International Archives of Integrated Medicine

8-17

Authors: Punam Kumari Jha, Nalin Chaudhary

Background: Parkinson’s disease (PD) is the second most common neurodegenerative disorder, commonly found in males above the age of 60. Increased life expectancy due to better health care and aging population will see a proportional rise in case of PD in India during next three decades making it a major health problem. Objective: There was no published epidemiological study on PD from south-central India. Hence, a longitudinal study was undertaken by a neurocenter from 2004-2015. Materials and methods: 382 patients with symptoms of PD presented to outpatient department of neurocenter between 2004-2015 were evaluated in relation with various epidemiological parameters. Results: Out of 382 subjects having clinical PD, it was found to be more common in males and in patients above the age of 60 with rural habitation. Conclusion: The present study documents the epidemiological data of PD from south-central India called Deccan plateau (Telangana state). It represents varied geographical, social, economic, cultural ethnicity among rural/urban population. There is low literacy rate, predominant rural population and insufficient health infrastructure where PD poses an invisible but major health problem for policy makers.

23-32

Authors: Shafia Sarfi, Neerja Sharma, Ekta Garg, Dildeep Bali

Background: It won’t be wrong to admit that composite resins are currently the back bone of aesthetic and conservative dentistry. However a major drawback of composite resins is that their setting reaction involves formation of polymer chains leading to polymerization shrinkage. Aim: To compare microleakage in silorane composite using oblique, vertical and horizontal layering techniques to microleakage of nanofilled composite using oblique, vertical and horizontal layering techniques. Materials and methods: 120 extracted maxillary premolar teeth were assigned to 2 groups based on the material used Group A nanocomposite and Group B-silorane and each group was divided further into 3 subgroups depending on incremental technique used for restoration into horizontal, oblique and vertical (sub groups A1, A2, A3, B1, B2 and B3). A Class 1 cavity measuring 3mm3mm2mm was prepared in all the teeth. In group A teeth Clearfil TMSE Bond (Kurary Medical inc. Okayama, Japan) was applied. Group A teeth were filled with FiltekTM Z350 XT (nanocomposite) (3M ESPE, St Paul, USA) using horizontal (A1), oblique (A2) and vertical (A3) incremental layering technique and each increment was cured for 30 seconds. In Group B teeth P90 system adhesive was applied and teeth were filled with FiltekTM P90 silorane (3M ESPE, St. Paul, USA) using horizontal (B1), oblique (B2) and vertical (B3) incremental layering technique. Specimens were thermocycled for 1000 cycles (5/55ºC, 30 seconds) and immersed in 2% methylene blue dye for 24 hours. Following immersion teeth were sectioned and observed under a stereomicroscope. Results were analysed using Kruskal-Wallis test followed by Mann Whitney U test. Results: Siloranes showed significantaly less microleakage than nanofilled composites. The difference between the horizontal group, oblique group and the vertical group was found to be statistically non-significant (P value >0.05) but mean microleakage was more in vertical group compared to oblique and horizontal group. Conclusion: Within the limitations of this study, we found that Siloranes exhibit significantly less microleakage as compared to nanofilled composites irrespective of the layering technique used.

39-44

Authors: Allanki Suneetha Devi, Jalem Anuradha

Background: Polycystic Ovarian Syndrome (PCOS) is a heterogenous collection of symptoms and signs, which form a spectrum of a disorder with a mild presentation and severe disturbance of reproductive, endocrine and metabolic function. Aim: To compare between metformin and Pioglitazone in treating polycystic ovarian syndrome. Materials and methods: This was a double blinded, randomized comparative study conducted at Government hospital Nizamabad and CKM Hospital, Warangal. 150 PCOS patients in the age group 18-35 years were enrolled, and were allocated to two groups and were given the following modalities for a period of 8 months. Group I: Metformin-500 mg, BID, Group II: Pioglitazone-15 OD. Each group consisted of 75 patients. The minimum sample size required was 50-60. In this study, 75 patients were included in each group to allow dropouts. Oligo or anovulation, hyperandrogenism, polycystic ovaries were included. Results: In group I, 68 (90%) out of 75 patients and in group II, 67(89%) out of 75 patients completed the trial. In group I, all the 68 patients had irregular menstrual cycles at the beginning of the study, and at the end of the study, 34 (47%) had regular menstrual cycles. In group II, 67 patients had irregular menstrual cycles at the beginning of the study, and at the end of the study, 38 (56%) had regular menstrual cycles. In both the groups, there was an increase in HDL levels (statistically significant versus baseline), more in Group II than in Group I. The average increase is 28 % in Group I as compared to 74 % in Group II. There is a trend of decrease in VLDL levels in both groups, the decrease being more in Group II (48 %) than in Group I (26 %) statistically significant when both groups were compared. In both the groups, there was a rise in SHBG, (statistically significant versus baseline). In Group I, the mean increase in SHBG was 6.22 nmol/l (22 %), but in Group II, mean rise in SHBG was more, i.e.34.56 nmol/l (72.7 %) and this difference is statistically significant (P<0.05). Both the Groups showed a decrease in LH/FSH ratio. The fall in LH/FSH ratio was more in Group II, than in Group I. This fall in Group II was statistically significant P<0.05 versus Group I. Conclusion: Pioglitazone can restore menstrual cycle, a better ovulatory rate is achieved, clinical signs of hyperandrogenism are improved, and type 2 diabetes is prevented or delayed, so pioglitazone is a better treatment in patients with PCOS.

56-60

Authors: Mishra A, Sharma RL

The authors had attempted to understand the pattern of Dermatosis coming to the skin OPD of Central referral Hospital, SMIMS, Gangtok. Out of 8630 Patients included in our study, 51.8% were female patients with female male ratio of 1.07:1. Majority of the patients (29.24%) was from the age group 21-30 years followed by age group of 31-40 years (18.96%). Eczema and allergic disorder constituted the maximum number of the cases (21.14%), followed by Fungal Infections (16.5%). The skin infections of viral and bacterial aetiology constituted 11.76% and 4.45% respectively. The pigmentary disorders comprised of 8.7%. Other pattern of skin diseases in a decreasing order as observed were Acne (6.62%), Alopecia (5.9%), Parasitic infestations (5.09%) Photodermatoses (4.6%), papulosquamous disorder (4.27%), vesiculobullous disorders (0.6%), Autoimmune diseases (0.35%) and malignancy (0.04%).

67-73

Authors: Bhagat B, Jha D

Background: The birth weight of an infant is the most important determinant of its chance of survival health growth and development. The prevalence of low birth weight (LBW) is higher in Asia than elsewhere. Low birth weight is a major determinant of mortality, morbidity and disability in infancy and childhood and has a long term impact on health outcomes in adult life. Objective: The purpose of this study was to assess the relationship between maternal hemoglobin concentration with neonatal birth weight. Material and methods: The maternal Hb concentration and birth weight parameters were obtain randomly in 100 women delivered from the Department of Obstetrics and Gynecology, Central Referral Hospital, Tadong 5th mile Sikkim. Out of 100 cases, 35 cases were maternal Hb (<10 gm%), 35 were maternal Hb (10-13 gm%) and 30 were maternal Hb (>13 gm%) and all the maternal age ranging from 20-45 years. All data analysis was done using SPSS V 16 statistical software. The data were presented mean ± SD, and statistical analysis was carried out using student-T test. Results: Analysis of the data shows that anemia (Hb< 10 g/dl) was associated with a significantly increase risk of low birth weight (< 2500 g) and even same for high maternal hemoglobin (> 13 g/dl). The minimum incidence of low birth weight occurs in association with maternal hemoglobin concentration of 10-13 g/dl. Conclusion: Maternal Hb concentration of 10-13gm% should be regarded as optimal for fetal growth and well-being associated with the lowest risk of low birth weight.

83-88

Authors: Kota Ramesh, M. Ramulu

Background: Human immunodeficiency virus (HIV) constitutes one of the most difficult challenges facing the healthcare profession today. A few studies showed the CD4 count to be a weak surrogate end point of clinical outcome in HIV infected patients, while three studies found that low CD4 count was a predictor of a poor outcome. There is no conclusive evidence regarding the association between CD4 counts, CD8 counts and wound healing in HIV infected patients. Materials and methods: This was a prospective study of 50 consecutive patients who were HIV positive and underwent emergency surgery at Gandhi Hospital from July 2013 to August 2015. Results: Out of the 50 patients surgical wounds of 13 patients were infected. Wounds of 37 patients were healthy. Of the 13 patients infected 7 patients had CD4 count less than 200 and 6 patients had CD4 count more than 200.Out of the 37 patients whose wounds were healthy 16 patients had CD4counts less than 200 and 21 patients had more than 200. Out of the 37 patients whose wounds were healthy 16 patients had CD4counts less than 200 and 21 patients had more than 200. Of the 13 patients infected 7 patients had CD4 count less than 200 and 6 patients had CD4 count more than 200. Conclusion: CD4 count does not correlate with healing of wound and severity of wound complication as test of significance is not proved. CD8 count has some correlation with wound healing but does not correlate with severity of wound complication. CD4 or CD8 count does not correlate with type of wound complication. CD4/CD8 ratio cannot be taken as a predictor of wound complication and assessing its severity.

105-110

Authors: Sanjay Kumar, Ruchi Ratnesh, Nafees Fatima, Md. Jawed Akhtar, Vinod Kumar

Background: Radius is the lateral bone of forearm. It has anterior, interosseus and posterior surface. Anterior surface bears a nutrient canal at the upper end transmitting nutrient artery. Nutrient artery is the major source of blood supply of long bones mainly during growing period and early phase of ossification. Aim and objectives: Nutrient foramina is essential for nutrition and growth for long bones and also for survival of osteocytes in some procedures such as bone graft, tumor resection, congenital pseudo-arthrosis, trauma and transplant techniques in orthopaedics. Study of nutrient foramina is important not only in academic purpose but also useful in medico-legal cases in relation to their position. Materials and methods: Present study was conducted in the department of Anatomy, Indira Gandhi Institute of Medical Sciences, Patna, Bihar. 110 dry adult and macerated human radii were selected for study. Results: In this study, out of 110 radii, 108 radii had single foramina and 2 radii had double nutrient foramina. Foraminal index was calculated which indicating nutrient foramina was near to the upper end. Conclusion: Nutrient foramen in radius was near to the upper end, so the lower end of radius is the growing end.

118-121

Authors: Ruchi Ratnesh, Sanjay Kumar, Nafees Fatima, Md. Jawed Akhtar, Vinod Kumar

Background: Dissection of human cadavers has been central part of medical education since renaissance. Dissection has also been labelled as the royal road and cadaver as the first patient. First year medical students when encounter human cadavers for first time, faces a variety of emotional reactions and mixed feeling. Aim and objectives: For the assessment of impact of anxiety and physical symptoms from the experience of dissection hall, we prepared questionnaires to see whether emotional stress can be diminished and obsereved changes in feeling and attitude in first year medical students. Materials and methods: The present study was conducted on 180 first year medical students over 2 years (Batch 2013 and 2014) at Darbhanga medical college, Laheriasarai, Bihar, India. All the students were given 3 sets of questionnaire. The students were asked the answer in either yes or no. Results: The difference in the rate of anxiety initially and 3 months later was significant. Conclusion: For improving the attitude of the students towards cadaveric dissection there must be better teacher-students interaction which in turn will help in improving their mental status to handle the highest level of stress in clinical carrier.

126-130

Authors: Jyoti Kumar Dinkar, Naresh Kumar, Chandrakishore

Background: Enteric fever (Typhoid fever) is a common systemic infectious disease worldwide, especially in developing countries like India and continues to be one of the leading causes of morbidity and mortality. It is caused by the bacterium Salmonella typhi or Salmonella paratyphi serotypes A, B and C. The clinical diagnosis of Enteric fever traditionally depends on Blood culture and Widal tests. However limitations such as longer time for Blood culture results and difficulties in the interpretation of Widal tests make them unpractical for screening patients in endemic regions and lead to misdiagnosis and missed diagnosis. Aim and objectives: Purpose of the study was to compare the sensitivity and specificity of Widal test and Typhidot based IgM and IgG assay with the Blood culture (taken as gold standard) in the diagnosis of Enteric fever. Materials and methods: This comparative study was done on 120 patients in the General Medicine Department of Indira Gandhi Institute of Medical Sciences, Patna. All patients above 11 years of age of either sex with acute febrile illness suspected to have Enteric fever were included in this study. Febrile patients with other diagnosis were excluded. Blood culture, Widal test, Typhidot (IgM and IgG) test and other routine investigations were performed in all patients. Typhidot tests and Widal tests were compared for sensitivity and specificity. Results: Out of 120 clinically diagnosed cases of Enteric fever, 18(15%) patients were Blood culture positive for Salmonella typhi, 27(22.5%) patients were positive on Widal tests and 36(30%) were Typhidot positive. Out of 18 Blood culture positive patients for Salmonella typhi, 10 patients were positive and 8 were negative on Widal testing. Out of 36 Typhidot positive patients 16 patients were positive and 20 were negative on Blood culture. Conclusions: Traditionally Blood culture and Widal test are used in the diagnosis of Enteric fever. However Typhidot (IgM & IgG assay) tests are simple and rapid screening tests that simultaneously detect and differentiate between IgM and IgG antibody to Salmonella typhi and paratyphi produced in response to infection, thus aiding in determination of current or previous exposure. It offers the advantage of early and rapid diagnosis and helps in early institution of therapy. Preliminary data have shown sensitivity and specificity of 95% and 86% respectively of Typhidot tests.

139-143

Authors: Chelliah Dharmaraj, Sigamani Saranya, Hibu Juli

Background: Ascites is defined as the collection of excessive amount of free fluid within the peritoneal cavity. For the purpose of lubrication normally at least 50 ml of free fluid is present in the peritoneal cavity. Objectives: This study was done to investigate the level of efficiency of various conventional parameters in differentiating cirrhotic ascites from malignancy related ascites and to propose serum ascites cholesterol gradient as a new diagnostic parameter. Materials and methods: This study was conducted among 100 patients of both sexes who have clinically significant ascites admitted in the wards of General medicine, Medical Gastroenterology and medical oncology in Govt. Rajaji Hospital, Madurai. Age group of 20-60 years of both sexes were included. Results: The mean (±SD) of ascitic fluid cholesterol concentration for cirrhosis group was 56.4 mg% (±7.76) and that for MRA group is 76.26 mg% (±8.27). The p value was <0.001 which was significant. The mean (±SD) of serum ascites cholesterol gradient (SACG) for cirrhosis group was 67.52 (±4.46) and that for MRA group was 60.16 (±3.38). The p value was <0.001 which was significant. The MRA group has low SACG compared to patients with cirrhosis. SACG has shown high specificity in this study which supports the findings of other similar studies. Conclusion: This study has shown that conventional parameters like ascitic fluid total protein, ascitic fluid albumin, serum ascites albumin gradient are still good at differentiating cirrhotic ascites from malignancy related ascites. SACG with a cut off level of 62.5 mg% has shown to be a better marker in terms of diagnostic accuracy to differentiate MRA from cirrhotic ascites. Thus ascitic fluid cholesterol level and SACG has been proposed as a new diagnostic marker which are more reliable and cost effective to differentiate MRA from cirrhotic ascites.

151-160

Authors: Khara R, Lakhani SJ, Vasava S

Background: Sepsis is a global problem causing substantial morbidity and mortality to the patients afflicted with it. Moreover sepsis due to fungal infections, especially, the Candida infections has increased in the recent times due to increase in patients with immunocompromised conditions. They are the normal commensal of the oral cavity, GIT and the mucosal surfaces in the body as well as the pathogens leading to colonization and also infection. Though Candida albicans is the most commonly isolated fungal pathogen from clinical samples, gradually non-albicans Candida species are becoming predominant pathogens. The increased use of anti-fungal agents for treatment and also for prophylaxis especially in ICU patients has lead to development of resistance against commonly used anti-fungal agents in the treatment like various azoles. Thus this study was carried out to identify different Candida species from specimens of clinically diagnosed sepsis patients and their antifungal susceptibility pattern which can be utilized for better management of sepsis patients. Objectives: The objectives of this study were to isolate and identify the species of Candida from different samples of clinically diagnosed sepsis patients and to determine the susceptibility pattern of the Candida species isolates against the commonly used anti-fungal agents from the clinical samples of sepsis patients from a rural based tertiary care and teaching hospital. Materials and methods: A total of 100 Candida species were isolated from different samples of clinically diagnosed sepsis patients. These were identified on the basis of gram stain of the samples, colony morphology on Saboraud’s Dextrose agar and HiCrome also germ tube and chlamydospore formation. The antifungal susceptibility testing was done according to CLSI M44-A2 for yeasts. Results: A total of 100 (14.26%) Candida species were isolated out of the total 701 isolates from 1136 different samples cultured from clinically diagnosed sepsis patients. Of these, 53% were C. albicans, 37% C. non-albicans, 6% C. glabrata and 4% C. tropicalis. Also 35% were obtained from blood, 20% from catheterized urine, 19% from sputum, 14% from non-catheterized urine, 7% from ET (Endotracheal) tips/secretions and the smaller percentage from other specimens. The antifungal testing showed a higher resistance to most of the antifungal agents tested with 80% towards clotrimazole, 77% to ketoconazole and 63% to fluconazole and 62% towards itraconazole. However, 80% of Candida species were susceptible to amphotericin B followed by 33% to fluconazole and 80% were susceptible-dose-dependent to nystatin. Conclusion: The findings of our study suggest that Candida species are an important pathogen causing various infections in our patients leading to sepsis as well as a higher resistance to most of the antifungal agents tested poses a real challenge in the management of patients with sepsis due to Candida. Thus routine identification using HiCrome Media and antifungal susceptibility testing by disc diffusion method for yeasts will help in better management of sepsis due to Candida infections.

167-172

Authors: Murugan, Sathvika

Introduction: Hypertension is one of the leading causes of death and disability among adults all over the world. It remains the major risk factor for coronary, cerebral and peripheral vascular disease. Essential hypertension comprises more than 90% of hypertension. Hypertension is an emerging health problem in India. When majority of people come to know that they have hypertension they have already advanced into a stage with target organ damage – a fatal stroke or myocardial infarction or irreversible renal failure. Unfortunately even in developed countries like United States, fifty million people are found to have hypertension. Of these, 70% are aware of their diagnosis, but only 50% are receiving treatment and only 25% are under control. Aim of the Study: To study the levels of sodium and potassium in patients with primary hypertension. To correlate the sodium and potassium levels with blood pressure. Materials and methods: Seventy newly diagnosed essential hypertensive patients attending the medicine OPD or admitted to the medical wards of Govt. Dharmapuri Medical College Hospital, Dharmapuri for the period of one year from June 2016 to May 2017 formed the study group. Thirty healthy people were kept as controls. This control group comprised of normotensive individuals who were attendants of patients with primary hypertension living in the same environment other than their own siblings. Results: The mean systolic and diastolic blood pressure distribution for the males was 172.63 ± 16.71 mm Hg and 103.42 ± 7.08 mm Hg respectively. Similarly for the females the mean systolic and diastolic blood pressure distribution was 171.56 ± 13.22 mm Hg and 103.13 ± 4.71 mm Hg respectively. There was no statistical significance in the systolic and diastolic blood pressure among the cases. Conclusion: Serum sodium was significantly more among hypertensives and it was independent of associated risk factors and gender. Serum sodium level was also correlated positively with the level of blood pressure. Serum potassium was significantly less among hypertensive and it correlated negatively with blood pressure.

179-185

Authors: M. Selvaraj, G. Kannan

Introduction: Cardiovascular disease is the leading cause of death in global deaths and accounts for 17 million people worldwide. Despite the favorable changes in the risk factors, new risk factors have emerged. These include abdominal obesity and physical inactivity, both of which are considered independent and mediating factors in the development of cardiovascular disease. They are also associated with type 2 Diabetes and Metabolic syndrome, growing health hazards all over the world and the major risk factors for cardiovascular disease. Aim of The Study: To determine the associations of Waist circumference and Waist Hip ratio with the risk of incident cardiovascular events and to determine the strength of association of waist and waist hip ratio with cardiovascular risk is different. Materials and methods: A total of 98 cases (49 Cases and 49 Controls) were selected. Newly diagnosed consecutive cases of myocardial infarction admitted to the department to the department of cardiology were enrolled into the study after obtaining consent. These patients were subjected to anthropometric measurements namely waist hip ratio, weight height, skin fold thickness and Lipid profile was done. Results: Both the groups were matched for age, sex and risk factors other than the one studied, namely smoking, alcoholism, diabetes, hypertension, family history. There was no statistical difference is noted between the two groups in age, sex, smoking, alcoholism, Hypertension, Diabetes, Family History. In all these parameters compared between these groups the P value was more than 0.05 which was statistically insignificant. Conclusion: BMI does not properly define obesity and the risk of cardiovascular events. BMI can be normal in a patient with cardiovascular disease. Abdominal obesity is an independent risk factor for coronary heart disease. Waist hip ratio and waist circumference are better indicators of the cardiovascular risk in a given individual than BMI.

191-195

Authors: A. Ravi

Introduction: Venous thrombo embolism (VTE) is a frequent cause of preventable illness and death in hospitalized patients. 25% of all cases of venous thrombo embolism are associated with hospitalization and 50 to 75% of cases of VTE in hospitalized patients occur on those in medical wards. Aim of the Study: Prevalence of Deep vein thrombosis in patients admitted with acute stroke. The need for routine anticoagulation for prophylaxis against DVT in acute stroke patients. Materials and methods: Out of 145 patients enrolled for the study after applying the exclusion criteria 50 patients were selected for duplex ultrasonography of lower limb venous system. Results: In our study the prevalence of DVT in acute stroke was analyzed by ultrasound venous Doppler of lower limbs. The analysis of co morbid conditions like diabetes, systemic hypertension, ischemic heart disease, smoking and alcoholism were analyzed to find out if there was any association between their presence and occurrence of DVT. In all these parameters compared within the group of DVT positive patients the p value was more than 0.05 which is statistically insignificant. Conclusion: The prevalence of DVT in acute stroke patients in our hospital group was 6% which is significantly less than that observed in western population. Duplex USG is a useful tool which can be used as a screening tool for early diagnosis of DVT. DVT occurs more commonly in paralyzed limb than non paralyzed limb.

201-206

Authors: P. Ravikumar

Introduction: Heart failure causes a number of pathophysiological affects which, alone or in combination result in liver cell damage. As a consequence, liver function abnormalities are so common in heart failure. Liver dysfunction in heart failure is usually mild and asymptomatic and often detected incidentally on routine liver biochemical investigations. Aim of The Study: To study the influence of congestive heart failure on liver biochemical profiles. Materials and methods: Among cases admitted with heart failure in the medical wards, government general hospital, sixty patients who had met the inclusion and exclusion criteria were taken up for study. Results: Among the total heart failure cases, 40% were due to rheumatic heart disease. Dilated cardiomyopathies represent about 23% of cases. Heart failure secondary to coronary artery heart disease is seen in about 13% of cases. We have found five cases with acute heart failure and three cases with hypotension. Present study revealed a strong correlation between liver function derangements and the above cases. Conclusion: The study observed 20% of cases with jaundice. Among sixty cases liver enlargement was seen in 63% of cases. Increased liver size is strongly correlated with hyperbilirubinemia. Though the conjugated fraction of bilirubin is also elevated, the levels of unconjugated fraction were higher. Serum aminotransferases were elevated in 78% of cases unlike serum alkaline phosphatase which is increased only in 25% of cases. There found to be a significant correlation between rise in unconjugated bilirubin and elevation of serum aminotransferases.

213-217

Authors: D. Radha, V. Sakthivadivel

Background: In recent years, there has been increasing evidence which shows strong links between inflammation and the pathogenesis of atherothrombotic stroke. Acute phase proteins have been implicated to play roles both during acute and chronic inflammatory processes in different diseases including ischemic stroke. Even low grade infections may cause elevation of various acute phase reactants which may partly be responsible for the inflammatory process observed in atherosclerotic lesions, which may in turn relate to occurrence of ischemic symptoms. Aim of the study: To evaluate the predictive value of hs-CRP in relation to the ultimate functional outcome in first ever ischemic stroke after 4 weeks. Materials and methods: A total of 50 patients who presented with acute ischemic stroke confirmed by CT scan were enrolled into the study. As soon as the patients were admitted within 48 hours of onset of stroke, serum samples were taken for hs-CRP estimation. The serum hs-CRP level was correlated with the functional recovery of patients after 4 weeks using the GOS. Patients with score of 4 and 5 were included in the good outcome and patients with score of 1, 2, 3 were included in the poor outcome category. Results: Mean age of individuals in this study was 60.32 years ± 7.44. Male patients were 48% (24) and female patients were 52% (26). Patients with GOS score of 4 or 5, i.e. those with favorable outcome (34%) 30% had CRP < 10.1 mg/L and 4% had CRP > 10.1 mg/L. All the remaining 66% cases with GOS score of 1, 2 or 3, (i.e. unfavorable outcome) had hs-CRP > 10.1 mg/L. Conclusion: Patients with elevated hs-CRP had a poorer outcome when compared to patients with lower levels of CRP, four weeks after the onset of ischemic stroke.

222-227

Authors: M. Selvaraj, P. Aruna

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a major cause of chronic morbidity and mortality throughout the world. It is a preventable and treatable disease with some significant extra pulmonary effects that may contribute to severity in individual patients. It is characterized by airflow limitation that is not fully reversible. Aim of the Study: To determine whether Chronic Obstructive Pulmonary Disease is associated with malnutrition, to determine whether there is a relation between the degree of malnutrition and severity of airflow obstruction and to determine whether the severity of airflow obstruction correlates with biochemical markers of visceral protein stores (Serum albumin and Serum prealbumin). Materials and methods: Out of 102 patients initially enrolled for the study, 50 patients were selected. Others were excluded as per exclusion criteria. The patients were defined as having COPD based on GOLD criteria with spirometer showing, post bronchodilator FEV1 / FVC ratio <0.70. The analysis was restricted to patients in the age group of 40 – 60 years. All the patients chosen were smokers and all the patients were males. For each subject, medical history was obtained and clinical examination was done. All subjects had a baseline blood sugar value and renal function tests. On the study day, height and weight were measured. Results: Of the 50 patients in the study, 12 (24%) had mild airway obstruction, 25 (50%) had moderate airway obstruction, and 13 (26%) had severe airway obstruction. The difference in the degree of airway obstruction among the different age groups was not statistically significant. There was a statistically significant difference between the Serum Prealbumin level and degree of airway obstruction among all three groups. 9 (18%) patients in the study were found to have a Serum albumin level of less than 3.5g%. Of these, 1 patient had moderate airway obstruction and 8 had severe airway obstruction. Conclusion: As the study is designed as a cross sectional study, the present analysis will be unable to elucidate the prognostic indications of the nutritional indices. The patients were on different durations of treatment and different drugs. These may have an effect on the findings of the study. Spirometer is a user dependent method of assessment and may not always accurately assess the degree of airway obstruction.

234-240

Authors: T. Elavarasan, R. D. Puvitha, M. S. Shruthi

Introduction: Injury to glomeruli results in a variety of signs and symptoms of disease, including proteinuria, hematuria, azotemia, oliguria, edema and hypertension. Specific glomerular diseases tend to produce particular syndromes of renal dysfunction; although multiple glomerular diseases can produce the same syndrome. Evaluation of pathogenic features identified in a renal biopsy specimen may be required for definitive diagnosis. In patients with glomerular disease, renal biopsy provides tissue that can be used to determine the cause, predict the prognosis, and direct the treatment. Aim of the Study: To evaluate the renal histopathology of patients with glomerular disease (with Significant Proteinuria > 1 gms/ 24 hours). Materials and methods: The amount of proteinuria, renal insufficiency, hypertension, and microscopic hematuria differ in different histopathological types and in different age groups .Hence all these parameters and the histopathological type of glomerular disease have prognostic implications in patients with glomerular disease Renal biopsy was performed in patients with glomerular disease (proteinuria <1 gms/24 hrs.) attending the nephrology clinic. Results: Among the 50 patients studied Focal segmental glomerulosclerosis (FSGS) was found in 11, IgA nephropathy and minimal change disease (MCD) in 8; Mesangi proliferative glomerulonephritis in 7, Membranous nephropathy and Lupus nephritis in 6, Membrano proliferative glomerulonephritis (MPGN) in 3 and Amyloidosis in 1 patient. The incidence of renal insufficiency was common in patients with MPGN (100%) and amyloidosis (100%) , followed closely by FSGS (87.5%), lupus nephritis (66.66%), mesangio proliferative glomerulonephritis (57.14%), FSGS (27.27%) and membranous nephropathy (16.66%). Conclusion: 50 patients with proteinuria more than 1 gram per 24 hours above the age of 12 years were biopsied for renal histopathological examination. There were 32 (65%) females and 18 (36%) males, with a mean age of 27.54 years. The commonest histopathological type found was FSGS in 11 (22%) patients followed by, IgAN in 8 (16%), MCD in 8 (16%), mesangio proliferative in 7 (14%), membranous nephropathy in 6 (12%), lupus nephritis in 6 (12%), MPGN in 3 (6%) and amyloidosis in 1 (2%). MCD was commonest histopathological type in age group of less than 20 years of age, FSGS in 21 to 40 years and mesangio proliferative glomerulonephritis above 40 years of age group. 23 (46%) of the 50 patients had renal insufficiency and is common in patients with MPGN (100%), amyloidosis (100%), IgAN (87.5%) and lupus nephritis (66.66%). None of the patients with MCD had renal insufficiency. 5.20 (40%) of the total patients studied had microscopic hematuria

244-247

Authors: Rathod G, Shah K

Nephroblastoma or Wilms' tumor is an embryonic tumor derived from primitive renal epithelial and mesenchymal components. It is the most common abdominal malignant tumour of young children. Overall, Wilms' tumor incidence is 7.8 cases per million children. Peak age of incidence is 2 to 3 years of age, or 99% occurring less than six years of age. Here, we are presenting a case of 3 years old female patient with diagnosis of Nephroblastoma.