Study of the Various Factors which Influence the Outcome of Patients with Blunt Injury Chest

Introduction: Injury is the most common cause of death among people aged 1–34 years. The most common cause of injury is a road traffic accident and the majority is confined to the thoracic cage. These consist of rib fractures with underlying pulmonary contusion. When ignored, underestimated or inadequately treated chest injuries may cause the death of a patient during surgical intervention for seemingly more pressing intracranial or abdominal hemorrhage. Aim: This study aims to study the outcome of blunt injury chest patients in emergency and various modalities of treatment to identify possible risk factors for mortality. Materials and Methods: A prospective review of all cases of trauma with blunt chest injuries evaluated with X-ray or computed tomography scan. The cases were examined for age, type of injuries, presence or absence of rib fractures, hemothorax, or pneumothorax. Results: There were 50 patients included in this study. All had rib fractures and hemo/pneumothorax, 3 had lung contusion, 19 patients had associated injuries, 1 patient underwent emergency thoracotomy, 3 patients were kept on ventilator support, and 3 expired. Conclusion: Close attention to improving gas exchange and early management of hemo/pneumothorax might improve outcomes in blunt injury chest.

Pleurodesis: A Comparision of Two Sclerosing Agents for Pleural Effusion

Introduction: Pleural effusion is one of the most frequentlyencountered pathology in our hospital. Thoracocentesis,thoracostomy, pleurodesis is the most commonly usedtreatment options for recurrent and persistent pleural effusion.Sterile talc powder is most commonly used as an sclerosingagent. In our study we have used sodium tetradecyl sulfateas a newer sclerosing agent and we have compared thecomplication rate, clinical response and success rate inboth sodium tetradecyl sulfate and talc sclerosing agent forpleurodesis. Study aimed to compare the safety and efficacyof the sodium tetradecyl sulfate and talc as a pleurodesis agentin pleural effusion cases.Material and methods: Pleural effusion cases (both malignantand non-malignant cases) were randomly allocated into groupA or group B. Group A patients were treated with 60mg of3% sodium tetradecyl sulfate, Group B patients were treatedwith 2 grams of sterile talc powder. Clinical data regardinggeneral complications, the rate of success, reduction in ICDdrainage and lung expansion were noted for every patient whounderwent pleurodesis.Results: 25 patients were allocated in each group. Patientscharacteristics were balanced between the two groups withthe majority of pleural effusion malignant in etiology. There isa statistically significant difference between the use of sodiumtetradecyl sulfate and talc in clinical response, ICD drainageand lung re-expansion. Sodium tetradecyl sulfate patient hasbetter lung reexpansion and clinical response in comparison totalc powder. The general complication was observed to be lowwith sodium tetradecyl sulfate than talc pleurodesis.Conclusion: Sodium tetradecyl sulfate pleurodesis appearsto have better pleurodesis effect than talc pleurodesis in ourstudy

Role of Magnetic Resonance Imaging in Evaluation of Low Back Pain of Non-Traumatic Causes

Low back pain (LBP) is a commonly encountered complaint in clinical practice with a significant economic burden to the society. The objective of study was to evaluate the changes seen on MRI in patients with low back pain due to various non-traumatic causes and to distinguish various causes of low back pain with level of spinal involvement. Methods: This descriptive observational study was carried from October 2015 to October 2017 in 106 patients with low back pain who underwent MRI of the lower spine at Department of Radio-Diagnosis, Chalmeda AnandRao institute of Medical sciences. Patients who met the inclusion/exclusion criteria were included in the study. Results: More than 40% of patients (n=43; 40.57%) were in the age group of 41 to 60 years (Figure 24). There were 29 patients in the age group of 21 to 40 years (27.36%), followed by age group of > 60 years (n =21; 19.8%) and least patients were in the age group of <20 years (n =13; 12.26%. Conclusions: We concluded that 106 patients, degenerative changes were the commonest cause for low back pain followed by infective and neoplastic etiologies. The ability of MRI to detect morphological abnormalities, extent of lesion and nerve root compression all help in complete evaluation of low back pain.

Percutaneous intervention for restoration of patency of occluded lower limb arteriovenous dialysis access

Background Arteriovenous (AV) fistula thrombosis is a serious complication in patients undergoing hemodialysis, often presenting with symptoms of venous hypertension, failure to dialysis and uremic symptoms. Treatment is aimed to provide symptomatic relief and to maintain hemodialysis access site patency. Aim To describe our initial experience in the endovascular treatment of lower limb AV dialysis access (AV fistula) thrombosis and/or obstruction in patients undergoing hemodialysis. Settings and design This was a retrospective study carried out in a tertiary care center. Study duration was 24 months. Follow-up was variable. Materials and methods Two patients with chronic kidney disease with stage 5 renal failure undergoing hemodialysis presented with lower limb arteriovenous dialysis access (arteriovenous fistula) failure between July 2014 and September 2016. Both the patients underwent endovascular treatment and were analyzed retrospectively. Results and conclusion Both the patient underwent successful endovascular treatment for the failure of the lower limb AV dialysis access thrombosis and/or obstruction. One patient had minimal dye extravasation during manipulation of the guide wire, which ceased spontaneously. On follow-up, both patients maintained patency of the dialysis access and are undergoing successful hemodialysis. One patient had a recurrence of the thrombosis of the fistula at 9th month of the follow-up. Endovascular treatment was tried but we could not succeed. However, we found endovascular treatment safe and effective in treating AV fistula failures.

Evaluation of thrombocytopenia in dengue infection along with seasonal variation

Introduction: Dengue fever is one of the most prevalent and fastest spreading mosquito borne arboviral infection, occurring in tropical and subtropical regions. They are single stranded RNA viruses and transmitted by Aedes mosquitoes. There are four serotypes of dengue virus DENV 1, DENV2, DENV3, DENV 4. Following an infection lifelong immunity develops against the respective serotype. The clinical spectrum of dengue infection varies from undifferentiated fever, Classical Dengue fever, Dengue hemorrhagic fever, Dengue shock syndrome, Expanded dengue syndrome. Continuous surveillance of dengue fever is important for the proper and timely institution of vector control measures. Aim: The aim of present study was to evaluate the thrombocytopenia with prevalence of dengue infection along with seasonal variation. Materials and methods: The present study was a retrospective study conducted in the Department of Hematology, at Chalmeda Anand Rao Hospital, Karimnagar during the period from 2015 June to 2016 May. Blood samples were collected from 4047 patients presented with acute febrile illness clinically consistent with Dengue infection. Serological confirmation of dengue infection was done using “Rapid Visual test kit” for detection of NS1 antigen and differential detection of IgM and IgG. Platelet count was done on “Automatic cell counter XN1000” which was correlated with manual platelet count in all the serologically positive cases. Results: Out of 4047 suspected cases, 1505 cases were confirmed as serologically positive for dengue infection. Out of 1505cases, 742 samples were positive for only NS1, 70 were positive for only IgM, 361 were positive for only IgG, remaining 332 were positive for more than one serological markers (NS1, IgM, IgG). A majority, 655 (43.52%) of the dengue cases were noted in the age group of 15-30 years, followed by less than 15 years of age. Among the dengue cases, 61.8% were males and 38.2% Vidyadhara Rani P, Naveen Kumar S. Evaluation of thrombocytopenia in dengue infection along with seasonal variation. IAIM, 2018; 5(2): 57-63. Page 58 were females. A significantly higher number of serologically positive cases 1342 (89.2%) were noted in the post monsoon period. Conclusion: Incidence of dengue infection was higher in monsoon and post monsoon period. Thrombocytopenia provide high suspicion of dengue infection, which could be life threatening. Platelet count is an important predictive and recovery parameter of dengue infection.

Ultrasonography (USG) and multi-detector computerized tomography (MDCT) evaluation of thyroid swellings

Background: Thyroid ultrasound has undergone a dramatic transformation from the cryptic deflections on an oscilloscope produced in A-mode scanning, to barely recognizable B-mode images, followed by initial low resolution gray scale, and now modern high resolution images. Aim: The aim of the present study was to evaluate the diagnostic role of ultrasonography (USG) and multi-detector computed tomography (MDCT) in thyroid swellings, compare the ultrasonographic findings with multi-detector computed tomographic findings and to correlate the radiological findings with histopathological examination (HPE). Materials and methods: The present study was carried out in the Department of Radiology, Kamineni Institute of Medical Sciences, Narketpally. In this study, 50 patients with thyroid gland swellings diagnosed clinically, referred to Radiology Department were selected during the period from October 2008 to September 2010. Histopathological examination was acquired in 35 cases. The study was carried out to observe the sensitivity, specificity and diagnostic accuracy of USG and MDCT in thyroid gland swellings. Results: Maximum number of patients belonged to the age group of 21-40 years that was 27 cases (54.00%) and maximum number of patients were females – 41 cases (82.00%). Most common diagnosis was multi-nodular goitre on USG-16 cases (32.00%) and MDCT- 14 cases (28.00%), solitary thyroid nodule is common in the right lobe of thyroid by USG -5 cases (62.50%) and MDCT5 cases (62.50%). Most common malignancy was papillary carcinoma of thyroid -5 cases (62.50%) and most common inflammatory disorder was hashimoto’s thyroiditis -5 cases (10.00%). Naveen Kumar S, Vidyadhara Rani P. Ultrasonography (USG) and multi-detector computerized tomography (MDCT) evaluation of thyroid swellings. IAIM, 2017; 4(9): 145-155. Page 146 Conclusion: The present study has concluded that USG is the fast and cost-effective modality of imaging investigation of choice in thyroid diseases and for differential diagnosis of thyroid nodules. MDCT is superior to ultrasound in evaluating retrosternal extension, relations and infiltrations in large lesions. It is also very helpful in evaluating extra-capsular, mediastinal, vascular invasion, lymph nodal involvement and metastasis. MDCT is very crucial in preoperative planning in malignancies of thyroid and large benign lesions.

Dosimetry in dentistry.

Aim: The purpose of this paper was to review various dosimeters used in dentistry and the cumulative results of various studies done with various dosimeters. Materials and Methods: Several relevant PubMed indexed articles from 1999 to 2013 were electronically searched by typing “dosimeters”, “dosimeters in dentistry”, “properties of dosimeters”, “thermoluminescent and optically stimulated dosimeters”, “recent advancements in dosimetry in dentistry.” The searches were limited to articles in English to prepare a concise review on dental dosimetry. Titles and abstracts were screened, and articles that fulfilled the criteria of use of dosimeters in dental applications were selected for a full‑text reading. Article was divided into four groups: (1) Biological effects of radiation, (2) properties of dosimeters, (3) types of dosimeters and (4) results of various studies using different dosimeters. Conclusion: The present review on dosimetry based on various studies done with dosimeters revealed that, with the advent of radiographic technique the effective dose delivered is low. Therefore, selection of radiological technique plays an important role in dental dose delivery.

A Study of Early Division of Renal Artery and their Incidence.

The knowledge of arterial supply of the human kidney is of special interest as it is not only having many morphological variations buy also many vascular surgeries are carried out in case of renal artery. The present study was done in 50 embalmed cadavers during the period of one year. We found variations in the form of the number of renal artery supplying the kidney, its level of origin, relation with the renal vein, branching pattern. Knowledge of these variations may help to avoid the clinical complications especially during radiological examinations and/or surgical approaches in this region.

Effect of plant growth promoting rhizobacteria (PGPR) on growth and yield of bitter gourd.

A field study was conducted to determine the effect of plant growth promoting rhizobacteria (PGPR) on growth and yield of bitter gourd. Four PGPR strains (Azospirillum, Phosphorous solubilising bacteria, Pseudomonas flourescens and Bacillus subtilis), one commercial organic product (Aishwarya) and non inoculated control were used. The study revealed that seeds inoculated with Azospirillum (basal @ 5 kg ha-1 + 40 days after sowing (DAS) @ 5 kg ha-1) recorded early germination (6.48 days). The maximum vine length (4.42 m) was recorded in basal @ 2 l/plant application of both Bacillus subtilis and Pseudomonas flourescens @ 2.5 kg ha-1. Number of primary branches was maximum (4.80) in plants applied with phosphorous solubilising bacteria (PSB) as basal @ 5 kg/ha and 40 DAS @ 5 kg/ha. Tap root length (23.57 cm) and secondary root length (39.88 cm) were highest in the plants supplied with Azospirillum (basal @ 5 kg ha-1 + 40 DAS @ 5 kg ha-1) where as, dry root weight (4.64 g) was more in case of double application of Bacillus subtilis basal @ 2 l plant -1 + 40 DAS @ 2 l plant -1. Two time application of Bacillus subtilis basal + 40 DAS @ 2 l plant -1 produced the maximum yield plant -1 and yield plot -1 (2.72 kg and 16.33 kg respectively).

Thanatophoric dysplasia: a rare entity

Thanatophoric dysplasia is the lethal skeletal dysplasia characterized by marked underdevelopment of the skeleton and short-limb dwarfism. The child will be having a short neck, narrow thoracic cage and protuberant abdomen. Other anatomical features include a relatively enlarged head with frontal bossing, prominent eyes, hypertelorism and the depressed nasal bridge. The diagnosis is usually made with the ultrasonography in the second trimester. In this study we report a case of this rare entity with emphasis on its anatomical features, abnormalities and clinical profile with relevant review of literature

Acute accidental exposure to chlorine gas: Clinical presentation, pulmonary functions and outcomes.

Background. To study the clinical presentation, pulmonary functions and outcomes in subjects who were accidentally exposed to chlorine gas. Methods. Prospective observational study of 64 patients who sustained acute accidental exposure to chlorine gas during a leak in the chlorination system of the public bathing pool of a temple. Results. The major presenting symptoms and signs included acute dyspnoea (100%), chest discomfort (100%), cough (97%), eye irritation (88%), giddiness (72%), vomiting (46%), and heaviness in the head (44%); tachycardia (100%), tachypnoea (96%) and polyphonic wheezing (28%). All patients were managed in the emergency room with humidified oxygen inhalation and beta-2 agonist nebulisation and 52 were discharged within six hours. Twelve patients were severely affected and required hospitalisation; three of them were admitted into the intensive care unit. Three patients developed pulmonary oedema six to eight hours following admission. Pulmonary function testing (n=12) at presentation revealed obstructive defect in eight and mixed obstructive-cum-restrictive defect in four patients. The mean duration of hospital stay was 5.1±2.1 days. None of the patients died. Reactive airway dysfunction syndrome (RADS) was observed in three of the 12 hospitalised patients, who complained of manifested persistent cough that lasted for three months period following discharge. Serial pulmonary functions recovered to normal range by the end of the six months in all patients and remained so at one-year follow-up. Conclusion. Acute exposure to chlorine gas is an uncommon, but important public health hazard and can cause RADS, acute lung injury and pulmonary function abnormalities , which are reversible on prompt and appropriate management.