<p class="abstract"><strong>Background:</strong> Osteoarthritis (OA) is one of the major cause of morbidity, having a substantial influence on health quality of life, imposing enormous burden of cost on the health care system. It is a chronic degenerative disorder that is characterised by articular cartilage degeneration. It can be caused by aging, heredity and injury from trauma or disease. Primary symptoms of OA include joint pain, stiffness and limitation of movement. Disease progression is usually slow but can ultimately lead to joint failure with pain and disability. Stromal vascular fraction (SVF) derived from adipose tissue is a rich source of pre adipocytes, mesenchymal cells (MSC), endothelial progenitor cell, T cells, B cells, mast cells as well as adipose tissue macrophages. It can be easily obtained from loose connective tissue that is associated with adipose tissue by lipoaspiration under local anaesthesia. SVF is isolated without using any enzymes or chemicals and its autologous grafting is done in a single surgical sitting. Here, we evaluated safety and clinical efficacy of freshly isolated Autologous SVF cells in patients with grade 2-4 degenerative osteoarthritis (OA). .</p><p class="abstract"><strong>Methods:</strong> A total of 116 joints mainly knee OA were treated with autologous grafting of SVF done in a single surgical sitting. A total of 116 joints studied out of which 80 joints were followed up for 12 months, 88 joints followed for 9 months, 110 joints followed for 6 months and finally all 116 joints were followed for minimum 1 month for safety and efficacy.<strong></strong></p><p class="abstract"><strong>Results:</strong> Modified KOOS clinical score was used to evaluate clinical effect and was based on pain, non-steroid analgesic usage, limping, extent of joint movement, and stiffness evaluation before and at pre-operative, 1 Month post-op, 6 months post-op and 12 Months post-op after grafting. No side effects, systemic infection or cancer was associated with Autologous grafting of SVF. There was a significant improvement from pre-op to post op in all the followed patients. Average KOOS score improved from pre-operative 46.4 to post-operative 12 months average 77.9 i.e. very significant improvement in all grades. All sub-scale parameter for pain, symptoms, activity of living and quality of life showed significant improvement. Higher grade of OA were associated with comparatively slower healing.</p><p class="Default"><strong>Conclusions:</strong> Autologous grafting of SVF in single surgical sitting is a novel and promising treatment approach for patients with degenerative OA. This treatment method was found to be minimal invasive, safe and cost-effective treatment modality for osteoarthritis. </p>
Introduction: The lymphadenopathy consist wide range of etiology from inflammatory process to a malignant condition and it is most common clinical presentation in outpatient department. Fine needle aspiration cytology is a simple, safe, reliable, rapid and inexpensive method of diagnosis in lymph nodes. Aims and objectives: To find out diagnostic accuracy of FNAC in lymphadenopathy and common pattern of lymphadenopathy in our institute. Methods: This prospective study was carried out in the department of Pathology of Index Medical College Hospital and research Centre, Indore, India from June 2011 to May 2013. The patients with palpable lymph nodes were included in this study. The slides were stained with Papanicolaou and May Grunewald Geimsa stain.Special stain like Ziel Neelson, Alcian blue was done whenever is required. A detailed analytic study was performed for correlation of Cyto-histopathological diagnosis. Results: The result shows male to female ratio of 1.0:0.8. The age of the patients ranges from 2 to 79 year with mean age of 32 years. The study shows reactive hyperplasia 149 (33.38%), tubercular lymphadenitis 177 (39.77%), granulomatous lymphadenitis 32(7.1%), lymphoma 25 (5.5%), metastatic carcinoma 40 (8.9%) and others 22 (4.9%). We found cyto-histpathological concordant in 161 (95.8%) cases and discordant in 7 (4.2%) cases. Conclusion: The sensitivity of FNAC in lymphoma and metastatic tumors is 81.48% and 97.5% with test accuracy of 96.5% and 99.4% respectively. Hence FNAC should be used as preliminary screening investigation in all forms of lymphadenopathy and interpretation should be done in conjunction with clinical picture of the patients.
Background: The new guidelines issued by the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure (JNC-8) emphasize that aggressive blood pressure (BP) control is essential to reducing morbidity and mortality. Patient non-adherence is a serious obstacle to the effective treatment of many acute and chronic disorders. Successful treatment and outcome of a chronic disease such as hypertension depend on many factors, including resources (e.g., funds, space, and people), avoidance of serious adverse events, patient adherence with treatment plans, and the availability of effective therapies. The aim of this study is to assess the antihypertensive drug prescription patterns and adherence to joint national committee (JNC-8) hypertension (HT) treatment recommendations among hypertensive patients attending a tertiary care teaching hospital.Methods: An observational and cross-sectional prospective prescription audit study was carried over a period of 1 year in ambulatory patients attending medicine OPD. A total of 500 prescriptions prescribed to diagnose HT were analyzed. Drug prescription patterns, and their adherence to JNC-8 report was assessed.Results: Out of 500 patients, 299 (59.8%) were male and 201 (40.2%) were female. Mean age of male and female patients were found to be 57.68±15.32 and 61.29±12.65 years respectively. As per present study, most of the physicians prescribed single drug (monotherapy, 34.6%) to control BP followed by two-drug combination (18.4%), three-drug combination (11.8%) and four-drug combination (3%). Two drugs regimen was prescribed in 18.4% of the hypertensive patients. Angiotensin receptor blocker + diuretic combination (4.4%) was mostly used in two drug combination therapy followed by Angiotensin receptor blockers + Diuretics (3.6%) and Calcium channel blocker + ACEIs combination (2.6%). No combination of ACEIs + ARBs was prescribed in any prescription. The overall rate of adherence was 16.5 % (Pre-hypertension); 87.90% (Stage 1 hypertension); and 68.20% (Stage 2 hypertension).Conclusions: In conclusion, present study demonstrated that physicians are not completely adhering to standard guidelines while treating hypertension with comorbid conditions.
The incidence of dengue has grown dramatically around the world in recent decades. The exact clinical and laboratory profile is crucial for diagnosis as well as successful management of the patients. This study is an attempt to assess the clinical and laboratory profile of serologically confirmed cases of dengue fever in a tertiary care hospital. This cross-sectional observational study was carried out including 45 dengue fever cases in a tertiary care teaching hospital. All patients above 18 years with confirmed dengue, who were either admitted in the medical wards of the hospital or managed as outdoor patients with NS1 (non-structural protein) antigen and/ or IgM dengue antibody positivity were included in the study. All the patients, who presented with fever and found positive Dengue IgM antibodies capture enzyme-linked immunosorbent assay (MAC-ELISA). The diagnosis of DF, DHF, and dengue shock syndrome (DSS) were based on the WHO criteria. Fever was documented in all 45 (100%) patients, the most common symptom followed by reduced appetite 41 (91.1%), myalgia 39 (86.7%), headache 36 (80%), abdominal pain 29 (64.4%), nausea/ vomiting 18 (40%), diarrhea 17 (37.8%) and pruritus 17 (37.8%). Bleeding manifestations occurred in 21 (46.7%) patients, of whom petechiae 17 (37.8%) was the most frequent followed by gum bleeding 5 (11.1%), gum bleeding 5 (11.1%). Ecchymosis 3 (6.7%), malena3 (6.7%) and hematuria 2 (4.4%) were less common. Fever associated with headache, retroorbital pain, erythematous morbilliform rash and itching in palms and soles along with thrombocytopenia, leucopenia, and elevated liver transaminases should prompt a clinician on the possibility of dengue infection. Proper confirmation of diagnosis, early institution of therapy, public awareness, and vector control are important factors to be taken into consideration in the prevention and management of dengue.
Background: Regional anesthesia increasingly used for gynecological surgeries, has advantage of decreased stress response to surgery, decreased cardiorespiratory depression, with improved postoperative analgesia.Methods: This randomized, prospective, double blind study was conducted at Amaltas Institute of Medical Sciences, Banger Dewas in Department of Anesthesia between June 2016-December 2016. Sixty patients who were posted for gynecological surgeries were enrolled and randomly divided into two groups: Group R received 3.5 ml (17.5 mg) 0.5% ropivacaine plain and Group L received 3.5 ml (17.5 mg) 0.5% levobupivacaine plain. The onset and duration of sensory and motor block and any undesirable side effects were noted.Results: Demographic parameters were comparable between the two groups (P >0.05). Onset of sensory and motor block was significantly faster in Group L, duration of motor and sensory block was significantly less in Group R. Patients in group R were hemodynamically stable (P = 0.032) compared to group L.Conclusions: Both ropivacaine and levobupivacaine have the desirable blocking property and can be used in gynecological surgeries. Ropivacaine showed shorter duration of sensory and motor block allowed early mobilization and early recovery of patients.
<p class="abstract"><strong>Background:</strong> <span>Accurate placement of the femoral tunnel is critical for long-term clinical success following anterior cruciate ligament (ACL) reconstruction.</span> <span> Current trends in ACL reconstruction favor anatomic positioning of ACL attachment sites. Surgical inaccuracy in femoral tunnel positioning can lead to potential early graft failure and early-onset osteoarthritis. The purpose of this study was to evaluate</span> the functional outcome in patients who underwent arthroscopic anatomic ACL reconstruction using hamstring tendon graft<span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> The<strong> </strong>study was conducted in the Orthopedics Department of IIMCHRC, Indore the placement of femoral tunnel, using femoral off set guide with other techniques. All the patients who were diagnosed clinically and radiologically with ACL tear and all who gave the consent were included in the study. All patients were enrolled to undergo primary arthroscopically assisted ACL reconstruction.<strong></strong></p><p class="abstract"><strong>Results:</strong> In the present study out of 42 patients; 23 patients (55%) had right sided ACL injury and remaining 19 patients (45%) had left sided ACL injury. We assessed functional outcome of the patients through pre-operative and post-operative IKDC scoring. The mean of the pre-op IKDC scoring was 33.61 with SD of 9.67 and the mean of the post-operative IKDC scoring was 77.95 with SD of 15.15<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> The commercially available off set guide technique of the femoral tunnel placement in arthroscopic ACL reconstruction is easy, reliable and reproducible with the foot print at anatomical place on the femoral site<span lang="EN-IN">.</span></p>
Background & Method: The present study has been conducted in pathology department study is based on serological correlation of CA -125 and Interleukin-6 in patient with ovarian mass lesion attending. Patient’s details regarding their inpatient number, age, parity, marital life, family history, menstrual status, clinical history including presenting symptoms and signs, radiological data whenever possible will be noted.
Result: Among 40 neoplastic lesions, right sided cases found in 20 (50%), and left sided lesion found in 12 cases (30%). 08 cases (20%) of lesions are observed to be bilateral. There is significant correlation (p-value=.000) in rise of levels of CA-125 and Interleukin-6 levels in patients with benign and malignant ovarian lesion.
Conclusion: Our study of 40 ovarian lesions at a Index Medical College Hospital and Research Centre, Indore aimed to find out the serological correlation of CA 125 and Intetleukin-6 as diagnostic marker in patient with ovarian mass lesion and it’s histopathological correlation. The results of present study are comparable to other series of studies regarding levels of these serological markers with histopathological type gross features and microscopy.
Keywords: Serum Levels, CA-125, IL-6 & Clinical & Outcome.
Background: Diabetes mellitus comprises a group of common metabolic disorders where increased fibrinogen levels can act as a thrombogenic factor. Diabetic patients have higher cardiovascular morbidity than non-diabetic subjects. Several studies have shown that haemostatic factor especially hyperfibrinogenemia is implicated as a source of atherosclerosis and its complications. Methods: A comparative observational study was conducted to compare fibrinogen levels between type 2 diabetes patients and healthy controls. Their fibrinogen levels were compared and co-related with glycemic status and other risk factors and parameters like glycosylated haemoglobin, age, sex, smoking, body mass index (kg/m 2 ), hypertension and ischemic heart disease. Results: It was seen that in the diabetic subset, the plasma fibrinogen levels are significantly higher than the non-diabetic subset (386.04±132.87 vs. 314.38±97.42; p<0.001). Our study re-established correlation between HbA1c and fibrinogen levels of the diabetic patient is positive i.e., poorer the glycemic status, higher the fibrinogen levels (r=0.24). Conclusions: It can be concluded from the study that fibrinogen levels are increased in type 2 diabetic subjects with and without CHD. Plasma fibrinogen levels usually increased in type 2 diabetes, thus suggesting that hyperfibrinogenemia could contribute to the excess cardiovascular morbidity and mortality in this disease.
<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Hip fractures in older patients are associated with impaired mobility, excess morbidity and mortality, and loss of independence. This study was aimed at evaluating the outcome of hemiarthroplasty, by assessing the quality of life and degree of function in the operated limb.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">Out of 30 patients treated in this manner, all cases were available for follow-up period of 6 months. Patients of age 60 years and above, diagnosed with fracture neck of femur, were included in the study</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Majority of patients belongs to age group 60-69 years was 56.7% Females were more common 56.7% than males in the present study. About 13.3% patients sustained the injury due to a fall from a height and 23.3% due to a road traffic accident. About 20 patients (60%) had a stay of less than 20 days in hospital. In our study Harris hip score, at end of six month ranged from 35 to 94.6. At final 6 months follow-up by Harris hip scoring system, 53.33% had excellent result, 33.3% had good results, 16.67% had fair results and 6.67% had poor results. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">We conclude that hemiarthroplasty for fracture neck of femur is a good option in elderly patients. The mortality and morbidity are not high, operative procedure is simple, complications are less disabling. Early functional results are satisfactory.</span></p>
<p class="abstract"><strong>Background:</strong> Several techniques are available to minimize the likelihood of blood transfusion following total knee arthroplasty. Tranexamic acid, an inhibitor of fibrinolysis that blocks the lysine-binding site of plasminogen to fibrin has been reported to reduce intraoperative and postoperative blood loss in patients undergoing total hip and total knee arthroplasties with or without cement. The objective of this study was to assess the efficacy of antifibrinolytic treatment along with other measures like saline adrenaline infusion, no drain, no tourniquet and hypotensive anaesthesia in reducing perioperative blood loss during total knee replacement<span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> Between January 2011 to January 2016, seventy five consecutive patients who had given written informed consent, undergoing a TKR received tranexamic acid 15 mg/kg body weight intravenous 5 minutes before the skin incision and two doses afterwards (3 and 6 hours after the first dose respectively). TKR was performed in a routine fashion without tourniquet. The saline adrenaline (1:200000) was infiltrated into the skin subcutaneous tissue and capsule before skin incision. A routine closure was carried out without drain. Total blood loss including the hidden blood loss was calculated. All patients were monitored for anemia and postoperative thromboembolic complications.<strong></strong></p><p class="abstract"><strong>Results:</strong> The average total blood loss in study group is 433 ± 148 ml. This is much lesser than what other studies have reported. Mean reduction in hemoglobin levels (gm/dl) between preoperative and postoperative readings is 1.6 gm/dl. One patient had a postoperative DVT which was treated with rivaroxaban 20 mg OD for 6 weeks (oral anticoagulant)<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> Antifibrinolytic agents like tranexamic acid used along with other measures reported in this study produces a significant decrease in blood loss in patients undergoing total knee replacement<span lang="EN-IN">.</span></p>
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