Asian Journal of Medical Sciences

Cardiovascular risk factors and impending 10-year risk of fatal or non-fatal cardiovascular disease events among an urban population in Tamil Nadu state in South India - A community based cross-sectional study

2023-02-18T06:47:51+00:00

Background: Coronary heart disease, peripheral arterial disease, cerebrovascular disease, congenital and rheumatic heart illnesses are among the heart and blood vessel disorders classified as cardiovascular diseases (CVDs). Sudden premature cardiovascular deaths among apparently healthy population can be well prevented by the early recognition of cardiovascular risk factors using validated cardiovascular risk prediction tools.

Aims and Objectives: The World Health Organization/international society of hypertension (WHO/ISH) Risk Prediction Charts was utilized to estimate the upcoming 10-year risk of CVD events, and the study’s objectives were to identify the risk factors for high CVD risk among urban residents aged ≥40–79 years in Tamil Nadu State, South India.

Materials and Methods: A total of 350 participants were selected for a community-based cross-sectional study using a two-stage selection technique. A pretested questionnaire, anthropometry and laboratory research were used to acquire the required data. Finding the relationship between the risk factors and high CVD risk among the subjects was done using both univariate and multivariate regression analysis.

Results: Mean age of subjects was 55.6 years. Hypertensives and diabetics were 35.4% and 27.4%, respectively. An alarming 75.1% subjects were either overweight or obese. The WHO/ISH chart categorized 20.9% subjects with >10% risk of impending CVDs. Risk factors which independently influenced high cardiovascular risk were “being unmarried” (adjusted odds ratio [aOR] 31.76; 95% CI; P=0.009), “positive family history” (aOR 4.13; P=0.017), “Sedentary Occupation” (aOR 3.18; P=0.036), and “alcohol usage” (aOR 3.03; 95% CI [1.06–10.27]; P=0.039).

Conclusion: The study has identified that more than one-fifth of the subjects were under the >10% CVD risk category thereby underscoring the immediate need for inclusion of CVD risk scoring tools in routine screening programs in all levels of health care settings as an effective health promotion strategy in curtailing the escalating incidence of CVDs events worldwide.

Seroprevalence of COVID-19 infection in a rural district of Tamil Nadu: A population-based seroepidemiological study

2022-12-28T05:02:38+00:00

Background: Coronavirus disease 2019 (COVID-19) was a recent global pandemic of the era which posed a great challenge for the health care in terms of preventive, diagnostic and treatment dimensions. The seroprevalence rate of COVID IgG antibodies is very crucial in estimating the susceptibility of a particular area to the viral disease. In our study, we estimated the seroprevalence of COVID-19 in a rural area.

Aims and Objectives: We aimed to estimate the seroprevalence of COVID-19 in a rural district of Tamil Nadu, 6 months after the index case.

Materials and Methods: We conducted a cross-sectional study of 509 adults aged more than 18 years. From all the seven Taluks, two gram panchayats (administrative cluster of 8–10 villages) were randomly selected followed by one village through convenience. The participants were invited for the study to the community-based study kiosk set up in all the eight villages through village health committees. We collected sociodemographic characteristics and symptoms using a mobile application-based questionnaire, and we tested samples for the presence of IgG antibodies for severe acute respiratory syndrome coronavirus 2 using an electro chemiluminescent immunoassay. We calculated age-gender adjusted and test performance adjusted seroprevalence.

Results: The age-and gender-adjusted seroprevalence was 8.5% (95% confidence interval [CI] 6.9–10.8%). The unadjusted seroprevalence among participants with hypertension and diabetes was 16.3% (95% CI: 9.2–25.8) and 10.7% (95% CI: 5.5–18.3), respectively. When we adjusted for the test performance, the seroprevalence was 6.1% (95% CI 4.02–8.17). The study estimated 7 (95% CI 1:4.5–1:9) undetected infected individuals for every reverse transcription polymerase chain reaction confirmed case. Infection fatality rate (IFR) was calculated as 12.38/10,000 infections as on October 22, 2020. History of self-reported symptoms and education were significantly associated with positive status (P<0.05).

Conclusion: A significant proportion of the rural population in a district of Tamil Nadu remains susceptible to COVID-19. A higher proportion of susceptible, relatively higher IFR, and a poor tertiary health-care network stress the importance of sustaining the public health measures and promoting early access to the vaccine are crucial to preserving the health of this population. Low population density, good housing, adequate ventilation, limited urbanization combined with public, private, and local health leadership are critical components of curbing future respiratory pandemics.

Assessment of stress, anxiety, and depression among the nursing personnel employed in tertiary care hospital during COVID-19 pandemic

2022-11-23T07:35:22+00:00

Background: Work related stress is an important occupational hazard among the forefront healthcare workers like nursing personnel. It is their demanding nature of occupation which exposes them to a higher risk of developing negative mental states.

Aims and Objectives: Objectives of the study were to assess the stress, anxiety, and depression among the nursing personnel and their potential risk factors for stress, anxiety, and depression.

Materials and Methods: A descriptive observational study was conducted among the nursing personnel employed in a tertiary care hospital in Kolkata. The data collection was done with the help of a predesigned pretested semi-structured questionnaire having information regarding socio demographic profile, history and personal history, and the questions from depression, anxiety and stress scale following permission from Institutional Ethics committee. The data were compiled, analyzed, and presented.

Results: The present study found that 29.09%, 40% and 33.64% of the study subjects were suffering from depression, anxiety, and stress, respectively. Nuclear families, staying at hostel, nonspecific symptoms, COVID-19 exposure, and nonspecific symptoms were significant contributing factors for depression. COVID-19 exposure was significantly associated with anxiety. Nuclear families, presence of nonspecific symptoms were significant contributing factor for stress. No significant association was found with age, educational level, marital status, leisure activity, chronic morbidity, testing, and quarantine.

Conclusion: Early assessment of the occupational stress, anxiety, and depression among the nursing personnel can initiate targeted intervention strategies. This would improve their personal and professional quality of life which affects the quality of health-care service.

Serum sodium and water imbalance after sellar, suprasellar, and parasellar surgeries: A prospective and observational study

2023-01-12T23:55:49+00:00

Background: Sodium and water imbalance is common after sellar, suprasellar, and parasellar surgeries. A wide variation in the diagnostic criteria of diabetes insipidus (DI) has been noted in literature. A highly variable incidence of DI and hyponatraemia has been reported. There is paucity of Indian studies.

Aims and Objectives: The study was designed to evaluate serum sodium level and water imbalance after sellar, suprasellar, and parasellar surgeries. This was evaluated in terms of occurrence of hyponatraemia and central DI on day 1 and day 7 in the post-operative period.

Materials and Methods: Patients of either sex, aged from 18 to 65 years, ASA physical status I-II, GCS score ≥13, with baseline normal electrolyte level, posted for elective neurosurgical procedures for sellar, suprasellar, and parasellar tumours, were included for this study after satisfying the inclusion and exclusion criteria. A convenient sampling of 50 patients was considered for this study. The primary outcome measures were to determine the incidence of hyponatraemia and central DI. Other adverse event and any requirement of desmopressin in the post-operative period were also noted.

Results: In the present study, the majority (74%) of patients were 31–50 years. Female preponderance was noted with male: female ratio as 1:1.4. Out of 50 cases 41 (82%) had transcranial surgery and 9 (18%) had transphenoidal surgery. The incidence of sodium and water disturbances (SWD) was observed in 22% (11/50) patients. Out of these 11 patients, nine developed DI and two had hyponatremia on day 1 in the post-operative period. Both the abnormalities were found to recover on day 7. Only 1 patient (2%) required desmopressin.

Conclusion: The incidence of SWD after sellar, suprasellar, and parasellar surgeries was found to be common (22%). The hyponatraemia and DI responded to the therapy and were transient in nature.

Does age and start of Ponseti treatment affect the functional outcome in club foot: A comparative study

2022-12-20T07:24:04+00:00

Background: Idiopathic clubfoot is one of the most common and complex congenital deformities which are difficult to correct.

Aims and Objectives: The present study was designed to assess the effectiveness and results of the Ponseti method’s early use in the treatment of idiopathic congenital talipes equinovarus (CTEV).

Materials and Methods: Seventy-six feet in 50 patients of CTEV during the period of May 2019–May 2020 were studied. All the cases were treated by Ponseti technique. Children with idiopathic CTEV and age <1 year were included in our study. The severity of deformity was graded according to Pirani scoring system both at the beginning and at the end of treatment.

Results: The mean age at presentation was 2.77 months. The mean initial Pirani score at time of presentation was 4.07, and at last follow-up was 0.13. We observed that 63 feet (82.89%) out of 76 feet required a percutaneous TA tenotomy along with plaster casting to correct the equines deformity. The mean total number of casts required to correct the deformity was 6.4. The mean duration of treatment from 1st plaster cast to cast for equinus correction was 8.4 weeks. About 94% of cases had a good outcome at last follow-up which was evaluated on the basis of Pirani score. The association of duration of treatment (weeks) with age and total number of cast with age has P=0.002 which was found to be significant.

Conclusion: The Ponseti technique is a very safe, efficient, and acceptable economical treatment for the correction of CTEV that gives excellent results on conservative treatment and in most of the cases avoid surgical intervention if protocol followed as prescribed. If the age of the patient is higher at time of presentation, it requires a longer casting period and more number of casts to correct the deformity compared to younger children with the early presentation.

Correlation analysis of HbA1c versus random, fasting, and postprandial glucose levels as predictors of glycemic control in type 2 diabetes patients

2023-03-08T15:42:06+00:00

Background: Glycated Hemoglobin (HbA1c) is used for assessing glycemic control over the past 8–12 weeks. This is critical for determining the efficacy of diabetes treatment and predicting the progression of microvascular complications. However, in health-care situations where tests for HbA1c are either unavailable or unfeasible for any reason, clinicians rely only on plasma glucose values for assessing the glycemic control of the patient.

Aims and Objectives: The purpose of this study was to determine the relationship between HbA1c and fasting, postprandial, and random plasma glucose levels.

Materials and Methods: Routine blood samples obtained from the laboratory to measure HbA1c and plasma glucose (fasting/postprandial/random) were used for study. A total of 207 samples were used to investigate the relationship between HbA1c and fasting and postprandial glucose (PPG/PP). The correlation of HbA1c with random glucose values was investigated using 112 samples. HbA1c was estimated by immunoturbidimetry and glucose was estimated by hexokinase method. Pearson’s correlation analysis was done by SPSS version 20 software.

Results: The Pearson correlation coefficient (r) with regard to PPG/PP and HbA1c was 0.75 (P=0.01, 95% CI), fasting glucose and HbA1c was 0.73 (P=0.01, 95% CI), and random glucose and HbA1c was 0.59 (P=0.01, 95% CI).

Conclusion: PPG/PP correlates with HbA1c better than fasting or random glucose. When it is impossible to perform HbA1c measurements, PPG measurements should be used instead.

Correlation of lipid profile with diastolic dysfunction in normotensive young patients under 40 years of age

2023-01-18T04:38:18+00:00

Background: Diastolic dysfunction in young adults is associated with increased morbidity and mortality. The identification of risk markers associated with diastolic dysfunction could allow for targeted primary prevention efforts.

Aims and Objectives: The aim of the study was to study whether dyslipidemia is associated with diastolic dysfunction independent of systemic hypertension in young patients under 40 years of age.

Materials and Methods: This was a cross-sectional analytical study done from April 2021 to March 2022 in SSMC and SGMH Rewa (M.P.), 214 normotensive cases under 40 years of age were taken as cases by simple random sampling. Sample size calculated by standard formula with confidence level of 95% and margin of error was <5%. Lipid profiles (S. Triglyceride [TG], S. Cholesterol, and S. low-density lipoprotein [LDL]) of all the patients were checked. 2D echocardiogram of patients was done to check for diastolic dysfunction. All data were compiled and compared with the previous studies.

Results: We found that the prevalence of diastolic abnormalities in adults under 40 years of age was 21.9%. It was found that there was significant correlation between dyslipidemia and presence of diastolic dysfunction in patients. Patients with higher than normal levels of S. TG, S. Cholesterols, and S. LDL were found to have more prevalence of diastolic dysfunction then patients with normal levels of S. TG, S. Cholesterols, and S. LDL. Higher grades of diastolic dysfunction were found in patients with dyslipidemia as compared to patients without dyslipidemia. High levels of TG and LDL and even Borderline high levels of LDL can be good predictors of diastolic dysfunction.

Conclusion: Dyslipidemia is associated with diastolic dysfunction in young patients even without systemic hypertension.

Assessment of neutrophil and platelet-to-lymphocyte ratio as inflammatory markers in type 2 diabetes mellitus patients

2023-01-17T00:37:15+00:00

Background: Diabetes mellitus (DM), metabolic disease, and its prevalence are increasing in India. DM causes micro- and macrovascular complications. Inflammation is one of the contributing factor in the pathophysiology of DM.

Aims and Objectives: This study aimed to evaluate neutrophil and platelet-to-lymphocyte ratio (PLR) in T2DM patients.

Materials and Methods: This study was carried out in Biochemistry Department, Lt. B.R.K.M Government Medical College, Chhattisgarh, India. In this study, 150 type 2 DM patients were considered as cases and 150 normal subjects were considered as controls. Baseline data was collected from subjects. All subjects underwent physical and clinical examination. Fasting and post prandial venous blood samples were collected. FBS, PPBS, renal profile (urea, creatinine and uric acid) were estimated in serum sample. EDTA samples were used for complete blood count (CBC). Neutrophil-to-lymphocyte ratio (NLR) and PLR ratio were calculated from CBC values. HbA1c was estimated using whole blood sample. Blood pressure and BMI were recorded.

Results: In this study, mean age of 61.2±4.0 years, systolic blood pressure 136.2±14.4 mmHg, diastolic blood pressure 100.1±12.5 mmHg, BMI 28.1±2.6 (kg/m2), FBS 180.7±22.3 mg/dL, PPBS 289.3±33.2 mg/dL, HbA1c 8.1±0.7%, serum urea 39.1±8.3 mg/dL, creatinine 1.1±0.2 mg/dL, uric acid 7.1±2.0 mg/dL, lymphocytes 18.3±3.0%, NLR 8.1±3.1, and PLR 20.3±7.1 were significantly increased in cases than controls.

Conclusion: Elevated ratios of NLR and PLR may serve as markers of inflammation in T2DM. These are inexpensive and helpful to assess the inflammatory status in T2DM.

To study fasting and post prandial lipid profile in type 2 diabetes mellitus in comparison to non diabetics

2023-01-04T00:46:47+00:00

Background: Postprandial diabetic dyslipidemia creates proatherogenic conditions which are associated with microvascular and macrovascular complications. Its timely identification might help prevent complications.

Aims and Objectives: The aims of this study were to assess the fasting and postprandial lipid abnormalities in type 2 diabetes mellitus (DM) in comparison to non-diabetic patients attending SGMH, Rewa, M.P.

Materials and Methods: This was a cross-sectional case–control study done from April 2021 to March 2022 in SSMC and SGMH Rewa (M.P). 200 cases and 200 controls taken as per inclusion and exclusion criteria, age, and sex matched. Relevant examination and investigations including fasting and postprandial lipid profile were done. All data compiled and compared with the previous studies.

Results: The comparative findings of fasting and postprandial lipid profile in type 2 DM compared to controls (non-diabetics) revealed the following observations. In fasting state, 56% cases and 30% controls had triglyceride levels of >150 mg/dL, while, in postprandial state, it was 82% cases and 32% controls. In fasting state, 28% cases and 8% controls had very low-density lipoproteins-cholesterol (VLDL-C) levels of >40 mg/dL, while, in postprandial state, it showed 46% cases and 14% of controls. In fasting state, 70% cases and 60% controls had high-density lipoproteins-cholesterol (HDL-C) levels of <35 mg/dL, while, in postprandial state, it was found in 80% cases and 58% controls.

Conclusion: In the postprandial state, there was significant hyper-triglyceridemia, increased VLDL-C, and decreased HDL-C levels in cases than controls. In the fasting state, there was significant hyper-triglyceridemia and increased VLDL-C levels in cases than controls.

A cross-sectional study on co-infection of hepatitis B and hepatitis C among people living with HIV/AIDS from a tertiary care hospital of Central India

2022-12-17T01:31:04+00:00

Background: Hepatitis B virus (HBV), hepatitis C virus (HCV), and Human immunodeficiency virus (HIV) infections are prevalent throughout the world. HIV infection increases the risk of HBV and HCV liver disease especially when HIV-associated immunodeficiency progresses.

Aims and Objectives: This study was carried out with the objectives as follows: Estimation of the prevalence of HIV- Hepatitis co-infection, determine CD4+T lymphocyte count in co-infected patients, identify most common opportunistic infections in HIV – Hepatitis co- infection.

Materials and Methods: A hospital-based, prospective, cross-sectional, and observational study was carried among people with confirmed HIV infection. HIV antibody, hepatitis B surface antigen (HBsAg), and HCV antibody tests were done in all patients visiting to integrated counseling and testing center. HIV, HBV, and HCV viral load were done in all serologically confirmed patients. In HBsAg positive patients various markers for hepatitis such as hepatitis B envelop antigen (HBeAg), anti-hepatitis B core antibody (HBcAb), and anti-hepatitis B envelop antibody were also done.

Results: Out of 357 people living with HIV/AIDS (PLHA) patients 15/357 (4.20%) were co-infected with HBV, 03/357 (0.84%) were co-infected with HCV. The overall seroprevalence of Hepatitis virus (HBV+HCV) in PLHA patients was found to be 5.04% (18/357). CD4+T lymphocyte count <200 cells/μL was seen in 66/339 (19.4%), 04/15 (26.6%), and 03/03 (100%) patients of HIV mono-infected, HBV co-infected, and in HCV co-infected patients, respectively. HIV Viral load ≤1000 copies/mL was seen in 324 and 15 patients in HIV mono-infected and HIV- hepatitis co-infected patient, respectively. Among PLHA patients who were positive for HBsAg; 46.7% (n=7) patients had HBV viral load >2000 IU/mL. All hepatitis B co-infected patients were positive for HBcAb test; HBeAg was positive in 40% (n=06). All HBeAg positive were having viral load >2000 IU/mL.

Conclusion: HIV-infected patients are more prone to hepatitis associated liver diseases and exposure to the HBV infection than the general population.

Effect of perceived social support and level of hope on quality of life among chronic kidney disease patients in a tertiary care center in Chennai - A cross-sectional study

2023-01-04T17:37:10+00:00

Background: Chronic kidney disease (CKD) is a major public health problem in developing countries, adversely affecting the quality of life (QOL) of the individual and their family. Perceived social support and hope are important factors influencing the QOL.

Aims and Objectives: The objectives of the study were to assess the QOL among patients with CKD and the effects of perceived social support and hope on QOL.

Materials and Methods: This is hospital based cross-sectional study among CKD patients attending nephrology department, between March and November 2018. Face to face interview using Adult Hope Scale and Multidimensional Perceived Social Support scale and WHOQOL-BREF-26 was done after obtaining informed consent. Epi-info and SPSS16.0 were used for statistical analysis. t-test, ANOVA, and correlation coefficient was done to find any association.

Results: Among the 152 participants, majority (70%) had fair QOL with the highest score in social relationships domain of 53 (±12), using the WHO BREF26 questionnaire. The QOL was also found to be associated with education and socio-economic status. A positive correlation between perceived social support and hope with QOL was observed.

Conclusion: Majority had a fair QOL, with the highest score in social relationship domain. Positive correlation was observed between perceived social support and hope with QOL. Apart from medical treatment, the key to better health outcome depends on social support. Hence, it is imperative to highlight the importance of social support and hope at the commencement of the treatment of CKD.

A cross-sectional epidemiological study of socio-demographic characteristics, and the functional assessment in geriatric population in field practice area of an urban health centre

2023-01-10T12:56:56+00:00

Background: India like many other developing countries in the world is witnessing the rapid aging of its population. Urbanization, modernization, and globalization have led to change in the economic structure, the erosion of societal values, weakening of social values, and social institutions such as the joint family. Active aging aims to extend healthy life expectancy and quality of life (QOL) in older persons, and the QOL are largely determined by its ability to maintain autonomy and independence.

Aims and Objectives: The present study was conducted at a teriary apex institute to study the socio-demographic characteristics, and the functional assessment in the elderly subjects in urban community.

Materials and Methods: It was a cross-sectional observational study conducted at the area situated near western suburb of metro city and population of around one lakh sixty thousand. It consisted of housing buildings, multiple slum area. The current study was conducted over 1 year 6 months (18 months).The sampling unit being 102 Geriatric individuals of selected area of urban health center.

Results: Out of 102 study, subjects 22 (21.56%) were complete independent to perform daily instrumental activities. Maximum study 48 (47.05%) subjects were required moderate assistance for performing the instrumental activities. Numbers of female study subjects were more among moderates assistance 24 (44.44%) and modified assistance 20 (19.60%). Out of 102 study subjects 55 (53.92%) were complete independent followed by 30 (29.41%) modified independence. Numbers of female subjects were more among moderate assistance 10 (58.82%).

Conclusion: No study subject was dependent or maximal assistance for their self-care activities. Male and female in the present study can perform their self-care activities of daily living with equal efficiency.

Sociodemographic profile, clinical presentations, environmental factors, and laboratory parameters of dengue patients: A retrospective study from Mizoram, India

2023-03-02T15:32:36+00:00

Background: Mizoram is one of the states in India with high cases of dengue for the year 2022. There is very limited data regarding the sociodemographic profile, clinical presentation, environmental factors, and laboratory parameters and outcome of infection of dengue patients in Mizoram.

Aims and Objectives: The present study was aimed to study factors and the proportion of patients getting admitted with dengue fever (DF), DF with warning signs and severe dengue.

Materials and Methods: The data collected retrospectively from the medical records of the patients admitted in three private hospitals and two governmental hospitals during the time period from July to November 2022. Descriptive analysis was carried out and categorical outcomes were compared between study groups using Chi-square/Fisher’s Exact test. Mean values were compared between study groups using ANOVA (>2 groups). P<0.05 was considered statistically significant.

Results: Out of 189 patients, 103 (54.50%) were male and majority were aged >14 years 166 (87.83%). Mean age was 42.08. Majority 157 (83.07%) belonged to urban population. DF were 137 (72.49%), severe dengue 10 (5.29%), and with warning signs of severe dengue 42 (22.22%). Most common symptoms observed were fever 181 (95.77%) followed by myalgia 95 (50.26%). Severe dengue was reported more among females 7 (70%), DF was more common among males 71 (51.82%) (P=0.041). DF was more common in patients from urban 113 (82.48%) versus rural 24 (17.52%) (P<0.001). Mortality was 1.59%.

Conclusion: Health education and integrated vector control measures need to be intensified to prevent future dengue outbreaks in Mizoram.

Exploring Healthcare Seeking Behavior Among Patients with Ischemic Heart Disease and Stroke; A Cross-Sectional Study in a Tertiary Care Centre in South India

2023-02-23T10:46:01+00:00

Background: Ischemic heart disease (IHD) and stroke represent the leading cause of mortality globally. Delays in seeking medical attention that result in diagnostic and treatment delays are significant roadblocks in achieving the best possible treatment outcomes for IHD and stroke.

Aims and Objectives: This study aims to assess the pattern of healthcare seeking behavior among patients of IHD and stroke in a tertiary care hospital at Salem District in Tamil Nadu, South India.

Materials and Methods: This cross-sectional study was conducted among 250 patients of IHD and stroke. A validated and structured questionnaire was used to collect information on socio-demographic details, knowledge, and health-care seeking behavior with regard to IHD and stroke based on the Health Belief Model.

Results: The mean age of study participants was 60 years with a male preponderance (56%). About 75% of IHD patients and 61.9% of stroke patients had no formal education. The prevalence of hypertension (74%) was higher than diabetes mellitus (45.6%) among the study subjects. The seriousness of the initial symptoms of IHD and stroke was perceived only by 7.75% of IHD patients and 2.23% of stroke patients. Alarmingly, 39.66% of IHD patients and 61.2% of stroke patients were not aware of any risk factors for IHD and Stroke. Only 21.56% of IHD patients and 14.17% of stroke patients sought immediate medical assistance whereas the others ignored the symptoms or did not undergo treatment even after knowing the symptoms of the disease.

Conclusion: This study depicted suboptimal healthcare seeking behavior and significant lack of knowledge about risk factors, initial symptoms, preventive measures, and reasons for pre hospital delay related to IHD and stroke. The study yields valuable references to incorporate the pattern of health-care seeking response of the community along with their sociocultural and economic factors in designing and implementation of any health program.

Prevalence of undernutrition and associated risk factors among under five children in rural Haldwani

2023-01-19T13:31:11+00:00

Background: The foundation of any nation is children. Malnutrition in children is global issue that may have both short- and long-term irreversible negative health consequences and thus associated with morbidity and mortality.

Aims and Objectives: The study aims to determine the prevalence and associated risk factors of under-nutrition among under-five children in rural area of Haldwani.

Materials and Methods: A community-based cross-sectional study conducted on Four hundred children residing in the rural field practice area of the Department of Community Medicine, Government Medical College, Haldwani.

Results: The prevalence of underweight, stunting, and wasting was 7.75%, 9.25%, and 4%, respectively among under five children. The risk factors found significantly associated with undernutrition and sociodemographic profile were family size, parent’s education, mother’s occupation, and the socioeconomic class. The maternal factors found significantly associated with undernutrition were intake of iron folic acid tablets during antenatal care and postnatal care period, duration of pregnancy, site of delivery. Prelacteal, colostrum given, exclusive breastfeeding, and age of introducing complementary feeding and occurrence of recurrent diarrhea, recurrent acute respiratory infection, and worm infestation were child characteristics and medical illness found significantly associated with undernutrition.

Conclusion: In this study, 17.5% of children were found undernourished. Factors determining undernourishment were parents literacy, social class, type and size of family, iron folic acid taken during pregnancy, feeding practices, immunization status, history of recurrent diarrhea, and other infections in the past 1 year.

Study of knowledge, attitude, and practice of contraception among antenatal women at tertiary care hospital in Western Rajasthan

2023-01-04T12:51:21+00:00

Background: The global population today stands at 7.7 billion and is expected to reach 9 billion by year 2045.1 Increasing population is a global problem today. India is the largest demographic country of the world, posses 2.4% of world land area and supports 16% of world’s population. India is going to be the highest populous country in the world by the year 2050.

Aims and Objectives: The aim of the study was to assess the knowledge, attitude, and practice of contraception among antenatal women attending ANC clinic at Umaid Hospital.

Materials and Methods: An observational and cross-sectional study conducted in department of Obstetrics and Gynaecology at Umaid Hospital, Jodhpur.

Results: Our study revealed that majority (86%) of illiterate women not using contraceptive methods while users of contraceptive increase with education, contraception usage was found more in urban area (51%). Majority (95%) of participants had some knowledge about methods of contraception, commonly heard method was tubectomy (87%) followed by IUCD (68%), condoms (64%), and pills (61%), but this knowledge is not leading to increased practice, as only 43%participants had used contraception. Family acted as major source of information (35%) followed by health care worker (27%). Most of users accessed contraception from pharmacy (43%) followed by health center (24%). Most common reason to use contraception is to give gap between kids (33%) followed by, to prevent unwanted pregnancy (25%). Near 60% of participants agreed that husband opinion is the most important factor for choice of contraception.

Conclusion: The consciousness to curb the rapid growth of population is rampant all over the world. Extensive efforts are being made in the developing countries to reduce the existing crude birth rates through the developing countries to reduce the existing crude birth rates through the development and reforms of indirect measures such as social, economic, cultural, health, and educational besides the direct programs of family planning.

Kitchen garden: Perceived role and utilization among rural households in Mandya, Southern Karnataka

2022-12-27T06:11:57+00:00

Background: Diversified diet is the key to combat micronutrient deficiency in India. Kitchen garden is a sustainable approach to provide diversified diet in rural area.

Aims and Objectives: The objectives of this study were to assess the utilization and perception of kitchen garden use among the households in rural area.

Materials and Methods: A community-based cross-sectional study carried out among women in the age group 18–65 years in Nagamangala was asked about the details on awareness and utilization of kitchen garden.

Results: One-third of the study subjects were in the age group 30–40 years. About 18.2% of them were involved in some form of agriculture related work. Around 64% of the households had space available for kitchen garden. About 54% households had kitchen garden and 95% of the subjects used their kitchen garden products for self-use.

Conclusion: Having kitchen garden contributes to household food security by providing direct access to food that can be easily harvested, prepared, and consumed.

Auditory perception in adult hearing aid users with and without auditory training - A comparative study

2023-01-17T08:51:26+00:00

Background: Individuals with sensorineural hearing loss can regain some lost auditory function with the help of hearing aids, but it may be insufficient under non – optimal condition. Future research aspect lies in processing strategy and training to enhance effects of auditory training and rehabilitation of patients using hearing aids. So research is done to supplement the rehabilitation process with patient centric education, counseling and auditory training to help the listener compensate for loss of auditory signal and improve communication. Whether age-related hearing loss can be decreased by auditory training along with hearing aid is to be researched as it is not clear from previous scientific works whether the outcome is significantly better than those with hearing aid who have not received training.

Aims and Objectives: The aim of the study was to determine the role of auditory training for improvement of auditory perception in aged patients with age-related sensorineural hearing loss using binaural hearing aid.

Materials and Methods: This prospective observational study was conducted in Otorhinolaryngology department of Burdwan Medical College and Hospital, Burdwan, a rural based tertiary care hospital in Burdwan for 2 months from June 2022 to July 2022 and 50 aged patients with audiologically proven age related sensorineural hearing loss using hearing aid were included in this study after through history taking and meticulous clinical examination after getting institutional ethics committee clearance. Patients were divided in two groups, 25 in experimental group (with auditory training) and 25 in control group (without auditory training) and result was analyzed.

Results: Formal auditory training was able to improve the central auditory skills of hearing aid users. Improvement was noted in an objective neurophysiologic correlate and perceived by patients, as revealed in a self-assessment questionnaire.

Conclusion: Formal auditory training in adult hearing aid users promotes: Improvement in auditory skills for sound localization, memory for nonverbal sounds in sequence, auditory closure, and figure-to-ground for verbal sounds. Greater benefits with hearing aids in reverberant and noisy environments.

A clinical study of mastoid ventilation tube in tympanoplasty

2023-01-11T10:08:33+00:00

Background: A ventilated middle ear space is an essential component of a functioning middle ear transformer mechanism. A mastoid ventilation tube (MVT) placed post-aurally in the antrum near the aditus is used in this study for the benefit of improvement in results of tympanoplasty. In support of this concept, very few experimental documents are reported.

Aims and Objectives: The aims of this study were to find out if the MVT has any effect on the outcome of tympanoplasty in cases of chronic suppurative otitis media (CSOM) tubo-tympanic disease.

Materials and Methods: This study was performed in 50 cases which were selected from the total number of cases using stratified random sampling method. In the research, patients with CSOM, who did not respond to medical therapy and required a combined approach tympanoplasty, were enrolled. Patients who needed just myringoplasty and those found to have cholesteatoma intraoperatively were not included in the research.

Results: The study showed significant improvement in graft uptake, air-bone closure, and hearing in cases with MVT, thus resulting in better success rate in cases with MVT than cases without MVT. Furthermore, most of the cases had sclerosed mastoids and very few cases had complications such as MVT block and post-operative discharge.

Conclusion: The MVT had a beneficial effect on the final outcome of combined approach tympanoplasty in cases of CSOM tubo-tympanic type active stage.

A comparison of clinical profile and outcomes among different age groups of critically ill elderly patients in a tertiary level hospital in Nepal: A retrospective study

2022-12-27T16:19:56+00:00

Background: Ageing population has increased the rate of hospitalizations and demand for critical care services. The data on the clinical profile and outcomes of different groups of elderly admitted to the intensive care units (ICU) are however sparse.

Aims and Objectives: The aim of this study was to evaluate and compare the clinical profile and outcomes among different age groups of critically ill elderly patients admitted to the ICU of a tertiary level hospital.

Materials and Methods: This retrospective and observational study reviewed all the elderly patients aged 60 years and above, admitted to the ICU of a tertiary hospital over a period of 1 year. The patients were divided into three groups, 60–69 years, 70–79 years, and 80 years and above. Non-probability sampling was done. Kruskal–Wallis H test was performed to compare the median values of the variables between the three groups.

Results: Among 173 patients analyzed, the three groups did not differ in clinical characteristics, requirement of renal replacement therapy and cardiovascular support, length of stay (LOS) in ICU, LOS in mechanical ventilator, and patients who improved and transferred out of ICU. Acute physiology and chronic health evaluation II (APACHE) II score was significantly higher in 70–79 years compared to the other two groups (P=0.01) as was the in-hospital mortality (P=0.03).

Conclusion: APACHE II score rather than age is a good predictor of adverse outcomes in ICU. Age should not be used to preclude the utilization of resources in ICU.

Correlation of serum albumin levels with the grading of esophageal varices

2022-11-30T09:00:12+00:00

Background: Variceal bleed is one of the major complications seen in patients with cirrhosis of liver of various etiologies and endoscopy is a gold standard for its diagnosis which is an invasive procedure. There are other modalities of non-invasive methods to determine the degree of varices and estimation of serum albumin levels in one among them.

Aims and Objectives: The aims of this study were as follows: (1) To measure serum albumin levels in patients with cirrhosis of liver and (2) to correlate serum albumin levels with grading of esophageal varices.

Materials and Methods: A cross-sectional study was conducted on a total of 100 patients in Bangalore during the study period from October 2016 to September 2017. Case record form with follow-up chart was used to record the duration of disease, history of treatment and complications. Patients underwent biochemical investigations and endoscopy. The presence of varices and their size was obtained from endoscopy reports.

Results: Study includes 100 patients that majority belonged to the age group 40–49 years (46%). Serum albumin levels of <2.8 mg/dL was seen in high number of study subjects (76%). Forty patients had albumin levels of <2.8 mg/dL with grade 3 OGD scopy, followed by 23 patients with Grade 1 esophagogastroduodenoscopy (OGD scopy). The association between albumin and OGD scopy grades was found to be significant (P=0.027).

Conclusion: We conclude that low albumin levels predict higher grades of esophageal varices. It can identify the subset of patients who require prophylactic endoscopic management. Estimating serum albumin levels are non-invasive that can screen the patient for esophageal varices. Thus, this reduces the economic burden on the patients and the cost of management of esophageal varices.

Antimicrobial resistance - are future prescribers aware? A study among undergraduate medical students in Kumaon region

2022-11-29T14:20:00+00:00

Background: According to the WHO, antimicrobial resistance (AMR) occurs when bacteria, viruses, fungi, and parasites change over time and no longer respond to medicines making infections harder to treat and increasing the risk of disease spread, severe illness, and death and is a global issue and measures to halt this is the need of the hour.

Aims and Objectives: This study aims at identifying awareness as well as knowledge, attitude, perception, and practice regarding AMR and antibiotic use among medical undergraduate students, so to get insight and take appropriate actions to enhance their knowledge that will help in reducing AMR as they are the future prescribers.

Materials and Methods: A descriptive cross-sectional study was conducted among 483 undergraduate medical students enrolled in government medical college, Haldwani. A pretested, semi structured questionnaire was designed to collect data from participants through Google forms regarding sociodemographic profile, and behavior of the participants regarding antibiotic use which comprises: Attitude, perceptions, and practice.

Results: Majority of study participants have heard about AMR before (97%) of which most of them got information about antibiotic resistance by web/internet (35%). Majority of study participants were aware (>90%) of phenomenon of antibiotic resistance, 98.9% of them were correctly able to identify Amoxicillin and Penicillin as antibiotics, most of them had correct knowledge about role of antibiotics. Majority (83.6%) of participants take antibiotic only after the prescription of doctor, 78.9% of them reported use of antibiotics in the last year.

Conclusion: A fair good amount of awareness, knowledge, attitude, perception, and practice regarding AMR and its use was found among study participants. Still, there is scope of improvement in it that can be addressed through giving more emphasis on this in undergraduate teaching curriculum.

Toward developing a scoring system for dengue fever in children

2022-11-20T17:17:18+00:00

Background: Dengue is a rapidly increasing global public health problem especially in tropical countries. Dengue is a benign and self-limiting febrile illness in the majority of children but in some children, it can progress to severe dengue (SD) resulting in shock, hemorrhage, and death.

Aims and Objectives: The aims of this study were to develop a scoring system to predict dengue infection severity.

Materials and Methods: This prospective and observational study was conducted on all children admitted with dengue fever at a tertiary teaching institute in India. Daily scoring was done for pulse rate, respiratory rate, blood pressure, hematocrit, platelet count (scores 1–3), and systemic complications (0 if absent, 3 if present). Then, highest score recorded during the hospitalization period was taken for statistical analysis.

Results: A total of 194 cases were classified into probable dengue (PD) 134 (69.1%), dengue with warning signs (DWS) 41 (21.1%), and SD 19 (9.8%) as per the WHO 2009 classification. Mean age of presentation was 11.5 years. The most common presenting symptoms were fever (97.9%), vomiting (73.1%) and signs noticed were flushing (63.4%), hepatomegaly (34.5%), and periorbital puffiness (27.3%). Among 134 children with PD, 116 (86.5%) had dengue severity score 5–6, with only 18 (13.5%) had score 7–13, whereas all 60 (100%) children with DWS and SD had score 7–13, none of them had score <7. Hence, a severity score of >7 identified all children with DWS and SD with overestimation in 13.5% children with PD.

Conclusion: Daily dengue severity score of >7 indicates the high probability of DWS and SD. However, this scoring system should be validated by similar studies in different settings before we can apply in routine clinical practice.

Observational study of changes in dominant ovarian follicle with and without administration of clomiphene citrate in primary infertility cases among eastern Indian women

2023-01-12T00:29:20+00:00

Background: Changing environment and social factors with advancement of science bestowed the human population with both curse and boon. Increasing number of primary infertility is one of the many challenges which is encountered among 3.59% of Indian women population in reproductive age group. Use of clomiphene citrate (CC) is one of the commonly practiced way to find out a ray of hope.

Aims and Objectives: The aim of the study was to measure the changes of morphometric parameters of dominant ovarian follicles and their numbers and compare the same before and after administration of CC was the aim of the present study.

Materials and Methods: This interventional and cohort study performed on 50 women coming to the infertility clinic at Institute of Post Graduate Medical Education and Research, Kolkata, with primary infertility of reproductive age group. Informed consent was taken from all. Transvaginal ultrasonography was utilized to measure the parameters related with dominant follicles. Comparison among them with respect to number, size, and time to rupture both before and after ovulation induction with CC was made.

Results: Statistically significant increase in number and average size of dominant follicle is seen from 1.08 to 2 and 12.26 to 15.31 mm following CC in the third cycle. In polycystic ovarian disease, cases also ovulation has increased significantly.

Conclusion: Transvaginal ultrasonography proves to be regarded as a gold standard procedure to measure and monitor the ovarian follicle status. Undoubtedly CC can be regarded as an easy and dependable solution toward treatment of primary infertility.

An analytical study on increasing number of cesarean section in a tertiary care hospital

2022-12-30T17:07:10+00:00

Background: One of the most common surgeries performed worldwide is cesarean section (CS). The World Health Organization has identified an ideal CS rate for a nation of around 10–15%. In recent times, the proportion of delivery conducted by CS has increased. However, it can lead to significant increase in maternal and infant morbidity and mortality.

Aims and Objectives: This study aims to analyze determine rate of CS and factors that lead to increased number of CS in a tertiary care hospital.

Materials and Methods: This analytical prospective study has been carried out on pregnant women undergoing CS in Calcutta National Medical College and Hospital from March 2019 to February 2020. Total 1000 cases undergoing emergency CS during study period were included in the study. Template was generated and analysis was done on SPSS software. Results: In this study, lower segment CS (LSCS) rate is highest in age group of 20–25 years (47.2%), followed by <19 years age group (24%) and lowest LSCS rates seen in >35 years age group. Relationship between parity and LSCS rate is also considered in the present study. Primipara contributes around 76% LSCS rate, where multipara shows only 24% of total LSCS in this study. In respect to total number of LSCS in this study, Robson Group 2B is maximum contributor (37.4%), followed by 2A (14.4%), 4B (13.2%), and Group 6 (7.6%).

Conclusion: The LSCS rate in the present study is far higher than standards which are statistically significant also. Hence, it is mandatory to assess risk and benefit ratio of mother and fetus before taking any measure to reduce LSCS rate.

Spectrum of parasitic infections on fine-needle aspiration cytology presenting as superficial nodules: A retrospective study of 5 years in a tertiary care hospital

2022-03-27T12:18:41+00:00

Background: Parasitic infestations are very common in a developing nation like India. They may present as superficial nodules and are often either missed or misdiagnosed as other soft-tissue lesions. Fine-needle aspiration cytology (FNAC) is an easy, minimally invasive technique to detect, and diagnose these lesions. Parasitic infections are present in every age group with cysticercosis being the most common parasitic infestation. The present study highlights the role of cytology in diagnosing parasitic lesions and also analyzes the spectrum of these lesions in a tertiary care hospital.

Aims and Objectives: This study was carried out to assess the spectrum of parasitic infestations in a tertiary care hospital of North West Delhi over 5 years (2015–2019). This was a retrospective and descriptive study done in the Department of Pathology, Dr. BSA Hospital, Delhi.

Materials and Methods: Sixty-six cases out of a total of 15094 FNACs performed over 5 years (2015–2019) that were diagnosed as parasitic lesions on FNAC were included in our study. The records were retrieved, analyzed, and recorded. Clinical details were obtained from the FNAC requisition slips.

Results: A total of 66/15094 FNACs conducted over 5 years were diagnosed as parasitic lesions. Fifty-seven cases of cysticercosis, six cases of filariasis, two cases of echinococcosis, and one case of toxoplasmosis were identified.

Conclusion: As parasitic infections pose a problem in a developing country like ours; hence, early detection is always helpful and reduces the morbidity associated with it. Careful assessment of cytological material aspirated from superficial nodules can be very helpful in detecting parasites.

Cellular diameter in desquamated cells of smokeless tobacco users

2022-12-09T13:46:15+00:00

Background: Tobacco-induced mucosal changes have been identified in exfoliated cells. The morphology of the exfoliated cells depends on the nature of the changes taking place in the epithelial layer; conversely, alteration in cytological pattern may be attributed to the changes occurring in the epithelial layer. Applying this possibility, exfoliative cytological techniques have been applied to examine the effect of tobacco on the oral mucosa.

Aims and Objectives: The study was conducted to study the alterations in the cellular diameter of buccal mucosal cells.

Materials and Methods: In a case controlled study, 240 participants were divided into four groups according to their habit of consumption of tobacco leaves, tobacco with areca nut, participants with oral lesions, and participants without any such habit. The groups were, further, subdivided according to their age. Desquamated cells from the buccal mucosa of were collected and smeared on a slide. The cells were stained with Papanicolou (rapid kit). Fifty cells per slide were studied and photomicrographs were obtained at ×40 magnification. The cellular diameter was obtained using the Leica 1000 software.

Results: The mean cell diameter was found to be highest in the group of normal subjects (49.51±7.31 micron), followed by the group of tobacco users (43.52±1.92 micron) and Gutkha users (39.05±3.57 micron). The mean cell diameter was minimum (24.97±3.13 micron) in the group of oral lesion patients. According to the ANOVA test, the difference in cell diameter among various groups is found to be highly significant (P<0.0001).

Conclusion: Tobacco used in any form can induce changes in the buccal mucosa. In our study, mean cellular diameter decreased from normal-cells to cells affected by oral lesions.

Observational study on histopathology of male anterior urethral stricture: Toward better understanding of stricture pathophysiology

2022-10-07T17:12:54+00:00

Background: Stricture urethra is generally limited to anterior urethra. At present, there are only a few studies which focus exclusively on the histopathology of stricture urethra disease.

Aims and Objectives: The aims of this study were to assess the urethral stricture pathology specimens for determining the severity of chronic inflammation and characteristics of stricture, demographics, and patient-reported outcome measures in patients with inflammatory and non-inflammatory strictures.

Materials and Methods: This was a prospective and observational study done on 60 male patients of anterior urethral stricture disease who underwent excision biopsy of stricture during urethroplasty. Pre-operative urinary symptoms assessment was done with a questionnaire provided to all patients and data maintained to assess patient-reported outcomes in inflammatory and non-inflammatory stricture urethra. Cohorts comprising strictures with no inflammation, mild, and moderate to severe inflammation were developed and stricture, the patient characteristics were compared.

Results: In a total of 60 histopathological stricture specimens, there was no inflammation in 40%, mild and moderate inflammation was in 28% and 3.3%, respectively. Lichen sclerosis-related strictures had moderate to severe inflammation and most of the strictures were in bulbar urethra (51.6%). Patients with BXO changes showed more inflammation. In patients with inflammatory strictures, hesitancy, straining, and stream were statistically more compared to non-inflammatory strictures. Idiopathic is the most predominant etiology for stricture which showed no inflammation.

Conclusion: Histopathological analysis of urethral stricture showed significant tissue heterogeneity in clinically similar strictures. Chronic inflammation was commonly found in stricture specimens indicating active antigen presentation for underlying pathology and patients with inflammatory strictures reported worse health outcomes.

Evaluation of thyroid nodules by ultrasonography with cytological and histopathological correlation

2022-05-23T09:04:44+00:00

Background: Nodular thyroid is a common clinical entity. The optimum diagnostic strategy for the patient with nodular thyroid is still a matter of debate. A thyroid nodule is a well-defined discrete lesion, sonographically distinct from the surrounding thyroid parenchyma. Thyroid nodules occur with relatively high frequency in the general population with prevalence of 4–7% by palpation alone, 13%–67% by sonographic evaluation, and 50% at autopsy. It is estimated that 4–8% of adult women and 1–2% of adult men have thyroid nodules that can be felt on clinical examination. However, in contrast to high prevalence of thyroid nodules, the prevalence of thyroid malignancy is low. <7% of thyroid nodules are malignant.

Aims and Objectives: The present study was undertaken to evaluate the diagnostic efficacy of ultrasonography (USG) and color Doppler in differentiating benign and malignant thyroid nodules and in comparing the findings with results of fine needle aspiration cytology (FNAC).

Materials and Methods: A prospective study was carried out on 65 patients from 11–80 years age group of both sexes, presenting with thyroid nodules. All patients were evaluated by gray scale USG and color Doppler and then subjected to FNAC. Histopathology was done whenever required. The results of FNAC were compared with that of USG and color Doppler.

Results: The majority of the cases presented were females between the age group of 21–50 years. Swelling in the anterior neck was the presenting complaint in all 65 cases (100%). The most of thyroid nodules were benign in nature. The sensitivity and specificity of US in diagnosing malignant lesions were 80% and 86%, respectively. The most common presentation was from the females in the age group of 21–50 years, with swelling in the anterior neck.

Conclusion: USG with color Doppler is a safe, reliable, and cost-effective diagnostic modality with a high sensitivity and specificity and is the single best radiological investigation for non-invasive evaluation of thyroid nodules. However, a combination of FNAC and USG gives optimum results and can avoid unnecessary surgery.

Clinico-demographic and hepatic profile as outcome predictor in scrub typhus in pediatric age group

2022-12-13T22:27:59+00:00

Background: Scrub Typhus, a Rickettsial disease is an emerging tropical disease mainly in South East Asia. Very few studies are there in pediatric age group and mainly limited to epidemiological and clinical profile only.

Aims and Objectives: The main objective of this study is to assess different clinical, laboratory, and biochemical parameters denoting hepatic function in scrub typhus and their role in measuring final outcome and disease severity.

Materials and Methods: This observational study included 90 children with history of febrile illness for ≥5 days between 1 and 12 years of age, diagnosed to be a case of scrub typhus by positive IgM ELISA test to assess the hepatic involvement by different clinical, laboratory, and radiological parameters and also to find out their role in disease severity and outcome.

Results: Fever followed by vomiting was the most common symptoms with eschar evident in only three patients. Raised aspartate transaminase (AST) and alanine transaminase (ALT) were seen in 71.1% and 64.4%, respectively, with hypoalbuminemia in 78.9%, hepatomegaly in 47.8%, and only 2.2% had altered hepatic echotexture on ultrasonography. All of them had ALT: lactate dehydrogenase (LDH) ratio of <5. Shock was the most important predictor of duration of hospital stay whereas serum AST was an important predictor for final outcome and duration of hospital stay.

Conclusion: Predominant feature of hepatic involvement in scrub typhus resembles that of anicteric hepatitis. Serum ALT: LDH ratio may be an important indicator of scrub hepatitis. Among lab parameters serum AST is the most important predictor of disease mortality and morbidity.

Evaluation of computed tomography in management of patients with head injury

2022-12-23T06:35:13+00:00

Background: The primary goal in treating craniocerebral trauma due to any cause is to preserve the patient’s life and remaining neurological function. It has also made the neuroradiologist an indispensable element of the trauma treatment team. The purpose of this study is to evaluate the efficacy of computed tomography (CT) in the diagnosis, treatment, and prognosis of patients with brain trauma.

Aims and Objectives: The objectives of this study were to evaluate the efficacy of CT in the diagnosis, treatment, and prognosis of patients with brain trauma.

Materials and Methods: The present study was conducted on patients with head injuries who were referred to the Department of Radiodiagnosis over a 2 years. Details were noted down on pro forma either immediately before or after the procedure was carried out, depending on the status of the patient. Few of the patients underwent plain radiography of the skull before conducting the CT scan.

Results: In the present study, the most common lesion observed by CT was edema (49%) followed by contusion (48%), whereas least lesion was observed as intraventricular hemorrhage (4%) and intracerebral hemorrhage (8%). In the present study, the patient with low scores (3–5) showed early deterioration as compared to those with higher scores. This could be attributable to the severity of the primary injury. Late deterioration was more common than early deterioration in scores of >8 where mortality within 48 h was virtually nil and the recovery rate was much higher.

Conclusion: This simple, affordable, highly successful, and safe imaging modality should be regarded the initial imaging modality of choice in acute head injury, as it serves as the foundation for cornerstone for rapid and effective diagnosis.

A prospective study of colonic tumors and accuracy of CT pneumocolon in staging colonic carcinoma

2023-01-17T11:24:25+00:00

Background: Preoperatively, reliable diagnosis of the amount of dissemination of a colorectal cancer not only reveals the probable outcome but also aids care. There have been few studies on the use of spiral computed tomography (CT) pneumocolon for pre-operative staging of colorectal cancer.

Aims and Objectives: Therefore, the present study was undertaken to evaluate colonic masses and determine the accuracy of spiral CT pneumocolon in staging colonic carcinomas.

Materials and Methods: This prospective and hospital-based study was conducted for 2 years of period at the Department of Radiodiagnosis and comprised 75 patients who were sent for CT abdomen. All patients of all ages referred for CT examination with symptoms and/or clinical suspicion of colonic cancer, suspected colonic tumor, blockage, or stricture on barium studies or colonoscopies, or worrisome sonographic abnormalities, including colonic wall thickening and other features indicative of colon cancer were included in the study.

Results: The predominated gender is male (63%) than female (37%). The observations reveal that, in malignant diseases, bleeding per rectum was the most prevalent symptom, while discomfort in the abdomen was the most common symptom in benign pathologies. CT pneumocolon correctly diagnosed cancer in all 57 patients, although three benign lesions were incorrectly categorized as malignant. The sensitivity and specificity for differentiating benign from malignant lesions were both 100% (57/57) and 83.3% (15/18).

Conclusion: CT pneumocolon looks to be a non-invasive and quick inquiry that clearly displays the lumen of the colon, wall of the colon, surrounding structures, extraluminal component of colonic lesions, and metastases and gives useful information preoperatively.

Concomitant chemoradiotherapy, brachytherapy, and parametrial boost versus concomitant chemoradiation and brachytherapy alone in locally advanced cervical carcinoma: A prospective and comparative study

2022-11-28T02:22:07+00:00

Background: The inherent property of brachytherapy is its steep dose gradient and parametrium, near the pelvic wall, which gets little contribution in dose from brachytherapy. As parametria are the common sites for treatment failure, parametrial boost (PMB) may increase the disease control in case of locally advanced cervical carcinomas after 45–50 Gy of external-beam radiotherapy (EBRT) to the whole pelvis.

Aims and Objectives: This study aimed to find whether a satisfactory control of the parametrial disease can be achieved with acceptable toxicity.

Materials and Methods: Between December 2014 and December 2017, 92 patients were treated by concomitant chemoradiation with whole pelvic EBRT of 50 Gy in 25 fractions and weekly Cisplatin (40 mg/m2) followed by brachytherapy. Out of 89 patients, 46 patients were given an additional PMB of 10 Gy in five fractions and 46 were given no boost.

Results: The local control of the disease in terms of CR or PR was comparable in the two arms (i.e., with or without PMB), with P=0.542. The central recurrences between the two arms were also comparable, 13.9% without PMB, and 9.76% with PMB, P=0.726. When parametrial recurrence is concerned, there were four parametrial recurrences (11.11%) in the arm without boost, in comparison to no parametrial recurrence (0%) in the boost arm, and this was statistically significant (P=0.044).

Conclusion: In locally advanced carcinoma cervix patients, in terms of parametrial recurrence, this study showed a significant clinical benefit of an additional external beam PMB.

A novel approach of neoadjuvant and adjuvant therapy with surgery for large keloids of the ear

2023-03-01T16:08:32+00:00

Background: Ear keloids form after ear piercing in genetically predisposed young adults, causing cosmetic disfigurement and negative psycho-social impact, and reducing quality of life. Total excision of ear keloids leads to loss of ear tissue distorting ear framework and reconstruction to restore esthetically pleasant ear causes scarring and more aggressive keloids. Rate of recurrence is higher than 80% when surgical excision alone is done.

Aims and Objectives: The study was conducted to compare the efficacy of intralesional triamcinolone acetonide (TAC) or 5-fluorouracil (5 FU) as monotherapy, combined TAC+5 FU and multi-modal therapy (TAC+5 FU+surgical excision) for keloids of the ear.

Materials and Methods: The prospective comparative study included 30 patients who presented to the out-patient clinic of plastic surgery department of Government Mohan Kumaramangalam Medical College Hospital, Salem for a duration of 2 years from January 2021 to December 2022. Patients were categorized into three groups based on size of ear keloids, Group I (10) – Injection TAC (A) or 5- FU (B), Group II (10): Injection TAC+5-FU, and Group III (10): Injection TAC+5- FU+Surgical excision (A – neoadjuvant+adjuvant; B – only adjuvant).

Results: Of a total of 30 patients, Group IIIA showed significant reduction of keloid with least side effects, most pleasing cosmetically (Patient and observer scar assessment scale 1/10). No recurrence in follow up.

Conclusion: Multi-modal therapy consisting of neoadjuvant TAC+5-FU, surgical excision, and adjuvant TAC+5 FU offers the best long-term results for large ear keloids.

Retaining the epigastric trocar, until rest all ports closed decreases post-operative shoulder pain in laparoscopic cholecystectomy patients

2023-01-09T11:33:03+00:00

Background: Laparoscopic cholecystectomy has become the mainstay of treatment for gallstone disease cases due to its lower morbidity and pain compared to open techniques. Unfortunately, the use of carbon dioxide to insufflate the abdomen is the main contributor to post-operative shoulder pain.

Aims and Objectives: The aim of the study was to evaluate the effectiveness of retaining the epigastric port trocar in position until rest all ports closed after completion of lap cholecystectomy in decreasing the post-operative shoulder pain.

Materials and Methods: A prospective, randomized, and clinical trial was done in AIIMS hospital, Bhubaneswar, on 102 patients who have undergone laparoscopic cholecystectomy. The patients were alternatively selected, one in the study group (52) and the other in the control group (50). For those patients in the study group, after the completion of the surgery, the epigastric port trocar is retained in position until the rest of all ports were closed. In the control group, all trocars were removed and port closure was done. The patients were evaluated for the next 24 h for post-operative shoulder pain. A numerical rating scale (NRS) was used to assess shoulder pain on patient arrival to the ward, at 4, 6, 12, and 24 h postoperatively. One hundred and two patients were included in the final data analysis.

Results: NRS pain scores were significantly lower in the study group at 6, 12, and 24 h post-laparoscopic cholecystectomy compared to the control group with no additional requirement of IV analgesics.

Conclusion: Retaining the epigastric trocar in position is an easy way that is beneficial in reducing post-operative shoulder pain post laparoscopic cholecystectomy surgery.

Scope of medical rigid thoracoscopy in patients with pleural effusion of unknown etiology: A prospective single center study

2022-09-15T12:51:42+00:00

Background: Pleural diseases commonly encountered are pleural effusion, pneumothorax, pleural wall thickening, and pleural mass. Medical thoracoscopy is a minimally invasive procedure that allows diagnostic and therapeutic intervention. The medical diagnostic thoracoscopy in local anesthesia is a simple, low-cost investigation with relatively high diagnostic accuracy, no mortality, and low morbidity. A diagnosis of pleural tuberculosis (TB) could be achieved in 99% of patients as against 51% using closed pleural biopsy.

Aims and Objectives: Assessment of the role of medical rigid thoracoscopy in patients with pleural effusion of unknown etiology in a tertiary health care setup. The primary objectives of the study were to evaluate the diagnostic yield of medical thoracoscopy in pleural effusion of unknown etiology.

Materials and Methods: The study duration/time frame to address the study: November 2017–February 2019 sample size with Justification Sample size: Minimum 31 patients. It was a prospective observational study. All patients admitted in hospital/daycare at LHRC presenting with pleural effusion with unknown etiology. All patients had a medical thoracoscopy, and samples were sent for microbiological and histological analysis. Clinical, thoracoscopic results and histopathological data of the patients were collected prospectively and analyzed.

Results: In this study, 28 patients out of 31 patients were diagnosed. The diagnostic yield of thoracoscopic pleural biopsy was 90.3% Out of 31 patients, the most common complication found was chest pain 48.4% (15/31), followed by 09.7% (03/31) of the cases had complications such as surgical emphysema, postoperative fever, and bleeding. There were no complications in 32.2% (10/31) patients.

Conclusion: Medical thoracoscopy is a noble procedure that helps the pulmonologist/surgeon to inspect the pleural cavity. It is a safe and effective diagnostic as well as a therapeutic tool with a high diagnostic yield. The most common differentials of undiagnosed pleural effusion cases are TB and malignancy.

Assessment of MBBS students’ attitudes on social media use: A cross-sectional study in Government Medical College and Hospital, Tiruvannamalai, Tamil Nadu

2023-01-10T04:14:28+00:00

Background: The latest internet and social media facilitate communication and increase the speed of work. However, it has a negative side also.

Aims and Objectives: The present study aimed to assess the MBBS students’ attitudes toward social media use.

Materials and Methods: A total of 322 MBBS students (1st year, 2nd-year, 3rd-year, and final-year students) from Government Thiruvannamalai Medical College were part of the study. Willing students were included in the study. Those students who are not using the smartphone were excluded from the study. Pre-tested semi-structured questionnaires assessing the frequency of social media use and attitudes toward the use of social media in their daily activities were used in the study.

Results: Most of the participants belong to 18 and 19 years of age. About 77.3% of participants started using the smartphone at the age of 10–15 years. About 92.8% of participants bought smartphones at age of 15–20 years. About 62.2% were not involved in physical activity. About 55.72% check their phone every 10–20 min. About 84.8% of participants sleep <6 h in 24 h. About 56.9% of participants reported that they will not experience neck pain after prolonged use of smartphones. About 52.3% of the participants reported that they have started using spectacles due to refraction errors after using smartphones.

Conclusion: The study results present that students in the medical field are addicted to smartphones and this overuse is associated with significant hazardous events. Hence, students should be counseled to reduce the use of smartphones.

Emotional intelligence and anxiety, stress, and depression in first phase medical undergraduates

2023-01-05T00:42:16+00:00

Background: Medical studies are one of the stressful course in India and worldwide. Emotional intelligence (EI) is a group of skills that can be learned to enhance coping skills and promote well-being.

Aims and Objectives: The present study is aimed to analyze the relationship between EI and psychological distress such as depression, anxiety, and stress in 1st-year medical undergraduates.

Materials and Methods: A self-reported questionnaire is used for assessing EI and psychological distress. A shorter version of the Trait EI questionnaire is used for assessing EI and the depression, anxiety, and stress subscale is used for assessing psychological distress. A total of 98 medical students participated in the study. Unpaired student’s t-test, ANOVA, and Pearson’s correlation coefficient analysis was performed.

Results: The results showed a negative association between EI and depression, anxiety, and stress. Depression, anxiety, and stress were found in 35.7%, 50%, and 14.3% of 98 participants, respectively. EI was found to be significantly higher in men. Women were found to be more affected than men.

Conclusion: High EI is associated with the lower psychological distress. This shows the need to assess and improve EI through practices that can improve their psychological health.

Empathy among male and female medical professionals: A cross-sectional study

2023-01-13T03:34:17+00:00

Background: The measurable index for selflessness in medical professionals is empathy with patients. Thus, the relationship between a doctor and a patient is mainly based on empathy. Several studies measured the empathy scores before and after medical education and there are ambiguous results.

Aims and Objectives: The present study was undertaken to assess the empathy among medical professionals in a tertiary care institute in North-east India.

Materials and Methods: Three hundred undergraduate students were part of the study. Willing participants were recruited for the study. The standard tool to assess the empathy JSE-S was used in the study. This tool consists of 20 questions.

Results: The empathy scores of female participants were significantly higher compared to male participants (P<0.0001). In both the residences wise that is a hostel and home, female participants’ empathy scores were higher than males (P<0.0001).

Conclusion: The study explains higher empathy scores in both male and female students. In comparison, females are having higher scores than males. The study highlights need for future multicentric studies in this area to better understand the empathy of medical students and plan the curriculum accordingly.

Checkmate with checkpoint inhibitors: New paradigm in immunotherapy

2023-02-26T12:38:31+00:00

Cancer immunotherapy is a form of biotherapy (also called biological response modifier therapy) that refers to a broad array of anti-cancer therapies targeted to activate and trigger the body’s immune system against cancer. This includes targeted antibodies to specific cell surface entities on cancer cells, anti-cancer vaccines like vaccines against HPV in cervical cancer, cytolytic virus, adoptive cell transfer, biologicals like cytokines and other small molecular agents, and the most explored immune checkpoint inhibitors.

Immunotherapies use immune modulatory materials from the same organism to fight disease, while some immunotherapy treatments use genetic engineering-based gene editing approaches to enhance the host immune system in an effort to eradicate the cancer cells and boost its cancer-fighting capabilities. Used in combination with surgery, chemotherapy, and radiotherapy, cancer immunotherapy improves their overall effectiveness.

WHAT IS AN IMMUNE CHECKPOINT

T cell activation involves the engagement of a number of signaling cascades, originating from the interaction between T cell receptors (TCR) with antigen-presenting cells (APC) that ultimately determine cell fate through regulating cytokine production, cell survival, proliferation, and differentiation. TCR alone is not sufficient to generate an adequate response. It needs the participation of coreceptors. Primary T cell activation involves the integration of three distinct signals (1) antigen recognition in the presence of APC, (2) costimulation, and (3) cytokine-mediated differentiation and expansion. To make sure that these activated T cells do not cross-react with self-antigens, these are rendered inactive by immune checkpoints. PDL on T cells and PDL1 on host cells engage in bringing about this. Programmed Cell Death Protein 1 (PD-1) inhibits immune responses by fostering a state of self-tolerance. This is achieved by activating apoptosis, anergy, and avoidance of antigen-specific T cells. The functional counterpart of PD-1, the Programmed Cell Death Ligand 1 (PD-L1), is a trans-membrane protein that acts as a coinhibitory immune response factor. This is what the cancer cells hijack for their survival. PD-L1 expressed on cancer cells attenuates the host T cell response transmitting negative signals. Therefore, the PD-1/PD-L1 axis is the main driver of cancer immune evasion, which needs serious attention.

WHAT IS IMMUNE CHECKPOINT INHIBITORS

These classes of molecules are designed to block the cross-talks between cancer cells expressing PD-L1 with T cells expressing PD-1 receptors. When the interaction is blocked, inhibitory influence on T-cells is circumvented, and an attack may be launched. Checkpoint inhibitors are used in cancer immunotherapy, including a wide range of cancers, such as melanoma, skin cancer, and lung cancer. Different drug classes block checkpoint proteins like CTLA-4 inhibitors, PD-1 inhibitors, and PD-L1 inhibitors. Commercially checkpoint inhibitors include pembrolizumab (Keytruda), ipilimumab (Yervoy), nivolumab (Opdivo), and atezolizumab (Tecentriq).

RAYS OF HOPE AND CAUTION

Because checkpoint inhibitors stimulate the immune system and are immunomodulatory, their usage has significantly improved cancer treatment and management, extending the life span for numerous patients. However, we need to be cautious as they may cause immune cells to attack healthy cells, causing side effects such as fatigue, nausea, high fever, flu-like symptoms, and inflammation.

A case series on post-traumatic facial nerve palsy

2023-02-16T16:06:29+00:00

Road traffic accidents accounts a for substantial proportion of traumatic facial nerve injuries. Facial nerve paralysis causes considerable facial disfigurement and emotional distress to the patient. It can cause detrimental effect on both voluntary and involuntary actions of facial muscles. Importantly, it can interrupt normal daily functions such as eating and drinking. Therefore, early identification and surgical intervention are of prime importance in the management of traumatic facial nerve palsies, which is described below in this case series. The goal is to find out type of temporal bone fractures in patients with traumatic facial nerve palsy, to find out the common site of facial nerve injury in patients with traumatic facial nerve palsy, and to assess the surgical outcomes in patients who underwent facial nerve decompression. Case series of five patients who are admitted in ENT Wards in Rajiv Gandhi Government General hospital with traumatic facial nerve palsy were included in this study. Thorough history taking, otoscopic examination, audiological evaluation, radiological Imaging (HRCT temporal bone), topodiagnostic tests, and nerve conduction studies were done in all the five cases. All five patients presented with either grade 3/grade 4 facial palsy according to House–Brackmann’s grading system. HRCT temporal bone showed a fracture line in all the five cases. Electroneuronography showed more than 90% degeneration in all the cases. All the patients underwent facial nerve decompression followed by a course of oral steroids and post-operative physiotherapy. All five cases showed remarkable improvement in facial palsy after surgery with leveling up to House–Brackmann grade 2 and grade 1, early identification of facial nerve palsy due to trauma and prompt management by surgical intervention plays a important role in the management of facial nerve palsy.

Endobronchial tuberculosis: A case-based approach

2022-12-20T00:55:17+00:00

Endobronchial tuberculosis (TB) or tracheobronchial TB is defined as tuberculous infection of the tracheobronchial tree with microbial and histopathological evidence. Here, in this article, we are reporting four surprising cases of endobronchial TB which came to our institution with clinical symptoms and signs suggestive of TB but chest X-rays were within normal limit and sputum microscopies were repeatedly negative. Bronchoscopy was performed which showed endobronchial lesions. Hence, early diagnosis and treatment were possible for these patients.

A case series on isolated maxillary sinus involvement in mucormycosis

2023-02-23T04:14:59+00:00

Mucormycosis is a potentially fatal fungal infection that can affect various parts of the body, including the sinuses. Isolated maxillary sinus involvement usually indicates an early diagnosis of Mucormycosis. The aim of the study was to present a case series on the clinical presentation and management outcomes in patients with isolated maxillary sinus involvement in Mucormycosis to emphasize on the early diagnosis and management of the condition. A retrospective study of 10 patients who presented to the RGGGH ENT department with isolated maxillary sinus involvement in Mucormycosis that was confirmed by diagnostic nasal endoscopy, CT scan and fungal KOH swab and who were managed by endoscopic sinus surgery. In our study, out of 10 cases, two patients had unilateral symptoms and eight patients had bilateral symptoms. Most common presentation was nasal obstruction, nasal discharge, and facial pain. Complete disease clearance was achieved in all cases by endoscopic sinus surgery with debridement. Diabetes was the most common underlying comorbidity, present in all 10 patients. All patients were treated with a combination of antifungal therapy and surgical debridement. All patients showed improvement on followup, with no recurrence or mortality reported during the follow-up period. Mucormycosis with isolated maxillary sinus involvement is a timely presentation of mucormycosis but potentially life-threatening due to the nature of the disease to spread rapidly. Prompt diagnosis and management are crucial for improving outcomes in these patients. A combination of antifungal therapy and surgical debridement appears to be an effective treatment approach in these patients.

Various unusual presentation of acute appendicitis in adult. A case series

2023-01-24T15:16:36+00:00

Acute appendicitis is common abdominal condition in our day to day surgical practice. Classical features include periumbilical pain that migrates to the right iliac fossa, anorexia, fever, and tenderness and guarding in the right iliac fossa. However, in our present study, three atypical presentation of acute appendicitis is demonstrated in clinical practice. These three cases do not have classical features of murphy’s triad, that is, nausea, vomiting, fever, and cardinal sign of positive Mcburney’s tenderness. Our three atypical cases are: (1) A 38 year old obese male patient who presented with features of umbilical inflammation with serous discharge due to presence of acute inflamed appendix in pre-existing small umbilical hernial sac. (2) A 49-year-old male medicine seller presented right sided scrotal pain with same sided inguino-scrotal swelling for short duration due to presence of inflamed swollen tip of appendix at bottom of right hemi-scrotum in pre-existing inguinal hernia. (3) A 81-years-male gentleman presented with anorexia, weakness, abdominal fullness, and bilateral pedal edema. He did not have pain abdomen, fever, and right iliac fossa tenderness. Imaging modalities confirmed the acute appendicitis in three cases. Diagnosis of appendicitis in absence of typical features is to be made from pre-occupied knowledge and with help of imaging studies.

A case series on allergic fungal rhino sinusitis – variable presentations

2023-02-16T16:22:35+00:00

Allergic fungal rhino sinusitis (AFRS) is a non-invasive fungal sinusitis resulting from an allergic and immunologic response to the presence of extramucosal fungal hyphae in the sinuses. Defined largely by the presence of allergic fungal mucin, which is a thick, tenacious, and eosinophilic secretion with characteristic histologic findings. To present a case series on the variable presentations in patients diagnosed with AFRS. A retrospective study of 10 cases that presented to Rajiv Gandhi Government General Hospital ENT outpatient department with allergic fungal rhinosinusitis confirmed by diagnostic nasal endoscopy and CT scan who were managed successfully by endoscopic sinus surgery. In our study, out of 10 cases, nine patients had unilateral symptoms, only one patient has bilateral symptoms. Most common presentation was headache, facial pain, nasal obstruction, and nasal discharge. Some patients had variable presentations such as proptosis, oroantral fistula, blurring of vision, watering of eye, and unilateral frontal headache. On diagnostic nasal endoscopy, two patients had nasal polyposis. Complete disease clearance was achieved in nine cases by functional endoscopic sinus surgery. Patients were started on topical and oral corticosteroids, pre/postoperatively. On follow-up, only one patient had recurrence. Preventing and treating the condition, as well as its spread and complications, are greatly aided by early detection and management of AFRS. The key to enhancing the result is surgical intervention (endoscopic sinus surgery) and medical therapy (corticosteroids). Antifungals have limited role in treatment of AFRS. Longstanding unilateral Sinusitis should always raise suspicious of AFRS.