Journal of Evidence Based Medicine and Healthcare最新文献

{"title":"The Study of Serum Calcium to Magnesium Ratio in Patients with Acute Coronary Syndrome in a Tertiary Hospital, Hubli, Karnataka","authors":"U. Bande, Kalinga Bommankatte Eranaik, Manjunath Shivalingappa Hiremani, B. Patil, Sushma Shankaragouda Biradar","doi":"10.18410/jebmh/2021/644","DOIUrl":"https://doi.org/10.18410/jebmh/2021/644","url":null,"abstract":"BACKGROUND Cardiovascular diseases are one of the leading causes of morbidity and mortality worldwide. High Ca levels and low Mg levels are associated with increased cardiovascular risk in the general population.1 The balance between Ca and Mg seems to play an important role in homeostasis since Mg is considered as physiologic antagonist of Ca.2 Hence Ca/Mg ratio was considered to study its association with acute coronary syndrome (ACS). METHODS This is a case control study conducted in Karnataka Institute of Medical Sciences, Hubli over a period of 2 years, February 2019 to December 2020. 200 cases and 150 controls were included in the study. The biochemical measurements including complete blood count (CBC), cardiac biomarkers, liver function tests, renal function tests (RFT), serum electrolytes and lipid profile were measured using standard laboratory methods. Student ‘t’ test was used to compare the data. Optimum cut-offs for diagnosis of acute myocardial infarction was calculated using receiver operating characteristics (ROC) analysis. The association among markers was established by calculating Pearson’s correlation. RESULTS Serum Ca/Mg ratio was significantly higher (p value < 0.001) in ACS when compared to control groups. It was also found that Ca/Mg ratio was significantly lower (p value < 0.001) in non-ST elevation myocardial infarction (NSTEMI) when compared to STEMI group. Serum Mg was significantly lower (p value < 0.001) in ACS group when compared to control group. Significant correlation (p value < 0.05) was found between serum Ca/Mg ratio and cardiac markers (CKMB, Troponin-I). ROC analysis of Ca/Mg (4.19) ratios showed optimum cut-offs in diagnosis of AMI. CONCLUSIONS Serum Ca/Mg could be useful adjuvant marker in diagnosis of AMI. The ratio is higher in ST-segment elevation myocardial infarction when compared to non-STsegment myocardial infarction, which could be due to greater decrease in Mg levels when compared Ca in ACS. KEYWORDS ST Elevation Myocardial Infarction (STEMI), Non ST Elevation Myocardial Infarction (NSTEMI), Calcium (Ca), Magnesium (Mg), Acute Coronary Syndrome (ACS), Creatine Kinase-MB (CK-MB).","PeriodicalId":15779,"journal":{"name":"Journal of Evidence Based Medicine and Healthcare","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81317567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Prospective Observational Study to Compare the Effect of Adaptive Radiation Therapy in Head and Neck Cancer Patients Treated with Helical Tomotherapy – Bangalore, Karnataka","authors":"S. Bhattacharjee, S. R.A., P. A, Muthuselvi C.A., Souradeep Bhattacharjee","doi":"10.18410/jebmh/2021/648","DOIUrl":"https://doi.org/10.18410/jebmh/2021/648","url":null,"abstract":"BACKGROUND Establishing the usefulness of adaptive radiotherapy in our setting with limited data might help to ensure better conformity and reduce treatment related morbidity. Hence we conducted this study to elicit the benefit of adaptive radiotherapy with helical tomotherapy. METHODS This is a prospective study conducted among 25 head and neck cancer patients undergoing radiotherapy with helical tomotherapy. All patients underwent initial radiation therapy treatment planning simulation positron emission tomography computed tomography (PET CT/ CT scan) [CT-1], followed by repeat PET CT/ CT scan at 4th - 5th week of radiotherapy [CT-2]. Planning for full intended dose [66 Gy - 70 Gy] was done on both the scans, keeping the radiation therapy planning parameters same. Changes in the volume of the clinical target volumes (CTV), changes in the volume and dose to spinal cord, bilateral parotids, and mandible were compared. A p - value of < 0.05 was considered for statistical significance. RESULTS A significant reduction in the volumes of tumour - CTV-1 [CT-1 v/s CT-2: 166.82 cc v/s. 150.63 cc] and of lymph nodal region - CTV-2 [CT-1 v/s CT-2: 260.29 cc v/s 228.00 cc], contra lateral parotid gland [CT-1 v/s CT-2: 33.00 cc v/s 18.72 cc] were observed (P < 0.05). The mean doses received by contra lateral parotid gland [CT-1 v/s. CT-2: 23.14 Gy v/s 21.26 Gy] were significantly lesser in the CT2 scans (P < 0.05). The mean maximum doses were also significantly lesser to the mandible and spinal cord i.e., CT-1 v/s. CT-2: 68.528 Gy v/s 67.39 Gy and 39.45 Gy v/s. 37.33 Gy respectively (P < 0.05). A significant reduction in standardised uptake value (SUV), values of the primary tumour and involved lymph nodes was observed between CT-1 and CT-2. CONCLUSIONS During 4th to 5th week of radiation therapy, significant reductions in the CTVs and in dose to OARs were noted. Thus, we recommend at least one re-simulation scan and re-planning during radiation therapy, irrespective of the type of technique of radiation therapy. KEYWORDS Adaptive Radiation Therapy, IMRT, Tomotherapy","PeriodicalId":15779,"journal":{"name":"Journal of Evidence Based Medicine and Healthcare","volume":"42 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79314881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High Resolution Computed Tomography (HRCT) Evaluation of Temporal Bone Infectious Pathologies - A Study from a Tertiary Care Hospital, Valsad, Gujarat","authors":"Ankur Patel","doi":"10.18410/jebmh/2021/639","DOIUrl":"https://doi.org/10.18410/jebmh/2021/639","url":null,"abstract":"BACKGROUND The complicated middle and inner ear anatomy challenge the diagnostic ease in radiological evaluation of the temporal bone. Their tiny dimension and close neighbouring of the structures limited the successful imaging facilities for long periods of time. Conventional radiological procedures have been inadequate for diagnostic imaging but recently multidirectional tomography and high-resolution computed tomography (HRCT) has gained importance. Inflammatory and infectious diseases of the temporal bone are a major indication to perform highresolution CT. Such studies allow one to evaluate the extent of the disease in the soft tissues and in the bony structures of the temporal bone. The purpose of this study was to evaluate temporal bone infectious pathologies using high resolution computed tomography (HRCT). METHODS The study is completely observational & retrospective type of study. HRCT of temporal bone was carried out on 50 cases with SIEMENS SOMATOM emotion 16 slice CT scan machine, GMERS Medical College & Hospital, Valsad, Gujarat depending upon the availability from February 2019 to January 2020 including all age groups, both sexes with suspicion of temporal bone infective pathologies based on sign and symptoms. RESULTS Out of 50 patients, 38 patients were diagnosed with chronic suppurative otitis media (CSOM) and 12 patients were diagnosed with acute suppurative otitis media (ASOM), of which 65 % of CSOM showed cholesteatoma formation. All the patients with ASOM showed air-fluid levels. Male to female ratio was nearly 1.77 : 1. Out of which, 52 % were paediatric patients. Common symptoms were ear, discharge, headache and deafness. Most commonly affected site was right side. There were 6 extra cranial and 2 intracranial complications seen. CONCLUSIONS Due to the ability to delineate the bony and soft tissue anatomy with high accuracy, high-resolution CT is the imaging modality of choice for topographic evaluation of temporal infective pathologies and their extracranial and intracranial complications. KEYWORDS ASOM, CSOM, Cholesteatoma, Air Fluid Level, Pneumatization, Ossicles, Middle Ear, Inner Ear, Complications","PeriodicalId":15779,"journal":{"name":"Journal of Evidence Based Medicine and Healthcare","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85991963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the Severity of Acute Pancreatitis with CT Severity Index and Other Conventional Methods in a Tertiary Care Hospital in Tamil Nadu, India – A Comparative Cross-Sectional Study","authors":"Jayaprakash Subramani, R. Prabhu, Jagadeesapandian Palpandi","doi":"10.18410/jebmh/2021/642","DOIUrl":"https://doi.org/10.18410/jebmh/2021/642","url":null,"abstract":"BACKGROUND Acute pancreatitis is not uncommon in surgical practice with variable clinical presentation. Because of its potential notable catastrophic complications, it is mandatory to assess the severity at the earliest. In recent times, the decision making in the management is quite difficult due to its complications and outcome. So, an objective assessment of severity based on clinical and laboratory scoring verses computed tomography (CT) severity is still debate, hence the need for study. The purpose of this study was to compare the efficiency of CT severity index verses APACHE II and Ranson criteria in predicting the severity of acute pancreatitis. METHODS A total number of 36 consecutive cases of acute pancreatitis who were admitted between January 2013 and December 2014 in Apollo Specialty Hospitals – Madurai were included in the study. Written informed consent was obtained from all study participants. RESULTS In our study, out of 36 patients, 30 (83.33 %) were males and 6 (16.66 %) were females. The sex distribution shows a clear male predominance. Most of the patients in the present study belonged to the middle age group. Alcohol was the most common cause accounting for 41.7 % of the cases followed by the billiary pathology. CT severity index was the superior tool for prediction of the prognosis and early complications. CONCLUSIONS When using contrast enhanced computed tomography, it was found that there was a significant correlation between the development of organ failure and severity of pancreatitis. The specificity, sensitivity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of Ranson and acute physiology and chronic health evaluation – II (APACHE II) at 48 hours of admission with acute pancreatitis does not correlate in determining the severity of acute pancreatitis. KEYWORDS Acute Pancreatitis, Severity Markers, CT Severity Index","PeriodicalId":15779,"journal":{"name":"Journal of Evidence Based Medicine and Healthcare","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90020405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison between Sniffing Position and 25 Degree Backup Position in View of Glottis During Direct Laryngoscopy and Intubation - A Study from Mangalore, Karnataka","authors":"Akhil Rao U.K, Athira Soman, Anuradha Yadav, Yashwant R., Sucheth Sharat","doi":"10.18410/jebmh/2021/647","DOIUrl":"https://doi.org/10.18410/jebmh/2021/647","url":null,"abstract":"BACKGROUND Endotracheal intubation for the purpose of providing anaesthesia was first described by William Mc Ewan. Jackson1 stressed the importance of anterior flexion of the lower cervical spine, in addition to obvious extension of the atlanto-occipital joint. Sniffing position has been commonly advocated as a standard head positioning for direct laryngoscopy which is achieved by flexion of the neck on chest and extension of the head at the atlanto-occipital joint. Present study was designed to evaluate the glottis view and ease of intubation achieved with direct laryngoscopy in the sniffing position with that of 25 degree backup position in a study group of 100 patients divided in 2 groups of 50 each. METHODS This study is a controlled comparative study. Controlled trial in 50 consecutive patients in each group [Group I and Group II] was conducted on patients who underwent elective surgery under general anaesthesia. Inclusion Criteria - General anaesthesia with endotracheal intubation, Aged 18 to 60 years, American society of Anaesthesiologists (ASA) grades I and II. Exclusion Criteria - Patients with body mass index more than 30 kg/m2. 1. Bucked teeth. 2. Restricted neck movement. 3. Inter-incisor gap less than 35 mm. 4. Thyro-mental distance less than 6 mm. 5. Patients with risk of regurgitation and aspiration. 6. Pharyngeal pathology. 7. Limitation of anterior and posterior movement of mandible 8. Pregnant patients Groups wereGroup I – Sniffing position Group II– 25 degree back up position RESULTS The glottis visualization was assessed by Cormack Lehane grading which revealed that glottis view was better in 25 degree backup position than sniffing position. CONCLUSIONS In our prospective randomized study in a series of 50 patients undergoing general anaesthesia in SIMS & RC, intubation difficulty scale (IDS) score was better in 25 degree backup position than sniffing position. It implies glottis view is better in 25 degree backup position than sniffing position. KEYWORDS Sniffing Position, 25 Degree Backup Position, Laryngoscopy","PeriodicalId":15779,"journal":{"name":"Journal of Evidence Based Medicine and Healthcare","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81634790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Platelet/Lymphocyte Ratio and Risk of In-Hospital Mortality in Patients with ST-Elevated Myocardial Infarction - A Prospective Observational Study from KIMS, Hubli, Karnataka","authors":"U. Bande, Kalinga Bommankatte Eranaik, B. Patil, Manjunath Shivalingappa Hiremani, Sushma Shankaragouda Biradar","doi":"10.18410/jebmh/2021/640","DOIUrl":"https://doi.org/10.18410/jebmh/2021/640","url":null,"abstract":"BACKGROUND Cardiovascular disease is a significant health problem in India with an estimate 3.7 million deaths each year. Mechanisms of myocardial ischemia include inflammation, endothelial dysfunction, platelet aggregation and coagulation. Acute coronary syndrome occurs due to rupture of atherosclerotic plaque. Platelets play a role in both development and rupture of the atherosclerotic plaque. Lymphocytes play a role in chronic inflammation of atherosclerosis. Lower lymphocyte count has increased mortality after acute myocardial infarction. METHODS The study was conducted in Department of General Medicine, Karnataka Institute of Medical Sciences, Hubli from February 2019 to December 2020. It is a prospective observational study. Patients aged ≥ 18 years with ST-elevated myocardial infarction (STEMI) were included in the study. Total 156 cases were selected based on inclusion and exclusion criteria. Cardiovascular events during the in-hospital period were noted. The study population was divided into tertiles based on the platelet-lymphocyte ratio (PLR) values. The low PLR group (n = 104) was defined as having values in the lower 2 tertiles (PLR ≤ 148.4) and the high PLR group (n = 52) was defined as having values in the highest tertile (PLR > 148.4). A ‘P’ value < 0.05 was considered statistically significant. RESULTS Out of 156 patients, 103 (66 %) were males and 53 (34 %) cases were female. Mean age group was 59 ± 10 years. Percentage of patients who underwent thrombolysis was higher in high PLR group (65.38 % vs. 48.07 %, P = 0.041). Death rate was higher in high PLR group (28.84 % vs. 8.65 %, P = 0.001). PLR > 148.4 was found to be an independent predictor of in-hospital cardiovascular mortality in multivariate analyses (hazard ratio: 13.222 (2.113-21.749) P = 0.006 with 95 % confidence interval). Receiver operating curve (ROC) analyses, a PLR value of 148.4 for in-hospital mortality rate had sensitivity of 62.5 % and a specificity of 72 % (area under the curve = 0.627, 95% confidence interval 0.485 – 0.769). CONCLUSIONS In our study, higher PLR had significant association with in-hospital mortality in patients with STEMI. KEYWORDS ST Elevation Myocardial Infarction (STEMI), Platelet/Lymphocyte Ratio (PLR), Ischemic Heart Disease (IHD)","PeriodicalId":15779,"journal":{"name":"Journal of Evidence Based Medicine and Healthcare","volume":"51 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91152808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Study to Evaluate the Role of Diffusion Weighted Imaging in Detection and Staging of Prostate Cancer and Correlation with Histopathology in and around East Godavari","authors":"S. D., A. S., H. P., J. T, Mytri Priyadarshini K.","doi":"10.18410/jebmh/2021/636","DOIUrl":"https://doi.org/10.18410/jebmh/2021/636","url":null,"abstract":"BACKGROUND Prostate is an associated gland of the male reproductive system. Worldwide, among the men, prostate cancer (PC) is the second most common cancer. PC is the seventh commonest cancers among the Indian male. Studies reported that diffusion weighted imaging (DWI) and dynamic contrast enhanced imaging (DCE-MRI), can offer additional value in localizing cancer. A study was conducted to evaluate and correlate the role of DWI in detection and staging of PC and correlation with histopathology. METHODS A cross-sectional observational study was conducted in the Department of Radiodiagnosis, GSL Medical College, over a period of 18 months. Males with symptoms of nocturia, urinary urgency, frequency, hesitancy and bone pain were included in the study. Trans rectal ultrasound scan (TRUS) biopsy was collected, Gleason‘s score (GS) was considered for the histopathologic analysis. The evaluation of DWI as a tool for detection of PC was based on comparing the sensitivity and specificity of the results after taking histopathology as the gold standard test chi-square test was used to find the statistical significance and P < 0.05 was considered statistically significant. RESULTS Total, 36 (82 %) were diagnosed to be malignant, maximum number (18; 50 %) were between 61 – 70 years age group. Peripheral zone is the most common (61.2 %; 22) area for the PC followed by transitional (33.3 %) and central zone (5.5 %). In this study, 16.6 % members had GS ≤6; Apparent diffusion coefficient (ADC) was ranged between 0.81 to 0.87 and mean + SD were 0.85 + 0.02. Out of the 22.2 % members whose GS was 7, the mean + SD ADC were 0.74 ± 0.02. For 22 (61 %) members, GS was >8; the mean + SD ADC was 0.63 ± 0.08; statistically there was significant difference between the parameters. Magnetic resonance imaging (MRI) revealed that 61.3 % (27) cases as highly suspicious, 25 % (11) as probably malignant and 13.6 % (6) as indeterminate; the sensitivity for MRI was 94.5 % and specificity was 85.7 %. CONCLUSIONS Patients with increased prostate specific antigen (PSA), multi-parametric magnetic resonance imaging (MPMRI) is valuable, non-invasive and a better option to detect PC. Also helps in localizing the exact location. KEYWORDS Cancer, Tumour, Biopsy, Study","PeriodicalId":15779,"journal":{"name":"Journal of Evidence Based Medicine and Healthcare","volume":"49 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90600757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Profile and Outcome of Multiple Organ Dysfunction Syndrome (MODS) in a Tertiary Care Centre of Manipal, Karnataka","authors":"Manthappa Marijayanth, Ashok Horatti, Varsha Tandure, S. Dhanse","doi":"10.18410/jebmh/2021/643","DOIUrl":"https://doi.org/10.18410/jebmh/2021/643","url":null,"abstract":"BACKGROUND To study the clinical profile and outcome of multiple organ dysfunction syndrome (MODS) in previously healthy adult patients and to assess the correlation between sequential organ failure assessment (SOFA) score at admission and mortality in these patients. METHODS This study was conducted at a tertiary care hospital attached to a medical college of south India. This was a prospective observational study. All adult patients presenting with multiple organ dysfunction syndrome between October 2010 and June 2012 were selected for the study. SOFA score was recorded for all the patients at the time of admission. Patients were followed up till the time of death or discharge. RESULTS In this study, majority of the cases were males and belonged to middle age group. Epidemic diseases such as scrub typhus and leptospirosis were the most common causes of MODS. Fever was the most common presenting symptom of MODS. Majority of patients recovered. Higher SOFA score at admission is associated with increased mortality, duration of hospital stay, requirement of ventilatory support, haemodialysis, and central venous access. CONCLUSIONS Infectious diseases are responsible for most cases of MODS. Higher SOFA score at admission is associated with increased morbidity and mortality. Majority of people recover with appropriate treatment. KEYWORDS MODS, Clinical Profile, SOFA Score, Outcome","PeriodicalId":15779,"journal":{"name":"Journal of Evidence Based Medicine and Healthcare","volume":"50 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75286906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dual Energy Computed Tomography (DECT) for Determination of Renal Calculi Composition - In-Vivo Analysis and In-Vitro Comparison with Qualitative Chemical Analysis - A Prospective Comparative Study at a Single Centre at SDM Medical College and Hospital – Dharwad, Karnataka","authors":"Srinivas K. Kalabhavi, P. Makannavar, Revanasiddappa A Kanagali, Prabhath A.N., N. Shah","doi":"10.18410/jebmh/2021/641","DOIUrl":"https://doi.org/10.18410/jebmh/2021/641","url":null,"abstract":"BACKGROUND Dual energy computed tomography (DECT) is a new method of computed tomography (CT) imaging which allows to determine stone composition in addition to assessing stone morphology. The purpose of this study was to evaluate the role of dual energy CT (DECT) preoperatively to assess the composition of urinary stones and to compare it with post-operative in vitro qualitative chemical analysis as reference standard. METHODS Forty patients (18 male and 22 female) who presented with symptoms of renal stones in the department of urology were included in the study. All 40 patients who were diagnosed to have renal stones clinically and by ultrasonography (USG) kidney, ureter and bladder (KUB) region were subjected to dual energy CT. The stone composition assessed in vivo using DECT preoperatively and in vitro by chemical analysis post operatively after stone extraction by surgical procedure. The results were compared by statistical analysis. Sensitivity, specificity and positive predictive value (PPV) were calculated and descriptive study done using Statistical Package for Social Sciences (SPSS) 20.00 version. Data was analysed by comparing it with correlative qualitative chemical analysis. RESULTS In our study, in vivo analysis using DECT showed most common type of stone was calcium oxalate seen in 20 cases compromising 50 % of total cases. Next common stone type was uric acid stone (22.5 %) followed by cysteine (17.5 %) and calcium hydroxyapatite (10 %) respectively. When the same stones were subjected to ex vivo chemical analysis, one of the calcium oxalate stone came out to be calcium phosphate and one of the cysteine stone came out to be mixed stone. Thus, out of 40 stones, 38 stones were found to have the same result in ex vivo chemical analysis as that of in vivo analysis by dual energy CT. Hence, accuracy of dual energy CT in diagnosis of renal stones was found to be 100 % with CI 91.19 % - 100 %. CONCLUSIONS With dual energy CT, it is possible to determine the composition of renal calculi in vivo non-invasively (with specificity of 100 % in our present study). Therefore, this helps in deciding the modality of treatment pre-operatively whether the stone is amenable to medical management (e.g., Uric acid stones) or requires extracorporeal shock wave lithotripsy (ESWL) or surgical intervention can be determined preoperatively. This helps to reduce the unnecessary financial burden and is found to be time saving. KEYWORDS Renal Calculus, Dual Energy CT, Stone Composition, Uric Acid Stones, Non-Uric Acid Stones, Attenuation, Hounsfield Units HU, Chemical Analysis of Stones.","PeriodicalId":15779,"journal":{"name":"Journal of Evidence Based Medicine and Healthcare","volume":"61 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81805345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Culture Sensitivity Patterns and Outcome of Liver Abscess in Children Admitted at a Tertiary Care Hospital in North India","authors":"Navya Sree Manugu, Narayana Lunavath, Ramu Pedada","doi":"10.18410/jebmh/2021/635","DOIUrl":"https://doi.org/10.18410/jebmh/2021/635","url":null,"abstract":"BACKGROUND Liver abscess has been recognised since the time of Hippocrates. Liver abscess is defined as collection of purulent material in liver parenchyma. They are usually caused by bacterial and amoebic infections, and less commonly, by other protozoal and helminthic organisms. Amoebic liver abscess is the commonest extra intestinal site of invasive amoebiasis which mainly affects infants and young children. The incidence of pyogenic liver abscess is much higher among children in developing countries than those in developed countries. The purpose of this study was to evaluate culture sensitivity pattern (Blood & Pus) of liver abscess in children. METHODS This prospective observational study was conducted in the Department of Paediatrics, Chacha Nehru Bal Chikistalaya, Delhi from July 2016 –to August 2017. This study has got Institutional Ethics Committee approval (Regd No: IEC/MAMC/78, Dt: 26/07/2016). All children aged 1 month to 12 years admitted with liver abscess (included consecutively) were enrolled after considering inclusion and exclusion criteria. Written and informed consent was taken from parents/guardians of children. Their clinical characteristics, radiological features, laboratory data, clinical management, and outcomes were analysed. RESULTS In our study, out of 70 patients, 3.2 % patients showed growth in the blood culture. Organsims isolated were Methicillin resistant Staphylococcus aureus (MRSA) 1.4 % (1), Salmonella typhi 1.4 % (1), staphylococcus coagulase negative 1.4 % (1). Out of 70 patients of liver abscess enrolled in the study, 36 patients underwent aspiration of pus from the abscess. Out of 36 aspirated cases, gram positive cocci was identified in 1 (1.4 %) patient. In our study, no acid fast bacilli was identified and no fungal culture showed growth of organism. Out of 70 cases of liver abscess, 10 were found to be amoebic liver abscess. In our study, all the 70 patients were started on empirical antibiotics. Out of 70 patients, surgical intervention was done in 36 patients. In our study all the patients were started on empirical antibiotics according to hospital protocol. CONCLUSIONS Liver abscess should be considered in children presenting with fever and abdominal pain. Organisms recovered from liver abscesses vary greatly. Surgical drainage has been the traditional mode of treatment of pyogenic liver abscess, but this was replaced by IV broad-spectrum antibiotics and imaging-guided percutaneous drainage. KEYWORDS Paediatric Liver Abscess, Amoebic Liver Abscess, Pyogenic Liver Abscess, Culture-Sensitivity, Children","PeriodicalId":15779,"journal":{"name":"Journal of Evidence Based Medicine and Healthcare","volume":"4 4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91188130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}