Asian Journal of Medical Research

PCNL in Staghorn Calculi: Our Experience

Mukesh Chandra Arya — 2019-08-24

Background: The treatment of STAG HORN calculi has varied from combination of percutaneous nephrolithotomy (PCNL) and shockwave lithotripsy (SWL) or sometimes open surgery. The goals of treatment of a STAG HORN stone are complete stone clearance with minimal morbidity. Although excellent stone-free rates are universally reported in the literature, complication rates vary widely, especially related to the need for blood transfusion.Subjects and Methods:From January 2015 to December 2018, 1400 patients underwent PCNL out of which 392 patients had stag horn stones. Our study included stag horn stones that were present in the renal pelvis and branched into two or more major calyces. All procedures were performed under general or spinal anesthesia by the same surgical team.Results:392 patients (144 women and 248 men) with mean age of 44.2 (range 8yr–72yr) years having partial/complete STAG HORN calculi were treated at our center S.P. Medical college, Bikaner from period of January 2015 to December 2018. 10 patients (10.2%) had pre existing renal insufficiency with a mean (range) serum creatinine of 3.0 (1.5-4.2) mg/dl.Conclusion: PCNL using multiple tracts is safe and effective and should be the first option for renal STAG HORN calculi. It must be done by experienced endourologists in a specialized centre with all the facilities for stone management and treatment of possible complications.

Retrospective Assessment of Postoperative Nausea and Vomiting after Unrestricted Clear Fluids before Day Surgery: An Observational Study

Prabodh Bansal — 2019-08-24

Background: Nausea and vomiting during and after the surgery are distressing for both the patient and his/her family. In addition, when vomiting occurs intraoperatively under regional anaesthesia, it offers significant challenge to the operating surgeon, potentially increasing the duration of the procedure and the risk of bleeding and inadvertent associated surgical trauma. Aim of the study: To assess postoperative nausea and vomiting after unrestricted clear fluids before day surgery.Subjects and Methods:The study was conducted in the Department of Surgery, Rama Medical College Hospital & Research Centre, Hapur, Uttar Pradesh, India. For the study, medical records of 200 patients who underwent surgical procedure at the hospital were selected for review. It was made sure that included patients were restricted from fluid intake for 12 hours before the surgery. We analysed records of randomly selected 200 patients who underwent surgical procedure at the hospital for the study period.Results:A total of 200 patient records randomly selected from the pool of records were analysed in the present study. We observed that mild nausea was experienced by 27 patients, moderate was experienced by 16 patients and severe nausea was experienced by 3 patients. We observed that 14 patients had vomiting only once, 8 patients had 2-3 times vomiting and 2 patients had vomiting more than 3 times. The results were compared and found to be statistically non-significant.Conclusion: From the results of the present study, this can be concluded that restriction of food and fluid intake before the day surgery is an efficacious method in avoiding nausea and vomiting in patients during post-operative time.

Role of Serum Bilirubin as a Marker of Acute and Complicated Appendicitis

Pankaj Garg — 2019-08-24

Background: Acute appendicitis is the most common surgical emergency and early surgical intervention is seen to improve outcomes. Jaundice has been associated with appendicitis and studies have shown hyperbilirubinemia to be a useful predictor of appendiceal perforation. Elevated serum bilirubin will help in early and accurate diagnosis of acute appendicitis. This study aims to evaluate the role of serum bilirubin as a marker in acute appendicitis.Subjects and Methods:This study was conducted in the department of surgery, Dayanand medical college and hospital, Ludhiana on patients of acute appendicitis. Routine investigations including bilirubin total and bilirubin direct were done and the mean value of bilirubin total and liver enzymes in cases of acute appendicitis was calculated. The p value <0.05 was considered significant.Results:The mean age of the patients was 27.29±16.4 years. There were a total of 59 patients with 47 males and 12 females. The total bilirubin levels in cases with acute appendicitis and complicated appendicitis were 0.71±0.29 and 1.46±0.66 respectively.Conclusion: Increase in serum bilirubin levels were seen in patients of complicated appendicitis and it can be added in the list of routine investigations at the time of admission in suspected cases of appendicitis.

Prevalence of Diastolic Dysfunction in Asymptomatic Young and Middle Aged Individuals Attending a Tertiary Care Hospital

Rajiv Arora — 2019-08-24

Background: Heart problem is a common health issue encountered these days. Hence; the present study was planned for assessing the prevalence of Diastolic Dysfunction in Asymptomatic Young and Middle Aged Individuals Attending a Tertiary Care Hospital. Subjects and Methods: A total of 200 patients were included in the present study. The study group comprised of patients who reported to the department for routine medical checkup. Echocardiography using color Doppler was done in all the patients. Physical examination was done to look for any evidence of cardiac involvement in each and every patient.The diastolic dysfunction was graded as; Grade 1: An isolated early relaxation abnormality,Grade 2: Impaired relaxation, but with modestly elevated Left ventricular end-diastolic pressure, and Grade 3: Restrictive filling.All the results were recorded in Microsoft excel sheet. Results: Diastolic dysfunction was found to be present in 50 patients. Therefore; prevalence of diastolic dysfunction was found to be 25 percent. Significant increase in the prevalence of diastolic dysfunction was seen among elderly patients. However; no significant correlation was seen among patients with diastolic dysfunction divided on the basis of gender. Conclusion: Diastolic dysfunction is a major health issue affecting a significant patient population. Also, increase in severity of diastolic dysfunction is found to be positive correlated with increasing age.

A Correlation of Duration of Diabetes with Glycemic Indices in the Type 2 Diabetes Mellitus: A Prospective Study

Anil Kumar Gupta — 2019-08-24

Background: The development of chronic complications is related to the duration of Diabetes Mellitus, however it may not reflect the true duration of disease, rather it reflects the time since diagnosis. The aim of this study to correlation of glycemic indices with duration of diabetes. Subjects and Methods: An observational study has done on 100 patients with type 2 diabetes mellitus in department of medicine, MSY Medical College & Hospital, Lalpur, Meerut. Diabetes was diagnosed according to American Diabetes Association (ADA) revised criteria. Blood glucose level estimation was done by glucose oxidase method in venous blood. Glycosylated haemoglobin (HbA1C) was measured by ion-exchange chromatography method. Results: Our results showed that the 5-10 years of duration of diabetes was present in 42% cases and less than 5 years duration of diabetes was present in 40%. HbA1c was not significant correlate but >10 years duration of diabetes was higher mean value as compared to less than 5 year duration of diabetes. Conclusion: We concluded that on applying spearman correlation for microvascular complications, a positive association was observed for age of patients, duration of diabetes, HbA1C. Duration of diabetes was found to be a main culprit of micro vascular complication.

Liver Dysfunction in Dengue Fever: A Prospective Study

Gautam Chand Jingar — 2019-07-15

Background: Dengue has emerged as an important arbovirus disease with significant impact on the disease burden in population residing in tropical countries. The virus seems to have some hepatotoxic effects.The aim of this study to rule out extent of liver dysfunction in Dengue fever. Subjects and Methods: A total of ninety six (n=96) serologically confirmed patients who were hospitalised were included in the study. NS1 and IgM anti dengue antibodies using the IgM antibody capture – enzyme linked immunosorbent assay (MAC – ELISA) for diagnosis of dengue fever were done. Detailed clinical examination was performed on admission, blood sample were collected, and all haematological, coagulation profile and biochemical investigations for renal and hepatic function were studied. Results:The study group consisted of 96 patients with male to female ratio was 2.3:1 and age ranging from 12 to 75 years (27.68 years). Common clinical features were fever (100%), persistent vomiting (79.17%), rash (33.33%) and bleeding manifestation (10.42%) hypotension was observed in 2 patients (2.63%) without involving particular age group. Our study showed that the leucopenia (WBC <4000/μl) wasfound in 58.33% of cases followed by platelet count <1000/μlfound in 35.41% of cases. Among liver function tests hepatomegaly (nontender) was present in about 58.3% patients and 91% patients had raised transaminase level ,very high >25 times increase was found in 20.8% patients. S. Alkaline Phosphatase was normal in 70% and only 11% patients showed abnormal echotexture on ultrasound. Conclusion: The pattern of hepatic involvement of liver in dengue fever varies as per the severity of disease. In milder case of dengue fever liver function test was normal but there was hepatomegaly was present commonly but in severe form of disease pattern of hepatic involvement varies from tender hepatomegaly to significant increase in liver enzyme.

Evaluation of Thyroid Hormone Deficiency among Female Visited In Government Hospital: A Prospective Study

Gajendra Singh — 2019-08-24

Background: Among females, there is significant prevalence of diseases of the thyroid gland. Hence; the present study was undertaken for assessing thyroid hormone deficiency among females visiting government hospital. Subjects and Methods:A total of 255 patients were identified to be suffering from thyroid hormone deficiency. Among these 255 patients, 152 were females. A separate data sheet was made for recording the clinical profile of females. Complete demographic and medical details of all the female patients with thyroid hormone deficiency were obtained. All the results were recorded in Microsoft excel sheet and were analyzed by SPSS software. Results: 38.82 percent of the patients belonged to the age group of more than 50 years. 27.63 percent of the patients belonged to the age group of 41 to 50 years. 20.39 and 13.13 percent of the patients belonged to the age group of 30 to 40 years and less than 30 years. Feeling of tiredness was found to be present in 69.08 percent of the patients, while weakness and pain in muscles and joints was found to be present in 72.37 percent of the patients. Conclusion: Thyroid hormone deficiency is common among elderly females with feeling of tiredness and muscle and bone pain the prominent clinical manifestation encountered.

Assessment of Quality of Life among Post-Menopausal Women Visited in Tertiary Care Hospital in Barmer (Rajasthan)

Sawai Khatri — 2019-08-24

Background: Menopause is a universal event in a women’s life causing a variety of physical, vasomotor, psychological and sexual symptoms. Hence; the present study was planned for assessing Quality of Life (QOL) Among Post-Menopausal Women Visited in Tertiary Care Hospital in Barmer (Rajasthan).Subjects and Methods: A total of 50 postmenopausal women were reenrolled in the present study. Postmenopausal women with more than one history of amenorrhea were included in the present study. Detailed demographic and clinical data of all the subjects was obtained. Modification of a preexisting menopause-specific QOL (MENQOL) questionnaire was used in the present study. All the items of the questionnaire were graded as present of absent. Sum total of all the symptoms comprised of QOL of postmenopausal women. All the results were recorded in Microsoft excel sheet and were analyzed by SPSS software. Results: Night sweats were found to be present in 56 percent of the subjects. Dissatisfaction with personal life and nervous feeling was found to be present in 58 percent and 8 percent of the subjects. Depression and weight gain was found to be present in 66 percent and 70 percent of the patient population. Conclusion: Menopausal significantly affects the quality of life of women. Adequate awareness programs should be started for increasing the awareness among women regarding postmenopausal symptoms.

To Evaluate the Correlation between Symphysis Fundal Height and Abdominal Girth at Different Periods of Gestation and Birth Weight

Kheta Ram Soni — 2019-08-24

Background: SFH and abdominal girth measurement is a simple method of fetal growth assessment which could be utilized even by paramedical workers to screen for small for gestational age babies. In this study, we evaluated the correlation between symphysis fundal height and abdominal girth at different periods of gestation and birth weight. Subjects and Methods: This is a prospective observational study which was conducted in the Department of Obstetrics and Gynaecology, PBM Hospital, SP Medical College, Bikaner. 500 pregnant women attending antenatal clinic were enrolled after an informed consent. Symphysis fundal height and abdominal girth measured at monthly interval till 28 weeks, 15 days till 36 weeks than weekly till delivery. Results: In the present study, abdominal girth at different periods of gestation is a better indicator of birth weight. Fundal height also predicts birth weight but not as well as the fundal height. At term fundal height <30cm predicts birth weight <2kg. Conclusion: We concluded that abdominal girth at different periods of gestational is a better indicator of birth weight.

Correlation between Iron Profile of Pregnant Women and Their Newborns: A Cross Sectional Study

Gorav Kumar — 2019-08-24

Background: Maternal anemia leads to many adverse effects on the fetuses fetal complications. The mechanisms leading to increased morbidity include a decreased oxygen delivery capacity and the dysfunction of enzymes. The aim of this study to relationship between iron status of pregnant mothers and their newborns using a combination of several hematological parameters. Subjects and Methods: A hospital based descriptive type of observational study done on 50 singleton primi pregnant women at term gestation (37-42 weeks) admitted to labour room in government Medical College and general Hospital, Dungarpur (Raj.). General physical examination was done meticulously to assess maternal conditions regarding anemia such as nutritional status, pallor, edema and glossitis. Results: Our study showed that the male to female ratio was 1.28:1. Normal birth weight in baby was seen in 80% of cases. The spearman correlation of hemoglobin concentration was statistical significant in the newborns of mothers with hemoglobin concentration (

To Evaluate the Endometrial Histopathological Etiology of Abnormal Uterine Bleeding: A Hospital Based Observational Study

Namrata Sharma — 2019-08-24

Background: The study of endometrial microscopy in women with AUB is helpful to distinguish anovulatory from ovulatory AUB and to diagnose hyperplasia and carcinoma of endometrium. The aim of this study to find out the endometrial histopathological causes of abnormal uterine bleeding. Subjects and Methods: A hospital based descriptive type of observational study done on all abnormal uterine bleeding cases of age above menarche attending the outdoor of Government hospital & Government Medical College, Bharatpur (raj.). The study material consisted of endometrial curettings from 100 patients attending Gynecology OPD. These patients were having a clinical diagnosis of Abnormal uterine bleeding. Endometrial curettage samples were fixed in 10% formalin and histopathological slides were prepared sand Hematoxyline and Eosin staining was done. Results: In the present Study, high incidence of AUB was noted in 31-40 years (42%). The incidence of AUB in the reproductive age group was 57%. Conclusion: We concluded that dilatation and curettage is useful for diagnosis, to assess therapeutic response and to know the pathological incidence of organic lesions in cases of abnormal uterine bleeding prior to surgery.

A Study on Effects of Dexmedetomidine Used as an Adjuvant in Epidural Post-Operative Analgesia

Bhaidas Onkar Patil — 2019-08-24

Background: Epidural anaesthesia with adjuvant is normally used for postoperative pain management in infra umbilical surgeries but search for ideal adjuvant without any side effect goes on. Aim: This study was done to assess the onset and duration of sensory and motor block and side effects of dexmedetomidine, when used as an adjuvant in epidural anaesthesia in infra umbilical surgeries. Subjects and Methods: 60 patients of ASA status I and II, posted for infra umbilical surgeries were randomly allocated into two groups of 30 each. Group L patients received epidural 0.5% levobupivacaine. Group LD patients received epidural 0.5% levobupivacaine and 1μg/kg dexmedetomidine. Preoperative and postoperative block characteristics as well as hemodynamic parameters and side effects were monitored. Results: Dexmedetomidine as an adjuvant had an earlier onset and longer duration of sensory and motor block compared to levobupivacaine alone. Sedation scores were statistically significant with dexmedetomidine group in comparison to levobupivacaine alone group. Conclusion: Dexmedetomidine, as an adjuvant to epidural levobupivacaine provided prolonged analgesia in infraumbilical surgeries.

To Find Out Prevalence of Various Ocular Manifestations and to Assess the Possible Aetiological Factors Including Psycho-Social and Hereditary Factors in Mentally Retarded Children

Vandana Misra — 2019-08-24

Background: Children with disabilities are at a higher risk of visual impairment as compared to normal population. The present study was conducted to find out the prevalence of various ocular manifestations and to assess the possible aetiological factors including psycho-social and hereditary factors. Subjects and Methods: The present study was undertaken in the department of ophthalomology and paediatrics, S.N. Medical College, Agra. Two hundred and forty mentally retarded children between the ages of 3 months to 15 years of either sex were scrutinized to find out the prevalence of ocular manifestations in cases of mental retardation. A complete case history was taken. Results: In the present study, in 50% cases, the cause of mental retardation could not be identified clinically. Causes of mental retardation which could be identified in our study were developmental cranial anomalies -12.5%, down’s syndrome (7.5%), post inflectional (6.7%), congenital cerebral palsy (5.8%) , epilepsy (3.3%), endocrine disorders, others 11.6%. Out of these 66.7% were males and 33.3% cases were females. Ocular examination of the mentally retarded children revealed that 60% cases were having one or other form of ocular abnormalities. Strabismus (30.5%) was the commonest ocular anomaly followed by refractive errors (27.8%). Other ocular manifestations in order of frequency were congenital cataract (12.5%), optic nerve disorders (7.5%), lid and orbital abnormalities (5.5%), nystagmus (2.7%) and retinal disorders (1.4%). Colour vision defects were found to be present in 13.2% mentally retarded children. Conclusion: The children with disabilities should undergo annual ophthalmic evaluation. We concluded from our study that visual function of the children should be assessed as soon as the child is admitted to the school. Earlier assessment and correction of the visual problems will have greater chance of achieving potential and will prevent unnecessary visual impairment.

KAP Study towards Organ and Whole Body Donation in Medical, Dental & Nursing Students: A Randomised Institutional Based Survey

Simmi Mehra — 2019-08-24

Background: In our country more than 500,000 people suffer from non-availability of organ and waiting for a transplant. About 150,000 patients wait for kidneys, 50,000 for hearts and 50,000 for liver transplants approximately. Nearly 10, 00,000 people suffering from blindness need donors. In a country such as ours with a population of 1.3 billion, the donor rate is comparatively low i.e. just 0.4 per million population when compared to the USA where it accounts to around 25 per million. This data shows a huge variation between demand and availability.Subjects and Methods:A total of 175 students were involved in our study analysis. A total of 109 MBBS, 52 BDS and 14 nursing students were involved in the study analysis. The study was conducted using an objective type questionnaire.Results:Awareness regarding organ donation during life was analysed and students of MBBS were able to give most correct answers. Awareness regarding organ donation after life was also analysed and students of MBBS yet again had the most correct answers.Conclusion: It can be understood that an aware population of the medical personnel will help to promote the concept of organ/ whole body donation in the public and motivate them.

A Prospective Study to the Morphological Variation on Radiological Examination (In Form of Appearance of Ossification Centers in Carpal Bones) in Boys and Girls of Age Group 5 to 12 Years of the Western Rajasthan (Jodhpur) Region

Ramratan Bishnoi — 2019-08-24

Background: The Determination of age of an individual by radiological observation of the time of appearance and fusion of ossification centers is a matter of great medicolegal and academic interest.In the present study estimation of age in the individual of age varying between 5 year to 12 years will, be conducted using the appearance of ossification of carpal bones in boys and girls of the western Rajasthan (Jodhpur) region.Subjects and Methods:A radiological prospective study done on appearances of ossification centers in the carpal bones inboys and girls of age group 5 years to 12 years in western Rajasthan jodhpur region.Results:There were 50% males and 50% females in the study with male to female ration of 1:1. Precaution was taken to select equal proportion of cases from each half year interval of age among both sexes.Conclusion: We concluded that trapezium, trapezoid and scaphoid carpals appeared between the age of 5 to 9 years.Their appearance was slightly earlier in females than in males.

A Study on Neck Injuries in Deaths Due to Hanging on Basis of Epidemiological Factors

Ashok Singh Dangus — 2019-08-24

Background: Most of the hanging cases are consider as suicidal until the homicidal and accidental are prove, because both homicidal and accidental hanging are rare. In these cases a watchful forensic examination plays an important role to determine the ante mortem character of the lesion and to exclude causes of hanging other than suicidal hanging. Aim: This study done to know the internal and external assessment findings among hanging cases. Subjects and Methods:Hanging deaths with external neck injuries along with ligature mark were included in this study. In this study a total of 60 cases of deaths due to hanging, was subjected to medico legal autopsy. Results:Most of the cases were observed in the age group of 21-40 years i.e., 41 (69.4%) out of 59 hanging deaths. Out of 59 deaths, 32 (54.2%) were females and 27 (45.7%) were males. Among neck structure injuries, majority of hanging cases had rupture / contusion of sternocleidomastoid and other strap muscles of neck, it was 57.6%. 33.8% cases had carotid intimal tear, 5% cases showed hyoid bone fracture and 3.3% thyroid cartilage. No fractures noted in Cricoid cartilage and cervical vertebra. Conclusion: Social awareness, problem solving and family support of most common age group is extremely necessary.