Asian Journal of Medical Sciences

Sexual dimorphism among medical students of north India assessed by interorbital circumference index

Vishal Kalia — 2023-12-01

Background: The human body dimensions are affected by ecological, geographical, racial, gender, and age factors. Craniofacial anthropometry has become an important tool used in genetic counseling, reconstructive surgery, and forensic medicine. Orbital measurements are important in the evaluation of several systemic syndrome, craniofacial abnormalities, and also surgical treatment of post-traumatic telecanthus. Among these measurements, normal interpupillary distance, inner canthal distance (ICD), and outer intercanthal distance are the vital features to be known.

Aims and Objectives: The aims and objectives of the present study were to assess the ICD, head circumference (HC), and circumference orbital index of male and female medical students of North India and find out gender differences in the respective parameters and thus to contribute the present finding to the available literature.

Materials and Methods: This was an observational descriptive study conducted in the department of anatomy at a fixed time in 150 MBBS course students in the age group 18–22 years. The ICD and HC were measured using round end digital spreading Vernier caliper. Then, circumference interorbital index (CII) was calculated and analyzed.

Results: The mean ICD in males was 3.44±0.33 mm and in females was 3.21±0.32 mm; mean HC in males was 56.03±1.55 mm and in females was 53.88±1.38 mm; and mean CII in males was 6.15±0.54 and in females was 5.95±0.51.

Conclusion: The result of this study will help to establish the mean values for of craniofacial anthropometric parameters for medical students of North India, and the results are showing that craniofacial anthropometric parameters are sexually dimorphic.

Morphometrical parameters of acetabulum of hip bone - An osteological study

Meril Ann Soman — 2023-12-01

Background: Acetabulum is an approximately hemispherical cavity on the lateral aspect of the hip bone. Acetabulum is not always of the same shape, size, or depth. Any deviations of the parameters from normal range have strong correlation with the development of various kinds of pathologies.

Aims and Objectives: Acetabulum is an approximately hemispherical cavity on the lateral aspect of the hip bone. Acetabulum is not always of the same shape, size or depth. Any deviations of the parameters from normal range have strong correlation with the development of various kinds of pathologies.

Materials and Methods: This study was conducted in department of Anatomy, Yenepoya Medical College, Mangalore. Two hundred hip bones were included in the study. Various parameters of the acetabulum were measured. The morphometrical parameters measured were: (a) Transverse diameter of acetabulum, (b) acetabular height, (c) acetabular depth, (d) acetabular volume, (e) distance from pubic tubercle to anterior rim of acetabulum, (f) ratio between distance from pubic tubercle to anterior rim of acetabulum and acetabular height. Range, mean, standard deviation, and standard error of mean were determined for each parameter. P value was also calculated to compare the parameters side wise.

Results: The independent T test was done and the P value was calculated for each parameter. Acetabular volume showed a significant difference between left- and right-sided bones. Most of the parameters showed highly significant difference between male and female hip bones in both right side and left side.

Conclusion: As total and partial hip replacements are common surgeries performed these days, knowledge of the dimensions of acetabulum will assist prosthetists to construct suitable prosthesis for Indian population. It would be also useful in the fields of anatomy, osteology, and anthropology.

Comparative study between dexmedetomidine and dexamethasone as an adjuvant to levobupivacaine for supraclavicular brachial plexus block in patients undergoing upper limb surgeries

Suman Sarkar — 2023-12-01

Background: Brachial plexus block (BPB) is widely used nowadays in patients undergoing upper limb surgery. Levobupivacaine is one of the best local anesthetics in the current scenario in this field. Both dexmedetomidine (DM) and dexamethasone (DX) are commonly used local anesthetic adjuvants in BPB to enhance blocking effects. In anesthesiology, there is always a search for a better alternative.

Aims and Objectives: In this study, we investigated the effect of DM and DX as adjuvants to levobupivacaine on the quality of supraclavicular BPB.

Materials and Methods: A prospective, double-blind, randomized controlled intervention study (superiority trial) was done involving 60 patients aged 20–60 years, randomly allocated into two equal groups (group S-DM group-Patients were received Injection 0.25% Levobupivacaine 2 mg/kg body weight+Inj. DM 1 mcg/kg body weight+distilled water [total volume 30 mL] and group C-DX group-Patients received Inj. 0.25% Levobupivacaine 2 mg/kg+Inj. DX 0.1 mg/kg body weight+Distilled water [total volume 30 mL]). The scores of the modified Gormley and Hill scale and the modified Bromage scale were recorded along with hemodynamic parameters. Pearson’s Chi-square test, Mann-Whitney U-test, one-way ANOVA, Kaplan–Meier survival analysis, and Z-test were used for statistical analysis.

Results: The onset of motor block was shorter in group-S patients (14.2667±1.0807 [min]) compared to group-C (15.9333±1.5742 [min]), and the duration of motor block was higher in group-S (708.5667±4.2644 [min]) compared to group-C patients (682.3667±20.0095 [min]) (P<0.001).

Conclusion: DM is a better alternative to DX when added to levobupivacaine for decreasing the onset of sensory and motor block and increasing the duration of supraclavicular BPB.

A comparative study on sedative and cardiorespiratory effects of clonidine and dexmedetomidine added to ropivacaine in supraclavicular brachial plexus block in upper extremity surgery

Anamitra Mandal — 2023-12-01

Background: Supraclavicular brachial plexus block is widely used peripheral nerve block technique used for surgery of the upper extremity. Several drugs have been used with local anesthetic as adjuvants for rapid, dense, and prolonged analgesia.

Aims and Objectives: The aims and objectives of the study are to compare the degree of sedation and cardiorespiratory effects of clonidine and dexmedetomidine added to ropivacaine in supraclavicular brachial plexus block.

Materials and Methods: A double-blinded comparative study was done on eighty patients who were randomly allocated equally into two groups and received clonidine and dexmedetomidine added to ropivacaine 0.5%. Intraoperative degree of sedation and cardiorespiratory parameters were monitored in regular intervals and compared to find difference.

Results: Heart rate was consistently lower with dexmedetomidine. Systolic, diastolic, and mean arterial pressures (MAPs) were comparable in both groups at all time points except at 45 min when diastolic and MAP were lower with dexmedetomidine and it was statistically significant. Sedation score in Group D was higher except at 5 min and difference was statistically significant. All patients in both groups were sedated and easily arousable. There was statistically significant difference in peroperative oxygen saturation between the groups although it was clinically not significant.

Conclusion: There was more hemodynamic effect of dexmedetomidine than clonidine but these effects can be managed by medication easily. In addition to this, it was found that dexmedetomidine provides conscious sedation without any respiratory depression. Comparing the risk and benefit dexmedetomidine can be used with local anesthetic in supraclavicular brachial plexus block in upper extremity surgery.

A clinical, comparative, prospective, and observational study of two different ratios of ketamine and propofol in short surgical procedures at a tertiary care hospital

Muralidhara KS — 2023-12-01

Background: Ketamine and propofol are two medications commonly used for procedural sedation because they possess many of the desired characteristics including rapid induction and recovery. The opposing physiologic effects of ketamine and propofol suggest the potential for synergy, and this has led to an interest in their combined use, commonly termed “Ketofol.” The purpose of this study is to compare two different proportions of ketamine and propofol, 1:2 and 1:3 in short surgical procedures.

Aims and Objectives: The aim of the study was to compare the quality of analgesia, level of sedation, and respiratory and hemodynamic parameters of two different proportions of ketamine and propofol in the ratio of 1:2 and 1:3 in short surgical procedures.

Materials and Methods: After obtaining approval from the institutional ethics and scientific committee, with IEC no.MIMS/IEC/2021/474 dated February 23, 2021, 86 consenting patients of 18–60 years categorized under American Society of Anesthesiologists Category I and II undergoing elective short surgical procedures lasting for about 20 min were selected. The study patients were divided into two groups of 43 each by convenient sampling method. In Group A, 43 patients received 1 mL of ketamine (50 mg/mL) mixed with 10 mL of 100 mg propofol (10 mg/mL). In Group B, 43 patients received 30 mg of ketamine mixed with 9 mL of 90 mg propofol (10 mg/mL). Non-invasive blood pressure, heart rate, oxygen saturation, Ramsay Sedation Score, Modified Aldrete Score, and any incidence of side effects were recorded.

Results: The quality of analgesia and level of sedation was achieved better in Group A compared to Group B. No significant difference was observed between the two groups with respect to hemodynamic and respiratory parameters.

Conclusion: The combination of propofol and ketamine has several benefits such as hemodynamic stability, lack of respiratory depression, good recovery, and potent procedural analgesia. Ketofol 1:2 proportion is comparatively better and can be used safely in short surgical procedures.

Influence of sleep patterns on hormonal regulation and metabolic biomarkers: A cross-sectional observational study

Banpur Rajini — 2023-12-01

Background: Sleep duration and quality play a critical role in health, impacting hormonal regulation and metabolic functions.

Aims and Objectives: This study aimed to investigate the complex interplay between sleep patterns, hormonal regulation, and metabolic biomarkers.

Materials and Methods: A cross-sectional observational study was conducted involving 100 individuals. Demographically, participants averaged 35.2 years, with 45% males and 55% females and an average body mass index (BMI) of 25.9 kg/m² (ranging 18.7–32.5). Sleep assessment revealed an average duration of 7.2 h (range: 5.5–9.0 h) and a mean sleep quality score of 6.8 (range: 3–11).

Results: Correlation analyses spotlighted significant associations between sleep duration and hormonal markers. Negative correlations emerged for cortisol and leptin, while insulin showed non-significance. Sleep duration exhibited both a positive correlation with fasting glucose and non-significant negative and positive correlations with total cholesterol and high-density lipoprotein cholesterol. Incorporating age, gender, and BMI, multivariate regression underscored sleep duration’s enduring impact on cortisol (Coefficient=−0.23, SE=0.09, P=0.021, 95% CI [−0.42, −0.04]). However, the sleep duration-fasting glucose relationship lost significance post-adjustment (Coefficient=0.09, SE=0.06, P=0.128, 95% CI [−0.03, 0.21]).

Conclusion: This study illuminates intricate links between sleep, hormones, and metabolism. Sleep duration influences cortisol, and fasting glucose associations involve multifaceted factors. These insights offer direction for future research and clinical approaches in managing sleep-related health aspects.

The clinical biochemical and hematological profile of scrub typhus meningoencephalitis

Souvik Sarkar — 2023-12-01

Background: Scrub typhus is a zoonotic infectious disease caused by the Gram-negative coccobacillus Orientia tsutsugamushi. Meningoencephalitis occurs in two-thirds of all the infected cases.

Aims and Objectives: The study of these cases was conducted to study the clinical, biochemical, and hematological features of scrub typhus meningoencephalitis.

Materials and Methods: We included 12 patients who were admitted in the General Medicine Ward of Medical College and Hospital, Kolkata, between May 2021 and July 2022. The serum scrub typhus immunoglobulin M (IgM) test was used to diagnose the cases after ruling out dengue, malaria, leptospirosis, bacterial, tubercular, and viral meningoencephalitis.

Results: A triad of fever, altered sensorium, and meningeal signs were present in all of the cases. 2 patients had seizures, 1 patient had lateral rectus palsy, 1 patient had a generalized maculopapular rash, and eschar was seen in only 2 cases. The most common laboratory abnormalities were hyponatremia, anemia, and transaminitis (each 83.33%). 8 cases (66.7%) had a combination of anemia, hyponatremia, and transaminitis. Cerebrospinal fluid abnormalities included protein elevation (75%) and lymphocytic pleocytosis (83.33%). Scrub typhus IgM was positive in all of them. All the cases showed excellent response to doxycycline.

Conclusion: A high degree of clinical suspicion is required to diagnose scrub typhus meningoencephalitis. The eschar is detected in very few cases and it may be difficult to recognize the same among the dark-skinned Indian population. However, as per our study, any case of meningoencephalitis with a combination of anemia, hyponatremia, and deranged liver function tests should always raise the possibility of the aforementioned disease and doxycycline therapy must be started promptly.

Study of cerebrospinal fluid adenosine deaminase activity for differential diagnosis of tuberculous and non-tuberculous meningitis

Seema Agarwal — 2023-12-01

Background: Diagnosing a case of tuberculous meningitis (TBM) has always been challenging. Numerous previous studies have demonstrated that cerebrospinal fluid-Adenosine deaminase (CSF-ADA) estimation is useful in the diagnosis of TBM and can differentiate TBM from other types of meningitis.

Aims and Objectives: The current study aims to look for a simple, rapid, cost-effective, and specific test to differentiate tubercular etiology from other causes of meningitis.

Materials and Methods: A total of 80 patients admitted to the hospital with signs and symptoms of meningitis were selected and divided into two groups: Group 1 (Cases): 40 patients of TBM, Group 2 (Control): 40 patients of pyogenic and viral meningitis. The CSF ADA was estimated by enzymatic method, CSF Protein by turbidimetric method, and CSF Glucose by Glucose oxidase (GOD) and Peroxidase (POD) method.

Results: CSF ADA levels (mean ± SD) in the TBM and non-TBM groups were 10.874+7.72 IU/L and 2.44+1.757 IU/L, respectively (highly significant, P<0.001). With the CSF ADA cut off as >6 IU/L, the sensitivity of the test was 95%, and the specificity of 92.5%. On comparison of the values of CSF ADA in the two groups, the t value is −6.75, and the difference in these two values was found to be highly significant (P<0.01).

Conclusion: ADA estimation in CSF is a simple, inexpensive, rapid, and specific method for making a diagnosis of tuberculous etiology in TBM. As a screening test, the determination of ADA activity in CSF can help the physician diagnose TBM early and reduce irreversible brain damage and neurologic sequelae by early administration of anti-tuberculous medications.

Evaluation of the diagnostic accuracy of microalbuminuria in predicting mortality among elderly patients with sepsis

Mita Bar — 2023-12-01

Background: Sepsis is a common cause of morbidity and mortality among geriatrics.

Aims and Objectives: The objective of study was to find the clinicomicrobiological profile of elderly inpatients (≥60 years) with sepsis and to evaluate the diagnostic accuracy of urine albumin to creatinine ratio (ACR) or microalbuminuria in predicting mortality.

Materials and Methods: A prospective observational study was conducted among 50 geriatric patients admitted with sepsis in the ward or intensive therapy unit under medicine department of a tertiary care center for a period of 1 year. Baseline clinicomicrobiological profile was noted. Urine ACR values were measured at admission, day 4, and day 7 and geriatrics were followed up for 28 days to see the outcome. Receiver operator characteristic curve analysis was performed to evaluate the area under the curve for microalbuminuria on the 3 days and to determine the optimum cut-off points to predict mortality.

Results: The mortality rate within 28 days was 64%. Urine microalbuminuria on day 1, day 4, and day 7 of admission was significantly higher among the non-survivors compared to survivors (P≤0.001, P≤0.001, and P=0.006, respectively). Microalbuminuria levels (in mcg/mg) of 143.0, 60.05, and 42.6 on day 1, 4, and 7 of admission, respectively, can be used as the cut-off to predict the death of geriatric sepsis inpatients with overall diagnostic accuracy of 83.0%, 83.4% and 86.1%, respectively, sensitivity as 93.75%, 87.50%, and 100.0%, respectively, and specificity as 44.44%, 72.22%, and 72.22%, respectively.

Conclusion: Microalbuminuria can be a potential biomarker to predict death among geriatric septic inpatients, which can further help in improving the treatment strategy.

Comparative study among the patients with different coronary risk factors for detection of asymptomatic coronary artery disease by treadmill test confirmed by coronary angiography

Moumita Saha Paul — 2023-12-01

Background: Cardiovascular diseases (CVD) such as ischemic heart disease (IHD) and cerebrovascular accidents such as stroke lead to 17.7 million deaths and are the leading cause of death worldwide. Global Burden of Disease study found that age-standardized CVD death rate in India (272/100,000 population) is much higher than the global average (235/100,000 population).

Aims and Objectives: This study aimed to compare among different coronary risk factors like dyslipidemia, diabetes mellitus hypertension (HTN), and obesity which may lead to coronary artery disease (CAD) and early detection of ischemic heart disease by the stress treadmill test (TMT) among the patients having coronary risk factors.

Materials and Methods: This is a prospective and observational study among 170 patients of age group 18–60 years having one or more coronary risk factors such as dyslipidemia, HTN, diabetes mellitus, and obesity. Patients with diagnosed IHD and other chronic debilitating diseases were excluded from the study.

Results: Out of 170 patients, 153 patients were males and 17 patients were females. Among all these patients, 42 patients were suffering from dyslipidemia, 44 patients were suffering from Type 2 diabetes, 45 patients were suffering from HTN, and 39 patients were having more than one risk factor. All 170 patients with coronary risk factors performed TMT. Out of those patients, 53 were found to be TMT-positive. Binary regression analysis showed among all the selected risk factors, dyslipidemia (P<0.05; odds ratio [OR]-2.104) and HTN (P<0.05; OR-2.159) were found to be significantly associated with the positive outcome of TMT. All 53 TMT-positive patients were selected for CAG. Out of those patients, 37 were found to be suffering from CAD. Binary regression analysis showed among all the selected risk factors, dyslipidemia (P<0.05; OR-1.964) and HTN (P<0.05; OR-2.125) were found to be significantly associated with the positive outcome of CAG.

Conclusion: Dyslipidemia and HTN were found to be significantly associated with the TMT-positivity as well as CAD. Diabetes mellitus and obesity were not statistically significant, though OR was more than 1 for both these risk factors.

Assessing adherence to hypertension medications and its impact on blood pressure control: A community-based observational study

Sandhya Rani M — 2023-12-01

Background: Hypertension is a prevalent cardiovascular condition requiring effective medication management for blood pressure control.

Aims and Objectives: The aim is to explore the relationship between adherence to hypertension medications and its impact on blood pressure control among a diverse population.

Materials and Methods: A participant cohort of 500 adults, with a mean age of 56 years, was examined for their adherence to hypertension medications and blood pressure control outcomes. Adherence was assessed through self-report questionnaires and pill count analysis, while blood pressure control was defined as systolic blood pressure below 140 mmHg and diastolic blood pressure
below 90 mmHg. The statistical analysis included logistic regression with adjustments for potential confounding variables.

Results: The participant cohort displayed a balanced gender distribution and predominantly managed hypertension through multi-drug regimens. Around 65% reported high medication adherence, confirmed by pill count analysis. Notably, 55% achieved the defined blood pressure control target, indicating effective management. A robust association was observed between high adherence and improved blood pressure control (adjusted odds ratio=1.65, 95% confidence interval: 1.28–2.12, P<0.001). Participants with high adherence were 1.65 times more likely to attain target blood pressure control than those with lower adherence, with a high level of statistical significance.

Conclusions: This study highlights the crucial link between medication adherence and blood pressure control in hypertensive individuals. High adherence increases the likelihood of optimal blood pressure
control, underscoring patient commitment. Tailored interventions and support mechanisms are essential for enhancing adherence and improving hypertension management outcomes.

Screening for sleep deprivation and mood states among staff nurses of tertiary care hospital in central India

Aryashree L — 2023-12-01

Background: A Nurse’s fatigue raises significant concerns for individual and patient safety. The impact of sleep deprivation on the quality of patient care is an important consideration in today’s health-care environment.

Aims and Objectives: The aim of this study was to find the proportion of sleep deprivation among nurses in a tertiary care hospital and to find the association between sleep deprivation and mood states among staff nurses.

Materials and Methods: It was a cross-sectional design done in a duration of 2 months from September to October 2022. The study group consisted of nurses working in a tertiary care hospital located in Jabalpur district. A sample size of 70 nurses was calculated through the statistical formula. The questionnaire has three sections: Demographics (nine questions), Epworth sleep scale (eight questions), and Profile of mood states (65 questions). The collected data were tabulated and analyzed using MS Office Excel and SPSS version 21.

Results: Interviews were conducted with 70 nurses and 8.6% of them were found to be excessively sleepy and should seek medical attention. Significant results have been obtained for the association with tension, depression, anger, fatigue, and confusion with sleep deprivation.

Conclusion: The findings suggest that sleep deprivation exists in a considerable state. Some workplace interventions need to be done to make the efforts of nurses worthwhile and to increase their vigor and positive mood.

Assessment and comparison of quality of life and sexual function after adjuvant therapy in post-mastectomy breast carcinoma: A prospective study

Bidisha Bandyopadhyay — 2023-12-01

Background: Quality of life (QoL) is an important measure in the evaluation of health, physical condition, and the effects of treatment and continues to gain importance. Health-related QoL gives information about the patient’s experiences (physical and psychological) related to the disease and the applied treatments, as well as the potential prognosis. It is known that breast surgery and its combination with chemotherapy (CT) and radiation therapy causes negative changes in the patient’s psychosocial well-being and QoL.

Aims and Objectives: To study the QoL and sexual function in female breast carcinoma patients who received adjuvant CT and radiation therapy after mastectomy.

Materials and Methods: This was a single institutional prospective study carried out in the Department of Radiotherapy, RG Kar Medical College and Hospital, Kolkata. From January 2017 to December 2019, according to inclusion and exclusion criteria, a total of 64 histologically proven breast carcinoma patients were included in this prospective study.

Results: On symptom scale analysis, it has been noted that all the symptoms increased after receiving CT and reached their highest after the 6th cycle of CT, then improved after radiation and further improved at 6 months follow-up, except for the breast symptoms, which decreased after the 6th cycle of CT, increased immediately post-RT, and then again decreased at 6 months follow-up.

Conclusion: Treatment with CT and radiation therapy significantly affects QoL, psychosexual function, and physical problems.

Relationship between dermatoglyphics and blood group of male and female first-year medical students at Rama Medical College, Kanpur

Hamid Ansari — 2023-12-01

Background: Apart from the flexion crease and secondary folds, dermatoglyphics is the scientific study of naturally existing epidermal ridges and their arrangement on the digits, palms, and soles. In medicolegal cases, fingerprints can be used to identify suspects, victims, and other people who touch a surface as well as to diagnose inherited diseases. ABO blood group is divided into A, B, AB, and O. ABO type is determined by two antigens and two antibodies. Due to the presence or absence of the D antigen, it is further divided into Rh-positive and Rh-negative.

Aims and Objectives: This study aimed to find correlation between ABO and Rh blood group with dermatoglyphic pattern in human beings.

Materials and Methods: The study was conducted among 107 medical students studying at RMCHRC, Kanpur, UP, India. Rubber stamp ink pads were utilized to smear each finger. Imprints were obtained, and each fingerprint pattern was inspected and documented using a strong hand lens on a sturdy white piece of paper.

Results: Among 1070 fingerprint patterns studied, the most common pattern observed was whorl. This pattern was present in 226 male’s digits (49.23%) and 233 female’s digits (50.26%), totaling to 459 forming 42.89% of the total patterns observed. B + blood group was the most common blood group present with whorl pattern, seen in 92 males and 99 females.

Conclusion: This study shows the association between the distribution of dermatoglyphics, ABO, Rh blood group, and gender.

Primary otomycosis: Assessment of risk factors and identification of fungal agents – A tertiary care hospital experience

Philip Ganeesh Moorthy R — 2023-12-01

Background: Primary otomycosis is one of the common conditions seen in general clinical practices. Although non-fatal, inappropriate management of this condition may lead to serious complications.

Aims and Objectives: A cross-sectional study was conducted in our tertiary care hospital to determine the fungal agents in primary otomycosis and its associated risk factors.

Materials and Methods: A total of 62 consecutive patients of more than 18 years of age with clinical diagnosis of otomycosis were included in this study. Samples were collected and processed and the fungal isolate was identified. The predisposing factors, fungal isolate, and demographical profile of the patients were analyzed.

Results: About 61.29% were males and 38.71% were females. Majority of the patients were in the age group of 18–30 years (62.90%). The most common associated risk factor was habitual self-cleaning (50%), followed by oil instillation (30.65%). Itching (75.81%) was the most common symptom followed by ear discharge (45.16%). About 79.03% of our fungal isolates were Aspergillus species, Aspergillus niger being the most common (58.06 %). About 12.90% of our isolates were Candida species. About 63.27% of Aspergillus isolates was associated with habitual self-cleaning and 62.50% of Candida isolates was isolated with the instillation of oil. About 66.67% of Penicillium species and 100% of Rhizopus species are associated with inappropriate use of topical antibiotics.

Conclusion: Health education of the community along with knowledge of common fungal agents causing otomycosis and its associated risk factor will help in reducing the incidence of otomycosis, which along with proper management will prevent further complications.

Clinico-etiological and histopathological correlation in erythroderma: In a tertiary care hospital of Eastern Odisha

Dharmendra Kumar Sahu — 2023-12-01

Background: Erythroderma, or “exfoliative dermatitis,” is a generalized inflammatory disorder of the skin manifesting with erythema and scaling affecting more than 90% of the skin surface. Primary erythroderma develops in normal skin, and etiological factors include drug reaction, lymphomas, and hematological malignancies, which may be idiopathic.

Aims and Objectives: The present study is to evaluate the clinico-etiological and histopathological correlations in erythroderma.

Materials and Methods: This prospective observational study was done in the Department of Dermatology, S.C.B. Medical College, Cuttack, from 2021 to 2022. Erythema and scaling involving more than 90% of the body surface area were calculated by Wallace’s rule of nine. A detailed demographic profile and history were recorded with a thorough clinical examination for each patient, involving type of scales, sizes of scales, color of scales, associated lichenification or fissuring, pedal edema, examination of the scalp for scales, hair loss, examination of the nails and mucosa, and associated arthritis.

Results: The most common disease was psoriasis (16), Idiopathic (7), followed by atopic and drug-induced dermatitis 6 patients each. Seborrheic dermatitis showed 3 cases, followed by contact dermatitis, Reiter’s disease, Pemphigus foliaceus, Ichthyosis (congenital), Dermatomyositis, and malignancy-induced 2 cases each, whereas contact dermatitis and Dermatophyte infection were found to be one patient each.

Conclusion: Though some of the etiology remains unknown, repeated investigations and continued follow-up are necessary to determine long-term complications. The role of alternative medicines and the injudicious use of steroids by quacks or untrained practitioners should be discouraged, and proper awareness should be given to patients with erythroderma.

Correlation of cervical cancers with long-term use of hormonal oral contraceptive pills - A retrospective observational multicentric study in suburban-based medical colleges in West Bengal

Partha Sarathi Mitra — 2023-12-01

Background: Hormonal oral contraceptive pills (OCP) may increase the risk of carcinoma cervix by changing the susceptibility of cervical cells to persistent infection with high-risk human papilloma virus. There is a causal and promoting association with long-term use of these pills for more than 5 years of use, and the association is diminished 10 years after last use.

Aims and Objectives: In this study, retrospective data were collected to analyze the risk of association of carcinoma cervix with hormonal contraceptive pill use.

Materials and Methods: Interview-based retrospective observational study to enquire about the history of hormonal OCP use and duration of intake in all diagnosed cases of cervical carcinoma attending gynecology and oncology outpatient departments over the period of 2 years in two medical colleges in suburban West Bengal.

Results: Of the total 401 subjects, 119 have a history of intake of hormonal OCPs, and 198 have a history of other methods of contraception. Among the subjects, 67.58% had squamous cell carcinoma (SCC), 31.67% had adenocarcinoma of the cervix, and 0.75% had other varieties. There is no correlation between the duration of hormonal OCP use and SCC cervix (P=0.269), whereas there is a significant correlation between adenocarcinoma of the cervix and duration of intake of hormonal OCP (P=0.002).

Conclusion: Studies have shown that women who have used OCPs for 5 or more years have a higher risk of cervical cancer than women who have never used oral contraceptives. This study reported a statistically significant increase in the relative risk of adenoca of the cervix but not of the SCC of the cervix, even after long-term use of hormonal OCPs.

Transthoracic ultrasonography in the assessment of interstitial lung disease in patients with systemic sclerosis

Shasanka Sekhar Das — 2023-12-01

Background: Transthoracic ultrasonography was considered, sometimes in the past as unsuitable for the assessment of lung but it eventually emerged as an important tool in the diagnosis and in guiding treatment of various lung and pleural diseases. Several studies in the past proved it to be a useful complementary tool in the detection of interstitial pulmonary fibrosis.

Aims and Objectives: This study aims to assess the utility of transthoracic uultrasonography (TUS) in comparison to high-resolution computed tomography (HRCT) thorax in the detection of interstitial lung disease (ILD) in systemic sclerosis (SSc) patients.

Materials and Methods: SSc patients with HRCT proven ILD were identified and classified according to Warrick’s score. Sonographic evidence of ILD in these patients were judged by the presence of B-lines or ultrasonic lung comets (ULCs). Each procedure was studied and interpreted by two independent examiners blinded about the patient’s clinical and radiological features. Standard spirometric measurements were performed in all patients.

Results: A highly significant positive linear correlation between ULCs and Warrick’s score was found in this study (r=0.83, P≤0.001). ULC score had moderate negative correlation with forced expiratory volume in 1 s (FEV1) % p (r=−0.60, P=0.001) and weak negative correlation with forced vital capacity (FVC) % p (r=−0.45, P=0.01) and FEV1/FVC % (r=−0.42, P=0.02).

Conclusion: USG lung can be suggested as a useful non-invasive tool in the detection of ILDs in scleroderma patients.

Organophosphorus poisoning: A retrospective study on clinical profile and outcomes in ICU

Nadia Rose — 2023-12-01

Background: Organophosphorus (OP) compounds are widely used in India as insecticides and contribute to both acute and chronic poisoning. Several parameters have been analyzed to evaluate the severity of poisoning and to prognosticate the outcome but contradictory results have been obtained from studies for example for the relationship between hypokalemia and outcome, pseudocholinesterase (PChE) levels, and outcome.

Aims and Objectives: The objectives of this retrospective study were to explore the epidemiological characteristics and clinical profile of patients admitted to intensive care unit with OP poisoning and to evaluate the outcomes including complications, in hospital mortality, and the predictors of mortality.

Materials and Methods: All the patients above 18 years admitted with a history of ingestion of OP poisoning during the study period were included in the study. Data were collected from case records.

Results: The mean age of the patients was 34±13.54. Fifty-four patients were male (69.2%) and 24 were female (30.8%). The correlation coefficient between intubation and PChE levels was 0.266. The mean period of ventilation was 4.16 days±2.41 days. About 80% (n=20) put on ventilator survived. Correlation of hypokalemia with patients getting ventilator support was 0.26 and that with mortality was 0.038.

Conclusion: OP poisoning cases were primarily noted in the younger male group with the intent to self-harm. Chlorpyrifos was the most common compound consumed. Early admission and appropriate treatment can reduce mortality and complications as there is no single factor which can be used to predict the outcome in these patients.

Clinical and etiological profile of new-onset seizures in adult patients: A cross-sectional study

Sivakumaran K — 2023-12-01

Background: In terms of the severity of the disease, the nature of the sickness, and its effects on the individual, the family, and the community, seizure disorder is a significant public health concern.

Aims and Objectives: This study evaluated the clinical and etiological profile of new-onset focal or generalized seizures in adult patients.

Materials and Methods: A cross-sectional study was conducted with 100 new-onset seizure patients admitted to the Government Ariyalur Medical College Hospital. A detailed history was taken from the relatives about the type of seizure and comorbid conditions. An examination of the central nervous system was done to find any underlying neurological deficits. Investigations done in all patients were blood sugar, urea, creatinine, serum electrolytes, and liver function tests. ECG, chest X-ray, electroencephalographic, and computerized tomography of the brain. Magnetic resonance imaging brain was done in the indicated cases.

Results: Of the 100 patients, 76% were males and 24% were females. The majority of the patients belonged to the age group of 41–60 years (40%). The most common type of seizure observed was the generalized tonic-clonic type (49%), followed by the focal type of seizure (23%). Of the various comorbid illnesses observed, diabetes mellitus was seen in about 41% of the patients; hypertension was seen in 40% of the patients; chronic kidney disease was seen in 24%; and cerebrovascular diseases were seen in 15%. The commonest etiology of new-onset seizures observed in this study was metabolic causes, constituting 41% of the cases, cerebrovascular diseases (32%), and alcohol-related seizures (10%).

Conclusion: Accurate identification of the cause of adult-onset seizures is crucial, and knowledge of clinical and etiological profiles will facilitate better treatment.

Rapid immunochromatographic test: An evolving tool for diagnosis of scrub typhus

Sabyasachi Saha — 2023-12-01

Background: Scrub typhus is prevalent in many districts of South Bengal throughout the year where an average temperature of 20–35°C, which contributes to the spread of Leptotrombidium deliense. However, its diagnosis remains complicated by the lack of readily available and validated assays, the non-specificity of clinical symptoms on admission, and even non-availability of the pathognomonic eschar in most of the cases.

Aims and Objectives: This study was carried out to evaluate the rapid immunochromatographic test (RICT) for early detection of scrub typhus for using it as an early diagnostic tool at the field level.

Materials and Methods: This cross-sectional study in which 181 serum samples from clinically suspected cases (after excluding dengue, malaria, Japanese encephalitis, and typhoid fever) collected over 13 months were processed for the detection of immunoglobulin M (IgM) antibodies for scrub typhus by enzyme-linked immunosorbent assay (ELISA) and rapid test.

Results: Considering IgM ELISA for scrub typhus as the gold standard, the sensitivity, specificity, positive predictive value, and negative predictive value for RICT were found to be 100%, 86.87%, 50%, and 100%, respectively.

Conclusion: RICT is a simple, rapid, and reliable assay for diagnosis of scrub typhus, capable of providing accurate results quickly and is highly suitable for field deployment in remote areas with limited medical support.

Comparative study of the diagnostic power of full outline of unresponsiveness score and Glasgow coma scale in patients with traumatic brain injury in an emergency department

Raaj Vishnu R — 2023-12-01

Background: The Glasgow coma scale (GCS) is the most commonly used scale, and the full outline of unresponsiveness (FOUR) score is new validated coma scale as an alternative to GCS to measure the level of consciousness and evaluate the severity of the injury in traumatic brain injury (TBI) patients.

Aims and Objectives: The present study compared the performance of FOUR scores and GCS in outcome predictions of TBI cases.

Materials and Methods: This prospective and cross-sectional study was conducted over a year by the Emergency Department of a tertiary care hospital, Kovai Medical Center and Hospital, Coimbatore, India. Of 159, 123 patients were recruited from intensive care unit (ICU), and 36 from the ward were included in this study. Data were collected using an observation checklist to determine the similarities and differences in predicting outcomes using the two assessment scales (GCS and FOUR).

Results: Most patients were 51–60 years (38%), with a mean age of 41.57. About 82% were male, 18% were female, and 31% had comorbidity of hypertension. Data analysis showed a significant statistical difference in mean FOUR and GCS scores between ICU and ward admission. A multivariate logistic regression study revealed that the probability of ICU admission in trauma patients from the emergency department was associated with a decline in GCS and FOUR scores. The range of predicted ICU admission was similar in both GCS and FOUR score models.

Conclusion: Although both scores are good predictors of TBI patients, we concluded that the FOUR score is a recommended predictive model for patients admitted to the medical ICU.

Endoscopic third ventriculostomy versus ventriculoperitoneal shunt in patients of hydrocephalus in eastern India: A prospective observational study

Anurup Saha — 2023-12-01

Background: Hydrocephalus is a disorder of cerebrospinal fluid (CSF) physiology, resulting in an abnormal enlargement of the ventricles due to excessive accumulation of CSF. Although neurosurgical treatment has evolved over time with ventriculoperitoneal shunt (VPS) as the standard of care, procedure-related complications and poor long-term cognitive and motor milestone outcomes are still considerable, justifying the need for safer alternatives. Endoscopic third ventriculostomy (ETV) has emerged as a promising prospect especially in non-communicating hydrocephalus (NCH).

Aims and Objectives: To compare the beneficial effects of ETV versus ventriculoperitoneal shunt in patients of NCH.

Materials and Methods: The present prospective study was conducted at the Department of Neurosurgery, Bangur Institute of Neurosciences, IPGMER and SSKM Hospital, Kolkata from July 2021 to December 2022 among 60 patients admitted with NCH. Out of 60 patients; 30 patients underwent ETV and the remaining 30 patients VP shunting. All included patients had their history taken and relevant clinical and radiological examination done pre-operatively. They were discharged on the third post-operative day or later depending on their clinical condition and recovery.

Results: Aqueductal stenosis was the most common etiology for NCH in both the groups. Post-intervention, complications and reoperation rate were reported more in VP group as compared to ETV group. Overall 3 subjects died, out of which 2 belonged to VP group and 1 to ETV group. Success was found in 70% and 86.67% of the subjects in VP and ETV group respectively.

Conclusion: In patients with non-communicating or obstructive hydrocephalus, ETV was reported to be superior to VPS in terms of reoperation and complication rate at 4th, 12th, and 24th weeks after the treatment.

A comparative and prospective study of surgical outcomes of cervical artificial disc to anterior cervical discectomy and fusion in the treatment of symptomatic degenerative disc disease of cervical spine in a tertiary care center of Eastern India

Rajat Dixit — 2023-12-01

Background: Cervical disc degeneration is known to be a primary cause of neck pain and neurologic symptoms and can cause significant morbidity. Degeneration can be related to radiculopathy or myelopathy due to compression of spinal nerves and/or spinal cord. Disc pathology may manifest clinically as localized and radicular pain, myelopathy, and spinal joint instability. If severe, such as in degenerative disc disease, infections, and trauma, surgical methods are indicated. Some studies reported that compared to anterior cervical discectomy and fusion (ACDF), cervical artificial disc (CAD) could provide better neurological outcomes and reduce the rate of adjacent segment degeneration, whereas other studies reported no difference between the two procedures.

Aims and Objectives: The aim of this study was to compare surgical outcomes of CAD to anterior cervical discectomy and fusion in the treatment of symptomatic degenerative disc disease in cervical spine.

Materials and Methods: It was a comparative study with prospective design conducted among 40 symptomatic cervical disc degenerative disease patients (20 patients undergoing CAD and the remaining 20 anterior cervical discectomy and fusion) at the Department of Neurosurgery, Bangur Institute of Neurosciences, 1PGMER and SSKM Hospital, Kolkata, from January 2021 to December 2022. Respective surgical procedures were done. All patients were required to return for follow-up. Clinical and radiological evaluations were performed at 1 month, 3 months, 1 year, postoperatively, and last follow-up (more than 18 months). Clinical effectiveness was evaluated by the visual analog scale (VAS) score, Japanese Orthopedic Association (JOA) score (17 points system, 1994 revised edition), and neck disability index (NDI) score.

Results: Improvement in NDI, VAS, and JOA index was found to be more in CAD as compared to ACDF group with a statistically significant difference as P<0.05. Subsequent surgical intervention was reported among four subjects, out of which one belonged to the CAD group while the rest three to ACDF. Overall success was found to be more in the CAD group (75%) as compared to the ACDF group (55%), though no significant difference was revealed as P>0.05.

Conclusion: The findings of the present study support the superior longevity and better outcome of CDA, as compared with ACDF, with regard to need for subsequent surgical intervention and also support better improvement in symptoms in subsequent follow-up in patients undergoing CDA as compared to ACDF despite having comparable mean operative time and blood loss.

Visual benefits and complications following neodymium-doped yttrium aluminum garnet (Nd: YAG) capsulotomy

Ajay R Kamath — 2023-12-01

Background: The incidence of posterior capsule opacification (PCO) noted at the end of 5 years following cataract extraction is 33%. With the advent of phacoemulsification various materials and designs of intraocular lenses, the incidence of PCO has been reduced. Following pediatric cataract surgery, the incidence of PCO was found to be 100%. Nd: YAG capsulotomy is considered a safe, effective, and non-invasive technique to treat PCO.

Aims and Objectives: The aim of the study was to evaluate the visual acuity among the patients with PCO and to assess the complications following Nd: YAG capsulotomy.

Materials and Methods: A total of 100 eyes of 100 patients with study period being 2 years from October 2015 to July 2017. The study was prospective study, and sampling was purposive sampling. After recruiting, the participants were divided into 2 case groups - pseudophakia and aphakia. A complete ophthalmological evaluation was done which included best-corrected visual acuity, torchlight and slit-lamp examination, and measurement of IOP which was followed by a fundus examination.

Results: The minimum and maximum age of the patient observed in our study was 34 and 88. Most of the study population was in the age group of 51–60 years. Majority of patients presented with PCO with an interval of 25–36 months following cataract surgery and were noted in about 52% of study population. Majority of the patients had visual acuity 6/36-6/18 and observed in 36% of study population. Comparison between pre-YAG and post-YAG day 1 visual acuity was done using significance test and P=0.000 which was highly significant, visual acuity at 4th week was compared to that of 6th week, and it was significant.

Conclusion: The loss of vision due to PCO is a distressing complication for a patient who has spent time and money getting their surgery done and finds that their vision is dropping again. YAG laser capsulotomy is a simple, outpatient solution that will bring the smile back on the patient’s face instantly. Capsulotomy improves visual acuity immediately after the procedure and more after 4 or 6 weeks with least complications.

Assessing the efficacy and safety of autologous bone marrow injections in treating delayed union of long bone fractures: A retrospective analysis

Suresh Katakam — 2023-12-01

Background: Delayed union in long bone fractures poses a significant clinical challenge, necessitating effective treatment solutions. The urgency for novel and effective treatment modalities is ever-increasing, especially considering the prevalence and complications associated with delayed union.

Aims and Objectives: This retrospective analysis aims to assess the safety and efficacy of autologous bone marrow injections in treating delayed union in a diverse cohort of individuals with long bone fractures.

Materials and Methods: The study includes 100 individuals aged 21–69 with varying fracture types. Fracture classifications comprised 40% closed fractures (n=40) and 60% open fractures (n=60). Notably, the femur had a higher prevalence of open fractures (n=30) than closed fractures (n=20). Tibia fractures demonstrated a similar propensity, with 25 open and 15 closed cases. Humerus fractures manifested an even distribution between open and closed categories (n=5 each), indicating their relative resilience to open fractures.

Results: Union was attained in 82 cases, with a mean union time of 7.4 weeks post-the-third bone marrow injection. The timeframe for the union varied widely, ranging from 4 to 17 weeks. In eight instances where bone marrow injections failed to achieve union, alternative treatment via bone grafting was necessary. No significant complications were reported; however, minor discomfort was experienced by 13% of the patients and was effectively managed with over-the-counter analgesics.

Conclusion: This retrospective analysis demonstrates the high efficacy and safety of autologous bone marrow injections in treating delayed union in long bones, making them a promising alternative treatment strategy with minimal complications.

A study of complications and their associated factors in the management of high-energy tibial plateau fractures treated by open reduction and internal fixation

Lawrence Mathias — 2023-12-01

Background: Tibial plateau fractures are one of the leading causes of joint dysfunction in major weight-bearing joints. Maintained articular surface, uniform plateau level, and a near-normal range of knee joint motion can all be preserved following the appropriate surgical guidelines.

Aims and Objectives: The objectives of the study are as follows: (1) To study the complications and their associated factors in the management of high-energy tibial plateau fractures treated by open reduction and internal fixation. (2) To assess radiological parameters pre-operative and post-operative and their relation to fracture pattern. (3) To assess factors, such as fracture patterns, those influence the loss of reduction.

Materials and Methods: Statistical analysis was done by expressing the data in frequency, percentage, mean, and standard deviation. Repeated measures ANOVA test or Friedman test or Wilcoxon signed-rank test will be used to compare radiological parameters from pre-operative to opposite side of the limb, and immediate post-operative to 6 weeks and 3 months.

Results: Thirty-one cases of proximal tibial plateau fractures were studied between January 2021 and September 2022. The joint width has reduced in the immediate post-operative and has almost remained the same at 45 days and 3 months. The articular step off was noted to have a reduction of 0.3 mm in particular depression which is not significant. In the comparison of tibial offset preoperatively to the immediate post-operative and the 45-day and 12-week follow-up values, there was decrease in the values from the pre-operative to immediate post-operative radiographs and the reduction in the values noted in the further follow-ups is not significant.

Conclusion: There was statistical significant difference noted between the pre-operative and immediate post-operative radiological parameters such as joint space width, tibial offset, and medial tibial plateau angle. Further radiological assessment done at 6-week and 3-month post-operative, there was no statistically significant loss of reduction.

Evaluation of the role of diffusion-weighted imaging in various pancreatic pathologies

Deepak Chakravarthy SS — 2023-12-01

Background: Diffusion-weighted imaging (DWI) can confidently characterize the nature of a lesion. “Apparent diffusion coefficient” (ADC) has a role in evaluating malignant lesions of the pancreas when conventional sequences appear normal.

Aims and Objectives: The aim of the study was to determine the role of DWI and ADC to differentiate benign from malignant pancreatic lesions.

Materials and Methods: An observational study was carried out on 75 participants with a suggestion of pancreatic pathologies at a tertiary care institute. Twenty-five participants, who had normal parenchyma of the pancreas, were taken as controls. Magnetic resonance imaging protocol was done, including DWI and ADC. Data analysis was done using coGuide software. ADC was the primary outcome of interest.

Results: Out of the 75 cases, 76.9 % (n=60) were males. 15.4 % (n=9) of pathologies were malignant. A significant decrease of ADC values in subjects with acute diffuse pancreatitis (1.12×10-3), acute on chronic pancreatitis (1.14×10-3), chronic pancreatitis (1.32×10-3) as well as adenocarcinoma pancreas (0.92×10-3) was seen in comparison to the controls (1.41×10-3). ADC values for acute pancreatitis, chronic pancreatitis, and acute on chronic pancreatitis were significantly higher than malignancy.

Conclusion: DWI and ADC is a useful tools complementing conventional MR imaging and other imaging modalities in characterizing pancreatic pathologies. Mean ADC values of various pancreatic diseases can be determined without major overlap and a reasonable cutoff value can be obtained for differentiating benign and malignant lesions.

Endoscopic features of non-IBD colitis

Flavia Pigò — 2023-12-01

Background: Studies about the endoscopic aspect of non-inflammatory bowel disease (IBD) colitis are scarce.

Aims and Objectives: The aim of this retrospective study was to describe the endoscopic appearance of non-IBD colitis (NIC) in an outpatient cohort.

Materials and Methods: All cases of NIC, from 2018 to 2021, with a recent outpatient colonoscopy, were enrolled. Diagnosis was based on clinical, endoscopic, and histological characteristics, and follow-up ≥6 months to recognize misdiagnosed IBD because of mimic causes.

Results: 158 patients (63 males, age 54 years±19) performed a colonoscopy with a final diagnosis of NIC associated with drug-exposition (74), food allergies (26), recent/active gastrointestinal infections (20), ischemic colitis (14), segmental colitis associated diverticulosis (SCAD) (10), obstructed defecation syndrome (ODS) (8) and microscopic colitis (6). Frequencies of endoscopic features and colon distribution were: Drug exposition (hyperemia, erosions/ulcers, 88%; right colon, 70%), recent infection (erosions, 60%; left colon/rectum, 88%), food allergies (red spots/erosions, 67%; all the colon), ischemic colitis (ulcers, 86%; right or left colon), SCAD (hyperemia/edema, 75%; always left colon), ODS (hyperemia, erosions, and loss of vascularity, 90%; always rectum), microscopic colitis (edema and hyperemia; all the colon).

Conclusion: Drug-exposition is the most frequent cause of out-patient NIC. In an appropriate diagnostic context, red spots, hyperemia, and erosions are associated with drug expositions, recent infections, and food allergies. Ulcers are more frequent with ischemic colitis or drug-exposition.

A prospective audit to assess the feasibility of sentinel lymph node biopsy and/or low axillary sampling in clinicoradiologically node-negative axilla for early breast carcinoma

Abasaheb Madhukar Tidake — 2023-12-01

Background: Sentinel lymph node (SLN) dissection was designed to minimize side effects of lymph node surgery but still offer outcomes of axillary lymph node dissection.

Aims and Objectives: Our study is designed to determine whether SLN resection achieves the same therapeutics outcome as complete axillary dissection but with fewer side effects for node-negative axilla in clinicoradiologically operable breast cancer patients.

Materials and Methods: Duration-based prospective observational study was carried out at the General Surgery and Surgical Oncology Department at Government Medical College and Hospital, Aurangabad with a duration of 2 ½ years from July 2019 to January 2022. A total of 36 patients of breast cancers with stages T1-T2, N0 with clinically and radiologically negative axilla from July 2019 to January 2022 duration were included in our study.

Results: When the histopathological status of axillary lymph nodes was compared to the histopathology of SLNs it was seen that out of 36 patients, the histopathology of sentinel node was positive in 10 patients (10/36) however the rest of the axilla was positive in 6 cases and negative in 4 cases and the histopathology sentinel node was negative in 26 patients out of 36 cases (26/36) however the rest of the axilla was also negative in 24 cases and positive in 2 cases.

Conclusion: SLN biopsy using methylene blue dye alone is a highly reliable and predictable technique to stage the axilla in breast cancer patients as this study shown a low false-negative rate (7.69%). This technique may help to avoid complete axillary lymph node dissection in sentinel node-negative patients thereby minimizing the morbidity of axillary lymph node dissection. This study demonstrates that sentinel node localization is possible with methylene blue dye alone.

A cross-sectional study of feeding practice status in children (6–23 months), association with malnutrition, and impacts of maternal determinants

Anil K Agarwal — 2023-12-01

Background: Inadequate complementary feeding practices lead to poor cognition, stunting, and increased rate of infections. Insight into deficiencies of complementary feeding practices could help in planning and implementing newer approaches at various levels of intersection.

Aims and Objectives: The aim and purpose of the study were to determine the complementary feeding practices, to identify maternal determinants of each practice, and to analyze the associations between complementary feeding practices with malnutrition.

Materials and Methods: A prospective observational study was conducted at the Department of Pediatrics, of a tertiary hospital over a 14-week period. All children aged 6–23 months were included in the study. Data were collected using a pre-structured questionnaire based on the World Health Organization Infant and Young Child Feeding (IYCF) indicators for assessing IYCF practices.

Results: A total of 400 mothers participated in the study. The mean age of children was 12.58 20±5.02 months, male: female = 1.6:1. The mean age of starting complementary feeding was 6.81±1.79 months. Semisolid food was introduced in 90.2% of children, minimum dietary diversity was received by 61.0%, minimum meal frequency by 83.8%, and minimum acceptable diet by 58.2%, eggs and flesh by 14.2% and 3.5% children, respectively; only 9.2% received vitamin A rich fruits and 38.5% did not receive any vegetable or fruit. Bottle feeding was present in 55.5% of population. Maternal parameters (education, employment access to media) and socioeconomic status were significantly associated with feeding practices (P<0.05). A significant difference was found in the nutritional status (wasting and stunting) of children who did not receive minimum dietary diversity (P<0.01).

Conclusion: Wide gap exists in feeding practices even in urban settings and was significantly associated with child’s nutritional status.

A study of morbidity and mortality pattern of pre-term neonates in neonatal intensive care unit of a tertiary care hospital of North East India

Dulal Kalita — 2023-12-01

Background: Pre-maturity is one of the major health problems and associated with high morbidities and mortality. According to the WHO every year, an estimated 15 million babies are born pre-term and this number is rising.

Aims and Objectives: The objectives of the study were to know the various morbidity pattern developed during the clinical course and to identify the cause of mortality of pre-term babies admitted in neonatal intensive care unit (NICU).

Materials and Methods: This prospective, observational study was conducted in the Neonatal Intensive Care Unit of Gauhati Medical College and Hospital, Assam, over a period of 1 year. A sample size of 150 pre-term babies selected randomly as per inclusion and exclusion criteria.

Results: The total number of cases studied in the present study were 150 pre-term babies admitted in NICU. Male pre-term babies were 82 (54.6%) and female pre-term babies were 68 (45.3%). The various morbidities observed among the pre-term babies during the study period were neonatal hyperbilirubinemia (48%) followed by respiratory distress syndrome (RDS) (30%), neonatal sepsis (22%), hypocalcemia (16%), hypothermia (14.7%), necrotizing enterocolitis (NEC) (5.3%), and intraventricular hemorrhage (4.7%). The overall mortality among the studied cases was 12.6%. Out of 150 cases, 19 cases were expired (12.6%). The present study shows that RDS (36.8%), neonatal sepsis (26.3%), birth asphyxia (21.1%), and NEC (15.7%) were the major causes of mortality among pre-term babies.

Conclusion: The survival rate increases significantly with increase in birth weight and gestational age. RDS, birth asphyxia, and neonatal sepsis were the leading causes of death.

Prevalence of hematuria and proteinuria in asymptomatic pediatric age group in suburban Chennai

Belukurichi Sadasivam Sangeetha — 2023-12-01

Background: Hematuria is rare in normal physiology. Proteinuria is almost always abnormal. It has been reported that hematuria and proteinuria are present even in apparently healthy children.

Aims and Objectives: This study was carried out to find the prevalence of proteinuria and hematuria in asymptomatic pediatric age group in suburban Chennai.

Materials and Methods: This cross-sectional study was carried out among 200 apparently healthy children of a suburban community in Chennai. Urine samples were collected from all children who satisfied the study criteria. The study period was from June 2020 to December 2021. The collected urine samples were analyzed in the laboratory for hematuria and proteinuria. The data were entered into Microsoft Excel and analyzed using SPSS version 23.

Results: Of the 200 children, 105 (52.5%) were males and 95 (47.5%) were females. The mean±standard deviation of the age of the study participants was 6.275±4.0362. Twenty-nine (14.5%) had hematuria, 45 (22.5%) had proteinuria, and 10 (5%) children had both.

Conclusion: Hematuria and proteinuria are present in asymptomatic children. Urinalysis is an effective, easy, and non-invasive screening method for early detection of an underlying renal disease.

Study of Mannheim peritonitis index for predicting morbidity and mortality in patients of hollow viscous perforation: In a tertiary care hospital of Eastern India

Parikshita Dalai — 2023-12-01

Background: Peritonitis is the inflammation of peritoneum, the serosal membrane that lines the abdominal cavity and organs inside. The hollow viscous perforation (HVP) is one of the most common surgical emergencies encountered by surgeons on a daily basis. Mannheim Peritonitis Index (MPI) is a simple and effective method in predicting the morbidity of patients with HVP.

Aims and Objectives: This study attempts to evaluate the prognostic value of MPI scoring system in patients with peritonitis due to HVP.

Materials and Methods: This is a clinical, prospective, and observational study. There were 50 patients with HVP (stomach, duodenum, ileum, and appendix) admitted in Srirama Chandra Bhanja Medical College and Hospital from March 2021 to October 2022 included in the study. Necessary data were collected; MPI score was calculated for each patient and analyzed.

Results: The number of post-operative complications, duration of intensive care unit, and hospital stay proportionately increased with the MPI score. Out of the eight variables used in this scoring system, duration of pain, intraperitoneal fluid and organ failure on admission carried more significance in predicting the morbidity in the post-operative period than the other variables.

Conclusion: MPI is a simple and effective method in predicting the morbidity of patients with HVP and to assess it as a clinical tool in stratifying these patients according to individual surgical risk.

A profile of hematological malignancies diagnosed in a tertiary care center of Assam: Highlighting the experience from a resource constraint perspective

Gayatri Gogoi — 2023-12-01

Background: Hematological disorders require a systematic approach, from clinical examination to a complete blood count, followed by a bone marrow study for diagnosis. To effectively plan, treat, and prognosticate, immunophenotyping and molecular studies are essential to incorporate.

Aims and Objectives: The aim of our study is to understand the pattern of neoplastic hematological conditions encountered in Assam and share our experience during the diagnosis.

Materials and Methods: This was a single-centered, observational study carried out for 18 months (January 2022–June 2023). A thorough hematological workout was done, including cytochemical staining and conventional polymerase chain reaction for the BCR-ABL transcript, after satisfying inclusion and exclusion criteria. The data were analyzed and correlated before arriving at the final diagnosis.

Results: The total of 38 neoplastic cases confirmed by bone marrow study. Out of 38 cases, 14 were chronic myeloid leukemia, 10 were chronic, 4 were in the blastic phase, and BCR-ABL was positive in 13 cases. Two cases were pediatric, of which 1 was in the blastic phase. All 8 cases of plasma cell dyscrasia presented with anemia, bone lesions, and hypercalcemia. The acute leukemia category consisted of 4 acute myeloid leukemia cases, of which 1 was acute promyelocytic leukemia. A total of 10 acute lymphoblastic leukemia (ALL) cases, where 1 case was T-ALL and the rest was B-ALL. Two cases showed a subleukemic presentation in peripheral blood.

Conclusion: The experience of pathologists and their meticulous approach can greatly aid in accurate diagnosis, but the immunophenotyping facility and molecular hematology setup can provide most of the relevant information for the best decision-making.

A study of cardiovascular reflex tests in adults with chronic migraine and chronic tension-type headache

Waqas Alauddin — 2023-12-01

Background: Autonomic function tests can be used by patients with chronic migraine and chronic tension-type headaches (TTH) as a non-invasive, sensitive, and reliable marker for evaluating heart function. Studies have demonstrated sympathetic and parasympathetic dysfunction. Patients with migraines experience sympathetic and parasympathetic nervous system hyperfunction, while tension headache sufferers experience the opposite.

Aims and Objectives: Parasympathetic reactivity tests will be used in the current study to evaluate the cardiac autonomic functioning in patients with chronic migraine and chronic TTH in the adult age group.

Materials and Methods: Two groups of headache patients were enrolled: Those with chronic migraine (n=25) and those with chronic TTH (n=25). To conduct statistical analyses, SPSS version 21 was used. For parameters with normal and abnormal distributions, the unpaired t-test and Mann–Whitney U-test, respectively, were employed.

Results: Out of 25 subjects, parasympathetic reactivity tests such as Valsalva ratio (1.38±0.10 vs. 1.49±0.19, P=0.022*) and expiratory-inspiratory ratio (1.18±0.03 vs. 1.25±0.77, P=0.000*) in chronic migraine were significantly decreased as compared to chronic TTH. Lying to standing 30:15 ratio (1.15±0.08 vs. 1.19±0.10, P=0.090) and delta heart rate (14.56±1.39 vs. 14.96±1.43, P=0.320) was decreased in chronic migraine as compared to chronic TTH but was not significant.

Conclusions: In contrast to the chronic TTH group, the chronic migraine group’s total parasympathetic tone was reduced. We therefore draw the conclusion from the findings that regular monitoring of the parasympathetic reactivity can be very helpful in predicting cardiovascular risk for these patients in addition to advising the treatment practices for chronic migraine and chronic TTH, which include regular exercise and medication.

Higher GOLD spirometeric class (severity of airflow limitation) correlated with higher number of comorbidities

Mohit Bhatia — 2023-12-01

Background: Various systemic manifestations of chronic obstructive pulmonary disease (COPD) are well known to us. One patient of COPD may have more than one associated comorbid conditions. Severity of airflow limitation is expressed as a global initiative for chronic obstructive lung disease (GOLD) spirometeric classification in patients with COPD, which has been proposed to better identify the disease severity and survival.

Aims and Objectives: In this study, we aimed to find out correlation between GOLD spirometeric classification and comorbidities in patients.

Materials and Methods: An observational study conducted at the Institute of Medical Science Banaras Hindu University Varanasi India. We evaluated 50 patients of COPD, containing smokers, non-smokers, and ex-smokers. The severity of airflow limitation in COPD was classified using the GOLD. The most frequent comorbidities are assessed in COPD which were cardiovascular diseases, diabetes, hypertension, osteoporosis, muscle wasting, psychological illness, and anemia.

Results: Fifty patients were analyzed: Male 90%, mean age 68.5 years and mean forced vital capacity in 1 s 34.3%. There is an association between GOLD spirometeric classification and total number of comorbidities in patients. Subjects with higher GOLD spirometeric classification have more associated comorbid conditions, which suggest that these conditions may aggravate COPD course and increase risk of mortality.

Conclusion: Assessment of GOLD spirometeric classification could provide information about a total number of various comorbid conditions in a patient with COPD. Patient with higher GOLD spirometeric classification has more comorbidities.

Study of exercise-induced desaturation in chronic obstructive pulmonary disease patients visiting tertiary care center in Bangalore

Anjali G — 2023-12-01

Background: Chronic obstructive pulmonary disease (COPD) patients often have a lower ability to exercise and muscle weakness, both decreasing their quality of life. The 6 min walk test (6MWT) offers insightful data on the functional capacity of respiratory variables on exercise performance. A significant reduction in oxygen saturation (SpO2) throughout the test signifies a lower tolerance for exercise or additional oxygen requirement.

Aims and Objectives: This study focuses to investigate desaturation in COPD patients with normal resting oxygen levels (normoxemic) employing the 6MWT. The objective of the study defines to analyze different clinical parameters such as smoking behavior, 6MWT, and clinical parameters of COPD patients to diagnose respiratory performance.

Materials and Methods: Between June 2019 and May 2020 study was conducted on patients presenting to our OPD, who were above 40 years and diagnosed with COPD, with baseline SpO2 ≥90%. 6MWT was performed on them as per American Thoracic Society guidelines. Noting their distance covered and desaturation if present.

Results: The study group included 60 patients; the group was divided into 35 desaturators (DS) and 25 Non-DS (NDS) based on fall in SpO2 during 6MWT, all current smokers were in the DS group and had low body mass index values, DS group covered less distance when compared to NDS, DS had low mean forced vital capacity and forced expiratory volume 1 second values.

Conclusion: This study established the relationship between COPD risk variables and 6MWT. The 6MWT was identified as a useful method to examine respiratory performance by noting exercise-induced desaturation and in turn the respiratory capacity among COPD patients.

Objective assessment of the factors affecting outcome of immediate management of mandibular fractures – A prospective study in a Level-I trauma care center

Tushar Dutta — 2023-12-01

Background: Mandibular fractures lead to complications if improperly treated. The management of mandibular fractures includes open reduction and internal fixation (ORIF) or closed reduction. Associated complications include malocclusion, infection, hardware extrusion, and nerve injury.

Aims and Objectives: The aims of this study were to evaluate the functional outcome of various treatment modalities of mandibular fracture and to identify the factors affecting the outcome.

Materials and Methods:
The study included patients admitted in the trauma care center, between 13 and 70 years of age, and having mandibular fracture. Patients underwent ORIF or closed reduction according to the type of fracture. Mandibular injury severity score (MISS), Mandibular functional impairment questionnaire (MFIQ) score, and pain visual analog score were used to assess the functional outcome of treatment and complications.

Results: Majority of the patients were male and were in the age group 21–30 years. The most common cause of fracture was road traffic accident (RTA). Majority of the patients underwent ORIF. Patients having higher injury severity scores, severe MFIQ scores and pain visual analog scores had more complications. Overall, complications in open reduction cases were higher than closed reduction ones. However, weight loss and time to functional improvement were more in closed reduction cases.

Conclusion:
Young males are most commonly affected with fracture of mandibles and mostly due to RTAs. There should be minimal delay from presentation to operative intervention in case of patients who require ORIF. Scoring systems such as MISS, MFIQ, and pain visual analog scale scores may help in the early prognostication of injury and warn against imminent complications.

To study the planned surgical procedure in single-dose antibiotic prophylaxis

Chandrakala Dutt — 2023-12-01

Background: Postoperative wound infection may be due to many causes, of which “microbial contamination” is the factor that is influenced by antibiotic administration. Since the concept of antimicrobial prophylaxis has emerged, several workers have searched for optimal antimicrobial drugs, their routes, and the timing of their administration, with the ultimate goal of achieving zero sepsis. The use of preoperative systemic antibiotics has brought down the incidence of wound infection considerably.

Aims and Objectives: The aim is to identify which drug is the best option for single-dose antibiotic prophylaxis to prevent postoperative wound infection.

Materials and Methods: This is a prospective study. The study was conducted in the surgical ward of J.A. Group of Hospitals, Gwalior, Madhya Pradesh, India, from May 2020 to April 2022. Patients of all sexes and ages were included in the study. Patients were divided into five groups according to a class of antibiotics. The study consisted of a total of 125 patients admitted to the surgical ward. Statistical Package for the Social Sciences–(10 systems) was applied for the study. P<0.05 was considered statistically significant.

Results: A total of 125 patients were studied in five groups, depending on the antibiotics. The A, B, C, and D groups were given only a single dose of antibiotics, while group E was given a full course of antibiotics during preoperative, intraoperative, and postoperative periods. Out of 125 cases, only 5 patients had clinical and bacteriological evidence of wound sepsis in different groups of single-dose antibiotics, and one case in group E had multiple doses of antibiotic given. The wound infection rate in clean patients was 20% in ceftazidine, 12.5% with piperacillin tazobactum and cefoperazone sulbactum, and 21.1% in the multiple dose group. No infection was reported with amoxycillin-clavulanic acid. Staphylococcus, Escherichia Coli, and Klebsiella were the offending agents, and anaerobic infections were not found.

Conclusion: A single dose of antibiotic prevents the suppression of normal, sensitive microbial flora, which is usually seen with multiple doses of antibiotics. In this way, it helps in keeping the patients infection-free without interfering with their naturally inherited immunological status of the patient.

Surgical site infections - A threat to the health-care system: An observational study from a tertiary care hospital of Bihar

Kunal — 2023-12-01

Background: A surgical site infection (SSI) is any infection occurring after a medical intervention. It is the most common nosocomial infection in low- and middle-income countries. It has raised both mortality and morbidity. Resistance to antibiotics due to irrational use has further added to the severity of the problem.

Aims and Objectives: The current study was designed with the aim of determining the incidence of SSIs among patients operated on a tertiary care hospital, along with their antibiogram.

Materials and Methods: An observational study with a cross-sectional design was conducted on 150 patients with suspected SSI were included in this study over a period of 1 year, from August 2021 to July 2022. An adult patient with pus, serous, or seropurulent discharge from the surgical wound was included in the study. Information was obtained using a pre-designed and pre-tested schedule. Identification of the colony was done by gram staining and inoculation on 5% sheep blood agar and Mac Conkey agar plates. Antimicrobial sensitivity testing was done. The data was analyzed using Microsoft Excel.

Results: A total of 152 patients were included in the study. The incidence of SSI was found to be 38.2%. The mean age of the participants was 47.7 ± 21.6 years. The maximum incidence of SSI was noted in the 5th decade of life. Among the 58 patients’ samples, 65 aerobic bacterial colonies were isolated. Out of which Staphylococcus aureus and Escherichia coli were the commonest organisms. On performing an antibiogram, a higher degree of resistance was observed among Gram-negative organisms.

Conclusion: SSI adds to the mortality as well as the morbidity of the patients. Not only this, but it also adds to the expenses. A more stringent surveillance system and reinforcement of the guidelines was the need of the hour to overcome this problem of hospital-acquired infections.

Idiopathic intraosseous ganglion of the distal tibia in a young adult male: A case report with review of literature

Javed Ahmad — 2023-12-01

Intraosseous ganglion is a benign cystic bony lesion containing viscous and mucinous gelatinous material, which is usually seen in middle-aged individuals. It is similar to soft-tissue ganglion cysts present in other parts of the body. We, hereby, report a rare case of idiopathic intraosseous ganglion of the tibia in a young adult who presented with chronic pain in his lower leg. The patient was subjected to X-ray and MRI investigations and managed by excisional curettage of the lesion and histopathological examination. On histopathology, the diagnosis of intraosseous ganglion was confirmed. On 2-year follow-up, the patient was doing well without any complication and recurrence. This report describes the diagnosis and successful management of intraosseous ganglion at a very rare site in a young individual. More in-depth studies are required to understand the predisposing factors, underlying pathology, early diagnosis, and management of this lesion.

Rhomboid intercostal subserratus plane block – the Holy Grail of post-operative analgesia in modified radical mastectomy or just another dot in the long list?

Priyanka Bansal — 2023-12-01

Despite the presence of numerous options for breast analgesia, our women continue to suffer the consequences of acute post-operative pain that progresses to chronic pain in up to 55% of the post-mastectomy patients a rapid surge in the use of interfacial blocks for analgesia of chest and abdominal procedures. The importance and efficacy of these blocks are because of the continuity of the interfacial planes across varied anatomical tissues. We report a series of cases of modified radical mastectomy (MRM) in five female patients with the American Society of Anesthesiology Grade II/III in whom rhomboid intercostal subserratus was used for post-operative analgesia proved to be a boon. Two were post-radiation with metastasis to axillary lymph nodes. The other three had invasive ductal carcinoma and were on chemotherapy. Rhomboid intercostal subserratus plain block is a novel block and provides pain management for patients of MRM. The analgesic efficacy may not be superior but the non-inferiority to an epidural is certainly an added advantage with safe efficacious profile fulfilling the enhanced recovery after surgery protocols following minimally invasive surgical techniques.

Myocardial injury in COVID-19: A case series

Pratiti Choudhuri — 2023-12-01

The COVID-19 pandemic has affected nearly millions of populations worldwide. The range of symptomatology is vast, though predominantly respiratory, and ranges from mild flu-like symptoms to severe respiratory illness with acute respiratory distress syndrome. COVID-19 is associated with many non-respiratory complications affecting the heart, kidneys, gastrointestinal system, central nervous system, and blood vessels. Myocardial injury in COVID-19 patients has varied presentations ranging from arrhythmias, myocardial infarction, myocarditis, and cardiomyopathy to cardiogenic shock. It is usually associated with elevated levels of cardiac biomarkers, with or without any changes in electrocardiography or cardiac imaging. Diagnosis may be difficult based on clinical symptoms or electrocardiogram changes alone, and it can be made using 2D echocardiography, coronary angiogram, CT coronary angiogram, or cardiac magnetic resonance imaging, depending on clinical suspicion. COVID-19-associated cardiac injury increases overall morbidity and mortality. In this case series, five COVID-19 cases with different cardiac manifestations were reported with the intention of presenting the various manifestations of cardiac complications, the course of the disease, and the challenges associated with the complications. This case series showed that cardiac complications are common in the 2nd week during the cytokine storm phase, and timely case-specific specialized diagnostic and therapeutic cardiac interventions might improve the chances of patient survival.

Incidental precancerous and cancerous neoplasms in routine cholecystectomy specimens – A fascinating series of cases in a tertiary care center

Meghadipa Mandal — 2023-12-01

Laparoscopic cholecystectomy is one of the most commonly performed surgeries for benign gall bladder pathologies. Pre-cancerous and malignant gall bladder neoplasms often have overlapping non-specific clinical manifestation in their early stages. Radiological findings are also non-specific in the early stages with the presence of cholelithiasis in a significant proportion of cases. Cholelithiasis is said to be one of the important comorbid risk factors for gall bladder carcinoma (GBC) as a source of constant irritation to biliary mucosa. In such cases, cholecystectomy done for benign indications may lead to a histopathological diagnosis of incidental gall bladder carcinomas. Pancreaticobiliary type of adenocarcinoma is the most common subtype of GBC with two described cases in this series. Invasive foci need to be ruled out in. All cases of high-grade biliary intraepithelial neoplasia as were seen in the third case. Intracholecystic papillary neoplasm is a recently described entity with one reported case in this series that was associated with invasive adenocarcinoma. Signet ring adenocarcinoma is a rarely encountered adenocarcinoma in gall bladder with worse outcome. One such case has been described here where the patient has succumbed to death within 3 months of surgery and during the course of adjuvant therapy.

The perfect trio to decrease mortality in pancreatic cancers: Molecular marker screening tests with biosensors in precancerous lesions

Hasan Zafer Acar — 2023-12-01

The mortality rates of pancreatic cancer (PC) are very high. The methods recommended in the studies conducted to date have been able to reduce mortality very little. This study aimed to review studies on this subject and to identify the most appropriate methods to decrease mortality in PCs. Therefore, research articles and reviews on this subject were analyzed intensely, and the findings were summarized. According to the results obtained in our study, to decrease mortality in pancreatic ductal adenocarcinomas, early diagnostic screening should be performed primarily with molecular markers and biosensors effective in precancerous lesions in risk groups. However, studies on such screening worldwide have not yet been conducted. Therefore, further research is needed to arrive at more precise conclusions.

Smart wearable devices for real-time health monitoring

Ruby Dhar — 2023-12-01

Smartwatches have emerged as powerful tools for health monitoring in recent years. These wearable devices combine advanced technology with portability, enabling individuals to track various aspects of their health and well-being conveniently. Heart rate monitoring has several advantages. Many smartwatches are equipped with optical heart rate sensors that continuously monitor a user’s heart rate. This feature provides real-time data on heart rate variations, which can be crucial for identifying irregularities and assessing overall cardiovascular health.

Activity tracking: Smartwatches often include accelerometers and gyroscopes that track physical activities such as steps taken, distance traveled, and calories burned. This information can aid in setting and achieving fitness goals.

Sleep tracking:Some smartwatches offer sleep tracking features, recording sleep duration, quality, and patterns. These data help users understand their sleep habits and make improvements for better rest.

Global positioning system (GPS) and location tracking: Integrated GPS allows users to track their outdoor activities accurately, including running and cycling. This feature not only measures performance but also enhances safety during workouts.

Stress monitoring: Certain smartwatches include tools that measure stress levels through heart rate variability analysis. Users can learn to manage stress more effectively based on these data.

Electrocardiogram (ECG) and blood pressure monitoring:High-end smartwatches may include ECG and blood pressure monitoring capabilities. These features are particularly useful for individuals with heart conditions or hypertension.

Notifications and alerts: Smartwatches can deliver notifications and alerts related to health goals, reminders to move, medication schedules, and emergencies. This functionality enhances user engagement and timely interventions.

BENEFITS OF SMARTWATCHES IN HEALTH MONITORING
Unlike periodic doctor visits, smartwatches enable continuous health monitoring. Users can track their vital signs and activities throughout the day, providing a more comprehensive picture of their health. Smartwatches empower individuals to take control of their health. Users can make informed decisions about their lifestyle, exercise, and diet by providing real-time data.

Smartwatches equipped with ECG and heart rate monitoring can detect irregularities and abnormalities early on. This early detection can be lifesaving for individuals at risk of heart-related conditions. Activity tracking and goal-setting features motivate users to engage in physical activities and maintain a healthier lifestyle. Achieving fitness goals can lead to increased motivation and adherence to healthier habits. Health data collected by smartwatches can be used to tailor fitness and wellness plans to an individual’s specific needs. This personalized approach can lead to more effective health improvements.

LIMITATIONS AND CONSIDERATIONS
Accuracy: While smartwatches offer valuable health data, their accuracy may vary. Factors such as skin type,device placement, and motion can affect the precision of measurements.

Battery life: Continuous health monitoring can drain a smartwatch’s battery quickly. Users may need to recharge their devices frequently, potentially limiting the monitoring duration.

Privacy and data security: Storing sensitive health data on a smartwatch raise concerns about privacy and data security. Manufacturers must implement robust security measures to protect users’ information. User reliance: There is a risk of over-reliance on smartwatches for health information. Users should be encouraged to consult health-care professionals for a comprehensive health assessment.

CONCLUSION
Smartwatches have become versatile tools for health monitoring, offering a range of features that empower users to track and improve their well-being. While they have numerous benefits, users should know their limitations and use them as complementary tools in their health-care journey. Manufacturers and health-care providers play a critical role in ensuring the accuracy and security of the health data collected by these devices.

Cervical intradural extramedullary chaotic lipoma in an elderly patient: A rare case report

Anurup Saha — 2023-12-01

Intradural spinal lipoma (ISL) prevalent in children and young adults usually presents with spastic progressive quadriparesis, sensory disturbances, and gait abnormalities. Chaotic lipomas named due to their haphazard distribution are an extremely rare variant of ISL present at the dorsal root entry zone. We describe a case of chaotic spinal lipoma and elucidate the challenges faced in the management of this entity.

Case of triple extradural hematoma in a single patient: A rare case report

Jolly Sinha — 2023-12-01

Epidural hematoma (EDH) is found in 1–4% of traumatic brain injury cases. Acute triple extradural hematoma is a rare presentation of head trauma injury. In sporadic cases, they represent 0.5–1% of all extradural hematomas. Here is a case report of a 36-year-old female patient who presented to us with a head injury due to fall from a bike due to collision with a stray animal. The patient had a Glasgow Coma Scale of 9 (E2V2M5) with bilateral sluggishly reacting pupil to light. Computed tomography showed asymmetric bilateral posterior fossa EDHs along with an extradural hematoma in the right frontal region with multiple small contusions with mass effect. The surgical evacuation was performed first of the posterior fossa in the prone position and then right frontal hematoma evacuation in the supine position in the same sitting. The patient recovered well and was discharged on the 10th post-operative day with no neurological deficit. Early drainage of hematomas has been demonstrated to be an effective technique that soon decreases the intracranial pressure and promotes an efficient resolution to the neurological damage.

Rhomboid intercostal sub serratus plane block – Same bird with different horizons

Priyanka Bansal — 2023-12-01

Sir,
We did a case series in five patients undergoing modified radical mastectomy who were given RISS for post-operative analgesia. We noticed that the intraoperative fentanyl consumption as well as the post-operative analgesic consumption was significantly less. The overall quality of life and satisfaction score for routine daily activities like wearing clothes was better in our patients. The importance and efficacy of these blocks are because of the continuity of the interfacial planes across varied anatomical tissues. These planes have various cutaneous as well as sympathetic branches and hence drug given spreads to cover a large dermatomal area.

RISS has been proposed to cover lateral cutaneous branches of T2 to T11 that extend medially to cover dorsal rami deep to the errector spinae muscle plane (ESP). The site of injectate is at T5-T6. The dermatomal coverage is 4 cm lateral to the midline anteriorly, posteriorly 4 cm medial to the posterior axillary line, cranially up to serrated posterior superior caudally up to serratus posterior inferior.

The advantages of RISS block are that the injection is far from the surgical site and hence the drug does not interfere with the surgical field or cautery if given preoperatively. After induction technically, it is more feasible than serratus plane block or pectoral blocks. Logistically prior catheterization is possible that does not interfere with the sterility of the surgical field. Despite the above advantages, the axillary coverage is inconsistent as it does not cover the intercostobrachial nerve (LCB of second ICN T2). The midline, thoracodorsal nerve, and long thoracic nerve are not covered. Complete analgesia is not provided for latissimus dorsi flap, segmental resection surgeries, lymph node dissections, or radical mastectomies.

Dr. Tulgar, first-ever reported of the use of RIB in a patient of MRM and highlighted the superiority of peri-peri-paravertebral blocks apart from previously used ESP and paravertebral blocks for a similar condition. Altiparimak conducted an RCT on 30 MRM patients with axillary lymph node dissection. The patients had enhanced recovery and quality of life scores (QoR-40), especially in terms of pain and emotional status.

RISS has proved its non-inferiority as compared to ESP, paravertebral, PEC, and SAP which are closer to neuroaxis, at non-compressible sites and difficult to execute in obese patients. Thus RISS is excellent as a part of MMA for post-operative pain management in MRM patients, who remain comfortable for up to 14 h and have an NRS score <3 was seen in all of our five patients. The dynamic nature of pain was apparent at 14 h in three of the patients who had extensive axillary lymph node dissection.

Is the journey of regional anesthesia just the replacement of “pops and clicks” with see it and block it? The renaissance in the era of blocks is visualizing an invention of a new block almost every month. We depend on the facial plane anatomy, its structure, and its relation to the surrounding organs and tissues to precisely disseminate the local anesthetic to its desired location. In this blind sheep race, enthusiasm should not blur our understanding of the basics. We should remember Triple A, improve health, enhance patient outcomes, and decrease the costs.

We open the doors for larger studies with more patients, comparing different blocks with RIB/RISS blocks before generalizing the results.

CONCLUSION
Rhomboid intercostal subserratus plane block is an excellent option for intra and post-operative pain management as a part of multimodal analgesia in MRM patients.