Role of accreditation and ranking in medical education V Vaikkakara Suresh, TS Ravikumar Journal of Clinical and Scientific Research 2019 8(2):65-66

Clinical presentation and outcome in patients presenting with acute coronary syndrome – A prospective study Sivaramakrishna Battula, V Satyanarayana, D Rajasekhar, A Krishna Simha Reddy, Venkatesh Satri Journal of Clinical and Scientific Research 2019 8(2):67-73 Background: Acute chest pain is one of the most common reasons for seeking care in the emergency department. Acute coronary syndrome (ACS) is a spectrum of diseases comprising unstable angina (UA), non-ST-segment elevation myocardial infarction (NSTEMI) and ST-segment elevation myocardial infarction (STEMI). The present study was undertaken to study the clinical presentation and outcomes of patients with ACS. Methods: In this prospective observational study conducted in a tertiary care teaching hospital in Tirupati, during the period February 2015 to June 2016, demographic, clinical profile, treatment modalities and outcome in patients with ACS were studied. Results: A total of 1034 patients with ACS presented to the emergency room, during the study period. Mean age of the study population was 56.7 ± 11.7 years. STEMI accounted for 67% of the cases. Three hundred and forty one patients (33%) presented with NSTEMI (n = 256) and UA (n = 85). In 823 patients with ACS (79.6%), percutaneous coronary intervention (PCI) with stenting was done, and among those, primary PCI was done in 196 cases. Mean duration of stay in the hospital was 4.86 ± 1.5 days. Thirty-seven cases (3.9%) expired during the follow-up period. Reinfarction in minority cases (0.8%). Conclusions: In the present study, ACS is more common in the younger age group with male predominance. Majority of the patients presented with Killip Class I. Most of the patients underwent PCI.

Evaluation of hepatitis B vaccination status and immune response among clinicians in a tertiary care hospital in South India R Jayaprada, N Ramakrishna, B Vasavi, B Venkataramana, KK Sharma Journal of Clinical and Scientific Research 2019 8(2):74-78 Background: Hepatitis B virus (HBV) infection remains an important health issue with an estimated 2 billion people worldwide infected with HBV. The risk of contracting HBV by health-care workers (HCWs) is four times greater than that of the general adult population. Protection is defined as immunoglobulin G anti-hepatitis B virus surface antigen antibodies (IgG anti-HBsAbs) level ≥10 mIU/mL following a successful vaccination course. Methods: Three hundred and seventeen clinicians participated in the present study. Vaccination history for hepatitis B was obtained. The concentration of IgG anti-HBsAbs in the serum was determined by quantitative enzyme-linked immunosorbent assay. Results: Two hundred and twenty nine participants (72.2%) had already received a complete course of HBV vaccination, 78 participants (24.6%) had received incomplete course and 10 participants (3%) were non-vaccinated. Among the clinicians having a complete history of vaccination, 86% had protective immunity; while of the 71.7% participants who had incomplete vaccination had protective immunity. We found that four clinicians (1.2%) could not attain protective anti-HBsAb level ≥10 mIU/ml, were designated as non-responders after second vaccine series. Conclusions: Even with full vaccination some of the clinicians have not achieved protective IgG anti-HBsAb titres. Hence, it is imperative that protective antibody titre ≥10 mIU/mL must be maintained in all HCWs. Non-responders must be identified and should be counselled regarding how to prevent hepatitis B infection.

A study of anomalous origin of medial circumflex femoral artery and its significance Chakka Sreekanth, Gandrakota Ravindranath, Chembeti Venkataramana Journal of Clinical and Scientific Research 2019 8(2):79-82 Background: Femoral artery, a branch of external iliac artery, is the blood supply to the anterior compartment of the thigh. Its branch, medial circumflex femoral artery (MCFA), supplies the head and neck of femur, adductor muscles and the acetabular pad of fat. By virtue of its anatomical location, usually there is a high risk of severing the artery after trauma or during total hip arthroplastic surgeries. Methods: We studied variations in the femoral artery and its branches in 100 femoral triangles from 50 properly embalmed and formalin-fixed human cadavers, from Sri Venkateswara Institute of Medical Sciences, Sri Padmavathi Medical College for Women, Tirupati, and NRI Institute of Medical Sciences, Visakhapatnam, Andhra Pradesh, India. Results: We observed that the MCFA arose from the common femoral artery in 10% of the cases and from the deep femoral artery in 88% of the cases and was absent in 2% of the cases. Conclusions: The MCFA variability must be taken into account by surgeons, especially during orthopaedic interventions in the region of the hip to prevent iatrogenic injury to the circulation of the femoral head.

Sonourethrography in evaluation of anterior urethral abnormalities and comparison with retrograde urethrogram C Anil, B Vijayalakshmi Devi, AY Lakshmi, N Anil Kumar, N Rukmangada Journal of Clinical and Scientific Research 2019 8(2):83-88 Background: Sonourethrography (SUG) offers important technical advantages over conventional retrograde urethrography (RGU) by estimating the length of strictures, degree of spongiofibrosis which could be more informative in making decisions about management. The present study is intended to evaluate the role of SUG in investigating anterior urethral abnormalities and comparison of SUG with RGU and per-operative (PER-OP) findings. Methods: All 31 patients had undergone RGU first and then followed by SUG. The findings of both examinations were tabulated and compared with per-operative findings. Results: Total number of pathologies detected in RGU, SUG and PER-OP are 45, 53 and 53, respectively. In detecting strictures, the overall sensitivity is 97% and 100%, specificity 50% and 66%, positive predictive value 94% and 97%, negative predictive value 66.6% and 100%, accuracy is 92% and 97% and Cohen's Kappa is 0.53 and 0.78 for RGU and SUG, respectively. The mean length of stricture calculated on SUG was closer to that of surgery when compared with RGU. The percentage sensitivity and accuracy of SUG in detecting spongiofibrosis is 94.7%. The accuracy of RGU and SUG in detecting urethritis is 47% and 94%. Conclusions: SUG gives more accurate information about stricture length and periurethral fibrosis, thus is more useful to determine the suitable operative procedure.

Respiratory dysfunction in hypothyroidism Palaparthi Sai Krishna Chaitanya, V Suresh, Alladi Mohan, Alok Sachan Journal of Clinical and Scientific Research 2019 8(2):89-94 Hypothyroidism is one of the most common endocrine disorders in adults. While it affects almost all systems of the body, little attention has been paid to the involvement of the respiratory system and its function in hypothyroidism. The present review summarises the available literature on respiratory function in patients with hypothyroidism. Hypothyroidism has myriad effects on respiratory function. It is known to cause upper airway obstruction during sleep causing sleep disordered breathing (obstructive sleep apnoea). It affects the respiratory drive causing reduced responsiveness to hypoxia or hypercapnia, potentially causing life-threatening hypoventilation on rare occasions. Pleural effusions solely attributable to hypothyroidism are a relatively uncommon occurrence. Deficiency of thyroid hormones reduces the strength of the respiratory muscles. A reduction in diffusion lung capacity for carbon monoxide points to lung parenchymal involvement as well. These two changes lead to a predominantly restrictive pulmonary physiology on spirometry. Studies show that the restrictive pattern improves after thyroxin replacement. Since pulmonary involvement is a relatively underevaluated aspect of hypothyroidism, more studies in this area are the need of the hour, to fill the current lacunae in our knowledge and understanding.

A rare case of paediatric non-Hodgkin's lymphoma D Bhargavi, T Kannan, KL Priyadarshini, V Santhosh, KM Ramprahlad, B Sreekanth Journal of Clinical and Scientific Research 2019 8(2):95-97 Anaplastic large cell lymphoma (ALCL) is a rare disease accounting for 10%–15% of all non-Hodgkin's lymphomas in children. It is distinguished from other lymphomas by their anaplastic cytology and constant membrane expression of the CD30 antigen. We report a 9-year-old boy presented with a left calf swelling. Biopsy from swelling revealed as small cell variant of anaplastic lymphoma kinase-positive ALCL. Staging with positron emission tomography–computed tomography showed lymph nodal and multiple extra-nodal involvement. The extra-nodal sites were lung, pancreas, bone, sphenoid sinus and muscles. He was started on ALCL-99 protocol.

Anti-synthetase syndrome V Arun Raja, J Harikrishna, M Ganesh, C Rahul, A Praveen, S Aparna Reddy, Alladi Mohan Journal of Clinical and Scientific Research 2019 8(2):98-100 We report the case of a 39-year-old female who presented with breathlessness on exertion, cough, myalgias for the past 6 months and fever for 1 month. Chest X-ray revealed bilateral multilobar consolidation. High-resolution computed tomography (HRCT) of the chest revealed bilateral interstitial thickening, traction bronchiectasis and consolidation in the posterior segment of the left upper lobe. Laboratory investigations showed mild normocytic, normochromic anaemia (haemoglobin 10.4 g/dL), thrombocytosis (platelet count 6.03 lakhs/mm3), peripheral blood eosinophilia (11%) and raised erythrocyte sedimentation rate (100 mm at the end of the first hour). Serum creatine kinase (178 IU/L) was normal. Anti-nuclear antibody (ANA) tested positive and ANA profile revealed anti-Jo-1 antibodies. She was diagnosed to have anti-synthetase syndrome based on the above clinical features and positive autoantibodies. The present case highlights the importance of obtaining HRCT chest and ANA profile in confirming the diagnosis in patients with clinically suspected inflammatory muscle diseases and associated interstitial lung diseases. This case also brings to light the uncommon occurrence of anti-synthetase syndrome among idiopathic inflammatory muscle diseases.

A unique case of systemic lupus erythematosus with medium- and large-vessel vasculitis Subbalaxmi V S. Malladi, Sumanth Vittamraj, Anu Kapoor, Naval Chandra, Liza Rajasekhar Journal of Clinical and Scientific Research 2019 8(2):101-103 Medium and large-vessel vasculitis in association with SLE is distinctly uncommon and is limited to occasional case reports only. We present a case of 40 year old female who presented with complaints of left sided pleuritic chest pain of 10 days duration. She was diagnosed to have hypertension 1 year ago which was treatment resistant. In present admission she had accelerated hypertension for which she was evaluated systematically. She was diagnosed to have SLE with Bilateral Renal artery stenosis and stenosis of other visceral vessels. Literature search revealed very few cases of SLE presenting with features of medium and large vessel vasculitis. Large vessel involvement in SLE is associated with high disease activity and therefore early recognition of this rare entity is essential.

A 57-year-old man with altered sensorium and renal failure S Praveen Kumar Reddy, Maria Bethasaida Manual, B Alekhya, G Swyritha, M Amarendra, K Naveen, A Sunnesh, N Sai Sameera, N Praveen, Prabhajan Kumar, N Rukumangadha, Aruna Prayag, R Ram, D Rajasekhar, V Siva Kumar Journal of Clinical and Scientific Research 2019 8(2):104-112