International Journal of Health and Clinical Research

Candidemia in intensive care units and their antifungal susceptibility pattern

Wed, 26 Apr 2023 00:00:00 +0000

Candida species are the commonest opportunistic fungal infections worldwide. The most common Candida species causing infection is Candida albicans. Candidemia is described as presence of candida species in bloodstream. It is a fatal fungal infection with mortality ranging from 35% to 75%. In ICU patients, the incidence varies from 0.24-34.3 patients per 1000 ICU admissions according to western literature. Antifungal susceptibility testing is a tool of increasing importance in clinical microbiological labs. The goal of AFST is to produce MIC values that may be used to guide patient therapy. Objective: Candidemia in intensive care units and their antifungal susceptibility pattern. Materials and Methods: Blood specimens from clinically suspected cases of BSI were processed by conventional blood culture or automated blood culture system as per availability. Blood from the bottles was subcultured on Sabouraud Dextrose Agar, antifungal susceptibility was performed on Candida isolates against antifungal drugs by broth microdilution. Results: A total of 1816 patients of suspected BSI were admitted in the ICUs during the study period. 75 of these samples were positive for growth of Candida species. Candidemia among males and females was almost equal. Commonest non-albicans species isolated were C. tropicalis. Posaconazole and flucytosine are the two most susceptible antifungal drugs for all the isolated candida species. Conclusion: Antifungal susceptibility plays an important role in targeted therapy of infection caused by common and uncommon Candida species. This will help to prevent emerging antifungal resistance and thereby reduce patient morbidity and mortality.

Factor Affecting Visual Recovery in Pitutary Adenoma

Harshit Agrawal, Aditya Shrivastava, Ashish Mathur — Wed, 26 Apr 2023 00:00:00 +0000

Introduction: Pitutary adenomas account for 10-15% of all brain tumours, it is the third most frequently diagnosed brain tumour .The growing of pituitary tumors may compress the surrounding structures especially optic nerve, cause visual field defects including bitemporal hemianopia , visual disturbance. Aims and objective: To estimate the effect of factors affecting visual recovery in pituitary adenoma .Materials and method: this is a prospective, observational study will be conducted on patients of pituitary tumour admitted between January 2020 and January 2022 in the department of Neurosurgery at the G. R. Medical College &J.A. Group of Hospitals, Gwalior(M.P.) Result & Conclusion: In our study 46.7% patients have duration of symptoms < 6 months and 6/6 - 6/24 visual acuity was present in 73.3% patients & 13.3% had optic atrophy(primary/secondary), 43.3%patients had bi-temporal hemianopia. In our study Suprasellar extension was present in 90% of patients & Vascular invasion was seen in 26.7% of patients. Good results are seen in patients who have a lesser duration of symptoms, and good pre-operative visual acuity has improved the final visual outcome

Factor Affecting Recovery of Cauda Equina Syndrome in Patients With Prolapsed Lumbar Intervertebral Disc

Mohammad Moeen, Aditya Shrivastava, Ashish Mathur — Wed, 26 Apr 2023 00:00:00 +0000

Introduction: Cauda equina syndrome is a neurological condition characterized by severe low back-pain, saddle anaesthesia, bowel and bladder dysfunction, sexual dysfunction and neurological deficit in lower limb. Aims and objective: To study the clinico-pathogenesis, Factors affecting the outcome and To assess the impact of early and delayed decompression of prolapsed lumbar intervertebral disc on the recovery of caudaequina syndrome. Materials and method: A prospective study was carried out on patients presenting with clinical features of caudaequina syndrome. Patients presenting with clinical feature of caudaequina syndrome and giving consent for surgery will be admitted in Department of Neurosurgery, J.A. group of hospitals, G.R. Medical College, Gwalior (M.P.), over a period of 24 month (from December 2017 to November 2019). Results & Conclusion:. Cauda Equina Syndrome is a serious surgical condition, Early diagnosis and surgical decompression within 48 hours of onset of bladder dysfunction in CES-I can prevent further neurological damage to bladder dysfunction and also prevent deterioration to complete CES.

To Study the Importance of Electrocardiographic and Echocardiographic Findings in Patient of Chronic Kidney Disease with Special Reference to Lipid Profile

Pramod Singh Yadav, Kanika Sethi, J.S. Namdhari, Ramavtar Rawat, O.P. Jatav — Wed, 26 Apr 2023 00:00:00 +0000

Introduction: Dyslipidemia is one of the most common complications of chronic renal failure (CRF) reflected even in the early stages of CRF and usually parallels the deterioration in renal function. As a consequence, dyslipidemia as a risk factor in CKD progression should be explored and documented more. dyslipidemia in CKD patients may actively participate in the progression of cardiovascular disease (CVD) and in the deterioration of kidney function. In the general population, dyslipidemia is a known risk factor for CVD but the relationship of dyslipidemia as a risk factor in CKD progression should be explored and documented more. One of the most important pathophysiological mechanisms for CVD in patients with CKD is the widespread and possibly accelerated formation of atherosclerotic plaques due to hyperlipidemia, uremic toxins, inflammation, oxidative stress, and endothelial dysfunction. Recent studies showed that the level of oxidized low-density lipoprotein (LDL) cholesterol increases and high density lipoprotein (HDL) cholesterol dysfunction occurs as kidney function declines and inflammation becomes more pronounced. Aim & Objective: To study the pattern of involvement of cardiovascular system in CKD patients. Correlation of ECG and ECHO findings in hemodialysis and nonhemodialysis patients. To compare the lipid profile in chronic kidney disease patients with and without hemodialysis. Methodology: A detailed clinical history and physical examination will be done and findings will be recorded. All the patients in the study will be subjected to biochemical tests like, CBC, renal function tests, and ultrasonographic examination of abdomen to confirm the presence of end stage renal disease and to assess echocardiographic findings of heart. Patients attending the I.P.D. of General Medicine Subjects meeting the inclusion criteria shall be selected. Haemodialysis Patients Nonhaemodialysis Patients ECG, Lipid profile. Results: Among CKD patients with hemodialysis, most common ECG abnormality was LVH (n=38), followed by ST changes (n=26), 18 patients had QTc prolongation and P-mitrale or p- pulmonale and 8 patients had tall T wave. Out of 46 hypertension patients of CKD patients without hemodialysis, 24 had LVH in ECG while out of 71 hypertension patients of CKD patients with hemodialysis, 28 patients had LVH in ECG. This correlation between hypertension and LVH in CKD patients with and without hemodialysis came out to be statistically insignificant with chi square value 0.058 (with yates correction) and p value 0.81. Conclusion: CKD patients should undergo baseline and regular electrocardiography to screen for cardiovascular diseased as the earliest so that early intervention can be done. Echocardiography is better the electrocardiography in detecting LVH because LVH was detected in 46.3% CKD patients via echo while LVH was detected in 41.2% CKD patients via ECG. ECG showcases the heart's electrical system, whereas ECHO showcases the heart's mechanical system for further investigation and planning of the respective patient's treatment.

Thyroid Dysfunction in Cirrhosis of Liver and Its Correlation with Severity of Liver Cirrhosis

Sudhanshu Sharma, Sushma Trikha, Neelima Singh — Wed, 26 Apr 2023 00:00:00 +0000

Background: The liver plays an important role in thyroid hormone metabolism and action. Liver cirrhosis leads to impairment of liver functions, including thyroid hormone metabolism. Aims and Objectives: To study thyroid dysfunction in patients with liver cirrhosis and its correlation with the severity of liver disease. Materials and Methods: Ninety-six in-hospital patients with liver cirrhosis were studied. Detailed history and physical examination were done as per a pre-fixed proforma. Relevant hematological, biochemical, and radiological investigations were done to assess thyroid function and liver cirrhosis. The severity of liver cirrhosis was judged by the Child Pugh score. Results: The prevalence of hypothyroidism in chronic liver disease was found to be 33.3% (32/96), with 27.1% (26/96) of patients having subclinical hypothyroidism, 3.1% (3/96) for primary hypothyroidism and sick euthyroid each. Most of the participants were in the age group of 41-59 years. Out of them, 78.1% were males, while 21.9% were females. There was a significant correlation between hypothyroidism and the severity of liver disease (p-value 0.001). Sixteen cases of subclinical hypothyroidism belonged to Child Pugh C, while ten belonged to B. No thyroid abnormality was seen in Child Pugh A category. Also, levels of serum albumin and T3 were also showing a statistically negative correlation with the severity of liver disease with p-values of 0.005 and <0.001, respectively. Conclusion: The prevalence of hypothyroidism in liver cirrhosis was found to be 33.3% with subclinical hypothyroidism being the most common. There was a significant association of hypothyroidism, low serum albumin, and low T3 levels with the severity of liver disease. Therefore, all patients with liver cirrhosis should be evaluated for thyroid function test to prevent the development of overt hypothyroidism and also to use thyroid function tests as a marker of liver disease severity.

Prognostic Study of Aluminium Phosphide Ingestion Patients and Their Correlation with Cardiac Manifestations On The Basis of ECG Abnormality

Santosh Singh Yadav, Archana Gupta, Sanjeev K. Dharmesh — Sat, 29 Apr 2023 00:00:00 +0000

Introduction: Mortality due to Aluminium phosphide ALP ingestion is very high (37-100%) and is directly related to freshness of tablet, dose of pesticide consumed and delay in institution of treatment etc. Death is mainly due to cardio toxicity, development of ARDS, non-responsiveness of shock to resuscitative measures, lack of an antidote and subsequent development of complications like acute massive GI bleed, acute respiratory arrest, acute CHF, DIC etc. Aim & Objective: To Study the ‘Clinico investigatory’ findings in Aluminium phosphide ALP poisoning. Assessment and correlation of ECG findings with the survival of these patients. Methodology: Patients of age group > 18 years and both sexes, who fulfilled criteria of patient's selection, will be taken into consideration. Results: Majority of victims were young patients in struggling phase of life as study, career and family matters between age range of 14-30 years and males & females ratio was 1.9:1 predominantly males.Majority of patients consumed one exposed tablets of Aluminium phosphide poisoning. Shock was the cardinal manifestation in majority of the patients. Tachycardia, cold clammy skin, mid pupillary dilatation with sluggish pupillary reaction and chest crepitations were the next common physical signs. Various ECG abnormalities recorded on the third day were the sinus tachycardia (10/77), non specific ST-T changes (00), low voltage complex (10/77) and RBBB in 06/77 cases. Conclusion: Thus, it can be concluded from the present study that Aluminium phosphide is cardiotoxic in 100% cases as evident from various changes in ECG recording an ECHO confirmed this and evident of focal carditis and wet pericarditis was evident. It is further stipulated that toxicity of conduction system of heart are more prominent than the myocardium.

Effects of Hyponatremia in Patient with Acute Coronary Syndrome

Sanjeev Kumar Dharmesh, Archana Gupta, Santosh Singh Yadav, Kanha Gupta — Sat, 29 Apr 2023 00:00:00 +0000

Introduction - Hyponatremia mostly occur very common in acute coronary syndrome and it is a bad prognostic indicator in patients with acute coronary syndrome. Also hyponatremia is a single independent predictor of adverse clinical outcomes on mortality in hospitalized patients due to severe heart failure1. In these patients with acute coronary syndrome hyponatremia has been related to the non-osmotic release of ADH, activation of RAS and then leading to catecholamine production. Coronary artery disease is the world’s most important cause of death. Electrolyte imbalance is common in hospitalized patients, especially in patients with heart failure. Hyponatremia is also common after myocardial infarction which increases the mortality and but there is very much clinical improvement followed by a rise in plasma Sodium at concentration. Hyponatremia is defined as plasma concentration of <135 mEq/L. Aim & Objective - To study the effects of hyponatremia in patients with acute coronary syndrome, To analyse prognostic significance of hyponatremia in patients with acute coronary syndrome. To access usefulness of hyponatremia in predicting short term mortality. To find association between hyponatremia and other risk factor like Ejection fraction, Hypertension, diabetes mellitus, type of infarction. Methodology - Prospective study, Study population: 105 patients admitted as acute coronary syndrome. Inclusion criteria: 100 clinically diagnosed cases of acute coronary syndrome. Patients with chest pain > 20 min and ST segment elevation in ECG. Exclusion Criteria: Patients with renal failure, Diabetic patients, Acute and chronic liver failure, COPD patients on beta agonists. Results - Acute coronary syndrome is an important cause of mortality and morbidity in the world. 105 cases of acute coronary syndrome was selected in our study conducted in Gajraraja Medical College, Gwalior, from 2020 to 2022 and was found that hyponatremia was a major prognostic factor in acute myocardial infarction. In my study middle aged population >40 years age are at more risk to developing coronary artery disease. It is relatively a small proportion of all MI. Studies show that 900 people under the age of 30 die every day from heart disease in India. Many risk factors like psychological stress, cocaine use, alcohol, APLA, family history, OCP, hypercoagulable states, etc have been attributed to the cause. In my study, the incidence of male and female were 81 and 24 respectively among the 105 patients. Hyponatremia is well known that it is a serum Sodium at level <135 mEq/L. The severity of hyponatremia was defined as mild(130-135mEq/L) and moderate to severe (<130mEq/L). Serum Sodium at levels were documented as follows: baseline measurement at the day of admission, the lowest Sodium at level during hospitalization i.e after 48 hrs of admission and during discharge. Conclusion - On concluding hyponatremia has significant prognostic value in short term and long term adverse events in patients diagnosed with ACS. It is a single predictive factor for prognosis of Acute Coronary syndrome. Prognosis worsen with increasing severity of hyponatremia. As seen in the study, mortality rate was higher with hyponatremia patients, both at admission and discharge. Among the patients in my study hyponatremia was more common in the 6th decade without any previous illness like diabetes mellitis, chronic kidney disease heart failure. The common cause of hyponatremia was ruled out of which acute myocardial infarction was the only cause for hyponatremia in the study population.

A Study on Non-Endoscopic Predictors of Esophageal Varices in Patients With Chronic Liver Disease - A Prospective Study

Althesnie SS, Ajay Pal Singh, Rohit Rawat — Sat, 29 Apr 2023 00:00:00 +0000

Background: Esophageal varices are a serious consequence of portal hypertension in patients with liver diseases. Non-invasive markers of esophageal varices helps to reduce unnecessary endoscopies in patients with cirrhosis. Aims and Objectives: To evaluate various clinical, biochemical and ultrasonographic parameters in predicting the presence of large esophageal varices. Materials and Methods: Ninety-four in-hospital patients with chronic liver disease were studied. Detailed history and physical examination was done as per pre-fixed performa. Relavant haematological, biochemical and radiological investigations were done to confirm chronic liver disease and to record spleen diameter, portal vein diameter and ascites. Screening for esophageal varices was done by upper GI endoscopy. The severity of liver cirrhosis was judged by the Child Pugh score. Results: The prevalence of large esophageal varices was found to be 45(47.9%). 69 (73.4%) of the participants were male and 25(26.6%) were female with mean age 45 years. Alcohol was the most common etiology found. Ascites, hepatic encephalopathy, Child-Turcotte-Pugh score, low platelet count, serum bilirubin, PT/INR, spleen diameter and portal vein size were found statistically significant (p value<0.001) in univariate analysis in predicting the presence of large esophageal varices. However on multivariate analysis, low platelet count, splenomegaly and portal vein diameter found to have independent predictive value (p value<0.001). Conclusion: Low platelet count, splenomegaly and increased portal vein diameter were found to be the independent predictors of large esophageal varices in chronic liver disease patients. Hence using these noninvasive predictors for the detection of esophageal varices seems to be more cost effective than the “scope all strategy”. This may help reduce the cost and discomfort for patients and the burden on endoscopy units.

Prospective Study of Renal Impairment in Stroke Patients

Manoj Tataware, Archana Kansal, Arvind Gupta, Sushma Trikha, Kanika Sethi — Mon, 01 May 2023 00:00:00 +0000

Introduction Renal impairment is commonly seen in stroke patients. more common in hemorrhagic strokes. In stroke patient renal impairment is transient so required renal replacement therapy is rarely. e-GFR decreased <40mL/min the risk of symptomatic stroke in the general population more 3.1 times. Aim & Objective: Study of renal impairment in stroke patients, To compare the renal impairment between hemorrhagic and ischemic stroke. Methodology: The study comprised 100 patients admitted in Department of Medicine, J.A. Group of Hospitals. A detailed clinical history and physical examination will be done and findings will be recorded. Renal function testing was performed in hospitalized stroke patient. Serum urea and creatinine were evaluated on alternate days throughout their hospital stay, and the e-GFR was calculated. Results: All participants were having normal Renal USG. Low eGFR< 60mL/minute per 1/73m2 was found significantly higher in CVA Hemorrhage 25 (75.8%) in comparison to CVA Infract 23 (34.3%). Outcome was statistically insignificant between CVA Hemorrhage (6%) and CVA Infract (3%) group. Conclusion: Decrease eGFR < 60mL/minute per 1/73m2 was found in 48 participants out of 100 participants significantly higher in CVA Hemorrhage 25 (75.8%) in comparison to CVA Infract 23 (34.3%) (p value <0.001).

"Primary Etiological Profile of Hospitalized Patients with Documented Episode of Hypoglycemia"

Mon, 01 May 2023 00:00:00 +0000

Background: Glucose is a major fuel source for body tissues. Plasma glucose concentrations are maintained between 70 to 110 mg/dl in the fasting state. Homeostasis is maintained by stimulating counter hormone response and suppressing insulin secretion during hypoglycemic episodes. Any derangement in homeostasis can cause hypoglycemia. Objectives: To investigate, identify, determine and analyze the incidence of primary etiological profile of hospitalized patients. Material and Methods: Patients admitted in the General Medicine wards who had at least one episode of documented hypoglycemia i.e less than 70mg/dl and age >=18 years were included and observed over a period of 24 months i.e November 2019 to November 2021. The data obtained was analyzed statistically by using chi square test. Results: In present study of 119 patients 90 were male and 29 were females. Diabetes with Chronic Kidney Disease was found to be the most common primary diagnosis. As we analyze the presence of risk factors in hospitalized hypoglycemic patents, it was found that as the number of risk factors in a patient increases, chance of succumbing to them also increases. In the category of patients having 3 or more risk factors, the death rate was 15 out of 42 which is 35.71%. Conclusion: Hypoglycemia needs to be investigated thoroughly to know the causative factor and should be treated appropriately. Hypoglycemia is an important predicting factor of mortality in cases of heart failure and sepsis.

An Epidemiological Study of Oral Cancer Patients Attending Tertiary Health Care Centre

Manoj Kumar Yadav, Dheeraj Kumar Yadav — Fri, 05 May 2023 00:00:00 +0000

Background: oral cancer is the most common cancer in India; amongst men (16.1%) while in women it is the fourth most common cancer (4.6%). Oral squamous cell carcinoma (OSCC) has been defined by WHO as a carcinoma with a squamous differentiation arising from the mucosal epithelium. Tobacco is addictive and is harmful to health in many ways. Smokeless tobacco includes betel quid with tobacco, pan masala, mainpuri tobacco, mawa, gul, tobacco with slaked lime(khaini) etc. Gutka chewing is the most and popular form of smokeless tobacco used in India. Material and methods: This prospective analytical study conducted at Department of Community medicine, Shree Narayan Medical College & Hospital, Saharsa, Bihar after approval from Thesis & Ethical Committee from Dec 2021 to Nov 2022 on 63 oral cancer patients. These 63 patients were collected from our medical college and hospital and multiple clinics of Surgery and ENT from Saharsa district and Purnea district. Permission from Surgery and ENT clinics was taken for the present study of diagnosed cases of oral cancer. Results: Most number of patients belongs to > 60 years’ group i.e., 24 (38.09%). Based on gender most common were male i.e., 46 (73.02%), According to distribution of patients with respect to occupation, most of them belong to Clerical and skilled category i.e., 15 (23.81%). Most number of studied patients were having cancer site- Tongue i.e., 16 (25.40%). Most common presenting symptom in studied patients was painful oral ulcer i.e., 50 (79.37%). Out of 63 cases, 10 (15.87%) cases were diagnosed as well differentiated SCC, 48 (76.19%) cases were diagnosed as moderately differentiated SCC and 05 (07.94%) cases were diagnosed as poorly differentiated SCC. Conclusion: Early Oral SCC discovery not only improves survival rates but also lessens the necessity for deforming procedures. Unfortunately, because up to 50% of patients already have local or distant metastases at the time of diagnosis, early detection of oral malignant lesions has proven challenging. Only a small number of cells or discrete regions of tissue are affected by the malignant change at the start of carcinogenesis.

Prospective Study of Metabolic and Electrolyte Disturbances in Patients with Chronic Kidney Disease

Rohit Rawat, Sushma Trikha, Althesnie SS, Neelima Singh — Fri, 05 May 2023 00:00:00 +0000

Background: Kidneys play a critical role in regulating body fluids, electrolytes and acid base balance. CKD can lead to metabolic as well as electrolyte disturbances that can result in serious adverse outcomes. Aim & Objective: To study metabolic and electrolyte disturbances in CKD patients and its correlation with GFR. Materials and Method: 100 patients of CKD were studied. Detailed clinical history and physical examination were done as per pre-fixed Performa. Relevant hematological, biochemical, radiological investigations were done for assessing renal function. Staging of CKD was done with GFR. Results: Mean age of study participants was 43 years out of them 70% were males. All the study participants were anemic out of them 28% severely, 51% moderately and 20% mildly anemic. Majority of study participants belonged to G5 category of GFR. Among electrolytes only serum sodium was found significantly associated with GFR (p value- o.oo2). Among metabolic parameters low triglyceride levels was significantly associated with GFR (p value-0.009). Conclusion: CKD patients are more prone to develop metabolic as well as electrolyte disturbances. Hence, every CKD patient should be screened for any such disturbances. Although studies on this regard is still lacking and we need further study for better understanding and management, as early screening can defer early morbidity and mortality. Therefore, serum electrolyte as well as metabolic disturbances to be included as one of the first line investigations in patients with chronic kidney disease.

Covid-19 associated coagulopathy with comparison of platelet parameters, PT, aPTT and D-Dimer in ICU and Ward patients

Padhiyar Khyati, Thesia Raj, Shah Bhagyesh, Gidwani Roopam K — Wed, 10 May 2023 00:00:00 +0000

Background: SARS-COV2 is the third known corona virus responsible for fatal respiratory illness in humans. Emerging evidence suggested that severe COVID-19 may be complicated with coagulopathy. These coagulation parameters help in assisting the prognosis of the disease and in optimization of its clinical monitoring. Aims: To assess and compare the coagulation parameters (platelet parameters, PT, aPTT, D-dimer) amongst ward and ICU patients of COVID-19 disease. Settings and Design: The present study was Analytical Cross-Sectional Study. Materials and Methods: This study included 220 COVID-19 positive cases (110 ICU and 110 Ward) at a tertiary care hospital. Tests were done for platelet parameters, PT, aPTT and D-Dimer in ICU and Ward patients. Statistical analysis used: The presentation of the Categorical variables was done in the form of number and percentage (%). The quantitative data were presented as means ± SD and as median with 25th and 75th percentiles (interquartile range). Results: In this study, we compared coagulation parameters (Platelet count, PT, aPTT, D dimer) of 110 ICU and 110 Ward covid-19 patients. We found that PT, aPTT, platelets, PDW cv and PCT between Covid ICU and ward patients had no significant difference (p value>0.05). Patients admitted to ICU had higher D-dimer level and decreased platelet count. There was clear significant difference in levels of D- dimer, platelet count and MPV between two groups (ICU and ward, p value<0.05). Conclusion: It is clear that alterations in the coagulation parameters in COVID-19 patients are strongly disturbed and signify the disease progression, severity and mortality.

Formulation and Evaluation of Rapid Dispersible Tablets of NSAIDS using Co-Micronisation Method

Azharuddin, Abhay Gupta, Mukesh Kumar Gupta — Wed, 10 May 2023 00:00:00 +0000

The objective of the present study was to develop a pharmaceutically active, stable, safe, cost effective and quality improved formulation of NSAIDS. Rapid Dispersible Tablets are an alternative to swallowing tablets, since they are made with a unique composition that dissolves rapidly in water to create a drinkable solution. As soon as a pill makes contact with the fluid, it begins to disintegrate. Next, the granules begin to de-aggregate, or break down into smaller, fundamental particles than they were originally. Less than three minutes is ideal for the RDT's rate of dispersal or disintegration. Superdisintegrants such as carboxymethyl cellulose, polyvinyl pyrrolidine, and sodium starch glycolate are crucial to the RDT development process. Solubility of drug is the basic factor which controls the release profile of the finished product. Particle size reduction or Co-Micronization (e.g. by high pressure homogenization) might also increase the saturation solubility of a drug, further enhancing the dissolution rate. The purpose of this study was to create a fixed-dose combination formulation for the efficient management of migraines. Co-micronization was used to enhance the release profile of tolfenamic acid.