Σάββατο, 5 Νοεμβρίου 2016

Screening for overall mental health status using mental health inventory amongst medical students of a government medical college in North Karnataka, India

Source: International Journal of Community Medicine and Public Health
Yuvaraj B. Y., Poornima S., Rashmi S..
Background: In developing countries like India, seeking mental health care is still a taboo, and a lot of stigma is attached to consulting a psychiatric specialist or a counselor. This problem magnifies when budding doctors have a mental health issue. Objective of the study was to assess the overall mental health status of undergraduate medical students studying in a Government Medical College of North Karnataka by using the mental health inventory (MHI) questionnaire. Methods: A cross-sectional study was carried out during the period of July to September 2016 amongst 210 undergraduate medical students at Government Medical College, Koppal, Karnataka by administer a standard 18 items MHI questionnaire. The raw MHI scores (0-6) and computed MHI scores (0-100) were calculated for overall and four subscales (i.e. anxiety, depression, behavioural control, and positive affect) were also calculated. Results: Out of total 210 study participants, 119 (56.67%) were male and 91 (43.33%) female students. The overall computed MHI scores (0-100) total score ranges from 58-74, mean score 63.5, median 64.43 and a standard deviation of 4.01. However, computed MHI (0-100) scores for subgroups like anxiety ranged from 8 to 60, mean score 47.36, depression ranged from 8 to 84, mean score 50.29, behavior control ranged from 30 to 85, mean score 67.76, and positive affect ranged from 25 to 100, mean score 42.7. Conclusions: Poor mental health and presence of some emotional health problems among medical students is substantially high. Early screening, diagnosis, care and support should be made available to all the medical students.


Gastric Perforation After Incidental Ingestion Of Datun: Report Of An Unusual Case

Source: The Southeast Asian Journal of Case Report and Review
Pal Naresh, Griwanmahavir S , Singhbikram J .
Gastric perforation is an extremely rare complication of foreign body ingestion, which usually presents with peritonitis. Ingestion of foreign bodies is a fairly common presentation and most of these cases can be managed conservatively. Larger foreign bodies however, can sometimes be difficult to manage. We present a peculiar case of gastric perforation following involuntary ingestion of a large foreign body i.e. Datun (It is a tree twig commonly used for cleaning teeth in rural India). A 57-year male presented to our accident and emergency department with complaints of pain in upper abdomen following involuntary ingestion of Datun while brushing his teeth 7-8 days back. During this period the patient was passing flatus and stools normally. He also had history of smoking and occasional consumption of alcohol. On examination of the abdomen the patient was found to have tenderness and guarding in upper abdomen. He was investigated further with a provisional diagnosis of perforation peritonitis. Free air under the diaphragm was evident on chest X ray. Upon exploratory laparotomy the patient was found to have a perforation in the body of the stomach with one half of the Datun protruding out of it. Primary closure of perforation was done after removal of the foreign body. Postoperative period was uneventful and the patient was discharged on the 5th post operative day. Symptomatic giant ingested FBscan be challenging to manage and may even require urgent surgical intervention if perforation is suspected. Although ingested foreign bodies are rarely symptomatic they should be considered in differential diagnosis of abdominal pain as well as possible cause of acute abdomen.


Amyand’s Hernia: An incidental Diagnosis

Source: The Southeast Asian Journal of Case Report and Review
Manish Swarnkar, Gaurav Pal, Raju Shinde.
Inguinal hernia repair is commonplace in general surgery practice. Amyands hernia is an extremely rare condition in which the appendix is positioned in the inguinal hernia sac. We report the intra-operative findings of a standard inguinal hernia repair and discuss the management of the Amyands hernia.


World’s Heaviest Spleen Removed

Source: The Southeast Asian Journal of Case Report and Review
Arjun Goel, Brahm Dutt Pathak, Vikrant Singh Chauhan, Laxmi Goel.
A 33 yr old man with hepatosplenomegaly, presented with abdominal pain and distension. After establishing the diagnosis of type I Gauchers disease, splenectomy was done which weighed a massive 14.96 kilograms. The heaviest spleen reported till date. A case report of splenectomy for massive splenomegaly with comparison of other reports is presented. Splenectomy in gaucherss disease have been reported in the past for hypersplenism and splenomegaly. Splenomegaly and hypersplenism causes poor quality of life with abdominal distension and discomfort, recurrent blood transfusions, increased risk of bleeding, pancytopenia. The main indication in our case was massive splenomegaly extending well below the umbilicus and reaching upto the opposite iliac fossa (Hacketts grade V). Such massive sized spleens have never been reported in the past as patients present before reaching this level. Performing splenectomy in this case was in itself an arduous task. Our patient was operated by conventional midline laparotomy and recovered well after surgery.


A Comparative Evaluation Of Intravenous Ranitidine And Rabeprazole On Gastric Volume And Ph In Patients Undergoing Surgery Under General Anaesthesia

Source: The Southeast Asian Journal of Case Report and Review
Sumit Kumar Singh, Mukesh Kumar, Usha Suwalka.
Introduction: The morbidity and mortality associated with the complication of Acid aspiration syndrome increases with the volume and acidity of gastric aspirates. Objective: Routine practice often includes use of pharmacological agents to reduce gastric volume and increase gastric pH. The aim of the study was to compare the effectiveness of intravenous Rabeprazole and intravenous Ranitidine on gastric fluid volume and pH in patients undergoing elective surgery under general anesthesia. Material and Methods: This prospective randomised double blind study was conducted on 90 healthy adult patients of either sex undergoing elective surgery under general anesthesia of age group 18-60 years and three groups were assigned with, Group 1 received intravenous Ranitidine 50 mg, Group 2 received intravenous Rabeprazole 20 mg, Group 3 received 5ml of normal saline(control group) before one hr, on the day of surgery and gastric volume and pH estimated just before induction of anaesthesia. Results: Volume of the gastric aspirates in preintubation was 15.8±2.73 ml in Group 1 (Ranitidine), 14.2±2.93 ml in Group 2 (Rabeprazole) and 20.8±2.81 ml in Group 3 (Control). There was significant (p=0.03) decrease in gastric volume with Rabeprazole compared to Ranitidine. The pH values determined in preintubation was 3.21±0.68 in Group 1 (Ranitidine), 3.66±0.79 in Group 2 (Rabeprazole) and 2.62±0.79 in Group 3 (Control). There was significant (p=0.018) increase in pH with Rabeprazole compared to Ranitidine. Conclusion: From present study it may be concluded that Ranitidine and Rabeprazole both are effective in reducing gastric volume and pH. As compared to Rabeprazole, Ranitidine is less effective in reducing gastric volume and pH but still more commonly used due to its cost effectiveness.


Immune thrombocytopenia and its association with lymph node tuberculosis – A dilemma!

Source: The Southeast Asian Journal of Case Report and Review
Sangita Deepak Kamath, Neeraj Jain, Saurabh Pathak, Ballamudi Srinivas Rao.
Background: Although various hematologic abnormalities are known to occur with tuberculosis, association of immune mediated thrombocytopenia with tuberculosis is uncommon. Newly diagnosed immune thrombocytopenia in TB is rare; only 27 cases have been reported so far. Case: We report a case of axillary lymph node tuberculosis who presented with immune thrombocytopenia. An eighteen year old girl was admitted to our hospital with excessive vaginal bleed of one week duration followed by the development of petechial lesions and ecchymosis over legs, hands and mouth. She also had solitary, firm, left axillary lymphadenopathy. A diagnosis of immune mediated thrombocytopenia (ITP) was made from peripheral blood smear and bone marrow examination. Intravenous methylprednisolone (30mg/kg body weight) followed by oral prednisolone (1mg/kg) failed to elicit any sustained platelet response. Fine needle aspiration cytology of the left axillary lymphadenopathy done later revealed tuberculosis. After two weeks of starting anti-tuberculous therapy, the platelet count returned to normal and she was off all therapy for ITP thereby suggesting likely association between tuberculosis and immune thrombocytopenia. Conclusion: This case report illustrates the causal association between immune thrombocytopenia and tuberculosis.


Pleural effusion in advanced liver disease

Source: The Southeast Asian Journal of Case Report and Review
Cyriac Abby Philips Lovkesh Anand and Apurva Pande.
We present the case of a decompensated cirrhotic in whom localized pleural effusion was managed on the lines of tubercular effusion inadvertently, with use of catheter drainage, leading to fatal complications. Pleural effusion in advanced cirrhosis must be evaluated in a step wise manner to minimize interventional treatments.


Anaesthetic Management of Hunter Syndrome with AmbuLMA

Source: The Southeast Asian Journal of Case Report and Review
Shwetha Seetharamaiah, Neisevilie Nisa, Lokesh Kashyap.
Patients with Hunter Syndrome have multisystem involvement and difficult airway due to infiltration of tissues with mucopolysaccharides. A eight year old, male child with Hunter Syndrome weighing 20 kg was admitted for repair of umbilical hernia and right inguinal hernia. Anaesthetic management was planned with IV induction and a 2.5 size Ambu Laryngeal Mask Airway (LMA). Post-operatively child was observed for 24 hrs and LMA was removed when the child was fully awake. Children with mucopolysaccharidosis are prone to atlantoaxial subluxation. Airway management with AmbuLMA in this case demonstrated safe alternative to endotracheal intubation.


A Study on Clinical Profile and Antimicrobial Drug Resistance in Infection with Stenotrophomonas maltophilia at a Tertiary Care Hospital of Rural Gujarat, India.

Source: National Journal of Integrated Research in Medicine
Disha Sharma*, Yagnesh Pandya**, Chirag Modi***, Suman Singh****.
Background & objectives: Stenotrophomonas maltophilia causes opportunistic infections and is emerging as an important hospital-acquired pathogen. Present study was undertaken to investigate the prevalence, clinical profile, associated factors and antimicrobial susceptibility of S. maltophilia. Methods: Cross sectional retrospective study was conducted whereby patients details including type of infection, hospital stay, indwelling devices, co-morbid conditions and outcome till discharge were collected from January 2012 to March 2016. Identification and antimicrobial susceptibility were done by using Vitek2-compact-microbiological system. Results: 45 (0.17%) S.maltophilia strains were isolated from 27,132 samples received, forming 1.63% of total non-fermenters. Prevalence of S.maltophilia infection ranged from 0.06% in 2012 to 0.26% in 2015. Common sites involved were respiratory tract i.e. 55.5%, followed by bloodstream (20%), urinary tract (13.3%) and soft tissue (11.1%). 64.4% patients were male, and adults (26.7%) between 51-60 years of age. 66.7% of the isolates were from critical care units followed by wards (33.3%). Co-morbid conditions observed were COPD with respiratory complications i.e. 26.7% followed by cardiovascular diseases 22.2%, malignancy 11.1%, post surgical patients 11.1%, complicated UTI and trauma 8.8% each, CNS complications 6.7%, burns and cellulitis 2.2% each. All patients had exposure to broad-spectrum antibiotics and 66.6% had indwelling devices. 17.8% isolates were resistant to trimethoprim-sulfamethoxazole. Mortality observed was 20%. Interpretation & conclusion: S maltophilia is an emerging pathogen and its prevalence has gradually increased at our hospital. ICUs are the main hospital sites and respiratory infections main clinical condition. [Disha S NJIRM 2016; 7(5):5-8]


Evaluation of protein: creatinine ratio on random urine samples in assessment of proteinuria

Source: International Journal of Research in Medical Sciences
Vyankatesh T. Anchinmane, Shilpa V. Sankhe.
Background: Significant proteinuria (>300mg/day) may indicate the presence of important renal disease. Quantitative estimation of urinary protein over 24 hours is the gold standard test for detection of proteinuria. However, 24 hours urine collection method is inconvenient and cumbersome to patients. The present study was undertaken to determine diagnostic accuracy of random urine protein: creatinine ratio for the diagnosis of proteinuria among patients with renal diseases. Methods: The prospective study was done in 200 nephropathy cases. The 24 hours urinary protein test used as gold standard test and compared with their random urine sample protein: creatinine ratio (cut off >0.3). The data analyzed for sensitivity, specificity and accuracy of random urine sample protein: creatinine ratio test. Results: Random urine sample protein: creatinine ratio test showed sensitivity, specificity and accuracy of 95.6%, 94.4% and 95.5% respectively Conclusions: The convenient and accurate protein: creatinine ratio method on random urine samples is reliable method for estimation and screening the proteinuria cases over quantification of proteinuria by collection of 24 hours urine samples and hence, a wider application of this method is recommended.


Clinico-pathological profile of abdominal tuberculosis and their treatment response in a tertiary care centre

Source: International Journal of Research in Medical Sciences
Rajani Mavila, Manoj D. Kottarath, Niyas Naseer, Neethu Thambi, Vinayak Mohan.
Background: Abdominal tuberculosis is an important clinical entity having varied mode of clinical presentation. So the diagnosis of abdominal TB is difficult and careful approach to the patients and supportive investigation data are necessary to make the final diagnosis. Objectives of the study were to evaluate the clinic-pathological profile of patients with abdominal TB in a tertiary care centre in northern Kerala and to assess their response to anti-tubercular therapy under DOTS. Methods: This was a retrospective follow up study conducted in the department of Pulmonary Medicine in association with the department of Gastro-medicine and Surgery, and medical college DOTS centre Pariyaram Medical College, Pariyaram Kannur districtKerala, India. Total 55 patients with abdominal TB diagnosed on the basis of clinical profile and supported investigation data like gross morphological findings at endoscopy, colonoscopy, diagnostic laparoscopy, laparotomy or histologically proven caseating granulomas were selected for this study. Results: Out of the 55 patients, 31 were males and 24 females with age ranging 16-80 (Mean 30.01±11.7) years. Abdominal pain was the most common presenting symptom in 45 (81.81%). The diagnosis of abdominal TB was confirmed histopathologically in 42 (76.36%). Remaining 13 (23.64%) cases were diagnosed microscopically and with supportive clinical and imaging background. All the patients were treated under DOTS. Conclusions: Neither clinical features, laboratory, radiological and Endoscopic methods nor bacteriological and histopathological findings by themselves provide a gold standard in the diagnosis of abdominal TB. If diagnosed early, it can be treated successfully with anti-TB drugs.


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