scholarly journals Validity of mannheim peritonitis index in predicting outcome of patients with perforative peritonitis in a tertiary care centre Kerala, India

2019 ◽  
Vol 7 (11) ◽  
pp. 4140
Author(s):  
Alex Mathew ◽  
Joby John ◽  
Asha Sasikumar
Keyword(s):  
Likelihood Ratio ◽  
Tertiary Care ◽  
Prognostic Index ◽  
Positive Likelihood Ratio ◽  
Negative Likelihood Ratio ◽  
P Value ◽  
Care Centre ◽  
Roc Curve Analysis ◽  
Tertiary Care Centre ◽  
Perforation Peritonitis

Background: Perforation peritonitis is one of the most commonly encountered surgical emergencies in our country. The prognosis of secondary peritonitis remains poor despite development in diagnosis and management. Early identification of patients with severe peritonitis may help in selecting patients for aggressive surgical approach.Methods: The study was conducted in 128 cases of perforation peritonitis admitted and treated in the department of surgery in a tertiary care centre. Initial diagnosis was made on the basis of detailed history, clinical examination and presence of pneumoperitoneum on erect abdominal X-ray. Patients were first assessed using a predesigned Performa, then MPI score was calculated for each patient and the patients were followed-up till death or discharge from the hospital.Results: The ROC curve analysis shows area under the curve was 0.986 with a standard error of 0.008, 95% CI (0.971 to 1.001), p<0.0001. In our study authors found that for the MPI score of 26, sensitivity was 91.3% and specificity was 92.4%, with a positive likelihood ratio of 12.01 and a negative likelihood ratio of 0.09. Age of the patient, presence of organ failure, associated malignancy, generalised type of peritonitis and the original MPI Score has got a significant association with the final outcome (i.e. p value <0.05).Conclusions: MPI is an excellent prognostic index for peritonitis with high accuracy in individual prognosis that is cheap, cost effective, easily measurable and reproducible. The study accentuates that early diagnosis, appropriate resuscitation and prompt surgical intervention still remain the keystones in the management of perforation peritonitis.

Diagnostic Test Validity of CT-Scan for Detection of Hepatocellular Carcinoma

2018 ◽  
Vol 4 (2) ◽  
pp. 133-136
Author(s):  
Md Akter Hossain ◽  
Md Saiful Haque ◽  
Mostaque Ahmed Bhuiya ◽  
Abu Bakar Siddique
Keyword(s):  
Hepatocellular Carcinoma ◽  
Ct Scan ◽  
Likelihood Ratio ◽  
Tertiary Care ◽  
Test Validity ◽  
Positive Likelihood Ratio ◽  
Negative Likelihood Ratio ◽  
Care Hospital ◽  
Hepatocelluar Carcinoma ◽  
Cross Sectional

Background: CT-scan can detect hepatocelluar carcinoma among the patients.Objective: The purpose of the present study was to see the pattern of hepatocelluar carcinoma among the patients attended at a tertiary care hospital in Dhaka city.Methodology: This cross-sectional study was carried out in the Department of Radiology and Imaging at Dhaka Medical College, Dhaka and Banghabandhu Sheikh Mujib Medical University, Dhaka from January 2007 to May 2008 for a period of around one and half year. All the patients presented with hepatocellular carcinoma at the age group of more than 20 years with both sexes were selected as study population. The patients were undergone CT-scan examination and the confirmation of tumor was performed by histopathological examination.Result: A total number of 50 patients were recruited in this study after fulfilling the inclusion and exclusion criteria. The sensitivity, specificity and accuracy of CT-scan in detecting hepatocellular carcinoma was seen to be 66%, 92% and 72% respectively. The PPV and NPV were 96.15% (95% CI 79.06% to 99.40%) and 45.83% (95% CI 34.53% to 57.58%) respectively. However, the Positive Likelihood Ratio and Negative Likelihood Ratio were 7.89 (95% CI 1.19 to 52.28) and 0.37(95% CI 0.23 to 0.60).Conclusion: In conclusion CT-scan is a good diagnostic tool for the detection of hepatocellular carcinoma.Journal of National Institute of Neurosciences Bangladesh, 2018;4(2): 133-136

scholarly journals Comparative assessment of fetomaternal outcome in twin pregnancy with singleton pregnancy at tertiary care centre

2017 ◽  
Vol 6 (6) ◽  
pp. 2395
Author(s):  
Divya Gupta ◽  
Premlata Mital ◽  
Bhanwar Singh Meena ◽  
Devendra Benwal ◽  
. Saumya ◽  
...  
Keyword(s):  
Twin Pregnancy ◽  
Tertiary Care ◽  
Comparative Assessment ◽  
P Value ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Singleton Pregnancy ◽  
Medical College ◽  
Obstetrics And Gynaecology ◽  
Twin Pregnancies

Background: Multiple pregnancy remains one of the highest risk situations for the mother, foetus and neonate despite recent advances in obstetrics, perinatal and neonatal care. Twin pregnancies have increased rates of obstetric and perinatal complications compared to singletons Objective of present study was comparative assessment of fetomaternal outcome in twin pregnancy with singleton pregnancy in Obstetrics and Gynaecology Department of S.M.S. Medical College, Jaipur.Methods: This was a hospital based, prospective observational study done in the Department of Obstetrics and Gynaecology. S.M.S. Medical College, Jaipur from April 2015 to March 2016. 150 women with twin pregnancy and 150 women with singleton pregnancies at gestation age of 28 weeks and above coming for delivery and consented for the study were included in the study. Women with chronic medical disorder or chronic hypertension were excluded from the study. Maternal and neonatal outcome recorded and analysed.Results: Occurrence of twin in our study was 2.82%. Risk of preterm labour was about nine times higher in twin pregnancies than the singleton (OR: 2.74, 95% CI; 1.4494-5.1884, P value 0.001). The risk of premature rupture of membrane was increased by 2.74 times in twin pregnancies (OR:2.74; 95% CI: 1.4494-5.1884, p value .001). There was 3-time increased risk of malpresentation (OR 3.14; CI:1.7184-5.7480, p value .00002) and 2.28 times increase in hypertensive disorder (OR 2.28; 95% CI: 1.0727-4.8823, p value .03) in twin pregnancies. The risk of asphyxia and septicaemia was 2.5 times more in twins.Conclusions: Twin pregnancy is a high-risk pregnancy with more complications in mother and foetus and is a great challenge for obstetrician. So, it should be managed carefully at tertiary care centre to reduce the maternal and perinatal mortality and morbidity.

scholarly journals Response of leuprolide on gonadal functions of women with overt hypothyroidism: a tertiary care centre study from Uttar Pradesh - India

2019 ◽  
Vol 8 (1) ◽  
pp. 277
Author(s):  
Manish Srivastav ◽  
Alankar Tiwari ◽  
Nihit Kharkwal ◽  
Keshav Kumar Gupta
Keyword(s):  
Human Subject ◽  
Tertiary Care ◽  
Uttar Pradesh ◽  
Ovarian Response ◽  
P Value ◽  
Overt Hypothyroidism ◽  
Newly Diagnosed ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Healthy Females

Background: Hypothyroidism can cause menstrual disturbances mainly oligoanovualtory cycles and sometimes menorrhagia. It has also been seen to cause subfertility and pregnancy related complications. Various studies have been done to evaluate gonadal dysfunctions in overt hypothyroidism but very few studies are there which have done using a gonadotrophin response in that subset of patients. Present study evaluates the response of leuprolide on gonadal functions of women with overt hypothyroidism in a tertiary care centre at Meerut.Methods: In this study 50 females of age 20 to 40 years with newly diagnosed overt hypothyroidism were taken as cases and age and Body Mass Index (BMI) matched healthy females were taken as controls. Both in cases and controls, basal FSH, LH, estradiol was measured on 2nd day to 5th day of menstrual cycle. Thereafter Leuprolide 20 mcg/kg was given subcutaneously on the same day. Post leuprolide test, stimulated LH, FSH and estradiol were measured. Basal and stimulated values were compared between both groups.Results: Basal LH was significantly higher in controls (8.2±3.2 mIU/L) when compared to cases (6.45±2.75 mIU/L) with a p value 0.03(<0.05). Basal estradiol and FSH levels were found to be nearly similar and non-significant in cases and controls. No significant differences were found between stimulated mean LH and estradiol in both the groups. Leuprolide response after stimulation test was found to be sluggish in patients with overt hypothyroidism compared to normal euthyroid controls. This study is the rare one done on human subject in tertiary care centre of India, however large sample and multicentric trials are necessary before establishing the biochemical results.Conclusions: Pituitary and gonadal (ovarian) response to leuprolide was found to have impaired (decreased) in overt hypothyroidism cases. This is the first study to be done in overt hypothyroid subjects to asses both basal and stimulated gonadotropin levels.

scholarly journals Diagnostic values of Xpert MTB/RIF, T-SPOT.TB and adenosine deaminase for HIV-negative tuberculous pericarditis in a high burden setting: a prospective observational study

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Xu Hu ◽  
Baochun Xing ◽  
Wei Wang ◽  
Pengwei Yang ◽  
Yumei Sun ◽  
...  
Keyword(s):  
Adenosine Deaminase ◽  
Likelihood Ratio ◽  
Predictive Value ◽  
Mononuclear Cells ◽  
Positive Likelihood Ratio ◽  
Negative Likelihood Ratio ◽  
Roc Curve Analysis ◽  
High Burden ◽  
Tuberculous Pericarditis ◽  
Hiv Negative

Abstract The diagnosis of tuberculous pericarditis (TBP) remains challenging. This prospective study evaluated the diagnostic value of Xpert MTB/RIF (Xpert) and T-SPOT.TB and adenosine deaminase (ADA) for TBP in a high burden setting. A total of 123 HIV-negative patients with suspected TBP were enrolled at a tertiary referral hospital in China. Pericardial fluids were collected and subjected to the three rapid tests, and the results were compared with the final confirmed diagnosis. Of 105 patients in the final analysis, 39 (37.1%) were microbiologically, histopathologically or clinically diagnosed with TBP. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio (DOR) for Xpert were 66.7%, 98.5%, 96.3%, 83.3%, 44.0, 0.338, and 130.0, respectively, compared to 92.3%, 87.9%, 81.8%, 95.1%, 7.6, 0.088, and 87.0, respectively, for T-SPOT.TB, and 82.1%, 92.4%, 86.5%, 89.7%, 10.8, 0.194, and 55.8, respectively, for ADA (≥ 40 U/L). ROC curve analysis revealed a cut-off point of 48.5 spot-forming cells per million pericardial effusion mononuclear cells for T-SPOT.TB, which had a DOR value of 183.8, while a cut-off point of 41.5 U/L for ADA had a DOR value of 70.9. Xpert (Step 1: rule-in) followed by T-SPOT.TB [cut-off point] (Step 2: rule-out) showed the highest DOR value of 252.0, with only 5.7% (6/105) of patients misdiagnosed. The two-step algorithm consisting of Xpert and T-SPOT.TB could offer rapid and accurate diagnosis of TBP.

scholarly journals Study of magnitude of anaemic problem in rural tertiary care centre in outpatient department

2018 ◽  
Vol 6 (11) ◽  
pp. 3499
Author(s):  
Anjaneya Prasad V. ◽  
Anjani Kumar C. ◽  
Neelima V. ◽  
Sai Prasanth R.
Keyword(s):  
Public Health ◽  
Low Cost ◽  
Tertiary Care ◽  
Outpatient Department ◽  
P Value ◽  
Cost Ratio ◽  
Care Hospital ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Major Health Problem

Background: Prevalence of anaemia is very high in rural tertiary care hospital O.P.D patients. Anemia is the most common morbidity among micronutrients and affects health, education, economy, and productivity of the entire nation. Anemia, like fever, is a manifestation and not a disease per se. The most common group among the causes for anemia is malnutrition and among that group, iron deficiency makes up the bulk of it. Girls are more likely to be a victim due to various reasons. In a family with limited resources, the female child is more likely to be neglected. She is deprived of good food and education and is utilized as an extra working hand to carry out the household chores. The added burden of menstrual blood loss, normal or abnormal, precipitates the crises too often. Anemia can usually be prevented at a low cost, and the benefit/cost ratio of implementing preventive programs is recognized as one of the highest in the realm of public health. This information has equipped everyone in public health to take action against this long-standing problem and to do whatever is needed to be done.Methods: In our study 200 people attending medical outpatient department at a tertiary care centre were enrolled. Assessment of the anaemic problem is worked out.Results: Out of 200 patients, 107 were females and 93 were males. 49 females out of 107 had haemoglobin less than 10 and 9 males out of 93 are having haemoglobin less than 10. Among people with hemoglobin less than 10, 84.5% are females. Significant p value was observed in females (<0.0001).Conclusions:Anemia continues to be a major health problem in developing countries like India, particularly rural India. Despite different strategies and programs have been taken by government of India the growing menace of anaemia is not solved. So newer strategies must be taken.Background: Prevalence of anaemia is very high in rural tertiary care hospital O.P.D patients. Anemia is the most common morbidity among micronutrients and affects health, education, economy, and productivity of the entire nation. Anemia, like fever, is a manifestation and not a disease per se. The most common group among the causes for anemia is malnutrition and among that group, iron deficiency makes up the bulk of it. Girls are more likely to be a victim due to various reasons. In a family with limited resources, the female child is more likely to be neglected. She is deprived of good food and education and is utilized as an extra working hand to carry out the household chores. The added burden of menstrual blood loss, normal or abnormal, precipitates the crises too often. Anemia can usually be prevented at a low cost, and the benefit/cost ratio of implementing preventive programs is recognized as one of the highest in the realm of public health. This information has equipped everyone in public health to take action against this long-standing problem and to do whatever is needed to be done.Methods: In our study 200 people attending medical outpatient department at a tertiary care centre were enrolled. Assessment of the anaemic problem is worked out.Results: Out of 200 patients, 107 were females and 93 were males. 49 females out of 107 had haemoglobin less than 10 and 9 males out of 93 are having haemoglobin less than 10. Among people with hemoglobin less than 10, 84.5% are females. Significant p value was observed in females (<0.0001).Conclusions: Anemia continues to be a major health problem in developing countries like India, particularly rural India. Despite different strategies and programs have been taken by government of India the growing menace of anaemia is not solved. So newer strategies must be taken.

scholarly journals Role of pretreatment neutophil to lymphocyte ratio as an independent prognostic factor in oral squamous cell carcinoma patients: a prospective study in a tertiary care centre

2018 ◽  
Vol 6 (6) ◽  
pp. 1977
Author(s):  
Shashwat Tiwari ◽  
Shivani Nautiyal
Keyword(s):  
Tertiary Care ◽  
Prognostic Index ◽  
Absolute Lymphocyte Count ◽  
Prognostic Scores ◽  
P Value ◽  
Tertiary Care Centre ◽  
High Group ◽  
Potential Biomarker ◽  
Significant Difference ◽  
The Absolute

Background: More recently, established systemic inflammation-based prognostic scores have been explored extensively, such as NLR and serum C-reactive protein (CRP). We postulated that NLR might be a readily available and inexpensive objective prognostic index that could be used in daily oncologic clinical practice and could help to stratify patients in clinical trials.Methods: In total, there were 150 patients with OSCC treated at GSVM medical college, Kanpur between October 2012 and January 2015 whose clinical information and laboratory parameters were obtained. The NLR was determined by dividing the absolute neutrophil count by the absolute lymphocyte count, and the NLR data were then dichotomized and divided into two groups as NLR-low and -high.Results: The 3-year OS rate of the NLR-high group tended to be significantly lower than that of the NLR-low group, this relationship was found to be statistically significant (p value <0.05). The 3-year DFS rate in the NLR-high group was lower than that in the NLR-low group; however, there were no significant difference between the two groups.Conclusions: Our findings reported herein demonstrated that pre-treatment NLR is a potential biomarker for predicting the overall survival in oral SCC patients. Combined with other markers, NLR may be used in decision-making and the selection of treatment modality in patients with oral SCC.

scholarly journals SPECTRUM OF PERFORATION PERITONITIS AT A TERTIARY CARE CENTRE IN PUNJAB

2018 ◽  
Vol 7 (20) ◽  
pp. 2433-2436
Author(s):  
Varun Gupta ◽  
Chiranjiv Singh Gill ◽  
Sanjeev Kumar Singla ◽  
Manvi Gupta
Keyword(s):  
Tertiary Care ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Perforation Peritonitis

Proportion and Clinical Profile of Thyroid Ophthalmopathy in Patients with Graves’ Disease Presenting at a Tertiary Care Centre in Kerala

2021 ◽  
Vol 8 (32) ◽  
pp. 3028-3033
Author(s):  
Liya K.Y ◽  
Naina Jabeen Hyder ◽  
Neeta Sidhan ◽  
Shaji Ankan
Keyword(s):  
Tertiary Care ◽  
Thyroid Eye Disease ◽  
Eye Disease ◽  
Clinical Activity ◽  
P Value ◽  
Graves Disease ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Clinical Activity Score ◽  
Active Disease

BACKGROUND Thyroid eye disease is a relatively rare condition, with an incidence of 2.9 to 16.0 cases per 100 000 population per year. Approximately 50 % of patients with Graves’ disease (GD) develop clinically apparent thyroid eye disease. It may cause severe damage to vision and orbital architecture. It is the most frequent cause of unilateral or bilateral proptosis in adults. METHODS A cross sectional study of 80 patients with GD was carried out in association with thyroid clinic of Government Medical college Thiruvananthapuram for a period of 1 year from April 2017 to March 2018. Subjects who have a prior diagnosis of Graves’ disease including those who are on antithyroid drugs were included in the study. Patients who are sick due to other systemic diseases like cardiac failure and end stage renal disease were excluded. RESULTS Eighty patients with mean age of 45.31 years were studied. Out of them, 66% were females and 34% were males. Ophthalmopathy was present in 38.8%.Majority had mild and bilateral disease (61.2 %). Only a small percentage had sight threatening disease (6.4 %).The mean age of patients with ophthalmopathy was 47.93. Major population with ophthalmopathy was females. Majority of patients with ophthalmopathy (64.5 %) retained a good visual acuity better than 6 / 9. Lid retraction was the most common manifestation among patients with Graves’ ophthalmopathy that is 74.2% followed by exophthalmos (64.5 %) and eye movement restriction and soft tissue involvement (58.1 %). Diplopia, optic nerve dysfunction were rare (3.2 %). Only 19.3 % patients had active disease according to clinical activity score. Major clinical sign of activity was redness of conjunctiva. Maximum no. of patients with active disease had a clinical activity score of 4. Smoking showed a significant association with the severity of ophthalmopathy. (p value 0.001) There was a significant association between age and activity of disease. (p value 0.021). No association was found between duration of disease with presence or severity of ophthalmopathy. There was no association between co- morbidities with presence or severity of ophthalmopathy. No association was found between hormone status and presence or severity of ophthalmopathy. CONCLUSIONS Our results indicated that the prevalence of ophthalmopathy in our population with GD evaluated at our tertiary care centre was similar to that reported in the Caucasians of European origin. Clinically active and sight threatening ophthalmopathy was uncommon. KEYWORDS Graves’ Disease, Ophthalmopathy

scholarly journals Vasculogenic mimicry as a poor diagnostic and prognostic indicator in patients with malignant‎ melanoma: A ‎systematic review and meta-analysis

2019 ◽  
Author(s):  
Zhenhua Zhang ◽  
Saber Imani ◽  
Marzieh Dehghan Shasaltaneh ◽  
Hossein Hosseinifard ◽  
Zou Linglin ◽  
...  
Keyword(s):  
Systematic Review ◽  
Likelihood Ratio ◽  
Meta Analysis ◽  
Vasculogenic Mimicry ◽  
Positive Likelihood Ratio ◽  
Negative Likelihood Ratio ◽  
Prognostic Indicator ◽  
Diagnostic Odds Ratio ◽  
P Value ◽  
Summary Receiver Operating Characteristic

Abstract Background Vasculogenic mimicry (VM), a brand-new tumor microvascular model of non-endothelial cells, is proposed as an important therapeutic target in malignant melanoma (MM). We performed a systematic review to evaluate the diagnostic and prognostics accuracy of VM for overall survival of MM patients. Methods The quality of the included studies was assessed by QUADAS-2 tool. Diagnostic capacity of VM variables were pooled by the Meta-Disc software in term of sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the summary receiver operating characteristic (SROC). Results A retrospective observational study was conducted based on ‎ten studies including 978 clinically melanoma patients with proportion (P). VM+ melanoma cells are associated with poor prognosis in 38% of MM group (P = 0.35, 95% confidence intervals (CI): 0.27-0.42, P-value < 0.001). The pooled sensitivity and specificity were 0.82 (95% CI: 0.79-0.84) and 0.69 (95% CI: 0.66-0.71), respectively. Furthermore, the pooled PLR, NLR, and DOR were 2.56 (95% CI: 1.94-3.93), 0.17 (95% CI: 0.07-0.42), and 17.75 (95% CI: 5.30-59.44), respectively. Also, the AUC of SROC was 0.63, indicating the highly conserving of VM as a biomarker‎. Importantly, subgroup results suggested that VM+ tumor was significantly accurate prognostics biomarkers when diagnosed by CD31-/PAS+ staining methods in Asian MM samples (P-value > 0.001). Conclusions Our finding supports the VM+ tumor as a promising prognostic biomarker and effective adjuvant therapeutic strategy in prognostics of Asian MM patients.

scholarly journals Study of patient profile of children with poor/delayed speech in a tertiary care centre in Western Uttar Pradesh, India

2021 ◽  
Vol 12 (1) ◽  
pp. 69-74
Author(s):  
Moumita Sen ◽  
Probal Chatterji
Keyword(s):  
Tertiary Care ◽  
Sensorineural Deafness ◽  
Uttar Pradesh ◽  
Hearing Screening ◽  
P Value ◽  
Care Centre ◽  
Group Presentation ◽  
Tertiary Care Centre ◽  
Normal Delivery ◽  
Patient Profile

Background: Humans convey their emotions and information to one another through language. Delayed or poor speech can have a profound effect on the social and professional life of a person. Aim and Objectives: A study of children with poor/delayed speech in a tertiary care centre in western U.P. Objectives were as follows • To study the risk factors for congenital hearing loss in children with poor/no speech. • To screen them regarding their hearing status. • To analyze results in detail and compare with available literature. Materials and Methods: A hospital based prospective observational study was done from Jan - Dec 2019. One-hundred fifteen children were identified. Hearing screening was done in all of them by OAE testing followed by tympanometry and BERA wherever applicable. Results: Out of 115 children, 9 (7.8%) had normal hearing, 9 (7.8%) had central cause of deafness and 97 (84.4%) had congenital SNHL. 64% of subjects were male (p value- <0.001). 79% of them had an association with some risk factor during birth (p value- <0.001). 40.8% of them were first order in birth with a typical age group presentation of 2-3 yrs. 60.1% of the study population with SNHL had history of normal delivery at home. Conclusion: Improvement in the quality of antenatal care, obstetric services and postnatal care will reduce the number of cases of congenital sensorineural deafness significantly by reducing the number of high-risk babies. Moreover, the introduction of practice of universal hearing screening of newborns will help in identifying them early for proper rehabilitation.

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