Current Issue Volume 3, Number 2 , April-June 2018

EDITORIAL
S Dwajani

Medication Adherence: How Important is It?

[Year:2018] [Month:April-June] [Volumn:3 ] [Number:2] [Pages:31] [Pages No:iv-vii]



Medication nonadherence is the most prevalent and complex problem. Nonadherence to medication causes considerable morbidity and mortality, with unavoidable health care costs.1 In 2003, it was estimated by the World Health Organization (WHO) that in developed countries, adherence averages to only 50% in patients suffering from chronic medical illness while in developing countries, the problem is greater.2,3


ORIGINAL ARTICLE
Sharanappa Patil, V Ajith Kumar, Sandhya Subramani

To evaluate Lipid Profiles in Patients with Chronic Kidney Disease in RajaRajeswari Medical College and Hospital, Bengaluru, Karnataka, India

[Year:2018] [Month:April-June] [Volumn:3 ] [Number:2] [Pages:31] [Pages No:31-34]



Background and objectives: Dyslipidemia is a fairly common occurrence in chronic renal failure (CRF) patients. Cardiovascular mortality in patients with CRF is related to dyslipidemia. This study was done to identify the lipid abnormalities and its significance in CRF patients by comparing with age, sex, and body mass index (BMI) of matched healthy control population.

Materials and methods: In this study, 56 cases of CRF were taken and three fasting lipid profiles were estimated. Twentyfive age-, sex-, and BMI-matched healthy population were taken as controls. The data were entered in a master sheet and analyzed statistically.

Results: Dyslipidemia is seen in CRF patients. Even though the total cholesterol was high in CRF cases compared with controls, the change was not significant statistically. Triglycerides showed a statistically significant increase in CRF cases. The low-density lipoprotein cholesterol (LDL-C) was elevated in CRF cases but the change was not significant statistically. The high-density lipoprotein cholesterol (HDL-C), on the contrary, showed a statistically significant drop compared with controls.

Interpretation and results: Lipid abnormalities are common in CRF. Total cholesterol changes are not statistically significant. Triglycerides shows statistically significant increase in CRF cases when compared with normal. The LDL-C is increased in CRF patients, but it is not statistically significant when compared with controls. The HDL-C shows a statistically significant decrease in CRF patients compared with controls. These lipid abnormalities may be an important contributing factor to the cardiovascular mortality in patients with CRF.

Keywords: Chronic kidney disease, Dyslipidemia, Lipid profile.

How to cite this article: Patil S, Kumar VA, Subramani S. To evaluate Lipid Profiles in Patients with Chronic Kidney Disease in RajaRajeswari Medical College and Hospital, Bengaluru, Karnataka, India. J Med Sci 2018;4(2):31-34.

Source of support: Nil

Conflict of interest: None


ORIGINAL ARTICLE
Bandi H Reddy, N Nagendra Prasad, R Nagaratnamma, MPA Sailakshmi

Correlation of Predicted Birth Weight at 20–24 Weeks of Gestational Age using the Formula devised by Chi-Feng Su to Actual Birth Weight

[Year:2018] [Month:April-June] [Volumn:3 ] [Number:2] [Pages:31] [Pages No:35-37]



Aim: The aim of the study is to use the formula demonstrated by Chi-Feng Su to determine the estimated birth weight (EBW) at 20-24 weeks gestation and try to find out the correlation between the estimated fetal weight with the actual birth weight in our local population.

Materials and methods: It is a retrospective study done at the Department of Obstetrics and Gynecology, RajaRajeswari Medical College, Bengaluru. Fifty patients who were booked, followed up, and delivered at our institution were selected for our study after meeting inclusion and exclusion criteria. Participant’s demographic characters like age, gravida, weight, body mass index (BMI), last menstrual period (LMP), and others were noted down as per the protocol. Their mid-pregnancy BMI, and fetal biometry report at 20-24 weeks were noted. Using the study formula, their anticipated fetal weight was calculated. After delivery, the exact birth weight was noted and was correlated with the predicted weight.

Results: In the study, majority (66%) aged less than 25 years and only 3 patients were aged above 30 years; 50% of the cases were second gravida; 60% of the participants had BMI between 20 and 25, 16% has BMI above 25, and 24% has BMI less than 20. The best correlation was seen in the weight group between 2.6 and 3.5 kg.

Conclusion: The formula demonstrated by Chi-Feng Su had variance as high as 0.303. Our study also showed high variability when the error was +17.6% with birth weight >2.5 kg.

Keywords: Actual birth weight, Body mass index, Estimated fetal weight.

How to cite this article: Reddy BH, Prasad NN, Nagaratnamma R, Sailakshmi MPA. Correlation of Predicted Birth Weight at 20-24 Weeks of Gestational Age using the Formula devised by Chi-Feng Su to Actual Birth Weight. J Med Sci 2018; 4(2):35-37.

Source of support: Nil

Conflict of interest: None


ORIGINAL ARTICLE
AN Dhanya, B Niranjana Murthy

Role of E-cadherin Expression in Breast Carcinoma

[Year:2018] [Month:April-June] [Volumn:3 ] [Number:2] [Pages:31] [Pages No:38-41]



Introduction: Cancer of breast has emerged as the leading site of cancer in India. E-cadherin (E-CD) is one of calciumdependent transmembrane glycoprotein mediating cell-cell adhesion. It has its application in differentiating invasive ductal carcinoma not otherwise specified (IDC-NOS) vs invasive lobular carcinomas (ILCs) and predicting the aggressiveness of the tumor. In this study, we intend to see E-CD expression in breast carcinoma by immunohistochemistry (IHC), comparing its status with histological grade and type.

Materials and methods: A total of 47 breast tissue specimens were included in the study. The histomorphological grading (Modified Scarf Bloom Richardson system) and immunohistochemical scoring were done. Chi-square formula was applied to check the association between E-CD expression and various variables.

Results: The mean age was 51 years. The most common type was IDC-NOS (79%) and grade II (38%). Majority (62%) were lymph node negative. The E-CD IHC performed showed most cases (55%) were severely reduced E-CD, while wellexpressed E-CD and moderately reduced E-CD were 28 and 17% respectively. The E-CD expression was statistically significant (p < 0.05) with histological grade and lymph node status. Though the p-value of E-CD expression vs histopathological type was not significant, all ILCs showed complete loss of E-CD expression compared with IDC-NOS.

Conclusion: The E-CD expression is well preserved in welldifferentiated carcinomas and reduced in poorly differentiated carcinomas. Loss of E-CD expression is seen in lymph node metastasis breast carcinomas and in high-grade breast carcinomas, which proves E-CD can be used as a marker of tumor invasion and tumor aggressiveness. Complete loss of E-CD is seen in all ILC, which can also be helpful in differentiating IDC NOS from ILC.

Keywords: Bloom Richardson score, Breast carcinoma, E-cadherin, Immunohistochemistry.

How to cite this article: D hanya A N, M urthy B N. R ole o f E-cadherin Expression in Breast Carcinoma. J Med Sci 2018;4(2):38-41.

Source of support: Nil

Conflict of interest: None


ORIGINAL ARTICLE
MD Abhilasha, Umashankar Nagaraju

A Study on Effectiveness of Platelet-poor Plasma as a Media in Autologous Noncultured Epidermal Cell Suspension in the Treatment of Stable Vitiligo.

[Year:2018] [Month:April-June] [Volumn:3 ] [Number:2] [Pages:31] [Pages No:42-47]



Introduction: Replenishing melanocytes selectively in vitiliginous macules by autologous noncultured epidermal cell suspension (NECS) is a promising approach. Limitation of this surgery is its expensive reagents. Platelet-poor (PPP) plasma may replace these expensive reagents.

Objective: To evaluate the surgical results when two reagents, namely trypsin inhibitor and Dulbecco’s modified Eagle’s medium (DMEM), are replaced by patient’s PPP as media in NECS.

Materials and methods: Descriptive and inferential statistical analysis has been carried out in a clinical study that enrolled 60 stable vitiligo lesions from 60 patients who formed the study group. Patients received melanocytes suspended in their own PPP.

Results: Results show that 96.7% repigmentation was achieved in 29 of 30 lesions. Additionally, 3.3% lesions achieved poor repigmentation. Statistical analysis revealed no significant differences with respect to the repigmentation achieved or adverse effects observed.

Discussion: Trypsin inhibitor can be replaced by blood plasma as plasma contains alpha 1 antitrypsin, which covalently binds and inactivates action of trypsin. Effective results with blood plasma was possibly due to growth factors in serum which may enhance activity of melanocytes. It also enhances the viscosity of suspension.

Conclusion: Platelet-poor plasma can be one of the novel surgical modalities. It is cost-effective and beneficial for our vitiligo patients.

Keywords: Dulbecco’s modified eagle’s medium, Noncultured epidermal cell suspension, Platelet-poor plasma.

How to cite this article: Abhilasha MD, Nagaraju U. A Study on Effectiveness of Platelet-poor Plasma as a Media in Autologous Noncultured Epidermal Cell Suspension in the Treatment of Stable Vitiligo. J Med Sci 2018;4(2):42-47.

Source of support: Nil

Conflict of interest: None


ORIGINAL ARTICLE
B Mamatha Patil, V Shreyas Kumar, Kotha Anusha

A Clinical and Etiological Study of Anemia in Patients with Primary Hypothyroidism

[Year:2018] [Month:April-June] [Volumn:3 ] [Number:2] [Pages:31] [Pages No:48-51]



Introduction: Hypothyroidism has significant hematological manifestations. Overt and subclinical hypothyroidism both are associated with anemia. This study was done to evaluate the clinical and etiological profile of anemia in patients with primary hypothyroidism.

Materials and methods: B ased o n t he s ymptoms a nd hormonal assay, 200 primary hypothyroidism patients were subjected to detailed examination. Patients were investigated before the thyroid hormone replacement therapy.

Results: Hypothyroidism is more prevalent in women than in men. Higher percentage of hypothyroid women (54%) suffer from anemia than hypothyroid men (45%). Normocytic normochromic anemia (58.49%) was the most common type of anemia followed by microcytic hypochromic anemia (20.75%), macrocytic hypochromic anemia (12.26%), and dimorphic anemia (8.49%). Among the symptoms and signs elicited, the most common was generalized weakness seen among 49.5% of the subjects with clinical hypothyroidism, followed by weight gain (34.5%), bradycardia (27.5%), peripheral edema (23%), menstrual irregularities in females (12.5%), and cold intolerance seen in 12% of the study population. Few subjects presented with more than one sign and symptom. Majority of the subjects were investigated only after they presented with one of the signs and symptoms, hence falling under the category of clinical hypothyroidism (78%). Antithyroid peroxidase (TPO) antibodies were present in only a minor percentage (15%) of the study population, majority of them being in the 4th decade of life and incidence decreasing as age progressed probably because the mean age group of the study population was in the fourth decade of life. Women (17.41%) had a slightly higher incidence of autoimmune hypothyroidism compared with men (13.63%).

Conclusion: Hypothyroidism is common in females, maximum in the third decade probably because the mean age of the study population was 32.53 years. Majority of the patients (53%) were diagnosed with anemia. Of them, majority presented with symptoms of hypothyroidism and were found to have normocytic normochromic anemia followed by microcytic hypochromic anemia. A systematic study was done to know the relationship of hypothyroidism with anemia and a study of the symptomatology of hypothyroidism. The identification of patients with hypothyroidism is an important individual and public health issue. Hence, early detection and initiation of hormone replacement therapy can minimize the incidence of associated anemia.

Keywords: Anemia, Antithyroid peroxidase antibodies, Hypothyroidism.

How to cite this article: Patil BM, Kumar VS, Anusha K. A Clinical and Etiological Study of Anemia in Patients with Primary Hypothyroidism. J Med Sci 2018;4(2):48-51.

Source of support: Nil

Conflict of interest: None


ORIGINAL ARTICLE
Ankita Das, B Niranjana Murthy

A Study of Cytohistopathological Correlation of Palpable Breast Lumps

[Year:2018] [Month:April-June] [Volumn:3 ] [Number:2] [Pages:31] [Pages No:52-56]



Introduction: Breast diseases are showing rising trend worldwide. Benign breast disease (BBD) is the most common cause of breast problem among women with prevalence rate of 68% among all breast lesions in India. It is more frequent than malignancy. Making an early diagnosis and planning the treatment help in alleviating unnecessary anxiety about breast cancer, and those with an increased risk of malignancy like atypical hyperplasia are given prompt treatment, follow-up, and awareness regarding the risk of breast cancer. Fine needle aspiration cytology (FNAC) is a relatively simple, reliable, nontraumatic, complication-free technique for breast lump evaluation.

Materials and methods: This study was done on a total of 55 female patients attending hospital for a period of 1 year in Tumkur, Karnataka. The FNAC technique was done with 23G needle attached to 10 mL syringe inserted into palpable breast mass. Cellular material aspirated and smeared on glass slide, fixed in 95% methanol, stained with hematoxylin and eosin. Air-dried slides were stained with Giemsa. Histopathological diagnosis was correlated with FNAC details in all cases.
All the collected data were transferred into a master sheet and fed into computer for statistical analysis using Pearson’s Chi-square test.

Results: In our study the patients belonged to age group of 14 to 65 years with a median of 37.5 years. Irrespective of sides, maximum numbers of cases were found in upper and outer quadrants. Maximum malignant lesions were in the age group of 45 to 49 years, whereas benign lesions were maximum in 30 to 34 years age group. The commonest pathology found in our study was fibroadenoma (51%) followed by ductal carcinoma (27%).
In our study out of 55 patients, 2 cases where FNAC showed benign proliferative breast disease, histopathological examination (HPE) report suggested infiltrating ductal carcinoma (IDC). Another 1 case where FNAC showed fibrocystic disease with atypical ductal hyperplasia (ADH), HPE report turned it out as IDC. Sensitivity of 75% specificity 100%, positive predictive value (PPV) 100%, and negative predictive value of 93% were obtained.

Conclusion: Fine needle aspiration cytology is a very important preliminary diagnostic tool in palpable breast lumps and results show high degree of correlation with final HPE report.

Keywords: Breast disease, Fine needle aspiration cytology, Histopathology.

How to cite this article: Das A, Murthy BN. A Study of Cytohistopathological Correlation of Palpable Breast Lumps. J Med Sci 2018;4(2):52-56.

Source of support: Nil

Conflict of interest: None


CASE REPORT
Hiremathada Shanmukh, Ravi S Shetty

Hybrid Cardiac Surgery in a Patient with Cardiogenic Shock and Ongoing Myocardial Ischemia

[Year:2018] [Month:April-June] [Volumn:3 ] [Number:2] [Pages:31] [Pages No:57-59]



Suitable time for coronary artery bypass grafting (CABG) after acute myocardial infarction (AMI) remains controversial. Many randomized studies have shown that primary angioplasty in AMI may result in better results compared with fibrinolytic therapy and CABG. We herewith report a case of a 72-yearold patient with fracture of femur who sustained massive myocardial infarction (MI). Hybrid cardiac surgery which combines percutaneous coronary intervention and CABG was performed on him.

Keywords: Angioplasty, Coronary artery bypass grafting, Hybrid coronary revascularization, Percutaneous coronary intervention.

How to cite this article: Shanmukh H, Shetty RS. Hybrid Cardiac Surgery in a Patient with Cardiogenic Shock and Ongoing Myocardial Ischemia. J Med Sci 2018;4(2):57-59.

Source of support: Nil

Conflict of interest: None


BRIEF COMMUNICATION
Shashikala Manjunatha, Subramanian Aishwarya, Rangenahalli V Anuradha

A Brief Review of Integrated Counseling and Testing Center in RajaRajeswari Medical College and Hospital, Bengaluru, Karnataka, India

[Year:2018] [Month:April-June] [Volumn:3 ] [Number:2] [Pages:31] [Pages No:60-62]



Introduction: The National AIDS (acquired immunodeficiency syndrome) Control Programme Phase four has envisaged the strengthening activities for prevention and control of AIDS through Integrated Counseling and Testing Center (ICTC)—a unit, where a person is counseled and tested for human immunodeficiency virus (HIV) through direct access or by physician referral. For HIV/AIDS victims, ICTCs are nodal points for preventive, curative, and supportive services.

Objective: To assess the patient’s profile in an ICTC of a private medical college hospital in Bengaluru, India, during the years 2014 to 2017.

Materials and methods: The study was conducted by record review and interviewing of patients attending ICTC of a private medical college hospital in Bengaluru. Statistical tests applied included univariate analysis and Chi-square test.

Results: This study depicted the functions and utilization pattern of services from a hospital-based ICTC attached to a medical college, through public-private partnership. The brief details of clients attending ICTC are reflected here. Among the total patients of 46,152 for 3 years referred to ICTC, 265 were HIV positive.

Conclusion: Here HIV positive cases are more among agriculturists and lower socioeconomic status persons, and sexual mode is the predominant mode of transmission.

Keywords: Human immunodeficiency virus positives, Integrated Counseling and Testing Center, Lower socioeconomic status.

How to cite this article: Manjunatha S, Aishwarya S, Anuradha RV. A Brief Review of Integrated Counseling and Testing Center in RajaRajeswari Medical College and Hospital, Bengaluru, Karnataka, India. J Med Sci 2018;4(2):60-62.

Source of support: Nil

Conflict of interest: None


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