ORIGINAL RESEARCH ARTICLE | Dec. 17, 2021
Clinical Profile of Peripartum Cardiomyopathy
Dr. Shish Mohammad Sarkar, Dr. Julekha Khatun, Dr. Mohammed Mirazur Rahman, Dr. Ahmed Imran Kabir, Dr. Md. Sohel Rana
Page no 401-409
Background: Peripartum cardiomyopathy (PPCM) is an uncommon illness of uncertain aetiology that arises between one month antepartum and five months postpartum in women without preexisting cardiac disease. This condition is associated with certain demographic features. There is no data on PPCM prevalence or risk factors in Bangladesh. Clinical characteristics and risk factors for PPCM are the focus of this investigation. Objective: A description of the symptoms and signs associated with Peripartum Cardiomyopathy and to find out the risk factors (advanced age, multiparity, multiple gestation, obesity, preeclampsia and chronic hypertension). Materials and Methods: This was an observational cross-sectional study, carried out in Department of Medicine, Cardiology, Gynecology and Obstetrics of Rajshahi medical college hospital, Rajshahi during the period from 01 June 2015 to 30 November 2015. A total n=30 patients meeting selection criteria were included in this study. Results: Total 30 patients were included, 17(56.7%) primigravida and 13(43.3%) patients were multigravida. Nine patients (30%) presented during pregnancy and 21(70.0%) after delivery. All patients presented with heart failure and three (6.7%) were complicated with ventricular tachycardia (VT) at presentation. LV systolic dysfunction was present in all (100%) patients. Two patients had LV clot, and thromboembolic stroke occurred in another 3 patients. Echocardiography was repeated after 2 months and in 22(73.3%) patients LV functions recovered to near normal. All patients were discharged in stable condition. Conclusion: Peripartum cardiomyopathy is a disease in which predominantly left ventricular dysfunction occurs in the peripartum period in previously healthy woman. Advanced maternal age, low socioeconomic status, elderly primi gravida and previous abortion play as major risk factors. The clinical course varies between complete recovery to end stage heart failure. Women presented early with moderate left ventricular dysfunction show a very good outcome.
ORIGINAL RESEARCH ARTICLE | Dec. 22, 2021
Study of Serum Magnesium, Calcium and Phosphorus Levels in Subclinical and Overt Hypothyroidism
Sharmin Akter, Mohammad Maruf Reza, Md. Rezaul Alam
Page no 410-413
Background: Hypothyroidism is one of the most common forms of hormonal dysfunction resulting from deficiency of thyroid hormone or its impaired activity. Various electrolyte and mineral disturbances have been observed in many studies. The role of thyroid hormones on mineral metabolism and its complications have not been established. Objective: To assess the alterations in the levels of serum magnesium, calcium and phosphorous levels in subclinical hypothyroidism. Materials and Methods: A descriptive case control study was done with a total 100 subjects in the department of Internal Medicine, Rangpur Medical College Hospital, Rangpur, Bangladesh from January 2008 to December 2008. 25 subclinical hypothyroidism cases, 25 overt hypothyroidism cases and 50 controls were taken. Blood sample for analyzing serum free T3, free T4, TSH, calcium, magnesium and phosphorus was taken and estimated in all subjects. Results: In this study the mean age of hypothyroidism (subclinical and overt) cases was 35.46 ± 7.26. A significant hypocalcaemia (P = 0.002) was observed in cases with overt hypothyroidism and a significant (P = 0.01) hyperphosphatemia was observed in cases with subclinical hypothyroidism. Conclusion: The present study showed a significant hypocalcaemia in overt hypothyroidism cases than controls and showed significant hyperphosphatemia in subclinical hypothyroidism. It can be concluded that there are various electrolyte disturbances in both subclinical and overt hypothyroidism, hence such disturbances need to be monitored prospectively to avoid further complications and needs to be treated accordingly.
ORIGINAL RESEARCH ARTICLE | Dec. 22, 2021
Awareness Regarding Hepatitis C among Dental Students in Bangalore, India: A Cross-Sectional Survey
Manish Kumar, Shafi Ahmad, Rajkumari Surbala Devi, Kundan Shah, Aruna CN, Raj Kumar Jha, Divya Jyoti
Page no 414-418
Background and Objective: Hepatitis C virus infection is a major cause of chronic liver disease and cirrhosis. The infection is transmitted by exposure to blood or body fluids. Since dental healthcare professionals have numerous patients and are exposed to blood, they are likely to have the maximum risk. The present study was conducted to assess the level of awareness and knowledge of Hepatitis C among third year and fourth (final) year dental students of various dental colleges in Bangalore city, Karnataka, India. Materials and Methods: A descriptive cross-sectional study was conducted among 400 students studying in third year and fourth (final) year in various dental colleges of Bangalore city. A close-ended structured questionnaire was administered which contained 11 questions. The responses were analyzed to evaluate the level of awareness regarding Hepatitis C, its mode of transmission, steps to prevent infection, associated complications and status of availability of vaccine against HCV. Results: The results of our study revealed that most of the students (72.5%) were aware of Hepatitis C vaccine but have less knowledge in terms of its mode of spread of infection, steps to prevent spread of Hepatitis C infection, associated complications and status of availability of vaccine against Hepatitis C virus. Conclusion: The present study shows that the students had poor level of awareness regarding Hepatitis C indicating need for education about HCV infection among dental students.
CASE REPORT | Dec. 24, 2021
A Case Report- Therapeupic Plasma Exchange in a Case of Alcohol Induced Acute On Chronic Liver Failure
Amarnath Pandey, Gita Negi, Rohit Gupta, Ajay Kumar, Sujay Kumar Das
Page no 419-421
A Case Report: A 26 year old, male admitted under Department of Gastroenterology, AIIMS Rishikesh with complaint of Jaundice since 25 days associated with fatigue & malaise. Patient also complained of gradual abdominal distention with pedal edema & decrease in urine output for 3 days & altered sensorium for 1 day. Patient was a chronic alcoholic consuming 100gms/day for 18years. Initially, on admission patient had stable vitals but increased prothrombin time, with raised serum bilirubin (44mg/dl). Serum electrolytes on admission were also altered. Patient was managed with TPE along with diuretics, antibiotics, steroids & protein supplements. 5 TPE procedures were done every alternate day with Fresh Frozen Plasma & 4% Albumin as replacement fluids. In this case, prothrombin time and serum bilirubin improved significantly after 5th procedure. Urine output and sensorium were also improved. Patient was discharged from the hospital with improved clinical symptoms and stable vitals.
ORIGINAL RESEARCH ARTICLE | Dec. 26, 2021
Fetal Growth Pattern Based on Fetal Sonographic Biometry
Dr. Bhavesh Dubey, Dr. Yogendra Pishorilal Sachdev, Dr. Ravindra Kawade, Dr. Ganesh Vikhe, Dr. Manohar Pravin Sachdev, Dr. Kalyan Prasad TV
Page no 422-427
Background: Fetal biometric measurements of different anatomical structures are valuable in radiological and obstetric practice for the estimation of gestational age, assessment of intrauterine growth and differentiation of normal from abnormal fetuses. Birth weight estimation also depends on different fetal biometric measurements and has tremendous value for neonatal management in terms of appropriate time of delivery, specific obstetric interventions and delivery under intensive neonatal care support. Material and methods: Present study was a descriptive study carried out on 500 pregnant women coming to OBGY department were referred to department of radiodiagnosis for antenatal ultrasound for the first time or for follow up scan were enrolled for the study. Results: On outcome of disease, 65% had AGA, 17% had IUGR and 18% had SGA. Mean gestational age in weeks among SGA was 37.97+1.66, IUGR was 35.03+1.18 and AGA was 38.01+1.76. Mean EFBW among AGA was 2954.7+343.5, among IUGR 2390.11+245.9, and SGA was 2546.44+242.5. p value showed high statistical significance. (p<0.0001). Conclusion: Ultrasound biometry is the gold standard for assessment of fetal size. Fetal weight less than 10th percentile for gestational age is mostly used to diagnosis SGA and IUGR but other criteria like elevated HC/AC ratio, elevated FL/AC ratio, and presence of oligohydramnios without ruptured membranes, presence of advanced placental grade can also be used for improving the accuracy of diagnosis.
ORIGINAL RESEARCH ARTICLE | Dec. 26, 2021
Whole Body Mr-Dwibs vs. [18F]-FDG-PET/CT in Oncology Patients Coming to Pravara Rural Hospital, Loni
Dr. Prerna Ajwani, Dr. Yogendra Pishorilal Sachdev, Dr. Ganesh Vikhe, Dr. Manohar Pravin Sachdev
Page no 428-434
Background: Over the past twenty years, advances in our understanding of tumour biology have led to the development of improved treatment strategies for many cancers. As a result, many patients are living longer with metastatic disease and the incidence of metastasis is continuing to rise. Based on post-mortem findings, approximately 70% of patients with breast or prostate cancer have bone metastases. Commensurate with the increased prevalence of bone metastasis, there is potential for significant comorbidities such as pain, limited mobility, hypercalcaemia, spinal cord or nerve root compression, myelosuppression and pathologic fracture. Therefore, early detection of skeletal metastasis is critical for accurate staging and optimal treatment; to allow the implementation of treatment strategies such as surgical fixation, radiotherapy, or bisphosphonate therapy to reduce the risk of complications and improve quality of life. Material and methods: The evaluation of diagnostic tests was carried out on50patients in the Department of Radiodiagnosis, Rural medical college, PIMS (D.U) Loni for duration of 2 years (2019-2021). Study population included all patients referred to Department of Radiodiagnosis for DWIB to look for metastases. The ethical clearance was obtained from the Ethics Committee, Rural Medical College and Hospital, Loni. All the patients fulfilling the selection criteria were explained about the purpose of study and a written informed consent was obtained to participate in the study before enrolment. Results: In our study out of 50 patients, 29 were males and 21 females. The most common age group were of 40 to 50 yrs. The sensitivity of DWIBS was 97.87%, specificity was 100%, positive predictive value of 100%, negative predictive value of 75% and accuracy was 98% in detecting metastases. Conclusion: Present study concluded that MR-DWIBS is useful in detection of metastases in patients with a low level of suspicion and normal or nonspecific and [18F]-FDG-PET/CT finding. DWIBS is a radiological modality devoid of radiation exposure like with [18F]-FDG-PET/CT. MR- DWIBS is a particularly useful modality in diagnosing metastases due to its high specificity, and accuracy as compared to [18F]-FDG-PET/CT.
ORIGINAL RESEARCH ARTICLE | Dec. 26, 2021
Anthropometric Profile of Type II Diabetes Patients Enrolled in a Lifestyle Modification Programme in Rural Medical College
Bharat Kumar Bhoi, Deepak Phalke, Rutuja Pundkar, Jyoti Bhoi, Vidya Bhoi
Page no 435-440
Background: Diabetes promises to be the most daunting public health challenge for India in the near future. The global figures on diabetes, released by the International Diabetes Federation (IDF), have raised a serious alarm for India. India is presently home to 62 million diabetics — an increase of nearly 2 million in just one year. By 2030, India's diabetes numbers are expected to cross the 100 million marks. Aim: To evaluate the Anthropometric profile of type II diabetes patients enrolled in a lifestyle modification programme. Material and methods: Present study was a Descriptive longitudinal study carried out among 120 diabetic patients in Ahmednagar district in Western Maharashtra. All patients coming to Urban health centre and known case of type II diabetes on OHA were considered for the study. Patients were followed up upto 12 months. Baseline anthropometric measurement were noted. Age, gender, Weight, height, BMI, waist circumference, hip circumference, Waist to hip ratio were calculated. This patients were told about lifestyle modification skills like, antigravity exercises, diet, deaddiction, yogasanas etc. then they were followed up at 6 months and 12 months. Again anthropometric parameters were measured and final analysis was done. Results: The mean age was 52.60 years (SD=9.52). In present study, anthropometric parameters like weight, BMI, waist circumference, hip circumference and waist to hip ratio were observed over a period of 1 year. For this, type II diabetes mellitus patients were included in the study and change in anthropometric parameters were observed at the end of 6th month and then at the end of 12th month. Conclusion: Present study showed that lifestyle modifications play a very important role in manging the anthropometric parameters among obese/ Diabetic patients. Antigravity exercises and diet show very good impact on the physical as well as mental wellbeing of the individual. Lifestyle modifications and skills should be promoted and added as a part of standard treatment protocols in manging the Diabetic cases.
ORIGINAL RESEARCH ARTICLE | Dec. 26, 2021
“Role of Spirometry in Lung Function Assessment in Post COVID-19 Pneumonia Cases: Correlation with CT Severity, Duration of Illness, Oxygen Saturation and Ventilatory Support in Critical Care Setting in Tertiary Care Setting in India.”
Patil Shital, Uttareshvar Dhumal, Abhijit Acharya
Page no 441-448
Background: Although Lung is the primary target organ involvement in corona virus disease-19 (COVID-19), post-covid lung pathology and its impact on lung functions is still uncertain. Material and methods: Prospective multicentric study conducted during May 2020 to September 2021, to find pulmonary function assessment in post-COVID-19 recovered pneumonia cases irrespective of their symptoms, included 600 cases in symptomatic and asymptomatic group and subjected to inclusion and exclusion criteria. All cases were subjected to Spirometry analysis. Statistical analysis was done by using chi-test. Results: In Spirometry assessment of post-COVID-19 pneumonia cases at 12 weeks post discharge form hospital, abnormal lung function in 77.5% post covid-19 pneumonia cases; restrictive pattern was predominant type and documented in 43.33% cases, normal lung functions were documented in 22.5% cases. In age and gender assessment in normal and abnormal lung functions assessment, statistically significant association in males 90/150 versus females 45/315 [p<0.00001]; and in age of population in study cases as below 50 years 110/300 versus above 50 years 25/165 [p<0.0001]. CT severity score has shown negative impact on lung function after recovery at 12 weeks post-discharge; cases with score <8, 8-15 and >15 documented normal and abnormal lung functions as in 36/54, 60/80 and 39/331 respectively of total 600 study cases [p<0.00001]. Duration of illness has associated negative impact on lung function; <7 days, 8-15 days and >15 days of onset of symptoms documented normal and abnormal lung functions in 108/132, 22/168 and 5/165 cases respectively [p<0.00001]. Low oxygen saturation at entry point has negative impact on overall outcome on lung function; cases with oxygen saturation <75%, 75-90% and >90% observed as normal and abnormal lung functions in 92/18, 35/135 and 6/314 cases respectively [p<0.00001]. Timing of BIPAP/NIV has significant association in attaining normal lung functions after post-COVID19 pneumonia recovery; cases received BIPAP/NIV at entry point <1 day, 3-7 days and after 7 days of hospitalization were documented normal and abnormal lung functions in 30/150, 40/35 and 5/50 cases respectively [p<0.00001]. Conclusions: Pulmonary functions abnormality in post-COVID-19 pneumonia cases has been documented and should be assessed cautiously to have successful treatment outcome. Restrictive lung disease is the predominant lung function impairment in post-COVID 19 recovered lung pneumonia cases. Age above 50 years, male gender, Diabetes, High CT severity, longer duration of illness, proper timing of initiation of BIPAP/NIV therapy, has documented significant impact on post covid lung functions at 12 weeks assessment.
CASE REPORT | Dec. 30, 2021
Granulomatosis with Polyangiitis Presenting as Gross Hematuria Followed by Anuria
Dr. M. Aslam, Dr. Rashid K. K, Dr. D. Bhowmik, Dr. A. Husain, Dr. K. S Zafar
Page no 449-452
Granulomatosis with polyangiitis is a rare disorder characterized by the necrotizing granulomatous lesions of both the upper and lower respiratory tract and glomerulonephritis. Rapidly progressive renal failure in GPA is not an uncommon presentation and always requires urgent intervention. A 25-year-old male patient who presented with fever, hematuria, hemoptysis, and decreased urine output with an abnormal renal function was found to have high titers of anti-PR3 antibody on evaluation. His prolonged hematuria followed by an anuric state during the hospital stay improved with multiple sessions of hemodialysis, and then he was started on immunosuppressive therapy with resolution of fever based on high clinical suspicion. A dramatic improvement of ongoing gross hematuria and hemoptysis was noted following a week of immunosuppression. Progression of GPA can be prevented by early diagnosis and initiation of treatment.