Prognostic Study of Aluminium Phosphide Ingestion Patients and Their Correlation with Cardiac Manifestations On The Basis of ECG Abnormality

Introduction: Mortality due to Aluminium phosphide ALP ingestion is very high (37-100%) and is directly related to freshness of tablet, dose of pesticide consumed and delay in institution of treatment etc. Death is mainly due to cardio toxicity, development of ARDS, non-responsiveness of shock to resuscitative measures, lack of an antidote and subsequent development of complications like acute massive GI bleed, acute respiratory arrest, acute CHF, DIC etc. Aim & Objective: To Study the ‘Clinico investigatory’ findings in Aluminium phosphide ALP poisoning. Assessment and correlation of ECG findings with the survival of these patients. Methodology: Patients of age group > 18 years and both sexes, who fulfilled criteria of patient's selection, will be taken into consideration. Results: Majority of victims were young patients in struggling phase of life as study, career and family matters between age range of 14-30 years and males & females ratio was 1.9:1 predominantly males.Majority of patients consumed one exposed tablets of Aluminium phosphide poisoning. Shock was the cardinal manifestation in majority of the patients. Tachycardia, cold clammy skin, mid pupillary dilatation with sluggish pupillary reaction and chest crepitations were the next common physical signs. Various ECG abnormalities recorded on the third day were the sinus tachycardia (10/77), non specific ST-T changes (00), low voltage complex (10/77) and RBBB in 06/77 cases. Conclusion: Thus, it can be concluded from the present study that Aluminium phosphide is cardiotoxic in 100% cases as evident from various changes in ECG recording an ECHO confirmed this and evident of focal carditis and wet pericarditis was evident. It is further stipulated that toxicity of conduction system of heart are more prominent than the myocardium

Correlation of Neutrophil to Lymphocyte and Monocyte to Lymphocyte Ratio with Acute Phase Reactant in Septicemia: A Prospective Study. NLR and MLR as Alternative in Sepsis

Introduction: Acute phase reactants (Procalcitonin, C-Reactive Protein) are important parameters in diagnosing and prognosticating sepsis. Despite availability of these, all the laboratories and hospitals are not equipped with the high end diagnostic capabilities in developing nations. Using alternative available markers in such conditions is preferable. We correlated the ratios from complete blood count with parameters procalcitonin and CRP.Material and Methods: This was a prospective study conducted in tertiary care hospital. All the patients admitted with diagnosis of sepsis who fulfilled the inclusion and exclusion criteria were included in this study. Venous sample were collected from all the patients. Complete blood count, procalcitonin and C reactive protein was done. Ratio of neutrophil to lymphocyte and monocyte to lymphocyte was calculated and correlated.Results: A total of 102 patients were included in this study. 49 were males and 53 females with an average age of 48.72 ± 11.21. The mean NLR was 14.09 ± 3.31 while mean MLR was 0.71 ± 0.15. Average procalcitonin was 25.38 ± 9.34 and the mean CRP was 142.97 ± 32.20. the correlation was checked using pearson’s coefficient. There was a strong correlation between NLR with procalcitonin and CRP which was statistically significant (<0.001). MLR had a strong to moderate correlation with both the parameters and was statistically significant.Conclusion: Calculating the ratio of blood parameters from the complete blood count is the easy and cheap way to diagnose the sepsis in hospitals where high end clinical investigations are not available

"Primary Etiological Profile of Hospitalized Patients with Documented Episode of Hypoglycemia"

Background: Glucose is a major fuel source for body tissues. Plasma glucose concentrations are maintained between 70 to 110 mg/dl in the fasting state. Homeostasis is maintained by stimulating counter hormone response and suppressing insulin secretion during hypoglycemic episodes. Any derangement in homeostasis can cause hypoglycemia. Objectives: To investigate, identify, determine and analyze the incidence of primary etiological profile of hospitalized patients. Material and Methods: Patients admitted in the General Medicine wards who had at least one episode of documented hypoglycemia i.e less than 70mg/dl and age >=18 years were included and observed over a period of 24 months i.e November 2019 to November 2021. The data obtained was analyzed statistically by using chi square test. Results: In present study of 119 patients 90 were male and 29 were females. Diabetes with Chronic Kidney Disease was found to be the most common primary diagnosis. As we analyze the presence of risk factors in hospitalized hypoglycemic patents, it was found that as the number of risk factors in a patient increases, chance of succumbing to them also increases. In the category of patients having 3 or more risk factors, the death rate was 15 out of 42 which is 35.71%. Conclusion: Hypoglycemia needs to be investigated thoroughly to know the causative factor and should be treated appropriately. Hypoglycemia is an important predicting factor of mortality in cases of heart failure and sepsis

Effects of Chronic Otitis Media on Contralateral Ear

Chronic otitis media (COM) is rarely an isolated entity, because the responsible factors for its development in one ear were in a similar way willimpact the contralateral ears, since both ears had a common “nasopharyngeal” drainage. Methods: The following study is a cross sectional studycarried out on 200 patients having COM (mucosal and squamosal type) presenting in the OPD in the department of ENT at Dr Susheela TiwariGovernment Hospital, Haldwani between January 2019 and September 2020. Result: Otoendoscopy, pure tone audiometry and X ray mastoid findings were noticed in both the ears in patients of COM (mucosal/ squamosal). Otoscopically the most common finding in contralateral ear in mucosal type of disease was tympanosclerosis (42.53%) and in squamosal type of disease it was pars tensa retraction (34.62%). Pure tone audiometry shows more severe hearing loss in the contralateral ear of squamosal COM than mucosal COM. Radiologically pneumatization was noticed in the contralateral ear in the mucosal and squamosal COM. Tympanometry was also performed in the patients with COM. Conclusion: Chronic Otitis media is a disease with a very varied clinical presentation and disease in one ear has been sometimes found to be associated with subtle to gross changes without any symptoms observed in the contralateral ear. These changes can eventually result in the beginning of a gradual and chronic inflammatory process in the contralateral ear. Clinical assessment of the contralateral ear is equally important as of the diseased ear

Breast Cancer Survival Rate of Luminal vs Non-Luminal Subtype at Prof. Dr. Margono Soekarjo Regional General Hospital Purwokerto in 2021-2023

Introduction: Breast cancer is a malignancy that originates from breast tissue such as epithelium, ducts and breast lobules. Breast cancer often occurs at a young age, due to many risk factors including alcohol consumption, diet, radiation and family history. Based on receptor gene expression in tissues, breast cancer is classified into two, namely luminal subtypes in the form of Luminal A and Luminal B, and non luminal subtypes in the form of Positive Human Epidermal Growth Factor Receptor 2 and Triple Negative Breast Cancer (TNBC). The survival rate for each subtype has a different time, so further understanding is needed to determine the right treatment for patients. This study aims to determine the relationship between survival rate and luminal and non luminal breast cancer subtypes. Methods: This study uses secondary data, namely the medical records of breast cancer patients at Prof. Hospital. Dr. Margono Soekarjo Purwokerto. The sample in this study were breast cancer patients at RSMS for the 2021-2023 period who fit the inclusion and exclusion criteria. Results: Of the 84 samples that complied, the survival rate for patients with the luminal subtype was 52.9%, while the survival rate for the non luminal subtype was 42.4%. Conclusion: The survival rate of breast cancer patients with luminal subtype is higher than that of non luminal breast cancer patients, and there is a relationship between survival rate with luminal and non luminal subtypes

Comparative Study on Laparoscopic vs Open Appendicectomy in the Treatment of Perforated Appendicitis

Background: Acute appendicitis is one of the most common causes of surgical emergency and perforated appendicitis is associated with higher morbidity and longer hospital stays. In recent times considering the overall benefits of laparoscopic surgeries, it has been widely preferred in the treatment of complicated appendicitis.Aim: To compare the outcome of laparoscopic appendicectomy (LA) vs open appendicectomy (OA) in the treatment of perforated appendicitis.Materials and Methods: 62 patients presenting with perforated appendicitis and undergoing surgical intervention in the Department of General Surgery, Kozhikode. Patients were monitored immediate postoperative period for 4 weeks for the development of complications.Results: Out of 31 patients who underwent laparoscopic none of the patients developed wound infection with a mean duration of hospital stay of 3.5 days. In open appendicectomy 7 patients developed wound infection with a mean duration of hospital stay of 5.3 days.Conclusion: Laparoscopic procedure for perforated appendicitis is a safe and feasible procedure which can be performed with a low incidence of infectious complications, possibly offering patients faster recovery and better cosmetic benefits than the open procedure. It has a clinically significant advantage. The patient’s factor and the experience of the surgeon both are deciding factors in the decision-making for the treatment approach

Adverse Drug Reactions (Adrs) Associated With Hospital Admissions – Male Patients Are At Highest Risk

Adverse Drug Reaction (ADR) may occur following a single dose or prolonged administration of a drug or may result from the combination of two or more drugs. The meaning of this term differs from the term "side effect" because side effects can be beneficial as well as detrimental. The study of ADRs is also known as pharmacovigilance. During this study ADRs assessed according to World Health Organization (WHO)–Uppsala Monitoring Centre (UMC) causality assessment criteria, Naranjo scale, Karch and lasagna scale, the result indicate symptoms of ADRs in male patient of adults and geriatrics common and it may be due to combination drug therapy. When ADRs assessed by using WHO Possible scale & Naranjo’s probability scale it was found that only 05.13% have certain ADRs which required treatment while possible ADRs are between 39.84 to 55.68% also required strict monitoring. The main aim of this study was to find out the cause of ADRs and their assessment during hospital stay and developing a monitoring system and actively electronic submission of identified ADRs as per WHO ADRs monitoring system to prevent risk of ADRs

A Cross Sectional Study of Feto-Maternal Outcome for Second Stage Cesarean Delivery

Background: Caesarean delivery at full dilation of cervix is associated with increased technical difficulty and feto-maternalcomplications.Objectives: To know the short term maternal and foetal outcome in second stage caesarean deliveries. Material & Methods: Thisis a descriptive, prospective cross-sectional study done at Vani Vilas hospital attached to Bangalore medical college and research institute fromJan 2022 to Dec 2022. Intra operative and immediate post operative complications were collected from case record, mother and new-born were followed during hospital stay till discharge. Data entered in MS excel sheet and analysed using SPSS version 20.0. Descriptive statistics of the explanatory and outcome variables were calculated by mean, standard deviation for quantitative variables, frequency and proportions for qualitative variables. Results: Sample size was 98 women in one year. Mean Age of the sample population is 25.71±3.26 years, 67.3% are primi gravid women. Common methods of extraction included Vertex and Patwardhan method. Extension of hysterotomy incision seen in 20.4%. PPH seen in 16% of women. About 16% of new-borns required NICU admission. One still birth and two neonatal deaths were noted. Conclusions: Second stage caesarean delivery carries increased morbidity both to mother and child. Skill and expertise are required to reduce the complications during second stage caesarean sections

Prospective Study of Metabolic and Electrolyte Disturbances in Patients with Chronic Kidney Disease

Background: Kidneys play a critical role in regulating body fluids, electrolytes and acid base balance. CKD can lead to metabolic as well as electrolyte disturbances that can result in serious adverse outcomes. Aim & Objective: To study metabolic and electrolyte disturbances in CKD patients and its correlation with GFR. Materials and Method: 100 patients of CKD were studied. Detailed clinical history and physical examination were done as per pre-fixed Performa. Relevant hematological, biochemical, radiological investigations were done for assessing renal function. Staging of CKD was done with GFR. Results: Mean age of study participants was 43 years out of them 70% were males. All the study participants were anemic out of them 28% severely, 51% moderately and 20% mildly anemic. Majority of study participants belonged to G5 category of GFR. Among electrolytes only serum sodium was found significantly associated with GFR (p value- o.oo2). Among metabolic parameters low triglyceride levels was significantly associated with GFR (p value-0.009). Conclusion: CKD patients are more prone to develop metabolic as well as electrolyte disturbances. Hence, every CKD patient should be screened for any such disturbances. Although studies on this regard is still lacking and we need further study for better understanding and management, as early screening can defer early morbidity and mortality. Therefore, serum electrolyte as well as metabolic disturbances to be included as one of the first line investigations in patients with chronic kidney disease

Low Health Literacy (LHL): A Devious Enemy of Patient Treatment Adherence

People must have particular personality traits and social resources, also known as health literacy, in order to access, comprehend, and use information to make decisions about their health. Patients' ability to engage in complex disease management and self-care is strongly related to their level of health literacy. It can help us stay healthy by preventing illness and effectively managing existing illnesses. People with low health literacy (LHL) may find it difficult to manage their condition and prevent illness, which may lead to increased use of healthcare services. Furthermore, LHL is associated with increased hospitalizations, increased use of emergency care, decreased use of preventative services, and a worsened ability to understand labels and health messages, a worsened state of health, higher mortality, and more expensive medical care