Ammatory Response Research Articles

MONITORING OF A SEVERE COVID-19 PATIENT WITH PNEUMOTHORAX COMPLICATIONS THROUGH RADIOLOGICAL AND LABORATORY DIAGNOSIS

Introduction: Monitoring and treatment of severely ill patients with the coronavirus disease who are on mechanical ventilation due to the severity of the disease with the development of many complications remains a challenge. The increased incidence of pneumothorax in Covid-19 patients on mechanical ventilation may be due to a combination of infection-induced parenchymal injury and infl ammatory response with additional positive pressure ventilation. Materials and methods: In our study, we report a case of a severe Covid-19 patient with a pneumothorax complication through radiological and laboratory diagnostics. The performed radiogram of the lungs was taken each time in the AP projection in a semi-sitting position. A digital mobile X-ray device was used for imaging. All laboratory parameters that were monitored in the patient are performed in the panel of standard routine controls for patients with Covid-19. Results: The radiogram was better as the administration of therapy and chest drain were eff ective. Biochemical and hematological parameters are performed, which indicate a decrease in the number in blood count and biochemistry. The patient spent a total of 80 days in the hospital. Conclusion: Survival of a severe form of Covid-19 infection with the complication of pneumothorax is very rare, but still possible, as shown in our case. A chest radiograph with laboratory monitoring of the condition is of great importance in establishing the diagnosis of Covid-19 infection, and in the fi nal assessment of the patient's condition upon discharge from the hospital. Keywords: Covid-19, mechanical ventilation, pneumothorax, radiological diagnostics, laboratory diagnostics.

STAGES OF MORPHOLOGICAL CHANGES OF TARGET ORGANS IN EXPERIMENTALLY SIMULATED ACUTE PERITONITIS

One of the urgent problems in urgent abdominal surgery remains acute disseminated peritonitis (AP), the mortality rate of which remains high due to the development of multiple organ failure syndrome, despite the use of modern methods of diagnosis and treatment.The purpose of the study. To substantiate the possibility of using laparoscopic methods of treatment depending on the severity and stage of morphological changes of the target organs and the duration of peritonitis simulated in the experiment.Material and methods. The experiment used 150 sexually mature non-linear female rats, weighing 180.0-220.0 grams, which were kept on the standard ration of the vivarium of the Central Research Laboratory with maintenance of food and drinking regimes recommended by the norms of keeping laboratory animals. The animals were divided into 5 groups – a control group (30 rats) and 4 experimental groups (120 rats), which underwent HP simulation by intraperitoneal injection of 1 ml of 30 % autocal. The animals of the research group were removed from the experiment under sodium thiopental anesthesia by bloodletting on the 1st, 3rd, 5th, and 7th days. Results of the study. Morphohistochemical study of the target organs on the 1st day of the experiment: singleorgan changes were observed (examination of the peritoneum revealed its pronounced swelling). A slight vascular reaction of the basal membrane of the mucous membrane was established in the small intestine. On the 3rd day, the changes remained monooraneous with increases in infl ammatory phenomena. On the 5th day, the spread of the systemic infl ammatory response to the lungs and kidneys was confi rmed. Areas with foci of dystrophic- necrotic changes in the epithelium of the tubules were visualized in individual excretory tubules in the kidneys.In the lungs: the number of erythrocytes and fi brin increased in the cellular component. On the 7th day of the experiment, the heart and liver were involved in the process. In the heart, dystonia and paresis of microcirculatory vessels, erythrocyte stasis, and the formation of cell aggregates in the lumen of vessels were observed. In the liver, it is observed: congestion of the central veins, manifestations of venous stasis.Conclusion. Based on the stages of morphological changes of the studied organs at diff erent times, the simulation of acute peritonitis allowed us to theoretically justify a diff erentiated approach to the selection of the type of surgical interventions.

A RARE CASE OF GOSSYPIBOMA SHOWING TRANSMURAL MIGRATION TO THE SMALL BOWEL

The most common surgically retained foreign body is the surgical mop or surgical sponge. The clinical presentation of a retained sponge can vary from an incidental nding on plain radiograph to an intense inammatory response with obstruction or perforation1. In this case report, we are going to discuss the case of a 36 year old lady presenting to the emergency room with obstructive symptoms. The patient underwent exploratory laparotomy after undergoing CT imaging, which had raised the suspicion of a foreign body in the distal small bowel. The retained surgical sponge was extracted from the small bowel. Retained surgical mops following surgery is an avoidable but serious complication. They are seldom reported because of medico-legal implications but clinicians need to be aware about varied presentations of this entity to avoid unnecessary morbidity. Transmural migration to the lumen of the bowel is a very rare occurence

RETROSPECTIVE OBSERVATIONAL STUDY ON CORRELATION OF VITAMIN D LEVELS IN MALES AND FEMALES COVID -19 POSITIVE PATIENTS ADMITTED IN GOVERNMENT GENERAL HOSPITAL VIJAYAWADA IN THE YEAR 2021

Vitamin D, a sterol, produced in the skin by ultraviolet radiation, endogenously activated by kidneys, have hormone like function, and has a role in immunity by neutralizing the inammatory response that damages the body. The association between Vitamin D and viral infection like inuenza has been documented. Vitamin D was also widely administered during COVID 19 pandemic and the rationale of its use in protection from severity during COVID-19 is debatable. To assess Serum Vitamin D AIM AND OBJECTIVES: (25- hydroxyvitamin –D) levels in male and female COVID -19 positive patients and correlate with normal Vitamin D levels METHODOLOGY: Retrospective observational study of Serum Vitamin D levels of 94 subjects who are COVID 19 positive patients were studied, out of which there were 47 males and 47 females. Serum Vitamin D levels were analyzed on AU480 Beckman Coulter. Comparison of Vitamin D values in males and females was done in SPSS 2020

HAEMODIALYSIS: THE TOOL TO CURB MORTALITY IN COVID AKI PATIENTS WITH ELEVATED INFLAMMATORY MARKERS

Background: In patients with multiple organ involvement and need of critical care, the severity of COVID 19 can be assessed using various biomarker of a hyperinammatory immune response. Our research aims to correlate these biomarkers with COVID severity and to comprehend the value of hemodialysis, not only in terms of lowering renal load but also in terms of enhancing outcomes by addressing the inammatory response Objective: To study the impact of haemodialysis on COVID positive patients with AKI and elevated inammatory markers (NLR, D-Dimer, Serum LDH, Serum Procalcitonin) Out of total 126 patients, 79 were survivors and 47 Results: non-survivors. In non-survivors, majority were older (p=0.009). Both the group had higher percentage of males 78.72% and 55.69% in survivors and non-survivors respectively. Mean NLR and D-dimer, procalcitonin, LDH, and prothrombin time was signicantly higher in non-survivor as compared to survivors (p<0.001). Mean serum urea and creatinine was signicantly greater in non-survivors (p<0.001). Mean number of haemodialysis sessions received by survivors were higher. Strong positive correlation was observed between CTSI versus serum procalcitonin, serum LDH, D-dimer, and NLR. Our Conclusion: study establishes NLR, D-dimer,serum procalcitonin, serum LDH to be strongly associated with both COVID CT severity and mortality making them early prognostic markers in COVID patients. It also proves the role of haemodialysis as a life-saving tool to reduce inammation while also improving kidney outcomes

DIAGNOSTIC VALUE OF PROCALCITONIN IN PREDICTING SEPSIS IN BURNS PATIENTS

Patients who have suffered from burns are at an increased risk of dying from sepsis. The combination of a systemic inammatory response and a recognised infection is what medical professionals call sepsis. If the infection is not treated, then it will lead to severe sepsis, which is characterised by organ dysfunction, low perfusion, and low blood pressure. The systemic inammatory response syndrome, often known as SIRS, may have an infectious or a noninfectious origin. When dealing with patients who have suffered serious trauma or burns, it is often difcult to determine whether SIRS is the consequence of the injury itself or whether it is related to a superimposed infection. In patients with SIRS, the majority of the clinical symptoms of infection, including fever, tachycardia, and leukocytosis, were also present. As a result, in order to circumvent this problem, the American Burns Association established a consensus panel, and criteria were drafted in order to dene sepsis in burns patients. In the past, a number of research have been carried out to determine the value of the PCT in both burns and non-burns related situations . Even in the absence of sepsis, the value of PCT may be modestly elevated due to the localised infection. Therefore, the diagnostic threshold for sepsis is quite low when using the cut off value that was examined in the earlier investigations. This study was carried out to determine the PCT value in burns patients and also to locate a threshold value that may be used to suspect sepsis in its early stages. We intend to incorporate this threshold value as a protocol into our existing set up

EFFICACY AND SAFETY OF APIXAN (APIXABAN) COMPARED WITH RIVAROXABAN IN COVID PATIENTS

Background: Increased risk of thromboembolic manifestations associated with COVID-19 shown in recent literature. Several hypotheses have been suggested to understand the underlying pathophysiology behind development of a prothrombotic state in COVID-19 such as exaggerated inammatory response resulting in activation of the coagulation cascade and endothelial injury. Methods And Materials: It was a prospective observational study, conducted in three tertiary care Private Hospitals of Chattogram City in Bangladesh. The study enrolled 253 consecutive outpatients from June 01, 2021 to May 31, 2022 due to Covid-19 disease on the basis of presentation of signs and symptoms severity. Upon admission, routine investigations, treatment and follow-up were carried out. Study population divided into two groups. In Apixan group, used only one brand drug tab. Apixan 5 mg twice daily and in Rivaroxaban group, used different brand of drugs 10 mg daily. Results: Mean age of the patients was 54.3±7.3 years. Between two groups, the predominant co-morbidity among patients was hypertension (74.0% vs 73.8%), followed by diabetes mellitus (53.5% vs 60.3%). Cough (95.2% vs 94.4%) was the most common symptom at presentation, followed by fever (86.6% vs 88.0%) and Fatigue (30.7% vs 30.2%), among cases of COVID patients. Maximum patients were mild illness 81.1 % vs 76.9% and severe cases 3.1% vs 7.1% which were statistically signicant (p=0.046). Patients Apixan group received more ACEi/ARB (74% vs 73.8%), antiplatelet (22% vs 20.6%) and Rivaroxaban group received more anti-diabetic (60.3% vs 53.5%), Beta Blocker (56.3% vs 50.3%). All event rates were numerically higher in the rivaroxaban group of COVID-19 patients compared with apixan group. In the unmatched analysis, hypoxia/ Oxygen used 9 cases of Apixan group compared with Rivaroxaban group 24 cases (7.1% vs 19%, p- 0.005), Lower limb swelling (DVT) (3.9% vs 11.1%, p- 0.03) and others bleeding events (16.5% vs 26.1%, p-0.047) which were signicant. In the term of primary outcome after propensity score matching (PSM), there were no signicant differences in the risks of all-cause mortality (0.8% vs 1.6%, p-0.62), muscle spasm (47.2% vs 46%, p-0.847), fatigue (37% vs 43.7%, p0.28) and hospital admission (6.3% vs 9.5%, p- 0.34). Likewise, there were no signicant differences in the risk of myocardial infarction (MI) between both groups (1.5% vs 2.3%, p-0.85) and major bleeding (ICH/GI bleeding) (1.6% vs 3.9%, p-0.42). The risk of suffering an ischemic stroke/TIAat 90-days after medication was higher in Rivaroxaban group (0.8% vs 6.3%, p-0.02) which was clinically signicant. Conclusion: In conclusion Rivaroxaban may be associated with an elevated bleeding risk and Apixan (Apixaban) may be associated with a lower bleeding risk with lower other events

COMPARISON BETWEEN C-REACTIVE PROTEIN AND SERUM LACTATE IN EVALUATION OF SEPSIS INDUCED ACUTE KIDNEY INJURY AND SEPSIS WITHOUT ACUTE KIDNEY INJURY

Background One of the main causes of death in critically ill patients is sepsis. In Intensive care unit half of the patients develop Acute Kidney Injury, and has high mortality rates. In assessment of sepsis there are multiple markers in which C-reactive protein, serum lactate are commonly used. C-reactive protein is known biomarker of inammation and involved in several immunological functions. Aim To correlate C-reactive protein and Serum lactate in evaluation of sepsis induced acute kidney injury and compare these parameters in sepsis without acute kidney injury. Materials & Methods This is a Cross-sectional study which will be done at Mahatma Gandhi Medical College and Research Institute, Pondicherry. This study comprises of 52 patients out of which Group 1 are 26 patients having sepsis with AKI and Group 2 are 26 patients are having sepsis without AKI. Complete case history including the socio-demographic data and other medical conditions of the patient was recorded and & the collected blood samples were recorded for CRP, Serum lactate as well as other parameters. Results Mean age of subjects in sepsis with AKI and sepsis without AKI are almost similar, with 55.8 % being females. 90% of sepsis with AKI group and 76% of sepsis without AKI group has CRP of >10 and 42% of sepsis with AKI group and 34% of sepsis without AKI group has Lactate of >2. Conclusion CRP and Serum lactate are markers of inammation. CRP has been used to monitor the course of infection and inammatory diseases. CRP has not only a biochemical marker of inammation but also an active modulator of the inammatory response.

LIVER INJURY IN COVID-19 INFECTION: A CROSS SECTIONAL STUDY IN TERTIARY CARE CENTRE.

Introduction The novel coronavirus disease 2019 (COVID-19) unquestionably changed the world and provided a fresh perspective on respiratory tract illness. However, coronavirus (COVID-19) cannot be viewed as a condition restricted to pneumonia of varying severity. Numerous reports have shown a variety of potential systemic symptoms, including liver issues. The pathogenesis of liver injury in COVID-19 individuals may include viral immunologic injury, drug-induced liver injury, the systemic inammatory response, hypoxia hepatitis, and worsening of pre-existing liver disease. We must distinguish between the onset of aberrant liver function, which can happen either at the time of diagnosis or while receiving treatment. Methods: 580 patients were admitted with COVID-19 between August 2020 -December 2020 in SUNSHINE HOSPITALS, SECUNDERABAD. A COVID-19 diagnosis was conrmed with a positive RT-PCR test.LFT was performed in all patients undergoing admission (DPD with sample blank,IFCC AMP method) in a standard laboratory. Results:In our observation only 34%(n=580) of patients had altered LFT in which majority are mixed type (51%), rest all were hepatocellular (39%) and cholestatic type (10%). Though mixed & hepatocellular pattern commonly seen in men, cholestatic pattern is signicantly seen in women(p<0.05), but there was no association found between BMI (p=0.10), other comorbidities and inammatory markers(P=0.10) in relation to altered LFT. Though 23% of the patients had altered LFT at the time of discharge, Majority (49%) got discharge with normalized LFT,but 28% of patients had worsening LFT with majority of them are in ICU. Most of the ICU admitted patients with altered LFT were elderly, obese with mixed type of altered LFT. 21 patients died in our series, but known of them had isolated liver injury. In covid patients all types of LFT changes were Conclusions: observed, most of the changes were resolved at the time of discharge. Persistent altered LFT was not a hindrance for the discharge. We could not notice isolated liver injury as causative factor for death in covid patients

CORRELATION OF SIZE AND VOLUME OF CT SCAN LESION WITH SYSTEMIC INFLAMMATORY RESPONSE IN ACUTE CEREBROVASCULAR ACCIDENTS

Background Acute cerebrovascular accidents (CVA) are the leading cause of mortality and morbidity worldwide. CVA is now considered to produce an inammatory response in brain and periphery in form of rise in inammatory markers. CT scan head is an initial investigation of choice in acute cerebrovascular accidents (stroke). This study was done to correlate the size and volume of CT scan head lesion with inammatory response in acute cerebrovascular accidents. Methods Study was conducted in 90 patients of acute CVA admitted in LLR and associated hospitals, G.S.V.M. medical college Kanpur. All patients of CVA (stroke) fullling the Inclusion and exclusion criteria were enrolled in the study. CT scan head was done as an initial investigation to conrm the diagnosis. To assess the inammatory response Serum CRP (hs-CRP) level was measured by Turbidimetric immunoassay. Statistical analysis was done by using T test and chi square test. Results Our patients were mostly in the age group of 40-79 years with mean age 59 year with male predominance. CRP levels were found to be elevated statistically signicant in all types of CVA patients as compared to controls. There was signicant rise from rst day to third day (P<0.05). CRP was maximum in patients of cerebral infarction as compared to other types of stroke. Observation showed higher CRP level in patients with larger lesion in CT head. Mean CRP of expired patients was higher as compared to whole study group (P<0.05). Conclusions We concluded that CRP level was much elevated with increase in size and volume of lesion in CT head in patients of CVA indicating the magnitude of inammatory response, assessing severity and outcome

C- REACTIVE PROTEIN - AN OUTCOME PREDICTOR IN ACUTE INTRA CEREBRAL HEMORRHAGE

Background Inammation is considered to play an important role in the pathogenesis of cerebrovascular disease. C-reactive protein (CRP) is a hallmark of acute inammatory response. There are growing evidences that inammations are involved in atherosclerosis, plaque formation and ischemic event. There are many studies showing that the levels of CRP (hsCRP) have been found to be raised in cerebral ischemia, but there are few studies about the association of CRP level and intracerebral hemorrhage. This study was done to observe the levels of CRP (hsCRP) in patients with acute intracerebral hemorrage, and to assess the severity and outcome. Methods Study was conducted in 30 patients admitted in medical ward and medical ICU of LLR and associated hospitals, G.S.V.M. medical college Kanpur. All patients of acute intra cerebral hemorrhage fullling the Inclusion and exclusion criteria were enrolled in the study. Serum CRP (hs-CRP) was measured by Turbidimetric immunoassay. Statistical analysis was done by using T test and chi square test. Results Maximum numbers of our patients were in the age group of 40-79 years with mean age of 64 years. Intra cerebral hemorrhage was more prevalent in males. CRP level was found to be elevated statistically signicant in intra cerebral hemorrhage patients as compared to controls. There was signicant rise from rst day to third day (P<0.05). Mean CRP level of expired patients was elevated as compared to whole study group (P<0.05). Conclusions We concluded that higher C reactive protein level may be associated with worse prognosis and poor outcome in intra cerebral hemorrhage patients and CRP level can be an important factor of prognostic signicance in these patients.

A PROSPECTIVE STUDY ON CORRELATION OF SERUM LIPID PROFILE AND SEPSIS SEVERITY IN ADULT PATIENTS DIAGNOSED WITH SEPSIS IN A TERTIARY CARE HOSPITAL.

Introduction: Sepsis causes, extensive physiological and biochemical abnormalities. Literature shows that infections cause reasonable alterations in lipid metabolism and in the composition of lipoproteins. In these situations, there is an increase in the levels of triglycerides and VLDL cholesterol and decrease in levels of HDL and LDL cholesterol. Patients with sepsis, having hypocholesterolaemia indicates disease severity when other causes of this condition are to be ruled out. Hence this study was done to understand the role of serum lipids in patients with sepsis. Material and methods: A prospective study was done in 60 adults patients admitted with sepsis (According to the Third International consensus Denitions for Sepsis and Septic Shock 2016 (Sepsis – 3), in medical wards and medical ICU of a tertiary care teaching hospital during December 2021 to April 2022 after obtaining institutional ethical committee clearance and consent from patients. All patients who gave informed consent were enrolled consecutively till the sample size was reached. Patients were subjected to detailed history taking, clinical examination and biochemical investigations were done and data was recorded in a semi-structured questionnaire. Data was entered in MS excel and analysis was done using SPSS -20, Data represented in frequency tables. Correlation between parameters assessed and APACHE II and SOFA score was done using pearsons correlation coefcient with P<0.05 considered as statistically signicant. Mean age of the study population was 40.22±11.831. Results: Majority of the study patients were males (71.7%). Respiratory tract infection (33/55%) was the major source of infection. Diabetes mellitus was the most common type of comorbidity (27/ 45%). HDL cholesterol was negatively correlated with both sepsis prognostic severity scores (APACHE II and SOFA score) which were highly signicant statistically. Pearsons correlation coefcient shows that total cholesterol, LDL cholesterol is poorly correlated with sepsis severity and triglycerides though negatively correlated the association is weak. Sepsis Conclusions: patients, shows alterations in lipid metabolism. Higher values of SOFA and APACHE II scores were associated with low HDL levels. Lipoproteins may function as potential biomarkers (especially high-density lipoprotein) in systemic inammatory response syndrome and sepsis

INTRANASAL FLUTICASONE SPRAY VERSUS INTRANASAL FLUTICASONE SPRAY WITH ORAL LEVOCETRIZINE IN TREATMENT OF ALLERGIC RHINITIS– A RANDOMIZED CONTROL STUDY

Background: Allergic rhinitis is an Ig E mediated inammatory response of nasal mucosa, known to have a signicant impact on quality of life. Clinical studies have found that combining an antihistamine with an intranasal corticosteroid provides few or no advantages over monotherapy with an intranasal corticosteroid. Objective-To compare clinically the effectiveness of intranasal uticasone spray and intranasal uticasone spray with oral levocetrizine in relief of symptoms in allergic rhinitis using TNSS (Total Nasal Symptom Score)- a randomized control study. Materials and methods: A Randomized control study with total number of 40 patients clinically diagnosed with allergic rhinitis coming to the ENT OPD, S.N.M.C, Bagalkot was done. Patients were randomized into two groups. In group A, intranasal uticasone spray 2 puffs OD was given and combination of intranasal uticasone spray with oral levocetrizine OD in group B for a period of 4 weeks. Results: Symptom improvement in nasal symptom scores in both groups were compared at 1st week, 2nd week and 4th week. Patients in intranasal uticasone with oral levocetrizine group had better improvement compared to the intranasal uticasone spray alone in third visit, which was statistically signicant (p=0.002). This study concludes that, although corticosteroids are the mainstay of treatment in allergic rhinitis, but when used with oral levocetrizine has better tolerabilit

“CERVICAL LYMPHADENOPATHY AND ITS ETIOLOGY IN CHILDREN: A STUDY IN A TERTIARY HEALTH CARE INSTITUTE.”

Background: Lymphadenopathy occurs in a number of cases presenting in ENT out-patient department. Most cases are found to have enlarged cervical lymph glands. Lymphadenopathy is a condition affecting the lymph nodes of the body as a result of infection, benign or malignant conditions. As a result, lymph nodes become enlarged and abnormal in size, shape, consistency and they may show xity, abnormal mobility or symptoms that differ from normal. This is due to uid accumulation and action of lymphocytes. The most common form is lymphadenitis when it is due to inammation. Inammation may spread from surrounding soft tissue via lymphatic vessels or direct involvement of the lymph glands. A study was conducted to have an idea about the most common cause of cervical lymphadenopathy in children as most common region of lymph node in children is cervical groups of lymph nodes. A hospital-based prospective study was Methods and Materials: conducted in the department of otorhinolaryngology and head and neck surgery, from a time period of October 2021 to March 2022 and results analysed from the collected data. Results: Reactive lymphadenopathy due to viral or bacterial infections is the leading cause followed by systemic and malignant diseases. Discussion: Inammatory response is the leading cause of cervical lymphadenopathy in children.

CHEMOTHERAPY INDUCED HISTOPATHOLOGICAL CHANGES IN MASTECTOMY SPECIMENS - STUDY AT A TERTIARY CARE CENTRE

Background: Pathological complete response (pCR) to Neo adjuvant chemotherapy (NACT) is a signicant prognostic marker in breast cancer, so accurate diagnosis and grading of pathological chemo response of tumour is needed for an effective planning of treatment regimen. To study the various histopathological Aims: changes in Mastectomy specimens following NACT and to evaluate the pathological response of tumour to NACT, also to compare the expression of ER, PR, and HER2 in biopsies and post NACT mastectomy specimens by Immunohistochemistry (IHC). Methods And Materials: 50 breast carcinoma cases, who was diagnosed on trucut biopsies and treated with preoperative NACT followed by mastectomy was included. In post NACT mastectomy specimens, the chemoresponse was classied according to Union for International Cancer Control (UICC) guidelines. ER, PR, and HER2/ neu receptor expression was compared between trucut biopsy specimens (pre- NACT) and resection specimens (post- NACT). Results were analysed by Chi square test and McNemar chi square test. Among 50 cases, patients presented with lump, Results: involved more on the right and in upper outer quadrant. Most common stage at presentation is stage III A. Histologically all belong to IDCC -NST histological subtype. Signicant reduction in mean tumour size by 52.7% after NACT was observed. pCR, pPR and pNR was observed in 20 %, 58 % and 22 %of the cases respectively. Most common histological change seen in post NACT is necrosis, desmoplasia, brosis, lymphocytic inammatory response. Discordance in ER expression (17.5 %), PR expression (20%) and HER2 /neu (12.5 %) before and after NACT. But these were statistically insignicant. CONCLUSIONS: Pathological evaluation of chemo response of tumour is the gold standard. The discordance rate of ER, PR and HER-2/neu expression following NACT was statistically insignicant, larger studies needed to analyse their impact in patient management.

OBSERVATIONAL STUDY OF 50 CASES OF EARLY OUTCOME OF SETON AND VIDEO ASSISTED ANAL FISTULA TREATMENT IN HIGH VARIETY PERIANAL FISTULA:

Background: Fistula is the Latin word for a reed, pipe or ute. Fistula in ano is an abnormal communication, lined by granulation tissue between the anal canal and the skin, which causes chronic inammatory response. Nowadays, stula surgery is done as an elective procedure due to patients' discomfort, and problems associated with it. Many surgical techniques are used for the treatment of stula but there is no gold standard treatment. The aim of our study is to know outcome of SETON & VAAFT for high variety stula. In our study we observed 50 casesMaterial And Method: of high variety perianal stula who had undergone SETON & VAAFT. All investigations were done with informed and written consent. Cases were observed for postoperative pain, wound healing, hospital stay and other complications like wound discharge, perianal abscess and recurrence. RESULT: In our study we found that, in case of SETON –5 cases had delayed wound healing at the end of 3 month, 2 cases had perianal abscess and 4 cases were reported to had reurrence. Whereas in case of VAAFT – only one patient had recurrence, no case reported with pain, perianal abscess delayed wound healing and. In this study, we observed that VAAFT had advantage over SETON in view of visualization of internalConclusion: opening and other communicating tracks of stula with shorty period of hospital stay and better tolerance by patient than other procedures.

CO RELATION OF SERUM TRIGLYCERIDES AND HIGH DENSITY LIPOPROTEINS WITH SEVERITY OF ACUTE PANCREATITIS-A PROSPECTIVE STUDY IN COASTAL AREAS OF KARAIKAL

Acute pancreatitis is an acute inammatory condition of pancreas that can range from mild self-limiting disease to severe pancreatitis charecterised by acute inammation,necrosis,Systemic Inammatory Response Syndrome(SIRS),Multi Organ Dysfunction Syndrome(MODS) and death. The atherogenic index of plasma(AIP) reects the TG and HDL levels calculated as log(TG/HDL).AIP is a biomarker for dyslipidemia ,metabolic syndrome , coronary syndrome.Low HDL level and elevated TG level is a well known risk factor for persistent organ failure in acute pancreatitis.In this study we aim to correlate serum triglycerides and HDL levels with severity of acute pancreatitis, All patients with rst episode of acute pancreatitis with serum amylase and/or lipase ≥3 times the upper normal limit and Characteristic imaging on a radiological study were included in the study. Clinical data and blood samples were obtained patients' diagnoses of AP. . The AIP was dened as log (TG/HDL). The severity of AP was evaluated according to the 2012 revised Atlanta classication and recorded as mild, moderately severe, or severe AP.statistical analysis was done and results were derived as Atherogenic Index of plasma(AIP) was signicantly higher in the SAP group. Hence AIP can be used as predictor for severity of acute pancreatitis

Therapeutic options in the treatment of infectious endocarditis of an implantable cardiac device lead

Right-sided endocarditis, and endocarditis of the tricuspid valve in particular, is a relatively uncommon condition, encountered in approximately 5 to 10 percent of all cases of infectious endocarditis (IE). The recent increase in the prevalence of right-sided IE is attributed to intravenous drug abuse as well as the increased utilization of implantable cardiac devices such as pacemakers, implantable cardioverter-defi brillators, and cardiac resynchronization therapy devices. These cases pose signifi cant therapeutic challenges, especially when right-sided devices are involved. We present a case of 45-year-old male patient with proven IE with involvement of the tricuspid valve and implantable cardiac device lead and demonstrate the results of an antibacterial treatment and surgical interventions carried out in two steps – explanation of the lead of the implantable cardiac device, excision of the tricuspid valve, and implantation of an epicardial implantable device; subsequent tricuspid valve replacement with mechanical valve, surgical revascularization, and fi nally replacement of the thrombosed mechanical valve with a biological valve. The optimal preoperative management and the following comprehensive surgical intervention resulted in resolution of IE as it has been demonstrated by the lack of recurrence of systemic infl ammatory response syndrome and no further hospitalisations due to cardiovascular events.

BIOCOMPATIBILITY OF DENTAL MATERIALS: A REVIEW

Biocompatibility is the ability of a material to elicit a biological response, when applied to the body, without causing a chronic inammatory reaction, foreign body reaction or toxicity, is related to the interaction of the cell or any biomaterial. There are several biological responses that can occur when a material is placed in contact with living tissue, this response may be inammatory in nature, allergic, toxic and mutagenic. The use of a non biocompatible material of the dental element can cause an increase in the inammatory response, leading to cell death and tissue necrosis.

“CORRELATION OF SPECIFIC ANA(IIF) PATTERN AND ANTIBODIES DETECTED IN ANA BLOT TEST IN VARIOUS AUTOIMMUNE DISORDERS: A PROSPECTIVE STUDY”

Background: One of the central features of the immune system is the capacity to mount an inammatory response to potentially harmful foreign materials while avoiding damage to self-tissues. Autoimmunity is dened as an immune response leading to reaction with self-antigen, this may be a harmless phenomenon, identied only by the presence of low-titre autoantibodies or autoreactive T cells. These are a major cause of chronic morbidity and disability, affecting up to 1 in 30 adults at some point during life. Autoimmune diseases result from the failure of immune tolerance, the process by which the immune system recognises and accepts self-tissue. Materials And Methods Hospital based Observational study. Total 152 cases were studied with suspected connective tissue disorders attending OPD/IPD in tertiary care hospital in One and a half years (January 2020 to July 2021), but only 57 out 0f 152 cases were screened by ANA IIF Test and ANA BLOT Test both. Result: ANA positivity was more observed in females. Autoimmune disorder was more common in the age group of 20-40 years about 22 cases (38.6%). Most common pattern observed was Homogenous (n=20, 48.78%). Most common band observed is dsDNA (14.92%) followed by SS/RO 60 (13.43%) PO (11.94%), Histone (10.44%) and Nucleosome (10.44%). The sensitivity, specicity, positive predictive value, negative predictive value of ANA Blot after comparing it with ANA IIF is 70.73 %, 87.50%, 93.54%, 53.84% respectively. Conclusion: In conclusion, detection of ANA by indirect immunouorescence is the most cost - effective screening test in investigating autoimmune disease. ALine-Immuno Assay is performed for further conrmation and detection of specic antibody in sera which can be quantitated with ELISA/RIA/CLIA methods and can help in assessing the prognosis, disease activity and monitoring of therapy for a particular auto-immune disorder. However, despite their easy use, line immunoassays have some drawbacks including lack of sensitivity and specicity for certain antigens.