Panacea Journal of Medical Sciences

2-5

Authors: Shuba Srinivasan, Jyothi Lingegowda, Sneha Thomas, Ramkumar Kurpad R, Prakash Muddegowda.

Access to endoscopy in India, particularly in a rural setup, is limited by the cost, trained personnel and limited resources. Literature suggests inappropriate referrals to be high, thereby over stretching this limited procedure, resulting in over-servicing. The present study was carried out to evaluate adherence of primary care physicians to ASGE guidelines when referring patients for upper GI endoscopy in rural Indian population. An observational cross-sectional study on consecutive patients referred to Department of Medicine for upper GI endoscopy. Patients above the age of 40 years were included in the study. All dyspeptic patients above the age of 50 years or patients with alarm findings were considered as appropriate referrals. Descriptive statistics was done.315 patients were included in the study. Appropriate referrals were 57.14%. Majority of the referrals were for dyspepsia and pain abdomen. Among all patients, H pylori infection was positive by rapid urease test in 55.23% indicating inadequate eradication therapy. Important endoscopic findings among the patients were carcinoma stomach, gastric/ duodenal ulcer, varices and gastritis. Among patients with dyspepsia, malignancies were noted in 1.96% of patients. Even though appropriate indications were high, the percentage of positive findings among dyspeptic patients was very low. Adequate eradication therapy for H pylori and empirical acid suppression therapy to reduce symptoms of dyspepsia as well as following strict guidelines for appropriate referrals will improve patient selection for upper GI endoscopy. This can improve efforts aimed at enhancing positive pathology identification, improved quality and efficiency of care.

11-14

Authors: Vivek Harkare, Kanchan Dhote, Kunal Shrimal, Nitin Deosthale, Priti Dhoke, Sonali Khadakkar.

Chronic dacryocystitis which is an inflammation and infection of lacrimal sac is an important cause of epiphora leading to ocular morbidity in India. Out of many etiological factors of chronic dacryocystitis, poor hygiene and allergy have a major contribution to the disease development. The aim is to find out occurrence of dacryocystitis in patients belonging to various socioeconomic groups and to correlate dacryocystitis with socioeconomic status. The present study is cross sectional hospital based study from June 2016 to Aug 2016 in a tertiary health care centre of central India. The result shows the maximum number of patients belonging to the age groups of 61-70 years (47.32%). Females outnumbered males 69(61.61%) female patients. In this study of 112 patients who underwent surgery for Chronic Dacryocystitis, there were more patients belonging to class III, IV, V of modified B.G Prasad classification. To conclude with, we found that there were greater number of patients belonging to class III of modified B.G. Prasad classification 2014 and maximum patients fell into Class III, IV and V of socioeconomic status criteria indicating that there may be some co-relation between dacryocystitis and poor socioeconomic status.

19-21

Authors: Kalpana Date, Neena Nagdeo, Meenal Kulkarni.

In revised national tuberculosis control program (RNTCP), microscopic examination of sputum for AFB plays an important role in the initial diagnosis of tuberculosis. Decontamination and liquefaction with by 5% sodium hypochlorite increases sensitivity and safety for handling specimen. In this prospective hospital based cross sectional analytical study, patients of all ages and either sex coming to RNTCP centre were included according to RNTCP criteria. From each patient, two samples of sputum were collected one spot and one morning. One set of smears was prepared by RNTCP guidelines and remaining samples were concentrated by using 5% NaOCl, followed by centrifugation and staining with ZN stain. Both set of smears were observed by two observers to remove observer’s bias. A total of 882 patients were included in the study with 577 (65%) males and 305 (35%) females. A total of 172(19.5%) patients were positive by RNTCP method whereas 201(22.79%) patients were positive by concentration method diagnosing 29 additional patients. This constitutes a rise of 3.29%. This constitute 16.86% rise in case detection over RNTCP method. There is a rise in smear positive cases after concentration with 5% sodium hypochlorite solution. The bleach method has advantage over routine RNTCP method as it is simple, does not require any additional expertise, is safe, reagents are also affordable and easily available and could diagnose additional cases.

28-30

Authors: Madhura Wasnik, Sushil Mankar.

Osteoporosis is a systemic skeletal disease characterized by low bone mass and micro-architectural deterioration of bone tissue which results in consequent increase in bone fragility and susceptibility to fracture and more common in post-menopausal women and elderly people. Fractures in osteoporotic bones can be prevented by simple methods like early detection by certain investigative methods like DEXA and its treatment. A questionnaire was devised to assess knowledge of osteoporosis, its risk factors, risk reducing factors, complications and required treatment along with investigations. It was completed by 97 patients who attended the orthopedic outpatient department. Overall knowledge about osteoporosis was poor. 57.73% patients were aware about osteoporosis, 50.01% were aware about its preventive measures, regarding risk factors (for alcohol only 33.33% could identify it as a risk factors, similarly for smoking scored 29.62%, malnutrition had 16.66%, lack of exercise had 3.7%, gender scored 11.11% and drugs scored 5.55%). Merely 29.89% and 7.21% were aware about the complications and investigations respectively. Knowledge about osteoporosis amongst patients was found low. There is a need for public to be made more aware about osteoporosis and its causes. With the help of social media and national campaigns, people can be well educated about this disorder.

35-39

Authors: Payal Katre, Vivek Harkare.

Chronic suppurative otitis media (CSOM) is one of the most common illnesses encountered in early childhood as well as in adult life hampering the quality of life. The incidence of CSOM has increased in recent years. The present study was carried out with the aim of studying the epidemiological factors contributing to causation of chronic suppurative otitis media in paediatric age group and also to suggest corrective measures for the same. A cross-sectional study was carried out in the department of ENT in a tertiary care hospital in rural area. Total 200 patients suffering from CSOM visiting ENT, Paediatrics and Medicine outpatient departments were selected. High incidence of CSOM in children in rural population was observed in the families having more number of children, illiteracy of the parents, low socioeconomic status, prone to various kinds of allergies. We concluded that the incidence can be controlled or prevented by implementing special measures like health education, awareness and providing proper medical aid at primary level.

48-50

Authors: Vivek Kumar, Nimish Gupta.

Although, anecdotal case reports are being published describing complicated opioid withdrawal e.g. seizure and delirium, various international classification system and standard textbooks do not mention about the complicated withdrawal like with alcohol. Interestingly, these complications reported from specific form of the opioid and specific geographical region. The case in this report presented with complicated opioid withdrawal like picture which later found to be due to medical condition. Hence, we report this case here to discuss various possibilities to be explored while dealing with the case of complicated opioid withdrawal.

53-55

Authors: Vaishali Walke, S. Kawathalkar, R. Rane, M. Goel, WK Raut.

Perivascular epithelioid cell (PEC) neoplasms are an unusual group of mesenchymal tumors which arise from the perivascular epithelioid Cell that characteristically expresses melanocytic and muscle markers. These neoplasms show a wide range of morphologic spectrum and have been described in multiple anatomical locations which includes uterus. We report a 46-year-old patient diagnosed as uterine fibroid on ultrasonography in whom the hysterectomy specimen unveiled characteristic features of intramural PEComa consisting of small nests and sheets of clear epithelioid cells particularly present around the blood vessels in a background of loose oedematous stroma along with the foci of mature adipose tissue which exhibits myometrial infiltration. The correct diagnosis is crucial as there is an emerging role of mTOR inhibitors which can provide a ray of hope to the patients of PEComa.