A CLINICAL STUDY OF PATIENTS WITH IDIOPATHIC THROMBOCYTOPENIC PURPURA

OBJECTIVE To study the incidence, age and sex distribution among adults, various modes of presentation, correlation between thrombocytopenia and bleeding manifestations and various modalities of treatment of Idiopathic Thrombocytopenic Purpura in a tertiary care hospital in India.MATERIALS AND METHODSProspective study consisting of 4o cases of ITP admitted to Kasturba Medical College Hospital, Manipal from November 2005 to March 2007. Patients above 14 years of age admitted with thrombocytopenia in this institution were screened based on detailed clinical history, physical examination and laboratory investigations.RESULTSThe maximum incidence was in the 3 rd decade of life accounting for 27.5% of the patients. Ratio of male to female was 1:1.9 with female preponderance. Females in 3 rd decade had maximum incidence while males in 4th decade have maximum incidence. Majority 12 (85.71%) of male patients and 15(57.69%) of female patients  developed purpura during the course of disease. The mean count was 17.8X109/L with range between 2.0 X109/L to 76 X109/L. Cutaneous bleeding spots were found to be assosiated with counts above 25000X109/L and hematuria with lowest counts around 4000 X109/L. 20 (50%) of the above 40 patients responded to corticposteroids alone and did not have any further relapse. Among the remaining patients 3 (7.5%) had a relapse of symptoms within next 6 months and responded to repeat prednisolone started at 1mg/kg. 2 (5%) patients were given steroids tapering dose with IV Immune globulins for initial 5 days as therapy to which they responded.CONCLUSIONIdiopathic thrombocytopenia is 1.9 times more common in females than males. Most common presentation is bleeding spots over body. Bleeding manifestations are more common with thrombocytopenia less than 30000/mm3. Corticosteroids are the mainstay in treatment. Complete remission is seen in up to 57.5% of the patients. Splenectomy is the second modality of treatment in ITP. Complete and sustained remission is seen 75% of patients. Â

A Case of Resolving Pontine Hemorrhage

Generally, Pontine hemorrhages though rare have poor prognosis with 48.1% all-cause mortality noted. A grim statistic which becomes worse if the patient presents to the hospital with depressed sensorium. Level of consciousness and hemorrhage size constitute two of the most important prognostication factors for patients with pontine hemorrhage. Here we present a case of a young lady who presented with poor sensorium and a large pontine hemorrhage who went on to return to good recovery status, modified Rankin Score 2 with conservative intervention

A CROSS-SECTIONAL STUDY ON ADHERENCE TO LIFESTYLE MODIFICATION AMONG KNOWN HYPERTENSIVE PATIENTS IN UDUPI DISTRICT

Objectives: Hypertension is the more prevalent non-communicable disease and is the major risk factors for the cardiovascular disease. Lifestyle modification plays a very important role in controlling or management of the hypertension. Hence, aim of this study is to assess the adherence and non-adherence to lifestyle modification among known hypertensive patients those who are visiting secondary care hospitals in Udupi District. Methods: This was a multi-centric hospital based cross-sectional study conducted at three secondary care hospitals. Samples were collected through convenient sampling. Standardized questionnaire used to collect data. Associations are obtained the help of frequencies, prevalence, and mean values, ANOVA test, Chi-square, and binary logistic regression were used for the analysis. Results: The mean age of the participants was 63.01±11.12 years. Males were 144 (42.2%) and females were 197 (57.8%) of the study population. It was found that the self-assessment is influenced by education level of participant (p=0.003) and time elapsed since diagnosis of hypertension (p<0.001). Majority of the participants from age group of 34 to 48 and 49 to 63 had good adherence to exercise, that is, 70.4% (19) and 74.6% (100), respectively, (p=0.001). Participants with awareness regarding risk factors and complications of hypertension showed good adherence to exercise. The patients, who adhered to exercise, also consumed less quantity of salt. Conclusion: Instilling positivity in mind of the patient regarding outcome of treatment and lifestyle modifications can help in controlling the high blood pressure and there by prevent cardiovascular and renal disease in the whole population