A Prospective Study of Evaluation and Management of Obstructive Jaundice in a Tertiary Care Hospital, North Coastal Andhra Pradesh

BACKGROUND Obstructive jaundice is defined as a condition occurring due to block in pathway between the site of conjugation of bile in liver cells and entry of bile into duodenum through the ampulla. This block may be intraheptic or extraheptic in the duct. Evaluation and management of obstructive jaundice is a challenging task to the surgeon owing the varied etiology and wide management option. Common bile duct (CBD) varies in length from 5 to 15 cm with average diameter of 6 mm. CBD can be divided in to four portions: supra duodenal, retro duodenal, intra duodenal and intramural portion. The purpose of this study was to evaluate the pattern of aetiology of obstructive jaundice in these parts and compare the clinical and laboratory presentations with obstructive jaundice between benign and malignant cases. METHODS This is a prospective analytical study. Patients with obstructive jaundice who attended the outpatient department of Surgery, GITAM Institute of Medical Sciences and Research, Visakhapatnam over a period of 24 months from November 2017 to October 2019 were admitted and taken up for the study. A total of 60 cases were studied. RESULTS Abdominal pain was a presenting symptom in 48 patients (80 %). Ninety five percent of patients of benign and 50 % of patients of malignant aetiology presented with this symptom. P value was found to be statistically significant for this symptom. This means that jaundice with pain in abdomen is more common in benign conditions while malignant conditions cause painless jaundice. CONCLUSIONS Malignant obstructive jaundice is most commonly seen in males while benign conditions are more common in females. Benign conditions causing obstructive jaundice is most common under 40 years of age while malignant obstructive jaundice is commonly seen between 50 and 60 years of age. KEYWORDS Cholestasis, Extraheptic, Obstructive Jaundice

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A STUDY FOR EVALUATION OF CLINICAL, BIOCHEMICAL, TUMOR MARKERS AND RADIOLOGICALPARAMETERS IN PATIENTS OF OBSTRUCTIVE JAUNDICE

10.36106/ijsr/1605093 ◽

2021 ◽

pp. 59-61

Author(s):

Sangamesh S K ◽

S R Ghosh ◽

Debarshi Jana

Keyword(s):

Obstructive Jaundice ◽

Tumor Markers ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Final Diagnosis ◽

Care Hospital ◽

Malignant Obstructive Jaundice ◽

Purposive Sampling ◽

Radiological Parameters ◽

Ca 19.9

Study was conducted in Command Hospital (Eastern Command) Kolkata - ATertiary Care Hospital with the following Aims and Objectives. Study and co relate clinical, biochemical, radiological parameters in obstructive jaundice. MATERIAL AND METHODS: Study was conducted in Command Hospital (Eastern Command) Kolkata - A tertiary care hospital. All adult patients who was diagnosed as case of obstructive jaundice based on clinical, radiological and pathological criteria. Study duration 3 Years. Purposive sampling, 50 in each group,100. RESULT AND ANALYSIS: BENIGN OBSTRUCTIVE JAUNDICE, 6(12.0%) patients had FEVER. In MALIGNANT OBSTRUCTIVE JAUNDICE, 2(4.0%) patients had FEVER. Association of FEVER vs FINAL DIAGNOSIS was not statistically signicant (p=0.1403). In BENIGN OBSTRUCTIVE JAUNDICE, 4(8.0%) patients had PRURITIS. In MALIGNANT OBSTRUCTIVE JAUNDICE, 37(74.0%) patients had PRURITIS. Association of PRURITIS vs FINAL DIAGNOSIS was statistically signicant (p<0.0001). CONCLUSION: AST and ALP were higher in malignant obstructive jaundice compared to benign obstructive jaundice which were statistically signicant. Mean GGT was higher in malignant obstructive jaundice compared to benign obstructive jaundice which was statistically signicant. It was found that mean CA 19.9 was higher in malignant obstructive jaundice compared to benign obstructive jaundice which was statistically signicant.

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A PROSPECTIVE STUDY ON CLINICAL PROFILE OF STROKE PATIENTS ATTENDING IN A TERTIARY CARE HOSPITAL OF GUWAHATI, ASSAM.

10.36106/paripex/2500607 ◽

2020 ◽

pp. 1-4

Author(s):

Dhrubajyoti Choudhury* ◽

N. C. Borah ◽

P. S. Deb ◽

Amit Ranjan Baruah ◽

Kinzang Wangda ◽

...

Keyword(s):

Risk Factor ◽

Prospective Study ◽

Cerebrovascular Disease ◽

Tertiary Care ◽

Common Type ◽

Care Hospital ◽

Medical Sciences ◽

Stroke Patients ◽

Common Risk Factor ◽

A Prospective Study

Cerebrovascular disease include most common devastating disorders :ischaemic stroke and haemorrhagic stroke.The incidence of cerebrovascular disease increases with age and the number of strokes is projected to increase as the elderly population grows.A stroke is the second leading cause of death worldwide. Some of the Indian studies have shown a stroke prevalence of 471.58/100000 population. OBJECTIVE:To study the clinical presentation, risk factors,neurological presentation,pattern of brain strokes,areas of brain affected as per CT/MRI Brain scan findings in a newly admitted patients in GNRC Institute of Medical Sciences, North Guwahati,Assam. METHODS:This is a prospective study included all new patients with stroke admitted in ICU and Ward under Neurology Department of GNRC institute of Medical Sciences ,North Guwahati,Assam,from 1st August,2018 to 31st July ,2019. RESULTS: The cerebrovascular strokes are more common in males (64.4%) than females (35.6%). Most common age group was 58-67 years (28.29%).Most common clinical feature was hemiplegia (71.21%).Most common risk factor was Hypertension (89.51%) followed by diabetes mellitus(51.70%) . Most common type of stroke was haemorrhagic (60.24%) followed by ischaemic (39.75%). In stroke infarct most common involved areas were parietal (13.65%). In hemorrhagic stroke most common site was basal ganglia (21.95%) followed by thalamus (10.97%). CONCLUSION: Males were more commonly affected with cerebrovascular accident with hypertension was the most common risk factor among the stroke patients and most common type of stroke was haemorrhagic.

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Study on rationality of different fixed dose drug combinations in tertiary care hospital: an evaluation study

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20200714 ◽

2020 ◽

Vol 9 (3) ◽

pp. 422

Author(s):

Maddala Rajitha ◽

Altaf Hussain Shaik ◽

G. B. Simpson ◽

A. Vishwa Shanthi

Keyword(s):

Private Hospital ◽

Tertiary Care ◽

Evaluation Study ◽

Drug Combinations ◽

Fixed Dose ◽

Care Hospital ◽

Medical Sciences ◽

Care Teaching ◽

Essential Drug List ◽

A Prospective Study

Background: The fixed dose drug combinations (FDCs) of drugs is defined as product of two or more active ingredients in a defined composition. There is a need to study the pattern of prescription from time to time to evaluate their rationality. In this context we undertook this study to know the prescription pattern of FDC in our setting. To study the rationality of different prescribed FDCs.Methods: This is a prospective study which is carried out in NIMRA Institute of medical sciences which is a tertiary care teaching private hospital. For this study we have collected one thousand prescriptions of patients for 3 months that is from 10th March 2017 to 25th of June 2017 including both in-patients as well as outpatients. Selection criteria of patients mainly basing on their willingness to give prescriptions. Institutional ethical committee permission was taken for the study. The prescribed FDCs were compared with the essential drug list of FDCs approved by Drugs Controller General of India, July 2018. we have used descriptive statistics to analyze data. The percentage of FDCs used in each class and their contribution to overall FDCs were calculated.Results: In a total of 2952 drugs were prescribed, of this 747 were FDCs and 2205 were non FDCs. In the prescribed FDCs 89.2% drugs were rational and 10.8% drugs were irrational.Conclusions: From this study, we can conclude that 10.8% of irrational prescription of fixed dose drug combinations are prescribed in Nimra Institute of Medical Sciences which is a tertiary care teaching private hospital.

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Burden, types of diseases and outcome in LBW babies admitted at a Tertiary Care Hospital.

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.03.3551 ◽

2020 ◽

Vol 27 (03) ◽

pp. 547-551

Author(s):

Shahid Iqbal ◽

Fazal Ur Rehman ◽

Muhammad Haneef

Keyword(s):

Birth Weight ◽

Analytical Study ◽

Distress Syndrome ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

P Value ◽

Care Hospital ◽

Duration Of Hospital Stay ◽

Hospital Study ◽

Study Setting

Objectives: LBW has long been labeled as one of the major risk factor for mortality as well as morbidity in neonates. South Asia is said to have highest number of LBWs which estimated to be 1 in 4 newborns that weigh < 2500 grams. This study was planned with an aim to note the burden, types of diseases and outcome in LBW newborns admitted at a tertiary care hospital. Study Design: Descriptive analytical study. Setting: Included all neonates admitted to NICU of Sheikh khalifa Bin Zaid Al Nahyan Teaching Hospital, Rawlakot. Period: 1st July 2018 to 31st December 2018. Material & Methods: The prevalence of LBW amongst all admissions was calculated along with demographic features of all LBW babies like disease, reasons for the admission, duration of hospital stay along with outcome was noted on a predesigned proforma. Results: Out of total of 1410 admission in NICU during the study period, 512 (36.3%) were noted to be LBW. Amongst LBW babies, mean weight was 1.91 kg while 269 (52.5%) were male and 243 (47.5%) female. There were 364 (67.6%) babies born at full term. There were 82 (16.0%) with birth weight of less than 1.5 kg, 166 (32.4%) between 1.5 to 2 kg while 264 (51.6%) were above 2 kg. Amongst all LBW babies, mortality was reported in 185 (36.1%) while 112 (60.5%) died on the 1st day of admission. Respiratory distress syndrome (31.4%), sepsis (20.3%) and neonatal jaundice 58 (11.3%) were the commonest diseases seen. Highest mortality (56.1%) was seen in babies who had birth weight below 1.5 kg (p value = 0.001). Conclusion: LBW is a major cause of hospitalization and mortality. RDS and sepsis were the most frequent diseases noted in LBW babies. Immediate care following birth is vital for babies already at risk of LBW.

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Intra uterine insemination: Limitations in a tertiary care hospital

Asian Journal of Medical Sciences ◽

10.3126/ajms.v7i1.12614 ◽

2015 ◽

Vol 7 (1) ◽

pp. 76-81

Author(s):

Rekha Rani ◽

Maruti Sinha ◽

Ratnaboli Bhattacharya ◽

Ridhima Gupta ◽

Gurcharan Kaur

Keyword(s):

Tertiary Care ◽

Male Partner ◽

Clinical Effectiveness ◽

Pregnancy Rates ◽

New Delhi ◽

Care Hospital ◽

Medical Sciences ◽

Management Protocol ◽

A Prospective Study ◽

Intra Uterine Insemination

Aims and Objectives: Infertile couples need expert guidance to be able to choose an appropriate therapy relevant to their sub-fertility where one in seven couples have infertility. The present study has been designed to study the clinical effectiveness of IUI in enhancing pregnancy rates in cases of unexplained infertility and to compare it with other modalities of expectant treatment. We enumerate our experience with IUI at Kasturba Hospital with a special effort to assess any limitations in performing this procedure in tertiary care centres like ours.Materials and Methods: This was a prospective study with observational analysis of data on sub fertile couples who underwent COH and IUI as a part of the management protocol in our hospital- Kasturba Hospital, New Delhi. The period of study extended from 2007 to 2014. Infertility work up of all the registered couples was done on a standard investigation protocol. The male partner was also assessed by a detailed history and semen analysis.Results: Average females were less than 30 years of age at 48.1% Majority of couples were having primary infertility (82.28%) whereas only 17.72% had secondary infertility. Pregnancy rates achieved with single IUI (22.55%) was more than that achieved in double IUI (11.11%). Pre rupture IUI resulted in higher pregnancy rates (23.08%) than post rupture ones (15.12%). Out of pregnancies that occurred from IUI cycles, term deliveries were 21.52% and there were 6.33% spontaneous miscarriages. Only 2.53% had twin pregnancies.Conclusion: In a resource deprived country like India where low per capita income make IVF-ET an unaffordable option to most of the patients, IUI has found wide acceptance with much lower costs. However the biggest limitation in offering IUI is that most of the tertiary care centres in India are yet to eqiup itself with standard IUI Laboratories to thus make Intra Uterine insemination widely available at affordably low cost.Asian Journal of Medical Sciences Vol.7(1) 2015 76-81

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A 4 year ERCP Profile of Tertiary Care Hospital: Indications and Diagnosis

10.53350/pjmhs211561419 ◽

2021 ◽

Vol 15 (6) ◽

pp. 1419-1422

Author(s):

A. H. Alvi ◽

A. Z. K. Chachar ◽

R. Parvaiz

Keyword(s):

Obstructive Jaundice ◽

Response Rate ◽

Tertiary Care Hospital ◽

Strong Association ◽

Tertiary Care ◽

Final Diagnosis ◽

P Value ◽

Care Hospital ◽

Statistical Association ◽

Chi Square

Aims: To find the indications and diagnosed conditions in the cases reported in Fatima Memorial Hospital Lahore. Also, the prevalence of this procedure amongst the genders in our setting. To establish statistical association between indications and diagnosis. Methodology: All the ERCP procedures done in 4 years from January, 2011 to January 2014 were compiled. The data was gathered using a simple form after the intervention. A total of 554 patients’ data was available, all participants were above the age of 18 years. A response rate 93% was recorded for who consented and allowed to share their information anonymously in the study. Chi square was used to find statistical association, with p-value <0.005 was taken as significant. IBM SPSS 22 was used for data input and evaluation. Results: In our study 35% of the participants were males and 65% were females. 58.33% of the patients underwent sphincterotomy. The highest number of patient’s indicated of undergoing ERCP was 58.33% because of obstructive jaundice without any cause on further investigations. Choledocholithiasis was the commonest diagnosis with 36.6%. A strong association between the indications and the final diagnosis was also found with p-value of 0.000. The success rate of the intervention was 79% making it a safer procedure to be applied. Conclusion: More females have undergone this procedure. Obstructive jaundice was declared as major indication with choledocholithiasis as the commonest condition diagnosed. It was a successful procedure in our setting. Keywords: ERCP, Gastroenterology, Intervention

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Risk factors for ectopic pregnancy; an institutional study in a tertiary care hospital

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20195312 ◽

2019 ◽

Vol 8 (12) ◽

pp. 4741

Author(s):

Ranjita Ghadei ◽

Swayamsiddha Mohanty ◽

Sushree Sovana Mishra ◽

Debashis Giri

Keyword(s):

Risk Factors ◽

Ectopic Pregnancy ◽

Tertiary Care ◽

Previous History ◽

Diagnostic Tools ◽

P Value ◽

Care Hospital ◽

Pregnancy Risk ◽

History Of ◽

A Prospective Study

Background: Ectopic pregnancy is the leading cause of maternal death during the 1st trimester of pregnancy, accounting for approximately 10% of all pregnancy related deaths. A better understanding of ectopic pregnancy risk can help prevent its occurrence. The present study was designed to evaluate the ectopic pregnancy risk factors and their strength of association with ectopic pregnancy at a tertiary care hospital.Methods: It was a prospective study with 104 cases of ectopic pregnancy and 125 controls conducted in the Department of Obstetrics and Gynecology, SCB Medical College, Cuttack for a period of 1 year. Detailed history suggestive of risks factor for ectopic pregnancy, menstrual and obstetrics history was taken. General, systemic, abdominal and vaginal examination was done. Diagnosis of ectopic pregnancy was confirmed by clinical examination, urine pregnancy test, ultrasonography and culdocentesis and only confirmed cases were included in the study group. Healthy pregnant women were taken as control group.Results: The study revealed that the risk of ectopic pregnancy was associated with the traditional risk factors including previous EP [Adjusted odds ratio (AOR) = 9.98, 95% CI: 0.89-11.1%], previous infertility (AOR= 7.29, 95% CI:2.53-21.0) and previous history of sterilization (AOR=12.47,95% CI: 3.50 - 44.4) and previous history of abortion (AOR= 3.10, 95% CI: 1.53-6.30). Age comparison between cases and controls revealed that the ODDS of having ectopic pregnancy was 4 times in the age group 30 to 35 years as compared to uterine pregnancy and this difference was statistically significant (P value = 0.007).Conclusions: Risk factors such as previous ectopic pregnancy, induction of ovulation, intra uterine device usage, abortion as well as increased maternal age along with recent diagnostic tools aid in early detection of ectopic pregnancy in women resulting in proper and timely treatment.

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Efficacy and safety of radiofrequency ablation for lower limb varicose veins

International Surgery Journal ◽

10.18203/2349-2902.isj20184643 ◽

2018 ◽

Vol 5 (11) ◽

pp. 3676

Author(s):

Anushtup De ◽

Prabal Roy ◽

Sunil Kumar

Keyword(s):

Radiofrequency Ablation ◽

Varicose Veins ◽

Tertiary Care ◽

Clinical Severity ◽

P Value ◽

Care Hospital ◽

Vein Thrombosis ◽

Venous Clinical Severity Score ◽

The Mean ◽

A Prospective Study

Background: Endovenous Radiofrequency Ablation (RFA) is gradually gaining widespread acceptance as a minimally invasive modality for treatment of varicose veins (VV). The objective of this study was to evaluate the efficacy based on Venous Doppler and Venous Clinical Severity Score (VCSS) and the safety of radiofrequency ablation for varicose veins.Methods: This is a prospective study of 58 consecutive patients who underwent Radiofrequency ablation of Varicose veins from January 2015 to January 2017 in a single unit of a Multispecialty Tertiary Care Hospital. The mean age was 44.10±13.74 years (19-75 years). A total of 78 limbs were treated in 58 patients. RFA was performed using Closure FastTM catheter according to the manufacturer’s recommendation. Treatment outcomes were estimated 15 days, 3 months, 6 months and 1 year after the procedure using Doppler scan and VCSS score.Results: There was 100% occlusion of the treated veins with no evidence of partial/complete recanalization. However, 2 (2.56%) patients had a GSV stump length > 3cm on Doppler at 6 months, without evidence of significant reflux. Minor complications such as ecchymosis erythema, pain and induration rapidly improved over short term. One patient (1.3%) had evidence of Deep Vein thrombosis (DVT) on follow up Venous Doppler. The mean VCSS improved from mean of 7.98 preoperatively to 2.24 after 1 year (P value <0.001).Conclusions: Radiofrequency ablation is a safe and effective procedure with minimal major complications. The minor complications were early and resolved rapidly.

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A study of clinical presentations and management of cholelithiasis

International Surgery Journal ◽

10.18203/2349-2902.isj20192386 ◽

2019 ◽

Vol 6 (6) ◽

pp. 2164

Author(s):

Sathish Kumar B. ◽

Venkat Reddy ◽

Suryanarayana Reddy V. ◽

Ram Mohan C. ◽

Jahnavi Koneru

Keyword(s):

Open Cholecystectomy ◽

Tertiary Care ◽

Gastrointestinal Diseases ◽

Care Hospital ◽

Medical Sciences ◽

Management Options ◽

Female Population ◽

Clinical Presentations ◽

Common Variety ◽

A Prospective Study

Background: Cholelithiasis or gallstones, is one of the most common and costly of all the gastrointestinal diseases. Gallstones are associated with high-calorie diets, type 2 diabetes mellitus, dyslipidemia, hyperinsulinism, obesity, and metabolic syndrome. The aim of the study was to analysis the incidence, clinical presentations, and management of cholelithiasis in tertiary care Hospital at Karimnagar, Telangana, India.Methods: This study was a prospective study; total 50 patients were enrolled in this study. The study was conducted at Department of Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar from September 2016 to September 2017. The data were analyzed and evaluated for clinical profile, management options of cholelithiasis.Results: The present study shows gallstones diseases are a common problem in female population. The female to male ratio is 3:2. Age, gender and incidence statistically there was no significant in this study.Conclusions: Gallstones analysis showed mixed stone in 90% of the cases and cholesterol stones in 8% of the cases as the most common variety. The period of post-operative stay in our study was 7 days for open cholecystectomy and 3 days for laparoscopic cholecystectomy in majority of the cases.

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Strategies to cope claustrophobia during magnetic resonance imaging examination

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20191319 ◽

2019 ◽

Vol 7 (4) ◽

pp. 1166

Author(s):

Syed Amir Raza Zaidi ◽

Kamran Masood ◽

Usman Khanzada ◽

Syed Omair Adil ◽

Munawar Hussain

Keyword(s):

Tertiary Care ◽

Magnetic Resonance Imaging Examination ◽

P Value ◽

Care Hospital ◽

Diagnostic Modality ◽

Effective Strategies ◽

Education Status ◽

Set Up ◽

A Prospective Study ◽

Short Intervention

Background: Claustrophobia associated with MRI scan is a well-recognized problem all over the world. The unpleasant psychological experience during MRI can lead to premature cancellation of the study resulting in non-interpretable data. In addition, performing future studies on the claustrophobic patient may not be possible leading to non-utilization of an important diagnostic modality. This study was conducted with the aim to determine a cheap and short intervention which can be applicable to small radiology set up as well.Methods: A prospective study was conducted at a tertiary care hospital from October 2016 to December 2016. Accompanying someone was the first strategy used to coped MR imaging claustrophobia followed by placebo (multivitamin), listening Quran and closed eye (blindfold). All those patients who failed to respond in these strategies were finally labeled as an unsuccessful candidate. Listening of Quran was selected as one of the tools as all the patients were Muslims in present study.Results: Among 84 claustrophobic patients, a closed eye was the most successful strategy found effective in (13) 81.2%, followed by placebo 66.7% patients, listening Quran (7) 30.4%, accompanying someone (15) 17.85% while 4% patients remained claustrophobic after application of all strategies. Significant association of accompanying someone and placebo was observed with education (p-value 0.037) and age of the patients (0.016) respectively.Conclusions: In general, placebo, being accompanied by someone and blindfold were found to be the most effective strategies to cope with MRI related claustrophobia. However, the success of these strategies is also dependent on certain factors like age, education status and socioeconomic status of the patients.

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