International Journal of Research in Medical Sciences

Case series on herbal medication induced acute kidney injury in central India

Vinay Kumar A. V. — 2023-05-29

Around 60 to 70 percent of the people from India reside in rural areas and usually opt for herbal medicine for illness from local traditional medicine practitioners before seeking allopathic advice. Kidneys play a central role in excretion of the metabolites of these substances or the substances themselves. Renal injury happens in the form of acute tubular necrosis, interstitial nephritis, rhabdomyolysis, nephrolithiasis, urothelial cancers and rarely renal cortical necrosis and progressive interstitial fibrosis. Physicians and patients may ignore the potential nephrotoxicity caused by certain herbal medicines, assuming them to be harmless. Adverse event reporting is usually done on a voluntary basis, and toxicity has been reported through case reports and series. It is important for clinicians to factor in the use of herbal medicines when treating patients with unexplained acute kidney injury or progressive chronic kidney disease. We hereby present a case series of renal injury mediated by herbal medications with different mechanism of injury to kidney. This article is first of its type reported from central India.

Interesting malignant renal tumours: a tripod of cases

Mamta Kumari — 2023-05-29

Renal malignancy is the 15^th leading cause of annual deaths, with late detection and misdiagnosis leading to decreased patient survival. We hereby present three cases of malignant renal tumours which grabbed our attention because of their rarity and interesting presentation. Case 1-A 38 year old male presented with palpable lump in right flank, CT revealed a multilocular cystic lesion in right kidney, along with horse-shoe kidneys. In view of renal biopsy suggesting Tubulocystic carcinoma, patient underwent nephrectomy and diagnosis confirmed to be the same histomorphologically as well as immunohistochemically using AMACR and PR. Case 2-A 77-year-old male had lower urinary tract symptoms due to prostatomegaly, and a left renal mass and small hepatic cysts were detected incidentally. Kidney function was normal. Microscopy showed Chromophobe renal cell carcinoma, which was confirmed with immunohistochemical markers CK7 and CKIT. Case 3-A 50 year female presented with recurrent lump in her left flank, CT confirmed a huge left renal fossa mass. Biopsy showed features of malignant mesenchymal neoplasm consistent with leiomyosarcoma based on immunohistochemical panel of vimentin, h-Caldesmon, SMA, EMA, HMB-45 and S100, which helped in differentiating it from tumours like angiomyolipoma. Renal tumours have varied morphological overlapping and it is important to rule out close differentials using immunohistochemistry before coming to a diagnosis. Awareness of such presentations and findings can broaden our understanding of renal tumours which can help in early and accurate diagnosis for better outcome of the patient.

Xanthogranulomatous orchitis: a case series

Tanvi R. Sambhus — 2023-05-29

Xanthogranulomatous orchitis (XGO) is a sporadic disorder that has no definite aetiology and is a mimicker of several conditions, most significant of which are testicular neoplasms. We present a case series of three cases. The first case presented with swelling in his scrotum. The second case presented with similar symptoms and had prior history of trauma to the scrotum. Both cases were clinically diagnosed with testicular tumour. The third case was a referred case of left chronic orchitis with sinus tract. All three patients underwent high inguinal orchidectomy. Regardless of clinical work-up and diagnoses, upon histopathological evaluation, all three cases were diagnosed with XGO. This study explores the variety of risk factors and aetiologies that may result in XGO.

An overview of laparoscopic closure of duodenal perforation in a tertiary care centre

Gobind Kshetrimayum — 2023-05-29

Duodenal ulcer perforation is one of the most commonly encountered condition in emergency surgery. Laparoscopic repair of the perforation has been reported in many cases since the first laparoscopic repair of a duodenal perforation in the year 1990 by Mouret et al. Aim and objectives were to study the clinical outcomes of laparoscopic repair of duodenal perforation in terms of duration of surgery, post operative pain, initiation of oral feeds, surgical site infection and duration of hospital stay. Over a 2 year period, 2018-2020, 20 patients with a presumptive diagnosis of perforated duodenal ulcers were considered for laparoscopic closure. Primary closure of the perforation was done with intracorporeal suturing followed by omental patch repair. The mean age was 38.75±8.53 years, mean duration of surgery was 97.80±7.89 minutes. The mean number of analgesic injection was 2.90±0.72. The mean duration of initiation of oral feeds was 3.20±0.41 days. The mean duration of removal of drain was 4.65±0.75 days and mean duration of hospital stay was 6.20±0.41 days. No intraoperative complications encountered. Postoperatively, none of the patients develop wound infections. In our setting, laparoscopic closure was found to be safe and a promising method in management of duodenal perforation as it appears to be more beneficial in terms of decreased post-operative pain, early initiation of oral feeds, decreased length of hospital stay and no major complications postoperatively. However, the procedure requires a surgeon with particular expertise in endoscopic suturing skills.

Normal platelet count and leukocytosis findings in chronic liver disease patient with portal hypertension: a rare case

Felicity Pheeyen Marthadinata — 2023-05-05

Haematologic abnormalities are commonly encountered in chronic liver disease (CLD) due to hypersplenism occurred. Hypersplenism in CLD is a major cause of peripheral pancytopenia in patients with hepatic cirrhosis and portal hypertensive gastropathy and is characterized by splenomegaly. Peripheral pancytopenia is defined as a reduction in all three major constituents of the blood to below lower normal range, manifesting as anemia, leukopenia, and thrombocytopenia all occurring at the same time. We report an unusual case, a 44-year-old female patient, no splenomegaly, presented with severe anemia, leukocytosis and normal platelet which are rarely found in CLD.

Keywords : chronic liver disease, portal hypertensive gastropathy, hypersplenism, leukocytosis, normal platelet

Mimicking Mills’ syndrome: progressive spastic hemiparesis on upper motor neuron dominant amyotrophic lateral sclerosis

Elizer M. Montemayor — 2023-05-29

Mills’ syndrome is an idiopathic, slowly progressive, spastic hemiparetic variant of primary lateral sclerosis (PLS). Despite this classic definition, this syndrome has recently been suggested to be present on all the variants of motor neuron disease (MND) spectrum (ALS, PLS or UMNdALS). Authors presented a 63 years old male with history of gradually progressive right-side hemiparesis associated with dysarthria and dysphagia. Neurologic examination revealed intact cognition, weak bilateral orofacial muscles, marked right-side spasticity with hyperreflexia and mild sensory deficit, progressing to right-upper extremity atrophy upon follow-up. Relevant blood and CSF examinations were within normal limits. MRI of brain and cervical spine were unremarkable. electromyography (EMG), nerve conduction velocity (NCV), facial motor and blinks studies initially revealed no evidence of lower motor neuron involvement. Based on the revised El escorial criteria, patient was diagnosed as upper motor neuron dominant amyotrophic lateral sclerosis (UMNdALS) mimicking the classic PLS-Mills’ hemiparetic variant.

A rare case of recurrent cerebrospinal fluid rhinorrhea

Ramalakshmi Karthikeyan — 2023-05-29

Cerebrospinal fluid (CSF) rhinorrhea is the leakage of cerebrospinal fluid through the nostrils due to an abnormal communication between the nasal cavity and sub–arachnoid space. CSF rhinorrhoea can be traumatic or spontaneous. CSF rhinorrhea carries a risk of ascending infection leading to meningitis. CSF rhinorrhea is not very common and could be easily mistaken for rhinitis. Physicians need to have a high index of suspicion to diagnose and treat this rare and potentially serious condition. Here we discuss a case of delayed post-traumatic CSF rhinorrhea -an unusual presentation in a primary care setting, focusing on presentation and diagnosis.

Primary pulmonary leiomyosarcoma: review of the literature and case report

López Alvarado Mariela Itzayana — 2023-05-29

Primary pulmonary leiomyosarcoma (PPL) is an extremely rare malignant tumor. It has been revealed that PPL may originate from the smooth muscle of the pulmonary parenchyma, pulmonary arteries and bronchi. Patients with PPL may be asymptomatic or present with symptoms similar to those observed in other primary lung tumors. The present study reports the case of a 21-year-old woman who presented with orthopnea, medium effort dyspnea, so an extension study computed tomography (CT) is performed, finding a left thoracic tumor. Where a percutaneous biopsy is performed, concluding PPL, by image, it is considered unresecable due to pericardial infiltration, and it is sent to cycle of chemotherapy. Currently completed treatment with partial response to it, due to findings by image, ECOG and patient age, a case session is decided, and panpleuronectomy was performed.

Recurrent stroke in Takayasu arteritis: a case report and review of literature

Joyce Angelie S. Tee — 2023-05-29

Takayasu Arteritis is a rare inflammatory vasculitis affecting medium to large blood vessels. Neurologic complications are seen in 10-20% of cases. A 28 year old female came in due to acute onset left sided weakness and numbness, with absent arterial pulses and blood pressure on the left extremities. She had a history of recurrent right-sided weakness and numbness. Imaging showed an infarct on the right thalamus and multiple chronic infarcts. CT aortogram was consistent with Takayasu Arteritis Type V. The patient was started dual antiplatelet consisting of Aspirin and Clopidogrel, and was started on Prednisone and Methotrexate with good clinical response.

Difficult airway management in an ankylosing spondylitis case using video laryngoscope: a case report

Nicholas Prathama Limalvin — 2023-05-29

Ankylosing spondylitis (AS) known as autoimmune disease with chronic inflammation within vertebral bone, characterized with bamboo spine. AS with cervical and temporomandibular joint involvement can lead to difficult airway. In this report, we present an AS patient with severe ARDS (acute respiratory distress syndrome) due to COVID-19 who was successfully intubated using video laryngoscope. A-37 years old male, came to emergency room in agitated condition, history of AS with cervical spine and temporomandibular joint involvement, history of pulmonary tuberculosis in 2008, and haven’t been vaccinated (COVID-19). This patient was diagnosed with severe ARDS due to COVID-19 with GCS 3-1-3, respiratory rate 36 times per minute, maximum peripheral saturation only 90% with Jackson Rees and pCO₂ 103 mmHg. These conditions are indication for endotracheal intubation. With the aid of video laryngoscope, endotracheal intubation was successfully performed. Improvements of peripheral saturation and blood gas analysis were obtained after intubation. This patient was included in the criteria for intubation due to respiratory rate over 30 times per minute and pCO₂ more than 100 mmHg. Based on difficult airway predictor (MOANS, LEMON, RODS and SHORT), this patient was categorized as hard to ventilate and hard to intubate so it is necessary to prepare supraglottic airway device if intubation fails or surgical cricothyrotomy if intubation and supraglottic device fail. In difficult airway conditions, endotracheal intubation is ideally performed without muscle relaxants or awake intubation. The use of video laryngoscope is a recommended procedure in difficult airway management as in AS patient or in head and neck trauma cases. The availability of video laryngoscope in every hospital will maximize airway management in emergency room in Indonesia.

Ewing’s sarcoma or peripheral primitive neuroectodermal tumor at the base of tongue: a rare location case report

Pinki Devi — 2023-05-29

Peripheral primitive neuroectodermal tumor now termed as Ewings sarcoma/PNET, representing a family of tumors with varying degrees of neuronal differentiation and genetic rearrangements. Most common sites are extraosseous involving trunk and lower limb. Base of tongue is a very rare site for Ewing’s/PNET, hence in view of rarity of the location as an uncommon presentation, the case has been reported for the better understanding and supporting the literature with the similar finding. A 68 years old female patient presented with the complaint of difficulty in swallowing since 3 months. On examination growth was identified at the left side base of tongue. Biopsy was processed and stained with H&E and other relevant markers. Differentials on the basis microscopic examination were lymphoma, neuroendocrine tumor and primitive neuroectodermal tumor. Various immunohistochemical markers to rule out the given differential were used. The tumor was positive for CD 99 and vimentin. The case was repored as PNET. Peripheral PNET is a challenging topic. Wide range of extraosseous locations have been observed but head and neck being less reported needs to be studied for understanding the behavior of this highly malignant disease in this rare location so that patient can be benefitted by advanced multimodality treatments including surgery, chemotherapy and radiotherapy.

Cor-pulmonale: a rare presentation in a case of middle lobe syndrome

Ankit Abhishek — 2023-05-29

Brock’s syndrome or middle lobe syndrome (MLS) is chronic or recurrent collapse of right middle lobe due to causes which may be obstructive or non obstructive. The pathogenesis is not completely understood. An expert committee of the world health organization defined cor pulmonale as hypertrophy of the right ventricle resulting from diseases affecting the function and/or structure of the lungs.” Cor pulmonale is a common heart disease and a leading cause of disability and death. We are reporting this association in a 65y old female who presented to the emergency with acute exacerbation of COPD with SpO₂=64% room air. Chest X-ray and HRCT thorax showed features suggesting MLS and ECG shows features suggesting P pulmonale /right atrial enlargement. BNP too was elevated. Patient was resuscitated and put on mechanical ventilation after ABG showed respiratory acidosis. Appropriate treatment with bronchodilators and antibiotics was given.

Anaesthesia for bougie dilatation of subglottic stenosis: report of two cases

Athira Raju — 2023-05-29

Subglottic stenosis is a rare but life-threatening condition characterized by narrowing of subglottis. Airway dilatation (balloon/bougie) has become very effective for correction of stenosis. Anaesthesia management for bougie or balloon dilatation of subglottic stenosis needs proper planning, team work and efficient utilization of resources. Airway management options include apneic pause technique, supraglottic jet ventilation, THRIVE (transnasal humidified rapid insufflation ventilatory exchange) and cardiopulmonary bypass/extracorporeal membrane oxygenation in emergency scenario. Total intravenous anaesthesia along with airway anaesthesia remains the best anesthetic management option as it provides excellent conditions for shared airway surgery.

Single puncture percutaneous nephrolithotomy for large staghorn calculus: experience at a tertiary care center

Sreedhar Dayapule — 2023-05-29

Percutaneous nephrolithotomy (PCNL) is recommended procedure for stones greater than 2 cm This procedure is being used commonly by all urologists worldwide. With increasing using of imaging studies, the incidence of large staghorn calculus has been consistently decreasing because most of the stones are being detected while they are still small. In this case report we are presenting a case of a large staghorn calculus of size 6.7×5.2 cm which was completely cleared by PCNL with a need for relook procedure.

A case of telescoping of bowel during sailing

Piyush Gupta — 2023-05-29

Intussusceptions as an entity is more common in children than adults in whom it is almost always secondary to some associated pathology. Moreover, the presentation is subacute or chronic in nature and all classical features of intussusceptions are rarely present together that makes the diagnosis more challenging. Here we presented a case of ileo-ileal intussusception in an adult male. Obligation of early diagnosis, initial management is unique in such cases. It also focuses on importance of availability of the imaging facilities in management of acute abdomen so as to assist in timely diagnosis as well as the definitive management of intussusceptions.

Orbital myocysticercosis: a rare case report

Gariyashee Lahkar — 2023-05-29

We describe a case of ocular myocysticercosis in a 26-year-old male patient, who presented with sudden onset proptosis of the right eye and double vision for 8 days with no history of trauma. MRI showed well defined peripherally enhancing intraconal lesion suggestive of myocysticercosis in inferior rectus muscle. On administration of low dose oral steroids followed by anthelminthic medications, patient showed marked resolution of symptoms.

Partial empty Sella syndrome in women-the significance of obstetric and lactational history

Jhalak Agrohi — 2023-05-29

Empty Sella syndrome is an uncommon condition characterized by the shrinking or flattening of the pituitary gland, resulting in the filling of the Sella turcica with cerebrospinal fluid rather than the normal pituitary gland. In this report, we present a case of undiagnosed partial empty Sella syndrome, which was found to be caused by pituitary hypophysitis with an idiopathic etiology. The patient, a middle-aged individual, presented atypically with acute adrenal insufficiency induced by a lower respiratory tract infection. The diagnosis was made following an investigative work-up that took into consideration the presence of hypotension, electrolyte imbalances, and a history of two post-partum lactational failures. Hormonal supplements were used to manage the patient conservatively, and no significant complications were observed.

Laparoscopic repair of traumatic intraperitoneal bladder rupture: a rare case report

Udit Jain — 2023-05-29

Laparoscopic repair of traumatic intraperitoneal bladder rupture is safe and effective technique. We here report case of 49 year male with traumatic intraperitoneal bladder rupture proven by CT urogram after sustaining blunt trauma abdomen injury, repaired by laparoscopy technique. Patient recovered without any complications and was discharged on postoperative day 6 under stable condition. we here by conclude that if bladder injury identified early and conditions if feasible, laparoscopic repair is one of the good options for further management without involving open laparotomy.

A case report of primary pleomorphic lung cancer with an atypical presentation

Sailaja Kambampati — 2023-05-29

Pulmonary pleomorphic carcinoma (PPC) is an uncommon primary lung tumor with a low incidence and aggressive biological characteristics that can occur in young people and nonsmokers. Pleomorphic carcinoma (PC) has a worse prognosis than other non-small cell lung tumors. We describe a 45-year-old man who complained of having a dry cough for a month. A well-defined mass in the anterior section of the left lower lobe was identified by chest high-resolution computed tomography (HRCT), and a positron emission tomography (PET) scan confirmed a left lobulated tumor with fluorodeoxyglucose (FDG) uptake in the left mediastinal lymph nodes. An endobronchial ultrasound guided transbronchial needle aspiration (EBUS TBNA) guided biopsy of the tumor was performed and sent for histopathological analysis, which identified pleomorphic squamous cells and giant cells. Positive IHC markers included P63, TTF1, pancytokeratin, Vimentin. Patient was diagnosed with stage IIIa (T3N2M0) pleomorphic carcinoma of the lung. Due to the tumor's advanced stage, the patient received chemotherapy and radiation therapy.

Neuromyelitis optica and liver cirrhosis: an association or co-incidence

Arjun Kumar — 2023-05-29

Neuromyelitis optica (NMO) is a rare central nervous system demyelination syndrome predominantly targeting optic nerves and the spinal cord. Here we present a middle-aged female presenting with new onset quadriparesis and a history of persistent splenomegaly and pancytopenia, eventually being diagnosed as NMO along with autoimmune cirrhosis. The association of NMO spectrum disorders (NMOSD) with chronic liver disease has not been previously described in the literature. The purpose of this case report is to bring forward an unusual presentation and to ascertain whether it could be part of a heterogenous spectrum of an autoimmune disorder, or merely a co-incidence.

Rheumatoid arthritis, multiple sclerosis and lupus: key points from the COVID-19 era

J. Miguel Vaz D. Silva — 2023-05-29

The purpose of this work was to analyse published data on rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and multiple sclerosis (MS) and SARS-CoV-2 infection: susceptibility, post-infection autoimmune disease (AD) exacerbation, immunosuppressive therapies and long COVID. Supported by PICO strategy, two independent reviewers conducted the research in the PubMed/Medline database from January 2020 to June 2022 and included 16 articles on RA, 25 on MS and 12 on SLE. The quality assessment of the studies was performed using criteria from the National Institute of Health. Patients with RA or SLE had increased susceptibility to contracting SARS-CoV-2. It was higher in RA and increased with the patients’ comorbidities. For MS, susceptibility to SARS-CoV-2 was similar to the general population. Post-infection AD exacerbation occurred in AR, SLE and MS with an increased number of hospitalisations and deaths. Regarding therapies, in RA the use of glucocorticoids (GC) was associated with a worsening of the infection. A more severe clinical picture was associated with anti-CD20 in SLE and with anti-CD20 and methylprednisolone in MS. Considering long COVID, RA and SLE patients had a higher risk of complications opposite to MS patients. There was a higher susceptibility to SARS-CoV-2 infection in rheumatological diseases AR and SLE, exacerbated by age and comorbidities. For RA and MS, GC aggravated the infection and for SLE and MS anti-CD20 antibodies use. In all AD there was exacerbation and worsening of the clinical picture translated in long COVID, the latter with MS exception.

Risk factors of mortality in hospitalized children with severe acute malnutrition

Bidhan Chandra Podder — 2023-05-12

Background: Severe acute malnutrition (SAM) is a major cause of morbidity and mortality in children around the world. It is critical to identify the factors that contribute to mortality to reduce SAM related mortality. This study aimed to analyze the risk factors of mortality in hospitalized children with SAM.

Methods: This case-control study was conducted in the SAM unit, department of pediatrics, institute of child and mother health, Matuail-1362, Dhaka, from January 2021 to December 2021. Data analysis was conducted using SPSS version 22. Univariate analysis was done to determine factors affecting mortality, and multivariate logistic regression was used to determine significant independent risk factors.

Results: Mean age of the study subject was 6.38±3.45 months and 10.90±10.00 months in the case and control groups respectively. So, death was more common in younger children. The percentage of death was more (61.5% vs 54.6%) in males. Mortality was more common in family income <10,000 Tk/ month, 53.8% in the case group and 21.9% in the control group. The mean age of the mother was 19.23±0.60 years and 21.78±4.78 years in the death and survived group. Among risk factors of mortality, dermatosis (46.2% vs 4.9%), oral ulcer (46.2% vs 5.5%), hypoglycemia (46.2% vs 3.8%), severe anemia (38.5% vs 2.2%), septicemia (76.9% vs 29.5%) in case and control group respectively. These risk factors were significantly higher in the death group compared to the surviving group. After doing multivariate logistic regression analysis it was observed that hypoglycemia (OR=9.17 with 95% CI 1.44 to 58.29) and severe anemia (OR=13.42 with 95% CI 1.42 to 126.13) were the strongest predictors of mortality among the hospitalized children with SAM.

Conclusions: Hypoglycemia and severe anemia were the main contributing factors of mortal among the children with SAM in the hospital.

Differential antibody response to COVID-19 disease and COVID-19 vaccines

Feray Ferda Senol — 2023-05-29

Background: In our study, antibody positivity was evaluated by two methods in vaccinated and unvaccinated people according to their demographic characteristics and history of COVID-19.

Methods: In this study, venous blood samples were taken from patients who were requested to have COVID-19 antibodies from our hospital's outpatient clinics between February 2022 and March 2022.

Results: There was no statistically significant difference when IgG antibody positivity was compared according to the age ranges in chemiluminescence and immunochromatographic methods. When patients were evaluated according to antibody titers, it was found that 81% of the seronegative patients were unvaccinated and had not had Covid-19, and it was found that this group was statistically significant compared to other groups.

Conclusions: It has been concluded that it will be of great importance for every country, even every region, to have a test and vaccine policy for diagnosis and follow-up in the fight against COVID-19.

Investigating the predictive effect of neutrophil to lymphocyte ratio as an inflammatory marker in the spontaneous excretion of ureteral stones

Hamid Deldadeh-Moghaddam — 2023-05-29

Background: The size and location of the stone have been suggested as the most important predictors of the possibility of spontaneous passage of the stone. The aim of this study was to investigate the predictive effect of neutrophil to lymphocyte ratio as an inflammatory marker in the spontaneous excretion of ureteral stones.

Methods: This descriptive-analytical study was done on 95 patients with ureteral stone during 2020-21. Required data include sex, age, BMI, previous history of stone, previous history of spontaneous passage of stone, side, location and size of stones, spontaneous passage of stone, and neutrophil and lymphocyte ratio were extracted from file of patients. The presence of the stone and its characteristics were confirmed by ultrasound. Patients were followed up for 2 weeks to determine whether or not the stone passed spontaneously.

Results: There was a significant relationship between spontaneous passage of ureteral stone with stone size, location, and neutrophil to lymphocyte ratio. The cut-off points of neutrophil to lymphocyte ratio for predicting spontaneous passage of ureteral stone was 2.52, so that patients with higher values were faced with a 4.2-fold increase in the risk of no spontaneous passage of stones (OR=4.202, 95% CI: 1.563-11.298, Sig.=0.004).

Conclusions: The results of the study showed that the ratio of neutrophils to lymphocytes is a significant predictor of spontaneous passage of ureteral stones, so that if used in addition to the size and location of the stone, the accuracy of predicting patients who benefit from conservative management, increase significantly.

Knowledge, comprehension, attitude to and practice of the five levels of prevention in child healthcare in a Nigerian teaching hospital

Timipah P. West — 2023-05-29

Background: Preventive Paediatrics involves all activities geared towards protecting, promoting and maintaining the health and wellbeing of children. The aim of this study to determine the knowledge, attitude and practice of the five levels of prevention by child-care doctors at the University of Port Harcourt Teaching Hospital.

Methods: This was a descriptive cross-sectional survey using a self-administered questionnaire. Information on socio-demographics, knowledge, comprehension and attitude of the respondents towards the five levels of prevention and its utilization by the doctors at the University of Port Harcourt Teaching Hospital was sought. Data were analyzed using descriptive statistics.

Results: 295 doctors participated. 26 (8.8%) doctors had good knowledge of the five levels of prevention. As the doctors’ age increased, they were less likely to be knowledgeable about the levels of prevention (OR=0.955; 95% CI: 0.917-0.995; p-value=0.029). Doctors in Pediatrics were four times more likely to be knowledgeable about the levels of prevention than the others (OR=3.637; 95% CI: 1.496-8.844; p-value= 0.004). 287 (97.3%) doctors had good attitude towards preventive activities while practice was by 222 (75.3%). There were no significant differences across gender, age, department, designation and years of practice. Doctors with good knowledge significantly practiced more levels of prevention compared to those with poor knowledge (p=0.049, 0.024, 0.001 and 0.010 respectively).

Conclusions: Majority of the doctors have poor knowledge of the five levels of prevention, despite having a good attitude and practice which suggests a knowledge-practice gap. Interventions to improve doctors’ knowledge are recommended.

Diagnostic accuracy of computed tomography scan in renal cell carcinoma

Shamsun Nahar — 2023-05-29

Background: Renal cell carcinoma (RCC) is becoming more common over the world. At the same time, numerous European and North American countries have achieved lower death rates.

Methods: This cross-sectional observational study was conducted from July 2013 to June 2014 in the department of radiology and imaging of Dhaka Medical College Hospital. Clinically suspected 50 cases of renal cell carcinoma were included in this study. The study taken ethical clearance from the department and consent from the respondents. Statistical package for the social sciences (SPSS) software used for the analysis.

Results: The mean age of the patients was 50.08±13.04 years. Male to female ratio was 2.1. More than half of the cases had hypodense lesion while 28% patients had calcification in the lesion. Mild enhancement was found in 56% cases and 50% were heterogenous in nature. Both nodal involvement and metastasis were limited. Computed tomography (CT) scan had 97.73% sensitivity and 100% specificity in diagnosis RCC. The diagnostic accuracy, positive predicative value and negative predicative values were 98%, 100% and 85.7 respectively.

Conclusions: CT scan is a useful diagnostic modality in diagnosis of renal cell carcinoma.

A 6-year retrospective study of fine needle aspiration cytology pattern of otorhinolaryngological cases of patients referred to national ear care centre Kaduna (2013-2018)

Maryam Ibrahim Rimi — 2023-05-29

Background: This study was carried out to obtain the retrospective study of FNAC cases referred to NECC; and review occurrences of ortorhinolaryngological swellings and demographic studies of patients for a period of 6 years (2013-2018). Records of FNAC were obtained from the laboratory department’s unit’s register alongside the biodata of patients for demographic studies.

Methods: FNAC samples were treated for diagnosis according to the unit’s standard operating procedure for cytology. A total of three hundred and fifty-three 353 cases were reported and tables were then plotted to present the study cases using simple descriptive statistics.

Results: Highest age distribution was between thirty to thirty-nine (30-39) years with a total of ninety-five cases 95(26.9%) followed by the range of forty to forty-nine (40-49) years with a value of eighty 80(22.6%). Females had the highest frequency of one hundred and thirty-three 133 (62.3%) compared to their male patient counterpart with a value of two hundred and twenty 220 (37.6%). The site of sample collection had ANS with the highest value of eighty-one 81 (42.4%) compared to other sites. The year 2016 had the highest number of FNAC cases and finally ninety 6 cases 96 (27.2%) of cases were inflammatory, two hundred and thirty-two 232 (65.7%) were benign while twenty five 25 (7.1%) were malignant.

Conclusions: In conclusion; FNAC plays a vital role in managing otorhinolaryngology conditions and gives a way forward for effective treatment to patients and often at times is therapeutic as some patients come with fluid field swelling that get relieved after the procedure.

Correlation between caries and hemoglobin level among primary school children suffering from iron deficiency anemia

Hossam Mohamed Hassan Soliman — 2023-05-29

Background: Iron deficiency anemia (IDA) is a severe health problem that affects over two billion people worldwide. Data has shown that IDA is intrinsically related to dental caries. However, few studies have been performed on their relationship. Our study aimed to assess the correlation between a caries index score and hemoglobin (Hb) level in primary school students in the age group 6-12 years.

Methods: A cross-sectional study was done. A sample of forty patients; suffering from IDA; was selected from three pediatric outpatient clinics by simple random technique and interviewed with a final questionnaire.

Results: Our findings concluded that there was a significant moderate negative correlation between caries index score and Hb level (r=-0.475, p=0.0019). There was a statistically significant Hb level mean difference between the high and low caries index groups. There was also a significant moderate negative correlation between caries index score and age, and height. Parameters predicting caries index score were identified as Hb level and frequency of sugar intake.

Conclusions: In conclusion, patients of three pediatric outpatient clinics have a significant moderate negative correlation between caries index score and Hb level and need implementation of proper dental screening and preventive programs.

Clinical presentations among adult patients with tuberculous meningitis

Kamal Ahmed — 2023-05-29

Background: Bangladesh is a country with a high burden of pulmonary as well as extrapulmonary tuberculosis. TBM is a particularly important public health issue in our country. Identifying prognostic predictors would improve the quality of management and ultimately will prevent long-term mortality and morbidity. The aim of the study was to observe and identify the most common clinical presentations among patients with tuberculous meningitis.

Methods: This hospital-based prospective cohort study was carried out at the in-patient Department of Clinical Neurology at the National Institute of Neurosciences and Hospital (NINS and H), Dhaka, Bangladesh from October 2016 to September 2017, 1 year. A total of 54 patients admitted to the hospital with features of tuberculous meningitis (TBM) were selected for the study following inclusion and exclusion criteria.

Results: Over 70% of patients were adolescents or young adults with a mean age of 28.2±12.3 years. The majority (48.2%) of the participants were from TBM stage II, while 37% were from stage III of TBM. Fever, headache, and systematic symptoms were the most frequent clinical presentations. The median delay in treatment was 30 days. Interruption in anti-TB treatment was reported in 3 (9.3%) cases.

Conclusions: The study found that among possible TBM cases, the most frequent clinical features were fever, headache, and systematic symptoms. Focal neurological deficit and cerebral nerve palsy also had a high prevalence among the participants. The majority of the participants were young adults and female prevalence was high in the present study. The majority were from stage II TB among the study participants.

Pattern and trends of respiratory diseases in an outpatient setting: a five-year review in a tertiary hospital in South-South, Nigeria

Airenakho Emorinken — 2023-05-29

Background: Limited information exists on the epidemiology of respiratory diseases in South-South Nigeria, especially regarding changing risk factors. This study aimed to assess the frequency and pattern of respiratory diseases in an adult outpatient clinic in a teaching hospital in South-South Nigeria.

Methods: Medical records of newly referred patients with respiratory diseases who received care at the chest clinic of Irrua Specialist Teaching Hospital from January 2018 to December 2022 were retrospectively reviewed.

Results: The study included 655 patients (mean age: 54.7±18.7 years). The majority of cases occurred in the 41-60 age group, and 55.4% were female. Non-communicable respiratory diseases accounted for 60.9% of cases, while communicable respiratory diseases accounted for 39.1%. The most common respiratory diseases observed were bronchial asthma (22.6%), tuberculosis (21.1%), chronic obstructive pulmonary disease (19.2%), pneumonia (11.1%), interstitial lung diseases (6.7%), and lung cancer (4.1%). Less common respiratory diseases included pulmonary aspergilloma (1.5%), pleural-related diseases (0.8%), hypersensitivity pneumonitis (0.8%), and obstructive sleep apnoea syndrome (0.6%). The study's annual trend showed a gradual increase in the number of respiratory cases, reaching a low point in 2020. Significant differences were found in the age and gender distribution of the top six respiratory diseases (p <0.001).

Conclusions: This study provides valuable insights into the demographic and disease patterns of respiratory diseases in an outpatient setting, informing targeted prevention and treatment measures for these conditions.

Initial experience with breast conserving surgery in Jos

Alexander F. Ale — 2023-05-29

Background: Breast conserving surgery is the treatment of choice in the surgical management of early-stage breast cancer in developed countries, while mastectomy has remained the most practiced surgical treatment in developing countries. The aim of the study was to describe the outcomes of a cohort of patients who had breast conserving surgery in a developing country.

Methods: The study is a retrospective review of patients who were offered breast conserving surgery between January 2018 and December 2020 at the Jos University Teaching Hospital and FOMAS Hospital.

Results: A total of 110 female patients had surgery for breast cancer in the study period. Of this number, eleven (10%) patients whose ages ranged from 28-70 years with a mean age of 53.5 years (SD=12.9 years) had breast conserving surgery, while 99 (90%) had mastectomy. A painless lump on self-breast examination was the most common reason for presentation in those who had breast conserving surgery. Most of the patients who had breast conserving surgery presented with tumor stage T2N1M0. Quadrantectomy was done in 7 (63.6%) patients while 4 (36.4%) had wide local excision. No patient developed any postoperative complication. No patient required re-excision due to positive margins. Three (27.3%) patients had only adjuvant hormonal therapy. Eight (72.7%) patients had radiotherapy following surgery, while 3 (27.3%) patients had only breast conserving surgery for loco-regional control. All patients had a minimum follow up of 2 years with no recurrence or mortality.

Conclusions: Breast conserving surgery can be safely practiced as an alternative to mastectomy in carefully selected patients with early breast cancer with good outcomes.

Association of serum uric acid level with angiographic severity of coronary artery disease: a study in a tertiary care hospital, Chittagong, Bangladesh

Khondaker M. Ismail — 2023-05-29

Background: Coronary artery disease (CAD) is a major global health issue. Serum uric acid (SUA), a byproduct of purine metabolism, is linked to CAD development and progression. Elevated SUA levels are an independent risk factor for cardiovascular mortality and may indicate endothelial dysfunction. The aim of the study was to the observed associate serum uric acid level with the angiographic severity of CAD.

Methods: This observational study was conducted at Chittagong medical college hospital in Bangladesh from October 2020 to September 2021. It included 130 patients and used unpaired t-tests to analyze the association between serum uric acid level and angiographic severity of CAD patients. Ethical clearance was obtained from the institutional review board of Chittagong medical college and hospital.

Results: A study of 130 patients found a significant relationship between serum uric acid (SUA) levels and CAD (CAD), vessel involvement, and CAD severity (p=0.001). Patients with CAD had higher SUA levels (mean 5.26±1.32 mg/dL) compared to those without CAD (mean 4.22±1.03 mg/dL). A SUA level range of 3.94-6.58 mg/dL was associated with CAD presence. Gender also showed a highly significant association with SUA levels (p=0.001), while age, BMI, and smoking status did not show significant differences.

Conclusions: A strong positive association has been found between serum uric acid level and the severity of CAD. The findings of this study approve the effectiveness of hyperuricemia as an emerging risk factor for CAD.

Analysis of presentation, etiology, management and outcome of perforation peritonitis in a tertiary care centre

Shweta Kumari — 2023-05-12

Background: The most common surgical emergency in general surgery is perforation peritonitis. It is a serious condition with a mortality rate of up to 20%, and it is the third most common cause of surgical abdomen after appendicitis and intestinal obstruction. The aim of this study to discuss presentation, etiology, management and outcome of perforation peritonitis in our hospital.

Methods: The 60 patients with features of perforation peritonitis admitted from September 2021 to August 2022 in the department of general surgery, PMCH, Patna were chosen. Descriptive statistics was used for analysis. Detailed history was taken, physical examination and X-ray was done. Signs and symptoms, duration of illness, age of presentation, intra-op findings regarding size and location, its management, post-op complications were documented.

Results: Total 60 cases of perforation peritonitis were included in this study, among that 80% (48) were males and 20% (12) were females, with male to female ratio of 4:1. Pain abdomen was a universal symptom. Generalized pain abdomen was seen in 54 (90%) cases, followed by lower quadrant in 3 cases (5%) and epigastrium pain seen in 3 cases (5%). Radiation of pain to right iliac fossa was seen in 6 cases (10%). Blunt injury was seen in 9 (15%) case. 14 patients were treated with anti-ulcer medications. Three patients with duodenal ulcer perforation were treated with nonsteroidal anti-inflammatory drugs. Liver dullness was obliterated in 28 patients (47%). Bowel sounds were either sluggish or absent in most cases.

Conclusions: Perforation peritonitis is a frequently encountered surgical emergency. Various factors like age, sex, duration, site of perforation, extent of peritonitis and delay in surgical intervention are associated with morbidity and mortality. A successful management depends upon early surgical intervention, source control and exclusive intraoperative peritoneal lavage.

An audit on the clinical and laboratory profile of patients with different variants of Guillain-Barre syndrome and effect of various treatment strategies on their recovery

Abhijit Prithviraj Chavan — 2023-05-11

Background: Guillain-Barre syndrome (GBS) is an immune-mediated disorder of the peripheral nervous system, causing muscle weakness, paralysis, and sensory deficits. Its treatment mainly involves supportive care, immunomodulatory therapies such as intravenous immunoglobulin (IVIg) and plasma exchange (PE), and rehabilitation. Several randomized controlled trials (RCTs) and meta-analyses have evaluated the efficacy and safety of apheresis in GBS, but the results have been conflicting and limited by methodological issues.

Methods: This is a retrospective study with a sample of 30 patients carried out at neurology OPD of tertiary care centre in Pune, Maharashtra over a period of 32 months from July 2020 and February 2023. Patients were followed up for six months, and their outcomes were compared in terms of the improvement of clinical disability scores, the need for mechanical ventilation, and the time to recovery of walking ability and other functional outcomes.

Results: Apheresis treatment significantly improved the clinical disability scores and NCV recovery of patients with GBS in comparison to IVIg and corticosteroids. Moreover, patients who received apheresis treatment showed a shorter time to recovery of walking ability and other functional outcomes than those who did not. Symptomatic differences were seen between patients with different subtypes of GBS, but there was no difference in the response to apheresis or IVIg between subtypes.

Conclusions: Treatment with apheresis should be considered in patients not responding to conservative management. Earlier treatment with apheresis has shown to have good clinical and electrophysiological outcomes regardless of the GBS subtype.

Laparoscopic versus open appendicectomy-a comparative study of clinical outcomes in an institutional centre

Noorin Fatma — 2023-05-09

Background: Appendicectomy remains to be one of the most common procedures performed by the general surgeon. Laparoscopic appendicectomy is likely to have less postoperative pain, less use of analgesics, early discharge, decreased wound infection, better cosmetics and also diagnostic and early return to routine work.

Method: This is a comparative study of 50 cases of appendicitis divided equally into two groups 25 in open and 25 in the laparoscopic which were randomly selected and operated in the department of general surgery at PMCH, Patna.

Results: In present study pain score was 2.97±0.7 for open group as compared to 1.56±0.7 in lap group (p<0.05) because of longer incision stretch of muscles and wound infection. Post operative complications like vomiting was lower in laparoscopic group with 12% as compared with 40% in open group (p<0.05) and ileus was lower in lap group with 27±4.6 and for open group 31±5.4 with p<0.05 which were significant. There is significant reduction in incidence of post operative wound infection in lap group 0% as compared to open group 32% (p<0.05). Duration of postoperative hospital stay was significantly low for lap group 2±0.78 as compared to open group 8±0.89. The return to normal activity was low for lap group 14±2.11 days as compared to open group 21.7±3.7days. Duration of surgery for open appendicectomy was 48±19 mins and for lap appendicectomy was 46±15 mins.

Conclusions: Overall laparoscopic appendicectomy is better than open appendectomy in selected patients with acute or recurrent appendicitis.

Upper gastro intestinal bleed: causes, endoscopic profile and usefulness of Rockall score in determining the outcome

Heet Bharatkumar Katira — 2023-05-05

Background: Upper gastrointestinal hemorrhage is defined as any bleeding from a site in the gastrointestinal tract proximal to the ligament of Treitz (fore-gut). Patients with Upper gastrointestinal hemorrhage present with a wide range of clinical severity ranging from trivial bleeds to fulminant and lethal exsanguinations. It is associated with multiple risk factors and multiple co-morbid condition.

Methods: A prospective cross-sectional study was conducted in a tertiary care hospital. A total of 56 patients who were subjected to endoscopy and were studied for 6 months. Appropriate statistical method had been applied wherever needed.

Results: In the studied population among 56 patients, most common cause of UGIB was variceal bleed 45 (80%); most common of age group with variceal bleed belonged to 40-59 years, Grade III varices were most commonly found 23 (52%). The mean Rockall score was 4.7 which indicated that most patients belong to moderate risk group. The need of packed red blood cell transfusion and chances of rebleeding were more in high-risk group compared to low and moderate risk group. Patient mortality were only observed in high-risk group compared to low and moderate risk group.

Conclusions: Upper GI endoscopy is beneficial in both diagnostic and therapeutic treatment of patients with UGIB. Rockall score helped in identifying that most of the patients belonged to moderate and high-risk group. Rockall score has been found to correlate well with clinical outcome, including need for transfusions, rebleeding and mortality, and may be used for effective triage of patients.

Changes in liver function tests in laparoscopic cholecystectomy versus open cholecystectomy in a tertiary care center

Shashank Kumar — 2023-05-11

Background: Gallstone disease is a major health problem worldwide particularly in the adult population. The traditional open cholecystectomy (OC) has been replaced by laparoscopic cholecystectomy (LC), with LC becoming the gold standard for management of gall stone disease. Elevation in the levels of liver enzymes following LC is a major cause of concern. Hence the present study determines and compares the changes in liver function tests following Laparoscopic cholecystectomy with open cholecystectomy, as well the significance of these changes is studied.

Methods: A total of 100 patients with symptomatic cholelithiasis were selected in the study from October 2020 to October 2022. The cases were randomly divided into two groups, Group LC and Group OC. The blood samples were collected for Liver Function Tests (LFT)-Pre-operatively, Post-operative Day (POD)-1, POD-2 and POD-7 and enzyme alterations were studied.

Results: The study demonstrated increase in levels of Serum AST, ALT, ALP in LC group on POD-1 and POD-2 with p<0.001, while the levels returned to reference values on POD-7. In OC group the increase in levels of Serum AST, ALT, ALP were observed on POD-1 only with p<0.05 and the levels returned to normal values by POD-2 of majority of patients. The changes in LFT were higher in LC group compared to OC group (where the changes were slight).

Conclusions: Cholecystectomy especially laparoscopic, leads to transient significant hepatic enzyme alterations which can be attributed to CO2 pneumoperitoneum, surgical manipulations, diathermy and arterial injury. These derangements at times may be of concern to surgeons for its implication to the integrity of biliary tract.

An observational study to compare Muhtaseb's and Habib's scoring systems in patients undergoing phacoemulsification to predict risk in cataract at a tertiary centre in West Bengal

Jagan Nandan Prasad Singh — 2023-05-09

Background: Cataract is derived from the Latin ‘cataracta’, meaning ‘waterfall’ as rapidly running water turns white, so term may have been used metaphorically to describe similar appearance of mature ocular opacities.¹

Methods: This observational study with prospective study design has been conducted in the college of medicine and JNM hospital, department of ophthalmology, COMJNMH, Kalyani-741235, Nadia District, West Bengal which catering mostly the rural and also urban population. The study was done spread over a period of 18 months starting from July 2018 to December 2019, i.e., 1 year for research and 6 months for analysis. It included all patients, irrespective of age, undergoing Phacoemulsification surgery for cataract admitted in our hospital fulfilling the laid criteria for the study.

Results: The study consisted of total 147 cases in these 14 (9.52%) cases complicated with PCR, 10 (6.80%) striate keratopathy and 4 (2.72%) cases complicated with both PCR and striate keratopathy. Though sample size derived was 126 cases, 147 cases were studied during the research period of 1 year. Out of 10.89% cases of miscellaneous risk (ex: poor position of the eye/patient) risk factor, posterior capsule rupture (12.5%), striate keratopathy (12.5%), cases having both complication (00.0%) and total complicated cases (25%) which is 1.36%, 1.36%, 0% and 2.72% of total cases respectively. Out of 8.84% cases of unable to lie flat risk factor, posterior capsule rupture (15.38%), striate keratopathy (7.69%), and total complicated cases (23.07%) which is 1.36%, 0.68% and 2.04% of total cases respectively.

Conclusions: The current study tries to validate two scoring systems to predict complications during phacoemulsification surgerylike risk of posterior capsule rupture and striate keratopathy and to predict the potential difficulty of a case.

Assessment of the outcomes of open side-to-side choledochoduodenostomy in the management of choledocholithiasis

Eunus A. Barbhuiya — 2023-05-05

Background: Gallstone disease is one of the most common digestive diseases leading to frequent hospital visits and its prevalence shows ethnic variability, with rates of approximately 10-15% in the United States and Europe. The present study aims to prospectively assess the outcomes of open side-to-side choledochoduodenostomy in the management of choledocholithiasis.

Methods: This hospital-based prospective observational study was conducted in the Department of Surgery, Tezpur medical College and Hospital, Tezpur, over one year period, from July 2021 to June 2022. The study includes twenty-four patients admitted to the surgery department for bile duct stone operations. After intraoperative confirmation of the criteria, these patients underwent choledochoduodenostomy. The patients were followed for 2 months postoperatively after discharge.

Results: Only a few patients had immediate postoperative complications which were managed conservatively. No patient had any evidence of retained stone, nor did they have any symptoms of cholangitis, features suggestive of the development of Sump syndrome, or any other follow-up postoperative complications.

Conclusion: Open side-to-side choledochoduodenostomy should be considered a method of choice in remote areas where endoscopic facilities are lacking and in patients where cost is a factor in deciding the choice of procedure, with reduced postoperative complications like retained stones and a shorter duration of hospital stay in expert surgical hands.

Flap and finger-tip blood glucose level monitoring to predict venous thrombosis in free flaps: a simple and effective method

Manish Jain — 2023-05-12

Background: Rapid detection and early re-exploration is the key to salvage congested flap. Various methods have been described in literature to monitor flaps in post operative period. We evaluate the efficacy of measurement of flap and fingertip blood glucose level and its role in predicting the flap congestion and salvage.

Methods: prospective observational study conducted in a tertiary care centre in North India between December 2020 to December 2022. A total of patients 500 underwent 507 free tissue transfer were included in this study. Flap congestion was noted clinically in 41 flaps. In these 41 flaps, flap and fingertip blood glucose level were measured.

Results: Congested appearing flaps divided into 2 groups. Group A consist of 8 flaps out of 41. The difference in flap and fingertip blood glucose level is less than 10%. Out of 8, 5 does not required re-exploration and were successfully salvaged. In 3 flaps, difference in flap and fingertip glucose level rises with time and were taken for re-exploration. Out of these 3, 2 were successful salvaged. Group B consist of 31 flaps. In these 31 flaps, 41. the difference in flap and fingertip blood glucose level is more than 10%. All these flaps were re-explored and 21 were salvaged.

Conclusions: Flap and body glucose level monitoring is a simple and reliable method for flap monitoring and it can be performed by residents as well as nursing staff.

Association of vitamin D3 with psoriasis and psoriatic arthritis-an observational study

Dibyendu Mukherjee — 2023-05-29

Background: The objective of this study is to investigate the association between 25 (OH) vit D3 level and psoriasis, in our city with long sunny weather, in an attempt to clarify the controversies.

Methods: The 100 patients with psoriasis including 29 with psoriatic arthritis were taken randomly as cases from medicine outpatient department of KPCMCH. Psoriasis area and severity index (PASI) was calculated for all patients with psoriasis and disease activity score (DAS28-CRP) in all arthritis patients. The control group had 150 age and sex-matched participants without any symptoms related to psoriasis or psoriatic arthritis. The 25 (OH) vit D3 serum level was estimated for both groups. This is an observational, cross-sectional study.

Results: Out of total 100 patients, 55% were male and 45% female, with mean age and disease duration 49.7±6.7 years and 11.4±3.5 years, respectively. The control group had 150 subjects (86 males, 64 females). The 25 (OH) vit D3 levels of both patients and controls were 19.2±8.5 ng/ml and 29.9±6.7 ng/ml, respectively and the difference was statistically significant (p<0.05). The 25(OH) vit D3 levels were 21.9±4.1 ng/ml in patients with disease duration <10 years, and 15.9±4.2 ng/ml in patients with disease duration ≥ 10 years and difference was statistically significant (p<0.05). It was 18.9±7.8 ng/ml and 20.1±8.4 ng/ml respectively in psoriasis patients with and without arthritis but the difference was statistically not significant (p>0.05). The 25(OH) vit D3 level was lower in psoriasis with high PASI compared to psoriasis with low-moderate PASI and lower in psoriatic arthritis with high disease activity compared to arthritis with low-moderate disease activity.

Conclusions: Both psoriasis and psoriatic arthritis patients had lower 25 (OH) vit D3 levels. The disease durations were directly related to 25 (OH) vit D3 insufficiency. Lower levels were associated with higher active diseases.

Study factors associated with poor glycemic control in type 2 diabetes mellitus patients in tertiary care center

Anita Mathuriya — 2023-05-29

Background: Poor glycemic control is a major public health issue among patients with type 2 diabetes mellitus and a significant risk factor for the progression of diabetic complications. This study aimed to assess the magnitude and contributing factors of poor glycemic control among type 2 diabetes patients.

Methods: A cross-sectional study was conducted among 150 type 2 diabetes patients a sample of 150 type 2 diabetics of both sexes was obtained diabetes in medicine OPD, any type 2 diabetes patient at the healthcare facilities over the age of 18 was eligible to participate in the study.

Results: Of the 150 type 2 diabetes patients included in the study, 118 had poor glycemic control. Mean age was 59.67 (SD = 9.617) years; 115 (76.9%) of them were men. Most patients [n = 62 (41%)] used insulin or oral anti-diabetics as monotherapy [n = 32 (21%)] to regulate their blood sugar levels. The glycemic control got worse the longer the patient had diabetes, from 5 to 10 years (OR = 1.74) to more than 10 years (OR = 2.55), compared to patients with less than 5 years of illness. In comparison to patients with co-morbidity, patients without co-morbidity had significantly better glycemic control (OR=1.56).

Conclusions: Gender, age, BMI, occupation, medical history, medication history, triglycerides, HDL, duration of diabetes, type and number of diabetes medications, and HbA1c were significantly associated. These factors can identify patients at risk of poor glycemic control, allowing targeted interventions for optimal outcomes. Adherence, physical activity, diabetes education, and training affect glycemic control, but this study did not.

Evaluation of disease distribution and drug utilization for management of psoriasis patients in dermatology OPD of a tertiary care centre: a retrospective observational study

Vandana Badar — 2023-05-29

Background: Psoriasis is a chronic skin disorder that can have different clinical presentations. Topical corticosteroids are the primary therapy for psoriasis, but there are many new drug options approved for its treatment. The aim of this study was to assess the prescription patterns and disease distribution of psoriasis patients in a tertiary care center in central India.

Methods: We conducted a retrospective observational study of 195 psoriasis patients treated in the Dermatology OPD of a teaching hospital from September 2020 to June 2021. We analyzed patient data for demographics, disease characteristics, and medications prescribed using frequency distributions in Microsoft Excel.

Results: Plaque psoriasis was the most common clinical variant among the patients, and the male to female ratio was 1.5:1. February had the highest number of patients treated, indicating an aggravation of symptoms during cold weather. Most patients (93.33%) were prescribed topical corticosteroids, with clobetasol being the most commonly used medication (78%). The average number of drugs per prescription was 5, with other drugs prescribed including emollients (53.33%), vitamin D (31.7%), anti-histamines (21.02%), and methotrexate (5.1%).

Conclusions: Topical corticosteroids, particularly clobetasol, were the most commonly prescribed medication for psoriasis patients in this study. Multiple drugs were needed for the management of most patients. The study provides insights into the prescription patterns of psoriasis medications, which may improve patient care and outcomes.

Study of cardiovascular responses to isometric hand grip test in medical students with hypertensive parents

Malarvannan K. A. — 2023-05-29

Background: Hypertension is one of the most powerful risk factors for cardiovascular disease. This biggest health challenge has to be detected early so that preventive measures can be taken for the susceptible population. Increased cardiovascular stress responsivity with sustained isometric muscle contraction is associated with cardiovascular disease. So this isometric handgrip exercise is a simple, non-invasive screening test to assess the risk of development of hypertension in future. Aim and objective of the study was to identify the chance of inheritance of hypertension in medical students of hypertensive parents.

Methods: After getting ethical committee approval, in this cross sectional study, 50 medical students of Government Sivagangai Medical college with normotensive and hypertensive parents were selected. Heart rate (bpm) and blood pressure (mmHg) before, immediately and 5 minutes after isometric hand grip exercise using hand grip dyanamometer in both the groups.

Results: Statistical analysis of the values among the participants was done by student t-test using statistical package for the social sciences (SPSS) version 11.0.and the results were compared between the study and control groups. A ‘p’ value of <0.05 is considered significant. Cardiovascular responses are found to be significantly higher in study group (p<0.001).

Conclusions: Early and regular screening of the students with hypertensive parents is necessary to prevent cardiovascular complications in future by emphasizing the life style modifications.

Revitalization of thiazolidinedione the optimum agents to be combined with SGLT 2 inhibitors to optimize glycemic control and reduce cardiovascular mortality: randomized control trial

Ishank P. Gupta — 2023-05-29

Background: Type 2 diabetes mellitus (T2DM) significantly increases morbidity and mortality from cardiovascular disease. The present study was conducted to know the effect of thiazolidinedione and SGLT2 inhibitor on glycemic control, blood pressure and lipid profile and effect on cardiovascular mortality in T2DM.

Methods: A total 80 patients of aged ≥40 years with T2DM were included and divided into 4 groups based on ongoing treatment i.e., (lifestyle modification + Tab metformin 500mg BD) + 1) Tab metformin 500mg; 2) Tab dapagliflozin 10mg OD; 3) Tab pioglitazone 15mg OD; 4) Tab pioglitazone 15mg OD + Tab Dapagliflozin 10mg OD.

Results: The change in FBS, PLBS and HbA1C from pre-intervention to post-intervention was highest in the patients with DAPA + pioglitazone group followed by patients with pioglitazone group then the patients with DAPA group and lowest in patients with metformin group. There was a statistically significant difference between them, (p<0.001). The weight reduction was highest in the patients with DAPA 10mg group followed by patients with metformin group, (p<0.001). The change in SBP, DBP and change in lipid profile (triglyceride and cholesterol, LDL and HDL) from pre-intervention to post-intervention was highest in the patients with DAPA+ pioglitazone group. This change was statistically significant (p<0.001).

Conclusions: The combination of pioglitazone and dapagliflozin not only helped in glycemic control but also had reduction in blood pressures, improvement in the lipid profile and caused slight weight reduction. There were no major adverse drug reactions, and no MACE was observed during the study. Hence this combination of pioglitazone and dapagliflozin may reduce the cardiovascular mortality (which needs longer duration study).

Likelihood of rising stroke in populace of western India: a case control study

Kuntal H. Patel — 2023-05-29

Background: Cerebrovascular accident (Stroke) is a non-communicable disease of increasing importance. According to the World Health Organization, 15 million people suffer from stroke worldwide each year. The National Commission on Macroeconomics and Health, India, has estimated 1.67 million stroke cases in India. Due to the increasing prevalence of hypertension, diabetes, dyslipidemia, fast changing lifestyle and re-structuring of population, stroke will be an epidemic in India in the days to come. Few studies have been carried out in developing countries like India. So, this study intended to know the presentation in addition to risk factors, patterns of warning signs and symptoms of stroke in patients admitted to state tertiary care Hospital.

Methods: Assuming the power ratio of the number of controls same as numbers of cases specifying values for two sided confidence level 95% and odd ratio 2.15 which was the minimum risk factor in previous study was taken to calculate sample size.

Results: After studying of 148 cases of stroke and same controls, we conclude that most common type of stroke is ischemic stroke followed by haemorrhagic stroke. After multivariate analysis we found, modifiable risk factors were mainly mental stress, active and passive smoking, hypertension and obesity.

Conclusions: Due to the sheer magnitude, devastating consequences and residual sequelae of the stroke, early intervention in the form of patient education, modification of the lifestyle, non-pharmacological and pharmacological interventions for modifiable risk factors should be an integral aspect of patient care.

Clinico-epidemiological profile of cutaneous tuberculosis at a tertiary care teaching hospital of South Rajasthan

Farzana Ansari — 2023-05-29

Background: Cutaneous tuberculosis represents only 1-2% of total tuberculosis cases but due to difficulty in diagnosis even with molecular methods and non-availability of such tests at resource poor set ups, actual burden of cutaneous TB remains under-estimated. The present study was performed to analyse the magnitude and clinico-epidemiological profile of cutaneous tuberculosis at our tertiary level referral centre.

Methods: All the clinically suspected cases of cutaneous tuberculosis attending the dermatology and paediatric outpatient department during a period of 30 months (from October 2015 to March 2018) were enrolled in the study. All patients were subjected to routine blood tests, Chest X-ray, sputum for Ziehl-Neelsen staining, HIV-ELISA, Mantoux test and cutaneous punch biopsy of the lesions for further confirmation.

Results: During the study period of 30 months, total 30 patients were recruited with male to female ratio of 1.5:1 and mean age of 27 years. Mean disease duration was 13 months with head and neck region (60%) being most commonly affected. Most common clinical type of cutaneous tuberculosis was scrofuloderma (60%), followed by lupus vulgaris (26.7%), tuberculosis verrucosa cutis (10%) and papulonecrotic tuberculid (3.3%). Mantoux test was positive in 56.7% patients. All the patients were put on antitubercular treatment as per guidelines of national tuberculosis control programme.

Conclusions: Tuberculosis in developing countries is still an important cause of skin lesions which remains doubtful in most case scenarios even after years of its advent due to difficulty in diagnosis. Clinical diagnosis and therapeutic trials are still helpful in managing most of the cases.

Study of vitamin D level in patients with different etiologies of chronic liver disease and its correlation with Child Pugh class in a tertiary care centre in North India

Ajit Kumar Verma — 2023-05-29

Background: Skeletal manifestation in liver diseases represents the minimally scrutinized part of the disease spectrum. Vitamin D has a central role in developing hepatic deficiency of osteodystrophy in patients with chronic liver disease. This study aimed to investigate vitamin D levels and their and their relationship with disease advancement in these patients according to child Pugh-score. Aims and Objectives were study of vitamin D level in patients with different aetiology of chronic liver disease and its correlation with child Pugh score.

Methods: This was a cross sectional study conducted over 200 patients after applying inclusion and exclusion criteria in patients with different etiology of chronic liver disease.

Results: In our study total (N=200), 152 patients of alcoholic liver disease 41 patients having deficient vitamin D, 79 having insufficient vitamin D level and 32 patients having normal vitamin D level. Patients of chronic liver disease also have negative correlation on vitamin D level with Child Pugh score. In our study it was found that patients having higher Child Pugh score there is more chance of having vitamin D deficiency and insufficiency than the patient’s low Child Pugh score.

Conclusions: The prevalence of vitamin d deficiency in patients with CLD was found to be having a significant correlation with increasing CTP score with p value <0.001.

Modified Rockall score: a predictor for outcome in patients presenting with upper gastrointestinal bleed

Farhan Khan — 2023-05-29

Background: Upper gastrointestinal bleeding (UGIB) is a life-threatening emergency with an overall mortality rate of around 10%. Complete Rockall score is designed to identify patients who are at greater risk of adverse outcome. The aim of this study was to assess the Rockall score as a predictor of adverse outcome in elderly population presenting with UGIB.

Methods: Cross-sectional observational study to be carried out in indoor patients presenting with upper GI bleed and to study the correlation between Rockall score and outcome of patients at GSVM Medical College, Kanpur during 2020-2022.

Results: Patients were grouped according to Rockall score with number of patients having score less than 3-13, 3-6-63, more than 6-18. Out of 120 cases, 56 (46.66%) had re-bleeding during hospital stay has an average score of 5.05 and rest 64 (53.33%) did not had re-bleeding and has a score of 4.11. Number of cases requiring having average score <3 has 8.1, score 3-6 has 8.38 and >6 has 9.67 has average hospital of stay (days). Number of cases requiring intensive care were 27 (22.5%) has 5.19 average Rockall score. Out of 120 studied cases, 101 (84.16%) were discharged has 4.29 and 19 (15.83%) were expired has 5.95 average Rockall score.

Conclusions: Acute UGIB is a medical emergency and Rockall score is ideal to stratify elderly patients to anticipate outcome and prognosis.

Gall bladder specimen histopathological findings after cholecystectomy

Shweta Kumari — 2023-05-12

Background: Cholecystitis is a generally widespread problem in adult population. Multiple finding has been found in gross and microscopic examination of gallbladder. Existence of stones is one of the known causative factors that lead to histopathological changes in gallbladder. It is also responsible for the development of gallbladder carcinoma. The purpose of this study was to find out the histopathology of gall bladder specimens following surgical intervention.

Methods: This observational study included 116 patients admitted in the department of general surgery, PMCH, Patna with acute or chronic cholecystitis from August 2018 to July 2019. Written and informed consent was taken from all the participants. Data was analyzed using SPSS version 20.

Results: A total of 116 gallbladder specimens that presented for histopathological examination during the study period were included into the study, with male to female ratio of 1:3. The highest prevalence was found in the age group of 31-50 years. The results of histopathological examination of these gallbladder specimens showed that chronic cholecystitis was found in 93 (80.1%), acute cholecystitis in 17 (14.6%), and dysplasia was found in 5 (4.3%) patients, and gall bladder carcinoma was detected in 1 (0.8%) patients. On morphological analysis, the commonest gall stones were made up of cholesterol and the most common lesion was chronic cholecystitis by histopathology.

Conclusions: This study concludes that the chronic calculus cholecystitis was dominant in our population. It is assumed that routine histopathological examination following cholecystectomies essential for all gallbladder specimens even in the non-existence of macroscopic signs of carcinoma, which was the case in our patients.

Accuracy of fecal calprotectin and endoscopic narrow band imaging in the prediction of severity of inflammatory bowel diseases

Abu Shahma — 2023-05-29

Background: Fecal calprotectin is a noninvasive and accurate marker of inflammatory bowel disease. In addition to aiding in diagnosis, it also predicts inflammatory bowel disease (IBD) relapses and the severity of the disease. Objectives of current study were evaluate the accuracy of Fecal calprotectin and Narrow band imaging for prediction severity in inflammatory bowel disease.

Methods: After informed written consent and ethical clearance, the study prospectively included 50 patients of IBD. Quantitative measurement of Calprotectin was done by ELISA kit (Eagle Biosciences, Nashua). Endoscopy activity was calculated using Narrow band imaging.

Results: Out of 50 patients, Males outnumbered the females with a ratio of 2.1. Increased frequency of stools was the most common symptom (94%). 39 (78%) patients had features ulcerative colitis while as 9 (18%) patients had features of Crohn’s disease. Total of 42 (84%) patients had elevated levels of Fecal Calprotectin. The severity of IBDs increased significantly when the Fecal Calprotectin level rises (p value >0.05). The relationship between endoscopic and histological scores to detect disease severity in IBD was statistically insignificant (p value=0.85). The accuracy of the fecal calprotectin levels was found to be 84%, sensitivity 87.5%, and specificity was 50%. The positive and negative predictive values were 97.6% and 12.55% respectively. 47 (94%) patients received medical treatment. 3 (7.7%) patients of UC were subjected to surgical intervention.

Conclusions: Fecal calprotectin is a valuable and non-invasive marker with good sensitivity and specificity for the diagnosis, evaluation of the severity, and monitoring of IBD activity.

Association of serum iron studies in COVID associated mucormycosis with stage of the disease

Chaitra Rao — 2023-05-29

Background: Mucormycosis is a rare and lethal invasive fungal infection caused by opportunist and ubiquitous fungi. India has reported surge in cases of post COVID 19 mucormycosis due to the increasing frequency of risk factors like corticosteroid therapy, uncontrolled diabetes, DKA, neutropenia and iron overload and hence warrants a detailed study to identify potential contributing factors. Aim of this study was to study the clinical profile of patients with CAM and to correlate serum iron studies with severity and extent of disease in CAM patients.

Methods: This prospective crosssectional study was conducted on 75 patients with CAM admitted to Bowring Hospital, Bangalore. Detailed history with clinical evaluation and appropriate investigations done and data was analysed.

Results: The mean age of the subjects was 48.19 with 52 males and 23 females. Among 75 patients 90.7% were unvaccinated against COVID, 62.7% had oxygen and steroid use, with diabetes mellitus as most common comorbidity. Rhino orbital-cerebral mucormycosis was the most common clinical presentation. Patients with stage 4 CAM had elevated levels of inflammatory markers LDH (292), D-dimer (457), CRP (74.64), mean serum iron (50.37) and TIBC (255.37). Case fatality rate was 12%.

Conclusions: The results of this study revealed significant correlation between the clinical severity of CAM and higher mortality, with increased serum iron levels and inflammatory markers. Therefore patients with elevated levels of available serum iron are uniquely susceptible to mucormycosis infection, suggesting dysregulated iron metabolism in its pathogenesis.

Prevalence of hypertension and diabetes in health workers of Jabalpur and Dindori: a brief study

Gautami Singh Sengar — 2023-05-29

Background: Hypertension and Diabetes comprises a major part as precursor of crucial diseases like cardiovascular diseases. Cardiovascular diseases are cause of death of around 17 million people per year globally, which includes 30% of total deaths.

Methods: The present study was conducted to observe the prevalence of hypertension and diabetes among health care worker groups, in different health care centres at Bajag block of Dindori district & Indian council of Medical Research- National Institute for research in Tribal Health (ICMR-NIRTH) Jabalpur during the study period from January 2022 to June 2022. The participants were subjected to anthropometric measurements, Blood pressure & blood glucose level measurements and they also responded to the detailed questionnaire.

Results: The 95 health care workers including nurses, technicians, ASHA workers, ANMs, which were assessed in the present study have shown 14.7% diabetes and 38% hypertension.

Conclusions: The present study is important step towards the wellbeing of health workers as very few efforts were made to observe the prevalence of NCDs in health workers of rural areas.

Risk factors, etiology and prognostic markers in patients of young stroke: a prospective observational study

Divya Goel — 2023-05-29

Background: The rate of stroke at a young age has accelerated over the years and is a matter of true concern. Young stroke causes devastating consequences leading to loss of productive years and life time disability.

Methods: We performed an observational prospective study to identify the risk factors, etiology and prognostic markers in patients of young stroke.

Results: The study was conducted on 50 patients who were less than or equal to 50 years and have suffered ischemic stroke during the time period of 6 months i.e. from April, 2022 to September, 2022 and visited Department of Neurology, at SSB heart and multispecialty hospital, Faridabad. We found the prevalence of young stroke was significantly more in males (81%) compared to same aged female participants.

Conclusions: Maximum patients suffered young stroke were at an age group 35-45 years. We could identify that the traditional risk factors including diabetes, hypertension and dyslipidemia were the major risk factors compared to the lifestyle based risk factors like smoking or alcohol consumption. The young patients showed similar response to thrombolysis treatment like old stroke patients. All the patients enrolled in the study were cured. Further research is required to understand the risk factors and prognosis of young stroke.

An in vitro study of probiotic activity exhibited by Lactobacillus acidophilus and Lactobacillus rhamnosus on oral isolates of Streptococcus mutans and Candida albicans

Ameena M. Naushad — 2023-05-29

Background: Oral infections caused by microorganisms have led to increased risk of oral health problems like dental caries (DC). Streptococcus mutans and Candida albicans are the organisms responsible for DC. The goal of the presented study was to investigate the potential of probiotics to prevent and treat DC. An in vitro assay was developed to investigate several probiotic strains for their ability to inhibit the aforementioned oral pathogens.

Methods: 40 oral isolates of Streptococcus mutans and 51 oral isolates of Candida albicans were tested for probiotic activity against Lactobacillus acidophilus and Lactobacillus rhamnosus using agar overlay interference technique as prescribed by Fleming et al.

Results: The zone of inhibition shown by L. acidophilus was higher than L. rhamnosus against Streptococcus mutans and Candida albicans.

Conclusions: In conclusion the two probiotic strains L. acidophilus and L. rhamnosus exhibited inhibitory activity on S. mutans and C. albicans respectively in vitro.

A clinical study to know the pattern of refractive error in children attending a tertiary care hospital

Prasenjit Kalita — 2023-05-29

Background: Refractive error is a major cause of low vision in children. Uncorrected refractive error causes amblyopia, poor school performance and severe visual impairment. The purpose of the present study was to know the pattern of refractive error in children attending a tertiary care hospital.

Methods: A hospital based observational retrospective study which was conducted in Gauhati Medical College and Hospital for a period of 15 months from January 2021 to March 2022. 300 children with refractive errors in the age group of 3 years to 15 years were included. Interpretation and analysis of the results were done using appropriate statistical method.

Results: Age of presentation of children was more in >10 years to 15 years (51%) followed by 5 years to 10 years (38%). Boys (61.66%) outnumbered girls (38.33%). There was a positive family history of refractive errors (57.33%). More children were found with refractive errors in parents with higher educational qualification. Myopia (49%) was most common followed by astigmatism (43%).

Conclusions: Refractive error is a preventable cause of visual impairment. A regular periodic screening for refractive errors should be done in children and it can be corrected simply by prescribing spectacles.

Correlation between length of tibia and dimensions of distal articular surfaces: a morphometric study

Falak S. Pandit — 2023-05-29

Background: Estimation of stature can be done from long bones especially tibia and femur as they have a correlation with height. Tibia is most commonly used as it resists erosion and keeps its anatomical shape even after burial. However intact bones are rarely available. Most often the exhumed remains are in fragmentary condition leading to lack of adequate sample for the study. A way of increasing utility of such samples would be the establishment of techniques which would permit estimation of stature from long bone fragments. The current study provides a correlation between length of tibia and its distal dimensions which can be used in anthropology for measuring the stature of an individual.

Methods: A total of 50 tibiae were obtained from the bone bank of the Department of Anatomy, Government Medical College, Srinagar. Measurements were taken from the bone using vernier calipers. Morphometric data obtained was analyzed, measurements expressed in mean and standard deviation and Pearson’s correlation test was carried out. This observational study was conducted within a period of 2 months, from April-June 2022.

Results: Width of talar facet with a Pearson’s correlation of 0.62 and width of fibular notch with a correlation of 0.3 showed positive statistical significance (p<0.05). On the other hand, breadth of medial malleolus with a correlation of 0.18 and height of fibular notch with a correlation of -0.02 (p>0.05) was statistically insignificant.

Conclusions: The study showed a positive correlation (p<0.05) between length of tibia with the width of talar facet and fibular notch.

Prevalence and spectrum of rheumatological diseases in a newly formed Peripheral Medical College in Northern India

Altaf Ahmed Malik — 2023-05-29

Background: Rheumatic disorders are chronic inflammatory and non-inflammatory disorders of the musculoskeletal system and connective tissue causing a significant socioeconomic burden resulting in immense morbidity owing to poor quality of life, loss of function and productivity.

Methods: In this prospective study, consecutive patients attending Medicine Outpatient Department at GMC Doda, between august 2019 and July 2022, were studied for various rheumatological diseases. Rheumatological diagnoses of 3560 consecutive newly detected and returning patients were recorded for three year.

Results: During the study period, a total of 27546 patients visited the Medicine OPD, 3560 of which were diagnosed with various rheumatic diseases, yielding a prevalence of 12.9%. The mean age of the patients in the study was 42.33±13.18 years ranging from a minimum age of 18 to a maximum age of 96 years. Females were notably predominant in all diseases at 64%. Non inflammatory rheumatological disorders osteoarthritis and soft tissue rheumatism were most predominant in this study.

Conclusions: Osteoarthritis and soft tissue rheumatism were the most predominant rheumatic disorders in our study. Rheumatic diseases constitute a major disease burden in almost all of the age groups, especially in young patients (30-50 years) within our setup.

Evaluation of Mycobacterium tuberculosis by conventional methods, GeneXpert and line probe assay in cases of extrapulmonary tuberculosis

Renuka Murhar — 2023-05-29

Background: Diagnosis of EPTB is often delayed due to its paucibacillary nature. Diagnostic modalities like conventional methods and molecular methods like GeneXpert are employed for Mycobacteria detection and their results are compared. Line Probe Assay is used for determination of resistance in first line and in second line anti-tubercular drugs.

Methods: In this study 302 extrapulmonary samples from suspected cases of all age groups were included. Samples were first homogenised and decontaminated and then subjected to various diagnostic modalities like microscopy, culture and GeneXpert for Mycobacteria detection. Culture and smear positive isolates were subjected to LPA for determination of drug resistance in first and second-line anti-tubercular drugs.

Results: Out of the 302 extrapulmonary samples, maximum samples were of lymph nodes (19.86%) followed by pus (17.88%). Male to female ratio was 1:3. GeneXpert detected 45.04% positive cases and 5.96% were rifampicin resistant. Positive samples detected by microscopy and culture were 21.19% and 24.17% respectively. When compared to culture, microscopy showed a sensitivity of 86.30% and specificity of 99.56%. GeneXpert reported 100% sensitivity and 72.48% specificity. LPA reported 9.45% isoniazid resistant cases, 4.05% rifampicin resistant cases and 5.40% both isoniazid and rifampicin resistant cases (MDR-TB). Out of the MDR-TB cases, 25% cases were resistant to fluoroquinolones indicating pre-XDR TB.

Conclusions: For Mycobacterium tuberculosis detection in extrapulmonary samples, multiple modalities should be employed so that the bacilli in these samples is not missed and the turn-around time is lowered which is a key to TB control strategy.

Fetal and maternal outcomes and risk factors associated with preterm prelabour rupture of membrane

Anita Thapa — 2023-05-29

Background: This study aimed to assess the fetomaternal outcome of preterm prelabour rupture of membranes (PPROM) and identify the risk factors associated with this condition.

Methods: The study was conducted in the Obstetrics and Gynecology department of Fakhruddin Ali Ahmed Medical College and Hospital, Barpeta, Assam, and used a hospital-based prospective observational study design. The study duration was 12 months from September 2021 to August 2022, and the sample size was 80.

Results: The study found that the majority of respondents were between the ages of 20-25, Hindu, and unemployed. The occurrence of PPROM was most frequent in women between 35-36 weeks of gestation, with 41 patients (51.25%) affected. Approximately 57.50% of the study participants presented to the medical facility within 6 hours of experiencing vaginal discharge.

Conclusions: Although PPROM is a common pregnancy complication, its consequences can be avoided by using antibiotics, corticosteroids, and other medications. The majority of the mothers had no risk factors. The study's findings may help healthcare providers to better understand the risk factors associated with PPROM and develop interventions to improve maternal and fetal outcomes.

A randomized comparison between intravenous iron sucrose and oral iron in treatment of iron deficiency anemia in pregnancy at a rural health training centre of a teaching medical institution

Swati S. Chavhan — 2023-05-29

Background: Iron deficiency is a leading cause of anemia in pregnancy. The standard treatment in majority of the institutions is oral iron, with blood transfusion reserved for severe or emergency cases. However, it is unreliable in the treatment of severe anemia. The aim of this study was to compare the efficacy and safety of intravenous iron sucrose and oral iron administration for the treatment of iron deficiency anaemia in pregnancy.

Methods: Hundred women with gestational age between 30 and 34 weeks with established iron deficiency anaemia with hemoglobin between 6-8g/dL were randomized to receive either oral ferrous sulphate 200 mg thrice daily or required dose of intravenous iron sucrose 200 mg in 200 ml NS on alternate days. Hemoglobin was measured at recruitment and on 2nd week, 4th week and at 37 weeks. Adverse drug reactions were also noted in both the groups. Results were analyzed by student’s t-test and Chi-square test.

Results: Haemoglobin values varied significantly with time between the two groups at second week, 4th week and at term (p<0.005). When compared to iron sucrose group, the oral iron group had significant gastro-intestinal adverse effects.

Conclusions: Intravenous iron sucrose treated iron deficiency anaemia of pregnancy faster, and more effectively than oral iron therapy, with no serious adverse drug reactions.

Phleboscore in chronic venous disease

Siddharth Mulki — 2023-05-29

Background: Chronic venous disease (CVD) is a multifactorial condition affecting among populations worldwide. The symptoms appear early in the progression of the disease and as the time progresses the severity of the disease increases. Thus a proper clinical management tool is essential to prevent potential harms of the disease, which also entails a significant loss of the quality of life in these individuals. The aim of the present study is to make use of the tool phleboscore for the patients with lower limb problems to quantify the risk of developing CVD complications.

Methods: A prospective observational study with 2788 patients with lower limb complaints of venous disease was conducted in the out-patient department at A. J. Institute of medical sciences, Mangalore. Patients were asked about the symptoms of the venous diseases like sensation in the limb, any changes in the limb. The patients with two or more symptoms were assessed with phleboscore questions. Based on the phleboscore a descriptive analysis of the collected data was done.

Results: With regards to the phleboscore patients were divided into three classes; low risk, moderate risk and high risk. Almost 73.6% patients were at medium risk of developing CVD. 7.6% patients at high risk. 63.5% of patients with sedentary lifestyle were at medium risk.

Conclusions: Phleboscore is an essential tool to assess the potential risk of patients developing CVD. This tool helps in early identification of patients who are about to go into high risk group and help them by early interventions to prevent the development of more serious disease.

Diagnostic utility of skin prick test in fungal asthma

Prasanna P. Raut — 2023-05-29

Background: Allergic bronchopulmonary mycosis (ABPM) is a clinical syndrome associated with immune sensitivity to various fungi. Aspergillus spp. predominates in colonizing the airways of asthmatics. Early and accurate identification of fungus in such cases can prevent worsening of asthma. Also, can help in retarding the progression of ABPM. Objectives of this study were to evaluate different fungal allergens associated with clinically diagnosed Asthma patients by Skin Prick testing (SPT), to study total IgE in asthmatic patients by serological testing and to characterize the fungal isolate associated with SPT+ cases by conventional mycological culture.

Methods: A prospective study of known asthma cases was done. Their sensitivity to fungal allergens was tested by SPT. The total IgE levels were measured by ELISA. Sputum collected from SPT+ cases were subjected for fungal identification.

Results: Out of 175 patients, 25 (14.2%) showed positive reaction against fungal antigens in which fungal growth was seen in 21 (84%) sputum specimens. Aspergillus fumigatus was isolated from 16 (76%) specimens followed by Candida albicans in 3 (14%) and Penicillium spp in 2 (9.5%) cases. Out of 25 SPT+ asthmatics, 21 patients with fungal growth had total IgE levels >600 IU/ml and 4 patients with negative culture had IgE levels 400-500 IU/ml.

Conclusions: A significant prevalence of fungal asthma is seen among asthmatics. Thus, it is essential to screen asthma patients for fungal allergy. SPT seems to be a good screening test. SPT is easy to perform, less time consuming and inexpensive however needs to be performed under pulmonologist’s supervision.

Bioabsorbable screws versus metallic interference screw fixation in anterior cruciate ligament reconstruction using hamstring autograft: comparative analysis of functional outcome

Vivekanand D. Hiremath — 2023-05-29

Background: This prospective comparative study aimed to evaluate the functional outcomes of bioabsorbable screws versus titanium interference screws for anterior cruciate ligament (ACL) reconstruction using hamstring autograft.

Methods: The study included 30 patients who underwent ACL reconstruction with a quadrupled hamstring graft; 15 were fixed with titanium interference screws and 15 with bioabsorbable screws. The patients were followed up for six months post-surgery. The functional outcomes were evaluated using the Lysholm score. The data were analyzed using SPSS version 22.0.

Results: There was no significant difference in the functional outcomes between the two groups at the six-month follow-up.

Conclusions: Our study shows that there was no difference in functional outcome whether bioabsorbable or titanium interference screw was used. The success of ACL reconstruction depends on the correct technique used for the surgery, precise placement of graft and rehabilitation methods than on type of graft fixation device used, neither titanium nor bioabsorbable screws.

Assessment of HIV-TB co-infection in newly diagnosed HIV positive patients and their correlation with CD4 and viral load

Vasanti C. Visawale — 2023-05-29

Background: Human Immunodeficiency Virus (HIV) and Tuberculosis (TB) constitute a major burden of infectious diseases in India. TB is the most common opportunistic infection and a leading cause of death among HIV positive patients. This study was conducted to assess the HIV–TB co-infection in newly diagnosed HIV patients and correlate co-infection with CD4 and viral load (VL).

Methods: A prospective observational study was carried out from January 2021 to June 2022 at ART center of a tertiary care hospital. Screening for TB was done by GeneXpert and Radiology. These patients were monitored for absolute CD4 count by flow cytometer and VL by Real time PCR.

Results: Among 380 newly diagnosed HIV patients screened, 94 (24.70%) had HIV-TB coinfection. Of these, 42 (44.6%) were pulmonary tuberculosis (PTB) and 52 (55.3%) were extrapulmonary tuberculosis (EPTB) of 42 patients with PTB, 31 (73.80%) were microbiologically confirmed by GeneXpert whereas of 52 patients with EPTB, 33 (63.46%) were diagnosed clinically and radio-logically. Of 94 patients, only 55 patients could be followed up further at 6 months. Of 55 patients, 33 (60%) had CD4 count <350 cells/mm³ and 2 (3.6%) had baseline VL≥1000 copies/ml. 46.80% patients completed their anti-tubercular treatment.

Conclusions: EPTB was more as compared to PTB. Co-infection was more with low CD4 counts. Hence, CD4 test can be used as a good immunological marker in co-infection. The study highlights the need of periodic screening of newly diagnosed HIV patients for TB and their monitoring for CD4 and VL.

Exploring satisfaction and outcomes in rhinoplasty: experience from a tertiary care hospital in Kashmir valley, India

Durfishan Bashir — 2023-05-29

Background: Augmentation rhinoplasty is a popular yet challenging procedure that aims to improve both the nasal appearance and quality of life of patients. The purpose of this study was to examine the satisfaction and outcome after augmentation rhinoplasty at a tertiary care hospital in Kashmir valley.

Methods: The study was conducted at a tertiary care hospital in Kashmir valley among patients who underwent the procedure using autologous cartilage grafts at the ENT department from October 2021 to December 2021. The sample size was 56. The patients age, gender, pre-operative findings, surgical techniques, post-operative outcomes, complications, and corrective interventions were recorded. The rhinoplasty outcome evaluation questionnaire was used to evaluate the patients' pre and post-operative status, with outcome assessed three months after surgery.

Results: The present study included 56 patients which comprised of 39 (69.64%) males. The mean age of patients was 41±9.6 years. The indication for surgery was a mix of aesthetic and functional reasons in 56% subjects with 78% undergoing a primary surgery. The mean pre-operative score on the ROE questionnaire was 9.21±0.8 which improved to a mean score of 19.56±1.1 at three months after surgery. Overall 75% (42/56) patients reported a post operative ROE score of ≥80%. There was a significant improvement in all domains assessed by the ROE questionnaire, including appearance and function.

Conclusions: Augmentation rhinoplasty can provide satisfactory aesthetic and functional outcomes for patients with nose deformities with consistent improvement across all domains related to aesthetics and functionality.

Cortical suspensory endobutton versus aperture interference screw fixation for arthroscopic anterior cruciate ligament reconstruction using hamstring graft: a prospective study

Tejaswi K. B. — 2023-05-29

Background: Anterior cruciate ligament injury is a common injury which occurs in sports with an annual incidence of 68.6% per 100,000 population. Anatomic arthroscopic reconstruction remains the main stay treatment of ACL injury. Fixation of graft is classified as direct and indirect. To compare the stability of knee joint, complications in arthroscopic anterior cruciate ligament reconstruction by aperture interference screw fixation versus suspensory device fixation in femur.

Methods: The randomized control study was conducted in department of orthopedics, The Oxford Medical College Hospital and RC from 2020-2021. 30 knees were operated, Ethical clearance taken and patient is followed up for six months.

Results: The preoperative Tegner Lysholm knee score was poor in both groups. Post-op in interference screw group, 12 patients 80% had excellent functional outcome, 3 patients 20% had good outcome. In the Endbutton group, 11 patients (73%) had excellent outcome while 4 patients (27%) had good outcome.

Conclusions: Suspensory device fixation gives equivalent results when compared to aperture screw fixation. complications of screw fixation were graft rupture cyst formation; complications of suspensory devices were loosening of graft and bungee cord effect. Hence, Both the techniques showed no statistical difference in post operative outcome.

Comparison between effectiveness of sublingual misoprostol and intracervical dinoprostone gel for induction of labour in pregnant women

Dhira Das — 2023-05-29

Background: This hospital-based, prospective, comparative interventional study aimed to compare the effectiveness of sublingual misoprostol and intracervical dinoprostone gel for induction of labor in primigravida women.

Methods: A total of 100 patients were alternately assigned to induction with either Misoprostol 25mcg 6 hourly or dinoprostone Gel 0.5mg 6 hourly.

Results: The induction delivery interval was significantly longer in the dinoprostone group compared to the misoprostol group. The incidence of fetal distress was slightly higher in the Dinoprostone group, but the difference was not statistically significant. There were no significant differences between the two groups in the incidence of respiratory distress, birth asphyxia, and APGAR 1 MIN <6.

Conclusions: This study suggests that sublingual misoprostol (a type of prostaglandin E1, or PGE1) is more effective than intracervical dinoprostone gel (a type of prostaglandin E2, or PGE2) for cervical ripening and induction of labor.

A comparative study to assess I-gel as an alternative to endotracheal tube in laparoscopic surgeries

Athar Un Nisa Quraishi — 2023-05-29

Background: This study was conducted to compare and evaluate the effectiveness of I-gel over endotracheal tube with regards to respiratory and hemodynamic parameters in laproscopic surgeries.

Methods: In this study 60 adult patients of either sex, of ASA status I or II, aged 16 to 60 years, undergoing laparoscopic surgeries under general anesthesia were randomly studied. In Group-A (I-gel) appropriate sized I-gel was inserted, and in Group-B (ETT) patient’s airway was secured with laryngoscopy-guided endotracheal intubation. Monitoring of PR, MBP, SpO₂ and EtCO₂ was done throughout the peri-operative period. Haemodynamic and ventilatory parameters were recorded before induction (baseline), just after intubation, then at 1, 3 and 5 min after I-gel insertion/intubation, after pneumoperitoneum, after change of position, before and 5 min after release of pneumoperitoneum and after I-gel removal/extubation.

Results: Following the insertion of airway device there was significant rise in PR (3 min after intubation [P = 0.011, df-58, CI-95%]) and MBP (3 min after intubation [P = 0.02, df-58, CI-95%], 5 min after intubation [P = 0.04, df-58, CI-95%]) in Group-B patients when compared to Group-A patients. Following insertion of airway device there was no significant difference in EtCO₂ (3 min after intubation [P = 0.778, df-58, CI-95%]), 5 min after intubation [P = 0.75, df-58, CI-95%]) in Group-B patients when compared to Group-A patients.

Conclusions: I-gel requires less time for insertion with minimal haemodynamic changes when compared to ETT. I-gel can be a safe and suitable alternative to ETT for laparoscopic surgery.

Clinico-epidemiological profile and treatment outcome of lip cancer: a retrospective study from north India

Tavseef Ahmad Tali — 2023-05-29

Background: Aim of present study to evaluate the Clinico-epidemiological profile and treatment outcome of Lip Cancer.

Methods: This was a retrospective study performed in our hospital. All necessary clinical and epidemiological details of the 11 cases diagnosed with lip cancer from January 2016 to December 2021 were analysed.

Results: The total number of new malignant cases diagnosed as lip cancer between January 2016 and December 2021 were 11, which comprised 6 male (55%) and 5 (45%) female. The male-to-female ratio was (1.2:1). The most common histological type was SCC, i.e., in 9 (81.8%) of the total number of cases and BCC was in 2 patients (18.2%). Overall survival at 5 years was 89% in our study.

Conclusions: In conclusion, we have reported higher levels of lip cancer among men and those above 45 years of age. The important prognostic factors for overall survival in these patients were cancer stages. Better survival is achieved with surgery alone in the early stages and with adjuvant radiotherapy in the later stages.

Study of insulin resistance as an inflammatory marker for ischemic stroke severity among non-diabetics

Mohammed M. Nawaz — 2023-05-29

Background: Insulin resistance (IR) is emerging as an important modifiable risk factor causing acute ischemic stroke. The purpose of the study was to evaluate insulin resistance among patients of acute ischemic stroke, in non-diabetic patients, and to correlate insulin resistance with the severity of acute ischemic stroke, and to observe its association with traditional risk factors.

Methods: It was a prospective study conducted at JSS Medical College, Mysore, India from September 2021 to December 2022. Patients who presented with the history of stroke, who were non-diabetics and aged >18 years were included with informed consent. Ischemic stroke was diagnosed with clinical findings and by neuroimaging. Stroke severity was assessed by NIHSS score. Homeostasis model assessment (HOMA) was used to estimate insulin resistance and the levels were studied in relation to the stroke severity.

Results: A total of 127 non-diabetic ischemic stroke patients were enrolled in the study. Hyperinsulinemia, i.e. serum insulin >9 μU/mL, was observed in 44 (34.64%) patients. IR with HOMA-IR ≥2.5 was noted in 39 (30.7%) patients. NIHSS score in severity (group III) was strongly associated with serum insulin >9 μU/mL (62.1%) (P = 0.001) and HOMA-IR ≥2.5 (62.1%) (P<0.0001).

Conclusions: Screening for insulin resistance in nondiabetic patients with ischemic stroke may identify those who are at higher risk for poor outcomes, allowing for early intervention and closer monitoring. Also, interventions to reduce insulin resistance, such as lifestyle modifications or medications, may be beneficial in improving stroke outcomes.

Effect of remdesivir on mortality rate, need of intubation and mechanical ventilation in COVID-19 positive patients: a retrospective observational study

Anand Nikalje — 2023-05-29

Background: The symptoms of SARS-CoV-2 infection vary widely, from asymptomatic disease to pneumonia and life-threatening complications, including acute respiratory distress syndrome, multisystem organ failure, and ultimately, death. Remdesivir has broad spectrum of activity against members of several virus families, including filoviruses and coronaviruses. Remdesivir is a potent inhibitor of SARS-CoV-2 replication in human nasal and bronchial cells.

Methods: This is a prospective and observational study conducted in patients of either gender, age more than 18 years with confirmed diagnosis of COVID-19 by RT-PCR. A predesigned, pretested and semi structured questionnaire containing socio demographic details like age, sex, BMI, comorbidities, findings of systemic examination of the cases, dose and duration of Remdesivir received and adverse effect due to therapy was used to collect the data.

Results: Mean age of the patients were 56.19±10.93 years. Male patients were 66% and 34% patients were female. After receiving the remdesivir, 43% of the patients needed bag mask and 27% of the patients maintained on room air oxygen. Non-invasive ventilation required in 19% of the patients and 11% of the patient required mechanical ventilation. s14% of the patients needed admission in the ICU. 3.5% of the patients were died and 96.5% patients were discharged from the hospital.

Conclusions: Remdesivir reduces the need of non-invasive oxygenation and mechanical ventilation. Mortality was seen in 3.5% patients, henceforth remdesivir, is an effective drug for moderate to severe COVID-19, if given in early stages of infection.

A study of serum uric acid levels in patients with ischaemic stroke and its relation with hypertension and diabetes mellitus in a tertiary hospital in Goa: a cross-sectional study

Samidha Utkarsh Kurdikar — 2023-05-29

Background: Stroke is second leading cause of mortality worldwide¹ and fifth leading cause of disability-adjusted life years in India. Multiple studies show relationship of serum uric acid levels to prognosis of cardiovascular and cerebrovascular diseases. The present study aims to ascertain relationship of serum uric acid levels with ischaemic stroke and its co-morbidities, hypertension and diabetes mellitus.

Methods: The present cross-sectional study was conducted in a tertiary care hospital in Goa. 100 admitted patients with ischaemic stroke meeting the inclusion criteria were enrolled for the study. Patients were evaluated for hyperuricemia, hypertension and diabetes mellitus. The unpaired student’s t test was used for assessing association.

Results: A total of 100 patients were studied during the study period of 18 months. The mean age among males was 60.92±11.49 years and among females was 70.55±12.03 years. The mean serum uric acid levels in the patients with ischaemic stroke was 6.04±1.09 mg/dl which was significantly higher in male patients. There was a significant association between the mean serum uric acid levels and hypertension and diabetes among these patients.

Conclusions: Serum uric acid levels could be of value in identifying patients at risk of ischaemic stroke especially those with comorbidities such as diabetes and hypertension. Judiciously selecting drugs, which could produce a hypouricemic effect may play a role in preventing ischaemic stroke in such patients. Further prospective studies are needed to establish the role of serum uric acid in ischaemic stroke.

Improvement in maternal child bonding and lactation establishment with antenatal counseling

Pallavi S. Meshram — 2023-05-29

Background: Breastfeeding (BF) is best food source for infants to improve child health, maternal health and mother-infant bonding. We aimed to assess the effect of antenatal education in increasing the frequency and duration of breast feeding and helpful in increasing the intimacy of mother and child and further improve the maternal and fetal outcomes.

Methods: It is a prospective, randomized and interventional study held at tertiary care hospital for 18 months on 200 pregnant females. The counselled group (n=100) received one session of antenatal breastfeeding education, while the non-counselled group received routine antenatal obstetric care with no special intervention applied.

Results: It was observed that the mean age and education of the mothers in the counselled as well as non-counselled group was statistically similar. The mean ANC visits, early initiation of BF, mean BSES and exclusive BF, were significantly higher in the counselled group as compared to non-counselled group. Complications are more in non-counselled group mothers.

Conclusions: This study results demonstrate that a meaningful breastfeeding support and clinical health education can improve exclusive BF and BF self-efficacy with lowers the risk of complications.

Role of renal doppler ultrasonography in evaluating renal haemodynamics in diabetic patients and its correlation with laboratory parameters (serum HbA1C and serum creatinine)

Kritika Sharma — 2023-05-29

Background: Due to high prevalence of Diabetes Mellitus in India, Diabetic nephropathy is on the rise. Diabetic Nephropathy is the leading cause of End stage renal disease and the major factor responsible for renal transplantation. Grey scale ultrasound can detect morphologic renal parenchymal changes late in the disease but the functional haemodynamic changes can be detected early on, by the means of doppler indices such as Resistive Index (RI) and Pulsatility Index (PI). Hence, application of renal doppler can aid in the diagnosis of early nephropathic changes to allow early medical intervention, therefore improving disease prognosis.

Methods: Renal doppler ultrasonography was performed in 64 diabetic individuals, in the main renal artery and at the interlobar arteries of both kidneys in the upper pole, interpolar region, and lower pole. RI and PI were obtained for each artery and averaged. The correlation between the Mean RI and Mean PI, each with HbA1c and serum creatinine was checked for every patient using relevant statistical tests.

Results: Mean RI and PI in study participants were above the normal range. RI and PI both showed a statistically significant positive correlation with serum creatinine, HbA1c as well as the age of the patient and duration of diabetes mellitus (p<0.001).

Conclusions: Evaluation of renal doppler indices while correlating them with laboratory parameters can help slow disease progression. The patient can be provided with medical intervention at the early stage on detection of altered renal indices, hence reducing morbidity and mortality and significantly improving disease prognosis and outcome.

Clinico-epidemiological profile and treatment outcome of pituitary adenomas: a retrospective study

Tavseef Ahmad Tali — 2023-05-29

Background: Aim of this study was to evaluate the clinico-epidemiological profile and treatment outcome of pituitary adenomas.

Methods: This was a retrospective study performed in the department of Radiation Oncology, Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, India, in which 30 cases diagnosed with pituitary adenoma from January 2016 to December 2021 were studied. There clinical and epidemiological features, treatment, overall survival and follow-up data was analyzed.

Results: Most patients were female in gender 17 (57%), and the incidence rate was higher in female patients than male. Microadenoma was seen in just 4 (13%) patients. Macroadenoma in 12 (40%) and giant tumours in 14 (47%). At three and five years, the overall survival rate was 92% and 83%, respectively. Additionally, patients who got adjuvant radiation had a higher overall survival rate (84% versus 76%, p=.833) than those who did not.

Conclusions: Radiotherapy is an effective treatment for pituitary adenomas, able to achieve excellent disease control. Patients with pituitary adenomas should be identified at an early stage so that effective treatment can be implemented. Initial therapy is generally transsphenoidal surgery with irradiation reserved for patients who do not achieve adequate reduction in tumor size after surgery.

Study of sleep disturbances in frontline healthcare workers during COVID-19 epidemic

Deepika Kumari — 2023-05-29

Background: Aim of this study was to study sleep disturbances in frontline healthcare workers during COVID-19 epidemic.

Methods: This is a case control study was conducted in the Department of Physiology at Pt. B. D. Sharma PGIMS, Rohtak. The study included hundred volunteer subjects of age group 25-35years and were divided into two groups (healthcare workers and and professionals from non-medical background).

Results: Subjective sleep quality was significantly altered in FHCW with P value of 0.001. Sleep latency was increased in study group with 50% of study group having score of 3 on Pittsburg sleep quality index. The duration of sleep was reduced in study group with increased sleep disturbances. Forty percent of FHCW reported use of medications for sleep. Almost 100% of FHCW reported Day time dysfunction.

Conclusions: COVID-19 resulted in significant sleep deprivation, increased latency, poor sleep quality and increased use of medication in FHCW. The FHCW suffered from poor quality of sleep during the COVID pandemic. FHCW were affected by several stress factors including heavy workload, high night shift frequency and constant use of PPE kit. All these stress factors affected their quality of sleep.

Effects of preoperative dexmedetomidine on the occurrence of postoperative delirium in adult cardiac surgery patients

Sharad Chandrika Mishra — 2023-05-29

Background: Postoperative delirium (POD) is a serious complication in elderly patients undergoing cardiac surgery. This study was aimed at investigating the effect of perioperative administration of dexmedetomidine for general anesthesia maintenance on occurrence and duration of POD in elderly patients after cardiac surgery.

Methods: This randomized control trial was done in central India after the institution's ethical committee gave their approval. One hundred and sixty-four patients were enrolled after cardiac surgery. Each patient gave their written consent after being fully informed. Patients over 60 years’ old who were going to have heart surgery were included in the study.

Results: The difference in POD incidence between the dexmedetomidine and propofol groups was not statistically significant (p=0.0758). When compared to patients receiving propofol, patients receiving dexmedetomidine had a median delirium onset time that was delayed (second day vs. first day) and a shorter median delirium duration (2 days versus 3 days). Additionally, the patients receiving dexmedetomidine showed a lower VAS score and less use of opiate analgesics. Regarding other postoperative results, no difference was seen.

Conclusions: Dexmedetomidine administration during cardiac surgery decreased the incidence, postponed the onset, and shorten the duration of POD in elderly patients.

Drug utilization study of patients with dermatophytosis attending dermatology outpatient department in tertiary care teaching hospital in Central India

Vandana A. Badar — 2023-05-29

Background: Dermatophytosis is a common fungal infection in India, with prevalence ranging from 36.6% to 78.4%. Treatment options include topical and systemic antifungal agents such as amphotericin B, clotrimazole, miconazole, luliconazole, itraconazole, and terbinafine. With the availability of newer antifungal drugs, a drug utilization study is necessary to understand prescription patterns and promote rational use.

Methods: This is a retrospective observational study conducted among the patients attending outpatient department of dermatology of Indira Gandhi Government Medical College and Mayo Hospital. Prescription of patients with diagnosis of tinea were collected using efficient digital database. These prescriptions were then analysed depending on their demographic profile, treatment and then results were evaluated with the help of MS Excel and results presented as percentage and proportion.

Results: Total 3701 patients had tinea with 1658 females and 2043 males with majority of patients from 16 to 30 years of age. 81% medicine were prescribed using brand names with prescription containing maximum antifungal drugs followed by antihistaminic drugs. Most common drug prescribed was terbinafine (29%), followed by luliconazole (27.46%) and itraconazole (17%). Most commonly topical antifungal agents were prescribed as cream (35.80%) followed by as lotion (26.26%).

Conclusions: Drug utilisation pattern study like this is very important for studying the varying prescription pattern in treatment of dermatophytosis and to make a first step towards uniform and rational drug prescription.

Recent trends in seroprevalence of syphilis in different patient groups attending a regional centre for sexually transmitted infections in central India

Radha D. Datkar — 2023-05-29

Background: Easy access to Suraksha clinics for sexually transmitted infections calls for a review of seroprevalence of syphilis.

Methods: Serum samples from attendees of sexually transmitted infections (STI)/ reproductive tract infections (RTI) clinic/antenatal clinic, and samples of high-risk group (HRG: female sex workers and men having sex with men) brought by non-government organizations from 2017-22 were screened for syphilis by Venereal Disease Research Laboratory (VDRL) and Treponema pallidum hemagglutination (TPHA) tests. Samples positive by both tests were considered seropositive for syphilis. Statistical methods used for analysis were chi square test for linear trends and Kruskal Wallis test.

Results: In STI clinic percentage positivity for syphilis has shown a statistically significant decline from 2017-22. In RTI clinic the decline was significant from 2017-19 but not significant in the years 2019-22. In antenatal clinic and in HRGs the change in seroprevalence was not significant from 2017-22 and 2017-20 respectively. However, the HRGs showed a significantly increasing trend in syphilis seropositivity from 2020-22.

Conclusions: There is a significantly declining trend in the seroprevalence of syphilis in patients attending the STI/RTI clinic from 2017-22 and in HRGs from 2017-20. However, a significant increase in trend in HRG from 2020-22 may have been due to behavioural changes during the lockdown for covid 19 pandemic. A significant decline in syphilis in patients attending the STI and RTI clinic and in HRGs attending the regional centre indicates the effectiveness of consistent detection, treatment and counselling efforts of the national control program on STI in the region.

Antibiotic susceptibility pattern of gram-negative bacterial isolates with special mention on colistin resistance from Intensive Care Unit of a tertiary care hospital: a prospective study assessing the impact of microbial resistance on clinical outcomes

Preethika Ravi — 2023-05-29

Background: The frequent use of broad-spectrum antibiotics in ICU leads to increased rates of antimicrobial resistance and occurrence of multidrug-resistant (MDR) micro-organisms. The aim of this study was to evaluate the antimicrobial resistance pattern and colistin susceptibility among bacterial isolates from ICU patients.

Method: It is a prospective study with 70 nonrepetitive isolates from ICU samples. The clinical data was obtained from the department records. The gram-negative bacterial isolates were identified by conventional biochemical tests. The antimicrobial susceptibility was determined by Kirby-Bauer disc diffusion method. ESBL producers were detected by double disc diffusion test using ceftazidime, cefotaxime alone and in combination with clavulanic acid. MBL detection was done by imipenem+ EDTA combined disc diffusion test. Colistin sensitivity was determined by broth microdilution according to CLSI guidelines.

Results: Out of 70 culture positive specimens. The most common gram-negative bacteria isolated from the samples was Acinetobacter spp. (41%), followed by Klebsiella spp. (20%). Among these 45% were MBL producers, 38.5% were ESBL producers and 14% were both ESBL and MBL producers. Colistin resistance was present among 5.7% isolates in ICU.

Conclusions: Non-fermenters were the most common agent causing ICU infections. An alarmingly high rate of resistance to antibiotics especially to colistin in ICU-acquired infections, necessitates new therapeutic strategies to prevent the emergence and control of antimicrobial resistance.

Nutcracker syndrome: a review

Mariely Ramos-Peralta — 2023-05-12

Left renal vein (LRV) entrapment is an anatomic condition characterized by extrinsic compression of the renal vein and consequent impaired inferior vena cava (IVC) outflow. Nutcracker syndrome (NCS) can be caused by compression of the LRV between the aorta and the superior mesenteric artery or by compression of LRV between vertebral bodies and the aorta. The most common presentations in NS include pelvic or left flank pain, hematuria, gonadal varices, thus the hallmark manifestations of NCS may be related to renal venous congestion and increased pressure within the venous structures. Computed tomography, magnetic resonance imaging and doppler ultrasonography are reasonable imaging studies in patients with suspected NCS, but invasive evaluation with catheter venography and pressure measurement is often required to the definitive diagnosis. For now, it is not possible to standardize a treatment modality, although the trend towards endovascular management is clear; therapeutic strategies with open surgery should not be lost for those cases that correspond to this.

Comparison of the efficacy of interlesional corticosteroid and silicone gel for keloid treatment: a review article

Claudia Felicia Limanda — 2023-05-29

Keloid is an abnormal scar associated with various skin problems including physical and psychological distress. Keloid is often presented as skin itching, swelling, and pain with possible complications such as recurrent sequelae and stigma. Prevention and treatment of this problem include topical non-invasive and invasive options, such as silicon-based products and corticosteroids which are available in the market. Silicon is stated as a standard product, however, is used more often as a combination with corticosteroids than single use. Effectiveness of both products have been discussed separately in previous studies, making it unclear which one is more superior. Thus, a review is needed to ensure their uses in daily practice and to determine their superiority as a single or combination treatment in order to apply them efficiently. Aim of this study is to compare effectiveness of corticosteroids and silicone products to prevent or treat keloid. Keywords such as "keloid," "corticosteroid," and "silicone products" were used in PubMed, national library of medicine, ResearchGate, and dermatology textbooks. Journals found were analyzed for their validity and reliability before the compilation of this review article. Results found stated that both silicone pharmaceutical products and corticosteroids have their own benefits and risks. In addition, according to their treatment phase, they can be used as single or combination treatment. However, due to limited existing studies found, further research is necessary.

Women with a history of congenital anomaly: preparation for next pregnancy

Adhi Pribadi — 2023-05-29

Congenital diseases are damaging to the fetus and have an influence on the length of pregnancy. Some congenital problems can still be fixed after birth, however the costs are significant. Prophylaxis is strongly advocated to reduce the risk of congenital abnormalities during preconception. The incidence of congenital anomalies in the first pregnancy is associated with a 2.5-fold increased risk of recurrence in future pregnancies. The likelihood of recurrence is more than 24 times larger for the same type of aberration, but just 1.4 times for separate anomalies. The MTHFR-folate gene polymorphism has been related to an increased frequency of neural tube anomalies. Infectious diseases and environmental teratogens have an effect on genetic or epigenetic factors. Environmental elements that are repeated such maternal diabetes, obesity, and nutritional shortages seem to increase the incidence of fetal malformations. Alcohol, nicotine, or psychotropic drugs can all be teratogens. The promotion of contraceptive usage, optimization of weight and micronutrient status, prevention and management of infectious illnesses, birth spacing and the prevention of adolescent pregnancy, screening for and the management of chronic diseases are a few of these interventions. In conclusion, the probability of recurrence is quite high in the category of congenital defects, particularly for similar anomalies. Structural abnormalities can be decreased even further with proper planning and preparation, especially in high-risk populations. Moreover, preconception intervention have the potential to minimize congenital malformations.

A review on determinants and barriers affecting the transition from curative care to palliative care in patients suffering from terminal cancer

Karan Sharma — 2023-05-29

The integration of palliative care into comprehensive cancer care has become increasingly recognized as an essential aspect of cancer treatment. Palliative care can improve patient outcomes, symptom management, and overall satisfaction with care. However, despite the benefits of palliative care, several barriers exist that prevent its widespread implementation, including lack of awareness and understanding of palliative care, lack of access to palliative care services, and stigma associated with palliative care. The decision to transition from curative to palliative care is complex and influenced by several factors, including patient preferences, disease stage, and prognosis, symptom burden, comorbidities, and social support. Effective communication between healthcare providers, patients, and families is essential in ensuring that patients are informed about their options and can make informed decisions about their care. This literature review aims to explore the factors that influence the decision to transition to palliative care and to identify the barriers to the implementation of palliative care in cancer patients. The review also discusses strategies to overcome these barriers and highlights the importance of integrating palliative care into cancer care from the time of cancer diagnosis.

Renal involvement in COVID-19: a review report

Pinki Pandey — 2023-05-29

COVID-19 is recent emerging pandemic caused by SARS-CoV-2 (severe acute respiratory syndrome- Coronavirus). It is seen mainly affecting lungs, but many recent studies have shown involvement of hematological, kidney, gastrointestinal and other systems. In kidneys it mainly affects the tubules and interstitial areas. The main pathology behind involvement of renal system in COVID-19 is due to presence of ACE 2 receptors in proximal tubules. These receptors are same like that found in lungs and they form binding sites for coronavirus and hence causing the disease. Therefore, patients presenting with raised serum urea and creatinine should be checked for potential renal damage caused by virus and their urine samples should also be tested for presence of coronavirus. Effective testing and prompt management will prevent this virus from being transmitted in community.