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Yadav, S.
- Risk Factors and Outcome of Patients with Diabetic Foot Ulcers
Authors
1 Dept of Medicine, 1st floor college building LTMGH, Sion, Mumbai, IN
2 SMO, Dept of Medicine, LTMGH, Sion, IN
3 Dept of Medicine, LTMGH, Sion, IN
Source
The Indian Practitioner, Vol 68, No 11 (2015), Pagination: 20-25Abstract
Background and objective
Diabetic foot ulcers result from a combination of vasculopathy, neuropathy and infections. The present study was aimed at identifying the demographics, clinical and biochemical risk factors for development of foot ulcer in diabetic subjects and their association with the macro and micro-vascular complications of Diabetes.The outcomes with respect to healing and requirement of amputation were also studied.
Methods
This was a cross sectional study conducted at a charitable tertiary care centre over a period of 18 months. Patients witha diabetic foot ulcer that had not healed for more than 14 days (n=106) were included in the study. Diabetic patients with pressure sores (bed ridden patients) and with major trauma causing ulcers were excluded from the study. Patients who failed to follow up were also excluded from the analysis. All patients were initially examined in detail clinically and evaluated for micro and macro vascular complications of diabetes and followed up for wound outcomes.
Results
In this study, diabetic foot ulcers were found in the 5th decade and men were affected more often than women. Ischemic heart disease and Cerebro-vascular accidents were present in 36.7% and 18.9 % and Retinopathy and Nephropathy were present in 19.8 % and 43.4% patients respectively. Deep, infected ulcers were associated with increased incidence of non-healing, greater number of amputations and higher mortality. The highest mortality (53.8%) was seen in smokers and alcoholics. Increased WBC count, raised creatinine, proteinurea and high HbA1c were associated with amputations and mortality. On Binary multiple logistic regression analysis it was found that duration of diabetes, stage of diabetic ulcer, diabetic nephropathy and diabetic retinopathy were independent predictors of ulcer healing and mortality.
- A Study of Lipid Profile and Antioxidant Capacity in Pregnancy Induced Hypertension
Authors
1 Department of Obstetrics and Gynaecology, M.G.M. Medical College, Indore, Madhya Pradesh, IN
Source
The Indian Practitioner, Vol 69, No 1 (2016), Pagination: 30-35Abstract
Objectives: (1) To evaluate the relationship between different fractions of serum lipid and subtypes of PIH. (2) Assessing consumption of antioxidants due to increased lipid peroxidation in pregnancy induced hypertension that may contribute to atherogenicity and pathogenesis in pregnancy induced hypertension.
Design and setting: This was a prospective study, conducted between October 2012 and December 2012 in the department of obstetrics and gynaecology- MGM Medical College and associated M.Y. Hospital.
Method and material: This study was carried out on 250 patients, divided in four groups: (a) gestational hypertension, (b) pre-eclampsia, (c) eclampsia and (d) normotensive pregnant women (controls). Blood samples were collected from all patients and analysed enzymatically for serum cholesterol, triglycerides, and VLDL, LDL, HDL and spectrophotometric antioxidant capacity.
Statistical analysis used: Statistical analysis done with SPSS-17 programme, variables were described first than compared between three groups using ANNOVA test. A p-value < 0 .05 was considered significant.
Results: In our study, level of serum cholesterol, triglyceride, low density lipoproteins and very low density lipoproteins were significantly higher in all subgroups of PIH as compared to normotensive pregnant patients. Antioxidant capacity was also significantly low in PIH patients compared to normotensive pregnant patients.
Conclusion: Significant difference in the level of lipids and antioxidant capacity between PIH and normotensive pregnant patients suggests that lipid metabolism and lipid peroxidation play key role in pathophysiology of PIH.
Keywords
Pregnancy Induced Hypertension (PIH), VLDL (Very Low Density Lipoproteins), LDL (Low Density Lipoproteins), HDL (High Density Lipoproteins), Antioxidant Capacity.- Correlation of Histopathological and Anatomical Changes in Placenta with Intrauterine Growth Restriction
Authors
1 Dept. of Obs and Gynae, MGM Medical College, Indore, Madhya Pradesh, IN
Source
The Indian Practitioner, Vol 69, No 5 (2016), Pagination: 30-37Abstract
Background: Placenta is a vital organ for maintaining pregnancy and promoting normal growth by transfer of essential nutrients between foetus and mother. Any morphological alteration of the placenta affects the growth of foetus leading to intrauterine growth restriction (IUGR). The purpose of this study was to find out morphological and histopathological changes of placenta and to evaluate correlation of IUGR and placental histology.Material and Methods: This study included 200 pregnant patients whose foetuses had intrauterine growth restriction and 200 patients with normal foetal growth. Gross and histopathological features of placentas of both groups were studied, analysed by student's t test and compared with chi square test. p values of < 0.05 were considered significant.
Results: Gross features, weight, thickness and calcification in study group show significant increase in value (p < 0.05) compared to control group and histopathology of placenta in study group also shows significant increase in syncytial knots formation, cytotrophoblastic proliferation, stromal fibrosis and calcification as compared to control group.
Conclusion: To conclude, whatever may be the cause of IUGR, these morphological and histopathological changes lead to decrease blood to the placenta and this restriction of blood flow ultimately causes IUGR in the foetus.
Keywords
Placenta, IUGR, Syncytial Knot, Cytotrophoblastic Proliferation.References
- Kaur P, Kaushal S, Singh K, Sharma A. Placental weight, birth weight and fetal outcome in preeclampsia and normotensive pregnancy. IJPAES. 2013;3(4):30-34
- Arias F. Practical guide to high risk pregnancy and delivery. 2008;3/e :99-100
- Dhabhai P, Gupta G. Placental weight and surface area in iugr cases. Innovative Journal of Medical and Health Sciences. 2014;4(6):198-200.
- Aherne W, Dunnill MS. Quantitative aspects of placental structure. J Pathol Bacteriol. 1966; 91(1):123-39
- Cetin I, Alvino G.Intrauterine Growth Restriction: Implications for placental metabolism and transport-A review Placenta.2009;(30):77-82
- Althshuler G, Russell P, Ermochilla R. The placental pathology of small for gestational age infants. Am J Obs Gynecol. 1975;121:351-59
- Nigam JS, Mishra V, Singh P, Singh A, Chauhan S, Thakur B.Histological study of placenta in low birth baby in india.2014;4(8):79-83.
- Hemlata M, Pani Kumar M, Jankai M, Dudala SR. Histopathological evaluation of placentas in IUGR pregnancies. Asian Pac J. Health Sci. 2014;1(4):566-569.
- Kotgirwar S, Ambiye M,Athavale S,Gupta V, Trivedi S. Study of Gross and Histological features of placenta in intrauterine growth retardation. J. Anat. Soc. India2011; 60(1) :37-40
- Biswas S, Ghosh SK. Gross morphological changes of placentas associated with intrauterine growth restriction of fetuses: a case-control study. Early Human Develop. 2008;84(6):357-62.
- Meeejus G. Influence of placental size and gross abnormalities on intrauterinegrowth retardation in high-risk pregnancies. Acta Medical lituanica. 2005;12 (2):14–19 12. Barker DPJ. Fetal growth restriction: A workshop report. Clin Sci. 1998:95;115-128.
- Correlation of Histopathological and Anatomical Changes in Placenta of Intrauterine Growth Restriction (I.U.G.R)
Authors
1 Dept of Obstetrics And Gynaecology, M.G.M. Medical College, Indore, Madhya Pradesh, IN
2 Department of Obstetrics And Gynaecology, M.G.M. Medical College, Indore, Madhya Pradesh, IN
Source
The Indian Practitioner, Vol 69, No 8 (2016), Pagination: 19-24Abstract
Background: Placenta is a vital organ for maintaining pregnancy and promoting normal growth by transfer of essential nutrients between fetus and mother. Any morphological alteration of placenta affects the growth of fetus leads to intrauterine growth restriction.
Material and methods: This study was conducted in 200 patients with IUGR and 200 normal patients. Gross and histopathological features of placentas of both groups are studied, analysed by student t test and compared with chi square test. p value<.05 was considered significant.
Results: Gross features weight, thickness and calcification in study show significant increase in value(p<0.05) compared to control group and histopathology of placenta also show significant increase in syncytial knots formation, cytotrophoblastic proliferation, stromal fibrosis and calcification in comparison to control group.
Conclusion: To conclude these morphological and histopathological findings of placenta are the etiological bases of I.U.G.R.
Keywords
Placenta, I.U.G.R., Syncytial Knot, Cytotrophoblastic Proliferation.References
- Prabhjot Kaur, Subhash Kaushal, Kuljit Singh and Ashish Sharma. Placental weight, birth weight and fetal outcome in preeclampsia and normotensive pregnancy. International journal of plants animal and environmental sciences Oct-Dec2013; 3(4):30-34
- Fernando Arias. Practical guide to high risk pregnancy and delivary. 2008;3/e :99-100
- Pooja Dhabha, Ghanshyam Gupta. Placental weight and surface area in iugr cases. Innovative journal of medical and health sciences. nov-dec 2014; 4-6: 198200.
- Aherne W, Dunnill MS. Quantitative aspects of placental structure. J Pathol Bacteriol 1966 Jan;91(1):123-39
- Cetin I, Alvino G. Intrauterine Growth Restriction: Implications for placental metabolism and transport-A review Placenta.2009;(30):77-82
- Althshuler G, Russell P, Ermochilla R.The placental pathology of small for gestational age infants. Am J obstet. Gynecol.1975; 121: 351-59
- J S Nigam, V Mishra, P Singh, P A singh, S Chauhan, B Thakur. Histological study of placenta in low birth baby in india.2014;4(8):79-83.
- Hemlata M, Pani Kumar M, Jankai M, Shankar Raddy Dudala. histopathological evaluation of placentas in IUGR pregnancies. Asian Pac J. Health Sci 2014;1(4):566-569.
- S Kotgirwar, M Ambiye, S Athavale,V Gupta, S Trivedi. Study of Gross and Histological features of placenta in intrauterine growth retardation. J. Anat. Soc. India2011; 60(1) :37-40
- Biswas S, Ghosh SK. Gross morphological changes of placentas associated with intrauterine growth restriction of fetuses: a case-control study. Early Human Develop 2008 jun; 84(6): 357-62.
- Gediminas Meèëjus. Influence of placental size and gross abnormalities on intrauterine growth retardation in high-risk pregnancies. Acta medica lituanica. 2005; 12 (2): p. 14–19
- Barker DPJ. Fetal growth restriction: A workshop report. Clin sci 1998: 95; 115-128
- Invasive Fungal Infections in Diabetes Mellitus
Authors
1 Dept of Medicine, 1st Floor College Building, LTMGH, Sion, Mumbai, IN
2 LTMGH, Sion, Mumbai, IN
3 Department of Medicine, LTMGH, Sion, Mumbai, IN
Source
The Indian Practitioner, Vol 69, No 7 (2016), Pagination: 17-22Abstract
Background and objective: Invasive fungal infections (IFI) are increasingly diagnosed in the immunocompromised patients due to improved diagnostic modalities. Major risk factors for IFI are diabetes mellitus, HIV infection, neutropenia, prolonged use of corticosteroids; recipients of bone marrow or solid organ transplant, haematological malignancies and inherited immunodeficiency disorders. In systemic fungal infections the outcome of the disease depends more on the host factors rather than the fungal virulence. Zygomycosis (Mucor) is the most lethal opportunistic fungal infection particularly among patients with diabetes mellitus and haematological malignancies. Rhino cerebral zygomycosis most common and fulminant type of zygomycosis leads to fatal consequences within a week of onset. Diagnosis of fungal infection include routine microscopy, cultures and advanced serological methods. Management of fungal infections depending on the type of infection and aetiologic agents. Antifungal agents have varying spectrum of activity, dosing, safety profiles and costs. Common antifungal agents used are polyene (AmphotericinB), Azole (Fluconazole, Itraconazole, and Voriconazole etc), Echinocandins (caspofungin, anidulafungin etc). Along with antifungal drugs treatment of co-morbid disease is important for better outcomes.
Methods: This was a prospective observational study performed in hospitalised patients. Patients hospitalised with suspected fungal infection or the patients hospitalised for any illness and suspected to have fungal illness during course of stay were screened and worked up in detail for fungal aetiology. Radiologicaly suspected fungal infection cases were worked up and specific samples collected for microbiology. Patient who were diagnosed to have definitive invasive fungal disease were included in the study.
Results: In present study 34 patients of conformed IFI were included and observed. 15 patients were diabetic with IFI. Male patients 19(55.9%) in age group12 to 70 years with the average age being 47.15 years were predominantly affected. Most common risk factor in the present study was diabetes mellitus which was noted in 15 out of 34 cases(44.11%). Mucor is commonest fungus in diabetic patients(60%) followed by aspergillus (26.66%).Naso-orbital infection was most common site of affection. Mortality was 46.7% in diabetic patients with fungal infections. Better outcomes observed in patients treated with combined medical and surgical treatment (64.3%) than medical treatment 45% alone.
References
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- Chander J. Chapter 24;Aspergillosis,Textbook of Medical Mycol.3rd edition, Mehta publishers. 2012, 345-49.
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- Purple Urine Bag Syndrome:An Uncommon Case Presentation
Authors
1 Pt. B.D. Sharma University of Health Sciences, ROHTAK-124001 (Haryana), IN
2 Department of Gyane and Obstetrics, Pt. B.D. Sharma University of Health Sciences, ROHTAK-124001 (Haryana), IN
3 Dept. of Medicine, PGIMS, Rohtak-124001 (Haryana), IN
4 Department of Medicine, Pt. B.D. Sharma University of Health Sciences, ROHTAK-124001 (Haryana), IN
Source
The Indian Practitioner, Vol 69, No 10 (2016), Pagination: 29-31Abstract
Purple urine bag syndrome (PUBS) is a rare condition indicating the presence of UTI characterized by intense purple discoloration of the urine. Although typically benign, purple urine is alarming to patients. This article presents the case of a chronically debilitated female patient whose urine became purple in the due course of hospital admission with indwelling urinary catheter in situ. The case report includes brief summary of PUBS, including its documented risk factors, the chemical chain reaction involved in producing purple urine, and how healthcare providers should treat patients when PUBS is encountered.Keywords
Purple Urine Bag Syndrome, Urinary Tract Infections, Chronic Catheterization.References
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