions. However, following a hip fracture, CKD did not increase post-hip fracture mortality except in those with CKD of various stages. Nonetheless, a reduction in hip fracture incidence in those with CKD would reduce the number of deaths after hip fracture in the Indian population.

A Study of Distribution of Orthopaedic Morbidities among Outdoor Patients in a Medical College in Bihar

Krishna Nand Prasad Gupta — 2019-06-25

Background: Pattern and prevalence of orthopaedic morbidities varies from region to region, due to difference in environmental, racial and geographic factors. Orthopaedic Outpatient Department (OPD) is an important part of health care system. This study was done to find out the orthopaedic morbidities in OPD of a tertiary care centre in Bihar. Subjects and Methods: It was an observational, cross-sectional study carried out in the outpatient department of ANMMCH, Gaya, Bihar. All the new patients more than 18 years of age were studied for one year. Prescriptions were collected from patients. No follow up of prescription was done. Results: 800 prescriptions were analysed. Male patients (63.7%) attended more than female patients (36.3%). Majority of patients came from 18-30 years age group. Low back pain was most common (28.9%) morbidity followed by osteoarthritis (11.9%), cervical spondylosis (8.7%). Orthopedic morbidities are mostly contributed by trauma (38.75%). Conclusion: Low back pain is the common problem among patients attended Orthopaedic OPD. Larger nationwide community based studies are required to know the extent of the orthopaedic morbidities and formulate better health policies.

A Study to Evaluate the Role of Hypokalemia in Acute Myocardial Infarction Patients: A Prospective Hospital Based Study

Kantilal Meghwal — 2019-05-10

Background: Congestive heart failure (CHF) is a common comorbidity following acute myocardial infarction (AMI), and CHF complicating AMI has an unfavourable outcome. Several studies have demonstrated a relationship between low serum potassium levels and the risk of ventricular arrhythmias in patients with acute myocardial infarction (AMI). Hence; under the light of above obtained results, we planned the present study to assess the role of hypokalemia in AMI patients. Subjects and Methods: A total of 38 AMI patients and 38 healthy controls were included in the present study. Only patients within the age group of 20 years to 60 years were included. Detailed demographic and clinical data of all the subjects was obtained. Fresh blood samples were obtained from all the subjects and were sent to the laboratory for assessment. Serum potassium levels were analyzed by using an auto-analyzer. Results: Mean serum potassium levels among the subjects of the AMI group was found to be 85.6 mmol/L, which was significantly lower than that of mean serum potassium levels of the subjects of the control group, which was found to be 93.4 mmol/L. 20 subjects of the AMI group had hypokalemia. Therefore, prevalence of hypokalemia among the subjects of the AMI group was 52.6%. Conclusion: AMI patients are significantly associated with hypokalemia, thereby, indicating its role in the pathogenesis of the disease.

The Importance of EEG Abnormalities Detection in Children with Febrile Seizure: A Combined Approach

Jagdeesh Chandra Kookna — 2019-05-10

Background: Febrile seizures (FS) are the common disorder in 3-month- to 6-year-old children, with an incidence varying between 2% and 5%. It is associated with fever, without evidence of intracranial infection or a definite cause. Subjects and Methods: Selection of cases of febrile seizure were done according to guidelines definition given by national institute of health consensus (NIH) and the International League against epilepsy. 50 Children with febrile seizure admitted in the pediatric intensive care unit at S. P. Medical College & Hospital were selected for the study. EEG was done with sedation. Results: Most common EEG abnormality is slow waves in 35% followed by sharp waves in 30 %. Generalized EEG abnormality is seen in 64%. Conclusion: Most common epileptiform discharge was of generalized epileptiform activity, and most common EEG abnormality is slow waves.

A Hospital Based Prospective Study to Assess the Prevalence of Iron Deficiency Anemia among Known Population

Hanuman Ram Choudhary — 2019-06-04

Background: Iron deficiency anemia is a form of anemia due to the lack of sufficient iron to form normal red blood cells. Iron deficiency, the most common cause, is responsible for 50% of all anemias. Hence; we assessed the prevalence of iron deficiency anemia among known population. Subjects and Methods: The present research aimed for evaluating the prevalence of iron deficiency anemia. Sample size included assessment of a total of 220 patients who reported to the department of internal medicine of the hospital for routine medical checkup. A self-framed questionnaire was made and was given to all the subjects for collecting the demographic details. Blood samples were obtained from all the subjects and were sent to central laboratory for the assessment of blood hemoglobin levels. WHO criteria, described in the past literature, was used for categorizing the subjects with presence of iron deficiency anemia. All the results were analyzed by SPSS software. Results: Overall prevalence of iron deficiency anemia in the present study was found to be 11.36 percent. Majority of the subjects with iron deficiency anemia were found to be more than 35 years of age. Iron deficiency anemia was found to be more common among females and among illiterates. Conclusion: Iron deficiency anemia is a frequency encountered pathologic condition among general population, with especially high prevalence among females and illiterate population.

Epilepsia Partialis Continua as a Symptom of Alcohol Withdrawal in a Type 2 Diabetic Patient.

Chandan Kumar — 2019-06-15

Epilepsia partialis continua is a rare form of focal epilepsy or focal status epilepticus which mostly involves motor component. It leads to arrhythmic muscle jerks for a prolonged period of time. It can present as a single episode or multiple repetitive episodes. There are multiple etiological factors including vascular lesions and tumors. Presenting as alcohol withdrawal in a type 2 Diabetic patient makes it a rare phenomenon. We report a case of 55-year-old male with Epilepsia partialis continua after alcohol abstinence. Familiarity and diagnosis of this rare event is important because the treatment depends on the underlying etiology.

A Comparative Study Of Efficacy Of 10% KOH, 50% Trichloroacetic Acid And 25% Podophyllin For The Treatment Of Genital Molluscum In Females

Shweta Amar — 2019-06-19

Background: Molluscum contagiosum is caused by MC virus, the largest human virus and sole member of genus molluscipox. Transmission of the virus occurs by direct person-to-person contact or via contact with infected objects. Sexually active adults are more prone to develop it in genital area due to sexual transmission. Subjects and Methods: A randomized comparative therapeutic study was conducted from November 2017 to October 2018. Results: A total of 60 female patients with genital molluscum were enrolled in the study. The average age of the patients was 25.6 yrs. 66% presented less than 10 lesions, 28% presented from 10 to 20 lesions, and 6% presented more than 20 lesions at the initial examination. The results showed that the mean lesion count decreased from 22.39 to 6.75 with KOH, from 20.79 to 4.31 with TCA and from 20.49 to 4.1 with 25% podophyllin at the end of 4 weeks. We found complete clearance of lesions in 13 (65%) patients with 10% KOH, 15 (75%) patients with TCA, and in 11 (55%) patients with 25% podophyllin. Minor side effects were seen in 11 (55%) patients on TCA, 12 (60%) patients on KOH and 16 (80%) patients on podophyllin. Conclusion: All the three modalities i.e. 10% KOH, 50% TCA and 25% podophyllin are effective local therapies for the treatment of genital molluscum.

Prevalence of Dysmenorrhea among Adolescent Girls: A Burning Issue

Kamal Chandrika Jampana — 2019-06-25

Background: Dysmenorrhea, defined as painful cramps that occur with menstruation, is the most common gynecologic problem in women of all ages and races and one of the most common causes of pelvic pain. Painful menses in women or dysmenorrhea is a very frequently observed gynecologic problem. The true incidence and prevalence of dysmenorrhea are not clearly established in India. Subjects and Methods: The data were collected from the schools and colleges present in Krishna district. Female medical students and a female medico-social worker were trained for this study. Three schools and three colleges were randomly selected and from this all the girls who were willing to participate and in the age group of 14-19 years were included in the study. Results: The overall prevalence of dysmenorrhoea was 68% (72.3% and 63.3% in the urban and rural areas respectively). The difference in the prevalence of the urban and rural adolescent girls (study subjects) is not significant. Conclusion: Dysmenorrhoea is a very common problem. A number of physical and emotional symptoms are associated with dysmenorrhea and it also affects the quality of life of girls to a great extent.

Evaluation of Histopathogical Changes in Gallbladder Mucosa in Gallbladder Stone Patients: An Institutional Based Prospective Study

Seema Gupta — 2019-05-10

Background: Mucus, calcium and lipids act together and lead to the formation of the gallstones. Gallbladder and biliary tract epithelium is unprotected from the high concentrations of harmful compounds both exogenous and endogenous that are excreted into the primary bile. The present study was conducted with the aim to evaluate the histopathogical Changes in Gallbladder Mucosa in Gallbladder Stone Patients. Subjects and Methods: The present retrospective study was conducted in the Department of Pathology, JLN Medical College, Ajmer, Rajasthan, India. For histopathological examination, Gall bladder was sectioned from neck to fundus and carefully washed with 0.15 N saline. All the data thus obtained was arranged in a tabulated form and analysed using SPSS software. Percentage of the whole data was calculated. Results: There were a combination of alterations observed in single bladder, some part was normal while the other showed signs of hyperplasia. Normal epithelium was seen in 20% cases, there were 44.7% cases that showed epithelial hyperplasia. Conclusion: Pathological alteration on the epithelium of gall bladder plays a pivotal role in the gall stone formation and if unmanaged or untreated it can lead to dysplastic changes and ultimately carcinoma in situ.

A Prospective Study to Assess the Bone Marrow Aspiration for Findings of Patients with Hematological Disorders

Sushma Singh Rathore — 2019-06-13

Background: Examination of bone marrow is beneficial procedure for the diagnosis of hematological and non-hematological diseases. Bone marrow aspiration singly is usually sufficive for the diagnosis of nutritional anemia, majority of the acute leukemia and Immune thrombocytic disorders. The present study was conducted with the aim to assess the bone marrow aspiration findings amongst subjects with hematological disorders. Subjects and Methods: The present cross sectional study was conducted in the department of pathology, Government Medical College, Dungarpur, Rajasthan (India) during a period of 2 years. Amongst all the subjects, peripheral smears, reticulocyte counts, sickling test and hemogram were obtained. Special stains Periodic acid Schiff staining was done for all subjects with acute lymphocytic leukemia, acute myeloid leukemia and Gaucher’s disorder. Block positivity was shown amongst ALL cases. In subjects with Gaucher’s disorder, Gaucher cells showed wrinkled tissue paper appearance using PAS staining. All the data thus obtained was arranged in a tabulated form and analyzed using SPSS software. Percentage of all the data was obtained. Results: The present study bone marrow aspiration was performed amongst 110 subjects and bone marrow biopsy was performed amongst 54 subjects. There were 48.2% cases of anemia, 14.5% (n=16) cases of acute leukemia. In 10.9% of cases myeloproliferative disorders were observed and 1.8% cases had myelodysplastic syndrome. There were 20.4% cases of hyoplastic anemia. There were 11.1% subjects that showed normal results. NHL deposits and myelofibrosis was seen in 5.6% cases each. ALL was diagnosed in 1 case. Conclusion: Aspiration of bone marrow is important for diagnosing, determining the prognosis and therapeutic response of different types of hematological and non hematological conditions.

Cytological Pattern of Papanicolaou Smears in a Tertiary Care Centre of Bihar, India

Naresh Kumar Srivastava — 2019-06-25

Background: Cervical cancer is the most common although preventable cancer of Indian females. It does not develop suddenly from normal epithelium but is presented by a spectrum of intraepithelial neoplasia. Pap smear is an ideal screening method and low cost effective test to detect intraepithelial neoplasia especially in developing countries although it has limitations and needs confirmation by histopathology. The objective of this study was to assess the prevalence and pattern of cervical lesions using conventional Pap smear method. Subjects and Methods: It was a retrospective study conducted in a tertiary care institute of Rohtas, Bihar. The data of two years was collected from medical records department. Results: Out of 664 smears, 397 (59.79%) were abnormal Pap smears, 169 (25.45%) were normal Pap smears while 98 (14.76 %%) smears had inadequate sample material to be examined. Out of 397 abnormal smears, 362 (91.18%) smears reported to have inflammatory/reactive changes whereas 10 (2.51%) had atrophic changes in Pap smear and abnormality in epithelial cell was reported in 25 (6.29%) smears. Conclusion: Pap smear is an effective screening procedure to detect cervical cytological abnormalities. Routine cytological screening by Pap smear should be offered to all women above 19 years or within 3 years of sexual activity. There is an urgent need to improve the awareness about the disease among females and skills of health care workers should be honed for preparation of Pap smears.

A Small Dose Clonidine Prolongs Post-Operative Analgesia after Sciatic –Femoral Nerve Block with 0.75% Ropivacaine for Foot Surgery: A Hospital Based Study

Ramesh Maheshwari — 2019-05-10

Background: To understand the effect of small dose clonidine with 0.75% ropivacaine for foot surgery, Hallux valgus repair is a minor surgical procedure, which leads to severe pain post surgicaly. For this reason, regional anaesthesia along with long-acting local anaesthetics has been advised. Subjects and Methods: All patients were screened for any other systemic disorder. Any patients with diabetes, hypertension or thyroid issues were also not included in the study. Patients of age group 18-75 were included in the surgery. The patients were divided randomly into two groups. Group A patients (16 patients) were injected with 1 μg/kg clonidine to 0.75% ropivacaine during combined sciatic-femoral nerve block for the repair of hallux valgus, whereas group B patients (16 patients) were injected with only 0.75% ropivacaine during the repair procedure. Results: It was observed that, not much difference was seen in the time required to achieve surgical anaesthesia between the patients receiving only 0.75% ropivacaine which was 10 minutes approx. Conclusion: As a result of this prospective, randomized, double-blinded study demonstrate that adding 1 μg/kg clonidine to 0.75% ropivacaine has no major effect on onset time and quality of combined sciatic-femoral nerve block.

Comparison of Complications that Arise after DT and FCLT in the Treatment of Post-Acne Scars

Dr Nikhita — 2019-05-23

Background: Acne vulgaris is a common chronic skin disease involving blockage and/or inflammation of pilosebaceous units (hair follicles and their accompanying sebaceous gland). Acne can present - non-inflammatory lesions (open and closed comedones), inflammatory lesions (papules, pustules, and nodules), and varying degrees of scarring or a mixture of both, affecting mostly the face but also the back and chest. Acne leads to significant morbidity that is associated with residual scarring and psychological disturbances such as poor self-image, depression, and anxiety, which leads to a negative impact on quality of life. Subjects and Methods: Total 200 patients divided into two groups of 100 each. One group was treated with dermaroller every four weeks for a period of 24 weeks and the other group was treated with fractional CO2 laser again every four weeks for a period of 24 weeks. Results: Six patients in dermaroller and nine patients in fractional CO2 laser group developed hyperpigmentation post procedure. Conclusion: Itching is not seen as a complication in the treatment with derma-roller, but in case of fractional CO2 laser group, a very small percentage of patients experienced itching a few days after the treatment due to peeling off of the scab that was formed after treatment.

Oral Mucosal Lesions in Psoriasis Patients: A Hospital Based Study

Abhishek Kumar Jha — 2019-06-19

Background: Oral lesions in dermatological diseases may be the early aspects of any disease manifestation and occasionally lesions occur simultaneously in the skin as well as mucous membrane. Subjects and Methods: The present work was designed as a prospective tertiary urban hospital based, case control study during the period from February 2018 to January 2019. The association between studied variables was calculated using descriptive statistics tests such as Chi-squared test and Fisher’s exact test, and P < 0.05 was considered statistically significant. Results: A total of 120 psoriasis patients, 55 males (45.88%) and 65 females (54.16%) were included in the study. The age of the patients ranged from 5 years to 56 years (mean age 24.6 years). The most common form of psoriasis was chronic plaque form (Psoriasis Vulgaris) observed in 85 cases. The majority of patients (72.56 %) were suffering from a mild form of the disease. Psoriasis Area and Severity Index (PASI) score of most patients (72.56%) were below 10. The oral lesion was seen in 31 cases (25.83%) of which fissured tongue and geographic tongue were the most common oral lesions identified. Of total 100 psoriatic patients, 45 cases were male, and 55 were female. Mean age of patients was 37.71 years. observed in 85 cases. The majority of patients (70 %) were suffering from a mild form of the disease. Psoriasis Area and Severity Index (PASI) score of most patients were below. Conclusion: The present study highlights the prevalence of oral lesions such as fissured tongue and geographic tongue is higher in psoriatic patients.

Efficacy of Mifepristone versus GNRH Analogue in the Treatment of Uterine Leiomyoma- A Comparative Study

Georgy Joy Eralil — 2019-05-10

Background: Uterine fibroids also called as uterine leiomyoma is the most common benign tumor of the uterus. Most women develop one or more uterine leiomyoma during their reproductive years. Hence; we assessed the efficacy of Mifepristone 25mg versus Inj.Leuprolide acetate 3.75mg in reducing size of uterine myoma. Subjects and Methods: The study was planned for detecting difference of 15 percent in the outcome variables between the two groups and Standard deviation of 156.00, with 90% statistical power and 5% level of significance, the sample size was calculated to be 70 for the study. The study subjects were randomly assigned into 2 groups of 35 patients each. Group 1: Patients treated with Tablet Mifepristone 25mg once daily for 3 months; Group 2: Patients treated with Inj. Leuprolide acetate depot preparation 3.75mg IM once a month for 3 months. Demographic data, history, clinical examination, details of drug prescription, laboratory investigations and imaging reports were recorded in the study proforma. Various clinical assessment parameters were assessed. Results: After three months of treatment, there was a marked relief with significant decrease in visual analog scale score in both the groups (p <0.001). 21 patients (60%) in group 1 and 25 patients (71%) in group 2 presented with mild anemia at the beginning of the study. After three months of treatment, there was a significant (p <0.001) rise in the hemoglobin and hematocrit values in both the groups. There was an increase in mean hemoglobin level by 2.9gm/dl in mifepristone group and 3gm/dl in leuprolide group. Conclusion: Treatment with either mifepristone or leuprolide acetate in uterine leiomyoma is safe and causes significant but temporary reductions in uterine size and myoma related symptoms.

Evaluation of Risk Factors and Changes in Liver Enzymes among the Patients with Antituberculosis Drug-Induced Hepatitis: A Teaching Hospital Based Study

Omparkash Dhania — 2019-06-19

Background: Tuberculosis remains a major global health problem despite the availability of highly efficacious treatment for decades. Subjects and Methods: Tuberculosis was diagnosed through bacteriological and histopathological methods. Bacteriological testing was based on three sputum samples or if the patient could not give the sample, three gastric aspiration samples were examined. The sputum were evaluated for Acid Fast Bacilli (AFB) by Ziehl–Neelsen staining. Results: The patients with DIH, one patient were treated with five anti-TB drugs because of relapse or treatment failure; 47% had ALT, AST ≥ 6 times of ULN. These patients had loss of appetite (80%), icterus (20%), nausea (80%), vomiting (50%), malaise (45%), right upper quadrant tenderness (24%), and loss of consciousness (2%). Liver enzyme levels were normal after four to 30 days. Conclusion: The frequency of DIH in the current study was higher than those of other studies, similar to other reports, most of the TB cases in which hepatotoxicity developed occurred in the subjects above 51 years old and a lot of them occurred after the first month of treatment.