Background: Perianal fistula is a common surgical problem which poses great discomfort to patients and causes prolonged morbidity when improperly managed or developed complications. Its management protocols are ill defined, and the efficacy of newer treatment modalities are not well established. The aim of the study was to study the clinicopathology of Perianal fistula and its prognostic factors.Methods: This was a prospective study conducted at the Department of General Surgery, Rajiv Gandhi Government General Hospital between August 2014 and July 2015. Purposive sampling method was used select patients with fistula in ano. After obtaining informed consent, patient details were collected in pre-tested structured questionnaire. Data entry and analysis were done using SPSS software.Results: Males between thirty and fifty years were the most affected population. Most of the patients had no co-morbidities while Diabetes Mellitus was the prevalent co-morbid factor, seen especially in the elderly. MRI fistulogram was the investigation of choice. Fistulotomy was the preferred procedure. Recurrence of fistula was an unavoidable morbidity.Conclusions: Proper preoperative evaluation which includes MRI fistulogram and planning the treatment is essential to prevent complications. Fistulotomy is the preferred treatment especially in patients with trans-sphincteric fistula and those with evidence of infection or secondary tract. The prognosis, if properly managed is very good, so proper management protocols need to be established.
Background: ABO discrepancies occur whenever the results of red cell grouping and serum grouping are in disagreement. The reasons for discrepancies both clinical and technical have to be sorted out. Further analysis is essential to resolve such discrepancies. If discrepancies are encountered, the interpretation of the ABO grouping has to be delayed until the same has been resolved. The aim of the study was to resolve ABO discrepancies encountered, by serological work up.Methods: All cases of discrepant samples received between August 2014 and May 2016 at the Department of Transfusion Medicine, The Tamilnadu Dr. MGR Medical University, Chennai, India were analyzed to determine the etiology by serological workup.Results: A total of twenty-one samples were analyzed and resolved. Fifteen cases of Type IV discrepancy, two cases of Type II discrepancy, one case Type III discrepancy, one case Type I discrepancy and two cases of technical errors were identified.Conclusions: ABO discrepancies can be resolved serologically if properly worked up. As ABO blood grouping is indispensible in blood transfusion service, it is imperative to resolve such discrepancies before transfusion.
Background: Schizophrenia is a major mental disorder which has to be assessed early and managed actively even though long term functional outcome remains relatively poor. The aim of the study is to analyze negative symptoms, suicidal risk and substance use in first episode schizophrenics in comparison with multi-episode schizophrenics.Methods: 30 patients with drug naive first episode schizophrenia and 30 patients with multi episode schizophrenia, who attended the outpatient department of Psychiatry, Government Stanley Medical College, Chennai, Tamilnadu, India were studied to compare predisposing factors and spectrum of symptoms for Schizophrenia for a period of one year (January 2010-December 2010). Psychiatric questionnaire by Michael C. Hilton, DAST by Harvey A. Skinner, AUDIT by WHO, Suicide risk scale by National Health and Medical Research Council, PANSS by SR Kay were used to assess patients.Results: Unemployment and family history of suicide attempts were observed more in drug naive first episode schizophrenics. 90% of these patients had completed their primary education while 47% of multi-episode schizophrenics were illiterates. Positive symptoms (delusions, hallucinatory behaviour and suspiciousness) and negative symptoms (blunted affect, emotional withdrawal and social withdrawal) were observed more in first episode schizophrenics while PANSS, DAST, AUDIT scores did not find any differences between both the groups.Conclusions: In our study, the first episode schizophrenia patients were more educated, more unemployed and had more family history of suicide, elevated sub score of positive symptoms as measured by PANSS. Relative assessment of violence and serious behavior problems that are related to positive symptoms must be done and managed with anti psychotics.
Background: Osteonecrosis, also referred to as avascular necrosis (AVN), aseptic necrosis, and ischemic necrosis, is not a specific disease but rather a condition in which a circumscribed area of bone becomes necrotic as a result of a loss of its blood supply. The femoral head is the site most often affected. A number of procedures have been described to accomplish this. Total hip replacement is a reconstructive surgical procedure that provides stability, better quality of life and mobility in patients suffering from hip disorders thus eliminates pain and restore functions of hip. In hip arthroplasty, the acetabulum, femoral head and proximal neck is replaced with metal shell, plastic liner and metal ball. Purpose: To evaluate the clinical, functional, radiological outcome and the complications of uncemented total hip replacement in avascular necrosis of femoral head in adults. Materials and Methods: This prospective study done in the Department of Orthopaedics, Post Graduate Institute of Swasthiyog Prathistan, Miraj, from February 2013 to February 2014. We included the patients of avascular necrosis of femoral head, in the age group of 30 to 60 years. Results: 36 hips of 30 patients with avascular necrosis of femur head who underwent uncemented Total Hip Replacement admitted during above period after evaluating clinically and radiologically Harris Hip Score was used to measure the functional outcome. 36.11 % of the patients were found to be in the 50 and above age group, with age ranging from 30 to 60 years and a mean age of 43.8 years. Majority, 27 (75%) were males and 9 (25%) were females. Excellent or good pain relived and function were obtained in 86.01%. The mean total preoperative score was 34.61, which improved postoperatively to a mean score of 90.83. In the scoring system ie, pain, gait, functional activity and ROM, there was a statistically significant improvement ('p' value of <0.001) in the postoperative score when compared to preoperative score. Conclusion:The outcome of uncemented total hip replacement done in cases of avascular necrosis of femoral head most of them who are in stage 3 and 4 of Ficat and Arlet classification in adults is determined by multiple factors, including the design of the component, the selection of the patients, and the operative technique.
Background: Caregivers of people with bipolar disorder experience a different quality of burden than seen with other illnesses. A better understanding of their concerns is necessary to improve the training of professionals working with this population. The aim of this study was to study the level of family burden, coping skills and psychological wellbeing among caregivers of bipolar affective disorder.Methods: This was a prospective cross-sectional study conducted over a six months period from January 2014 to June 2014. Patients diagnosed as bipolar disorder as ICD-10 and their caregivers were included in the study. Purposive sampling technique was employed. Socio-demographic data were collected in preformed questionnaire. Disease burden was calculated using burden assessment schedule, psychological general well being index and brief COPE scale.Results: Around 63.4% of the caregivers were males, 38.5% were illiterate, 44.2% were unskilled labourers, 57.6% were spouses, mean BAS score was 86.03, mean coping score was 55.77 and BAS was inversely related to PGWBI. Male caregivers used self-distraction and substance use as coping strategies while females used religion and denial.Conclusions: The perceived burden was higher among caregivers of bipolar disorder. Coping strategies varied based on caregiver demographic characteristics. Higher the perceived burden, lower was the psychological wellbeing. Psycho-educational family intervention for caregivers has to be implemented along with pharmacological therapy in patients with bipolar affective disorder.
Background: Antipsychotic treatment for schizophrenia is prone for drug side effects. Both typical and atypical antipsychotics are prone for metabolic derangements. The aim of this study was to compare the emergence of metabolic syndrome with haloperidol and risperidone in drug naïve first episode schizophrenics.Methods: This was a prospective observational study conducted at the Institute of Mental health, Chennai, India from April 1, 2011 to November 15, 2011. 24 patients received haloperidol and 29 patients received risperidone and followed up for 6 months, after obtaining informed consent. PANSS score, AHA criteria for metabolic syndrome, plasma glucose, waist-hip ratio, body mass index and lipid profile were recorded at every two months interval.Results: PANSS score showed a decrease in both groups, systolic blood pressure showed an increase with Haloperidol and an initial decrease with risperidone while diastolic blood pressure increased with haloperidol. Weight gain, increase in waist circumference and hip circumference, rise in triglyceride levels and fall in HDL cholesterol were equally observed in both groups. Increase in plasma glucose was seen more with risperidone (93.1%). 18.86% (n = 10) developed metabolic syndrome at the end of 6months with no difference in emergence between both groups.Conclusions: Risperidone may be considered equivalent to haloperidol in efficacy and with minimal changes in metabolic profile. Blood pressure lowering effect of risperidone is more marked in earlier months warranting patient education. Stringent guidelines are needed during antipsychotic treatment to prevent cardiovascular and cerebrovascular morbidity and mortality.
Background: Gastroparesis is characterized by delayed gastric emptying in the absence of mechanical gastric outlet obstruction. There is strong association of gastroparesis with carcinoma gallbladder. The aim of the study was to find out the incidence of delayed gastric emptying in carcinoma gallbladder and its correlation with symptoms of stasis and stage of the disease.Methods: Patients diagnosed with carcinoma gallbladder and their matched controls were included in this study. Patients with mechanical gastric outlet obstruction were excluded. All patients underwent contrast enhanced computer tomography scan and radio labeled (Technitium 99) solid meal Scintigraphy study. Normal gastric emptying time was calculated from control group as Mean +2SD.Results: 30 patients were matched with 20 controls after obtaining informed consent. Upper limit of gastric emptying time is 55.09 minutes. Adenocarcinoma was the commonest histological subtype (50%), abdominal pain was the commonest symptom (86.7%) and hepatomegaly was the commonest sign (46.7%), GETt1/2 for patients was 66.72±26.52 minutes while it was 40.53±7.28 minutes in controls (p <0.05). Gastroparesis increased with advancing stage of carcinoma gallbladder (p <0.05). Symptoms of gastric stasis were seen only in 15.6% of patients.Conclusions: Patients with carcinoma gallbladder can have gastroparesis without obvious symptoms of delayed gastric emptying. This delay in gastric emptying can be documented reliably using solid meal scintigraphic study even in patients without symptoms of gastroparesis. The pathophysiology of gastroparesis needs further study. It may be prudent to remember that while performing palliative bypass surgery for gastric outflow obstruction, that in patients with carcinoma gallbladder, the gastrojejunostomy may not function as expected due to delayed gastric emptying.
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