Gardi Medical College Research Articles

Antimicrobial Susceptibility Pattern of Klebsiella pneumoniae Isolated from Various Clinical Specimens in Ujjain City, Madhya Pradesh, India

Klebsiella pneumoniae is an important opportunistic pathogen that commonly causes nosocomial infections and contributes to substantial morbidity and mortality. We sought to investigate the sensitivity pattern of K. pneumoniae isolated from various clinical specimens. Methods- This cross-sectional study was conducted at Ruxmaniben Deepchand Gardi Medical College and Ujjain Charitable Trust Hospital in Ujjain City during March 2021 to September 2021 on total 463culture positive isolates from various clinical specimens. Identification of K. pneumoniae and antibiogram testing were performed by using VITEK-2 compact bacterial identification and monitoring system (bioMerieux, US). The data were analyzed by using NCSS statistical software 2021. Results- In total, 83 positive K. pneumoniae cultures from various clinical samples were examined. The isolates were more predominant in the females (n = 45; 54.2%) compared to males (n = 38; 45.8%). The antibiotic resistance rate of K. pneumoniae varied among different isolate clinical sample sources. Overall, high resistance rates were recorded for ampicillin (100%), amoxyclav (81.48%), piperacillin/ tazobactam (73.68%), cefuroxime (94.74%), ceftriaxone (91.2%), cefotaxime (91.2%), and cefepime (73.68%). A total of 83 K. pneumoniae isolates, 75 were ESBL (90.36%) producers. However, colistin (100%) showed the highest susceptibility rate against the isolates. Conclusion- the wide variety of MDR K. pneumoniae harboring β-lactams and virulence genes strongly suggest a necessity for the implementation of effective strategies to prevent and control the spread of antibiotic resistant infections.

Evaluation of respiratory Failure in Patients with Chronic Obstructive Pulmonary disease

Objectives: - The aim of the present study is to evaluate the clinical profile, investigations, treatment protocol and the response to the therapy in patient of COPD presenting with Respiratory failure.
 Materials and Methods: - All those patient with COPD with respiratory failure admitted in IPD in department of Respiratory Medicine R. D. Gardi Medical College Ujjain included in the study. Patients were evaluated by a detailed history, clinical examination, chest radiograph, arterial blood gas analysis and relevant blood investigation and were put on treatment. All the information was written in a proforma and the results were analysed.
 Results: - Majority of the patients were males (83.3%) with mean age of 65 years. In our study, the most common risk factor for COPD with respiratory failure was found to be smoking (80%). Nearly 70% cases were having type 2 respiratory failure. The main causes of exacerbations were bronchospasm(88.3%) and secondary infection (68.4%). 65% of the patients were discharged on room air with medical treatment, 23.3% patients were discharge on home oxygen with medical treatment, 3.33% patients discharged on NIV along with medical treatment and 5 patients died during hospitalization.
 Conclusion: - It is very important to take holistic approach toward COPD patient with respiratory failure. Early diagnosis, prompt treatment, pulmonary rehabilitation and vaccination are mainstay of management modalities and to prevent further exacerbation in patients.

Assessment of variations in selective biochemical parameters and its correlation with age and gender in COVID-19 patients of Ujjain district: A retrospective study

Background: At Ujjain district, in which the current study is based, has no prior studies examining the variations of liver function tests in the resident population. Aims and Objectives: The present study was undertaken to assess the variation in selective biochemical parameters and their correlation with age and gender in COVID-19 patients of Ujjain district: A retrospective study. Materials and Methods: 199 cases of confirmed COVID-19 patients from June 2020 to November 2020 were admitted to R. D. Gardi Medical College, Ujjain, Madhya Pradesh, were part of the study. Aspartate aminotransferases (AST), Alanine aminotransferases (ALT), Alkaline phosphatases (ALP), Total protein (TP), Total bilirubin (TB), C-reactive protein (CRP), Lactate dehydrogenase (LDH), sodium, and potassium parameters were recorded in the study participants. AST, ALT, TP, TB, CRP, and LDH were analyzed using vitros 5600 integrated system which is a dry chemistry autoanalyzer of ortho clinical diagnostics. Sodium and potassium analysis were analyzed on the vitros 5600 integrated system by using the direct potentiometry principle. The data were obtained from the patient information sheet from the MRD of our hospital. Results: The study results present the age-wise and gender-wise correlation of the parameters. There was an increase in the AST, ALT, CRP, and LDH levels in both male and female participants. However, the difference is not statistically significant. ALP, TP, TB, and potassium levels are within the normal limits in male and female participants. Albumin levels were decreased in male and female participants. However, the difference was not statistically significant. Sodium levels were significantly decreased (P<0.05) in males when compared with females. Conclusion: The study assessed the variations in selective biochemical parameters and their correlation with inflammatory markers in COVID-19 patients of the Ujjain district. The study results help to understand the biochemical aspects of the Covid disease. Further, detailed studies are recommended to understand the role of the biochemical parameter which helps for early diagnosis to save the life of the covid patients in general.

Assessment of the efficacy of electrical vestibular nerve stimulation as an adjunct therapy in the management of motor functions and quality of life in patients with Parkinson’s disease

Background: The existing treatments for Parkinson’s disease (PD) were associated with side effects and do not offer a complete cure. Hence, there is a need for an alternative therapy that can prevent or delay the onset of PD with less or no side effects. Our extensive review of literature has shown no studies to be existing so far in India regarding vestibular stimulation as a treatment method for PD. Aims and Objectives: The present study was undertaken to administer electrical vestibular nerve stimulation (VeNs) as an adjunct therapy in the management of motor functions and to improve the quality of life in PD patients. Materials and Methods: The present study was a randomized controlled trial. (ClinicalTrials.gov Identifier: NCT04450550). 30 cases of PD, of both genders, were part of the study by convenient sampling after obtaining written informed consent. Patients were recruited from the out-patient ward of the General Medicine department, R.D. Gardi Medical College. Motor activities were assessed using the Berg balance scale, strength procedures by hand dynamometer and hand-eye coordination by 100 pin dexterity test. Quality of life was assessed by the World Health Organization Quality of Life Brief. Results: The study results support the earlier studies as there was a significant improvement in the motor functions and quality of life of the study participants. Conclusion: The study recommends further detailed studies with higher sample size and involving many centers to recommend the use of electrical VeNs as adjunctive therapy in the management of PD.

Pancytopenia: Clinical and Haematological Profile from a Tertiary Care Centre in Central India

Introduction: Pancytopenia is a characterised by the decrease in number of red blood cells, white blood cells, and platelets. It is not a final diagnosis; instead, a manifestation of underlying haematological and other disorder. No study has been carried out to evaluate the cause of pancytopenia from this region. The majority of the Western world studies suggest aplastic anaemia as a significant cause of pancytopenia. However in India, the pancytopenia causes are not well defined and varied. Earlier studies from India show megaloblastic anemia being the primary cause of pancytopenia. Aim: To investigate the clinical and haematological correlation of pancytopenia and to ascertain aetiopathological causes of pancytopenia in patients admitted to a tertiary care center. Materials and Methods: This prospective cross-sectional study was conducted from August 2012 to August 2014 at RD Gardi Medical College, Ujjain, a total of 100 consecutive patients with two or all three of the following inclusion criteria were enrolled: Haemoglobin <10 gm/dL Total Leukocyte Count (TLC) <4000/μL and platelet count <1,00,000/μL. All patients underwent complete hemogram, peripheral smear, and reticulocyte count evaluation. Bone marrow aspiration was also performed in all patients, and in addition, a trephine biopsy was done in the same setting in 23 patients. Data were analysed using standard statistical methods. Various sign, symptoms of pancytopenia were recorded and analysed. Results: Underlying cause of pancytopenia was ascertained with the help of blood picture of bone marrow aspiration and biopsy, fatigue was the most common symptom (54%) followed by fever (49%) and breathlessness (15%). Pallor was detected in 85% of patients, splenomegaly in 47%, followed by hepatomegaly, oedema, lymphadenopathy, icterus, and ascites. Megaloblastic anemia was found to be the most prevalent cause of pancytopenia, which was seen in 49% of patients and followed by hypersplenism (16%). Conclusion: Pancytopenia is not an uncommon condition and should be suspected on clinical grounds when a patient presents with unexplained anaemia, fatigue and prolonged fever. Along with the clinical examination, the haematological study includes peripheral smear, bone marrow aspiration and bone marrow biopsy plays a critical role in the diagnosis.

Seroprevalence of Transfusion Transmitted Infections among Multiple Transfused Patients in Indian Scenario: Step for Safe Transfusion Practices

Introduction: Transfusion Transmitted Infections (TTIs) is a worldwide problem both in past and in the present days. The risk of TTIs is increased due to the constant need to receive blood transfusion in patients requiring multiple transfusions. The problem of TTIs runs parallel to the prevalence of the infections in the blood donor group and to the number of units transfused. Aim: To estimate the current prevalence of blood TTIs in patients requiring multiple units of blood transfusions and to determine their association with age, gender, various disease category and number of units transfused. Materials and Methods: This cross-sectional retrospective study was conducted in the Department of Pathology, RD Gardi Medical College, Ujjain, Madhya Pradesh, India from January 2017 to December 2020. Patients of all the age groups and both gender from Outpatient and Inpatient Department, requiring regular transfusions and having a history of 10 or more units of blood transfusion were enrolled. Serological detection of TTIs was done by Enzyme-Linked Immune Sorbent Assay (ELISA) method. Statistically the results were analysed using Statistical Package for Social Sciences (SPSS) version 19.0. Results: In this study, 480 patients were included of which 293 (61.1%) were males and 187 (38.9%) females. Maximum 195 (40.6%) were children in age group of <1-10 years. A total of 63 (13.12%) patients with Hepatitis C virus, 9 (1.87%) patients with Hepatitis B virus and 2 (0.42%) patients with Human Immunodeficiency Virus (HIV) infection were found at the end of study. Highest seropositivity of TTI was seen in patient who had undergone >400 number of transfusions , thus association was established but no association detected with age and sex of the patients. Majority of TTIs were positive in thalassemia patients 164 (34.17%) followed by patient undergoing haemodialysis 151 (31.45%). Conclusion: The results of this study raise an alarm to the existence of a significant risk of TTIs in our society. There is requirement of advanced and vigilant screening of donors with proper strategies to reduce the breach in safe blood transfusion practices.

Integrated antimicrobial resistance management strategy: A way forward to mitigate antimicrobial resistance crisis.

1Department of Environmental Medicine, Indian Initiative for Management for Antimicrobial Resistance, R.D. Gardi Medical College, Ujjain 456 001, India 2Division of Environmental Monitoring & Exposure Assessment (Water & Soil), ICMR- National Institute for Research in Environmental Health, Bhopal 462 030, Madhya Pradesh, India 3Department of Global Public Health, Karolinska Institutet, Stockholm 17177, Sweden For correspondence: [email protected] Received August 04, 2021 This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 4.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Correlation of Pupil to Limbus Diameter Ratio with Blood Pressure and Heart Rate among Parkinson’s Disease Patients

Introduction: Variation in blood pressure and heart rate is observed in patients with parkinson’s disease. Pupil to Limbus Diameter (PDL) ratio is one of the emerging autonomic functions. The studies measuring the autonomic functions of parkinson’s patients are sparse. Aim: To observe the correlation of the PLD ratio with blood pressure and pulse rate among parkinson’s disease patients. Materials and Methods: This observational study was conducted among 31 parkinson's disease patients attending Outpatient Ward of General Medicine Department at Ruxmaniben Deepchand Gardi Medical College, Ujjain, Madhya Pradesh, India, from 1st March 2021 to 1st November 2021. Pupil to limbus diameter ratio was recorded using the two-box method. Data was analysed using Statistical Package for Social Sciences (SPSS) version 20.0. Pearson’s correlation was used to observe the correlation. A p-value less than 0.05 was considered significant. Results: The mean age of the participants was 61.9±13.07 years. The mean PLD ratio of the left eye was 0.343±0.042. There was a significant positive correlation between the PLD ratio of the left and right eye with blood pressure in males. There was a positive correlation between pulse rate also with PLD ratio of the left and right eyes. However, it was not significant. Conclusion: There was a significant positive correlation of the PLD ratio with blood pressure and pulse rate in males, but negative correlation was observed between the PLD ratio of the left eye with systolic and diastolic blood pressure in females. The study results support the need for further detailed studies in this area to investigate further details of this correlation observed.

Correlation of Pupil to Limbus Diameter Ratio with Blood Pressure and Heart Rate among Parkinson’s Disease Patients

Introduction: Variation in blood pressure and heart rate is observed in patients with parkinson’s disease. Pupil to Limbus Diameter (PDL) ratio is one of the emerging autonomic functions. The studies measuring the autonomic functions of parkinson’s patients are sparse. Aim: To observe the correlation of the PLD ratio with blood pressure and pulse rate among parkinson’s disease patients. Materials and Methods: This observational study was conducted among 31 parkinson's disease patients attending Outpatient Ward of General Medicine Department at Ruxmaniben Deepchand Gardi Medical College, Ujjain, Madhya Pradesh, India, from 1st March 2021 to 1st November 2021. Pupil to limbus diameter ratio was recorded using the two-box method. Data was analysed using Statistical Package for Social Sciences (SPSS) version 20.0. Pearson’s correlation was used to observe the correlation. A p-value less than 0.05 was considered significant. Results: The mean age of the participants was 61.9±13.07 years. The mean PLD ratio of the left eye was 0.343±0.042. There was a significant positive correlation between the PLD ratio of the left and right eye with blood pressure in males. There was a positive correlation between pulse rate also with PLD ratio of the left and right eyes. However, it was not significant. Conclusion: There was a significant positive correlation of the PLD ratio with blood pressure and pulse rate in males, but negative correlation was observed between the PLD ratio of the left eye with systolic and diastolic blood pressure in females. The study results support the need for further detailed studies in this area to investigate further details of this correlation observed.

Determinants and pathways of healthcare-seeking behaviours in under-5 children for common childhood illnesses and antibiotic prescribing: a cohort study in rural India

ObjectivesTo explore the healthcare-seeking pathways, antibiotic prescribing and determine the sociodemographic factors associated with healthcare-seeking behaviour (HSB) of caregivers for common illnesses in under-5 (U-5) children in rural Ujjain, India.Study...

Study of clinico-epidemiological profile of leprosy patients at tertiary care center

<p><strong>Background:</strong> Leprosy is often mentioned as the oldest disease known to man, the origins of which are lost in the mists of antiquity. In spite of having been declared eliminated in December 2005 from India as a public health problem, India has still 60% of the entire global case load.</p><p><strong>Methods:</strong> A total of 60 Leprosy patients belonged to Ujjain and its adjoining districts, attending the outpatient department of dermatology at R.D Gardi medical college, Ujjain (M.P.). Over a period of 1 year i.e. January 2019 to December 2019 constituted the subject material for study. The data was analysed for clinico-epidemiological characteristic and relevant investigations were done.</p><p><strong>Results:</strong> A total of 60 patients attended the leprosy clinic during the study period. Maximum number of patient belonged to age groups of 21-40 years. Male preponderance with M:F ratio was 3:1. Family history was seen in 3 patients (5.0%). 73.3% patients were from rural area. Borderline tuberculoid (19 patients) was commonest clinical presentation and 2 cases of childhood leprosy were recorded.</p><p><strong>Conclusions: </strong>The present study gives a general picture about the current trends of Leprosy in this particular region and highlights the importance of clinico-epidemiological profile and relevant investigations. This study emphasizes the need of spread of awareness about the disease, facilities for investigation and early diagnosis.</p><p class="abstract"> </p>

Evaluation of markers of thrombosis and fibrinolysis in malaria patients in tertiary care hospital in Central India

Background: Cases of malaria are known to be associated with variable degrees of coagulopathy asevident from abnormalities of screening coagulation assays in a large number of patients during theillness. However, attempts to use laboratory parameters as indicators of the severity of theunderlying coagulopathy and for monitoring disease progression have met with only partial success.Methods: This prospective study was conducted in the department of Pathology in RuxmanibenDeepchand Gardi Medical College, Ujjain. Blood samples of all the patients diagnosed positive withmalaria were collected in vials containing ethylene tetra-acetic acid tri potassium salt forhematological parameters and in trisodium citrate tubes for coagulation assays. Result: Out of thetotal positive cases, PT was prolonged in 65% of total cases, Percentage positivity for prolonged PTfor falciparum and vivax is 60% and 68.5% respectively. APTT has raised 47% of malaria positivecases with percentage positivity for falciparum and vivax 48% and 45.7% respectively. 55% of totalcases showed raised levels of fibrin degradation products, which included 48% of falciparum casesand 60% of vivax cases. Out of 120 positive cases of malaria, D- Dimer was raised 41.7% cases.Conclusion: As blood is the chief component affected by malaria, not only proper examination ofperipheral smears is required for detection and species identification, but a careful evaluation ofother laboratory parameters should be done irrespective of the malarial species for the earlydiagnosis of compensatory and non-compensatory consumptive coagulopathy.

Clinico-epidemiological and histopathological study of newly diagnosed leprosy patients at tertiary care center

Leprosy, also well-known as Hansen’s disease, is a chronic granulomatous infectious disease caused by . In spite of having been declared eliminated in December 2005 from India as a public health problem, India has still 60% of the entire global case load. This study entailed the epidemiological, clinical features and histopathological findings of new leprosy patients and assessing the current situation of leprosy at a tertiary level referral center in central India.A total of 60 Leprosy patients belonging to Ujjain and its adjoining districts attending the out patient Department of Dermatology at R.D Gardi Medical College, Ujjain (M.P.), over a period of 12 month i.e. Jan-2019 to Dec-2019 constituted the subject material for study. The data was analysed for Clinico-epidemiological and histopathological characteristics.Out of all leprosy outpatients, Maximum number of patient belonged to age groups of 21-40 years and 2 cases of childhood leprosy were recorded. Male preponderance with M: F ratio was 3:1. Family history was seen in 3 patients (5.0%). 73.3% patients hailed from rural area. Borderline Tuberculoid (19 patients) was commonest clinical presentation. The overall clinico-histopathological concordance observed was 75%.The present study gives a general picture about the current trends of Leprosy in this particular region and highlights the importance of both clinical & histopathological examination and determining parity between their findings. This study emphasizes the need of spread of awareness about the disease, facilities for investigation and early diagnosis.

Study of thyroid function in pregnancy, its feto-maternal outcome; a prospective observational study

BackgroundPregnancy is a stress test of maternal thyroid function. The prevalence of thyroid dysfunction in pregnant women is high. Subclinical hypothyroidism occurs in 10% of all pregnancies. Effects of hypothyroidism in pregnancy are anemia, low birth weight and mental retardation in neonate. This study is aimed to evaluate maternal and fetal outcomes in pregnant women with deranged thyroid profile. The relevance of this study is to document the association of hypothyroidism and its adverse effects on mother and fetus.MethodsThis prospective observational study was carried out at R.D. Gardi Medical College, Ujjain, India. Subjects of this study were 198 antenatal women in third trimester with singleton pregnancy admitted in the obstetric ward, and informed consent was obtained. Women were chosen irrespective of age, parity, residence and socioeconomic status. Women with multiple pregnancy, a known case of thyroid disorder, or any pre-existing medical disorder were excluded. Routine hematological parameters and estimation of T3, T4 and TSH was conducted. Patients with deranged thyroid profile were subsequently assessed for maternal and fetal complications. History of infertility, family history of thyroid disease, menstrual pattern, recurrent abortion, hemoglobin level and fetal outcome were the main study variables. Data was analysed in SPSS software for statistical co-relation.ResultsPrevalence of thyroid disorder is 11%; with subclinical hypothyroidism, overt hypothyroidism and subclinical hyperthyroidism occurring in 5.6, 3.5 and 1.5% of subjects respectively. In women with subclinical and overt hypothyroidism, anemia was present in 26.3% being significantly associated with hypothyroidism (p = 0.008). With respect to fetal outcome, LBW 31.6% (p = 0.001), NICU admission 42.1%, (p = 0.000) and low APGAR Score (21.1%, p = 0.042) were statistically associated with hypothyroidism. Risk of anemia, Low Birth weight, NICU admissions, and low APGAR score was 4.8, 6.3, 0.14 and 3.64 times higher respectively in women with hypothyroidism than in women who are euthyroid.ConclusionPrevalence of subclinical hypothyroidism is 5.6% in 3rd trimester of pregnancy. Anemia, pre-eclampsia, high caesarean rates and neonatal morbidities is significantly associated with hypothyroidism.

Study of serum vitamin d levels and its association with neonatal sepsis among newborns

Introduction: Vitamin D plays an important role in immune function. It plays an important role in the neonatal period in fetal skeletal growth, prevention of rickets, neonatal sepsis, respiratory tract infections, cardiovascular diseases, diabetes, and other endocrine disorders. It has been found that newborns' low level of cholecalciferol is closely related to neonatal sepsis. Aims and Objectives: To determine the neonatal plasma cholecalciferol levels and severity of vitamin D deficiency in neonatal sepsis. Material and Methods: This was a prospective, observational study conducted at Neonatal Care Intensive Unit of R. D. Gardi Medical College, Ujjain. The cases included all babies >34 weeks of gestational age having postnatal age of 0-28 days with clinical signs and laboratory findings of neonatal sepsis. Statistical analysis was performed using STATA 10.0. Results: Total 70 newborns with sepsis were included in the study among which n=47 (67%) had deficient (less than 20ng/ml), n=16 (22.86%) had insufficient (between 20-30ng/ml) and n=7 (10.00%) of newborns had sufficient levels of cholecalciferol (more than 30ng/ml). The mean cholecalciferol levels among term were 18.53ng/ml (±4.8) and in preterm is 15.7ng/ml (±2.6) and this finding was statistically significant (p=0.04). The mean cholecalciferol in newborns with culture-positive sepsis was 14.8ng/ml (±6.04) and in culture-negative sepsis was 16.4ng/ml (±5.2) and this finding was statistically significant (p=0.02). Conclusions: More than 65% of newborns were deficient in 25-OH cholecalciferol and the mean 25-OH cholecalciferol levels were lower in preterm than in term newborns and lower in newborns with culture-positive sepsis than in newborns with culture-negative sepsis.

Determinants of motor, language, cognitive, and global developmental delay in children with complicated severe acute malnutrition at the time of discharge: An observational study from Central India.

BackgroundUndernutrition leads to impaired psychosocial and cognitive development. This study explored the developmental status of children with complicated severe acute malnutrition (SAM) and correlated it with various risk factors for SAM.Methods and findingsWe recruited 100 children with SAM and no other associated significant health issues during the recovery phase of treatment using the Bayley Scales of Infant and Toddler Development III prior to discharge from the nutritional rehabilitation unit in R D Gardi Medical College, Ujjain, Central India. We also assessed composite developmental scores, developmental age equivalents, and average differences in developmental age. Risk factors for developmental delay were identified in children with complicated SAM. The results revealed that 75%, 75%, and 63% of children with SAM exhibited delay in motor (mean score: 78.22), language (mean score: 83.97), and cognitive (mean score: 78.06) domains, respectively. A total of 63% children exhibited delay by an average of 4–7 months in the total developmental age. The proportion of children with delay in motor, language, and cognitive domains was determined. An increased risk of global developmental delay was observedin children with a low birth weight (adjusted odds ratio [aOR]: 18.06, 95%CI: 2.08–156.56; P = 0.009), having working mothers (aOR: 17.54, 95%CI: 3.02–102.59; P = 0.001), weight-for-age less than three standard deviations (aOR: 6.09, 95%CI: 1.08–34.10; P = 0.04), and presence of severe anemia (aOR: 16.34, 95%CI: 2.94–90.73; P = 0.001).ConclusionsThe results indicated that children with SAM exhibit developmental delay across all domains. Identifying multiple modifiable risk factors for developmental delay in children with SAM will be helpful in devising early interventional strategies in low-middle income countries; however, the exact timing of such interventions should be investigated.

A Study on the Impact of Foundation Course on 1st Year MBBS Students (2019 Batch) at RD Gardi Medical College, Ujjain

Introduction: A 1 month foundation course has been envisaged by the Board of Governors to orient the firstyear medical student to the new professional environment and help him/her to acquire some basic skills.Objectives: To assess student’s feedback on various modules of foundation course. To improve thesubsequent course.Methodology: A feedback questionnaire was provided to first year medical students before and after theone month foundation course for self assessment of their knowledge skills and confidence before and afterthe course.Result: 98.6% students participated in the study. There was significant improvement (p<0.05) in student’sperception of all the modules before and after the course.Conclusion: Encouraging feedback was obtained. Most of the students enjoyed group work, gainedknowledge and improved their skills and confidence.

Trichoscopy in common scalp alopecia: an observational study

<p class="abstract"><strong>Background:</strong> Many patients of alopecia are encountered in daily practice with diagnostic dilemma. Trichoscopy is a sensitive, non-invasive tool which aids in clinical diagnosis.</p><p class="abstract"><strong>Methods:</strong> An observational study performed in adult patients with alopecia attending R.D. Gardi Medical College, Ujjain, over a period of one year. Trichoscopy was performed using a Dinolite digital microscope with both polarized and non polarized modes.<strong></strong></p><p class="abstract"><strong>Results:</strong> 269 patients of alopecia (257 non cicatricial, 12 cicatricial) aged 18-50 years were enrolled. The diagnosis was made after detailed history and clinical examination. 173 (64.3%) males and 96 (35.7%) females. 45.4% patients were diagnosed to have alopecia areata in which yellow dots were the most common trichoscopic finding observed in 88.5% patients. 37.2% patients were diagnosed with androgenetic alopecia with hair diameter diversity >20% observed in all the patients. 9.3% patients were diagnosed to have telogen effluvium with short vellus hair seen in 64% patients. 3.7% of the patients were diagnosed to have seborrheic dermatitis with arborizing vessels being the most common finding seen in 90% patients. 2.9% patients were diagnosed with lichen planopilaris in which loss of follicles and peritubular white casts were seen in all the cases. 0.9% patients were diagnosed to have discoid lupus erythematosus with hyperkeratotic follicular plugging seen in all the cases. Overall yellow dots were the most common trichoscopic findings seen in 61% cases.</p><p class="abstract"><strong>Conclusions:</strong> Trichoscopy is a reliable diagnostic tool in hair and scalp disorders. Hence trichoscopic evaluation should be done in every case of alopecia. </p><p class="abstract"> </p>

Clinical pattern of papulosquamous dermatoses: an observational study conducted at tertiary care center, Ujjain, Madhya Pradesh, India

<p class="abstract"><strong>Background:</strong> Papulosquamous dermatoses is a complex group of disorder characterized by scaly papules and plaques. There is a need to study the exact, pattern and prevalence of this disorder in different age groups and their line of treatment. Objective of the study was to observe the clinical pattern of various papulosquamous dermatoses and their prevalence at tertiary care center, Ujjain.</p><p class="abstract"><strong>Methods:</strong> This was an observational study done in R.D. Gardi Medical college, Ujjain over a period of one year. A total of 229 cases including male and female of papulosquamous dermatoses were enrolled from the outpatient department. All patients were studied clinically and relevant data was recorded. Microsoft excel was used for data entry and analysis was done using SPSS version 23.<strong></strong></p><p class="abstract"><strong>Results:</strong> There were 139 (60.7%) males and 90(39.3%) females with overall male to female ratio was 1.54:1. Most common age group affected with papulosquamous dermatoses was 31-50 years. The clinical pattern observed was psoriasis 49.3%, lichen planus 24.5% followed by pityriasis rosea 10.5%. The least common papulosquamous diseases were pityriasis rubra pilaris (1.3%) and lichen nitidus (1.3%). Most common variant of psoriasis and lichen planus was chronic plaque and classical respectively. Classical juvenile variant of pityriasis rubra pilaris was seen in our study. A single rare case of lymphomatoid papulosis was noted in our study.</p><p class="abstract"><strong>Conclusions:</strong> Psoriasis, lichen planus and pityriasis rosea were commonest papulosquamous diseases were observed but still we need more longer duration of observational studies on papulosquamous dermatoses to understand the morphological features for the effective management of these diseases.</p>

Complications of stapled hemorrhoidectomy

Background: Stapled hemorrhoidectomy (SH), a new approach to the treatment of hemorrhoids, removes a circumferential strip of mucosa about four centimeters above the dentate line. Immediate complications (first week) were: severe pain in all patients, bleeding, thrombosis, urinary retention, anastomotic Dehiscence, fissurePerineal intramural hematoma, and submucosal abscess The most common complication after 1 week was recurrence of hemorrhoids in of patients, severe pain, stenosis, fissure, bleeding, skin tag, thrombosis, papillary hypertrophy, fecal urgency, staples problems, gas flatus and fecal incontinence, intramural abscess, partial dehiscence, mucosal septum, and intussusceptions. The most common complication in the first 25 cases of the surgeon’s experience was the pain. Even though SH and banding are necessary before recommending the procedure. It was a prospective and retrograde study conducted in R.D. Gardi Medical College, Ujjain. Study Duration was from November 2017 to November 2019. All the patients who were post-op (stapled hemorrhoidectomy) case of hemorrhoid disease. The total number of patients operated with stapled hemorrhoidectomy in the 2 years period (2017-2019) was 400.