Willardmclain4821

Background Chronic Obstructive Pulmonary Disease (COPD) is now considered as multisystem disorder with high cardiovascular mortality. The study was carried out with an objective to observe the pattern and variation of blood pressure (BP) using ambulatory blood pressure monitoring (ABPM) in COPD patients. Methods Thirty six cases of COPD diagnosed by spirometry underwent ABPM for blood pressure evaluation. Thirty controls without COPD underwent spirometry and ABPM. Analysis were carried out both during wakefulness and sleep. Results Out of 36 COPD cases 25 were found to be hypertensive on ABPM, while 2 out of 30 controls were found to be hypertensive on ABPM. A significant difference was found between blood pressure levels during the wakefulness, sleep, and 24-hour BP amongst COPD cases and controls. Higher blood pressure levels were observed in COPD patients then in control, except for diastolic levels during wakefulness. The normal nocturnal dip was attenuated in COPD patients whereas physiological dip was present in controls. Conclusion COPD patients had higher blood pressure levels than the control group and had abnormal dipping pattern of blood pressure which may lead to high cardiovascular mortality in patients of COPD. © Journal of the Association of Physicians of India 2011.Background and Objectives Cerebral venous sinus thrombosis (CVT) occurs due to occlusion of the veins and sinuses which drain the brain parenchyma. It is an uncommon form of stroke, predominantly found in young patients1 . Despite advances in the recognition of CVT in recent years, diagnosis and management can be difficult because of the diversity of underlying risk factors, presenting features and the absence of a uniform treatment approach. This study aimed to ascertain the clinical presentation, various aetiologies and prognostic indicators of cerebral venous sinus thrombosis. Methodology This hospital-based descriptive study was carried out on 30 eligible patients from December 2013 to July 2015 after approval of Institutional Ethics Committee. Detailed history, clinical findings and required relevant investigations were recorded and analysed. Results CVT was commonly observed in younger persons, commonly between 21-30 years. Female Male ratio was 2.33. Altered sensorium at presentation was a poor prognostic indicator. The most common etiology was pregnancy and puerperium, followed by hyperhomocysteinemia. Superior sagittal sinus was found to be the most common site of thrombosis in this study, in 17 (56.7%) of the patients. 17 patients (56.67%) recovered completely without any neurodeficit. 24 ( 80%) and 22 (66%) subjects had cerebral infarction secondary to CVT. 5 (16.67%) patients succumbed to thrombosis or complications, most commonly due to intracerebral haemorrhage and cerebral edema. Conclusion CVT is a disease with multifactorial, gender-related specific causes and has a wide and varied clinical spectrum. MMAE inhibitor © Journal of the Association of Physicians of India 2011.Background Clinico-epidemiological profile of snake envenomation varies in different regions; however, data from India is inadequate. This study was planned to obtain such data from Goa, to help in quick identification of envenomation, prompt treatment and help in building a national database. Methods In this prospective observational study,all patients presenting to emergency department between April 2016 to August 2017 with history of snakebite and meeting inclusion and exclusion criteria were enrolled and analysed. Results 236 patients were screened, 156 were eligible. Mean age was 39.5±15.6; majority (n=122, 78.2%) were in the age group of 20-59 years; 119 (76.3%) were males. Seasonal variation was noted, highest number being in June, July and between September and December. Bites occurred commonly in housewives, students and retired personnel (n=108, 69.23%). 120 patients (76.9%) had hemotoxicity, 7 (4.5%) had neurotoxicity, 29 (18.6%) had only local reaction. Clinical features seen were bleeding (n= 40, 25.6%) , vomiting (n=15, 9.6%), giddiness/syncope (n=14, 9%), breathlessness (n=5, 3.2%), diplopia (n= 5,3.2%), ptosis (n=7, 4.5%), dysarthria (n=1, 0.6%), altered sensorium (n=7, 4.5%), oliguria (n=2, 1.3%), and chest pain (n=1, 0.6%). Majority (n= 117, 78.5%) received antivenom within 6 hours of bite. 31 patients (20.8%) developed reactions to antivenom, most were febrile reactions (n=12, 8.05%). link2 Anaphylaxis occurred in 4 (2.68%) patients. link3 Conclusion Snakebite is a common medical emergency in Goa, with distinct seasonal variation. There was no association between occupation and risk of bite. Hemotoxic and local cytotoxic features predominate in this area. Antivenom reactions though common, are usually mild. © Journal of the Association of Physicians of India 2011.Background Sexual problems are common in the society. But the medical professionals are reluctant to address sexual health issues. In this study we are assessing the attitude of medical practitioners towards various sexual health issues. Methods The study used anonymous self-responsive questionnaire survey of hundred medical practitioners from various parts of Kerala. Medical practitioners were asked to respond to various questions regarding their area of practise, their training in sexual medicine and about their perception and attitude towards patients' sexual health problems. Data collected and basic descriptive statistics were calculated. Results Out of 125 anonymous self-responsive survey questionnaires send to medical practitioners, we received hundred completed responses. Only 18% reported that they had some training in sexual medicine. Most of the medical practitioners are having the opinion that sexual problems are common in the society and only very few percentage (about 4%) seek help from medical practitioners regarding their sexual health issues. Anxiety and inhibition from the patient side to disclose and lack of privacy in the busy OPD are the major obstacles which prevent patients to seek medical help. Majority of doctors are reluctant to ask about their patients sexual issues. The participants identified that lack of time and privacy in the busy OPD and lack of proper training to address sexual issues are the major factors that prevent doctors from addressing sexual issues in their day to day clinical practice. Conclusion Sexual issues are common in the society. This study identified gaps in sexual health training among medical professionals in Kerala. Lack of proper training to address the sexual health issues is a major obstacle in managing sexual problems which can be addressed by improving training in sexual medicine to both medical students and medical practitioners. © Journal of the Association of Physicians of India 2011.Aim To study the clinical profile and outcome of the patients with kidney biopsy diagnosis of IgA Nephropathy (IgAN). Methods A retrospective study of the patients diagnosed IgAN over a period of three and half years. Results Sixty (13.5%) had a diagnosis of IgAN. Twenty four (40%) had a clinical diagnosis of rapidly progressive glomerulonephritis (RPGN), 20 (33.3%) chronic kidney disease (CKD), 11 (18.3%) nephrotic syndrome, three (5%) acute glomerulonephritis and two (3.3%) asymptomatic urinary abnormalities. Fifty-six (93.4%) patients had hypertension; 15 (25%) patients were presenting as a hypertensive crisis with malignant hypertension in two. Fifteen of the RPGN patients presented with the hypertensive crisis, and all of them had evidence of thrombotic microangiopathy (TMA) on biopsy. Three (5%) patients had secondary IgAN. Patients with the nephrotic syndrome responded to treatment and had a significantly higher renal survival. Patients with interstitial fibrosis and tubular atrophy (IFTA) ≥25% and mesangial hypercellularity score of >0.5 did not respond to treatment. Conclusion RPGN, CKD, and nephrotic syndrome were the typical manifestation of IgAN. Hypertension and hypertensive crisis were common. Response to treatment was seen in nephrotic syndrome whereas those with IFTA ≥25% and mesangial hypercellularity score of > 0.5 did not respond to treatment. © Journal of the Association of Physicians of India 2011.Aim Appropriate calculation of sample size and choosing the correct sampling technique are of paramount importance to produce studies that are capable of drawing clinically relevant conclusions with generalizability of results. The current study was planned with an objective to determine reporting of sample size and sampling considerations in clinical research articles published in the year 2017. Methods One high impact factor journal and one low impact factor journal belonging to the specialities of Medicine, Surgery, Obstetrics and Gynaecology, Paediatrics and Pharmacology were selected and checked for adherence to reporting of sample size and sampling considerations. Results A total of 264 articles were examined. These consisted of 55 interventional studies and 209 observational studies. Interventional studies showed higher reporting of sample size calculation/justification for sample size selection (29.1%) compared to observational studies (14.8%). Only 33 out of 155 articles from high impact factor journals and 14 out of 109 articles from low impact factor journals mentioned about sample size calculation or justified the sample size. In addition to this, merely 68 out of 209 observational studies mentioned about sampling considerations such as sampling technique/participant follow up/matching details. Conclusion The reporting of sample size and sampling considerations was found to be low in both high impact factor and low impact factor journals. Though interventional studies had better reporting compared to other study designs, the reporting was still not adequate and there is an immense scope for improvement. © Journal of the Association of Physicians of India 2011.The safety of metformin use for patients with type 2 diabetes mellitus (T2DM) and advanced kidney disease is controversial, and more recent guidelines have suggested that metformin be used cautiously in this group until more definitive evidence concerning its safety is available. The Korean Diabetes Association and the Korean Society of Nephrology have agreed on consensus statements concerning metformin use for patients with T2DM and renal dysfunction, particularly when these patients undergo imaging studies using iodinated contrast media (ICM). Metformin can be used safely when the estimated glomerular filtration rate (eGFR) is ≥ 45 mL/min/1.73 m2. If the eGFR is between 30 and 44 mL/min/1.73 m2, metformin treatment should not be started. If metformin is already in use, a daily dose of ≤ 1,000 mg is recommended. Metformin is contraindicated when the eGFR is less then 30 mL/min/1.73 m2. Renal function should be evaluated prior to any ICM-related procedures. During procedures involving intravenous administration of ICM, metformin should be discontinued starting the day of the procedures and up to 48 hours postprocedures if the eGFR is less then 60 mL/min/1.73 m2.BACKGROUND Laparoscopic cholecystectomy represents the gold standard technique for the treatment of lithiasic gallbladder disease. Although it has many advantages, laparoscopic cholecystectomy is not risk-free and in special situations there is a need for conversion into an open procedure, in order to minimize postoperative complications and to complete the procedure safely. The aim of this study is to identify factors that can predict the conversion to open cholecystectomy. METHODS We analyzed 1323 patients undergoing laparoscopic cholecystectomy over the last five years at St Orsola University Hospital-Bologna and Umberto I University Hospital-Rome. Among these, 116 patients (8.7%) were converted into laparotomic cholecystectomy. Clinical, demographic, surgical and pathological data from these patients were included in a prospective database. An univariate analysis was performed followed by a multivariate logistic regression. RESULTS On univariate analysis, the factors significantly correlated with conversion to open were the ASA score higher than 3 and the comorbidity, specifically cardiovascular disease, diabetes and chronic renal failure (p less then 0.