Rajarajeswari Medical College Research Articles

Prevalence and Awareness of Risk Factors for Hypertension among Urban and Rural High School Children in the Field Practice areas Rajarajeswari Medical College, Bengaluru: A Cross Sectional Comparitive Study

It is the era of non-communicable diseases (NCDs), non-communicable diseases are the leading global cause of death, causing more deaths than all others causes combined, and they strike hardest at the world’s low and middle income populations. This was a school based cross-sectional study carried out with the objective of finding the prevalence and awareness of risk factors for selected Non-Communicable diseases(Hypertension, IHD and diabetes) among the urban and rural government high school students, with a sample size of 510 (255 urban and 255 rural) drawn by simple random sampling method. This study was conducted using a pre-tested, semistructured questionnaire based on the study done by Diwakaran et al.,With modifications made to cater the need of the study. Awareness of Hypertension was 39.8%and 30.6% (statistically significant, p = < 0.001) among the rural and urban study subjects respectively. In our study, 20.1% of rural and 28.2% of urban children were consuming fast foods daily. 64.5% of rural and 60.8% of urban children were consuming Fruits and vegetables daily. There was significant difference in Fruits and Vegetable consumption pattern was observed between two groups. Similarly14.3% of rural and 27.1% of urban children were consuming Soft Drinks daily. 20.1% of rural and 20.8% of urban children thought that re-use of cooking oil is good for health, which was statistically not significant. Awareness of risk factors like Alcohol, Tobacco, Stress / anxiety, Obesity, passive smoking as risk factors for Hypertension, was significantly higher in rural areas than in urban areas as a risk factor for HTN. Were as in urban area Awareness of Fast food consumption, reuseof cooking oil was significantly higher in urban areas.

Prognosticators of bone health in pediatrics with epilepsy using anti-epileptic drugs

Introduction: Epilepsy is a common and long-lasting neurological disorder in children who require long-term treatment with Antiepileptic drugs (AED). Such long-term AED use may have negative effects on bone causing bone loss and osteoporosis, necessitating frequent monitoring. Data on the effect of AED on bone health in children is scarce compared to adults and hence this study was undertaken. Aim: To compare and quantify the effects of sodium valproate (SV), carbamazepine (CBZ), and levetiracetam (LEV) on bone health in children using specific bone biomarkers such as vitamin D, calcium, phosphorus, ALP, osteocalcin (OCN), and beta serum cross laps (CTx). Materials and methods: A prospective interventional study was carried out in Rajarajeswari Medical College and Hospital, Bangalore, between October 2019 to March 2022. A total of 79 confirmed cases of epilepsy within the age group of 1-18 years, receiving treatment with sodium valproate (SV), carbamazepine (CBZ), and levetiracetam (LEV) monotherapy for a period of minimum one month were enrolled. Serum samples of calcium (Ca), phosphorus (PO4), alkaline phosphatase (ALP), Vitamin D were analyzed at the time of initiation of study and these levels were considered as baseline levels.

THE EFFECT OF HEAVY MENSTRUAL BLEEDING ON WOMEN'S QUALITY OF LIFE: A CASE CONTROL STUDY

Introduction: Heavy menstrual bleeding (HMB) is dened as excessive menstrual blood loss which interferes with a woman's physical, social, emotional and material quality of life. In India, 16% of the women aged between 15 and 44 are diagnosed with HMB. HMB has signicant effects on personal, social, family, and work life of women and thereby reduces their quality of life Aim And Methods: In this study, we aim to identify menstruation characteristics of the women and the effects of HMB on women's quality of life. The participants are 150 volunteer women who were not pregnant or had menopause at the time the study was conducted and who consulted to the Department of Gynecology and Obstetrics at a Rajarajeswari Medical College and Hospital, Bengaluru between November 2020 and January 2021. The patients who had HMB complaint were included in the case group (฀ = 75) while the relatives of the participants who did not have any specic health problems composed the control group (฀ =75 ). Results: Mean age of the participants in the case group was 45.5 year (p<0.05) . 23.9% women had HMB >3years , frequent cycles noted with average length of cycle being 22.79 days and 53.3% being diagnosed with myoma . We evaluated the participants' quality of life and found that HMB group members were affected more signicantly in all subscales of the SF-36 scale (physical functioning, pain, general health, vitality, social role functioning, emotional role functioning, and mental health) when compared to the women in the control group and was found to be statistically signicant with p < 0.05. Conclusion: HMB has negative effects on women's quality of life. Therefore, quality of life of the women with HMB complaint should be investigated and effective approaches should be designed.

Amit Jain’s surgical scoring system and its ability in predicting the major amputation in diabetic foot complications

There are numerous scoring system used in different parts of the world and most of them are for diabetic foot ulcers only with Amit Jain’s surgical scoring system being the first such scoring for diabetic foot complications. This study aims to validate the Amit Jain’s scoring system in predicting the risk of major amputation in diabetic foot complications. A retrospective analysis was done in Department of General Surgery of Raja Rajeswari medical college, Bengaluru, India. The study period was from January 2018 to December 2019. All the patients who underwent surgeries for diabetic foot complications in our department were included in the study. A total of 47 patients were included in this study. Majority of patients (76.6%) were males 61.7% of patients had diabetes mellitus of less than 10 years duration. Abscess was the most common pathological lesion seen in the foot affecting 36.17%. Most of the patients (59.6%) with diabetic foot complications had Amit Jain’s surgical score of 6-10 and were in low risk category. 12 patients (25.5%) underwent major amputation in this study and a significant association (P<0.001) was noted between Amit Jain’s surgical scoring and major amputation.

Assessment of adherence to COVID appropriate behavior among post-vaccinated individuals in rural practice area of Raja Rajeswari medical college and hospital, Bengaluru

Background: As per observations related to the highly mutant corona virus, being vaccinated does not mean that people can avoid COVID preventive rules and guidance and put themselves and others at risk. The study aimed to assess adherence to COVID appropriate behaviour (CAB) among COVID vaccinated individuals in the rural field practice area of Raja Rajeswari medical college and hospital, Bengaluru.Methods: Community-based, cross-sectional descriptive study was conducted from 1 September to 31 November. A semi-structured, pre-tested, interviewer administered tool was used.Results: Out of 2285 study participants, the mean age of participants was 42±16 years. About 56% of participants were female and majority belonged to middle class. The most common measure adhered by the study participants was proper use of mask 94% and 70% before and after COVID vaccination respectively.Conclusions: Of 17 CAB practices, the adherence found to be reduced after vaccination among study participants.

A Morphometric Study on Anatomic Characteristics of Corona Mortis in South Indian Population

Introduction: The Corona Mortis or the “crown of death” is the vascular anastomosis between the external iliac and obturator vessels in the retropubic region. If injured accidentally during laparoscopic inguinal hernia repair and certain minimally invasive gynaecological procedures such as midurethral or pubovaginal sling, can result in inadvertent haemorrhage. Recognising the anatomic characteristics of the corona mortis vessel is needed in order to prevent bleeding catastrophe. Aim: To estimate the prevalence and location of corona mortis in South Indian population and to determine the frequency of occurrence and its morphometry in males and females. Materials and Methods: This was an observational cross- sectional study conducted between December 2020 to August 2021 in the Department of Anatomy, Rajarajeswari Medical College and Hospital, Bangalore, Karnataka, India. Dissection of 55 adult cadavers (42 male and 13 female hemipelvises) was performed and corona mortis was observed on pelvic surface of superior pubic ramus, number of venous and arterial anastomosis were noted and photographed. In addition to diameter of the anastomotic vessel, the distance of corona mortis vessel from the pubic symphysis was measured using electronic digital caliper. Demographic data was expressed as frequency and percentage and continuous data as mean and standard deviation. Z test and t-test were done using statistical software Statistical Package for the Social Sciences (SPSS) version 23.0 to deduce the results. A p-value of <0.05 was considered as significant. Results: The corona mortis was observed in 35 out of 55 specimens (63.64%). It was seen in 29 male (69%) and six female hemipelvises (46%). In all the specimens, venous anastomosis was observed between the obturator vein and inferior epigastric or external iliac vein. Consequently, in the present study all the determined corona mortis were venous. The mean distance of corona mortis vessel from the pubic symphysis was 5.26±1.2 cm in males and 5.63±0.94 cm in females with p-value= 0.48, thus the distance of the anastomotic vessel remains consistent in both the sexes. Furthermore, diameter of corona mortis vessel (greater than 1 mm) was measured in both the sexes and found to be statistically not significant. Besides there was incidental finding, aberrant obturator artery was more prevalent in females in comparison to males (p-value=0.013). Conclusion: Corona mortis was present in 63.64% of the South Indian population and no statistically significant difference was found in prevalence in males and females. The distance of corona mortis vessel and the diameter of the vessel was consistent in both males and females.

Para Adnexal CystsA Clinicopathological Study

Introduction: Para adnexal cysts (paraovarian and paratubal) constitutes a homogenous group of cystic lesions originating from mesosalphinx or broad ligament, located in proximity of the fallopian tube and ovary. As with the lesions of the adnexa, paraovarian and paratubal cysts can be neoplastic but are often misinterpreted as true functional cysts. A correct radiological and clinical diagnosis would be useful in order to render necessary treatment. Aim: To highlight the histomorphologic spectrum of the paraadnexal cysts and correlate with clinical findings. Materials and Methods: The present study was a descriptive study conducted in the Department of Pathology, Rajarajeswari Medical College, Bengaluru, Karnataka, India over a period of two years six months. All specimens including salpingoophorectomy specimens which harboured paratubal or paraovarain cysts, or paratubal/paraovarian cysts diagnosed on radiology and resected and sent separately for histopathologic evaluation were sampled and included in the study. All surgically and radiologically proven paratubal and paraovarian cystic lesions were included and solid lesions were excluded. The results were analysed using descriptive statistics. Results: The mean age of diagnoses was 40.1 years and menstrual abnormalities was the most common presentation. Of the Neoplastic cysts, paraovarian cysts (78.6%) were more common than paratubal cysts (21.4%). About 75.4 % were non neoplastic cysts and 24.6% were neoplastic. Conclusion: Para adnexal cysts are often misdiagnosed or not sampled as they are thought of as functional cysts. Present study analysed 114 cases and found that 28 of the cases showed neoplastic cysts, one of them showing a serous borderline tumour, which have the potential to turn malignant. Hence, histopathologic evaluation of these lesions would help in understanding the different histological types that would arise in para adnexal sites which in turn helps in better management of these patients.

Ferritin – The key model inflammatory marker in diabetic and non-diabetic COVID-19

Background: Diabetics exhibit elevated serum ferritin level when compared to non-diabetic counterpart, indicates impact of its association with coronavirus disease 2019 (COVID-19) infection and disease progression. Ferritin is a key mediator of immune dysregulation through direct immunosuppression contributing to cytokine storm resulting in fatal outcome in COVID-19. Aims and Objectives: This study aims to estimate serum ferritin in diabetic (cases) and non-diabetic (controls) COVID-19 patients and its correlation with their diabetic profile (FBS, PPBS, RBS, and HbA1C). Materials and Methods: A retrospective case–control study conducted at Rajarajeswari Medical College and Hospital, Bengaluru, for a period of 8 months among diabetic and non-diabetic COVID-19 patients. Results: The study population consisted of 957 individuals, out of them, 425 patients were type 2 diabetes mellitus and 532 were non-diabetic COVID-19-positive patients (controls). Diabetic profile parameters (FBS, PPBS, RBS, and HbA1c) and serum ferritin were significantly (P<0.05) high in cases as compared to controls. Among diabetic COVID-19, the glycated hemoglobin and serum ferritin showed a significantly positive correlation (r=0.55) with serum ferritin (mean=648.98±320.48). Conclusion: Hyperferritinemia is more prevalent in diabetic COVID-19 individuals. Serum ferritin can be considered as a valuable biomarker to screen the diabetic and non-diabetic for the presence of hyperinflammation and to predict severity of COVID-19 infection so that it will help the clinician for proper management.

Prospective analysis of post-operative pain management in elective laparotomies in a tertiary care centre

Background: The study was conducted to record the drug used for postoperative pain in elective laparotomies and to determine the effectiveness of multimodal analgesics used.Methods: A prospective observational study for a period of 15 months from March 2019 to May 2020 in 140 patients who underwent elective laparotomies from the department of general surgery Rajarajeswari medical college and hospital (tertiary care center).Results: A total of 140 patients were included among which 58 (41.4%) were female and 82 (58.6%) were male patients. The 20 different types of surgeries were recorded. In our study the most common surgery performed was open appendectomy followed by open cholecystectomy. Most common mode of analgesia used was combined analgesia. Opioids, NSAIDS (non-steroidal anti-inflammatory drugs), epidural and transdermal patch was used. NRS (numerical rating scale) score was recorded for all 140 patients on postoperative days 1, 2 and 3.Conclusions: Combined analgesia was better mode of pain management method than a single analgesic. Due to different multimodal analgesics used in different institutions patients experienced different degrees of pain, hence we need a standard protocol for a best pain management method.

D-Dimer and Coagulation profile are significant prognostic indicators in COVID-19 patients – A retrospective study in a tertiary healthcare hospital

To determine the value of coagulation indicators: D-dimer (DD), prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), in predicting the severity and prognosis of COVID-19.Around 150 patients with confirmed COVID-19 disease, who were admitted at Rajarajeswari Medical College and Hospital, Bangalore between April 15 2021 and July 15, 2021, were included in the study. The changes of D-Dimer, PT, APTT were tested, and the correlation with, clinical classifications, demographics, CT imaging, vaccination status against COVID-19 and prognosis were observed.Coagulation disorder occurred at the early stage of COVID-19 infection, in a total of 150 patients observed, 109 (72.66%, St. deviation of 4.26) patients having DD increased at time of admission and 148 patients (98.66%) having increased coagulation profile. The levels of DD and coagulation profile were correlated with clinical classification and also the CT severity and vaccination status. Among 41(27.33%) patients who died, 31(20.66%) patients had DD increased at the first lab test, 40 (26.66%) patients had DD increased on the fifth day of lab tests. The results shows that D-dimer is raised in severe category of COVID-19 infection. Also the CT severity is high (severe, with CT score>15) 71(47.33%) patients with increased D-dimer on admission. It was observed that 41(27.33%) patients who were vaccinated had increased D-dimer 70(46.66%) compared to unvaccinated patients. In addition, with the progression of the disease, the change of CT imaging was closely related to the increase of the DD value (P <0.01).Coagulation dysfunction is more likely to occur in severe and critically ill patients. DD and PT could be used as the significant indicators in predicting the mortality of COVID-19 and measuring the level of D-dimer and coagulation parameters from the early stage of the disease can also be useful in controlling and managing of COVID-19 disease, also vaccinated patients had better outcome among the unvaccinated patients.

English

BACKGROUND Foot amputations are common in diabetic patients and they are either minor or major. We conducted this study to analyse minor amputations done in diabetic patients through this new Amit Jain’s extended “SCC” classification for foot amputations. METHODS A descriptive retrospective study was conducted in Department of Surgery of Raja Rajeswari Medical College, Bengaluru, Karnataka, India, which is a tertiary care teaching hospital. The study period was from January 2018 to December 2019. This study was approved by institutional ethics committee. RESULTS 32 patients were included in this study with majority of patients being above 40 years. 78.1 % of them were males. Infected ulcers in the foot accounted for 34.4 % of the cases and were the commonest cause for amputation. 96.9 % of the patients who underwent minor amputation were of type 1-foot amputation. 6.3 % ended up in major amputation in the same hospitalisation. There was no in-patient mortality in this study. CONCLUSIONS Diabetic foot amputations are common in clinical practice and they often cause increased morbidity and add financial burden to patients and their family. Toe amputations, which are type 1-foot amputations, are the commonest amputations performed. Type 3-foot amputations are rarely done as they are complicated and require expertise. Amit Jain’s extended SCC classification for foot amputation is a simple, easy to understand and practical classification that categorises the minor amputation into 3 simple types. This is the first such classification exclusive for foot amputation. KEYWORDS Diabetes, Amputation, Foot, Amit Jain, Osteomyelitis, Gangrene, Ulcer

English

BACKGROUND Hypothyroidism is a common endocrine disorder which affects 11 % of the adult population in western countries. Hypothyroidism can cause a wide variety of anaemic disorders. Patients with both hypothyroidism and Vitamin B12 deficiency also have similar symptoms. Thus, this study was conducted to evaluate the relationship between the two and also hypothyroidism due to autoimmune cause. METHODS This was a descriptive study of 50 newly detected hypothyroid patients from Rajarajeswari Medical College evaluated for vitamin B12 deficiency. The study was conducted between January 10th 2019 to July 21st 2019. Lab parameters analysed included haemoglobin, thyroid function test (TFT), vitamin B12 levels and antithyroid peroxidase (anti-TPO) antibody levels. RESULTS Of the 50 hypothyroid patients evaluated, 23 were males and 27 were females between the age of 18 to 70 years. Anti TPO antibodies were present in 24 patients (48 %) out of 50, out of which 17 (70 %) patients had vitamin B12 deficiency. Out of 50 hypothyroid patients, 26 patients (52 %) had vitamin B12 deficiency. Thus hypothyroidism and autoimmune thyroid disease was associated with Vitamin B12 deficiency which was statistically significant. CONCLUSIONS Patients with hypothyroidism were studied for the incidence of deficiency of vitamin B12. It was found that 26 of 50 (52 %) patients had low B 12 levels. Incidence in females (54 %) was more than in males (46 %). Our study showed association between hypothyroidism and vitamin B12 deficiency and also autoimmune thyroid disease. KEYWORDS Hypothyroidism, Autoimmune Thyroid Disease, Vitamin B12 Deficiency

Estimation of Stature from Footprint Length

The human foot is studied for various reasons in forensic departments, by anthropologists, anatomists etc. Footprints are of immense value in a crime scene in establishing the personal identity and in a potential link between the perpetrator and the scene of crime. Identification of a person is of prime and foremost importance in both civil and criminal cases. Time is a critical factor in crime scene investigation, so rapid identification of suspect is very important. Here, in our study, the aim is to estimate the stature of individuals based on their footprint lengths among the students (Both male and female students between the age group 18 to 22 years) 50 male and 50 female students, studying in Rajarajeswari Medical College and Hospital, Bengaluru.that the footprint length help us in estimating the stature of an unknown individual which will be helpful in investigation of various crimes. Also not much difference is statistically noted in the stature estimated by right and left footprint length in both the sexes.Stature; Foot print length; Identification

Analysis of various thyroid disorders presenting to a tertiary care hospital and evaluation of accuracy of pre operative sonographic finding, fine needle aspiration with post operative histopathological examination.

Background: With over 42 million people Indians affected with thyroid disorders, it becomes crucial to arrive at an accurate diagnosis pre-operatively for better patient care. The use of minimally invasive techniques like ultrasound (USG) and fine-needle aspiration cytology (FNAC) has helped in the early diagnosis. Hence the study was conducted to look for the accuracy of these investigations in arriving at a correct pre-operative diagnosis. Methods: A retrospective observational study conducted from December 2016 to December 2018, included 96 patients who underwent thyroidectomy at RajaRajeswari Medical College and Hospital, Bangalore. The preoperative data were collected and the FNAC and USG were separately analysed to check for accuracy. Results: Of the 96 patients analysed. The ultrasound had a sensitivity of 52.6% and a specificity of 74%. The FNAC on the other hand had a sensitivity of 73.7% and a specificity of 90.9%. Conclusion: FNAC is a superior investigation in accurately diagnosing thyroid disorders pre-operatively. But the use of both the modalities together may yield a better outcome which has to be investigated further.

Prevalence and Grading of Rotator Cuff and Labral Injuries in Shoulder Pain and Instability using MRI: ACross-sectional Study

Introduction: Shoulder joint is a highly mobile joint but is prone for rotator cuff injuries and dislocations. It is necessary to accurately diagnose rotator cuff and labral injuries so that appropriate plan of action for treatment can be taken. Magnetic Resonance Imaging (MRI) can be used to diagnose and describe the extent of rotator cuff tendon and labral injuries and any secondary rotator cuff muscle abnormalities. Aim: To study the demographic profile of patients presenting with shoulder pain and instability, identify the various rotator cuff injuries causing shoulder pain, identify the rotator cuff interval lesions causing microinstability, identify the various labral and bony pathologies in instability, describe the MRI features of the rotator cuff, rotator cuff interval, labral and bony injuries. Materials and Methods: This study was a cross-sectional study of patients with symptoms of either shoulder pain or instability who underwent MRI evaluation of the shoulder in the Department of Radiodiagnosis, Rajarajeswari Medical College and Hospital, Bengaluru, Karnataka, India, from July 2018 to December 2020. The study population consisted of 54 patients with either shoulder pain or instability who underwent MRI of shoulder. All the MRI scans of the shoulder in this study were performed using 1.5 Tesla Siemens Magnetom Avanto (Tim 76x18) MR machine using a flex coil. Results: The study population consisted of 54 patients comprising of 38 males and 16 females. The age of the patients ranged from 20-77 years. Majority of the patients were older than 50 years constituting about 33.33% of the total study population. Rotator cuff injury was the commonest cause of pain. Tendinosis was the commonest type of rotator cuff injury followed by partial-thickness and full-thickness tendon tears. The commonest grade of tendinosis was mild or grade 1. Supraspinatus tendon was the most commonly affected tendon followed by subscapularis and infraspinatus tendons. Teres minor tendon was normal in all the cases. Anterior instability was the commonest type of instability with equal prevalence of soft tissue Bankart, bony Bankart and Perthes lesions. Biceps pulley lesions resulted in long head of biceps tendon instability, microinstability and internal impingement. Conclusion: Rotator cuff injuries are the commonest cause of shoulder pain and are seen more frequently after the fifth decade. Shoulder instability is most commonly seen in young male adults. Tendinosis is the commonest type of rotator cuff injury. Supraspinatus tendon is the most commonly injured tendon. Anterior instability is the commonest type of shoulder instability. Biceps pulley lesions result in long head of biceps tendon instability, microinstability and internal impingement. MRI can diagnose interstitial or intrasubstance tendon tears which are not visualised on arthroscopy. MRI description of tendon and labral tears, tendon retraction and muscle atrophy can guide the orthopaedician during arthroscopy and in treatmentplanning.

Prevalence of Anaemia in Patients with Type-2 Diabetes Mellitus in the Absence of Renal Impairment: A Cross-sectional Study

Introduction: Despite an increasing incidence of diabetic nephropathy, undermining the renal production of Erythropoietin (EPO), there are significant number of studies being reported with anaemia among diabetic patients with renal insufficiency, implicating numerous theoretical pathogenesis. Its impact being ignored over the years among Indian contexts, women and men in rural Southern India are particularly vulnerable to anaemia. The associated risk factors and occurrence of anaemia in Type-2 Diabetes Mellitus (T2DM) can be seen even in the absence of renal insufficiency. Aim: To determine the prevalence of anaemia in T2DM patients with normal renal function and assessment of its association with sociodemographic characteristics, biochemical and haematological variables. Materials and Methods: A descriptive cross-sectional study was conducted for a period of six months from December 2018 to May 2019 on total of 150 patients with T2DM, attending the Outpatient Department, Rajarajeswari Medical College and Hospital, Bangalore, India. All the patients of either sex, aged between 18-60 years, with a duration of Diabetes Mellitus (DM) more than five years, with no renal involvement, were included in the study. All statistical analysis was done using Statistical Package for Social Sciences (SPSS) version 20.0. The Chi-square test, Z-test was used for data analysis. Results: Among the 150 subjects, 86 (57.3%) were classified to be anaemic, with a mean age of 53 years whereas, 64 (42.6%) were classified as non anaemics with a mean age of 50 years. The mean duration of diabetes was found to be 10.5 years among anaemics and 9.7 years among non anaemics. Compared to non anaemics subjects, drug therapy with both Oral Hypoglycaemic Agents (OHA) and insulin showed a statistically significant difference among diabetic subjects with anaemia. The high prevalence of normocytic anaemia (52.3%) suggests the importance of non renal causes of anaemia in diabetic patients. Conclusion: Patients with T2DM have an independent risk for anaemia irrespective of renal insufficiency, posing a significant adverse effect on the quality of life and the progression of the underlying disease with high cardiovascular morbidity and mortality. Hence, management of diabetic patients should include mandatory routine haematological tests, with consideration of advancing age and poor glycaemic control.

Glutamic Acid Decarboxylase and Islet Cell Cytoplasmic Autoantibodies Positivity in Latent Autoimmune Diabetes of Adults: Need for Early Insulinisation

Introduction: Latent Autoimmune Diabetes of Adults (LADA) remains a poorly understood disease at both the clinical and research level and usually misdiagnosed as Type 2 Diabetes Mellitus (T2DM) and treated with Oral Hypoglycaemic Agents (OHA). This might lead to accelerated b-cell destruction leading to early insulin-dependency in these patients. Screening of T2DM and determination of C-peptide and insulin antibodies helps to differentiate this disease from LADA. Early insulinisation of these patients prevents b-cell destruction and preserves residual b cell function. Aim: To screen type 2 diabetic patients for potential LADA subjects based on LADA clinical risk score and to confirm them as LADA based on Glutamic Acid Decarboxylase (GADA) positivity and Islet Cell Cytoplasmic Autoantibodies (ICA) positivity. Materials and Methods: The hospital based cross-sectional study was done on 945 T2DM patients attending Out Patient Department (OPD) of Rajarajeswari Medical College and Hospital, Bengaluru, Karnataka, India from March 2017 to May 2019. Patients were screened using LADA clinical risk score and potential LADA subjects were identified and tested for C-peptide, GAD and IC Antibodies to confirm LADA. C-Peptide and GAD antibodies were measured by ELISA method. IC antibodies were observed using immunoflorescence microscopy. Inferential Statistics (Chi-square test, Z test, t-test) by using SPSS V20 and MS Excel was used. Results: Out of 945 T2DM patients, 188 patients (20%) were considered as potential LADA subjects based on LADA clinical risk score. All 188 subjects were tested for C-peptide, GAD and IC antibodies. 36% (68 subjects) of them had low C-peptide levels. Among them four subjects (6%) had high GADA titer confirming them as LADA subjects. Three (4%) of the subjects had low GADA titer, remaining 61 subjects did not show antibody positivity. Only one of them had both IC antibody positivity out of four subjects with high GADA titer. Remaining 64% (120 subjects) had normal C-peptide levels and antibody negative. Conclusion: Using 5-point LADA clinical risk score 20% were identified as potential LADA subjects out of 945 T2DM subjects. 6% of the potential LADA subjects had high GADA titer confirming them as LADA, who may be benefited by early insulinisation.

Insight into the exocrine pancreatic function (serum amylase and lipase) in type 2 diabetes mellitus

Introduction: Insulin has its effect on the basal and stimulatory secretion of exocrine pancreatic enzymes. In this context this study has been done to understand the relationship between the exocrine and endocrine entities of pancreas by analyzing two most commonly estimated exocrine enzymes; serum amylase and serum lipase in type 2 DM. Materials and Methods: The study was conducted at Rajarajeswari Medical College and Hospital, Bengaluru, Karnataka from January 2012 to December 2012. Hundred clinically diagnosed cases of type 2 diabetes mellitus {Fifty well controlled (HbA1c < 7> Results: Serum amylase and serum lipase levels were within the reference range in all the three study groups. There was no significant difference in serum amylase among well controlled and poorly controlled type 2 DM. In contrast, significant difference in serum amylase levels was observed between diabetic group and controls (p Conclusion: The potential underlying connection between exocrine and endocrine function of pancreas in patients with type 2 DM needs further investigation with larger population; to consider the analysis of serum pancreatic enzymes especially serum lipase levels as an additional informative parameter to assess the glycemic control in type 2 DM. Keywords: Type 2 DM, Serum amylase, Serum lipase.

A study of sensorineural hearing loss in hypothyroidism patients and its association with thyroid stimulating hormone levels

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; The most common symptom of hypothyroidism regarding ear, nose and throat is hearing insufficiency accompanied with cochleovestibular symptoms such as tinnitus, dizziness.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This was a hospital based observational clinical study conducted in Rajarajeswari medical college between December 2016 to June 2018. Patients with hypothyroidism attending department of ENT-HNS that satisfied the inclusion and exclusion criteria were included in the study. Patients were subjected to pure tone audiometry, thyroid function test after detailed history and physical examination. PTA was recorded and average of 500 Hz, 1 kHz and 2 kHz were taken as the pure tone average.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; 150 patients were included in the study. Mean age of patients with hearing loss was 37.2 years. 84.3% were females. 41 patients presented to us with unilateral hearing loss and 10 patients had bilateral hearing loss. 43 (84.3%) patients had mild degree of hearing loss, 8 (15.7%) had moderate hearing loss. Patients with hearing loss had altered TSH levels. Significant correlation (p&amp;lt;0.001) was found between hearing loss and duration of hypothyroidism, mean TSH levels.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; It was found that hy­pothyroidism affects the hearing producing hearing impairment, ranging from mild to moderate in severity and had significant correlation between duration of hypothyroidism and mean TSH levels with the severity of hearing loss.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;

Pattern of drug utilization in pediatric out patient department of a tertiary care teaching hospital

Background: Drug utilization studies have special significance among paediatric age groups as infant and children represent about 42% of the population in developing countries. This is the vital period of rapid growth and development. Therefore, drugs should be used very cautiously and rationally among these sub groups. The present study is conducted to analyse the prescribing pattern of drugs in paediatric age group for various illnesses. Methods: It was a prospective observational study, conducted in paediatric outpatient department of Raja Rajeswari medical college and research hospital for a period of 6 months after obtaining approval from institutional ethical committee. Descriptive statistical was used to determine the frequency, percentages, mean and standard deviation.Results: In the present study, fever (30.8%) followed by respiratory diseases were most common diseases seen. The commonly used drugs include antipyretics (66%), antimicrobials (53.6%), cough syrups (34.4%), antihistaminic (31.2%) and nasal decongestants (23.2%). Prescribing indicator shows existence of polypharmacy. Prescribing drugs by generic name was seen only in 8.1% and 47.82% of the drugs were prescribed from EDL. The frequency of use of injectables in our study was 5.8%. Conclusions: Irrational use of antibiotics and polypharmacy needs to be curbed. Prescribing drugs in their generic name and prescribing drugs from EDL need to be promoted. The present prescribing pattern can be improved by advocating rational drug prescribing, patient education and improving hospitals.