Incidence Of Various Causes Research Articles

Evaluation of Acute Abdomen by Multidetector Computed Tomography: A Prospective Study in a Tertiary Care Hospital in Andhra Pradesh, India

Abstract Background and Objective: Evidence on the efficiency of multidetector computed tomography (MDCT) in diagnosing acute abdomen in the Indian setting is lacking. This study was conducted to estimate the incidence of various causes of acute abdomen, correlate MDCT observations with postoperative findings, and estimate the sensitivity and specificity of MDCT findings. Methods: In this prospective study, 54 patients with acute abdomen were recruited in the emergency department (ED) of a tertiary care hospital in Chittoor, India. In these patients, MDCT observations were compared with postoperative findings, and the sensitivity and specificity of MDCT findings were estimated. Results: The majority of the patients presented with pain in epigastrium (n = 13, 24.1%), and 46 (85.2%) had nontraumatic acute abdomen. Pancreatitis was the major cause of nontraumatic acute abdomen. MDCT had failed to detect one case of acute appendicitis, one calculous cholecystitis, Meckel’s diverticulum, stricture ureter, and degloving injury of the colon. Overall, MDCT was positive for 57 out of a total of 63 conditions (eight patients had two different diagnoses) and it could rule out acute abdomen accurately in one patient. The sensitivity of MDCT in diagnosing acute abdomen was 92% and specificity was 100%. Conclusion: MDCT is a valuable diagnostic radiological investigation for patients with acute abdomen presenting to the EDs. Its multiple advantages put it ahead of the other traditional radiological investigations.

HEMATOLOGICAL STUDY OF MACROCYTIC ANEMIA: STUDY AT A TERTIARY CARE HOSPITAL

Introduction: Anemia is one of the most commonly diagnosed conditions in a health care set up. Iron deciency anemia is the predominant cause of anemia across countries and in both sexes (1,2) . Although, in approximately 2 to 4 % of patients, laboratory evidence of macrocytosis is found (3) .The cause of macrocytic anemia is classied into megaloblastic or non-megaloblastic (4). Common causes of macrocytosis are different by region and setting. The present study aims at studying patients admitted in Civil Hospital Ahmedabad during the study period with MCV value more than 100 fL and utilizing the clinical prole and other biochemical parameters to further classify anemia into Megaloblastic and NonMegaloblastic type. The study period is January 1, 2018 to July 31, 2019. Relevant medical Materials and Methods: history of the patients participating in the study was considered. MCV value was determined from complete hemogram which was performed using Automatic Hematological Analyser. Peripheral smear examination was done with slides stained in Giemsa stain. Biochemical tests were performed using Automated Biochemistry Analysers. The data obtained from the above was then utilized in establishing the incidence of various causes of macrocytic anemia in our study population. Result: Out of the total 325 patients 160 (49%) were found to have megaloblastic anemia and 128 patients (40%) were found to have non-megaloblastic anemia. In the remaining 37 (11%) patients, no cause of macrocytosis was identied. The etiologies of macrocytic anemia identied in the present study were Vitamin B12 deciency, hepatic dysfunction, hypothyroidism, renal dysfunction and accelerated erythropoiesis (due to hemolysis or blood loss). Conclusion: The most common cause of macrocytic anemia in our study population was found to be Megaloblastic anemia.

Acute peritonitis: A clinical study

In this study we have tried to find out the incidence of acute peritonitis in relation to age group and sex of the patient and evaluate the relative incidence of various causes of acute peritonitis including trauma. We have also found out the relative incidence of complications and its relation to the primary cause and analyzed the various causes of mortality and morbidity and the factors influencing it. Methods: 50 cases of acute peritonitis due to traumatic and non-traumatic causes admitted in tertiary care center was included in this study. After detailed medical history and clinical examination the patients were taken up for treatment as per the proforma for acute peritonitis. Results: In this series maximum number of cases was seen between the age group of 15-50 years with male patients accounting for 80% of cases. Mean age of patients was 36 years. Pain abdomen (100%), vomiting (56%) and fever (50%) were most common presenting symptoms in all cases of peritonitis. Tenderness and rigidity were present in all the cases. In this series duodenal perforation was the most common cause of acute peritonitis followed by appendicular perforation (16%), ileal (8%), intestinal gangrene (8%), jejunal perforation (6%), gastric perforation (4%) and colonic perforation (2%). All the patients were taken for surgery. Wound infection was must commonest complication (10%) seen in the post-operative period. This was followed by fecal fistula (6%) and pelvic abscess (4%). In general complications septicemia (12%) was the most common. Mortality rate was (12%) in this study with septicemia and multi organ failure being the commonest cause of mortality. Mean age of patients who expired was 51 years. Mortality was clearly more in patients who presented more than 24 hours duration after the onset of symptoms. Conclusion: Duodenal perforation was the most common cause of acute peritonitis, having male predominance. Laparotomy was the treatment of choice.

Usefulness of fine needle aspiration cytology in diagnosis of causes of lymphadenopathy in children

Background: The present study was conducted to study the causes of lymphadenopathy, associated clinical findings, usefulness of FNAC in diagnosis of various causes of lymphadenopathy as lymph node biopsy is a difficult and invasive procedure in children attending pediatric department.Methods: A study was done at Katuri medical college and hospital. A total of 50 patients with lymphadenopathy including both local and generalized were studied for a period of 2 years by taking proper history, through physical examination both generalized and systemic and all the patients were subjected for relevant investigations for establishment of diagnosis which is essential for institution of proper treatment. A prospective study consisting 50 patients with lymphadenopathy (<12year) is undertaken to find the incidence of various causes of lymphadenopathy in the affected patients for 2 year.Results: It was observed that 10, 17 and 23 children were having lymphadenopathy in the age groups of 0-3-year, 4-8 year and 9-12 year respectively. Majority of patients were having lymphadenopathy only after 4 year of age, male 28 and female 22. The major symptoms in order of incidence were palpable swelling, fever, cough, weight loss, loss of appetite and sore throat. Duration of lymphadenopathy of less than 1 month was seen in 25 cases ,1-6 months 24 cases and more than 6 months in 1 case. Enlargement of lymph nodes in cervical region, was the major finding in these patients. 47 cases were having local lymphadenopathy mainly in the cervical region and 3 cases were having generalized lymphadenopathy. 80% of the patients were having firm lymph nodes, remaining 20% of the patients were having soft lymphadenopathy. 36 patients were having mobile lymph nodes while 14 patients were having matted lymph nodes. Tenderness was observed in 21 cases against absence of tenderness in 29 cases. Analysis of the FNAC results revealed positive for tuberculosis in 11 cases reactive hyperplasia in 26 cases, granulomatous changes seen in 4 cases and suppurative lymphadenitis in 6 cases.Conclusions: In developing countries like India whenever a patient attends the Department of Paediatrics with lymphadenopathy it is always be prudent to exclude tuberculosis, which is quite prevalent. FNAC is helpful in those with benign conditions like reactive hyperplasia to rule out underlying serious systemic diseases and reassuring the parents.

Incidence of various causes of infectious keratitis in the part of rural central India and its visual morbidity: Prospective hospital-based observational study

Introduction: Infectious keratitis is potential causes for vision loss in India. Early recognition with prompt diagnosis and rapid institution of appropriate therapy will significantly improve visual prognosis. Aim: The aim of this study was to evaluate the incidence of various causes of infectious keratitis in this part of rural central India, predisposing factor and visual morbidity. Materials and Methods: This was a prospective observational hospital-based study conducted at the Department of Ophthalmology, at a tertiary care hospital, in the part of rural central India. Data related to socioeconomic status, predisposing factor, and course of disease was collected. Results were analyzed on the basis of history, slit lamp examination, and appropriate laboratory investigation. Results: During the period of January 2015 to February 2017 total 680 patients were examined in cornea specialty clinic, of which 88 were diagnosed with infective keratitis and were included in the study. Majority of patients of infectious keratitis were in between 41 and 60 (41%) age group followed by 21–40 (23%) and incidence in male was higher (61%) as compared to female. Prevalence of Fungal keratitis (59.09%) was higher than bacterial (19.31%) and viral (17.04%) in this part of India. Ocular trauma and occupational accidents were the most common (42%) among farmer. Majority of corneal ulcer (68%) healed, 11% had no change in ulcer status, 4% was progressed, and 10% perforated. About 53% had stable best-corrected visual acuity (BCVA) as compared to BCVA at the time of presentation and in 34% BCVA improved. Conclusion: Incidence of fungal corneal ulcer is higher among various causes of infectious keratitis in this part of rural central India. Agricultural injuries are the main predisposing factor for infectious keratitis in this region. Prompt diagnosis and early appropriate treatment on the basis of laboratory investigation can helps the community to reduce the burden of corneal blindness.

English

BACKGROUND: Lymphadenopathy is one of the commonest clinical presentation among the children (0-14years) having several etiologies and can pose a diagnostic dilemma to a pediatrician. FNAC is an important and rapid diagnostic modality for the etiologic workup in significant lymphadenopathy. AIMS AND OBJECTIVES: To know the incidence of various causes of lymphadenopathy in children. To know the advantages of FNAC over surgical biopsy. MATERIALS AND METHODS: The present study comprises of FNAC of lymph nodes of 120 cases in pediatric age between 0-14years with lymphadenopathy, who attended the OPD and those admitted in Khaja Banda Nawaz Teaching and General Hospital, Gulbarga during the period between JAN 2013 to DEC 2014. Detailed history and thorough clinical examination and routine examination was done on approach of the patient. FNAC was carried out in all cases on significant lymph nodes and aspirated materials was smeared and sent to laboratory various stains were used for staining cytological smears. RESULTS: Over all lymphadenopathy was common in (5-10years) age (35%), higher in males (54.1%) than females. Anatomically cervical lymphadenopathy was commonest (90%). Most common cause was found to be TB lymphadenitis. CONCLUSION: FNAC of lymph node in children is simple rapid diagnostic method with minimum discomfort to the patient and readily accepted by

Treatment of acute scrotum in children: 5 years' experience

A retrospective review was carried out to determine the incidence of various causes and outcome of management in patients with acute scrotum. Fifty children had a diagnosis of acute scrotum between 1st January 2007 and 15th May 2012. Age, mode of presentation, associated anomalies, and results of treatment were studied. Diagnosis of acute scrotum was confirmed by physical examination, Doppler ultrasound and biochemical investigations. Clinical presentation consisted of sudden swelling and pain in the inguinoscrotal region. The average age was 7.5 years (2 months-14 years). Causes of acute scrotum were orchitis/epididymo-orchitis (O /EO) in 22, strangulated inguinal hernia (SIH) in 16, testicular torsion (TT) in 11, and torsion of testicular appendage (TTA) in 1. Associated urological anomalies were found in 5 patients with O /EO. Medical treatment was applied to patients with O /EO, and surgical treatment was performed in patients with SIH, TT and TTA. In this series, O /EO was found to rank first as the cause of acute scrotum. Immediate surgical treatment in acute scrotum patients, except those with O /EO, is necessary. Associated urological anomalies should be investigated in patients with O /EO.

Unilateral Vocal Cord Palsy: An Etiopathological Study

ABSTRACT Objective The incidence of various causes of unilateral vocal cord palsy (UVCP) has been found to change over time and place. To arrive at the correct diagnosis is important in determining the prognosis as well as the time and mode of intervention. This study intends to evaluate the current etiological profile of unilateral vocal cord palsy in our center and compare it with the previous studies. Methods A retrospective study of case records of all consecutive patients with a diagnosis of UVCP presented to Kerala Institute of Medical Sciences, Thiruvananthapuram, Kerala, South India in the period between September 2002 and May 2009 was conducted. The exclusion criteria were all laryngeal and hypopharyngeal malignancies, intubation injuries and cricoarytenoid joint ankylosis. Factors taken for analysis were age, gender, side of palsy and etiology. Results A total of 121 cases including 88 males and 33 females in the age range of 2 to 86 years were studied. 61.1% patients had left-sided palsy and 38.8% had right-sided palsy. The incidence of various etiologies were idiopathic (42.1%), surgical trauma (22.3%), nonsurgical trauma (6.61%), nonlaryngeal malignancy (6.61%), central (12.4%) and other benign lesions (9.09%). The incidence of all nonthyroidectomy surgeries together (59.3%) was more than that of thyroidectomy (40.7%). The most common individual surgical procedure was still thyroidectomy (11 cases, 40.7%) followed by coronary artery bypass grafting (CABG) (7 cases, 25.9%). Conclusion Idiopathic vocal cord palsy constituted the major subgroup. Thyroidectomy continues to be the single most common surgical procedure responsible for vocal cord palsy. Cardiac surgeries, trauma and cerebrovascular accidents are also increasingly causing vocal cord palsy, which is suggestive of the changing trend in life style and life expectancy. The right recurrent laryngeal nerve is not at higher risk than the left in thyroid surgery. Benign thyroid swellings also contribute significantly to UVCP.

Sudden Unexpected Child Deaths: Forensic Autopsy Results in Cases of Sudden Deaths During a 5-year Period

The aim of the present study was to determine the incidence of various causes of sudden unexpected child deaths (SUCD) and to assess the importance of an autopsy in predicting the likelihood of finding a cause of death. A retrospective analysis of autopsy findings in 97 cases of SUCD between the ages of 0--11 years was undertaken at the Council of Forensic Medicine, Ankara during a 5-year period (1995--2000). Cases were classified as explained causes (80.42 per cent) and sudden infant death syndrome (SIDS) (19.58 per cent). A total of 25.77 per cent of the deaths occurred in the neonatal period, 45.31 per cent of them in the first year of life and the remaining 28.86 per cent after 1 year of life. The causes of neonatal deaths were respiratory pathology (five cases), birth complications (four cases), gastrointestinal pathology (one case), homicide (10 cases), and SIDS (five cases). The incidence of SIDS in the newborn period was 33 per cent. The incidence of unexplained causes of deaths in the postneonatal period was 31 per cent and the causes of deaths were respiratory pathology (15 cases), aspiration (five cases), gastrointestinal pathology (four cases), SIDS (14 cases), and other causes (four cases). The study of an entire population provides more reliable data regarding causes of sudden unexpected child deaths than does the study of small groups and it is also recommended that in addition to a through evaluation, a detailed autopsy must be performed for each case in experienced centers.

Sudden unexpected deaths in infancy: What are the causes?

Objectives: To determine the incidence of various causes of sudden unexpected death (SUD) within an entire population and to assess the relative importance of an expert autopsy, as well as age of demise, in predicting the likelihood of finding a cause of death. Methods: We reviewed all cases of SUD in infants aged 1 week to 18 months that occurred in the province of Quebec (Canada) between 1987 and 1996. Results: We identified 623 cases of SUD; in 80% the diagnosis was sudden infant death syndrome (SIDS). Infection was the most common non-SIDS diagnosis (7.1% of all SUDs), followed by cardiovascular anomalies (2.7%), child abuse or negligence (2.6%), and metabolic or genetic disorders (2.1%). The percentage of non-SIDS deaths was much higher for autopsies performed in centers with expertise in pediatric pathology (18% vs 6%, P < .005). The likelihood of a non-SIDS diagnosis was much higher at age ranges atypical, as compared with typical, for SIDS (33% at 7 to 27 days, 19% at 6 to 12 months, and 64% at 12 to 18 months [atypical] vs 15% at 1 to 6 months [typical]; P = .003). Conclusion: The study of an entire population provides more reliable data regarding causes of SUDs than does the study of small groups. We recommend that in addition to a thorough investigation of each SUD, autopsies be performed in centers with expertise in pediatric pathology. This recommendation takes on added significance in this era of decreasing SIDS rates. (J Pediatr 1999;135:437-43)

Atlas of Orbital Radiography.

Ophthalmologists dealing with orbital trauma and proptosis need a handy reference on orbital radiography to indicate its uses, the significance of various signs, and its limitations. This book serves admirably as a basic comprehensive atlas to fill that need. The book is divided into two large sections. The first, written by Dr. Zizmor, covers conventional radiography and tomography; the second, by Dr. Lombardi, covers orbital contrast radiography and angiography. The initial chapters of Section One, presenting normal orbital anatomy and routine radiographic techniques and findings, are brief and sparsely illustrated. Interesting comparisons on the incidence of various causes of proptosis as compiled separately by radiologists, ophthalmologists, and otolaryngologists illustrate how such figures are influenced by specialty orientation. The usefulness of radiographic signs in diagnosing the commoner causes is given quantitatively for one series (Pfeiffer, 1943) but not elaborated on by the author. Each of the following 12 chapters deals with