Asian Journal of Medical Sciences https://www.nepjol.info/index.php/AJMS <p>The inaugural issue of the Asian Journal of Medical Sciences was published in May 2010. Full text articles available. AJMS is both online and printed journal. The electronic -ISSN is 2091-0576 and Print-ISSN is 2467-9100.</p> <p>AJMS was added to <a href="https://doaj.org/toc/2091-0576" 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> en-US <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="http://creativecommons.org/licenses/by-nc/4.0/" 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="http://opcit.eprints.org/oacitation-biblio.html" target="_new">The Effect of Open Access</a>).</li></ol> ajmscience@gmail.com (Prof Dr Arun Kumar) sioux.cumming@ubiquitypress.com (Sioux Cumming) Thu, 01 Feb 2024 08:08:17 +0000 OJS 3.3.0.6 http://blogs.law.harvard.edu/tech/rss 60 A case of ostium secundum atrial septal defect for major decompressive spine surgery – covering the paths still left untreaded https://www.nepjol.info/index.php/AJMS/article/view/59251 <p>Atrial septal defect (ASD) accounts for 35% of all congenital heart diseases in adults. Patients usually present in their twenties or thirties owing to gradually progressive right ventricular remodeling because of left to right shunt, right-sided heart failure, and pulmonary hypertension. In this case report, we present the management of young female patient with ASD posted for D5 spine decompression and fixation. Patients with congenital heart disease for spine surgery present with unique set of challenges for anesthesiologists. Well-prepared anesthesia plan is essential to prevent increase in shunt fraction, shunt reversal, hypoxia, hypercapnia, acidosis, and hypothermia along with careful addressal of positioning issues to ensure smooth recovery of patient.</p> Nidhi Sultania, Priyanka Bansal, Kunal Bansal Copyright (c) 2023 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/AJMS/article/view/59251 Thu, 01 Feb 2024 00:00:00 +0000 A rare case of caseous necrosis of mitral valve https://www.nepjol.info/index.php/AJMS/article/view/59163 <p>Caseous calcification of the mitral annulus, an uncommon kind of intracardiac mass, is a form of degenerative disease that afflicts the mitral valve causing liquefactive or caseous necrosis. Caseous calcification of mitral annulus is rarely encountered in practice; however, it should be on the list of differential diagnosis of any intracardiac masses located close to the mitral annulus.</p> Deepti Naik, Sanjaya Viswamitra Copyright (c) 2023 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/AJMS/article/view/59163 Thu, 01 Feb 2024 00:00:00 +0000 Evaluation of compliance and adherence to medications in diabetic and/or hypertensive patients during the lockdown period and the effect of COVID-19 lockdown on blood glucose levels and blood pressure levels https://www.nepjol.info/index.php/AJMS/article/view/54960 <p><strong>Background:</strong> To contain the COVID-19 pandemic, a nationwide lockdown was imposed, which affected the lives of people with diabetes and hypertension as the patients were not able to regularly follow up with the doctor.</p> <p><strong>Aims and Objectives:</strong> This prospective observational study was conducted to find out the compliance and adherence to oral hypoglycemic agents and antihypertensives during lockdown, to consult with doctors during lockdown, and also to analyze the effect of lockdown on blood glucose levels and blood pressure control by comparing the pre- and post-lockdown blood pressure and blood glucose levels.</p> <p><strong>Materials and Methods:</strong> A prospective observational study was conducted on 100 participants aged between 35 and 85 years. They were studied by a questionnaire for a period of 3 months. The majority belonged to the 55–65 years of age group, and a male predominance was seen across all age groups. The changes in lifestyle habits of the participants during lockdown and complications due to diabetes and hypertension were also studied.</p> <p><strong>Results:</strong> There was a statistically significant decrease in the adherence to prescribed medications during lockdown due to various reasons, the most important of which was the lack of access to personal consultation with the doctor during lockdown. Patients also could not follow their diet and physical exercises due to lockdown. All these factors led to poor control of blood pressure and blood glucose levels, as evidenced by comparing the pre- and post-lockdown blood glucose levels and blood pressure.</p> <p><strong>Conclusion:</strong> This study concludes that there was a significant decrease in adherence to medications during the COVID-19 lockdown and there was poor control of blood pressure and blood glucose levels due to the lockdown period.</p> Renuka BG, Kandagaddala Yaswath, Shweta R Chittawadgi, Yogeshwar, Sushma HK, Narendranath Sanji Copyright (c) 2024 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/AJMS/article/view/54960 Thu, 01 Feb 2024 00:00:00 +0000 Comparison of clinical efficacy of hyperbaric ropivacaine with hyperbaric bupivacaine in spinal anesthesia for transurethral resection of prostate: A randomized and double-blind study https://www.nepjol.info/index.php/AJMS/article/view/60765 <p><strong>Background:</strong> Ropivacaine is an ammino-amide local anesthetic agent with properties similar to bupivacaine, but its decreased lipophilicity is associated with reduced incidence of central nervous system toxicity and cardiotoxicity. This study evaluated the safety, efficacy, effects on hemodynamics and complications of spinal anesthesia using 0.5% hyperbaric bupivacaine and 0.75% hyperbaric ropivacaine in patients undergoing transurethral resection of the prostate (TURP).</p> <p><strong>Aims and Objectives:</strong> The aim was to evaluate the safety, efficacy, hemodynamic stability, and side effects of spinal anesthesia using 0.5% hyperbaric bupivacaine and 0.75% hyperbaric ropivacaine in patients undergoing TURP.</p> <p><strong>Materials and Methods:</strong> Sixty adult patients with physical status classes I and II, as determined by the American Society of Anesthesiologists, scheduled to undergo elective transurethral resection of prostate, were randomly allocated to receive either hyperbaric ropivacaine 0.75% 2.8 mL plus fentanyl 15 mcg or hyperbaric bupivacaine 0.5% 2.8 mL plus fentanyl 15 mcg. The parameters, such as demographic characteristics, duration of surgery, onset of sensory and motor blockade, hemodynamic stability, and complications, were compared in both groups.</p> <p><strong>Results:</strong> Hyperbaric ropivacaine exhibited significantly slower onset times for sensory and motor blockade compared to hyperbaric bupivacaine. Patients in the ropivacaine group demonstrated better hemodynamic stability and experienced less hypotension compared to those who received bupivacaine. Moreover, the sensory and motor block lasted significantly longer in the bupivacaine group.</p> <p><strong>Conclusion:</strong> About 0.75% hyperbaric ropivacaine is a better choice for spinal anesthesia in elderly patients undergoing TURP as compared to 0.5% hyperbaric bupivacaine.</p> Savita Gupta, Isha Yadav, Anupriya Saxena, Satendra Kumar Copyright (c) 2024 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/AJMS/article/view/60765 Thu, 01 Feb 2024 00:00:00 +0000 Comparison of Baska mask and I-gel with endotracheal tube in laparoscopic cholecystectomy: A randomized controlled study https://www.nepjol.info/index.php/AJMS/article/view/58754 <p><strong>Background:</strong> Supraglottic airway devices are frequently used instead of endotracheal intubation in laparoscopic surgeries. Two such devices, I-gel (IG) and Baska mask (BM), have been compared with respect to their sealing properties and leak fraction (LF) in comparison to the endotracheal tube.</p> <p><strong>Aims and Objectives:</strong> The aim of the present study is to compare the performance of IG and BM with endotracheal tube in patients undergoing laparoscopic cholecystectomy under general anesthesia.</p> <p><strong>Materials and Methods:</strong> In this randomized trial, 84 patients scheduled for laparoscopic cholecystectomy under general anesthesia were randomized to group (endotracheal tube [ETT], n=28), group BM (BM, n=28), or group IG (IG, n=28). All the patients received standard general anesthesia and the airway was maintained with either of three devices. The primary outcomes were the difference in the LF and airway sealing pressure (ASP) at different time points before and after pneumoperitoneum. Secondary outcomes were insertion-time, number of insertion attempts, and gastric insufflations. Heart rate and blood pressure were recorded. Complications such as sore throat, coughing, laryngospasm, blood staining of the device, and aspiration were noted.</p> <p><strong>Results:</strong> P-values of LF of the three groups at time points T- after insertion (Ti), T-after pneumoperitoneum (Tp), and T- after peritoneal deflation (Tr) were 0.000 each and P-values of ASP at those time points were 0.000 each, respectively. Insertion time was significantly less for IG than ET (P&lt;0.001). Heart rate and blood pressure showed P-values at Ti and Tp (P=0.004 and 0.000).</p> <p><strong>Conclusion:</strong> It was concluded that IG or BM can maintain an airway with adequate seal and were not associated with any incidence of aspiration or laryngospasm. IG placement was found to be easier whereas the ease of ventilation was noted with BM.</p> Avijit Gain, Suchismita Mallick, Sujata Ghosh, Sarbari Swaika, Uday Sankar Mandal, Arpita Choudhury Copyright (c) 2023 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/AJMS/article/view/58754 Thu, 01 Feb 2024 00:00:00 +0000 Association between anesthetic type and perioperative outcomes in pediatric patients undergoing elective surgery: An observational study https://www.nepjol.info/index.php/AJMS/article/view/59580 <p><strong>Background:</strong> Pediatric surgeries require careful anesthetic choice. The impact of general anesthesia (GA) versus regional anesthesia (RA) on post-operative outcomes remains underexplored.</p> <p><strong>Aims and Objectives:</strong> The aims and objectives of the study are to assess the association between anesthetic type and perioperative outcomes, including post-operative pain, nausea incidence, and recovery room stay duration in pediatric patients undergoing elective surgery.</p> <p><strong>Materials and Methods:</strong> This observational study involved 100 pediatric patients undergoing elective surgery. Participants were grouped based on the anesthetic received: GA or RA. Outcomes measured included post-operative pain (0–10 scale), post-operative nausea incidence, and recovery room stay length.</p> <p><strong>Results:</strong> The mean post-operative pain score for GA patients was 4.5 (standard deviation [SD]: 1.5), with most reporting scores between 3.0 and 6.0. For RA patients, the mean pain score was 3.8 (SD: 1.2), with the majority reporting scores between 2.6 and 5.0. Patients under RA had marginally reduced post-operative pain scores than those under GA. Regarding nausea, 56% of GA patients reported post-operative nausea, while only 36% of RA patients did. The mean recovery room stay for GA patients was 120 min (SD: 30 min), with most staying between 90 and 150 min. RA patients had an average stay of 100 min (SD: 25 min), with the majority staying between 75 and 125 min.</p> <p><strong>Conclusion:</strong> Pediatric patients administered RA demonstrated slightly lower post-operative pain, decreased incidence of nausea, and a shorter recovery room stay compared to those given GA. These findings suggest potential benefits of RA in pediatric elective surgeries, although further research is warranted.</p> Sugandhini Boda, Rajeshwari K Copyright (c) 2023 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/AJMS/article/view/59580 Thu, 01 Feb 2024 00:00:00 +0000 A comparative study of endotracheal tube cuff pressure changes in patients undergoing open abdominal and laparoscopic surgeries https://www.nepjol.info/index.php/AJMS/article/view/57811 <p><strong>Background:</strong> Laparoscopic surgeries are routinely performed because it’s minimally invasive and early recovery for patients. The preferred mode of anesthesia is general anesthesia with an endotracheal tube (ETT). The creation of the pneumoperitoneum and various positions cause cuff pressure (CP) changes.</p> <p><strong>Aims and Objectives:</strong> We aim to study the CP changes and post-operative complications related to it. The secondary objective was to observe the post-operative complications such as sore throat, hoarseness of voice, and blood-streaked expectoration after extubation at 12 h, and at the time of discharge from the post-anesthesia care unit.</p> <p><strong>Materials and Methods:</strong> One hundred and fifty patients undergoing elective open abdominal and laparoscopic surgeries were enrolled. Three groups (open abdominal [group A], n=50; lap head up [group B], n=50; and lap head down [group C], n=50) were compared for CP changes before and after pneumoperitoneum and position change. CP changes and post-operative complications were recorded and analyzed with Statistical Package for the Social Sciences version 19.</p> <p><strong>Results:</strong> Mean differences in CP after intubation at 5 min were similar in all three groups. At 45 min onward, the mean CP in group C was found to be elevated and continued to increase till the end of surgery. However, at 90 min, group B also showed some increase in CP. There was a mild increase in CP in groups B and A. The mean difference between groups was found to be remarkable. During the post-operative period, there were 0.7% and 3.3% of cases with throat pain in group B and group C, and 2% of patients in group C had blood streak expectoration.</p> <p><strong>Conclusion:</strong> In laparoscopic surgery, especially in a head-down position, a considerable increase in CP is associated with postoperative complications.</p> Shanmugavalli Ettiyan, Hari Babu Jayabal, Rajesh Prabhu Chandrasekaran Copyright (c) 2023 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/AJMS/article/view/57811 Thu, 01 Feb 2024 00:00:00 +0000 Influence of various positive airway pressure levels on catheterization of the right internal jugular vein https://www.nepjol.info/index.php/AJMS/article/view/59540 <p><strong>Background:</strong> Central venous catheterization is a commonly used method of administering drugs and measuring central venous pressure during major surgery. Chronic obstructive pulmonary disease, acute respiratory distress syndrome, and obstructive sleep apnea are among the respiratory disorders that can be treated with positive airway pressure (PAP). While PAP therapy benefits patients with respiratory disorders, its impact on central venous catheterization must be more adequately studied, particularly in the right internal jugular vein (RTIJV).</p> <p><strong> Aims and Objectives:</strong> The study aimed to predict the most applicable PAP for RTIJV catheterization and to evaluate the complications with different airway pressures.</p> <p><strong>Materials and Methods:</strong> This study was conducted using a comparative prospective randomized control trial study design in a tertiary care hospital. One hundred participants were selected from subjects who came for gastrointestinal tract surgery and urological surgery, and they were randomized through a computer-generated random number table.</p> <p><strong>Results:</strong> Participants were divided into four different groups (A, B, C, and D), and they were subjected to four pressures 0 cmH2O, 10 cmH2O, 15 cmH2O, and 20 cmH2O, respectively. The cross-sectional area of RTIJV is significantly increased in Groups C and D compared to Groups A and B. The number of completed catheterizations was higher in Groups C and D. The number of first-pass punctures was also higher in Groups C and D. Depth of needle insertion is significantly reduced with increased pressure.</p> <p><strong>Conclusion:</strong> Moderate-to-high PAPs, specifically around 15 cmH2O to 20 cmH2O, boost catheterization success. This is achieved through improved vein dilation, enhanced accuracy, and decreased needle insertion depth.</p> Renganathan S, Ramji R, Ganesh Prabhu SC Copyright (c) 2023 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/AJMS/article/view/59540 Thu, 01 Feb 2024 00:00:00 +0000 Comparison of different induction techniques on hemodynamic changes in pediatric patients undergoing infra umbilical surgeries using laryngeal mask airway https://www.nepjol.info/index.php/AJMS/article/view/58634 <p><strong>Background:</strong> Post-induction hypotension associated with various agents is well-known in adults undergoing general anesthesia for various procedures. However, this phenomenon has not been addressed well in pediatric patients. We studied the incidence of postinduction hypotension in patients 1–5 years using inhalational induction with sevoflurane, intravenous induction with propofol, and co-induction with sevoflurane plus propofol. </p> <p><strong>Aims and Objectives:</strong> To compare three different induction techniques in children 1–5 years undergoing various infra-umbilical surgeries under general anesthesia with laryngeal mask airway using sevoflurane induction, propofol induction, and sevoflurane plus propofol co-induction.</p> <p><strong>Materials and Methods:</strong> Out of 150 patients observed in this study, 50 patients (group S) received inhalational induction with sevoflurane, 50 (group P) patients received intravenous induction with propofol, and 50 (group SP) patients received co-induction with propofol and sevoflurane.</p> <p><strong style="font-size: 0.875rem;">Results:</strong><span style="font-size: 0.875rem;"> Intravenous induction with propofol resulted in maximum </span>hemodynamic changes Inhalational induction was responsible for significant changes in heart rate whereas co-induction with propofol (1–1.5 mg/kg) and sevoflurane 5% yielded minimum hemodynamic variations with least adverse effects.</p> <p><strong>Conclusion:</strong> We conclude that co-induction with propofol (1–1.5 mg/kg) plus Sevoflurane 5% provided better hemodynamic stability with the least adverse effects.</p> Amrina Ashraf, Shafat A Mir, Khalid Sofi, Majid Jehangir, Akbar Shah M, Altaf Hussain Mir Copyright (c) 2023 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/AJMS/article/view/58634 Thu, 01 Feb 2024 00:00:00 +0000 A time-motion study and patient satisfaction in the fever clinic of a Government Medical College and Hospital in India https://www.nepjol.info/index.php/AJMS/article/view/58637 <p><strong>Background:</strong> During the recent pandemic, the number of patients with influenza-like symptoms had considerably increased in fever clinics of hospitals leading to queuing and increased patient dissatisfaction.</p> <p><strong>Aims and Objectives:</strong> A time-motion study was therefore designed to evaluate the time taken at different service delivery points in the fever clinic and patient satisfaction regarding service delivery time.</p> <p><strong>Materials and Methods:</strong> An institutional cross-sectional observational study was conducted at the fever clinic of Midnapore Medical College and Hospital for 1 month. A total of 200 patients were selected by systematic random sampling from the fever clinic outdoors and their movement was recorded and satisfaction assessed.</p> <p><strong>Results:</strong> Most patients visited the clinic during the start of the week and in the first half of the day. The total mean time required from entry to exit was 9089 s±143.0. The maximum time was spent waiting time in the fever clinic entry queue followed by that at the pharmacy. The minimum time required was at the nursing table followed by a doctor’s consultation. The maximum meantime for movement between two stations was between station 5 (laboratory investigation station) and station 6 (pharmacy), that is, 1144 s±183.6. The majority of the study population was not satisfied with the time management in the fever clinic whereas only 18.0% of the participants were fully satisfied.</p> <p><strong>Conclusion:</strong> Identifying the loopholes and formulating an effective time management strategy can help deliver better patient care as well as boost patient satisfaction.</p> Mahua Chowdhury, Sucharita Maji, Manas Patra, Amitabha Chattopadhyay Copyright (c) 2023 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/AJMS/article/view/58637 Thu, 01 Feb 2024 00:00:00 +0000 Prevalence of obstructive sleep apnea among Southern Indian pregnant women attending antenatal care https://www.nepjol.info/index.php/AJMS/article/view/56383 <p><strong>Background:</strong> Physiological and hormonal changes during pregnancy can alter the sleep patterns of the pregnant women and were said to be precursor for the development of obstructive sleep apnea (OSA) and complication of pre-existing OSA. Developing country like India has no health cost distribution for the treatment, as this condition’s treatment trends absorbs 65–82% of all health cost. There is oblivious state among clinicians and patients, self-reporting of the symptoms are poor which, in turn, results to upshot underdiagnoses of OSA among southern Indian population.</p> <p><strong>Aims and Objectives:</strong> The aim of the study is to screen the prevalence of OSA among the southern Indian pregnant women attending antenatal care and to evaluate its predisposing factors.</p> <p><strong>Materials and Methods:</strong> We enrolled 305 pregnant women according to our study selection criteria, attended antenatal care at ACS medical college and hospitals from Chennai. On face-to-face basis, berlin questionnaire screening was done. With a brief interview, sociodemographic details, medical records and laboratory parameters were obtained. To cluster the risk of OSA prevalence, percentage was estimated using frequency distribution. Chi-square analysis was done to obtain significant relationship between contributing factors and OSA symptoms. Statistical testing was done with SPSS software version 21.</p> <p><strong>Results:</strong> Among 305 pregnant women, 31.8% (97) were shown to have high-risk OSA and 68.2% (208) low-risk OSA. Across the trimester, high-risk OSA were noted among 8.2% (25), 11.1% (34), and 15.4% (48) at first, second, and third trimester, respectively. Age, body mass index, occupation, neck circumference, multiple pregnancy, and presence of conditions such as gestational hypertension, chronic hypertension, adenoids, mallampatti grade, nasal congestion, and family history of OSA can be the predisposing factors which could influence the OSA symptoms.</p> <p><strong>Conclusion:</strong> The future investigations should rely on the analysis of the fetal outcomes after proper diagnosis of OSA. Furthermore, independent predictive values of physical signs, history, risk factors, and mechanisms behind the progression of OSA should be studied well. Region and area specific difference of risk of OSA to identify disparities and to promote decentralization of sleep care could be done.</p> Kirthana G, Mirnalini VS, Roshini S, Keerthika R, Balamurugan, Chandrasekhar C Copyright (c) 2023 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/AJMS/article/view/56383 Thu, 01 Feb 2024 00:00:00 +0000 Evaluating the role of digital media in language development among pre-schoolers: An observational study https://www.nepjol.info/index.php/AJMS/article/view/59871 <p><strong>Background:</strong> Digital media consumption is prevalent among pre-schoolers, but its impact on language development remains unclear.</p> <p><strong>Aims and Objectives:</strong> This study investigates the effects of different types of digital media on pre-school children’s language outcomes.</p> <p><strong>Materials and Methods:</strong> A total of 100 pre-school-aged children (mean age 4.2±0.5 years; 51% male) were observed for 12 months. Digital media exposure was categorized into educational interactive, educational passive, and non-educational content, with average screen time being 1.5±0.45 h daily. Language development was assessed using the Preschool Language Scale-5 (PLS-5) at baseline and 12-month follow-up.</p> <p><strong>Results:</strong> At the 12-month follow-up, the study participants exhibited an average Total Language Score (TLS) increase from 100±10 to 107±12. Interactive educational app users showed significant language improvements (TLS: 112±10; P&lt;0.05), exceeding gains seen in passive educational (TLS: 104±10) and non-educational content users (TLS: 102±12). Vocabulary size, expressive language, and receptive language improvements were highest in the interactive group (20%, 15%, and 10%, respectively). Behavioral assessments indicated enhanced use of complex sentences and turn-taking skills in the interactive group. Parental co-viewing correlated with higher TLS gains across all groups, with the most pronounced benefit in the interactive group (9 points vs. 6 without co-viewing). Interactive app users also exhibited higher cognitive (40%) and emotional engagement.</p> <p><strong>Conclusion:</strong> Our study emphasizes the positive influence of interactive educational apps on pre-schoolers’ language development, with notable gains and augmented outcomes through parental involvement. This highlights the value of guided media use in early childhood education.</p> Ramisetty Uma Mahesh, Tumati Kedarnath Reddy, Haarika V, Chandra Sekhar G Copyright (c) 2023 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/AJMS/article/view/59871 Thu, 01 Feb 2024 00:00:00 +0000 Exploring the impact of health education on medication adherence and health outcomes in low-income neighborhoods: An observational study https://www.nepjol.info/index.php/AJMS/article/view/59364 <p><strong>Background:</strong> Medication adherence and health outcomes are influenced by multiple factors, including patient education.</p> <p><strong>Aims and Objectives:</strong> The aims and objectives of the study are to explore the impact of health education on medication adherence and various health outcomes in low-income neighborhoods.</p> <p><strong>Materials and Methods:</strong> An observational study was conducted involving 100 participants from low-income neighborhoods, aged 18–65, who were prescribed at least one chronic medication. Participants underwent a comprehensive health education program focusing on medication adherence, potential side effects, dietary habits, and physical activity. Outcomes were measured using the Morisky Medication Adherence Scale (MMAS-8), biometric values (e.g., blood pressure, blood sugar levels, cholesterol, and body mass index [BMI]), self-reported health status, hospitalization records, medication side-effects awareness, and dietary habits.</p> <p><strong>Results:</strong> Post-education, there was a significant improvement in MMAS-8 scores (5.3 pre to 6.8 post, P&lt;0.001). Biometric outcomes revealed a decrease in average blood pressure (from 145/90 mmHg to 130/85 mmHg), fasting blood sugar (from 150 mg/dL to 130 mg/dL), cholesterol levels (from 210 mg/dL to 180 mg/dL), and BMI (from 28.5 to 27.3), all with a statistical significance of P&lt;0.01. Participants reporting “Good” or “Very Good” health increased from 45% to 65%, and those reporting regular physical activity increased from 25% to 45% (P&lt;0.05). Hospitalizations/medical visits decreased from an average of 2.1–1.3 over 6 months (P&lt;0.01). The proportion of participants with awareness of their medication's side effects significantly increased from 30% before the health education program to 70% afterwards (P&lt;0.001). In addition, participants reporting adherence to dietary guidelines rose from 20% to 50% (P&lt;0.01).</p> <p><strong>Conclusion:</strong> Health education appears to have a substantial positive impact on medication adherence, biometric health outcomes, and overall well-being in low-income neighborhoods. Structured health education interventions may play a pivotal role in improving community health.</p> Sandhya Rani M, Ramesh Palabindela, Tejkumar C, Nagendra Naidu B Copyright (c) 2023 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/AJMS/article/view/59364 Thu, 01 Feb 2024 00:00:00 +0000 Behavioral and emotional functioning of children with specific learning disorders https://www.nepjol.info/index.php/AJMS/article/view/58140 <p><strong>Background:</strong> Specific learning disorder (SLD) is distinct from other Diagnostic and Statistical Manual (DSM)-5 mental disorders as it is recognized clinically in medicine and as a separate category in special education.</p> <p><strong>Aims and Objectives:</strong> The study aimed to study the behavioral patterns and emotional functioning in children with SLD.</p> <p><strong>Materials and Methods:</strong> This observational cross-sectional study was conducted at Tirunelveli Medical College, Tirunelveli, from January 2019 to April 2020 on 100 patients (study group 50 and control group 50) diagnosed with SLDs as per DSM5 criteria. A patient’s history includes age, gender, symptoms, and diagnosis. Assessments were done through a semi-structured proforma, Rutter Children’s Behavior Questionnaire (parent form), the Vanderbilt attention deficit hyperactivity disorder (ADHD) diagnostic rating scale, and the Rosenberg self-esteem scale (RSES).</p> <p><strong>Results:</strong> The patient’s domicile in rural areas was 82% compared to urban areas, which is 18%. The Rutter scale – total score was higher in the study group, with a mean of 3.24, compared to the control group, with a mean of 0.44. The RSES compared self-esteem scores and the mean self-esteem scores of 21.56 and 14.72, respectively (P&lt;0.0001). The deviant/antisocial behavior subscale scores were higher for the study group, with a mean score of 1.08, than the control group, with a mean score of 0.02 (&lt;0.05). The ADHD (inattentive type) Vanderbilt scale was compared, and it was found to be positive for the study group and none for the control group (P=0.022).</p> <p><strong>Conclusion:</strong> The scores show a significant correlation between higher rates of neurotic behavior and behavioral problems, predominantly inattentive types, in SLD children.</p> Asarnisa Begum M, Kandasamy V Copyright (c) 2023 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/AJMS/article/view/58140 Thu, 01 Feb 2024 00:00:00 +0000 Evaluation of perioperative complications in patients with obstructive sleep apnea: An observational analysis with clinical implications https://www.nepjol.info/index.php/AJMS/article/view/59041 <p><strong>Background:</strong> Obstructive sleep apnea (OSA) poses significant perioperative risks, yet limited research exists to quantify these complications.</p> <p><strong>Aims and Objectives:</strong> The study aims to fill this gap by investigating a variety of perioperative complications in OSA patients. The primary objective was to assess the types and prevalence of perioperative complications across diverse surgical procedures.</p> <p><strong>Materials and Methods:</strong> A cohort of 100 OSA patients undergoing different surgical interventions was monitored prospectively. Descriptive statistics, Chi-square tests, independent t-tests, and logistic regression were employed to evaluate the data.</p> <p><strong>Results:</strong> In this cohort study involving 100 OSA patients, 57% experienced at least one perioperative complication, most commonly postoperative hypoxemia (23%), cardiac events (18%), and delirium (12%). The mean age for those with complications was 56 years, significantly higher than the 52 years for those without complications (P&lt;0.05). Abdominal surgeries were particularly associated with hypoxemia (P&lt;0.05), while pre-existing cardiac conditions predisposed to cardiac events (P&lt;0.01). Older patients (&gt;60) were more prone to delirium (P&lt;0.05). Complication severity varied, with 29 mild, 20 moderate, and 8 severe cases requiring an intensive care unit. Diabetes and hypertension emerged as significant predictors, with odds ratios of 2.5 and 2.8, respectively (P&lt;0.05).</p> <p><strong>Conclusion:</strong> This study highlights the substantial risk of perioperative complications among OSA patients, especially those with certain pre-existing conditions, older age, or undergoing specific types of surgeries. The findings suggest the need for specialized perioperative care plans for these patients to mitigate the risks.</p> Pathlavath Swapna Rathod, Madhulika Koormala, Nikhila Choalla, Indira Priyadarshini CH Copyright (c) 2023 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/AJMS/article/view/59041 Thu, 01 Feb 2024 00:00:00 +0000 Prevalence of skin diseases among hostellers attending the tertiary care hospital https://www.nepjol.info/index.php/AJMS/article/view/58486 <p><strong>Background:</strong> Skin diseases are more common but are mostly non-fatal and chronic. Dermatological conditions account for a significant proportion of the global burden of diseases.</p> <p><strong>Aims and Objectives:</strong> The study aimed to determine the prevalence of skin diseases among hostellers, determine the causative factors, and describe the prevention.</p> <p><strong>Materials and Methods:</strong> This cross-sectional study was conducted for 2 months in the outpatient Department of Dermatology, Government Medical College, Pudukottai, on 507 hostellers. The study subjects were examined and diagnosed by the dermatologist. Questions such as exposure to sunlight, usage of sunscreen, frequency of head baths, and junk food consumption were asked and recorded in a case study form by the principal investigator.</p> <p><strong>Results:</strong> Pityriasis capitis was the most prevalent skin disease among 507 participants, followed by acne vulgaris (54.83%) and pediculosis capitis (25.64%). Pityriasis capitis is more common in men (56.17%), with higher chances in those with head baths (&lt;3 times/week) and exposure to sunlight (28.08%). Acne vulgaris affects both males and females equally; face washing &lt;3 times daily is associated with oil and sebum retention, while lack of sunscreen and junk food intake are linked. Periorbital melanosis is more prevalent in females (54.62%) and is linked to stress (66.39%). Sleep duration is also a factor, with 69.23% of girls having a history of cosmetic usage.</p> <p><strong>Conclusion:</strong> Pityriasis capitis, acne vulgaris, pediculosis capitis, dermatophytosis, and periorbital melanosis are common skin diseases caused by sharing, sleep deprivation, stress, and poor hygiene. Proper hygiene, sleep patterns, and self-care can reduce skin disease incidence.</p> Abirami P, Narmadha S Copyright (c) 2023 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/AJMS/article/view/58486 Thu, 01 Feb 2024 00:00:00 +0000 Comparison of success between external and endonasal dacryocystorhinostomy in primary acquired nasolacrimal duct obstruction in South India population https://www.nepjol.info/index.php/AJMS/article/view/58605 <p><strong>Background:</strong> Dacryocystorhinostomy (DCR) has been the standard procedure for primary acquired nasolacrimal duct obstruction (PANDO) for many years. This process can be performed either using an endoscopic or external approach.</p> <p><strong>Aims and Objectives:</strong> The aim is to evaluate the results and recurrence rates of external DCR (ExDCR) and endonasal DCR (EDCR) surgery in patients with PANDO in the South Indian population.</p> <p><strong>Materials and Methods:</strong> Medical records were reviewed in all patients who underwent surgery for PANDO between December 2021 and August 2023 at Government Medical College Mahabubabad.</p> <p><strong>Results:</strong> This study was conducted in 92 patients; 34 males (36.96%) and 58 females (63.04%) were the gender split. ExDCR was used in 52 (56.52%) of the cases, and EDCR was used in 40 (43.487%) of the cases. Operation success rates of these data revealed that 50 (54.34%) cases were recorded as successful, 24 (26.10%) of the cases were accepted as partially successful, and 18 (19.56%) of the cases were deemed unsuccessful. There was no statistically significant difference between success rates and recurrences in both groups (P&gt;0.05).</p> <p><strong>Conclusion:</strong> Endoscopic DCR produced simple, minimally invasive, and preferable results compared to ExDCR in the South Indian population. Although the success of ExDCR is higher and the recurrence is lower than endoscopic DCR, with the outcomes of this study, endoscopic DCR can be tried as the first choice to protect the patient from major surgery and anesthesia in PANDO.</p> Flarence MR, Meduri Nikhitha Kishore, Muderla Rajesh Copyright (c) 2023 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/AJMS/article/view/58605 Thu, 01 Feb 2024 00:00:00 +0000 Demographic pattern and histopathological profile of neuroendocrine neoplasms diagnosed at a tertiary care center in North East India https://www.nepjol.info/index.php/AJMS/article/view/59946 <p><strong>Background:</strong> Neuroendocrine tumors (NENs) are a group heterogenous group of tumors that can arise in any organ in the body and have a wide range of aggressiveness.</p> <p><strong>Aims and Objective:</strong> To compare the frequency of NENs in our setup to those reported in the literature to age, site, and degree of differentiation by doing a retrospective study.</p> <p><strong>Materials and Methods:</strong> Cases of NENs that were diagnosed in the Department of Pathology, in our hospital over the past 5 years were studied considering the age, location, and degree of differentiation. A fresh panel of immunohistochemistry (IHC) was conducted for those cases where IHC was not done.</p> <p><strong>Results:</strong> A total of 46 cases of NENs were reviewed. About 56.5% (26 cases) were males and 43.5% (20 cases) were females, with a median age of 46 years. In our study, most of the tumors are found in the gastro-entero-pancreatico-hepatobilliary group followed by the NENs of the endocrine gland (21.7%) and broncho-pulmonary group (15.2%). NENs were graded based on mitotic count and/or Ki-67 labeling index, and/or the presence of necrosis. In total 21 cases (45.7%) had G1 grading, 7 cases (15.2%) had G2 grading, 2 cases (4.3%) had a G3 grading, and 16 cases (34.7%) were graded as neuroendocrine carcinoma.</p> <p><strong>Conclusion:</strong> As the majority of the studies do not include benign NENs and those arising from the endocrine glands, therefore comparison of our results can be difficult. This is the first attempt to study the NENs from North East India and to analyze their clinicopathological features.</p> Bifica Sofia Lyngdoh, Vandana Raphael, Yookarin Khonglah, Jaya Mishra, Evarisalin Marbaniang, Biswajit Dey Copyright (c) 2023 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/AJMS/article/view/59946 Thu, 01 Feb 2024 00:00:00 +0000 A study on outcome of hepatic fibrosis in chronic hepatitis B patients on anti-viral therapy https://www.nepjol.info/index.php/AJMS/article/view/59316 <p><strong>Background:</strong> Hepatitis B infection is a global public health problem. Chronic hepatitis B (CHB) infection leads to complications such as cirrhosis, liver failure, and hepatocellular carcinoma. Effective antiviral therapy significantly improves the stages of fibrosis in these patients. Hence, the liver stiffness measurement using transient elastography (Fibroscan) in CHB patients undergoing treatment is important to evaluate the effectiveness of the therapy and to predict the prognosis.</p> <p><strong>Aims and Objectives:</strong> To see the outcome of Hepatic Fibrosis by non-invasive measurement in CHB patients after 6 months of oral anti-viral therapy.</p> <p><strong>Materials and Methods:</strong> Seventy new CHB patients are included in a prospective hospital-based study and at the end of 6 months 53 patients were analysed.</p> <p><strong>Results:</strong> Our study showed a significant statistical reduction in Liver Fibrosis as well as improvement of serological and biochemical parameters in CHB patients.</p> <p><strong>Conclusion:</strong> There is liver fibrosis reversal in CHB patients after 6 months of anti-viral therapy and Fibroscan helps not only as a marker for initiation of treatment depending on the degree of fibrosis but also indicates the response or progression of the disease.</p> Avick Nag, Saubhik Ghosh, Souvik Sarkar, Soumya Sarathi Mondal, Enamul Hossain, Sanjay Kumar Mandal Copyright (c) 2023 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/AJMS/article/view/59316 Thu, 01 Feb 2024 00:00:00 +0000 Association of mesenteric lymphadenitis with abdominal pain in children – A case–control study https://www.nepjol.info/index.php/AJMS/article/view/59395 <p><strong>Background:</strong> Enlarged mesenteric lymph nodes (MLNs) are a frequent ultrasonography finding in children with abdominal pain. Studies have shown that the incidence of enlarged mesenteric lymph nodes varies widely from 14% to 86%. The site, size, and number of lymph nodes are the distinguishing criteria for abnormal lymphadenopathy from normal lymph nodes.</p> <p><strong>Aims and Objectives:</strong> The aims and objectives of the study are to estimate the prevalence of mesenteric lymphadenitis in children aged 4–15 years, who have abdominal pain with age and sex-matched controls without abdominal pain.</p> <p><strong>Materials and Methods:</strong> The study was conducted after getting approval from the Institutional Ethics Committee. The MLN of all sizes was evaluated and measured using an ultrasound abdomen. Age and gender-matched controls were included in the study. Children with MLN were divided into 2 groups based on the size of the lymph nodes. (group A-MLN &lt;4 mm and group B MLN &gt;4 mm). In some cases, the site and size of MLN were noted and correlated with the severity of abdominal pain.</p> <p><strong>Results:</strong> The ultrasonogram of the abdomen revealed that 15 (22.7%) cases had ≤4 mm nodes and 38 (57.6%) had &gt;4 mm nodes. Out of the 38 cases, 2 (3.8%) had &gt;10 mm nodes. Among the controls, 16 (24.2%) had ≤4 mm, 8 (12.1%) had &gt;4 mm nodes, and none had MLN &gt;10 mm. The odds ratio (OR) of cases having mesenteric lymphadenitis over controls was 5.067 (OR=5.067).</p> <p><strong>Conclusion:</strong> Based on the results of our study, mesenteric lymphadenopathy &gt;4 mm is associated with abdominal pain in children aged 4–15 years.</p> Binchu Kurian, Prince Philip, Peter Prasanth Kumar Kommu Copyright (c) 2023 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/AJMS/article/view/59395 Thu, 01 Feb 2024 00:00:00 +0000 Antimicrobial susceptibility pattern and mupirocin resistance among methicillin-resistant Staphylococcus aureus isolated from skin and soft-tissue infection patients attending a tertiary care hospital in North India https://www.nepjol.info/index.php/AJMS/article/view/57877 <p><strong>Background:</strong> Antimicrobial susceptibility among bacterial isolates varies from center to center. Mupirocin is a topical antibacterial antibiotic used to treat wound infections caused by methicillin-resistant Staphylococcus aureus (MRSA).</p> <p><strong>Aim and Objectives:</strong> This study was conducted to know the prevalence of high and low levels of mupirocin resistance along with antimicrobial susceptibility in MRSA isolates from skin and soft-tissue infection in patients admitted to a tertiary care hospital in North India.</p> <p><strong>Materials and Methods:</strong> A total of 97 non-repetitive isolates of MRSA from various pus samples over a period of 1 year were included in this study. These strains were identified as per standard laboratory protocols given by the Clinical Laboratory Standards Institute. High- and low-level mupirocin resistance of the isolates was tested by using mupirocin discs of 200 μg and 5 μg, respectively. Mupirocin strips of 256 μg and 512 μg were used for the E-test to detect low-level and high-level mupirocin resistance, respectively. The isolates were reported as sensitive to mupirocin, with minimum inhibitory concentrations of &lt;4 mg/L.</p> <p><strong> Results:</strong> Overall, 9.27% of mupirocin resistance was found, of which 2.06% of isolates were high-level resistant to mupirocin, while 7.21% had low-level resistance. All MRSA strains were susceptible to vancomycin, followed by linezolid (94.84%), teicoplanin (91.75%), and fusidic acid (88.65%).</p> <p><strong> Conclusion:</strong> Regular monitoring, good infection control practices, and proper awareness about utilizing mupirocin therapeutically and prophylactically may help prevent the emergence of mupirocin resistance in health-care facilities.</p> Bajarangi Lal Chaudhary, Sanjeev Sahai Copyright (c) 2023 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/AJMS/article/view/57877 Thu, 01 Feb 2024 00:00:00 +0000 Speciation of Candida species isolated from cutaneous skin lesions using CHROMagar and conventional methods https://www.nepjol.info/index.php/AJMS/article/view/59383 <p><strong>Background:</strong> Candida species are members of the normal flora of the skin, mucous membranes, and gastrointestinal tract. They are endogenous opportunists which cause secondary infection in individuals with some underlying immunocompromised conditions. Candidiasis is a common fungal disease found in humans affecting mucosa, skin, nails, and internal organs of the body. Candida albicans is generally considered the major pathogen among the Candida species. An increase in the prevalence of non-albicans species has been noted during the last decades.</p> <p><strong>Aims and Objectives:</strong>The study was done to evaluate the performance of the conventional identification method and commercially available chromogenic Candida speciation media (CHROMagar) for the identification of medically important yeast and yeast-like organisms in a routine clinical microbiology laboratory. </p> <p><strong>Materials and Methods:</strong> This study was conducted in the Department of Microbiology, Gandhi Medical College, Hamidia, and Associated Hospitals, Bhopal (M.P.), from January 2020 to October 2021. A total of 180 samples were collected from patients suspected of superficial mycoses which were then subjected to direct KOH examination and culture on plain Sabouraud’s dextrose agar (SDA), on SDA with antibiotics slants (cycloheximide and chloramphenicol). The growths were examined macroscopically as well as microscopically. Germ tube tests and inoculations on CHROMagar Candida medium were performed on all growths identified as yeasts and confirmed by morphology on CMA.</p> <p><strong>Results:</strong> In our study, the majority of patients, belonged to the age group of 21–30 years (25%) with a male-to-female ratio of 2:1. Candida tropicalis (44.68%) was the most common Candida species, followed by C. albicans (38.30%), Candida krusei (12.77%), and Candida glabrata (4.25%).</p> <p><strong>Conclusion:</strong> Along with C. albicans, non-albicans Candida spp such as C. tropicalis, C. krusei, and C. glabrata are increasingly being isolated from clinical specimens. Identification of Candida species by colony color on Hicrome correlated with the morphology on CMA. Thus, the incorporation of CMA in routine yeast identification is more judicious than Hicrome as it increases the accuracy in the identification of Candida species within the same time as that of Hicrome.</p> Neha Rathore, Jaya Lalwani, Priyanka Singh, Mamta Meena Copyright (c) 2023 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/AJMS/article/view/59383 Thu, 01 Feb 2024 00:00:00 +0000 Clinical and investigative profile of scrub typhus patients at a tertiary care center in Southern West Bengal, India https://www.nepjol.info/index.php/AJMS/article/view/58401 <p><strong>Background:</strong> Scrub typhus, caused by Orientia tsutsugamushi, is an acute febrile illness with symptoms such as fever, chills, and organ failure. The similar clinical presentation in other common diseases such as malaria, dengue fever, and typhoid fever creates difficulty and delay in the clinical diagnosis of scrub typhus. This delay may increase the risk of scrub typhus complications. In India, it is a public health issue with a paucity of data.</p> <p><strong>Aims and Objectives:</strong> This study aims to evaluate the clinical characteristics, outcomes, and prognostic factors of patients with scrub typhus.</p> <p><strong>Materials and Methods:</strong> This institutional-based observational, cross-sectional study was conducted among consecutively selected 154 adult patients suffering from scrub typhus at a Medical College Hospital situated in the southern part of West Bengal, India. All data were collected according to a pre-designed proforma. At the end of the study, results were analyzed statistically.</p> <p><strong>Results:</strong> Younger, females, and homemakers are more susceptible to scrub typhus, mostly in the post-monsoon season from July to November. The incidence of scrub typhus complications is high in the southern part of West Bengal. The case fatality rate of scrub typhus is 6.5%. Male sex, pre-hospitalization duration of illness more than 7 days, presence of diabetes mellitus, serum creatinine (Scr) more than 1.5 mg/dL, serum bilirubin more than 3 mg/dL, systolic blood pressure below 90 mmHg, altered sensorium, and acute respiratory distress syndrome were associated with poor prognosis.</p> <p><strong> Conclusion:</strong> A high degree of clinical suspicion is required for the early diagnosis of scrub typhus and the factors associated with poor prognosis must be considered to reduce morbidity and mortality.</p> Kalyan Kumar Bhowmik, Amit Sarkar, Arpan Chakrabarti, Neelakash Mukhopadhyay, Arnab Paul Copyright (c) 2023 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/AJMS/article/view/58401 Thu, 01 Feb 2024 00:00:00 +0000 Study of biofilm formation among uropathogens isolated from catheter-associated UTI patient from a tertiary care hospital https://www.nepjol.info/index.php/AJMS/article/view/59265 <p><strong>Background:</strong> Catheter-associated urinary tract infection (CAUTI) is a serious health threat and challenging infection. CAUTI accounts for up to 40% of all nosocomial infections. Biofilm provides a survival strategy to microorganisms and ultimately leads to re-infections and recurrence of urinary tract infections (UTI) despite a full course of antibiotics.</p> <p><strong>Aims and Objectives:</strong> The present study was conducted to determine the prevalence of CAUTI in suspected UTI patients and prevalence of biofilm-forming uropathogens among CAUTI patients.</p> <p><strong> Materials and Methods:</strong> The cross-sectional study was done over a period of 6 months among 95 catheterized CAUTI patients. Biofilm production among isolated uropathogens was tested by tissue culture plate, tube test, and congo red agar method. Isolates were identified as biofilm producer if they were tested positive by any one of the all four methods, and isolates were considered biofilm non-producer in consensus with all four methods.</p> <p><strong>Results:</strong> In this study, the prevalence of CAUTI was 68.42%. Among 65 isolates most common uropathogen was 28 (43.07%) Escherichia coli. In this present study, the prevalence of biofilm-forming uropathogens was 58.46% (38). Tissue culture plate was the most sensitive (97.36%) method in detecting biofilm formation followed by modified congo red agar (82.21%), congo red agar (71.05%), and tube test (65.78%). Biofilm productions were significantly associated with female gender, diabetes, and prolonged catheterization.</p> <p><strong>Conclusion:</strong> Indwelling urinary catheter acts as a nidus for biofilm formation among microorganisms. Duration of catheterization is inversely associated with UTI. Hence, the need for catheter removal should be assessed daily to prevent infection. Periodic surveillance should be done to detect biofilm formation where prolonged catheterization is inevitable.</p> Retina Paul, Priyanka Saha, Kuhu Pal, Avi Kapoor, Arpita Sinha, Joydip Roy Copyright (c) 2023 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/AJMS/article/view/59265 Thu, 01 Feb 2024 00:00:00 +0000 Comparative study on ultrasonic placental grading among normotensive pregnancy and pregnancy-induced hypertension and its correlation with fetal outcome https://www.nepjol.info/index.php/AJMS/article/view/59734 <p><strong>Background:</strong> Placenta is essential for the fetal well-being, growth, and development which can be evidenced as early as possible through ultrasound at 6 weeks of gestation. The placenta mediates the intrauterine interaction between a mother and her baby.</p> <p><strong>Aims and Objectives:</strong> This study aims to compare the pattern of placental grading among normotensive and pre-eclampsia mothers in a tertiary care hospital.</p> <p><strong> Materials and Methods:</strong> This hospital-based observational analytical study has been conducted in the labor ward and outpatient department of the Department of Obstetrics and Gynaecology, Bankura Sammilani Medical College and Hospital from April 2021 to September 2022. A total of 69 pre-eclampsia mothers (study group) and 69 normotensive mothers (control group) who fulfill inclusion and exclusion criteria were included in the study. Template was generated and analysis was done on Statistical Package for the Social Sciences software.</p> <p><strong>Results:</strong> A total of 138 pregnant women with 69 pregnant normotensive and 69 pregnant preeclampsia mothers were included in the study. The mean age of the study participants was 21.3 years (standard deviation=3.6). About 81.2% and 89.9% of the normotensive and hypertensive mothers, respectively, resided in rural areas. Cesarean/instrumental delivery was higher among the hypertensive pregnant women (42.0%) when compared to normotensive pregnant women (27.5%) and it was found to be statistically significant. Birth asphyxia was observed to be higher among the neonates in the hypertensive group (15.9%) when compared to the normotensive group (4.3%) and it was found to be statistically significant. Neonatal intensive care unit admission was more among the neonates of the mother with hypertension and it was found to be statistically significant. There was no significant difference in the birth weight of the newborn with the placental grading among the normotensive pregnant women.</p> <p><strong>Conclusion:</strong> Ultrasonographic placental grading could be used as a screening tool for antepartum fetal surveillance in the obstetric population. Placental grading will help us to early diagnosis and to formulate line of management and timely intervention to reduce maternal and perinatal complications.</p> Pratima Garain, Sannyasi Charan Barman, Priyanka Mandal, Kajal Kumar Patra, Kishore P Madhwani Copyright (c) 2023 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/AJMS/article/view/59734 Thu, 01 Feb 2024 00:00:00 +0000 A cross-sectional study on incidence and indications for induction of labor and the factors associated with failure of induction https://www.nepjol.info/index.php/AJMS/article/view/60761 <p><strong>Background:</strong> Induction fails in about 20% of induced pregnancies and has no universally accepted definition. Failed induction is the failure to establish labor or inability to achieve the active stage of labor, considering the definition of induction of labor (IOL). It needs to be differentiated from the failure of progress of labor. There is no evidence to recommend treatment for failed induction, but usually, delivery by cesarean section will be required.</p> <p><strong>Aims and Objectives:</strong> The study was designed to start induction for an indication that justifies operative delivery in cases of failure.</p> <p><strong>Materials and Methods:</strong> A prospective observational study was done over a period of 1 year among antenatal women confirmed to be at term with cephalic presentation in the absence of active labor with unscarred uterus.</p> <p><strong>Results:</strong> The incidence of IOL was found to be 25.97% and failure was observed in 50 (21.83%) of those included in the study. Among those with failure, failed pre-induction ripening was seen in 26 (11.3%) and failed induction in 24 (10.4%). Although many variables were found to be associated with the outcome of labor, a statistically significant association was observed with premature rupture of membranes, pre-induction Bishop score, and birth weight of the baby.</p> <p><strong>Conclusion:</strong> The study helps in better clinical judgment of patients who will have a successful induction or a failed induction and the patients could be counseled accordingly. This judgment will also help to avoid unnecessary inductions in those who have the risk factors for failed induction unless the induction is absolutely necessary.</p> Kalpana N, Manvi MR Copyright (c) 2024 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/AJMS/article/view/60761 Thu, 01 Feb 2024 00:00:00 +0000 The role of life events in obsessive-compulsive disorders https://www.nepjol.info/index.php/AJMS/article/view/57961 <p><strong>Background:</strong> A small number of studies are available to assess the role of stressful life events (SLEs) in obsessive-compulsive disorder (OCD). The previous studies have reported contradictory results and they have methodological limitations.</p> <p><strong>Aims and Objectives:</strong> The objectives of our study are (i) to find out the frequency of life events in patients with OCD in comparison to their matched healthy controls and (ii) to find out the impact of life events on the severity of the disorder.</p> <p><strong>Materials and Methods:</strong> Sixty patients fulfilling Diagnostic and Statistical Manual of Mental Disorder, 5th edition (DSM-V) criteria of OCD were rated with Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Hamilton Rating Scale for Anxiety (HAM-A), Hamilton Rating Scale for Depression (HAM-D), and Presumptive Stressful Life Events Scale (PSLES). A group of 60 normal controls were also rated on PSLES. Finally, both groups were compared in terms of life events.</p> <p><strong>Results:</strong> The frequency of life events, past 1 year (t=5.307, P=0.006) and lifetime (t=11.527, P&lt;0.001), were significantly higher in the patient group in comparison to controls. PSLES scores showed a<br />significant correlation with Y-BOCS total scores, Y-BOCS obsession scores, and HAM-A scores. There was a positive correlation between past 1 year PSLES score and HAM-D scores. Step-wise linear regression analysis showed PSLES scores significantly positively predicted Y-BOCS total score, Y-BOCS obsession score, and Y-BOCS compulsion score.</p> <p><strong>Conclusion:</strong> Life events were significantly more frequent in OCD patients both past 1 year and lifetime, as compared to healthy controls. The severity of obsessive compulsive symptoms was found to be directly proportional to the number of SLEs experienced in the past 1 year and lifetime.</p> Uday Sankar Mandal, Suchismita Mallick, Surjendu Bikash Khatua, Arijit Mondal, Sandip Kumar Hazra Copyright (c) 2023 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/AJMS/article/view/57961 Thu, 01 Feb 2024 00:00:00 +0000 Correlation of circulatory VEGF and miRNA 126 in angiographically proven coronary artery disease and its clinical importance https://www.nepjol.info/index.php/AJMS/article/view/58422 <p><strong>Background:</strong> Atherosclerotic ischemic coronary artery disease (CAD) is a major cause of morbidity and mortality in both developed and developing countries, indicating the need for the discovery of deeper molecular insights of CAD mechanisms, biomarkers, and innovative therapeutic targets. Vascular endothelial growth factor (VEGF) may have some role, in the progression of human coronary atherosclerosis. Circulating microRNAs (miR) have a potential as a diagnostic as well as a prognostic biomarker of cardiovascular disease and dysfunctions.</p> <p><strong>Aims and Objectives:</strong> The aim of the study was to correlate the levels of miRNA-126 and VEGF in the serum of CAD patients.</p> <p><strong>Materials and Methods:</strong> The study was conducted on 100 cases of freshly diagnosed CAD patients (angiographically proven) and 80 normal healthy patients. Various serum biomarkers were estimated. The level of serum VEGF and Mi-RNA was correlated for CAD patients.</p> <p><strong> Results:</strong> Highly significantly difference was found in levels of hemoglobin A1C, low density lipoprotein, total cholesterol, and total homocysteine while high-density lipoproteins and triglycerides were less significantly different for controls and cases. VEGF levels of CAD cases were found to be very significantly higher as compared to controls. The miRNA-126 expression was found to be lower in the CAD subjects compared to non-CAD subjects.</p> <p><strong>Conclusion:</strong> The study was suggested the role of VEGF in atherogenesis and plaque instability. No significant correlation was found among between miR-126 levels and VEGF levels among CAD cases. The study is limited by a smaller sample size and was single-centered; therefore, multicentric study with a larger patient cohort needs to be done and to validate our findings.</p> Manzeela Swale, Neetu Kushwaha, Mohd Sajid Khan Copyright (c) 2023 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/AJMS/article/view/58422 Thu, 01 Feb 2024 00:00:00 +0000 Immunohistochemical expression of p53, beta-catenin, and PD-L1 in colorectal carcinoma with respect to grade and stage-an observational study in a tertiary care center https://www.nepjol.info/index.php/AJMS/article/view/59891 <p><strong>Background:</strong> Colorectal cancer (CRC) has consistently shown a global rise in incidence. p53 exerts regulatory function in signaling processes, with the p53 mutation accelerating the late stage of colorectal carcinogenesis. Programmed death ligand 1 (PD-L1) is an immune checkpoint regulator whose role in targeted therapy of CRCs needs to be evaluated. Beta-catenin plays a fundamental role in cell adhesion, with long-term effects on disease progression and survival. A detailed evaluation of all these factors is essential to tailoring new therapeutic approaches in advanced-stage cases.</p> <p><strong>Aims and Objectives:</strong> To study the immunohistochemical (IHC) expression of p53, PD-L1, and beta-catenin in different histologic grades and stages of colorectal carcinomas.</p> <p><strong>Materials and Methods:</strong> A total of 29 cases of segmental colectomy were included in the study population. Tumor sections were sent for IHC study of p53, PD-L1, and beta-catenin and interpreted as per standard protocol. Findings were tabulated against the histologic grade and stages of CRCs. Statistical analysis was done using SPSS 25.0 to test for statistical significance at P&lt;0.05.</p> <p><strong>Results:</strong> The study population predominantly consisted of males (66%), mainly in the age group of 46–60 years. p53 was significantly more expressed in left colonic tumors. PD-L1 expression was also significantly associated with histologic grade and nodal metastasis. High beta-catenin expression was seen in well-differentiated adenocarcinomas and lower T and N-stage disease. Positive p53 also correlated with positive PD-L1 expression. However, expression of p53 was also high in tumors with low beta-catenin expression.</p> <p><strong>Conclusion:</strong> p53, PD-L1, and beta-catenin may have a role in prognostication and predicting long-term survival outcomes in CRC cases. These may also act as potential therapeutic targets with a more detailed evaluation and a larger sample size of CRC cases.</p> Sanghamitra Mukherjee, Sucharita Sarkar, Rena Guha, Palash Kumar Mandal, Meghadipa Mandal Copyright (c) 2023 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/AJMS/article/view/59891 Thu, 01 Feb 2024 00:00:00 +0000 To study ERG expression in benign, pre-neoplastic, and neoplastic lesions of prostate https://www.nepjol.info/index.php/AJMS/article/view/59093 <p><strong>Background:</strong> Prostate cancer (PCa) is the second most common malignancy in men and the sixth leading cause of death. Clinical course of PCa is highly variable and current clinico pathological parameters are unable to predict accurately the course of the disease because of genetic heterogeneity seen in this tumor.</p> <p><strong>Aims and Objectives:</strong> The aim of the study was to study the prevalence of E26 transformation-specific-related gene (ERG) expression in benign and malignant lesions of prostate in Northern Indian patients. Whether ERG expression using immunohistochemical (IHC) methods can also be used for differentiating various lesions of the prostate gland is also evaluated.</p> <p><strong>Materials and Methods:</strong> This is an observational study conducted on 50 biopsy specimens encompassing different lesions of prostate. The study was carried out in the Department of Pathology at Integral Institute of Medical Sciences and Research, Lucknow, India, during the period January 2020–September 2022.</p> <p><strong>Results:</strong> Amongst 50 cases of prostatic lesions included in the study, there were 20 cases of benign prostatic hyperplasia (BPH), 17 cases of benign mimicker lesions and 13 cases of PCa. ERG expression was absent in all cases of BPH and benign mimicker lesions. ERG expression was seen in 38.5% of cases of PCa.</p> <p><strong>Conclusion:</strong> In our study, none of the patients of BPH or benign mimicker lesion expressed ERG on IHC, while 38.5% of patients of PCa showed positive staining. This figure differs from reports from other parts of the world. ERG expressions can be a potential therapeutic target for personalized treatment in a subset of patients of PCa. However, it was not found to be a sensitive marker for the diagnosis of PCa.</p> Rishabh Chaudhary, Pradeep Tandon, Anubhav Raj, Nausheen Sanaullah Khan Copyright (c) 2023 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/AJMS/article/view/59093 Thu, 01 Feb 2024 00:00:00 +0000 Comparative analysis of different cervical screening methods with special reference to the WHO recommended human papillomavirus detection at a rural tertiary care center - A pilot study https://www.nepjol.info/index.php/AJMS/article/view/60320 <p><strong>Background:</strong> Cervical cancer (Ca Cx) the 4th common cancer has a high mortality rate. Human Papilloma Virus (HPV) is chiefly responsible for a long latent period to progress from preinvasive to invasive Ca Cx. So it can be prevented by screening procedures such as visual inspection with acetic acid (VIA), conventional cervical PAP smear (CP), liquid-based cytology (LBC), and high-risk (HPV-hr) detection along with vaccination.</p> <p><strong>Aims and Objectives:</strong> The study aims to determine the socio-demographic profile of Ca Cx and the most appropriate cost-effective community screening method.</p> <p><strong>Materials and Methods:</strong> A prospective observational study with 80 symptomatic women of reproductive and peri/postmenopausal age groups attending the Gynecology Department who underwent VIA, CP, and LBC and thereby detected positive along with screened negative but clinically suspicious women were tested for HPV-hr detection. Results were tabulated into an Excel sheet and screening methods were compared using Chi-square test, gold standard being cervical histopathology (P&lt;0.5 significant). Statistical software used - Graphpad Prism 9 (San Diego, CA).</p> <p><strong>Results:</strong> The mean age was 43.3 years. Multiparity and early marriage were seen in 80% and 45% respectively. Inflammatory lesions were best diagnosed by CP but epithelial cell abnormality and more satisfactory smears by LBC (P&lt;0.05). Sensitivity was highest (93.75%) in VIA, positive predictive value, and specificity in CP (91.66%, 75%). negative predictive value was highest in VIA and HPV-hr DNA (50%).</p> <p><strong>Conclusion:</strong> VIA with CP/LBC is an economically viable and effective screening method for Ca Cx in developing countries along with HPV vaccination.</p> Sandip Kumar Sengupta, Rupsha Dutta Pal, Dwaipayan Samaddar, Jaya Bagchi Samaddar, Bidyut Krishna Goswami Copyright (c) 2024 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/AJMS/article/view/60320 Thu, 01 Feb 2024 00:00:00 +0000 A randomized control study on the effect of probiotics on feed tolerance in very low birth weight neonates https://www.nepjol.info/index.php/AJMS/article/view/59416 <p><strong>Background:</strong> Probiotics are live microbial supplements that increase feed tolerance, colonize the gut of these newborns with beneficial flora, and promote growth in these infants.</p> <p><strong>Aims and Objectives:</strong> This study was planned to compare the role of probiotics in low birth weight (LBW) infants in the time taken to reach full feeds, episodes of feed intolerance, weight gain, duration of hospital stay, incidence of necrotizing enterocolitis (NEC) stage 2 or more, and morbidity and mortality during hospital stay.</p> <p><strong>Materials and Methods:</strong> This interventional two-arm blinded randomized control study was conducted in Thoothukudi Government Medical College Hospital, Thoothukudi, from November 2019 to October 2020. The selected sample of babies was randomly divided into two groups, the probiotic and the no-probiotic group. Bifidobacterium breve M-16 was administered to infants in the probiotic group at a dose of 0.5 g/day once a day in breast milk. Only breast milk was used to feed babies in the no-probiotic group.</p> <p><strong>Results:</strong> The time to reach full enteral feed was shorter in the probiotic group (9.21±1.74 days) than in the no-probiotic group (12.43±3.74 days). Better feed tolerance (12%) was seen in the probiotic group than in the no-probiotic (44%) group. A low incidence of sepsis (12%) was seen in the probiotic group than in the non-probiotic group (40%). A lesser duration of hospital stay (10.42±1.77 days) was seen in the probiotic group than in the probiotic group (13.78±4.18 days).</p> <p><strong>Conclusion:</strong> Very LBW neonates who received probiotic supplements along with their feeds have shorter times to reach full feeds, greater feed tolerance, lower rates of sepsis, and shorter mean hospital stays.</p> Senthil Kumaran G, Chairman Muthu Prem Kumar L, Jeyarama Krishnan R Copyright (c) 2023 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/AJMS/article/view/59416 Thu, 01 Feb 2024 00:00:00 +0000 Diagnostic role of serum prolactin level in different kinds of seizure and seizure-like episode in children: A hospital-based study https://www.nepjol.info/index.php/AJMS/article/view/57907 <p><strong>Background:</strong> Serum prolactin level has been previously used in distinguishing epileptic seizure from non-epileptic seizure, as prolactin level usually rises following an epileptic seizure in children.</p> <p><strong>Aims and Objectives:</strong> We conducted this study to determine the role of serum prolactin as a surrogate marker of seizure disorder and whether serum prolactin level varies between different types of seizure, febrile seizure, and seizure mimics.</p> <p><strong>Materials and Methods:</strong> This cross-sectional comparative study was conducted for 1 year among 113 children between 6 months and 16 years of age of either sex. They were divided into 3 groups (1) epileptic seizure, (2) febrile seizure, and (3) seizure mimics. The blood sample was collected within 1 h of the occurrence of seizure for estimation of serum prolactin level. Each child was investigated and treated according to the protocol.</p> <p><strong> Results:</strong> Mean post-ictal prolactin level was found significantly higher in epileptic seizure (29.94±7.97 ng/mL) compared to febrile seizure (10.21±0.94 ng/mL), and seizure mimics (8.73±0.67 ng/mL). Among group 1, serum prolactin levels significantly elevated in children with generalized tonic-clonic seizure (GTCS) (34.18±2.76 ng/mL) and complex partial seizure (CPS) (31.38±1.59 ng/mL) compared to simple partial seizure (SPS) (14.36±2.33 ng/mL). Post-ictal serum prolactin levels remain elevated for a longer duration in GTCS (54.26±5.19 min) and CPS (45.19±1.73 min) compared to children with SPS (26.76±2.33 min).</p> <p><strong>Conclusion:</strong> Estimation of serum prolactin level within 1 h after a seizure can be used for screening purposes to distinguish between epileptic and non-epileptic seizures. A high prolactin level is suggestive of GTCS or CPS whereas a low level is indicative of SPS, febrile convulsion, or seizure mimics with a prolactin cutoff taken 24 ng/mL in our study.</p> Priyanka Kumari, Sudipto Paul, Moshihur Rahaman Sk, Sumanta Laha, Saikat Mondal, Aditya Kayal Copyright (c) 2023 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/AJMS/article/view/57907 Fri, 02 Feb 2024 00:00:00 +0000 A comparative study to evaluate the optimum intubating dose of rocuronium bromide versus succinylcholine chloride as an ideal intubating muscle-relaxing agent https://www.nepjol.info/index.php/AJMS/article/view/58850 <p><strong>Background:</strong> Rocuronium bromide is a new amino steroidal neuromuscular blocking agent which is structurally related to vecuronium and its onset time and intubating conditions are comparable with succinylcholine and without the undesirable side effects.</p> <p><strong>Aims and Objectives:</strong> This study was planned to evaluate the ideal intubating dose of rocuronium bromide by comparing intubating conditions achieved by its different doses of rocuronium bromide and to consider rocuronium as an ideal intubating muscle relaxing agent, in place of succinylcholine chloride for elective long surgeries.</p> <p><strong>Materials and Methods:</strong> This study was conducted on 120 patients who fulfilled the eligibility criteria. These patients were randomized into four groups of 30 each by block randomization technique. Each group received rocuronium bromide 0.6 mg/kg, 0.9 mg/kg, 1.2 mg/kg, and succinylcholine chloride 1 mg/kg, respectively.</p> <p><strong>Results:</strong> Out of all the three doses of rocuronium bromide 0.9 mg/kg produced a similar intubating condition as succinylcholine chloride in the dose of 1 mg/kg without undue prolongation of the neuromuscular blockade.</p> <p><strong>Conclusion:</strong> Rocuronium bromide can be used as an alternative to succinylcholine as an ideal intubating muscle relaxing agent.</p> Pratibha Bhunia, Anupama Mandal, Subhrangsu Chatterjee, Nairita Mayur Copyright (c) 2023 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/AJMS/article/view/58850 Thu, 01 Feb 2024 00:00:00 +0000 Surgical outcomes of neoadjuvant chemoradiotherapy versus neoadjuvant chemotherapy in patients of locally advanced carcinoma of esophagus: A prospective cross-sectional comparative study https://www.nepjol.info/index.php/AJMS/article/view/58705 <p><strong>Background:</strong> Neoadjuvant chemoradiotherapy + radiotherapy (NACT+RT) or neoadjuvant chemotherapy (NACT) has been shown to improve survival in locally advanced esophageal carcinoma (EC). Comparative evaluation of NACT+RT versus NACT is ambiguous.</p> <p><strong> Aims and Objectives:</strong> The current study was designed to evaluate the outcomes of NACT+RT versus NACT in locally advanced EC.</p> <p><strong>Materials and Methods:</strong> In this prospective cross-sectional study, patients with operable, non-metastatic squamous cell carcinoma, and adenocarcinoma of the mid and lower esophagus (T3–T4a) were treated with NACT (paclitaxel 175 mg/m2 plus carboplatin 5 Area under curve (AUC) every 3 weeks) or NACT+RT (NACT with 45 Gy in 25 fractions over 5 weeks). Response, R0 resections, post-operative complications, and recurrence were comparatively evaluated.</p> <p><strong> Results:</strong> Of 40 enrolled patients, 20 received NACT and 20 received NACT+RT. In the NACT arm, 50% of patients had a partial response and 20% had disease progression. In the NACT+RT arm, 10% of patients had disease progression whereas 25% of patients had complete pathological response. Transhiatal esophagectomy was performed in 60% of patients in the NACT arm, whereas in the NACT+RT arm, 80% of patients had three-stage esophagectomy. The average surgery duration was numerically greater for the NACT+RT arm; blood loss was also greater. Pulmonary complications and anastomotic leak rate were higher in NACT+RT arm whereas other complications such as hoarseness of voice, and wound dehiscence were higher in the NACT arm.</p> <p><strong>Conclusion:</strong> NACT+RT had better partial and complete response rates and low recurrence rates versus NACT. Post-operative complications were higher in the NACT+RT, especially pulmonary complications and anastomotic leak. Further, large-scale studies are warranted to confirm the efficacy of NACT versus NACT+RT in EC.</p> Rohit Kumar Jha, Shalini Kumari, Sumedha Gargy, Rajen A Tankshali, Kiran C Kothari Copyright (c) 2023 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/AJMS/article/view/58705 Thu, 01 Feb 2024 00:00:00 +0000 Assessing the need for home-based end-of-life palliative care in pediatric cancer care https://www.nepjol.info/index.php/AJMS/article/view/59876 <p><strong>Background:</strong> Palliative care is underrepresented in our community at large. End-of-life care is offered mainly in palliative care hospices or hospitals worldwide. As access to such a facility is often sparse, and since many of them are located far away from home, most families wish to go home if a curative treatment option does not exist.</p> <p><strong>Aims and Objectives:</strong> The study was done to analyze the preferences for the location of end-of-life care for families of children with cancer. We analyze the reasons for the same and offer suggestions for improving this situation.</p> <p><strong>Materials and Methods:</strong> Parents of 77 children who died following a diagnosis of childhood cancer between 2019 and 2023, either due to progressive or refractory disease or due to toxic death, were interviewed to understand their choice of location for end-of-life care. The interview was done telephonically or face to face.</p> <p><strong>Results:</strong> 41 out of 77 deaths were anticipated, and out of these, we observed that only 3 (7.3%) opted for a formal palliative care center. Fifteen families (36%) opted for end-of-life treatment in the hospital, and 23 families (56%) went home despite having no support at home for palliation. The decision is taken considering the practical needs of the rest of the family, although it is more difficult to implement. The reasons behind the decision are analyzed here.</p> <p><strong>Conclusion:</strong> We recommend that integrated home-based palliation for end-of-life care in children be developed instead of hospice support. Hospices that take care of adults may be used with children where required. A multidisciplinary team that can support the needs of families and can visit them at home needs to be developed around centers managing children with cancer.</p> Anukriti Srivastava, Nita Radhakrishnan, Archit Pandharipande, Shruti Verma, Zeenat Brar, Eby P Baby Copyright (c) 2023 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/AJMS/article/view/59876 Thu, 01 Feb 2024 00:00:00 +0000 A longitudinal study of the prevalence of post-surgical inguinodynia and the factors responsible for the development of chronic pain among the patients undergoing open hernioplasty at a tertiary care center https://www.nepjol.info/index.php/AJMS/article/view/59890 <p><strong>Background:</strong> Chronic groin pain (Inguinodynia) is a potential complication following inguinal hernia mesh repair and has a significant impact on the quality of life. The incidence varies among studies ranging between 0% and 62.9%.</p> <p><strong>Aims and Objectives:</strong> The present study was conducted with the objectives of estimating the prevalence of post-surgical inguinodynia among the patients undergoing open hernioplasty. The secondary objective was to assess the factors associated with the development of post-surgical inguinodynia.</p> <p><strong>Materials and Methods:</strong> A longitudinal study was carried out in a tertiary care center in Bangalore, Karnataka among the hernia patients attending the outpatient department of General Surgery department. A pro forma prepared with expert validation was used to collect details regarding pre-operative characteristics, type of anesthesia, intraoperative findings, and post-operative complications. The pain was assessed by the visual analog scale. Descriptive statistics and Chi-square test were used to identify the risk factors.</p> <p><strong> Results:</strong> A total of 112 patients underwent hernioplasty. Out of this, 108 were males and 4 were females. The mean age of the patients was 48±10.8 years. Majority of them (84, 77.7%) presented with indirect inguinal hernia. The prevalence of inguinodynia at 3-month post-hernia surgery was 21.4% (n=24). Patients with significant pre-operative pain had higher chances of developing chronic pain (P=0.000). It was found that post-operative surgical site infection was associated with increased chances of development of chronic pain (P=0.000).</p> <p><strong>Conclusion:</strong> Our study found that around one-fifth of the hernia patients had developed chronic post-surgical inguinal pain following open hernioplasty. There was no significant relationship between patients’ characteristics and development of chronic post-operative pain. The presence of pre-operative pain and post-operative infection in the patients was significantly associated with the development of chronic pain. Intraoperative nerve identification and chronic post-operative pain did not have a significant relationship in our study. Most of the patients who developed chronic pain had experienced only mild pain and none of them had severe inguinal pain. From the findings of our study, we would like to recommend that all measures must be taken to prevent and treat post-operative surgical site infection which leads to the development of chronic pain in patients.</p> Prabhu T, Aakash Kumar Indransh, Laishram Sanjana Copyright (c) 2023 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/AJMS/article/view/59890 Thu, 01 Feb 2024 00:00:00 +0000 A comparative study between laser hemorrhoidoplasty with digital-guided hemorrhoidal artery ligation and conventional (Milligan-Morgan) hemorrhoidectomy https://www.nepjol.info/index.php/AJMS/article/view/59505 <p><strong>Background:</strong> Hemorrhoids have a much higher incidence than rectum and colon diseases worldwide. The prevalence was estimated to be between 2.9% and 27.9% among the worldwide population, of which 4% are symptomatic. Based on the Gauss method, the highest incidence was present in patients aged between 45 and 65 years.</p> <p><strong>Aims and Objectives:</strong> To compare laser hemorrhoidoplasty with digital-guided hemorrhoidal artery ligation (DGHAL) and conventional (Milligan-Morgan) open hemorrhoidectomy procedures.</p> <p><strong>Materials and Methods:</strong> A prospective follow-up study was undertaken in the Department of Surgery, Maharani Laxmi Bai Medical College, Jhansi, from January 2020 to June 2021. In this comparative and prospective study, 60 patients were included, of whom 30 were treated with open surgical hemorrrhoidectomy (Milligan-Morgan) and 30 were treated with laser hemorrhoidoplasty with the DGHAL method.</p> <p><strong>Results:</strong> Male patients numbered 41 and female patients numbered 19. Between laser hemorrhoidoplasty with DGHAL and the open surgical hemorrrhoidectomy (Milligan-Morgan) approach, there were significant differences in operating time, blood loss, bleeding; and early postoperative pain. In terms of early postoperative pain, there were statistically significant differences between the two groups (P&lt;0.001). The mean operational time for laser hemorrhoidoplasty with DGHAL was 22.57±1.794 min, compared to 29.43±3.664 min for the open surgical hemorrrhoidectomy (Milligan-Morgan) method (P&lt;0.002).</p> <p><strong>Conclusion:</strong> Laser hemorrhoidoplasty with Doppler-guided hemorrhoidal artery ligation (DGHAL) is safe and effective in cases of all grades of hemorrhoids as compared to open surgical (Milligan-Morgan) hemorrhoidectomy.</p> Rajkumar Verma, Narendra Kumar, Vipin Mishra Copyright (c) 2023 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/AJMS/article/view/59505 Thu, 01 Feb 2024 00:00:00 +0000 Peritoneal rent: No hindrance to completing eTEP https://www.nepjol.info/index.php/AJMS/article/view/51501 <p><strong>Background:</strong> Extended view total extraperitoneal (eTEP) has rapidly gained popularity over the last decade. Peritoneal rent during surgery is another complication that makes surgery difficult and forces surgeons to convert to either transabdominal pre-peritoneal or open hernioplasty. With our approach despite peritoneal rent developed intraoperatively, surgery can be completed in the same extraperitoneal plane during eTEP.</p> <p><strong>Aims and Objectives:</strong> The primary objective of this study was to investigate the feasibility of completing eTEP surgery despite the occurrence of peritoneal rent during the procedure.</p> <p><strong>Materials and Methods:</strong> It is a retrospective case series conducted at high volume center, All India Institute of Medical Science, Bhubaneswar, where eTEP is performed on regular basis for patients with inguinal hernia. While performing eTEP, we came across 10 cases where peritoneal rent developed intraoperatively and was repaired using 2–0 vicryl following which eTEP was successfully completed.</p> <p><strong>Results:</strong> Six patients out of 10 underwent peritoneal rent repair through the extraperitoneal approach, with an average operative time of 97.5 min. The repair process added an average of 12.5 min to the standard eTEP operative time of 85 min. Four patients underwent peritoneal rent repair through the intraperitoneal approach, with a mean operative time of 120 min. This approach added approximately 35 min to the surgery, reflecting the additional time required for the intraperitoneal repair.</p> <p><strong>Conclusion:</strong> Our findings suggest that peritoneal rent developed during eTEP surgery can be effectively managed without compromising the integrity of the procedure. Repairing the peritoneal rent extraperitoneally takes advantage of the wide extraperitoneal space provided by the eTEP approach, offering flexibility in port placement and enhanced ergonomics. Alternatively, intraperitoneal repair with additional ports is a viable option. Peritoneal rent should not be perceived as a hindrance to the successful completion of eTEP surgery. This innovative approach expands the scope of eTEP by providing solutions for unforeseen complications, ensuring its continued efficacy in inguinal hernia repair.</p> Srishti Swarupa, Vikeerna Bharti, Leesa Misra, Nivedita Sahoo, Manash Ranjan Sahoo, Sreeparna Ghosh Copyright (c) 2023 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/AJMS/article/view/51501 Thu, 01 Feb 2024 00:00:00 +0000 The Comparison of outcomes between USG guided ESWL Vs Fluoroscopy guided ESWL – Our institutional Experience https://www.nepjol.info/index.php/AJMS/article/view/59809 <p><strong>Background:</strong> Extracorporeal shockwave lithotripsy (ESWL) is a commonly used non-invasive treatment modality for urolithiasis. While fluoroscopy (FS)-guided ESWL has been the traditional approach, the use of ultrasound (USG) guidance has gained traction due to its potential benefits in terms of reduced radiation exposure and improved stone targeting.</p> <p><strong>Aims and Objectives:</strong> The aims and objectives are to study the safety and efficacy of extracorporeal shock wave lithotripsy in the management of renal stones, outcomes of overall stone-free rate (SFR), pain intensity, urinary biochemical variables, mean hospital stay, quality of life, and adverse events.</p> <p><strong>Materials and Methods:</strong> Patient data from the period of May 2022 to April 2023 were reviewed, including 20 patients who underwent USG-guided ESWL and 20 patients who underwent FS-guided ESWL.</p> <p><strong>Results:</strong> Our analysis revealed that the USG-guided ESWL group demonstrated comparable stone fragmentation rates and SFR (P-value) when compared to the FS-guided group. Moreover, radiation exposure was significantly reduced in the USG-guided ESWL group, with a mean total FS time of [55] s compared to [3005] s in the FS-guided group. No significant differences were observed in terms of complications between the two groups.</p> <p><strong>Conclusion:</strong> This study highlights the successful implementation of USG-guided ESWL in our institution’s experience, showing comparable outcomes in terms of stone fragmentation rates and SFR, while significantly reducing radiation exposure, also can be considered an effective and safe alternative for the treatment of urolithiasis.</p> Pugazhenthi Periasamy, Jayaprakash Narashimman, Rajasekar Maruthamuthu, Rajkumar Ramakrishnan, Kuladeep Vankadara Copyright (c) 2024 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/AJMS/article/view/59809 Thu, 01 Feb 2024 00:00:00 +0000 Association between intraoperative fluid management and post-operative acute kidney injury: A single-center observational study https://www.nepjol.info/index.php/AJMS/article/view/59646 <p><strong>Background:</strong> Post-operative acute kidney injury (AKI) poses significant risks. Identifying intraoperative determinants is crucial for enhancing patient outcomes and tailoring surgical interventions.</p> <p><strong>Aims and Objectives:</strong> This study aimed to investigate the onset of post-operative AKI in patients subjected to various surgical interventions and identify potential intra-operative determinants.</p> <p><strong>Materials and Methods:</strong> In this observational investigation conducted at our institution, 100 patients who underwent diverse surgical procedures were included in the study. AKI diagnosis was based on the kidney disease: improving global outcomes guidelines. The parameters assessed encompassed patient demographics, intraoperative fluid management, surgical and anesthetic durations, and post-operative AKI incidence. Determinants of AKI were identified using multivariate logistic regression.</p> <p><strong>Results:</strong> The cohort comprised 58% males, with a mean age of 65±12 years. Key comorbidities included hypertension (42%), diabetes mellitus (28%), chronic kidney disease (15%), and cardiovascular disease (20%). Intraoperatively, the average fluid volume administered was 2.5 ± 0.8 L. Fluid management primarily included balanced crystalloids (70%), followed by normal saline (20%), and colloids (10%). Anesthesia was maintained for an average of 3.5 ± 1.2 h. Post-surgery, 15% of the patients developed AKI. A detailed evaluation revealed a strong association between positive intraoperative fluid balance and AKI onset. The statistical analysis pinpointed elevated intraoperative fluid balance (odds ratio: 5.89; 95% confidence interval [CI]: 1.72–20.15; P=0.004) and extended anesthesia duration (odds ratio: 2.12; 95% CI: 1.01–4.47; P=0.046) as significant predictors.</p> <p><strong> Conclusion:</strong> AKI onset post-surgery is closely tied to intraoperative factors, notably fluid balance, and anesthesia duration. This underscores the importance of personalized fluid management and vigilant post-operative renal function monitoring to mitigate AKI risks.</p> Rajeshwari K, Irukulla Avanthi Copyright (c) 2023 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/AJMS/article/view/59646 Thu, 01 Feb 2024 00:00:00 +0000 A study on sporadic renal cell carcinoma in young adults, our institutional experience https://www.nepjol.info/index.php/AJMS/article/view/58011 <p><strong>Background:</strong> Renal cell carcinoma (RCC) accounts for around 2–3% of all adult malignant neoplasms. Most RCC instances are sporadic, with about 4–6% being familial. Sporadic RCC is uncommon in young patients under 45, accounting for 3–7% of all instances. We report our experience with sporadic RCCs in young adults between the age of 20 and 45 years.</p> <p><strong>Aims and Objectives:</strong> The aim is to study clinical presentation, evaluation, management, and prognosis of sporadic RCC in young adults.</p> <p><strong>Materials and Methods:</strong> A retrospective review of 22 patients diagnosed with sporadic RCC between ages 20 and 45 years during a period of 7 years from 2016 to 2022 was performed at Government Stanley Medical College. Demographic details such as age, gender, clinical condition, blood investigations, radiological imaging, and histopathological evaluation were conducted. Patients were assessed for long-term outcomes by comparing metastasis and lymph node involvement with survival outcomes.</p> <p><strong>Results:</strong> The mean age at diagnosis was 37 years. Most patients belong to lower socioeconomic status (54.5%), Tumors were detected incidentally in 9 patients (41%) and were symptomatic in 13 (59%). Around 87% of patients were not having any associated comorbidities. The average duration of presenting complaints in symptomatic patients was 41 days. About 59% of patients were smokers or chewing tobacco before diagnosis. Renal biopsy was performed in 27% of patients before definitive surgery. The difference in prognosis was found to be insignificant between patients who were asymptomatic at the time of diagnosis compared to patients who were symptomatic. The tumor stage and grade had a significant impact on survival. The mean postoperative follow-up was 38 months.</p> <p><strong>Conclusion:</strong> The result of our study shows that sporadic RCC does not behave aggressively in young adults. The most important determinants in prognosis are tumor stage and histological grade. The type of surgical procedure does not affect the overall outcome.</p> Prakash JVS, Thiruvarul PV, Vetrichandar S, Mohamadali Basitali Sayyad Copyright (c) 2023 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/AJMS/article/view/58011 Thu, 01 Feb 2024 00:00:00 +0000 Perioperative management of awake craniotomy: Role of anesthesiologist https://www.nepjol.info/index.php/AJMS/article/view/59533 <p>Awake craniotomy is performed for resection of lesions located within or close to the eloquent areas of the brain. Both asleep-awake-asleep technique and conscious sedation have been used effectively for awake craniotomies, and the choice of optimal anesthetic regime is mainly as per the preferences of the anesthesiologist and surgical team. Propofol, remifentanil, dexmedetomidine, and scalp nerve block have been used successfully for intraoperative brain mapping. Appropriate patient selection, adequate perioperative psychological support, and proper anesthetic management for patients in every stage of surgery are essential for the safety and success of the surgery.</p> Chayanika Kutum, Prashant Lakhe, Uzma Begum Copyright (c) 2023 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/AJMS/article/view/59533 Thu, 01 Feb 2024 00:00:00 +0000 Intron Retention: What that means for the biologist https://www.nepjol.info/index.php/AJMS/article/view/61029 <p>Introns are non-coding segments within eukaryotic genes that are transcribed along with exons. They are subsequently removed during splicing, and their presence allows for generating diverse mRNA isoforms through the process called alternative splicing. The functional significance of introns going beyond mere "junk DNA" is questionable until recently; scientists identified that these pieces of junk DNA could hang around with the functional mRNA escaping splicing. Intron retention is a type of alternative splicing, a process that occurs during the maturation of messenger RNA (mRNA) in eukaryotic cells. In eukaryotes, genes typically consist of exons (coding regions) and introns (non-coding regions). After transcription, the precursor mRNA (pre-mRNA) undergoes splicing, where introns are removed, and exons are joined together to form the mature mRNA. Intron retention, however, deviates from this typical splicing process. Instead of being entirely removed from the pre-mRNA, the mature mRNA may retain one or more introns. This results in the inclusion of intronic sequences within the final mRNA transcript. The retained introns may contain premature stop codons or regulatory elements that can influence gene expression and protein function. Intron retention is a form of alternative splicing because it generates multiple mRNA isoforms from a single gene. This diversity in mRNA transcripts can produce different protein isoforms with distinct functions or regulatory properties. The regulation of intron retention is complex and involves various cellular factors, including splicing machinery components and RNA-binding proteins. Research on intron retention has revealed its importance in various biological processes, including development, cell growth and differentiation, and diseases like cancer. Aberrant intron retention has been associated with certain genetic disorders and cancers. Understanding the mechanisms and functional consequences of intron retention is crucial for unraveling the complexity of gene regulation and its impact on cellular processes. With an increasing output of data from high throughput assays line RNA Seq, scRNA-Seq, etc., it's high time data scientists look into these signatures in the context of disease pathology. This may well be the tip of the iceberg.</p> <p> </p> <p> </p> Ruby Dhar, Arun Kumar, Subhradip Karmakar Copyright (c) 2023 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/AJMS/article/view/61029 Thu, 01 Feb 2024 00:00:00 +0000 Torsion of wandering spleen presenting as acute abdomen: A case report https://www.nepjol.info/index.php/AJMS/article/view/59071 <p>Wandering spleen is a very rare condition characterized by the absence or weakness of one or more ligaments holding the spleen in its normal position. “Acquired” wandering spleen may occur during adulthood due to injuries or other underlying conditions that may weaken the ligaments that hold the spleen in its normal position. Torsion of a wandering spleen is an unusual cause of an acute abdomen and is rarely diagnosed preoperatively. Associated torsion of the distal pancreas is even more uncommon. We report a patient with torsion of a wandering spleen and distal pancreas presenting as acute abdomen with lower abdominal lump who was further diagnosed and managed.</p> Surya Prakash, Pankaj Saunakiya, Gouthaman S, Abhishek Kumar Yadav, Sandeep Kumawat Copyright (c) 2023 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/AJMS/article/view/59071 Fri, 02 Feb 2024 00:00:00 +0000 JN.1: The new COVID-19 variant of concern? https://www.nepjol.info/index.php/AJMS/article/view/61144 <p>Emergence of new variants of COVID-19 is nothing new. Different variants evolved with additional mutations of the virus as part of the viral replication cycle have different infectious properties. JN.1 is the latest COVID-19 variant that seems to circulate the globe contributing to many infections and hospitalizations labeling it a variant of interest by the WHO. The scientific community has yet to understand its full lethal potential if any. In this mini-review, we summarized the facts known so far about this variant and its possible consequences if any for humanity.</p> Ruby Dhar, Hiya Aidasani, Om Saswat Sahoo, Arun Kumar, Subhradip Karmakar Copyright (c) 2024 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/AJMS/article/view/61144 Thu, 01 Feb 2024 00:00:00 +0000 External oblique intercostal block in open nephrectomy patients - A zenith in analgesia for anterolateral upper abdominal surgeries: A case series https://www.nepjol.info/index.php/AJMS/article/view/59407 <p>Open nephrectomy is a common surgery usually performed for malignant and non-malignant renal pathologies. The external oblique intercostal block (EOIB) blocks the anterior and lateral cutaneous nerves from T6 to T10 and provides somatic analgesia. We present a case series of the use of EOIB in patients undergoing open nephrectomy by subcostal incision. Ten patients were given EOIB, which included patients undergoing simple nephrectomy for non-functioning kidneys and radical nephrectomy for renal mass. The patients had satisfactory numerical rating scale scores, mostly &lt;4 for 24 h. Post-operative opioid consumption was minimal. The external oblique fascial plain block is a novel thoracic block that provides reliable upper thoracoabdominal somatic analgesia. It can certainly be considered a suitable option in surgeries such as nephrectomies that involve an upper lateral abdominal wall incision.</p> Priyanka Bansal, Nidhi Sultania, Tarun Mittal Copyright (c) 2023 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/AJMS/article/view/59407 Thu, 01 Feb 2024 00:00:00 +0000 Variable presentations of dengue fever with diagnostic dilemma: A case series https://www.nepjol.info/index.php/AJMS/article/view/59781 <p>Dengue is a viral fever in humans which is caused by 4 serotypes of the flavivirus. It is spread by the bite of the infected Aedes mosquitoes. The acute febrile illness is often associated with multisystem involvement with complications. The case series presented here depicts atypical manifestations of dengue which may present with hypoplastic anemia, hepatitis, pancreatitis, and encephalopathy. The cases were diagnosed based on history of dengue with subsequent persistence of pancytopenia, presence of hepatitis, pancreatitis, and encephalopathy with serological evidence of dengue and after ruling out other possible etiologies supported by laboratory evidence of investigations. The bone marrow revealed pancytopenia with hypocellular marrow causing hypoplastic anemia, transaminitis and rise of lipase and amylase with symptoms diagnosed hepatitis, pancreatitis, and finally impairment of consciousness with electroencephalogram proved encephalopathy. The importance of the case series lies in the fact that atypical manifestations may occur in dengue patients challenging the physicians and early detection may avoid unnecessary treatment and complications.</p> Somnath Maitra, Koushik Ray, Debes Pal, Oendri Bhattacharyya Copyright (c) 2023 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/AJMS/article/view/59781 Thu, 01 Feb 2024 00:00:00 +0000 Exploring anesthesiologist niche in burn management: Putting the tube where it belongs. A case series on difficult airways in burns https://www.nepjol.info/index.php/AJMS/article/view/59170 <p>Burn injuries are complex and challenging, requiring a multidisciplinary approach. We have done more than 15 cases of severely distorted airways in patients with burns (photos attached); although the basic case management remains the same, there are a plethora of other concerns that make these patients unique. The most unique and severe 11 cases we have discussed assiduously. Out of all the concerns, airway management remains the most challenging one. Timely intervention and keen vigilance are required to prevent a disaster later on.</p> Priyanka Bansal, Nidhi Sultania Copyright (c) 2023 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/AJMS/article/view/59170 Thu, 01 Feb 2024 00:00:00 +0000 Untoward outcomes of successful chronic subdural hematoma evacuation, cortical blindness and brain stem stroke: A Case series https://www.nepjol.info/index.php/AJMS/article/view/59322 <p>Chronic subdural hematoma (CSDH) is one of the most commonly encountered emergencies in neurosurgery practice. Burr hole with drainage of hematoma has been a time-tested standard treatment with good results and in itself a simple procedure to relieve patient clinical status. However, apparently simple surgery may at times have an unexpected surgical outcome of bilateral vision loss. All bilateral CSDHs should be treated diligently with early recognition of any visual deterioration in post-operative phase if any and due to possible interventions to be offered to the patients for prevention of permanent vision loss.</p> Rakesh Singh Raghuvanshi , Rakesh Gupta, Piyush Panchariya, Ajay Chaudhary Copyright (c) 2023 Asian Journal of Medical Sciences https://creativecommons.org/licenses/by-nc/4.0 https://www.nepjol.info/index.php/AJMS/article/view/59322 Thu, 01 Feb 2024 00:00:00 +0000