International Journal of Research in Medical Sciences

A Colocolonic intussusception in an adult secondary to an inflammatory polyp of the transverse colon - clinical case

2023-02-03T19:14:14+00:00

There are multiple causes of colocolonic intussusception in adults, such as tumors, autoimmune pathologies, previous abdominal surgeries, and gynecological conditions. Associated complications are small bowel obstruction, ischemia, necrosis, perforation with peritonitis, and sepsis that require urgent attention. A 78-year-old woman who started with colic in the mesogastrium of 5 months of evolution and changes in bowel habits. She went to the emergency room due to intense pain in the mesogastrium. On physical examination, she presented dehydration of the mucous membranes and pale integuments, pain on superficial and deep palpation in the mesogastrium. Admission laboratories: leukocytosis 17,110/ul, neutrophilia 67.9%, hydroelectrolyte imbalance: mild hyponatremia, mild hypochloremia, slightly prolonged coagulation times, normal blood chemistry. Abdominal ultrasound with "pseudokidney" image. Computed tomography reports an image of the introduction of a segment of the transverse colon into a contiguous segment of the same, with data of associated intestinal pneumatosis. Due to the previous findings, an emergency exploratory laparotomy was performed. Invagination of the transverse colon is located, accompanied by dilation of the vessels of the greater omentum; it is reduced manually, an enterotomy is performed and a tumor dependent on the wall is located, for which a 25 cm transverse colon resection, end colostomy and mucous fistula are decided. Pathology report reports inflammatory polyp. In the postoperative period, the patient improved and was discharged. Abdominal pain is the common presentation of intussusception; however, given its rarity in adults, the possibility of missing the finding on abdominal imaging leads to misdiagnosis.

An interesting case of genital infantile hemangioma

2023-02-06T10:28:24+00:00

Vascular lesions are commonly seen in newborns. They may be present at birth or appear in the days, weeks or months that follow. Most are benign and self-limiting but rarely they may be part of complex syndromes or systemic disorders, or they may be associated with complications requiring treatment. This is a case of a 2-month-old baby presenting with an Infantile hemangioma in the genital region.

Dapsone hypersensitivity syndrome: a case in rural area of Indonesia

2023-02-25T03:34:36+00:00

Dapsone hypersensitivity syndrome is a potentially fatal adverse drug reaction ranging from mild to severe involvement. If left unrecognized and untreated, this syndrome may lead to death. We reported a 19-year-old female with dapsone hypersensitivity syndrome in the rural area of Papua, Indonesia. The diagnosis was made clinically with some supporting laboratory examinations. The patient was planned to be given systemic corticosteroid of dexamethasone along with supportive care. However, due to the limited resources, dexamethasone could not be given daily to the patient leading to a poor clinical outcome.

Intestinal intussusception due to “Rapunzel syndrome” in an adult

2023-01-09T04:12:58+00:00

The bezoars are collections of foreign bodies or ingested material that accumulate over time and are often located in the stomach or small intestine,but can be found throughout the digestive tract. Most bezoars are of indigestible organic matter such as trichobezoars (hair); or vegetable and fruit- phytobezoars; or a combination of both but other rare substances have also been described in literature. In some cases, the trichobezoar extends through the pylorus into duodenum, jejunum or even into the colon. Rapunzel syndrome is a rare manifestation of a trichobezoar, which occurs when strands of swallowed hair extend beyond the pylorus of the stomach, into the intestine as a tail. It was first described by Vaughan et al in 1968. Trichobezoars can block the intestinal tract and, if left untreated, can be a life-threatening emergency requiring surgery. Patients are often women, under the age of 20 and have insidious non-specific abdominal symptoms and staggered presentations over months to years. The diagnosis of this type of pathology is usually a challenge for the attending physician, so we present a case report of a 38-year-old female with gastric-intestinal occlusion secondary to trichobezoar.

Hepatic hematoma following endoscopic retrograde cholangiopancreatography: overview and case report

2023-02-05T21:23:23+00:00

Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure with a high risk of complications. Hepatic subcapsular hematoma is an infrequent complication, with few cases reported in the international literature. Treatment can be conservative with the patient under close surveillance in an intensive care unit and surgical management is reserved for failure of conservative treatment and cases with hemodynamic instability. We present a case of subcapsular and intraparenchymal hepatic hematoma in an adult male who presented sudden hemodynamic instability, associated with hemoglobin decrease, which required surgical management. The challenge in the therapeutic decision due to sudden hemodynamic instability is clearly demonstrated; therefore, there was a need for surgical treatment as the best measure of hemorrhage control. Conservative management should be reserved for hemodynamically stable patients and invasive management by interventional radiology or surgery for cases of acute abdomen associated with hemodynamic instability.

Omphalocele and macroglossia: a case of Beckwith-Wiedemann syndrome

2023-02-18T17:06:18+00:00

Beckwith-Wiedemann syndrome (BWS) is a pediatric overgrowth disorder which predisposes to tumor development. The following case study examined a prenatal finding of omphalocele with postnatal findings of macroglossia and cutaneous hemangioma, ultimately leading to a diagnosis of BWS. This case highlighted the features of BWS, the diagnostic principles and the importance of a multidisciplinary team approach to its management.

Drainage of the hepatic cyst by laparoscopy - clinical case

2023-02-03T20:37:04+00:00

Liver cysts are formations of serous content surrounded by normal liver parenchyma, without communication with the bile duct. The cyst wall is generally lined with cuboidal epithelium surrounded by layers of connective tissue. They are rare entities in adult patients, generally, they are asymptomatic in 3%, and between 10-15% of all patients will generate symptoms that lead them to consult. A 38-year-old man with an external abdominal tomography study that reported a giant hepatic cyst. Laboratory blood tests: hemoglobin 7.9 g/dl; leukocytosis 11,000/ul; serum electrolytes, liver transaminases, and bilirubin were normal, alkaline phosphatase, and gamma glutamyl-transpeptidase 94 U/l and 241 U/l, respectively. Non-reactive anti-human immuno-deficiency virus (HIV 1) and two antibodies, venereal disease research laboratory (VDRL), cancer antigen (CA) 19-9 antigen, hepatitis B-C surface antigen, and carcinoembryonic antigen were negative. He underwent surgery by laparoscopic drainage of the liver cyst, through a median infraumbilical incision with the Hasson technique and placement of three 12 mm trocars, hepatomegaly was observed without finding an exit site for purulent material, it was punctured through liver segment V, and 2000 ml of citrine fluid was extracted. The hepatic wound is addressed with a 1-0 caliber chromic catgut thread, placing a Penrose-type drain. At 48 hours postoperatively, it evolves favorably, so it is decided to discharge. Hepatic cysts are fluid-filled cavities lined by a single-layered cuboidal or columnar biliary epithelium in the liver. A majority of hepatic cysts are found incidentally on liver imaging, such as abdominal ultrasonography, computed tomography, or magnetic resonance imaging.

Bilateral cerebral oxygen saturation monitoring in carotid body tumour excision under general anaesthesia: a case report

2023-02-28T17:04:20+00:00

Carotid Body tumour is an uncommon non-chromaffin paraganglioma arising from chemoreceptor cells at the external and internal carotid artery bifurcation. The reported incidence is 1-2 cases per 1,00,000 population. Surgical excision is extremely difficult and possess challenges to both surgeon and the anaesthetist. We report here a case of CBT excision with the use of cerebral oximetry to reduce the chances of intra-operative cerebral ischemia.

An anomalous origin of 1st lumbrical: a case report

2023-02-18T15:35:53+00:00

Hand is an organ of prehension. Human hand is an example of revolution in evolution. It is endowed with skilled movements. It consists of different group of muscles, ligaments, joints which are responsible for the fine movements of hand. It also contains neurovascular structures which are the terminal branches of median nerve, ulnar nerve and radial nerve. The terminal branches of ulnar and radial arteries provide the arterial supply. Here, we have reported the variant of lumbrical muscles. Lumbricals perform movements on metacarpophalangeal joints, proximal interphalangeal joints and distal interphalangeal joints. Lumbricals are spindle rich fibres. Variations in the structures present are immensely important for the orthopaedic surgeon, digital transposition surgery, cleft hand surgery etc. Anatomically, incursion of the lumbricals inside the carpal tunnel may lead to work related carpal tunnel syndrome.

Colonic perforation secondary to post traumatic diaphragmatic hernia: a case report

2023-02-23T09:35:07+00:00

Post traumatic diaphragmatic hernia (PTDH) is a rare cause of large bowel obstruction, and can present weeks or years after the initial trauma. We report the case of a 42 years old male adult who presented in emergency with features of acute generalised peritonitis secondary to closed loop obstruction. Patient had history of fall leading to blunt trauma chest 9 months back which was managed with Intercostal drainage (ICD) left chest at that time. Chest radiography showed multiple air-fluid levels in the left upper quadrant, an air-fluid level in the left thoracic cavity and significant free air under the right side of diaphragm. On laparotomy there was feculent material in abdominal cavity, dilated caecum, ascending colon, transverse colon with invagination of splenic flexure of colon into thoracic cavity. A segment of transverse colon was gangrenous and there was a perforation of size 2 x 2 cm present. Right hemicolectomy performed and loop ileostomy along with DMF transverse colon fashioned in emergency setting. Diaphragmatic hernia repaired after 3 months. Posttraumatic diaphragmatic hernias should be part of the differential diagnosis for patients with bowel obstruction, especially if there is a history of trauma. Radiography is useful in facilitating a quick diagnosis. When patients present complications, there is a higher rate of morbidity and mortality (31%) therefore emergency surgery is mandatory.

Osteosarcoma: a fluid cytologic diagnosis

2023-02-24T09:47:05+00:00

Osteosarcoma is the most common malignant bone tumor characterized by the formation of disorganized immature bone or osteoid tissue from mesenchymal tumor cells. It most commonly occurs in the appendicular skeleton involving the metaphysis of long bones. It is the third most common cancer in adolescence with an annual incidence of 5.6 cases per million children under the age of 15 years. Giant cell-rich osteosarcoma (GCRO) is an exceedingly rare histological variant of conventional primary osteosarcoma. It constitutes about 1%-3% of all osteosarcomas. A 20-year-old male presented with the complaints of pain and swelling over the right knee. Examination revealed a tender 15×10×8 cm swelling palpable on the distal femur. Radiological investigations showed features suggesting right femoral osteosarcoma in the meta-epiphyseal region. A core needle biopsy from the lesion was performed and 15 ml of fluid obtained from the biopsy site was sent for cytological examination, which showed features suggestive of osteosarcoma. Biopsy showed features of osteosarcoma probably of giant cell rich type confirming the fluid cytology findings. Cell block preparation also revealed giant cell predominance. Osteosarcoma is a bone tumor found in areas of rapid bone turnover, most commonly the distal femur and proximal tibia of adolescent patients. Cytology plays a vital role in diagnosing bone tumors, being a rapid, easy, and minimally invasive outpatient department procedure. Histopathology, since it gives a complete architectural pattern of tissue, remains the gold standard diagnostic tool.

Atypical chest pain with non-specific ST changes: an incidental finding of myocardial bridge without flow limiting coronary lesion

2023-02-02T20:14:45+00:00

Myocardial bridging is a developmental anomaly characterized by intramural course of a short segment of epicardial coronary artery which mostly remains silent in the initial few decades of life. A 42 years old male non diabetic, hypertensive on single regime therapy presented with atypical chest pain for the last two hours. Serial 12 lead ECGs on an interval of half-hour showing nonspecific dynamic ST changes in lead II, III and aVF suggesting of inferior wall changes with negative bio markers like troponin-T and troponin-I. Coronary angiography reveals myocardial bridge in mid segment of left anterior descending artery (LAD). Considering superficial type of bridging in this case, a conservative management strategy was planned accordingly. Physicians should be more vigilant on possibilities of underlying myocardial bridging as a major differential in emergency scenarios with low suspicion of atherosclerosis but with a picture equivalent to acute coronary syndrome (ACS). Myocardial bridge carries a wide array of complications depending on variabilities like depth of tunnelling, collapsibility, loss of wall sheer stress and vasospastic changes. Hence it needs to be promptly diagnosed with immediate treatment.

Extrafollicular adenomatoid odontogenic tumor: a case report

2022-12-10T00:41:41+00:00

Adenomatoid odontogenic tumor (AOT), a benign epithelial odontogenic tumor, constitutes around 2-7% of all odontogenic tumors that are biopsied. This lesion is unique with regard to its clinical, radiographic, and histopathological features making its diagnosis more predictable. This article emphasizes an extrafollicular variant of AOT leading to maxillary anterior jaw swelling along with cortical plate expansion, perforation, and root resorption within a short duration of time pointing towards its aggressive nature.

Gastrointestinal stromal tumours: a series of 5 cases with review of literature

2023-02-22T13:06:49+00:00

Gastrointestinal stromal tumors (GISTs) are the most common malignant mesenchymal lesions of the gastrointestinal tract originating from the interstitial cells of Cajal. They are characterized by overexpression of the tyrosine kinase receptor, protein product of c‑KIT gene (KIT). In this case series we retrieved from our database, a total number of 5 patients, admitted and operated in the surgical department of Gauhati Medical College and Hospital and histopathologically diagnosed as GIST in the Pathology department of Gauhati Medical College and Hospital. The age range of the patients was 25 to 55 years, with mean age of 43.6 years. Out study population consisted of 2 males and 3 females. Out of 5 cases, 1 occurred in the stomach, 2 in jejunum, 1 in ileum and 1 involved the ileocaecal region; 2 were diagnosed as Malignant GIST and 3 as Benign. The differential diagnoses for spindle cell GISTs are leiomyoma, leiomyosarcoma, intra-abdominal desmoid fibromatosis, schwannoma, inflammatory myo-fibroblastic tumor and solitary fibrous tumor and that for epithelioid GIST include neuroendocrine carcinoma. Knowledge of the differential diagnoses of mesenchymal lesions of the gastrointestinal tract is important to accurately diagnose both GIST and non GISTs as the management approach is very different.

The relation between obstetric conjugate diameter during pregnancy and the type of delivery: a narrative review

2023-02-20T20:54:34+00:00

Obstetric conjugate diameter is the first point of the maternal pelvis through which the head of the fetus has to pass during the stages of birth and it is the most important female pelvimetry during pregnancy. This review aims to find out the relation between obstetric conjugate diameter measured by radiography during pregnancy and the type of birth, vaginally, or by caesarean. Narrative review conducted at Najran Medicine College (Kingdom of Saudi Arabia).

METHODS: Articles review describing the association between obstetric conjugate diameters measured by radiography during the last stage of pregnancy and type of delivery were selected from the electronic database (PubMed, LILACS, SciELO, and Google scholar). The search date was on January to February 2023. This review showed that there is a relationship between obstetric conjugate diameter and the type of delivery and can be used in predicting the mode of birth (vaginal or cesarean). This knowledge is important for obstetricians and gynecologists to predict the type of childbirth, vaginally, or by cesarean.

Organochlorine pesticides application, xenobiotic metabolizing gene polymorphism and incidences of cancers in India: a review

2023-02-21T03:56:56+00:00

Excessive application of pesticides on crops has been noticed to gain maximum yield. It results in heavy damage to human health as well as environment. Pesticides application beyond permissible limit has detrimental effects on ecosystem. Organochlorine compounds are widely used as pest controller. These are considered as substantial environmental pollutant and carcinogens due to their extensive environmental release. There are sufficient numbers of studies that supports positive co-relation of organochlorine pesticides with cancer. To evaluate these detrimental effects on human health we have reviewed various studies and concluded the positive co-relation of organochloro compounds with cancers. In this study, the altered metabolism effects of organochlorine pesticides on cytochrome P450 enzyme have been observed.

An evidence based review on effect of oral motor therapy on feeding in preterm infants

2023-02-18T13:48:50+00:00

Present study was done to know the effect of Oral Motor Therapy on preterm infants for feeding and related issues. Most preterm infants have low body weight, immature brain development, sucking and swallowing problems, and decreased oral motor ability, which affects infants' growth and normal development. Oral Motor Therapies are used to increase functional strength and control of movement for feeding, to promote the onset of oral feeding, and to improve oral feeding performance. The study started with the search articles on Google Scholar, ResearchGate, Cochrane and PubMed with keywords in range of year 2012-2023. 250 articles were found from the sources. 46 articles were studied which were related to aim of the study. From all of them 10 articles were selected on the basis of inclusion criteria. All the articles suggested improvement in all the post intervention outcomes which showed clinical significance of the Oral Motor Therapy. The study hereby concluded that Oral Motor Therapy is useful in preterm infants for feeding initiation and progression, weight gain as well as in dysphagia rehabilitation and reduced hospital stay.

A prospective study on the role of immunotherapy in metastatic cancer patients at Combined Military Hospital Dhaka

2023-03-08T17:21:12+00:00

Background: Immunotherapy is a treatment that uses a person’s immune system to fight cancer. Immunotherapy can boost or change how the immune system works so it can find and attack cancer cells. Among several cancers, metastatic cancer causes high mortality, and immunotherapies are expected to be effective in the prevention and treatment of metastatic cancer patients. In Bangladesh, we do have not enough research-based information regarding the role of immunotherapy in treating metastatic cancer patients. This study aimed to assess the role of immunotherapy in treating metastatic cancer patients.

Methods: This prospective observational study was conducted in combined military hospital Dhaka, Bangladesh during the period from 26 March 2021 to 21 July 2022. In total 19 patients with metastatic cancer were enrolled in this study as study subjects. Proper written consent was taken from all the participants before data collection. Two (02) different outcomes were studied in this study; progression-free survival (PFS) and side effect percentages. A predesigned questionnaire was used in data collection. All data were processed, analyzed, and disseminated by using MS excel and SPSS version 23 program as per necessity.

Results: In using pembrolizumab, side effects, fatigue, nausea, and decreased appetite were found 43%, 22%, and 20% lesser respectively than chemotherapy which was noticeable. In using nivolumab, as a side effect, skin rash was found 66% lesser than chemotherapy. Besides this, itching, face swelling, and apnea was found 33% lesser. On the other hand, in using atezolizumab, as side effects, swelling of arms and constipation were found 66% lesser, and itching, as well as apnea, was found 33% lesser than that in chemotherapy. At the 6-month follow-up we observed that in the nivolumab and atezolizumab treated groups 66% of cases survived separately whereas, in pembrolizumab treated group, 61% survived.

Conclusions: In this study in all treatment groups, side effects were found as lesser than that in using chemotherapy. No major complication of any patients was observed in this study. So, can conclude that immune checkpoint inhibitors (ICIs) are better choice for metastatic diseases and ICIs exert lesser side effects than conventional chemotherapies.

Validation of the Indonesian version of the non-motor symptoms scale for Parkinson’s disease

2023-03-04T14:53:00+00:00

Background: Non-motor symptoms are common, have a wide range of symptoms, and have emerged as a key determinant of poor quality of life (QoL) in Parkinson’s disease (PD) patients, contributing to severe disability, and shortened life expectancy. However, although common, the non-motor symptoms of PD are often not well recognized and under-reported in clinical practice. This study aimed to translate the origin non-motor symptoms scale for PD (NMSS), which was written in English, into an Indonesian version and to evaluate its reliability and validity.

Methods: Linguistic validation and psychometric analysis of the Indonesian version of NMSS were conducted in 70 patients with PD using a cross-sectional study. The acceptability, reliability, and construct validity of NMSS were analyzed. Test-retest reliability was assessed over a time interval of 14 days in all patients.

Results: The 70 patients were assessed (median age 67.5 years; 57.1% males; median duration of illness 48 months; median Hoehn and Yahr stage: 3). Mean NMSS was 51.86 (SD 44.02; median 37). Neither floor nor ceiling effect was observed on the Indonesian version of the NMSS total score. Validity test using Pearson product moment showed all 9 domains Indonesian version of NMSS were valid (r=0.506-0.805, p<0.001). NMSS total score showed satisfactory reliability (Cronbach’s α coefficient on the total score was 0.852, the range for domains: 0.146-0.814).

Conclusions: Indonesian version of NMSS showed good reliability and validity for the assessment of non-motor symptoms in PD patients in Indonesia.

Depression, self-esteem disorders and emotional distress during the COVID-19 pandemic in the elderly population of Mexico City and the metropolitan area of the valley of Mexico (a preliminary study)

2023-03-11T13:31:14+00:00

Background: SARS-CoV-2 has spread over the world and caused concern and panic in the elderly, which can promote the development of mental illness. The main aim of this study was to identify depression and self-esteem disorders in the elderly population of Mexico City and the metropolitan area of the valley of Mexico in the context of the COVID-19 pandemic.

Methods: A non-experimental, observational, cross-sectional, correlational and descriptive study was conducted via means of a survey distributed and applied via telephone and online using Google Forms among the elderly via snowball sampling. Data was analysed in Microsoft Excel and bivariate analysis was performed using Chi squared test with a statistical significance of p≤0.05.

Results: The sample was conformed by 175 participants, 115 were female and 60 were male. 4.35% of women and 1.67% of men showed depression and 16.52% of women and 10% of men had mild symptoms of depression while 6.69% of women and 1.67% of men showed symptoms indicative of low self-esteem and 14.78% of women and 10% of men showed normal self-esteem. Women recorded higher levels of depression (p ≤ 0.01) and men recorded lower levels of self-esteem (p≤0.01). Participants with diabetes showed lower levels of self-esteem and higher levels of depression in comparison to people without diabetes (p≤0.05).

Conclusions: It is suggested in making use of the technologies that have emerged to do telemedicine and to keep in touch with patients. This is a preliminary study; future research should be done on a larger sample.

The effect of applying alarm fatigue strategies related to nursing performance

2023-01-26T12:12:20+00:00

Background: Nurses working in an intensive care unit (ICU) are dependent on various medical devices to assist with patient monitoring, care and safety. Alarm fatigue is a consequence of an excessive number of alarms in the practice environment. The goal of this research was to identify the effect of applying alarm fatigue strategies related to nursing performance and to evaluate nurses’ perceptions concerning to alarm fatigue in intensive care unit King Abdullah medical city, Makkah.

Methods: The study type was a cross-sectional design. A sample of 85 nurses was obtained using a survey instrument that was created using a structured self-administered questionnaire designed based on literature review.

Results: The most rated mean score for Strategies that reduce the alarm fatigue was education and remaining was optimized technology, electrodes, setup customized alarms, and attitude respectively. When proving hypothesis, the findings demonstrate that there are no statistically significant differences between the nurses’ alarm fatigue with study variables including gender, age, professional experience and staff position. The use of an evidence-based alarm management strategy can reduce alarm fatigue and ensure the safety of all monitored patients. Therefore, the above strategies on alarm management will be beneficial to reduce the alarm fatigue.

Conclusions: This study’s findings have several practical implications on reducing alarm fatigue in intensive care unit. Nurses play a significant role on monitoring the patients, which may leads to alarm related fatigue.

Spectrum of ultrasonographic findings in gynaecological emergencies in a Nigerian Tertiary Hospital

2023-01-16T12:17:46+00:00

Background: Gynaecological emergencies are a common cause of morbidity and mortality among women of reproductive age group worldwide and can be life threatening. They can be easily managed if diagnosed early. Ultrasonography (USS) is a readily available and excellent diagnostic tool in the prompt and accurate diagnosis of these conditions. This is a comparative study aimed at evaluating the ultrasonographic findings in gynaecological emergencies and comparing with the clinical diagnosis.

Methods: 400 patients presenting with suspected gynaecological emergencies at the National Hospital, Abuja were evaluated. The USS findings of these patients were recorded and matched with their socio-demographic parameters and the radiological diagnosis was then compared with the clinical diagnosis at presentation.

Results: The mean age of participants was 34.2±7.5 years. Pregnancy related emergencies were the most common, making up 65.8%. Abortion was the most common emergency seen. Pregnancy related cases were commoner in the younger age group 20-39 years. A higher proportion of USS diagnosis for pregnancy related cases (96.7%) corresponded with the clinical diagnosis when compared to a smaller proportion for non-pregnancy related cases (80.6%), and this had significant correlation (x²=256.12, df=1, p<0.0001)

Conclusions: USS evaluation of gynaecological emergencies as seen in this study, allows for quick and accurate diagnosis so that appropriate emergent care can be instituted to improve the outcome in these cases.

Oral health related disorder among children with behavioral problems

2023-01-27T05:31:10+00:00

Background: The best mouth function, the absence of disease, and oral health are achieved by maintaining the highest self-esteem possible. When someone has good dental health, they can communicate and connect with people without getting sick, feeling uncomfortable, or feeling embarrassed. This study aimed to evaluate the Oral health-related disorder specifically to assess dental caries and gingivitis among children with behavioral problems.

Methods: This study was a prospective cross-sectional investigation carried out at Kalachandpur Government Primary School and Jashim Uddin Institute, Dhaka. The study was carried out between October 2021 and December 2022 and included 650 pediatric patients who were aged between 6 to 15 years.

Results: Most 290 (44.62%) children were aged 6-9 years, 250 (38.46%) were 10-12 years, and the rest 110 (16.92%) were 13-15 years old. Patients with 11-15 years had lower dental caries. 310 (48%) were female, and 340 (52%) were male. Dental caries is associated with elevated risk. Children in the elevated caries risk group had a significantly higher mean value of conduct problems and Hyperactivity/inattention based on the SDQ compared to those with low caries risk. No statistically significant differences were found between the low caries risk group and the elevated caries group for the other subscales.

Conclusions: There were statistically more children in the study group who had a high risk of getting caries. Behavior problems were observed while externalizing children who had a high risk of getting caries. Children with externalizing behavior also have more conduct problems and hyperactivity compared to children with reduced caries risk.

Frequency of venous thromboembolism during hajj sessions 2017-2019 in Makkah, Saudi Arabia

2023-01-28T15:16:00+00:00

Background: Venous thromboembolism (VTE) includes deep vein thrombosis (DVT) and pulmonary embolism (PE), both are serious health risks. In western countries, VTE affects about 114 to 184 people per 100,000. Asian populations have a significantly lower incidence than western populations. The true incidence of VTE is still not well documented in Saudi Arabia (KSA). There are different major risk factors especially in hajj season that predispose a person to thrombosis. The mortality rate of autopsy-based pulmonary embolism reaches up to 30%.

Methods: This single-centered retrospective descriptive study was done in security forces hospital Makkah, Saudi Arabia during hajj period (30 days) for consecutive three-year. All admitted confirmed DVT and PE patients (N=32) of both genders with age >14 years were included. Patients’ data were extracted from the electronic medical record. Data were analysed by SPSS version 23.

Results: Deep venous thrombosis (DVT) was developed in 67.7% while 19.3% of patients suffered from pulmonary embolism (PE) out of a total of 32 subjects. Females were more affected by 18 (56.3%) than males by 14 (43.8%). The mean age of patients was 51.78 years (SD ±16.21). A statistically significant association (p<0.005) between provoked VTE status and age, immobility, and history of surgery was seen. There was no mortality documented in this study.

Conclusions: This study provides insights into hajj period hospital admitted patients’ frequency of VTE, changing patient profiles, management strategies, and subsequent outcomes in patients with venous thromboembolism. There is a need for greater awareness of VTE prophylaxis about its prevention, especially in hajj season.

The effects of stress biomarkers on sex hormones, sperm quality and quantity in infertile men in Abuja, Nigeria

2023-01-11T10:06:25+00:00

Background: Studies have shown the adverse effects of stress on infertility. It has been reported that 40% of infertility cases are attributed to the men. Therefore, this study is aimed at determining the effects of stress biomarkers on sex hormones, sperm quality, and quantity in men investigating infertility.

Method: A total of one hundred and fifty-two (152) participants were recruited into a case control study between September 2018 to August 2019. Prolactin, testosterone, follicle stimulating hormone (FSH), luteinizing hormone (LH), salivary cortisol and salivary alpha amylase were estimated using both competitive and non-competitive enzyme linked immunosorbent assay (ELISA) techniques; semen was examined directly after liquefaction according to world health organization criteria.

Results: The mean and standard deviation of testosterone, FSH, sperm cells count and sperm activity (%) were significantly lower (p<0.05) in the men study group relative to the control group; while prolactin, salivary cortisol and alpha amylase were significantly higher (p<0.05) in the men study group relative to the control group. There was no significant difference in the value of LH in the men study group compared with the men control group (p>0.05).

Conclusions: Stress in men affects sex hormones, semen quality and quantity. Both conditions of oligospermia and azospermia were observed in the men study group, with associated hormonal abnormalities, decrease in sperm quality, quantity and elevated stress biomarkers.

The relationship between the axial length of the eye ball and the retinal vein occlusion

2023-02-08T15:41:59+00:00

Background: Retinal vein occlusion is one of the most common form of retinal vascular diseases. There’s a need for better understanding of various predisposing factors and pathophysiology of retinal vascular occlusions in order to improve the treatment modalities and have a better visual outcome including the relationship between axial length and retinal vascular occlusions.

Methods: The study was conducted on 60 patients attending the eye OPDs of upgraded department of ophthalmology of government medical college, Jammu during a period of six months from April 2022 to September 2022. 30 patients were clinically diagnosed cases of retinal vein occlusion whereas 30 patients were their age and sex matched controls. The axial length of both eyes of all the patients were measured using A scan Biometry. The data was then analysed by student t test and chi square test.

Results: It was found that the axial length of the affected eye was significantly shorter than the unaffected eye and the axial length of the unaffected eye was also significantly shorter than the control eye.

Conclusions: It was concluded that the axial lengths in the patients having retinal vein occlusion were significantly shorter than the controls. The significant difference in the axial lengths can be a risk factor in the development of retinal vein occlusion.

Correlation of myopia with age, axial length and anterior chamber depth

2023-02-24T09:47:43+00:00

Background: Uncorrected myopia or near sightedness is a major cause of vision impairment and legal blindness in younger population. It has huge social, psychological, economic and developmental implications. Changes in anterior chamber depth and a significant increase in axial length increase the risk of myopia which can lead to a number of visual complications.

Method: This hospital based observational study was conducted in the OPD of department of ophthalmology, government medical college, Jammu over a period of one month from November 2022 to December 2022. A total of 100 patients were involved in this study. Data was interpreted in both descriptive and inferential statistics i.e., frequency and percentage distribution by using SPSS, version 22.

Results: It was observed that maximum patients were in the age group of 21-30 years (46%) and male:female ratio was 1.38:1. A positive correlation was found between myopia with axial length and anterior chamber depth (p<0.05).

Conclusions: Understanding the role of ocular biometric parameters in myopia is important in not only interpreting the disease pattern but also modelling the pathology and management of ocular diseases. It will go a long way in reducing the burden of myopia and its associated complications.

Hyperphosphatemia-a predictor of poor prognosis among patients with sepsis or septic shock

2023-02-24T06:55:02+00:00

Background: Sepsis is a life-threatening organ dysfunction resulting from dysregulated host responses to infection. Serum phosphorus level was closely related to the occurrence and prognosis of kidney disease and cardiovascular disease. It is of vital importance to re-evaluate the association between serum Phosphorus level and mortality in patients with sepsis and different septic subgroups. This study aims to examine the association of serum phosphorous levels with clinical outcomes among patients with sepsis.

Methods: This study included 100 cases and was conducted at KIMS hospital Bangalore. Patients were included in the study as per inclusion criteria. SOFA scoring and APACHE-II scoring was done on first day of admission and serum phosphorus levels were sent. Patients were categorised according to phosphorous levels normal range (2.5-4.5mg/dl). Patients were followed up till primary and secondary outcome.

Results: Of the 100 patients in this study 53 patients had normophosphatemia, 17 patients had hypophosphatemia, 30 patients had hyperphosphatemia. Comparison of mean APACHE-II scores, mean length of ICU stay (in days), mean length of hospital stay (in days), serum creatinine levels, between 3 groups was statistically significant.

Conclusions: Hyperphosphatemia on first ICU admission day indicates poor clinical outcome among patients with sepsis or septic shock. Therefore, when patients are on ICU admission and under treatment, clinicians should pay more attention to the change of serum phosphate.

Correlation of sinonasal polyposis with chronic suppurative otitis media

2023-02-27T09:39:34+00:00

Background: Aim of the study was to assess correlation of sinonasal polyposis with CSOM. To see the role of lignocaine nebulisation and to compare its role with use of steroids and bronchodilators alone in post bronchoscopy patients.

Methods: In the present study, 50 patients of sinonasalpolyposis were subjected to otoscopic, microscopic examination of tympanic membrane findings and tuning fork tests were performed. Pure tone audiometry (PTA) was also done in all patients. High resolution computed tomography (HRCT) of temporal bones and computed tomography (CT) of paranasal sinuses were used to assess otological and sinonasal pathology.

Results: Out of 50 patients, males were 26 and females were 24. Age group 11-20 years had 8 males and 8 females, 21-30 years had 5 males and 7 females, 31-40 years had 11 males and 8 females and 41-50 years had 2 males and 1 female. Left side was involved in 6, right in 9 and both sides in 10 patients. Swab cultures revealed pure aerobic isolates in 16, mixed aerobic and anaerobic isolates in 10. Micro-organisms were staphylococcus aureus in 10, Pseudomonas aeruginosa in 6, Streptococcus spp. in 5, Peptostreptococcus in 3 and Bacteroides in 2 cases. The difference was significant (p<0.05). Out of 50 Sinonasal polyp patients, 26 (52%) had CSOM. Type identified was tubotympanic in 12 and atticoantral in 14. There was positive pearsoncorrelation of CSOM with sinonasal polyp (r value of 0.92, p value 0.021).

Conclusions: In the present study there was positive correlation of sinonasal polyposis with CSOM. The prevalence rate was 26%. Micro-organisms were Staphylococcus aureus, Pseudomonas aeruginosa, Streptococcus spp., Peptostreptococcus and Bacteroides.

Diagnostic utility of bone marrow aspiration in bicytopenia

2023-03-01T13:14:39+00:00

Background: Haematological diseases are frequently seen now a days in different age groups. Patients can present with a variety of presentations in form of cytopenia of a single lineage or in a dual combination or with pancytopenia. Our study focusses on the utility of bone marrow aspiration for diagnosis of bicytopenias by assessment of pattern of bicytopenias in peripheral smear examination.

Methods: This was a retrospective study that was conducted over a period of one year in a tertiary care institute of Northern India. Cases of bicytopenia were subjected to bone marrow aspiration and parameters such as cellularity, myeloid to erythroid ratio and cytomorphological details of the cells were documented.

Results: Study consisted of male predominance with maximum patients in the age group of 21-30 years. Most common bicytopenia was found to be anaemia with thrombocytopenia and normoblastic erythroid hyperplasia was the most common aetiology.The results of this study were similar to those in the earlier literature with the inference that bone marrow aspiration performed for all cases significantly helped in arriving at the diagnosis.

Conclusions: Bicytopenia is a good haematological indicator for many non-malignant and malignant diseases. Knowledge of its aetiologies can help in the diagnosis and efficient management of patients. Bone marrow study forms a cost-effective tool in interpretation of bicytopenia.

Utility of bone marrow aspiration and trephine biopsy in various haematological malignancies

2023-03-09T12:30:02+00:00

Background: The bone marrow examination is a useful and cost-effective diagnostic procedure in haematological practice for the diagnosis of haematological disorders. It may either confirm the clinically suspected disease or may provide the previously unsuspected diagnosis. The bone marrow examination can be done by bone marrow aspiration as well as by performing bone marrow biopsy. The aim of the study is to compare the diagnostic accuracy and rate of concordance between two modalities of bone marrow examination in diagnosis of haematological malignancies.

Methods: The study was conducted at haematology section of the Department of Pathology, Government Medical College, Jammu spanned over a period of 2.5 years from June 2020 to December 2022. The clinical data along with physical examination, relevant haematological, biochemical and radiological investigations were also reviewed. After taking the informed consent bone marrow aspiration and bone marrow biopsy were done under aseptic precautions.

Results: A total of 250 cases of haematological malignancies were studied over a 2.5 year period. The most common haematological malignancy was found to be leukemia 194 (77.6%) cases, followed by plasma cell dyscrasia with 30 (12%) cases, lymphomas and myeloproliferative disorders each with 11 (4.4%) cases and metastatic deposits 4 (1.6%) cases. In the present study, 64/250 (25.6%) patients underwent BMA and trephine biopsy simultaneously. A positive concordance was seen in 46 (71.8%) of the cases between the two methods and diagnostic discordance was observed in 10 (16.3%) of the cases.

Conclusions: Bone marrow aspiration and biopsy both complement each other and should be evaluated simultaneously. This study emphasizes the need for greater vigilance in the early diagnosis and an interdisciplinary approach for the effective management of patients as well as inclusion of trephine biopsy as regular procedure for complete evaluation of patients with haematological malignancies.

Cytological spectrum of lymph node lesions in fine needle aspiration cytology

2023-03-10T06:50:14+00:00

Background: Fine needle aspiration cytology (FNAC) is becoming preoperative method of choice for diagnosis and management of various lumps and lesions since few decades. It helps clinician to decide mode of treatment in most cases in both non-neoplastic and neoplastic disorders. As cervical, axillary and inguinal lymphadenopathies are commonly encountered clinical problems, in this study, we evaluated the utility of FNAC for assessment of lymphadenopathy.

Methods: This was a retrospective observational study done during the period between January 2016 to December 2019 in a private laboratory centre affiliated with private multispeciality hospital in Bhopal Madhya Pradesh. The FNAC procedure was done without radiological guidance for palpable lymph nodes of cervical, axillary, and inguinal regions. 10ml syringe and 23/24-gauge needles were used along with a plunger for FNAC procedure. Smears were made by standard smearing technique. Slides were stained with Papanicolaou (PAP), Lieshman and Giemsa stain and Diff-Quik methods. Ziehl-Neelson (ZN) staining for acid fast bacilli was done wherever required.

Results: Total 128 cases of lymphadenopathy were assessed. Cervical lymph nodes were most commonly (77.3%) involved and reactive lymphadenitis (34.3%) was most common diagnosis on FNAC. Tubercular lymphadenitis was most common in young adults and reactive nonspecific lesions were most common in paediatric group. Metastatic carcinomas were most common after 50 years age group.

Conclusions: Fine needle aspiration is simple, rapid and cost-effective method to know the cause of lymphadenopathy and also a reliable method to categorize the cause of lymphadenopathy into reactive, inflammatory, metastatic, and lymphoproliferative, avoiding the necessity of biopsy.

Histomorphological spectrum of ovarian lesions from a single institute

2023-02-28T15:27:11+00:00

Background: Ovarian tumours pose a significant and intricate issue, contributing to the wide-ranging problem of ovarian pathology. The mortality rate of this condition surpasses the combined mortality rate of endometrial and cervical neoplasms. To address this challenge, we conducted a study of the clinical spectrum, its accompanying findings, and various histomorphological patterns of ovarian lesions. Our findings provide a definite diagnosis, which is of great clinical importance and aids in enhancing the understanding of the disease and developing proper management plans for patients.

Methods: This is a retrospective study conducted in the department of pathology, ESIC hospital from January 2021 to December 2021. A total of 62 ovarian tumours, were analysed for a year, verifying their clinical, radiological, and gross features and correlating them with histopathological findings.

Results: Out of 62 cases, 53 were benign, 3 cases were borderline and 6 were malignant. Most of the patients (60%) were from the reproductive age group. Among non-neoplastic lesions, the commonest epithelial tumours were serous cystadenoma 35 cases (43.5 %), 10 mucinous (16.1%). The most common germ cell tumour was mature cystic teratoma 10 cases (16.5%) and others. Among neoplastic lesions, five cases were of surface epithelial type. Abdominal pain (70.97%) is the most common presenting symptom, followed by dysfunctional uterine bleeding (9.6%), mass per abdomen (4.8%), abdominal distention (4.2%), and loss of weight (3.4%). The right ovary is more affected than the left. Bilaterality was observed in all lesions of size more than 4.5 cm.

Conclusions: The ovary is a frequently affected site of tumours in the female reproductive system, and they often exhibit a diverse range of clinical, morphological, and histological characteristics. Among these tumours, benign tumours are the most prevalent, with surface epithelial tumours being the most commonly observed subtype. In this study, benign epithelial tumours comprised the majority of cases, accounting for 66.2% of cases. The most common types of benign tumours were serous cysts, corpus luteal cyst and mature cystic teratoma. It is important to note that although most ovarian tumours are benign, some can be malignant, requiring more aggressive treatment. Therefore, an accurate diagnosis and appropriate management are crucial to warrant the best probable outcome for the patient.

Mental health status and its correlates among people living with HIV/AIDS in a tertiary care center of West Bengal

2023-03-01T08:11:05+00:00

Background: People with mental disorders experience disproportionately higher rates of disability and mortality. Bidirectional link between mental illness and HIV/AIDS accelerates the disease progression, reduces willingness to access health care, promotes high risk behavior, leads to low medication adherence, and ultimately results in poor disease outcome. The present study was conducted with the objectives to estimate the prevalence of common mental disorders (CMD) among people living with HIV/AIDS (PLWHA) attending anti-retroviral therapy (ART) clinic at Burdwan medical college and hospital and to find out the association if any, between sociodemographic characteristics and CMD among the study population.

Methods: A cross sectional descriptive study was conducted among 410 adult PLWHA, selected through systematic random sampling, registered at ART clinic of Burdwan medical college and hospital, West Bengal during October 2022 to February 2023. Interview of each study subject, with a pre-designed, pre-tested, semi-structured schedule was done to obtain socio-demographic characteristics and CMD was assessed using WHO’s self-reporting questionnaire (SRQ)-20. Univariate and multivariable logistic regression was performed to predict the factors associated with CMD. Data were analysed using SPSS v23.

Results: Prevalence of CMD was 30.2% among PLWHA attending ART clinic. In univariate logistic regression, female gender, persons not living with partner (un-married, widow/widower, divorced/separated), current smoker, pre-ART cases and persons with WHO stage 3 disease were found to be significantly associated with presence of CMD. But in multivariable logistic regression, persons not living with partner [AOR 2.114 (95% CI: 1.228-3.641)] and pre-ART cases [AOR 8.909 (95% CI: 4.770-16.640)] were remained statistically significant.

Conclusions: Screening and treating the PLWHA suffering from CMD, should be considered to be an integral part of HIV care, support and treatment at the primary level.

A comparative study on short term outcome of Karydakis versus Limberg procedure for pilonidal sinus

2023-03-06T19:05:54+00:00

Background: Pilonidal sinus disease is a common chronic disease occurring in the natal cleft of the sacrococcygeal region and is common among young adults. It is characterized by inflammation, abscess and sinus formation. It is accepted that pilonidal sinus results from the penetration of shed hair shafts through the skin. there is no consensus about treatment of pilonidal sinus disease. Some procedures include shaving, phenol application, treatment with crystallised phenol, incision and curettage, unroofing and curettage, excision with primary closure, excision with marsupialization, vey flap reconstruction, Bascom procedure, Limberg flap reconstruction, modified Limberg flap reconstruction, Karydakis flap reconstruction, modified Karydakis flap reconstruction and musculocutaneous flap reconstruction are some of the treatments for pilonidal disease. We compared the short-term outcome of Karydakis procedure and Limberg flap surgery at MMC, Chennai

Methods: Prospective study-> period of 12 months from April 2020 to March 2021 was done in our hospital. 110 patients undergoing surgery for pilonidal sinus at MMC Chennai who fulfilled the criteria were included in the study. Patients were divided in two groups of 55 each into KP and LFS.

Results: MLF has shorter duration of hospital stay and lesser workdays loss as compared to KP. No significant difference in two procedures in view of wound infection and post op pain.

Conclusions: In this study, no significant difference was found between the surgical techniques in terms of post-operative pain and wound infection. MLF procedure achieves shorter return-to-work time when compared to KP.

Comparison of 2D and 3D gamma evaluation method in patient speciﬁc intensity-modulated radiotherapy quality assurance

2023-03-15T07:03:55+00:00

Background: In this study we have compared 2D and 3D gamma pass percentage for a variety of acceptance criteria for 40 step-and-shoot IMRT (intensity-modulated radiotherapy) plans.

Methods: Treatment planning was done for 40 patient including head and neck, abdomen and pelvis simulated on the Siemens Healthcare GmBH CT simulator with images of 3 mm slice thickness using treatment planning system (TPS) (Monaco Version 5.11.03, Elekta medical system) using Monte Carlo algorithm. The gamma evaluation was done using PTW VeriSoft 8.1 which allowed us to perform 2D and 3D gamma index calculation, slice-by-slice comparison of measured and calculated dose distributions, measured dose was compared against the calculated DICOMRT dose on the OCTAVIUS 3D phantom from TPS.

Results: The average 3D and 2D gamma passing in coronal planes were 96.61±0.45% and 96.27±0.78% for 5 mm/5% criteria, 93.74±4.17% and 91.9±4.88% for 3 mm/3% criteria, 85.83±7.58% and 82.41±8.06% for 2 mm/2% criteria and 62.8±9.42% and 59.18±9.52% for 1 mm/1% criteria respectively for all cases. The average gamma passing rate for 3D gamma analysis was 0.35%, 1.97 %, 3.97% and 5.78% higher when compared with 2D coronal planar analyses for 5 mm/5%, 3 mm/3%, 2 mm/2% and 1 mm/1% DTA criteria respectively.

Conclusions: It is concluded in the study that 3 D gamma passing rate is higher compared to 2D gamma passing for head and neck, abdomen and pelvis cases.

Accuracy of smartphone based electrocardiogram for the detection of rhythm abnormalities in limb lead: a cross sectional study, non-randomised, single blinded and single-center study

2023-03-10T12:47:16+00:00

Background: For the identification of arrhythmia and abnormal instances, researchers are examining the reliability of the interpretation offered by smartphone-based portable ECG monitors. The indicator of an unclear alteration in the electrical activity of the heart is a cardiac abnormality. As a result, its early and accurate identification can avoid myocardial infarction and even sudden cardiac death. Objectives of this study were to evaluate and validate the Spandan 12 lead ECG interpretation for accuracy in detection of the cardiac arrhythmias in comparison to the cardiologist diagnosis, and to evaluate the accuracy of the arrhythmia detection of Spandan ECG in comparison to the 12 lead ECG machine.

Methods: This cross-sectional study, non-randomised, single blinded and single-center study was carried out at Shri Mahant Indresh Hospital (SMIH), Dehradun, Uttarakhand, India from 1st August 2022 to 31st January 2023. All patients (n=312) visiting the electrocardiogram (ECG) room at the department of cardiology of the SMIH, Dehradun with the prescription of ECG screening during the study period were included in the study were included in the study.

Results: In total, 1528 patients with or without a history of cardiovascular disease were enrolled from outpatient and emergency departments of cardiology. A final total of 312 participants considered for accuracy of interpretation of cardiac arrhythmias detected by the standard 12 lead ECG and smartphone ECG in comparison to cardiologists’ diagnosis. Mean age (SD) was 53.90±14.52 years. The male gender (68.78%) showed the maximum frequency than female gender. True Positive cases derived from confusion matrix for 12 lead standard ECG and smartphone ECG in comparison to cardiologist diagnosis was 264 as compared to 273 from 12 lead gold standard. Sensitivity of smartphone Spandan ECG (81.23%) was comparable to gold standard 12 Lead ECG (81.49%). And, specificity, PPV and NPV of smartphone Spandan ECG was recorded to be better than gold standard 12 Lead ECG. Arrhythmia was detected correctly in 403 (70.8%) cases and 431 (61.86%) cases by smartphone ECG and 12 lead gold standards, respectively.

Conclusions: Spandan ECG device scored a high accuracy and sensitivity and high specificity. The overall accuracy of smartphone ECG in detecting the rhythm abnormalities increase by 9%, the significance rises in accuracy of computer interpretation when compared to the cardiologist’s diagnosis.

Study of histopathological pattern of endometrium in abnormal uterine bleeding in a tertiary care center

2023-03-21T07:13:32+00:00

Background: It is estimated that 9-30% of women of reproductive age suffer from abnormal uterine bleeding. As most cases are associated with anovulatory menstrual cycles, adolescent and perimenopausal women are particularly vulnerable to this particular condition. The aim of this study was to evaluate the histopathological pattern of endometrial biopsy from patients presenting with abnormal uterine bleeding.

Methods: The retrospective study was conducted in the Department of Pathology in tertiary care centre from 1st January 2021 to 31 December 2022. All the patients presenting with abnormal uterine bleeding and who underwent endometrial biopsy were included in this study. Distribution of various histopathological patterns was observed in the different age groups.

Results: A total of 260 cases were included in the study. The commonest pattern in these patients was proliferative endometrium (31 %) and products of conception (31%), hyperplasia without atypia (13.7%). Other patterns identified were secretory endometrium, chronic endometritis, endometrial polyp, complete mole, partial mole, and Ca endometrium.

Conclusions: As observed from the study, there is an age specific association of endometrial bleeding, with highest incidence in 21-30 years of age group. Hence, dilatation and curettage are helpful for diagnosis, to assess therapeutic response and to know the pathological incidence of organic lesions in cases of abnormal uterine bleeding.

Effect of addition of disodium EDTA to ceftriaxone and sulbactam on the susceptibility of gram-negative pathogens

2022-07-08T06:14:15+00:00

Background: Indiscriminate use of antibiotics has resulted in the emergence of resistant pathogens. Ethylenediaminetetraacetic acid (EDTA) is a well-known chelating agent. EDTA is also a potentiating and sensitizing agent when combined with antibiotics. Objectives of current study were to examine the antibacterial activity of Ceftriaxone+Sulbactam+ Disodium EDTA against pathogens isolated from urine, blood, and respiratory secretions (sputum, tracheal tube aspirates) and compare it with other antibiotics.

Methods: The study was a retrospective study conducted in a tertiary care hospital between January 2019 and December 2019. Gram-negative isolates were obtained from clinical samples of urine, blood and respiratory samples were tested for susceptibility to different antibiotics and also for ESBL and MBL production

Results: Respiratory isolates: Against Acinetobacter baumannii, 64% of isolates were sensitive to Ceftriaxone Sulbactam EDTA. Highest resistance rates were observed with Piperacillin tazobactam, amoxicillin clavulanate and Cefoperazone+Sulbactam. All Clinical isolates of Pseudomonas were sensitive to Ceftriaxone Sulbactam EDTA. Blood isolates: 25% isolates of Acinetobacter were sensitive to Ceftriaxone Sulbactam EDTA as compared to just 13% susceptibility for Cefoperazone+Sulbactam Urine isolates: 78% E. coli were sensitive to Ceftriaxone Sulbactam EDTA.

Conclusions: The combination of ceftriaxone, sulbactam and disodium edetate was effective even against pathogens isolated from isolates from respiratory secretions, blood and urine resistant to other antibiotics.

Assessment of various cognitive domains in patient with obsessive-compulsive disorder

2023-01-03T15:45:38+00:00

Background: OCD is often chronic disorder and causes impairment of functional efficiency. Various researchers have found that cognitive dysfunction frequently present even when mild symptoms are present. This study aimed to investigate various domains of cognitive function in patients with OCD using cross sectional design. In this study we have tried to find out the various domains of cognitive function in OCD and their relation with clinical severities. We also compared the cognitive function of patients with OCD and their control.

Methods: Total 60 subjects (30 in case group and 30 in control group) were taken for study. The study subjects (OCD group) were taken from psychiatric OPD and control group from general populations. The subjects of both the groups were screened as per inclusion and exclusion criteria and the Y-BOCS, ACE –III scales were applied.

Results: In the case group, 96.70% had a normal ACE-III score and 3.30% had an inconclusive score, while in the control group 100% had a normal score at ACE-III scale, on further scoring. 60% patients have moderate and 33.3% have severe score in the YBOCS scale. We have found the significant decline in total mean ACE-III scores between case and control group (p value 0.000) and decline in memory domain with severity of illness was also significant (p value 0.037).

Conclusions: Decline in cognition domain of memory in patient with OCD, was significant in comparison to control group.

Utility of nucleated RBCs in critical care patients in a tertiary care centre

2023-02-06T18:26:03+00:00

Background: In healthy adults and older children, NRBCs are normally found only in the blood-building bone marrow where they mature. Their appearance in peripheral blood points to extramedullary erythropoiesis or disruption of the blood-bone marrow barrier. Aim of current study was to evaluate and compare the prognostic significance of NRBCs in the peripheral blood of intensive care patients (ICU) and non-intensive care patients (non-ICI) and to assess the morbidity and mortality risk associated with NRBCs among ICU and non-ICU patients.

Methods: Relevant clinical details and investigations were collected from the Haematology nominal Register of the Department of Pathology, Saveetha Medical College. Blood samples were routinely drawn in the morning. The presence of NRBCs in the peripheral blood was detected with the help of an automated analyser (Sysmex XN 1000) and confirmed by a peripheral smear.

Results: Among the NRBC-positive study population, mortality rate was 28% and was associated with ICU admission status, and death was predominantly due to cardiovascular causes. The highest NRBC value during the period of admission was significantly associated with deceased patients and ICU patients (p values of <0.001 and 0.002 respectively). The Pearson correlation of NRBC shows a significant positive correlation with serum creatinine and a negative correlation with platelets.

Conclusions: The presence of NRBCs in the peripheral blood of critically ill adults is a significant prognostic marker of morbidity and mortality, laying down the emphasis on daily screening of peripheral smears for NRBCs.

A study of clinico-epidemiological profile of patients of snake bite and their outcome in a tertiary care centre in central zone of Himachal Pradesh

2023-01-11T03:20:09+00:00

Background: The aim of this study was to assess clinico-epidemiological profile, prevalent treatment practices and outcome of snake bite patients in a tertiary care hospital in a hilly North central region of Himachal Pradesh.

Methods: A hospital record based retrospective descriptive study was done which included demographic data, clinical profile, prevalent traditional treatment methods of snake bite, treatment given at hospital and outcome among 144 patients.

Results: The 123 (83%) patients were young (age group of 17-50 years) and number of female patients was 89 (62%), 29 (38%) more than male patients. Most of snake bite cases recorded, presented in the months of July to September 56 (72.7%). The most frequently bitten sites were the upper limbs particularly left hand. 61 (42%) of patients presented without any features of envenomation. Hematotoxicity was the commonest presentation in 68 (82%) of patients followed by neuroparalysis in 26 (18%) of the symptomatic cases. Green snake (Green pit viper) was the commonest snake seen. Cure rate in our study was more than 80%. Major reason for delayed presentation was consultation of traditional healers.

Conclusions: In the tropics and subtropics, snake bite is a life threatening health hazard especially in poor rural people who usually waste precious time by indulging in harmful activities. This needs public as well as health care workers’ awareness and prompt intervention in a health care facility.

Histopathological study of neoplastic and non-neoplastic lesions of salivary gland: a study at a tertiary care center

2023-01-26T17:04:47+00:00

Background: Salivary gland lesions are highly heterogenous group of disorder. There are no reliable criteria to differentiate benign from malignant lesions on clinical grounds, so histopathological evaluation is essential.

Methods: The present study was retrospective study carried out in the department of pathology, Government medical college, Surat from January 2015 to June 2020. Biopsies/specimens were fixed by 10% neutral buffered formalin and processed, embedded in paraffin and sections were cut and stained with hematoxylin and eosin stain. All the slides were reviewed by authors and re-staining of slides and fresh sections of tissue blocks were performed whenever required.

Results: Out of 80 cases, 22 were non-neoplastic, 45 were benign and 13 were malignant. In our study most common non neoplastic lesion was chronic sialadenitis. Most common benign lesion was pleomorphic adenoma. Most common malignant lesion was mucoepidermoid carcinoma. Most commonly involved gland was parotid gland. In parotid gland, most common lesions were benign. The overall sex incidence of salivary gland lesions in male was 45% and 55% in females with a male to female ratio of 1:1.2.

Conclusions: Thorough knowledge of morphology of salivary gland lesion is helpful in final diagnosis in predicting prognosis, typing, staging and grading of salivary neoplasms.

Relationship between stress and sleep quality among undergraduate physiotherapy students of India who are engaged in clinical posting: a cross sectional study

2023-01-27T13:59:55+00:00

Background: Physiotherapy students are exposed to different kinds of stress while pursuing their course and this stress affects their sleep quality. The author in this study investigated the relationship between stress and sleep quality among undergraduate physiotherapy students across India.

Methods: A cross sectional study was conducted among 150 undergraduate physiotherapy students studying in different physiotherapy colleges across India, using convenience sampling method. Data was collected with help of an Online Google form™. In order to assess the relationship between stress and sleep quality among students, student stress inventory (SSI) and Pittsburgh sleep quality index (PSQI) outcome measures were used.

Results: A high prevalence of stress (99.9%) and poor sleep quality (76.7%) were found among students. To analysis the relationship between stress and sleep, Pearson’s correlation coefficient was used, value of correlation coefficient was 0.613 shows a moderate positive relationship between variables and p value was 0.000 (<0.05) shows highly significant relationship between stress and sleep.

Conclusions: The study confirms a strong association between stress and sleep among undergraduate physiotherapy students across India. A recommendation for management required promotion of sleep hygiene and including physical activity in the curriculum of students to deal with the stress.

WhatsApp control: a new norm to succeed in LIMS adoption

2023-01-30T11:32:56+00:00

Background: Adoption of the LIMS (laboratory information management system) serves varied purposes in the diagnostic laboratory and might take a very lengthy period for its implementation. But, without controls being put in place, it can create a barrier to the project’s execution and prevent it from being finished on time.

Methods: A WhatsApp group with 22 members, including lab technicians, heads of lab sections, a billing manager, an operations assistant manager, an assistant nursing caretaker, and administrative staff, was created. The assistant operations manager posted the daily pending report status in the WhatsApp group to help the lab team ratify, correct, and complete the assignments. To track pending report closures in real-time, the WhatsApp group mediated weekly follow-ups. The laboratory services department head informed the team monthly on the project’s status. The nonparametric Wilcoxon rank test and paired student t-test were performed to compare pre and post-survey responses before and after the seven-month intervention period.

Results: The non-parametric Wilcoxon rank test and paired t-test results of the post-test demonstrated that the participant’s answer had improved significantly since the pre-test. The questionnaire showed that participants liked the new WhatsApp control mechanism. The number of pending reports reduced from 4,000 to 240 in seven months, a statistically significant decrease at a p value of 0.01. This supports the newly implemented WhatsApp control.

Conclusions: Based on this interventional study, WhatsApp-based controls can be employed in conjunction with more conventional ways to regulate process outcomes during LIMS adoption.

Studying drug prescription pattern of dermatology OPD of an Indian tertiary care hospital- a prospective, observational, cross-sectional study

2023-01-29T11:10:36+00:00

Background: Studying prescription patterns helps prescribers to provide rational and cost-effective medical care. Drugs prescribed for skin disorders by a specialist differ in terms of numbers and the selection of drug class, necessitating periodic prescription audits and drug utilization studies.

Methods: This prospective, cross-sectional, observational study was conducted at the dermatology department OPD of Government Medical College, Aurangabad (Maharashtra, India) from January 2021 to May 2021. Digital records of prescription were collected from the hospital management information system (HMIS).

Results: N=5338 prescriptions were analysed, 40.89% of patients were from the 21-35 years age group. Polytherapy was 62.96% and monotherapy 36.99%. Drugs prescribed by generic names were 18% and brand names were 82%. Topical drugs constituted 71.67% followed by systemic drugs 28.32% of total prescriptions and the average injectables prescribed per encounter was 0.33%. Antifungals were most prescribed followed by steroids. The average number of drugs prescribed was 1.85 per encounter and the percentage of antibiotic prescriptions was 17.70%.

Conclusions: The current study showed that WHO DUS indicators were followed. The results reflect rational prescription of drugs within the available resources.

Observational study of segmental epidural anesthesia for orthopedic surgeries

2023-01-29T14:07:14+00:00

Background: Epidural anaesthesia is suitable technique for lower abdominal and lower limb surgery. Compared to conventional epidural anesthesia (EA), segmental epidural anaesthesia (SEA) denotes the use of a small volume enough to block only the segments involved in the field with stable hemodynamics and limited spread of analgesia. We decided to do study of SEA for lower limb surgeries. Aim was to observe characteristic of sensory and motor block, quality of analgesia, hemodynamics and peri-operative complications.

Methods: After institutional ethical committee approval, prospective observational study of SEA for orthopedic surgeries was carried out in 130 patients of 18 to 60 years of either sex with ASA grade І-Ш. For SEA, we used bolus dose of lignocaine with adrenaline (L+A) 2% 8 to 12 ml injected over 4 minutes according to anticipated segments required to be blocked and patient’s condition and type of surgery. Top up dosages were repeated every 60 minutes. Quality of analgesia and block, total local anesthetic used and hemodynamics were recorded intraoperatively. Results were analysed statistically and were compared using the student’s paired ‘t’ test. P value <0.05 was considered as significant.

Results: Requirement of bolus dose was 8 ml, 10 ml and 12 ml in 78 patients, 31 patients and 7 patients respectively. In all patients 1^st top up dose was given while 2^nd top up was required in 32 patients only. Intra op MAP remains near to baseline. Quality of block was excellent in 66 patients (55%), good in 35 patients (29%) and fair in 15 patients (12.5%).

Conclusions: We concluded that SEA is a safe and reliable technique for orthopedic surgeries with stable hemodynamics, limited spread of analgesia involving only required segments with minimal side effects.

Correlation between prostate specific antigen and prostate volume with disease symptom severity assessed by international prostate symptom score

2023-01-29T17:17:00+00:00

Background: Benign prostatic hyperplasia (BPH) is clinically defined as prostate adenoma, resulting in bladder outlet obstruction (BOO), which may eventually harm the bladder and even kidneys. For differential diagnosis of male LUTS, uroflowmetry can be used together with non-invasive ultrasound to ascertain the flow rate and IPP. PSA is also an important indicator for differential diagnosis. International prostate symptoms score (IPSS) is used to assess the severity of the symptoms for clinical BPH. There is also a recommendation to consider the quality of life (QoL) index, where a QoL score of ≥3 is considered as worrisome.

Methods: This was a retro-prospective study based on secondary and primary data collection and analysis, pertaining to BPH patients who visited the study site previously as well as those who are coming for regular follow-up since 2019. Patient enrolment was done at a teaching hospital Shree Krishna Hospital affiliated to the Pramukh Swami Medical College, Bhaikaka University, Karamsad. About 100 patients presenting with lower urinary tract symptoms (LUTS) and histo-pathologically proven cases of BPH were enrolled to pursue research objectives. All patients were followed up to a period of 3-months after initiating the treatment and disease severity through IPSS and quality of life upon completion of treatment were also assessed.

Results: PSA is also an important indicator for differential diagnosis, which is generally less than 1 μg/l in patients in absence of clinically confirmed BPH. In our study, mean prostate volume was reported to be 43.46±19.35 cc. A positive correlation was observed between prostate volume and serum PSA with disease severity.

Conclusions: Our study evaluated the IPSS to predict the disease severity and correlated it with quality of life, prostate volume and serum PSA. Our findings were in line with currently available evidences, and suggested that QoL, prostate volume and serum PSA are better predictors of disease severity, IPSS.

Evaluation of axial length measurements obtained using three different techniques- applanation A-scan, immersion A-scan and optical biometer

2023-02-04T09:13:37+00:00

Background: To compare measurements of axial length obtained with manual A-scan, immersion A-scan and optical biometer and assess the accuracy of different techniques of intraocular lens power calculation.

Methods: This was a prospective randomized study done in 90 patients over a period extending from November 2019 to October 2020 in the upgraded department of ophthalmology, Government Medical College Jammu. Intraocular lens power was calculated by measuring axial length by three different techniques and further the accuracy of the axial length values obtained were compared.

Results: In this study, mean axial length measured by applanation A-scan was 22.86±0.85 mm which ranged from 20.99-24.6 mm and axial length measured by immersion technique ranged from 21.5-24.9 mm with a mean AL of 22.92±0.85 mm. AL measured by non-contact method ranged from 20-25.08 mm with a mean AL of 23.1±0.93 mm. There was a statistically significant difference between all the three techniques regarding the measured AL (p=0.0004).

Conclusions: This study concludes that the optical biometry has greater accuracy than ultrasound biometry including applanation and immersion A-scan.

Safety and efficacy of formoterol/tiotropium bromide and formoterol/glycopyrronium combination in patients with chronic obstructive pulmonary disease

2023-01-31T20:28:36+00:00

Background: Chronic obstructive pulmonary disease is characterized by a progressive development of airflow limitation that is not fully reversible. The study investigated the efficacy and safety of formoterol/tiotropium bromide and formoterol/glycopyrronium combination in patients with chronic obstructive pulmonary disease. Glycopyrrolate, a long-acting anti-muscarinic agent is recently approved for the maintenance therapy of chronic obstructive pulmonary disease in combination with formoterol. However, the studies on glycopyrrolate along with long-acting beta 2 agonist, particularly in Indian patients are limited. Hence it was considered worthwhile to determine safety and efficacy of fixed dose combinations of formoterol/ tiotropium vs. formoterol/glycopyrrolate in grade-2 patients of chronic obstructive pulmonary disease patients.

Methods: Efficacy and safety of formoterol/glycopyrrolate and formoterol/tiotropium were compared in Grade-2 patients. Total 68 patients were analysed and the efficacy of treatment was determined by Spirometry, Chronic Obstructive Pulmonary Disease Assessment Test score and Symptom score at day zero (before therapeutic intervention) and at two weeks of interval till 12 weeks.

Results: The treatment with inhaled combination of formoterol/glycopyrrolate and formoterol/tiotropium has shown an improvement in spirometric variable Forced Expiratory Volume (in one second) decrease in mean Symptom score and COPD Assessment Test score among the grade-2 Chronic Obstructive Pulmonary Disease patients.

Conclusions: Combination therapy of formoterol/glycopyrrolate is non-inferior to formoterol/tiotropium in terms of efficacy and safety profile of patients with chronic obstructive pulmonary disease.

Amphotericin B in the management of COVID-19 associated mucormycosis

2023-02-02T06:26:21+00:00

Background: Amphotericin B is considered the drug of choice for primary treatment of mucormycosis. During second wave of COVID-19 pandemic there was severe scarcity of liposomal amphotericin B. This study aims to determine role of various formulations of amphotericin and their side effects when used for the treatment of COVID-19 associated mucormycosis.

Methods: A retrospective study was conducted between May 2021 and December 2021 at a tertiary care centre. 380 patients with post-COVID rhino-orbito-cerebral mucromycosis (ROCM) were included in the study. Liposomal amphotericin B, conventional amphotericin deoxycholate, lipid complex amphotericin B was used in the treatment. Patients were observed for side effects like fever, chills, rigors, hypokalemia, renal function derangements, thrombophlebitis and respiratory difficulties.

Results: Majority of patients received liposomal amphotericin B (331) and 31 patients received conventional amphotericin deoxycholate and 5 patients were given lipid complex amphotericin B injections. The most commonly encountered side effects were of the mild type constituting chills (98% with liposomal and 100% with amphotericin deoxycholate), and fever (94% with liposomal and 74% with amphotericin deoxycholate).

Conclusions: Our study highlights the role of various formulations of amphotericin B in the treatment of COVID-19 mucormycosis.

Study of the prescription pattern of anti-depressants in a tertiary care hospital: a prospective observational study

2023-02-05T11:07:58+00:00

Background: One of the most important public health priorities are psychiatric disorders. Prescribing medications play a crucial role in providing good health care. Therefore, there is a need to understand prescription patterns at regular intervals.

Methods: This was a prospective, cross-sectional, observational study conducted at the psychiatry department OPD of Government Medical College, Aurangabad (Maharashtra, India) from January 2021 to June 2022. Records of prescriptions were collected from the hospital management information system.

Results: N=417 prescriptions were analysed. The male: female ratio was 1.25. Among total prescriptions analysed, selective serotonin reuptake inhibitors (SSRIs) were the most prescribed drug class (32.18%) followed by benzodiazepines (25.19%) and atypical antipsychotics (19.97%). Drugs prescribed as fixed dose combinations (FDC) were 2.10%. Most of the patients received polytherapy in which most patients constituted of two drug therapy (46.28%) and 34.53% of patients received monotherapy. In the patients managed by monotherapy, SSRIs were the most prescribed (29.16%), followed by atypical anti-psychotics (26.38%) and benzodiazepines (24.30%). Prescriptions with generic names were 93.12%. The average number of drugs per encounter was 1.88. Drugs prescribed from the essential drugs list (India) were 41.66%. Drugs prescribed from the essential medicines list (WHO) were 47%. The total number of prescriptions with injections 0.23%.

Conclusions: Prescribing patterns were according to the WHO-DUS parameters. Most patients were prescribed generic medicines. SSRIs, benzodiazepines and tricyclic antidepressants were the most prescribed drug class.

Proficiency of platelet parameters as an inexpensive efficient early marker for diagnosis of neonatal sepsis

2023-02-06T14:52:03+00:00

Background: Neonatal sepsis is an invasive serious infection which is life threatening if not treated early. Though blood culture is the gold standard for diagnosis but it yields positive results in fewer number of cases and it also time consuming. So it is requisite to ordain a cost effective and easy marker for its early diagnosis to initiate treatment to reduce the case fatality.

Methods: A prospective study was done for 12 months upon 48 blood culture proven cases of neonatal sepsis. 48 normal babies were taken as control group. Platelet parameters were studied in all 96 babies of the study population.

Results: It was found that thrombocytopenia, mean platelet volume (MPV), platelet large cell ratio (P-LCR) and mean platelet volume to total platelet count ratio (MPV/TPC) are early helpful markers for diagnosis of sepsis in neonates with p value of 0.0003, <0.0001, <0.0001 and <0.0001 respectively. MPV/TPC has the highest specificity (95.6%) with positive predictive value (90.2%).

Conclusions: Platelet count and its indices are cheap, early and workable marker for diagnosis of neonatal sepsis.

A study of tumour infiltrating lymphocytes and neutrophil to lymphocyte ratio in papillary carcinoma thyroid

2023-02-09T12:20:07+00:00

Background: Papillary thyroid carcinoma accounts for 70-80% of all diagnosed thyroid carcinomas. Immune response including systemic inflammation is thought to be essential for suppression of carcinogenesis. This study aims to correlate the tumour infiltrating lymphocytes (TIL) and neutrophil to lymphocyte ratio (NLR) in various demographic data and histomorphological features of papillary carcinoma thyroid.

Methods: A total of 60 cases of papillary carcinoma were taken from a period between January 2018 and July 2021. TIL was analyzed as diffuse or focal at the area of highest concentration and was graded subjectively as: absent (no lymphocytes), mild (1-10%), moderate (>10-50%) and dense (>50%). NLR was calculated as the neutrophil count divided by the lymphocyte count, based on the preoperative complete blood cell counts.

Results: The cases belonged to age group varying from 20 to 75 years with female preponderance (88.3%). In this study, there was significant correlation between TIL and tumour stage with a p value of 0.001. Lower the tumour stage, higher was the concentration of TIL. A cut of value of 2.17 was taken for NLR. Cases with diffuse, moderate to dense peritumoural lymphocytes had lower NLR and were statistically significant. High NLR was also seen in higher TNM stage. On the other hand, there were no association with gender, age, tumour size, histological subtype and focality with NLR.

Conclusions: As an index of inflammation, tumour infiltrating lymphocytes and NLR can be considered. We found increased TIL in lower tumour stage and increased NLR values in higher tumour stages.

Morphometeric study of dens and its clinical importance

2023-02-08T09:56:42+00:00

Background: The axis vertebra's distinguishing characteristic is the existence of the odontoid process. The axis vertebra's morphology is very different from the morphologies of the other cervical vertebrae. Surgery on the axis vertebrae is exceedingly risky, and dens of axis vertebrae fractures are fairly common. As a result, it is essential to have a good grasp of the anatomical variance before performing the procedure. The study aimed to evaluate the morphometric parameters of the odontoid process of the axis vertebra. The different anatomical parameters of the odontoid process of the vertebra will be measured and compared with the previously studied parameters.

Methods: Thirty dried human axis vertebrae of unknown sex will be taken. The linear and angular morphometric measurements of odontoid process will be recorded by using vernier caliper and goniometer.

Results: The mean height, a-p diameter, and minimum and maximum width were 15.8mm, 10.7mm, 10.3mm and 8.5mm respectively. The total height and vertical angle were 38.1mm and 52.2 degrees respectively.

Conclusions: To prevent damage to vital components and to help treat dens fractures, the information gleaned from this study may be helpful to surgeons working around the dens of the axis vertebra.

Comparative evaluation of immunochromatographic card tests with enzyme-linked immune sorbent assay for the detection of hepatitis C virus antibody

2023-02-11T06:03:20+00:00

Background: Hepatitis C virus (HCV) is a global prevalent pathogen causes both acute and chronic hepatitis and leading to serious liver damage. Correct and rapid diagnosis is pivotal for the management of HCV disease. Rapid card tests are superior alternatives for the large-scale screening of HCV infection.

Methods: The present observational study evaluates analytical performance of four different anti-HCV rapid tests. A total of 200 ELISA confirmed, HCV positive (n=100) and HCV negative (n=100) clinical specimens were selected and re-tested for anti-HCV antibodies by using commercially available four different immunochromatography cards (Meriscreen, Accurate, Oscar and Biolab).

Results: Among all, Biolab rapid card test shown highest (98%) sensitivity. On the other hand, all rapid card test kits showed identical 100% specificity.

Conclusions: Overall BioLab anti-HCV rapid card tests found to be superior in the present study and strongly suggest in house validation of rapid card tests before their diagnostics use on clinical specimens.

Migraine Synonyms in South Indian coastal population- A retrospective study

2023-02-12T07:22:17+00:00

Background: A direct question like, do you get headaches or had headaches in the past will not unravel past history of migraine in many patients in Southern coastal region of India. This study was conducted to document migraine synonyms in this population.

Methods: A 5-year retrospective study was conducted in three outpatient clinics in a coastal region of Southern India. When children were brought with recurrent headaches, as an aid to diagnosing migraines, family history of headache or migraine was recorded from their mothers and grandmothers. They were asked two questions - 1) do you get headaches or 2) suffered from headaches in the past. If they replied in the negative, a third question was asked (Do you get any head discomfort /head pain along with any other illness).

Results: Out of 7000 mothers and grandmothers interviewed, 1778 reported headache in the past resembling migraine or probable migraine. 1001 who said no headache in the past, were getting other migraine synonym disorders in which headache was one of the complaints. 22 different synonyms which fitted into migraine diagnostic features were documented in this group of study participants.

Conclusions: To diagnose migraine and its subtypes, 2 (aura) to 5 (without aura) past episodes are mandatory. This study proves that a sound knowledge about local migraine synonyms and slangs are important to elicit past history of migraine. Headache epidemiological studies can be flawed if only one leading question like do you get headaches/suffered from headache in the past is asked.

Prevalence of subclinical hypothyroidism in patients of chronic liver disease

2023-02-13T13:28:02+00:00

Background: Chronic liver disease (CLD) is a continuous process of inflammation, destruction, and regeneration of liver parenchyma, which leads to fibrosis and cirrhosis. Liver plays an essential physiological role in thyroid hormone activation and inactivation, transport, and metabolism, as well as the synthesis of thyroid binding globulin. A complex relationship exists between thyroid and liver in health and disease.

Methods: 103 patients of CLD were included in this study from December 2020 to September 2022. They were classified as per child Pugh scoring after clinical assessment and investigations. Thyroid function profile was measured for all the patients.

Results: Among 103 patients, 8 (7.76%) patients were having overt hypothyroidism and 28 (27.18%) patients had subclinical hypothyroidism, while 67 (65.04%) patients had normal thyroid profile levels. There was significant correlation between CTP class and hypothyroidism status of patient (p value <0.001) with 25 (56.81%) patients of CTP class C having subclinical hypothyroidism, while 3 (7.5%) patients of CTP class B had subclinical hypothyroidism and none patient of CTP class A had subclinical hypothyroidism.

Conclusions: Our study found that there was increased prevalence of subclinical hypothyroidism in CLD patients which increased with severity of CLD as assessed with CTP class.

Distribution of ABO and Rh blood groups among people visiting tertiary hospital of Dibrugarh district of Assam, India

2023-02-24T14:53:04+00:00

Background: Clinical application of blood grouping are many. Blood grouping are needed for blood transfusion, in preventing hemolytic disease, paternity dispute, medico legal cases, in knowing susceptibility to disease, and also necessary for genetic research. This study was carried out with an objective to provide data regarding distribution of ABO and Rh blood groups among people visiting various department of tertiary hospital of Dibrugarh district of Assam, India.

Methods: Data of 200 subjects were collected and analyzed regarding ABO and Rh blood groups from 01 August 2021 to 31 July 2022 and reported in simple numbers and percentage. ABO and Rh blood group type is determined by glass slide method.

Results: The most common blood group among the subject was O (33%), B (33%), A (23%) and AB (22%). Rh positivity among the subject was 93% and Rh negativity is 7%.

Conclusions: The most common blood group among the subject was O positive and B positive and least common was AB negative.

Gender differences in description of chronic musculoskeletal pain

2023-02-14T11:00:27+00:00

Background: Pain is a subjective experience and different people describe their pain differently. Due to biological, psychological and sociocultural differences among different gender there is a variation in their pain experiences. Though gender differences in medical history taking have been studied it is still a concept that needs exploration. In addition the gender differences in the impact of pain on sleep function needs to be explored.

Methods: A sample of 240 patients including both male and females were randomly recruited from OPD of a tertiary care hospital. The patients were asked to describe their pain in terms of quality through face to face structured interview. The number of descriptors used by every individual was noted. Specific questions regarding pain intensity on numeric pain rating scale and sleep function were also recorded.

Results: 67.8% of females used more than two descriptors to explain their pain compared to 53.3% of males. The mean pain intensity reported by females was 7.28±1.24 which was significantly higher than males. 37.8% of females reported bad sleep quality as compared to 16.7% of males.

Conclusions: Females report greater pain intensity and use more number of descriptors to report their pain. In addition there is higher impact of musculoskeletal pain on sleep quality in females than in males.

Characteristics of blood infections and phenotypic detection of extended-spectrum β-lactamases in ICU patients in Central India posing a challenge

2023-02-16T06:22:41+00:00

Background: Bloodstream infection (BSI) is defined by positive blood cultures in a patient with systemic signs of infection and may be either secondary to a documented source or primary, that is, without identified origin. The aim of this study was to improvise blood culture systems for a quicker, optimum diagnosis and prompt treatment.

Methods: A prospective study was conducted with total of 309 samples for determining the bacteriological profile and prevalence of ESBL in BSI’s in patients admitted in the ICU’s (surgical/medical/gynaecological) with the suspicion of sepsis. Samples received in department of microbiology were processed as per standard protocol and identification of bacteria was carried out with the help of relevant biochemical tests. AST for both the ICUs was done together by Kirby-Bauer disk diffusion method according to CLSI guidelines.

Results: Of the total, 149 (48.22%) samples were positive for growth with the major isolates out of these being gram negative bacilli, 104 (69.79%) and 45 (30.21%) were gram positive cocci. Among the gram negative bacilli, Klebsiella pneumoniae 35 (33.65%) was the most common bacteria while the least frequent organism isolated was Acinetobacter baumanii 10 (9.62%). Imipenem, piperacillin-tazobactam and levofloxacin were the most sensitive antibiotics whereas cefepime, cefuroxime were the most resistant antibiotics.

Conclusions: This study highlights the incidence of gram negative bacilli in ICU’s and the emergence of multi-drug resistant organism. Infections with MDR organisms can lead to inadequate or delayed treatment which is associated with adverse patient outcomes.

Strengthening primary health care in rural western India-team based approach

2023-02-16T09:13:16+00:00

Background: Non-communicable diseases (NCDs), such as cardiovascular diseases (CVDs), diabetes, have taken an epidemic form. With a huge population and existing sedentary lifestyle, in developing countries like India, there exists a struggle to deliver quality chronic care. A reorganization of systems in healthcare service delivery is crucial to improve primary healthcare. We have reported our model to address primary healthcare service delivery in rural settings. The SPARSH team-based care approach is designed with the objective of improving adherence to anti-hypertensive and anti-diabetic medications to improve blood pressure (BP) and blood sugar (BS) control among hypertension (HTN) and diabetes mellitus (DM) patients.

Methods: This is a descriptive study describing a model and array on interventions delivered through a team-based care approach from 2016 till 2020 by Shree Krishna Hospital, Karamsad across three districts in Gujarat. Data was collected on case record forms and later was analysed using Microsoft excel.

Results: From the financial year of 2016 till 2020 patients enrolled in SPARSH increased from 932 till 1920 for availing treatment and ongoing care. A total of 108 training sessions were conducted and facilitated by a senior member of SPARSH. Average monthly cost of treatment for hypertensive, diabetic and patients with both conditions was Rs. 38, 78 and 130 respectively.

Conclusions: Our model described here can be tested for effectiveness through a rigorous community trial focusing on objective outcome measures such as BP control and glycemic control.

Evaluation and perception of MBBS first year students regarding early clinical exposure

2023-02-17T10:13:52+00:00

Background: Evaluation and perception of MBBS first year students regarding early clinical exposure (ECE). The goals of ECE are to provide significance to basic sciences along with expansion of medical knowledge so as to establish the cognitive component of professional learning. Medical council of India has given new curriculum for MBBS for undergraduate medical education in which ECE is one of the reforms to improve quality of medical education.

Methods: The study was conducted in the department of physiology, Peoples college of medical science and research centre Bhopal. The study duration was one year, 150 students of MBBS first year were included in study. All didactic lecture on systems was delivered mainly on respiratory physiology. It was vertically integrated with department of medicine and is followed by hospital visit. During hospital visit students was divided in 6 groups of 25. Clinicians was exposing the students to the relevant patients and discuss important symptoms and examination/findings on the patients. To assess whether the skills gained through ECE helped the students in the physiology classes of clinical examination, OSCE (Objectively structured clinical examination) was arranged before and after the intervention.

Results: The post OSCE scores are better than pre OSCE scores. Perception of students toward ECE they have better understanding and retention of topic.

Conclusions: ECE is a good tool for teaching and learning for first year MBBS.

Correlation between ischemic heart disease and coronary atherosclerosis: an autopsy based cross-sectional study in a tertiary care hospital

2023-02-19T07:21:37+00:00

Background: The most common cause of ischemic heart disease (IHD) is reduced blood flow due to obstructive lesions in the coronary arteries. In adults, IHD associated with coronary atherosclerosis and acquired forms of cardiomyopathy are the most common findings of autopsies. Aim and objectives were to study age and gender related prevalence of IHD in population of Sonepat district of Haryana and its association with coronary atherosclerosis in autopsy cases.

Methods: A cross sectional study was conducted from April 2019-March 2020 for a duration of one year on 140 post-mortem heart specimens received in the department of pathology at Bhagat Phool Singh government medical college for Women, Khanpur Kalan, Sonepat, Haryana. Sections from various parts of heart and from three main coronary arteries were processed and examined.

Results: In our study, 22 cases (15.71%) of chronic IHD (CIHD) and 7 cases (5%) of myocardial infarction (MI) was observed. The overall prevalence of IHD was 20.7%. All 7 cases (100%) of MI and 95.46% of CIHD revealed atherosclerosis in their coronary arteries. A highly significant statistical correlation was observed between IHD and atherosclerosis p<0.05 (p=0.001). All the cases of MI and 81.82% of CIHD were observed in more than or equal to 40 years age group.

Conclusions: The awareness regarding atherosclerosis and various preventive and screening of cardiovascular risk factors should be initiated in young population as early as second decade.

Maternal and foetal outcome of acute kidney injury in pregnancy single centre experience from North India

2023-02-24T09:26:09+00:00

Background: The diagnosis and treatment of acute kidney injury in pregnancy is a challenge to the physician as various pathophysiological changes take place during pregnancy, variability of symptoms and occasionally overlapping laboratory and clinical features. The occurrences of feto-maternal mortality associated with it decreased in developing nations due to increased prenatal and postnatal care and improved medical facilities. This study was undertaken to provide insight into feto-maternal outcome in patients presenting with acute kidney injury (AKI) during pregnancy.

Methods: This was an open label prospective hospital-based cohort study comprising patients admitted in obstetrics and nephrology wards, presenting with AKI and no known chronic illnesses prior to pregnancy. Following criteria were used to diagnose AKI during pregnancy: (a) Elevation of S. creatinine ≥ 1 mg/dl; (b) Oligo-anuria for ≥ 12 hours and (c) Need for RRT. 50 such cases were enrolled in the study.

Results: Out of all patients enrolled, majority (60%) had improved renal function, 16% expired, and 24% had no recovery in renal function. Out of all patients taken for haemodialysis, 20% of patients had improved renal function, 20% expired and 60% had no recovery in renal function. Mean S. creatinine on 3 months follow-up in conservative group found-1.67±1.31 mg/dl. 60% pregnancies resulted in the birth of a live baby and rest resulted in foetal loss.

Conclusions: In our study, it was found that acute kidney injury in pregnancy results in significant feto-maternal mortality and morbidity. Those patients, who had significant renal derangement and concomitant complications, had poorer outcome.

Study of the bronchoscopic evaluation of patients undergoing bronchoscopy in respiratory medicine department

2023-03-01T02:28:44+00:00

Background: Bronchoalveolar lavage or BAL is a minimally invasive procedure that involves instillation of sterile normal saline into a subsegment of the lung, followed by suction and collection of the instillation for analysis. This procedure is typically facilitated by the introduction of a flexible bronchoscope into a sub-segment of the lung. The purpose of this study was to investigate the pathological variations in the tracheobronchial tree in various respiratory diseases.

Methods: The study evaluated the bronchoscopic profile of 150 patients who underwent flexible bronchoscopy in the respiratory medicine department of MGM Medical College in Aurangabad, India from October 2020 to September 2022.

Results: The majority of the patients were males (65%) and above the age of 50. The most common reason for bronchoscopy was radiological opacity (80% of cases), followed by diffuse pulmonary infiltration (10%). The study found that bronchoscopy was useful in obtaining samples for diagnosis of various respiratory diseases, including malignancies, tuberculosis, bacterial pneumonia, and hematological malignancies. The study also noted the therapeutic utility of bronchoscopy in managing inoperable stenosis of the central airways.

Conclusions: The authors concluded that bronchoscopy is an important diagnostic and therapeutic tool for the management of pulmonary diseases.