International Journal of Research in Medical Sciences <p>International Journal of Research in Medical Sciences (IJRMS) is an open access, international, peer-reviewed general medical journal. The journal's full text is available online at The journal allows free access to its contents. International Journal of Research in Medical Sciences is dedicated to publishing research in medical science from all disciplines and therapeutic areas of medical science or practice. The journal has a broad coverage of relevant topics across medical science or practice. International Journal of Research in Medical Sciences (IJRMS) is one of the fastest communication journals and articles are published online within short time after acceptance of manuscripts. The types of articles accepted include original research articles, review articles, editorial, medical news, case reports, adverse drug reactions, short communications, correspondence, images in medical practice, clinical problem solving, perspectives and new drug updates. It is published <strong>monthly</strong> and available in print and online version. International Journal of Research in Medical Sciences (IJRMS) complies with the uniform requirements for manuscripts submitted to biomedical journals, issued by the International Committee for Medical Journal Editors.</p> <p><strong>Issues: 12 per year</strong></p> <p><strong>Email:</strong> <a href="" target="_blank" rel="noopener"></a>, <a href="" target="_blank" rel="noopener"></a></p> <p><strong>Print ISSN:</strong> 2320-6071<br /><strong>Online ISSN:</strong> 2320-6012</p> <p><strong>Publisher:</strong> <a href="" target="_blank" rel="noopener"><strong>Medip Academy</strong></a></p> <p><strong>DOI prefix:</strong> 10.18203</p> <p>Medip Academy is a member of Publishers International Linking Association, Inc. (PILA), which operates <a href="" target="_blank" rel="noopener">CrossRef (DOI)</a></p> <p> </p> <p><strong>Manuscript Submission</strong></p> <p>International Journal of Research in Medical Sciences accepts manuscript submissions through <a href="" target="_blank" rel="noopener">Online Submissions</a>:</p> <p>Registration and login are required to submit manuscripts online and to check the status of current submissions.</p> <ul> <li><a href="" target="_blank" rel="noopener">Registration</a></li> <li><a href="" target="_blank" rel="noopener">Login</a></li> </ul> <p>If you find any difficulty in online submission of your manuscript, please contact editor at <a href="" target="_blank" rel="noopener"></a>, <a href="" target="_blank" rel="noopener"></a></p> <p><strong> </strong></p> <p><strong>Abbreviation</strong></p> <p>The correct abbreviation for abstracting and indexing purposes is Int J Res Med Sci.</p> <p><strong> </strong></p> <p><strong>Abstracting and Indexing information</strong></p> <p>The International Journal of Research in Medical Sciences is indexed with</p> <ul> <li><a title="PubMed and PubMed Central (PMC)" href="" target="_blank" rel="noopener">PubMed and PubMed Central (PMC)</a> (NLM ID: 101772888, Selected citations only)</li> <li><a href=";journalId=31374" target="_blank" rel="noopener">Index Copernicus</a> </li> <li><a href="" target="_blank" rel="noopener">Index Medicus for South-East Asia Region (WHO)</a></li> <li><a title="Scilit" href="" target="_blank" rel="noopener">Scilit (MDPI)</a></li> <li><a href="" target="_blank" rel="noopener">ScopeMed</a></li> <li><a href="" target="_blank" rel="noopener">CrossRef</a></li> <li><a href="" target="_blank" rel="noopener">Google Scholar</a></li> <li><a href="" target="_blank" rel="noopener">Ulrichsweb</a></li> <li><a href="" target="_blank" rel="noopener">Journal Index</a></li> <li><a href="" target="_blank" rel="noopener">J-Gate</a></li> <li><a href="" target="_blank" rel="noopener">Directory of Science</a></li> <li><a href="" target="_blank" rel="noopener">JournalTOCs</a></li> <li><a href=";issn=23206071&amp;uid=r0eec0" target="_blank" rel="noopener">ResearchBib</a></li> <li><a href="" target="_blank" rel="noopener">ICMJE</a></li> <li><a href=";fIDnum=|&amp;mode=simple&amp;letter=ALL&amp;la=en" target="_blank" rel="noopener">SHERPA/RoMEO</a></li> </ul> <p> </p> Medip Academy en-US International Journal of Research in Medical Sciences 2320-6071 Tuberous sclerosis complex type 2 in a subgroup of 7 pediatric patients <p>Tuberous sclerosis complex (TSC) is a multisystemic genetic disorder with autosomal dominant inheritance, characterized by hamartomas that affect multiple organs, including the central nervous system, skin, heart, kidneys, and lungs. It occurs due to variants in the tumor suppressor genes TSC1 or TSC2. In this case series, we present a subgroup of 7 pediatric patients with variants in the TSC2 gene and discuss their genotypes, phenotypes as well as genotype-phenotype correlation.</p> Aferdita Tako Kumaraku Kristi Aleksi Aida Bushati Armand Shehu Sonila Tomori Renald Mecani Paskal Cullufi Copyright (c) 2023 International Journal of Research in Medical Sciences 2023-01-25 2023-01-25 11 2 678 681 10.18203/2320-6012.ijrms20230184 Unusual sites of delayed metachronous metastases from renal cell carcinoma: a case series of five cases and review of literature <p>Renal cell carcinoma (RCC) is the most common malignant tumour of the kidney, representing 3% of all adult malignancies. Among men it is the sixth most common cancer while among women it is the ninth most common cancer. The mainstay of treatment for localized RCC is surgical resection with curative intent. The aggressive and often insidious nature of RCC is reflected by high recurrence rates of upto 20-40% after nephrectomy. Most commonly encountered sites of recurrent metastases include the lung, followed by bone, liver, brain, and local recurrence. Atypical sites of delayed metastases of RCC, although rare, have been reported in literature. We present our series of five cases where delayed metastasis has occurred at atypical sites including right sartorius muscle, right atrium and ventricle, urinary bladder, shaft of tibia and distal phalanx of hand upto six years later from the time of initial curative treatment of primary. The metastatic lesions in sartorius muscle, right atrium and ventricle, urinary bladder and distal phalanx were primarily managed by metastatectomy while that in the tibial shaft was managed by palliative targeted therapy with tyrosine kinase inhibitors. The key takeaway from this case series is that any primary neoplastic lesion in a patient with history of RCC should be evaluated with histopathology before definitive intervention is undertaken keeping in mind the notorious tendency of RCC to cause delayed metachronous metastases at unusual sites. In presence of solitary metastatic lesions at resectable locations, curative treatment can be offered by metastatectomy.</p> Anshuman Singh Arun Chawla Manjunath Irappa Wali Abhijit Shah Kasi Viswanath Gali Copyright (c) 2023 International Journal of Research in Medical Sciences 2023-01-25 2023-01-25 11 2 682 687 10.18203/2320-6012.ijrms20230185 3D printing for surgical planning in bone grafts for cleft-palate: a case report <p>3D printing has been used for teaching purposes. Creating models for simulating surgeries. Gong et al presented a workflow for digital planning for surgery and Rendon et al previously presented a low-cost method with acceptable precision. This paper aims to present a case where 3D printing surgical planning was applied for bone graft shape and dimensions. A 16-year-old female patient with a history of bilateral cleft lip and palate has received 6 surgical interventions to treat her congenital pathology. She begins orthodontic management at the age of 6 years and is referred to the plastic surgery service 10 years later, presenting oral and nasal fistula on the nasal floor with mainly liquid leakage. A bone graft was taken and applied from the patient's left iliac crest. the iliac crest is taken and the bone graft is molded Assisted with 3D printed model which is fixed in the premaxilla with a 14-hole linear plate. We proposed a new application for low-cost 3D printed models. Patient specific models have applications in cleft palate bone grafting. We present a case and more studies are required to measure variables as time, graft integration, and patient satisfaction.</p> Marco Aurelio Rendón-Medina Leidy Arias-Salazar Alejandro Covarrubias-Noriega Edgardo Araiza-Gómez Maria De Los Angeles Mendoza-Velez Rubén Hernandez-Ordoñez Hecly Lya Vázquez-Morales Ricardo C. Pacheco-López Copyright (c) 2023 International Journal of Research in Medical Sciences 2023-01-25 2023-01-25 11 2 688 690 10.18203/2320-6012.ijrms20230186 Plastic bronchitis and a novel management approach with streptokinase inhalation therapy: a case study <p>Plastic bronchitis (PB) is a rare condition of obstructive bronchial casts. The most common demographic that is affected by PB is children but adults with acute onset have also been reported. At present, there are no established guidelines for the management of PB which has led to the proposition of a variety of treatment regimens. Inhaled streptokinase (SK) can be one such treatment modality for this rare condition. An adult female patient presented to the Grodno university clinic with complaints of dyspnea, shortness of breath, and expectoration of firm, long, and branching bronchial casts. We used inhaled SK to treat this patient based on the cast composition on microscopic evaluation. Written consent was taken from the patient mentioned in the study. The study was approved by the hospital and institutional ethics committee. SK, a potent fibrinolytic agent, can be useful in lysing fibrin-rich bronchial casts. With Inhaled SK therapy, there was a gradual improvement in the overall condition of the patient. In the subsequent clinical follow-up, the patient was asymptomatic and without recurrent casts. The course of treatment and positive recovery of the patient signifies the fact that inhaled SK can be a suitable therapeutic approach in PB. Therefore, based on our novel therapeutic approach, SK inhalation may be a possible treatment for bronchial casts in PB.</p> Nataliya Hlutkina Mehul Hitesh Sadadiwala Hardik Bakulkumar Mevawala Copyright (c) 2023 International Journal of Research in Medical Sciences 2023-01-25 2023-01-25 11 2 691 696 10.18203/2320-6012.ijrms20230187 Undifferentiated uterine sarcoma: case report <p>Undifferentiated uterine sarcoma is a rare condition characterized by abnormal bleeding and pelvic pain, which may overlap with the clinical picture of uterine myomatosis. Its presentation is usually chronic and drastically affects the stage at the time of diagnosis. Since it is usually seen in postmenopausal patients, undifferentiated uterine sarcoma presentation in premenopausal patients is rare. We herein report a rare presentation of undifferentiated uterine sarcoma in a 58-year-old Mexican woman, who suffered from progressive pelvic pain for 3 months as well as a 5-day course of postmenopausal bleeding. Study images revealed a pedunculated uterine-mass suggestive of sarcomatous degeneration, accompanied by a left internal iliac necrotic adenopathy, as well as scarce pelvic free fluid. The patient underwent a pelvic tumor and implants resection, total abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic lymphadenectomy, omentectomy and appendectomy via laparotomy. Despite the therapeutic options for the management of undifferentiated uterine sarcomas described in literature, its survival rate varies between 21% to 68%, when diagnosed on time and depending on if the cancer is localized, regional or distant.</p> Victoria P. Holguín-Montaño Patricio Mendoza-Gálvez María F. Zalapa-Gómez Raúl Leal-González Copyright (c) 2023 International Journal of Research in Medical Sciences 2023-01-25 2023-01-25 11 2 697 700 10.18203/2320-6012.ijrms20230188 Distant delayed hypersensitivity reactions after taking spike protein containing adenoviral vector vaccine for COVID-19 <p>COVID-19 epidemic is still going on and various SARS-CoV-2 vaccines are available for emergency administration since December 2020. It has many side effects as other vaccines, but as it is a new vaccine, different side-effects are not well-known to us. Here, we are reporting one side-effect, appearance of distant delayed hypersensitive reaction lesions after covid vaccine.</p> Suchibrata Das Srutee Barman Aritra Roy Sangita Patra Copyright (c) 2023 International Journal of Research in Medical Sciences 2023-01-25 2023-01-25 11 2 701 703 10.18203/2320-6012.ijrms20230189 Tubo-ovarain abscess in patient with ovarian endometriosis <p>Tubo-ovarian abscess (TOA) is a sequela of pelvic inflammatory disease (PID) found in 15-34% of patients, is comprised of an infectious, inflammatory complex encompassing the fallopian tube and ovary. We are presenting a case of TOA with endometriosis in a patient who underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy. Histopathological findings were compatible with endometriosis with xanthogranulomatous salpingitis and oophoritis. In our patient there was no history of any chronic infection, gynecological procedures or intra uterine device and single partner. The purpose of this case is to make aware of this condition and requirement of further studies to investigate the risk of TOA in patients with endometriosis to find out the exact cause to prevent unnecessary surgery at later stage.</p> Monika Gupta Tripti Jain Neha Goel Sunita Singh Copyright (c) 2023 International Journal of Research in Medical Sciences 2023-01-25 2023-01-25 11 2 704 706 10.18203/2320-6012.ijrms20230190 Neuropsychiatric systemic lupus erythematosus: a rare case of acute polyneuropathy <p>Systemic lupus erythematosus (SLE) is a chronic autoimmune disease which presents most commonly in middle aged females and affects multiple organ systems. Amongst the many systems involved, the nervous system generally gets affected later in the course of the disease. We report a case of a male patient who developed quadriparesis as the initial presentation of SLE who progressed to lupus nephritis. The patient was started on methylprednisolone, and later planned on IVIg when he did not respond to the initial treatment. Unfortunately, the patient developed diaphragmatic paralysis and succumbed to the illness.</p> Aditya Anand Ammar S. Siddiqui Shivam Singh Pragati Basera Copyright (c) 2023 International Journal of Research in Medical Sciences 2023-01-25 2023-01-25 11 2 707 709 10.18203/2320-6012.ijrms20230191 Two birds one stone-two rare cases of adenine phosphoribosyl transferase deficiency <p>Complete adenine phosphoribosyl transferase (APRT) deficiency is a rare inherited metabolic disorder that leads to the formation and hyperexcretion of 2,8-dihydroxyadenine (DHA) into urine. We had a 52-year-old male with Hypertension for 18 months, presented for routine evaluation and was found to have creatinine of 4.29 mg/dl. His urine analysis was done which showed no proteinuria or urinary sediments. His USG done demonstrated normal sized kidneys with mildly increased echogenicities. He underwent a renal Biopsy for etiology determination. Similarly, we had another case of a 54-year-old female with no comorbidities who was identified to have chronic kidney disease in 2018 with a baseline creatinine of 2 mg/dl came with uremic symptoms and history of NSAID intake in June 2019. Her creatinine peaked to 7.9 mg/dl. Urine analysis displayed 1+ proteinuria with no active sediments. Her USG of the kidneys showed normal kidneys with increased echogenicities. She underwent renal biopsy for etiology determination. Biopsy of case 1 showed chronic interstitial nephritis and case 2 showed acute interstitial nephritis. Both biopsies showed deposition of 2,8-dihydroxyadenine crystals. Genetic analysis of both cases showed an exon mutation in chromosome 16.</p> Mohammed Fahad Khan Vishwanath Siddini Mahesha Vankalakunti Sudarshan Ballal Copyright (c) 2023 International Journal of Research in Medical Sciences 2023-01-25 2023-01-25 11 2 710 713 10.18203/2320-6012.ijrms20230192 A case report of Kounis syndrome: acute myocardial injury caused by multiple bee stings <p>Kounis syndrome, also known as “allergic angina syndrome” or “allergic myocardial infarction”, refers to acute coronary syndrome secondary to hypersensitivity reaction as a result of exposure to various allergens. Signs and symptoms may include chest pain, with or without raised troponins and cardiac enzymes, vomiting, syncope, hypotension or acute renal failure. A 60-year-old male, farmer by occupation, was bitten by multiple bees over head, neck region and bilateral upper limbs in the afternoon on 04/03/2022. On presentation, vitals were stable. After 2 hours, patient developed severe chest pain, palpitations, and dizziness. ECG showed inferior wall ST elevation MI. Subsequently CPK, CK-MB, troponin I were done, which were found to be elevated. Echocardiography was done, which showed regional wall motion abnormality in the inferior wall. Patient was treated with anticoagulants and antiplatelets. CT coronary angiography showed healthy coronaries. In literature, we had few cases of myocardial infarction following bee sting. In acute myocardial infarction after bee stings, it has been suggested that vasoconstriction secondary to mediators released after the sting, aggravated by exogenous adrenaline and platelet aggregation contributes to myocardial ischemia. Cardiac complications can accompany bee sting. Intensive supportive treatment in intensive or coronary care facilities with administration of drugs to treat complications early in the course of the illness will improve the outcome.</p> Megha S. Gaurav Agarwal Copyright (c) 2023 International Journal of Research in Medical Sciences 2023-01-25 2023-01-25 11 2 714 715 10.18203/2320-6012.ijrms20230193 An unusual case of cavitary lung lesion in catheter related blood stream infection <p>Cavitary lung lesions are commonly caused by <em>Staphylococcus aureus</em>, <em>Klebsiella pneumoniae</em>. <em>Pseudomonas</em> rarely causes such lesion. Here we report a case of cavitary pneumonia due to <em>pseudomonas</em> aeruginosa in the setting of catheter related blood stream infection in a 25-year-old male with crescentic IgA nephropathy who was on immunosuppressive medication.</p> Himadri Koley Sandeep Saini Chandrashekar Cheluvaiah Dipesh K. Dhoot Devada Sindhu Copyright (c) 2023 International Journal of Research in Medical Sciences 2023-01-25 2023-01-25 11 2 716 718 10.18203/2320-6012.ijrms20230194 A combination effect of manual assisted cough techniques and respiratory proprioceptive neuromuscular facilitation on ventilatory decompression craniotomy patients: a case report <p>After traumatic brain injury (TBI), brain starts swelling due to the formation of hematomas in the intracranial cavity and owing to forming rigid nature of the skull. Decompression craniotomy is a surgical procedure in which skull is removed and underlying dura is opened-for escalating the brain edema. Patients with TBI will be on prolonging bed rest depending on severity of injury and level of consciousness i.e., low GCS score and neuromuscular weakness. Prolong bed rest can contribute to cardio-pulmonary dysfunction and there by receiving ventilatory support via endotracheal tube or tracheostomy. Experience of ineffective cough reduced airway in the lung field due to impaired respiratory muscle weakness or paralysis which contributes various pathophysiological effects in TBI. A case report study of 51 years old patient diagnosed with TBI with left sided subdural haemorrhage with right extradural haemorrhage who operated for decompression craniotomy and with ventilatory support. Outcomes were taken on day one and fourteenth day i.e., vitals, GCS score, RLA stage, chest expansion, lung compliance and ICP, there is significant improvements in outcomes is seen after intervention. In the present case study, combination of manual assisted cough techniques (MACT) and respiratory PNF have shown improvement in efficacy of cough, thoracic cage mobility and weaning off from ventilator, hence by implementing these combination techniques, will reduce ICU stay and improve quality of life.</p> Namathota Chandra Akshay Kumar Karuna Kamble Copyright (c) 2023 International Journal of Research in Medical Sciences 2023-01-25 2023-01-25 11 2 719 722 10.18203/2320-6012.ijrms20230195 A case report demonstrating intestinal tuberculosis in an infra-umbilical incisional hernia <p>Abdominal tuberculosis is common but it is rare to diagnose it through the contents of hernia. Clinical presentations of abdominal tuberculosis are diverse depending on the organ involved in the abdominal cavity. Thirty-five-year-old female was admitted in the surgical ward of Ajmal khan Tibbiya college hospital, Aligarh Muslim university Aligarh with the complaints of a swelling in the infra-umbilical region in a previous vertical LSCS incision. Hernia repair surgery revealed the features of intestinal tuberculosis which was confirmed by histopathology. Anti-tuberculosis treatment was started and she was in a stable condition upon discharge. This case report is the first documented case of intestinal tuberculosis in an infra-umbilical incisional hernia. The case report highlights the relevance of advance investigations in simple looking hernial cases. There is very limited data within literature related to the histopathological diagnosis of hernial sacs in an endemic area of tuberculosis, but it will be beneficial for surgeons working in endemic areas of tuberculosis.</p> <p><br /><br /></p> M. Tarique Iqbal Aziz Copyright (c) 2023 International Journal of Research in Medical Sciences 2023-01-25 2023-01-25 11 2 723 726 10.18203/2320-6012.ijrms20230196 Rheumatoid arthritis-associated interstitial lung disease seen in two generation of females in an Indian family <p>Interstitial lung diseases<strong> (</strong>ILDs) or diffuse parenchymal lung diseases (DPLDs) are a group of lung diseases that is distinguished by subacute or chronic inflammation and/or fibrosis. Family history is currently being considered one of the biggest risk factors for ILD. Rheumatoid arthritis (RA) a systemic autoimmune disease has lungs as its most common extraarticular organ involved. Interstitial lung disease associated with it is one of the major causes of mortality along with severe disability. Lung involvement in RA might appear as ILD, pleural effusion, or pulmonary vasculitis. In this case report a 42-year-old female presented with complain of progressive breathlessness, dry cough, chest pain, joint pain since past 10 years. HRCT Thorax of patient suggested it to be ILD of UIP pattern with raised RF, anti CCP and positivity in ANA profile. Patient had a family history with mother being diagnosed with ILD-NSIP pattern. She was suspicioned for RA as she had complained of small joint pains and swellings and was responding well to steroids and HCQ.</p> Arti D. Shah Kaushani H. Patel Parshwa Naik Chirag H. Chakravarti Copyright (c) 2023 International Journal of Research in Medical Sciences 2023-01-25 2023-01-25 11 2 727 729 10.18203/2320-6012.ijrms20230197 A rare presentation of common tropical fever, scrub typhus-purpura fulminans, lower limb arterial thrombosis and pulmonary artery thrombosis <p>Purpura fulminans (PF) is an acute emergency condition manifested as purpuric rash secondary to thrombosis of microvasculature. It is rapidly progressive, can cause thrombosis in large as well as small vessels and tissue infarction. Although it is commonly associated with <em>Meningococcal</em> and <em>Streptococcal</em> infections, here we report this case of PF associated with scrub typhus infection. Our patient presented with generalised body rash and progressed to multiorgan dysfunction. On evaluation, common causes of PF were ruled out and eventually patient came out to be IgM scrub typhus serology kit test positive. Lower limb angiography and pulmonary artery angiography revealed vascular thrombosis. The patient started on IV antibiotics, other supportive managements, anticoagulation. Later the patient improved clinically, skin rash resolved with excoriations but developed gangrenous changes in both lower limbs. Hence the uncommon presentation of scrub typhus infection as purpura fulminans needs early identification and effective treatment to achieve mortality and morbidity benefit.</p> Arko Bandyopadhyay Milind S. Vyawahare Jayanth Sakhale Copyright (c) 2023 International Journal of Research in Medical Sciences 2023-01-25 2023-01-25 11 2 730 734 10.18203/2320-6012.ijrms20230198 Dentinogenesis imperfecta type 1-Shield’s classification (1973): a rare case report and literature review <p>Dentinogenesis imperfecta (DI) is an autosomal dominant disorder that affects the dentin development. It is characterized by the presence of opalescent dentin, with dusky blue to brownish discoloration of the teeth. This condition is genetically and clinically heterogeneous; DI may affect only the teeth or it may be associated with the osteogenesis imperfect (OI). When both are associated there are various degrees of clinical presentation from mild form with less significant signs to severe form such as death in infancy. The most familiar classification system of this hereditary disorder is Shields classification which is of 3 types namely, type I, DI associated with OI, type II is not associated with OI. Type III which is also known as ‘Brandywine type’ DI. This case report describes a rare case of 32-year-old female patient who showed the characteristic features of Shield’s classification type I with penetrance of defect through 4 generations. </p> Saraswathi Gopal K. Poogodi V. Priyadharshini S. Copyright (c) 2023 International Journal of Research in Medical Sciences 2023-01-25 2023-01-25 11 2 735 740 10.18203/2320-6012.ijrms20230199 Protective effects of pomiferin isolated from Maclura pomifera on ischemia-reperfusion injury of rat ovary: biochemical and histopathologic evaluation <p><strong>Background:</strong> The aim of this study was to investigate the antioxidant and anti-inflammatory properties of pomiferin, a prenylated flavonoid was purified from <em>Maclura pomifera</em> by thin layer chromatography method, on oxidative stress, sterile inflamation and ovarian tissue damage caused by ischemia-reperfusion model.</p> <p><strong>Methods:</strong> Thirty female Wistar albino rats were divided into five groups. In the group CN only laparotomy operation was performed. In group CN<sup>Pomifer<strong>in</strong></sup>, rats received 200 mg/kg pomiferin. In group IR<sup>Vehicle</sup>, reperfusion for 3 h performed after an ischemic period of 3 hours. In groups IR<sup>Pomiferin100</sup> and IR<sup>Pomiferin200</sup> rats received 100 mg/kg and 200 mg/kg doses of pomiferin, by oral gavage 1 houes before reperfusion. After the experiments, tissue level of malondialdehyde (MDA) and activities of myeloperoxidase (MPO), catalase (CAT), superoxide dismutase (SOD) were determined, and histopathological changes were examined in all rat ovarian tissue.</p> <p><strong>Results:</strong> It was determined that irreversible cell damage such as apoptotic and necrotic deaths and reversible cell damage occurred in follicular, endothelial and stromal cells due to oxidative stress in the group IR<sup>Vehicle</sup>. In this group, it was determined that the LPO level exceeded the cellular antioxidant capacity (SOD and CAT enzyme activities) and the PMNL infiltration and activity (MPO), an indicator of sterile inflammation, increased. It was determined that oxidative stress sterile inflammation and irreversible cell damage decreased in a dose-dependent manner with pomiferin treatment.</p> <p><strong>Conclusions:</strong> Pomipherin treatment strongly protects ovarian follicles and vascular structures against ischemia-reperfusion injury, thus it may prevent the reduction of ovarian follicle reserve, which is an indicator of female fertility.</p> Osman Nuri Keleş Hüseyin Serkan Erol Dilek Vural Keleş Mehmet Karaca Ahmet Çakır Jale Selli Murat Koç Mesut Bünyami Halıcı Copyright (c) 2023 International Journal of Research in Medical Sciences 2023-01-10 2023-01-10 11 2 433 441 10.18203/2320-6012.ijrms20230010 Pattern of skeletal metastasis in breast cancer patients of northern part of Bangladesh <p><strong>Background:</strong> Breast cancer is the most frequent female cancer, especially in 'developed' countries. 30-85% of metastatic breast cancer patients will develop bone metastases during the course of the disease. The study was aimed to evaluate the pattern of skeletal metastasis in breast cancer patients with whole body bone scan using 99mTechnetium methyl diphosphonate (<sup>99m</sup>'Tc-MDP).</p> <p><strong>Methods:</strong> This single center based retrospective observational study was conducted among the histopathologically proven breast cancer patients referred to INMAS, Rangpur for <sup>99m</sup>'Tc-MDP bone scintigraphy between March 2015 and March 2019. Bone scan was done with SPECT digital dual head gamma camera (Siemens S series) 3 hours after intravenous bolus injection of 20 mci<sup>99m</sup>I'c-MDP.</p> <p><strong>Results:</strong> Out of total 300 patients, 120 (40%) patients were found secondaries in bones. Among them 80(66.7%) had only axial skeletal metastases and 15 (12.5%) had appendicular skeletal metastases. Both axial and appendicle skeletal metastases were found in 25 (20.8%) patients. </p> <p><strong>Conclusion:</strong> Thoraco-lumbar spine was the most common site of involvement in our study.</p> <p><strong> </strong></p> A. M. M. Minhazur Rahman M. Murshed Ali Copyright (c) 2023 International Journal of Research in Medical Sciences 2023-01-25 2023-01-25 11 2 442 445 10.18203/2320-6012.ijrms20230150 Perceived professionalism and its relationship with communication skills, social interaction and attitude towards medical subjects among undergraduate medical students in Malaysia <p><strong>Background:</strong> Professionalism is an essential core competency in medical education in line with societal expectations. It is expected that the medical professionals show a specified set of behaviours and attitudes towards patients and society. This study assessed professionalism and its relationship with undergraduate medical students’ communication competency skills, learning attitude, and social interaction.</p> <p><strong>Methods:</strong> This was a cross-sectional-correlation study conducted among undergraduate medical students irrespective of gender and nationality. A total of 319 students’ data were collected using a validated self-administered questionnaire. The collected data were analysed using IBM SPSS version 27.0. Pearson’s moment correlation and multiple linear regression analysis were done to identify the potential predictors of perceived medical professionalism. A p value of less than 0.05 was considered statistically significant.</p> <p><strong>Results:</strong> The study showed that professional relationship was significantly correlated with a positive attitude on communication skill (p&lt;0.001), environmental control (p&lt;0.001), interaction management (p&lt;0.01), immediacy (p&lt;0.01), attitude towards the medical subject (p&lt;0.001). However, no statistically significant correlation was found between perceived empathy and age, gender, year of study, parental education and previous CGPA (p&gt;0.05).</p> <p><strong>Conclusions:</strong> The study found an interrelationship between professionalism, communication skills, interpersonal communication, and attitude towards medical subjects. However, the multivariate analysis revealed different weightage of influence to professionalism. Further advanced analysis is warranted to get the impact of each of the contributing variables to academic achievement.</p> M. Mizanur Rahman Daneish Raman Elvyronna Anthony Nor Syamimi Hazwani Nurul Iffah Copyright (c) 2023 International Journal of Research in Medical Sciences 2023-01-25 2023-01-25 11 2 446 452 10.18203/2320-6012.ijrms20230151 Correlation between quality of healthcare and safety culture in Saudi Arabia organizations <p><strong>Background:</strong> The current study aimed to examine the association between hospital nurses’ attitudes about the safety culture and patients’ views about the quality of healthcare services delivered to them during their hospitalization.</p> <p><strong>Methods:</strong> This study was cross section study as well as adopted the correlational design. The study used the hospital survey on patient safety culture to assess nurses’ perceptions about the safety culture, and the consumer assessment of healthcare providers and systems survey to assess patients’ experience of care. The current study was conducted in a tertiary healthcare organization in Riyadh city in Saudi Arabia.</p> <p><strong>Results:</strong> The response rates for nurses and patients were 79% and 80%, respectively. In nurses’ sample, the majority 92.9% was female and 90.6% was non-Saudi; while 43.5% of patients were male and the majority was Saudi 97.1%. More than half of the nurses 57.2% were married and 35.4% identified themselves as single. On the other hand, the majority of patients 81.5% were married and 48.7% of patients had a diploma or high school or less.</p> <p><strong>Conclusions:</strong> The results of canonical correlation analysis showed positive and strong correlations between nurses’ perceptions of safety culture (facilitators and threats to patient safety) and patients’ perceptions of quality of healthcare (interpersonal care communication and technical quality of care). The canonical variates for both root pairs (canonical correlation coefficients = 0.89 and 0.81). This finding clearly proves that in workplaces where staffs have more positive perceptions of patient safety culture, patients have more positive experiences of care.</p> Mansour M. Alanazi Mohammed R. Alanazi Copyright (c) 2023 International Journal of Research in Medical Sciences 2023-01-25 2023-01-25 11 2 453 458 10.18203/2320-6012.ijrms20230152 Sign language in autistic spectrum disorders children: special education teachers’ attitudes and experience <p><strong>Background:</strong> There is evidence that sign language can help autistic children communicate more effectively. The present study aimed to assess the attitude and experience of special education school teachers toward sign language use in autistic spectrum disorder (ASD) and to explore the associated variables that influence positive attitudes.</p> <p><strong>Methods:</strong> A cross-sectional study includes fifty-three teachers working with special education children. A conventional online survey was distributed to uncover the primary ideals of teachers’ attitudes toward using sign language by ASD children. The scores in the attitude domain were typically distributed and expressed as mean, then were categorized as poor (&lt;50%), fair (50-69%), and good (≥70%).</p> <p><strong>Results:</strong> More than 50 percent of the survey respondents have a level of education after graduation and 37% work in special needs education. Seventy-three percent of respondents had experience teaching ASD children, and more than half had less than five years of experience. However, about 73% received training courses in teaching ASD children, and only 37.7% had a good experience using sign language with ASD children. The overall percentage of good attitudes was 53%, which significantly correlates to gender and the number of students in the school.</p> <p><strong>Conclusions:</strong> Even though sign language is a widely used form of communication for children with ASD, Sudan’s unique-education teachers still need support and training to instruct autistic students and caregivers how to use it. The teachers’ positive attitudes were significantly related to the teacher’s gender and the number of students per school.</p> Ebtihal Elameen Eltyeb Copyright (c) 2023 International Journal of Research in Medical Sciences 2023-01-25 2023-01-25 11 2 459 464 10.18203/2320-6012.ijrms20230153 The role of umbilical artery doppler indices in predicting perinatal outcome in preeclampsia <p><strong>Background: </strong>Preeclampsia currently accounts for the majority of causes of perinatal morbidity and mortality. Umbilical artery Doppler (UAD) is a non-invasive effective method of antenatal fetal surveillance for early detection and prevention of potentially adverse perinatal outcome in preeclampsia. The objective of this study is to predict adverse perinatal outcome using UAD in Preeclampsia.</p> <p><strong>Methods: </strong>This was a prospective cohort study in which 170 consecutively consenting women with preeclampsia were recruited. An UAD was done using Voluson P8 ultrasound. The pulsatility index, resistance index, systolic/diastole ratio. Reduced end diastolic flow, absent end diastolic flow and reversed end diastolic flow were measured. The participants were divided into two groups based on UAD indices findings. Both groups were followed up to determine their perinatal outcomes.The data was analyzed using SPSS version 20.0 for windows (IBM SPSS Inc, Chicago, IL, USA). Categorical variables were analyzed using Chi-Square ( <sup>2</sup>) test and Fisher's exact test p&lt;0.05 was considered statistically significant. Specificity, sensitivity, PPV and NPV were determined.</p> <p><strong>Results:</strong> The sensitivity, specificity, PPV, and NPV of umbilical artery Doppler in predicting adverse perinatal outcomes was 68.5%, 59.7%, 74.7%, and 52.1% respectively.</p> <p><strong>Conclusions:</strong> Although the use of UAD indices in this study showed modest predictive values for adverse perinatal outcome in preeclampsia, it’s use should be combine with other methods of antenatal fetal surveillance to prevent adverse perinatal outcome.</p> <p> </p> Omoregie Irowa Mohammad Hameed Nombur Lahaga Issac Eti Arichi Elizabeth Copyright (c) 2023 International Journal of Research in Medical Sciences 2023-01-25 2023-01-25 11 2 465 470 10.18203/2320-6012.ijrms20230154 A study on demographical, clinical-radiological, and histopathological profile of bronchial carcinoma in a tertiary care hospital in Bangladesh <p><strong>Background:</strong> Bronchial carcinoma has different demographical, clinico-radiological, and histopathological profiles depending on the environment, gender, and racial group. The purpose of this study was to explore the sociodemographical, clinical, radiological, and histopathological patterns of bronchial carcinoma in Bangladesh.</p> <p><strong>Methods:</strong> This cross-sectional descriptive study was conducted at the respiratory medicine department of Bangabandhu Sheikh Mujib Medical University (BSMMU). The study period was one year from January 2021 to December 2021. Our study documented socio-demographic patterns, smoking habits, history of COPD, clinical features, radiological findings, histopathological patterns of the tumor, and participants' performance status.</p> <p><strong>Results:</strong> One hundred histopathologically confirmed patients with bronchial carcinoma were included in this study. The mean age of the participants was 59.57±10.41 years. The majority of the participants were in the 5<sup>th</sup> and 6<sup>th</sup> decade, 35% and 34% respectively. Smokers were 80% in our study. The presenting complaints were cough (87%), shortness of breath (61%), and chest pain (58%). Mass lesions (83%) followed by collapse (8%) were the most common imaging findings. Adenocarcinoma (48%) and squamous cell carcinoma (35%) were the predominant histological types.</p> <p><strong>Conclusions:</strong> The histopathological profiles of bronchial carcinoma are changing and adenocarcinoma is becoming the predominant type in Bangladesh.</p> Rajashish Chakrabortty Dibanur Rashid Siddiqua Samia Rahman Susanta Kumar Paul Copyright (c) 2023 International Journal of Research in Medical Sciences 2023-01-25 2023-01-25 11 2 471 475 10.18203/2320-6012.ijrms20230155 The percentage of hepatitis B virus infection and related factors in Tra Vinh province, Vietnam <p><strong>Background:</strong> Hepatitis B virus infection continues to be a public health problem in developing countries. This study aimed to assess the percentage of hepatitis B virus infection and related factors among adult population in Tra Vinh Province, Vietnam 2022.</p> <p><strong>Methods:</strong> The study applied the cross-sectional descriptive design with the combination of structured interview and serological blood tests, from September 1, 2021, to June 1, 2022.</p> <p><strong>Results:</strong> There were 1,289 respondents in the study. Overall, the percentage of sample positive reaction with HBsAg were 7.68% (99 peoples). Most of the people did not likely have relatives with a family history of hepatitis B virus infection, the proportion of people who had household family members who had hepatitis B, hepatocellular carcinoma, and cirrhosis was 1.24%, 0.93%, and 2.48% respectively. People who did not preventive vaccination for hepatitis B virus had higher rates of HBsAg (+) than people get preventive vaccination, with p=0.005. However, in other medical practice, the rate of HBsAg was non-significance, such as blood transfusion, surgery, dental treatment, injecting medications, and injected skin boils. The percentage of hepatitis B virus infection in the study was not significantly associated with hepatitis B prevention practices in daily life, including acupuncture, sharing shavers, sharing toothbrushes, sharing nail tools, and spraying tattoo.</p> <p><strong>Conclusions:</strong> The percentage of hepatitis B virus infection in Tra Vinh province was 7.68%. There was a statistically significant relationship between the incidence of hepatitis B with preventive vaccination for the hepatitis B virus.</p> Tào Gia Phú Huynh Thi Hong Nhung Huynh Thi Hong Ngoc Nguyen Thi Mong Trinh Nguyen Thi Ngoan Copyright (c) 2023 International Journal of Research in Medical Sciences 2023-01-25 2023-01-25 11 2 476 479 10.18203/2320-6012.ijrms20230156 Functional evolution in total knee arthroplasty: first and second-generation patient-specific instrumentation compared with conventional instrumentation <p><strong>Background</strong>: This study compares the functional evolution between the first- and second-generation patient-specific instrumentation and conventional instrumentation pre-surgery and the third month post-surgery after TKA. We analyzed the functional outcomes achieved and the absolute gains of each study variable. In addition, we aimed to elucidate the results of the three surgical techniques regarding the surgery length of time, length of hospital stay, percentage drop in hemoglobin (Hg) at 24 h, and hip-knee-ankle angle post-surgery.</p> <p><strong>Methods: </strong>We reported our experience in TKA using PSI Visionaire System® and CI technique in 688 procedures. The patients were divided into first (N=272) and second-generation (N=151) PSI designs. The control group (N=265) underwent TKA with the CI. The instruments for assessing the functioning were: visual analog scale, goniometry, 6-minute walk test (6MWT), and domains of the WOMAC Index.</p> <p><strong>Results:</strong> The functioning achieved three months after surgery was lower in the CI than the first-generation PSI. The respective differences at absolute gains were found in the 6MWT and pain and function WOMAC scores (p=0.023, p=0.049, and p=0.018, respectively). The mean surgical time was higher in the CI compared to PSI designs (both p&lt;0.001), and the mean hospital length of stay was higher in the CI compared to second-generation PSI (p=0.002). The percentual drop in Hg was higher in the first-generation PSI than with the CI (p=0.006).</p> <p><strong>Conclusions:</strong> Three months after TKA, the functioning achieved with the first-generation PSI was greater than the CI. However, the functional results between second-generation PSI and CI were similar.</p> <p> </p> Ana Paula Fontes Rui Miguel Cintra Luís Gomes João Paulo Sousa Copyright (c) 2023 International Journal of Research in Medical Sciences 2023-01-25 2023-01-25 11 2 480 487 10.18203/2320-6012.ijrms20230157 Weight reduction and glycemic control in type 2 diabetes mellitus using a wholly Nigerian diet at university of Port Harcourt teaching hospital, Nigeria <p><strong>Background:</strong> Weight gain is associated with poor glycaemic control in patients with type 2 diabetes and worsened by resource restrained environment with almost no access to sustainable therapy. In the absence of effective access to health care and medication due to poverty, safer locally available and proven scientific options to manage their health becomes a priority. Today, targeted lifestyle interventions are found to be clinically effective and affordable for diabetes prevention and treatment. This study aimed to evaluate the efficacy of a wholly Nigerian diet in achieving weight reduction and good glycaemic control in patients with type 2 diabetes mellitus.</p> <p><strong>Methods:</strong> Sixty study participants were randomized into matched control (standard of care) and intervention (caloric restriction dietary intervention) groups. Participants were followed for 24 weeks and samples taken 3 times a week for the duration of the study.</p> <p><strong>Results:</strong> The result revealed a significant drop in weight (waist circumference and BMI) in the intervention group. Mean waist circumference decreased from 88.82 cm to 80.0 cm (p=0.001) while BMI decreased from 22.67 to 22.86 kg/m<sup>2</sup> (p=0.025). The fasting blood sugar dropped from a group mean of 7.97 on the initial visit to a mean of 5.35 after six months in the intervention group.</p> <p><strong>Conclusions:</strong> Caloric restriction with locally available food reduced weight and normalized fasting blood sugar in study participants with type 2 diabetes mellitus.</p> <p> </p> Sokiprim Akoko Iyeopu M. Siminialayi Sunday Chinenye Copyright (c) 2023 International Journal of Research in Medical Sciences 2023-01-25 2023-01-25 11 2 488 496 10.18203/2320-6012.ijrms20230158 Granulocyte to monocyte ratio: leucokinetics in hematic biometry for appendicitis screening <p><strong>Background:</strong> Acute appendicitis diagnosis is still challenging and is established with clinical history, physical exam, laboratory tests, and imaging studies. It´s crucial to analyze the blood biometry with physiopathological asses and not with a statistical approach for establishing diagnostic items. The interaction between neutrophils with monocytes is noticeable in the blood biometry, so its relationship could be explained as directly proportional to the neutrophils count because of cellular recruitment and inversely proportional to the monocyte count because of cellular migration.</p> <p><strong>Methods:</strong> A retrospective, transversal and analytic study was conducted, admission blood biometry of all patients (n=160) that went through appendectomy in Pemex´s North Central Hospital between 2014 and 2019 were dissected. Statistical correlation between sensibility and likelihood ratio of granulocyte/monocyte ratio (GMR), leucocyte elevation, and left shift of neutrophil count were contrasted. IBM® SPSS<sup>© </sup>statistical software performed the statistical analysis.</p> <p><strong>Results:</strong> GMR (1.00) sensitivity showed to be superior to leukocytosis (0.785) and percentage neutrophils (0.846). the same for the negative likelihood ratios (LR-) calculated for GMR (0.00), leukocytosis (0.59) and percentage of neutrophils (0.579).</p> <p><strong>Conclusions:</strong> GMR showed higher sensibility for detecting immune response in a patient with suspected acute appendicitis compared to leucocyte elevation and left shift of neutrophil count or both.</p> Daniel Benito Castillo Martinez Doris Michelle Palacios Rivera Juan Antonio Clemente Castillo Karla Itzell Altamirano Moreno Luis Daniel de los Cobos Duran Alejandro Aragón Montes Copyright (c) 2023 International Journal of Research in Medical Sciences 2023-01-25 2023-01-25 11 2 497 501 10.18203/2320-6012.ijrms20230159 Burden and features of neurological patients in Chittagong Medical College and Hospital in Bangladesh <p><strong>Background:</strong> Neurological disorders are a common and significant public health problem globally, and innovative strategies are needed to address the epidemic in resource-poor settings in Bangladesh. The aim of this study was to evaluate the burden and features of neurological diseases requiring hospitalization in a tertiary care hospital in Chittagong, Bangladesh.</p> <p><strong>Methods:</strong> This study was a prospective observational study conducted from January to June 2021 on patients admitted to the adult neurology unit of a hospital in Chittagong, Bangladesh. Data was collected through face-to-face interviews, laboratory data, and previous medical records, and in-hospital complications and outcomes were recorded. The data was cleaned and analysed using SPSS and presented in tables.</p> <p><strong>Results:</strong> In this study, stroke was the most common neurological condition requiring hospitalization, accounting for 74% of cases and leading to death in 73% of cases. The most frequent in-hospital complication was urinary tract infection (26%), mostly in stroke patients. Of stroke patients, 88% had incomplete recoveries at discharge, while 7% died. Hypertension was the most common risk factor present in both acute confusional state and stroke cases. The median duration of hospital stay was longest among patients with central nervous system infections.</p> <p><strong>Conclusions:</strong> Stroke dominates the burden of neurological diseases requiring hospitalization in tertiary care hospitals in Bangladesh. The most frequent in-hospital complication was urinary tract infections, mostly in stroke cases. The overall in-hospital mortality was 7%, most patients recovered incompletely at discharge (82%).</p> M. Ridwanur Rahman Farhana Zaman M. Hassanuzzaman Akramul Azam M. Mahabubul Alam Khandker Tasbeen Akhtar Sheekha Copyright (c) 2023 International Journal of Research in Medical Sciences 2023-01-25 2023-01-25 11 2 502 506 10.18203/2320-6012.ijrms20230160 First metatarsal bone reconstruction using Masquelet’s technique after bone loss in open III B injury <p><strong>Background:</strong> Masquelet technique involves two stages for reconstruction of bony defects. During stage one decontamination and debridement is performed. The bone defect is filled by a spacer made of bone cement. After a gap of around 6 weeks, a bio-membrane is established around the cement spacer. During stage two, the cement spacer is removed and cancellous autologous bone graft is used to fill the space that was previously occupied by the cement spacer. However, there is a huge scarcity of literature on reconstruction of bone defects in foot metatarsals, especially open injuries that require soft tissue coverage also.</p> <p><strong>Methods:</strong> This prospective study involved 25 patients with a minimum follow-up of 12 months. Masquelet’s technique was used to reconstruct large bony defects in metatarsals of foot in a staged manner. The primary outcome variable was union and consolidation of the bone. The secondary outcome variables included complications and functional outcome using Maryland foot score. </p> <p><strong>Results:</strong> One of the patients needed a below knee amputation for extensive bone and soft tissue infection. Pin site infection was the commonest indication observed and deep infection was observed on table at the time of second stage in two patients. Both the patients needed a re-do of stage one and a new cement spacer was placed which was removed at six weeks. Hallux varus deformity was observed in two patients at the final follow-up. Excluding the patient that needed amputation, all the patients had consolidation and union at the final follow-up and the mean Maryland foot score was 79.45±8.8. Good to excellent functional outcome was observed among 91.66% patients. </p> <p><strong>Conclusions:</strong> Masquelet’s induced membrane technique is a potentially fruitful method to deal with bone defects created by open fractures of metatarsals of feet. However, due to limited sample size and lack of control group, we recommend large scale randomized control trials be conducted on the subject.</p> <p><strong> </strong></p> Tanveer Ahmed Bhat Pallav Gupta Zubair Ahmad Lone Lone Mohammed Farooq Butt Abdul Ghani Sanjeev Gupta Copyright (c) 2023 International Journal of Research in Medical Sciences 2023-01-17 2023-01-17 11 2 507 510 10.18203/2320-6012.ijrms20230028 Radiological study to determine the association of proximal femoral geometry in hip fractures <p><strong>Background:</strong> In literature there is scarcity of documentation to test the relationship of radiological geometry of proximal femur with incidence and patterns of hip fractures especially in Indian population. In this study radiological parameters like femoral neck length (FNL), hip axis length (HAL), neck shaft angle (NSA), femoral neck diameter (are measured in standardized digital pelvis radiograph of patients with hip fractures presented at a tertiary care hospital and efforts were made to establish a relationship of these parameters with the pattern of hip fractures in Indian population.</p> <p><strong>Methods:</strong> Total of 72 patients attending orthopaedics outpatient clinic or admitted into the hospital with proximal femoral fractures were included in the study. Thorough history and clinical examination data were obtained. Radiographs and necessary investigations were done and FNL, HAL, NSA was calculated. Analysis was done using SPSS package version 26.</p> <p><strong>Results:</strong> Among the 72 patients included in the study, the mean age of the patients is 65 years with a SD of 13.64. The mean FNL was 2.452 cm with a SD of 0.471. The mean HAL was 11.1547cm and SD of 1.062. The mean NSA was 124.56degree with a SD of 3.339. The distribution of NSA is statistically insignificant at p&lt;0.05. The mean NSA of extracapsular fracture and Intracapsular fracture in 51-60 years is 123.1956 and 125.7750 with SD of 2.58782 and 3.99555 is respectively. The p=0.151 and is statistically significant.</p> <p><strong>Conclusions:</strong> In our study, we concluded that the HAL is significantly increased for intracapsular fractures than for Extracapsular fractures in old age group of 51-60 years. In our study, we could not establish any significant correlation between FNL, HAL and NSA in any age group for any fracture type.</p> K. Sivaprasad Rachna Patil Copyright (c) 2023 International Journal of Research in Medical Sciences 2023-01-10 2023-01-10 11 2 511 517 10.18203/2320-6012.ijrms20230009 Single interrupted vs. continuous all layer closure in bowel anastomosis in emergency surgeries: a comparative study <p><strong>Background:</strong> Intestinal anastomosis dates to ancient eras and hand sewn intestinal anastomosis is the most used technique worldwide. Various complications following bowel anastomoses are anastomotic leak resulting into peritonitis, abscess, fistula, necrosis, stricture. Various factors contribute to these complications including suturing technique. Leakage from the bowel anastomoses complication and accounts for about 1.3 to 7.7%, that is often associated with increased morbidity and mortality and prolonged stay. This comparative study endeavours to compare outcome of extra-mucosal interrupted single layer versus continuous all layers intestinal anastomosis in small and large bowel in terms of duration required to perform intestinal anastomosis, post-operative complications like anastomotic leak, duration of hospital stay in each group Aim of the present study was to compare time required to perform anastomosis and to compare the rate of postoperative complications and hospital duration.</p> <p><strong>Methods: </strong>Based on detailed history, clinical examination and radiological investigations; patients were allotted in either group A or B. Group A: Bowel Anastomosis done by single layer (20 Patients) and Group B: Bowel anastomosis done by double layer (20 Patients). Time required to perform anastomosis and post op complications was assessed and compared.</p> <p><strong>Results: </strong> In this prospective study of 40 patients, it was found that Group A required an average of 17 minutes and Group B required 24 minutes for anastomosis. The rate of postoperative complications were found to be similar in both groups. The mean hospital stay was also found to be similar.</p> <p><strong>Conclusions:</strong> Thus, from this prospective comparative study, we conclude that both extra mucosal interrupted single layer and continuous all layer anastomosis have operative technical challenges and similar postoperative outcomes.</p> Shifa A. Kalokhe Rohit Sonawane Shrutik Devdikar G. S. Narshetty Copyright (c) 2023 International Journal of Research in Medical Sciences 2023-01-06 2023-01-06 11 2 518 522 10.18203/2320-6012.ijrms20233678 Prevalence of iron deficiency anaemia among school going adolescent girls: a cross sectional study <p><strong>Background: </strong>The field of nutrition of women in India that has been sadly neglected pertains to the adolescent girls. The adolescent girls, the young women, the mothers to be, represent an age group which experience a crucial phase of growth. Iron deficiency anaemia is a highly prevalent and seemingly intractable problem, particularly among females of reproductive age group in developing countries. Following early childhood, during the adolescent growth spurts, the risk of iron deficiency and anaemia reappears for both boys and girls, after which it subsides for boys but remains for girls because of menstrual loss. Aim of the study was to find the prevalence of iron deficiency anaemia among school going adolescent girls in the field area of National Institute of Unani Medicine, Bangalore.</p> <p><strong>Methods: </strong>The present study is an observational, cross-sectional, school health survey undertaken to know the prevalence of iron deficiency anaemia among adolescent girls in the field area of NIUM. The present study was completed within a period of 6 months from August 2008 to January 2008. Prevalence of IDA was determined on the basis of RBC indices (MCV, MCHC) and erythrocyte morphology, evaluated from the points of anisocytosis, poikilocytosis, hypochromia and microcytosis on peripheral blood smear examination.</p> <p><strong>Results: </strong>In the study population (240 girls), 25% (60) subjects were affected with various grades of anaemia, i.e., 20.4% (49) were mildly anaemic and 4.6% (11) moderately anaemic. There was no case of severe anaemia. The prevalence of IDA was seen in 11.6% of study population.</p> <p><strong>Conclusions: </strong>The present study provides an indication to initiate the anaemia prophylaxis measures for adolescent girls in India including nutrition education in schools. Adolescent girls should be a target group in any programme that builds demand for sustaining iron supplementation or higher dietary intake.</p> Afroza Rahman Aasiy Ul Erum Amjad Waheed Yousuf Copyright (c) 2023 International Journal of Research in Medical Sciences 2023-01-10 2023-01-10 11 2 523 529 10.18203/2320-6012.ijrms20230011 Pilonidal sinus: excision and primary closure over suction drain and its outcome <p><strong>Background</strong>: Pilonidal sinus is a chronic inflammatory disease predominantly involving Sacrococcygeal region. Despite advances in medical sciences, management of pilonidal disease is still not well defined. Treatment varies from simple techniques to more sophisticated surgeries with their own pros and cons.</p> <p><strong>Methods</strong>: This prospective observational study comprised of forty-two patients who underwent the surgery for pilonidal sinus as per the procedure described. This study was carried from 1 May 2019 till 30 November 2022. Median age of the patients was 24.5 years, ranging between 19-32 years. Sinus discharge was the predominant symptom of our study population with 34 patients (80.94%) complaining of same.</p> <p><strong>Results</strong>: Mean operative time was 54 minutes with a range of 45-78 minutes. Average hospital stay was 1.8 days though it ranged from 1 to 3 days. Five patients (11.90%) developed seroma while four patients (9.52%) had superficial wound site infection. We had two recurrences (4.76%) over the follow-up period of 1 year.</p> <p><strong>Conclusions</strong>: Excision and primary closure of the pilonidal disease is effective with comparable complication rates and shorter time off work. The surgery can be easily performed.</p> Altaf Ahmed Malik Sumat-ul- Khurshid Rahil Muzaffar Khalid Muzzafar Copyright (c) 2023 International Journal of Research in Medical Sciences 2023-01-10 2023-01-10 11 2 530 534 10.18203/2320-6012.ijrms20230012 Effect of ketamine infusion in treatment resistant depression and in depressive patients with active suicidal ideations: a study from North India <p><strong>Background:</strong> Treatment resistant depression can be a life-threatening condition as it leads to an increase of suicide attempts by two to three folds. It has been estimated that nearly 1 million people die due to suicide every year, and more than two-third of these cases occur when the person is undergoing a major depressive episode. Ketamine is an NMDA receptor antagonist, an anesthetic agent that is short acting and has recently been used as an antidepressant and anti-suicidal agent. It has been seen that a single intravenous infusion of ketamine at a lower dose. i.e., subanesthetic dose of 0.5 mg/kg over a period of 40 minutes produces antidepressant effect which lasts for about a week and various studies have proved that repeated infusions of ketamine can prolong the duration of the antidepressant response.</p> <p><strong>Methods:</strong> It was an observational/descriptive study done in the ketamine clinic/ECT suite of institute of mental health and neurosciences Kashmir (an associate hospital of government medical college Srinagar) which runs once a week. In this study, patients satisfying the criteria of TRD and depressive patients with active suicidal ideations, visiting the ketamine clinic who had given a valid informed consent for ketamine infusion enrolled and observed for ketamine efficacy by using specific scales. The study done over a period of 18 months from January 2020 till July 2021.</p> <p><strong>Results: </strong>The response rate of ketamine in our study for treatment resistant depression was 70.27%. The response rate of ketamine for suicidality in our study was 63.16%. Our study showed a rapid onset of action for ketamine, two hours after ketamine infusion.</p> <p><strong>Conclusions:</strong> A significant fraction of patients suffering from major depressive disorder do not respond to antidepressants and have a poor psychosocial functioning and an increased risk of suicide attempts making their condition life threatening. These patients therefore require special attention to address their underlying condition as well as suicidality to improve their outcome. In this context we studied the role of intravenous ketamine infusion in these patients in improving the psychosocial outcome as well as preventing the suicidal ideation.</p> <p><strong> </strong></p> Ubaid Rasool Neelofer Jan Marya Zahoor Fazle Roub Yasir Hassan Rather Arshad Hussain Rukhsana Najeeb Copyright (c) 2023 International Journal of Research in Medical Sciences 2023-01-17 2023-01-17 11 2 535 543 10.18203/2320-6012.ijrms20230029 Study on awareness and utilization of Ayushman Bharat Arogya Karnataka scheme in Chamarajanagar taluk: a cross-sectional study <p><strong>Background:</strong> Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is India's government-funded health insurance scheme that covers over 10.74 crore poor and vulnerable families. Karnataka has been at the forefront of successfully implementing this health scheme which named as Ayushman Bharat Arogya Karnataka (ABArK) through Suvarna Arogya Suraksha trust (SAST).</p> <p><strong>Methods:</strong> This cross-sectional study was conducted in Chamarajanagar Taluk. All the 22 rural and urban field practice area of Chamarajanagara medical college and hospital were enlisted and the study subjects were randomly selected. After obtaining consent, the head of the family or in his absence the eldest adult in the households were taken as respondents.</p> <p><strong>Results:</strong> The study included 1027 households; out of which 452 (44%) are card holders. The majority of ABArK card holders 434 (96%) are BPL card holders and rural residents (60%). The totals of 666 (65%) study subjects are aware about the scheme, out of which 68% are the beneficiaries. Unfortunately, only 3% of the card holders were utilized the scheme and get benefitted.</p> <p><strong>Conclusions: </strong>The ABArK scheme and service utilisation by the study population were inadequate. The lack of adequate awareness and poor communication between health workers are the major factors for under-utilization of the scheme.</p> Girish B. Jithin Surendran Vishma B. K. Jyothika V. Shifa Tahreem Copyright (c) 2023 International Journal of Research in Medical Sciences 2023-01-25 2023-01-25 11 2 544 550 10.18203/2320-6012.ijrms20230161 Changing histological spectrum of adult nephrotic syndrome in comparison to previous study: single centre analysis <p><strong>Background:</strong> Glomerular diseases are an important cause of chronic renal failure in developing countries. The spectrum of diseases causing nephrotic syndrome is changing globally in the last few decades.</p> <p><strong>Methods:</strong> Patients in the age group 18-60 years with nephrotic syndrome were consecutively included in the study. Renal biopsies were performed in all patients and were subjected to light microscopy, immunofluorescence (IF) and electron microscopy (EM).</p> <p><strong>Results:</strong> 189 patients (67% males) were included in the study. The mean age was 43 years. Primary glomerular diseases accounted for 92.5% of cases while lupus nephritis was the most common secondary glomerular disease. Focal segmental glomerulosclerosis (FSGS) accounted for 28.6% of primary glomerular diseases making it the most common cause of nephrotic syndrome. It was followed by membranous glomerulonephritis (MGN) in 13.2%, membranoproliferative glomerulonephritis in 11.2%, diffuse proliferative glomerulonephritis in 10.6% and minimal change disease in 9.5%.</p> <p><strong>Conclusions:</strong> The biopsy diagnosis of FSGS has increased considerably in last few decades and it is now the most common cause of nephrotic syndrome in adults in North India. MGN is the most common lesion in patients over 40 years of age.</p> Nath M. Yousuf Dar M. Ahmad Wani F. Dawood Copyright (c) 2023 International Journal of Research in Medical Sciences 2023-01-25 2023-01-25 11 2 551 557 10.18203/2320-6012.ijrms20230162 A correlation of the spirometric outcomes of follow up patients of COVID-19 pneumonia with their admission time computed tomography severity score on high resolution computed tomography thorax <p><strong>Background:</strong> Coronavirus disease (COVID-19) is an infectious disease caused by the SARS-CoV-2 virus. Most people who fall sick with COVID-19 experience mild to moderate symptoms and recover without any special treatment. However, some become seriously ill and require serious medical attention. The respiratory system has been the main organ affected by COVID-19 along with other organs such as heart, kidneys and liver. Spirometry is the most common of the pulmonary function tests. Spirometry is helpful in assessing respiratory outcomes that identify conditions such as asthma, pulmonary fibrosis, cystic fibrosis, and COPD.</p> <p><strong>Methods:</strong> A total of 100 COVID-19 pneumonia patients coming for follow-up 6-10 weeks post-discharge in OPD at Department of General Medicine, Dr. D. Y. Patil Medical College Hospital and Research Institute, Kolhapur, Maharashtra, satisfying the inclusion criteria and exclusion criteria were enrolled. High resolution computed tomography (HRCT) thorax reports during their admission were collected and Computed tomography severity score (CTSS) was noted. Their spirometry was done and pattern of spirometric outcome noted. Admission-time CTSS and spirometric outcome were correlated.</p> <p><strong>Results:</strong> In majority of the patients, CT severity score during course of illness had strong correlation with spirometric outcome after 6 weeks of follow up and the association was statistically significant.</p> <p><strong>Conclusions:</strong> CT severity score during course of illness had strong correlation with spirometry findings after 6 weeks of follow up. Higher age and higher HRCT score are good predictors for impaired pulmonary function after discharge.</p> Sucharita Patra Rajesh Khyalappa Copyright (c) 2023 International Journal of Research in Medical Sciences 2023-01-25 2023-01-25 11 2 558 561 10.18203/2320-6012.ijrms20230163 Evaluation of buprenorphine as an adjuvant to 2% lidocaine during intravenous regional anaesthesia <p><strong>Background: </strong>Intravenous regional anaesthesia (IVRA) is a simple, effective method of anaesthesia for surgical procedures on the extremities. Major limitations are tourniquet pain, short duration of block and absence of post-operative analgesia. Buprenorphine is known to improve the quality of anaesthesia. Aim of this study is to evaluate the efficacy of buprenorphine as an adjuvant to lignocaine in IVRA.</p> <p><strong>Methods: </strong>Sixty patients between 18-60 years age, belonging to the ASA grade 1, 2 undergoing upper limb surgeries were enrolled into the study. Patients belonging to group BL patients received 10 ml of preservative free lidocaine 2% diluted to 40 ml. Group BB-patients received 10 ml of preservative free lidocaine 2% mixed with 60 mcg of buprenorphine diluted to 40 ml. Onset of sensory and motor block; recovery time and postoperative analgesia were noted. Data were analyzed using chi-square test, independent ‘t’ test.</p> <p><strong>Results: </strong>The onset time of both sensory and motor block were significantly shortened, the recovery of sensory and motor block was prolonged, the incidence of tourniquet pain was comparatively lesser and there was significantly increased duration of post-operative analgesia in the buprenorphine group. Haemo-dynamic parameters were similar in both groups</p> <p><strong>Conclusions: </strong>Sixty mcg buprenorphine as an adjuvant to lidocaine in IVRA effectively enhances the anaesthesia and post-operative analgesia.</p> <p><strong> </strong></p> Yashoda Venkappa Sanchara M. Paramesh Champa Banavara Venkatesha Murthy Geetanjali Masamaddi Copyright (c) 2023 International Journal of Research in Medical Sciences 2023-01-25 2023-01-25 11 2 562 566 10.18203/2320-6012.ijrms20230164 Generalised anxiety and depression during COVID-19 pandemic among post-metric science students at Baramulla <p><strong>Background:</strong> COVID-19 pandemic has greatly affected the studies of students because of strict lockdown and closure of schools. As such students might have developed a lot of stress. Primary objective of this study was to find out the prevalence of generalized anxiety and depression during the COVID-19 pandemic among post-metric science students at Baramulla preparing for professional exams after senior secondary.</p> <p><strong>Methods:</strong> This cross-sectional study was conducted by distributing a pre-designed questionnaire among post-metric science students at Baramulla, Kashmir. Two tuition centres were randomly selected out of all the centres. All the students who returned filled questionnaires were included. Binary logistic regression was employed to find the association of anxiety and depression with independent variables.</p> <p><strong>Results:</strong> Of the 173 participants, 91 were male (52.6%), the mean age was 16.9±1.4 years. For 81% of students, the pandemic had negatively affected their studies. About 16% (28) students had severe anxiety whereas 33% (57) had moderate anxiety and 14 students (8%) had severe depression whereas 23 (13%) had moderately severe depression. Those who did not perform routine exercise daily had higher odds of depression (AOR=2.86) and anxiety (AOR=2.3).</p> <p><strong>Conclusions:</strong> Anxiety and depression levels among young students as high as found in this study cannot be ignored. A habit of routine exercise that may have been hampered during the current pandemic must be inculcated among youngsters for healthier mental health.</p> Syed Nasir Ahmad Gilani Syed Najmul Ain Mohamad Azhar Gilani Copyright (c) 2023 International Journal of Research in Medical Sciences 2023-01-25 2023-01-25 11 2 567 572 10.18203/2320-6012.ijrms20230165 Predicting the immediate outcome in patients with acute on chronic liver disease by comparison of chronic liver failure-organ failure assessment, acute-on-chronic liver failure scores and meld scores <p><strong>Background:</strong> Acute on chronic liver disease is determined by the acute deterioration of liver function over a short period of time. It leads to an increase in morbidity and mortality, hence scores like model for end-stage liver disease (MELD) and chronic liver failure-sequential organ failure (CLIF-C ACLF) are identified to determine prognosis. A comparison would help us in determining which score is better for predicting immediate outcomes.</p> <p><strong>Methods: </strong>In this single centre study, patients of both genders, &gt;18 years of age, &gt;48 hours hospital stay with organ failure either ≤1, defined as, an increase in serum creatinine by 50% or more (1.5-fold from baseline), hepatic encephalopathy (HE) graded III/IV according to West haven criteria, liver failure, bilirubin ≥5 mg/dl, international normalized ratio (INR) ≥1.5 were enrolled after which relevant lab investigations and imaging was done and MELD and CLIF-C ACLF scores were applied, they were compared and analyzed.</p> <p><strong>Results: </strong>Among 50 patients, 62% had grade 2, 36% had grade 3 and only 1 had grade 4 HE. Mean MELD score and CLIF- C ACLF scores were significantly high in patients who expired (both p&lt;0.05), and the mean PaO<sub>2</sub>/FIO<sub>2 </sub>ratio was considerably low in patients with mortality (p=0.00). Sensitivity and specificity for CLIF-C ACLF score is much higher (90.9% and 100% respectively, with cut off value of 59), compared to the MELD score (77.3% and 60.7% respectively, with cut-off value of 25.50)</p> <p><strong>Conclusions: </strong>CLIF-C ACLF score is a better predictor of mortality and for survival in ACLF than the MELD score in changing the outcome of the patient.</p> <p><strong> </strong></p> Andrea Janice Fonseca Rajendra Mane Copyright (c) 2023 International Journal of Research in Medical Sciences 2023-01-25 2023-01-25 11 2 573 577 10.18203/2320-6012.ijrms20230166 Functional outcome of the distal femur fractures using plate osteosynthesis <p><strong>Background:</strong> Distal femoral fractures are a catastrophic event with bimodal distributions. Despite the advances in techniques and the improvements in surgical implants, treatment of distal femoral fractures still remains a challenge in many situations. The purpose of this study is to evaluate the rate of union, functional outcome and complications of these fractures treated by open reduction and internal fixation via plate osteosynthesis. Objectives were-1. Whether fractures reduction and fixation with plate will give acceptable results in the distal femur fractures treated in our setup. 2. To study the clinical outcome associated with this treatment modality and 3. What are the potential associated complications</p> <p><strong>Methods:</strong> This is a prospective, randomized observational study of 17 patients, with distal femur fractures (Muller classification type 33 A, C) who were treated with DFLCP at department of orthopaedics, Raja Rajeswari medical college hospital, Bangalore from January 2021 to July 2022. The study sample was 17 patients and all these patients were included with predefined inclusion and exclusion criteria in this study. Minimum of 2 months and a maximum of 12 months follow up was done. The functional and radiographic results were recorded according to Neer’s criteria.</p> <p><strong>Results:</strong> In this study, most of the patients in this study were patients in the age group 61-75 years. The 53% of the cases were Muller type A and 47% were type C. The shortest follow up period was 2 months and longest period was 12 months, average union time was 18 weeks. Most common complications are knee stiffness, infection and shortening. In this study, there were two cases with excellent results, nine cases with good results, four cases with fair results and no cases went for failure.</p> <p><strong>Conclusions:</strong> We conclude that using locking plates is a safe and reliable method although careful preoperative planning and case selection and taking up cases for surgery as soon as possible are important factors which determine the final outcome.</p> Shingati Muhammed Hashim Sachin Sahuji Copyright (c) 2023 International Journal of Research in Medical Sciences 2023-01-25 2023-01-25 11 2 578 583 10.18203/2320-6012.ijrms20230167 Outcome of volar Barton fractures of distal radius managed with open reduction and internal fixation with volar locking plate <p><strong>Background: </strong>Volar Barton fractures of distal radius almost always require a surgical fixation. Near anatomical reduction and a stout fixation is imperative for good outcome. The present study aimed at studying the outcome of open reduction and internal fixation with volar locking plate for volar Barton fractures.</p> <p><strong>Methods:</strong> The present study included 25 patients with volar Barton fractures of distal radius presenting to the orthopaedic department who were managed with volar locking plate. The minimum follow-up period was 12 months. Wrist movements were recorded and outcome was studied using modified mayo wrist score at final follow-up. <strong> </strong></p> <p><strong>Results: </strong>The mean modified mayo wrist score at final follow-up was 88.47±15.3. Excellent to good outcome was observed in 80% of the patients. None of the patients had a poor outcome. Clinically significant movements were observed at wrist at final follow-up. Superficial wound infection was the most common complication and deep infection was seen in two patients and both of them needed early implant removal at three months. Hypertrophic scar at surgical incision site was observed in two patients but did not bother the patients. Two patients needed a stellate ganglion block and physiotherapy for complex regional pain syndrome (CRPS) and both responded well.</p> <p><strong>Conclusions: </strong>Open reduction and internal fixation (ORIF) with volar locking plate provides stout fixation in volar Barton fractures and allows early physiotherapy and rehabilitation of wrist. The results are predictably good in most patients with minimal complications rates. </p> Sukhil Raina Lone Tanveer Ahmed Bhat Zubair Ahmad Lone Neeraj Mahajan Farid Hussain Malik Mohammed Farooq Butt Sanjeev Gupta Copyright (c) 2023 International Journal of Research in Medical Sciences 2023-01-25 2023-01-25 11 2 584 587 10.18203/2320-6012.ijrms20230168 Comparison of two palliative regimens of radiation on the quality of life in metastatic non small cell lung cancer <p><strong>Background:</strong> Lung cancer is one of the most common cancers in males worldwide and its number is increasing every year. Of these cases 75-80% case are of non-small cell type.</p> <p><strong>Methods:</strong> This study was conducted on 30 patients of stage IV non-small cell lung cancer in the department of radiation oncology at tertiary care center, Shimla, Himachal Pradesh India from 1<sup>st</sup> Jun 2019 to 30<sup>th</sup> Jun 2020 by dividing them into study and control arm for assessing quality of life (QOL) with EORTC QLQ-C30 version3.0.</p> <p><strong>Results:</strong> We observed significant improvement in Global health scale of control arm (p=0.005) but it got worse in study arm (p=0.743). All the parameters of Functional scale i.e. Physical (p=0.584; 0.170), Role (p=0.213; 0.016), Emotional (p=0.239; 0.002), Cognitive (p=0.793; 0.247) and Social functioning (p=0.030; 0.231) got worse in study arm while they improved in control arm. As far as Symptom scale is concerned, in the study arm; dyspnea (p=0.724), appetite (p=0.836), constipation (0.192), diarrhea (p=0.341) improved but other symptoms like fatigue (p=0.566), nausea (p=0.347), pain (p=0.305), insomnia (p=0.025), financial difficulties (p=0.082) got worse while in control arm; fatigue (p=0.003), pain (p=0.000), dyspnea (p=0.022), insomnia (p=0.336), appetite (p=0.028), constipation (0.019), diarrhea (p=0.336), financial difficulties (p=0.336) improved and nausea (p=0.120) got worse.</p> <p><strong>Conclusion:</strong> QOL assessment by the physician before commencement of the treatment and later on at every visit seems to be beneficial for symptom relief and to allay the anxiety of both patient and their attendants.</p> Tarun J. Singh Gurpreet K. Taggar Vikas Fotedhar Manish Gupta Siddharth Vats Copyright (c) 2023 International Journal of Research in Medical Sciences 2023-01-25 2023-01-25 11 2 588 594 10.18203/2320-6012.ijrms20230169 Comparison of pre-operative and post-operative liver function tests in patients undergoing laparoscopic cholecystectomy at different intra-peritoneal pressures <p><strong>Background:</strong> Establishing pneumoperitoneum is a pre-requisite for any laparoscopic procedure. However, its adverse effects are not uncommon. Increased intra-peritoneal pressure during laparoscopic cholecystectomy is expected to alter the liver function test (LFT) in immediate post-operative period, which may raise concerns in surgeons’ mind regarding integrity of biliary tract. The aim of our study was to compare the post-operative LFT with pre-operative values in patients undergoing laparoscopic cholecystectomy at different pneumoperitoneal pressures and to assess its clinical significance.</p> <p><strong>Methods:</strong> It was a prospective observational study in which the enrolled patients were divided into 2 groups. Group 1 patients underwent laparoscopic cholecystectomy at 12 mm Hg pressure and group 2 underwent the surgery at 15 mmHg pressure. Pre-operative LFT was compared with post-operative LFT done 24 hours and 2 weeks after surgery.</p> <p><strong>Results:</strong> Among 73 included patients, 41 constituted group 1 and 32 were included in group 2. Statistically significant difference was observed in hepatic transaminases between pre-operative and post-operative (1<sup>st</sup> POD) values. Mean AST in group 1: 34.7 versus 51.4 U/l; in group 2, the values were 35.1 versus 50.9 U/l respectively. Mean ALT in group 1: 36.3 versus 50.1 U/l; in group 2, values were 32.9 versus 45.6 U/l respectively. However, the enzymes normalized in all patients in 2 weeks without any adverse clinical outcome.</p> <p><strong>Conclusions:</strong> Early post-operative transient elevation of hepatic transaminases after laparoscopic cholecystectomy is not associated with any adverse clinical outcome.</p> <p> </p> Zahida Akhter Naveed Nabi Showkat M. Kakroo Sharik Mehraj Copyright (c) 2023 International Journal of Research in Medical Sciences 2023-01-25 2023-01-25 11 2 595 599 10.18203/2320-6012.ijrms20230170 A cross-sectional study on pain management during vaso-occlusive crisis in sickle cell disease <p><strong>Background: </strong>Sickle cell disease is an inherited hematological disorder characterized by hard and sticky red blood cells that appears like a C-shaped “sickle” in contrast to the healthy, round red blood cells which tend to stick and clog the blood vessels during blood flow leading to pain or vaso-occlusive crisis.</p> <p><strong>Methods: </strong>A cross-sectional study was conducted at Yashoda hospital in Hyderabad, India. Data regarding the management of acute pain during VOC in SCD patients was gathered from the hematology department on a daily basis during the duration of the study<strong>. </strong>The data was recorded in an online questionnaire form and a subsequent DUE was conducted.</p> <p><strong>Results: </strong>Among all the patients that were enrolled in the study, acute pain as VOC was presented in 72%, whereas 28% did not experience pain. Pain was manifested as acute chest syndrome, generalized body pain, headache. Crizanlizumab, a monoclonal antibody was administered to patients who were <strong>≥</strong>16 years to decrease the frequency of VOC. Upon DUE, per prescription distribution of crizanlizumab was 11.2%, while 88.8% constituted of anti-metabolites, antibiotics, analgesics, opiate antagonist, etc. Frequency of use of crizanlizumab among SCD patients was 69.23%</p> <p><strong>Conclusions: </strong>Management of VOC cannot be described as one size fits all. Interindividual variability must be considered at all times during planning and implementing a treatment regimen. Assessment of pain on pain scale to ensure targeted treatment at maximum effective concentration followed by titration of dose to reduce the occurrence of tolerance, withdrawal, dependence and addiction should be basis of management.</p> Ganesh S. Jaishetwar Dr. Fouqia Mahnaz Khanam Copyright (c) 2023 International Journal of Research in Medical Sciences 2023-01-25 2023-01-25 11 2 600 605 10.18203/2320-6012.ijrms20230171 Histomorphological study of vesiculobullous lesions of skin: a study of 66 cases at tertiary care center <p><strong>Background:</strong> Wide variety of pathological processes can lead to development of vesiculobullous eruptions over the body. They may occur in many dermatoses which include various inflammatory, infective, autoimmune, drug induced as well as genetic conditions. Each entity of vesiculobullous lesion has similar or confusing clinical features but different histopathological morphology outcome. However, these disorders are still associated with substantial morbidity, considerable mortality and impaired quality of life. Histopathological examination is helpful in definitive diagnosis of vesiculobullous disorder which is very essential for specific treatment and an appropriate desirable outcome. Aim was to study and classify various vesiculobullous lesions of the skin.</p> <p><strong>Methods:</strong> It was a hospital based prospective and retrospective study conducted for a period from January 2016 to July 2019 in the department of pathology at Government medical college, Surat, Gujarat. Total of 66 patients, aged 3-70 years with vesiculobullous lesions of both sexes attending the department of dermatology were selected and analysed clinically. The specimens were routinely processed and hematoxylin and eosin stained slides were studied.</p> <p><strong>Results:</strong> In the present study, majority of patients presented between 41-50 years of age (32%) with male to female ratio of 1.08:1. Pemphigus vulgaris constituted the most common vesiculobullous disorder (30.30%) followed by pemphigus foliaceous (24.24%) followed by bullous pemphigoid (15.05%). Bullae were located intra epidermally in (36%+24.78%) and sub epidermally in 24% of the patients.</p> <p><strong>Conclusions:</strong> Thorough histopathological workup and clinical correlation is essential to confirm diagnosis of vesiculobullous lesions of skin.</p> Krutika Patel Vasudha Bhagat Jahanvi Vyas Prashant Patel Copyright (c) 2023 International Journal of Research in Medical Sciences 2023-01-25 2023-01-25 11 2 606 610 10.18203/2320-6012.ijrms20230172 Pattern of renal and urinary tract disorders in children <p><strong>Background:</strong> Pediatricians encounter a wide spectrum of renal and urinary tract ailments in children most of which cause considerable morbidity and mortality in children. Such disorders are seen in children of all age groups starting right from infancy up till adolescence. The aim of our study was to study the prevalence, spectrum and clinical profile of such disorders in children.</p> <p><strong>Methods:</strong> This was a hospital based prospective observational study conducted over a period of 12 months from September 2017 to September 2018 at G. B. Pant hospital and Sher-i-Kashmir Institute of Medical Sciences Srinagar. Children presenting with renal and urinary tract disorders between the age group of 1 month and 12 years were prospectively observed and recorded.</p> <p><strong>Results:</strong> Total number of patients between age group 1month to 12 years admitted with renal and urinary tract disorders were 197. Majority of patients i.e. 56 (28.4%) were less than one year old. Mean±SD age of patients was 3.9±3.41 years. Fever was the most common complaint present in 78 patients (39.6%). Urinary tract infection was the most common diagnosis in our study comprising of 71 (36%) patients followed by nephrotic syndrome in 39 (19.8%). Other diagnosis were congenital anomalies of kidney and urinary tract- CAKUT (13.2%), acute glomerulonephritis-AGN (10.2%), Acute kidney injury- AKI (9.1%), chronic kidney disease- CKD in 9 (4.6%) and tubular disorders (4.1%).</p> <p><strong>Conclusions:</strong> Because of their significant prevalence and impact on the quality of life, renal and urinary tract disorders require prompt diagnosis and management because early detection and treatment improves the morbidity and mortality.</p> Mehraj Uid din Khan Yaseer Ahmad Mir Touseef Ul Ayoub Muzafar Jan Copyright (c) 2023 International Journal of Research in Medical Sciences 2023-01-25 2023-01-25 11 2 611 616 10.18203/2320-6012.ijrms20230173 Evaluation of efficacy of pregabalin as premedication for post-operative analgesia in open appendicectomy <p><strong>Background:</strong> Pregabalin is gamma amino butyric acid (GABA) structural analogue, effectively used in management of different neuropathic pain, incisional and inflammatory injuries. Current study aimed to evaluate the efficacy of pregabalin 75 mg with a placebo as premedication for post-operative analgesia in patients posted for open Appendicectomy under regional anesthesia.</p> <p><strong>Methods:</strong> A randomized controlled trial was conducted on 90 patients undergoing open Appendicectomy under regional anesthesia. The patients were divided in two groups of 45 each: group C (placebo); group P (75 mg pregabalin), drug was administered orally 60 minutes before surgery. The Ramsay sedation scale (RSS) was used for assessment of sedation and the visual analog scale (VAS) was used to determine pain at rest and cough, along with assessment of time required for rescue analgesics on the first post-operative day.</p> <p><strong>Results:</strong> The RSS scores were significantly higher in groups P as compared to the controls (p&lt;0.001). Postoperative VAS scores for pain both at rest and on cough were significantly reduced in group P (p&lt;0.001). Rescue analgesic consumption decreased significantly in group P (p&lt;0.001). The time at which first dose of rescue analgesia administered was 4.50±3.04 hours in group C, 10.90±5.37 hours in group P (p&lt;0.001).</p> <p><strong>Conclusions:</strong> Pregabalin as premedication prolong the postoperative analgesia in addition to decreased consumption of analgesics.</p> Mubina Begum Bijapur Nazeer Ahmed Kudligi Syed Moizuddin Mohammed Rasool Shabeer Ali K. Copyright (c) 2023 International Journal of Research in Medical Sciences 2023-01-25 2023-01-25 11 2 617 621 10.18203/2320-6012.ijrms20230174 Metabolic syndrome: a crucial risk factor for dermatophytosis <p><strong>Background:</strong> Dermatophytes contribute to 20-25% of superficial mycotic infections. Loss of metabolic control secondary to any pathophysiological dysfunction could result in cutaneous diseases including dermatophytoses. Aim of current study was to determine the age and gender variation between metabolic syndromes and different dermatophytosis and to find the association between the two.</p> <p><strong>Methods:</strong> The study included a total of 370 patients of confirmed superficial fungal infections visiting a tertiary care hospital (Government Medical College, Srinagar) from August 2021 to January 2022. Demographic profile was recorded, dermatological examination done and screening for metabolic syndrome done followed by analysis of results.</p> <p><strong>Results:</strong> Highest prevalence was found in male patients in the age group 26-35 years which were 80 (21.6%) and female patients were 47 (12.7%). Metabolic syndrome was diagnosed in 155 (41.9%).</p> <p><strong>Conclusions:</strong> Patients with metabolic syndrome are at a higher risk to develop recurrent and recalcitrant fungal infections.</p> <p> </p> Shuhaab Ahmad Shah Rayees Ahmad Mir Kamran Ahmad Quraishi Uzair Khursheed Dar Copyright (c) 2023 International Journal of Research in Medical Sciences 2023-01-25 2023-01-25 11 2 622 625 10.18203/2320-6012.ijrms20230175 Association of ABO blood group and Rh factor in cleft lip and palate patients <p class="Default" style="text-align: justify;"><strong><span style="font-size: 10.0pt;">Background: </span></strong><span style="font-size: 10.0pt;">One of the most common congenital malformations, with widespread racial and regional variation is an orofacial cleft. The occurrence is attributed to an array of environmental and genetic factors. Blood grouping and Rh factor are genetically determined. Any possible association of clefts with them helps in planning interventional services. </span></p> <p class="Default" style="text-align: justify;"><strong><span style="font-size: 10.0pt;">Methods: </span></strong><span style="font-size: 10.0pt;">A case control observational study was conducted on 111 samples who were cases presenting with oral clefts in Super speciality hospitals and other 111 samples who came to hospital for their treatment other than for cleft lip or cleft palate, were controls in the study. Cases were evaluated for various phenotypes of clefts. Blood samples of each case and control was collected to elaborate on blood group genotype and Rh typing. SPSS 22.0 version was employed for statistical analysis<strong>. </strong></span></p> <p class="Default" style="text-align: justify;"><strong><span style="font-size: 10.0pt;">Results: </span></strong><span style="font-size: 10.0pt;">The most common blood group noted in cases as well in controls respectively was type ‘B’ in 31.5% and 43.2%, while blood group ‘AB’ was noted the lowest in both cases (14.5%) and controls (7.3%).Rh positive was noted 94.6% in both cases and control population. Clefts were observed more in male population than female counterparts.Cases of cleft lip and palate (CLP) was noted the highest, in 61 (55%) of cases, followed by defects in lip, palate and lastly in soft palate.</span></p> <p class="Default" style="text-align: justify;"><strong><span style="font-size: 10.0pt;">Conclusions: </span></strong><span style="font-size: 10.0pt;">Though not associated to the biological characteristics of cleft lip and palate in the current study, the functional importance of ABO blood group distribution may be the subject of future research. Identification of any associative traits for clefts assesses individuals with risk so as to help eliminate the chance of occurrence and early identification for better prognosis. </span></p> Juhi Yadav Pradeep Raghav Raj Kumar Mishra Divya Narain Upadhyay Veerendra Prasad Chandra Prakash Chaturvedi Kritanjali Singh Copyright (c) 2023 International Journal of Research in Medical Sciences 2023-01-25 2023-01-25 11 2 626 631 10.18203/2320-6012.ijrms20230176 Assessment of the quality of life in parents of children suffering from epilepsy <p><strong>Background:</strong> In case of paediatric epilepsy, parents are responsible for providing medicines, round the clock care to the child, while also sustaining their own needs and expectations from life. Socioeconomic status, interaction with healthcare workers, and the level of monetary and emotional support from external agencies play an important role in modelling the quality of life of these parents. The authors’ objective was to assess the quality of life of parents of children suffering from epilepsy and evaluate the influence of demographic and clinical variables.</p> <p><strong>Methods:</strong> We conducted a cross-sectional analytical study at the out-patient department of our hospital. We recruited parents of epileptic children and those of children not suffering from any chronic illness and elicited demographic data, clinical history of illness, and QOL using the Quality of Life in the Child’s Chronic Disease Questionnaire of parents in both groups followed by analysis of the data by applying appropriate statistical tests. We used Student t- test to find the significance of data on continuous scale and Chi-square test for discrete variables. One-way ANOVA test was performed to find the influence of various variables on QOL of parents.</p> <p><strong>Results:</strong> Male child, female caregiver, Hindu religion, illiterate parent, low monthly family income, residence in rural areas, GTCS type of seizure, frequent seizures during the day, and multiple medications negatively affected the QOL of parents.</p> <p><strong>Conclusions:</strong> To provide holistic care to epileptic children, we need to integrate and provide social, occupational, emotional, and financial help to their parents in an acceptable, affordable, and sustainable way.</p> <p> </p> Purva C. Shah Vaishali R. Chanpura Maliha I. Ansari Priyansh P. Shah Copyright (c) 2023 International Journal of Research in Medical Sciences 2023-01-25 2023-01-25 11 2 632 639 10.18203/2320-6012.ijrms20230177 Effect of microneedling by dermaroller on acne scars: an observational study at tertiary care hospital <p><strong>Background:</strong> Post acne facial scar is very distressing phenomenon. There are many treatment options like laser resurfacing, dermabrasion, microdermabrasion and non-ablative laser resurfacing but it may cause adverse effects and interference with the daily activities of the patient. Microneedling or dermaroller therapy is newer modality in management of acne scars with satisfactory improvement and no significant side effect. Objective of our study was to evaluate efficacy and safety of microneedling in the treatment of atrophic facial acne scars.</p> <p><strong>Methods:</strong> Twenty-eight patients of Fitzpatrick skin type IV to V having atrophic facial acne scars and fulfilling inclusion criteria were treated with multiple sittings of microneedling (dermaroller) treatment at monthly interval. Goodman and Baron’s qualitative and quantitative acne scar grading system was used for assessment. Patients were evaluated clinically and by serial photography. Presence of any active infection, active acne, wounds, blisters, keloids, taking some medications like Accutane, antihypertensives, anticoagulants, systemic retinoids, topical retinoids, those undergoing cosmetic procedures, treatment with injecting fillers or ablative or non-ablative laser resurfacing, diabetes, collagen diseases and those who do not agree to participate in study were excluded.</p> <p><strong>Results:</strong> Any change in the grading of scars after the end of treatment and follow-up period was noted. Efficacy and improvement of dermaroller treatment was assessed by Goodman and Baron’s global acne scarring system. Out of 18 patients (of total 28) with Goodman and Baron’s qualitative grade-4, 16 (88.90%) patients reduced to grade-1. 21 out of 28 patients achieved ‘excellent’ response. Adverse effects were limited to transient erythema and post inflammatory hyperpigmentation.</p> <p><strong>Conclusions:</strong> Microneedling therapy seems to be simple, safe and efficacious for the management of atrophic facial acne scars.</p> Anjum M. Momin Jignesh B. Vaishnani Sanjay S. Bosamiya Ankita A. Mistry Copyright (c) 2023 International Journal of Research in Medical Sciences 2023-01-25 2023-01-25 11 2 640 646 10.18203/2320-6012.ijrms20230178 A study of association between serum TSH levels and severity of heart failure in subclinical hypothyroidism <p><strong>Background:</strong> Cardiovascular diseases account for most common cause of death in India and world so far. One of the established risk factors for HF is subclinical hypothyroidism. Our study aimed to study the relationship between TSH levels in subclinical hypothyroidism and the clinical severity of HF in patients with pre-existing HF.</p> <p><strong>Methods:</strong> This cross-sectional study was conducted in the hospitals attached to Bangalore medical college and research Institute. 51 patients with HF who had subclinical hypothyroidism who satisfied the inclusion criteria were included, Data was collected in the form of history, clinical examination and relevant investigations. Statistical analysis was performed using SPSS software, p&lt;0.05 was considered significant.</p> <p><strong>Results:</strong> Out of 51 patients, 70.6% were males and 29.4% were females and majority of the patients (33.3%) were aged 40 to 50 years. 35.3% patients had LV global hypokinesia, 31.4% had LV diastolic dysfunction and 21.6% had RWMA. Chi-square test showed statistically significant association between TSH and RWMA(p=0.00). Out of the 51 patients, NYHA Class-1 were 9.8%, Class-2 were 31.4%, Class-3 were 27.5% and Class-4 were 31.4%. Chi-square test showed no statistically significant association between TSH levels and NYHA class (p=0. 32).</p> <p><strong>Conclusions: </strong>There was significant association between features suggestive of cardiac compromise on 2D-echocardiography with subclinical hypothyroidism, but there was no significant association between the severity of HF assessed clinically by NYHA class with subclinical hypothyroidism. Hence, our study couldn’t establish an association between severity of subclinical hypothyroidism on clinical severity of existing HF.</p> Sudha K. Prabhu S. Naazim J. Khan Ramesh N. Teli Copyright (c) 2023 International Journal of Research in Medical Sciences 2023-01-25 2023-01-25 11 2 647 653 10.18203/2320-6012.ijrms20230179 Study of serum calcium and serum magnesium levels in newly diagnosed hypertensives <p><strong>Background:</strong> In normal vascular tissue physiology, calcium plays a crucial role. Calcium and magnesium metabolism have been implicated in the pathogenesis of primary hypertension. The present study aimed to assess serum calcium and serum magnesium levels and to study the association of the serum magnesium and serum calcium levels with hypertension in newly diagnosed hypertensive patients of Bikaner, Rajasthan.</p> <p><strong>Methods:</strong> This cross- sectional study was carried out on 60 subjects aged between 18 years to 60 years in the department of physiology and in association with department of medicine and department of cardiology, S. P. Medical College and associated group of hospitals, Bikaner. Data was compiled and entered into Microsoft software statistical package for the social sciences (SPSS) version 22.0. Data was summarised as frequencies, mean and standard deviations. For continuous data the means were compared between cases and controls using unpaired or independent t test; and for nominal data, chi-square or Fisher’s exact tests were applied to compare frequency distribution between cases and controls to see the statistical significance.</p> <p><strong>Results:</strong> The present study shows statistically insignificant change in serum calcium and serum magnesium levels in newly detected hypertensive patients when compared to normotensive controls.</p> <p><strong>Conclusions:</strong> In view of statistically insignificant change in serum calcium and magnesium levels in newly detected hypertensive patients in our study, further studies with a large sample size and more uniform population are required to find if any significant association exists between these cations and hypertension.</p> Jaiprakash Devendra Kumar Pallavi Dubey P. V. V. Bhanupriya Copyright (c) 2023 International Journal of Research in Medical Sciences 2023-01-25 2023-01-25 11 2 654 658 10.18203/2320-6012.ijrms20230180 Attitude and perception versus reality of COVID-19 vaccination among healthcare professional: a survey <p><strong>Background:</strong> The pandemic of COVID-19 infection has almost paralyzed the world since the first infection was reported in December 2019. We have seen 3 waves of infection in the country, out of which the second wave caused by the delta variant was the most severe. Along with the preventive measures of masking, maintaining social distance, and handwashing, the vaccines seemed to be the most logical next step. Many vaccines received emergency use approvals with hardly any efficacy and adverse effects data available with the process inducing a significant amount of anxiety among the public. This survey was aimed at understanding the attitude and perception of our hospital employees towards COVID-19 vaccination.</p> <p><strong>Methods:</strong> This is a cross-sectional study conducted among health care workers (HCW) at CMC, Vellore between March 2021 to July 2021. The HCWs who are willing to participate in this study were recruited and collected the quantitative data on their attitude and perception towards COVID vaccine. In-depth interviews were conducted among those who did not take vaccine to understand the reasons for not taking vaccine. The data were analyzed using statistical package for the social sciences (SPSS).</p> <p><strong>Results:</strong> The survey results were analyzed on 435 HCWs. 58.4 percent of the HCWs trust the institutional protocols as the trusted source of information about vaccine. Most of the HCWs agreed that vaccines are the only protective way, and they are safe and effective.</p> <p><strong>Conclusions:</strong> Sensitization and awareness programs with transparency of vaccine development processes, safety and efficacy will help remove barriers.</p> Divya Deodhar Vignesh Kumar J. Hema E. Paul Sudha J. Rajan Malathi Murugesan Priscilla Rupali Copyright (c) 2023 International Journal of Research in Medical Sciences 2023-01-25 2023-01-25 11 2 659 665 10.18203/2320-6012.ijrms20230181 Influence of maternal and child factors on the dental service utilization among preschool children in Bangalore urban district: a cross-sectional study <p><strong>Background:</strong> Dental visit is considered primary marker of oral care. Maternal characteristics, attitudes and psychosocial factors and the child’s oral health may influence dental visits of preschool children. This study aimed to determine the influence of maternal and child factors on dental services utilization among preschool children.</p> <p><strong>Methods:</strong> A cross-sectional study was conducted among 600 preschool children and mothers visiting Anganwadis and Primary Health Centres in Bangalore Urban District. Mothers answered questions on socio-demographic characteristics and dental attendance. Maternal dental anxiety and child’s oral health-related quality of life were assessed using modified dental anxiety scale and early childhood oral health impact scale respectively. Oral health of children and mothers were assessed using WHO oral health assessment form 2013 for children and adults respectively. Descriptive statistics, Poisson’s regression with robust variance and mediation analysis were performed and p&lt;0.05 was considered significant.</p> <p><strong>Results:</strong> The proportion of dental visit among preschool children was 13.5%. Majority of the mothers had high dental anxiety (76.2%) and perceived their children’s oral health-related quality of life to be good (71.2%). The caries experience in mothers and children were 63.5% and 54.2% respectively. Mothers with higher education (PR=2.05, p=0.037), caries experience (PR=3.17, p&lt;0.001) and poor perception of child’s oral health-related quality of life (PR=5.88, p&lt;0.001), and children with pain experience (PR=1.62, p=0.003) and decayed teeth (PR=1.81, p=0.017) influenced children’s dental visit. Maternal perception on child’s oral health-related quality of life mediates the relationship between child’s oral health and dental visit.</p> <p><strong>Conclusions:</strong> The utilization of dental services among preschool children was low. Maternal and child oral health factors influenced the child’s dental service utilization. Hence, oral health promotion approaches towards mothers and children is the need for the hour.</p> Sruthy S. Manjunath P. Puranik Sowmya K. R. Copyright (c) 2023 International Journal of Research in Medical Sciences 2023-01-25 2023-01-25 11 2 666 672 10.18203/2320-6012.ijrms20230182 Orbital involvement in COVID-19 associated mucormycosis <p><strong>Background:</strong> Mucormycosis is an opportunistic, potentially lethal, fungal infection predisposed by uncontrolled diabetes mellitus, immunosuppressive therapy, primary or secondary immunodeficiency, injudicious use of corticosteroids, hematological malignancies, hematological stem cell transplantation, solid organ malignancies, solid organ transplantation. Rhino-orbital mucormycosis is the commonest form of mucormycosis. This study was done to discuss the management strategies (orbital decompression/clearance, orbital exenteration, retrobulbar amphotericin B) in the treatment of orbital mucormycosis and its clinical outcomes.</p> <p><strong>Methods:</strong> A retrospective descriptive study was conducted between May 2021 and October 2021 at Bowring and Lady Curzon hospital, Shri Atal Bihari Vajpayee Medical College and Research Institute, Karnataka, India. 181 patients with post-COVID RTPCR negative rhino-orbital mucormycosis were included in the study. Patients underwent endoscopic orbital clearance, orbital exenteration based on the extent of orbital involvement.</p> <p><strong>Results:</strong> 143 were males and 38 were females. 160 patients underwent orbital decompression and clearance of necrotic tissue. 21 patients underwent orbital exenteration. Final visual acuity of perception of light (PL) positive and above was achieved in 147 patients. 57/58 (98.27%) patients had improvement in extraocular movements post-surgery and resolution of diplopia after orbital decompression/clearance.</p> <p><strong>Conclusions:</strong> Endoscopic orbital clearance helps to reduce the need for orbital exenteration in PL negative patients. TRAmB as adjuvant helps in decreasing the ocular morbidity. Orbital exenteration is best avoided, when possible, to avoid cosmetic disfigurement and psychological trauma to the patient. </p> Manasa P. Dhanapala N. Pruthvi Raj S. Architha Menon P. Rahul Gopi Theerta V. M. Shwetha Kumari C. Copyright (c) 2023 International Journal of Research in Medical Sciences 2023-01-25 2023-01-25 11 2 673 677 10.18203/2320-6012.ijrms20230183