Indian Journal of Medical and Health Sciences

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Introduction: Scrub typhus is a re-emerging Rickettsial infection presenting with protean manifestations and increasingly reported from all over the country. It is an important cause of acute febrile illness. Case Report: A middle aged adult male presented with complaints of fever, abdominal pain and pain in the testes of about two weeks duration. On examination patient was toxic, icteric, had inguinal and cervical lymphadenopathy, hepatosplenomegaly and unilateral tender testes and epididymis. All common causes of FUO (viz) Malaria, Typhoid fever; Dengue and Brucellosis were ruled out by laboratory tests. Serology for Scrub typhus was positive. The patient responded in 24 hours to Doxycycline thus clinching the diagnosis. Conclusion: This case is reported because of the unusual complication of epididymo orchitis in an adult due to Scrub typhus.

Keywords: Scrub Typhus; Epididymo Orchitis; Doxycycline.

There are situations when patients are unfit for anesthesia or unwilling for surgery when plastic surgeon has to make the wound heal by secondary intention.In such situations adjunct therapies like Low Level Laser (LLL) helps in promoting wound healing. LLL are lasers with a wave-length between 600 and 1000 nanometers and power from 5 to 500 Mw. The bio-stimulatory properties of LLL has been found to accelerate wound healing, tissue repair and regeneration. This study highlights the application of LLL in a 40-year-old male with multiple pressure sores unfit foranesthesia.

Keywords: Pressure Sore; Wound Healing; Low Level Lasers.

Nothing is nor ever will be more significant in medical science, nor more necessary to it, than the observation of the pulse [1]. The characteristic pulse of aortic regurgitation (AR) is so familiar to the observation of everyone that it may perhaps be thought that its mode of origin must be so well known that there can be little room for further discussion on the subject [2]. This review article elaborates the pathogenesis, causes, clinical approach to evaluate collapsing pulse and its sensitivity and specificity .

Keywords: Collapsing Pulse; Water Hammer Pulse; Watson Pulse; Pulsus Celer; Rhazes Pulse; Al Razi Pulse; Cuming Pulse; Vieussens Pulse.

 Background: The triad of DKA includes hyperglycaemia, ketosis, and acidemia. The management of diabetic ketoacidosis is complex and involves many aspects. It includes identification and correction of all the metabolic abnormalities and treating all the co-morbid and precipitating conditions. In DKA the most important and the initial step of management is correction of acidosis by rapid fluid replacement using a crystalloid and among them the most commonly used were 0.9% normal saline or ringer lactate. Aim: 1. To compare individually, the effects of Ringer lactate, Normal saline and plasmalyte on the serum electrolytes during the recovery period of diabetic ketoacidotic patients. 2. To determine the IV fluid most suitable for fluid resuscitation in the management of diabetic ketoacidosis. Materials and Methods: A prospective comparative study was done on 120 patients with diabetic ketoacidosis reported to our hospital over a period of one year from June 2015 –Nov 2016. The patients were divided into three groups of 40 in each group. Group A (40) were administered normal saline, Group B (40) were given ringer lactate and Group C (40) were given plasmalyte. Patient’s blood glucose was measured on an hourly basis and their serum electrolytes and anion gap were measured for every 2 hours. Results: Among the intra-group comparison the serum sodium and chloride levels showed a statistically significant increase among the patients treated with normal saline (Group A) and plasmalyte (Group C). Serum potassium levels had shown a statistically significant increase among the patients treated with ringer lactate (Group B) and plasmalyte (Group C) and the serum bicarbonate levels had shown a statistically significant increase among all the three groups. Among the inter-group comparison serum potassium and bicarbonates level showed a more significant increase in plasmalyte group than that of the patients who received normal saline and ringer lactate. Among the three groups DKA status had resolved more early in the patients who had received plasmalyte, six patients in this group had got the DKA status resolved in 6 hrs and another eleven patients had got DKA resolved in 8 hrs and for the remaining 23 patients it got resolved in 10 hrs. Conclusion: In patients with diabetic ketoacidosis which is considered as a life-saving emergency condition should be treated promptly with a better I.V. fluid which would resolve the condition at the earliest. In our study it was proven that the plasmalyte was a better crystalloid than 0.9% NS and RL in resolving DKA at a faster rate.

Keywords: Diabetic Ketoacidosis; Normal Saline; Ringer Lactate; Plasmalyte; Serum Electrolytes.

Background: The use of mobile devices has become increasingly universal in almost every aspect of life, including emerging use in healthcare, which encompasses diverse issues to solve clinical problems and promote public health initiatives in pioneering ways. Wide availability of Mobile phones with low call rates and smart phone applications like Skype, WhatsApp can be used as means of communication between the consultant and patient. Methods: The study is an observational retrospective study conducted in the Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Pondicherry from April 2015 to May 2016. The tele -OPD consisted use of telephonic conversations, video conferencing, mail, whatsApp etc. At the end of the study period, the feedback was obtained from consultants, patients and analyzed. Results: In the 1 year study period, 2048 telephonic calls were made to patients, 1806 calls were received from patients, 126 WhatsApp messages, 118 emails received and 20 Skype calls were done. On taking feedback from patients & Consultant it was found to be patient friendly, inexpensive and time saving. An internal record of all the patients phone numbers, email ids were noted down in a register. Conclusion: Tele-OPD is found to be a promising method of communication, especially in nonemergency situations where the patient doesn’t have to physically come to OPD but might need some advice or information regarding treatment. It is Userfriendly, time saving and cost-effective means to obtain consultation in less time-critical contexts.

Keywords: Telemedicine; Tele-OPD; Smart Phone.

Background: Obesity is the first of the “diseases of civilization” to appear. Its prevalence is escalating at an alarming rate to epidemic proportions throughout the developed world. Environmental and behavioral changes brought about by economic development, modernization and urbanization has been linked to the rise in global obesity. Obesity may induce systemic oxidative stress. Objectives: The present scenario suggests that higher oxidative stress is the key factor of obesity and hence a management strategy aiming at control of lipid Peroxidation in obesity by use of Maize diet is envisaged. Material and Methods: This study has been conducted on 1001 Gujarati and non Gujarati girls aged between 18-30 years. They were further distributed according to age, inhabitance, socioeconomic status, dietary habits, family history and blood pressure. Every subject in each group was asked to replace the wheat chapatti for 30days; the girls were examined for oxidative stress parameter MDA before and after maize diet along with the statistical evaluation. Results: There was a Positive effect of maize diet on biochemical parameter of all the girls in all the subgroups Malondialdehyde level in total girls before the maize diet was 2.35 ± 0.76 nmol/ml which reduced to 1.8 ± 0.46 nmol/ml after the diet (P< 0.001). Conclusions: The oxidative stress showed improvement in normal , overweight and obese girls, most significantly on overweight and obese after taking the diet (P<0.001). Current dietetic practice is to recommend a healthy eating plan of reduced fat, and increased fiber intake.

Keywords: Obesity; Prevalence; Oxidative Stress; Malondialdehyde (MDA); Age; Inhabitance; Socioeconomic Class; Dietary Habits.

With the receding threats of communicable diseases, and looming over threats of Coronary Artery Disease, Hypertension and Diabetes Mellitus, the research in the later has been focused on detection of their preclinical stages. The co-occurrence of metabolic risk factors for both Type 2 Diabetes and CVD suggested the existence of a “metabolic syndrome”. From a clinical perspective, the importance of the metabolic syndromes is attributable to two factors: 1) it is extremely common, and 2) it is a target for the prevention of and therapy for the multiple disorders with which it is associated. In India, age-standardized prevalence rates of metabolic syndrome are 33.5%. Sedentary lifestyle, older age, female gender, obesity, inadequate fruit intake, hypercholesterolemia, and middle-to-high socioeconomic status significantly contribute to increased risk of metabolic syndrome. This study was conducted to assess the prevalence of metabolic syndrome in apparently normal population attending Medicine Outpatient Department of a tertiary care hospital and to analyse the risk factor profile of the individuals with Metabolic Syndrome. In our study 39 out of 150 subjects (26%) were found to have metabolic syndrome using ATP III Revised Criteria. The prevalence increased as the age advanced (51% in 40-59-year age group and there was female preponderance (37 vs 19%). High blood pressure, Body mass index, Waist circumference, Hypertriglyceridemia, high fasting blood sugar level, Low HDL cholesterol in blood, Aging & High LDL cholesterol in blood were the risk factors associated with high prevalence of Metabolic syndrome.

Keywords: Metabolic Syndrome; ATP III Criteria, Risk Factors.