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Background and Objective: Cardiovascular disease (CVD) is a significant cause of morbidity and mortality worldwide, with high-risk patients requiring effective management to reduce their risk of cardiovascular events. Bempedoic acid is a novel therapeutic agent recently approved as an add-on therapy to statins in patients with uncontrolled LDL-c. Bempedoic acid inhibits cholesterol synthesis in the liver, which ultimately reduces the risk of cardiovascular events. Therefore, the present study aims to assess the efficacy and safety of bempedoic acid in patients with uncontrolled LDL-c (Previously on moderate or high-intensity statins) with a high risk of CVD in real-world settings. Methods: This is a multicenter, retrospective, observational study on the data of high-risk-CVD patients collected from Bempedoic Acid on Efficacy and Safety in patients (BEST) Registry. The clinical data of 140 patients who were already on statin therapy and were receiving Bempedoic acid at a dose of 180 mg, along with measurements of the level of LDL-c, HbA1c, HDL, TG, TC, PPPG, FPG, AST, ALT, serum creatinine was taken into consideration. The primary outcome includes a change in LDL-c level, and secondary outcomes involve a change in the level of HbA1c, HDL, TG, TC, PPPG, FPG, AST, ALT, and serum creatinine at week 12 and 24. Adverse events were reported at both time points. Results: A total of 140 patients were included in the present study with a mean age of 51.8 ± 9.2 years and had primary confirmed diagnosis of dyslipidemia with uncontrolled LDL-c. The mean levels of LDL-c decreased from the mean baseline value of 142.67 ± 46.49 mg/dL, to 106.78 ±33.92 mg/d; a statistically significant reduction by 23.23% (p < 0.01) at week 12. Similarly, at week 24, the mean LDL-c value reduced to 90.39 ± 38.89 mg/dL. A 33.38 % decrease was observed (p < 0.01). Other parameters such as non-HDL, FPG, PPPG, AST and serum creatinine also showed statistically significant reduction at week 12 and week 24. Conclusion: The present study demonstrates that bempedoic acid is an effective add-on medication in lowering LDL-c levels in high-risk CVD patients with uncontrolled LDL-c.
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Background: Laboratory diagnosis in Indian health-care setup is usually the mainstay of screening and diagnosis of diseases. Accreditation is a process of approval by establishing adherence of pre-defined quality standards to the existing system which can bring about utmost quality in service delivery by increasing accuracy and reliability and minimizing errors. Need for accreditation is ever-increasing in public sector health-care centers. Aim and Objectives: To ascertain and to quantify the impact of accreditation via training and exposure in the cadre of laboratory technicians in tertiary care public sector hospital. Materials and Methods: It was an interventional study to check competency of laboratory technicians in various domains of NABL standards, before and after training and exposure to accreditation process. It was carried out amongst MLT students and employed laboratory technicians in the clinical biochemistry department of a public sector, tertiary care, teaching hospital and lasted for 2 months. Preformed questionnaire was used. Difference between pre- and post-test results was compared with appropriate statistical analysis. Results: Marked difference was seen in the performance of study subjects before (27.6 ± 9.9) and after (56.7 ± 6.2) exposure to training and accreditation process (Max. score of 80). Average gain was 37.5%. The difference was highly significant for each domain. Domains of pre-analytical, analytical, and post-analytical procedures saw the highest difference. There was a significant difference in competence gain between student lab. techs. and employed lab. techs. Conclusion: Benefits of accreditation are immense, yet it is a voluntary process in our country. Strict adherence to already laid out standards and protocols at national level can be achieved by continuous sensitization and capacity building. Public sector laboratories need to gear up and embrace this need. The same should also be incorporated effectively in the curriculum of laboratory technician students.
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Background: One of the major challenges for pharmacology teachers is how to capture students’ interests and engage them in the subject, to create an engaging and enjoyable learning process. “Creative study guide posters” is one such novel educational tool that can help achieve these goals. Aims and Objectives: The authors tried to recreate visual artwork in the subject of pharmacology to engage students and at the same time make learning easy and fun-filled. Materials and Methods: In this study, 2nd year medical students participated and prepared creative study guide posters on antimicrobials and microbes in the form of two armies. On the one hand, antimicrobial drugs depicted the good army, consisting of the name of the drug, drug group, and mechanism of action, while on the other hand, the microorganisms depicted the evil army, consisting of the names of the common microbes, representing the battle of Kurukshetra as in the Indian epic of Mahabharata. Results: The majority of the students found this model interesting and useful for revising antimicrobials. About 82.3% of students agreed that their concepts of antimicrobials improved after this activity. About 86.46% of students believed that this model would foster interactive learning. Only 65.63% of students felt that the traditional methods of revising topics were better than this activity. Conclusion: Creative instruction encourages students to think independently, paricipate actively, and express themselves freely. Creative study guide poster activities help with better student engagement, reinforcing concepts, and better retention than just passing information passively in classrooms.
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Introduction: In Western population, a threshold of 5 drinks per day may exist for alcohol to increase pancreatitis risk. Given ethnic differences in alcohol metabolism, we examined the associations between smoking, alcohol, and pancreatitis in Western Indians. Methods: A case control study was conducted in a surgery department of a hospital in western India. In-formation on drinking was collected by in-person interview. Baseline characteristics and alcohol con-sumption was compared between cases of pancreatitis and control (without pancreatitis). Results: Baseline characteristics of cases and control are Among 4% of the cases and 2% of the control, bile stone was found to be present and this difference was also statistically not significant. Alcohol use was associated with pancreatitis in a dose-dependent way. Those who were taking heavy amount of al-cohol had more than five and half-time risk of developing pancreatitis compared to those who are not taking alcohol. Conclusions: Indians are more prone to alcohol-related pancreatitis than Westerners, and alcohol con-sumption is the leading cause of pancreatitis in India.
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Background:Ischemic heart diseases are the leading cause of death due to non-communicable diseases in India. Tobacco consumption is well proven risk factor for ischemic heart disease. Tobacco chewing is a very common practice done in Gujarat as well as other regions of India. Nicotine is the active ingredient in tobacco which causes alteration in lipid profile over long term consumption. According to “global adult tobacco survey (2016-2017)” over 21.4% of Indian adults consume smokeless/chewable tobacco. Present study was conducted to compare the lipid profile of non-tobacco consumers vs. chronic smokeless/chewable tobacco consumers.Material And Methods:The study was conducted after taking approval of Institutional Ethics Committee. A total of 100 selected study participants (non-obese male without any history of cardiovascular diseases and diabetes and not on any lipid altering medications) were divided in to case and control arm based on the history of consumption of CSLT(chronic smokeless tobacco)for 8 years or not. After overnight fasting,blood samples of both group individuals were taken for estimation of lipid profile. Details of lipid profile along with other demographic data were recorded in predesigned case record form. Result:A significant increase in lipid profile parameters such as TC, LDL, and TG were seen in chronic tobacco chewers compared to control group. Mean total cholesterol (TC), low density lipoprotein(LDL)and serum triglycerides levels in CSLT consumers were 222 mg/dl, 148 mg/dl and 171 mg/dl respectively. These parameters were higher in CSLT consumers as compared to control group by 68mg/dl (TC), 53 mg/dl (LDL) and 66 mg/dl (TG).Conclusion:Chr onic tobacco chewing was found to be associated with alteration in all the lipid profile parameters. Altered lipid profile is the proven risk for cardiovascular ailments. Hence ahypothesis can be generated from the study that CSLT consumption is the responsible factor for cardiovascular diseases. This can be tested further on large scale studies along with differences in the type of CSLT consumption and development of cardiovascular diseases can be evaluated.
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Background:Gingival recession is the one of the widespread mucogingival deformity and should be treated at its most primitive recognition. Exposed root surfaces are more likely to develop root sensitivity, root caries, cervical abrasions and post esthetic problems. Amid innumerable procedures, laterally positioned pedicle graft (LPG) is extensively used efficaciously to conceal recession defects. The main advantages of thelaterally positioned pedicle graft is, it produces excellent esthetic results as it has good vascularity of the flap and ability to cover the denuded surfaces. Thus,the present case report describes the use of lateral pedicle graft technique in an isolated gingival recession on mandibular incisor.
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Background:Traditional complete dentures were the most common treatment option for patients with edentulous arches. However, the initiation of implant-supported overdentures has substitutedorthodox dentures as animproved standard for restoration. Careful case selection is important criteria for improving success rate of implant supported over denture. Lower arch implant-supported overdentures have a better success percentage than upper arch implant-supported overdentures. Upper arch implant-supported overdentures are simulating a form of “salvage treatment,” rather than being the primary modality of treatment for patients with completely edentulous upper arch.
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Background:In the last decade, the use of lasers (lightamplification by stimulated emission of radiation) has occupied part of the dialogue within periodontology and oral surgery because of several proposed advantages. Laser uses produces less postoperative swelling, reduces inflammation and is also relatively painless. In the arena of periodontology, laser use as an adjunct to non-surgical therapy was demonstrated to enhance periodontal health. The present study was done to highlight these facts and to add over the previous researches. Material And Methods:Atotal of 50 patients with generalized chronic moderate to severe periodontitis with pocket probing depth (PD) ?5 mm were selected for a split-mouth study. Flap surgery with adjunctive diode laser irradiation was performed in the test quadrant while routine OFD was done in the control quadrant. Clinical parameters including PD, plaque index, and gingival index were recorded at baseline, 3 months and 6 months following treatment. Result:All clinical parameters significantly improved after therapy without any statistically significant difference between the two groups for any of the parameters. The results of the present study indicate that diode laser used as an adjunct to in OFD did not significantly e nhance the treatment outcome. Conclusion: Sincethere was a significant clinical improvement in case of gingival inflammation, it can be safely and effectively used to achieve the same and can aid in tissue healing.
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Background: Anterior shoulder dislocation is a common injury, accounting for 95% of all shoulder injuries. However, many doctors and hospitals do not have a fixed protocol for the treatment of dislocations. The current study have compared 8 different techniques for shoulder dislocation reduction in this study. Methods: Eight different methods namely the Scapular Manipulation, Matsen’s Traction-Countertraction, Kocher’s, Spaso, External Rotation, Cunningham, Modified Milch, and the FARES methods were compared on the basis of efficacy, pain experienced during reduction (VAS score), and time taken for reduction. Results: The Matsen’s Traction-Countertraction method had the highest efficacy, while the Scapular Manipulation method had the least VAS scoring. The FARES Method had the fastest reduction time on average. Interpretation and Conclusions: As per the data analyzed, the FARES and Scapular Manipulation method appear to be the most effective in reducing anterior dislocations, having consistently high success rates, and low VAS scores and reduction times. These 2 methods may be recommended to new practitioners to treat acute shoulder dislocations.
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INTRODUCTION:Breast carcinoma is the leading most common malignant tumor and leading cause of carcinoma death with more than 1000000 cases occurring world wide annually 1. FNAC (Fine Needle Aspiration Cytology) has become widely accepted as a reliable diagnostic tool for diagnosis of breast masses3.The aim of the study was to classify Breast lesions & correlate with histopathology Report.MATERIALS & METHOD:This was a retrospective observational study done over a period of one year (Jan. 17-Dec. 17) in Cytology Division of Department of Pathology of AMC MET Medical College at L.G.Hospital Campus ,a tertiary Health Care located in Maninagar Ahmedabad .Of total 1104 FNAC were done in the department among these 215 were Breast Lesions.Breast lesions were categorized into Inflammatory,Benign with No Risk, Benign with moderate Risk,Suspicious & Malignant.RESULTS:The Maximum number of cases was in the age group of 18-30 in Benign Breast Lesion. Malignant Breast Lesion was found in the age group of above 41.
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OBJECTIVES: Mobile health (m-Health) technologies may provide an appropriate follow-up support service for patient groups with post-treatment conditions. While previous studies have introduced m-Health methods for patient care, a smart system that may provide follow-up communication and decision support remains limited to the management of a few specific types of diseases. This paper introduces an m-Health solution in the current climate of increased demand for electronic information exchange. METHODS: Adopting a novel design science research approach, we developed an innovative solution model for post-treatment follow-up decision support interaction for use by patients and physicians and then evaluated it by using convergent interviewing and focus group methods. RESULTS: The cloud-based solution was positively evaluated as supporting physicians and service providers in providing post-treatment follow-up services. Our framework provides a model as an artifact for extending care service systems to inform better follow-up interaction and decision-making. CONCLUSIONS: The study confirmed the perceived value and utility of the proposed Clinical Decision Support artifact indicating that it is promising and has potential to contribute and facilitate appropriate interactions and support for healthcare professionals for future follow-up operationalization. While the prototype was developed and tested in a developing country context, where the availability of doctors is limited for public healthcare, it was anticipated that the prototype would be user-friendly, easy to use, and suitable for post-treatment follow-up through mobility in remote locations.
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Humans , Artifacts , Climate , Decision Support Systems, Clinical , Delivery of Health Care , Developing Countries , Focus Groups , Follow-Up Studies , Patient Care , TelemedicineРеферат
INTRODUCTION: Haemovigilance is defined as a set of surveillance procedures covering whole transfusion chain from the collection of blood and its components to the follow up of its recipients, intended to collect and access information on unexpected or undesirable effects resulting from the therapeutic use of labile blood products, and to prevent their occurrence and recurrence.(1) AIMS AND OBJECTIVES: An effective effort towards the study of haemovigilance programme by evaluating the different adverse reactions occurring due to blood transfusion in patient receiving regular or temporary blood transfusion.The ultimate goal of a haemovigilance system is to improve the safety of blood transfusion. METHODS & MATERIALS: The current study was done at Blood bank AMC MET Medical College & LG Hospital, Ahmedabad. All the adverse reactions related to transfusion of blood components between April-2014 to March-2016 issued were studied.RESULT: In this study, total 17264 blood component (PCV, PRC, FFP, CRYO) were issued. From total 20 BTR, 18 BTR due to PCV, and 02 BTR due to PRC. In which 08 patients have febrile reaction, 07 patients have allergic reaction, 02 patients have non TRALI associated dyspnea and 01 patient has uneasiness-giddiness due to the PCV. 02 patients have allergic reaction which occurred due to PRC.CONCLUSION: Haemovigilance is an essential component of quality management in a blood system and is needed for the continual enhancement of quality and safety of blood products and transfusion process by monitoring and safeguarding the adverse events associated with the use of blood products.
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Background: Acute disseminated encephalomyelitis is an acute demyelinating disorder of the central nervous system and is characterised by multifocal white matter involvement. Diffuse neurological signs with multifocal lesions in brain and spinal cord characterise the disease. It do not invade central nervous system. Aim: To evaluate role of MRI in acute disseminated encephalomyelitis. Materials and methods: A prospective study of 10 cases which was conducted in the pediatric department in Dhiraj hospital. MRI brain was done on 1.5 Tesla MRI machine. Results: ADEM can be distinguished from acute viral encephalitis because the disease is not the result of primary tissue invasion by an infectious organism. It was thought to be immune-mediated and is characterized neuropathologically by perivenular inflammation and demyelination. Conclusion: ADEM is more common in female and more associated with previous infection as compared to previous vaccination. Neurological deficit is mostly associated with it. CSF showed raised protein in almost cases. It showed hyperintense lesion on T2W and FLAIR sequences. Periventricular area of brain is commonly associated.
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Background: Shoulder pain is the third most common musculo-skeletal complaint after low back pain and knee pain. The most common cause of shoulder pain is rotator cuff disease. For the evaluation of shoulder joint, MRI is the modality of choice and is considered over USG. MR imaging is the global assessment of all shoulder structures. Materials and methods: A prospective study of 65 patients were conducted, who were referred to the Department of Radiodiagnosis, Dhiraj General Hospital with shoulder pain. All the scans were done on Philps MR systems Achieva 1.5 tesla. T1 and T2 weighted images in the sagittal, coronal, axial planes were obtained in each patient. Results: In a retrospective review, 50 patients referred to our institution for diagnostic workup for shoulder complaints from June 2016 to December 2016. Out of these, only 7 had no visible pathology. Rotator cuff tendinopathy accounts maximum in which supraspinatus tendinopathy was found in 60% cases (26 patients), subscapularis tendinopathy were in 10% (4 patients), infraspinatus tendinopathy and rotator cuff tendinopathy was not found in any patient. Rest of the pathologies included soft tissue pathology, subacromial-subdeltoid bursitis. Conclusion: MRI provides elaborate diagnosis thus it replaces other investigations. Thus MR imaging is the standard among the imaging methods for optimal depiction of almost all shoulder pathology.
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Granulomatous lesions of the skin and subcutaneous tissue are common in India. They are known as “Dermal Granulomas”. In present study following types of Dermal Granulomas were included – Leprosy, Cutaneous Tuberculosis, Syphilis, Fungal, Actinomycosis, Foreign body Granuloma, Granuloma annulare and Sarcoidosis. Histopathology remains a time tested tool for establishing a correct diagnosis. Clinical lesions often reveal surprising underlying pathology. Hence carrying out skin biopsies and microscopic study with routine haematoxylin and eosin (H&E) as well as special stains are must in these disorders so that the type and aetiological agent of the granuloma are properly identified. Besides, follow-up biopsies after the commencement of treatment help in evaluation of the response to therapy. Methods: 52 cases were studied over a period of 2 and a half years. Specimens were collected from the patients of skin, surgery and ENT department. A brief clinical history with age presenting symptoms and signs were recorded. Routine investigations like ESR were performed. Comparison of our study was done with others around the country. Results: Most common type of dermal granuloma was leprosy (59.6%) followed by cutaneous tuberculosis (21.1%), Foreign Body (5.7%), Granuloma Annulare (5.7%), Fungal (5.7%), Actinomycosis (1.9%) and Sarcoidosis (1.9%). Dermal granulomas were most common between the age group of 31 – 50 years. In leprosy and cutaneous tuberculosis, males were affected more as compared to females. Conclusion: Leprosywas most common than other dermal granuloma. Most common type of leprosy and tuberculosis were lepromatous leprosy and lupus vulgaris respectively.
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OBJECTIVES: To explore alternate modality of treatment in patients of advanced cancer cervix by neo‑adjuvant chemotherapy (NACT) followed by External Beam Radiotherapy (ERT) and Brachytherapy (BT). Short‑ (6 months) and long‑ (12 months) term follow‑up data from these patients were compared with the retrospective data from an urban cancer centre, where standard protocol of concurrent chemo‑radiotherapy is practiced. MATERIALS AND METHODS: Two hundred patients of advanced cervical cancer, treated at our rural cancer centre between January 2007 and December 2007, were included in the study arm (Group A). These patients received three cycles of neo‑adjuvant chemotherapy with Cisplatin, Bleomycin, and Vincristine before External‑Beam Radiotherapy (EBT) followed by brachytherapy. Patients in the control arm (Group B) of an urban cancer centre, received EBT with weekly concomitant Cisplatin, followed by brachytherapy. Short‑ (6 months) and long‑ (12 months) term follow‑up data from our patients were compared with the retrospective data from the urban cancer centre. RESULTS AND ANALYSIS: Complete response rate was comparatively higher among patients of Group A, also correspondingly proportion of patients showing progressive disease and stable disease was lower among them. Local treatment failure was 87.5% among patients from Group A and 94.4% in Group B patients. Concomitant chemoradiation (CRT) was associated with more GI toxicities. CONCLUSION: Our result suggests NACT arm is as effective as CRT arm in respect of complete response with less pelvic failure and G.I toxicities. Further follow‑up data are needed before arriving at a definite conclusion.
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Objectives: To study and establish clinical and haematological correlation in cases of dengue viral infection. Methodology: A total 169 serum samples were received from L.G. Hospital for the detection of Dengue IgM during the period of October 2013 to January 2014. They were tested for the same with ELISA method. The clinical -haematological case study was done and the data was analyzed retrospectively. Results: Total 169 serum samples were tested, out of which 44(26.03%) were positive for Dengue IgM antibodies. Out of the total serum samples, Male: Female ratio and Urban: Rural ratio was 1.6:1 and 2.8:1 respectively. Peak incidence of the disease is seen in October. Clinically fever was the commonest presentation in 39(88.6%) patients followed by headache and muscle pain i.e., 33(75%) and 16(36.3%) respectively; the least common was epistaxis in 4 (9.04%) patients. Retrobulbar pain was in 3(6.8%) rash was in 6 (13.6%) and hemorrhagic manifestations in 12 (27.2%) patients. Amongst total WBC count, the proportion of Lymphocyte was above 70% in 3(6.8%) cases, between 50-70% in 17(38.6%) cases, and between 35-49% in 16(36.3%) cases and below 35% was in 8(18.18%) cases. The platelet count less than 50,000 was observed in16(36.3%) cases, 50,000 to 1, 00000 in 15(34.09%) cases and greater than 1,00,000 was in 13(29.5%) cases.19(43.1%) patients had erythrocyte sedimentation rate less than 7mm/hr, While 15(34.09%) patients had8- 20mm/hrand 10(22.7%) had more than 20 mm/hr.
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In spite of advancement in medical facilities, the natural end of life is inevitable. But for some persons, the death is destined earlier in an un-natural way. A few choose to make their own way by committing suicide. The major reasons are personnel problems, stress of life, family problems and financial problems. There are many methods for committing suicide like poisoning, hanging, self-immolation, drowning etc. Hanging provides painless death so it is one of the commonly adopted methods for suicide. However, in a few instances false allegations are made claiming that the ligature mark over neck is of strangulation rather than hanging. Vice versa cases are also likely. In such cases, the post-mortem findings are very helpful to differentiate between the two. Present prospective study was carried out at the mortuary of Civil Hospital, Ahmedabad over 2 years period ranging from December 2008 to November 2010 with a view to study to incidence, ligature materials, and post-mortem findings in hanging cases. The place of hanging, manner of death and reason for death were also studied in the study.
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Asphyxia/epidemiology , Asphyxia/etiology , Asphyxia/mortality , Autopsy , Demography , Humans , India , Population Dynamics , Suicide/epidemiology , Suicide/mortalityРеферат
The toxicity studies were carried out a 50% aqueous ethanolic extract of Benincasa hispida ( B. hispida )in rodents.The acute toxicity study, B. hispida was found to be well tolerated upto 2000mg/kg, produced neither mortality nor in behavior in mice. In subacute toxicity study, B. hispida at dose level of 200 and 400 mg/kg did not produce any significant difference in their body weight, food and water intake when compared to vehicle treated rats. It also showed no significant alteration in hematological and biochemical parameters in experimental groups of rats apart from a decrease in aspatate transaminase, alanine transaminase and alkaline phosphate content at the dose of 400 mg/kg. Histopathological study revealed normal architecture of kidney and liver of B. hispida treated rats. These results demonstrated that there is a wide margin of safety for the therapeutic use of B. hispida and further corroborated the traditional use of this extract as an anti hepatocarcinogenic agent.
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Introduction: This prospective study was undertaken to observe the prospects of daycare inguinal hernia surgery in general hospital setup in a developing country like Nepal and to assess the advantages, acceptability and safety of this approach. Methodology: The study was carried out prospectively for one year from March 2009- Feb 2010. Before surgery, children were examined in surgical referral clinic (SRC). Parents were given verbal and written instructions for pre-operative fasting. Operations were carried out under intravenous anesthesia without intubation by experienced consultant general surgeon or by registrar under supervision. Children were observed in recovery area till conscious. Once awake, the children were handed over to parents for further observation till fully conscious and could tolerate liquid. Oral Paracetamol and homecare instructions were given to parents. Appointment slip was given for follow up visit in SRC within 3-5 days. Results: There were 90 children, male 81 (89%), age 2 months to 13 years. Right inguinal hernias were 62 (70%). There were no major complications, mortality or readmission. Saving in terms of less disruption of routine work at home and office was more appreciated by parents. Conclusion: We conclude that day care inguinal hernia surgery in children in our setup is safe, economic well accepted by child and parent's both.