IMJ Health : July 2017

Medical Journal: Published volume-3, Issue-7, July 2017 with ad publications

Trends of steroid modified tinea at tertiary care hospital in India

Abstract—Dermatophytes are the common fungal agents implicated in superficial skin infections worldwide, commonly known as tinea. They include species of Trichophyton, Microsporum and Epidermophyton. Infections of this organism have dramatically increased in last one decade by misuse of topical corticosteroids cream alone or in combination with topical antibacterial and antifungal agents. So this study was conducted with the aim to study about culprits (prescribers) and various offending agents. This study was conducted on 1239 consecutive patients of tinea between ages 1-70 years. Tinea was diagnosed by detailed history and clinical examination. Detailed inquiry was made for topical steroid use by recall method or relevant prescriptions. It was found that out of 1239, 1000 (80.7%) patients were using topical corticosteroid in any form. Most common age group was 21-30 years (38.3%). Pharmacist appeared as chief culprit (50.4%) and Clobetasol was major offending agent (34.8%). Majority (55.3%) of patients applied these formulations for 4 week or more. Study concluded that use of topical corticosteroids in tinea has become menace because of unethical manufacture, sales, prescription and end misuse by patient.

Keywords: Dermatophytes, Topical corticosteroids, Tinea, Culprits, Offending agents.

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Alarming tropical steroid misuse on face: A descriptive study

Abstract— Acne vulgaris is a chronic inflammatory disease of the pilosebaceous unit. The clinical lesions are non-inflammatory open and closed comedones and or papules, pustules and nodules of varying degree of inflammation and depth. A lot of steroid, cosmetic and Ayurvedic products containing unlabeled depigmenting agent and steroids are available readily over the counter sale. The side effects of these products are not documented and can lead to adverse effects of continuous usage. This study was aimed to find out various offending depigmenting agents (topical unlabeled steroid containing cosmetics) for treatment of Acne and its side effects with type of offering persons. This study was conducted on 1110 OPD patient of which 1000 (90.10%) patients are using steroid and unlabeled steroid containing cosmetics and only 110 (9.90%) patient not using any topical application. Mostly affected common age group was 11-20 years (58%) with slight female preponderance (M:F 0.96). Urban patients were more affected than rural (74% v/s 26%). Unmarrieds (76%) were more affected than married (24%). Friends appeared as chief culprit or suggestions given to them (39%) followed by family member(13.5%), self-application (12%) influenced by advertisements, chemist(11.5%), general practitioner (9.5%), neighbor (4.5%), compounder(1.5%), parlor(2%) and only 2% by dermatologist. Betamethasone (32.5%) was major offending agent followed by Clobetasol (25%), unlabeled steroid containing cosmetics (12.5%), Aloe Vera gel (7.5%). Monomorphic acne was main side effect diagnosed in 79% of patients followed by pustular acne (8%), nodular acne (4%), rosacea (4%), nodulocystic acne (3%) and perioral dermatitis (2%). Study concluded that misuse of topical steroids and unlabeled steroid containing cosmetics causing various side effects. It is unethical to sale and use without the prescription of an authorised person. So these depigmenting agents should be banned to sell without authorization and without the prescription of an authorised person.

Keywords: Acne, steroid, Culprits, Offending agent, cosmetics.

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Biochemical characteristics of Malaria patients with their association with severity of disease

Abstract— Malaria is one of the oldest and most widespread disease which affects more than 2400 million people, over 40% of world’s population, in more than 100 countries in tropics from South America to Indian Peninsula. This study was designed to assess the platelet counts, haematocrit & liver enzymes (Alanine transaminase, Aspartate transaminase, Alkaline phosphatase) in patients of Plasmodium vivax & Plasmodium falciparum malaria and its association with the severity and prognosis of disease. In a hospital based observational descriptive study, 100 patients with Plasmodium falciparum and/or vivax positive diagnosed by peripheral blood film examination and/or by MPQBC (Malaria Parasite Quantitative Buffy Coat) method were included and submitted to a complete clinical & laboratory evaluation. Patients who were ≤ 14 years and who refused to give consent were excluded. They were divided into Plasmodium vivax and Plasmodium falciparum positive group; evaluated, compared and statistical analysis done. Out of total 100 cases of malaria positive, P. falciparum constituted 66% and P. vivax constituted 34%. The pathophysiological processes causing the haematological changes in malaria are complex and multiple. Thrombocytopenia presents with bleeding manifestations and it increases the severity of disease with poor prognosis.

Keywords: P. Vivax, P. Falciparum, Platelet, Haematocrit, Liver enzymes.

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Abstract— Kikuchi-Fujimoto disease (KFD) is a rare disease. It has a worldwide distribution with a higher prevalence in Asians. KFD is usually a self limiting disease and benign in nature. Clinically it presents as regional cervical lymphadenopathy and sometimes may presents as generalized lymphadenopathy as well. Night sweats and low grade fever may also be associated in some cases. A case of a 36 year old female had attended in SMS Hospital. She presented with fever, weight loss and tender cervical lymph nodes. Diagnostic significance of KFD lies in that it may mimic some of the common diagnosis like SLE (Systemic Lupus Erythematosis), Tuberculosis, lymphoma and rarely adenocarcinoma. Diagnosis is usually made by biopsy of lymph node which shows fragmentation, necrosis and karyorrhexis. On thorough investigation this case was found of Kikuchi-Fujimoto disease (KFD) which is a rare disease. So case presenting with fever, weight loss and tender cervical lymph nodes should also be investigated for Kikuchi-Fujimoto disease (KFD).

Keywords: Kikuchi-Fujimoto disease (KFD).

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Hereditary Spherocytosis in a 17 year girl: A case report

Abstract— Hereditary spherocytosis (HS) is a familial hemolytic disorder with marked heterogeneity of clinical features, ranging from an asymptomatic condition to a fulminate haemolytic anaemia. Although a positive family history of spherocytosis increases the risk for this disorder, it may be sporadic in some cases. Seventeen years old girl presented with mild anaemia, jaundice and moderate splenomegaly. Her haematological parameters supported diagnosis of hereditary spherocytosis. Appropriate treatment was started with an advice to patient to undergo splenectomy as an active part of management of the disorder. Mother and other siblings were normal.

Keywords: Anaemia, Jaundice, Splenomegaly, Hereditary, Spherocytosis.

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Outcome analysis of Intra-articular distal end radius fracture treated with volar plating

Abstract—Fractures of distal end radius are most common fractures of the upper limb. Various techniques have been described including closed reduction, percutaneous fixation and open reduction and fixation. This study was conducted to assess the functional and radiological outcomes of volar plate osteosynthesis to manage intra-articular distal end radius fracture. For this study, 30 patients with intraarticular distal end radius fractures involving radiocarpal joint operated with open reduction and internal fixation with the volar plate were taken. Minimum follow up 6 months were done. During the follow-up, radiological parameters were assessed in terms of radial length, radial inclination, radial (palmar) tilt, articular step-off, functional parameters were assessed in terms of range of motion i.e.dorsifleion, plantar flexion, pronation, supination radial and ulnar deviation and Gartland and Werley score. Mean age of patients was 46.8 years with male: female ratio 6:4. Mean radial height was 11.2mm, mean radial inclination was 21.8 degree and mean radial (palmar) tilt was 10 degrees. Average Gartland and Werley score was 3.6. Average dorsiflexion was 71 degrees, palmar flexion was 68 degrees, mean radial deviation was 16 degrees and mean ulnar deviation was 29 degrees. Mean pronation was 72 degrees and mean supination was 75 degrees. It was concluded that volar plating has good outcome for intraarticular distal end fractures of radius with minimal complications. So, it should be considered as the first line of management for intraarticular distal end radius fracture.

Keywords: Intraarticular, Distal end Radius, Volar Plate, Gartland and Werley Score.

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Thrombocytopenia burden and its associating Risk factors: A cross-sectional study at a tertiary care set up

Abstract—Thrombocytopenia is a very common finding in the neonatal intensive care unit. This study was designed with aim to study the risk factors associated with neonatal thrombocytopenia. In this cross-sectional observational study, 263 newborns admitted in the NICU from October 2016 to December 2016 were enrolled in the study. Proportion of thrombocytopenia was found along with its various neonatal and maternal risk factors associated. Chi-square test was used to find out association. Neonatal thrombocytopenia was found in 29% of neonates; 64 % had early onset and 36 % had late onset thrombocytopenia. Mild, moderate and severe thrombocytopenia was found in 49 %, 34 % and 17 % respectively. Thrombocytopenia was found to be associated with APH and PROM among maternal factors and with LBW, prematurity and birth asphyxia among neonatal factors.

Keywords: Thrombocytopenia, Neonatal Intensive Care Unit (NICU), Asphyxia.

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Gynecological morbidity and co-morbidity in postmenopausal women: A descriptive study

Abstract—Menopause is very crucial phase of woman’s life. There are many health problems that are associated with postmenopausal phase. So this present study was conducted on 215 postmenopausal women with the aim to find out gynecological problems associated with postmenopausal period. This study observed that 70.5% women experienced hot flushes and sweating, 65.5% had insomnia, 37.6% complained of headache. Decreased libido was observed in 80.9% women and 54.4% reported dyspareunia. 78.1% women complained of backache. Joint pain was complained by 52.5% of women. 32% women noted weight loss and 26.5% women complained of weight gain after menopause. Among gynecological problems Genital Prolapse was most common morbidity found in 45.1% of cases followed by Cancer cervix in 12.5%, Fibroid uterus in 9.3%, Senile vaginitis in 5.6%, Ovarian neoplasm in 4.1%, Cancer endometrium 1%, Pyometra in 0.9%, Carcinoma vagina 0.4% and Carcinoma vulva in 0.4% of menopausal women. Genital prolapse was found with PMB in 9.2% cases and with PMB & Vaginal discharge in 10.3% of cases.

Keywords: Postmenopausal Phase, Gynecological Problems.

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Risk factor and outcome with Gestational Diabetes Mellitus (GDM): A Cross-sectional Analysis

Abstract—Gastational diabetes Mallitus (GDM) is a condition in pregnancy which may result bad maternal and neonatal outcomes. So this study was aimed to find out various risk factors associated with GDM. This study was conducted 500 females of 2nd and 3rd trimester pregnancy. They underwent GCT (Glucose Challenge Test) with 50 gm of glucose load which was followed by GTT (Glucose tolerance test) with 75 gm glucose recommended by WHO after 72 hrs of GCT irrespective of result of GCT. Out of 500 pregnant women 27(5.4%) women are diagnosed as GDM. In women with GDM gravida ≥3, age >25 years and positive family h/o of diabetes were found with high proportion of GDM. PIH, preeclampsia and recurrent infections are most common antenatal complication seen in GDM group. It can be concluded from this that universal screening should be done for early diagnosis of GDM so complication related to tit can be controlled and bad pregnancy outcomes may be prevented.

Keywords: Gastational diabetes Mallitus (GDM), Risk factors, Pregnancy outcomes.

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Knowledge and practice of adolescent girls about menstruation: A Cross-sectional study

Abstract— Adolescence constitutes about 20 % of world’s population. Reproductive and sexual health problems are quite common in adolescent girls in India. Bad menstruation hygiene may lead to reproductive health problems. Unsafe menstrual practices expose them to risk thrice as much of contracting RTI, therefore it is important how adolescent girls maintain hygiene during menstruation. This study was conducted to assess knowledge and practices regarding menstruation in adolescent girls. Total 376 eligible adolescent girls were studied, out of that 337 (89.62%) knew about menstruation and out of them 45.10% considered that menstruation starts at puberty, followed by physiological process (34.42%) & sign of reproductive maturity (12.46%) while 39.76% respondents thought it to be due to out flow of dirty blood. Out of 337 who knew about menstrual-cycle, only13.64% knew the fact that conception is not possible during menstrual-cycle. 59.94% respondents had prior knowledge of menarche and majority (51.54%) had this knowledge from their mothers. Out of 325 girls, who were having menstrual period, although 214 (65.84%) were using sanitary napkins but remaining 34.16% were using cloths. When association of this practice with education was evaluated it was found that above primary educated were significantly more (P< 0.001) in using sanitary napkins than girls of up to primary educated (69.47% v/s 40%). When change of material used during menstruation was asked, twice and more was answered in 194 (59.06 %), which was mot found to be associated with education (p=0.65). It was concluded that majority knew about menstruation but practice was not hygienic as they were using cloths and majority of them were less educated. So main emphasis should be given to female education.

Keywords: Adolescent Girls, Menstruation, Knowledge and Practices.

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