Innovative Journal of Medical and Health Sciences

Since the number and amount of health services tried to be given in health institutions cannot be measured, it cannot be charged as the remuneration of services in other sectors. For this reason, health services should be evaluated, coded, and grouped on the basis of disease, and should be charged within the framework of these codes and groupings. . In the light of all these evaluations, the aim of this study is to provide a fair and quality distribution of the health services provided to the community, to provide a fair reimbursement system to the health service providers in return for the health services provided and to provide the maximum quality, the least cost of the health services provided and the reimbursement in health institutions. Diagnose Related Groups (DRGs) system. One of the most important issues in the DRGs system is the process of determining costs clearly, accurately, objectively and up-to-date. This process should be determined not only by hospitals but by the participation of all stakeholders in health services.

Since the number and amount of health services tried to be given in health institutions cannot be measured, it cannot be charged as the remuneration of services in other sectors. For this reason, health services should be evaluated, coded, and grouped on the basis of disease, and should be charged within the framework of these codes and groupings. . In the light of all these evaluations, the aim of this study is to provide a fair and quality distribution of the health services provided to the community, to provide a fair reimbursement system to the health service providers in return for the health services provided and to provide the maximum quality, the least cost of the health services provided and the reimbursement in health institutions. Diagnose Related Groups (DRGs) system. One of the most important issues in the DRGs system is the process of determining costs clearly, accurately, objectively and up-to-date. This process should be determined not only by hospitals but by the participation of all stakeholders in health services.

Cardiovascular disease is one of the most important reasons of death in the world and high levels of cholesterol is concerned as an essential risk factor for cardiovascular disease, thus a decrease in serum cholesterol levels can decrease cardiovascular disease. One preventative approaches for reduction of serum cholesterol levels could be caused by consumption of yoghurt containing probiotic bacteria. Probiotics are live microorganisms that provide health benefits when ingestion. There are a big number of probiotics presently utilized and accessible in dairy fermented foods, particularly in yogurts. Lactic acid bacteria represent a varied group of organisms given significant benefits to people, some as usual population of the intestinal area. This review presents relevant information on probiotics such as the definitions and characteristics of probiotic bacteria, their utilization in yogurt preparations, and the claimed benefits of the ingestion of these bacteria, particularly on lowering hypercholesterol.

Cardiovascular disease is one of the most important reasons of death in the world and high levels of cholesterol is concerned as an essential risk factor for cardiovascular disease, thus a decrease in serum cholesterol levels can decrease cardiovascular disease. One preventative approaches for reduction of serum cholesterol levels could be caused by consumption of yoghurt containing probiotic bacteria. Probiotics are live microorganisms that provide health benefits when ingestion. There are a big number of probiotics presently utilized and accessible in dairy fermented foods, particularly in yogurts. Lactic acid bacteria represent a varied group of organisms given significant benefits to people, some as usual population of the intestinal area. This review presents relevant information on probiotics such as the definitions and characteristics of probiotic bacteria, their utilization in yogurt preparations, and the claimed benefits of the ingestion of these bacteria, particularly on lowering hypercholesterol.

Introduction and objectives: Ureteric calculi usually present as acute episode of ureteral colic. Primary aim of our study was to compare the stone expulsion rate for tadalafil and tamsulosin. We also compared time to stone expulsion, need for an analgesic requirement and side effect associated with these drugs.
Methods:  150 patients presenting with single lower ureteral stone  (juxtavesical ureteral lithiasis at lower 5 cm of the ureter), 4 to ? 10 mm in size were randomized in three groups. Patients in group one received placebo and served as control, group two received phosphodiesterase 5 inhibitors (tadalafil 10mg OD) and group 3 received alfa one blockers (tamsulosin 0.4 mg OD) for accelerating the passage of the stone.
Results: The stone expulsion rate was 58% (36 of 50 patients) for the placebo group, 80 % (40 of 50 patients) for tadalafil group and 74 % for the tamsulosin group (37 of 50 patients). Tadalafil was superior to placebo in terms of stone expulsion rate (p-value: 0.017) but comparable to tamsulosin (p: 0.139). Patients in the tadalafil group had significantly less pain scores at 1 and 2 weeks follow up in comparison to the other two groups. Mean analgesic requirement for placebo, tadalafil and tamsulosin was 331, 132.93 and 277.08 mg of diclofenac respectively.
Conclusion: Tadalafil has better stone expulsion rate and faster stone expulsion as compared to tamsulosin but the difference is not statistically significant. Tadalafil results in statistically significant improvement in pain scores and decreased requirement of analgesic as compared to other two groups.

Introduction and objectives: Ureteric calculi usually present as acute episode of ureteral colic. Primary aim of our study was to compare the stone expulsion rate for tadalafil and tamsulosin. We also compared time to stone expulsion, need for an analgesic requirement and side effect associated with these drugs.
Methods:  150 patients presenting with single lower ureteral stone  (juxtavesical ureteral lithiasis at lower 5 cm of the ureter), 4 to ? 10 mm in size were randomized in three groups. Patients in group one received placebo and served as control, group two received phosphodiesterase 5 inhibitors (tadalafil 10mg OD) and group 3 received alfa one blockers (tamsulosin 0.4 mg OD) for accelerating the passage of the stone.
Results: The stone expulsion rate was 58% (36 of 50 patients) for the placebo group, 80 % (40 of 50 patients) for tadalafil group and 74 % for the tamsulosin group (37 of 50 patients). Tadalafil was superior to placebo in terms of stone expulsion rate (p-value: 0.017) but comparable to tamsulosin (p: 0.139). Patients in the tadalafil group had significantly less pain scores at 1 and 2 weeks follow up in comparison to the other two groups. Mean analgesic requirement for placebo, tadalafil and tamsulosin was 331, 132.93 and 277.08 mg of diclofenac respectively.
Conclusion: Tadalafil has better stone expulsion rate and faster stone expulsion as compared to tamsulosin but the difference is not statistically significant. Tadalafil results in statistically significant improvement in pain scores and decreased requirement of analgesic as compared to other two groups.

Background: Pleural effusions are collections of fluid in pleural cavities and are
actually manifestations of diverse diseases both infective and non infective and also
cardio-pulmonary in origin or extra-pulmonary. Based on the pathology of formation
the fluid can be either transudate or exudate. The most commonly accepted criteria
of differentiation is the Light’s criteria published by Richard Light in 1972 where
pleural fluid protein and lactate dehydrogenase enzyme were estimated along with
their respective level in serum and necessary calculation were done. In1987 Hamm
et.al suggested that estimation of pleural fluid cholesterol too reliably can differentiate
as the cholesterol level increases in infective and malignancy like pleural fluid protein
and it is low in transudates. The present study was done to estimate pleural fluid
cholesterol in infective, malignant and other non infective cases in our setup and to
study its accuracy in differentiation.
Aims & objective: to study pleural fluid cholesterol level and to study its accuracy
in differentiation of exudates verses transudates and to study correlation of pleural
fluid cholesterol with serum cholesterol and pleural fluid protein
Methodology: There were 100 cases of pleural effusions and 75 were due to infective
and malignant cases and rest were transudative. Fluids were aspirated and analysed
accordingly. Pleural fluid protein and pleural fluid cholesterol both were estimated
along with their levels in serum. American society of clinical pathologist laid down
value of pleural fluid cholesterol54mg/dl & ratio of pleural fluid cholesterol/serum
chlosterol0.3 as exudates. Further correlation in between cholesterol and protein level
in pleural fluid were studied and also serum cholesterol and pleural fluid cholesterol.
Results achieved were analysed statistically. A P0.05 was considered as statistically
significant.
Results & observation: With a cut of value of pleural fluid cholesterol 54mg/dl
all malignant and parapneumonic cases were classified as exudates. Among the 57
tubercular cases 52 cases were classified as exudate and among the 25 transudate cases
24 are successfully dedifferentiated. So the misclassification rate is 6% with accuracy
of 94%; the sensitivity achieved is 98.5% & specificity82.7%. When the ratio of pleural
fluid cholesterol/serum cholesterol is used as the differentiating marker misclassified
rate is 5% & accuracy 95%.The sensitivity is 98.6% & specificity 85.7%. The study of
correlation reveals that there is a strong positive correlation in between pleural fluid
protein and pleural fluid cholesterol in both exudate and transudate and the result
being statistically significant (P0.05).
Discussion: In this study pleural fluid cholesterol level and its ratio with serum
cholesterol were used as differentiating parameter for classifying exudate and transudate
in 100 cases of pleural effusion in our setup and compared with studies of Light
et.al and Hamm et.al . We got similar accuracy of differentiation like the pioneer study
in separation of serous fluid i.e. Light’s criteria. The study of correlation also signifies
that in infective causes and malignancy pleural cholesterol increases as pleural fluid
protein and decreases in transudate and this is statistically significant.
Conclusion: To overcome few fallacies of Light’s criteria there was a search for new
parameters in pleural fluid for better differentiation and cholesterol was used in this
regard. In our study pleural fluid cholesterol and its ratio with serum cholesterol can
reliably be used as differentiating parameter and in our results the misclassification
rate was 5% with accuracy of 95%

Background: Pleural effusions are collections of fluid in pleural cavities and are
actually manifestations of diverse diseases both infective and non infective and also
cardio-pulmonary in origin or extra-pulmonary. Based on the pathology of formation
the fluid can be either transudate or exudate. The most commonly accepted criteria
of differentiation is the Light’s criteria published by Richard Light in 1972 where
pleural fluid protein and lactate dehydrogenase enzyme were estimated along with
their respective level in serum and necessary calculation were done. In1987 Hamm
et.al suggested that estimation of pleural fluid cholesterol too reliably can differentiate
as the cholesterol level increases in infective and malignancy like pleural fluid protein
and it is low in transudates. The present study was done to estimate pleural fluid
cholesterol in infective, malignant and other non infective cases in our setup and to
study its accuracy in differentiation.
Aims & objective: to study pleural fluid cholesterol level and to study its accuracy
in differentiation of exudates verses transudates and to study correlation of pleural
fluid cholesterol with serum cholesterol and pleural fluid protein
Methodology: There were 100 cases of pleural effusions and 75 were due to infective
and malignant cases and rest were transudative. Fluids were aspirated and analysed
accordingly. Pleural fluid protein and pleural fluid cholesterol both were estimated
along with their levels in serum. American society of clinical pathologist laid down
value of pleural fluid cholesterol54mg/dl & ratio of pleural fluid cholesterol/serum
chlosterol0.3 as exudates. Further correlation in between cholesterol and protein level
in pleural fluid were studied and also serum cholesterol and pleural fluid cholesterol.
Results achieved were analysed statistically. A P0.05 was considered as statistically
significant.
Results & observation: With a cut of value of pleural fluid cholesterol 54mg/dl
all malignant and parapneumonic cases were classified as exudates. Among the 57
tubercular cases 52 cases were classified as exudate and among the 25 transudate cases
24 are successfully dedifferentiated. So the misclassification rate is 6% with accuracy
of 94%; the sensitivity achieved is 98.5% & specificity82.7%. When the ratio of pleural
fluid cholesterol/serum cholesterol is used as the differentiating marker misclassified
rate is 5% & accuracy 95%.The sensitivity is 98.6% & specificity 85.7%. The study of
correlation reveals that there is a strong positive correlation in between pleural fluid
protein and pleural fluid cholesterol in both exudate and transudate and the result
being statistically significant (P0.05).
Discussion: In this study pleural fluid cholesterol level and its ratio with serum
cholesterol were used as differentiating parameter for classifying exudate and transudate
in 100 cases of pleural effusion in our setup and compared with studies of Light
et.al and Hamm et.al . We got similar accuracy of differentiation like the pioneer study
in separation of serous fluid i.e. Light’s criteria. The study of correlation also signifies
that in infective causes and malignancy pleural cholesterol increases as pleural fluid
protein and decreases in transudate and this is statistically significant.
Conclusion: To overcome few fallacies of Light’s criteria there was a search for new
parameters in pleural fluid for better differentiation and cholesterol was used in this
regard. In our study pleural fluid cholesterol and its ratio with serum cholesterol can
reliably be used as differentiating parameter and in our results the misclassification
rate was 5% with accuracy of 95%

Introduction: Thyroid nodules are common, their prevalence being chiefly dependent on the identification technique. The estimated prevalence by palpation alone ranges from 4% to 7%, up to 67% by ultrasound, and fifty percent at autopsy with a noticeably higher incidence in iodine deficient provinces. This study was aimed to determine the ultrasound imaging findings of thyroid nodules in patients and correlate it with clinical records to develop a standardized diagnosis system for interpreting thyroid ultrasound imaging.

Methods: This Retrospective Analytical  study involved data of 200 of the randomly selected patients ( candidates / study subjects ) who seek care for Thyroid Nodules between Aug 2018 to Nov 2018 were retrospectively identified. From Lew et al. guidelines ultrasound of nodule margins, suggestive of malignancy guidelines was adopted. A fine needle aspiration (FNA) biopsy was recommended to the referring physician is required.[14,15] All participants provided informed written consent to participate in it.Patients with diagnosed thyroid nodules of more than 1 cm and who underwent   ultrasonography  were included.

Results: From all nodules, 21.50% were single and 78.5% were multiple nodules; 53 nodules (26.5%) were solid and 157 (78.5%)   cystic.   Concerning   echogenicity,   46   nodules (23%) were Hypo-echo , 44 nodules (22%) were Hyper-echo & rest were Iso echoic.  192 nodules (96.0%) had a regular edge. 59 nodules (29.5%) were without Halo. 157 nodules (78.5%) were larger than 15mm. According to histopathology results, the benign nodules were 92% and malignant cases were 08%

Conclusion: Based on the result of this study, thyroid nodule size must not be considered as a criterion for malignancy and thyroid nodules of any size must be suspected as malignant. Important criteria for malignancy include irregular edges, being Solid hypoechogenicity and being a single nodule respectively. However, the presence of calcifications in the nodule by US indicates a higher risk of malignancy and should prompt the clinician to evaluate the nodule further with repeat FNA.

Key Word : USG , Thyroid Nodules , Malignant , Benign , Single Nodule