Journal of clinical and diagnostic research

Differences In Risk Factors And Mortality, In Young And Old Individuals With Acute Myocardial Infarction In Goa

DANG A, DIAS A

Background: Coronary Heart Disease (CHD) is a major cause of mortality and is a global health problem. Aims: There could be a difference in the risk factors in the young and the old individuals with Acute Myocardial Infarction (AMI), and the information about these may have an influence on the strategies for preventive cardiology. In this study, we tried to investigate the same. Settings and design: Retrospective record based study done in a government medical college. Methods and materials: Records of patients with AMI admitted from January 1 to December 31, 2005 were investigated retrospectively. A total of 355 patients admitted to the Department of Medicine with AMI, were analysed. Characteristics of the patients who were ≤ 45 years of age and were considered young were compared with those above 45 years. Statistical analysis used: SPSS software. Results: 22.25% (79) of those admitted with AMI were ≤ of 45 years. 11.39% (9) of the AMI in young individuals, occurred in females, compared to 27.69% (77) in the old AMI patients. 21.51% (17) of the young AMIs presented with cardiac failure (CF) compared to 41.30% (114) in the older age group. Risk factors like alcohol and smoking were more commonly found in the young AMIs, whereas diabetes mellitus (DM), hypertension (HT) and past history of Ischaemic Heart Disease (IHD) and AMI were higher in the older patients. 10.12% (8) of the young AMIs died, as compared to 27.53% (76) in the older population. Conclusions: Preventive measures for AMIs in the younger age group should involve measures to prevent smoking and alcohol consumption. Preventive measures in the elderly patients should emphasise on control of DM and HT.

Correct Use Of A Metered Dose Inhaler: A Prospective Interventional Study Among Healthcare Professionals In A Nepalese Teaching Hospital

KISHORE P.V., PALAIAN S, ALAM K, SHANKAR PR, BAJRACHARYA B, DEN ENDE J. V.

Background: Asthma and Chronic Obstructive Pulmonary Disease (COPD) are common in Nepal. Inhaled medications form the cornerstone of the management of these diseases. Metered Dose Inhalers (MDIs) are a common mode of delivering inhaled medications, and hence knowledge of the healthcare professionals regarding MDIs is the cornerstone for educating the patients about the correct use of MDIs. Objectives: To study the correct use of MDIs by the doctors, nurses, pharmacists and medical interns, and to evaluate the impact of an educational intervention on the use. Methods: A prospective, interventional study was carried out at the Manipal Teaching Hospital, Pokhara, Nepal. The subjects were asked to demonstrate the technique using a placebo inhaler, and the steps were graded as per the National Asthma Education and Prevention Program (NAEPP) criteria. Intervention was done by demonstrating correct MDI use with the help of placebo inhalers and an information leaflet. The post intervention response was analyzed using appropriate statistical tests. Results: Altogether 143 health professionals (male 53.8%, female 46.1%) were studied prior to intervention, and 101 (male 41.5%, female 58.4%) of them in the post interventional phase. The overall mean ± SD score obtained by the professionals was 4.44 ± 2.07 (pre intervention), and 7.68 ± 1.74 (post intervention). (P< 0.001, Z value - 10.020, Mann Whitney test). With regard to the individual scores of different categories of healthcare professionals, the scores for the nurses were 3.99 pre intervention and 8.14 post intervention, for doctors it was 5.96 and 7.18, for pharmacists it was 5.8 and 7.1, and for interns it was 4.72 and 7.12. None of the professionals could initially demonstrate all the ten steps involved in the correct use of MDI. Following the intervention one doctor, four medical interns, and eight nurses all demonstrated the steps correctly. Conclusion: MDI use among healthcare professionals was poor before the intervention. The intervention was substantially effective in improving the technique.

Inflammatory Bowel Disease (IBD) in Northeast of Iran

This study was designed to provide the clinical and epidemiological data on Inflammatory Bowel Disease (IBD) in the Golestan province (northeast of Iran). We carried out a retrospective study with regards to all IBD patients (pathologically confirmed cases) during 2001- 2004. Registered cases were 108 [104 with Ulcerative Colitis (UC) and 4 with Crohn's disease (CD)]. Information about age, sex, education, colitis extent, extra intestinal manifestations, the lag between onset of the disease, and time of final diagnosis, were recruited. Data were analyzed using SPSS –V12 analytical software. There was a slight female predominance in UC cases. Most of the cases (83.3%) were highly educated, and 65.7% were living in urban areas. Patients with US mainly presented with diarrhoea, whereas those with CD complained of abdominal pain. The predominant form of UC was left sided colitis, which affected almost 35.4% of patients. The most extensive form (pan colitis) was present in 22.1%. Mean age was significantly different with regards to anatomical sites; patients with proctitis was younger than other groups (p =0.001). The mean lag time between the onset of symptoms and definite diagnosis was 2.2 1.1 and 5 months in UC and CD, respectively. Extra intestinal manifestations were seen in 10 patients. In the Golestan province, IBD is predominant in females, and its most severe form is higher than that documented in European studies.

Drug-Related Hospitalizations at a Tertiary Level Hospital in Bangalore: A Prospective Study

Koneri R, Prakasam K, Mishra V, Rajan H

The Objective of the present study was to determine the causality, severity, preventability, classification of adverse drug events, and drug therapeutic failures resulting in hospitalization, at a tertiary level hospital in Bangalore. Prospective data was collected from a total of 155 consecutive adult patients hospitalized during a period of six months due to drug related events at the Kempegowda Institute of Medical Sciences, Bangalore. The prevalence of Drug-related hospitalizations was (6.4%)[95% CI 5.6%-7.7%] in the study. Multiple drug therapy in patients was associated with drug related hospitalizations. 50 % of the admissions were due to Adverse Drug Reactions (ADR), 38% due to Dose Related Therapeutic Failure (DTF), and only 12% were due to Self or Intentional Poisoning (SIP). On sub-group analysis, 64% of ADR were noted to be due to normal side effects; and 68% of DTF were due to non-compliance. Using Naranjo’s probability scale for causality assessment, 58% of Drug Related Hospital Admission (DRHA) was classified as definite; whereas 36% was probable. Out of these, 84% of DRHA were predictable, whereas 16% were non-predictable. 72% of DRHA was managed by altering the dose. The prevalence of Drug-related hospitalizations is high in this hospital, which merits further research and intervention.

Postgraduate Students As Facilitators In Problem-Stimulated Learning Sessions

SHANKAR PR*, SUBISH P

Problem-based or problem-stimulated pharmacotherapy teaching in undergraduate medical curricula has been identified as a key intervention towards promoting the more rational use of medicines. The department of Pharmacology at the Manipal College of Medical Sciences (MCOMS), Pokhara, Nepal, emphasizes the more rational use of medicines. The department also admits students to the MSc (Medical Pharmacology) programme. The post graduates (PGs) act as facilitators during the undergraduate problem-stimulated learning (PSL) sessions. Recently, microteaching PSL sessions were conducted and the PGs were assessed by the student groups and faculty members. A total of five sessions were conducted and assessed, each session being of two and half hours duration. The PG facilitators were assessed by the student groups and faculty members by using a scoring form. The PGs were scored from 1 to 5 on various parameters, and faculty members gave a written assessment of the strengths and weaknesses of the facilitators. The PGs also filled in a self-assessment form after each session. The median total score was 34.5, and the interquartile range was 5. The maximum possible score was 40. The student group gave a higher score to the PG facilitators compared to the faculty members, and the scores were highest for the third session. Initially, the facilitators acted more like teachers in a traditional setting. Occasional problems with discipline were noted. Making the sessions more interactive, facilitating self-directed learning, and toning down the traditional role of a teacher, were problems. The overall opinion was positive. We plan to continue and strengthen the sessions for future generations of PGs.

Paroxysmal nocturnal haemoglobinuria with Budd Chiari syndrome and Myelofibrosis

ABBAS MT*, KHAN FY**, MATAR I***, BAIDAA A****

We report a case of paroxysmal nocturnal haemoglobinuria (PNH) in a 38-year-old Indian female, who was admitted to our hospital with abdominal distension of 2-weeks duration, with leg oedema and jaundice. Her medical history was remarkable for deep vein thrombosis 15 years back, and stroke, nine years before admission. On clinical examination, spleen and liver were palpable, along with evidence of shifting dullness on abdominal percussion. Bone marrow examination showed hypoplastic bone marrow with agnogenic myeloid metaplasia, with myelofibrosis. Acidified serum lysis (Ham test) and sucrose lysis tests were strongly positive. The diagnosis of PNH was confirmed by flow cytometry. The patient could not be followed further, as she left for her country.

Lateral Gastrocnemius Muscle Flap for Cover of Large Popliteal Fossa Defect following Resection of Marjolin's Ulcer

PURKAYASTHA J

Marjolin’s ulcer rarely involves the popliteal fossa. The problem in the surgical management of such lesions lies in the soft tissue cover of the post resection defects. We describe our technique to cover such post surgical defects by utilising the gastrocnemius muscle flap along with split skin graft .

Life Threatening Lactic Acidosis Secondary To Metformin, In A Low Risk Patient

KHAN FY*,IBRAHIM AS**,ERRAYES M***

A 45-year-old lady was admitted to the intensive care unit (ICU) with a two day history of persistent nausea, vomiting, abdominal pain, and shortness of breath. Her medical history was remarkable for diabetes mellitus (DM) type II on Gliclazide 80 mg twice daily, and metformin 500 mg, three times daily. On examination, the patient was tachypnic, with cold extremities. Blood chemistry showed: random blood sugar levels of 20.6 mmol/L, and blood lactate concentration levels of 9.45 mmol/L, while urine and plasma tests were negative for ketone bodies. A provisional diagnosis of metformin-induced lactic acidosis was made. Intravenous calcium gluconate, soluble insulin, and bicarbonate were given initially, and urgent haemodialysis was performed. On the following days, the level of lactic acid and potassium returned to normal. The patient made a subsequent smooth recovery, and did not require further renal support.

Pre-Operative Diagnosis Of Gastrointestinal Stromal Tumour Of Stomach By Endoscopic Biopsy: Report Of Two Cases

DEBNATH S, MISRA V, MISRA S P, SINGH P A, DWIVEDI M

Gastrointestinal stromal tumor (GIST) is a rare mesenchymal tumour of the gastrointestinal tract. Submucosal GIST grows most frequently towards the lumen of the gut along with attenuated, degenerated or regenerative proliferative epithelium, with bridging folds, and may be endoscopically misdiagnosed as adenocarcinoma. Pre-operative diagnosis can be done by endoscopic ultrasound guided fine needle aspiration cytology. However, diagnosis by endoscopic biopsy is rarely reported. We report here, two cases of GIST that were diagnosed by endoscopic tissue biopsy and confirmed by examination of the resected mass

Posttraumatic Bilothorax In A Child: A Case Report

Ghritlaharey RK

Blunt injury liver associated with diaphragmatic tear and bilious pleural effusion is a rare clinical finding in children. A 12 years old boy was referred to us for respiratory distress following blunt injury abdomen. Investigations revealed liver contusion, tear in right dome of the diaphragm, bilious collection in subphrenic space and right pleural cavity. He responded well to the right intercostal chest tube drainage and antibiotics.

A Rare Suspected Case Of Congenital Dyserythropoietic Anaemia Type II

SHAH V N, MEHTA M N, SANTWANI P M

A young 18 year old Hindu boy presented with anaemia, joint pain and features of growth retardation. There was hepato-splenomegaly and features suggestive of haemochromatosis. As it was a classical bone-marrow picture with markedly elevated S.ferritin level and evidence of increase iron overload, we suspected it as a case of Congenital Dyserythropoietic anaemia type II.

Oral Malodor: A Review

VANDANA K.L., SRIDHAR A.,

Breath malodor is a condition that health and social implications. The origin of oral malodor problems are related to both systemic and oral conditions. This paper provides a comprehensive review of the etiology of breath odor, its prevalence, diagnosis and treatment strategies for this condition.

Chemotherapy In Advanced Non-Small Cell Lung Cancer: A Review

JOSHI S C*, PANT I**, SHUKLA A N***, KHAN F A****

Treatment of advanced non small cell lung cancer (NSCLC) has been a challenge for oncologists in the past two decades. Meta-analysis conducted decade determined that cisplatin based chemotherapy prolonged survival in advanced NSCLC. Since then various combinations of cytotoxic agents like gemcitabine, docetaxel, paclitaxel and vinorelbine with either cisplatin or carboplatin have made undeniable gains in survival rates among the patients with advanced NSCLC and this has been confirmed by various randomized studies between 1991 and 2001. This article gives a critical appraisal of published data related to chemotherapeutic approaches for advanced NSCLC including a recent meta-analysis which aims to quantify the treatment effect of gemcitabine plus platinum agents in advanced NSCLC using randomized clinical trials. The evidence suggests an improvement in progression free survival for gemcitabine-platinum compared to other agents. Some encouraging data about various targeted therapies (Eroltinib and Gefitinib) in advanced NSCLC has also been discussed.

Evidence Based Periodontal Therapy- A Review

NILIMA S *, VANDANA K.L

With regard to dentistry, these are indeed the best of times. We have available materials and techniques that visionaries could only dream of 25 years ago. We can predictably replace missing teeth with implant-supported prosthesis, regenerate tissues lost to disease and trauma. Yet as our profession hurdles ahead these are also the worst of times. The new technologies are so enamoring that the collective common sense is lost. This paper attempts to review the periodontal therapy and evidence based approach.

Effect of Treatment of Periodontitis on C-reactive Protein, Tissue Plasminogen Activator and High-serum/Low Density Lipoprotein in Cholesterol: A Pilot Study

RAI B, KHARB S, ANAND SC

Background: Periodontitis is associated with elevated levels of C-reactive protein (CRP), tissue plasminogen activator (tPA) and low density lipoprotein cholesterol (LDL-C), recently postulated as coronary heart disease or cardiovascular disease risk factor. Material and Methods: (CRP), (tPA) and (LDL-C) levels were measured in 12 patients (7M:5F) with periodontitis, before and after treatment (scaling and root planning). Results: Periodontal treatment significantly decreased CRP, t-PA and LDL-C levels in these individuals, and it may thus decrease their CHD risk.

Medical Practice in the new millennium

SHANKAR PR, BISWAS R

Can Medical Humanities Take Root in Asia?

SHANKAR P R

Medical humanities are a diverse group of disciplines. Literature, arts, music, drama, films, bioethics, medical anthropology, philosophy of medicine, history of medicine and medical sociology has been included in the group of medical humanities. Asia is a huge continent and has the largest number of medical schools in the world. Recently, many new medical schools have been opened, predominantly in the private sector. English is the language of instruction in many medical schools. Medical Humanities, as a discipline, is most developed in the United States of America. Strong programs also exist in the United Kingdom, Switzerland, Norway and Sweden. In Asia, the University of Tel Aviv in Israel conducts a course in “The philosophy of medicine”. In the west, there has been strong support for Medical Humanities at an administrative level. A variety of methods are used to teach the subject, and learning is fun and is interesting. A number of journals publish articles related to Medical Humanities. Online journals and blogs make publishing easy, and online databases serve as a repository of material. In Asia, the traditional hierarchical structure of the student-teacher relationship may be a problem towards widespread adoption of interactive, small-group learning. This is however, changing. English being the language of instruction, and lack of division of the medical curriculum into core areas and electives, may also be a problem. Interdisciplinary learning is not well developed. Voluntary modules offered to interested students can create a case for introduction of the humanities in the curriculum. The humanities will be helpful towards creating more ‘humane’ doctors.

Manipal In Nepal, Twelve Years On: Lessons Learned And Relearned

Shankar PR

The Manipal College of Medical Sciences, Pokhara, the first medical college in the private sector in Nepal was started in 1994. The college has included retired teachers and officials from the services in the team. Most activities have been linked up with teaching and training and the college has joined hands with local service clubs and other organizations for service delivery. The institution maintains a close relationship with the local community and rewards team members who stay longer. The college is trying to attract Nepalese faculty and to adapt its curricula and training to the healthcare needs of Nepal.

Need to estimate the prevalence of persistent/chronic diarrhoea in children living in vulnerable communities in north India

GARG P

Ischiopagus Tetrapus Conjoined Twins

GHRITLAHAREY R K

Resistance Pattern Of Pseudomonas Aeruginosa Isolates From Surgical Wounds

GARG R, GUPTA V, AGGARWAL A

Nepal’s quest for health

SHANKER PR