tuberculosis has been thrown open 3 . Studies have noted that the risk of developing TB was 11 to 18 times greater in Diabetics than in normal population 2 .Increased reactivation of tuberculosis lesions has also been recorded in diabetics 2 . At the same time, tuberculosis appears to aggravate hyper glycaemia, with patients requiring higher doses of insulin. The primary objectives to carry out this study are to compare clinical and radiological presentation of PTB in DM and non DM cases, to compare treatment outcome of PTB in DM and non DM cases, and to assess impact of Glycemic control on smear conversion.There is an increased sputum positivity compared to general population in DM patients and delayed conversion to sputum negativity 6 .This importance of hyperglycemia has to be emphasized because of an alteration in host defense and consequently increased susceptibility to infection eventually altering the clinical course of the disease 5 .
The natural history of tuberculosis is defined by its airborne route of transmission and the diversity of its clinical manifestations. M. tuberculosis is not highly infectious as compared with infectious agents such as measles virus and varicella zoster virus, an average infectious individual might infect 3–10 people per year, of whom only a minority will progress to active TB disease(11). However, among those with active tuberculosis, the average duration of infection — as inferred from the incidence to prevalence ratio — is >1 year in many high-burden settings(12). In the absence of treatment, approximately 50% of individuals who develop active tuberculosis will succumb to it(13).
result of low CD4 counts, failure of ATT (drug resistant TB) and toxicities of ATT/ART. Management of TB-IRIS is guided more by clinical situation rather than evidence from trails. Anti-inflammatory agents are the mainstay of treatment. Steroids (dose and duration depending on clinical response) are used in severe TB-IRIS and ART may be discontinued in life-threatening situation. Finally drainage/aspiration of abscesses is needed frequently for many patients. ATT is also recommended if there is a high index of suspiction for active TB. Though TB-IRIS is associated with high morbidity, only CNS TB has been associated with higher mortality (24) .
to be carried out with routine structure and does not need much expensive and extra hard work. Single puncture was used for HIV-Ab test and RBG. Limitations of this study are that self- reported Diabetes Milletus Performa did not apply FBG was not done and HbA1c (glycosylated hemoglobin), was not performed which could have provided an index of hyperglycemia during a period of time and have overcome the problem of having infection induces hyperglycemia. However, the results of this preliminary study will help in incorporating the detection of TB patients for diabetes in the DOTS program to better treatment outcomes.
India leads the world with largest number of diabetic subjects, earning the dubious distinction of being termed the “Diabetes as associated with increased risk of TB regardless of study design and population. There is now good evidence that people with DM have 2–3 times the risk of developing active TB compared with those who do not have Jeon, 2008). Not only may this lead to an increase in the TB burden, but patients with dual disease appear to have an increased frequency of adverse TB treatment outcomes, with delayed sputum culture conversion, an increased risk of death during anti-tuberculosis treatment and an increased risk of recurrent disease after successful Baker et al., 2011). The large dual burden of disease may make management of both conditions more difficult. High quality implementation research is needed he value and ways of screening for TB in patients with DM and vice versa, and to setup standardised system of monitoring and evaluation based on the DOTS model used for
to be significant. There is need of awareness and education among common people to avoid such unhealthy habits. The diabetic epidemic encounters the global tuberculosis control, particularly because most of the countries with higher tuberculosis burden bear the higher burden of diabetes too. There are several questions, such as the relationship of tuberculosis treatment outcome and the glycaemic control, whether frequently recommended DOTS is acceptable for patients with both the situations, and whether chemoprophylaxis should be made compulsory for the diabetic patients with latent tuberculosis infection. All these problems have to be addressed by directing well-designed forthcoming trainings. Incorporation of nation-wide tuberculosis and diabetes programs is also necessary to tackle the situation in India. As per report of some studies in tuberculosis -HIV, we must adapt similar methods to prevent, screen and manage the two diseases diabetes and tuberculosis together and it is also vital to ensure the availability of medicines for proper management of the two diseases (Harries et al.). The advantage of tuberculosis treatment observance through current DOTS programme can be exploited for the acquiescence to diabetic drugs and lifestyle amendments also, which will have benefit in the long run for the management of diabetes among those affected with both diseases. The link between tuberculosis and diabetes mellitus has been documented, now good- quality implementation investigation to screen out, to care off, and to monitor this dual load of diseases.
Inour study, out of 271 patients 63.1% were males and 36.9% were females. The age of the study participants ranged from 18 years to 85 years, with maximum number of patients (31%) were in the age group of 36-45 years. Incidence of cardiovascular cause of chest pain increases with age as 78.6% patients were above 46 years of age. In study conducted by (Paichadze Nino, 2015), where 58% were males and 39% were females. Almost 35% of patients admitted with chest pain symptoms were in the 30-45 age group. Patients with CVS cause of chest pain 45.9% had constricting type while 34.7% had pain in form of tightness. Among patients with GIT cause of chest pain 93.8% had burning type. Similarly in study of Zaimi et al (Zaimi Edmond, 2014) the most common type of pain was squeezing in 39.6% patients and burning pain in 11.5% patients. In our study, exertion is an aggravating factor for chest pain in 29.5% patients and all these patients had CVS cause of chest pain. In another study conducted by Jim Christenson et al (Christenson Jim, 2006), 32.8% patients had pain which increases with a deep breath. In the present study among patients with CVS cause of chest pain 12.2% had history of past cardiac disease while 8% patients with respiratory cause of chest pain had past history of cardiac disease. While in the study of Laurence D. Prina (Prina, 2004) pre-existing CAD was present in 27.0% patients of chest pain. In our study diabetes mellitus was found in 7% patients and hypertension was present in 8.1% patients with chest pain. 2.9% patients had both diabetes and hypertension. In another study conducted by Richard Body et al. (Body, 2010), hypertension was found in 49.3% patients who had AMI while Diabetes mellitus was present in 15.5% patients. In our study aetiology of chest pain
study population had a high risk profile, as demonstrated by a higher incidence of diabetes mellitus (42.8%), previous myocardial infarction (21.8%), and chronic renal failure (7.4%) compared with non-OHCA patients (Table 2). The incidences of other risk factors were also high, ie, hyperten- sion (42.7%), obesity (28.2%), and smoking (19.9%). The lower prevalence of dyslipidemia in the OHCA group might be explained by the fact that this was a selected population that had been successfully resuscitated and survived long enough to be admitted to hospital. Further, hypercholes- terolemia has been shown to be an important risk factor, and to adversely affect the outcome of cardiopulmonary resuscitation. 18
Methods: All the cases who were clinically suspected of having pulmonary arterial hypertension amongst the hospitalized children admitted for various reasons underwent detailed relevant history and clinical examination which was recorded in the preset proforma. Chest X ray, and Other investigations included complete blood counts, ABG analysis, ECG, screening for connective tissue disorders and HIV, PBF, LFT, KFT wherever indicated. Those patients in which PAH was suspected underwent Transthoracic Doppler Echocardiography by a cardiologist having experience in pediatric cardiology using echocardiographic machine Acuson. The echocardiographically proved PAH cases were classified into mild, moderate and severe PAH on the basis of measured sPAP values. These cases were divided as: Mild PAH: 36-45 mmHg sPAP Moderate PAH: 46-55 mmHg sPAP Severe PAH: ≥ 56 mmHg sPAP The incidence of PAH and IPAH was calculated on the basis of patients presenting to the sole tertiary care hospital for children from the entire Kashmir Valley which has a children population of 2,001,340 aged 0- 15 years.
Investigators included individuals with positive sputum smears and sensitivity to at least 3 of the 5 classes of drugs used in the background antimycobacterial regimen (BR) for pulmonary MDR-TB. The primary outcome parameter was the time to sputum culture conversion during treatment with bedaquiline or placebo. In the first stage, 47 patients were randomly assigned to receive 8 weeks of placebo or bedaquiline (400 mg daily for 2 weeks, followed by 200 mg 3 times weekly for 6 weeks) in addition to the BR. Adding bedaquiline to the BR reduced the time to sputum culture conversion (hazard ratio [HR] 11.8, confidence interval [CI] 2.3–61.3, P = 0.003) and increased the proportion of patients whose sputum cultures converted to negative (48% [10 of 21] vs 9% [2/23] at 8 weeks, P = 0.003). In the second stage, 160 patients were randomized to receive bedaquiline or a placebo 400 mg daily for 2 weeks followed by 200 mg thrice weekly for 22 weeks. The time to sputum culture con- version was again significantly reduced in the bedaquiline group (HR 2.44, CI 1.57–3.80, P0.0001). 9,66,75 Headaches
while it remains relatively common in low income coun- tries [3, 28]. For example, the International Pilot Study of Schizophrenia, a cross-country cohort study of schizo- phrenia involving both high and low income countries, has described catatonia to be more common in low in- come countries . However, systematic studies on the subject are limited, particularly in low income countries. The possible contribution of genetics, socio-cultural, en- vironmental and public health factors as well as change in clinical practice to the difference in prevalence of catato- nia between the high income and low income countries is not settled [29, 30]. There are also uncertainties around the best treatment practices even if current treatment rec- ommendations favor the use of benzodiazepines with electro-convulsive therapy (ECT) reserved for patients who fail to respond to adequate treatment with more con- servative approaches . For example, when catatonic symptoms occur in the context of chronic schizophrenia, response to treatment with benzodiazepines has been less favorable [31, 32]. The role of antipsychotics is still con- troversial. The common recommendation is to avoid anti- psychotics at least during the early phases of treatment to avoid antipsychotic-associated neuroleptic malignant syn- drome (NMS), which has been believed to occur in up to 10 % of patients with catatonia treated with antipsychotics [33–35]. The prognosis of catatonia is variable, ranging from good recovery to acutely rapid progression to death (often complicated by renal failure). Instituting appropri- ate treatment promptly may prevent complications and improves outcome [36–38]. Despite the recent revival of interest in the study of catatonia , contributions to the field from low income countries has been scarce and vir- tually non-existent in sub-Saharan Africa. The primary purpose of this study was to describe the profile of symp- toms occurring in catatonia, and to evaluate the treatment and outcome of catatonia in a low income country. It was also hoped that the study would help to clarify effective management choices in low income countries.
This is to certify that this dissertation work titled “A STUDY ON CLINICAL, MICROBIAL PROFILE, PROGNOSTIC FACTORS AND TREATMENT OUTCOME IN PATIENTS OF ACUTE PYELONEPHRITIS WITH TYPE 2 DIABETES MELLITUS” of the candidate Dr.S.KARTHIKAA with registration Number 201611010 for the award of M.D. in the branch of GENERAL MEDICINE. I personally verified the urkund.com website for plagiarism Check. I found that the uploaded thesis file contains from introduction to conclusion pages and result shows 7 percentage of plagiarism in the dissertation.
Methodology: This study was applied on 70 TB patients .It involved also 30 apparently healthy control. The patients consists of 43 males and 27 females with age range 8-76 years old, 29 of them were diabetic .Blood samples were collected from patients and controls to estimate the immune parameters interferon-gamma (IFN-γ) and interleukin - 2(IL-2 )as , and anti –CMV IgG antibodies by enzyme linked immunosorbent assay (ELISA).
All patients received topical steroids and a dilating agent during the uveitic episode. Throughout the follow up period regional corticosteroid injections were re- quired in 10 eyes (9 patients). Pulsed intravenous meth- ylprednisolone (1 g/kg per day for 3 days) was given to 1 patient, 9 patients received systemic corticosteroids and 2 patients received systemic immunosuppressive drugs (1 azathioprine, 1 cyclosporine). Of these 9 patients who received systemic corticosteroids only 1 patient on long term 5 mg oral prednisolone had progression of non- proliferative to proliferative DR and 2 patients on short course of systemic corticosteroids needed better gly- caemic control. In the patients with an infectious aeti- ology, 1 patient received a systemic anti-parasitic agent for clinically presumed toxoplasma uveitis, both patients
In 1981, the sensitivity and specificity of ST-segment elevation in the right precordial lead V4R as an early indicator of right ventricular infarction were examined in a consecutive series of 110 patients admitted for acute inferior myocardial infarction. Some other studies have also showed this type of observations  . The sensitivity was 82.7%, the specificity was 76.9% and the positive predictive value was found to be 70% in 58 patients with RVMI. Because of its simplicity and its high sensitivity and specificity, recording of V4R should be an intrinsic part of the early evaluation and electrocardiographic examination of acute IWMI . In combi- nation to the ECG, the triad of hypotension, elevated jugular venous pressure and clear lung fields have been recognised as markers of RVMI in IWMI   .
Sample size Estimation was done using the formula n = 4 pq/ l 2 where, p = known prevalence of the disease, q = 1 – p, l = error. For the purpose of sample size calculation p of 50% was considered due to paucity of studies in India on Vitamin D status of TB patients in DOTS centre. Hence, using p=50% with the absolute error of 5%, the total sample size was calculated to be 400. The study tool comprised of a pre- designed, pre-tested, semi-structured, interviewer administered questionnaire in Hindi. The questionnaire had questions pertaining to socio-demographic information, clinical features of Tuberculosis, history of substance abuse, average consumption of common dairy products such as milk, butter, ghee (clarified butter), paneer and curd in a week etc. General physical examination and systemic examination was done for all the study participants. All patients in whom VDD was detected were counselled about the diet, sun exposure and started on Vitamin D supplementation and further referred to the nearest government health facility.
Stroke is predominantly a disease of later life;70% of strokes occur in people aged over 65.Early risk factor assessment and prompt treatment is necessary in primary prevention of stroke, as stroke is not only the leading cause of death but is also a major cause of disability leading to impaired quality of life particularly for elderly people. Raised blood pressure is the most important causal and treatable risk factor for stroke. The other risk factors are smoking, alcohol, pre-existing vascular disease(previous stroke or transient ischaemic attack, coronary artery disease, peripheral vascular disease), diabetes and atrial fibrillation.
With progression in weakness, compensatory mechanism become less effective, gait becomes more abnormal. With severe quadriceps weakness they cannot walk and once knee flexion contracture develops they cannot stand. Stretching exercises should be continued and orthotics may be used to maintain ability to stand. At this stage, patients should have wheelchair to maintain independent mobility and conserve energy. During this phase scoliosis develops and worsens, so patients should be regularly screened with spine x rays every 6 months from about 10 years of age, wheel chair should have an appropriate pressure distributing seat cushion, and proper head lateral trunk supports. Patients should have cardiac and respiratory evaluation, which should be repeated annually. Steroids and calcium supplements should be continued with dietary advice.
As per our hospital protocol (based on WHO guide- lines), all patients bitten by a poisonous snake received polyvalent anti-snake venom (ASV) manufactured by VINS Bioproduct Limited, within 15 minutes of reaching the hospital, if they had clinical features of envenomation. The antivenom is a polyvalent one and would neutralize the venoms of the 4 major snakes of India (common cobra, common krait, Russell’s viper, and saw-scaled viper). If they did not have features of envenomation at presentation, ASV was administered when the first sign of envenomation appeared. ASV was not administered for pit viper bites. An initial dose of 10 vials of ASV was given for all snake bite patients with features of envenomation. Response to ASV was monitored clinically and by doing 20 minute whole blood clotting time (WBCT20). WBCT20 was done for all patients every 30 minutes for the first 3 hours and hourly for next 3 hours, and hourly after that. If the fea- tures of envenomation were persistent or if the WBCT20 was prolonged after 6 hours of first dose,a repeat dose of ASV was given. A maximum of 20 vials were given for hemotoxic snakebites and a maximum of 10 vials were given for neurotoxic snakebites.
This study was carried out in 40 patients of traumatic cataract attending SSG Hospital from April 2015 to October 2016 after the approval from Institutional research and ethics committee. After taking written and informed consent about enrollment in the study and maintaining adequate privacy and confidentiality, the demographic data of the patients, including age, sex, registration number, occupation and residential address were recorded. The exact duration between the injury and 1 st consultation at SSG Hospital was recorded. The mode of injury whether it was domestic, agricultural, industrial, assault or sports related trauma was also noted. Traumatic cataracts were grouped according to their cause into open or closed globe injuries. A detailed history of all patients was evaluated and they were then thoroughly clinically examined. All patients underwent the standard preoperative cataract evaluation and then had undergone cataract surgery with or without IOL implantation with explained visual prognosis.