International Journal of Research in Medical Sciences

Occupational stress and burnout among young surgeons: a review

Dhivakar S. — 2023-02-14

A surgeon's lifestyle is a multifaceted commitment that revolves around their workplace, physical, personal, emotional, and communal domains. Surgical training programs are competitive and challenging to match and provide a sense of gratification among medical school trainees. But they also report a much higher level of burnout when compared to their peers from other specialities. Workplace burnout has been a scorching issue since the COVID pandemic broke out in 2019. We did this review to understand the factors leading to workplace burnout, identify any East-West differences, and find possible solutions. We also tried to find the role of COVID-19 in worsening occupational stress among surgeons. We searched the PubMed and SCOPUS databases for studies between January 2000 to January 2022 on burnout, well-being, wellness, and practice improvement among surgeons. The search included studies on COVID-19 that were available either as full-text papers or abstracts. Burnout has affected younger surgeons owing to loss of professional control, inefficient work-life balance, administrative burdens, medico-legal problems, and the competitive nature of the job and tiresome training programs. Burnout is more common in South-Asian countries. Workplace stressors, including long hours and difficult interactions with co-workers, are linked to greater levels of burnout. The COVID-19 pandemic has only made matters worse.

Atypical myocardial infarction masquerading as gastroenteritis

Shafqat Mahmood — 2023-02-14

Acute coronary syndrome (ACS) encompasses unstable angina and myocardial infarction (MI). MI typically presents as chest pain that may radiate to the arm or jaw and is described as dull, heavy, tight, or crushing. However, it may present atypically with symptoms other than chest pain including epigastric pain, often described as burning in character or like indigestion. This is a case of a 51-year-old patient who presented with symptoms of epigastric pain, nausea and vomiting resembling gastroesophageal disease. The patient was initially evaluated by a physician as a non-urgent case of gastroenteritis. Following further assessment due to ongoing symptoms, he was diagnosed with ST elevation MI (STEMI) and treated according to ACS treatment guidelines. To accurately diagnose ACS, clinicians must demonstrate competent communication, history taking and physical examination skills, identify red flags and make use of appropriate investigations. Correct medications and timely referral to secondary care services is vital to prevent morbidity and mortality.

Right proximal sub-clavian artery pseudoaneurysm masquerading as right upperzone opacity of lung

Vasavi Cheguri — 2023-02-28

Right proximal subclavian artery pseudoaneurysms are uncommon conditions with a relatively small number of recorded instances to date. Such cases might be challenging to diagnose since the patient may have symptoms that are similar to those of other illnesses, including lung cancer. The diagnosis is aided by imaging methods including contrast-enhanced computed tomography (CECT) chest and computed tomography angiography, as well as a high level of clinical suspicion. We present a rare case of a 23-year-old man with no history of lung disease or trauma, who had a complaints of change in voice, difficulty in swallowing and haemoptysis. Right-sided upper zone homogeneous opacity was seen on the chest X-ray. CECT revealed large, well-defined solid cystic areas that extended up to the posterosuperior aspect of the right upper thoracic region. Aneurysm rupture with active contrast leak. Pulmonary angiography revealed the presence of a pseudoaneurysm in the middle mediastinum on the right side, originating from the right proximal subclavian artery. The patient was operated on, and the right subclavian artery and innominate artery pseudoaneurysm were repaired. If subclavian artery pseudoaneurysms are large, they can cause compression symptoms. For compressive symptoms, open surgical resection and vascular reconstruction are required. In a patient with hemoptysis and opacities on chest imaging, arterial aneurysm should be considered as a differential diagnosis alongside lung mass. Before considering a biopsy from the lesion, further evaluation with CECT should be performed.

A rare cutaneous infection in a chronic intra-muscular drug abuser

Jagadeesh Chandrasekharan — 2023-02-28

After rhinocerebral and pulmonary, mucormycosis affecting the skin is considered to be the third most common type of mucormycosis. It has varied presenting features and hence it is important to make a diagnosis early to achieve better outcomes. Although a large proportion of published cases have no underlying disease, it is most commonly associated with diabetes and blood malignancies. The mode of infection is usually due to cutaneous trauma, while the rest of the cases are health-care associated. Apophysomyces spp are usually seen in Asia, while Rhizopus is the most common genus in Europe, North America and South America. It is usually treated with antifungals like amphotericin B and/or surgery. In this article, we presented a case of a middle aged immune-competent female with a history of recurrent intramuscular and intravenous drug usage presenting with cutaneous mucormycosis.

Carcinosarcoma of the vulva: a rare case report

Barasha S. Bharadwaj — 2023-02-28

Carcinosarcomas are rare and clinically aggressive neoplasms with poor outcome. A very few cases has been reported in the literature. We present a case of a 54 yrs woman with bleeding per vagina for 1.5 months. On per vaginal examination, a lump of size 3×2 cm was found over the left anterior region of vulva. CECT abdomen revealed a well-defined heterogeneously enhancing lesion with calcific foci involving both labia minora. MRI pelvis reveals carcinoma left vulva with involvement of lower 3rd of vaginal wall. Histopathological examination showed features suggestive of carcinosarcoma of the vulva. This was further confirmed by immunohistochemistry which showed positivity for CK, SMA, caldesmon and negative for S100, CD34, desmin, CD31, ERG and MyoD1. Because it is a very rare tumor with severe prognosis, we presented this case as this case report can be a useful addition to the literature.

A case report of pulmonary and muscular cysticercosis

Sanjay Fotedar — 2023-02-28

Pulmonary cysticercosis is extremely rare manifestation of a rather common disease which is distributed worldwide. Most common sites for the growth of cysticercosis are muscle and brain followed by eye. Pulmonary involvement in cysticercosis is very rare and if at all present, then ill-defined nodular shadows distributed throughout the lung is the usual radiological presentation which might be attributed to other diseases also. No case of cysticercosis presenting as lung parenchymal along with muscular involvement without cerebral involvement has been reported so far in literature. We came across a rarest presentation of cysticercosis as pulmonary involvement. After nullifying all the differential diagnosis of parenchymal nodular lesions as seen on CT chest and with clinical suspicion, a diagnosis of pulmonary cysticercosis was made as enzyme linked immunosorbent assay (ELISA) titres for cysticercosis was significantly raised. Case was successfully treated with albendazole (15 mg/kg) with steroid cover with resolution of lesions as well.

A rare case of para-testicular dedifferentiated liposarcoma: a diagnostic dilemma

Biren P. Modi — 2023-02-28

Paratesticular dedifferentiated liposarcoma (DD-LPS) are rare neoplasms. It has been estimated that 12% of DD-LPS occur in the paratesticular region, while the retroperitoneum is the most common site for this tumor. Herein, we presented a case of a 66-year-old male with a history of pedal edema and right scrotal swelling, CT scan shows a solid mass arising from the right side of the scrotum. Following this, a radical orchiectomy of the right testis with mass was performed, and after thorough microscopic and immunohistochemistry positive for MDM2 and CDK4, the diagnosis of low-grade dedifferentiated liposarcoma was given. This case report expands the morphologic spectrum of dedifferentiated liposarcoma and emphasizes the need to consider these tumours in the differential diagnosis of other neoplasms.

Cystic fibrosis presenting as small bowel obstruction in pediatric patient: a case report

Pinki Devi — 2023-02-28

Intestinal obstruction complete or incomplete has been found commonly in patients with cystic fibrosis in all age groups with variable presentation. Prevalence of intestinal obstruction in children with cystic fibrosis is 7-8%. Neonates present with meconium ileus due to inspissated meconium and complete obstruction. This case demonstrates similar presentation in a pediatric patient. A six day old male patient presented in the pediatric surgery department with abdominal distention, vomiting and fever. Patient was operated and intraoperative meconium plug was seen along with dilated proximal bowel, filled with sticky meconium. Resected gut segment was received in the Department of Pathology. Grossly dilated gut segment on cut section was seen filled with thick putty like greenish fecal matter. Histopathological examination showed features consistent with cystic fibrosis. There are multiple causes for intestinal obstruction in neonates, cystic fibrosis can be one of them which needs to be considered by the clinicians. Such cases need to be reported for better understanding of their clinico-pathological presentation and prevalence.

A case report of pyrexia of unknown origin in a 15-year-old boy

Mohammad Ali — 2023-02-28

We present a case of a 15-year-old boy presenting with a 3-week history of fever whilst visiting relatives in the United Sates (US). Despite extensive workup, a definitive diagnosis was not reached. The clinical history and course of the disease required consideration of broad range of differential diagnosis. This case highlights the importance of clinical history and examination in the assessment of fever of unknown origin (FUO).

Study of association of dry eye with diabetes mellitus

Chandra Shekhar Majumder — 2023-02-07

Background: Aim of the study was to evaluate the tear status in diabetes mellitus (DM) patient.

Methods: This study was a prospective observational case control study. Eighty patients with DM aged from 50 to 80 years were compared with a group of 80 normal healthy age matched control group. A general ophthalmological check-up was performed. The main points of comparison were subjective complaints, objective findings on basic Schirmer test, break-up time, Rose Bengal test.

Results: The results show that 27.5% of all diabetic subjects accompanied of dry eye symptoms, as against 6.25% of the control group. A mean BUT value was 15.5s and Standard Error was 0.20. In the control group mean BUT value was 14s and standard error was 0.23. Basic Schirmer test in DM group mean value was 9.50 mm and SE was 0.268. In the control group mean basic Schirmer test value was 15 mm and SE was 0.405. Rose Bengal test score in DM group, normal score (score <3) was found in 80% case and abnormal score (score >3) was found in 20%. In the control group, normal score was found in 93.75% and abnormal score was found in 6.25% case. Dry eye percentage in DM group 11.25% had definitive dry eye, 16.25% cases had possible dry eye and 72.5% cases had no dry eye. In control group 2.50% cases had definitive dry eye, 3.75% cases had possible dry eye and 93.75% had no dry eye.

Conclusions: The study shows that dry eye is associated with DM.

Urothelial carcinoma of urinary bladder with histologic grading: a study in a tertiary care hospital, Bangladesh

M. Ariful Islam — 2023-02-03

Background: Urinary bladder cancer is one of the most common forms of all cancers in the world. It is the ninth leading cause of death from cancer among men. The incidence of urinary bladder cancer in Bangladesh is increasing day by day. The aim of the study was to evaluate different clinic-pathological parameters of urothelial carcinoma of urinary bladder with the grade of the tumor.

Methods: This study was a cross sectional study done over a period of two years, from March 2018 to February 2020 at the department of pathology, Dhaka medical college, Dhaka. Total 73 samples were collected, fixed overnight in 10% buffered formalin and stained with hematoxylin and eosin staining. Pathological grading was confirmed and different clinic-pathological parameters were evaluated.

Results: Most of the cases (22 cases, 30.1%) were found in the fifth decade (51-60). Mean age of the patients was found to be 60.85 (±12.72) years, 58 (79.5%) cases were male and 15 (20.5%) cases were female with male to female ratio of 3.9:1. Most of the cases (49 cases, 67.1%) were smokers. Most common clinical presentation was hematuria (91.8% cases), most frequent tumor location was the lateral wall of the urinary bladder and 75.3% cases were reported as high-grade urothelial carcinoma.

Conclusions: Different clinic-pathological parameters with histologic grading were evaluated in this study which may have a significant impact in epidemiology, diagnosis and assessment of biological behavior of urothelial carcinoma.

Knowledge and practice of breast self-examination among female patients attending general outpatients in BPKIHS

Rajani Giri — 2023-02-03

Background: Breast cancer is the most common and remains a major health problem all over the world, affecting both developing and developed countries. The strategy to detect early breast cancer is important which includes breast self-examination (BSE), clinical breast examination, and mammography. The studies have found that women who reported that they had been BSE performers had their breast cancer detected at a smaller size and earlier clinicopathological stage. There is a paucity of data on the knowledge and practice of BSE in Nepal among the female population of eastern Nepal. Therefore, this study is conducted to know the knowledge and practice of BSE among the female population attending the general outpatient department.

Methods: A cross-sectional study was conducted over one and half years among 262 females attending general outpatients, using a semi-structured questionnaire.

Results: The majority of the participants (29.4%) were in 3^rd decade of life followed by 2^nd decade (26%). Forty-one (41%) of the respondents had ever heard of BSE and the main source of information was social media (51%). Only 14.5% had adequate knowledge of BSE. Out of all, only 10.7 % were practicing BSE and the frequency of practice among them was rarely (53.5%). Seventy-two (72%) responded that they don’t know how to perform when asked why they did not perform BSE.

Conclusions: This study revealed that most of the participants had low knowledge and practice of BSE. Therefore, developing a health education program to raise awareness about BSE is important.

Post treatment outcome and quality of life in patients with inoperable advanced gastric carcinoma

Major Tariq Hasan — 2023-02-07

Background: The outcome of treatment for advanced gastric carcinoma can vary depending on a number of factors, including the stage and aggressiveness of the cancer, the patient's overall health, and their response to treatment. In general, the prognosis is poor, with a median overall survival of less than one year. Quality of life (QOL) is an important consideration for patients with advanced gastric carcinoma, as they may experience a range of symptoms such as pain, fatigue, and difficulty eating. This study aimed to evaluate the post-treatment outcomes and QOL in patients with inoperable advanced gastric carcinoma after treatment with cisplatin-capecitabine and with oxaliplatin-capecitabine.

Methods: This Quasi-experimental study was conducted at the department of oncology, Bangabandhu Sheikh Mujib medical university, Dhaka, Bangladesh. The study duration was 1 year, from February 2021 to March 2022. During this period, a total of 64 cases of advanced gastric cancer were divided in two equal groups, arm A who had received cisplatin capecitabine, and arm B who received oxaliplatin capecitabine.

Result: The mean age at diagnosis was 55.85 and 56.76 respectively. The majority of the patients, 43.8% in arm A and 50% in arm B, ranged in age from 61 to 70. The gender distribution was similar, 78% and 69% of patients in arm A and B respectively were male. Both groups had the majority of patients receiving an ECOG performance rating of 2, with 68.8% in arm A and 59.4% in arm B, and the liver being the most common metastatic site for 56.3% in arm A and 50.0% in arm B. The most frequent risk factor was Helicobacter pylori infection, observed in 68.8% of arm A and 78.1% of arm B. The most common primary tumor site was the antrum, with 50% and 53.1% patients in arm A and B respectively had the primary tumor in the antrum of the stomach.

Conclusions: In inoperable advanced gastric cancer, the cisplatin-capecitabine regimen is equally effective as oxaliplatin-capecitabine in terms of disease outcome. Furthermore, the cisplatin-capecitabine regimen is less costly than the combination of oxaliplatin-capecitabine, and provides almost similar QOL. As a result, the cisplatin-capecitabine regimen could be utilized as an alternate choice in patients who are unable to afford an oxaliplatin-based regimen.

Biological characterization of a biodegradable scaffold for common bile duct replacement in an experimental model

Baltazar Barrera-Mera — 2023-02-14

Background: The nanofiber scaffolds achieved by the electrospinning technique have been used to develop several biological tissues, the nanofibers obtained by electrospinning procure a favorable microenvironment to mimic the extracellular matrix.

Methods: Study type was of experimental. Study conducted at National Autonomous University of Mexico, from May 2018- May 2022. The protocol was approved by the research and ethics commissions of the UNAM school of medicine. A viscoelastic solution of polylactic-co-glycolic acid (PLGA) and polycaprolactone (PCL) in a 70:30 ratio and gelatin (Gel) in an 80:20 ratio was prepared while a dynamic collector was used with the electrospinning technique.

Results: Mechanical and biological tests were carried out on the scaffold obtained by electrospinning; the resultant scaffold achieves good mechanical matching and structural similarity between the graft and the extrahepatic bile duct.

Conclusions: In this study we managed to create a porous, biocompatible scaffold with good cell adhesion and proliferation, potentially applicable to tissue engineering, especially for the replacement of tubular organs such as blood vessels, bile ducts, and urethra.

Correlation between red cell distribution width and coronary artery disease in patients undergoing elective coronary angiography

Sayem Bin Latif — 2023-02-03

Background: Coronary artery disease (CAD) is the primary cause of death in developed countries and is one of the leading causes of disease burden in developing countries.

Methods: This descriptive cross-sectional study included 124 purposively selected patients who underwent elective CAG in the department of cardiology, Chittagong medical college hospital, Chattogram, from July 2020 to June 2021. SPSS 23.0 software was used for processing and analysis at the end of the data collection period.

Results: According to the Gensini score, patients were categorized into two groups (score <30 and ≥30). There were no significant differences between the two groups concerning BMI, smoking, hypertension, DM, F/H of CAD, statin or beta-blocker use, or the levels of hemoglobin, hematocrit, MCV, MCH MCHC, and creatinine. However, the mean age was older, and there were more males in the severe CAD group. The percentage of dyslipidemia was significantly higher in patients with Gensini score ≥30 than in patients with <30. RDW (OR: 2.629; 95% CI: 1.425-4.484; p=0.002) and age (OR: 1.058; 95%CI: 1.00-1.111; p=0.027) were independently correlated with the severity of CAD. The AUROC for red cell distribution width (RDW) was 0.915 with a p<0.001 for predicting CAD on CAG. It indicated a statistically significant association of RDW with the presence of CAD. A cut-off value of 13.65% RDW had a sensitivity of 80% and specificity of 84.2% for the prediction of CAD. There were no significant differences between patients with and without angiographic CAD for BMI, hypertension, DM, statin, or beta-blocker use, or of the levels of hemoglobin, hematocrit, MCV, MCH, MCHC, and creatinine. However, the mean age was older, and there were more males in the CAD group. The percentage with dyslipidemia, smoking, and F/H of CAD was significantly higher in patients with CAD than in patients without CAD. The data indicate that only RDW was independently correlated with the presence of CAD (OR: 2.593; 95% CI: 1.347-4.989; p=0.004).

Conclusions: RDW is associated with the presence of CAD and suggests that it might be a readily available test for predicting coronary artery diseases.

Electrocardiogram changes due to sodium stibogluconate treatment of kala-azar

M. Shamshul Alom — 2023-02-10

Background: Kala-azar [visceral leishmaniasis (VL)] is caused by the protozoon Leishmania donovani complex. Without adequate treatment, most patients with clinical VL die due to secondary infections. Pentavalent antimonial compounds are commercially available as sodium stibogluconate and meglumine antimoniate. Sodium stibogluconate remains the mainstay of treatment in most parts of the world. The aim of the study was to evaluate the serious adverse effects of sodium stibogluconate in the treatment of kala-azar (VL).

Methods: The study was carried out in the medicine department of North Bengal Medical College Hospital, Sirajganj during the period of June 2021 to December 2021. It was a descriptive cross-sectional study with a sample size of 30. Complete history taking and physical examination were done and recorded in a case record form. At least 7 electrocardiograms (ECGs) were done (1 before treatment, 5 during treatment weekly intervals, and 1 after completion of treatment).

Results: In ECG, the following changes were noted (the rhythm, T wave amplitude, ST segment, and QTc interval). Out of 30 patients, 19 patients (63.33%) developed abnormalities in ECG. Among them, 14 patients (46.67%) developed prolongation of QTc interval, 6 patients developed T wave inversion, and 1 patient developed transient 1st-degree heart block. No patients developed symptomatic arrhythmia.

Conclusions: Kala-azar is prevalent among the poor in Bangladesh and can be fatal without treatment. Sodium stibogluconate has been associated with cardiological adverse effects, but it can be used safely with proper monitoring.

Preventive effects of geraniol in schizophrenia-like symptoms in mice models of psychosis

Christian I. Uruaka — 2023-02-07

Background: The pathogenesis of schizophrenia has been linked to N-methyl-D-aspartate receptor (NMDAr) inhibition and DAr hyperfunction. Geraniol is a naturally occurring acyclic monoterpene with diverse pharmacological applications. We aimed to assess the effect of geraniol on schizophrenia-like symptoms, vis a vis its modulatory actions on neurochemicals in mice models of psychosis.

Methods: In acute studies, male Swiss mice (n=5/group) were intraperitoneally treated with geraniol (25, 50 and 100 mg/kg), risperidone (0.5 mg/kg) or vehicle (10 ml/kg) prior to ketamine (KET) (10 mg/kg)-induced stereotypy and hyperlocomotion. In the chronic studies, mice (n=7/group) were exposed to 14 days interventions (geraniol or risperidone) following a preventive treatment with KET (20 mg/kg) from days 7-14 consecutively. The effects of treatments (e.g., geraniol or risperidone) alone and on KET-induced schizophrenia-like symptoms were investigated on the last day, 24 hours after treatments. Following that, neurochemical and neurotrophic alterations in the brain (striatum, prefrontal cortex, and hippocampus) tissues were investigated.

Results: Intoxication with KET was associated with schizophrenia-like symptoms as evidenced by stereotypy behavior and hyperlocomotion. KET further induced hyperlocomotion, behavioral despair, and cognitive impairment in the chronic studies. It altered the levels of dopamine, 5-hydroxytrypamine, glutamic acid decarboxylase (GAD), acetylcholinesterase (AChE), and brain-derived neurotrophic factor (BDNF) in brain tissues. However, GER (50 and 100 mg/kg) administration significantly prevented the brain's insults caused by KET.

Conclusions: Altogether, the findings support geraniol's neuroprotective activity while also adding to the body of knowledge that geraniol inhibits schizophrenia-like symptoms via modulation of neurochemical and neurotrophic pathways.

An audit to analyze the three-week-wait pathway at department of otolaryngology, head and neck surgery, Sligo university hospital

Tanvir Hussain — 2023-02-28

Background: Otolaryngology, head and neck surgery is an area of medicine concerned with diseases of the ear, nose, throat, head and neck regions. The Three-week wait pathway was introduced in Ireland as a way to improve access to specialist care for patients with symptoms suggestive of malignancy. The pathway allows patients to be seen by a specialist within three weeks of referral from their general practitioner. This study is aimed to study the three-week wait-pathway at the department of otolaryngology head and neck surgery, its functioning and how it can be applied in the department to reduce delays.

Methods: The quantitative and qualitative research was conducted during one year from January 2021 to December 2021.

Results: The results from the audit showed an average of 22 days on referral and an average of 70 days between the times a patient enters the facility and gets out after medical decision making is done. According to the audit, the three-week wait-pathway at department of otolaryngology Head and Neck surgery Sligo university hospital is effective. There are no significant delays in referrals or appointments, and patients are generally happy with the care they receive. The audit found good communication practices within the department, as measured by patient satisfaction scores.

Conclusions: This audit has looked at a variety of aspects of the pathway, including its effectiveness in diagnosing and treating patients, its impact on patient satisfaction, and its cost-effectiveness. The evidence suggests that the three-week wait pathway is an effective way to improve patient care and outcomes. Some quality improvement strategies would be necessary to optimize patient flow and clinical efficiency.

Comparative study between breast conservative surgery and modified radical mastectomy in early stage of breast carcinoma in a tertiary care hospital

Syeda Mehbuba Joty — 2023-02-28

Background: Breast cancer is the most prevalent cancer in women globally, with two million new cases and more than half a million deaths each year. Surgery is the key component of treating breast cancer and there are two primary types of breast surgery available: breast conservative surgery and modified radical mastectomy. The aim of this study was to compare BCS and MRM in the treatment of early-stage breast carcinoma.

Methods: This was a prospective observational study that involved 74 patients and was carried out in the Department of Surgery at Shaheed Suhrawardy Medical College & Hospital and Enam Medical College & Hospital with an 18-months minimum follow-up. The time frame for inclusion was from July 2018 through July 2020. There were two patient groups, 37 patients in Group A who underwent breast conservative surgery and Group B was made up of 37 individuals who had MRM for early-stage breast carcinoma.

Results: With a mean age of 47.65 years in the BCS group and 48.19 years in the MRM group, the operative time for BCS was 1.04±0.25 hours, whereas 3.20±0.48 hours for MRM. Statistically significant higher amount of post-operative drainage volume in MRM group compared to BCS group (p value=0.000). With an excellent aesthetic outcome rate in BCS group (p value<0.0001) as well as better quality of life than MRM group.

Conclusions: Breast conservative surgery and modified radical mastectomy are both oncologically safe treatments for early-stage breast cancer with multidisciplinary approach. BCS offers less trauma, infection and hospital stay; better aesthetic outcome and quality of life than MRM, making it more deserving of being promoted clinically in the treatment of early-stage breast cancer.

Diagnosis of cervical lesion by colposcopy, VIA, pap smear tests, and their correlation with histopathology in a tertiary level laboratory in Chattogram, Bangladesh

Syeda Rumman Aktar Siddiqui — 2023-02-28

Background: Cervical carcinoma is one of the most common causes of mortality among women. This mortality rate can be reduced by early detection of cervical neoplasm by different screening tests. The main objective of this study was to diagnose cervical diseases by colposcopy, by pap smears for cytological examination as well as correlate these findings as screening tests with histopathological diagnosis.

Methods: In this cross-sectional observational study, total 143 cases were included. History was taken and clinical examination was done. Colposcopy and VIA test was done, pap smear sample was collected and reporting was made. Cytological findings were correlated with histopathology.

Results: Mean age of the study cases was 41.2±11.5 years. VIA test was positive in 98 study cases (68.5%). On colposcopy, most of the cases show neoplastic proliferation (80 cases, 55.9%). Among them, most cases were diagnosed as cervical intraepithelial neoplasia-I (CIN-I). Sixty-three (63) cases (44.1%) were non-neoplastic. Most of the biopsies was diagnosed histopathologically as cervical intraepithelial neoplasia-I (CIN-I) (20 cases, 14.0%). Association of colposcopy findings with histopathological diagnosis was done which was significant. Sensitivity of diagnosis of cervical malignancy by colposcopy was 33.33% and specificity was 98.57%.

Conclusions: The study provides good cyto-histopathology correlation in detecting different cervical lesions and malignancy with colposcopy. Although colposcopy sensitivity was low but it can be increased by adequate training and avoiding technical errors. Bethesda system is strongly recommended for adequacy of sampling to minimize inconsistency. Early and regular screening should be advised for reduction of mortality rates from cervical carcinoma.

The effect of ethanolic extract of premature Musa Paradisiaca (plantain) pulp on the histology of the liver and kidneys of female Wistar rats

Progress D. Victor — 2023-02-28

Background: Premature plantain is a major component in herbal remedies used for the treatment of different ailment such as reducing blood sugar, and peptic ulcer disease. The aim of the study was to determine the effect of ethanolic extract of premature Musa paradisiaca on histology of the liver and kidneys of female Wistar rats.

Methods: Twenty female Wistar rats weighing between 180-200 g were divided into four groups. Group 1 was administered distilled water only, while groups 2, 3 and 4 were administered the ethanolic extract of premature Musa paradisiaca in low, medium, and high dose respectively for 14 days.

Results: Twenty-four hours after the last administration, all animals were sacrificed, tissues were harvested. The histological reports showed varying level of damage to the cytoarchitecture of the liver and kidney tissues of the treatment groups when compared to the control.

Conclusions: This plant may likely induce nephrotoxic and hepatotoxic changes.

Computed tomography aspect of primary lung cancer

Christian Tomboravo — 2023-02-28

Background: Primary lung cancer (PLC) is the world’s leading cancer in terms of incidence and mortality. The objective of our study is to identify morphological criteria by scanning towards a histological type of PLCs.

Methods: This is a retrospective transversal analytical study, carried out at the oncology, radiotherapy and clinical haematology department of Joseph Ravoahangy Andrianavalona teaching hospital, from January 01, 2014 to December 31, 2018, covering all new histologically proven cases of PLC. The parameters of the study were epidemiological, CT scan and anatomopathological data.

Results: We collected 95 cases. The average age was 59.11 years. The male gender was the most affected with a sex ratio of 1.8. The most common clinical call sign was chronic cough with 74.74% of cases. The radiographic appearance was parenchymal opacity in 54.5% of cases. Adenocarcinoma had the predominant histological type with 45.26% of cases associations were found between histological type and tumor site (p=0.0001), intratumor excavation (p=0.0001), intratumor necrosis (p=0.012).

Conclusions: Morphological appearance of CT scan lesions may approach histological type of PLCs.

The role of the initial modality in the investigation of thyroid lesions

Farzana Tabassum — 2023-02-28

Background: Partial or complete thyroidectomies are frequently encountered via the working towards pathologist and the opportunity of neoplastic disease is of principal problem in patients with thyroid nodules. Pathological comparison of these specimens ranged from non-neoplastic lesion to exceedingly aggressive malignancy. The aim of this study is to assess the role of the initial modality in the investigation of thyroid lesions.

Methods: This is an observational study. The study used to be carried out in the admitted patient’s department of histopathology, National institute of ear, nose and throat, Dhaka. Bangladesh. In Bangladesh for the duration of the period from June 2021 to May 2022.

Results: This study shows that according to 301 patients where, most of the patients in initial modality in the investigation of thyroid lesions 95 (31.56%) were 40 to 49 years and the minimum sex distribution of study 105 (34.88%) belongs to males. Non-neoplastic of goiter were 194 (64.45%), benign cyst was 43 (14.29%), DeQuervains (Subacute) thyroiditis 11 (3.65%), Lymphocytic thyroiditis were 8 (2.65%) and hashimoto thyroiditis were 3 (1.0%). And acfemalesg to neoplastic of papillary carcinoma were 30 (9.97%), Follicular neoplasm were 9 (2.99%) and Anaplastic carcinoma were 3 (1.0%).

Conclusions: Thyroid lesions are more common in female. The majority of the thyroid nodules are either non-neoplastic or benign neoplasm. Thyroid lesions present a dependable analysis and is an incredible first line technique for investigating the nature of lesion.

Evaluation of mucin histochemistry in relation to p63 expression in nodular hyperplasia and adenocarcinoma of prostate

Rumana Afrin Sweety — 2023-02-06

Background: Prostate cancer is a leading cause of death in men. Nodular hyperplasia and adenocarcinoma are common causes of prostatic enlargement. Diagnosis of these lesions on routine biopsies can be difficult for pathologists. Immunohistochemical stain p63 can help, but it is costly and not widely available. The present study aimed to evaluate the usefulness of mucin histochemistry in relation to p63 expression in differentiating nodular hyperplasia and adenocarcinoma of prostate.

Methods: This study was conducted in the department of pathology at Dhaka medical college from July 2018 to June 2020. 50 cases of prostatic lesions (25 NHP and 25 adenocarcinoma) were examined using histomorphology. The sections were stained with periodic acid Schiff (PAS) to identify neutral mucins and Alcian blue (2.5 pH) to identify acidic mucins. Additionally, p63 antibody was used in immunohistochemistry.

Results: NHP showed positivity for neutral mucin (96% with PAS stain) but not for acidic mucin (Alcian blue stain), while prostatic carcinoma showed positivity for both neutral mucin (28%) and acidic mucin (44%). The grade group 1 tumors of prostatic carcinoma showed 100% positivity for acid mucin, with a decrease in Alcian blue staining as the grade increased. P63 was positive in 100% of NHP cases and negative in 100% of prostatic carcinoma cases.

Conclusions: Positivity for acidic mucins with Alcian blue stain can be a helpful diagnostic tool to differentiate well differentiated adenocarcinomas from benign lesions where facility for p63 immuno-stain is not available and poor people who cannot afford the cost of immunohistochemistry.

Comparison of outcome between suture and suture-less surgery following pterygium excision and conjunctival autograft

Chandra Shekhar Majumder — 2023-02-07

Background: A pterygium, known as surfer's eye, is a raised, wedge-shaped growth of the conjunctiva that extends onto the cornea, the outer layer of the eye. Aim was to compare the safety, efficacy and outcome of suture less technique with suture of conjunctival autograft in the management of pterygium.

Methods: This study was carried out in the department of ophthalmology, Sir Salimullah medical college and Mitford hospital, Dhaka. Study period was July 2019 to June 2020. Subjects for this study were divided into two groups, forty patients were enrolled in each group of the study population. Group I (control) comprised the subjects in whom suture was used following pterygium excision and conjunctival autograft and group II (experimental) comprised the subjects in whom no suture was used following pterygium excision and conjunctival autograft.

Results: In group I, 20% were 20-29 years old, 30% were 30-39, 27.5% were 40-49, and 22.5% were over 50, with 77.5% being male and 22.5% female. In group II, 22.5% were 20-29 years old, 27.5% were 30-39, 30% were 40-49, and 20% were over 50, with 72.5% being male and 27.5% female. The most common symptom was "foreign body sensation" in both groups. In group I, 5% experienced partial graft dehiscence, 2.5% a conjunctival cyst, 10% hyperemia, and 17.5% visual improvement. In group II, 2.5% had partial graft dehiscence, 2.5% hyperemia, and 22.5% visual improvement. Neither group had graft retraction or recurrence.

Conclusions: Postoperative presentation like hyperemia was significantly less in experimental group. Incidence of post-operative complications like graft dehiscence and conjunctival cyst were comparatively less frequent in suture less technique. Thus, suture less technique following pterygium excision and conjunctival autograft is a safer and less complicated than sutured technique.

Screening and diagnosis of gestational diabetes: a hybrid method

Rene Zalapa-Rios — 2023-02-28

Background: In Mexico the gestational diabetes prevalence varies between 4 and 13%. The main purpose of this study is to determine the prevalence of gestational diabetes, the relevance of its risk factors, and its repercussions in pregnancy with a hybrid diagnostic method.

Methods: This prospective, longitudinal, and observational study includes 347 pregnant women. Screening for gestational diabetes was performed with the O’Sullivan test, with a cut-off point of 140 mg/dL of glucose, followed by a 75-gram oral glucose tolerance test in patients with an abnormal screening test. The diagnosis was made with one or more abnormal results. Different variables were evaluated in these patients; from risk factors, to complications of gestational diabetes.

Results: Of the 347 patients studied, 77 (22.2%) had a positive screen and 34 patients were confirmed with gestational diabetes (9.8%). A body mass index greater than or equal to 25 increased the relative risk by 2.52, the history of macrosomia by 4.10, a maternal age greater than or equal to 36 years by 2.54, and the presence of a twin pregnancy by 6.94. Regarding complications, there was an increase in prevalence of macrosomia (RR=4.09).

Conclusions: The prevalence of gestational diabetes, using the combination of the two existing classical methods, is similar to that reported in other national and international studies, while also avoiding overdiagnosis, over-monitoring, and reducing typical discomforts that may come by using the one-step method.

Morbidity and mortality profiles and outcomes of neonates admitted in the special newborn care unit of tertiary care hospital of Government Medical College Rajouri of district Rajouri of union territory of Jammu and Kashmir: a hospital-based study

Javaid Iqbal — 2023-02-21

Background: Neonatal deaths constitute major portion of under-five mortalities in India. Neonatal period is very important and precious period because most of the preventable morbidities and mortalities occur in this period. In our country, prematurity, infection and prenatal asphyxia are three major causes for neonatal mortality. Various special newborn care unit (SNCU) are established in different district Hospitals to provide neonatal care which further decrease neonatal mortality.

Methods: This observational retrospective study was planned to determine the clinical profile and outcome of various neonatal admissions at SNCU, of department of paediatrics Government Medical College Rajouri, Jammu and Kashmir a newly established medical college in the rural setting of northern India which is a tertiary care hospital. The data was collected for a period of 1 year from 01 April 2021 to 31 March 2022. Detailed information was collected from files and registered onto the preset proformas and results were compiled.

Results: A total 2495 newborns were enrolled for the study. 1796 (71.98%) were inborn and 699 (28.01%) were out born. Total male babies were 1569 (62.88%) and female babies were 926 (37.12%). Majority of patients were full term and weight ≥2.5 kg (86.05%). major indications for admission were sepsis 557 (22.32%), prenatal asphyxia 532(21.32%), neonatal hyperbilirubinemia 387 (15.5%), Low birth weight 348 (13.94%) and respiratory distress 308 (12.34%). Out of total, 1879 (75.3%) newborn were discharged successfully after treatment. 192 newborns were referred to higher centre for specialized care. 174 (7%) newborns died during the treatment.

Conclusions: Neonatal period is a very crucial period for development of morbidity and mortality. SNCU with skilled staff can prevent the worst outcomes by early interventions.

Epidemiology of prediabetes and prehypertension-progression, regression and interaction

Mudasir Muzamil — 2023-02-07

Background: The major portion of the non-communicable diseases is formed by cardiovascular diseases. The two major modifiable risk factors are hypertension and diabetes. The probable CVD risk with pre-hypertension and pre-diabetes, to some extent, is dependent on whether pre-HTN leads to hypertension and pre-DM leads to diabetes. Our aim was to study: the progression of prehypertension and prediabetes to overt hypertension and diabetes or to normal status, and the association of pre-obesity and obesity with prehypertension and prediabetes.

Methods: A total of 1200 patients equally distributed among three groups were studied for progression or regression. Group A included 400 patients of pre-hypertension, and group B included 400 patients of pre-diabetes and group C included 400 patients of pre-diabetes and pre-hypertension.

Results: Among the 400 studied patients with prediabetes 31 (7.8%) progressed to diabetes and only 9 (2.3%) progressed to hypertension over a period of two years. Patients with both prehypertension and prediabetes had a higher risk of progression to hypertension and diabetes (3% to hypertension and 15.5% to diabetes). Males were more prone to develop both pre-hypertension and pre-diabetes mellitus and progression. Obesity increased the risk of progression to hypertension and diabetes significantly.

Conclusions: The screening of people for pre-diabetes mellitus and pre-hypertension should be carried out at mass levels so as to diagnose them at an early stage and hence, their progression can be either halted or modified.

Lens thickness and associated ocular biometric factors among cataract patients in tertiary hospital

Shivani Sharma — 2023-02-07

Background: A significant factor in determining intraocular lens power is the biometry assessment of cataract patients prior to surgery. To evaluate the distribution of lens thickness (LT) and its associations with other ocular biometric factors among cataract patients.

Methods: Total 978 eyes from cataract patients were retrospectively included. Ocular biometric factors including k1, k2, LT, central corneal thickness (CCT), anterior chamber depth (ACD), white-to-white (WTW) distance, and axial length (AL) were collected based on the medical records. The associations between LT and general or ocular factors were assessed. We analyzed the data using descriptive analysis and correlated each variable using the Spearman’s Rho analysis.

Results: The mean age was 62.5±15.70 years and 55.11% were females. Mean LT was 4.35±0.41 mm. The LT was greater in older patients. LT positively correlated with AL, WTW and CCT, while negatively correlated with ACD.

Conclusions: LT is an important biometric parameter that should be considered, along with other biometric parameters, in determining effective lens position in patients undergoing cataract surgery. ACD is predominantly influenced by LT than the AL.

Comparison of electrocardiogram diagnostic criteria in diagnosis of left ventricular hypertrophy using 3D echocardiography as standard

Rohit Mathur — 2023-02-07

Background: The echocardiogram (ECHO) has a better diagnostic performance for left ventricular hypertrophy (LVH) than the electrocardiogram (ECG), but ECG is most widely used diagnostic method. We aimed to assess the correlation between ECG based diagnosis of LVH with echocardiography-based diagnosis of LVH as standard.

Methods: Patients with evidence of LVH using echocardiographic criteria were included in the study. Patients were subjected to four electrocardiographic criteria to assess the LVH: 1. Sokolow-Lyon criteria; 2. Romhilt and Estes scoring system; 3. Cornell voltage criteria; and 4. Gubner voltage criteria. After assessing the results of ECG and echocardiography diagnostic validity tests (by calculating specificity and sensitivity), the Kappa measure of agreement was performed.

Results: In maximum patients (52.8%) LVH was detected by using ECG LVH Sokolow Lyon criteria, followed by Cornell voltage CR criteria that detected LVH in 38.9% cases. Sokolow Lyon ECG criteria showed high sensitivity while Romhilt and Estes criteria showed maximum 98% specificity in diagnosing LVH. Sokolow Lyon’s ECG criteria was highly sensitive in assessing all co-morbidities, except CKD where it was diagnosed better by using Cornell voltage criteria.

Conclusions: In cases of diagnosing LVH in patients with co-morbidities, ECG LVH Sokolow Lyon CR was found to be the most sensitive criteria except CKD where it was diagnosed better by using Cornell voltage criteria. For assessing the patients for LVH, the role of ECG with all the commonly used criteria is of limited value and ECHO should be the method of choice.

A morphometric study of supratrochlear foramen of humerus in a medical institute in North-East India

Meiraba Singh Laishram — 2023-02-14

Background: The clinical importance of the supratrochlear foramen (STF) of the humerus, an anatomical variation, has been recognised because of its association with low-impact fractures of the distal end and narrow medullary canal of the humerus. According to the literature, STF prevalence varies between ethnic groups and even between individuals of the same ethnic group. Many studies in India also reflect variations in the prevalence of STF in different regions. However, the study of STF is still a rarity in northeast India, where different indigenous peoples are living.

Methods: A descriptive cross-sectional study of dry humerus bones was conducted a medical institute in Manipur. The presence of STF, its shape, maximum dimensions (transverse and vertical), and distances from the medial and lateral epicondyles were observed.

Results: STF was present in 28.57% of bones, of which 53.85% were observed in the left humerus and 46.15% in the right humerus. STF was found in different shapes, including oval (46.15%), round (19.23%), irregular (19.23%), and triangular (15.38%). The 66.67% of the STF were situated more medially in the right humerus, while 78.57% of the STF were also located more medially in the left humerus.

Conclusions: The study of STF showed a prevalence of 28.57%. The oval-shaped foramen was the most common. The majority of the STF was placed more medially in both the right and left humeri.

Efficacy of biofeedback in treatment of migraine

David Rosario — 2023-02-14

Background: Migraine is characterized by increased excitability of CNS. Biofeedback is a non-invasive, non-pharmacologic therapeutic technique, which helps patients control stress response by deep breathing,visualization and medication. The aim of the study was to compare efficacy of conventional therapy, biofeedback and combination of pharmacotherapy with biofeedback.

Methods: This is a randomized study conducted for period of 2 years from April 2020 to May 2022 in Srinivas Institute of Medical Science and Research Centre, Mukka, Surathkal. 100 patients who were diagnosed with migraine between 18 and 60 years of age were included in the study after ruling out other primary causes of headache. Patients<18 years of age >60 years of age, with known comorbidities that can precipitate headache and on treatment for any other condition were excluded from the study. They were randomly assigned to groups for receiving conventional therapy, biofeedback therapy and combination of pharmacotherapy and biofeedback. 35 patients were allotted to group which received conventional therapy, 35 were assigned to the group that received combination of biofeedback and pharmacotherapy and 30 patients were allotted to the group that received biofeedback alone.

Results: Among 100 migraine patients 58 were females and 42 were males. 62 of them were in the age group of 30 to 40 years of age. 66 patients belonged to moderate to severe category of migraine. Out of 35 patients who received conventional therapy 21 (57.4%) reported improvement in quality of life, whereas 26 out of 35 (74.28%) who received combination of biofeedback and pharmacotherapy reported reduction in severity and frequency of headaches with better quality of life compared to 13 patients out of 30 who received biofeedback alone (43.3%).

Conclusions: Patients who received combination of biofeedback and pharmacotherapy had best outcome (74.28%) compared to the ones who received biofeedback (43.3%) or conventional therapy (57.4%) alone.

A cross sectional study to determine the correlation of blood glucose and HbA1C in type 2 diabetes mellitus patients

Reeta Baishya — 2023-02-14

Background: Measurement of glycosylated hemoglobin (HbA1c) is considered the gold standard for monitoring chronic glycemic level of diabetes patients. HbA1c is a form of hemoglobin that is measured primarily to identify the average plasma glucose concentration over prolonged periods of time. Levels of HbA1C represent the average blood glucose levels of diabetic patients over the previous 120 days. The objective of this study was to see the correlation between HbA1c levels and glucose levels.

Methods: This cross-sectional study included 60 randomly selected subjects with known diabetes. Both fasting and post prandial blood glucose levels were measured by using venous blood samples. HbA1c levels were measured in venous blood by immunoturbidimetric method. Data were recorded on a proforma in MS-excel sheet. Pearson's coefficient of correlation was applied to find out any significant correlation between the HbA1c levels and the both fasting and postprandial blood glucose levels.

Results: Results were obtained by statistical calculation and plotted with respect to scatter and bar diagram was done and a p<0.05 was considered significant (With 95% CI).

Conclusions: A significant linear positive correlation exists between levels of HbA1C and fasting and post prandial blood glucose.

A comparative study between single dose intralesional autologous blood and corticosteroid injection in chronic plantar fasciitis-a short term follow-up study

Mahesh Kumar N. B. — 2023-02-28

Background: Plantar fasciitis was initially thought to be an acute inflammatory disease, but histology findings show that it is a chronic degenerative process leading to pain at the calcaneal insertion without any inflammation. The diagnosis of plantar fasciitis is mainly based on clinical symptoms, like heel pain and tightness, and diagnostic imaging is not routinely required. Injection of autologous blood can help stimulate a healing response in chronic tendon disorders.

Methods: Radiological imaging of the affected foot in lateral view will be taken. 30 patients will be treated with 2 ml of autologous blood with 1 ml lidocaine and another 30 patients with 2 ml of triamcinolone acetonide with 1 ml lidocaine. The main outcomes measured are subjective based on the visual analog scale done pre-injection, 2 weeks, 4 weeks and 12 weeks post injection. Final outcome was measured based on the pain and activity level at 3 months.

Results: The corticosteroid group showed an early sharp and then more gradual improvement in pain scores, but autologous blood group had a steady gradual drop in pain.

Conclusions: Autologous whole blood and corticosteroid local injection can both be considered as effective methods in the treatment of chronic plantar fasciitis.

Epidemiology, diagnosis and management of patients with biliary dyskinesia and sphincter of Oddi dysfunction: a survey of Indian gastroenterologists

Ameet Mandot — 2023-02-28

Background: A cross-sectional, physician-based survey was conducted to address the relative lack of data on the awareness about and management of biliary dyskinesia and sphincter of Oddi dysfunction among Indian gastroenterologists.

Methods: A structured questionnaire containing questions on epidemiology, etiology, clinical presentation, diagnostic investigations, prognosis and management was used. Physician responses were analyzed as descriptive statistics and reported as frequency and percentages.

Results: A total 146 gastroenterologists across 137 cities participated in the survey. Majority (76.0%) of physicians stated that <10% of their patients with cholecystitis get diagnosed with BD, while 84.7% stated that <25% of patients with BD have SOD. SOD and BD were reported to be common in females <50 years. Patients recovering from major surgeries/stroke/heart attack/sepsis/extensive trauma were identified by 53.0% of physicians to be at risk for BD. Majority of physicians (69.4%) reported that irritable bowel syndrome (IBS) was a major risk factor for SOD. Cholescintigraphy and hepatobiliary scintigraphy were investigations of choice for BD and SOD according to 55.5% and 33.6% of physicians, respectively. Sepsis was identified as a frequent complication of BD (45.2%). Laparoscopic cholecystectomy was identified by 64.4% participants to result in partial resolution of symptoms in many patients. Calcium channel blockers and antispasmodics were preferred by 55.9% and 30.8% physicians for functional gall bladder disorder, respectively. IBS was the most common indication for prescribing the antispasmodic pinaverium, with the primary objective of pain relief.

Conclusions: Findings from this survey provide insights for further research on BD and SOD in India.

Renal morbidity in type 2 diabetes mellitus patients with and without non-alcoholic fatty liver disease

Tanuku Vivek — 2023-02-28

Background: Non-alcoholic fatty liver disease (NAFLD) is independently associated with with prevalent as well as incident cardiovascular diseases (CVD), type 2 diabetes mellitus (T2DM), chronic kidney disease (CKD) and Metabolic syndrome (MetS). Awareness of Renal Morbidity and full understanding is work at progress. Hence it was determined to assess the Renal morbidity as measured by eGFR in patients of T2DM with and without NAFLD.

Methods: Patients with T2DM (ICMR 2018 criteria) with proper informed and valid consent and satisfying essential inclusion and exclusion criteria were screened for presence of fatty liver by ultrasound and were divided into two groups; those with NAFLD and without NAFLD. All patients were investigated for renal morbidity in terms of eGFR using MDRD formula.

Result: Diabetic patients with NAFLD had lower eGFR levels compared to diabetics without NAFLD (p<0.05). Patients with diabetes and NAFLD has significantly higher BMI, WHR, duration of diabetes compared to Diabetes patients without NAFLD.

Conclusions: Group of diabetics with NAFLD have to be closely monitoring for serum creatinine levels and BMI is required for early intervention and optimisation of treatment. Elderly patients required more prompt monitoring.

Spectrum of clinical and biochemical profile and its importance in diabetic ketoacidosis: a tertiary care hospital experience in Gujarat

Trupti R. Jansari — 2023-02-28

Background: Diabetes mellitus (DM) is a disorder of multiple etiologies, and diabetic ketoacidosis (DKA) is one of the life-threatening complications of DM. This study was aimed to study the clinical and biochemical profile of DKA patients.

Methods: We conducted this retrospective study at a tertiary care hospital in Gujarat. We included total 100 patients above the age of 18 years having DM, presented with DKA. A detailed history, clinical examination and biochemical tests were carried out: random blood sugar, urinalysis, arterial blood gas analysis, serum ketone, HbA1c, serum creatinine, serum electrolytes- potassium and sodium and serum osmolality. The results were analysed using Microsoft excel.

Results: Out of total 100 patients, 76 (76%) patients had type 1 DM and 24 (24%) had type 2 DM, 42 (42%) were in the age group of 18-30 years. The mean age was 39.75±12.14 years. There were 56 (56%) males and 44 (44%) females with male: female ratio of 1.3:1. Most common clinical features of DKA were nausea/vomiting (88%), breathlessness (43%) and fever (35%). The main biochemical parameters altered were blood sugar (>400 mg/dl in 41%) and serum ketones (≥5 in 84%) as well as majority of patients (64%) had their HbA1c level between 11-15% with the mean HbA1c value of 12.25±2.43%.

Conclusions: DKA is a frequently observed emergency with high mortality rate. Education regarding symptoms of ketoacidosis, not missing insulin doses especially during illness, strict adherence to treatment and lifestyle modifications can greatly reduce DKA occurrence.

A comparison of outcomes in ultrasonography guided versus landmark guided corticosteroid injection for the treatment of adhesive capsulitis

Gopinath K. M. — 2023-02-28

Background: Adhesive capsulitis is a debilitating disease in an otherwise healthy individual. Intra-articular corticosteroid injections offer a cost-effective, non-operative treatment option. However, it is currently unclear whether an ultrasound-guided injection relieves the symptoms of shoulder pain more effectively than if the injection was delivered landmark-guided.

Methods: Eighty patients with adhesive capsulitis were randomized to two intervention groups - landmark guided and ultrasound (USG) guided. The functional status of the patients was documented prior to the intervention. Following allocation, the intra-articular steroid was administered either under USG guidance or following identification of the site of injection using landmarks. Follow-up was done on day 5, 3 weeks, 6 weeks, and 12 weeks post procedure to document the functional status.

Results: The difference in visual analogue score (VAS) between the two arms was found to be statistically significant in favour of the ultrasound guided technique only on day 5 and day 21. On the other hand, the difference in disability of arm, shoulder, and hand (DASH) score between the 2 arms was found to be statistically significant in favour of the ultrasound guided technique on day 5, 21, 42 and 84. Finally, in our study, both shoulder flexion and abduction on day 84 achieved a statistically significant improvement, favouring the ultrasound guided arm.

Conclusions: Ultrasound guided corticosteroid injections may offer modestly better short-term functional outcome and symptom relief when compared with landmark guided corticosteroids.

Comparative analysis of immunohistochemistry and flow cytometry in the diagnosis of acute leukaemia: a single centre study

Usha Sarma — 2023-02-28

Background: Morphological evaluation and immunophenotyping are the major diagnostic modalities of acute leukaemia (AL). Although immunohistochemistry (IHC) and flow cytometry (FCM) are necessary for lineage assessment, but in many cases the use of these modalities alone might possess a diagnostic challenge. The study was aimed to analyse the diagnostic utility of IHC and FCM in the diagnosis of AL.

Methods: This cross-sectional hospital-based study was done for one year and included 55 cases. Following peripheral blood examination and bone marrow study, IHC and FCM analysis was done using CD34, anti-MPO, CD3 and CD20.

Results: There were 74.5% acute myeloid leukaemia (AML) and 25.5% acute lymphoblastic leukaemia (ALL) cases. By IHC, CD34 was positive in 94.5% cases, anti-MPO in 69.1%, CD3 in 3.6% and CD20 in 12.7% cases. But by FCM, CD34 was positive in 96.2% cases, anti-MPO in 61.5%, CD3 in 3.8% and CD20 in 19.3% cases. FCM could not be done for 3 cases as there was dry tap with pancytopenia and lineage assessment was done by IHC. On comparative analysis, CD34 was found to be better expressed by FCM. Anti-MPO and CD20 were better expressed by IHC and CD3 was equally expressed by both.

Conclusions: IHC is an easy and cost-effective technique which gives an accurate characterization of the lineage and subtype of AL, especially in cases where use of FCM is limited such as cases with dry tap and pancytopenia and in limited resource centers.

Study of aetiological factors and clinical profiles of neonatal jaundice in the special newborn care unit of tertiary care hospital of Government Medical College, Rajouri, Jammu and Kashmir union territory: a hospital-based study

Javaid Iqbal — 2023-02-21

Background: Neonatal hyperbilirubinemia may be physiological or pathological. Neonatal hyperbilirubinemia is a common condition requiring inpatient treatment and monitoring and many time requires readmission to hospital. Estimated incidence of jaundice in neonates is 60% to 84% of late term and term infants. Present study was undertaken to study clinical profile of neonates with jaundice at our tertiary care centre.

Methods: This prospective observational study was conducted in neonates with jaundice admitted in SNCU ward during study period with serum bilirubin more than 10 ml/dl.

Results: During study period 339 neonates were considered for presented study. 192 newborns (56.63%) developed jaundice after 72hrs. of birth. Only 28.90% newborns developed jaundice within 24 hrs. Of birth. 61.65% babies were male as compared to 38.34% female babies. Jaundice was most commonly noted in babies delivered at more than 34 weeks gestational age (60.17%), while only 10.02% babies were delivered between 28-32 weeks gestational age. 2500- 4000 gm birth weight babies were 60.14% while only 39.82% babies had weight less than 2500 gms. Incidence of neonatal jaundice was 60.06%, 30.38%, 08.55% in vaginal, caesarean section and instrumental delivery respectively. Physiological jaundice (30.67%), prematurity (25.30%), Rh incompatibility (10.91%), breast feeding/jaundice (10%), ABo incompatibility (6.19) and idiopathic (5.01%) were most common causes noted in our study.

Conclusions: Male gender, 2500-4000 gm birth weight, vaginal delivery, physiological delivery, prematurity were common causes associated neonatal jaundice in our study. Parent counselling and monitoring of baby is most important in management of neonatal jaundice.

Role of yoga in improving pulmonary efficiency in post-menopausal women

Aniket Bhaskar — 2023-02-28

Background: Menopause is a natural transition in a women’s life. Menopausal transition has been linked to impairment of respiratory function. Female hormones play an important role in overall lung health. Yoga is an ancient Indian science as well as the way of life, which includes practice of yogasana in specific posture and pranayama which includes the regulated breathing techniques. The aim of the study was to evaluate the cumulative effect of practicing yoga and pranayamas on certain respiratory parameters and physical characteristics in post-menopausal women.

Methods: A total of forty post-menopausal women (46-60 years) were divided into two groups. Group I was control group (women not doing yoga) and group II was regularly doing yoga for one year. Based on the duration of yoga- pranayama and meditation, the respiratory parameters such as VC, FVC, FEV₁, PEFR, and FEF₅₀ was measured with the help of vitalograph (pneumotrac; 11). Data collected were compiled, categorized and statistically analyzed, t-test was used for comparing the effect of yoga between the two groups and p≤0.05 was considered as statistically significant.

Results: One-year yoga showed a significant decrement in Body weight (p<0.001) and Body Mass Index (p<0.01). Group II showed significant improvement (p<0.001) in all the respiratory parameters such as VC, FVC, FEV1, PEFR, and FEF50 when compared to respective control group. Respiratory rate was decreased significantly (p<0.0001) and Breath hold time was increased significantly (p<0.0001) when compared to control group.

Conclusions: The present study demonstrated that the one-year of yogic practice is suitable for improving pulmonary efficiency and physical characteristics in post-menopausal women.

Liver and renal biochemical parameters in preeclampsia: a cross sectional study

Javid Ahmed Khan — 2023-02-28

Background: Pre-eclampsia is a multisystem disorder of human pregnancy with a genetic predisposition. It occurs more frequently in first pregnancies and leads to elevation in blood pressure and mainly affects maternal renal, cerebral, hepatic and clotting functions. This study evaluated biomarkers of renal and liver function among preeclamptic women.

Methods: This was a cross-sectional study conducted among 150 preeclamptic women and 150 normotensive healthy pregnant women in hospital. The baseline data comprising age, gestational age, and blood pressure were obtained. Serum urea, creatinine, and plasma levels of liver enzymes ALT and AST, total protein, albumin, globulin and glucose were measured.

Results: The plasma total protein, and albumin in preeclamptic group were significantly decreased (p<0.05) when compared with control. There was statistically significant increase (p<0.05) in urea creatinine, glucose, serum AST, and ALT activities in preeclamptic group.

Conclusions: Preeclampsia has harmful effects on renal and liver function as shown by alteration of these parameters.

Indirect signs of anterior cruciate ligament tear on MRI knee: a retrospective study

Gagan Sandhir — 2023-02-28

Background: Anterior cruciate ligament is the most common ligament tear in knee and its primary role is to provide stability to the knee joint. Aim of study is to describe various secondary signs that are helpful in diagnosing partial/complete ACL tear. MRI offers distinct advantages over arthroscopy as a means of evaluating the ACL. MRI evaluation is effective in preventing unnecessary arthroscopy by assessing the severity of ACL tear and coexisting injuries.

Methods: In this retrospective study 30 cases of partial/complete ACL tear were studied over a period of six months using Siemens Magnetom Essenza 1.5T MRI scanner in Srinivas institute of medical sciences and research centre, Mangalore.

Results: To establish the sensitivity and specificity of indirect signs at MR imaging of Anterior Cruciate Ligament in 30 patients (18 with complete and 12 with partial thickness tear). The indirect signs were as follows: Bone Contusions (70%); Buckling of PCL (72%); Posterior displacement of lateral meniscus (54%); Anterior displacement of tibia (28%); pericruciate fat pad (86%); Wavy patellar tendon sign (28%) and associated joint effusion (90%).

Conclusions: ACL ligament is the most commonly disrupted ligament in knee seen in radiology and orthopedic practice. A significant percentage of partial tears will progress to a functionally complete ACL tear. MRI helps guide the treatment decision process by demonstrating the extent of ACL injury and secondary signs make the accuracy of diagnosis stronger.

Prevalence of obstructive airway disease in pulmonary function tests of patients visiting respiratory medicine out patient department

Thritia S. — 2023-02-28

Background: The recognition of obstructive airway disease as a public health problem, however, has failed to keep pace with its increasing impact on health-care resources. This study is conducted to evaluate the prevalence of obstructive airway disease in pulmonary function tests (PFT) of patients visiting respiratory medicine out patient department (OPD).

Methods: This is a retrospective study of patients from October 2020 to September 2022 (2 years), on 80 subjects reporting to respiratory medicine OPD, MGM medical college, Aurangabad. Data collected from 80 subjects who were diagnosed with obstructive airway disease in PFT.

Results: The study population had a COPD prevalence of 16 (19.7%). GOLD criterion revealed that 54.2% (9/16) of COPD patients had mild COPD. This research showed no evidence of very severe COPD. In terms of gender distribution, 8 (16.6%) of 46 males and 7 (19.5%) of 34 women had COPD. However, there was no statistically significant (p=0.167) difference in COPD prevalence between sexes. Furthermore, univariable analysis revealed no significant differences in marital status (p=0.836), co-morbidities (p=0.541), family size (p=0.535), educational status (p=0.827), employment status (p=0.643), and medical visits (p=0.366) between persons with and without COPD.

Conclusions: According to the findings of this research, the variables that increase a person's likelihood of developing COPD are as follows: advancing age, prolonged exposure to smoke from biomass burning, tobacco use, and inadequate ventilation in the kitchen.

Comparison of hysteroscopic and laparoscopic myomectomy in large type 2 submucous leiomyomas

Ashima Taneja — 2023-02-28

Background: Uterine leiomyomas are the most common benign tumors, affecting 30% of women of reproductive age. Submucous myomas are seen in 5.5-10% of all myomas. This study aimed to compare clinical, peri, and post-op outcomes of hysteroscopic and laparoscopic myomectomy in large type 2 submucous myomas.

Methods: A prospective study was performed on 50 patients with large submucous type 2 leiomyomas measuring 3-5cm from October 2020 to August 2022. Patients were randomized into two groups of 25 each. Group A underwent hysteroscopic myomectomy and group B underwent laparoscopic myomectomy.

Results: There was no significant difference in the demographic data of both groups except parity. Perioperative outcomes including bleeding, pain, and hospital stay were significantly higher in the laparoscopy group. None of our patients had air embolism. One patient had blindness in the postoperative period. 2 patients had uterine perforation in the hysteroscopy group. Postoperative pain was higher in the laparoscopy group. Recurrence at 3 months was seen in 2 patients of group A. Asherman syndrome was seen in group A. Single-stage success rate was seen higher in the laparoscopy group.

Conclusions: Laparoscopy and hysteroscopy both are feasible techniques of myomectomy for submucous leiomyomas but for removal of large submucous leiomyomas laparoscopy myomectomy is considered better. For successful removal of large myomas in single-stage hysteroscopy, use of hysteroscopic morcellation should be considered.

Comparative analysis of fibreoptic bronchoscope aided cytohistological techniques in diagnosis of benign and malignant lesions of lung

Shilpa Garg — 2023-02-28

Background: Morbidity and mortality from chronic lung diseases are increasing worldwide. A combination of various cytological and histopathological techniques are required for the high diagnostic accuracy. This study aims to evaluate and compare diagnostic accuracy of fiberoptic bronchoscope aided cytohistological techniques such as BAL (bronchoalveolar lavage), TBNA (Transbronchoscopic needle aspiration) and FB (forceps biopsy) in diseases of lung.

Method: A prospective study conducted on 100 patients with symptoms and signs of various respiratory diseases who underwent fibreoptic bronchoscopy. Diagnostic accuracy of various samples alone and in combination were analysed.

Results: Sensitivity of BAL-24%, TBNA 64% and FB 66%. Addition of BAL to FB increased the sensitivity to 69%. Addition of BAL to TBNA increased the sensitivity to 70%. Sensitivity of cytological methods (FB and TBNA) 90%. Addition of both BAL and TBNA to FB increased overall senstivity to 93%. FB the most specific amongst the three techniques with specificity of 94% followed by TBNA (59.4%) and BAL (50%).

Conclusions: There are variable results regarding diagnostic yields and utilities of various fibre-optic bronchoscope aided cytohistological techniques but there combination adds the yields. Thus a combination of various cytohistological samples should be taken in a patient undergoing fiberoptic bronchoscopic examination to increase the diagnostic yield, to cut short the diagnostic time and early start of treatment.

Prevalence of splenomegaly and factors contributing to splenomegaly among pancytopenia patients: a facility-based cross-sectional study

Kaushik N. — 2023-02-28

Background: The spleen is an organ that cannot be clinically felt in a normal individual. Splenomegaly is a significant diagnostic indicator of the presence of underlying pathology. It is associated with a number of diseases like hematological, infectious, portal hypertension and immunological problems. However, it’s unclear what exactly causes hypersplenism. The objective was to assess the prevalence of splenomegaly in people with pancytopenia and the contributing factors.

Methods: A cross-sectional study was conducted among adult patients diagnosed with pancytopenia in a tertiary care hospital in Bengaluru, Karnataka. We have considered only inpatients who accessed care at the facility over a period of 12 months from Aug 2021 to July 2022 among those who have given written informed consent. Socio-demographic details, smoking status, alcohol consumption history, existing comorbidities, and other biological parameters were assessed by accessing the medical records. The abdominal ultrasound of the admitted patients was used to diagnose splenomegaly.

Results: Splenomegaly was present in 25 (56.8%) of patients out of 44 we enrolled. Among those patients, 17 (38.6%) had mild, while 4 (9.1%) had moderate and massive splenomegaly respectively. The majority were females (28 versus 16 males) and the mean age was 44.84 years (±15.45 SD). The age ranges from 24-80 years. We observed that patients aged 36-50 years and comorbidities like hypertension and hypothyroidism were the associated factors for splenomegaly.

Conclusions: The prevalence of splenomegaly among pancytopenia patients is high. This is a significant clinical indication that requires careful investigation. Ageing, hypertension, and hypothyroidism are contributory factors for splenomegaly in patients with pancytopenia.

Prevalence of dry eye and tear film changes in diabetic population: experience at our tertiary care centre

Erum Waris Khateeb — 2023-02-28

Background: Abnormalities in tear secretion, alteration of epithelial barrier and autonomic neuropathy lead to tear film and ocular surface changes in diabetes, thus causing dry eye. Aim was the evaluation of tear film and ocular surface of diabetic patients and to assess the prevalence of dry eye in diabetic patients presenting to our department.

Methods: It was prospective, observational study. Visual acuity was tested for all the patients and slit lamp evaluation was done followed by staining methods to evaluate dry eye. The parameters included ocular symptoms, Schirmer test, tear meniscus height, tear film breakup time, corneal staining with fluorescein, conjunctival staining, presence of strands/filaments and presence of diabetic retinopathy.

Results: A total of 200 diabetic patients were assessed. Forty percent had the duration of diabetes mellitus ranging between 6-10 years. Majority of patients were having grittiness (54%). Around 32% of the study participants are having dry eye. On Schirmer test majority (43%) were having 6-10 mm. 69% of the study participants were having more than 1 mm of tear meniscus height. Majority (69%) of the study participants had more than 10 sec tear film breakup time. 18% of the study participants were having positive conjunctival staining and 18% of the study participants were having positive corneal staining. 13% of the study participants are having filaments/strands.

Conclusions: The incidence of dry eye was seen to increase with increasing duration of diabetes and increasing age. Careful elicitation of history followed by proper evaluation to diagnose dry eye is emphasized.

Spectacle adherence and barriers towards spectacle wear among primary school going children

Rakesh Kumar Yadav — 2023-02-28

Background: The aim of the study was to assess the spectacle adherence and barriers towards spectacle wear among primary school going children in the west UP.

Methods: A cross-sectional, descriptive questionnaire-based study was conducted among the primary school going children in rural area of west UP. Spectacle was provided after the comprehensive eye examination, free of cost to the children those who required. An uninformed visit was planned after 3 months of initial examination to assess the compliance of spectacle wear and non-compliant subjects were questioned about the reasons for not wearing spectacle.

Results: This study consists of total 158 children. In this study, majority of participants 88.61% were myopic having low degree of myopia being more common. Compliance rate towards the spectacle wear was high in males as compared to female children. Compliance rate was significantly varied with the age of participants. Myopic patients show more compliance than the hyperopic patients, it was insignificant while considering the severity of refractive error. The main cause for non-compliance towards spectacle was the cosmetic blemish.

Conclusions: It has been found that the compliance rate towards the spectacle wear was not good enough even after distributing the spectacle free of cost to the children. Various factors including cosmetic blemish, parents and children perception for wearing spectacle and difficulties experienced by the children while wearing glasses were responsible for the non-compliance. The compliance rate can be increased by providing the education and training and Counselling to school teachers, children and their parents regarding the eye health.

Pattern of dermatology referrals in a tertiary care center in North East India

Thokchom Nandakishore — 2023-02-28

Background: Dermatologists besides providing service to patients in the outdoors, also play a vital role in the care of inpatients admitted to dermatology unit and other departments. The aim of the study was to evaluate the pattern of referrals sent to the dermatology department by other departments.

Methods: A retrospective study was carried out on 487 patient referrals requested to department of dermatology, of Regional institute of Medical Sciences, Imphal, Manipur for a period of 5 years from January 2005 to December 2010. The department maintains a consultation register where the demographic details, specialty requiring dermatological consultation, time frame between admission and referral request and diagnosis, investigation and treatment of the patients were entered. Patients were evaluated within few hours from the time of consultation. Procedures such as skin biopsy, fungal culture or KOH smears etc. were performed wherever required. All these information’s entered in referral register were collected from register. All the patients entered in register from January 2005 to December 2010 were selected and none were excluded. Ethical approval was obtained from research ethics board. Data were entered in IBM SPSS statistics 21 for Windows (IBM Corp. 1995, 2012). Descriptive statistics such as frequency, percentages, mean with standard deviation and median were used. Analysis was done using Chi-square test to check the significance between proportion and p value<0.05 was taken as statistically significant.

Results: A total of 487 consultations were recorded. Most (48.3%) consultations were received from general medicine, followed by surgery (14.4%), gynecology (9.4%), chest medicine (5.54%) with the least from PMR (1.23%) and psychiatry (1.84%). Infectious skin diseases were most common (37.5%) followed by eczema (22.3%) and drug reactions (11%). Among infections viral infections topped the list (Herpes simplex- 35.9%), among eczema chronic eczematous dermatitis (22.9%). Among drug reaction severe cutaneous adverse drug reaction was present in 12 cases.

Conclusions: Dermatology referrals can enhance the dermatological knowledge of non-dermatologists to diagnose and manage common dermatoses thus improving overall patient care.

Study of the clinical profile and treatment outcome of pulmonary and extrapulmonary tuberculosis patients coming to respiratory medicine OPD

Thamil Mani S. — 2023-02-28

Background: The major risk factors for development of tuberculosis are extremes of age, malnutrition, overcrowding and immune deficient states like AIDS, diabetes mellitus, measles, whooping cough and leukaemia. Chronic malaria and worm infestation are less important risk factors. Tobacco smoking, high alcohol consumption, corticosteroid therapy and immunosuppressive drug therapy reduce body defences there by increasing the susceptibility to tuberculous infection. This study was undertaken to analyse the various clinical presentations in patients with pulmonary tuberculosis and extra pulmonary tuberculosis.

Methods: This was a retrospective study of patients from October 2020 to September 2022 (2 years). Data collected from 300 patients who were diagnosed with pulmonary and extrapulmonary tuberculosis visited. The subjects were divided into subjects who had pulmonary TB (PTB), and who had extrapulmonary TB (EPTB).

Results: The most common systemic disorders accompanying EPTB were DM (n=11; 8.8%) and chronic renal failure (n=8; 6.4%); while DM (n=16; 9.1%) and chronic obstructive pulmonary disease (n=13; 7.4%) were those detected frequently in PTB group.

Conclusions: Present study showed higher percentage of males and greater predominance of pulmonary TB. It is also observed high percentage extrapulmonary TB. High percentage of positive treatment outcomes with fewer relapses and failures was observed in this study. A high positive treatment outcome noted may be attributed to the availability of specialist doctors and diagnostic facilities in the tertiary care centre.

Outcomes of retropupillary iris-claw lens implantation

Diksha Panchbhai — 2023-02-28

Background: Inadequate posterior capsular support during cataract surgery makes it difficult to implant posterior chamber intraocular lens.One of the secondary intraocular lens implantation options is iris claw lens.Retropupillary iris claw lens is preferred than anterior because chances of damage to the anterior chamber angle and iris root are avoided as the lens is fixed to the mid periphery of iris. The prospective study aims to analyse the visual outcomes and immediate postoperative complications after retropupillary iris-claw lens implantation in a tertiary care hospital.

Methods: It was a prospective study done conducted on 24 patients with inadequate posterior capsular support in which retropupillary iris-claw lens implantation was done from December 1, 2021 to May 31, 2022 at Government Regional Eye Hospital, Visakhapatnam. Immediate postoperative complications were noted. Final visual outcomes were noted after 2 months.

Results: The study comprised of 24 eyes. The mean patient age was 55.91 years (range 44-77 years).The IOLs were inserted during primary lens surgery in 16 eyes (66.6%) and as a secondary procedure in 8 aphakic eyes (33.4%). The mean postoperative intraocular pressure was 15.1 mmHg. Majority of the eyes had best corrected visual acuity of 6/12 (41.6%).The most common immediate postoperative complication was pupil ovalization (25%) and striate keratopathy (25%). Least common complication was choroidal detachment (3.6%).

Conclusions: Visual outcomes of primary and secondary iris claw implantation were similar. The retro-pupillary iris-claw lens implantation provided good visual outcome with tolerable complications. It can be used in eyes with inadequate posterior capsular support.

Stigmatisation in chronic hepatitis B and C infections-time to debunk the myth!

Sabreena Qadri — 2023-02-28

Background: Hepatitis B and C are chronic diseases with mental and social impacts which can result in poor quality of life. The routes of transmission and lack of education among the masses may cause stigmatisation of the affected patients. The aim of the study was to document the stigmatisation among chronic hepatitis B and C positive patients.

Methods: The 242 patients suffering from hepatitis B and C were included in the study. Stigma experienced from relatives, friends, spouse and health care providers was assessed using a semi structured questionnaire.

Results: Majority of the patients were males 174 (72%). The 162 (67%) were hepatitis B infected and 76 (32%) were Hepatitis C infected and 4 were dual infected. Male patients were significantly more affected than females in term of changes in lifestyle (86% versus 61%) and changes in relationship with the spouse (89% versus 16%). Significantly more females than males reported feelings of loneliness and isolation (64% versus 30%). Stigma was marked in terms of disease transmission, with 170 (70%) of patients fearing that they could transmit the infection to others. Marital relationships were affected for 52% of married patients. Around 80% unmarried patients were experiencing delay in getting married.

Conclusions: Patients comments showed a sense of family and societal discrimination resulting in feelings of disappointment which could be changed by educational interventions, effective patient and family centric awareness and scientific models of approach.

Assessment of online teaching as teaching learning method among the university students in the COVID pandemic

Binay Kumar — 2023-02-28

Background: The urgent need to educate during COVID times has led to stresses and needs for reimagining the education system, and now the system is evolving and has led to organising and designing in the current scenario to reap the benefits.

Method: A total of 600 electronic students in Bihar, India participated in the study conducted to assess the barrier and facilitator of online learning. Participants in the study were post-secondary students graduating in electronics stream. Access to the online platform was through mobile and mobile data was used for connecting to online platform like google classroom. Majority of them (42%) preferred traditional teaching and complained of health issues, eye strain and loss of concentration.

Results: The study showed most commonly used gadget for online teaching was mobile (98.8%) and google meet was the most common connecting platform (66.8%). The most common challenge faced was network issue (68.3%). Average screen time spent was 4.5 hours, that leads to eye strain and mental fatigueness as most common symptom reported.

Conclusions: The reflection on how teaching learning process evolved during pandemic and incorporating ideas to deal with challenges help us build education system that is resilient and help us embrace an evolving teaching learning format now and in future.

Analysis of feedback of private wards patients: missing links in patient satisfaction in services at tertiary care public hospital

Ruchi Garg — 2023-02-28

Background: Feedback of client/customer is the key for improvement in any services. It is a precious input for identifying gaps and developing an effective action plan for quality improvement in any organization. Hence, patient feedback on services provided by the health care organization is important quality tool for improvement of services both in public and private hospitals. With the back ground this study was conceptualized with the aim to analyse feedback of inpatients admitted in private wards of a government tertiary care hospital of India, regarding hospital personnel and for basic amenities provided by the hospital.

Methods: This was a record-based study where predesigned feedback forms of one year were analysed. Feedback was categorized under three themes and subthemes which were services provided by the hospital, infrastructure of the hospital and feedback with respect to the care provided by the hospital staff.

Results: 80% patients were dissatisfied with the delay in conduct of investigations and receipt of reports and cleanliness in ward, housekeeping services and quality of food. As far as clinical care and soft skills of healthcare providers are concerned, 80% of the patients were satisfied by the care provided by doctors and nurses. Suggestions were analysed and implemented to strengthen the service delivery to initiate quality assurance.

Conclusions: Major factors for dissatisfaction among patients are the unscientific processes which can be improved with minimum cost.

Normative study of VO2 max in healthy young adults upon exercise on treadmill and cycle ergometer

Ruchi Kothari — 2023-02-28

Background: As there is a linear relationship between the level of physical activity and health status therefore it is quintessential that an individual’s fitness levels be regularly assessed. Cardio-respiratory fitness (CRF), is quantifiable as VO₂ max which is maximal oxygen uptake and is generally considered by exercise physiologists as one of the best indicators of physical fitness. This study aimed to establish baseline normative values of VO₂ max in healthy central Indian population upon exercise on treadmill and cycle ergometer as assessed in sports physiology laboratory of a rural medical college.

Methods: A total of 150 healthy young subjects were included in the study within the age group of 17-28 years. The VO₂ max score was evaluated by using metabolic module of lab chart software investigated through power lab data acquisition system, AD instruments.

Results: Out of 150 subjects, there were a total of 89 (59.33%) male subjects and 61 (40.66%) female subjects. The mean age of males was 21.20±2.62 years and of females was 20.36±2.69 years. The mean and SD value of VO₂ max on treadmill for males was 34.09±4.34 ml/kg/min and for females was 25.09±6.99 ml/kg/min, and on cycle ergometer for males was 32.79±1.85 ml/kg/min and for females was 24.15±5.45 ml/kg/min.

Conclusions: The baseline normative data for CRF parameter, VO₂ max was established in the current study to lay the foundation for risk assessment to improve patient management.

Thyroid dysfunction in human immuno-deficiency virus infected patients: a non-randomized, cross-sectional, single-center study

Vaheed U. Mujawar — 2023-02-28

Background: Increasing prevalence of thyroid dysfunction has been reported in human immuno-deficiency virus (HIV)-infected patients. However, there is insufficient evidence to recommend routine thyroid screening of asymptomatic individuals. Hence, this study was undertaken in an attempt to resolve these issues. Objectives of this non-randomized, cross-sectional, single-center study was to study thyroid function in HIV positive patients at various stages of disease.

Methods: This single-center study was carried out at Al-Ameen Medical College Hospital and Government District Hospital Bijapur, Karnataka, India from December 2020 to December 2022. The final selected study population included newly diagnosed adult and adolescent (17-60 years) HIV+ patients was composed of 100 participants of either gender. Patients were interviewed and enrolled in the study after examining in detail according to the proforma and then by taking their written consent and explaining the purpose of the study. The thyroid hormone assays (S. TSH, FT3 and FT4) were done by chemiluminescence immuno assay (CLIA) using ADVIA Centaur-equipment.

Results: Overall mean age was 36 years (range in years: 17–66 years) and 66 patients (66%) were males. Male: female ratio of 1.94:1 was recorded. In the 50 patients having acquired immuno-deficiency virus (AIDS), FT3 levels ranged from 0.230 to 4.0 picogram/ml with a mean of 2.131+0.9826 picogram/ml. In 50 patients having AIDS, the FT4 levels ranged from 0.30 to 1.90 nanogram/dI with a mean 1.179±0.4484 nanogram/dl.

Conclusions: All forms of thyroid dysfunction were observed.

Clinical profile and outcome of patients with meningoencephalitis in a tertiary care hospital

Monika N. — 2023-02-28

Background: Encephalitis is an important cause of morbidity, mortality, and permanent neurologic sequelae globally. Causes are diverse and include viral and non-viral infections. In the emergency setting differentiating the bacterial from other causes such as viral, fungal, tubercular, toxic or autoimmune causes is extremely difficult. Although plenty of literature is available on meningitis, the clinic-etiological profile and outcome with meningoencephalitis remains not that well studied, except for in paediatric population.

Methods: The present prospective observational study included 75 patients who presented with acute encephalitis syndrome in tertiary care hospital, Bengaluru. All patients were subjected to complete clinical evaluation and appropriate investigations to study the etiology, clinical profile and outcome in them.

Results: Among 75 patients, majority of them were <60 years constituting about 73.2%, mean age being 49.14 years with female preponderance. 30 (40%) patients had viral meningoencephalitis where aetiology was confirmed in 15 patients, remaining were presumed to be of viral aetiology. 12 (16%) had tubercular meningitis and 8 (10.6%) had bacterial meningitis followed by cryptococcal meningitis 7 (9.3%). In about 18 (24%) patients, aetiology was not identified and were treated based on syndromic approach. The most common presentation was fever and altered sensorium. Thrombocytopenia was common among viral and bacterial aetiologies and those in unspecified etiological group. Mortality was highest among cryptococcal meningitis (71.4%) followed by tubercular (66.7%) and bacterial meningitis (62.5%).

Conclusions: A large number of number of cases where aetiology cannot be identified maybe benefited by a syndromic approach and better diagnostic modalities.

Prevalence of panic and agoraphobia in post COVID-19 patients

Visalakshi H. Subramanian — 2023-02-28

Background: COVID-19 pandemic and quarantine of people who were tested positive made more cautious and anxious when being out in public. This study concentrates on the prevalence of panic and agoraphobia using panic and agoraphobia scale.

Methods: Survey research study of 121 subjects using web-based data collection (Google form).

Results: The result were obtained using panic and agoraphobia scale. Statistical analysis did not show considerable panic attack and agoraphobia in people who were tested positive for COVID-19.

Conclusions: The study population did not show considerable panic attack and agoraphobia after being quarantined or hospitalised during 1^st, 2^nd and 3^rd wave of COVID-19.