Evaluation of Clinical Profile of Bipolar and Unipolar Depression Patients- A Clinical Study

Background: The present study was conducted to assess the clinical profile of unipolar and bipolar depressive patients. Subjects & Methods: 74 patients diagnosed with unipolar (40) and bipolar (34) depressive disorders were selected. Depressive cognitions, catatonic features, suicidal thoughts, anhedonia, pseudodementia, dissociative features, panic attacks, delusions, first-rank symptoms, auditory hallucinations, and affective reactivity were recorded. Results: Out of 74 patients, males were 32 and females were 42. Age of onset was 32.2 years in group I and 20.4 years in group II, total duration was 12.4 years in group I and 16.2 years in group II, the number of episodes was 3.4 and 7.1 in group II, the number of hospitalizations was 2.8 in group I and 5.2 in group II, suicidal thoughts were seen in 21 in group I and 24 in group II, anhedonia 10 in group I and 23 in group II, psuedodementia 7 in group I and 13 in group II, dissociative features were seen in 11 in group I and 27 in group II, delusions 4 in group I and 8 in group II, panic symptoms 10 in group I and 18 in group II and auditory hallucination 7 in group I and 18 in group II. The difference was significant (P< 0.05). Conclusion: Authors found that common clinical features were suicidal thoughts, dissociative features, and anhedonia.

A Study to Assess the Neurocognitive Profile of Patients with OCD and Depression

Background: The present study was conducted to assess the neurocognitive profile of patients with OCD and depression. Subjects & Methods: It comprised of patients of OCD (42) and depression (42) of both genders. An equal number of healthy control was also recruited. VAIS and performance tests of intelligence (BSS) were recorded. Results: Group I had 22 males and 20 females, group II had 18 males and 24 females and group III had 21 males and 21 females. The value for VAIS and performance tests of intelligence (BSS) parameters such as information were 94.2, 96.4 and 98.3 in all groups respectively, digit span was 103.4, 102.5 and 105.6 in all groups respectively, arithmetic was 95.8, 96.2 and 8.4 in all groups respectively, comprehension was 102.4, 104.5 and 107.3 in all groups respectively, verbal quotient was 105.2 in group I, 103.6 in group II and 10.6.7 in group III respectively. Block design was 9.12, 10.2 and 10.4 in all groups respectively, pass along test was 9.4, 9.8 and 10.2 in all groups respectively and the performance quotient was 102.2, 103.5 and 10.5.7 in all groups respectively. The difference was non-significant (P> 0.05). Conclusion: Neuropsychological/cognitive parameters in patients with OCD, depression and healthy control were comparables.

Osteoid Osteoma of Cuboid Bone- A Rare Cause of Chronic Foot Pain in Childhood –A Case Report

Chronic foot pain in pediatric age group is less common. The usual differential diagnosis may vary from musculoskeletal injury to serious diseases such as osteomyelitis. Benign bone tumor such as osteoid osteoma of foot is exceedingly rare in this age group. Here we present a rare case of osteoid osteoma of cuboid mimicking osteomyelitis. Patient was managed conservatively by Non-steroidal Anti-inflammatory drugs (NSAIDs) with good clinical outcome. Osteoid osteoma of foot bones should be kept in mind in cases with normal blood parameters.

Floor Level Activity as a Sign of Congruency and Containment in Perthes’ Disease

Background: This study aims to note the role of floor level activities like squatting and sitting cross-legged as the indicator of healing with good containment and congruency in Perthes’ disease in children below eight years of age. The research hypothesis of the study is that the functional outcome of the affected hip joint in the form of spontaneous, free and full painless floor level activity in day to day life of the child is a better indicator of outcome irrespective of the radiographic changes in the hip joint. Subjects and Methods: A retrospective observational study was conducted in a tertiary care university hospital. The study included all the patients diagnosed with Perthes’ disease whose last radiological assessment showed signs of healing. Patients above eight years and patients who had not started showing radiological healing were excluded. Parameters assessed were the presence of lurch, pain at the hip joint, limb length discrepancy, range of motion at the hip joint and ability to sit cross-legged and squat and epiphyseal extrusion index on radiographs. Results: Nineteen hips in 18 patients met criteria with a mean age of 7.1 1.5 years at presentation with a minimum follow-up of 30 (30 – 72) months. None of the patients had any residual lurch or tenderness at the hip joint at final follow up and all were able to sit cross-legged and squat symmetrically and comfortably with significant improvement of motion at the hip joint (p<0.05). No correlation was noted among the clinical and radiological features; except the internal rotation at healing with epiphyseal extrusion index at healing. Conclusion: Clinical function holds the key primarily in the course of treatment of Legg-Calve-Perthes’ disease. Conservative management in the form of bracing, floor level activities, and hip flexion and abduction exercises lead to congruency and containment in Legg-Calve-Perthes’ disease up to the age of eight years.

A Study on Prevalence of Serum Resistant & Sensitive Escherichia Coli in Urinary Tract Infection

Background: Escherichia coli is the commonest organism causing urinary tract infection in women and children especially in those with uncom- plicated infections. It has been traditionally described Serotypes of Escherichia coli were consistently associated with Uropathogenicity and designated as Uropathogenic Escherichia coli.It is now recognized that a subset of fecal Escherichia coli can be colonized in the peri-urethral area, enter the urinary tract and cause symptomatic disease. These are currently defined as Uropathogenic Escherichia coli. The aims & objectives are to the isolation of Escherichia coli in Urinary tract infection. 2. To determine the prevalence of Serum resistant Uropathogenic Escherichia coli. 3. To compare antimicrobial efficacy in Serum resistant and Serum sensitive Uropathogenic Escherichia coli. Subjects & Methods: An observational study was conducted on 100 patients and urine samples collected from suspected and suffering from urinary tract infection. Study period from August 2018 to July 20019 attending General medicine OP in Hospital. Escherichia coli were isolated and identified by conventional techniques Mackie & Mc Cartney. The strains were subjected to multiple drugs to study serum resistance and sensitivity. Results: From 100 urine samples 71 Uropathogenic, 18 males & 53 females. 40% Sero-resistant and 60% Sero-sensitive among them 2 to 18 years males and > 40 years females resistant, above 40 years males and 19 to 40 years females are sensitive to multiple antibiotics. Conclusion: it emphasizes Serum resistance is an important virulence factor, It may lead to pyelonephritis and septicemia. Serum resistant E. coli are multiple drug-resistant, so the present study formulating guidelines for planning effective treatment and Periodic surveillance to monitor resistance.

Outcome of Pregnancies with Fibroids and its Associated Complications: A Prospective Study

Background: Fibroids (leiomyomas) are benign smooth muscle cell tumors of the uterus. Although they are extremely common, with an overall incidence of 40% to 60% by age 35 and 70% to 80% by age 50, the precise etiology of uterine fibroids remains unclear. Some studies have shown a relationship between uterine fibroids and pregnancy complications, such as preterm birth, premature rupture of membranes (PROM), fetal malpresentation, placental abruption and intrauterine fetal demise. The aim is to study the outcome of pregnancies with fibroids and their associated complications. Materials and methods: The present study was conducted in the Department of Gynecology in a tertiary care hospital. For the study, a total of 40 patients were selected between the age range of 21 to 45 years from the outpatient list of the department of gynecology with pregnancy with fibroid after attending first-trimester ultrasonography examination which diagnosed them. The patients underwent both consequent antenatal care and delivery at the study institute in the study time. Ultrasonogram was done at successive visits to evaluate the change in the size of the fibroid and any associated complications either in fibroid or in pregnancy in general. Results: We observed that 15 patients had threatened miscarriage, 12 had preterm labor, 2 had antepartum bleeding, 3 had abdominal pain needing admission, 2 had laparotomy due to pain, 1 had a postpartum hemorrhage and only one patient needed a blood transfusion. Spontaneous abortion was observed in 2 patients, premature delivery in 15, delivery at 37-41 weeks in 37, vaginal delivery in 5 patients and cesarean section in 44 patients. Conclusion: Within the limitations of the present study, it can be concluded that pregnant women diagnosed with uterine fibroids are at a greater risk of complication during the antepartum, intrapartum, and postpartum periods.

Study of Influence of Vaginal Ph on the efficacy of Dinoprostone gel for Induction of Labor

Background: Inducing labor is a procedure intended to trigger artificial contractions of the uterus that generally involve progressive erasure and dilation of the cervix. This will hopefully lead to the birth of a baby through the vaginal route. To assess the efficacy of dinoprostone gel in cervical maturation and its effect on vaginal pH. Subjects and Methods: The participants were grouped by their vaginal pH into two groups. Group, I included patients with vaginal pH 4.5 and Group II included vaginal pH >4.5 and the differences between the groups with respect to maternal age, parity, gestational age. Those women with minimal change in Bishop Score, received up to 3 doses of dinoprostone gel intracervically, 6 hours apart. Women, who had no change in Bishop Score at the end of induction with 3 doses of dinoprostone, were further reassessed. Results: There was no statistically pertinent relationship between the two groups in regard to maternal age, gestational age, parity, and initial Bishop Score. The mean maternal age in Group I was 25.9 years and Group II was 26.9 years. The mean gestational age was 39.5 weeks in group I and 38.9 weeks in group II. The majority of subjects were primigravidas (70 percent in group I and 63 percent in group II). The mean Bishop score before labor induction was 3.6 0.9 in Group I and 4 1.0 in Group II. Out of 200 cases, 33 (23.3 percent) needed an improvement in Oxytocin, 33 (33.3 percent) in Group I and 4 (13.3 percent) in Group II. The vaginal delivery rate was 90% in Group I and 87% in Group II. The Caesarean section was marginally higher in Group II (10 percent) compared with Group I (13 percent). Conclusion: Parity has a major impact on the pre-induction of the Bishop Score and the pH itself has a vaginal influence. Knowing the pre-induction vaginal pH may also be a helpful method for determining the outcome of PGE2 induction.

Assessment of Bacteriological Quality of Drinking Water from Households of Sarvodaya Nagar, Lucknow, Uttar Pradesh, India

Background: In the current scenario, the urbanization is happening at a faster pace and the economy is not able to match at par with urbanization, this In turn is causing problems of unavailability of safe and potable water along with proper sewage system, despecially in urban slums. As a result of the scenario many urban slums are still using poor quality pit latrines and even drawing water from nearby wells, water taps which are not complying with government norms. Space is also a big problem which is being faced by these slums, due to which there is a lack of enough spaces in the houses and nearby areas, therby causing overcrowding. Due to overcrowding, the space between houses, pit latrines, wells, taps and water bodies has decreased and thus the potential of contamination of water bodies by fecal microorganisms has increased drastically. Given the above knowledge, a study is much needed to estimate the presumptive and differential coliform count of water samples from the urban slum area in Lucknow. Subjects & Methods: A cross-sectional survey was conducted during the period of January to June 2019. Samples were collected from all the taps, hand pumps that were currently in use, along with potable water stored in households of Sarvodaya Nagar (an urban slum area), Lucknow and were processed in the Microbiology department of IIMS&R, Lucknow. Results: A total of 53(63%) samples were taken from Public supply, out of which 36(67. 9%) were found unsatisfactory and 17(32.0%) were intermediate, were found to be contaminated with Pseudomonas sp., E.coli, Thermotolerent E.coli, Klebsiella Spp. Citrobacter, Enterococcus and Pseudornonas Spp., E.coli, Thermotolerent E.coli, Klebsiella respectively. In the study more than half of the samples were taken from the Public water supply. Out of these about seventy percent were unsatisfactory and were found to be contaminated with Pseudomonas. Conclusion: The proper sanitation, regular treatment, supervision of water sources, arid regular bacteriological assessment of all water sources for drinking should be planned and conducted.

Clinical Profile and Outcome of Patients with Severe Acute Pancreatitis

Background: Acute pancreatitis (AP) is an acute inflammatory condition of the pancreas leading to pancreatic autodigestion. The present study was conducted to study the clinical profile and outcome of patients with severe acute pancreatitis. Subjects & Methods: The study was conducted on 40 patients of acute pancreatitis. Clinical profile including history, examination findings, etiology of pancreatitis, clinical severity (according to Modified Marshall Score, BISAP score, APACHE II, HAPS score, SOFA score) was recorded. Results: Severe Acute Pancreatitis (SAP) among patients. Majority of the patients i.e. 22 (55%) had alcohol consumption as etiological factor causing SAP followed by biliary 10 (25%) & idiopathic 5 (12.5%). Hypertriglyceridemia and drug-induced (herbal medication) pancreatitis was present in 1 (2.5%) patient each. Out of all 1 (2.5%), patients had a history of both alcohol consumption and the presence of gallstone as an etiological factor. 22 patients (55%) out of 40 patients only conservative management was used while 18(45%) patients underwent USG guided percutaneous drainage was done. Out of these 18 patients, 3(7.5%) patients required Laparoscopic Necrosectomy & 2(5%) patients required open necrosectomy in addition to ultrasound-guided PCD. Patients who improved had a mean BISAP SCORE of 2.15 0.54, Modified Marshall score of 3.65 1.44, APACHE II score of 9.77 4.45, SOFA score 5.54 2.49, RANSON’s score 3.85 1.80 and HAP score of 0.65 0.63. Conclusion: Most common etiology of severe acute pancreatitis is alcohol followed by biliary etiology. Out of severity scores (BISAP, APACHE-II, SOFA, HAPS), only BISAP score ≥3 is predictive of poor outcome in patients with severe acute pancreatitis.

Management of Occult Hypoperfusion Syndrome in Trauma Patients: A Narrative Review

Occult hypoperfusion (OH) is connected with higher levels of morbidity and mortality after trauma. Occult hypoperfusion, defined as serum lactate concentration of more than 2.5 mmol / L persisting in the intensive care unit for more than 12 hours after admission. This refers to the reversible risk factor for negative results after traumatic injury. Occult hypoperfusion can be observed and patients at risk of complications should be classified other than frequently regulated metrics (blood pressure and heart rate), central venous oxygen saturation, and blood lactate levels. An elevated hospital duration of stay (LOS) and a greater incidence of postoperative difficulties are linked with OH. The focus of this review article is to assess the different approaches and methods involved in the management of OH syndrome in trauma patients. Identification of OH treatment methods can be helpful in reducing morbidity in patients with various injuries. The outcomes from this review article may prove beneficial to patients by rapid resuscitation and aggressive monitoring of OH. These management practices will severely reduce OH-associated morbidity and mortality. LOS, ICU readmission incidence and post-operative complications per patient was decreased by early treatment of OH.