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 Comprehensive study on Conduction Block in Acute Stemi in Thanjavur Medical College

BACKGROUND: Acute myocardial infarction is a grave clinical condition that remains the leading cause of mortality worldwide. World wide around 3 million people suffer from STEMI and another 4 million people develops NSTEMI. Conduction blocks are commonly seen in patients associated with myocardial infarctions. Several studies have shown data that AV and infranodal blocks are present approximately 12 to 25% in acute MI. But this largely varies with studies. Several studies have pointed out that the AV blocks complicating STEMI are associated with increased morbidity and mortality. The prognosis of the patient may vary depending upon the type of AV block and timely intervention as well. OBJECTIVES: To study the prevalence of conduction block in acute STEMI in Thanjavur Medical College and the association with various modifiable and non modifiable risk factors and also the prognosis of the patients. METHODS: The study was conducted as a cross sectional observational study in Thanjavur Medical College from the period of JANUARY 2021 to JANUARY 2022. A total of 100 cases who presented as acute STEMI in Thanjavur Medical College were studies and the prevalence of various heart blocks developed in them where studied and their associations were various risk factors and outcomes were assessed. All the cases were assessed for demographic and clinical presentation b the principal investigator using a pre structured proforma. Patients were followed along the course of treatment ; serial ECG monitoring was done. patient was followed with ECHO and assessed until the patient is discharged or has been expired. Patients were subjected to following investigations to identify the comorbidities : CBC, RBS, RFT, LIPD PROFILE. The data were entered in MS office excel SPFTWARE and analysed using SPSS version 2.0 RESULTS: In our study 100 subjects were taken into consideration and Commonest age group who developed acute STEMI were within the age group of 45 to 60 years males. Incidence of conduction block in our study was 28 %. In literature the conduction blocks in STEMI varies from 12% to 25% depending on various studies. Also the mortality of study subjects was 16% in the study. Age, gender, and comorbidities have no association with conduction block or prognosis of patients. In our study AWMI have the highest incidence being 64% followed by IWMI which is 17%. In our study the most common conduction block was infranodal blocks, of which RBBB more than LBBBB (7%). Conduction blocks and alcoholism has statistically significant association with prognosis of the patient so are the Ejection fraction and killip class at presentation. CONCLUSION: The incidence of heart block in the study was 28% There is significant association between alcoholism and conduction block. RBBB and LBBB are the most common conduction blocks seen. Bundle branch blocks are more seen with AWMI and AV nodal blocks are common with inferior wall MI. There is significant association with mortality of the patient as well as the duration of stay of discharged patients with conduction blocks. There is also association between conduction block and Killip class at the time presentation and reduced Ejection fraction in ECH

Comparison of High Carbohydrate, Whole Food Plant- Based Diet to Standard Mixed Diabetic Diet in the Management of Type 2 Diabetes Mellitus in a Tertiary Care Hospital: A Randomised Controlled Trial

INTRODUCTION: Type 2 diabetes mellitus (T2DM) is a major public health concern. According to the International Diabetes Federation (IDF) as of 2021 there are 537 million adults living with diabetes. T2DM is by far the most common type of diabetes mellitus in adults (>90%). Diabetes mellitus is caused by varying degrees of insulin resistance and defective insulin secretion (beta cell dysfunction) or both. The etiopathogenesis for diabetes is multifactorial and includes genetic predisposition, environment factors, fetal programming, epigenetics and inflammation. Diabetes mellitus is diagnosed in those with a HbA1C of ≥6.5%, fasting plasma glucose ≥ 126mg/dl or a 2-hour plasma glucose of ≥ 200mg/dl. As per the American Diabetic Association (ADA) guidelines, diabetes mellitus should be screened for all adults ≥ 35 years, or even earlier for those with obesity, hypertension. strong family history, dyslipidemia, polycystic ovarian syndrome, past history of gestational diabetes mellitus or other conditions associated with insulin resistance (e.g., acanthosis nigricans). The goals of treatment are to control blood sugars, prevent microvascular and macrovascular complications as well as to ensure a good quality of life. The treatment of diabetes is centered around the patient. AIM OF THE STUDY: The aim of the study is to compare the efficacy of two different types of diabetic diets [a high-carbohydrate (70-75% of the total calorie intake), whole food, plant-based diet and a moderate carbohydrate (50-60% of the total calorie intake) standard, mixed diabetic diet] for their efficacy in improving glycaemic control by lowering of HbA1c levels. OBJECTIVES: Diabetes Mellitus is a disease with a large global burden. Current treatment strategies include medical nutrition therapy, physical activity, oral antidiabetic agents and insulin. At present there is a paradigm shift towards a more holistic approach in diabetic management. We investigated whether there is a difference in the glycaemic control among type 2 diabetics allocated to a high carbohydrate, whole food plant-based diet in comparison to a standard diabetic diet. METHODS: We did a single-center, open-label, assessor blinded, randomised controlled trial to compare the efficacy of two different types of diabetic diets in lowering HbA1c levels. After obtaining informed consent, we randomly allocated 94 participants with type 2 diabetes mellitus to receive either a high carbohydrate, whole food plant-based diet (carbohydrate 70-75%) or a moderate carbohydrate, standard diabetic diet (carbohydrate 50-60%). Participants were followed up for a total of 3 months. At enrollment they were given an intensive dietary education by a certified dietician and were instructed in maintaining a food dairy. During the study period they received weekly telephone calls to ensure compliance, tackle any practical difficulties, motivate participants and ensure they fill the 24-hour food diary. After the completion of 3 months, they underwent repeat testing of the baseline parameters (anthropometry, blood glucose, HbA1c, fasting lipids and a Montreal cognitive questionnaire) to check for difference. RESULTS: Of the total of 50 participants who under randomization, 47 completed the study. The median decrease in HbA1c was -0.2% (-0.5 — 0.2) and -0.2% (-0.9 — 0.2) in the standard diabetic diet and the whole food plant-based diet respectively. Both diets also showed a trend towards a reduction in the body weight and fasting lipid profile. There was no difference between the diets in any of the outcomes assessed. There were no major adverse events noted in our study. CONCLUSION: In patients with type 2 diabetes mellitus, both the standard diabetic diet and the whole food plant-based diets are dietary options that can be advised