scholarly journals Demographics, Clinical profile, Causes and Outcome of Intracerebral Hemorrhage in Neurosurgical Unit in Manipal Teaching Hospital of Western Nepal

2021 ◽  
Vol 3 (01) ◽  
pp. 8-14
Author(s):  
Prabin Bhandari ◽  
Suman Adhikari ◽  
Aabishkar Bhattarai ◽  
Nikunj Yogi ◽  
Balgopal Karmacharya ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Blood Volume ◽  
Teaching Hospital ◽  
Clinical Profile ◽  
Study Group ◽  
Midline Shift ◽  
Tertiary Center ◽  
The Mean ◽  
Gcs Score ◽  
Ct Finding

Background: This research article aims to evaluate the demographic variables, clinical profile, causes and outcome determinants of spontaneous intracerebral hematoma (SICH) in a population of Western Nepal. The study represents the cases of SICH reported from Manipal Teaching Hospital, a tertiary center at Gandaki province of Western Nepal. Materials and methods: Retrospective data collection and analysis were done with consecutive cases of SICH admitted to our center between January 2018 and March 2019. The variables analyzed include age, gender, chronic conditions like hypertension, diabetes mellitus, history of tobacco abuse, alcohol abuse, Glasgow coma score (GCS) on admission, radiological(CT scan) findings, treatment modality, an outcome at 6 months period, etc. Modified Rankin score (mRS) was used to assess the outcome at discharge and after six months.  Results: Our study group of 237 patients included 171 males and 66 females and the mean age of presentation was 64.02 years. The study group included 121 patients (51.1%) who were previously diagnosed with systemic arterial hypertension and 15 patients diagnosed with diabetes mellitus. The most frequent locations of hematoma were basal ganglia (n=127), lobar (n=94), intraventricular hemorrhage (n=69), cerebellar (n=15) and brainstem (n=11). The mean volume of the blood clot on admission was 25.97 ml. surgical evacuation of hematoma and decompression through craniotomy was done in 52 (21.9%) patients. Independent predictors of unfavorable outcomes includes the variables like headache (p=0.007), aphasia (p=0.017), mean GCS score (p=0.00) and motor GCS score (p=0.00); CT finding of intraventricular extension of hemorrhage (p=0.00), midline shift (p=0.00), intracerebral blood volume (p=0.00); and surgery (p=0.007). Conclusion: ICH predominantly affects a younger population in Nepal in comparison to the Western world. The variables include clinical features like headache, aphasia, pupillary size and reaction, mean GCS score and motor GCS score; CT finding of intraventricular extension of hemorrhage, midline shift, intracerebral blood volume; and surgery were the predictors of an unfavorable outcome. On binary logistic regression, the ICH score was the most consistent predictor of unfavorable outcomes in terms of MRS (OR 2.236, p=0.002).

scholarly journals Hymenoptera stings: a study of clinical profile, complication and outcome from a teaching hospital of central Nepal

2014 ◽  
Vol 9 (3) ◽  
pp. 17-24 ◽  
Author(s):  
M Ghimire ◽  
B Pahari ◽  
N Paudel ◽  
G Das ◽  
SK Sharma ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Serum Albumin ◽  
Teaching Hospital ◽  
Kidney Injury ◽  
Clinical Profile ◽  
Common Complication ◽  
Medical Sciences ◽  
Female Ratio ◽  
Hymenoptera Sting ◽  
The Mean

Background Hymenoptera sting is a common health hazard in the tropics. Wasp and Bee stings can produce symptoms ranging from local allergic reactions to serious complications including anaphylaxis and multiple organ dysfunction syndromes.Objective To evaluate the clinical profile, management and early outcome of patients with gallbladder cancer.Methods We prospectively analyzed all the consecutive patients with Hymenopterid sting (Wasp and Bee stings), who were admitted in Nephrology Unit in college of Medical Sciences Teaching hospital over a period of two year; from June 2010 to May 2012. Data including demographic profile, clinical profile, complications and outcomes associated with the Hymenopterid stings were entered in a designated profroma and were analyzed.Results A total of 15 cases with Hymenopterid stings (Wasp and Bee stings) were analyzed. Majority of the cases were females (n=8). The male to female ratio was 0.88. The mean age of the case was 37.1± 17.38years. Most of the cases (n=11) were younger subjects d"45 years and majority of them felt in the age group of 21-30 years; (n=4). Mean number of stings (Wasp or Bee stings), were 46 ± 18.4 (12-74) and the mean time to reach the hospital from the bite time was 78.23±82.24 hours (30 minutes-13 days). Black Wasps were the commonest species to inflict the stings in (n=10) cases and Bees in (n=5) cases. The Hymenoptera stings were observed more frequently in the month of July to September in (n=8). The commonest site of bite was head and face seen in (n=11) cases. Among the clinical presentations the commonest clinical presentation was local burning pain and pruritus which was present in all the cases (n=15) followed by nausea (n=10). The commonest clinical sign was bipedal edema which was seen in (n=7) cases. Low Hb (defined as Hb <10gm/dl) was seen in (n=5) cases of Hymenopterid stings. Low platelet (defined as Platelet < 100X109/L) was documented in (n=10) cases. Serum creatinine >1.5mg /dl was seen in (n=7) cases. Low serum albumin (defined as Serum Albumin (<3.5gm/dl) was seen in (n=6) cases. Among the complications, the most common complication was Hepatitis which was seen in (n=9) cases, followed by Acute Kidney Injury. There was no mortality associated with Hymenopterid stings in our study. However 1 patient left against medical advice.Conclusion Black Wasps were the commonest species to inflict the stings in (n=10) cases. The most common complication of Hymenoptera sting was Hepatitis, which was seen in (n=9) of cases, followed by Acute Kidney Injury. Majority of complications were seen in Wasp stings which caused significant morbidity. No mortality was observed in our study except one case; that left hospital against medical advice. Journal of College of Medical Sciences-Nepal, 2013, Vol-9, No-3, 17-24   

scholarly journals Cental Macular Thickness in Patients with Type 2 Diabetes Mellitus without Clinical Retinopathy

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Mehmet Demir ◽  
Burcu Dirim ◽  
Zeynep Acar ◽  
Murat Yılmaz ◽  
Yekta Sendul
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Plasma Glucose ◽  
Healthy Subjects ◽  
Macular Thickness ◽  
Control Group ◽  
Study Group ◽  
Central Macular Thickness ◽  
The Mean

Objective. To compare central macular thickness (CMT) of diabetic patients with type 2 diabetes without clinical retinopathy and healthy subjects.Materials and Methods. Optical coherence tomography (OCT) measurements were performed in 124 eyes of 62 subjects with diabetes mellitus without clinical retinopathy (study group: 39 females, 23 males; mean age: 55.06 ± 9.77 years) and in 120 eyes of 60 healthy subjects (control group: 35 females, 25 males; mean age: 55.78 ± 10.34 years). Blood biochemistry parameters were analyzed in all cases. The data for central macular thickness (at 1 mm), the levels of fasting plasma glucose, and glycosylated hemoglobin (HbA1c) were compared in both groups.Results. The mean central macular thickness was 232.12 ± 24.41 µm in the study group and 227.19 ± 29.94 µm in the control group. The mean HbA1c level was 8.92 ± 2.58% in the study group and 5.07 ± 0.70% in the control group (P=0.001). No statistically significant relationship was found between CMT, HbA1c, and fasting plasma glucose level in either group (P>0.05).Conclusions. Central macular thickness was not significantly thicker in patients with type 2 diabetes without clinical retinopathy than in healthy subjects.

scholarly journals Is the central corneal thickness of diabetic patients thicker than that of non-diabetics’ eyes?

2015 ◽  
Vol 74 (1) ◽  
Author(s):  
Solani D. Mathebula ◽  
Tshegofatso M. Segoati
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Retinopathy ◽  
Central Corneal Thickness ◽  
Statistical Significance ◽  
Corneal Thickness ◽  
Control Group ◽  
Diabetic Patients ◽  
Study Group ◽  
Group 3 ◽  
The Mean

The purpose of the study was to evaluate central corneal thickness in diabetic patients and to compare the results with controls without diabetes mellitus. Sixty-five diabetic patients (65 eyes) constituted the study group, and 50 eyes were from the healthy control group (50 non-diabetic patients). The study group was subdivided into group 1 (no diabetic retinopathy, n = 35), group 2 (mild to moderate nonproliferative diabetic retinopathy, n = 20), and group 3 (proliferative diabetic retinopathy, n = 10). Central corneal thickness measurements in microns were determined using ultrasound pachymetry. The mean central corneal thickness was significantly greater in the study group (567.14 μm ± 14.63 μm) than in the control group (531.14 μm ± 5 μm). In addition, the mean central corneal thickness was found to be greater in group 3 (577 μm ± 12 μm) than in groups 1 (562 μm ± 13 μm) and 2 (566.86 μm ± 15 μm), but the difference did not reach statistical significance. We found that the mean central corneal thickness for diabetic patients was thicker than that of the healthy controls. Thicker central corneas associated with diabetes mellitus should be taken into consideration when obtaining accurate intraocular pressure measurements in diabetics.

scholarly journals PECULIARITIES OF ACUTE ALIMENTARY PANCREATITIS AND THE RISK OF COMPLICATIONS IN PATIENTS WITH A COMBINATION OF PRSS1 AND SPINKI1 GENE MUTATIONS

2020 ◽  
pp. 58-63
Author(s):  
Yu. V. Avdosiev ◽  
K. M. Pankiv ◽  
S. D. Hіmіch ◽  
І. V. Bеlоzorоv ◽  
О. М. Kudrevich ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Gene Mutations ◽  
Multiple Organ ◽  
Study Group ◽  
Systemic Complications ◽  
Moderate Severity ◽  
Pancreatogenic Diabetes ◽  
Mutational Status ◽  
Purulent Peritonitis ◽  
The Mean

Summary. Aim. To evaluate the features of acute alimentary pancreatitis and the risk of complications in patients with a combination of PRSS1 and SPINKI1 gene mutations. Materials and methods. 70 patients with acute alimentary pancreatitis were examined. The mean age was 45.4±13.87 years. The study group included 48 (68.57 %) men and 22 (31.43 %) women. In 34 (48.57 %) patients there was a severe course of acute pancreatitis, in 25 (35.72 %) – moderate severity, in 11 (15.71 %) – mild. Complicated disease was diagnosed in 59 (84.29 %) patients, 11 (15.71 %) – uncomplicated. The severity of the course and the presence of complications were evaluated using the Atlanta Classification, 2012. The polymorphism of the PRSS1 and SPINKI1 genes was determined by all subjects. Statistica 13 was used for statistical analysis. Results and discussion. The combined effect of the PRSS1 and SPINKI1 gene mutation is associated with a higher risk of severe alimentary pancreatitis. The presence of a combined mutational status increases the chances of developing peritonitis, pleurisy, pancreatic accumulation, pseudocysts and pancreatogenic diabetes mellitus. In addition, these patients have proven significantly higher chances of formation of purulent peritonitis, phlegmon, suppuration of pseudocysts, development of systemic complications – systemic inflammatory response syndrome and multiple organ failure syndrome. Conclusions. The reliable connection between the presence of a combination of mutations of the studied genes and the development of severe course of acute alimentary pancreatitis and the formation of complications have been proved.

scholarly journals Endoscopic assisted key-hole surgery for subacute subdural hematoma evacuation in emergency situations

2020 ◽  
Author(s):  
guo-chen Sun ◽  
Chong Li ◽  
Hao Tang ◽  
Ke-fan Yi ◽  
Fang-ye Li ◽  
...  
Keyword(s):  
Subdural Hematoma ◽  
Open Surgery ◽  
Control Group ◽  
Study Group ◽  
Hematoma Evacuation ◽  
Surgery Group ◽  
The Mean ◽  
Gcs Score ◽  
Endoscopic Group ◽  
Small Bone

Abstract Background Endoscopic removal of subacute subdural hematoma is seldom performed, but there is no standard technique till date. We investigated whether a simple endoscopic method is effective for the evacuation of subacute subdural hematoma. Methods A total of 51 patients with subacute subdural hematoma requiring surgery were enrolled in this study. Endoscopic hematoma evacuation was performed through a small bone window for 22 patients. Hematoma evacuation by open surgery was performed in 29 patients. Pre- and postoperative Glasgow coma scale (GCS), operation time, displacement of midline, and intraoperative blood loss were recorded and analyzed. Results The median time from incision to suture completion was 40 min (range: 31.25–43.75 min) for endoscopic group, and 70 min (range: 65–80 min) for open surgery group (P<0.01). The average total blood loss was 50(30-50) ml for endoscopic group, and 250(200-300) ml for open surgery group (P<0.01). No patient showed post-operative re-bleeding in both groups. The mean preoperative mid-line displacement for the two groups was 11.51±3.51mm for study group vs 10.47±2.93mm for control group (P>0.05). Mid-line displacement showed significant improvement on the day after surgery to 5.29±1.91mm for study group vs 6.75±1.37mm for control group (P<0.01). At 1-month follow-up, the midline was normal in both groups. Computed tomography revealed almost no residual hematoma, representing an average evacuation rate of 100% in both groups. The mean preoperative GCS score was 13(12.25,15) for study group vs 13(12,14) for control group(P>0.05). GCS score on the day after the operation was improved to 15 for each patient in endoscopic surgery group, while 15(14,15)in the open surgery group (P<0.01). Conclusions Endoscopic subacute subdual hematoma removal through a small bone window achieved a satisfactory hematoma removal with minimally invasive method when compared to open surgery.

scholarly journals Clinical profile of type 1 diabetes mellitus among children in eastern part of Nepal

2019 ◽  
Vol 6 (2) ◽  
pp. 583
Author(s):  
Dipak Muktan ◽  
Lisa Tamang (Ghising) ◽  
Rupa Rajbhandari Singh
Keyword(s):  
Diabetes Mellitus ◽  
Weight Loss ◽  
Type 1 Diabetes ◽  
Type 1 Diabetes Mellitus ◽  
Glycosylated Hemoglobin ◽  
Clinical Profile ◽  
Duration Of Symptoms ◽  
Family History Of Diabetes ◽  
The Mean

Background: The objective of this study is to determine the clinical profile of Type 1 diabetes mellitus (T1DM) among children.Methods: Descriptive cross sectional study was conducted at B.P. Koirala institute of Health Sciences (BPKIHS), Dharan, Nepal, the eastern part of Nepal. A total of 42 diabetic children of less than 20 years old diagnosed with T1DM were included in the study. Data were collected via semi-structured interviews and medical records of patients attending diabetic clinic at the time of follow up.Results: The mean age at diagnosis of disease was 11.1±4.9 years. Polyuria 33 (78.6%) was found to be the commonest symptom followed by polydipsia 27 (64.3%), weight loss 23 (54.8%) and polyphagia 13 (30.9%). The mean duration of symptoms before diagnosis was 14.3±9.7 days. DKA was present in 25 (59.5%) children at the time of diagnosis. Mean Glycosylated hemoglobin (HbA1c) value was 10.6±2.7. Obesity was observed in 9 (21.4%) children. Nine (21.4%) children had family history of diabetes. In most of the cases, primary caregiver was mother, among them only 24 (57.2%) had formal education. Almost half of the caregivers were using FRIO, an insulin cooling case, for insulin storage.Conclusions: Polyuria was the most common presenting symptom followed by polydipsia, weight loss and polyphagia. Moreover, most of the children had landed up in diabetic keto-acidosis (DKA) at the time of diagnosis. Therefore, community awareness programs should be emphasized among parents and primary health care workers especially in rural areas regarding T1DM for early recognition and prompt treatment.

scholarly journals A study to know the serum total testosterone levels in type II diabetes mellitus male patients from North India

2019 ◽  
Vol 7 (6) ◽  
pp. 2106
Author(s):  
Saurabh Agarwal ◽  
Brijesh Kumar ◽  
Sushmita . ◽  
Richa Giri ◽  
Sanjay Kumar Verma
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Testosterone Level ◽  
Control Group ◽  
Total Testosterone ◽  
Study Group ◽  
Lower Serum ◽  
Male Patients ◽  
The Mean

Background: Diabetes mellitus is major public health issue facing the world in present century and the prevalence of type 2 diabetes is increasing explosively.  There are various diabetes related complications, one of which is low testosterone levels in men. This study was designed to estimate the serum testosterone level in male patients of type 2 diabetes mellitus.Methods: The patients of type -2 diabetes mellitus were picked up from out-patient and in-patients section of the hospital at random.Results: Seventy male  patients with type 2 diabetes mellitus were enrolled during the study period. The mean age of study population was 56.36±10.26 years (range 36-70), while that of control group patients was found to be 39.80±7.92years. Family history of diabetes was present in 14 (22.2%) patients. The mean HbA1c in study group was 8.83±1.95 %, which was significantly higher as compared to control group with HbA1c 4.82±0.40 %. Among study group, lower serum total testosterone level was observed in 85.7 % cases and normal level in 14.3 % cases. Among control group, lower serum total testosterone level was observed in 6.7 % cases and normal level in 93.3 % cases.Conclusions: The present study highlighted that significant difference in serum total testosterone level has been observed between cases and control groups (X2 =55.7, P=0.0001).

scholarly journals Effect of sulfonylureas on attenuation of electrocardiographic ST- segment elevation during an acute myocardial infarction in diabetics

2018 ◽  
Vol 7 (4) ◽  
pp. 579
Author(s):  
Bapugouda Sahebagouda Patil ◽  
Naser Ashraf Tadvi
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Control Group ◽  
Diabetic Patients ◽  
Study Group ◽  
St Segment Elevation ◽  
St Segment ◽  
Significant Difference ◽  
The Mean

Background: Sulfonylureas are primarily used in the treatment of diabetes mellitus act by inhibiting ATP sensitive potassium ATP (K-ATP) channels. Similar channels are also present are also present in heart venticular muscle. Previous studies reveal that these drugs are able to reduce the electrocardiographic ST- segment elevation changes during an acute myocardial infarction. Hence, the present study was designed to evaluate the attenuating effect of sulfonylureas on ST- segment elevation in diabetic patients presenting with acute myocardial infarction.Methods: This cross sectional study included 73 diabetic patients presenting with the signs and symptoms of acute myocardial infarction of less than 24 hours duration along with CPK levels of more than 25 IU/L. Of them 5 were excluded from the study. The remaining 68 patients were included in the study, out of which 36 patients were in the study group (sulfonylurea group), and 32 patients were in the control group (non-sulfonylurea group).Results: No statistically significant difference was seen in the demographic parameters like age, sex, duration of diabetes mellitus and CPK levels (p>0.05). Among 68 patients 38 patients were diagnosed as STEMI. The mean magnitude of ST-elevation in the study group (n=16) was 2.3±0.12 and in control group (n=22) patients it was 3.7±0.33. The percentage of NSTEMI was significantly higher in study group compared to control. Statistically significant difference (p<0.05) was seen only between CPK level of range 25 and 100IU/L and mean magnitude of ST-segment elevation in STEMI patients. Significant difference in the mean magnitude of ST-segment elevation was observed in case of females among the study and control groups (p<0.05).Conclusions: Sulfonylureas drugs play a significant role in attenuation of ST-segment in diabetic patients presenting with acute myocardial infarction. Further, large multicentric studies are required to confirm the exact correlation between sulfonylureas and ST-segment.

scholarly journals Post Neonatal Tetanus as Seen in Rivers State University Teaching Hospital, Nigeria: Prevalence, Clinical Profile and Outcome

2021 ◽  
pp. 38-47
Author(s):  
Tamunoiyowuna Grace Okari ◽  
Boma Awoala West
Keyword(s):  
Teaching Hospital ◽  
Tetanus Toxoid ◽  
Rural Areas ◽  
Case Fatality ◽  
Clinical Profile ◽  
University Teaching ◽  
Neonatal Tetanus ◽  
State University ◽  
The Mean ◽  
Rivers State

Background: Post neonatal tetanus, a vaccine preventable disease is a cause of childhood morbidity and mortality in many developing countries including Nigeria. This study was carried out to determine the prevalence, clinical profile and outcome of children with post-neonatal tetanus. Methods: This prospective observational study carried out over 3years in the Paediatric ward of the Rivers State University Teaching Hospital, was among children older than 28days and up to 16years. Result: Of 966 children admitted during the period of study, 12 had post-neonatal tetanus giving a prevalence of 1.2%. Six (50%) were > 10years old with a M:F ratio of 5:1, 5(41.7%) resided in rural areas and all (100%) were of low socioeconomic status. Six (50%) did not receive tetanus toxoid vaccine and no child had booster doses. Portal of entry for the infection was majorly via injuries on their limbs, 7(58.3%). The mean incubation period was 10.58±7.39 days while the mean onset interval was 31.58±27.85 hours. Three (25%) children had severe tetanus using Ablett’s classification with spasm 11(91.7%) documented as the commonest symptom. Half, 6(50%) of the children had autonomic complications and an overall case fatality rate of 25%. Conclusion: The prevalence of post-neonatal tetanus in the Rivers State University Teaching Hospital was low being 1.2%, although unacceptable. The mortality rate of post-neonatal tetanus of 25% was high. Thus, there is a need to strengthen existing immunization program and immediately adopt the commencement of booster doses of tetanus toxoid vaccines for eligible children in Nigeria.

scholarly journals Clinical Profile and Predictors of Outcome in Spontaneous Intracerebral Hemorrhage from a Tertiary Care Centre in South India

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Ajay Hegde ◽  
Girish Menon ◽  
Vinod Kumar ◽  
G. Lakshmi Prasad ◽  
Lakshman I. Kongwad ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Intraventricular Haemorrhage ◽  
Clinical Profile ◽  
Western Society ◽  
Study Group ◽  
South Indian Population ◽  
Poor Outcome ◽  
South Indian ◽  
Surgical Evacuation ◽  
The Mean

Background. This article attempts to evaluate the clinical profile and outcome determinants following hypertensive SICH in a South Indian population. The study represents the largest series of SICH reported from a single centre in India. Materials and Methods. Prospective data collection and analysis of patients with SICH admitted to our centre between 1st January 2015 and 31st December 2018. The variables analysed include: age, sex, comorbidities, Glasgow coma score (GCS) on admission, radiological features, treatment modality, and outcome at three months. Modified Rankin score (mRS) was used to assess the outcome at discharge and three months. Results. Our study group of 905 patients included 638 males and 267 females and the mean age at presentation was 58.10 ± 12.76 years. The study group included 523 patients (57.8%) previously diagnosed hypertensive, of whom 36.3% (n=190) were on irregular medication. The most frequent locations of hematoma were basal ganglia (478), thalamus (202), lobar (106), cerebellar (61), brainstem (31), and primary intraventricular haemorrhage (27). Secondary intraventricular extension was seen in 425 (47%) patients on admission. The mean volume of the clot on admission was 23.45 ± 19.79 ml, and clot progression was seen in only 46 (5.08%) cases. Surgical evacuation through craniotomy was done in 147 (16.8%) patients, and external ventricular drainage (EVD) was placed in 56 (6.2%) patients. Overall 3−month mortality was 30.1% (266 patients). On the last follow up a favorable outcome (mRS 0−3) was observed in 412 (45.53%) patients and a poor outcome (mRS 4−5) in 207 patients (22.87%). Independent predictors of mortality are Age >70 (p=<0.001, OR 4.806, 95% CI 3.064–7.54), admission GCS <8 (p=<0.001, OR7.684, 95% CI 5.055#x2013;11.68), and Hematoma volume >30 ml (p=<0.001, OR 2.45, 95% CI 1.626–3.691). Intraventricular haemorrhage was an additional poor outcome predictor (p<0.015, CI 1.105–2.585). Surgical evacuation reduced mortality in the group, but morbidity rates remained the same. Conclusions. SICH predominantly affects a younger population in India in comparison to the Western society. Elderly age, poor GCS on admission, clot volume above 30 ml and intraventricular extension remain the most consistent predictors of death and poor outcome. Further studies are needed to assess the risk of SICH among hypertensive patients and to prognosticate the outcome after SICH using novel predictors, including biomarkers.

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