Government Medical College Hospital Research Articles

A Study comparing Olecranon osteotomy with Triceps reflecting anconeus pedicle approach (TRAP) for internal fixation of supracondylar and intercondylar fractures of the humerus

Objective: To evaluate the outcome of the Olecranon osteotomy approach and TRAP (triceps reflecting anconeus pedicle) approach and comparing them, attributable to Mayo Elbow Performance Score, range of motion, duration of fracture union and duration of surgery. Studydoneat: Government Medical College, Ratlam, MP, India Method and Material: The study is a retrospective randomized control trial on patients with intercondylar and supracondylar fractures of humerus admitted and operated in Department of Orthopaedics, Government medical college and District Hospital, Ratlam from July 2019 to September 2020. Total of 30 patients was included in the study, 15 in each group viz. Group-A operated by TRAP approach and Group-B operated by olecranon osteotomy approach. Results: The difference in Mean duration for fracture union was not statistically significant, in group-A was 12.21 ± 1.621 weeks, while it was 13.46 ± 2.307 weeks in group-B. Duration of surgery was statistically significantly different, more in group B (1.42 ± 0.14 hours) compare to group-A (1.21 ± 0.21 hours). Comparison between ranges of motion of both groups was assessed by Average of extension lag, the mean elbow arc of motion and average of flexion. No significant difference was found between the parameters. The average of extension lag was 11.96 ± 9.26 degree in group-A and it was 16.77 ± 10.31 degree in group-B. The mean elbow arc of motion in group A was 98.34 ± 24.17degrees and in group B was 91.25 ± 21.84 degrees. Average flexion was 109.71 ± 16.65 degrees and 111.47 ± 20.37degrees in group-A and group-B respectively. The average Mayo Elbow Performance Score in group-A was 86.93 ± 12.42 and in group-B was 83.48 ± 15.93. P-value was >.05 show that there was no statistically significant difference between two groups Mayo elbow score. Finally, 25 patients (83.33%) out of 30 showed good and excellent results and hence concluding that there is no statistically significant difference between these two modalities when it comes to outcome. Conclusion: TRAP approach is comparatively better than osteotomy approach in terms of stable fracture fixation and better outcome, with the advantage of intact olecranon. However the approach demands fast rehabilitation. Design: Prospective randomized control trial

Social factors in understanding illness behaviour of women with Type 2 diabetes mellitus in Jammu, North India

AimsFemales in the South Asian region form a deprived community in diabetes management, and if we narrow it down to the Indian context, the situation is even grimmer. This necessitates an exploration of the socio-cultural factors, in the form of personal perception of the respondents, responsible for diabetes management among women. MethodsData for the present study were collected at Government Medical College (GMC) Hospital, Jammu (India). In total 41 female respondents suffering from diabetes, for more than two years, were interviewed by using an unstructured interview schedule. Field research consisted of purposive sampling method and observation which took place in the out-patient department and in-patient department of the Department of Medicine, GMC. ResultsResults show that the biggest challenge posed by diabetes management for women is to take care of household expenses amid treatment demanded by this disease. Results were looked at from social constructivist point of view which revealed that socially constructed notions about disease have a major role to play in its management. ConclusionThese women opt for different mechanisms for diabetes management which may or may not be recommended by their diabetologist; however, their personal beliefs have maximum role to play in disease management.

Thrombocytopenia during pregnancy and its outcome- A prospective study

Thrombocytopenia is the second most common haematological finding in pregnancy after anaemia. Thrombocytopenia is defined as decrease in platelet count < 1,50,000/µL. The physiological thrombocytopenia of pregnancy is mild and has no adverse effects on mother and foetus whereas thrombocytopenia associated with medical conditions can have serious maternal-foetal consequences and needs specific monitoring and appropriate management. : The aims of the study were to evaluate causes of thrombocytopenia in pregnancy and to study clinical profile, maternal and perinatal outcome in thrombocytopenic antenatal patients after 28 weeks.: Aprospective study was conducted in department of Obstetrics and Gynaecology and department of Pathology at Government Medical College and Rajendra Hospital, Patiala.100 antenatal females were included in the study with platelet count <1,50,000/µL and period of gestation more than 28 weeks. The subjects were investigated after detailed history and examination. Maternal and foetal outcomes were observed in all cases.Out of 100 subjects with thrombocytopenia, 33% had gestational thrombocytopenia, which was the most common cause; followed by preeclampsia/eclampsia (24%). 18% subjects had severe thrombocytopenia. Complications were seen in the form of HELLP (6%), ICU admission (3%), PPH (3%), Puerperal sepsis (1%). Maternal thrombocytopenia due to medical causes needs strict observation and timely intervention for favourable maternal and perinatal outcomes.

English

BACKGROUND Alcoholism remains to be the major cause of morbidity and mortality throughout the world. Consuming alcohol is the potent etiological factor for the development of alcoholic liver diseases (ALD), ranging from fatty liver to hepatocellular carcinoma with varying rates of development in both genders depending on the quality, quantity, and duration of the drink. Zinc deficiency has been documented with the progression of alcoholic liver disease. It is also a well-known fact that zinc is a co-factor for enzyme alkaline phosphatase. This study aims to assess the zinc status and alkaline phosphatase activity in patients with various stages of alcoholic liver disease, correlate zinc with alkaline phosphatase activity, albumin, gamma glutamyl transferase activity, MELD score and duration of alcohol intake and analysing the need for evaluating zinc in these patients. METHODS This comparative observational study involves group I healthy controls and group II patients diagnosed to have ethanol related decompensated liver disease with or without portal hypertension for more than three years from the Department of Medical Gastroenterology, Government Medical College Hospital. 5 ml of venous blood in fasting state was collected from both groups and assayed for serum zinc, and serum alkaline phosphatase activity. The data was statistically analysed. RESULTS The study results demonstrate that higher percentage of patients with alcoholic liver disease have low serum zinc levels than healthy controls. Zinc when compared with variables like serum albumin, duration of alcohol intake, MELD score, serum gamma glutamyl transferase and alkaline phosphatase in the case and control groups were found to be statistically significant. CONCLUSIONS There is decrease in serum zinc level and increased alkaline phosphatase activity in patients with alcoholic liver disease. The statistically significant data is a strong rationale for evaluating the zinc status and thereby supplementing zinc to patients with alcoholic liver disease. KEYWORDS Alcoholic Liver Disease, Zinc, Alkaline Phosphatase, MELD Score

English

BACKGROUND Acute pancreatitis is a very common disease and severe acute pancreatitis is life threatening and needs early identification. Current severity predicting indices in acute pancreatitis are cumbersome. There have been previous reports of low HDL cholesterol in life threatening acute pancreatitis. Previous studies in this regard were done in a single ethnicity population and needed to be validated in other ethnic groups. We wanted to estimate the proportion of pancreatic necrosis among the patients with acute pancreatitis attending Government Medical College, Thiruvananthapuram. We also wanted to compare the mean HDL values in those who developed pancreatic necrosis and those who didn’t develop pancreatic necrosis and evaluate the association between HDL value measured 48 – 72 hours of onset of symptoms and pancreatic necrosis. METHODS This was a prospective observational study conducted among 271 patients diagnosed with acute pancreatitis in Government Medical College Hospital, Thiruvananthapuram. Consecutive sampling method was used. RESULTS There were 42 cases of pancreatic necrosis out of 271 cases. The mean HDL of those patients with pancreatic necrosis was found to be less than those without necrosis (P < 0.001). Mean HDL value among those having pancreatic necrosis was 17.7 whereas those without necrosis was 34.9. CONCLUSIONS Proportion of pancreatic necrosis was 15.5 %. The mean HDL measured at 48 hours of symptom onset among the necrotising pancreatitis patients was significantly low when compared to the non-necrotic group (17.7 vs 34.9). All the patients with pancreatic necrosis had their HDL less than 40. Thus, an inference that low HDL at 48 hours of symptom onset was associated with higher incidence of pancreatic necrosis and severe pancreatitis could be made. KEYWORDS Pancreatitis, HDL, Pancreatic Necrosis

Prevalence of delirium among older adults in a tertiary care referral hospital in Kerala

Background: Delirium is a common neuropsychiatric condition in older adults in medical and surgical settings. It is important to identify cognitive impairment in the elderly population early in their stay at the hospital to reduce morbidity and mortality. The literature on the prevalence of delirium in the elderly population shows that the occurrence of delirium is associated with patient factors and clinical settings. Delirium may affect the outcome of the primary medical condition in addition to the occurrence of poor compliance to treatment and long-term psychological sequela. Aim: The study aims to identify the prevalence of clinical delirium among patients at the age of 60 years or above, admitted in medical and surgical units of Government Medical College Hospital, Kozhikode, Kerala. The study also looked into the related factors and management aspects of the condition. Methods: A cross-sectional observational method was used in a sample of 300 older adult patients who were selected using a census approach from medical and surgical inpatient units of the hospital. Clinical and personal details were collected in addition to the assessment of the participants with the Confusion Assessment Method (CAM) and Nursing Delirium Screening Scale(Nu-DESC). Results: Findings of the study revealed the prevalence of delirium in older adult patients at 16%. The study also shows a significant association between the prevalence of delirium and selected clinical variables and area of admission. Conclusion: Early identification and prompt medical and psychiatric care, and environmental manipulation will reduce the development of complications in older adults.

PREVALENCE AND RISK FACTORS FOR STILL BIRTH IN CHENGALPATTU

This study aimed to determine whether maternal age, maternal education , socio-economic status are factors for still births and identify the high risk age group which are likely to get affected , determine the signicant maternal medical conditions which are attributed to stillbirths and signicant obstetrics causes which are attributed to stillbirths. A cross-sectional hospital based study in government medical college hospital, chengalpattu was conducted. Data relating to socio- demographic information , passed obstetric history, associated medical conditions, index pregnancy characteristics where collected . economic classication was based on B.G.prasad's recommendation. medical and obstetric causes classied based on ReCoDe classication. Out of 11023 births from june 2016- may 2017 121 still births incidents were recorded at chengalpattu amounting to 11\1000 still birth incidents. The study showed mothers age between 19 and 21 is high risk group, literacy level has a positive impact in preventing stillbirths, economic status is a inuencing factor for stillbirth and placenta related complications remains a major causative factor of still birth followed by clinical conditions of the mother. The study could not establish any cross dependency on the variables and most of the factors have an independent inuence on the outcome.It is recommended that importance of antenatal care need to be communicated to the society especially to young mothers and practiced efciently

COVID-19 pandemic and lockdown

Purpose:The aim of this study was to evaluate the changing trends in terms of patient load, presenting complaints, surgical procedures and resource utilization in a multispeciality tertiary care hospital after lockdown due to COVID-19.Methods:Retrospective data were collected from Ophthalmology in-patient and emergency services of a government medical college and multispecialty tertiary care hospital in North India. Data pertaining to patient census, presenting complaints, surgical procedures and resource consumption were compared in the 6-month period (March 25 to September 30, 2020) following national lockdown and subsequent gradual unlock to data of same time period last year.Results:A total of 1152 new patients visited Ophthalmology emergency service, whereas 324 sought tele-ophthalmology consultation. Majority were males (61.8%, n = 712), whereas average age of presentation was 34 ± 7.2 years. The number of patients seeking emergency ophthalmic care reduced by 23.9% in the current year, in-patient record reduced by 96.53% and number of surgeries reduced by 98.13%. Tele-ophthalmology services comprised 21.95% of the total patient load. Use of triple layered surgical masks increased by 85.7%, use of disposable gloves increased by 89.5% but interestingly the availability of chlorhexidine hand rub fell by 15.9%, in the current year compared to last year.Conclusion:COVID-19 pandemic and lockdown have reduced the number of patients visiting tertiary health care facility for ophthalmic care. As manpower and resource consumption has increased, smart management is needed to tackle the current scenario efficiently. Tele-ophthalmology must be promoted and we must understand the changing trends to plan for the future accordingly.

Role of high dose oral liposomal vitamin -C in reducing mortality in patients with COVID-19

Introduction: Severe cases of COVID-19 are associated with hypoxemic respiratory failure, acute respiratory distress syndrome (ARDS), septic shock, cardiac dysfunction, elevation in multiple inflammatory cytokines, thrombo embolic disease, and/or exacerbation of underlying co morbidities. In addition to pulmonary disease, patients with COVID-19 may also experience cardiac, hepatic, renal, and central nervous system disease. AIM OF THE STUDY;To describe the role and outcome, of high-dose of oral liposomal vitamin C treatment in reducing mortality in Covid-19 patients admitted in Government Medical College & ESI Hospital, Coimbatore, India. Materials and methods: Patients who admitted with the diagnosis of COVID-19 by RTPCR in government medical college and ESI hospital Coimbatore during 1 th march 2021 to may 31,2021 are taken for this retrospective study. Of the 8634 patients admitted 5422(62%) required non oxygen beds. -2989(34%) required oxygen beds on admission -223 patients(2.5%) required beds (with,98 on c pap, 34 ventilators,64 high flow nasal oxygen, 43 non re-breathing mask and 58 non invasive ventilators), all outcomes are compared with same type of patients admitted in similar hospital and similar set of patients, without high dose vitamin c.

Study of outcome of high dose oral liposomal vitamin-C in COVID-19 patients

Background: The current pandemic Covid-19 causes several clinical manifestations from asymptomatic presentation to more serious Severe Acute Respiratory Syndrome (SARS) on humans. There is no specific antiviral treatment for Covid-19 and the management is mainly symptomatic. Aim: To describe the role and outcome of high-dose of oral liposomal vitamin C treatment in a drink form for Covid-19 patients admitted in Government Medical College & ESI Hospital, Coimbatore, India. Materials and methods : Patients who admitted to the with the diagnosis of COVID-19 by RTPCR in government medical college and esi hospital Coimbatore during 15 th march 2020 to april 30,2020 are taken for study is one of the earliest cases studies of Covid-19 in the Indian subcontinent.

Neutrophil-to-Lymphocyte Ratio as an Early Predictor of Severe COVID-19: A Retrospective Study

Introduction: The ongoing pandemic Coronavirus disease-2019 (COVID-19) is posing a great challenge to the medical fraternity across the world. The disease has an unpredictable complex clinical course. Despite intermittent lockdowns of varying lengths and several containment procedures including personal behavioural changes observed, the virus persists with continuing mutations and surges in infection being reported in many countries. With existing limited knowledge about post infection immunity and efficacy of the newer vaccines currently, there is a need to identify risk factors and early predictors of severe COVID- 19 that could help timely risk stratification and prompt initiation of appropriate treatment to reduce morbidity and mortality. Aim: To identify the risk factors associated with severe COVID- 19 and to analyse the significance of neutrophil-to-lymphocyte ratio (NLR) in detecting severe COVID-19 early. Materials and Methods: This was a retrospective observational study conducted in Government Medical College Hospital, Omandurar Government Estate, Chennai, a tertiary care hospital in Tamil Nadu, India from July 2020-September 2020. The study included 300 COVID-19 patients admitted during the study time period. The clinical, demographic and laboratory profile were compared between the patients with severe and non severe disease to analyse the role of baseline NLR and other risk factors associated with severe COVID-19. Results: Majority of the patients were males (69%), with median age of 55 years. Older age and co-morbidities, diabetes mellitus and hypertension showed increased association with severe COVID-19. Complete Blood Count (CBC) examination at admission demonstrated significant elevation of total count, neutrophil count, NLR and reduction of lymphocyte count, platelet count in patients with severe and critical illness. Logistic regression identified NLR at admission, age, co-existing diabetes mellitus, serum ferritin and Computed Tomography (CT) chest lung involvement as independent risk factors for severe COVID-19. NLR had the largest Area Under the Curve (AUC) of 0.901; 95% Confidence Interval (CI), 0.867-0.935 followed by CT chest lung involvement with AUC of 0.887; 95% CI, 0.851-0.923 and serum ferritin with AUC of 0.818; 95% CI, 0.762-0.874 in Receiver Operating Characteristic (ROC) curve analysis. Conclusion: This study demonstrated NLR at admission as an early predictor of severe COVID-19. Increased baseline NLR, older age, co-existing diabetes mellitus, elevated serum ferritin and higher CT chest lung involvement percentage were independent risk factors associated with severe and critical illness.

Correlation between Arterial and Venous Blood Electrolytes in Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Cross-sectional Study

Introduction: Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) is a common health problem coupled with huge mortality and morbidity across the world. Acute exacerbation in COPD patients leads to electrolyte disturbances. Routinely, electrolytes are measured from venous blood. Electrolytes can also be measured from whole blood by blood gas analyser along with blood gases measurement. Aim: To study the correlation between venous and arterial blood electrolytes in AECOPD patients. Materials and Methods: The cross-sectional study was conducted at Clinical Biochemistry Laboratory, Government Medical College and Sir Takhtsinhji General Hospital, Bhavnagar, Gujarat, India, from December 2013 to May 2014. Arterial and venous blood were taken at same time from 150 patients of AECOPD and analysed for electrolytes (sodium, potassium and ionised calcium) in arterial blood gas analyser. Correlation of arterial and venous blood electrolyte levels was done by Pearson’s correlation. Results: This study comprised 109 (72.67%) male and 41 (27.33%) female AECOPD patients. Mean age of subjects was 59.01±11.42 years. Mean level of arterial sodium was 143.1±8.81 mmol/L and venous sodium was 144.8±8.47 mmol/L (p-value=0.0973). Mean level of arterial potassium was 3.53±0.73 mmol/L and venous potassium was 3.19±0.56 mmol/L (p-value <0.0001). Mean level of arterial ionised calcium was 0.83±0.13 mmol/L and venous ionised calcium was 0.76±0.17 mmol/L (p-value <0.0001). Correlation coefficient values for sodium, potassium and ionised calcium were 0.878, 0.762 and 0.537, respectively. Conclusion: Arterial sodium and potassium can be used as a substitute of venous sodium and potassium in management of AECOPD patients, while arterial ionised calcium should not be used in place of venous ionised calcium in management of such patients.

Metabolic Derangements in Patients of Psoriasis and their Association with Psoriasis Area Severity Index Score: A Cross-sectional Study

Introduction: Psoriasis is a chronic inflammatory disease of skin associated with various metabolic derangements. These metabolic derangements increases the risk of cardiovascular diseases in psoriatic patients. Aim: To study the metabolic parameters- Fasting Blood Glucose (FBS), serum lipid profile, serum uric acid, C-Reactive Protein (CRP) in psoriatic patients in relation to clinical disease severity- Psoriasis Area Severity Index (PASI) score. Materials and Methods: The study was a hospital based cross-sectional observational study carried out over a period of 18 months in Department of Dermatology at Government Medical College and Rajindra Hospital, Patiala that included 250 psoriatic patients. Their percentage Body Surface Area (BSA) involved and PASI score were calculated as per the standard guidelines. The severity of psoriasis was divided into mild (PASI<7), moderate (PASI 7-12) and severe (PASI >12) disease based on PASI score. Serum lipid profile was measured by enzymatic method, blood glucose by glucose oxidase method, serum uric acid by uricase method and CRP by latex slide agglutination method and the values obtained were compared with severity of psoriasis. Results: There was a rise in the value of FBS, serum lipid profile, serum uric acid and CRP as PASI score increased and the difference between these values was statistically highly significant (p-value <0.001). Conclusion: There was a significantly higher derangement of metabolic parameters in patients with higher PASI scores. So, patients with severe psoriasis have a higher risk of metabolic complications and cardiovascular diseases as compared to patients with mild disease. These patients should be advised lifestyle modifications and should be regularly monitored so that the metabolic derangements can be detected earlier and metabolic complications can be avoided.

Accuracy of Two-dimensional Ultrasound and Magnetic Resonance Imaging in Diagnosis of Foetal Congenital Anomalies in a Tertiary Care Hospital- A Cross-sectional Study

Introduction: Ultrasound screening for foetus congenital malformations is the mainstay in diagnosis and is commonly performed at 19-22 weeks gestation. Magnetic Resonance Imaging (MRI) is known as a problem solving tool which is used for answering a specific question. Both ultrasound and foetus MRI are highly sensitive and specific in diagnosis of congenital anomalies of the foetus with high agreement between both modalities. Aim: To determine the accuracy of Ultrasound Sonography (USG) and High Field 3 tesla MRI in diagnosis of different types of foetal Central Nervous System (CNS) and non CNS congenital abnormalities. Materials and Methods: A cross-sectional study was conducted in the Department of Radiodiagnosis at Agartala Government Medical College and GB Pant Hospital from June 2017 to May 2019. A total of 65 cases with ultrasound diagnosis of foetus abnormalities were examined by 3 Tesla MRI. MRI were performed within 15 days after USG detected anomalies. Statistical analysis was done using Chi-square test. Results: In cases with foetus anomalies high field MRI provided detailed findings leading to a more refined diagnosis. CNS anomalies were more as compared to other anomalies. Some of the antenatal findings were confirmed in some cases following termination of pregnancy and some were by postnatal examination. Among them chest anomalies was least common i.e., 1.5%. sensitivity of MRI was 88.13%, specificity was 66.66%, Positive Pressure Ventilation (PPV) was 96.29%, Negative Predictive Value (NPV) was 36.36% and USG sensitivity was 82.43%, specificity and 77.77%, PPV was 95.83%and NPV was 41.17%. Conclusion: High field MRI should be used as a second line of investigation in patients with foetus abnormalities diagnosed by ultrasound for confirmation of diagnosis and selecting the treatment protocol. In cases of fatal abnormalities, a confirmed diagnosis made before 20 weeks of pregnancy may help by terminating the pregnancy.

An Assessment of the Impact of COVID-19 on the Mental Health of Medical Students Across Various Medical Colleges of Punjab

Background: The COVID-19 pandemic has had far reaching effects on almost all aspects of everyday living especially on the economic front and has brought more focus on the importance of mental health amidst all the uncertainty and fear looming large on the minds of people. Various studies have been conducted amongst medical students in different countries and have shown varying levels of anxiety and depression in them. Hence this study was designed to assess the prevalence of the same in the medical students of Punjab. Method: This was an observational, cross sectional study conducted amongst 267 undergraduate medical students on World Mental Health Day 10th October 2020 using an online questionnaire comprising of the GAD-7 and PHQ-9 scale questions. Outcome: A total of 267 students participated in the online survey out of which 170(63.6%) were females and 97(36.3%) were males. According to the scoring obtained using the GAD-7 scale, some levels of anxiety were prevalent in 181 students i.e.67.7% with scores more than five, which came out to be statistically significant with a p- value of 0.018 for the study population. A significant positive correlation was seen between the levels of anxiety and depression with the Pearson correlation coefficient r=0.72.Interpretation: The present study implies that substantial efforts are required to promote good mental health and reduce the stigma that plagues these topics. Early diagnosis and treatment can help the students experience a more fulfilling life and medical career.Funding: NoneDeclaration of Interests: None.Ethics Approval Statement: The study protocol was reviewed by the Ethical Committee of Government Medical College and Rajindra Hospital and was granted ethical clearance.

Study of histological changes of placenta in pregnancy-induced hypertension in poorvanchal region of Uttar Pradesh, India

Introduction: The placenta is a fetomaternal organ. It is a connection of the fetus with the uterine wall of mother. Through the placenta, exchange of gases and nutrient supply takes place. Through the placenta, fetal blood tissue comes in direct contact with the maternal blood without any rejection. It is a special transient organ of pregnancy. In our study, we carried out the microscopic examination of the placenta in pregnancy-induced hypertension, i.e., syncytial knot, cytotrophoblastic cellular proliferation, fibrinoid necrosis, endothelial proliferation, and calcified villous spot. Material and Methods: One hundred and fifty-two placentas of full-term pregnancy were collected from the labor room/operation theater of the Gynecology and Obstetrics Department of the Government Medical College and Superfacility Hospital Azamgarh. Out of one hundred and fifty-two placentas, 76 cases were controls from mothers with no known history of preexisting hypertension and 76 were collected from mothers with pregnancy-induced hypertension. Placentas were kept in 10% formalin for 24 h for fixation. After 24 h, tissues of placentas were passed through a series of the procedures from dehydration and clearing to wax impregnation before being sectioned from automated microtome. Time took for processing was 24 h. Five microns thick tissues sections were cut. Prepared slides were mounted in DPX and covered with the cover slip. Through binocular light, microscope slides were examined at ×10, ×40, and ×100 magnifications. Results: Histology in our study revealed that syncytial knots were present in placentas of all 100% of hypertensive and only 32.89% of normotensive mothers. Cytotrophoblastic proliferation was seen in 98.68% and 19.73% placentas of hypertensive and normotensive mothers, respectively. Fibrinoid necrosis of placenta was found in 88.15% of hypertensive and only 28.94% of normotensive mothers. The 100% placentas of the hypertensive mothers had endothelial proliferation as compared to controls. Calcified villous spots were seen in 84.21% and 31.57% of placentas of hypertensive and normotensive mothers, respectively. Discussion and Conclusion: Pregnancy-induced hypertension adversely affects the health of the fetus through its harmful effects on the placentas. Syncytial knots, cytotrophoblastic cellular proliferation, fibrinoid necrosis, endothelial proliferation, and the calcified villous spots were present more in the placentas of hypertensive mothers in our study in comparison to the study of other authors. In our research, we found that endothelial proliferations were present in all placentas. If proper treatment is given to the mother in the early stage of pregnancy, it may prevent the death of a fetus. Hence, this study helps the clinician for early diagnosis and treatment of pregnancy-induced hypertension.

High dose vitamin-C in COVID-19 induced neuro-cognitive dysfunction

BACKGROUND: The current pandemic Covid-19 causes several clinical manifestations from asymptomatic presentation to more serious Severe Acute Respiratory Syndrome (SARS). There is no specific antiviral treatment for Covid-19 and the management is mainly symptomatic. The symptoms mainly include many neurological as well as cognitive impairment in majority of patients. AIM: The study aims to find out the covid induced neurological symptoms and cognitive dysfunction and the role of high-dose of oral liposomal vitamin C in patients admitted in Government Medical College & ESI Hospital, Coimbatore, India. MATERIAL: All the patients admitted with positive covid19 confirmed by RTPCR are randomly selected and included in study age between 18 years to-60 years only are included, male and female total number 150 are taken for study after getting informed consent. RESULTS: More than one Neurological Symptoms are experienced by 12-88% of patients and Cognitive Impairment by 82% of people. By Administrating Symptomatic treatments and supplements with 2 gms of liposomal Vitamin -C in a palatable juice form, 76% of them improved within 5 days rest of them in 10 days. CONCLUSION: Vit-c is most under estimated vitamin. It is cheap, easily available, more efficient and helps the body to fight against covid -19 too. High dose intravenous as well as oral liposomal vitamin-C is more effective in protection and recovery from covid -19 induced neuro-cognitive dysfunction.

Validity of Computed Tomography in Evaluation of Acute Ischaemic Stroke in Comparison to Magnetic Resonance Imaging: A Cross-sectional study

Introduction: Cerebrovascular disease represents a major reason for mortality and morbidity worldwide. Imaging plays a pivotal role in the management of stroke patients. Haemorrhagic stroke diagnosis is straightforward using a Computed Tomography (CT) scan whereas early ischaemic strokes are sometimes difficult to diagnose by imaging. The use of Magnetic Resonance Imaging (MRI) may diagnose ischaemic stroke more convincingly; however MRI remains less available, time consuming and complicated. Unenhanced CT can be performed quickly; can help to identify early signs of stroke. Aim: To determine the validity of CT in the evaluation of acute ischaemic stroke compared to MRI for early diagnosis. Materials and Methods: The study was a cross-sectional study conducted in the Department of Radiodiagnosis, Agartala Government Medical College and GB Pant Hospital, Agartala, Tripura, India. The study period was from December 2018 to December 2020 and included 70 patients. The instruments used were SIEMENS 128 slice CT-SOMATOM model definition AS and SIEMENS 3.0 Tesla MRI-SKYRA model. Statistical Package for Social Sciences (SPSS) for Windows, version 25.0 (SPSS Inc, Chicago, USA) was used for data analysis. Results: Out of all patients (n=70) 63 patients were ultimately found to have infarction. Out of these 63 cases of infarction 69.84%(n=44) were male and 30.16% (n=19) were female. Sensitivity of CT scan was 87.3%, specificity was 71.4%, positive predictive value was 96.4%, negative predictive value was 38.4% and accuracy was 85.7%. The p-value was 0.002. In all patients who presented before six hours (n=15) showed decreased creatinine value during Magnetic Resonance Spectroscopy (MRS) in the lesion area compared to the normal side of brain. None of the patients showed variation in the lactate value. Those presenting after 6 hours (n=48), creatinine was reduced in all the cases (100%), Choline was increased in 89.6%. Conclusion: Sensitivity and specificity of CT scan is lower than MRI. Diffusion-Weighted Imaging (DWI) has 100% sensitivity in diagnosing acute infarction.

Incidence of Malignant Diseases in Punjab: A Retrospective Study in a Tertiary Level Government Hospital in Punjab

Introduction: Cancer is a grave problem with increase in incidence of various malignancies at an alarming rate in Punjab. Crude annual incidence rate of all cancers in Punjab has increased from 58.0 in 1990 to 85.5 in 2016 while crude mortality incidence ratio of all cancers in Punjab is 0.61 in females and 0.81 in males. Not only it is increasing mortality and morbidity, but it is also increasing the economic burden on a state already facing financial crisis. The exact burden of malignancies is not well known, although many local surveys have been done. Aim: To know the accurate burden of malignant diseases in patients presenting to a tertiary level government hospital in Punjab. Materials and Methods: A retrospective observational study in which data of all cases diagnosed to have malignant disease on histopathology at Government Medical College and Rajindra Hospital, Patiala, Punjab, from January, 2006 to December, 2015. The data was retrieved on yearly basis and total of each malignant disease was done to know the exact incidence of various malignancies over the decade by the measure of relative frequency. Results: A total of 4270 patients (41.65% in age group 41 to 70 years) were diagnosed to have malignant disease on histopathology out of which 2341 (54.82%) were females and 1929 (45.18%) were males. Leading causes of malignancy were the cancers of the f emale genital organs i.e., 20.05%, followed by breast cancer i.e., 1 8.17% and cancers of lip, oral cavity and pharynx i.e., 15.36%. Conclusions: Maximum incidence was seen in Carcinoma Breast followed by carcinoma cervix and carcinoma larynx. Early screening, timely diagnosis and management along with regular scrutiny of records should be done in routine to know the actual burden of cancer in the society.

KNOWLEDGE, ATTITUDE AND PRACTICES AMONG HEALTH CARE WORKERS TOWARDS BIO MEDICAL WASTE MANAGEMENT IN MEDICALAND SURGICAL SETTINGS AT A GOVERNMENT MEDICAL COLLEGE, GOA

Background: Correct knowledge and attitude are critical towards bringing about a favourable change in practice. Medical professionals in India have always turned a blind eye to scientific management of BMW. Objective: To assess knowledge, attitude and practices of health care workers regarding specific aspects of Bio Medical Waste Rules, 2016 and its amendments. Material & Methods: In this cross-sectional survey data was collected among 250 randomly selected doctors and nurses from an apex Government medical college hospital in Goa during the period September 2019 to December 2019 using a self-administered questionnaire. The results are expressed as percentages, and the significance of difference in percentages is expressed using chi-square test at 95% confidence level. Results: Overall, the knowledge regarding BMW Rules was poor, especially with regards to the segregation practices and the colour coded bins, with their practices being non-concurrent with the prevailing rules. An assessment of attitudes, however, revealed their positive inclination towards proper BMWM. Conclusion: The study emphasizes the need for periodic reorientation of these health care workers in elements of Bio Medical Waste Management, especially the segregation.