Jhalawar Medical College Research Articles

STUDY OF SERUM URIC ACID LEVEL IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

BACKGROUND:Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. AIM:To evaluate the serum uric acid level in patients with type 2 Diabetes mellitus. MATERIALS AND METHODS:It was a prospective observational study conducted on 100 patients attending Medicine Department of Jhalawar Medical College, Jhalawar, Rajasthan. The study was done to assess the uric acid status in patients with diabetes mellitus and to find out its association with Age, Gender, Body Mass Index (BMI), Waist Hip Ratio (WHR), Dyslipidemia and Hypertension. Relevant history, vitals, clinical examination and laboratory investigations were done and recorded. RESULTS:This study evaluated the level of serum uric acid in Type 2 diabetes mellitus patients and confirmed there significantly high prevalence of hyperuricemia among type 2 diabetes subjects and increased association with increasing age, BMI, WHR, Dyslipidemia, Hypertension and female sex. CONCLUSION: Patients with Poor metabolic control and longer duration of diabetes were more susceptible to develop various complications including hyperuricemia. Early diagnosis and control of Diabetes Mellitus and its complications is indicated and potential therapeutic approaches (therapeutic life style changes and pharmacotherapy) should be initiated.

Trends of Fatal Poisoning in Jhalawar Region of Rajasthan: A 5 - Year Retrospective Study

India is predominantly an agriculture based economy. Problem of poisoning is one of the importantcauses of mortality and morbidity in India and other agriculture based developing countries due to easyavailability, low cost and no restriction on sale and supply of insecticidal compounds. The aim of this studyis to find out the association of episodes of fatal poisoning with various factors like age, gender, area ofresidence, religion, occupation type of poison and manner of death. This retrospective study was carriedout on total poisoning cases brought to mortuary of Jhalawar Medical College and associated group ofhospitals, Jhalawar (Rajasthan) in 5 year duration from 1st January 2014 to 31st December 2018. In thisstudy maximum cases of poisoning were of age group 21 - 30 year, incidence were more among malesbelonged to rural population who were involved in agricultural work. Majority of poisoning cases were dueto Organophosphorus compounds.

A retrospective study - epidemiological analysis of traumatic spinal injuries in Rajasthan, India

Traumatic spinal injuries (TSI) are major source of morbidity and motility throughout the world. Epidemiological study of TSI has an important role in future planning for prevention and management of them. Aim of this study was determine epidemiology of TSI in Jhalawar Rajasthan state of India. Retrospective analysis of patients hospital data records, admitted in Jhalawar medical college Rajasthan from January 2018 to Dec. 20019 (Period of Two Years).One hundred and fifty eight cases of traumatic spinal injuries reported in period of two years from January 2018 to December 2019. Male to female ratio was 2.16:1, the most prevent age group was 30-39 years (27.8%) followed by 20-29 years (19%). Fall from height (unprotected roof, well, tree, construction site/electric pole) was most common mode of injuries (44.9%) followed by road traffic accidents (43%). Most common level of injury was lumbar spine (55%) followed by thoracic spine (22.78%). Other associated injuries with TSI were head injuries (9.5%) and extremities injuries (9.5%). Maximum number of TSI cases was reported during summer season (may-14.5% and June 15.8%). TSI is major source of morbidity and mortality in Rajasthan India. Younger age group and Male are more commonly affected as compare to older age group and female. Accidental fall and RTA are major cause of TSI.

Study of effect of yoga on blood pressure, blood glucose, and glycosylated hemoglobin levels of patients with Type 2 diabetes mellitus

Background: India is known as the diabetic capital of the world. Yoga induces relaxation, which is also a crucial factor in the healthy functioning of the internal organs of the body. It can help to maintain normal BSL. Aims and Objectives: This study was planned to assess and compare the effect of yoga on BP, fasting blood glucose, and Glycosylated hemoglobin (HbA1C) level before and after the intervention (Yoga) in patients of Type 2 diabetes mellitus (T2DM). Materials and Methods: Current research has been conducted in collaboration with the Department of Medicine, Department of Pathology, and Department of Biochemistry, Department of Physiology, Jhalawar Medical College and Hospital, Jhalawar (Rajasthan) and Yoga OPD. A randomized, controlled study is currently underway. The test group consisted of 50 subjects with a control group of 50 subjects. The goal of this research was to examine the 3-month effect of yoga practice on subjects with T2DM. Results: In the current study, differences in blood pressure between cases and controls were not relevant in terms of height, whereas mean fasting glucose levels, HbA1C, and body mass index were found to be significantly lower in the yoga-medication study community relative to controls who took only non-yogapractice drugs. Conclusion: Yogic practices play a role in both primary and secondary prevention of DM. Yoga therapy can also be considered to be a beneficial adjuvant in the treatment of T2DM.

Misery of Living with Parthenium Dermatitis: Correlation between Clinical Severity and Quality of Life.

Background:Parthenium dermatitis is caused by friable plant extracts of Parthenium hysterophorus and related species. Approximately 40% of cases of plant dermatitis in India are contributed by this single species.Materials and Methods:This was a cross-sectional, observational study conducted in the Department of Dermatology of Jhalawar Medical College. Ninety-nine consecutive patch test positive parthenium dermatitis human subjects of age more than 16 and either sex were included. The study period was 11 months between September 2019 and August 2020. Sociodemographic, clinical profile parthenium dermatitis severity score (PDSS) and Dermatology life quality index (DLQI) were obtained from each patient. Correlation between PDSS and DLQI was obtained using Pearson's two-tailed coefficients.Results:Our study included 62 men and 37 women (1.67:1). The mean age was 51 ± 10.27 years. Mean duration of disease was 8.47 ± 4.45 years, and mean PDSS was 57.25 ± 17.65, mean DLQI was 17.14 ± 5.56. ABCD with CAD was the most common clinical subtype (45.45%). A significant positive correlation was observed between PDSS and DLQI.Conclusion:In this study, a significant impairment in quality of life (QoL) was observed in patients with higher score of PDSS and increasing duration, emphasizing that the disease needs specialized care including multiple indoor admission at the time of flare-up of disease.

Maternal Serum C – Reactive Protein: A Biomarker for Prediction of Preterm Delivery and Neonatal Outcome at Early Pregnancy

Background: Preterm labour defined as less than 37 weeks of gestation is responsible for most of the neonatal morbidity and mortality worldwide. This study was conducted to estimate the relation between C reactive protein (CRP) with preterm labour. Method: This prospective observational cohort study was conducted from February 2018 to January 2019 at Obstetrics and Gynecology department of Srimati Heera Kunwar Ba hospital, Jhalawar Medical College, Jhalawar, Rajasthan with 150 outpatient singleton pregnant women of <20 weeks of gestation enrolled at the prenatal visit. Baseline data and serum CRP values were taken in all participants. Conventional statistical methods were used for analysis. Result: We discovered measurably critical contrasts in the CRP levels estimated in early pregnancy between the women delivering preterm and those delivering at term. The baseline cut off value for maternal CRP was 5.5 mg/l with sensitivity of 100%, and specificity of 95.7%, positive and negative predictive value for serum CRP to predict preterm labour were 95.8 % and 99.2% respectfully. Conclusion: Maternal serum concentration of CRP can be utilized as fitting biomarker for foreseeing preterm delivery.

To identify the role of occlusive clothing (undergarments) in the maintenance of fungal infection in treatment resistant, recurrent and persistent tinea cruris: A pilot study at tertiary care hospital

Chronic and recurrent dermatophytoses are very common in tropical countries like India. Among many patho-mechanisms implicated, the role of changing lifestyle and clothing patterns is highly suggestive. Our study was done to identify whether the dermatophytes could be cultured from undergarments of the patients and also to find out the persistence of fungi after conventional washing techniques. It was a cross-sectional study carried on patients attending out- patient department of Department of skin and VD of Jhalawar Medical College with samples size of 50.KOH examination of recurrent and chronic tinea cruris patients was done followed by culture of skin scarping from advancing margin of tinea, samples of unwashed and washed undergarment pieces, followed by species identification by using lactophenol cotton blue stain. Males outnumbered females (28 M:22F). Maximum cases belonged to age group of 21 -30 years (27/50); most of the patients opted for tight synthetic undergarments (26/50).Samples of 44 patients were KOH positive. Fungal elements were cultured from 28/50 samples from skin scarping,22/50 from unwashed undergarments,15/30 from washed undergarments. Most common species identified was Trichophyton mentagrophytes. Recurrent and chronic tinea infections are becoming causes of increasing financial burden and impaired quality of life of affected patients. Although culture is not a very sensitive method to confirm dermatophytic infections, yet fungal elements can sustain in undergarments of patients affected by chronic and recurrent tinea cruris which may lead to non-response to standard dose and schedule of antifungal agents. Dermatophytes may sustain in undergarments, even after washing; causing recurrent and chronic tinea cruris.

A PROSPECTIVE OBSERVATIONAL STUDY FOR RELATIONSHIP BETWEEN THROMBOCYTOPENIA AND CULTURE POSITIVE NEONATAL BACTERIAL SEPSIS

Background: Changes in Platelet parameters like Mean Platelet Volume and Platelet Distribution Width are helpful in diagnosis of neonatal sepsis but these indices have not been extensively studied in neonatal sepsis. Hence, the present study is undertaken to evaluate Platelet count and platelet indices in diagnosis of neonatal sepsis.
 Methods: This prospective observational study was conducted over a period of 4 months i.e from December 2019 to March 2020 in neonatal intensive care unit of Jhalawar Medical College & Attached Hospitals, Jhalawar. During the study period 154 consecutive neonates (both inborn and out born), with clinical signs and symptoms of sepsis along with either positive culture (confirmed neonatal sepsis ) or other laboratory findings suggestive of bacterial and fungal infection in absence of positive cultures (probable sepsis), were included after written informed consent from parents.
 Results: Out of total (154), 81.8%, 76% and 67.5% of cases had thrombocytopenia, raised MPV (>10.8) and raised PDW respectively. As compared to Non-sepsis group, MPV values were raised in more cases of Sepsis proven group (88%) and the difference was statistically significant with P value of 0.011. PDW values were also more increased in Sepsis proven group compared to Non-sepsis group.
 Conclusion: Platelet count and platelet indices, which are easily available hematological parameters in remote & resource poor areas of our country, should be taken into consideration for suspected cases of neonatal sepsis so that prompt treatment can be given, and morbidity and mortality can be reduced.
 Keywords: Sepsis, CRP, MPV, PDW.

THE COMPARISON OF ETOMIDATE AND PROPOFOL FOR ATTENUATION OF HAEMODYNAMIC RESPONSE TO INDUCTION AND ENDOTRACHEAL INTUBATION

Background: This study is designed to compare the degree of attenuation of hemodynamic response to induction, laryngoscopy and endotracheal intubation of etomidate with those of propofol in patients undergoing noncardiac surgical procedures.
 Methods: The present study conducted in Non Cardiac Surgeries in the Department of Anaesthesiology, Jhalawar Medical College & Associated Hospitals, Jhalawar, Rajasthan.After institutional ethical committee’s approval and written informed consent from the patient’s attendant in the format as per proforma, the present study was conducted on 60 patients of ASA Grade I and II of either sex, aged 18 to 60 years, scheduled for a variety of non-cardiac surgical procedures requiring general anaesthesia.
 Results: The findings of the study suggest that use of etomidate as inducing agent provides more hemodynamic stability as compared to propofol and can be preffered in patients prone to hemodynamic instability, cardiovascular abnormalities, hypovolemia, prone to renal failure due to hypotension. Propofol may be preffered for induction where hypertension is contraindicated or hypotension is preffered and myoclonus is to be avoided.
 Conclusion: Etomidate provides a more stable hemodynamics during general anesthesia as compared to propofol.
 Keyword:- Etomidate, Propofol, Hemodynamic.

Study of serum electrolyte (Sodium and potassium) levels in malarial Patients at Tertiary Hospital, Jhalawar Medical College and associated group of hospitals, Jhalawar

Study of serum electrolyte (Sodium and potassium) levels in malarial Patients at Tertiary Hospital, Jhalawar Medical College and associated group of hospitals, Jhalawar

Epidemiology and clinical characteristics of traumatic head injuries in central part of India, 2018-2019

Epidemiology and clinical characteristics of traumatic head injuries in central part of India, 2018-2019 - IJN- Print ISSN No: - 2581-8236 Online ISSN No:- 2581-916X Article DOI No:- 10.18231/j.ijn.2019.017, IP Indian Journal of Neurosciences-IP Indian J Neurosci

USE OF THE CONDOM CATHETER TO CONTROL THE MASSIVE POSTPARTUM HEMORRHAGE

Background: To evaluate the efficacy of a condom as a tamponade for intrauterine pressure to stop massive postpartum hemorrhage (PPH)
 Methods: This prospective study was done in the Obstetrics and Gynecology Department of Jhalawar Medical College and Hospital, Jhalawar, between June 2017 and October 2017. In this study period, total 30 cases of PPH were identified; 20 were managed medically,2 were managed using the B-Lynch procedure, and 7 were managed using the condom catheter,1 underwent hysterectomy. The condom catheter was used when PPH that occurred as a result of atonicity could not be controlled by uterotonics. Under aseptic precautions, a sterile foley ‘s catheter fitted with a condom was introduced into the uterus. The condom was inflated with approximately 250-500 mL normal saline and kept for 24-48 hours, depending upon the initial intensity of blood loss, and gradually deflated when bleeding stopped.
 Results: In all 7 cases in which the condom catheter was used, bleeding stopped within 15-20 minutes. No further intervention needed.
 Conclusion: The hydrostatic condom catheter can control PPH in a very short time and effective manner. It is simple to use, cheap, and safe.
 Keywords: PPH, Condom Catheter

SIGNIFICANCE OF WHO MODIFIED PARTOGRAPH IN MANAGEMENT OF SPONTANEOUS LABOUR IN PRIMIGRAVIDAS

Introduction: The importance of partogram is to prevent the maternal and perinatal complications. The WHO has simplified the partogram for its use by skilled birth attendants.
 Aims and Objectives: To study the progress and outcome of labour using modified WHO partogram in spontaneous labour in primigravidas.
 Materials and Methods: A cross sectional study of 100 women primigravidas admitted to Jhalawar Medical College from November 2017 to October 2018 with spontaneous onset of labour at term with no high risk factors were recruited for the study using modified WHO Partogram.
 Patients were divided into 3 groups –. Group 1- cervical dilatation and descent curve falling to the left of the alert line. Group 2- cervical dilatation and descent curve falling to the right of the alert line. Group 3 with women to right of action line was planned.
 Results: Most women belonged to age group of 21-25 years. The mean gestational age was 38.2 weeks. In Group 1, the mean duration of active phase of first stage of labour was 4.52±0.10 hours, where as it was 5.94±1.46 hours in Group 2. In Group 2, the mean duration of second stage of labour was 45.44±1.94 mins but it was 34.42±16.41mins in Group 1study subjects. Mean rate of cervical dilatation is 1.2 cm/hr. Seventy seven percent had normal delivery, 11% had caesarean delivery and 12% had instrumental delivery. Augmentation was significantly higher in Group 2 (92.3%) than in Group 1 (67.8%). In the study group, there were no maternal and perinatal deaths.
 Conclusion: The partograph is an inexpensive and easily accessible tool that can effectively monitor the progress of labour. The WHO simplified partograph is highly useful in identifying when to intervene and also reduces perinatal and maternal mishaps.
 Keywords: WHO partogram, Alert line, Maternal outcome, Perinatal outcome

THE STUDY OF SERUM LIPID PROFILE IN PREGNANCY INDUCED HYPERTENSION IN JMC, JHALAWAR.

Only one group was investigated for serum lipid profile in third trimester of pregnancy in which included all PIH patients admitted in labor room in Department of Obstetrics in Jhalawar Medical College and was substantially compared with the normal values of Lipids in women. In this study we investigate the role of lipid profile in PIH. LDL value increase, HDL value decrease, TG value increase and VLDL value increase in PIH patients and also TG : HDL ration increased significantly in PIH patients. Dyslipidemia mediated activation of endothelial cells to placentally derived endothelial disturbing factors like lipid peroxides and trophoblastic components as possible contributors for pathogenesis of PIH. Thus assessment of blood lipids may be helpful in preventions of complications in PIH.
 Key Words: Bloodlipids, PIH, Dyslipidemia, Triglycerides, Low Density Lipoprotiens, High Density Lipoprotiens.

Functional outcome of percutaneous screw fixation of intra-articular calcaneum fractures

<p class="abstract"><strong>Background:</strong> The treatment of displaced calcaneum fractures has been a subject of intense discussion. Displaced intra-articular calcaneum fractures gives poor result with conservative treatment and requires reduction and internal fixation for favourable long term results. Open procedures are more prone to complications regarding wound healing. Percutaneous fixation offers a middle pathway in treating simpler variety of displaced calcaneal fractures. The aim of the study was to access the functional outcome of intra articular fracture calcaneum managed with closed reduction by Essex-Lopresti technique and percutaneous screw fixation.</p><p class="abstract"><strong>Methods:</strong> This study was done in department of Orthopaedics Jhalawar medical college and SRG Hospital Jhalawar, Rajasthan from January 2015 to January 2018. 26 intra-articular calcaneal fractures treated with closed reduction and percutaneous screw fixation under image intensifier.<strong></strong></p><p class="abstract"><strong>Results:</strong> 25 cases evaluated (one patient had lost follow-up), all fractures were united, average time of union was 8 weeks. The mean AOFAS score was 80 (range from 45 to 96), 9 patients had excellent, 12 patients had good, 3 patients had fair and one patient had poor result for that subtalar arthrodesis was done after one year of follow-up. Average Bohler’s angle 24.5 and Gissane angle was 120 degree. No clinically significant varus or valgus in any case (less then 5 degree).</p><p class="abstract"><strong>Conclusions:</strong> Treatment of intra-articular fractures of calcaneum is challenging but close reduction and internal fixation with 6.5 cannulated cancellous screws yields favorable outcome in majority of cases.</p>

Correlation between association of hypothyroidism and cardiovascular risk indices

Background: Association of hypothyroidism and cardiovascular diseases are important in development of Atherosclerosis. Hypothyroidism and sub clinical hypothyroidism reported highly risk factors due to lipid levels dearranged. Present study to demonstre of correlation of hypothyroidism and cardiovascular disease.Methods: The present study has carried out in the department of medicine and Biochemistry SRG Hospital and associated hospital, Jhalawar Medical College Jhalawar (Raj.) Total 100 Hypothyroidism cases and 100 euthyroidism subject were included in the study Information regarding clinical history were recorded in self Constructed present questionnaires Patients were examined and estimated TSH, T3, T4 total Cholesterol, LDLc, HDCc, TG data were analyzed by SPPS version 20.0.Results: Present study demonstrated increased levels of total cholesterol, LDH, VLDLC and TG and decreased level of HDLC and increased TSH level and decreased T3 and T4 Level in hypothyroidism cases when compared with euthyroid cases It was found significant.Conclusions: In present study hypothyroidism and hormone Level (TSH, T3, T4) and lipid level dearranged values are associated with development cardiovascular disease atherosclerosis.

Clinical Profile of Fever with Thrombocytopenia in Tertiary Hospital, Jhalawar Medical College

Clinical Profile of Fever with Thrombocytopenia in Tertiary Hospital, Jhalawar Medical College

Epidemiology of cephalalgia in population of central part of India

Introduction: Headache is a major and common neurological problem in worldwide and is a main reason of morbidity, incapacity, absenteeism at work place, interrupted social interaction mood and behavioral disturbances. Yet they are under-recognized, under-diagnosed and under-treated worldwide, only minorities of people with headache disorders are professionally diagnosed. Aim: Given the population load, and the fact that most headaches seen in practice are under diagnosed and undertreated, the burden of headache is significant. The present study was aimed to assess the Epidemiology of chronic headache in population of south eastern Rajasthan India. Materials and Methods: This study was conducted in department of neurosurgery Jhalawar medical college Jhalawar Rajasthan from 15th January 2015 to 15 july2016. Clinical and radiological details of Two thousand Patients of south east Rajasthan and west part of Madhya Pradesh were noted. The data obtained was statistically analyzed using SPSS version 22 and descriptive statistics was used to compare the results obtained. Results: Out of two thousand patients 900(45%) patients were male and 1100(55%) were female. 1760(88%) patients were between 16-60 year age group, there were 1320(66%) patients residing in rural areas and 880(44%) patients were residing in urban areas. Socioeconomic status occupation / income were low in 680(34%) patient’s medium in 1200(60%) patients. Tension type headache occur in1200 (60%), migraine in 400 (20%), cluster headache in 60 (3%), medication overuse headache present in100 (5%) patients. Other cause of headache noted in 240 (12%) as sinusitis, stroke, decrease vision, atypical pain like trigeminal neuralgia brain tumor and abscess. Conclusion: Headache prevalence in central part of India is more in female, adult between 16-60 years age groups, and rural areas with low socioeconomic status / income. Most common cause of headache is tension type headache. Keywords: Cephalalgia, headache, Tens

A clinical study of comparison of pterygium surgery with and without Mitomycin- C on bare sclera technique

Introduction: A pterygium is a triangular wedge of fibro-vascular conjunctival tissue that appears on the epibulbar conjunctiva, which can be removed by various methods. Recurrence of Pterygium after exicision is a very common problem encountered by ophthalmologist. Several methods have been suggested to avoid these recurrences. We studied the recurrence rate of pterygium after application of intraoperative mitomycin C (0.04%). Method: This is a prospective study of fifty eyes in fifty patients who underwent pterygium excision by the same surgeon using intraoperative topical mitomycin C(25 patients) and without using mitomycin c(25 patients) during September 20014—September 2015 in the ophthalmology department at Jhalawar medical college, Jhalawar( raj.). 0.04% Mitomycin applied to bare sclera after excision for two minutes by swab sticks. Postoperative follow up period was 6 months. Outcomes measured in the form of recurrence and complications were analyzed. Results: In Group A with use of mitomycin C there was no recurrence after 6 months follow-up while in Group B recurrence was seen in 5 patients within 3-6 months, however in group A, 1 patient had scleral thinning. Conclusion: Intraoperative administration of mitomycin C 0.04% is safe and effective to prevent pterygium recurrences.

Prevalence of LRTI in Patients Presenting with Productive Cough and Their Antibiotic Resistance Pattern.

To find out the prevalence of Lower Respiratory Tract Infection (LRTI) such as bacterial, fungal, mycobacterial infections etc. in patients with productive cough of duration less than 15 days and to rule out the patients having previous history of tuberculosis or having treatment of tuberculosis. Outdoor and Indoor patients of Department of Medicine and Chest & TB, SRG hospital and Jhalawar Medical College, Jhalawar were included. After sample collection the specimens were sent to the Microbiology department, for processing of Gram staining, Acid fast staining, KOH mount and bacteriological culture and sensitivity. A total of 200 samples were obtained from the outpatient and inpatient Department of Medicine and Chest & TB of which 66% were male and 34% were female. Seventy seven percent of samples were culture positive for both single pathogen and mixed infection of which 56.5% were male and 20.5% were female as males are more at risk for LRTI. Klebsiella pneumoniae was the most prevalent pathogen (71/193), followed by coagulase positive Staphylococci i.e. COPS (43/193). More resistant pattern was found in coagulase negative Staohylococci (CONS) showed 61.11% Methicillin Resistant Staohylococci (MRS) incidence compared to 41.86% in COPS, also regarding Extended Spectrum Beta Lactamase (ESBL) production Escherichia coli showed incidence of 36.36% as compared to other gram negative bacilli. Pseudomonas aeruginosa was the most resistant organism found based on the antibiotic susceptibility pattern while Proteus mirabilis was the most sensitive organism. Lower respiratory tract infections can spread easily among community and indiscriminate use of antibiotics contributes to their therapeutic failure. Area-wise studies on antimicrobial susceptibility profiles are essential to guide policy on the appropriate use of antibiotics to reduce the morbidity and mortality and also to control the emergence of antimicrobial resistance in local area.