International Journal of Research in Medical Sciences

Assessment of factors related to treatment failure and recurrence of superficial dermatophytosis

Evana Ibrahim — 2024-04-06

Background: Superficial dermatophytosis, commonly known as ringworm, is a fungal infection of the skin, hair, or nails caused by dermatophytes, primarily belonging to the genera Trichophyton, Microsporum, and Epidermophyton. Despite being a superficial infection, the rising incidence of treatment failure and recurrence has become a matter of concern in recent years.

Methods: This prospective observational study, conducted at the department of dermatology and venereology of Chittagong Medical College Hospital, aimed to investigate the epidemiological factors associated with treatment failure and recurrent cases of superficial dermatophytosis. The study spanned from March 2022 to February 2023, involving 249 participants diagnosed with Tinea corporis, Tinea cruris, Tinea facies, or Tinea pedis. Factors such as excessive sweating, use of warm water, clothing habits, sharing practices, and topical corticosteroid application were analyzed.

Results: The most common age group affected was 21-30 years, with a male preponderance (1.6:1). Excessive sweating, wearing water-soaked garments, and sharing towels were prevalent among participants. After 4 weeks of treatment, 81.5% achieved complete cure, but 52.7% of these cases experienced a recurrence within the subsequent 4 weeks. Multivariate analysis identified sharing towels, family history of dermatophytosis, and past topical steroid use as significant risk factors for treatment failure/recurrence.

Conclusions: The study emphasizes the importance of linen (sharing towels) in the transmission of dermatophytosis and highlights the increased risk associated with a family history of the condition. Additionally, the injudicious use of topical steroids emerged as a significant factor contributing to treatment failure and recurrence.

Hepatitis B virus total core antibody status in unvaccinated general population in a community of Bangladesh

Mostak U. Ahmed — 2024-04-10

Background: Hepatitis B virus (HBV) infection poses a significant health challenge in Bangladesh, with the hepatitis B core antibody (anti-HBc) being a crucial marker due to its lifelong presence in the bloodstream. This study aimed to evaluate the prevalence of anti-HBc (total) positivity among unvaccinated adults in Northeastern Bangladesh.

Methods: This cross-sectional observational study was conducted in the Sobhanighat area of Sylhet, Bangladesh, in collaboration with the department of gastroenterology, Sylhet MAG Osmani Medical College, from November 2022 to August 2023. A total of 216 participants were selected using consecutive sampling. HBsAg, anti-HBs, and anti-HBc (total) were tested for all subjects, and data were collected using a pre-formed questionnaire and analyzed using statistical package for the social sciences (SPSS) version 24.

Results: Among the participants, 16 (7.4%) tested positive for anti-HBc (total), while HBsAg was positive in 6 (2.77%) individuals. Anti-HBs was detectable in 23 (10.6%) participants, with 3 (1.38%) showing isolated anti-HBc positivity. Notably, 20% of HBsAg-positive cases exhibited heterotypic anti-HBs. Moreover, 56.25% of respondents with anti-HBc (total) positivity had detectable anti-HBs (p<0.001). Gender did not show significant associations with HBsAg, anti-HBc (total), anti-HBs, or isolated anti-HBc (p>0.05).

Conclusions: The study underscores a notable prevalence of anti-HBc (total) positivity among unvaccinated individuals in Bangladesh, indicative of past HBV exposure. It underscores the necessity for enhanced vaccination coverage and robust infection control measures to mitigate HBV transmission in this demographic.

Risk factors associated with in-hospital mortality in critically ill elderly patients with venous thromboembolism

Anju Puri — 2024-04-12

Background: Venous thromboembolism (VTE) is a major cause of morbidity and mortality for patients admitted to the intensive care unit (ICU). The present study aims to investigate the risk factors for in-hospital mortality among critically ill elderly patients with VTE.

Methods: This was a retrospective cohort study utilizing data from the large medical information mart for intensive care IV (MIMIC-IV) database. All elderly patients diagnosed with VTE were included in the analysis. The analyses were conducted using SPSS version 26.0 software and MedCalc version 19.6. Univariable and multivariable logistic regression models were conducted to explore potential risk factors associated with in-hospital mortality.

Results: The study population had a median age of 75 years, with a range from 69.0 to 82.0 years, and males represented 50.4% of the cohort. Among critically ill VTE patients, the in-hospital mortality rate was 18.5% (237 out of 1282). Multivariable regression analysis revealed that longer ICU stays [OR: 1.034; 95% CI: 1.010-1.059, p=0.005], higher Charlson comorbidity index (CCI) scores [OR: 1.090; 95% CI: 1.001-1.187, p=0.046], elevated simplified acute physiology score II (SAPS II scores) [OR: 1.039; 95% CI: 1.023-1.056, p<0.001], increased red blood cell distribution width (RDW) levels [OR: 1.088; 95% CI: 1.006-1.178, p=0.035], lower mean arterial pressure (MAP) [OR: 0.975; 95% CI: 0.957-0.994, p=0.011], presence of severe liver disease [OR: 2.036; 95% CI: 1.051-3.941, p=0.035], and the necessity for renal replacement therapy (RRT) [OR: 2.478; 95% CI: 1.315-4.671, p=0.005] were significantly associated with an increased risk of in-hospital mortality among elderly ICU patients with VTE.

Conclusions: The study identifies numerous independent risk factors associated with in-hospital mortality among critically ill elderly patients with VT. These factors include prolonged length of ICU stay, elevated scores on the CCI and SAPS II, increased RDW, reduced MAP, the presence of severe liver disease, and the necessity for RRT.

Histopathological and biochemical effect of Liv-52 on rifampicin and isoniazid induced liver toxicity in adult albino rats

Hans Lwunza Libamila — 2024-04-30

Background: Rifampicin and Isoniazid are two main medicinal drugs used as regimen in the treatment of Tuberculosis. These drugs induce hepatotoxicity. Liv-52, a polyherbal formulation has been shown to have clinical use in the treatment of liver disorders. The aim of this study was to investigate the histopathological and biochemical effects of Liv-52 on INH and RIF induced hepatotoxicity.

Methods: Adult albino rats weighing 150g to 250g were used. A total of 24 rats were randomly assigned into 4 groups of 6 rats each. Group 1 served as negative control. Hepatotoxicity was achieved by administering 50 mg/kg/day of RIF and INH each as positive control. Hepatoprotective effect was determined by administering Liv-52 concurrently with positive control. Low dose Liv-52 and high dose Liv-52 was administered at (155 mg/kg/day and 207 mg/kg/day) respectively, concurrently with RIF and INH at (50 mg/kg) each orally daily. After 21 days, the albino rats were sacrificed humanely, liver harvested and blood samples taken for estimation of liver serum biomarkers. The livers were processed and stained with Haematoxylin and Eosin for histological examination. Significance levels of (p≤0.05).

Results: The three selected liver biochemical parameters (ALT, AST and ALP) significantly increased in positive control group relative to negative control. The hepatoprotective groups (especially the HD Liv-52 group) showed significant reduction in the biochemical parameters. The liver histopathological results confirmed the above findings.

Conclusion: High dose Liv-52 significantly prevents hepatotoxicity induced by antitubercular therapy by inhibiting rise liver biochemical parameters and also ameliorating the deranged liver histomorphological features.

Study endoscopic and colonoscopy findings in children under 16 years of age with gastrointestinal bleeding from 2018 to 2021

Faramarz Ajri Khamesloo — 2024-04-30

Background: One of the most common reasons for Children to visit clinics is gastrointestinal issues in which endoscopic studies are used occasionally to investigate it’s etiology more accurately. GI bleeding eventhough uncommon in children, can be life threatening. The aim of this study was to study endoscopic and colonoscopic findings in children with GI bleeding.

Methods: This descriptive analytical study was done on 73 children under 16 years in Ardabil with the diagnosis of gastrointestinal bleeding. A checklist including demographic and treatment information of patients like severity of bleeding, bleeding type (melena, hematochezia, occult blood), laboratory results (hemoglobin, hematocrit) and clinical findings (abdominal pain, nausea and vomiting, ETC), endoscopic and colonoscopic results were collected and then analyzed by statistical methods in SPSS version 21.

Results: Total 38 cases (52.1%) were gone under upper endoscopy and 35 cases (47/9%) were gone under colonoscopy. The most common indications for upper endoscopy was GI bleeding (76.3%) and the most common involved anatomical part was lower portion of esophagus (44.7%). The most common indication for colonoscopy was recurrent abdominal pain (62.9%). Pathologic cases were often seen in sigmoid, rectum and anus (52/8%). The most common colonoscopic findings were nodular hyperplasia (25/7%) and solitary nodule (20%).

Conclusions: Results of study showed that, the frequency of endoscopic evaluation has been significantly lower in female children. According to the most common indications for upper and lower endoscopy, it is important to consider the frequency pattern of indications for endoscopic study.

Risk stratification of newly diagnosed multiple myeloma patients

Ismat Ara Islam — 2024-04-30

Background: Multiple Myeloma is a neoplastic proliferation of plasma cells, associated with an M (monoclonal) protein in serum and/or urine and evidence of organ damage. Despite advances in treatment, the disease remains heterogeneous, necessitating a comprehensive understanding of its risk stratification. Risk-adapted initial therapy, maintenance therapy, refractory disease management and prognosis varies according to risk group. The aim of our study is to categorize the newly diagnosed MM patients according to their risk groups.

Methods: This cross-sectional observational study was conducted at the Department of Haematology of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, from August 2019 to July 2020. A total of 31 newly diagnosed MM patients were enrolled based on specific inclusion and exclusion criteria. Risk stratification was performed using ISS, R-ISS, mSMART criteria and Avets risk group categorization.

Result: The majority of the patients were male (64.52%) and aged between 55-64 years (45.16%). Clinical features predominantly included low back pain (74.19%) and general weakness (38.71%). Cytogenetic abnormalities were noted in 38.7% of the patients, with del (13q) being the most common (32.30%). Most patients were in ISS Stage III (70.97%) and R-ISS Stage II (48.39%). According to mSMART criteria, 80.65% were at standard risk while Avet's risk stratification identifies 58.06% were at intermediate risk.

Conclusion: The study reveals a high prevalence of patients in advanced ISS stages and intermediate to high-risk categories, emphasizing the need for early and personalized intervention strategies.

Riding under the influence: unravelling substance abuse patterns among motorcyclists in South-Eastern Nigeria

Francis Chibuike Anigwe — 2024-04-30

Background: Drug and substance abuse has been outlined as a worldwide problem that is wreaking havoc on both social and public health across many nations. It is a global problem that affects both developed and developing countries. The objective of this study was to assess substance abuse among Okada riders in Nnewi, Anambra State, Eastern Nigeria.

Methods: Drug and substance abuse has been outlined as a worldwide problem that is wreaking havoc on both social and public health across many nations. It is a global problem that affects both developed and developing countries. The objective of this study was to assess substance abuse among Okada riders in Nnewi, Anambra State, Eastern Nigeria.

Results: About 221 Okada riders were assessed. Majority of them were middle aged. The mean age of the respondents were 39.5±11.1 years, with a range of 19-65 years. About 100% of the respondents were aware of substance abuse. Overall 73.3% of the respondents abuse at least a substance, with alcohol recording the highest use with 93.8% prevalence. About 77.2% of the abusers have taken these drugs before driving, and 65.2% have been involved in an accident, however only 5.4% admitted it was as a result of substance used.

Conclusions: The prevalence of substances use among Okada riders in Nnewi was high. There was however a high awareness of the negative consequences of use of substance. Non-governmental organizations should target Okada riders for interpersonal communication interventions to help mitigate the use of substances.

Factors associated with the prevalence of diseases in the scalp: a prospective study in Mugdha Medical College and Hospital, Dhaka, Bangladesh

Abu Jafar M. Shahidul Hoq — 2024-04-30

Background: The scalp skin is distinct from other areas of the body due to its unique characteristics, including the density of hair follicles and the high rate of sebum production. So of creating a dark, warm, and moist environment and various types of diseases in the scalp are usually occur.

Methods: This was a prospective cross-sectional study conducted at the Department of Dermatology in Mugdha Medical College and Hospital during January, 2023 to June, 2023. A total of 60 clinically diagnosed scalp diseases patients were enrolled in this study. The collected data were analysed using Statistical Package for Social Sciences (SPSS) software, version-23.0. The ethical clearance of this study was obtained from the Institutional Review Board (IRB) of Mugdha Medical College and Hospital, Dhaka, Bangladesh.

Results: A total of 60 clinically diagnosed scalp diseased OPD patients aged 1 to 60 years were enrolled in this study. Among the patients, 30 (50%) were male and 30 (50%) were female. According to multinomial logistic regression, the major factors contributed to exposing the diseases on scalp were age, sex, educational level, occupation, socio-economic condition, family history and behaviour (OR>1 or OR<1).

Conclusions: This study prevailed, Age, sex, behaviour, family history, occupation, education level, socio-economic condition, hygiene, associated systemic diseases, hair grooming are the factors associated with the prevalence of diseases on the scalp of humans.

Association between transient receptor potential melastatin genotypes and the prostate surface antigen levels in BPH patients

Royronald Ochieng Ongonga — 2024-04-30

Background: Benign Prostate Hyperplasia (BPH) is a prevalent condition among older males, characterized by an enlarged prostate gland leading to lower urinary tract symptoms and impacting quality of life. Transient receptor potential melastatin (TRPM) genes regulate various physiological processes.

Methods: We studied 194 BPH patients and 194 healthy controls, genotyping six selected TRPM gene SNPs. PSA levels were measured using the Cobas® e411 analyzer.

Results: Prostate-specific antigen (PSA) levels were significantly higher in BPH patients (135.76±578.03 ng/mL) than in controls (2.01±1.09 ng/mL). TRPM2 (rs168355) and TRPM7 (rs2362295) genotypes were significantly associated with elevated PSA levels. The TRPM2 GG genotype was associated with decrease in the likelihood of severe PSA levels (OR=0.34, 95% CI: 0.12-0.96, P=0.034), while the TRPM7 CC genotype showed increased odds for severe PSA levels (OR=1.48, 95% CI: 1.08-3.56, P=0.041).

Conclusions: Our findings suggest a potential link between TRPM gene variants and the severity of prostatic changes reflected in PSA secretions, indicating the need for further research to understand the underlying mechanisms and clinical implications.

QT interval prolongation in people treated with bedaquiline for drug-resistant tuberculosis

Mohammad Zannatul Rayhan — 2024-04-30

Background: Bedaquiline (BDQ) is indeed recommended for treating multidrug-resistant tuberculosis (MDR-TB). However, it's essential to monitor patients receiving bedaquiline therapy closely because it has been associated with prolongation of the QTc interval. This study aimed to assess the association of bedaquiline to QT interval prolongation in DR-TB patients.

Methods: This was an observational longitudinal study conducted in the Department of Respiratory Medicine in Chest Disease Hospital, Rajshahi, from August 2020 to February 2023. A total of 44 MDR-TB patients were included in the study. Data analyses were done by using Statistical Package for Social Sciences (SPSS) version 25.0.

Results: Out of 44 patients the majority 30(68.2%) patients belonged to age >40 years with a mean age of 49.3±15.6 years, and all patients were male. All MDR patients were detected by sputum Gene-Xpert, 44 (100%), and sputum for AFB culture was done in all patients, 44 (100%). QT level and QT changes were statistically significant for baseline and 24 weeks. Only one patient died in 2 weeks of follow-up (Table 3). Changes of QT >60 ms was found in 6 (13.6%) and ≤60 ms was 38 (86.4%). Age, sex, marital status, residence, educational status, occupational status, monthly income, chief complaints, co-morbidities, and using drug-causing QT prolongation were not statistically significant (p>0.05).

Conclusions: Prolonged QT interval is in DR-TB patients who receive treatment using the bedaquiline regimen. We observed that with a moderate prolongation of QTc, there were no arrhythmias recorded and 1 death occurred due to acute MI.

Psychosocial correlates of depression in paediatric patients with epilepsy in a teaching hospital in Nigeria

Nonyenim Solomon Enyidah — 2024-04-30

Background: Seizures are the most common paediatric neurological disorder with most children suffering at least one seizure before the age 16yr. The psychosocial comorbidities which adversely affect quality of life especially depression, are often neglected. This study sorts to highlight the psychosocial correlates of depression among these children.

Methods: Recruitment was in a paediatric neurology clinic in a tertiary-level hospital. Children were eligible for recruitment if aged 9-18 and had a diagnosis of epilepsy as confirmed by a neurologist, in care for a period of more than 3 months, and parents gave consent. Children who met the study inclusion criteria were subjected to a two- stage interview process using CES and DICA-1V tools, designed to screen and confirm depression. These instruments have previously been validated on a Nigerian population. The study was cross section and descriptive, with psychometric evaluation p-values<0.05, statistically significant.

Results: A total of 400 children were offered participation, and 380 were recruited, among them, 117 (30.8%) met the clinical criteria for major depression with 40 (10%) of them in need of urgent medical attention. Males were more depressed, p=0.000, OR: 0.861, respondents aged 9-11yr showed a strong association with depression p=0.001, OR: 1.911. Living arrangements of patients, p=0.001, OR: 0.632, family size (siblings), p=0.004, marital status of mothers, p=0.001, OR: 2.373, turned out significant with mothers’ marital status showing a strong association. Duration of illness and frequency of seizures, showed a very strong association with depression p=0.023, OR:1.203, and p=0.001, OR:1.411 respectively.

Conclusions: The study highlights a strong association between effects of epilepsy and psychosocial wellbeing of children and the high risk posed by unstable family settings on children’s health.

Efficiency of ganciclovir ophthalmic gel of 0.15% in treatment of acute adenoviral keratconojunctivities

Fareya Nadir — 2024-04-30

Background: Adenoviral eye infection is contagious, self-limiting, causing symptoms like burning, pain, photophobia, and tearing. Diagnosis is clinical; existing treatments lack consistency. Ganciclovir, a selective and less toxic antiviral, shows promise for inhibiting viral DNA synthesis. The primary objective of this study was to assess the efficacy of topical 0.15% Ganciclovir gel in treating adenoviral keratoconjunctivitis, focusing on symptom and sign improvement during the follow-up period.

Methods: A study at the National Institute of Ophthalmology and Hospital included 40 adenoviral keratoconjunctivitis patients diagnosed by cornea specialists. Symptoms were scored on a 0-3 scale during a 6-week follow-up. Patients were randomly assigned to group 1 (0.15% ganciclovir) or group 2 (artificial tear control). Data included history and ophthalmic exams. Statistical analyses used SPSS version 13.0 with p<0.05 significance, employing unpaired t-tests and chi-square tests.

Results: A study with 40 adenoviral keratoconjunctivitis patients assessed Ganciclovir 0.15% ophthalmic gel efficacy. No age difference between groups was observed. Most patients were male (82.5%), spanning different economic classes. Symptom variations included more foreign body sensation in group 1 and increased watering in group 2. Group 1 exhibited faster symptom improvement over 6 weeks, while group 2 had a slower decline. Both groups experienced complications, but group 1 showed faster recovery, suggesting Ganciclovir's potential efficacy in treating adenoviral keratoconjunctivitis.

Conclusions: In summary, the study confirms the effectiveness of 0.15% Ganciclovir gel in treating acute adenoviral keratoconjunctivitis, showing statistically significant and rapid improvement in signs and symptoms.

Item analysis of multiple-choice questions in summative assessment for professional examination I of an outcome-based integrated MBBS curriculum

Kyaw Zwar Htoon — 2024-04-30

Background: This study presents an item analysis of multiple-choice questions (MCQ-Type A) used in the summative assessment for Professional Examination I at Defence Services Medical Academy, Yangon, Myanmar. The objectives of the study were to perform item analysis using Difficulty Index (DIF I) and Discrimination Index (DI) and to correlate between DIF I and DI.

Methods: A cross-sectional observational study was conducted with 200 multiple-choice questions from two written examination papers answered by 46 medical year 2 students of Defence Services Medical Academy, Yangon, Myanmar. Item analysis of multiple-choice questions were done by using DIF I and DI calculated post-exam.

Results: Results showed that the majority of items were categorized as easy based on DIF I, with 63% and 60% in Papers I and II, respectively. Only about one-third of items were deemed acceptable, and few fell into the difficult category. DI ranged from negative to excellent, with 62% and 61% of MCQs in Papers I and II showing acceptable to excellent discrimination. Items with poor discrimination (35% and 34% in Papers I and II) should be revised or discarded. Moreover, items with negative DI should be re-evaluated for potential key errors or vague wording. A low negative correlation between DIF I and DI was observed, indicating that as DIF I increased, discrimination power decreased. Notably, items with easy DIF I demonstrated a moderate negative correlation with DI, consistent with previous research.

Conclusions: This study underscores the importance of item analysis to enhance the validity of assessment tools and ensure the effective evaluation of student cognition levels. Consequently, reconstruction and modification of MCQs are recommended to improve assessment quality and accurately measure student abilities.

Relation of radial artery occlusion after trans-radial percutaneous coronary intervention with the duration of hemostatic compression

Atikur Rahman — 2024-04-30

Background: Trans-radial percutaneous coronary intervention (PCI) in cardiac procedures accesses coronary arteries through the wrist's radial artery. Post-PCI, hemostatic compression on the radial artery prevents bleeding and aids healing. Radial artery occlusion (RAO), a possible complication, involves blockage of the radial artery. This study aimed to assess the relationship between radial artery occlusion after trans-radial percutaneous coronary intervention with the duration of hemostatic compression.

Methods: This prospective observational study was conducted in the Department of Cardiology, National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh, spanning from September 2018 to August 2019. The study enrolled 140 patients who underwent percutaneous coronary intervention (PCI) through the trans-radial approach (TRA), randomly assigned to two groups: Group I (2-hour hemostatic compression after PCI) and Group II (6-hour hemostatic compression post-procedure). Data analysis was performed using SPSS version 23.0.

Results: In this study, early radial artery occlusion was observed in 4.3% of patients in group I and 12.8% in group II (P=0.04), while late radial artery occlusion occurred in 2.8% of patients in group I and 11.4% in group II, with a statistically significant difference (P=0.04). Multivariate logistic regression analysis identified a 6-hour hemostatic compression duration (P=0.01), post-procedural nitroglycerine use (P=0.03), and procedure time (P=0.03) as predictors of radial artery occlusion.

Conclusions: Reduced hemostatic compression duration is linked to a decreased occurrence of both early and late radial artery occlusion following trans-radial intervention.

Risk factor for premature rupture of membranes: a clinical study

Intan Purnamawati — 2024-04-30

Background: Premature rupture of membranes (PROM) is the rupture of the amniotic membrane before the onset of labour. Based on the time of occurrence, PROM can be divided into two, namely Premature Rupture of Membranes (PROM) and Preterm Premature Rupture of Membranes (PPROM). PROM occurs at or after 37 weeks gestation. PPROM, occurs before 37 weeks gestation.

Methods: This study is a descriptive retrospective analytical observational study with cross sectional method. This research uses SPSS data processing. Data were taken from the medical records of inpatients in the maternity ward at Bima Hospital in the period January-December 2023.

Results: The results of the analysis showed that there was a significant relationship in the maternal age factor of less than 20 years by 70.6%. Risk factors in the education sample were most prevalent in low education level at 62.7%. The risk factor of gestational age of the sample was mostly found in preterm gestation (less than 37 weeks) showing a significant relationship to the incidence of PROM by 66.6%. In the risk factor of parity most in primigravida is 66.6%.

Conclusions: In this study there is a relationship of risk factors that affect the occurrence of premature rupture of membranes in the maternity ward of Bima Hospital, namely maternal age less than 20 years, low education level, with preterm gestational age or less than 37 weeks and primigravida parity.

The impact of surgical closure of atrial septal defect on the pulmonary hypertension: a prospective observational study

M. Abul Bashar Maruf — 2024-04-30

Introduction: The most prevalent congenital disease is atrial septal defect. Atrial septal defects that have a left to right shunt result in persistent volume overload in the pulmonary vasculature. So histological changes occur in pulmonary vasculature leads to pulmonary hypertension. Without surgery, both life expectancy and functional ability are reduced. The aim of this study was to observe the impact of surgical closure of atrial septal defect on pulmonary hypertension.

Methods: This observational study was done in the department of cardiac surgery, Bangabandhu Sheikh Mujib Medical University from June 2020 to June 2022. Sample size was 24 Patients were evaluated preoperatively, postoperative day of operation through a clinically, ECG, color doppler echocardiography. The statistical analysis was performed by using SPSS version 26.0 for windows software.

Results: In my study, the mean age of the patients was 33.33±11.3 years, male female ratio was 1:2. The mean pulmonary artery systolic pressure got decreased from 57.54±7.9 mmHg to 53.29±8.30 mmHg on postoperative day. 75% patients improved into New York heart association class 2 on post operative day. Significant improvement was seen in functional capacity of the patients. 29.2% patients had atrial fibrilation preoperatively, after surgery on post-operative day it became 25%.

Conclusions: This study concludes that surgical closure of atrial septal defect leads to a significant reduction in pulmonary hypertension.

Three-year retrospective analysis of code blue calls: single center experience

Müge Arıkan — 2024-04-30

Background: The Code Blue (CB) is a universal emergency system used to alert the CB team for patients in cardiac or respiratory arrest. The purpose of this study is to evaluate CB calls in our hospital and determine the effectiveness and deficiencies of the application.

Background: The code blue is a universal emergency system used to alert the CB team for patients in cardiac or respiratory arrest. The purpose of this study is to evaluate CB calls in our hospital and determine the effectiveness and deficiencies of the application.

Methods: After receiving approval from the ethics committee, we analyzed retrospectively the CB call forms in our hospital between January 2020 and January 2024. The demographic data of the patients, CB call time and locations, the arrival time of the team, medical interventions, cardiopulmonary resuscitation time, outcomes of the calls and true-false calls rate were recorded.

Results: We had 376 CB calls in the study period. The mean arrival time of the team was1.58±0.62 minutes. Most of the CB calls were given in intensive care units (140 patients, 37.23%), internal medicine services (50 patients, 13.30%), followed by palliative care unit (47 patients, 12.50%). Most of the CB calls (236 calls, 62.77%) were during off times. The rate of false CB calls was found to be %15.96. Of the 316 patients in the true CB codes, 198 patients were transferred to the ICU and 118 patients died.

Conclusions: We found that CB calls were most frequently given from ICU’s during off hours. We think that the lack of a night duty doctor in the ICU, especially in rural hospitals like ours, led to this result. Each center should analyze CB calls at regular intervals and educational programs should be planned for these deficiencies.

Comparison of stent-related symptoms, passive ureter dilatation and stone clearance rate using 4.5 French versus 6 French double J stenting of unfavourable ureter: a prospective randomized controlled trial in a tertiary care centre

Manu K. Nagabhairava — 2024-04-06

Background: Retrograde intrarenal surgery (RIRS) is the standard of care for renal stones of less than 1.5 cm and less than 1000 Hounsfield units (HU). Most virgin ureters do not allow the flexible ureteroscope in the first setting. Placement of a D-J stent in the ureter dilates the ureter. Therefore, our study aimed to compare stone clearance rates and symptom complex of passive ureteral dilation following 4.5 French/Fr versus 6 French/Fr double J (DJ) stent placement.

Methods: After obtaining ethics approval and written informed consent, 100 patients satisfying the inclusion and exclusion criteria were included and data recorded. patients were randomized into group A (4.5 Fr) and group B (6 Fr). Stent was placed. After 4 weeks, symptoms were assessed by the ureteral stent symptom questionnaire (USSQ). Following retrograde intrarenal surgery (RIRS) successful passage of ureteric access sheath (UAS) and stone clearance rates were assessed.

Results: The surgical success rate, stone clearance rate was similar in the two groups (p value: more than 0.05). The USSQ score was significantly lower in group A (p value: 0.001).

Conclusions: Stent of smaller diameter (4.5 Fr) is associated with less patient discomfort with similar surgical completion rates and stone clearance.

A study of detection of diarrhoea associated human rotavirus and co-infection with diarrhoea genic pathogens in childhood stool specimen by using ELISA and RT-PCR in a tertiary care hospital at Indore, Madhya Pradesh

Madhurendra Singh Rajput — 2024-04-15

Background: Childhood diarrhoea mainly caused by Group A Rotavirus, is a major global health issue, especially for children under five. In India, RVA-induced diarrhoea causes numerous deaths, hospitalizations, and outpatient visits annually. Vaccination is crucial in preventing RVA, with WHO-approved oral vaccines significantly reducing global mortality and morbidity. However, challenges persist in implementing vaccines in regions like sub-Saharan Africa due to factors like malnutrition and unsanitary conditions. Despite this, since 2009, low-income countries have seen a decline in RVA-related illness.

Methods: Over 18 months, from January 2021 to June 2022, a study at the Post Grad Dept. of Microbiology, Index Medical College, Hospital and Research Centre in Indore, MP, involved 250 children under five with acute gastroenteritis. Ethical clearance and parental consent were obtained. Data included demographic, antenatal, diarrhoea l symptoms, feeding, hygiene, physical exams, and stool analysis.

Results: 250 children under five were screened for Rotavirus. 60 tested positive, mostly in 6–12-month-olds during cooler months in urban areas. 80% were from low socioeconomic backgrounds. Exclusive breastfeeding linked to lower incidence. Vomiting and severe dehydration more frequent in positive cases. ELISA and ICG methods equally effective.

Conclusions: Childhood diarrhoea, primarily caused by Rotavirus, remains a leading cause of under-five deaths, totalling 600,000 annually. Among 250 children studied, 60 tested positive for Rotavirus, especially among males aged 7-12 months, with infections peaking in cooler months. Both ELISA and ICG were equally effective in detection. Treatment primarily involves oral rehydration with low osmolarity ORS. Predominant strains were G1 P (8) and G2 P (4). Global endorsement of rotavirus vaccines like Rotarix and Rotateq, with Rotavac showing promise in India, signals progress in fighting rotavirus, potentially improving public health via inclusion in state immunization programs.

Comparison of tamsulosin hydrochloride versus tamsulosin hydrochloride and deflazacort in relieving postoperative urinary retention in patients undergoing transurethral resection of prostate: a prospective randomized controlled trial in a tertiary care centre

Manu K. Nagabhairava — 2024-04-06

Background: Benign prostatic hyperplasia (BPH) is common amongst the elderly. Even after transurethral resection of prostate (TURP), retention of urine may persist in some leading to significant morbidity adversely affecting the quality of life. The role of alpha blockers in this situation as a combination is unclear. The present study was conducted to evaluate and compare the efficacy of tamsulosin versus tamsulosin and deflazacort in relieving the postoperative retention of urine following TURP.

Methods: After obtaining ethics approval and written informed consent, 72 patients satisfying the eligibility criteria were included. After TURP, patients with urinary retention following catheter removal were randomized into group A (tamsulosin hydrochloride) and group B (tamsulosin hydrochloride and deflazocort). baseline international prostate symptom score (IPSS) score was done to assess quality of life and findings of radiological investigations were noted. Thereafter, medical therapy was done as per assigned group and postoperative findings were documented and analyzed.

Results: Both the groups were similar in terms of demographic characteristics and baseline characteristics. The relief of symptoms was significantly more in group B along with lower IPSS score and residual volume.

Conclusions: We recommend addition of deflazacort to tamsulosin hydrochloride as medical therapy for the management of postoperative retention of urine (POUR), especially following TURP.

Admission, outcome and referral pattern of admitted neonates: a cross-sectional descriptive study at selected district hospital SNCUs in Odisha

Smitamayee Sahu — 2024-04-30

Background: The state of Odisha is one of the leading states in the country for infant mortality in India. Odisha has established 44 special neonatal care units (SNCUs) to improve neonatal survival. The study aims to assess the morbidity, mortality, and referral trends to develop targeted suggestions to lower newborn deaths.

Methods: We conducted a cross-sectional descriptive retrospective study on all admitted neonates, taking the secondary data from 8 SNCUs of District Hospitals in the State of Odisha for the period of 3 calendar years (2020-2022). We profiled the type of admission, age, gender, birth weight, admission indication, maturity, mortality profile and referral. Data was extracted in Excel 2021 and analyzed using Excel and Epi info.

Results: Of the 43050 neonates admitted to the SNCU, 21069 (49%) were inborn. There were 58% male neonates. (59%, n=29401) were low birth weight neonates (<2500 gms); out of that, 869 babies (2%) were below 1000 gm. The median duration of stay in the SNCUs was 4 days. Perinatal asphyxia (n=13093) constitutes 30% of the admissions, followed by neonatal jaundice (7561, 18%), low birth weight <1800 gm (5728, 13%), refusal to feed (4745, 11%), and prematurity (n=3888, 9%). 75% of the total were discharged, 11% were referred, 10% died, and 4% left the SNCU against medical advice. The primary reasons for mortality & referral were birth asphyxia, hypoxic ischaemic encephalopathy (HIE), sepsis, and prematurity.

Conclusion: Birth asphyxia is the primary cause of morbidity, mortality, and referral in newborns. Early referrals, effective intervention, and high-quality prenatal care are essential to prevent it.

Cataract surgery in leprosy patients: visual outcomes and complications

Shazia Tabassum — 2024-04-30

Background: Objective of study was to study the outcome of cataract surgery in terms of visual results and intra and postoperative complications in case of leprosy patient.

Methods: The study analyzed all new cataract cases with leprosy at the outpatient unit, including patients cured of leprosy with senile or complicated cataracts but excluding those with corneal or retinal issues. Small incision cataract surgery was performed, with outcomes and complications assessed. Data collection and analysis utilized descriptive statistics. Follow-ups occurred at discharge and 1-, 4-, and 12-weeks post-surgery, revealing visual acuity ranging from good (6/6-6/18) to poor (<6/60).

Results: The study involved 117 eyes from 98 patients (55 males, 43 females, ages 30-89). Pre-surgery, visual acuity was good in 6 eyes (5.12%), borderline in 29 (24.78%), and poor in 82 (70.08%). Post-surgery, 78 eyes (66.67%) had good, 25 (21.37%) borderline, and 10 (8.55%) poor visual acuity. At 12 weeks, 91.14% had good, 5.9% borderline, and 2.95% poor acuity. Common intraoperative issues included posterior capsular rupture in 8 eyes (6.84%), cortical matter loss in 4, iris prolapse in 2, and zonular dehiscence in 1. Early postoperative complications were iridocyclitis in 11 eyes (9.4%) and hyphema in 7 (5.98%), with late complications like chronic anterior uveitis, corneal decompensation, and choroidal detachment occurring in 3 and 2 eyes respectively.

Conclusions: Visual outcome was good and the rates of intra and post-operative complications were minimal in our study. Functional vision can be achieved with timely surgical intervention.

Diabetes mellitus and odontogenic infections: a life threatening combination in Ludwig's angina

Anjana Kumari — 2024-04-30

Background: The present study was a prospective study which was aimed to assess the risk factors, microbiological profile, management strategies of Ludwig’s angina patients and its association with odontogenic infections and diabetes mellitus.

Methods: The study population consisted of 40 patients of Ludwig’s angina those presented to and were managed in the department of ENT, Government Medical College, Amritsar, Punjab, India, from January 2022 to May 2023. All the patients exhibiting clinical symptoms and signs of Ludwig’s angina were examined and a detailed history of the duration of each symptom, present and past illness, dental infection, throat infection, diabetes mellitus was taken.

Results: It was observed that in 85% cases of Ludwig’s angina history of dental infection was present. History of diabetes mellitus was present in 50% cases followed by tooth extraction (10%). Streptococcus viridans was found in 22.5% patients, Staphylococcus aureus (12.5%) and no growth was seen in 52.5% cases. Major co-morbidity was diabetes mellitus (50%), followed by HIV and HCV infections in 15% patients. Surgical drainage was performed in 90% cases including tracheostomy in 12.5% cases rest 10% patients were treated medically.

Conclusions: Uncontrolled diabetes mellitus, delayed treatment of odontogenic infection complicates the management of Ludwig’s angina and leads to life threatening complications. Ludwig’s angina should be actively treated as a surgical and medical emergency in which incision and drainage is required as early as possible. Tracheostomy should be considered as an emergency measure to relieve the respiratory obstruction.

Comparative study between open versus laparoscopic inguinal hernioplasty

Manjunath A. P. — 2024-04-30

Background: Inguinal hernia repair is one of the commonly performed procedure and has undergone a paradigm shift from open to laparoscopic approach in the era of minimally invasive surgery but the superiority is still debatable. The aim was to compare open (Lichtenstein) versus laparoscopic transabdominal preperitoneal approach (TAPP) hernia repair techniques.

Methods: A total of 60 patients were enrolled in the study and divided into two equal groups (open versus laparoscopic) were compared.

Results: It was observed that laparoscopic repair (TAPP) has statistically significant superiority than open inguinal hernioplasty in terms of lesser post-operative pain (VAS score of 4.8±0.66, 3.67±0.66, 2.53±0.82 versus 6.7±0.92, 5.03±0.72, 3.83±0.65 at 24 hours, 48 hours and 72 hours post operatively, p value <0.001), shorter duration of hospital stay (3.1±0.71 days versus 5.83±0.75 days, p value <0.001) and early resumption to regular activities (10.57±2.28 days versus 12.2±1.52 days, p value 0.002). It also showed that incidence intra operative and post-operative complications was lesser in laparoscopic group but not statistically significant. Whereas duration of surgery was prolonged in laparoscopic group (104±27.49 min versus 61.5±17.08 min, p value <0.001).

Conclusions: Laparoscopic inguinal hernioplasty (TAPP) is superior to open inguinal hernioplasty in terms of lesser intra operative and post-operative complications, lesser post-operative pain, shorter duration of hospital stay with early resumption to regular activities having better subjective and objective cosmetic results in short term follow-up. However, duration of surgery was prolonged on comparison with Lichtenstein open inguinal hernioplasty.

Serum urea: an independent risk factor for cataract

Haziqa Bashir Bhat — 2024-04-30

Background: Elevated levels of blood urea/blood urea nitrogen in serum is considered an independent risk factor for the occurrence of cataract. Estimation of these levels can be used as a predictor for the occurrence of cataract.

Methods: This was a hospital-based prospective case control study conducted in the department of ophthalmology at SKIMS MCH, Srinagar from January 2023 to June 2023. We evaluated 25 patients admitted for cataract surgery in our department for serum urea and BUN levels and compared their results with 25 age and sex-matched controls admitted for causes other than cataract. The cases with significantly elevated levels of urea were further screened for possible renal impairment using Glomerular filtration rates and urine albumin.

Results: 7 out of 25 cases had elevated levels of serum urea with a mean of 44.2±16.19 mg/dl whereas all 25 patients of the control group had normal serum urea levels with a mean of 28.84±4.3 mg/dl. The mean levels of urea were significantly higher in the cases than controls with p<0.0001. 4 out of the 7 patients in the case group with elevated serum urea levels showed impaired glomerular filtration rates and clinically significant levels of urine albumin.

Conclusions: The study suggested a statistically significant correlation (p<0.0001) between serum levels of urea and BUN with cataract.

A study to assess the effectiveness of clinical teaching on the level of knowledge regarding nursing care bundle to prevent ventilator associated pneumonia among ICU nursing officers at AIIMS Bhopal

Ranjana Verma — 2024-04-30

Background: Healthcare is a professional area bound to the ethical foundation of “do no harm.”, But in the current scenario, a rush to promote the curative scenario has led to the total downplay of the preventive aspect of care. The aim of this study was to assess the knowledge regarding nursing care bundle for the prevention of VAP among nursing officers before and after clinical teaching and to evaluate the effectiveness of clinical teaching.

Methods: This pretest-post-test study was conducted on nursing officers working in the ICU of the All-India Institute of Medical Sciences, Bhopal, Madhya Pradesh. 100 nursing officers were enrolled in the study via convenience sampling technique. The self-structured tool was validated by 10 experts with a mean CVI value of 0.94. The reliability of the self-structured knowledge questionnaire was determined by the test-retest method and found to be 0.87. The collected data was analysed for frequency, mean, standard deviation, t-test, and association.

Results: Findings showed that the mean knowledge score was 18.46±3.543 before intervention. After the intervention of video-assisted clinical teaching, a post-test was conducted, and the mean post-test knowledge scores was 25.07±2.801 at the p value <0.01. Knowledge of subjects about nursing care bundle for prevention of VAP was found to have a significant association with only educational qualification.

Conclusions: This study's findings concluded that educational interventions are necessary for the enhancement of knowledge and better compliance of nursing officers with guidelines regarding the bundle of care for the prevention of ventilator-associated pneumonia.

Comparison of pain control between lignocaine and prilocaine spray versus oral analgesia in post-circumcision patients: a prospective randomized controlled trial in a tertiary care center

Manu K. Nagabhairava — 2024-04-10

Background: Pain in the postoperative period is of particular concern. It is a major barrier in the uptake of circumcision. There are various systemic and local analgesics for the management of postoperative pain. However, data regarding efficacy is scarce. Therefore, the present pilot study was conducted to compare the efficacy of lidocaine and prilocaine spray with oral analgesics for the relief of pain.

Methods: After obtaining ethics approval and written informed consent, 100 patients meeting the inclusion and exclusion criteria were included. After circumcision, patients were randomized into group A (Lidocaine and prilocaine spray) and group B (Oral analgesics). Pain was assessed by visual analogue scale (VAS) score and patient reported comfort levels were assessed in the postoperative period till 72 hours. Findings were noted and analysed.

Results: Both the groups were similar in terms of demographic characteristics and baseline characteristics. The VAS score was significantly lower in group A and the patient-reported comfort level was significantly more in group A.

Conclusions: We recommend that the lidocaine and prilocaine spray is better in relieving pain in the postoperative period following circumcision as compared to oral analgesics.

A comparative study between intrathecal fentanyl and intrathecal buprenorphine as adjuvants to 0.5% hyperbaric bupivacaine in females undergoing lower segment caesarean section under spinal anesthesia: a randomized and double blinded study

Brati Mukhopadhyay — 2024-04-30

Background: Double blinded study involving intrathecal hyperbaric bupivacaine (1.5 ml) with adjuvants as Fentanyl and Buprenorphine

Methods: Sixty-six females posted for lower segment caesarean section under spinal anesthesia were randomized into two groups-A and B. Group A received 1.5 ml of hyperbaric Bupivacaine and 0.5 ml (75 µg) of Buprenorphine. Group B received 1.5 ml of hyperbaric Bupivacaine and 0.5 ml (25µg) of Fentanyl. Sensory blockade, motor blockade and duration of analgesia were evaluated. Randomization was done using randomization.com program with GraphPad Quick Cals. Statistical analysis was performed with Statistical Package for the Social Sciences (SPSS) statistics version 28 software.

Results: There is no statistical difference in the demographic profiles of both groups. Duration of analgesia(minutes) in group A=255.37±34.63 and in group B=175.43±23.58 with p<0.001.

Conclusions: A significant drop in mean arterial pressure in both groups from preoperative values throughout surgery, (p<0.05) with the exception of MAP at 50 minutes in B (p=0.139). A significant increase in heart rate at 2 and 4 minutes in group A when compared with baseline HR (p<0.05). In group B, a significant increase only at 2 minutes post spinal anesthesia, p=0.002. Forty-three patients had hypotension (28 vs. 15), p=0.008. Nausea is higher in Group A than B (26 vs. 4). The difference in sensory level of blockade is statistically insignificant, p=0.62. The difference in time of onset of motor blockade of Bromage score 1 was statistically insignificant, p=0.093. Duration of analgesia (minutes) in group A=255.37±34.63 and in group B=175.43±23.58 with p<0.001.

Proportion of metabolic syndrome among overweight and obese children of age 6 to 16 years attending a tertiary care centre, Kerala

Jayaram Sankar — 2024-04-30

Background: This study aimed to find out the proportion of overweight and obese children of age 6-16 years having metabolic syndrome and to find out the risk factors for the same.

Methods: This hospital based cross sectional study was conducted in obesity clinic of Department of Paediatric, Government T D Medical College, Alappuzha over a period of 18 months (from jan 2019 to june 2020). Sample size was calculated as 210 children including 20% expected dropout. Children of age 6-16 years with BMI > 85th centile attending the obesity clinics were enrolled for the study as per the inclusion and exclusion criteria. After getting consent/assent, relevant points from history, physical examination and investigations were recorded. The data obtained were entered in excel spread sheet and analyzed.

Results: In this study, 28.9% were overweight and 71.1% were obese. Proportion of metabolic syndrome [MetS] among subject with overweight and obese were 18% and 29.3% respectively. Metabolic syndrome were more in males, children receiving more calories, have passive smoking and were born as preterm or big baby. Abdominal obesity was present in all children with MetS. Significant associations were found between MetS and inflammatory markers like CRP. Among the metabolic parameters, elevated level of uric acid, SGOT, SGPT and abnormal lipid profile were found to have a positive correlation with MetS.

Conclusions: More than 25% of children with BMI > 85th centile is found to have MetS. Being overweight also is high risk for development of metabolic syndrome. High calorie intake, passive smoking, prematurity, birth weight more than 4 kg and abdominal obesity are significant risk factors identified.

Efficacy of 0.5% levobupivacaine with clonidine 30 μg versus 0.5% levobupivacaine with 150 μg buprenorphine for USG guided interscalene brachial plexus block for shoulder, upper and middle humerus surgeries: a prospective randomized double blinded comparative study

Rehana Shaik — 2024-04-30

Background: Ultrasound imaging is increasingly used for peripheral nerve blocks, offering real-time visualization of nerves, surrounding structures, and needle tips. Levobupivacaine, a local anesthetic, provides excellent intraoperative and postoperative analgesia. Buprenorphine, a partial µ-opioid receptor agonist, and clonidine, an α2 adrenergic agonist, also offer postoperative analgesia. We aimed to compare levobupivacaine with clonidine versus levobupivacaine with buprenorphine for ultrasound-guided interscalene block for shoulder and upper-arm surgeries. This study aimed to determine the onset and duration of sensory and motor block, duration of postoperative analgesia, hemodynamics, complications, and sedation.

Methods: Patients scheduled for elective shoulder and upper-middle humerus surgeries received either levobupivacaine with clonidine or levobupivacaine with buprenorphine. Assessments include onset and duration of sensory and motor blockade, analgesia duration, sedation, side effects, and block quality. Onset and duration of sensory and motor blockade, and analgesia duration was analyzed using unpaired T-Test.

Results: Levobupivacaine with clonidine group showed longer duration of analgesia (595±148 mins) compared to levobupivacaine with buprenorphine group (445±44.16 mins), with a significant difference (P<0.039).

Conclusions: Levobupivacaine with clonidine provided excellent blockade quality, and both clonidine and buprenorphine added to levobupivacaine offered good surgical and postoperative analgesia. However, levobupivacaine with clonidine significantly prolonged postoperative analgesia compared to buprenorphine.

Outcome of substitutional urethroplasty by using dorsal onlay buccal mucosal graft: our experience of 10 years

Aklesh K. Maurya — 2024-04-30

Background: The term urethral stricture is anterior urethral disease, or a scarring process involving the spongy erectile tissue of the corpus spongiosum.

Methods: Total 127 patients were included in the study. Patient selection criteria for urethroplasty by using buccal mucosal graft was length of stricture more than 2 cm, deep spongiofibrosis, failed optical urethrotomy for 3 times, adequate oral hygiene and proper buccal mucosa.

Results: Length of stricture varied from 3.2 to 14 cm. In first postoperative week, 20.47% (n=26) patients developed minor wound infection culture negative seroma formation in stitch line in the skin. Donor site complications like eating and drinking difficulty, dysguesia, pain, sensitivity, speaking disorders were not found in any patient while oral tightness was noted in 43.30% (n=55) of patients. On postoperative follow-up mean peak urinary flow rate (Q_max) was 28.0 ml/sec (range 20.0-30.6 ml/sec). After a mean follow-up of 8.8 months range (1 month to 33 months) overall success rate was 90.55% (n=115).

Conclusions: Buccal mucosa is an excellent graft material for substitution free graft urethroplasty in case of long anterior urethral stricture with excellent success rate. Success rate of dorsal onlay substitution free buccal mucosal graft urethroplasty is affected by length of stricture and aetiology of strictures. Lichen sclerosus having moderate success rate of urethroplasty and higher rate of complication and failure rate in 1-stage buccal mucosal urethroplasty and can be considered for two stage urethroplasty in case of very long stricture of anterior urethra of lichen sclerosus origin.

Flipped classroom teaching as a tool to enhance self-directed learning among first MBBS students

Seema Jawalekar — 2024-04-30

Background: Medical education shifts from a teacher-centered to a student-centered which fosters self-directed learning, critical thinking, and problem-solving skills, especially in the scenario of a large classroom. Flipped classroom is a blended learning to increases student engagement with content, improves faculty contact time with students, and enhances learning. This study was conducted to compare the effectiveness of the flipped classroom method and didactic lecture on students’ performance and to obtain students’ and teachers’ perceptions in teaching-learning biochemistry.

Methods: All participant students were randomly divided into two groups and subjected to the FC method and TDC method in module A and a crossover of groups was done in module B. Both groups were subjected to pre and post-tests after intervention in modules. Feedback was obtained from students and teachers on both learning methods.

Results: There was a statistically significant difference (P < 0.0001) after applying independent t-test in pre and post-test scores and module completion test in both learning methods. About 91% of participants were satisfied with using a flipped classroom and found it more enjoyable, creates interest in the subject, whereas faculties’ feedback shows it requires more efforts and time.

Conclusions: Considering responses and results of the assessment, it can be concluded that the FC approach, effectively engage students in the learning process, inculcation the attributes to develop self-directed and lifelong learning skills. Also improved the students’ performance and perceptions of the learning experience. Most of the students indicate that this approach is worth to use in future.

Conditions associated with discarding of blood and its components in a blood bank of tertiary care hospital of Western Uttar Pradesh: a retrospective study

Preeti Singh — 2024-04-30

Background: Blood transfusion services in India rely on different factors for a smooth workout. Thus proper utilization of blood is necessary with minimal wasting. The aim was to evaluate the causes of discarding of blood and its components and to implement possible intervention for minimizing wastage.

Methods: A retrospective study was carried out in the blood bank of Sardar Vallabh Bhai Patel Hospital, Lala Lajpat Rai Medical College, Meerut, Uttar Pradesh over a time period of 24 months from April 2019 to March 2021.

Results: A total of 21627 units were collected from donors. A total of 11534 whole blood (WB), 10093 packed red blood cells (PRBC), 3245 platelets (PC), and 9669 fresh frozen plasma (FFP) were prepared. A total of 4046 units of blood and its components were discarded. The discard rate for WB, PRBC, PC and FFP was 6.25%, 7.46%, 38.39%, and 13.71% respectively.

Conclusions: An average of 18.70% of blood units were discarded during this study period. The overall most common reason for discard was the date of expiry followed by transfusion transmitted infections (TTI). To minimize wastage of blood units, blood banks should be fully committed to organizing and coordinating the blood transfusion services,implementing all possible strategies as discussed in order to lower the discarding of blood and its units and to make them widely available.

Potential effect of metformin and vildagliptin against isoniazid induced hepatotoxicity in Wistar albino rats

Shoba S. — 2024-04-30

Background: Metformin and vildagliptin both are anti-diabetic agent and they play an important role in diabetic patients as they reduce blood glucose levels. Studies revealed that both metformin and vildagliptin has the ability to promote beta cell neogenesis and regeneration. So, our study was planned to explore the hepatoprotective potential of metformin and vildagliptin in Wistar albino rats exposed to isoniazid (INH) induced hepatotoxicity.

Methods: Wistar albino rats weighing 150-180 g were obtained from Mass Biotech, Chengalpattu, Tamil Nadu. The animals were divided into 6 groups (n=6) and further treated orally against INH-induced hepatotoxicity except normal control group. group 1: normal control, group 2: INH, group 3: metformin+INH, group 4: vildagliptin+INH, group 5: metformin amd vildagliptin+INH, group 6: silymarin.

Results: In the present study, INH was administered for 21 days to induce liver damage to rats except normal group. Each group was treated with metformin, vildagliptin, (metformin+vildagliptin) combination and silymarin half an hour before INH challenge. On the 22nd day the blood samples were collected to estimate the AST and ALT levels. Immediately after blood collection the animals were sacrificed, the livers were removed and kept in 10% formalin for histopathological examination.

Conclusions: The study found that metformin, vildagliptin, and their combination showed hepatoprotective activity against INH-induced hepatotoxicity. The combination of metformin+vildagliptin was the most effective. Metformin reduces oxidative stress, while vildagliptin balances pro-oxidant and anti-oxidant levels, contributing to their hepatoprotective effects. This suggests their potential usefulness in drug-induced hepatotoxicity.

Comparison of temporal-spatial gait parameter in patients with osteoarthritis knee: an observational cross-sectional study

Aavrati Rastogi — 2024-04-30

Background: Osteoarthritis knee (OA) symptoms, including pain, joint stiffness, reduced joint movement, and muscle strength, can affect gait kinetics, kinematics, and temporal-spatial characteristics. Spatial-temporal gait parameters are useful for assessing and identifying clinically significant changes in an individual's gait patterns and helps in rehabilitation.

Methods: In this study 108 patients diagnosed with osteoarthritis knee according to EULAR classification knee OA were included in study. Age, gender and BMI were recorded for pain and function WOMAC Score was used, gait analysis was done to evaluate difference in temporo-spatial gait parameters between OA knee patients with KL grade 2 and 3.

Results: A total of 108 patients with osteoarthritis knee were enrolled, including 40 men and 68 women. Total mean age was 55.92±9.05 years with P-value <0.05, and their average BMI was 27.24 kg/m². Total WOMAC score mean 29.3±1.03. Mean WOMAC scores for pain 4.57±3.26, stiffness 2.60±0.12, function score 22.20±7.55 respectively. There was no significance difference between KL grade II and III including gender in temporal spatial gait parameters.

Conclusions: This study suggests there is no significant difference in temporal-spatial gait parameters between Kl grade 2 and 3. Potential confounders including age, gender, BMI disease severity did not alter magnitude, although 95% CI.

Study of depression among patients with type 2 diabetes mellitus at a tertiary care hospital

M. D. Imtiyazuddin — 2024-04-30

Background: Diabetes and depression are two major issues related to community health. Diabetes patients frequently co-occur with depression. Diabetes patients frequently co-occur with depression, which calls for serious attention because delayed diagnosis and treatment can worsen the patients' complications. Assessing the prevalence of depression in diabetic patients and identifying the various factors associated with it were the objectives of this research study.

Methods: In this study 70 adult patients suffering from type 2 DM participated in this 6-month prospective study. Sociodemographic data and clinical features of the participants were collected. The presence and severity of depressive symptoms in patients have been assessed by a PHQ9 questionnaire. Ethical approval was taken before the commencement of the study. SPSS (Version 20) was used for data analysis.

Results: The majority of the patients were from 41-50 years of age group (32.9%) with a female predominance (58.6%), with no symptoms of depression before type 2 DM (92.9%). Most of them had primary education (32.9%) and majority were homemakers (44.3%) residing in urban are (65.7%) living joint family setup (68.6%). Most of them had 11 to 20 years of type 2 DM duration (745.8%) with a high family history of type 2 DM (75.7%). Majority of them were on Oral therapy (47.1%) with ophthalmic complications (32.9%). The majority of them had mild depression (5-9) i.e. 67.1%.

Conclusions: Due to patient-specific diabetes management and inappropriate diabetes treatment, the majority of cases were found to have depressive disorders. This article focused on a few common factors and their relationships that lead to depression in people with diabetes.

Efficacy of Ayurved based therapy on global longitudinal strain in ischemic heart disease: a retrospective analysis

Rohit Sane — 2024-04-30

Background: The current study aimed to investigate the efficacy of the Ischemia Reversal program (IRP) as an Ayurveda based therapy to standard anti-ischemic therapy in patients with ischemic heart disease (IHD).

Methods: A retrospective, single centre, observational study was conducted from January 2022 to May 2023. A total of 39 patients diagnosed with ischemic heart disease and global longitudinal strain (GLS) <15, regardless of underlying co-morbidities such as diabetes mellitus, hypertension, obesity, hyperlipidemia, low ejection fraction, history of myocardial infarction were included in this study. The primary endpoint was improvement in GLS from baseline to the 90-day follow-up in various different categories. Secondary endpoints were improvement in EF, abdominal girth, weight and reduction in dependency on allopathic medication from baseline to the 90-day follow-up.

Results: The mean age of the study population was 59.23±9.01 years. Weight (day 1: 67.29±13.16 kg and day 90: 61.39±11.11 kg; p=0.00), body mass index (day 1: 25.75±4.03 and day 90: 23.79±3.50; p=0.00), abdominal girth (day 1: 95.31±10.75 cm and day 90: 85.67±17.02 cm p=0.00), EF (day 1: 40.74±10.30% and day 90: 53.91±11.87%; p=0.00), and GLS (day 1: -10.99±2.72 and day 90: -13.17±3.75; p=0.00) improved at the 90 day follow-up.

Conclusions: The study showed notable improvements in weight, body mass index, abdominal girth, EF, and GLS after 90 days. These results suggest that IRP is beneficial treatment for IHD, but more extensive research is needed to confirm its effectiveness.

A comparative study of single incision laparoscopic cholecystectomy versus four port laparoscopic cholecystectomy

Saurabh Raina — 2024-04-30

Background: Since Langenbuch's pioneering open cholecystectomy in 1882, surgical approaches to gall bladder diseases have seen continual evolution. Laparoscopic surgery has emerged as the preferred method for treating benign gall bladder conditions, offering benefits like decreased postoperative discomfort and enhanced cosmetic outcomes. Variations to the traditional four-port laparoscopic cholecystectomy have been developed to further refine the procedure.

Methods: A comparative randomized study was carried out at the Department of Surgery, Govt. Medical College and Hospital Jammu, spanning from November 1, 2018, to October 31, 2019. Thirty eligible patients were recruited, with 15 assigned to undergo single-incision laparoscopic cholecystectomy (SILC - Group A) and 15 assigned to undergo four-port laparoscopic cholecystectomy (Group B).

Results: The study comprised patients aged between 20 and 60 years, with mean ages of 41.9 years for Group A and 40.3 years for Group B. Substantial variances were noted between the two groups concerning surgery duration, conversion rates, postoperative pain scores, and hospital stay.

Conclusions: Based on our findings, single-incision laparoscopic cholecystectomy (SILC) cannot be deemed a standard operative procedure, mainly due to its cost implications and the necessity for specialized instruments. At present, SILC does not serve as a substitute for four-port laparoscopic cholecystectomy. Continued research and advancements are warranted to solidify SILC as a feasible alternative.

Comparison of pain control between lidocaine and prilocaine spray (TEMPE) versus lidocaine gel in the treatment of premature ejaculation: a prospective randomized controlled trial in a tertiary care centre

Manu K. Nagabhairava — 2024-04-10

Background: Premature ejaculation is the most common cause of sexual dysfunction. There is no consensus on the treatment protocol due to poor understanding of the underlying mechanisms. Therefore, the present pilot study was conducted to compare the efficacy of topical eutectic mixture for premature ejaculation (TEMPE) spray with lidocaine gel for the treatment of premature ejaculation.

Methods: After obtaining ethics approval and written informed consent, 100 patients meeting the inclusion and exclusion criteria were included. Baseline values of intravaginal ejaculation time (IELT) and international index of erectile function (IIEF) were recorded. Patients were randomly assigned into group A (lidocaine plus prilocaine spray) and group B (lidocaine gel). After 4 weeks of treatment IELT and IIEF score were recorded. The findings were noted and analysed.

Results: Both the groups were similar in terms of demographic and baseline characteristics. There was a significantly higher improvement in IELT and IIEF score following treatment in group A as compared to group B. The incidence of side effects was lower in group A as compared to group B.

Conclusions: We recommend that the use of TEMPE spray for the treatment of premature ejaculation as it is better than lidocaine gel.

Correlation between clinical, radiological and arthroscopic findings in cases of osteoarthritis of knee joint

Pritam Kalyan Kuila — 2024-04-30

Background: Osteoarthritis (OA) is the most common degenerative joint disorder and a major public health problem throughout the world. The knees are the most commonly affected joints. In view of multiple conflicting reports in the literature the present study was undertaken to study the correlation amongst radiological, arthroscopic and pain findings in knee OA patients to facilitate early and precise diagnosis leading to appropriate and timely treatment.

Methods: Total 53 (39 female and 14 male) cases of primary OA were screened and selected for our study. Apley’s pain score equated to Visual Analogue Score and Western Ontario and MacMaster Universities Osteoarthritis score (WOMAC) sub scales were used for assessment of pain, stiffness and physical function respectively. Radiographic evaluation were done according to Kellgren-Lawrence Grading scale (X-ray) and modification of Outerbridge classification system (MRI). Outerbridge classification system was used to assess arthroscopic findings.

Results: Clinical symptom of pain had statistically significant correlation with stiffness, physical disability, radiological severity and arthroscopic findings. Stiffness and physical disability scores individually doesn’t have any statistically significant correlation with MRI and arthroscopic severity. Radiological findings were found to corroborate with the arthroscopic findings significantly.

Conclusions: Radiological and clinical findings in combination should be considered in concluding the final diagnosis and treatment of OA knee. Improvised criteria for precise diagnosis yet to be evolved.

Comparative study of the effects of intranasal midazolam with intranasal dexmedetomidine as premedication in paediatric anaesthesia

Parthasarathy Mohanraj — 2024-04-30

Background: Premedication in children is more acceptable with the intranasal route. In this study, we evaluated the efficacy of intranasal dexmedetomidine as premedication in paediatric surgeries as compared to intranasal midazolam.

Methods: This study was conducted in 60 patients of 6 to 12 years posted for tonsillectomy surgeries. Patients were randomly allocated into Group 1 and 2. Patient in group 1 (30) received 0.2mg/kg of intranasal midazolam as nasal drop using 1ml insulin syringe and similarly group 2 (30) received 1µg/kg of intranasal dexmedetomidine as nasal drops using 1ml insulin syringe. Sedation score, Anxiolysis score, pre oxygenation mask holding response score, post-operative agitation scores were evaluated.

Results: In our study, we observed that 76.7% of children in dexmedetomidine group attained better sedation compared to 46.7% in midazolam group. Anxiolytic effect in Group 1 (83.3%) was slightly better than in Group 2 (80%). 90% of the patients in dexmedetomidine group allowed easy pre oxygenation compared to 80% in midazolam group. Venipuncture response was better with dexmedetomidine group (86.7%) compared to midazolam group (73.3%). Postoperative agitation response in both the groups was same. The fall in HR, SBP was more with dexmedetomidine and there was no significant change in DBP in both the groups.

Conclusions: From our study, we concluded that premedication with intranasal dexmedetomidine is more effective than intra nasal midazolam in providing sedation. Both the drugs are effective in providing anxiolysis and better inducing condition. Therefore, intranasal dexmedetomidine is more efficacious than intranasal midazolam as premedication in children.

Effectiveness and safety profile of fluticasone propionate 0.05% in paediatric dermatoses

Atul Dilip Mohankar — 2024-04-30

Background: Topical corticosteroids are effective in the treatment of paediatric dermatoses. However, concerns regarding possible side effects of topical steroids have limited the use of moderate-potency corticosteroids in children. Objective of this study was to evaluate the effectiveness and safety profile of fluticasone propionate 0.05% cream in paediatric dermatoses.

Methods: A total 84 children between 6 months to 12 years of age with moderate to severe dermatoses (< or =30% body surface area) were treated with fluticasone propionate 0.05% cream twice daily for 4 to 6 weeks. Adverse effects of topical steroids were analyzed.

Results: Out of total 84 patients, 46 (54.76%) patients completely cured at 4 weeks and 23 (27.38%) patients at 6 weeks, while remaining 11 (13.10%) patients showed moderate improvement, 4 were lost for follow up after 2 weeks. Only in 2 patients we observed hypopigmentatipon of skin, otherwise in all patients no significant side effect were seen.

Conclusions: Fluticasone propionate 0.05% cream appears to be quite safe for the treatment of moderate to severe dermatoses for up to 4 to 6 weeks in children less than 12 years of age.

Assessment of knowledge and attitude on breast self-examination among female college students at Adichuchanagiri University

Thanushree D. R. — 2024-04-30

Background: Breast self-examination (BSE) is a preventive and easy way for people to keep an eye on the health of their breasts. People who routinely examine their breasts may be able to identify changes or abnormalities at an early stage, which may help in the early diagnosis of breast cancer. This self-care routine encourages an active approach to breast health and actively participate in their own well-being. Objectives of the study were assessment of the knowledge and attitude on breast self-examination among female college students, to assess the major barrier to perform breast self-examination, and to assess the impact of pharmacist mediated education program on breast cancer.

Methods: This study is an interventional cross-sectional community based-survey. 1007 students’ female college students at Adichuchanagiri University in B. G. Nagar belonging to 18-33 years were chosen at random using stratified sampling. Knowledge, attitude on breast cancer. Data was analyzed using statistical package for the social science (SPSS) version 25.

Results: In pre-test out of 1007 students 251 students had good knowledge about breast self-examination. In post-test 1006 members had good knowledge about breast self-examination. In our study statistical relation found between pre and post questionnaires (p=0.001).

Conclusions: The study emphasizes how important it is to launch educational programs to increase awareness of breast self-examination. Additionally, awareness needs to be raised by removing known barriers. It is important to encourage women in the community to self-examine their breasts and to report any changes to a doctor as soon as possible.

Role of ultrasonography in evaluation of right iliac fossa mass compared to CT scan

Ayantika Roy — 2024-04-30

Background: With the demonstration of origin and nature of RIF mass by high-resolution ultrasound and multidetector CT scan, the patients presenting with clinically palpable mass in RIF need not to undergo time consuming, uncomfortable and unpalatable barium study. The objective is to evaluate the diagnostic precision of CT and ultrasonography in the diagnosis of right iliac fossa masses and to assess the effectiveness of USG in diagnosing various right iliac fossa masses in comparison with CT scan in terms of sensitivity, specificity, and predictive accuracy.

Methods: The study was conducted on 35 patients presenting with right iliac fossa mass who were stable enough to undergo USG followed by CT scan. The time gap between these studies had kept to minimum to make the studies comparable. USG and CT scan was performed by 2 expert radiologists, who had been blinded of each other findings.

Results: More than 50% cases were related to appendicular pathology. Ultrasound abdomen had a sensitivity and specificity of 88.9% and 94.11% in diagnosis of appendicular mass, 71.42% and 96.42% in diagnosis of appendicular abscess, 66.7% and 96.6% in diagnosis of ileo-caecal tuberculosis, 50% and 100% in diagnosis of carcinoma caecum respectively as compared to CT scan.

Conclusions: USG is the most easily available bed side investigation and excellent screening test for RIF mass. However, CECT whole abdomen remains the gold standard investigation for etiological diagnosis of RIF mass.

Normative values of neck muscle strength in adult population of Delhi NCR region

Shivani Bisht — 2024-04-30

Background: The neck pain is common problem in the adult population. Neck muscles have the potential to regulate the neck movement and to maintain its physiological functions and hence should have a quantitative value for strength. The aim of this study was to evaluate the neck muscle strength which would be used as a reference in the analysis of neck pain. Further aim of this study was to analyze the effect of age, weight, height, gender, body mass index (BMI) on muscle strength.

Methods: This study was an observational study conducted at physiotherapy department of I. T. S. Institute of Health and Allied Sciences from 23 September 2023 to 24 February 2024.The study comprised 1200 participants, both male and female, in the age group of 21 to 50 years old. Isometric strength measurements for several neck muscles were made using a handheld dynamometer after ethical approval. Normative strength values were calculated, and multivariate analysis was performed to conclude the effect of age, weight, height, gender and BMI on neck muscle strength. Data analysis was calculated using statistical package for the social sciences (SPSS) version 21.0.

Results: Males are at lower risk than females to develop neck pain as males are having more strength than females in all age groups. Weight and age were positively associated with muscle strength (p<0.5). Height and BMI showed no significant correlation to muscle strength (p>0.5).

Conclusions: This research provides the normative ranges of neck muscle strength in the adult population that will serve as a baseline and aid in prevention, maintenance and treatment of neck pain. It provides the standard for the clinician to compare the muscle strength of different age groups and unaffected.

Carotid intima-media thickness in patients with non-alcoholic fatty liver disease: a study from eastern part of India

Ruchika Narayan — 2024-04-30

Background: Carotid intima-media thickness (CIMT) is a reliable marker of atherosclerosis and cardiovascular events. Association between CIMT with non-alcoholic fatty liver disease (NAFLD) is well known; however, such data are limited from India. This study aimed to assess CIMT in NAFLD patients compared to the healthy control, its relationship with other metabolic covariates, and predators of increased CIMT.

Methods: In an observational study, involving 150 subjects (84 NAFLD and 66 healthy controls), B-mode ultrasound was used for the evaluation of CIMT.

Results: The mean CIMT was significantly higher in NAFLD patients compared to the control group: 0.77±0.27 versus 0.57±0.11 mm on left side, p<0.001 and 0.79±0.22 versus 0.54±0.12 mm on right side, p<0.001. The difference was significant even after adjustment of metabolic confounders. Eight NAFLD patients had carotid plaques compared to none in the controls. The mean CIMT did not differ significantly between lean, overweight and obese subjects. A progressive increase in mean CIMT was noted with increasing grades of hepatic steatosis. High CIMT values (>95^th percentile value in controls, 0.79 mm) were found in 52.3% of NAFLD. On multivariate regression analysis, age [odds ratio (OR) 1.42, p<0.001], serum HDL cholesterol [OR 0.92), p=0.02] and NAFLD [OR: 3.5, p<0.001] were found to be independently associated with high CIMT.

Conclusions: NAFLD was significantly associated with CIMT which increased progressively with increasing grades of hepatic steatosis. Over half of NAFLD had increased CIMT, and NAFLD along with higher age and lower HDL- cholesterol independently predicted high CIMT values.

Decoding pituitary tumors: a systematic analysis of diagnostic methods and treatment modalities

Pruthvi Bandari — 2024-04-30

Pituitary tumors are growths that form in the gland these tumors are rare representing 10-15% of all brain tumors. They can disrupt the production of hormones, in the body leading to symptoms related to hormone imbalance. This review offers an overview of the methods used for diagnosing and treating tumors. It is worth noting that relying solely on references may restrict the scope and depth of discussions about tumors in this paper. Suggestions for research include exploring diagnostic tools like molecular imaging and liquid biopsy to enhance early detection and accurate assessment of these tumors. Additionally, more research is required to understand the long-term effects and quality of life outcomes for patients undergoing treatment options for tumors. In conclusion, significant progress has been made in diagnosing and treating tumors over time. Advances in imaging technologies such as diffusion-weighted imaging and magnetic resonance spectroscopy have enhanced precision and treatment strategies for these tumors. The discussion also covers the roles of surgery, radiation therapy and medical interventions, in managing tumor growth and hormonal imbalances further advancements, in research and innovation are crucial, for enhancing our knowledge and treatment of tumors ultimately bringing outcomes for both patients and healthcare professionals.

The integration of surgical and dermatological techniques in the treatment of cutaneous aging: multidisciplinary approaches and clinical outcomes - a comprehensive systematic review of current literature

Andrés S. P. Portilla — 2024-04-10

This comprehensive review explores the integration of surgical and dermatological techniques in treating cutaneous aging, highlighting the evolution of anti-aging strategies towards more refined and less invasive methods. As aging skin results from a combination of intrinsic and extrinsic factors, leading to structural and physiological changes, dermatology has advanced to offer multifaceted treatment approaches. We aimed to review advances and evolution in surgical interventions such as facelifts and blepharoplasty. We will discuss noninvasive and minimally invasive techniques, such as Ultherapy and fat grafting, which are widely used and are the best alternatives to traditional surgery. Other techniques, such as thread lifts and novel materials like polydioxanone (PDO) and polylactic acid (PLA) threads, are also reliable techniques for minimally invasive facial rejuvenation.

Laparoscopic versus open colectomy for acute complicated diverticulitis: a comparative study of outcomes - a systematic review

Leslie D. R. Pinto — 2024-04-15

Acute complicated diverticulitis presents a more severe form of diverticular illness frequently needing urgent medical intervention and possibly surgical therapy. The aim of this review is to gather conclusive evidence from the literature comparing laparoscopic techniques to open and conservative ones in order to determine the most effective treatment plan for complicated diverticulitis. Online databases like PubMed, Google Scholar, Cochrane, Elsevier and many others were systematically searched according to an inclusion criterion to obtain a total of 13 studies to be included in the review. 8/13 studies presented short term outcomes while 5/13 studies concluded with long term outcomes following index surgeries. Based on the end results, it can be concluded that laparoscopic surgery, in particular laparoscopic colon resection is superior to other techniques in treating complicated diverticulitis in terms of fewer short-term complications, low mortality rate better quality of life with few recurrence rates. However, other approaches have their own advantages and can be given priority based on the unique presentation of each case. The clinicians are advised to make informed decisions keeping in view all the patient and disease associated aspects.

A systematic review of clinical applications and diagnostic efficacy of intravascular optical coherence tomography in cardiology

Vanessa Marisol Almeida Sacoto — 2024-04-30

Intravascular Optical Coherence Tomography (OCT) has emerged advanced imaging modality in cardiology, offering high-resolution visualization of coronary artery structures. Since its inception in the late 1990s, OCT has undergone significant advancements, transitioning from time-domain to frequency-domain systems, thereby enhancing its clinical viability and diagnostic efficacy. We aimed to comprehensively assess the clinical applications and diagnostic efficacy of intravascular OCT in cardiology, particularly in guiding percutaneous coronary interventions (PCI) and evaluating coronary artery diseases. In methodology, A systematic search was conducted in PubMed and Google Scholar databases for studies published between 2013 and 2023, comparing OCT with intravascular ultrasound (IVUS) and conventional angiography (C.A.) in guiding PCI procedures. Studies were selected based on predefined inclusion and exclusion criteria, focusing on major adverse cardiovascular events (MACE), cardiac death, and revascularizations as outcomes. In results we included 28 studies from databased and 3 manuals, highlighting OCT's superior resolution in identifying thin-capped fibroatheromas (TCFAs), optimizing stent placement, and assessing plaque composition. Comparative analyses revealed no significant differences in clinical efficacy between OCT and IVUS, with both modalities showing superiority over C.A. in reducing cardiovascular events. The OCTIVUS trial further confirmed the non-inferiority of OCT-guided PCI compared to IVUS-guided PCI, with lower procedural complications reported in the OCT group. In conclusion, Intravascular OCT has revolutionized the diagnostic and interventional landscape in cardiology, offering unparalleled insights into coronary artery pathology. Its high-resolution imaging capabilities facilitate accurate plaque characterization, stent optimization, and real-time intervention guidance, thereby improving clinical outcomes in PCI procedures. Future research should focus on expanding OCT's applications and further validating its efficacy in diverse clinical settings.

The deep inferior epigastric artery perforator flap: a review

Erick F. Hernández — 2024-04-15

Breast cancer is recognized worldwide as a major health problem among women due to its high incidence and high mortality and morbidity rates. Breast reconstruction is an approach of great value for those patients who underwent mastectomy, impacting their quality of life and psychological stress. The deep inferior epigastric artery perforator (DIEP) flap was described as the preferred graft for breast reconstruction with an autologous flap by surgeons because it represented a decrease in complications for the time and obtained better results. DIEP flap reconstruction requires microsurgical skills as well as continuous monitoring of the patient to identify and resolve possible associated complications.

Understanding the factors influencing pharmacokinetics of tacrolimus

Sivakumar V. — 2024-04-30

Tacrolimus, a potent calcineurin inhibitor integral to immunosuppressive regimens, exhibits complex pharmacokinetics influenced by diverse factors and understanding these factors is crucial for safety, efficacy and dose optimisation. Genetic variations, particularly in CYP3A enzyme systems and P- Glycoprotein, contribute significantly to inter-individual variability in tacrolimus metabolism. Polymorphisms in these systems alter drug bioavailability, impacting clinical outcomes. Ethnicity further compounds this variability, with distinct genetic profiles leading to differential drug responses. Notably, black patients, often characterized by CYP3A5 expressor status, may have higher drug clearance. Age-related changes in tacrolimus clearance highlights the discrepancies in elderly and paediatric populations. On the other hand, prediction of gender-specific differences is difficult due to lack of evidence. Body composition, specifically variations in fat and muscle mass, significantly impacts drug distribution and clearance. Obesity, associated with altered CYP3A activity, results in decreased drug clearance, emphasizing the importance of accounting for body composition in dosing calculations. Pregnancy -induced physiological changes affect tacrolimus absorption, distribution, metabolism, and excretion, necessitating careful monitoring and dose adjustments in pregnant individuals. Dietary factors and drug interactions, particularly with CYP3A4 and P-glycoprotein, further contribute to the intricate web of variables influencing tacrolimus pharmacokinetics. In conclusion, this review sheds light on the multifaceted factors influencing tacrolimus pharmacokinetics, providing essential insights for clinicians to tailor individualized dosing regimens and enhance therapeutic efficacy while minimizing the risk of adverse events.

The pathophysiology and therapeutic approaches in retinitis pigmentosa

Suryanita Sariningsih — 2024-04-30

Retinitis Pigmentosa is a prevalent hereditary retinopathy that involves the gradual deterioration of vision cells and the disturbance of retinal pigment epithelium. The typical triad of retinitis pigmentosa is the pigmentation of the bone spicules, blood vessel constriction, and pallor of the optic nerve. The variety of clinical presentations is nyctalopia, tunnel vision, loss of colour discrimination, and in a later stage, complete loss of visual acuity. The immense genetic mutation accounts for the pathogenesis of RP. This diverse mutation makes treatment exceptionally challenging for RP. Until now, there is no specific therapy recommended for RP. Gene therapy is possibly the best option for RP, but further clinical trials are needed to provide customized therapy for each patient. Various therapeutic trials use pharmacologic agents such as neurotrophic, anti-apoptotic, antioxidant, anti-inflammatory, and anti-VEGF also use to postpone the progressivities of RP.

Role of vitamin D in controlling vertigo: a review

Santosh Kumar Swain — 2024-04-30

Vertigo is a disabling symptom that has a high recurrence rate and interferes with day-to-day functioning. Vertigo is frequently caused by Meniere's diseases and benign paroxysmal positional vertigo (BPPV). The most prevalent neuro-ontological condition causing vertigo is BPPV. Vertigo attacks that last only a few seconds and are brought on by changing the head's position with respect to gravity are the hallmark of BPPV. There is a suggestion that vitamin D deficiencies and BPPV and Meniere's diseases are positively correlated. However, there is not much awareness among clinicians about association between vitamin D deficiency and certain etiologies of vertigo. After taking vitamin D supplements, vertigo attacks stop happening. Supplementing with vitamin D may be beneficial for patients with low vitamin D levels who have BPPV and Meniere's disease. This review's goal is to discuss about how vitamin D helps to treat vertigo, especially BPPV and Meniere's disease.

Advancements in understanding and addressing Alzheimer's disease: a comprehensive review

M. Shakir Hussain — 2024-04-30

Alzheimer's disease (AD) presents a multifaceted challenge in the realm of neurodegenerative disorders, affecting millions globally and posing significant burdens on patients, caregivers, and healthcare systems alike. Over a century of research has illuminated various facets of AD pathophysiology, highlighting the intricate interplay between genetic, molecular, and environmental factors in disease progression. This comprehensive review synthesized key findings from recent literature, encompassing diverse topics ranging from diagnostic challenges and emerging therapeutic approaches to caregiver support and evolving research strategies. Furthermore, it explored the complexities of AD pathogenesis, elucidating the role of amyloid-beta (Aβ) plaques, tau protein pathology, neuroinflammation, and mitochondrial dysfunction in neuronal degeneration. Therapeutic interventions for AD, both current and emerging, are critically evaluated, with a focus on pharmacological agents targeting Aβ aggregation, tau pathology, and synaptic dysfunction. Non-pharmacological strategies, including lifestyle modifications and cognitive interventions, are also explored for their potential in disease management. Finally, the review examined the landscape of AD research, highlighting ongoing efforts to elucidate disease mechanisms, identify novel therapeutic targets, and address existing gaps in prevention and treatment strategies. It emphasizes the need for collaborative endeavours among stakeholders to accelerate progress towards effective AD management and ultimately, improve outcomes for affected individuals and their families. Through its comprehensive synthesis of current knowledge and future directions, this review aims to inform clinicians, researchers, policymakers, and advocates involved in the fight against Alzheimer's disease, offering insights that may catalyse advancements in diagnosis, treatment, and care.

Exploring the psychological facets of cosmetic rhinoplasty

Pooja Shriwastav — 2024-04-30

Cosmetic rhinoplasty is a surgical procedure aimed at enhancing the aesthetic appearance of the nose, with implications beyond physical changes. This review synthesizes evidence regarding the psychological effects and quality of life outcomes post-cosmetic rhinoplasty. Through a comprehensive literature review, it explores the psychological aspects, including body dysmorphic disorder (BDD), the development of assessment tools like the rhinoplasty outcome evaluation (ROE) questionnaire, the Derriford assessment scale (DAS), and the Rosenberg self-esteem scale. The review concludes that while cosmetic rhinoplasty positively impacts psychological well-being and quality of life, further research is needed to understand long-term effects and optimize patient care.

Prevention and risk factors associated with incidence of central line associated bloodstream infection: a narrative review

Sivakumar V. — 2024-04-30

Central line-associated bloodstream infections (CLABSI) are a critical concern in healthcare settings, associated with high mortality rates and substantial financial burdens. This article highlights the various risk factors contributing to CLABSI, emphasizing both intrinsic and extrinsic factors, such as patient age, gender, underlying medical conditions, and catheterization duration. The prevention of CLABSI is addressed through a comprehensive bundle of evidence-based interventions, including hand hygiene, proper catheter insertion, skin preparation, catheter kits, selection of catheters, and maintenance bundles. Antimicrobial lock and flush solutions are crucial in eradicating microbes within catheter lumens. Furthermore, chlorhexidine bathing is recommended to reduce skin contaminants. Implementing these strategies collectively can significantly reduce the incidence of CLABSI, enhancing patient safety and reducing healthcare expenditure.

Perineal reconstruction with V-Y advancement flap at the general hospital of Mexico: a case report

Rodolfo Luciano Rios Lara Lopez — 2024-04-15

Extramammary Paget's disease represents a rare entity whose only definitive management is resection, resulting in significant raw areas requiring reconstruction by the plastic surgeon. Currently, bilateral gluteal advancement VY fasciocutaneous flaps have been for some time one of the best options for perineal reconstruction, allowing for adequate coverage, low morbidity at the donor site, and satisfactory aesthetic and functional outcomes. In this study, we report the performance of a bilateral VY advancement flap for perineal reconstruction in the Plastic and Reconstructive Surgery Department of the General Hospital of Mexico.

Neurodevelopmental disorder associated with NARS1 gene mutation in a child with cerebral palsy

Danilo Nonkulovski — 2024-04-30

Cerebral palsy is the most common cause of chronic motor disability in children. CP has a multitude of causes, including developmental, genetic, metabolic, ischemic, infectious, and acquired, all of which result in comparable neurologic symptoms. As of right now, the cause of CP remains unclear. Research has found a substantial link between low birth weight, birth hypoxia, and poor fetal position and placenta. When diagnosing children with cerebral palsy and determining its cause, brain imaging is crucial. The final diagnosis should consider many factors, including physiological, topographic, ICF/functional, and neuroradiological categorization, origin, time of injury, concomitant disorders, sequelae, and nutritional status. This assists with planning, management, counseling, progress tracking, and prognosis. We present a case of a 5-year-old child with cerebral palsy who has a complicated clinical presentation including delayed psychomotor development, dysmorphia, and a verified pathogenic variation in the NARS1 gene linked to a neurodevelopmental condition. The child has been receiving frequent monitoring and multimodal therapies, such as physical therapy, defectologist sessions, and omega fatty acid supplements. Genetic testing found a pathogenic variant in the NARS1 gene, emphasizing the significance of genetic screening for parents to prevent recurrence in future pregnancies. Collaboration with special education instructors and speech therapists remains active to meet the child's communicative and cognitive requirements.

Surgical resection of giant pleural solitary fibrous tumor: a case report

Mohammed A. Alrefai — 2024-04-30

Solitary fibrous tumors of the pleura (SFTP) are uncommon neoplasms. We present the case of a 73-year-old male diagnosed with SFTP, exhibiting two masses measuring 20×18 cm and 9×8 cm in diameter, resulting in a notable cardio mediastinal shift towards the right side. The patient underwent successful surgical resection without experiencing any postoperative complications and was discharged in favorable condition. Although complete resection diminishes the risk of recurrence in both malignant and benign SFTP cases, long-term follow-up is necessary.

A case report on choledochoduodenal fistula: how to suspect this unusual entity?

Omar Sosa Sánchez — 2024-04-30

A choledochoduodenal fistula is an abnormal connection between the common bile duct and the duodenum, which are associated with a history of problems in the common bile duct. It has appeared in 0.74% of patients submitted for biliary tract surgery. The most frequent symptoms of non-obstructive enteric biliary fistulas are: epigastric pain, cholangitis (80.91%), jaundice (54,.26%), fever (50.69%), nausea and/or vomiting (10.30%), abdominal distension (0.39%), asymptomatic (0.11%), and diarrhea (0.11%). Diagnostic imaging methods provide the data of greatest interest in revealing the presence of air in the bile duct. This method, as well as barium reflux under the biliary tree in contrasted studies and in ERCP, reveal the fistulous tract and its location. Neither the prevalence, nor the clinical characteristics that pertain to its presentation, are well known among our population. Possible treatments for this illness include conservative treatment with medication, endoscopic sphincterotomy, and surgical therapy.

Subcapsular hepatic hematoma post-endoscopic retrograde cholangiopancreatography: a case report and literature review

Olga E. Amador — 2024-04-30

A 23-year-old female with a history of long-standing obesity, recently was diagnosed with cholelithiasis, along with a 15 day development of jaundice. An ERCP (endoscopic retrograde cholangiopancreatography) was performed, during which resulted an unsuccessful sphincterotomy, this was followed by placing a 7-centimeter, 10 French Amsterdam-type stent, subsequently she experienced sudden abdominal pain, and a CT scan revealed a subcapsular hepatic hematoma, which required surgical management. The objective was to describe a clinical case of subcapsular hepatic hematoma, clinical presentation, and therapeutic conduct. The treatment of subcapsular hepatic hematoma will depend on the patient's hemodynamic stability. However, survival is uncertain due to its rarity, making it crucial to recognize its early signs and symptoms and act promptly.

Effective endovascular reconstruction using multiple leo stents and silk flow-diverting stents for asymptomatic extracranial internal carotid artery

Gamaliel Wibowo Soetanto — 2024-04-30

Extracranial carotid artery dissection (ECAD), although infrequent, represents the predominant form of artery dissection within the brain. It accounts for 25% of young-onset ischemic strokes in adults. Its atypical presentation and limited availability of high-quality evidence underscore the importance of precision medicine in its management. This study aimed to illustrate a combined approach utilizing multiple scaffolding Leo stents and Silk flow-diverting stents to manage asymptomatic ECAD a week after the onset of acute ischemic stroke. A 40-year old Indian male with uncontrolled hypertension was admitted due to acute vestibular syndrome. His brain computed tomography (CT) scan showed cerebellar infarct. However, his angiographic cervical CT scan showed asymptomatic ECAD, which was confirmed with digital subtraction angiography. He was therefore managed with optimal antihypertensive agents and dual antiplatelet. The endovascular reconstruction procedure initiated one week after the onset of stroke by employing one scaffolding Leo stent and one Silk flow-diverting stent at his right internal carotid artery. He was discharged three days following the endovascular procedure and presented no complications until three-month follow-up. This safe approach could be considered for individuals with ECAD to help prevent secondary strokes, particularly among those in the productive age group.

CT findings of a patient with Hay-Wells syndrome: a case report

Jorge Ariel Montero Torres — 2024-04-30

Hay-Wells syndrome is a rare genetic disorder caused by a heterozygous mutation in the TP63 gene that affects the development of ectodermal derivatives. While the exact prevalence of hearing loss in this condition is not well established, it has been suggested that approximately 50% of patients may present with varying degrees of hearing impairment. Here we present a case of a 6-year-old female patient diagnosed with Hay-Wells syndrome since birth who has been developing hearing loss predominantly on the right side for the past year. Considering the embryological origin of the external ear, an associated abnormality with the syndrome cannot be disregarded. Early recognition and diagnosis of this syndrome are crucial for appropriate management and potential interventions for hearing loss. Utilizing imaging methods can aid in demonstrating the characteristic alterations of the syndrome, which is important given its low incidence in the general population. This case report emphasizes the significance of prompt diagnosis, which is critical for implementing genetic counseling and effective disease prevention measures. We should be well-versed in the characteristic imaging findings that aid in early identification and genetic diagnosis of the disorder.

Anal mucosal melanoma presenting as per rectal bleed: a case report

Aditya M. Bhosale — 2024-04-30

Anorectal mucosal melanoma is a rare, malignant and aggressive tumor that usually presents late. It primarily arises from the melanocytes but can also arise from the mucosal surface. It also carries poor survival rates. Early diagnosis of the disease and prompt treatment is necessary. Overall 5-year survival rate for anal melanoma is below 10%. We present a case of a 77 years old male patient who presented with chief complaints of per rectal bleeding and decreased appetite. Patient’s symptoms were initially confused for benign conditions like hemorrhoids. He was diagnosed with anal mucosal melanoma on per rectal biopsy. Patient’s radiological investigations including PET scan and MRCP were suggestive of liver and lung metastasis. In view of the advanced stage of the disease, the decision was taken to treat the patient conservatively. He was started on imatinib therapy and a regular follow up was kept and palliative care was provided.

Melioidosis: acute respiratory distress syndrome and sepsis

Bharat M. Shah — 2024-04-30

Melioidosis is a serious infection caused by the bacterium Burkholderia pseudomallei (B. pseudomallei) mostly found in endemic areas like Southeast Asia. Herein, we presented a case of melioidosis in a 32-year-old man who presented with respiratory distress, was a known case of type 2 diabetes not on any treatment presented to the emergency department (ED) with a history of pustules over skin, shortness of breath, and fever. He was initially misdiagnosed and treated as pulmonary tuberculosis in another hospital prior to his latest presentation. Melioidosis is a severe infection that can be misdiagnosed due to variable presentation and low awareness among healthcare workers of the disease. Diagnosis requires high clinical suspicion, especially in patients who are coming from endemic areas with appropriate risk factors such as diabetes mellitus. Treatment with appropriate antibiotics for a long duration, and outpatient follow-up is vital to reduce the risk of recurrence.

Orogenital ulcers and the Behcet’s disease

Bhavana V. Nagabhushanarao — 2024-04-30

Behcet’s’s disease is a systemic vasculitis involving small to large veins and arteries. It is a sporadic disease, mostly prevalent among the ancestors of the silk route. It is characterized by recurrent oral ulcers, genital ulcers, and uveitis. It also can manifest as skin, vascular, gastrointestinal, neurological, cardiac, and renal involvement. Though overall mortality is around 5%, delay in diagnosis and treatment may lead to significant morbidity. Cardiovascular and pulmonary arterial aneurysms are dreadful complications of this disease. Being uncommon in south India it is liable to be wrongly diagnosed and treated. Delay in the diagnosis and treatment may lead to severe complications. Here we present a case of Behcet’s disease which was managed at primary health care inadequately. We also demonstrated a quick response to steroids which are the mainstay of treatment. In this case presentation we illustrated pre and post treatment scrotal and oral Behcet’s’s lesions for clinicians to memorize. We also discussed international criteria to diagnose Behcet’s disease (ICBD) in concurrence with our case. In this presentation, we briefly described the involvement of other systems and their treatment. This article also elaborated on the latest developments in the treatment of Behcet’s disease.

Habit nail tic disorder: onychotillomania involving thumbs and toes responding to fluoxetine

Akash Bose — 2024-04-30

Habit nail tic disorder is a type of nail dystrophy caused by repetitive trauma to the nail matrix. It is a body-focused repetitive behavior that is commonly reported among adults and may or may not be associated with obsessive-compulsive behavior. In this report, we present a case of a 12-year-old adolescent girl who had a central furrow with longitudinal ridges running parallel from the proximal to the distal end of both her thumbnails and toenails, giving them a "washboard" appearance and diagnosed as habit nail tic disorder, and treatment involved fluoxetine 20 mg and the application of permeable adhesive tape to protect the nails from external trauma. There was a positive response observed two months after the beginning of the treatment and the nail matrix resolved spontaneously.

Spontaneous laceration of spleen with hilar lymph node metastasis: a case of primary splenic mantle cell lymphoma in elderly

Mithlesh Bhargav — 2024-04-30

Mantle cell lymphoma (MCL) is a type of non-Hodgkin (B-cell) lymphoma (NHL) with manifestations ranging from indolent to aggressive disease. It arises from mantle zone or primary follicle lymphocytes and is associated with translocation t (11;14) which is seen in almost all cases. Most of the cases present at stage III/IV with hepatospenomegaly, generalized lymphadenopathy, bone marrow involvement or lymphoid polyposis. Rate of relapse is high occurring in 50-60% patients and 5-year survival rates are low ~27-30%. Median overall survival is 3.5 years. Age >60 years, raised serum LDH, high mitotic count, Ki67>30%, blastoid or pleomorphic variants, TP53 mutation, gains in 3q,11q and deletions of 13q as well as 17p are important prognostic factors associated with worst outcome. Treatment involves conventional chemo-immunotherapy and stem cell transplantation (SCT). In our case the elderly patient had an atraumatic splenic rupture with no past medical history of trauma. The patient presented to the emergency department with severe abdominal pain in left upper quadrant. Thus emergency splenectomy was executed successfully, and the patient was stabilized. After receiving initial cycle of R-CHOP regime, he was lost to follow up. In this case report, we will discuss the clinical presentation, as well as current treatment guidelines for atraumatic splenic rupture.

Evaluation of a rare case of orbital venous varix with multiple intracranial venous malformations using prone MRI technique

Kavan A. Parikh — 2024-04-30

Orbit is a common site for vascular lesions in all age groups, with venous malformations being the most common type. Orbital varices are a rare subset of venous malformation which is a vascular hamartoma that communicate with normal orbital veins. The mainstay of diagnosis and differentiation from other vascular and neoplastic lesions of orbit is demonstration of change in size of lesion on dynamic maneuvers. In this article, we present a case of left orbital venous varix which showed enlargement on Valsalva maneuver. The patient was evaluated using prone MRI technique to demonstrate increase in the size of lesion. Multiple asymptomatic developmental venous anomalies were detected on brain screening, which is a known association.

Conservative management of traumatic brachial plexus injury: a case report

Simran A. Mishra — 2024-04-30

Brachial plexus injury (BPI) is one of the devastating conditions for patients, which has a negative impact on patients' quality of life. It renders patients with an inability to achieve functional independence. With advancements in surgeries and rehabilitation, improvement in these domains is possible. This case report describes the rehabilitation of a 28-year-old male patient. Being a driver by occupation and the only earning member in the family, upper limb function was essential for functional independence and resume work. After examination, problems were identified, goals were set, and intervention was planned. The patient took 2 months of inpatient rehabilitation six days a week. After completion of treatment, the patient was independent in basic and instrumental activities of daily living. The study concludes that structured, evidence-based physiotherapy treatment is effective in achieving functional independence and reducing disability in patients with traumatic BPI.

Analysis of mixed connective disorder: a case report

Muzammil Mohammed — 2024-04-30

Mixed connective tissue disease (MCTD) as an autoimmune disorder with characteristics that resemble systemic sclerosis, systemic lupus erythematosus (SLE), and polymyositis. Due to this overlap, MCTD is often categorized as an overlap disease. As the disease progresses, symptoms may become more indicative of one of the three primary illnesses, accompanied by elevated levels of anti-U1RNP antibody. 30yrs female Patient presented with a classical malar rash as the initial presentation, followed by the development of a painful red lesion on the knuckles over a few weeks. Additionally, the patient observed a hypopigmented large lesion on the forearm resembling vitiligo, with a salt and pepper appearance. Upon clinical evaluation and further extensive investigation, the patient was diagnosed with mixed connective tissue disease (MCTD). On further evaluation the anti-U1RNP antibody, ANA, was positive and patient was treated on lines of MCTD. Patient responded well to the treatment. Our case suggests that mixed connective tissue disease if recognised early with symptoms and signs and workup we can prevent the shift to other connective tissue diseases over a long period; therefore, it is necessary to identify whether patients with mixed connective tissue disease fulfil the diagnostic criteria for other connective tissue diseases when new manifestations appear.

Bilateral cadaveric variations of musculocutaneous nerve and median nerve in the anterior brachium: a case report

Vinodhini Periyasamy — 2024-04-30

Formation of the brachial plexus is by the union of ventral rami of C5-T1 spinal nerves. The musculocutaneous nerve is a continuation of the lateral cord, pierces the coracobrachialis and supplies the flexor compartment of the arm. Our case report presents a unique bilateral cadaveric variation in the musculocutaneous nerve and median nerve branching patterns, in the flexor compartment of the arm. A case report of bilateral variations of musculocutaneous nerve and median nerve (R-Right, L-Left) was found during the routine dissection in the Department of Anatomy, Shridevi Institute of Medical Sciences and Research Hospital, Tumakuru. From the right lateral cord, separation of few nerve fibres forming the lateral root of the median nerve was appreciated. The lateral root joins the medial root of the medial cord, after emerging out of the ulnar nerve and forms the initial segment of median nerve. Before the union of lateral and medial roots of initial segment of median nerve, ulnar nerve, medial cutaneous nerve of arm and medial cutaneous nerve of forearm descends along the medial aspect of the right arm. From the left lateral cord musculocutaneous nerve pierces the coracobrachialis. Before piercing the muscle, it gives one vascular branch and a motor branch. After piercing, the musculocutaneous nerve runs downwards and gives a motor branch to left biceps brachii. Variations of brachial plexus are frequently subjected to compression neuropathy. During surgical approaches to the brachium region, awareness about the anatomical variations of lateral and medial cords is mandatory for diagnosing the peripheral nerve entrapment syndrome. An integrated understanding of these branches prevent iatrogenic injuries during surgical procedures.

A clinical study on reconstruction of traumatic auricular defects

A. Ravi Chandra Mohan — 2024-04-10

The auricle or external ear is an important aesthetic subunit of the face. The intricate anatomy due to multiple convolutions along with the thin integument poses a challenge to the reconstructive surgeon. The prominent position of the ear on either side of the face and over a bony prominence makes it more prone for injury. The objective of the study is to describe various traumatic auricular defects and their subsequent reconstructive methods. A retrospective analysis of 15 patients with traumatic auricular defects was carried out over a period of 2 years between the time period of January 2022 and December 2023. Various reconstructive methods such as Primary closure, use of chondral grafts and chondrocutaneous flaps, local flaps were employed depending on the size of the defect and according to the reconstructive ladder. Out of 15 patients, 12 were male and 3 were female, with traumatic ear defects secondary to road traffic accidents (12) and human bite (3). The site of the defect was upper 1/3d (8), upper+middle 1/3^rd(3), lower+middle third (2), middle third (1) and lower 1/3^rd(1) of the auricle. They were managed by debridement and primary closure in 5 cases, post auricular flap in 5 cases, preauricular flap in 2 cases, peninsular conchal island flap+postauricular flap in 1 case, and bilobed flap in 1 case. All the flaps settled well. 4 patients needed secondary procedures in the form of flap division and contour corrections. This study employed a variety of reconstruction methods of the auricle as per the reconstructive ladder. Some of the patients required secondary procedures. All patients in this study had a satisfactory end aesthetic outcome with no major complications.

Navigating the complexity of osmotic demyelination syndrome in the elderly: insight from three cases

Kavita Chaudhry — 2024-04-30

Osmotic demyelination syndrome (ODS) results from rapid shifts in serum osmolality and can be triggered by various factors such as hyponatremia, hyperglycaemia, malnutrition, alcohol abuse, and liver disease. Although hyponatremia prevalence increases with age, ODS typically manifests between ages 30 to 50, indicating a complex age-susceptibility relationship. Its pathophysiology involves brain volume restoration adaptation, with rapid correction of osmolality leading to dehydration and subsequent demyelination. Hyperglycaemia-induced ODS results from rapid correction of hyperosmolar states, overwhelming neuronal compensatory mechanisms. Neuroimaging, usually MRI, is crucial for diagnosis, revealing hyperintense lesions. Clinical manifestations vary widely, from dysarthria and dysphagia to spastic quadriparesis, with poor outcomes, especially in older patients. Below, three cases of ODS in elderly patients are presented, each with distinct clinical presentations and outcomes. Case1 highlights the association between rapid correction of hyperglycaemia and ODS while Case 2 and 3 illustrates the consequences of overly rapid correction of hyponatremia. Diagnosing Osmotic Demyelination Syndrome (ODS) in the elderly poses challenges due to overlapping clinical features with conditions like encephalopathy, delirium, and postictal confusional states, which closely mimic ODS. Further research is needed to better understand the pathophysiology and optimize management approaches, especially in vulnerable populations like the elderly.