Background: Acute encephalitis syndrome (AES) is a public health problem in India. One of the causes is the Japanese encephalitis (JE), but in many patients this infection can be ruled out. The current hospital-based surveillance was conducted on patients with AES and JE. No comparative study on the long-term outcomes of JE vs. non-JE AES was available from India and there was no study on socioeconomic impact of the illness. Objectives: The current study aimed at comparing the long-term outcomes of JE vs. non-JE AES and studying the socioeconomic impact of AES on the population of Uttar Pradesh, India. Methods: Patients with AES discharged from hospital were followed-up by hospital or home visits, or telephone interviews. Functional outcomes and sequelae were compared between the patients with JE and non-JE AES by the Glasgow outcome scale (GOS), Liverpool outcome scale (LOS), and child & adolescent scale of participation (CASP). Socioeconomic impact and coping mechanisms were studied by the semi-structured qualitative methods. Results: A total of 91 patients (29 with JE, 62 with non-JE AES) were followed-up based on the mean (SD) duration of 21.9 (5.6) months after discharge from hospital. Functional outcomes were significantly worse in the cases with JE, but there was no significant difference in CASP scores between the groups. Only 4 patients with JE got financial help from the government. In the rest, almost all the expenses for travel, hospitalization, drugs, and investigation were borne by the families themselves. Most of the families borrowed money from relatives, while some mortgaged or sold their land and/or jewelry. Rehabilitation services were seldom available as it needed travelling to cities. The joint family system has a cushioning effect, however, providing physical and mental support. Conclusions: AES is a serious illness with severe long-term sequelae in survivors. Functional outcomes got worse in the patients with JE compared with the ones with non-JE AES. The illness had a severe socioeconomic impact and all expenses should be borne by poor families. Rehabilitation remained an unmet need. Some supports were provided through the joint family system.
Background: Gunshot injuries are range from minor superficial pellet injuries to devastating soft tissue and visceral injuries. The objective of study was to evaluate complete profile and outcome of gunshot injuries in tertiary care centre.Methods: This study was a prospective study. All gunshot injury patients who admitted in Department of Surgery, Moti Lal Nehru Medical College, Allahabad were included in study.Results: Result were analysed in terms of age, sex, rural-urban and religion wise distribution, etiology of injury, arms and ammunition, time elapsed in first aid, site of injury, associated injury, organ involved, Glasgow coma scale, injury severity score, revised trauma score, various blood and radiological investigations, treatment and complications.Conclusions: Gunshot injury was common in male patients, age group 21-30years, Hindu community and in rural areas. Most patients received injury by shotgun. Assault was most common cause followed by accidental injury. Majority of patients had Glasgow coma scale between 13-15, injury severity score below 20 and revised trauma score more than eight. Mortality and morbidity were more common in patients with high injury severity score, low revised trauma score and Glasgow coma scale below 8. Abdomen was most common site involved in gunshot injury. Most of the patients were managed conservatively as these patients had external body surface injury. Laparotomy was done for intra-abdominal injury. Wound infection was the most common complication.
Background: Breast cancer is the most common female cancer worldwide representing nearly a quarter (25%) of all cancers. Search for a marker which can predict lymph node metastasis in clinically negative axilla has been a matter of research for long. The present study is an attempt to evaluate role of coagulation makers with special reference to D-dimer and factor 7 and 8 in patients of carcinoma breast in predicting lymph node metastasis in carcinoma patients.Methods: The study was a prospective study conducted in 50 diagnosed patients of carcinoma breast in whom D dimer levels and factor 7 and 8 levels were measured at the time of commencement of the treatment and at six weeks after surgery.Results: Most of the patients in the study group were in the age group 41-70 (80%) years. 22% patients were of early Breast cancer. The reduction in D-dimer, factor VII and factor VIII value after 6 weeks of surgery were significant (p value 0.0001 for all three).Conclusions: D-dimer and factor VII were found to be an independent predictive factor for lymph node metastatsis, thus providing as a safe, easy, objective and convenient supplement to sentinel node biopsy in assessing metastatic disease in axilla. Combined- with other biomarkers, it may prove to be an alternative to sentinel node biopsy in assessing metastatic disease in axilla. Significant postoperative decrease in D-dimer, factor VII and factor VIII may provide objective criteria to assess completion of surgery.
Background: There is paucity of information regarding the effects of cholecystectomy on serum lipid profile parameters and blood glucose levels in the patients of cholelithiasis. Therefore, this study was undertaken to compare some serum lipid parameters and blood glucose levels in patients of cholelithiasis and effect of cholecystectomy on the same.Methods: The study was conducted on 50 patients of cholelithiasis who were admitted in Surgery department, MLN Medical College over a period of one year and were planned for cholecystectomy. Complete lipid profile (which included total cholesterol, triglycerides, high density lipoproteins (HDL) cholesterol, low density lipoproteins (LDL), very low density lipoproteins (VLDL) and atherogenic index) and fasting blood glucose was evaluated pre-operatively and post-operatively on the 3rd, 7th and further after 1 month of cholecystectomy. Results: Out of 50 patients, maximum of 38% were in their 4th decade with females constituting 82% of total. There was significant elevation in fasting blood glucose and HDL cholesterol on 3rd, 7th and 30th day post-cholecystectomy as compared to pre-operative values (p value<0.0001). Triglyceride and VLDL cholesterol elevated on 3rd and 7th day but it significantly decreased one-month post-cholecystectomy as compared to pre-operative levels (p value<0.0001). However, LDL, total cholesterol and atherogenic index significantly decreased on 3rd ,7th and 30th day post-cholecystectomy.Conclusions: Cholelithiasis is an important cause associated with significant pathological changes in many lipid profile parameters, which will return towards normal after cholecystectomy. This normalization will be a time dependent phenomenon with long term beneficial effects.
Background: The study was to compare 25-hydroxy vitamin D levels in women with benign and malignant breast disease patients to the age-matched controls in a tertiary care center in North India.Methods: This was a prospective study carried out in the Department of Surgery, S.R.N. Hospital associated with M.L.N. Medical College, Allahabad. The levels of vitamin D are measured by electrochemiluminescence and the serum levels divided into normal, mild, moderate, and severe vitamin D deficiency.Results: Overall 60 patients were included. 30 was having malignant breast disease and 30 having benign breast disease. On comparing the mean value of serum vitamin D level between malignant breast disease and controls, the serum vitamin D level was found to be lesser in the former group and the difference was highly significant. On comparing the mean value of serum vitamin D level between benign breast disease and controls, the serum vitamin D level was found to be elevated in the former group, the difference was nonsignificant.Conclusions: Our study supports the hypothesis that vitamin D deficiency is an important risk factor in the development of malignant breast disease. The study was also concluded that vitamin D is not associated with the etiogenesis of benign breast diseases. There is also a possibility of using 25-hydroxy vitamin D as an adjuvant therapy during the treatment of breast malignancy.
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