Asian Journal of Medical Sciences

Gestational diabetes: The epicenter of feto-maternal crisis

2023-08-05T01:04:57+00:00

Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. The rising trend in obesity and overweight globally poses a serious risk for developing GDM, more among South Asian population. The occurrence of perinatal complications seems to parallel with incidence of GDM contributing significantly to adverse pregnancy outcome. The matter of fact is that diabetes just do not affect the mothers only, but also the new-born, predisposing them to various neonatal adverse outcomes, including metabolic and cardiac disorders, and respiratory distress, as wells as neurologic impairment compromising with metal development. Further, low birth weights, macrosomia, and infections are some of the most commonly occurring outcomes of GDM, the severity of which parallels with maternal blood glucose levels and age. Further, there are higher risk of hypoglycemia among the new born of hyperglycemia diabetic mothers.

The numbers are soaring high, more in developing nations, with India almost topping the list with currently, over 80 million women worldwide who are affected by GDM and pregestational diabetes mellitus. How exactly GDM affects the developing fetus is still not precisely known. Animal studies using rodent models indicated glucose mediated oxidative stress, leading to excess apoptosis in the target organs as wells production of other reactive oxygen and nitrogen species. Further, an activation of unfolded protein response leading to endoplasmic reticulum stress seems to contribute to the pathogenesis of hyperglycemia. However, what is assuring is that risk mitigation against this detrimental effect can be adopted. This involves risk assessment of pregnant females at the first prenatal visit with special focus on comorbidities such as overweight with/and obesity, glycosuria, and family history and hence should be recommended for blood glucose testing (between 24 and 28 weeks of gestation). With the prevalence of GDM reported to range from 3.8% in Kashmir 17.9% in Tamil Nadu, the stakes are high. It is also clear that India has a very high prevalence of GDM by all global standards. Rational steps to tackle this problem at the early and effectively will decide its long-term consequences on maternal and child health.

Agenesis of gallbladder-series of four cases - why it is difficult to diagnose preoperatively?

2023-04-23T08:43:42+00:00

Agenesis of gallbladder (AGB) is a rare clinical entity first reported by Bergman in 1702. The incidence is about in 10–65 cases/1,00,000 population. It is seen in 1/6th cases of biliary atresia. It is of unknown etiology and is believed to be due to abnormal embryonic development. Nearly 70% cases are sporadic. AGB may be associated with other congenital abnormalities including the biliary system. The majority (nearly 50%) of the patients are symptomatic with misinterpreted signs and symptoms of cholecystitis and lands up to unnecessary surgery. Our series of four cases have male: female ratio of 3:1. Two of the cases underwent laparoscopic surgery. Among the other two, one had biliary pancreatitis due to primary calculous in the common bile duct (CBD) with upstream dilation. Other cases had chronic pancreatitis with dilated pancreatic duct and a proximal calculous close to ampulla causing proximal dilation of CBD. Two operated cases were postoperatively diagnosed by magnetic resonance cholangiopancreatography (MRCP) and the non-operated patients were also diagnosed by MRCP. Symptomatic AGB is often wrongly interpreted as cholecystitis with cystic duct obstruction or as sclero-atrophic gallbladder, therefore leading to pointless surgical interventions. In case of false-positive ultrasonography (USG) of AGB, it has been suggested that either a loop of gas-containing bowel located in the gallbladder fossa or periportal tissue and subhepatic peritoneal folds impersonate a contracted gallbladder containing gallstones. When USG reveals such reports or in cases of non-visualization in other imaging modalities, the need of additional preoperative imaging investigation must be in the surgeon’s mind such as MRCP to avoid surgery which is not at all required.

Position of oral cephalosporins and its fixed-dose combinations in the guideline recommendations for the management of community-acquired infections

2023-05-06T07:20:44+00:00

Community-acquired infections (CAIs) represent a major burden for health-care system. This directly aids the emergence of antibiotic-resistant organisms. India is not immune to it. This review assessed the current guideline recommendations for the usage of oral cephalosporins in the management of common CAIs. The researchers conducted iterative searches in PubMed, SCOPUS, and Google Scholar for published articles using various keywords. The search was conducted in November 2022 and considered articles published till date. Different CAIs are caused by similar organisms, susceptible to first-line antibiotics such as penicillin and cephalosporins. Most of the guidelines recommend the use of oral cephalosporins for the management of the commonly prevalent CAIs. These antibiotics however should be used as a monotherapy and not as fixed-dose combinations (FDCs), as FDCs with oral cephalosporins lack scientific basis and may be detrimental. For burden of CAIs intensified by anti-microbial resistance, guidelines are useful for the management of CAIs to educate the prescribers and preserve currently available antibiotics.

Alice in wonderland syndrome – A medical enigma

2023-07-07T10:50:19+00:00

Alice in Wonderland syndrome (AIWS) is a disorder in which patients report distorted visual perception and an impaired sense of time. It was first described in 1955 by the British psychiatrist John Todd, who associated these symptoms with disorders such as migraine and epilepsy. Before Todd’s observations, many symptoms of this disorder had made appearances in literature describing hysteria. Similar symptoms were observed in soldiers with occipital wounds after World Wars I and II.

Patients with AIWS experience a plethora of symptoms such as, “kinetopsia” – Stationary objects appear to be moving, “total microsomatognosia” – Body parts appear unusually smaller. “Depersonalization” – Feeling of strangeness in perceiving one’s body image is common in AIWS. Often, this is accompanied by “derealisation” – Patients start perceiving their surroundings and the people around them as unreal. However, the patient is aware that this state of consciousness is not normal- which is what differentiates it from the state of psychosis. Other symptoms include: Dyschronometria, dysmorphops, macropsia, micropsia, kinetopsia, prosopometamorphopsia, and plagiopsia. In migraine patients, the prevalence rate of these symptoms increases to about 15%.

Most symptoms of AIWS are ascribed to neurons of the central nervous system and cell columns that respond to specific sensory inputs (Ex- like visionary inputs of cortical areas V1–V5). Area V4 of the extrastriata visual cortex, particularly responds to the colors, whereas area V5 responds to movement. V4 and V5 also respond to shape and depth, but the bilateral loss of function of V4 results in achromatopsia (the inability to visualize color), and bilateral loss of V5 results in akinetopsia (the inability to visualize motion).

Anatomically speaking, a critical region for developing this syndrome is the junction of three major areas, i.e., temporooccipital, parieto-occipital, and temporo-parietal junctions, known as the temporoparietal-occipital carrefour, point where our visual and somatosensory perceptions of the world are integrated to develop an external and internal representation of ourselves.

AIWS remains a poorly understood and usually misdiagnosed syndrome. It is mostly associated with Epstein–Barr virus infection in children. Most cases of AIWS are expected to have a full remission of symptoms; sometimes, this may occur spontaneously with/without proper treatment. However, in cases with an associated chronic disease, like migraines and epilepsy, symptoms tend to occur in accordance with the active phases of these diseases.

The number of fascinating disorders that surround and confound the medical community has no limit. The journey into the human brain is about as daunting and baffling as Alice’s journey into Wonderland. Efforts to understand the functioning and physiology of this extraordinary organ will keep both doctors and scientists on their toes for many years to come.

Awareness, acceptance, and hesitancy about COVID-19 vaccine among residents of urban and rural health training center field practice area of a medical college at Kolkata: A cross-sectional survey

2023-05-15T23:55:42+00:00

Background: Effective vaccination is a successful tool for controlling COVID-19 pandemic, along with other preventive measures. Both intention to get vaccinated and barrier to vaccination played important role in COVID vaccination drive.

Aims and Objectives: The present study was conducted to assess awareness, acceptance, and hesitancy about COVID-19 vaccine among the residents of rural and urban area and to assess the factors related to their attitude.

Materials and Methods: A descriptive cross-sectional survey was conducted among the adult residents of urban and rural area over 6 months. Total sample size was 400. Simple random sampling technique was adopted to recruit the study participants after obtaining informed verbal consent. This process was continued until the desired number of sample size was attained. Data were compiled after collection and analysis was done.

Results: Rural population had significantly higher knowledge of coronavirus and urban population knew prevention of coronavirus infection more. Correct knowledge of COVID vaccine availability was higher among rural people but higher knowledge of vaccine related information was among urban population. Sources of information were mainly from mass media. Vaccine acceptance was more among urban population, but apprehension was significantly higher among urban residents. Higher proportion of urban people was motivated significantly by the healthcare workers as well as self-motivated than their rural counterpart.

Conclusion: Targeted interventions could be developed for increasing awareness of disease and availability of COVID-19 vaccines. Population-based vaccination program can decline the trend of the pandemic in long term.

Gender-related differences in the morphometry of the corpus callosum: MRI study

2023-03-23T17:06:08+00:00

Background: The size and shape of the adult corpus callosum (CC) may vary with gender. There is, however, less literature available on data involving the morphometry of CC among the Indian population.

Aims and Objectives: To measure the size of CC using magnetic resonance imaging (MRI) scans of normal Indian adult females and males and identify gender-related differences, if any.

Materials and Methods: The dimensions of CC were measured on MRI scans on a midsagittal section view belonging to 150 (59 females, 91 males) normal Indian adults (North India) using e-measurement tools. The measurements included the maximum length and height of CC, the thickness of various parts of CC, the CC index (CCI), and the distance of CC from the frontal and occipital poles of the cerebral hemisphere. The study was carried out in the Department of Anatomy in collaboration with the Department of Radiodiagnosis, King George’s Medical University, U.P., Lucknow, India. The data was analyzed using the statistical package for social sciences, 23rd version. Means were compared for significant differences using the independent unpaired t-test.

Results: The mean length of the CC was found to be 6.94±0.63 cm; mean height was 2.57±0.43 cm; the mean thickness of the genu was 9.16±2.26 mm; the mean thickness of the body was 5.09±0.99 mm; the mean thickness of splenium was 9.10±2.22 mm; the mean distance from the frontal pole was 3.66±0.35 cm; the mean distance from the occipital pole was 5.70±0.74 cm; and the mean CCI calculations showed to be 3.37±0.56. All measurements were found to be greater in males as compared to females except mean height (males 2.56±0.47 cm; females 2.59±0.37 cm) and mean thickness of the body (males 5.04±0.94 mm; females 5.17±1.06 mm). A statistically significant difference was observed in the distance of CC from the frontal pole in our population with respect to gender (P=0.03).

Conclusion: Based on observations made in the study, normative data of CC measurements was generated, and it was found that there was no significant gender-related difference in the morphology of CC; the only significant difference was in the distance of the genu from the frontal pole, which was greater in females as compared to males.

Beyond the veil: Unveiling the unconventional - exploring the profiling, attitudes, and influential factors of body donors

2023-05-31T23:35:09+00:00

Background: Cadavers are essential for anatomical education, yet their scarcity plagues medical colleges in Kerala and India. However, the Government Medical College in Thrissur has experienced a rise in annual body donations.

Aims and Objectives: This study aims to explore the motivating factors behind this increase among the population of Thrissur.

Materials and Methods: This study employed a cross-sectional survey design conducted at the Department of Anatomy, Government Medical College in Thrissur, Kerala. The study utilized data from the Body Donation Register, which covered a period from May 1st, 2011 to April 30th, 2012, encompassing a total of 223 individuals. During this specific period, which was selected due to the notable surge in body donation trends, there was a significant increase observed. The sample size was set at 110 participants. Data collection was conducted through face-to-face interviews with the voluntary body donors and was analyzed using the statistical package for the social sciences, version 16.0.

Results: Gender distribution: Among 120 donors, 56.7% were male and 26.7% were female. Age groups 61–70 had the highest percentage (36%) of body donors. Socioeconomic status: the majority were above the poverty line (78.2%). Religious affiliation: Hindus had the largest representation (40 individuals). Marital status: Most donors were married (92 out of 110). Number of children: Most donors had two children (64 individuals). Sources of information: Family and relatives were the primary sources. Awareness of dissection: An equal number of donors were aware and unaware. Motivations for donation varied, including social service and avoiding burden after death.

Conclusion: A good proportion of donors had a socioeconomic status above the poverty line, and most of them were graduates or postgraduates. The majority of body donors did not have a religious affiliation. However, they had a strong family background and received support from their families. Interestingly, most of the donors were unaware of how their bodies would be used after donation.

A randomized comparative study to estimate the safety and effectiveness between laryngeal mask airway supreme and I-gel in patients undergoing elective surgeries

2023-03-14T02:20:37+00:00

Background: Supreme laryngeal mask airway (SLMA) and i-gel airway devices are second generation supraglottic airway devices (SAD) and are good alternatives to intubation during elective surgeries.

Aims and Objectives: This study was conducted with the objective of comparing the two SAD with respect to ease of insertion, number of attempts of insertion, insertion time, ease of gastric tube insertion, accompanying hemodynamic changes, incidence of adverse effects like regurgitation, lip and dental trauma, post-operative sore throat, dysphagia, and hoarseness.

Materials and Methods: This study was conducted at M.G.M. Medical College and M.Y. hospital, Indore. Eighty patients belonging to ASA class 1 or 2, with Mallampati grading 1 or 2, between age group of 18–60 years and with BMI <30 kg/m2 were selected for the study. After induction of anesthesia, one of the SAD’s (SLMA or i-gel) was inserted following randomization, and accordingly, the patients were divided into two groups of 40 each. Insertion parameters, hemodynamic, and respiratory parameters were noted. Patients were also observed for any possible complication at 1 h and 24 h postoperatively.

Results: The Two groups showed no statistically significant difference in terms of demographic characteristics, insertion parameters, hemodynamic, or respiratory parameters (P>0.05). Postoperatively, no significant complications were observed in terms of dental injury, laryngospasm. Ease of gastric tube insertion was found to be more in SLMA group than i-gel and the difference was statistically significant (P=0.0057). Incidence of sore throat after 1 h was found to be more in SLMA group than i-gel group (P=0.048).

Conclusion: There was no significant difference between SLMA and i-gel in terms of insertion characteristics and hemodynamic changes. Ease of gastric tube insertion was found to be significantly more in SLMA group than i-gel. Incidence of post-operative sore throat at 1 h was more with SLMA as compared to i-gel.

Efficacy of pre-emptive peripheral nerve block using 0.25% bupivacaine for postoperative analgesia in patients undergoing maxillofacial surgeries under general anesthesia

2023-04-30T22:56:53+00:00

Background: Conventional analgesia using non-steroidal anti-inflammatory drugs not only provides inadequate pain relief but also can produce a multitude of systemic adverse effects. During oral and maxillofacial surgeries, inhibition of central sensitization by pre-incision nerve blocks with local anesthetic can reduce postoperative pain, may curtail analgesic requirement, and thereby can provide better patient comfort.

Aims and Objectives: This study aimed to evaluate the effectiveness of pre-incisional peripheral nerve block using 0.25% bupivacaine over placebo for postoperative pain relief in patients undergoing oral and maxillofacial surgery under general anesthesia.

Materials and Methods: One hundred and twenty patients of 18–35 years of either sex, American Society of Anesthesiologists physical status class I and II had undergone oral and maxillofacial surgeries were divided into two groups to receive bupivacaine 0.25% (Study group, n=60) normal saline (Control group, n=60) for nerve block before surgical incision. Postoperative pain was assessed by Visual Analog Scale (VAS) score and verbal response scale (VRS) score. The number of rescue analgesia was required in the first 24 h and the incidence of any complications associated with this agent was documented.

Results: The VAS score was found considerably lower in the bupivacaine group compared with the control group in the first 24 h of postoperative period (P<0.05). A similar trend was observed with VRS score in the first 16 h of postoperative period (P<0.05). The number of rescue analgesia required in the control group was much higher in comparison with the study group. There was no serious adverse event in both the groups.

Conclusion: Bupivacaine 0.25% as pre-emptive analgesia can be used to reduce postoperative pain and analgesic requirements in maxillofacial surgeries.

Comparison between transcutaneous electrical nerve stimulation and metoclopramide in preventing postoperative nausea and vomiting after gastrointestinal laparoscopic surgery-A prospective and randomized study

2023-04-13T15:56:53+00:00

Background: Postoperative nausea and vomiting is a common complication after laparoscopic surgery and general anesthesia. It increases the patient’s discomfort and compromises the surgical outcome.

Aims and Objectives: The study aimed to compare the effectiveness of Transcutaneous Electrical Nerve Stimulator (TENS) and Injection of Metoclopramide for the prevention of post-operative nausea and vomiting in patients undergoing gastrointestinal laparoscopic surgery. The secondary objective of the study was to find out the percentage of cases needed rescue antiemetic drug (Inj. Ondansetron) when prophylaxis failed.

Materials and Methods: The study was a prospective, double-blind, randomized trial conducted at M.G.M. Medical College and M.Y. Hospital, Indore. 90 patients of 18–60 years of age, ASA physical status I-II, undergoing elective laparoscopic gastrointestinal surgery were included. Patients were allocated randomly into two equal groups. Group T received TENS (the stimulation group) at P6 acupressure point, whereas group M received an injection of Metoclopramide before induction of anesthesia. Patients in both groups were observed for 24 h postoperatively for the incidence of nausea and vomiting and the requirement for rescue antiemetic.

Results: The percentage of Postoperative Nausea Vomiting (PONV) and requirement of rescue antiemetics in both the groups were comparable in the first 6 h following laparoscopic gastrointestinal surgeries (P=1.000). There was no significant difference in PONV and rescue antiemetic requirement at 24 h in both the groups.

Conclusion: TENS stimulation at P6 acupressure point is comparable to injection of Metoclopramide in preventing postoperative nausea and vomiting after laparoscopic gastrointestinal surgeries.

A randomized clinical study to compare postoperative pain relief in ilioinguinal nerve block versus transversus abdominis plane block following inguinal hernia repair surgery

2023-02-28T18:08:08+00:00

Background: Inguinal hernia surgeries are associated with postoperative pain and discomfort. Transversus abdominis plane (TAP) block and Ilioinguinal/Iliohypogastric (IIIH) nerve blocks are widely used to control postoperative pain. In this study we have compared postoperative pain relief between TAP block and IIIH nerve block in the patients undergoing inguinal hernia surgery under spinal anesthesia.

Aims and Objectives: The primary aim of this study was to compare postoperative pain relief of TAP block and IIIH block in patients undergoing inguinal hernia surgery. Secondary objectives were to observe hemodynamic parameters and to observe for postoperative side effects if any.

Materials and Methods: Sixty patients of age group 18–65-year-old males, ASA grade I, II, were randomised into two groups TAP group (n=30) and IIIH group (n=30). TAP group received 30 mL of 0.25% ropivacaine TAP block and group IIIH received 20 mL, and wound infiltration with 10 mL of 0.25% ropivacaine. Duration of analgesia was recorded, visual analogue scale (VAS) score compared in first 24h postoperatively. Perioperative haemodynamic parameters were recorded.

Results: VAS score was found significant at 1, 2, 3, 4, 5, 8, 10, 16 h (P<0.001). The mean duration of analgesia was found to be 4.64±1.16 h and 6.3±1.84 h for IIIH group and TAP group respectively which was statistically significant (P<0.001). Haemodynamic were stable and no complication was there in both the groups.

Conclusion: As a part of multimodal analgesia regimen both TAP block and IIIH block provided good pain relief postoperatively in patients undergoing inguinal hernia. In this study TAP block provided prolonged pain relief than IIIH block after inguinal hernia repair.

To evaluate the analgesic efficacy of intravenous dexamethasone as an adjuvant to caudal block: A prospective, randomized, double-blind study

2023-05-13T02:38:04+00:00

Background: Post-operative pain is of great concern in pediatric age group. Intravenous dexamethasone has been found to be promising in reducing post-operative pain when administered as an adjuvant to epidural anaesthesia in abdominal and orthopedic surgeries. However, little is known about its efficacy in children receiving caudal block for post-operative pain relief.

Aims and Objectives: This study aimed to evaluate the analgesic efficacy of intravenous dexamethasone as an adjuvant to caudal block in children posted for infraumbilical surgeries.

Materials and Methods: This interventional, double-blinded, randomized controlled study included 110 children aged 1–5 years with American Society of Anesthesiologists Grade I and II undergoing elective infraumbilical surgeries. To test our hypothesis, the superiority of intravenous dexamethasone was compared with the control group. All children received caudal bupivacaine 0.25% (1 mL/kg). Children were randomly allocated to two groups to receive: normal saline 0.075 mL/kg (Group C) and IV dexamethasone 0.3 mg/kg (0.075 mL/kg) (Group D). Post-operative pain scores (Face, Legs, Activity, Cry, and Consolability [FLACC] score), duration of analgesia, post-operative analgesic consumption, and intraoperative hemodynamics were compared.

Results: FLACC score was found to be higher in Group C than Group D at all times. The mean FLACC score was significantly less with the study drug compared to the control group (P<0.001). The time to request for first rescue analgesia was significantly less in Group C as compared to Group D (4.01±0.69 h vs. 5.51±0.50 h, P=0.019). The mean total analgesic consumed in the first 24 h was significantly higher in Group C than in Group D (666.09±174.69 mg vs. 384.55±125.04 mg, P=0.015). Hemodynamic parameters were comparable in both the groups.

Conclusion: Intravenous administration of dexamethasone 0.3 mg/kg as an adjunct to caudal bupivacaine 0.25% provides significantly longer duration of post-operative analgesia and lesser total analgesic consumption compared to the use of caudal bupivacaine 0.25% alone.

Non-invasive ventilation using RAM’S cannula in neonates-what difference does it make?

2023-04-12T14:45:55+00:00

Background: Neonates undergo transition at birth from breathing fluid to breathing air. If this change is not tolerated by neonate, need of assisted ventilation arises. Non-invasive ventilation (NIV) refers to any mode of respiratory support provided through nasal airway. Using RAM’S cannula as an interface, complications of invasive ventilation can be prevented, and therefore it can be impactful in improving respiratory care in neonates.

Aims and Objectives: The aim of the study was to find the association of clinicoetiological factors and the outcome of NIV using RAMS’s cannula in neonates.

Materials and Methods: This prospective observational study was done from March 1, 2021 to August 31, 2022 at Neonatal Intensive Care Unit of a Tertiary care center in Central India. Neonates given NIV through Ram’s cannula were enrolled. Primary diagnosis of subjects and clinical parameters - birth weight, gestational age, duration of NIV given, and severity of respiratory distress were recorded and analyzed to find an association with the outcomes. Informed consent was obtained from parents.

Results: 100 neonates (62 male) were given NIV. 78 neonates were weaned off from NIV and 22 needed intubation. Duration of NIV, gestational age, severity of respiratory distress, and birth weight were found to be statistically significant. Weaning was more in gestation >34 weeks, weight >1 kg, duration of NIV given <3 days, and neonate having mild respiratory distress.

Conclusion: NIV through RAM’s cannula is useful in both respiratory and non-respiratory illness. Higher rates of NIV failure were seen in the duration of NIV >7 days, weight <1 kg, and gestation <34 weeks.

Intubation challenges in surgeries of thyroid swellings

2023-06-10T02:31:35+00:00

Background: Difficult airway is when a trained anesthesiologist experiences difficulty with face mask ventilation of the upper airway or tracheal intubation or both. It has always been a challenging issue for anesthesiologists.

Aims and Objectives: The objective was pre-operative assessment of airway in patients with goiter and to find the incidence of difficult intubation and its management.

Materials and Methods: A prospective study was done in 32 patients presenting with goiter of various sizes. Routine airway examination includes mouth opening, Mallampati grading, neck circumference, neck mobility, thyromental distance, tracheal deviation on chest X-ray, AP and lateral views of neck, and Cormack-Lehane grading on laryngoscopy. The technique followed in each case was noted.

Results: Out of 32 cases, difficult intubation was experienced in five cases. Among the studied parameters, neck mobility (66.7%) followed by neck circumference (44.4%) and Mallampati grading (37.5%) was found to be more predictive in assessing the airway. 62.5% patients were intubated through direct laryngoscopy, followed by bougie in 21.9% patients. Due to difficulty in intubation, 15.6% patients were intubated through videolaryngoscopy.

Conclusion: We conclude that induction of anesthesia can be challenging for patients with goiter. A thorough history and examination are mandatory pre-operatively in these patients. Neck circumference and neck mobility are the most crucial factors as evident in our study. Videolaryngoscopy plays an important role in patients with difficult airway.

To compare the efficacy of intrathecal 0.75% heavy ropivacaine and 0.5% heavy bupivacaine for lower abdominal and lower limb surgery

2023-04-03T08:38:27+00:00

Background: Spinal anesthesia is the most popular regional anesthesia technique for lower limb and lower abdominal surgery. Bupivacaine 0.5% heavy is commonly used for intrathecal use. New long-acting local anesthetic agents such as ropivacaine have claimed benefits of reduced cardiac toxicity on overdose and more specific effects on sensory rather than motor nerve fibers. The use of intrathecal hyperbaric ropivacaine is not much studied. With this background, we studied intrathecal ropivacaine hyperbaric 0.75% against intrathecal bupivacaine hyperbaric 0.5% for lower abdominal and lower limb surgery.

Aims and Objectives: To note the effectiveness of intrathecal ropivacaine and bupivacaine on characteristics of subarachnoid block such as sensory block, motor block, hemodynamic parameters, and complications if any.

Materials and Methods: We randomized patients undergoing lower abdominal surgeries and lower limb orthopedic surgeries under spinal anesthesia into two groups so as to receive intrathecal either ropivacaine 0.75% hyperbaric (3 mL) or bupivacaine 0.5% hyperbaric (3mL) and noted study parameters.

Results: Time of sensory block onset (P=0.0005), peak sensory level (P=0.0029), and onset of L1 bromage-3 motor block (P=1.27E–08) was significantly delayed in the ropivacaine group as compared to bupivacaine group. However, maximum sensory level achieved (T6), time required for two-segment sensory regressions (P=0.1162), and time of onset of pain (P=0.1162) were comparable in both groups.

Conclusion: Intrathecal ropivacaine 0.75% hyperbaric produced slow onset sensory and motor block than 0.5% hyperbaric bupivacaine with comparable cephalic spread and duration of sensory block.

A randomized comparative study of patient-controlled epidural analgesia with manual standard intermittent bolus for labor analgesia

2023-05-08T06:35:45+00:00

Background: Patient-controlled epidural analgesia (PCEA) pump has proven to reduce the incidence of unscheduled clinician interventions and total dose of local anesthetic administered for labor pain.

Aims and Objectives: The aim of the study was to compare the quality of analgesia, maternal satisfaction, amount of rescue analgesia needed, and neonatal outcome between clinician delivered manual bolus doses and PCEA pumps for epidural labor analgesia.

Materials and Methods: 60 parturients of the American Society of Anesthesiologists II scheduled for normal vaginal delivery were randomly divided into two groups, Group A (PCEA) and Group B (Manual bolus). Both groups received an initial epidural bolus of 10 mL of 0.125% Inj. Bupivacaine+20 mcg injection fentanyl. Group A (PCEA) patients received a basal infusion of 5 mL/h with self-administered bolus of 2 mL with a lockout interval of 15 min. Group B patients were provided with a bolus of 10 mL of the same solution manually after every hour. Patients of both groups were given manual rescue boluses for distressing pain (visual analog scale [VAS] >5).

Results: Mean VAS score in Group A was 2.97±0.73; and in Group B, it was 3.03±0.56 (P>0.05). Total bupivacaine use and mean duration of second stage of labor in both groups was found comparable. Mean top-up requirement of local anesthetics was significantly high in Group B. Maternal satisfaction was also higher in PCEA group.

Conclusion: As PCEA pump provides continuous infusion of local anesthetics, there was lesser requirement of top ups of bupivacaine and higher maternal satisfaction score in PCEA group than manual bolus group.

Evaluation of thyromental distance versus tongue width versus weight-based method for size determination of laryngeal mask airway in adults

2023-04-16T14:19:32+00:00

Background: Supraglottic airway devices (SGD) are indispensable for airway management. The successful placement of the laryngeal mask airway (LMA) supreme largely depends on the right size selection.

Aims and Objectives: The study was undertaken to compare three LMA supreme insertion methods in short elective surgeries under general anesthesia.

Materials and Methods: Atotal of 90 American Society of Anesthesiologists I and II patients (either gender, 18–55 years, Mallampati grade I and II) undergoing short surgeries were randomized into three equal groups (n=30 in each). Insertion of LMA was done after an adequate depth of anesthesia for jaw relaxation (Young’s criteria). The efficacy of controlled ventilation through LMA by each method, success rate, ease of insertion, insertion time, additional induction dose (propofol) required during insertion, hemodynamic stability (baseline vitals and 10 min after insertion), and adverse events after LMA removal were evaluated between groups.

Results: Better ventilation (tidal volume at 10 cmH2O) was observed in the thyromental group (448±35) than in tongue width (440±46) and weight-based (409±33) groups. Minimum additional propofol requirement during insertion was in thyromental distance group. Thyromental distance group had the most easy LMA insertions (70%) with minimum insertion time (10±4) and minimum additional propofol requirement during insertion (P<0.05) than other groups. Overall hemodynamic stability and incidence of adverse events were comparable.

Conclusion: Thyromental distance may be an alternative attractive choice for size determination of LMA supreme in female adults with normal airway anatomy in comparison to tongue width and conventional body weight-based methods.

Effects of intra-operative administration of intravenous dexmedetomidine on incidence of emergence phenomenon after general anaesthesia in adults; An observational study

2023-05-17T02:04:54+00:00

Background: The occurrence of emergence agitation (EA) is the most common and practical problem faced in the immediate post-operative period during the process of Extubation under General Anaesthesia. Dexmedetomidine, an α2 adrenoceptor agonist is an excellent drug that has been shown effective to decrease the preoperative anxiety and smooth induction and emergence.

Aims and Objectives: To assess the effect of intravenous dexmedetomidine primarily on EA and other complications that may occur during emergence from general anesthesia.

Materials and Methods: 80 patients of either gender aged 18–65 years with ASA status I and II, undergoing various elective general and urological surgeries under general anesthesia were included in the study. Patients receiving adjuvant drug dexmedetomidine, were labelled as Group D (n=40) and those who didn’t receive any adjuvant were labelled as group C (n=40). Dexmedetomidine was given at 1 μg/kg and then maintained at infusion of 0.4 μg/kg/h till the end of the surgery for group D. The hemodynamic parameters and SpO2 were measured during the intraoperative period at various intervals of time till the end of surgery and also on arrival to the recovery room till patient was discharged from post-anesthesia care unit in both the groups.

Results: The use of IV dexmedetomidine has proved significantly effective in prevention of incidence of EA with the overall incidence of agitation of 7.5% in Group D as compared to 42.5% in group C.

Conclusion: Intraoperative administration of intravenous dexmedetomidine decreased the incidence of EA and other emergence phenomena like cough, pain and PONV with stable hemodynamics, safety profile, good analgesic properties and opioids sparing side effects.

Evaluation of antiarthritic activity of ethanolic extract of Derris brevipes (benth.) Baker leaves

2023-05-24T03:40:54+00:00

Background: Derris brevipes is a common medicinal plant used in the traditional system of medicine as an anti-arthritic agent.

Aims and Objectives: The present study was to evaluate the anti-arthritic activity of ethanolic extract of D. brevipes (EEDB) leaves, belonging to the family Leguminosae.

Materials and Methods: The dried leaves were collected and extracted using 95% ethanol, and the extract was subjected to a preliminary phytochemical screening. In vivo activities were evaluated in collagen (chicken sternal collagen)-induced arthritis (CIA) in Sprague–Dawley rats. Prednisolone was used as the standard, and EEDB (at doses of 300 mg/kg and 600 mg/kg) was administered through the oral route. Body weight measurement, arthritic score, histological score, and radiology score assessments were carried out.

Results: Preliminary phytochemical screening of leaf extract from D. brevipes showed the presence of components such as steroids, triterpenoids, and flavonoids. In vivo tests on CIA rats given the extract showed that it could lower the arthritic score, the paw volume, the radiological score, and the histological score.

Conclusion: From this study, it is concluded that the D. brevipes leaf extract possesses antiarthritic activity.

A randomized, open-label, controlled, parallel-group comparative study of two varieties of Carica papaya leaves in dengue-induced thrombocytopenia

2023-04-03T06:46:47+00:00

Background: Dengue-induced thrombocytopenia can be life-threatening. However, supportive and symptomatic treatment is the current management protocol. The leaf extract of papaya has shown promising results in improving the platelet count. There are many varieties of Carica papaya such as Washington, Honeydew, Coorg honeydew, Solo, Surya, Red lady, C0-1, CO-3, CO-5, C0-6.

Aims and Objectives: The aim is to evaluate the efficacy and safety of two varieties (“Red Lady” and “Solo”) of C. papaya fresh leaf extract in patients diagnosed with dengue-induced thrombocytopenia.

Materials and Methods: The study was conducted for 2 months, and 18 dengue-confirmed inpatients with thrombocytopenia (platelet count <1,50,000/μL) were enrolled. The study participants were grouped into the standard “Control” group, “Solo” group who received fresh papaya leaf extract “Solo” and “Red Lady” group who received fresh papaya leaf extract of “Red Lady.” About 30 mL of leaf extract was given thrice daily for 5 days.

Results: The mean change from the baseline value of platelets was found to be 59,168/µL for the control group and 57,000/µL for Red Lady, and 93,167/µL for the solo group. The study showed a positive trend with improvement in platelet count in “Solo” Variety group when compared to “Red Lady” group and the control group. The safety results showed that both the papaya leaf extracts have a favorable safety profile.

Conclusion: There was an improvement in platelet count in “Solo” variety group when compared to “Red Lady” and the control group. However, the results were not statistically significant. No adverse events were observed during the study.

Association of metabolic syndrome with hypothyroidism and hyperuricemia: A cross-sectional study in a tertiary care hospital, Kolkata, West Bengal

2023-04-25T23:22:10+00:00

Background: Metabolic Syndrome (MetS) (Syndrome X, insulin resistance syndrome, MetS) consists of a constellation of metabolic abnormalities which include central obesity, hyperglycemia, insulin resistance, high triglycerides, low high-density lipoprotein (HDL) cholesterol, and hypertension. Obesity is a critical component of MetS. It causes alteration in the thyroid hormones and hyperuricemia. Furthermore, insulin resistance seen in MetS causes decreased uric acid excretion.

Aims and Objectives: To study the association of MetS with hypothyroidism and hyperuricemia.

Materials and Methods: A cross-sectional study was conducted among patients from the outpatient department of General Medicine, IPGME and R, Kolkata from January 2012 to June 2013. A total of 112 patients, consisting of 53 patients with MetS and 59 patients without MetS were selected. Patients’ history, clinical and laboratory findings were recorded and data were analyzed.

Results: Majority (66%) of the patients with MetS were female and the rest were male. The mean Body mass index of patients with MetS was 33.31±4.36 (Mean±SD) kg/m2 and without MetS was 25.21±2.62 (Mean±SD) kg/m2. A significant association was observed between weight, height, waist circumference, fasting blood sugar, HDL value, and MetS (P<0.05). About 39.6% of the patients with MetS had hyperuricemia. The association between MetS and hyperuricemia was found to be significant. Similarly, 45.3% of the patients with MetS had hypothyroidism. This association was also found to be significant. Serum thyroid-stimulating hormone had a minimal correlation with serum uric acid in patients with MetS (correlation coefficient r=0.344), while no correlation was observed between fT3, fT4 with serum uric acid.

Conclusion: Increased prevalence of hyperuricemia and hypothyroidism was seen among patients with MetS. More extensive population-based research is needed to support this finding.

Clinical profile and outcome of patients of common krait bite with features of neurotoxic envenomation, treated with intravenous calcium gluconate infusion in conjunction with AVS, a tertiary care center-based study

2023-01-23T07:51:58+00:00

Background: Snake bite is one of the most neglected diseases in South East Asian region. Common Krait (CK) (Bungarus caeruleus) is the deadliest snake found in the dry zones of India. With the polyvalent anti-venom serum (AVS) remaining the cornerstone of treatment of neurotoxic snake envenomation, there is no universally accepted treatment for CK envenomation-associated neuroparalysis, except supportive measures.

Aims and Objectives: Our study was conducted to describe the epidemiology, define clinical features, study outcome, and apparent efficacy of calcium gluconate in preventing or reversing neuromuscular paralysis with respiratory failure in CK bite patients.

Materials and Methods: This study is a prospective observational study done on 52 CK bite patients. Patients were enrolled according to inclusion and exclusion criteria and were treated with AVS and calcium gluconate infusion according to National Standard Guideline, 2016. Patients developing severe respiratory muscle paralysis were offered mechanical ventilation.

Results: Patients developed ptosis and dysphagia, pain abdomen, cyanosis, paralysis of jaw and tongue, perioral numbness, altered sensorium, dysphonia, ophthalmoplegia, and paradoxical breathing. 21.15% of patients developed respiratory failure and needed ventilator support with average critical care unit stay of 3 days and average stay on a ventilator of 2 days. 3 patients expired (case fatality rate 5.77%). The average hospital stay was 3.33 days.

Conclusion: Our study shows that early intervention in patients of CK bite with neurotoxic envenomation, with calcium gluconate infusion, leads to less mortality and morbidity compared to other relevant studies. Further large-scale studies are required for better understanding and implementation.

Effect of treatment of Helicobacter pylori with combination antibiotic therapy on iron deficiency anemia in patient with H. pylori-associated gastritis

2023-05-27T11:37:01+00:00

Background: The failure to identify a cause of iron deficiency in a substantial subset of patients with low iron stores raises the question of whether there are additional as of yet unexplained causes of iron depletion. Recently, there has been a growing body of evidence to suggest a relationship between Helicobacter pylori gastritis and iron deficiency anemia (IDA) in the absence of peptic ulcer disease.

Aims and Objectives: Therefore, the present study was undertaken to investigate the effect of treatment of H. pylori with combination antibiotic therapy on IDA in patient with H. pylori-associated gastritis.

Materials and Methods: The present study was carried out at a tertiary care hospital catering to a large population in south Solapur and nearby areas. The study was conducted for 2 years. All patients with IDA attending outpatient department and admitted to the hospital for 2 years, were included in the present study. All patients who have IDA according to the World Health Organization criteria, as a hemoglobin concentration <13 g/dL for men and <12 g/dL for women, a mean corpuscular volume (MCV) <75 fL and a serum ferritin level < 30 ng/mL, both in-patient and outpatient setting were evaluated with detail history, clinical examination, and investigation.

Results: Baseline hemoglobin (Hb) in group I is 8.99±1.23, while in group II 7.55±2.08.All the parameters are comparable in groups I and II except baseline Hb%. There is a significant increase in Hb, packed cell volume (PCV), MCV, mean corpuscular hemoglobin (MCH), and MCH concentration (MCHC) after 2 months of treatment with oral iron therapy. There is a significant increase in Hb, PCV, MCV, MCH, and MCHC after 2 months of treatment with oral iron and triple therapy for H. pylori.

Conclusion: Treatment of H. pylori infection was associated with more rapid and significant response to oral iron therapy in IDA as compared with the use of iron therapy alone.

Clinical assessment of etiological risk factors of chronic kidney disease in patients admitted for dialysis to a tertiary care hospital

2023-04-25T15:34:55+00:00

Background: Chronic kidney disease (CKD) is defined as a reduced glomerular filtration rate, increased urinary albumin excretion, or both, and it is an increasing public health problem with a prevalence of 8–16%. However, there is a paucity of such studies evaluating risk factors among dialysis patients in India and also there could be associated setting specific varied contributory factors. Hence, we have undertaken this study to assess common risk factors in CKD patients admitted for dialysis to a Tertiary Care Hospital.

Aims and Objectives: To assess the clinical presentation and the common risk factors in CKD patients admitted for dialysis to tertiary care hospital.

Materials and Methods: The present study was cross-sectional study in which 100 CKD patients admitted to the dialysis unit of tertiary care hospital were included on the basis of predefined inclusion and exclusion criteria and were analyzed as regards the history of illness, environment, and physical behavior was collected based on various pre-validated questionnaires (The WHO STEP wise approach to chronic disease risk factor Surveillance questionnaire for NCDs, dietary questionnaire, environmental/occupational questionnaire, and patient history questionnaire) in a face-to-face interview with participants and their family members. Etiological Risk Factors and clinical assessment of patients were studied. P<0.05 was taken as statistically significant.

Results: 49 (49%) of the study participants were from the age group of 41 to 60 years with the mean age of the 51.9±12.3 years. There was a male ponderance with M: F ratio being 1:0.61. The most common underlying condition responsible for end-stage renal disease (ESRD) was hypertension (25%) followed by diabetes mellitus (21%), glomerulonephritis (18%), analgesic nephropathy (15%), and renal stones (8%). CKD of unknown etiology was present among 7% and polycystic kidney 6%. Common clinical presentation in studied cases was anorexia (61%) followed by easy fatigability (58%) patients, Facial puffiness (49%), weakness (45%), and oliguria (44%).

Conclusion: Male gender, advancing age, and occupational exposure to nephrotoxic metals were the baseline risk factors. Hypertension and diabetes mellitus were the two most common comorbidities among ESRD patients which are the important risk factors for progression to ESRD.

Clinical profile and 30-day outcome of patients with acute coronary syndrome

2023-05-23T09:31:16+00:00

Background: Acute coronary syndrome (ACS) accounts for a quarter of all-cause mortality, with substantial loss of productivity and socio-economic implications. Analyses of the clinical presentation, age- and gender-specific differences, and mortality pattern are decisive in determining the clinical outcome of a patient.

Aims and Objectives: The primary objective was to determine the in-hospital and 30th day outcomes in patients with ACS. The secondary objectives were to study cardiometabolic risk factors, the clinical presentation, and the clinical course of the patients with ACS during hospitalization.

Materials and Methods: The present study was conducted for 1-year duration involving 110 patients diagnosed with ACS. The patients’ data pertaining to socio-demographic information, clinical features, details of hospitalization, and treatment modalities were collected. The outcomes based on mortality and major adverse cardiovascular events (MACE) were evaluated in two phases: (a) in-hospital and (b) at the 30th day from the date of hospitalization.

Results: Out of 110 patients hospitalized with a diagnosis of ACS, the majority were male (71.82%), and their mean age was 58.45±9.18 years. Hypertension, obesity, smoking, and family history of ACS were reported by 40%, 30%, 30%, and 27.27% of patients, respectively. Chest pain was the commonest symptom, followed by sweating and radiating pain. The mean duration of hospitalization was 6.345±2.46 days. ST-segment elevation myocardial infarction (STEMI) was the commonest type of ACS, with a predominance of anterior wall myocardial infarction (MI). The mean door-to-needle time was 43.53±7.75 min, and 29.1% of patients underwent thrombolysis. During hospitalization, improvement and MACE were observed in 73.64% and 26.36% of patients, respectively. 30-day outcome MACE was significantly higher among STEMI patients. Mortality was significantly higher in patients with <30% left ventricular ejection fraction (LVEF), both during hospitalization and after 30 days.

Conclusion: The present study revealed that the mean age of presentation was 58.45±9.18 years. Anterior wall MI was the commonest pattern of STEMI. Thus, the type of MACE and mortality were significantly higher among patients with either LVEF <30% or STEMI. Thus, type and severity of ACS, along with clinical presentation, existing risk factors, and access to medical care, play a determining role in the clinical outcome of a patient.

A cross-sectional study to determine association between sleep quality and mental health of medical faculty from a tertiary care center of India

2023-06-01T04:37:24+00:00

Background: Sleep quality is very important for the mental health of individual. The sleep quality and mental health have bidirectional relation and mean that the poor mental health affects the one’s sleep quality or poor sleep quality affects the mental health.

Aims and Objectives: The objective of the study was to document the relation between sleep quality and mental health of medical faculty. The secondary objective of the study was to identify the determinants of quality of sleep and mental health.

Materials and Methods: This was cross-sectional study done between August and November 2021 after the second wave of COVID-19. Pittsburgh Sleep Quality Index Scale (PSQI) was used to access sleep quality and Zung Self-Reporting Depression Scale (ZSDS) was used to access the metal health. All the medical faculty of medical institutes were included in the study and three attempts were made to enroll them in study.

Results:
Cronbach’s alpha for PSQI for this study was 0.80 and for ZSDS was 0.69 both were in an acceptable range. This study reported that 60.2% of participants have good quality of sleep while 16.3% of participants have recorded in mild or moderate ZSDS score. Exercise and chronic disease condition have statistically significant difference with ZSDS score. Remaining all the lifestyle-related habits do not have any significant association either with PSQI or ZSDS.

Conclusion: Although there was no statistically significant difference between quality of sleep and ZSDS score, the mean score was higher of those participants who categorized as mild or moderate Zung score in comparison to those who categorized as normal.

Correlation between the Internet addiction and affect score among medical students

2023-05-31T03:54:33+00:00

Background: The Internet has become an integral part of our day-to-day life. It is one of the most influential media in the modern era and incorrect usage might be harmful. About 90% of adolescents use it for acquiring information. Its development has given lots of chance for exchange of information, communication, and social interactions. One of the major public health concerns accompanied with it is the internet addiction.

Aims and Objectives: The objective of the study was to assess and to correlate the affect scores and Internet addiction test (IAT) score among medical college students using the positive and negative affect (NA) schedule scale and Young’s IAT.

Materials and Methods: This cross-sectional study was conducted among the 1st-year and 2nd-year medical students to assess the Internet addiction and positive and NA score. They were asked to fill separate questionnaires.

Results: The result showed that the duration spent in viewing the Internet and IAT score had a significant negative correlation with the positive affect score (P=0.001) and significant positive correlation with NA score (P≤0.001).

Conclusion: Intervention measures should be taken to minimize the effects of internet addiction on affect score. Awareness about harmful effects of excess Internet use should be provided so as to enhance the academic performance of students.

Awareness on human papilloma virus vaccine among medical students in rural area

2023-03-27T07:38:16+00:00

Background: Cervical cancer, with an estimated 604,000 new cases and 342,000 deaths in 2020, is the fourth most common cancer among women globally. Low- and middle-income countries accounted for 90% of the new cases and deaths worldwide in 2020. Cervical cancer in females can be prevented to a great extent by vaccination. Implementation of the human papillomavirus (HPV) vaccine is still facing challenges, but it has the potential to address the challenges of cervical cancer screening in India. Implementation of HPV vaccination faces barriers of acceptance and lack of awareness, along with a high vaccine cost.

Aims and Objectives: To assess the knowledge, attitude, and practise of the HPV vaccine among 1st and 2nd year medical students in a rural medical college.

Materials and Methods: A descriptive cross-sectional study was conducted among 240 study subjects using a pre-tested, semi-structured questionnaire. The results were expressed in descriptive statistics like proportions and percentages.

Results: 94% of the students were aware that cervical cancer is preventable, whereas 87% of them knew that cervical cancer can be prevented by a vaccine. 84% of the students had the knowledge that HPV vaccine is available in India. The maximum number of students were unvaccinated (92%), whereas 67% were ready to take the HPV vaccine in the future.

Conclusion: Sensitization regarding the importance of the HPV vaccine to the general public can be achieved only when health care professionals are adequately aware of the safety and efficacy of the HPV vaccine. The first step in this direction is to educate the students who will form the backbone of our health care system in the future.

Demography, clinical features, and outcome of fungal keratitis presenting in tertiary eye care in Nepal

2023-04-18T15:37:16+00:00

Background: Fungal keratitis is an important cause of ocular morbidity in developing countries.

Aims and Objectives: To study fungal keratitis in detail along with its outcome.

Materials and Methods: This is a retrospective study of fungal keratitis that had presented between October 2013 and March 2015.

Results: 168 fungal ulcers were enrolled. 145 had fungus isolated in the culture; 23 had fungal elements seen only in potassium hydroxide mount examination. The average age of patients was 46.7 years. 55.3% were male. 75% were farmers. Patients presented at an average of 23.6 days since the onset of symptoms. In 85 cases (50.6%), trauma was the risk factor followed by steroid use (12.5%, n=21) and diabetes mellitus (7.7%, n=13). 72 out of 85 cases of trauma were due to vegetative matter. 94 (55.9%) ulcers had hypopyon. 56 (33.3%) ulcers had infiltrate size of ≥¼ of corneal surface. 12 (7.1%) ulcers were perforated at presentation. Out of 145 fungal isolates, Aspergillus species and Fusarium species were isolated in equal numbers (n=41, 28.3% each), followed by unidentified hyaline fungus (14.4%, n=21). The ulcers were treated with combination of topical natamycin 5% and fluconazole 0.3% with or without oral fluconazole. 111 (66.1%) fungal ulcers improved with medical treatment, 37 (n=22.0%) underwent therapeutic penetrating keratoplasty, 6 (3.6%) were eviscerated and outcome unknown in 14 (8.3%). Smaller-sized ulcers, ulcers without hypopyon and those presenting within 7 days had better prognosis (>80% healing with medical treatment) with statistical significance.

Conclusion: Farmers were constantly at risk of fungal keratitis due to work-related trauma. Fungal ulcers presented late with large sized ulcers and with complications, thus making treatment challenging and necessitating surgical intervention. Timely treatment had better prognosis.

A clinical study of keratomycosis to compare the efficacy of topical 10% NaCl with 5% natamycin versus 5% natamycin alone as a treatment strategy

2023-05-22T12:49:05+00:00

Background: Corneal blindness is a major public health problem worldwide and preventable cause of blindness in India. Corneal blindness is the second most common cause of blindness, after cataract, in developing countries.

Aims and Objectives: A clinical study of keratomycosis to compare the efficacy of topical 10% NaCl with 5% natamycin (Group A) versus topical 5% natamycin (Group B) alone as a treatment strategy.

Materials and Methods: This prospective, randomized, interventional, and comparative study with parallel design enrolled 100 cases diagnosed with unilateral keratomycosis and fulfilling the inclusion criteria, who presented to the outpatient department of Ophthalmology, Maharani Laxmi Bai Medical College and Hospital, Jhansi, Uttar Pradesh, between April 2021 and June 2022 (15 months).

Results: Maximum patients in both the study groups belonged to the age group of 41–50 years showed male preponderance and belonged to the low socioeconomic status. Maximum patients in both the study groups had shown total regression in 66 cases with 41 cases from Group A and 25 cases from Group B, respectively. Regression was not seen in 34 cases with 9 cases belonging to Group A and 25 cases belonging to Group B. Maximum patients in study Group A had shown ulcer regression in 3.56 average weeks duration, while it was in 4.50 average weeks duration in Group B.

Conclusion: This comparative and interventional study demonstrates that the study Group A receiving 10% sodium chloride solution with 5% natamycin helps in faster healing of corneal ulcer, rate of progression of ulcer is slowed down, and complications are less in comparison to Group B receiving 5% Natamycin alone owning to the anti-edema property of hypertonic saline. Hence, topical 10% NaCl solution can be used with 5% natamycin, as a cost-effective adjunct in the management of fungal keratitis.

Clinical profile of newly diagnosed leprosy patients with special references to deformities and disabilities

2023-04-28T19:49:18+00:00

Background: After leprosy was declared eliminated as a public health problem in India on December 2005, the focus has shifted to the prevention of disability and deformities. This indirectly measures the effectiveness of health education and awareness.

Aims and Objectives: This study was conducted to assess the clinical profile and different patterns of disabilities and deformities among newly diagnosed leprosy patients.

Materials and Methods: A cross-sectional study was conducted for a period of 1 year on newly diagnosed leprosy patients attending a tertiary care hospital in Kerala. 32 patients included in the study were examined and disabilities observed were graded using WHO disability grading system. The variables are mentioned as numbers and percentages.

Results: 50% of the subjects had different grades of deformity/disability (6.25% had Grade 1 disability while 43.75% had Grade 2 disability). The mean duration of disease in patients with and without deformities was 44.19 and 20.5 months, respectively, which was statistically significant (P=0.025). A positive family history of Hansen’s disease was present among 5 (15.63%) patients. The different disability/deformity observed were ulcers, scars, muscle weakness, and redness of eyes. Feet were the most commonly affected site.

Conclusion: Proper health education and awareness activities that will promote early recognition of symptoms and reporting are crucial to decrease deformities.

Pattern of sexually transmitted infections from a tertiary care hospital, Pokhara: A six-month retrospective study

2023-01-15T07:39:11+00:00

Background: Sexually transmitted infections (STIs) are major public health problem that have profound effect in reproductive and mental health. STIs have direct impact on sexual and reproductive health through stigmatization, infertility, and cancers and can increase the risk of HIV.2 Unprotected sexual contact with an infected partner is the most important risk factor associated with STI. Pattern of STI varies from region to region depending on socioeconomic status, ethnicity, and educational factor.

Aims and Objectives: The aim of the study was to assess pattern of STIs in a tertiary level hospital, Pokhara.

Materials and Methods: The following is a hospital-based retrospective study conducted in the Dermatology department of Pokhara academy of health sciences (PoAHS). All patients who attended the STI clinic of dermatology OPD from 2078/05/01 to 2078/11/30 B.S. with clinical manifestations of STI and associated positive serological investigation with their risky sexual behavior, related information was recorded in STI register and was analyzed. HIV cases are enrolled directly to antiretroviral therapy clinic of PoAHS, so HIV cases were not included in the study.

Results: Out of 87 STI patients, 71.3% were males and 28.7% were females. The mean age of patient with STI was 31.34+8.4. The most common diagnosis was syphilis 55.2% followed by urethral discharge syndrome 16.1%. STIs were common among married individuals 74.7%. Most common high-risk sexual behavior among patients with STI was multiple sexual partners 79.3%.

Conclusion: The study showed that the prevalence of STIs is still high in the society. Lack of awareness, delinquent behavior, and an inconsistent use of condoms during sexual contact may be the major contributing factors.

Umbilical cord diameter study on microscopic tissue in gestational diabetes mellitus and its correlation to fresh tissue diameter and fetomaternal parameters

2023-04-05T04:45:27+00:00

Background: Umbilical cord is the only vital link between the mother and the fetus and is essential for maintaining the fetomaternal exchange of oxygen, nutrients, and waste products. Clinical studies have shown that umbilical cord diameter (UCD) is larger in gestational diabetes mellitus (GDM) and UCD analysis based on microscopic tissue (dry) provides more accurate information.

Aims and Objectives: The present study was conducted to measure the UCD using microscopic tissue in GDM and normal cases and ascertain its correlation with fresh tissue (wet) diameter, fetal weight, maternal BMI, and gestational weight gain.

Materials and Methods: The study included 111 subjects. They were divided into two groups. Group I consisted of umbilical cords obtained from non-diabetic pregnant women (n=52) and Group II comprised umbilical cords obtained from mothers with GDM (n=59). UCD was measured using Vernier calipers and all the other parameters were assessed through standard methods.

Results: UCD in microscopic (P=0.005) and fresh tissues (P=0.0001) was significantly higher in GDM patients. Although microscopic tissue measurements tended to underestimate fresh-tissue measurements of UCD, these measurements had a positive correlation with each other in both groups. UCD also had a statistically significant positive correlation with maternal BMI and a negative correlation with gestational weight gain.

Conclusion: UCD in GDM was statistically higher in both microscopic and fresh tissues and thus may be considered for GDM screening. The correlation of wet and dry specimens can also provide useful insights in clinical situations centered around variations in UCD.

A clinical study with changes in microbiological flora in chronic rhinosinusitis

2023-04-04T11:34:41+00:00

Background: Chronic rhinosinusitis (CRS) is characterized by mucous membrane inflammation that lines the paranasal sinuses and nasal cavity for at least twelve consecutive weeks. Microbes play a major role in pathogenesis. The treatment objectives are to reduce mucosal edema, restore paranasal sinus ventilation, and eliminate infectious pathogens.

Aims and Objectives: (1) To study the presenting clinical features of chronic sinusitis. (2) To study the changes in microbiological flora.

Materials and Methods: The study was conducted on 202 patients in the Department of ENT and Microbiology (JNMCH) from December 2020 to 2022. Patients above the age of 10 years were evaluated in this study. Those who received antibiotics in the last week of the presentation and those resistant to medical therapy were excluded. Patients were subjected to a detailed history, the clinical examination, and a radiological examination. Under all aseptic precautions and after the patient’s informed consent, the sample was taken from the middle meatus area for culture and sensitivity.

Results: The study had a male predominance (71.28%), with the maximum number of patients in the age group 21–30 years (38.11%). The most common clinical features were nasal obstruction (96.03%) and mucopurulent discharge (100%). The most common isolate was Staphylococcus aureus (45.13%).

Conclusion: Bacterial infection is a major etiological factor in CRS. Screening for S. aureus carriers may be an alternative to decrease the infection of S.aureus. There is a statistically significant increasing trend for methicillin-resistant S. aureus (19.46%) and fungal sinusitis (13.36%).

Assessment of macular thickness following cataract surgery in diabetic patients

2023-05-30T09:26:30+00:00

Background: Cataracts and diabetes very commonly coexist. While the results of cataract extraction (CE) procedure are astounding, patients with diabetes may have more unfortunate visual outcomes in comparison to their counterparts.

Aims and Objectives: This study is planned to see the frequency of development of macular oedema (ME) in diabetic patients as compared to non-diabetics and also to see the progression of ME after cataract surgery.

Materials and Methods: This prospective comparative study enrolled 100 diabetics and 100 non-diabetics undergoing cataract surgery fulfilling inclusion criteria. Complete ocular examination was done for both the groups preoperatively and postoperatively at 1 week, 1 month, and 3 months including central macular thickness evaluation using optical coherence tomography (OCT).

Results: Improvement in visual acuity was observed in both the group but, non-diabetics achieved better visual acuity in comparison to diabetics. A significant increase in mean central foveal thickness (CFT) in diabetics and in non-diabetics post 1 month of surgery was observed; however, at 3 month, the difference was not significant. All the patients with mild, moderate, and severe non-proliferative diabetic retinopathy (NPDR) showed increment in the CFT from the baseline value but none of the patient of mild NPDR grade presented with new development of clinically significant macular edema on OCT.

Conclusion: Cataract surgery causes a significant increase in macular thickness post 1 month of surgery in both diabetic and non-diabetics. Cataract surgery did not lead to the progression of stages of DR, although patients with all the three grades of DR showed increment in CFT from the baseline reference value.

Estimation of radiological and functional outcome of closed calcaneus fractures treated by open reduction internal fixation with calcaneal plate and screws: A prospective study

2023-06-07T11:37:22+00:00

Background: Calcaneus fracture comprising only about 2% of all fractures is the most common tarsal bone fracture, constituting about 60% of all tarsal bone fractures. Most of calcaneus fractures are intra-articular making them difficult to treat conservatively with unpredictable outcome. With surgical fixation, there is apprehension of soft-tissue complication. Hence, we decided to conduct this study to estimate radiological and functional outcome of closed calcaneus fractures treated by open reduction internal fixation (ORIF) with calcaneal plate and screws.

Aims and Objectives: Study was conducted to estimate radiological and functional outcomes of closed calcaneus fractures treated by ORIF with calcaneal plate and screws.

Materials and Methods: This prospective study included patients with calcaneus fractures operated by extended lateral approach and fixed by ORIF with standard calcaneal low-profile locking plates and screws at Bankura Sammilani Medical College, Department of Orthopaedics and reviewed at out or inpatient department between January 2021 and August 2022. 15 patients with total 19 calcaneus fractures, with 4 patients needing bilateral calcaneus fixation, were enrolled for the study. The data were then recorded as for duration to fracture union, satisfactory radiological reduction as for Bohler’s angle, and functional outcome using the American Orthopaedic Foot and Ankle Society score. Data were then processed and analyzed with the help of Microsoft Excel spreadsheet and SPSS (version 27.0) using descriptive statistics in terms percentage and frequency, range, and standard deviation.

Results: Comparing pre-operative and post-operative Bohler’s angle, 17 (89.47%) had adequate reduction and for 2 (10.53%) cases, adequate reduction could not be achieved. In our study, overall 7 out of 19 limbs (36.84%) had excellent functional outcome, 10 (52.63%) had good result, and 2 (10.53%) had fair result.

Conclusion: ORIF of displaced intra-articular calcaneal fractures through extended lateral approach with low-profile locking calcaneal plates gives good subtalar joint reduction in most cases with satisfactory functional outcome with few complications.

Role of Wilms’ tumor 1 in diagnosis and grading of astrocytomas

2023-05-30T09:32:15+00:00

Background: Wilms’ tumor 1 (WT1) mutation has recently been detected in gliomas. Growing data indicate that WT1 mutation plays a causal role in gliomagenesis and is overexpressed in most glioblastomas. Emerging immunotherapy targeting WT1 has shown to be effective in resistant glioblastomas in clinical trials. WT1 expression and its potential utility in various grades of astrocytomas is still unclear and needs further elucidation. The evaluation of WT1 can be done by molecular or immunohistochemical methods. As immunohistochemistry is easier with wider routine use, immunoexpression of this biomarker was studied.

Aims and Objectives: This study aimed to evaluate WT1 immunoexpression across different histological grades of astrocytomas and differentiate low-grade astrocytomas from reactive astrogliosis.

Materials and Methods: This was an observational prospective study on 54 cases of astrocytomas.

Results: In the present study a total of 54 cases have been diagnosed as astrocytomas. Grade IV was the most common (31%) followed by grade II (44%). WT1 score correlated with histological tumor grades (P<0.001) with a higher score in a higher grade. It was also observed that different tumor grades depicted two distinct expression patterns. WT1 score and pattern were valuable in differentiating high- and low-grade astrocytomas.

Conclusion: This study supports the oncogenic role of WT1 in astrocytomas. WT1 was found to be valuable in distinguishing different grades of astrocytomas. The scoring and distinctive patterns of WT1 can aid in distinguishing high-grade and low-grade astrocytomas. However, one needs to be careful in pilocytic astrocytomas in which there is a mixed expression. WT1, therefore, appears to be an attractive immunohistochemistry (IHC) marker to be used concomitantly with other IHC markers in astrocytomas. In addition, the frequent expression of WT1 in astrocytomas supports its promising role in immunotherapy and its potential to guide patient selection for targeted immunotherapy.

Clinicopathologic study of triple-negative breast cancer with special reference to basal-like breast cancer phenotype in a tertiary care hospital of Eastern India

2023-05-25T11:57:28+00:00

Background: Triple-negative breast cancer (TNBC) is defined as absent expression of estrogen receptor (ER) and progesterone receptors and human epidermal growth factor receptors (HER2neu). These cancers are associated with poor prognosis.

Aims and Objectives: We aimed at to study the clinicopathological profile and survival among women with TNBC.

Materials and Methods: The study was conducted over a period of 4 years. Surgical specimens of patients with breast cancer were analyzed histopathologically as well as immunohistochemical analysis for estrogen, progesterone, HER2neu, and Ki-67 index was also done. Statistical analysis was done using software version 20.0. Results were expressed in number and percentage. Comparison was done by x2 test. P=0.05 was considered statistically significant.

Results: In our study, 26.92% cases were of TNBC. Predominant age group affected was between 50 and 70 years. Most common histologic type was invasive carcinoma of no special type with higher grade (Grades 2 and 3) mostly with frequent nodal metastasis. Higher percentage of Ki-67 proliferation index and basal cytokeratin expression were associated with higher tumor grade and stage along with reduced short-term disease-free survival on follow-up.

Conclusion: TNBCs are usually of higher grade with frequent recurrences and distant metastasis. There are no widely accepted prognostic markers available. Panel of immunohistochemical markers should be used specially to categorize the basal-like breast cancer subtype among TNBCs for better clinical outcome.

Diagnostic utility of Risk of Malignancy Index in differentiation of benign from malignant ovarian masses

2023-05-12T18:11:46+00:00

Background: Women with adnexal masses still pose a diagnostic dilemma and require efficient triaging. The Risk of Malignancy Index (RMI) is an algorithm used for differentiation of malignant from benign ovarian masses.

Aims and Objectives: The present study aimed to evaluate the four indices RMI 1, RMI 2, RMI 3, and RMI 4 to discriminate a malignant ovarian tumor from a benign one.

Materials and Methods: This cross-sectional study was carried out at a tertiary care hospital of Eastern Uttar Pradesh, India, in 312 patients with ovarian masses. RMI scores were calculated based on pre-operative cancer antigen-125 levels, ultrasonography, and menopausal status followed by post-operative histopathology, taken as gold standard. Using cutoff points of RMI indices, the sensitivity, specificity, positive predictive value, and negative predictive value of RMI were assessed.

Results: Out of total 312 patients, 68 (21.8%) had malignant disease and 244 (78.2%) had benign pathology. All indices presented a significantly better performance in detecting malignancy than the use of a single parameter. Each of the RMIs had a different optimal threshold; however, using a threshold of 250, RMI 1, RMI 2, RMI 3, and RMI 4 had a sensitivity and specificity of 64.7%, 70.5%, 64.7%, and 65.2% and 93.4%, 83.6%, 90.2%, and 91.4%, respectively.

Conclusion: The RMI is a simple, composite tool that at lower values can reliably predict benign nature of adnexal tumors. However, at values above the cutoff points, it is helpful for appropriate surgical planning and averts radical surgeries in women of reproductive age group.

Gastric lavage to reduce feed intolerance among vigorous neonates >34 weeks born through meconium stained liquor: A comparative study

2023-05-26T12:03:19+00:00

Background: Feed intolerance during early postnatal period is common in newborns with meconium-stained liquor (MSL). Prophylactic gastric lavage in neonates delivered with MSL and its recommendation by some pediatric textbooks, despite negligible scientific evidence and evidence-based recommendations.

Aims and Objectives: This study was designed with the objective of determining if gastric lavage in all babies with MSL led to the development of less feed intolerance as compared to those who were not subject to the procedure.

Materials and Methods: The present study was a randomized control trial, conducted at National Medical College and Teaching Hospital, Birgunj, from December 01, 2021, to November 30, 2022. The study populations were 280 vigorous neonates with ≥34 weeks of gestation and ≥1800 g delivered with MSL. Among them, 140 neonates were kept in the lavage and non-lavage group. Data were analyzed using the Chi-square test, odds ratio, and level of significance at P<0.05.

Results: Thirty-two (22.85%) and 54 (38.57%) neonate in the lavage and no lavage group developed the first episode of vomiting with a significant P=0.005. No significant difference in the incidence of feed intolerance was found (8.57% vs. 15%, P=0.099). None of the neonates in either group developed any complications during the procedure.

Conclusion: Gastric lavage seems to reduce the first episode of vomiting but not overall feed intolerance in vigorous infants born through meconium-stained amniotic fluid. Hence, concluded that gastric lavage should be reserved for treating the rather rare feed intolerance than routine prophylactic in vigorous neonates delivered with MSL.

Myocardial dysfunction in newborns with severe birth asphyxia

2023-03-24T23:28:34+00:00

Background: Severe birth asphyxia is one of the leading causes of mortality and morbidity in developing countries like India. Severe birth asphyxia can result in transient myocardial ischemia, myocardial dysfunction, and cardiac failure.

Aims and Objectives: The current study was undertaken for a better understanding of myocardial dysfunction with the help of serum levels of CPKMB and their correlation with mortality.

Materials and Methods: It was a prospective observational study. We studied 150 newborns with severe birth asphyxia admitted to be SNCU of Maharaja Yashwantrao Hospital Indore from August 2021 to July 2022 after clearance from the Institutional Ethics Committee and informed parental consent.

Results: A total of 150 newborns with severe birth asphyxia were enrolled. Nearly 75% were males, and 25% were females. Most of the mothers (80%) were multigravidas. Antenatal complications were present in 85.33% of cases. Amniotic fluid was meconium stained in 73.33%, and fetal distress was present in 72.70%. CPKMB was deranged in 93%, and the ejection fraction was reduced in 53%. Out of the total 150 cases, 72 died, with levels of CPKMB elevated in 70 cases and ejection fraction reduced in 62 cases.

Conclusion: We conclude that serum CPKMB levels rise early before ejection fraction is reduced and can help us identify myocardial dysfunction early. There is a statistically significant association between CPKMB, ejection fraction, and mortality in babies with severe birth asphyxia. Cardiac-specific enzyme CPKMB helps in the early recognition of myocardial dysfunction, and there is significant correlation with neonatal mortality.

Effectiveness of Tinospora cordifolia in comparison to tramadol for analgesic activity in albino rats

2023-05-28T15:12:22+00:00

Background: Pain and pyrexia are the warning signals, primarily protective in nature, that cause discomfort and suffering and may even be unbearable and incapacitating. The modern drugs (such as opioids, NSAIDs, and corticosteroids) currently used for the management of pain, fever, and inflammatory conditions, present with many known adverse effects. Tinospora cordifolia known as Giloe or guduchi, widely used in folk medicine due to its property to cure several diseases.

Aims and Objectives: The present study was undertaken to explore the analgesic activity of water-soluble extract of T. cordifolia in albino rats in experimentally induced pain.

Materials and Methods: The present study was done in the Department of Pharmacology, Gandhi Medical College, Secunderabad. Albino rats were used to study the analgesic activity of T. cordifolia aqueous extract at the dose of 300 mg/kg and 1 g/kg and tramadol 50 mg/kg per orally. Eddy’s hot plate was used for the antinociceptive study.

Results: In Eddy’s hot plate, an increase in reaction time was observed with peak effect at 90 min. Results were close to the standard drug tramadol.

Conclusion: Aqueous extract of T. cordifolia was effective in model of pain suggesting its possible action by central and peripheral mechanisms, and in higher doses, it was found to be effective like that of tramadol.

A cross-sectional study of road traffic accident victims at a tertiary care teaching hospital at Gwalior city in Madhya Pradesh of Central India

2023-05-06T14:11:57+00:00

Background: Road crash deaths in India, which were the highest in the world, are a burden on its demographic dividend and have a tangible impact on poverty.

Aims and Objectives: The present study was conducted to investigate the sociodemographic characteristics, type of vehicle, types of road, primary treatment, and safety measures adopted by the victims of road traffic accidents (RTA).

Materials and Methods: The present cross-sectional study was conducted at Trauma Center, Madhav Dispensary, J.A. Group of Hospitals Gwalior, M.P. on 528 Victims of RTA between the period of January 01, 2020, and June 30, 2021. The descriptive statistical measures such as mean, standard deviation, frequency, and percentage were used. The data analysis was done in Microsoft Excel Software.

Results: In the present study, a total of 528 RTA victims were enquired. Their average age was 33.02±13.31 years, with 81.8% were male and 18.2% were female. Most of the victims (67.80%) were on two-wheeler vehicles. About half of the victims were found to have Head on Collision during accidents. The accidents mostly occurred in the time period from 9.00 am to 9.00 pm. It was observed that 65.90% RTA victims had soft-tissue injury and bony injury.

Conclusion: It was vital to obtain valid information of the real importance of RTA along with the preventive action concerning RTAs. It was recommended to provide the basic treatment to victims related with RTA at Primary Care Center of the nearest accident place.

A prospective observational study on etiology and management influencing outcome in operatively managed cases of acute intestinal obstruction in adults

2023-03-17T15:55:39+00:00

Background: Acute intestinal obstruction (IO) is an important cause for acute abdomen in surgery which presents as abdominal pain, vomiting, distension, and constipation depending on the level and extent of obstruction of gastrointestinal tract. Early diagnosis of acute IO with understanding of various etiologies, use of better diagnostic techniques, and skillful operative management and good postoperative care, carries a good outcome.

Aims and Objectives: The objective of the study was to find out the prevalence of various etiologies of acute IO and to study the various post-operative morbidity and mortality.

Materials and Methods: This was a hospital-based observational study in the Department of General Surgery of Calcutta National Medical College and Hospital among patients with a diagnosis of acute IO during the study period of December 2016-April 2018.

Results: Acute IO commonly affects male with a male: female ratio 7:3 and the most common occurrence in the age group of 40–59 years (30%). The most common etiology was obstructed/strangulated hernia (36%), followed by large bowel neoplasm (18%), adhesion (16%), intestinal tuberculosis (12%), and volvulus (10%). The most common surgical procedure performed was the resection of gangrenous bowel and creation of stoma (30%), followed by prosthetic repair of hernia (28%). The mortality rate of the present study was 12%. The morbidity rate was 46%attributing mainly to respiratory complications (30.4%) and surgical site infections (26.08%).

Conclusion: This study demonstrates that the pattern of IO differs from the Western world with obstructed hernias being the most important cause and also emphasizes the fact that intestinal tuberculosis assumes a prominent role.

A comparative analysis of computed tomography and ultrasonography in diagnosis of neck masses

2022-12-21T13:10:11+00:00

Background: Neck swellings constitute the chief complaint of many patients coming to ENT outpatient department. Adequate evaluation of all cases with assistance from radiological, cytopathological, and histopathological is necessary.

Aims and Objectives: The present study aims to evaluate the role of clinical, radiological, and cytopathological evaluation to reach the diagnosis and the accuracy of these tools.

Materials and Methods: The study was conducted in the Department of Otorhinolaryngology and Head and Neck Surgery and the Department of Radiodiagnosis, AMU, and included 100 patients with neck swelling.

Results: Maximum number of patients were of lymph node masses (44%), followed by thyroid masses (26%) and salivary gland pathologies, congenital neck masses, and others. 78% were benign masses while only 22% were malignant. Out of all cases, the maximum were reactive lymphadenitis (16%), followed by metastatic lymph nodes (12%) and pleomorphic adenoma (10%). The correlation between clinical diagnosis and ultrasound (USG) was 70.93 with a diagnostic accuracy of 86%; with fine-needle aspiration cytology (FNAC) accuracy being 82%. 91% of metastatic lymph node swellings were accurately diagnosed by these two modalities alone. The sensitivity and specificity of FNAC with computed tomography (CT) were 62.25% and 98.59%, respectively; while with biopsy were 84.63% and 97.10%.

Conclusion: Clinical evaluation remains the utmost important step in the management of patients with neck swellings. USG provides the necessary information to guide further management, followed by FNAC. Although CT and histopathological evaluation provide detailed information, it was rarely needed in our study to reach the clinical diagnosis however their need in the management of pathology could not be ruled out.

Computed tomography versus ultrasonography in the evaluation of periumbilical abdominal pain

2023-05-20T00:16:14+00:00

Background: The objective of this study was to study, assess, and make early diagnosis of periumbilical pain abdomen accurately.

Aims and Objectives: To study, assess, and diagnose causes of periumbilical abdominal pain accurately so as to minimize the unnecessary exploratory laparotomy and operations and consequently improved patient care and to compare the role of ultrasonography (USG) and computed tomography (CT) in the evaluation of various causes of periumbilical abdominal pain.

Materials and Methods: This prospective study (CTRI/2023/01/048809) was done on 315 patients with periumbilical pain at M.L.B. Medical College Jhansi, Uttar Pradesh on PHILIPS 16 Slice multi-detector CT SCAN machine and GE Vivid T8 ultrasound machine. These patients were blindly and randomly divided by chit system into two groups irrespective of their age and gender. The first group of patients which included 160 patients undergoes ultrasonographic evaluation and the other group of patients which includes 155 patients undergoes contrast-enhanced computed tomographic evaluation.

Results: Among 315 patients, the most common cause of periumbilical pain was found to be appendicitis followed by bowel pathologies which include gastrointestinal tuberculosis.

Conclusion: USG is the initial modality and modality of choice in female and young (3rd and 4thdecade) patients presenting with periumbilical pain as it is diagnostic in gynecological causes of periumbilical pain and also minimizes unnecessary radiation exposure to female and young patients. Contrast-enhanced CT is the modality of choice in male and old age patients (5th and 6th decade) as it is diagnostic in vascular causes. Overall plain CT has limited role.

A prospective study of post-operative surgical site infections after open gastrointestinal surgeries

2023-05-06T07:08:24+00:00

Background: Surgical site infections (SSIs) are infections of the tissues, organs, or spaces exposed by surgeons while performing an invasive procedure. SSI is one of the most common healthcare-associated infections, but its importance as a health-care priority is not fully understood, and limited work has been published defining the role of surgeons in SSIs.

Aims and Objectives: In the present study, we assess the burden of SSI after gastrointestinal (GI) surgery in a tertiary care hospital in the Central India.

Materials and Methods: The present study was conducted on patients admitted to Gandhi Medical College-affiliated Hamidia Hospital, Bhopal, in the General Surgery Department. The study included 207 patients who underwent emergency/routine GI surgeries between September 2020 and April 2022. Patient characteristics and laboratory data were recorded on a pre-designed form, and all patients were evaluated postoperatively for soakage along with culture and antibiotic testing.

Results: The overall incidence of SSI was 42.51% and its distributions between emergency and routine surgeries were 22.7% and 19.8%, respectively. SSI was predominant in male patients. White blood cell level was significantly associated between emergency and routine surgeries, while Hb level, serum protein level, and the time required for surgery were insignificant. SSI under contaminated dirty wounds was prevalent in both emergency and routine surgeries. Klebsiella was the most commonly isolated organism, followed by Escherichia coli. The commonly susceptible antibiotics have been found to be meropenem, pipzo, amikacin, and imipenem. Commonly resistant antibiotics were amoxiclav, ceftriaxone, linezolid, and doxycycline.

Conclusion: This paper presents the incidence of SSI in the hospital setting of Central India and the factors that may contribute to the high incidence of SSI. Further research needs to be done to better understand how specific risk factors are responsible for post-operative wound infections in open GI surgery.

To study the usefulness of islanded tongue flap reconstruction for carcinoma buccal mucosa defect

2023-06-26T23:23:49+00:00

Background: Carcinoma buccal mucosa is very prevalent among the Indian population. The mainstay of treatment is surgical excision, which leaves tissue defects requiring reconstruction. Various techniques and flaps have been used for reconstruction of such defects, and research is still underway for better cosmesis and functional outcomes.

Aims and Objectives: The aims of this study were to assess the usefulness of an islanded tongue flap in buccal mucosa cancer defect reconstruction after segmental mandibulectomy.

Materials and Methods: The present hospital-based observational study was conducted on patients with carcinoma buccal mucosa, with an age greater than 20 years and both sexes included after obtaining written and informed consent. The patients underwent islanded tongue flap reconstruction after wide local excision of tumor and segmental mandibulectomy.

Results: Twenty-four patients underwent the procedure and were included in this study. The outcome of the surgery was compared in terms of deglutition and difficulty in speech on a scale of good, satisfactory, and poor. The cosmetic outcome was also compared in the same way. During the post-operative period, eight (33.33%) patients developed early complications of hematoma and pus discharge. Three (12.5%) developed wound dehiscence. Two (8.33%) of these patients also developed flap necrosis. All these complications were managed conservatively. Overall, the surgery had a good cosmetic outcome with minimal difficulty in deglutition or speech.

Conclusion: Based on results, an islanded tongue flap can be regarded as a good alternative for small and medium-sized buccal mucosa cancer defect reconstruction after segmental mandibulectomy.

Study to find out about various risk factors responsible for repeat acute exacerbation of COPD, which cause readmission within 90 days after admission in hospital due to acute exacerbation of COPD

2023-04-20T13:16:51+00:00

Background: Approximately 3.2 million global deaths occur each year due to chronic obstructive pulmonary disease (COPD), in which exacerbations of COPD remain a prevailing cause. Exacerbations requiring hospitalization are associated with high mortality, and mortality risk is increased with higher exacerbation frequencies.

Aims and Objectives: This study aimed to prospectively identify the risk factors of COPD that cause readmission within 90 days after admission to the hospital due to acute exacerbations of COPD.

Materials and Methods: An observational study conducted at the School of Pulmonary Excellence, NSCB Medical College, Jabalpur, from the duration of March 2021 to August 2022 with a sample size of 140 estimated through 56% prevalence of readmission rate in available literature. Study participants, including all patients, were readmitted within 90 days after admission due to acute exacerbation of COPD (post-bronchodilator FEV1/FVC <0.70). Data analysis was performed using IBM software SPSS 22.0 and statistical association with the confidence interval of 95% and P<0.05.

Results: The majority of COPD cases were male (84%) and belonged to the 50–60 years of age group. There was a statistically significant (P=0.001) association between grades of dyspnea and readmission cases. Dyspnea among readmission patients was found to be 100%. The prevalence of CAT score >10 was 64% and <10 is 36% among readmission patients the association was highly significant and more exacerbation leads to more readmission.

Conclusion: In the study, various clinical parameters were found statistically significant between the admission and readmission groups. These parameters were CAT score, previous hospitalization history, previous exacerbation history, SpO2, dyspnea grading, and co-morbidities. The lung function test was difficult to do due to many of readmitted patients were not in a condition to do spirometry.

Clinical and functional outcomes of open versus minimally invasive surgeries in single-level prolapsed intervertebral disc in lumbar region at tertiary care center: A prospective study

2023-05-04T16:17:28+00:00

Background: Spine surgery has been transformed significantly by the growth of minimally invasive surgery (MIS) procedures. Modern MIS techniques allow spine surgeons to achieve the same goals of open surgery while minimizing the collateral damage associated with the open approaches.

Aims and Objectives: The aim of MIS is to do an efficient “Target Surgery” with a minimum of iatrogenic trauma.

Materials and Methods: This is a prospective study done in the Department of Neurosurgery, JA group of hospitals, Gajra Raja Medical College, Gwalior, from July 2021 to July 2022. Study was conducted on 30 randomly selected patients whose presentation and imaging showed indication for surgery.

Results: Better symptomatic relief was seen in patients with MIS at 7 days with about 80% of them having a visual analog scale score between 0 and 2; however, not much difference was noted at 1 month. Not much difference was noted for wound status, neurological improvement, and Oswestry Disability Index at 1 month. However, gross difference was noted at the rate of return to work by the patients with approximately 93.3% of patients undergoing MIS returning to work within 1 month in comparison to only 20% in case of open surgery.

Conclusion: Minimally invasive techniques are remarkably better option to traditional open surgeries, as these procedures showed a significant reduction in immediate post-operative pain, duration of hospital stay, and return to work by the patient. However, not much difference was noted in status of pain at 1 month, rehospitalization, degree of disability at 1 month, wound status, and neurological improvement of the patient.

Management and outcome of unknown patients with head injury in tertiary health-care center

2023-05-15T13:38:52+00:00

Background: Patients who are admitted to government hospitals without any personal, family, or identification details are categorized as unknown patients or unidentified patients or destitute patients. Managing unknown patients pose unique challenges in developing countries, particularly in India, where there are significant medicolegal issues, humanitarian concerns, and treatment and rehabilitation challenges.

Aims and Objectives: Our study aims to investigate the demographic characteristics and outcomes of unidentified patients in our health-care facility and to evaluate the quality of care provided to them with the intention of enhancing it.

Materials and Methods: It is a prospective study conducted in the Department of Neurosurgery, Jayarogya Hospital, Gajra Raja Medical College, Gwalior, India, which is a tertiary care center. The study was conducted for a duration of 2 years between April 2021 and March 2023 in which 50 patients of traumatic brain injury (TBI) whose identity was unknown at the time of admission were analyzed.

Results: Out of the 50 TBI patients with unknown identities, 21 patients survived while 29 patients died as a result of their injuries. Among the 38 patients who were managed conservatively, 17 patients survived while 21 patients died. Of the 12 patients who underwent surgery, 4 survived while 8 patients died. The stable patients who were transferred to other departments were discharged to their homes.

Conclusion: Our study highlights the high mortality risk associated with unknown TBI patients. Due to the lack of crucial details about the traumatic event and the absence of a family support system, managing these patients are more challenging, and relevant health information is often unavailable. Improvements in identifying unknown victims are necessary, and resources must be allocated to address this challenging situation properly.

SEM study of resin tags depth for filled pit and fissure sealants using subpressure and adhesive system - An experimental analysis

2023-05-03T13:18:46+00:00

Background: Pit and fissure caries account for about 90% of the caries of permanent posterior teeth and 44% of caries within the first teeth in children and adolescents. Sealant application may be a preventive conservative approach. However, it is still challenging to bolster the retention of the filled sealant and to chop back the microleakage.

Aims and Objectives: To evaluate and compare the depth of resin tags of three filled pit and fissure sealants (PFS) using subpressure and adhesive system under scanning electron microscope (SEM).

Materials and Methods: This study was in vitro experimental study. Forty-five orthodontically extracted premolars were prepared for resin tag depth measurement and divided according to materials and subgroups. Group A- Resin-based filled PFS, Group B- Resin modified glass ionomer-based filled PFS, Group C- Giomer based filled PFS. Subgroup 1- Only sealant application, Subgroup 2- Subpressure application, Subgroup 3-Adhesive system + Subpressure application. Samples were subjected to thermocycling. The sectioned tooth fragments were polished using a carbide stone and then mounted under SEM for analysis. Photographs of the sections were obtained and the resin tag lengths were measured. Unpaired t-test and one-way analysis of variance test used for analysis. Results were considered significant when P<0.05.

Results: The depth of resin tags of the tested materials differed significantly for Giomer-based and resin-modified glass ionomer-based filled PFS group with P<0.05. Whereas Resin-based filled PFS group was not found significant P>0.05 for the depth of resin tags.

Conclusion: This study concludes that Giomer based filled PFS group and Resin-modified glass ionomer-based filled PFSs showed the highest Resin tag depth respectively when compared with Resin-based filled PFSs. The Subpressure application group was more effective followed by Adhesive+subpressure application group and Control group.