1. Comparison of Quality of Life in Patients with Diabetes Mellitus Treated with Oral Hypoglycemics and Insulin Ashok Goyal, Ashok Kumar Agarwal, Abdul Sajid Mansoori
Background: Diabetes is a chronic disease in etiology and occurs when the pancreas does not produce enough amount of insulin or when there is resistance towards its action on the body. The present study aimed to evaluate factors affecting the quality of life among patients diagnosed with type-2 diabetes mellitus and taking treatment with insulin and oral hypoglycemic drugs. Material & Methods: 200 patients who were diagnosed with type-2 diabetes mellitus and taking either insulin or oral hypoglycemics drugs for at least 12 weeks who were attending outpatient department enrolled for the present study by simple random sampling. Written informed consent was taken from each study participant. Patients who had chronic illnesses other than diabetes and patients who were being treated by both insulin and oral hypoglycemics drugs were excluded from the study. Results: About 68% of the patients were on insulin while 76% of the patients who were on oral hypoglycemics had a satisfactory quality of life. The cut-off value was being 87.5 i.e. the 50% of the total possible mean score value. Based on the mean quality of life score among study participants it was found that mean the quality of life score values among patients on oral hypoglycemic drugs was 115.3 and mean the quality of life score values among patients on insulin was 105.9. This difference was statistically non-significant (P-value >0.05). Conclusion: We concluded from the present study that patients who were on oral hypoglycemics had a satisfactory quality of life in comparison to the patients on insulin therapy. The poor quality of life scores was significantly (P-value <0.05) associated with lower socioeconomic status, lesser physical activity and lesser education, duration of illness, and positive family history.
2. Assessment of Salivary Gland Pathology by Ultrasound and Doppler Modalities Bijendar Kumar Meena, Sweta Meena
Background: Various studies were reported that diseases of salivary glands are diverse in etiology ranging from the inflammatory etiology to a diverse category of benign and malignant neoplasms. Many of these salivary gland pathologies are rare and the diagnostic methods available are also not optimal and less sensitive. Material & Methods: The present prospective study was conducted at department of radiodiagnosis of our tertiary care hospital. The study duration was of one year from January 2019 to January 2020. A sample size of 50 was calculated at 95% confidence interval at 10% acceptable margin of error. Patients with swelling or lesions of salivary glands were included in the present study irrespective of age, sex duration of history and etiology. Results: In the present study, on the basis of colour doppler findings of the pathological lesion, the benign lesions like pleomorphic adenoma reported peripheral vascularity and the inflammatory lesions had diffuse and marked vascularity in the salivary gland. The malignant lesions showed central vascularity on color Doppler. Out of the 50 study participants the benign lesions showed well-defined margins and the malignant lesions reported irregular margins on ultrasonography findings. The most common pathological lesion was benign type which was found in 90% of the cases which was followed by malignant lesion which was reported in 10% patients. Conclusion: We concluded from the present study that ultrasonographic findings can differentiate various salivary gland pathology. Along with colour Doppler findings, the diagnostic accuracy of ultrasonography is increased.
3. Effect of Chronic Unpredictable Stress on Behaviour and Apoptosis in Zebrafish Heart Nivedita Manoharan, Dheepthi Jayamurali, Sathya Narayanan Govindarajulu
Apoptosis plays an important role in the pathogenesis of cardiovascular diseases. Zebrafish has emerged as a promising animal model for studying stress related disorders. To evaluate the effect of chronic unpredictable stress (CUS) exposure on anxiety behaviour and apoptosis in zebrafish heart.320 adult zebrafish of both sexes were used. They were divided into Control and CUS group of 160 fish each. CUS groups were exposed to CUS for 15 days. The anxiety behaviour was assessed using novel tank and light/dark preference test. The effect of stress induced apoptosis in cardiac myocytes was assessed using qRT-PCR and cortisol levels were evaluated using ELISA. Novel tank showed a significant decrease (p<0.05) in average duration, transitions and time spent in upper tank, and a significant increase (p<0.05) in the latency to reach the upper portion of the tank, freezing duration and erratic movement in stressed zebrafish. In light/dark preference test, CUS exposed zebrafish spent more time in the light compartment. A significant increase (p<0.05) in cortisol level and crf expression and decrease in gr expression (p<0.05) was observed in stressed zebrafish. A significant increase (p<0.05) in p53, noxa, tnfα, caspase3 expression and decrease (p<0.05) in of bcl2 expression was seen in heart of the CUS group. Exposure of zebrafish to chronic unpredictable stress has induced anxiety like behaviour. The increased expression of p53, noxa, tnfα, caspase3 and decreased expression of bcl2 indicates the onset of apoptosis in zebrafish heart.
4. Assessment of Clinical Profile, Risk Factors and Impact of Renal Impairment on the Management of Patients with Lower Urinary Tract Obstruction Yogendra Singh Wadiwa, Himanshu Mathur, Ajay Gangji
Background: Obstruction to outflow of urine either organic or functional, below the bladder neck is considered as lower urinary tract obstruction i.e., benign prostatic hyperplasia (BPH), urethral stricture (US), post urethral valves (PUV) and Phimosis. Normal point of narrowing such as the ureteropelvic and ureterovesical junction, bladder neck, and urethral meatus are common sites of obstruction.Early diagnosis and prompt therapy are therefore essential to minimize the otherwise devastating effect of obstruction on kidney structure and function. Material & Methods: This prospective study of renal impairment in the management of lower urinary tract obstruction (LUTO) had been done in department of General Surgery and Paediatric wards at Netaji Subhash Chandra Bose Medical College, Jabalpur M.P., which comprises of 42 patients. The study duration was from May 2004 and September 2005, we evaluated and treated these patients with lower urinary tract obstruction (LUTO). Results: In the study, among all patients who had risk factors 9 patients had severe renal impairment and 1 patient had mild renal impairment. Among patients who did not have risk factors 19 patients had normal renal function and 8 patients had mild renal impairment (p≤0.001). Among age group II (16-45 years) 10 patients had normal renal function, 4 had mild renal function impairment and 1 had severe renal function impairment. Among age group III (above 45 years) 4 patients had normal renal function, 10 had mild renal function impairment and 11 had severe renal function impairment (p≤0.001). Out of 10 patients 9 were having BPH; only one patient had US with mild elevated serum Creatinine levels. This shows degree of impairment was more in patient with BPH than Urethral Stricture (p ≤0.001). All 16 patients were of BPH, it means severity noted to be more in patients with BPH. Post-drainage procedure these patients shown normal or near normal levels of S. Creatinine (p≤0.001) BPH or obstruction to the tract plays a major role in renal impairment. Blood Urea levels returned to normal or reduced after drainage procedure as compared to before drainage status (p≤0.001). Conclusion: In patients with lower urinary tract obstruction (LUTO) majority of patients were of Benign Prostatic Hyperplasia (BPH) followed by urethral stricture (US), posterior urethral valve (PUV) and Phimosis. Degree of renal impairment was more with Benign Prostatic Hyperplasia (BPH) compared to Urethral Stricture (US), Posterior Urethral Valve (PUV) and Phimosis. All patients with associated risk factors (single or multiple) and having benign prostatic hyperplasia (BPH) had marked renal impairment. In patients with lower urinary tract obstruction (LUTO) degree of renal impairment is aggravated if there was an associated risk factor present. In patients of lower urinary tract obstruction (LUTO) with impaired renal function, drainage procedure is recommended before planning for the definitive surgery.
5. Management of Adhesive Capsulitis of the Shoulder: PRP and Steroid Injections Kanhaiya Lal Gupta
Aim: Significance of platelet rich plasma (PRP) and Corticosteroid injection in management of Adhesive capsulitis of shoulder. Methods: 50 patients of frozen shoulder after proper clinical and radiological (X-ray, CT, MRI) . in our institute and divided them randomly equally into two subgroups: subgroup A received PRP injection while subgroup B had received methylprednisolone injection. The inclusion criteria of this study was adult more than 18 year and stage 2 or more of per arthritis shoulder, shoulder range of motion decrease to 50% or more than opposite shoulder. All patients of our study advised neither to take any kind of analgesics i.e. NSAIDS nor any massage of shoulder, if patient had severe pain following injection opioids analgesic like the one tramadol can be given to patients. Patients were followed up at 1 week post injection, then after 1 month and then at 3 months. Results: In this study, there were 60% female patients and 40% were males. Most of the patients are in age group of 41-60 years in both the groups. Most of the patients (60%) were injected with PRP in period of 3-6 months and with inj. MPS also in 3-6 months (56%). There is statistically significant reduction in VAS pain scores after getting either with PRP injection as well as with MPS injection over 3-6 month period. The comparative clinical outcome during the follow-up period with PRP and MPS injection were given and final 3-month follow up suggest 20% patients with excellent, 48% with good and 32% with poor outcome with PRP injection. For subgroup B this was found as 16% excellent, 36% good and 48% poor outcome. The complication rate as PRP is made of patients own blood, there is no such complications except local site post injection pain seen in 14 patients (56%) for some time. Conclusion: Both PRP and MPS showed good efficacy on treating frozen shoulder. The current study provides strong evidence in support of a statistically significant effect of platelet concentrate in the treatment of frozen shoulder in vivo where steroid contraindicated or refused by patient.
6. Rotator Cuff Damage in the Elderly: Assessment of Function, Integrity, and Strength Kanhaiya Lal Gupta
Aim: Rotator cuff injury in patients over the age of 65 years: evaluation of function, integrity and strength. Methods: A prospective study was conducted in the Department of Orthopedic, Jawaharlal Nehru Medical College and Hospital,Bhagalpur, Bihar, India from November 2018 to August 2019. consecutively selected shoulders in individuals of the specified age, with a clinical diagnosis of rotator cuff injury that had been confirmed by means of magnetic resonance imaging, were treated surgically. The inclusion criteria were that the patients should be over the age of 65 years at the time of the surgery; the procedure was performed under arthroscopic viewing and the minimum postoperative follow-up. Results: The preoperative mean UCLA score result was 17.46 and the postoperative mean was 32.39, i.e. 89.28% of the results were excellent or good. The mean result from the Simple Shoulder Test was 9.86; the worst result (score of 4) was from the oldest patient in the study (82 years of age), who presented renewed tearing of the supraspinatus, measuring 2 cm on postoperative ultrasound performed 27 months after the treatment, and an UCLA score of 13. From evaluating the postoperative ultrasound, renewed tearing was detected in 7 (25.9%) of the patients who returned for control examinations. In six cases, the lesion was less than 1 cm in length. Only in the most elderly patient was the lesion 2 cm. All of the other patients had good or excellent UCLA scores. Conclusion: The repairs on rotator cuff lesions among patients over the age of 65 years performed by means of arthroscopy produced major clinical improvements, based on pain relief, function and integrity of the repair. The information regarding strength was inconclusive.
7. Effect of Gender and Physical Lifestyle on Quadriceps Angle in Young Adults Tuhin Ghulyani, Meenakshi Singhal, Sumit Babuta, Virendra Kumar
Introduction: Quadriceps angle (q-angle) is an important anatomical vector describing the alignment of the lower extremity and plays a significant role in evaluating patients with patellofemoral syndrome. Aim: To evaluate the magnitude and variations trends of q-angle in asymptomatic young males and females and to assess the effect of daily physical activity on its values. Materials and Methods: A total of 120 asymptomatic adults were divided into three groups of male students (MS), male laborers (ML), and female students (FS) with sixty subjects in each group. Normal values of Q angle were recorded in a standardized Romberg standing position using a flexible plastic goniometer. Data were statistically analyzed. Results: Q angles noted were in the range of 9-20°. Higher mean q-angle values were in females than males and it was found to be statistically significant. The mean q-angle obtained was 12.98° and 14.83° in males and females respectively. Mean q-angle was greater on the left side 13.11° & 14.90° than on right 12.84° & 14.83° in males and females, respectively. Comparison of q-angle in MS and ML revealed lower Q angle values, on both sides, in the ML group but it was not statistically significant. Conclusion: The study established normal reference values in adults of the Rajasthan region. The results concorded with most other studies of a higher q-angle in females and its bilateral asymmetry. The lower mean q-angle in the male laborer group does indicate physical lifestyle effect on q-angle but the study needs to be performed on a larger scale.
8. A Randomized Double-Blind Controlled Trial Comparing Efficacy of Epidosin and Drotaverine for Faster Cervical Dilation in Active Labour Lata Mehta, Kuldeep Wagh, Sanchita Dashora
Prolonged labour is one of the important causes of maternal and neonatal mortality and morbidity. Both Drotaverine hydrochloride and Epidosin exert their main effect on the cervix, facilitating its dilatation and thus, can be used for augmentation of labour. The present study is conducted to compare the efficacy of Epidosin and Drotaverine for faster cervical dilation in active labour. This was a prospective study conducted in a tertiary center over 1 year. All the 90 patients who reported to the department during the study period & were fulfilling the inclusion criteria were enrolled in the study. They were randomly assigned to group 1, 2, and 3. The group as per protocol. In primigravida and multigravida, the mean duration of the active phase of the first stage of labor was highest in the control group followed by injection Epidosin least in the injection drotaverine group. On statistical analysis, this difference in the mean duration of the active phase of the first stage of labor between the groups was found to be statistically significant (p-value < 0.001). The study concluded that the mean duration of the active first stage of labor was short with Drotavarine & Epidosin group as compared to the control. Thus, both injection drotaverine hydrochloride and Epidosin are effective in the acceleration of labor. However, drotaverine accelerates labor more rapidly and is a safe & potent drug without any significant fetal or maternal side effects for shortening the labor.