Asian Journal of Medical Sciences <p>The inaugural issue of the Asian Journal of Medical Sciences was published in May 2010. Full text articles available.<br>AJMS was added to <a href="" target="_blank" rel="noopener">DOAJ</a> on 26th May 2020.</p> <p>AJMS was added to CAB Abstracts and/or Global Health database on 15th December 2020. Coverage will start from Volume 11, No. 1, 2020 onwards.</p> Asian Journal of Medical Sciences Pokhara en-US Asian Journal of Medical Sciences 2467-9100 <p>Authors who publish with this journal agree to the following terms:</p><ol start="1"><li>The journal holds copyright and publishes the work under a Creative Commons <a title="CC-BY-NC" href="" target="_blank">CC-BY-NC license</a> that permits use, distribution and reprduction in any medium, provided the original work is properly cited and is not used for commercial purposes. The journal should be recognised as the original publisher of this work.</li><li>Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.</li><li>Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See <a href="" target="_new">The Effect of Open Access</a>).</li></ol> Placenta percreta with bladder invasion – a novel approach for management: A case report <p>Placenta percreta is an obstetric emergency often associated with massive hemorrhage, emergency cesarean section, and peripartum hysterectomy. We present a case of a 30-year-old woman, G4P1L1A2 with placenta percreta managed by an alternative approach. The placenta was left in situ along with B/L internal iliac artery ligation during cesarean section and later on delayed subtotal hysterectomy with bladder repair was successfully performed. Placenta percreta spectrum is an obstetricians dilemma associated with massive hemorrhage and is a potential life-threatening condition for both mother and the baby. Cesarean section with B/L internal iliac artery ligation and delayed hysterectomy may be a reasonable strategy in the most severe cases.</p> Sushila Kharkwal Divya Jain Manish Jain Shitangsu Kakoti Divya Pandey Copyright (c) 2022 Asian Journal of Medical Sciences 2022-10-01 2022-10-01 13 10 284 287 10.3126/ajms.v13i10.46640 Hepatitis B virus-induced CD4 lymphocytopenia: A rare cause of progressive multifocal leukoencephalopathy <p>Progressive multifocal leukoencephalopathy (PML) is a rare subacute-onset fatal demyelinating disease of the central nervous system caused by the John Cunningham (JC) virus. It usually occurs in impaired cell-mediated immunity settings such as lymphoproliferative disorders, chronic infective or granulomatous conditions on immunosuppressive medications, and human immunodeficiency virus infection. It also appears very rarely with idiopathic CD4 lymphocytopenia. We present a case of PML with visual field defect, progressive motor impairment, behavioral alteration, and dementia. Magnetic resonance imaging had features of asymmetric non-enhancing hyperintense subcortical white matter lesions in the background of chronic active hepatitis B infection. To the best of our knowledge, this is the first case report of CD4 lymphocytopenia associated PML following chronic hepatitis B infection.</p> Amar Kumar Mishra Sanjay Kumar Niraja Agasti Gautam Guha Saikat Ghosh Bijendra Mohanty Pideno S Ngullie Joydeep Mukherjee Copyright (c) 2022 Asian Journal of Medical Sciences 2022-10-01 2022-10-01 13 10 288 292 10.3126/ajms.v13i10.44407 Diaphragmatic eventration with impending gangrenous organoaxial volvulus of the stomach: Role of timely intervention <p>Eventration of diaphragm is a rare entity and often is characterized by a developmental abnormality of the diaphragm musculature. The acute presentation of organoaxial volvulus with impending gangrene of stomach is a life-threatening event and requires emergency diagnosis and surgical intervention. A 45-year-old man visited our hospital for evaluation of upper abdominal discomfort. He had a feeling of fullness and discomfort in the upper abdomen for 3 years. These attacks lasted about 2 hours and were not usually severe but eventually presented with severe abdominal pain. The patient was explored as general condition was deteriorating. On exploration, it was found that there was huge organoaxial stomach volvulus with impending stomach gangrene. Emergency exploration, gastropexy, and plication of diaphragm was done. Early diagnosis and prompt intervention may avoid consequent gastric volvulus and complications,improving the overall outcome and mortality.</p> Ravindran Chirukandath Sharath Kesavan Krishnan Nimisha Chemmangattuvalappil Ramachandran Safna Kunhikandilakath Babu Pulluvileyil John Nayanathara Parayarukottayil Copyright (c) 2022 Asian Journal of Medical Sciences 2022-10-01 2022-10-01 13 10 293 296 10.3126/ajms.v13i10.39651 The Brunner’s Gland Lesions: An uncommon entity mimicking malignancy <p>Brunner’s gland hyperplasia (BGH) or adenoma is an uncommon benign lesion which mimics malignancy in the duodenum. In the present study, five cases of BGH were reported, out of which one case was presented with large size measuring 5.54×4.05 cm, which has not been yet reported. Computed tomography demonstrated a large obstructing polypoidal mass, on esophagogastroduodenoscopy demonstrated polypoidal growth, and histologic examination revealed brunner’s gland adenoma. Most of the cases presented with gastric outlet obstruction and upper gastrointestinal bleeding with other non-specific symptoms. BGH is an uncommon benign condition of the duodenum, patients were usually asymptomatic or may present with non-specific symptoms or present as an incidental finding on endoscopy. Endoscopic and/or surgical resection represents the ideal approach. Brunner’s gland described by the Swiss anatomist Johann Conrad Brunner in 1688, predominantly present within the submucosa, begin just distal to the gastroduodenal junction, and gradually decrease in size and number distally and are often used as a histological marker of the duodenum. A Brunner’s gland adenoma (BGA), also known as BGH or hamartoma, is an uncommon<br />benign lesion in the duodenum.</p> Sarika More Madhubala Swarnakar Rajendra Kumar Chandrakar Manjula Lader Copyright (c) 2022 Asian Journal of Medical Sciences 2022-10-01 2022-10-01 13 10 297 300 10.3126/ajms.v13i10.46544 Neglected tropical disease: Why we need to prioritize them more <p>Neglected tropical diseases (NTDs) are those that are commonly found in several low-income countries in Africa, Asia, and Latin America and where people do not have access to hygiene, clean water, or safe ways to dispose of human waste. NTDs comprise a diverse group of diseases that is highly prevalent in tropical countries and is caused by a variety of pathogens, including bacteria viruses, parasites, and fungi. Although there are debates on what is included under NTD, few that are listed are ascariasis, Buruli ulcer, Chagas disease, dracunculiasis, hookworm infection, human African trypanosomiasis, Leishmaniasis, leprosy, lymphatic filariasis (LF), onchocerciasis, schistosomiasis, trachoma, and trichuriasis, though this list. keeps on changing. They are called “neglected,” because they are hardly represented in the global health agenda of the developed countries and are often associated with stigma, blind faith, and social exclusion. The epidemiology of NTDs is quite complex and often related to environmental conditions. Many of them are vector-borne, have a zoonotic origin with well characterized animal reservoirs, and are associated with complex life cycles. All these factors make their public health control challenging.</p> <p>With a population of over 1.3 billion, India accounts for nearly one-half of the world’s prevalent cases of visceral leishmaniasis and one-half of the global incident cases of dengue, one-third, or more of the prevalent cases of leprosy, LF, cysticercosis, and visual impairment due to trachoma. India also accounts for 25% world’s burden of ascariasis and hookworm cases. Unfortunately in India, we don’t have a uniform distribution of neglected diseases. It was found to be very much dependent on the geographical locations as well as biased on the socialeconomic status, with more prevelant amongst the lower income groups. NTDs are not just any regular disease but were reported to cause permanent disabilities, impacting mental health and thereby posing a serious threat to livelihood and standard of living.</p> <p><strong>Challenges in studying NTD</strong><br />The primary challenge is adequate research funding and efforts. Affecting emerging economies, NTD severely suffers from the limelight that other lifestyle diseases such as cardiovascular, diabetes, and oncology enjoys. There was not much research output from the Western world too as NTD mostly affects the poorer nations. NTD related technologies are not considered profitable. This trend is slowly changing with larger participation from the government to aid in NTD research. We hope that future days will show more effort and awareness toward a better solution.</p> Ruby Dhar Arun Kumar Subhradip Karmakar Copyright (c) 2022 Asian Journal of Medical Sciences 2022-10-01 2022-10-01 13 10 1 2 10.3126/ajms.v13i10.47519 Eyes: conduit to COVID-19, relevance of eye protection, and face shield in ophthalmology waiting areas <p>COVID-19 pandemic caused by highly contagious Severe Acute Respiratory Syndrome Coronavirus 2 has affected the health and economy of the population worldwide. A major route of transmission of coronavirus is through respiratory system by aerosols and microdroplets. Virus can also spread by direct or indirect touching of the inmate objects harboring live virus. Virus can gain access through the nasal and oral ororopharyngeal mucosa. Coronavirus has been isolated from the ocular surface and tearfilm. Severe Acute Respiratory Syndrome Coronavirus 2 has been documented to drain from the ocular surface to oropharyngeal mucosa through tears. In the preventive measures, the mask acts as a<br />barrier to touch and aerosol transmission and its use has been advocated all over the world. Transmissions through eyes (ocular surface and tear film) are possible, however, compared to the aerosol transmission the risk may be small. The use of glasses, safety goggles and face shields may provide protection to eyes from contamination and minimizes the risk of transmission from the ocular surface and tear film. In this review, the authors aim to highlight the role of the ocular surface and tear film in the transmission and possible measure to prevent the infection through the eyes.</p> Rajan Sharma Mamatha Balakrishna Parul Chawla Nagesha K Chokkahalli Ashok Sharma Rekha Gyanchand Jagat Ram Copyright (c) 2022 Asian Journal of Medical Sciences 2022-10-01 2022-10-01 13 10 279 283 10.3126/ajms.v13i10.45706 An epidemiological study to determine demographic factors influencing COVID-19 IgG antibody production among the adult population of urban area in Malegaon, Maharashtra - A cross sectional study <p><strong>Background:</strong> Seroprevalence of COVID-19 antibody production in a person can be dependent on many physiological and demographic aspects such as previous infection, age, sex, body mass index, and also status of vaccination. It is of immense value to know about demographic aspect of COVID-19 antibody production so as to know about vulnerable population and suggest preventive measures.</p> <p><strong>Aims and Objectives:</strong> The present study was aimed to determine effect of demographic variables COVID-19 antibody production in population of urban area.</p> <p><strong>Materials and Methods:</strong> In this study, a total of 2454 subjects were screened for COVID-19 neutralizing antibody by ELISA technique. Subjects more than 18-year-old were selected for the study. We used cluster sampling method for data collection. A pre-structured questionnaire was administered after informed consent and 5 mL venous blood was collected in plain bulb for testing.</p> <p><strong>Results:</strong> The prevalence of neutralizing antibody was found to be 93.9%. Female had 95% positive antibodies against males (92.34%). Maximum positive antibody status was seen in age group of 20–40 (55.6%). About 77.9% subjects following mixed diet were having positive COVID-19 antibody test as compared to subjects following pure vegetarian (10.2%). About 83.2% subjects who received vaccine showed positive antibody test. The lowest positivity is seen in underweight subjects (8%) followed by obese subjects (12.7%). Maximum inhibition % was seen in subjects using Vitamin C Zinc tablets (92.1%). The lowest inhibition was seen in subjects using Unani Kadha. A one-way ANOVA revealed that there was not a statistically significant difference in prophylactic measures for prevention of COVID-19 infection other than vaccination and COVID-19 neutralizing antibody inhibition %. ([F-1.363], P=0.244).</p> <p><strong>Conclusion:</strong> COVID-19 neutralizing antibody prevalence was found to be much higher in the population (96%), which was mostly associated with younger age, gender, diet, and vaccination status of the population. Extensive studies are required to establish any association between prophylactic methods other than vaccination and COVID-19 antibody response.</p> Nirmalkumar Adhar Rawandale Vikrant Sayaji Pagar Madhuri Magan Suryawanshi Sushant Shamrao Chavan Jinendra Mohan Jain Pallavi Supriya Prabhakar Saple Madhuri Rajeev Kanitkar Copyright (c) 2022 Asian Journal of Medical Sciences 2022-10-01 2022-10-01 13 10 3 11 10.3126/ajms.v13i10.46722 COVID-19 appropriate behavior: Are the health care workers of Arunachal Pradesh competent enough to fight the pandemic? <p><strong>Background:</strong> COVID-19 is caused by coronavirus, first identified in Wuhan, China in December 2019, spread rapidly across international borders, and was declared pandemic on March 11, 2020. Occupation hazards such as close patient contact, suboptimal hand washing, inadequate use of personal protective equipment (PPE), and breach in infection control measures pose higher risk to health care workers (HCWs).</p> <p><strong>Aims and Objectives:</strong> The objectives of the study are as follows: (1) To assess knowledge, beliefs, and practices of HCWs of a tertiary care hospital in Arunachal Pradesh regarding COVID appropriate behavior. (2) To create awareness and thereby prevent the spread of infections.</p> <p><strong>Materials and Methods:</strong> A stratified sampling technique was applied to identify the study participants. A pre-tested and semi-structured questionnaire was administered to assess their knowledge, beliefs, and practices toward COVID-19. All departments (study units) were enlisted, all the HCWs were stratified according to their profession, for example, doctors, nurses, pharmacists, laboratory technician, and other HCWs. From each stratum, HCWs were randomly selected using simple random sampling and interviewed.</p> <p><strong>Results:</strong> We found, 96.18% wore mask properly, 74.81% maintained physical distancing, and 55.34% greeted without physical contact while only 24.05% maintained respiratory hygiene. Mask was observed to be the most commonly known preventive measure (85.5%), followed by hand hygiene (69.47%), physical distancing (56.49%), and PPE kits (17.56%). It was observed that 53.44% of HCWs relied on government source of information.</p> <p><strong>Conclusion:</strong> Most of the HCWs were practicing COVID appropriate behavior and the vaccination coverage was high among the HCWs (up to 2nd dose).</p> Pallavi Boro Debarshi Paul Mandula Prashanth Kumar Kimo Ori Anoop Dev Copyright (c) 2022 Asian Journal of Medical Sciences 2022-10-01 2022-10-01 13 10 12 17 10.3126/ajms.v13i10.45601 SARS-CoV-2 and human milk presence of virus and antibodies in just delivered mothers and possible transmission to the babies: An observational study over a period of 1 year in the state of Mizoram <p><strong>Background:</strong> Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a very virulent and contagious coronavirus and has caused a pandemic of acute respiratory disease, named “Coronavirus disease 2019” (COVID-19) that emerged in the late 2019. In breast milk (BM), presence of SARS-CoV-2 virus and its antibodies have been examined.</p> <p><strong>Aims and Objectives:</strong> The current observational study was conducted over a period of 1 year in the state of Mizoram to investigate the presence of SARS-CoV-2 virus and antibodies in pregnant mothers and their newborn along with breast milk.</p> <p><strong>Materials and Methods:</strong> A total of 115 breast milk samples and 70 breast swabs (before or after breast washing) from 115 women who were recently diagnosed with COVID-19 were collected. Samples were analyzed for SARS-CoV-2 RNA using RT-PCR. Breast milk was also analyzed for SARS-CoV2, IgA, and IgG receptor binding domain (RBD), S2 subunit of the spike protein of SARS-CoV-2.</p> <p><strong>Results:</strong> BM RTPCR was found to be positive 78 and 37 BM samples were found to be negative for RTPCR. Among the infants, 32 were exclusively on breastfeed and 83 were mixed feeding infants. Post-breastfeeding four infants were shown the signs and symptoms of COVID-19. IgA and IgG RBD and S2 subunit of the spike protein of SARS-CoV-2 antibodies were positive in 17, 16, and 12 BM samples which show that maternal antibodies to be developed in BM take time for production and the mothers infected almost 10 days ago, only showed presence of those antibodies.</p> <p><strong>Conclusion:</strong> Our findings have shown increase admissions of COVID-19 infected antenatal mothers with positive outcome despite the requirement of intensive care. SARS-CoV-2 was detected in BM which was significantly high, but there was no transmission to the babies during the postnatal period.</p> Elizabeth Lalhmangaihzuali Fanai Zonuntluangi Khiangte Lalrintluangi Chhakchhuak Swagnik Roy Jenny Lalduhawmi Ralte Remthangpuii Gracy Laldinmawii Zomuanpuii Colney John Zohmingthanga Copyright (c) 2022 Asian Journal of Medical Sciences 2022-10-01 2022-10-01 13 10 18 22 10.3126/ajms.v13i10.45550 Demographic and Mortality Trends across three COVID-19 waves in Kashmir Division, India <p><strong>Background:</strong> The demographic profile and fatality varied across different waves with the appearance of new variants. Further the trends varied from country to country and within the country. We have analyzed the trends from a selected geographic area.</p> <p><strong>Aims and Objectives:</strong> To assess the trends in COVID-19 cases and deaths and to compare the characteristics of three different COVID-19 waves in Kashmir Division.</p> <p><strong>Materials and Methods:</strong> It is a cross sectional study based on secondary data.</p> <p><strong>Results:</strong> The mean age of deaths increased from 64.53 years in first wave to 65.02 years in the second wave and further to 69.23 years in the third wave (p-value = 0.006). An overall CFR of 0.85% was observed in our population with a maximum case fatality of 1.67% in first wave followed by 0.79% in second wave and only 0.13% in third wave (p &lt; 0.0001). Lowest CFR of 0.04% was observed in the age group of &lt;20 years and maximum CFR of 6.12% was observed in the subjects with age more than 60 years. It was also observed that the CFR increased with the increase of age across all the three waves (p &lt; 0.0001).</p> <p><strong>Conclusion:</strong> Our study suggests that the Case Fatality Ratio declined with time despite new variants appearing which spread at very fast rate. The mortality remained higher in elderly and in males in all the three waves.</p> Tahir Ahmad Magray Umar Nazir Rouf Hussain Rather Feroz Ahmad Wani Copyright (c) 2022 Asian Journal of Medical Sciences 2022-10-01 2022-10-01 13 10 23 28 10.3126/ajms.v13i10.47234 Comparison of intravenous route versus nebulization of magnesium sulfate (MgSO4) for post-operative sore throat and hoarseness: A randomized comparative double-blinded clinical trial <p><strong>Background:</strong> Multiple drugs in different routes have been studied for the treatment of post-operative sore throat (POST). We are studying effect of magnesium sulfate on POST in two different routes.</p> <p><strong>Aims and Objectives:</strong> This study aims to compare the efficacy of nebulization versus intravenous (IV) magnesium sulfate in reducing incidence of POST and hoarseness of voice.</p> <p><strong>Materials and Methods:</strong> This prospective randomized double-blind study was done on 150 patients undergoing unilateral percutaneous nephrolithotomy (PCNL) surgeries under general anesthesia. Patients were randomly allocated into Group N (n=75) and Group I (n=75). Group N received 10 mg/kg MgSO4 in 5 mL of normal saline as nebulization 20 min before induction and 100 mL normal saline IV over 20 min post-induction. Group I received 5 mL of normal saline as nebulization pre-induction and 10 mg/kg MgSO4 in 100 mL saline IV over 20 min post-induction. Postoperatively, visual analog scale (VAS) score was used for the assessment of sore throat at rest and dynamic VAS (DyVAS) for pain during swallowing at the 0, 1st, 6th, 12th, and 24th h. Post-operative hoarseness graded on 4-point score was also assessed.</p> <p><strong>Results:</strong> Incidence of POST in Group N was 29.17% compared to 52.86% in Group I at 0 h which was lower and statistically significant and results were alike at the 1st and 6th h. The VAS at rest and DyVAS were lower and statistically significant in Group N compared to Group I at the 0, 1st, and 6th h.</p> <p><strong>Conclusion:</strong> Incidence of POST was significantly less with nebulized route of magnesium sulfate compared to IV route of magnesium sulfate.</p> Rashmi Raghavendra Surekha Kumar Sowmya Madihalli Janardhan Iyengar Copyright (c) 2022 Asian Journal of Medical Sciences 2022-10-01 2022-10-01 13 10 29 34 10.3126/ajms.v13i10.45314 Comparing efficacy of oral clonidine and gabapentin premedication for post-operative pain and analgesic requirement in patient undergoing laparoscopic cholecystectomy: A prospective, double-blind, and placebo-controlled study <p><strong>Background:</strong> Post-operative pain is an area, which has been receiving an increasing amount of attention in recent years. Pain associated with laparoscopic cholecystectomy has been an area of interest for many, various modalities have been tried for pain relief.</p> <p><strong>Aims and Objectives:</strong> The study aimed at comparing analgesic efficacy of oral clonidine and gabapentin premedication on post-operative pain and analgesic requirement in patients undergoing laparoscopic cholecystectomy.</p> <p><strong>Materials and Methods:</strong> Ninety patients of American Society of Anesthesiologists Status I and II, between 20 and 60 years undergoing elective laparoscopic cholecystectomy, were randomized into three groups. Group C received 150 mcg of clonidine, Group G received 600 mg of gabapentin, and Group P received placebo multivitamin tablets 2 h before surgery. The primary objective was to study the duration of post-operative analgesia and total rescue analgesic required. The secondary objective was to find out any sedation and adverse effect associated with the use of premedicant drugs.</p> <p><strong> Results:</strong> The duration of analgesia was found to be highest in Group G (174.33±85.81 min) than in Group C (77.17±63.99 min) and Group P (29.33±14.55 min). Total dose of tramadol consumption in 6 h was highest in Group P (91.67±23.06 mg) with statistically insignificant difference between Group G (46.67±12.69 mg) and Group C (48.33±9.13 mg). No statistically significant adverse event was noted in post-operative period.</p> <p><strong>Conclusion:</strong> The use of oral clonidine and gabapentin 2 h before laparoscopic cholecystectomy significantly prolongs duration of post-operative analgesia and decreases the requirement of rescue analgesics without causing any significant adverse events.</p> Ravi Prakash Amey Dixit Kuldeep Kumar Patel Ashish Malik Copyright (c) 2022 Asian Journal of Medical Sciences 2022-10-01 2022-10-01 13 10 35 41 10.3126/ajms.v13i10.45697 I-GEL versus LMA classic: Comparison of two supraglottic airway devices in short surgical procedures <p><strong>Background:</strong> Supraglottic airway devices are more efficient than endotracheal intubation in management of difficult airway and hemodynamic response.</p> <p><strong>Aims and Objectives:</strong> This study was undertaken for to compare laryngeal mask airway (LMA) Classic and I-Gel in terms of ease of insertion, insertion attempts, time taken for insertion, hemodynamic change, and adverse events after administering muscle relaxants for airway management in short surgical procedures.</p> <p><strong>Materials and Methods:</strong> A total of 120 patients of American Society of Anaesthesiologist 1 and II, aged between 18 and 50 years with Malampatti score 1 and II posted for elective short surgical cases were randomly allotted into two groups (n=60 in each), Group A for LMA Classic and Group B for I-gel. Patients were pre oxygenated with 100% O2 and pre-medicated. After induction and proper muscle relaxation, LMA Classic or I-GEL was inserted. The time and number of insertion attempts were assessed. Heart rate, Blood pressure, SpO2 recorded at the time of insertion, 1, 3, 5, and 10 min following insertion. The recorded results were analyzed statistically.</p> <p><strong>Results:</strong> The mean insertion time of Group A was 34.80±3.193 and Group B was 21.72±1.975. P&lt;0.001 and in Group B all patients were successfully intubated at first attempt whereas in Group B 23.33% patients required second attempts. Hemodynamic changes were also less with Group B.</p> <p><strong>Conclusion:</strong> I-Gel has better hemodynamic stability. Ease of Insertion, insertion attempts and time taken for insertion are more convenient for I-Gel than LMA Classic after administering muscle relaxants.</p> Tinamoni Biswas Manisankar Nath Amitayu Nandi Purba Haldar Mousumi Neogi Copyright (c) 2022 Asian Journal of Medical Sciences 2022-10-01 2022-10-01 13 10 42 46 10.3126/ajms.v13i10.45058 Efficacy of clonidine as an additive to levobupivacaine for epidural anesthesia and post-operative analgesia in infraumbilical surgeries – A randomized and double blind study <p><strong>Background:</strong> Epidural anesthesia as a safe alternative to general anesthesia is commonly used for inducing anesthesia and post-operative analgesia in patients undergoing infraumbilical surgeries. The addition of an adjuvant not only increases the effectiveness of a local anesthetic by prolonging and intensifying the sensory blockade but also causes reduction in the dose of rescue analgesic agent in post-operative period. Clonidine is a potent and selective α-2-adrenoceptor agonist with analgesic potency.</p> <p><strong>Aims and Objectives:</strong> This study was conducted to evaluate the efficacy of clonidine as an additive to levobupivacaine in infraumbilical surgeries.</p> <p><strong>Materials and Methods:</strong> One hundred patients of American Society of Anesthesiologists Grade I or II who were undergoing infraumbilical surgery were randomly divided into two groups as levobupivacaine (L) and levobupivacaine with clonidine (LC). Patients were allocated to one of the two groups by computer generated random selection. Group L received 0.5% levobupivacaine (1.5 mg/kg) and Group LC received 0.5% levobupivacaine (1.5 mg/kg) with clonidine (2 μg/kg). The onset time for sensory, motor blockade, duration of anesthesia and duration of analgesia, and Visual Analog Scale (VAS) score were observed in both the groups. The hemodynamic variables such as heart rate, systolic and diastolic blood pressure, respiratory rate, and oxygen saturation at various time intervals were measured. Any untoward side effects were noted in both groups.</p> <p><strong>Results:</strong> The onset of sensory (7.8±1.7 min) and motor blockade (10.9±1.9 min) were significantly faster in clonidine group. Duration of anesthesia and duration of analgesia were prolonged in Group LC (234.5±16.1 min, 412.8±48.3 min) compared to Group L (173.56±12.78 min, 269.2±24.2 min) which was statistically significant (P&lt;0.05). Similarly, clonidine group had less VAS score compared to control group. There was no significant change in the hemodynamic variables between the two groups. Hypotension and bradycardia were found more in clonidine group compared to the control group.</p> <p><strong>Conclusion:</strong> Clonidine as an adjuvant to levobupivacaine prolongs the post-operative analgesia and the duration of anesthesia for infraumbilical surgeries.</p> Arunkumar Arumugam Bharti Badlani Puja Singh Sonali Tripathi Copyright (c) 2022 Asian Journal of Medical Sciences 2022-10-01 2022-10-01 13 10 47 53 10.3126/ajms.v13i10.45813 Comparison of norepinephrine and phenylephrine boluses during spinal anesthesia for cesarean delivery <p><strong>Background:</strong> Cesarean sections are frequently carried out under spinal anesthesia (SA) to reduce the risk of neonatal drug transfer and airway difficulties associated with general anesthesia. Maternal hypotension is a typical consequence following SA, despite sufficient fluid loading.</p> <p><strong>Aims and Objectives:</strong> The aim of this study was to evaluate the efficacy of norepinephrine and phenylephrine in treating spinal hypotension caused by cesarean delivery.</p> <p><strong>Materials and Methods:</strong> This hospital-based interventional study was carried out at Sri Venkateswaraa Medical College Hospital and Research Centre, Ariyur, Puducherry from February 2020 to March 2022. Eighty patients were included in our trial and were split equally into two groups at random following approval by an ethical committee and written informed consent. Age, weight, height, and American Society of Anesthesiologists physical state of the patients was equivalent across the two groups.</p> <p><strong>Results:</strong> In our study, mean age found in N group (25.96±2.046) and P group (24.84±1.748) which were insignificant. Vasopressor bolus dose needed for the treatment of hypotension was considerably less in<br />Group N patients (1.71±0.77 vs. 2.43±1.01, P=0.024). Group P had a higher incidence of bradycardia, although the difference was statistically insignificant (four patients vs. eight patients P=0.242). The fetal parameters such as birth weight, umbilical PH, PCO, PO2, and Apgar 1 and 5 min were comparable across the two groups, and no statistically significant differences were found.</p> <p><strong>Conclusion:</strong> Intermittent norepinephrine boluses are a successful treatment for spinal hypotension during cesarean delivery. We found no evidence that norepinephrine had a detrimental effect on the newborn outcome as compared to phenylephrine, when used to maintain blood pressure during spinal and combined spinalepidural anesthesia for cesarean birth.</p> Chandraleela Sundararajan Chinthavali Sujatha Arthi Asokan Copyright (c) 2022 Asian Journal of Medical Sciences 2022-10-01 2022-10-01 13 10 54 58 10.3126/ajms.v13i10.47232 Role of pectoral nerve block (PECS II) in post-operative pain management for breast surgeries <p><strong>Background:</strong> Pain after breast surgeries is a major problem which costs both in patient comfort and duration of hospital stay. Uncontrolled post-operative pain may produce a range of detrimental acute and chronic effects. Optimal pain relief and minimal side effects following surgery have a major impact on patient outcome, including patient satisfaction and earlier mobilization, as well as fulfilling the needs for streamlined surgical services with lower costs.</p> <p><strong>Aims and Objectives:</strong> The aim of the study was to assess for the pain score during the first 24 h with time of the first request for rescue analgesic and total analgesic requirement and also to assess the patient‘s satisfaction for post-operative pain relief and consequences if any during the first 24 h.</p> <p><strong>Materials and Methods:</strong> This prospective study was conducted in 60 patients of ASA status I or II considering for mastectomy categorized into two groups, the first group with 30 patients who received Bupivacaine drug and second group with 30 patients who received normal saline. In the PACU, each patient’s VAS score and tramadol use were evaluated. The pectoral nerve block is a less invasive interfacial plane block used for post-operative pain relief in breast surgeries that involves deposition of local anesthetic between the pectoralis major and minor muscles, in addition to the serratus anterior and pectoralis minor muscles and the intercostal muscles, blocking the lateral branches of the intercostal nerves and the long thoracic nerve.</p> <p><strong>Results:</strong> We found a significant difference in total rescue analgesia intake among control and PECS II block groups, in an initial 24 h of surgery. In the control group, mean VAS score and total rescue analgesia intake in 24 h were statistically significant greater (P&lt;0.05).</p> <p><strong>Conclusion:</strong> We concluded that pectoral nerve block is an effective and easy technique for pain control and fast recovery in post-operative period following breast surgeries.</p> Mili Yadav Amey Dixit Arvind Kumar Rathiya Subhash Kumar Agrawal Copyright (c) 2022 Asian Journal of Medical Sciences 2022-10-01 2022-10-01 13 10 59 65 10.3126/ajms.v13i10.45812 A study to observe the effects of infusion of 6% Hydroxyethyl starch (130/0.4) on renal function in cardiac surgical patients <p><strong>Background:</strong> The possibility of nephrotoxic effect caused by hydroxy ethyl starch (HES) used as volume therapy in this particular setting is of major clinical concern. We conducted this retrospective study to look for the possible nephrotoxic effects and other systemic adverse effects if any, of 6% HES 130 kD, 0.4 DS used as intraoperative volume expander in the cardiac surgery setting.</p> <p><strong>Aims and Objectives:</strong> This study aims to determine whether the infusion of 6% hydroxyethyl starch (130/0.4) harms renal function in cardiac surgical patients.</p> <p><strong>Materials and Methods:</strong> The present study was a retrospective study. Sixty-six patients who received crystalloids with hydroxyethyl starch and a matched control of 66 patients based on age and sex and other baseline parameters who received crystalloids only were part of the study. The data extracted from the electronic medical record include patient demographics, details for additive EURO score, and pre-operative data that include details of comorbid illnesses, namely, hypertension and diabetes, plasma hemoglobin, serum creatinine, and eGFR.</p> <p><strong>Results:</strong> There is no statistically significant difference in serum creatinine and incidence of post-operative renal dysfunction between the study groups. There was a higher rate of re-exploration and duration of intensive care unit, and hospital stay.</p> <p><strong>Conclusion:</strong> In our study, HES 130/0.4 in the dose used as a plasma expander did not adversely affect renal function in cardiac surgical patients undergoing CABG. The study recommends further detailed studies in this area involving multiple centers.</p> Pradeep Kumar Das Bhyravajosula Koumudi Danda Vijaya Kumar Rajeswara Rao S Copyright (c) 2022 Asian Journal of Medical Sciences 2022-10-01 2022-10-01 13 10 66 70 10.3126/ajms.v13i10.46244 Pancreatic Beta-cell function and degree of Insulin resistance among newly detected type 2 diabetics and their correlation with anthropometric, glucose, and lipid parameters: An Observational cross-sectional study <p><strong>Background:</strong> Insulin resistance is a major cause for developing type 2 diabetes. However, simultaneously pancreatic beta-cell dysfunction must coexist in for clinical occurrence of type 2 diabetes (T2D). Hence, knowledge regarding residual beta-cell function and degree of insulin resistance is required while treating type 2 diabetic patients.</p> <p><strong>Aims and Objectives:</strong> The present study was done to estimate degree of insulin resistance (homeostatic model assessment insulin resistance - HOMA-IR) and pancreatic beta-cell functional capacity (HOMA-B%) among newly detected type 2 diabetics and correlation of these with anthropometric, glucose, and lipid parameters.</p> <p><strong>Materials and Methods:</strong> This was an observational cross-sectional study conducted in 100 newly diagnosed type 2 diabetic patients. Detailed anthropometric and clinical examination were carried out. Venous blood samples were drawn for fasting plasma glucose, c-peptide, fasting insulin level, hemoglobin A1C (HbA1C), lipid profile, and postprandial glucose. HOMA-IR and HOMA-B% were calculated using HOMA 2 calculator and correlations were calculated between the study variables.</p> <p><strong>Results:</strong> The mean age of the study population was 45.55±11.64 years and 58% of study participants were male. The mean HOMA-IR and HOMA-B% were 2.55±1.75 and 40.67±23.55%, respectively. HOMA-IR positively correlated with abdominal circumference, triglyceride to HDLc ratio, and negatively correlated with HDLc. There were statistically significant negative correlations between HOMA-B% and fasting glucose(r=−0.48, P&lt;0.001), 2 hr post prandial glucose (r=−0.37, P&lt;0.001 and HbA1C (r=−0.24, P=0.01).</p> <p><strong>Conclusion:</strong> This study found more reduced beta-cell function compared to reduced insulin sensitivity in new T2D mellitus patients. Hence, this kind of functional assessment needs to be done while selecting appropriate anti-diabetic drugs for a particular patient.</p> Avijit Saha Copyright (c) 2022 Asian Journal of Medical Sciences 2022-10-01 2022-10-01 13 10 71 76 10.3126/ajms.v13i10.46707 A prospective study on prevalence of thalassemic gene disorder and hemoglobinopathies in pregnancy: Antenatal and intranatal outcome in a hospital-based population of Eastern India <p><strong>Background:</strong> Thalassemia syndromes are autosomal recessive disorders and the most commonly inherited hemoglobinopathies in the world. Among these, β-thalassemia is the most common type of thalassemia in Eastern India and in West Bengal. Thalassemic mothers are more predisposed to maternal complications such as hypertensive disorders, gestational diabetes mellitus (GDM), and adverse neonatal outcome in terms of low birth weight, prematurity, etc. This study was to assess the effect of thalassemia gene disorder and hemoglobinopathies (thal-hbpathy) on fetomaternal health.</p> <p><strong>Aims and Objectives:</strong> This study was done to evaluate the effect of thal-hbpathy on fetomaternal health and to compare their antenatal, intranatal outcome with control unaffected mothers, and with anaemic non-thalassemic mothers.</p> <p><strong>Materials and Methods:</strong> This is a prospective and observational study of 150 women who attended tertiary care hospital during 18 months, fulfilling pre-defined inclusion and exclusion criteria. All women were evaluated during antenatal and intranatal period. Observations were recorded and interpreted.</p> <p><strong>Results:</strong> Among 150 participants, 80(53.3%) were having normal hemoglobin (Hb) level and normal hemoglobin high performance liquid chromatography(Hb-HPLC), 54(36.7%) had anemia (Hb &lt;10.9g/dl) with normal Hb pattern on HPLC, and 16(10.66%) had thal-hbpathy. Hb-HPLC revealed β-thalassemia trait in 7.3%, E β-thalassemia trait in 0.7%, whereas HbE heterozygous 2.7% in our study population. Majority (15/16) of thal-hbpathy patients were anemic. Oligo-hydramnios was detected in 18.7% of thalassemic women as compared to anemic (3.7%) and normal group (3.7%), which were significant. Obstetric cholestasis (OC) 12.5%(2/16) and intrauterine growth restriction (IUGR) were observed in thal-hbpathy group antenatal patients which were statistically significant P&lt;0.05.</p> <p><strong>Conclusion:</strong> Overall prevalence of thalassemia was 10.7%. The important fetomaternal complications observed were prematurity, IUGR, OC, oligohydramnios, OC(PIH), and GDM.</p> Mayuri Nita Singh Priyadarshini Nanda Rajib Roy Manisha Bajaj Copyright (c) 2022 Asian Journal of Medical Sciences 2022-10-01 2022-10-01 13 10 77 82 10.3126/ajms.v13i10.46458 The study of association of serum ischemia-modified albumin and prediabetes in women: A case–control study <p><strong>Background:</strong> Prediabetes, diabetes, and their associated complications adversely affect women’s health worldwide. Women in the reproductive age group are more prone for developing diabetes and its associated complications such as gestational diabetes and infertility. Hence, it is the need of the hour to diagnose women at risk of pre-diabetes. Oxidative stress, ischemia, and hypoxia have been suggested as important factors in developing prediabetes and its sequels.</p> <p><strong>Aims and Objectives:</strong> The present study aimed to study the association of serum ischemia-modified albumin (IMA), namely, a marker of oxidative stress, ischemia, and hypoxia with prediabetes in the women of reproductive age group.</p> <p><strong>Materials and Methods:</strong> The present study was carried out in 50 females in the reproductive age group of 19–45 years. The study population was further sub-divided into two groups: Group I consisted of 25 prediabetic patients and Group II consisted of 25 healthy controls. Serum samples of the subjects were analyzed for serum IMA, blood sugar profile, and other routine biochemistry tests.</p> <p><strong>Results:</strong> The present study showed that mean serum IMA was raised in prediabetic group as compared to healthy controls. The serum IMA also positively correlated with blood sugar profile.</p> <p><strong>Conclusion:</strong> Increased serum IMA could be used as a biomarker for predicting prediabetes in females of reproductive age group. This, in turn, would be helpful in preventing the burden of various complications known to occur in the natural course of prediabetes and diabetes.</p> Ashok Kumar Ahirwar Rashmi Jain Udit Choubey Ankit Jain Roshan Takhelmayum Apurva Sakarde Akash Mahadeo Pawar Bharatsing Deorao Rathod Copyright (c) 2022 Asian Journal of Medical Sciences 2022-10-01 2022-10-01 13 10 83 88 10.3126/ajms.v13i10.46117 Role of post-operative carcinoembryonic antigen as predictor of outcome: Evaluation of patients with colorectal malignancy at a tertiary care center <p><strong>Background:</strong> Colorectal cancer is the third most common cancer worldwide. The colorectal cancer has varied presentation and often patients present in late stages of disease. Pre-operative carcinoembryonic antigen (CEA) levels are indicative of tumor stage and thus are predictive of prognosis. However, the importance of post-operative CEA value is seldom discussed and utility of this clinically relevant parameter needs to be established to predict survival of subjects after surgical resection of tumor.</p> <p><strong>Aims and Objectives:</strong> This study aims to understand the colorectal malignancy in a group of population and evaluate its complexity, clinical presentations, modalities of treatment, and its complications. Furthermore, we aimed to access predictive utility of post-operative CEA levels for forecasting the long-term outcome in the patient.</p> <p><strong>Materials and Methods:</strong> All subjects with diagnosed cases of colorectal malignancy were included in the study. The subjects presenting complaints were clinically examined and the observations were noted. Colonoscopy and histopathological investigations were scheduled, and based on CT findings, further management was planned. Carcinoembryonic antigen levels were assessed in pre-operative and post-operative serum sample. Follow-up was done at regular intervals. CEA levels in subjects with different outcome were compared retrospectively.</p> <p><strong>Results:</strong> The most common age group of subjects with colorectal malignancies was 51–60 years. Bleeding per rectum was the most common symptom and the most common sign was per rectal palpable mass. Laparoscopic surgery had less hospital stay, less blood loss, and lower rate of wound site infection. The pre-operative CEA levels were found to be matched; however, post-operative CEA levels were found to be significantly elevated in non-survivor subjects compared to those who survived.</p> <p><strong>Conclusion:</strong> Patients with high post-operative CEA values should be closely followed up for relapse and dealt with more caution to reduce the mortality.</p> Sanjay Devidas Dakhore Shilpa Namdev Pande Suraj Govind Jadhao Nilesh Parashuram Mangam Dnyanesh Balkrishna Amle Copyright (c) 2022 Asian Journal of Medical Sciences 2022-10-01 2022-10-01 13 10 89 94 10.3126/ajms.v13i10.45781 Evaluation of diabetic foot ulcer with reference to demography, clinical presentation, and imaging modalities for diagnosis: An observational study <p><strong>Background:</strong> Demography and clinical presentation of diabetic foot ulcer varies across geographical location. Multiple imaging modalities such as plain radiography and magnetic resonance imaging (MRI) are used to evaluate osteomyelitis or neuroarthropathy in diabetic foot. Plain radiography is a low cost and easily available test while MRI is reported to be of higher sensitivity and specificity for delineating the extent of soft tissue and bone involvement.</p> <p><strong>Aims and Objectives:</strong> The study was designed to determine the spectrum of demographic and clinical findings and to find the utility of different diagnostic modalities such as clinical, plain radiography, and MRI that were used to differentiate between osteomyelitis and neuroarthropathy.</p> <p><strong>Materials and Methods:</strong> After obtaining permission of Institute’s Ethics Committee’s permission, this observational study was carried out among patients, males and females aged 13 years and above, who presented with diabetic foot ulcer for treatment. The study spanned from March 2020 to August 2021 to reach a sample of 50 patients following non-random purposive sampling. A pro forma (containing history, physical examination findings, and laboratory investigations) was used to explore patient data. Besides clinical diagnosis, plain radiography and MRI were used to evaluate the clinical findings.</p> <p><strong>Results:</strong> In the study, most of the subjects were between 51 and 70 years of age having diabetes for a duration of 5–15 years. The basis of complications observed is infections, ischemia, and neuroarthropathy. Among the diagnostic modalities used to reach a diagnosis of osteomyelitis or neuroarthropathy, MRI was able to pick up the diagnosis in a greater number of patients for above two entities. Osteomyelitis was identified in 24 (48%) patients and neuroarthropathy was identified in 22 (44%) patients. Use of plain radiography helped in reaching diagnosis in 30% of patients for each category. Clinical diagnosis about osteomyelitis or neuroarthropathy was made in 22% and 26% of patients, respectively. However, on analysis, it was not significant.</p> <p><strong>Conclusion:</strong> The present study showed a male preponderance. Moreover, MRI was able to categorically diagnose different pathological parameters of osteomyelitis and neuroarthropathy. Marrow edema was detected in a larger proportion of patients among the MRI-diagnosed cases of osteomyelitis and neuroarthropathy. MRI appears to be more useful than plain radiography for clinical diagnosis.</p> Sanjay Maitra Kaushik Biswas Sangita Mandal Aditya Chowdhury Mohanchandra Mandal Copyright (c) 2022 Asian Journal of Medical Sciences 2022-10-01 2022-10-01 13 10 95 100 10.3126/ajms.v13i10.47843 Risk factors associated with prediabetes and cardiovascular disease: A perceptive study <p><strong>Background:</strong> Diabetes mellitus is emerging as a major health problem due to its serious complications. It is important to assess the various factors contributing to the occurrence of the diseases so that by limiting these factors the progression of the disease in patients can be controlled. Prediabetes is a state characterized by impaired fasting glucose or impaired glucose tolerance.</p> <p><strong>Aims and Objective:</strong> The present study was undertaken to determine the risk factors for Type 2 diabetes mellitus (T2DM) among adults, prediabetic subjects were identified from first degree relatives of T2DMpatients.</p> <p><strong>Materials and Methods:</strong> The present observational study was carried out at Department of Physiology, S.P. Medical College and Hospital in collaboration with diabetic research center P.B.M. hospital Bikaner (Rajasthan). Prediabetic subjects were identified from first degree relatives of T2DMpatients, enrolled in diabetic research center P.B.M. hospital Bikaner. Prediabetics (impaired fasting glucose) subjects were identified on the basis of fasting blood glucose 100–125 mg/dL and HbA1C (5.7–6.4%) as per American Diabetic Association (ADA) 2011 guidelines. Consecutive sampling was conducted till sample size satisfied during the period of study. Subjects of age group 20–74 years having FPG between 100 and 125 mg/dL, HbA1C between 5.7% and 6.4%, and gave informed written consent were included in study. Pre-structured performa was used to collect general information, sociodemographic information, baseline physical characteristics, personal habits, biochemical analysis, and for blood parameters.</p> <p><strong>Results:</strong> Age, occupation, body mass index (BMI), diet, smoking, alcohol, truncal obesity, and family history of DM were significantly associated with prevalence of T2DM/prediabetes whereas gender and literacy were not.</p> <p><strong>Conclusion:</strong> In the present study, it was observed that advanced age, occupational changes, BMI, substance abuse such as alcohol and smoking, truncal obesity, and family history of diabetes were highly associated risk factors for T2DM whereas literacy, gender, and central obesity showed no association with risk of T2DM.</p> Neeta Kumari Deepak Kumar Verma Bijendra Kumar Binawara Copyright (c) 2022 Asian Journal of Medical Sciences 2022-10-01 2022-10-01 13 10 101 107 10.3126/ajms.v13i10.45148 Impact of polypharmacy in older patients with type 2 diabetes in rural population in South India <p><strong>Background:</strong> The World Health Organization describes polypharmacy as a safe and efficient treatment that complies with evidence-based medicine and uses at least five different medications.</p> <p><strong>Aims and Objectives:</strong> The aim of our study was to investigate the impact of polypharmacy in older patients with type 2 diabetes mellitus (T2DM) in rural population in South India.</p> <p><strong>Materials and Methods:</strong> The study comprised a total of 100 patients, who were referred to the Government General Hospital, Nizamabad, between January 2020 and March 2022. The records of 50 randomly chosen non-diabetic patients who visited our hospital for other ailments were compared to those of the 50 T2DM patients.</p> <p><strong>Results:</strong> In this study, a total of 100 patients were enrolled, out of which 62 were male (62%) and 38 were female (38%). The duration of diabetes was noted to be 0–5 years in 28 patients, 6–10 years in<br />52 patients and &gt;10 years in 20 patients. In our study, we observed that more than five drugs were prescribed to 45 patients in the case group and only ten patients in the control group.</p> <p><strong>Conclusion:</strong> Our study shows that older adults with diabetes have a high prevalence of polypharmacy and that this condition may have a significant impact on a number of health-related outcomes. Each patient should receive a customized course of treatment with the right number of medications for their particular ailment. The danger of side effects increases with the number of medications.</p> Sanjeev Kumar Adepu Madhukar Sirasu Gudas Ravinder Copyright (c) 2022 Asian Journal of Medical Sciences 2022-10-01 2022-10-01 13 10 108 111 10.3126/ajms.v13i10.47279 Association of uric acid as a risk factor in ischemic stroke – A hospital-based observational study <p><strong>Background:</strong> The second most prevalent cause of mortality globally, next to coronary artery disease, is stroke. In humans, uric acid is the final catabolite in the metabolism of purine.</p> <p><strong>Aims and Objectives:</strong> The aims of this study were to determine the importance of blood uric acid levels in stroke patients in South Indian population.</p> <p><strong>Materials and Methods:</strong> In this observational study, we evaluated acute stroke patients who were admitted to Melmaruvathur Adhiparasakthi Institute of Medical Sciences and Research (MAPIMS) Hospital from December 2021 to May 2022. One hundred patients meeting the inclusion standards were enrolled and divided into two groups randomly following acquisition of ethical approval and informed consent.</p> <p><strong>Results:</strong> In our study consisting of both study and control groups, low-density lipoprotein cholesterol (P=0.034), non-high-density lipoprotein cholesterol (HDL-C) (P=0.0127), total cholesterol (P=0.0196), HDL-C (P=0.042), and triglyceride (P=0.0266) were found to be statistically significant. Mean serum uric acid (SUA) level between cases (6.94±1.97 mg/dL) and controls (5.49±1.27 mg/dL) were also statistically significant (P=0.0306 and P=0.049).</p> <p><strong>Conclusion:</strong> Our study showed that stroke patients had a significant occurrence of hyperuricemia. In keeping cardiovascular risk factors such as diabetes, hypertension, triglyceride level, total cholesterol level, coronary heart disease, and tobacco use under control, SUA was observed to be substantially linked with the initial phase of ischemic stroke.</p> Jegan Mohan Yogiswaran Sasthanathan Ganesan Sathyan Elangovan Copyright (c) 2022 Asian Journal of Medical Sciences 2022-10-01 2022-10-01 13 10 112 116 10.3126/ajms.v13i10.47267 Acute pancreatitis and its association with dyslipidemia <p><strong>Background:</strong> Pancreatitis is described as any inflammation that manifests in acute or chronic forms in the pancreas. Acute pancreatitis (AP) is a quick attack that results in pancreatic inflammation and affects the peripancreatic tissue and surrounding organ.</p> <p><strong>Aims and Objectives:</strong> This study aims to evaluate lipid profile tests in AP patients.</p> <p><strong>Materials and Methods:</strong> The present study was conducted in the Department of General Surgery, Government Medical College, Nizamabad, India, prospectively from July 2019 to May 2022. In our study, we enrolled 100 patients between the age of 20 and 60 and divided them into two groups by random selection. We chose 50 consecutive cases of pancreatitis for the study group and 50 other hospitalized patients for the control group.</p> <p><strong>Results:</strong> Mean age of the case group and control group was found to be 39.17±7.42 and 41.92±9.1, respectively. We observed that the peak incidence of pancreatitis occurred between the ages of 40 and 70, with a male predominance in all age categories. When compared to control, low-density lipoprotein cholesterol (P=0.715), total cholesterol (P=0.3124), high-density lipoprotein cholesterol (HDL-C) (0.164), non-HDL-C (0.2436), and triglyceride (P=0.1266) of the study group were found to be statistically non-significant.</p> <p><strong>Conclusion:</strong> It is determined that serum lipid profile and pancreatitis are frequently linked. To reduce the risk of developing this disease, prevent its underlying complications, and manage the possibility of subsequent recurrences, patients with the aforementioned risk factors should be assessed for any changes in their serum lipid profile. If such an alteration is discovered, they should be treated with antilipidemic medications, dietary modification, lifestyle change, and physical activity.</p> Gudas Ravinder Ramchandraiah Chintalaboguda Sanjeev Kumar Adepu Copyright (c) 2022 Asian Journal of Medical Sciences 2022-10-01 2022-10-01 13 10 117 120 10.3126/ajms.v13i10.47245 A study of “rational use of investigations” in a tertiary hospital <p><strong>Background:</strong> Rational laboratory use is defined as effective and correct laboratory use by providing the most appropriate test selection with the right clinical approach in line with the evidence-based data and considering the cost and patient safety. The present study was thus conducted for the prevalence and features associated with rational use of investigations in a tertiary hospital.</p> <p><strong>Aims and Objectives:</strong> The objectives of the study were to estimate prevalence of rational use of investigations and its associated confounding factors; to explain the educational approach underlying the study; and to explain how to teach rational approach of investigations so that we reduce the use of unnecessary and inappropriate tests which are not likely to have any ill effects on the patient.</p> <p><strong>Materials and Methods:</strong> A cross-sectional study including 100 patients was selected by random sampling from medicine and orthopedic wards and OPD.</p> <p><strong>Results:</strong> In our study,we observed 29 different types of clinical and laboratory investigations out of 2155 investigations ordered by physicians before any intervention. These investigations done in 100 patients, among those 39.16% were contributed to the management of patients and 60.83% were not considered to have contributed toward management of patients.</p> <p><strong>Conclusion:</strong> Several external and internal factors can promote irrational use of investigation at different stages. Hence, understanding these factors and implementing appropriate measures are key steps to change behavior of prescriber and nursing staff. We must have logic-based flow chart or algorithm in all investigations for diagnosis as a part of good laboratory or good clinical practices.</p> Gulab Kanwar Shivprakash Rathore Arpit Khandelwal Divya Khandelwal Ankur Khandelwal Rajmal Meena Manna Lal Kumawat Copyright (c) 2022 Asian Journal of Medical Sciences 2022-10-01 2022-10-01 13 10 121 125 10.3126/ajms.v13i10.45449 Clinico-mycological profile and trichoscopic findings among pediatric tinea capitis patients: A cross-sectional study from northern India (Haryana) <p><strong>Background:</strong> Tinea capitis (TC) is the most common cause of hair loss in pediatric patients leading to varied manifestations. Essentially, TC is a superficial infection which affects hair shaft, hair follicle, and the scalp.</p> <p><strong>Aims and Objectives:</strong> The aims of this study were to describe the clinic-mycological characteristics and trichoscopic findings of TC among pediatric patients.</p> <p><strong>Materials and Methods:</strong> This cross-sectional study was undertaken in Shaheed Hasan Khan Mewati, Government Medical College and Hospital after obtaining approval from the Institutional Ethics Committee. All the pediatric patients of TC enrolled during the study period of 1.5 year (between January, 2020 and June, 2021). Trichoscopy was performed and findings were recorded on a predesigned pro forma. All participants were clinically examined and sample of hair and scalp scrapping was taken for mycological investigation (potassium hydroxide [KOH] and Sabouraud Dextrose Agar culture).</p> <p><strong>Results:</strong> Among 100 children of TC (M/F=2.2), gray patch type TC was most common, whereas pustular variant was least common. Trichoscopic findings were seen in all 100 cases with short broken hair being most common. Perifollicular scaling was statistically significant in gray patch TC, black dot, and comma shape in black dot TC and, crock screw hair and thick crust in kerion TC. By combining perifollicular scaling, comma hair, short-broken hair, black dot, and erythema, a sensitivity of 98.8% was achieved. KOH revealed fungal spore/hyphae in 79% patients with ectothrix pattern (56.9%) more commonly than endothrix pattern (34.2%). Trichophyton violaceum (25.9%) was the most common species isolated among culture positive patients.</p> <p><strong>Conclusion:</strong> Trichoscopy could be a simple, valuable, non-invasive, rapid, and easy to perform method for diagnosing tinea capitis in resource poor settings, where mycological culture facility is not available and in situations where delay in treatment can be counterproductive.</p> Ashish Dalal Suraj Chawla Prakriti Vohra Jyoti Sangwan Janshruti Copyright (c) 2022 Asian Journal of Medical Sciences 2022-10-01 2022-10-01 13 10 126 132 10.3126/ajms.v13i10.44730 A study on cervical lymphadenopathy in a rural based teaching hospital in India <p><strong>Background:</strong> Presence of cervical lymphadenopathy may indicate serious systemic disease process. Proper evaluation of cervical lymphadenopathy is of extreme clinical importance.</p> <p><strong>Aims and Objective:</strong> The study objective was to evaluate clinical and demographic profile of cervical lymphadenopathy, to find the etiology, and to study the role of fine-needle aspiration cytology (FNAC) in it’s etiological diagnosis.</p> <p><strong>Materials and Methods:</strong> Prospective observational study was carried out in a rural based teaching hospital in India for 1 year. One hundred and twenty-one patients of more than 12 years of age from both genders were included in the study. Detailed history, clinical, blood examination, radiological, microbiological evaluation, and FNAC from lymph node were done for all patients. Excision biopsy was done for selective cases.</p> <p><strong>Results:</strong> It was a male predominant study with male: female ratio of 1.12:1 and mean age of the patient was 34.54 years. Cervical lymphadenopathy was mostly unilateral (77.69%) and it was more common in the right side (43.80%). Tuberculosis (TB) (36.37%) was the most common cause of cervical lymphadenopathy in our study followed by reactive hyperplasia of lymph node (23.14%) and metastatic deposit (19%). Among metastatic deposit, 9 (39.13%) had squamous cell carcinoma, 5 (21.74%) had adenocarcinoma, and 1 (4.35%) had small cell carcinoma.</p> <p><strong>Conclusion:</strong> TB is the most common cause of cervical lymphadenopathy followed by reactive hyperplasia and metastatic secondary deposit. FNAC is a simple inexpensive relatively painless rapid and reliable method for diagnosis which can be considered as a frontline investigation and can guide requirement for further investigation in the management of cervical lymphadenopathy.</p> Aparup Dhua Pranab Mandal Priya Ranjan Chattopadhyay Santu Kumar Samanta Copyright (c) 2022 Asian Journal of Medical Sciences 2022-10-01 2022-10-01 13 10 133 137 10.3126/ajms.v13i10.45766 Comparative evaluation of placental elasticity in normal pregnancy and pregnancy-induced hypertension and its association with uterine artery pulsatility index and fetal outcome <p><strong>Background:</strong> Pregnancy-induced hypertension (PIH) is associated with significant maternal as well as fetal morbidity and untreated cases may be associated with poor pregnancy outcomes. It brings about various histological and morphological changes in the placenta such as infarcts, fibrosis, and calcification thereby affecting the well-being of fetus. Detection of it at an early stage is important from the point of view of management as early intervention is associated with improved maternal and fetal outcome. Shear wave elastography (SWE) of placenta is a non-invasive investigation that can detect changes in placental elasticity during the pregnancy.</p> <p><strong>Aims and Objectives:</strong> The aim of the study was to assess and compare the difference in values of placental elasticity in normal pregnancy and in clinically diagnosed cases of PIH and to study its association with uterine artery-pulsatility index (UtA-PI) and fetal outcome.</p> <p><strong>Materials and Methods:</strong> This was a prospective and observational study in which pregnant females with gestational age of 20–34 weeks who were referred to radiology department for routine sonography including the clinically diagnosed pregnancies with PIH were included on the basis of a predefined inclusion and exclusion criteria. A total of 106 individuals were included in the study, B-mode sonography, uterine artery Doppler, and placental SWE were performed in all these patients. All these pregnancies were followed up for the fetal outcome.</p> <p><strong>Results:</strong> The mean gestational age of the studied cases was found to be 26.51±4.415 weeks. Higher SWE values were found, as compared to the normal pregnancies, in pregnancies complicated by PIH and the difference was found to be statistically highly significant (P&lt;0.001). Placental SWE showed a strong association with UtA-PI and fetal outcome. Incidence of adverse fetal outcome such as preterm deliveries, intrauterine death, stillbirths, and small for gestational age babies was more commonly seen in PIH group and the difference was statistically significant (P&lt;0.005). Incidence of birth asphyxia (as determined by low APGAR score) and neonatal intensive care unit admissions was more in neonates born to patients with PIH as compared to those in healthy women and the difference was statistically significant (P&lt;0.005).</p> <p><strong>Conclusion:</strong> SWE has the potency to detect the changes in placental morphology and can help with diagnosis of pregnancies complicated with PIH. It does have a synergistic role to play alongside the uterine artery Doppler and clinical parameters to predict the pregnancies with PIH.</p> Ayushi Chhabra Satish Pathak Ankur Malhotra Subhra Agarwal Copyright (c) 2022 Asian Journal of Medical Sciences 2022-10-01 2022-10-01 13 10 138 145 10.3126/ajms.v13i10.45028 An audit of maternal near-miss and mortality cases in a tertiary care rural teaching hospital in Eastern India: A 2-year retrospective analytical case–control study <p><strong>Background:</strong> Maternal near-miss and mortality patients provide firsthand knowledge of remote and immediate factors linked to morbidity and mortality.</p> <p><strong>Aims and Objectives:</strong> The objectives of this study were to evaluate the characteristics of maternal near-miss and mortality cases in a tertiary care hospital.</p> <p><strong>Materials and Methods:</strong> The present study is a retrospective analytical case–control study analyzing the different factors associated with maternal near-miss and mortality and comparing the same with a control group having mothers with normal outcome. Data were obtained from record section of Rampurhat Medical College from January 2019 to December 2020.</p> <p><strong>Results:</strong> During the study period, maternal mortality ratio was 223 and near-miss cases were 501/lakh live births. Critical care unit admission rate was 2.1% of the total admitted obstetric cases. The maternal near-miss mortality ratio was 2.25. Most women in our study group were anemic teenagers or multigravidas from rural areas with poor educational status and irregular antenatal check-ups as compared to the control group. The most common primary diagnosis in the near-miss group was obstetric hemorrhage (47.47%), while in the mortality group was eclampsia and pre-eclampsia (29.5%), obstetric h emorrhage (20.45%), and heart disease (15.9%). About 81.8% of the participants in the study group had fulfilled the near-miss criteria at the time of admission itself, while 4.5% were brought dead.</p> <p><strong>Conclusion:</strong> The underlying risk factors have to be corrected. There should be strict screening protocols from first antenatal visit itself, and earlier referral to higher centers.</p> Nishat Parveen Begg Subhankar Dasgupta Swarup Chowdhury Copyright (c) 2022 Asian Journal of Medical Sciences 2022-10-01 2022-10-01 13 10 146 151 10.3126/ajms.v13i10.44734 Placental thickness and its correlation to gestational age estimated by fetal biometry: A cross-sectional study <p><strong>Background:</strong> Accurate estimation of gestational age is important not only for appropriate antenatal care but also is crucial for undertaking various diagnostics tests such as chorionic villous sampling and amniocentesis. In certain conditions, where biometry cannot be entirely relied on for estimation of gestational age placental thickness (PT) that can be used for estimation of gestational age.</p> <p><strong>Aims and Objectives:</strong> The aims of this study were as follows: (1) To analyze relationship between PT and gestational age as determined by fetal biometry in second and third trimester of pregnancy. (2) To find out cutoff PT value for differentiating between preterm and term gestations.</p> <p><strong>Materials and Methods:</strong> This was a cross-sectional, in which 140 patients, in 2nd and 3rd trimester, were included on the basis of a predefined inclusion and exclusion criteria. PT was measured in mm along with their respective standard deviation. The correlation between PT and gestational age as determined by biometry.</p> <p><strong>Results:</strong> The mean age of the studied cases was found to be 4.15±3.5 years. At 12 weeks of gestation, the mean PT was 14.36 mm. There was a strong positive correlation between gestational age and PT in 2nd (r=0.9943) and 3rd (r=0.9973) trimesters. After 37 weeks of gestation, there was no significant correlation between PT and gestational age (P=0.469).</p> <p><strong>Conclusion:</strong> PT has a significant positive correlation with gestational age in 2nd and 3rd trimester of pregnancy (up to 37 weeks of gestation) and can be reliably used for determination of gestational age independent of fetal biometry.</p> Ashwini Nagesh Naik Sushilkumar Kale Atul Tayade Dhananjay Ghodke Copyright (c) 2022 Asian Journal of Medical Sciences 2022-10-01 2022-10-01 13 10 152 157 10.3126/ajms.v13i10.46005 Prevalence of asymptomatic airflow obstruction among patients visiting a tertiary health-care center <p><strong>Background:</strong> Chronic obstructive lung disease is a major health problem worldwide, with a huge impact on health and economics, both at the individual and community levels. In clinical practice, only symptomatic patients seem to undergo spirometry screening, whereas persons with no symptoms or those with early or negligible symptoms are ignored until they present with acute exacerbations and complications. Fair evidence indicates that most individuals with airflow obstruction do not recognize or report symptoms.</p> <p><strong>Aims and Objectives:</strong> The present study was conducted to identify the prevalence of undiagnosed airflow obstruction in asymptomatic adults, without known obstructive lung disease or any other pulmonary condition.</p> <p><strong>Materials and Methods:</strong> A total of 500 subjects between 18 and 65 years of age, coming to the outpatient department for a routine/preventive health checkup who were<br />asymptomatic and never diagnosed for airflow obstruction, with no evidence of any physical disease on examination were selected by random sampling method after taking informed written consent. A detailed history, complete general physical and clinical examination, and spirometry (as per the ATS guidelines) for individuals were done.</p> <p><strong> Results:</strong> Overall prevalence of AO was 16% of patients (80 patients out of 500). About 4.20% of patients had mild obstruction (GOLD – Stage 1), 4.60% had moderate obstruction (GOLD – Stage 2), 5.40% had severe obstruction (GOLD – Stage 3), and 1.80% had very severe obstruction (GOLD – Stage 4). Subjects with asymptomatic airflow obstruction had a higher prevalence of ever smoking (72.5%, 58 out of 80 patients) than never smokers (27.5%, 22 out of 80 patients) and this difference was highly significant statistically.</p> <p><strong>Conclusion:</strong> There is a high prevalence of asymptomatic airflow obstruction, detected by spirometry, in asymptomatic patients of different severities. Smoking is a strong risk factor and AO is directly associated with age, both among smokers and never smokers. The use of spirometry should be implemented in all routine health checkup plans, as an important diagnostic tool.</p> Priya Charan Reshu Gupta Prahlad Dhakar Copyright (c) 2022 Asian Journal of Medical Sciences 2022-10-01 2022-10-01 13 10 158 162 10.3126/ajms.v13i10.41882 Understanding the journey and decision-making process of doctors throughout their career <p><strong>Background:</strong> Often, we perceive healthcare from the patient’s point of view. Very seldom do, we think about the doctors, pillars of our health-care system. They have to overcome the journey and faced challenges before fully established.</p> <p><strong>Aims and Objectives:</strong> This study aims to explore this area on the perception of doctors about their career, the support they desire and the challenges they face to establishment of their private clinical practices.</p> <p><strong>Materials and Methods:</strong> The data were collected from doctors using questionnaires circulated through digital platform during COVID-19 pandemic situation for cross-sectional study. Cluster followed by snowball sampling method was followed to collect the data using two different Google form questionnaires for doctors completed under-graduation and completed postgraduation/super-specialty. Chi-square analysis was used to assess the frequency count variables.</p> <p><strong>Results:</strong> The millennial as well as senior doctors have securing financing the highest rank overall as the major challenge, they faced before starting a clinic.</p> <p><strong>Conclusion:</strong> Decision-making process of doctors is very complex and dynamic influenced by different factors throughout their career. Factors such as securing post-graduation, securing finance and procuring equipments for the establishment of clinics were found to influence career decision.</p> Manabendra Makhal Pradip Kumar Ray Sampa Ray Bhattacharya Pranab Mandal Avik Kumar Layek Copyright (c) 2022 Asian Journal of Medical Sciences 2022-10-01 2022-10-01 13 10 163 167 10.3126/ajms.v13i10.42901 Evaluation of rapid antigen test (RAT) screening test among people attending fever clinic of Shimoga Institute of Medical Sciences, Shivamogga: An analytical cross-sectional study <p><strong>Background:</strong> COVID-19 pandemic continues to be a public health threat. Rapid antigen tests (RATs) for the detection of SARS-CoV-2 infection will help in formulation of clinical and public health strategies for the control of transmission. In India, 49% of COVID-19 tests done are RATs.1 The sensitivity of RAT is 50.6–84%. RAT has specificity ranging from 99.3% to 100%.2 The present study aims at evaluating the RAT screening test done on people attending fever clinic of Shimoga Institute of Medical Sciences, Shivamogga.</p> <p><strong>Aims and Objectives:</strong> The objectives of the study were to evaluate the COVID-19 RAT screening test with reverse transcriptase-polymerase chain reaction (RT-PCR) as the gold standard test done at fever clinic of SIMS, Shimoga.</p> <p><strong>Materials and Methods:</strong> An observational, cross-sectional analytical study was conducted for a period of 1 month, May 2021. The study participants included all the people attending fever clinic of SIMS, Shimoga. Assuming the sensitivity of RAT to be 85%, power of 80%, and precision of 5%, the calculated sample size was 204. Considering non-response rate of 10%, the final sample size was 224. Secondary data regarding contact number of the people attending fever clinic were collected from the COVID-19 test register. Oral consent was taken after explaining about study and assuring confidentiality. Telephonic interview was done to collect relevant information. Analysis was done using Epi Info software version Descriptive statistics such as percentages and analytical statistics such as Student’s t-test and Chi-square test were used.</p> <p><strong>Results:</strong> Overall positivity rate was 43.7%. About 71% of people had contact history. Sensitivity and specificity of RAT test were found to be 64.2% and 97.2%, respectively, and were comparable with the previous studies. Significant difference was found (P&lt;0.05) between RAT and RT-PCR results.</p> <p><strong>Conclusion: </strong>Significant difference was found between RAT and RT-PCR results which indicate that RAT is not diagnostic for people who test positive in RT-PCR. Sensitivity of RAT is relatively less in our study (but crucial in detecting disease early) and hence we strongly recommend that RT-PCR for those who test negative for RAT test.</p> Darshitha Rajanna Shashi Kiran Guttinadu Mallikarjunappa Kanchana Nagendra Raghavendraswamy Koppad Anitha Bheeme Gowda Padma Copyright (c) 2022 Asian Journal of Medical Sciences 2022-10-01 2022-10-01 13 10 168 171 10.3126/ajms.v13i10.46185 Seroprevalence of Scrub typhus in a rural tertiary care hospital of Eastern India <p><strong>Background:</strong> Scrub typhus is a Rickettsial infection caused by a gram-negative intracellular bacillus Orientia tsutsugamushi. It is an important cause of pyrexia of unknown origin (PUO). The infection is spread by the larval form of a mite--Trombiculid soft mite and is called ‘chiggers’. The infection affects man accidentally.</p> <p><strong>Aims and Objectives:</strong> The study was done to find the sero-prevalence of the infection in patients with high fever not responding to any treatment.</p> <p><strong>Materials and Methods:</strong> The study was conducted for 1 year (January 2021 to December 2021 in patients of all ages and sexes complaining of high fever and body ache with/without seizures and change in mental status. The serum samples were subjected to immunoglobulin M enzyme linked immunosorbent assay for Scrub typhus after excluding the other causes of the common febrile illnesses such as Malaria, Japanese encephalitis), chikungunya, dengue, typhoid and leptospirosis.</p> <p><strong>Results:</strong> The seroprevalence of Scrub typhus in this study period was 39.74 % amongst the 761/1915 positive samples. Maximum number of positive cases were noted in the cooler months of the year -- November 2021 (192 cases; 25.23%) followed by December (142; 18.66%). Of all the positive cases, maximum 396 (78%) were found in patients residing in the rural areas of the Purba Burdwan district. Furthermore, the maximum number of cases was found in the age group 0-10 yrs—463 (60.84%) but a very slight male predominance. No mortality, however, was reported.</p> <p><strong> Conclusion:</strong> Scrub typhus is an emerging infection and early treatment can save many lives.</p> Saswati Chattopadhyay Nabamita Chaudhury Tanusri Biswas Copyright (c) 2022 Asian Journal of Medical Sciences 2022-10-01 2022-10-01 13 10 172 175 10.3126/ajms.v13i10.45554 Prevalence of multidrug resistant non-fermenters in a tertiary care centre <p><strong>Background:</strong> Infections due to multidrug resistant organisms especially Gram-negative non-fermenting bacteria such as Acinetobacter baumannii and Pseudomonas aeruginosa are increasing, ultimately leading to shortage of clinically effective antibiotics. Indiscriminate use of antibiotics is the key factor influencing the prevalence and distribution of drug resistance in any community or nosocomial setting.</p> <p><strong>Aims and Objectives:</strong> The objectives of the study are as follows: (1) To know the antibiotic susceptibility pattern of commonly isolated non-lactose fermenters. (2) To know the prevalence of multidrug resistant P. aeruginosa and A. baumannii.</p> <p><strong>Materials and Methods:</strong> Clinical samples from various departments were processed using standard isolation and identification procedures. Only non-lactose fermenting colonies were processed further and only those isolates that were identified as P. aeruginosa and A. baumannii. were considered and their antibiotic susceptibility testing by disk diffusion method was carried out. Results were tabulated and analyzed.</p> <p><strong>Results:</strong> Among 558 non-lactose fermenting Gram-negative bacilli isolates, P. aeruginosa (355) and A. baumannii. (203) were the most common isolates. Resistance to commonly used drugs such as aminoglycosides, cephalosporins and inhibitor combinations, and fluoroquinolones ranged from 40% to 65%. Carbapenem resistant isolates were around 24–25%. Multidrug resistant isolates and extensively drug resistant accounted for 17.4% and 9.1%, respectively.</p> <p><strong>Conclusion:</strong> Increasing multidrug resistance and extensive drug resistance resistance among non-fermenters are on the rise leaving a very small window of treatment options. This is an alarming situation that needs strict antibiotic policy and a robust antimicrobial resistance management plan.</p> Veena Manjunath Shwetha Vadnal Revanappa Asha Bullappa Jayasimha Vedalaveni Lakshminarayana Copyright (c) 2022 Asian Journal of Medical Sciences 2022-10-01 2022-10-01 13 10 176 182 10.3126/ajms.v13i10.46366 Seroprevalence of brucellosis among the high-risk population in Ujjain district, Madhya Pradesh <p><strong>Background:</strong> Brucellosis is the most common zoonotic disease caused by Gram-negative coccobacillus belonging to genus Brucella. It is a recognized public health problem in developing countries including India.</p> <p><strong> Aims and Objectives:</strong> The aims of these study were to determine the seroprevalance of brucellosis in population having occupation dealing with animals and thus are in close contact of animals.</p> <p><strong>Materials and Methods:</strong> The study was conducted in semi-urban areas of central India. Blood samples were collected from personnel working in slaughter houses, meat shops, and veterinarians and their close contact and who are willing to participate in study. A total 102 samples collected randomly from butchers (n=20), veterinarians (n=29), and animal handlers (n=53) and were tested for Brucella abortus and Brucella melitensis by a commercial kit which allows the detection of both complete (IgG and IGM) and incomplete antibodies.</p> <p><strong>Results:</strong> A total 102 subjects were included in the study and overall prevalence of brucellosis among high-risk group was found to be 2.9%. One veterinarian doctor was also found positive for both B. melitensis and B. abortus. Highest prevalence of brucellosis was found in veterinarians (6.8%) followed by animal handlers (1.8%), and none of the butcher was tested positive for any of the Brucella antibody.</p> <p><strong>Conclusion:</strong> The present study screened all possible known high-risk groups for brucellosis and revealed that veterinarians have high chances of getting the infection. Occupation-related disease like brucellosis needs regular surveillance and integration into control and prevention program at a local and national level.</p> Riddhi Pradhan Anand Bhadkariya Vidit Khandelawal Vishal Diwan Waghe SR Deepak Saxena Shah H Manju Purohit Copyright (c) 2022 Asian Journal of Medical Sciences 2022-10-01 2022-10-01 13 10 183 187 10.3126/ajms.v13i10.45698 Isolation and identification of aerobic bacteria and their antibiogram profile in catheter related bloodstream infection among the hemodialysis patient in a tertiary care hospital <p><strong>Background:</strong> Catheter-related bloodstream infection (CRBSI) is quite evident in hemodialysis (HD) patients. The pattern of the isolates from the catheter tip as well as blood culture and their sensitivity against antibiotics varies and set a huge challenge for the physician for its management.</p> <p><strong>Aims and Objectives:</strong> The present study was undertaken to isolate and identify, causative organism in CRBSI from the HD patient and to determine the antibiotic susceptibility profile of each isolate and determines the current trend.</p> <p><strong> Materials and Methods:</strong> A total (n=101) patients admitted for HD in the nephrology unit of a tertiary care hospital with preexisting comorbidities such as diabetes and hypertension (HT) were recruited according to inclusion/exclusion criteria after obtaining written consent. Blood samples from peripheral blood vessel of suspected CRBSI patients were collected as well as the catheter tip was cut and collected in sterile test tube and transported to microbiology laboratory for isolation, identification, and antibiotic susceptibility test.</p> <p><strong>Results:</strong> The HD catheter tip culture was found positive in 54 (53.46%) samples out of the total 101 samples. The distribution of catheter tip culture positive patients and their association with diabetes mellitus was highest at age group &gt; 60 years with a p &lt; 0.0001. The association between catheter tip culture positive and HT was also found significant with P&lt;0.0001. After analysis of culture reports of HD catheter tip and peripheral blood, culture-positive reports were found in 15 (14.85%) patients as CRBSI. The distribution of CRBSI predominantly found in the age group of 41–50 years (33%) which was significant with P=0.004. The causative organisms for CRBSI were Gram negative under this study and multidrug resistant too. The only drug polymyxin B was 100% sensitive to Gram-negative organism whereas vancomycin and linezolid were 100% sensitive to Gram-positive organisms.</p> <p><strong>Conclusion:</strong> Patients with kidney disease receiving HD with a central venous catheter experience high rates of bloodstream and catheter tip infection commonly in those suffering from diabetes, HT, and dyslipidemia. The causative organisms for CRBSI were mainly Gram negative with a concern over existence of multidrug resistance strain.</p> Swapan Kumar Mandal Kanailal Karmakar Kumaresh Chandra Sarkar Goutam Sarkar Arunava Biswas Maitreyi Bandyopadhyay Anjan Adhikari Manas Kumar Bandyopadhyay Copyright (c) 2022 Asian Journal of Medical Sciences 2022-10-01 2022-10-01 13 10 188 195 10.3126/ajms.v13i10.45223 Laparoscopic deroofing of post-renal transplant lymphoceles – A single-center observational study <p><strong>Background:</strong> Lymphocele formation is the most common identifiable surgical complication of renal transplant recipients, which often requires surgical deroofing. In this retrospective study, we are determining the efficacy of laparoscopic deroofing surgery in the management of post-renal transplant lymphocele.</p> <p><strong>Aims and Objectives:</strong> This study aims to determine the efficacy of laparoscopic deroofing surgery in the management of post-renal transplant lymphocele.</p> <p><strong>Materials and Methods:</strong> All patients who underwent surgical deroofing for post-renal transplant lymphocele at the Institute of Kidney DISEASE and Research Center, Ahmedabad, India, between January 2016 and October 2019 were included in the study and retrospectively reviewed. Information about symptomatology, clinical features, radiological findings, preoperative drainage, ultrasound-guided percutaneous nephrostomy (PCN) diversion, intraoperative, post-operative findings, and complications were retrieved and analyzed.</p> <p><strong>Results:</strong> Among the 1138 open renal transplant recipients, 28 patients developed symptomatic lymphocele (incidence 2.5%). The mean interval to develop these lymphoceles was 8 weeks (3 weeks–4 months). All 28 patients underwent laparoscopic lymphatic deroofing surgery. There were no conversions to open surgery. Overrunning of cut edges was performed in six and omentopexy in two patients, rest of the 20 patients only deroofing of lymphocele was performed. Graft PCN was placed before surgery in four patients and in two patients, percutaneous drain was placed into the lymphocele. The mean operative time was 80 min. The mean hospital stay was 3.5 days. In one case, there was an injury to the ureter intraoperatively which was repaired over a DJ stent laparoscopically. There was one case with recurrence who had a prior history of continuous ambulatory peritoneal dialysis. He was explored and perivascular lymphatics were tied and omental packing was performed.</p> <p><strong>Conclusion:</strong> Laparoscopic deroofing of symptomatic lymphoceles following renal transplantation appears to be safe and effective, because it has minimal post-operative morbidity, rapid convalescence, and low recurrence rate. Laparoscopy should be considered the first-line treatment for symptomatic lymphoceles.</p> Raghuveer Machiraju Devashish Kaushal Mandavi Agarwal Jamal Rizvi Copyright (c) 2022 Asian Journal of Medical Sciences 2022-10-01 2022-10-01 13 10 196 202 10.3126/ajms.v13i10.45407 An evaluative study to find the correlation between semitendinosus graft dimension with respect to patient’s anthropometry <p><strong>Background:</strong> A prospective study of a cohort of anterior cruciate ligament (ACL) reconstructed patients 7 years after surgery revealed degenerative radiographic changes in 95% of patients, and only 47% were able to return to their previous activity level following ACL reconstruction.</p> <p><strong>Aims and Objectives:</strong> The aims of this study were to find the correlation between Semitendinosus graft dimension with respect to patients anthropometry such as age, height, weight, body mass index (BMI), and true leg length (TLL).</p> <p><strong>Materials and Methods:</strong> The proposed study was the patients coming to orthopedics-outpatient department and emergency with<br />30 complete thickness ACL tears which were screened and recruited based on fulfillment of inclusion and exclusion criteria from January 2020 to August 2021 (20 months duration). The sample size was sufficient to draw conclusive findings. Correlation was calculated by Pearson correlation analysis. The Pearson product-moment correlation coefficient was a measure of the linear dependence between two variables X and Y. P≤0.05 was considered for statistically significant.</p> <p><strong>Results:</strong> The age has positive correlation with graft length (r=0.11) and relatively strong positive correlation with graft diameter (r=0.437). Height has relatively strong positive correlation with graft length (r=0.4258) and graft diameter (r=0.1375). Weights have strong positive correlation with graft length (r=0.604). TLL also had positive correlation with graft length (0.23) and graft diameter (r=0.1).</p> <p><strong>Conclusion:</strong> In selective cases, graft may be reinforced with additional Hamstring tendon harvest like gracilis or any alternative graft such as Bone–patellar tendon–bone (BPB) and Peroneus longus tendon autograft that may be taken to prevent graft failure and future complications. This current data can be a reference for surgeons in preoperative planning and counseling to patients about alternative autograft selection.</p> Tanmay Datta Dibyendu Biswas Kunal Mondal Santu Sarkar Copyright (c) 2022 Asian Journal of Medical Sciences 2022-10-01 2022-10-01 13 10 203 209 10.3126/ajms.v13i10.45305 Comparative evaluation of “in-the-bag” intraocular lens implantation with cionni ring versus pars plana lensectomy–vitrectomy with anterior chamber IOL implantation in subluxated lenses in pediatric eyes <p><strong>Background:</strong> Subluxation of the crystalline lens has various surgical management options. In moderate zonular dialysis, the capsular bag may be preserved and used for intraocular lens (IOL) implantation using a capsular tension ring or Cionni ring or Capsular tension segment. It is technically demanding and associated with high incidence of complications such as IOL decentration, dislocation, and posterior capsular opacification (PCO). Advantages of the combined pars plana lensectomy–vitrectomy (PPL/PPV) with anterior chamber IOL (ACIOL) approach include a closed ocular surgical system, minimal corneal trauma, limited iris trauma, and good vitreous control. Therefore, in this study, we aim to study the outcomes of inthe-bag IOL implantation with Cionni ring versus PPL/PPV with ACIOL in subluxated lenses in children.</p> <p><strong>Aims and Objectives:</strong> The aims of this study were to compare “in-the-bag” IOL implantation with Cionni ring versus PPL/PPV with ACIOL implantation in subluxated lenses in children.</p> <p><strong>Materials and Methods:</strong> In this prospective, comparative, and interventional case series, 20 eyes (18 children, 8–18 years) with 90–210° subluxation were randomly allocated into two groups (ten eyes each). Group A underwent single eyelet Cionni Ring with in-the-bag PCIOL implantation and Group B underwent PPL/PPV with ACIOL. Outcome measures included best-corrected visual acuity (BCVA), endothelial cell count (ECC), intraocular pressure, fundus evaluation, and intraoperative/post-operative complications.</p> <p><strong style="font-size: 0.875rem;">Results:</strong><span style="font-size: 0.875rem;"> The etiology of subluxation included trauma (40%), Marfan’s syndrome (20%), myopia (20%), and others (20%). In Group A, intraoperative difficulties were encountered in capsulorrhexis, irrigationaspiration, and increased duration of surgery. Two eyes in Group B had intraoperative lens </span>fragment drop in vitreous. At 3 months, no statistically significant difference in BCVA was noted. About 90% eyes in Group A and 80% eyes in Group B had final BCVA of ≥6/18. ECC and PCO were significantly higher in Group A at 3 months.</p> <p><strong>Conclusion:</strong> Implantation of planned open-loop ACIOL is viable surgical alternative to Cionni ring with PCIOL implantation in large lens subluxation and good pre-operative ECC.</p> Sweta Singh Anju Rastogi Jaidrath Kumar Vartika Srivastava Copyright (c) 2022 Asian Journal of Medical Sciences 2022-10-01 2022-10-01 13 10 210 215 10.3126/ajms.v13i10.45937 Comparative status of syncope among voluntary blood donors with and without prior water administration: A Randomized Study in a Medical College from North India <p><strong>Background:</strong> Blood center rely heavily on young donors to meet blood demand, but syncope is more frequent in younger donors. Studies have suggested administration of water before donation may reduce syncope related complications in this group.</p> <p><strong>Aims and Objectives:</strong> The aim of the study was to compare status of syncope among voluntary blood donors with and without prior water administration.</p> <p><strong>Materials and Methods:</strong> This study was conducted to establish the effect of pre-loading with 500 ml of water on the rate of syncope in young blood donors who came for blood donation voluntarily in outdoor blood donation camp organized by the department. Nearly Fifty percent of blood donors received water and another Fifty percent were not given water pre donation and the effect of water on blood donors studied. Incidence of syncope was compared between randomization groups using multivariable logistic regression.</p> <p><strong>Results:</strong> Out of 2345 study participants, 1172 received water, and 1173 did not; groups differed slightly by gender and number of donation. Syncope was seen in 3 (0.25%) in the test group (who received water before donation) and 39 (3.32%) of the control subjects (who were not given water before donation). After adjusting for, gender, age, and donation history, there was significant difference in outcome between the water versus no water administration (adjusted odds ratio [OR] = 0.80 [95% CI 0.42–1.53]).</p> <p><strong>Conclusion:</strong> Preloading young donors with 500 ml of water have a major effect in reducing syncope related complications among young and 1st time blood donors.</p> Shailesh Kumar Mishra Copyright (c) 2022 Asian Journal of Medical Sciences 2022-10-01 2022-10-01 13 10 216 222 10.3126/ajms.v13i10.46237 Use of Cyclosporine A and danazol in treatment of aplastic anemia: A real-world data from a teaching hospital in South India <p><strong>Background:</strong> Due to financial constraints, there are limited treatment options for Aplastic anemia (AA) in developing countries.</p> <p><strong>Aims and Objectives:</strong> In the present observational retrospective study, utility of Cyclosporine A (CsA) along with Danazol (an anabolic steroid) in AA was assessed.</p> <p><strong>Materials and Methods:</strong> The study included patients of AA treated in our hospital from 2017 to 2020.</p> <p><strong> Results:</strong> The present study included total of 95 patients. Out of these, 69 patients (73%) were lost to follow-up. It was observed that, out of 26 patients who could be followed up, 18 (69%) patients responded to the treatment (transfusion independent) at the end of 6 months. Out of 18 patients who had responded, two were very severe AA, 12 were severe AA, and four were non-severe AA patients. Eleven out of 18 (61.1%) females responded, whereas seven out of eight males (87.5%) responded to the treatment. In four patients who received Eltrombopag in addition to CsA-Danazol, three patients responded to the therapy.</p> <p><strong>Conclusion:</strong> Treatment with CsA and Danazol may represent a promising therapy for patients with AA, especially in resource limited settings. Further, large-scale collaborative studies are necessary to evaluate such approaches in management of AA.</p> Girish Kamat Renukaradhya K Math Deepak Goni Girish Balikai Ambuja Savanur Nayana Mudennavar Palaksha Kanive Javaregowda Copyright (c) 2022 Asian Journal of Medical Sciences 2022-10-01 2022-10-01 13 10 223 226 10.3126/ajms.v13i10.45513 Quantification of sleep architecture in different grades of apnea hypopnea index in patients having obstructive sleep apnea <p><strong>Background:</strong> Optimum sleep architecture is important from the point of view of optimum physiological functions. Sleep is qualitatively as well as quantitatively affected in patients of obstructive sleep apnea (OSA). Male gender and obesity are associated with increased risk of OSA. It is being increasingly recognized due to increased awareness not only among treating physicians but also in general population. We undertook this study to do quantification of sleep in individuals diagnosed with apnea/hypopnea syndrome and having different grades of apnea/hypopnea index (AHI).</p> <p><strong>Aims and Objectives:</strong> The aims of this study were to analyze sleep pattern in individuals diagnosed with obstructive sleep apnea having different grades of AHI.</p> <p><strong>Materials and Methods:</strong> This was a retrospective analytical study, in which data were collected from polysomnography reports of 92 patients having obstructive sleep apnea. The study was conducted in the Pulmonary Medicine, Seth GS Medical college and KEM Hospital Mumbai. Ninety-two patients diagnosed to be having OSA were included in this study on the basis of a predefined inclusion and exclusion criteria. The sleep parameters included in the study were total sleep time, percentage of time spent in rapid eye movement (REM), percentage of time spent in non-REM (NREM) Stage I, percentage of time spent in NREM Stage II, percentage of time spent in Stage III, percentage of time spent in stage NREM IV, N2 sleep, and wake after sleep onset (WASO) Index. P&lt;0.05 was taken as statistically significant.</p> <p><strong>Results:</strong> Among the 92 studied cases, there were 66 (71.74%) males and 26 (28.26%) females with a M: F ratio of 1: 0.39. Most of the patients belonged to age group between 35–50 years (39.13%) and 51–70 years (42.39%). Most of the patients with obstructive sleep apnea were either obese (59.78%) or overweight (27.17%). AHI was found to be mild, moderate, and severe in 32 (34.78%), 15 (16.30%), and 16 (17.39%) patients, respectively. Percentage of NREM I, NREM II and NREM IV, and N3 SL was found<br />to be comparable across groups of different AHI (P&gt;0.05). The median AHI of the patients with underweight, healthy weight, overweight, and obese individuals was found to be 7.6, 5.5, 11.6, and 6.9, respectively, and it was found to be comparable with no statistically significant difference (P&gt;0.05).</p> <p><strong>Conclusion:</strong> Obstructive sleep apnea affects sleep pattern qualitatively as well as quantitatively and is more likely to affect NREM I and WASO.</p> Nyrvan Balen Baishya Vrunda Vishal Joshi Amita Umesh Athavale Copyright (c) 2022 Asian Journal of Medical Sciences 2022-10-01 2022-10-01 13 10 227 232 10.3126/ajms.v13i10.46324 Effectiveness of 12-week Om chanting on reaction time and spatial and verbal memory <p><strong>Background:</strong> Chanting Om was reported to increase the blood supply to brain structures involved in cognitive functions and improve cognition.</p> <p><strong>Aim and Objectives:</strong> The present study was undertaken to observe the effectiveness of 12-week Om chanting on reaction time and spatial and verbal memory.</p> <p><strong>Materials and Methods:</strong> Apparently, healthy volunteers (n=20; nine men and 11 women) who were right-handed and were consenting to participate in the study were recruited in the study. The age range of the subjects was 25–55 years. The intervention group participants were trained for reciting OM with the help of professional yoga instructor for a week days. After a week, they were instructed to assemble at the meditation hall of the institute at sharp 6:30 am every day and recite Om chanting for 20 min. Spatial and verbal memory was assessed using the standard methods explained in the literature that is spatial and verbal memory test. Auditory and visual reaction time was assessed using RT apparatus.</p> <p><strong>Results:</strong> Spatial, verbal memory, and reaction time in control and intervention group participants were compared in this study. There was a significant improvement in the spatial memory scores in the intervention group when compared with control group. There was a significant improvement in the auditory reaction time for high and low pitch sounds and also visual reaction time for red and green light in the intervention group when compared with control group.</p> <p><strong>Conclusion:</strong> The study results explain significant improvement in the spatial and verbal memory scores and auditory and visual reaction time after the intervention. The study recommends further detailed studies to support practicing Om chanting for the well-being of general population.</p> Aalasyam Naveen Vijay Kumar Sayeli Uma Pokala Copyright (c) 2022 Asian Journal of Medical Sciences 2022-10-01 2022-10-01 13 10 233 236 10.3126/ajms.v13i10.45067 A study of dynamic pulmonary function tests in street cleaners <p><strong>Background:</strong> Street cleaners are exposed to many risk factors such as dust, chemicals, and gases emitted by vehicles and factories, which make them vulnerable to develop certain occupational diseases. The fact that they do not use any protective measures increases their probability of contacting the hazards associated with chronic dust inhalation.</p> <p><strong>Aims and Objectives:</strong> The objectives of this study were to evaluate the pattern of changes in the dynamic pulmonary function parameters in street cleaners of Shimoga city.</p> <p><strong>Materials and Methods:</strong> The study has been conducted on 80 subjects, out of which 40 are street cleaners as cases and 40 other group D workers as controls. The dynamic pulmonary function tests such as forced vital capacity (FVC) in liters and forced expiratory volume in 1st sec (FEV1) were recorded. Furthermore, the percentage of FVC expired in 1st second (FEV1/FVC %), peak expiratory flow rate (PEFR), and forced mid expiratory flow rate (FEF25–75%) in liters per second were recorded for each of the subjects in standing position.</p> <p><strong>Results:</strong> A significant reduction in the pulmonary functions of street cleaners was noted compared to controls. The results indicated fall in the parameters such as FEV1, FEV1/FVC %, PEFR, and mid expiratory flow rate, which suggest an obstructive pattern in the lung functions and points toward the development of Chronic Obstructive Pulmonary Disease.</p> <p><strong>Conclusion:</strong> The study, hence, concludes that street sweeping and cleaning as an Occupation has adverse effects on the lungs. Periodic screening for the pulmonary functions of the workers at risk should be undertaken by spirometry which is a simple, non-invasive, and cost-effective method to identify the disease process at an early asymptomatic stage.</p> Mohammed Aleemuddin Sai Sailesh Kumar Goothy Dunna Santha Rao Javeria Firdous Manjunath Lakshmayya Mayasandra Copyright (c) 2022 Asian Journal of Medical Sciences 2022-10-01 2022-10-01 13 10 237 242 10.3126/ajms.v13i10.46547 Radiological evaluation of ovarian mass by contrast-enhanced computed tomography abdomen with clinicopathological correlation in Eastern Indian population <p><strong>Background:</strong> Adenexal masses present diagnostic challenges. After identification of the ovarian mass, the most critical step is to determine the degree of suspicion for malignancy. It is mainly based on imaging modalities and clinicopathological correlation.</p> <p><strong>Aims and Objectives:</strong> This radiological study was designed to differentiate benign and malignant ovarian masses by contrast enhanced-computed tomography (CECT) of abdomen and correlation of the radiological findings with histopathological report.</p> <p><strong>Materials and Methods:</strong> This was a hospital-based prospective study conducted in Department of Radiodiagnosis, Nilratan Sircar Medical College and Hospital, Kolkata during January 2019–June 2020. The study was done on clinically suspected 50 patients of 15–50 years with ovarian mass having CECT diagnosed solid/complex solid cystic mass.</p> <p><strong>Results:</strong> Among 50 cases under study, 37(74.0%) were benign which was significantly higher than that of malignant cases (26.0%). Malignancy was significantly associated with wall irregularity, solid-cystic composition, presence of thick septations, septal enhancement, presence of both septal, and solid enhancement pattern in CECT.</p> <p><strong>Conclusion:</strong> Based on the results of the present study, multi-detector contrast-enhanced CT could be a rapid non-invasive and cost-effective step in the evaluation of ovarian masses.</p> Dona Saha Ram Chandra Bhadra Nabonita Biswas Copyright (c) 2022 Asian Journal of Medical Sciences 2022-10-01 2022-10-01 13 10 243 247 10.3126/ajms.v13i10.45625 Role of power Doppler and gray-scale ultrasound of the median nerve in the evaluation of carpal tunnel syndrome: A comparative analysis between sonographic and surgical measurements of the median nerve <p><strong>Background:</strong> Carpal tunnel syndrome (CTS) is the prevalent cause of pain, numbness, tingling, and weakness. It is known that whenever the median nerve, a major peripheral nerve of the upper limb, originating from the forearm into the palm of the hand, becomes pressed or squeezed at the wrist, it leads to a condition commonly known as CTS.</p> <p><strong>Aims and Objectives:</strong> The present study has been objectively conducted to assess the role of grey scale and power Doppler ultrasound of the median nerve at the wrist in evaluating CTS. The comparative analysis between USG findings and surgical findings of median nerve in CTS will also be made.</p> <p><strong>Materials and Methods:</strong> The present prospective study has been conducted at the SKIMS-MC, Srinagar for a period of 6 months from January 2022 to June 2022 in the Department of Radio diagnosis and Imaging in association with the Department of Orthopedics. A total of 30 patients have been included in the study. The cases were referred from Department of Orthopedics with clinically characterized CTS.</p> <p><strong>Results:</strong> Out of total 30 patients; 03 (10%) were males and 27 (90%) were females with a male to female ratio of 1:9. We observe that vascularity of median nerve was present in (56.7%) and absent in (43.3%) patients. The median nerve thinning and indentation were reflected by (80%) patients and the same was absent among (20%) patients, we did not find any agreement between surgical and sonographic parameters with the mean difference of 2.527 mm between sonographic and intraoperative perimeters, the difference was statistically significant (P&lt;0.001, CI 95%).</p> <p><strong>Conclusion:</strong> The present study demonstrated that ultrasonography aided with power Doppler precisely detected CTS cases. Evidently, we find a significant difference between surgical and sonographic parameters with the mean difference of 2.527 mm between sonographic and intraoperative perimeters.</p> Mohammad Farooq Mir Shazia Bashir Hilal Ahmad Lone Tahir Ahmad Dar Copyright (c) 2022 Asian Journal of Medical Sciences 2022-10-01 2022-10-01 13 10 248 253 10.3126/ajms.v13i10.46013 Feasibility and safety of laparoscopic nephrectomy in emphysematous pyelonephritic kidneys <p><strong>Background:</strong> Emphysematous pyelonephritis (EPN) is a serious suppurative infection of renal and extrarenal tissues. Most of them end up in nephrectomy, either in an emergency setting or delayed, which is increasingly favored. Laparoscopic nephrectomy is difficult in the post-EPN state due to dense adhesion around the kidney.</p> <p><strong>Aims and Objectives:</strong> In this study, we want to check the feasibility of laparoscopic nephrectomy in EPN kidneys. To the best of our knowledge, our series is the single largest series as of today with 10 cases of laparoscopic nephrectomies in EPN kidneys.</p> <p><strong>Materials and Methods:</strong> All patients of EPN who underwent laparoscopic nephrectomy at Institute of Kidney Diseases and Research Centre, Ahmedabad, between December 2017 and October 2019 were taken as study subjects and retrospectively reviewed. Patients in whom conservative management was successful were excluded from the study. All patients were diverted initially, either ultrasound/computed tomography-guided percutaneous nephrostomy (PCN) insertion or double J stenting, with or without PCN along with antibiotics and supportive therapy. Delayed transperitoneal laparoscopic nephrectomies were performed for poorly functioning EPN kidneys in follow-up renal scans.</p> <p><strong>Results:</strong> A total of 10 patients underwent nephrectomy in this period. The male-to-female ratio was 3:7. As per Huang and Tseng’s EPN classification, one patient had Class 2, four patients had Class 3a, and five patients had Class 3b EPN disease. Mean operative time was 192 min and mean blood loss was 206 ml. Two cases had intraoperative complications managed laparoscopically. No conversion to open nephrectomy or mortality was seen. The drain was placed for a mean period of 3.1 days. The mean hospital stay was 4.8 days.</p> <p><strong>Conclusion:</strong> Laparoscopy is safe and feasible for nephrectomy in EPN kidneys. Experience with laparoscopy and operating on pyelonephritis cases is important to reduce complications and extend the advantages of laparoscopy in these groups of patients. An increase in class does not increase the degree of difficulty during laparoscopy.</p> Raghuveer Machiraju Devashish Kaushal Jamal Rizvi Gopal R Tak Mandavi Agarwal Copyright (c) 2022 Asian Journal of Medical Sciences 2022-10-01 2022-10-01 13 10 254 258 10.3126/ajms.v13i10.45154 Assessment of severity of Parkinson’s disease by optical coherence tomography <p><strong>Background:</strong> Parkinson’s disease (PD) is the second most common movement disorder after essential tremor. Diminished visual acuity, color vision, and contrast sensitivity are also described in PD. Optical coherence tomography (OCT), a producible test for axonal degeneration, helps in prognosticating diseases such as Alzheimer’s, Parkinson’s, and multiple sclerosis.</p> <p><strong>Aims and Objectives:</strong> To assess the severity of Parkinson’s disease with the changes in various variables of OCT. The objective is to evaluate variables such as (RNFL, CMT, TMV) of both eyes with SD – OCT.</p> <p><strong>Materials and Methods:</strong> It is a hospital-based cross-sectional study conducted for a period of 22 months at the department of neurology. A total of 55 PD patients and 30 age- and sex-matched controls were evaluated.</p> <p><strong>Results:</strong> There was a significant difference between patients and controls in average retinal nerve fiber layer (RNFL) and all RNFL quadrants in both the eyes (P&lt;0.001). A significant negative correlation was found between the RNFL thickness and Unified Parkinson’s Disease Rating Scale (UPDRS) motor score and Hoehn and Yahr (H&amp;Y) score in both the eyes (P&lt;0.001). A significant negative correlation was found between total macular volume (TMV) and central macular thickness (CMT) with UPDRS motor score in both the eyes (P&lt;0.001). A significant negative correlation was found between CMT and H&amp;Y stage in both the eyes (P&lt;0.001). There was a significant difference between patients and controls in CMT and TMV in both the eyes (P&lt;0.001).</p> <p><strong>Conclusion:</strong> A significant negative correlation between severity and stage of the PD with OCT values was identified, which may suggest the possibility of dopaminergic depletion in the retina corresponding with basal ganglia dopamine depletion.</p> Bharat Vishnu Reddy Bindela Vamsavardhana Reddy Pidathala Kamalesh Tagadur Nataraju Copyright (c) 2022 Asian Journal of Medical Sciences 2022-10-01 2022-10-01 13 10 259 265 10.3126/ajms.v13i10.45933 Study of reasons for relapse in patients with bipolar I disorder with repeat admissions and its correlation with substance use <p><strong>Background:</strong> Mood disorder is one of the common causes, for which psychiatric consultations are sought. A better understanding of the factors that lead to repeated admissions, increased relapse rates, and concurrent substance dependence is necessary for the development of interventions that may reduce the likelihood of adverse effects in patient with bipolar I disorder.</p> <p><strong>Aims and Objectives:</strong> The aims of this study were as follows: (1) To study the correlation between the reasons for relapse and substance use with various sociodemographic factors in patients having bipolar I disorders and (2) to find out the correlation between reasons for relapse, substance use, and severity of illness.</p> <p><strong>Materials and Methods:</strong> This was a cross-sectional single interview study, in which 67 consecutive patients having bipolar I disorder and admitted in psychiatry ward were admitted on the basis of a pre-defined inclusion and exclusion criteria. The details about psychiatric, relapse-related symptoms, substance use-related symptoms, as well as other aspects of clinical profile were taken.</p> <p><strong>Results:</strong> Out of 67 patients, 51 (76.1%) were male and 16 (23.8%) were female. Mean age of the participants was 30.43 years (S.D.=9.05). Sleep disturbance was seen in all patients (67) and was also the most common symptom. It was followed by psychomotor disturbances in 60 (89.5%) of the patients. Among 67 patients included in the study, substance use was seen among 28 (41.7%) of the patients. Substance use was significantly associated with age of the patients and occupation (P=0.03 each). The age group of more than 30 years (57.7%) had significantly higher substance use compared to those &lt;30 years (31.7%).</p> <p><strong>Conclusion:</strong> Concurrent substance use is associated with increased risk of relapse and readmissions in cases of patients with bipolar I disorders. A thorough history is necessary to rule out substance use in these cases.</p> Megha Maghade Abhishek Somani Anand Saoji Vivek Kirpekar Copyright (c) 2022 Asian Journal of Medical Sciences 2022-10-01 2022-10-01 13 10 266 273 10.3126/ajms.v13i10.44922 Study of anxiety disorders and its association with quality of life in patients of oral cancer <p><strong>Background:</strong> Anxiety is a response to a threat that is unknown/known, internal/external, vague, or conflictual, cancer is threatening and so many patients are anxious.</p> <p><strong>Aim and Objectives:</strong> The present study was performed to assess the prevalence of anxiety disorders (AD) and quality of life (QoL) and its association in patients of oral cancer.</p> <p><strong>Materials and Methods:</strong> There were 62 patients attending cancer OPD of tertiary care center was assessed for cross-sectional, observational, and questionnaire-based study. Patients those diagnosed with oral cancer were included in our study. They were diagnosed for AD by clinical interview using DSM-5 diagnostic criteria. We assessed QoL in patients with oral cancer by scale of Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&amp;N Version 4). Patients were further assessed for demographic details. Statistical analysis was done using SPSS version 15, proportions were compared using Chi–square test, FACT H&amp;N QoL scores were compared by Mann–Whitney U test. P&lt;0.05 was considered to be statistically significant.</p> <p><strong>Results:</strong> We found that 17.74% had AD and those patients who were diagnosed of AD have poorer QoL in all domains of FACT H&amp;N QoL.</p> <p><strong>Conclusions:</strong> QoL was found to be poor in patients with oral cancer who had diagnosed with AD then those without AD.</p> Archanaben Surajprasad Kantak Kinjal Bhupendrasinh Chauhan Ashokkumar Ukabhai Vala Bharat Navinchndra Panchal Copyright (c) 2022 Asian Journal of Medical Sciences 2022-10-01 2022-10-01 13 10 274 278 10.3126/ajms.v13i10.46369