A Clinical study on Effect of Platelet Rich Plasma on Wound Healing in Patients Undergoing Modified Radical Mastectomy

BACKGROUND AND OBJECTIVES: Breast cancer forms more than thirty three percent of all malignancy affecting women and for twenty percent of cancer related deaths in women. The standard of therapy for the majority of patients with invasive breast cancer is still complete breast excision along with axillary lymph node dissection. Seroma development might occur anywhere from 5% to 85% of the time. Seroma can increase morbidity, lengthen hospital stays, necessitate multiple aspirations, cause wound gaping and erythema, and delay chemotherapy and radiotherapy cycles, among other things. To evaluate using platelet rich plasma in a prospective randomised controlled manner, the decrease in the incidence of seroma formation among patients subjected to modified radical mastectomy. METHOD: A total of 90 Carcinoma Breast who underwent Modified Radical Mastectomy in the Institute of General Surgery, Madras Medical College, Chennai, were in included in this prospective study and randomised into two groups based on in-patient number. 45 patients with odd IP no in Group A received Platelet Rich Plasma injections and 45 patients with even IP no in Group B did not receive any topical treatment. Patients were evaluated for day 1 drain volume, total drain volume, drain removal day, seroma, and wound complications using REEDA score Vancouver Scar Scale. RESULTS: The mean seroma formation on post-operative day one was 141.11 ml in PRP group and 162.33 ml in control group and there is a statistically significant association between PRP injection and seroma formation. There was also statistically significant association between PRP injection and total seroma formation and day of drain removal. In our study wound healing was also observed using two parameters REEDA score and VSS. CONCLUSION: The most common complication following modified radical mastectomy is seroma formation and the present prospective study demonstrated that local injection of Platelet Rich Plasma significantly decreased the seroma formation and favours wound healing

A Study of Serum Lipid Profile in T2DM Patients and Its Association with Diabetic Nephropathy

BACKGROUND: Diabetes is the most prevalent endocrinopathy with life threatening macrovascular and mierovascular complications which has to be prevented. Diabetic nephropathy develops in majority of diabetes patients. Recent studies showed that alteration in lipid profile does play a significant role in pathogenesis of development of diabetic nephropathy. However the pattern of alteration in lipid profile are different among different studies. OBJECTIVES: 1. To study serum lipid profile in type 2 diabetes mellitus patients. 2. To estimate the association between serum lipid profile and nephropathy in type 2 diabetes mellitus patients. METHOD: This study was conducted as an observational cross sectional study in the department of General Medicine in Thanjavur Medical College among cases diagnosed with diabetes and diabetic nephropathy during January 2021 to January 2022.A total of hundred and two cases were included in this study. Ethical committee approval was obtained for this study from the institutional human ethics committee. For assessing, blood and urine samples analysis, fundus examination, ultrasonographic examination of abdomen was done. Data was entered in excel sheet and analysis using SPSS version 2.0. RESULTS: A positive correlation of LDL-cholesterol, triglycerides and total cholesterol levels with occurrence of diabetic nephropathy in diabetic patients. VLDL levels and HDL levels doesn’t have any significant impact on occurrence of diabetic nephropathy. CONCLUSION: Appropriate use of antilipidemic drugs, with regular follow up of lipid profile in diabetic patients in addition to lifestyle modification, control of hypertention and blood sugar levels will make a significant impact on life of diabetic patients and prevent occurrence of diabetic nephropathy and slow down its progression to end stage renal disease

Study of Clinical Profile in Diabetic Ketoacidosis and Its Outcome in relation to Bicarbonate Levels

INTRODUCTION: Diabetic Ketoacidosis (DKA) is a common complication of diabetes which comes to the emergency as the disease diabetes turns to be the common non communicable disease affecting the world. The understanding of the pathophysiology of the sickness, features, early diagnosis, and adequate treatment of DKA, and the triggering causes, can change how the disease affects the study population. This will help to reduce the disease's rates of morbidity and mortality. OBJECTIVES: 1. To evaluate age, sex distribution , common presentation and precipitating factor in diabetes ketoacidosis. 2. To study the incidence of DKA in poorly controlled diabetes by HbA1c level. 3. To study the correlation between serum bicarbonate level and duration of hospital stay in DKA patients. 4. To study the outcome of DKA during treatment. METHODOLOGY: The study was a prospective study conducted among 46 subjects with an aim to assess the clinical profile, precipitating factors, outcome and correlation of bicarbonate level among DKA subjects. The subjects with diabetic ketoacidosis were included in the study. Patient with hyperglycaemic hyperosmolar coma, chronic renal disease, with hyperemesis gravidarum, with starvation ketosis and severe anaemia. After selecting the subjects the clinical profile including age, Sex, Total stay in Hospital, family history and treatment history was assessed. Clinical findings including level of consciousness, heart rate, respiratory rate, blood pressure, random blood sugar, renal function test, bicarbonate, plasma/urine acetone was assessed. The data was entered into Microsoft excel and analysed using SPSS 23. RESULTS: In the study the mean Age (years) among the subjects was 47.87 (± 17.15) years ranging from 17 to 85 years. Among the subjects, 28 (60.87%) were Males and 18 (39.13%) were Females. In our study among the subjects, 33 (71.74%) had Type 2 and 13 (28.26%) had Type 1 Diabetes. In the study the mean Serum Bicarbonate (mEq/L) among the subjects was 13.84 (± 3.53) ranging from 7 to 21 mEq/L. The mean HbA1C (%) among the subjects was 8.98 (± 1.07) ranging from 6.7 to 11.4. Among the subjects, 10 (21.74%) had Vomiting, 9 (19.57%) had Fever and 5 (10.87%) had Altered Sensorium/Fever. Among the subjects, 32 (69.57%) had due to Non-Compliance, 6 (13.04%) had due to Infection and 5 (10.87%) had due to Inadequate dose. Among the subjects, 43 (93.48%) had Recovered and 3 (6.52%) had Death. Comparing the Treatment History with Outcome distribution, OHA + Insulin had significantly higher proportion of death with 28.57% followed by Insulin with 5.88% and least in OHA with 0%. The mean Random Blood Sugar (mg/dl) among subjects with Death was significantly higher 600 (± 0) vs. 450.35 (± 68.02). The mean Serum Bicarbonate (mEq/L) among subjects with Death outcome was significantly lower than recovered outcome subjects was 7.6 (± 0.53) vs.14.28 (± 3.22) .The mean HbA1C (%) among Death was 10.5 (± 1.31) which is higher by 1.63 and statistically significant compared to 8.87 (± 0.98) in Recovered. Serum Bicarbonate (mEq/L) has a significantly negative correlation with Duration of Stay (days) with a correlation coefficient of -0.84. Duration of Stay (days) decreases by -0.65 times for each unit increase in Serum Bicarbonate (mEq/L). CONCLUSION: Diabetic Ketoacidosis with increased blood glucose value, decreased serum bicarbonate, and higher glycosylated haemoglobulin had death as an outcome. As the bicarbonate level decreases the duration of hospital stay increases

Serum Cortisol Levels in Assessing the Severity of Acute Stroke: A Cross Sectional study in Chengalpattu Medical College and Hospital

INTRODUCTION: The stress response that occurs after the event of acute stroke causes the activation of the hypothalamo–pituitary–adrenal (HPA) axis. Certain studies have found that increased serum cortisol level in patients with acute stroke is related to greater stroke severity. Whether the stress response is just an epiphenomenon to stroke severity or independently contributes to prognosis remains uncertain. But there is a immense need to detect a biomarker for predicting the outcome of acute stroke. OBJECTIVE OF THE STUDY: The aim of the study was to investigate if a single serum cortisol determination was related to severity of acute stroke. METHODS: A cross sectional study was conducted in 120 patients with acute stroke presenting within 24 hours of stroke onset after getting informed consent. The patients were studied from medical wards and IMCU in Chengalpattu government hospital. Scandinavian Stroke Scale (SSS) was used to study severity of acute stroke. Diagnosis of Acute Ischemic or Hemorrhagic stroke was based on CT imaging in all patients. Blood samples are taken for assessing serum cortisol levels. Data was entered in MS excel analyzed using SPSS software for appropriate descriptive and inferential statistics. RESULTS: The mean age group is 50 to 59 years with 50% males and 50 % females. The mean cortisol level was 637nmol/L. Of the 120 cases 98 had acute ischemic stroke and 22 had acute hemorrhagic stroke. The mean SSS score was 20.85 and mean time duration was 9.5 hours. The correlation coefficient for SSS and serum cortisol was -0.984 which had significant correlation indicating high serum cortisol levels had low SSS score and also the P value being < 0.001 which was statistically significant. CONCLUSION: Acute stroke severity related to increasing serum cortisol levels. Serum cortisol was associated with stroke severity and markers reflecting stroke severity

A Comparative study of the Prognostic Significance of Curb 65 and Expanded Curb 65 in Community Acquired Pneumonia Patients

INTRODUCTION: Community acquired pneumonia is the eighth leading cause of mortality worldwide. Several scoring systems have been devised in the past to compute CAP severity. The aim of this study is to compare the prognostic significance of CURB 65 and Expanded CURB 65 in CAP patients. These are simple tests which can be done on day 1 of admission and have profound value in identifying the at risk individuals. AIM OF THE STUDY: The aim of the study is to compare the prognostic significance of CURB 65 and expanded CURB 65 in community acquired pneumonia patients. PRIMARY OBJECTIVES: 1. To assess the length of stay in hospital in CAP patients and their CURB 65 and expanded CURB 65 score at admission. 2. To assess the need for intensive medical care admission in CAP patients and their CURB 65 and expanded CURB 65 score at admission. 3. To assess the in hospital mortality rate in CAP patients and their CURB 65 and expanded CURB 65 score at admission. SECONDARY OBJECTIVE: 1. To correlate the serum LDH levels ,serum albumin levels and platelet levels with curb 65 and expanded curb 65 scoring. MATERIALS AND METHODS: The present study titled “A COMPARATIVE STUDY OF THE PROGNOSTIC SIGNIFICANCE OF CURB65 AND EXPANDED CURB65 IN COMMUNITY ACQUIRED PNEUMONIA PATIENTS” was carried out in the Department of General Medicine, Government Royapettah Hospital, Government Kilpauk Medical College Hospital, Chennai. 1. Study Design: Prospective cohort study. 2. Period of study: April 2022 to September 2022 3. Duration of study: 6 months. 4. Place of study: Government Royapettah Hospital, Chennai. 5. Study population: Inclusion criteria: 1. Age more than 18 years of both sex. 2. Patients with at least two clinical signs and symptoms related to pneumonia (fever, cough, chest pain, dyspnoea and crackles on auscultation). 3. New infiltrates on chest x ray. Exclusion criteria: 1. Age < 18 years, 2. Malabsorption and malnutrition status, 3. HIV infection, 4. Organ transplant recipient, 5. On immunosuppressant and steroids, 6. Pregnancy and lactation, 7. Symptoms after 48 hours of hospitalization. Sample size: 100 patients of community acquired pneumonia in Government Royapettah Hospital. RESULTS: In this study it was found that both scores predicted the length of hospital stay, need for intensive care, need for mechanical ventilation with equal significance. However expanded curb score is sensitive in predicting the mortality better than curb 65 since it includes platelets, albumin and serum LDH values. Further serum albumin on day one admission is a better predictor of longer duration of hospital stay and intensive care. CONCLUSION: In a resource limited setting, CURB 65 is not inferior to expanded curb 65 in identifying the at risk patients and serum albumin better predicts mortality. Expanded curb 65 is sensitive but not specific in assessing the mortality