A Prospective Study to Compare Intensity-modulated Radiation Therapy Planned by Flattening Filter Free and Flattening filter Beam in Patients of Carcinoma Cervix
Saurabh Tiwari; H.U. Ghori; Priyanka Kanel; Veenita Yogi; Suresh Yadav; Nungshitombi Loktongbam; Gajendra Singh Yadav; Ramsingh Jamre; Rajesh Kori
DOI : 10.5281/zenodo.8121163
Background: Modern linear accelerator (LINACs) is capable of delivering flattening filter (FF) and flattening filter free (FFF) photon beams as well. FFF and FF photon beam based LINACs have their own advantage and disadvantage and the choice between them ultimately depends on specific need of patientstumour site and treatment planning techniques.
Aim: This study aimed to compare the quality of intensity-modulated radiation therapy (IMRT) treatment plan for cervical cancer with and without a FF photon beam in terms of dosimetric analysis, toxicities, and response.
Materials and Methods: This study was conducted as prospective analytical study in Department of Radiation oncology at tertiary care centre on 60 patients with cervical cancer. Participants were divided into two groups according to treatment plan i.e. IMRT-FF and IMRT-FFF and were compared for tumour characteristics, dose volume histogram, toxicities, and response to treatment.
Results: The patients of two groups were comparable with respect to baseline variables and tumour characteristics and treatment (p>0.05). Significantly higher proportions of cases in FFF group had complete response (p<0.05). Mean total dose, urinary bladder maximum dose, bowel minimum and maximum dose as well as rectum maximum dose were significantly higher in FFF group (p<0.05) as compared to FF group. Minimum rectum dose was significantly higher in FF group (p<0.05). Hematuria was observed in significantly higher proportions of patients of FF group and itching was observed in higher proportions of cases in FFF group at 3 months (p<0.05) after completion of radiotherapy.
Conclusion: The FFF photon beams in comparison to the FF photon beam provide a clinically desirable and physically acceptable treatment plan at lower dose for target coverage. FFF photon beam in comparison to FF photon beam provides better organ at risk (OAR) sparing by less scattered dose and runs treatment process smoothly. Overall treatment time is less for FFF Beam than FF beam.
A Prospective Study to Compare Intensity Modulated Radiation Therapy (IMRT) Planning by Flattening Filter (FF) versus Flattening Filter free(FFF) beam in Carcinoma Esophagus
Priyanka Kanel; Veenita Yogi; Saurabh Tiwari; H.U. Ghori; Suresh Yadav; O.P. Singh; Rajesh Kori; Rapolu Rudra Sanjeev; Manish Dhakad; Rakesh Mahawar
DOI : 10.5281/zenodo.8121185
Background: Esophageal cancer was previously treated with 3-dimensional conformal radiation therapy (3D-CRT). In order to benefit from the clinical potential of preserving the lung and spinal cord, radiation therapy for esophageal cancer has switched from 3D-CRT to intensity-modulated-radiation-therapy (IMRT).
Aim: It is important to investigate whether esophageal cancer radiotherapy employing flattening filter-free compared to flattened beams has any advantages. The goal of this study is to extensively compare the dosimetric features, delivery effectiveness (response), and toxicity of a treatment regimen for esophageal cancer of Flattening Filter (FF) and Flattening Filter Free (FFF) photon beams using Intensity Modulated Radiation Therapy (IMRT) technology.
Material and Methods: The present study was conducted as a prospective observational study on 60 patients with esophageal cancer undergoing radiation in Department of Radiation oncology, Govt. Medical College of Central India and associated Hospital. All 60 participants were randomly assigned into either of the two treatment group (IMRT-FF and IMRT-FFF) and were compared for dose volume histogram, toxicities and response.
Results: Two groups were comparable with respect to baseline variables and tumor characteristics (p>0.05). Mean and maximum heart dose; minimum, maximum as well as mean dose of left lung; minimum and maximum dose of right lung and minimum and mean dose in spinal cord in IMRT-FF group were significantly higher in IMRT-FF group as compared to IMRT-FFF group (p<0.05). The response was significantly better in FFF group (p<0.05). We found no significant difference in toxicities to organ at risk between two treatment arm (p>0.05).
Conclusion: IMRT FF and IMRT FFF are standard photon beam used for management of patients with esophageal cancers. FFF photon beam in comparison to FF photon beam provides better OAR sparing by less scattered dose, improves quality of life and runs treatment process smoothly. The most beneficial character of FFF beam plan is clinically desirable and physically acceptable treatment plan at lower dose for target coverage and reduction of peripheral dose around target without compromising quality of beam.
Fiber Gap in the Daily Diet of Indian Population: A Narrative Review
Nidhi Singh; Salome Benjaminl; Mariam Lakdawala; Vaidehi Nawathe
DOI : 10.5281/zenodo.8121198
Dietary fiber (DF) is made up of lignin, which is an intrinsic component of plants but cannot be broken down by the body. Consuming DF improves insulin sensitivity, controls the release of specific gut hormones, and has an impact on a number of metabolic and inflammatory indicators linked to metabolic syndrome. Despite several recommendations by experts for emphasizing increasing fiber intake many population groups continue to consume less fiber on a daily average basis than advised which may cause the emergence of various chronic disease conditions. The objective of this study was to understand dietary fiber consumption in the Indian population and to identify the role of awareness and knowledge about dietary fiber for better health outcomes. A narrative review of the current literature was performed. We used PubMed and Google Scholar for this purpose and reviewed all potential and relevant articles written in English, with no restrictions on the date of publication. As per this paper, numerous scientific studies support the many and various health advantages of dietary fiber and the hazards of a diet low in fiber. Also, it was observed that the disparity between knowledge and attitude toward the intake of dietary fiber could limit its health benefits and thus better knowledge and awareness about dietary fiber could be determinants of healthy eating behavior in the Indian Population. However, further intervention studies should be carried out to disseminate information on the emotional, cognitive, and sensory aspects of food choices in order to close the gap between nutrition knowledge and the adoption of healthy high-fiber diets.
Surgical Management of Anterior Cruciate Ligament Injuries by Arthroscopic Reconstruction Using Semitendinosus and Gracilis Tendon
Dr. Purushothama K; Dr. Krishnamurthy; Dr. Archit Verma
DOI : 10.5281/zenodo.8156433
Background: Anterior cruciate ligament (ACL) and meniscal injuries pose significant challenges for individuals of all age groups. Arthroscopic reconstruction, utilizing hamstring tendon autografts, has emerged as an effective approach for restoring knee function and reducing morbidity. The aim of this study was to assess the functional outcome of combined arthroscopic reconstruction for ACL injuries using semitendinosus and gracilis autografts.
Materials and Methods: A total of 20 patients with ACL tears were enrolled in this study. All patients underwent arthroscopic ACL reconstruction using hamstring tendon autografts. The functional outcomes were evaluated using the International Knee Documentation 2000 Score (IKDC) and Lysholm Knee Scoring Scale. Data analysis was conducted using the IBM SPSS software, employing the chi-square test.
Results: Our findings demonstrate that arthroscopic anterior cruciate ligament reconstruction using hamstring autografts yields excellent to good functional outcomes in 80% of patients. Through careful patient selection and adherence to a comprehensive physiotherapy protocol, most patients can expect to regain full occupational and recreational activities within four to six months following the procedure.
The Haemodynamic Response to Endotracheal Intubation at Different Time of Intravenous Fentanyl Given During Induction in Elective Surgeries
Dr Keshav Meena; Dr S C Dulara; Dr Pooja Jain; Dr Devraj Kuldeep
DOI : 10.5281/zenodo.8167001
Introduction: Fentanyl is a potent short acting synthetic opioid agonist which is similar to morphine and confers analgesic effect at a greater extent. Fentanyl targets opioid receptors present in brain neuroanatomical structures that better hold the speaking, pain and emotions and so on.
Aim: The main aim was to study and compare the effects of fentanyl at varying time intervals before anaesthesia induction on haemodynamic response to laryngoscopy and endotracheal intubation and side effects of the drugs in patients undergoing surgical procedures under general anaesthesia.
Materials and Method: Study population (50 patients) was randomly divided by computer generated numbers into 2 groups with 25 patients in each group. Group F5: received Inj. Fentanyl 2µg/kg 5 min before Anaesthesia induction. Group F10: received Inj. Fentanyl 2µg/kg 10 min before Anaesthesia induction. Standard monitors like ECG, NIBP, and pulse-oximeter were applied and baseline parameters [SpO2, Heart rate (HR), Systolic blood pressure (SBP), and Diastolic blood pressure (DBP), Mean arterial pressure (MAP)] were recorded.
Results: The difference in mean HR, systolic blood pressure, mean diastolic blood pressure, mean arterial pressure were increased compared with baseline and statistically highly significant with p value of <0.0001after anaesthesia induction, 1min, 2min, 3min, 5min and 10min of endotracheal intubation. No significant changes occurred in HR, SBP at baseline and after premedication inn between the groups. An increase in the HR, SBP was observed in both the groups after intubation However, in group F5 the increase was seen to a lesser extent and lower compared to group F10 at all time points. The changes observed with regard to DBP, MAP and RPP were same as that seen in SBP, indicating that successful suppression of stress response was achieved in group F5.
Conclusion: Our results indicated that 5 minutes prior to induction was the most effective injection time of fentanyl at a dose of 2 mcg/kg to prevent the hemodynamic responses to tracheal intubation.
A morphometric Study of Mandibular Fossa(Glenoid Fossa) with Articular Eminence and Identifying their Relation with Temporomandibular Joint(TMJ) Dysfunction
Dr Gouri Shankar Jha; Dr Archana Gautam; Dr Irfan Ahmad; Dr Kunal Kishor Gautam; Dr Radhika Raman; Dr G K Mishra
DOI : 10.5281/zenodo.8166274
Aim: Present study aimedatmorphometric study of mandibular fossa (glenoid fossa) with articular eminence and identifying their relation with temporomandibular joint(TMJ)dysfunction.
Methods: It was anexploratory and observational study conducted at Departments of Anatomy and Radiology, Darbhanga Medical College &Hospital, Laheriasarai, Darbhanga. Ethical approval was obtained fromInstitutional Ethical Committee.
Present study was done on 65 dry skull (130 sides) of unknown sex and age and 45 CT scan (90 sides)of patients having mild to moderate pain in either temporomandibular joint, Age group of patients were 30 to 50 years (mean 39.4), and that of control group were 25 to 45 years (mean 32.5).Patients were divided into symptomatic and asymptomatic groups based on Helkimo index.
Mandibular fossaand articular eminence were observed bilaterally. We reconstructed the sagittal images for TMJin axial sectionfor CT Scan measurements.
Results: Our study showed statistically significant differences between the patient and control group in mandibular fossadepth (p= 0.006) and mandibular fossa width (p= 0.002) and the articular eminence height(p=0.002).
There were no significant statistical differences in age between 2 groups having (p= 0.139) and between right and left side of joint (p= 0.157).
Average distance between the lowest point of articular eminence and the centre of mandibular fossawas 10.18 mm.
Observed shapes of mandibular fossa wereconcave in 65% and angled in 35% cases. Flattened shape was not seen in our study. The average height of mandibular fossa was 6.81 mm, width was 14.13 mm and depth were 5.16 mm.
Conclusion: The present study established reference standards for Patient's with temporomandibular joint dysfunction and showed -
- Steeper Inclination of articular eminence.
-higher depth and width of mandibular fossa.
A Comparison of Clinical Findings and CT Severity Index in Acute Pancreatitis
Dr Dileep C; Dr Harish Kumar C; Dr Shirisha V
DOI : 10.5281/zenodo.8166306
Background: Acute pancreatitis is a severe inflammatory condition with a varied clinical course. Early prediction of disease severity is crucial to guide management and improve outcomes. This study aimed to compare the predictive accuracy of Ranson's criteria and Mortele’s modified CT severity index (MDCTSI) in assessing the severity and prognosis of acute pancreatitis.
Methods: A retrospective study was conducted on 120 patients with acute pancreatitis admitted to the Department of General Surgery in hospitals associated to Bangalore Medical College and Research Institute from September 2021 to August 2022. Patients were evaluated based on clinical findings, laboratory results, and CT scans. Outcomes were assessed using Ranson's score and MDCTSI.
Results: Both scoring systems accurately predicted the severity of the disease, complications, and mortality. All deaths occurred in patients with a Ranson's score and MDCTSI of >3 and >6, respectively. Patients with a Ranson’s score of >3 and MDCTSI of >6 had a higher rate of complications (59% and 71%, respectively) and ICU admission (100% and 80%, respectively).
Conclusion: Ranson's scoring system and Mortele’s MDCTSI are effective tools in predicting the clinical course, complications, and mortality in acute pancreatitis. These findings underline the utility of these scoring systems in facilitating patient management and potentially reducing morbidity and mortality.
Patients’ Perception & Attitude Towards Medical Students’ Involvement In Patient Care: A Cross Sectional Study At A Tertiary Care Teaching Hospital In Maharashtra
Dr. Pallavi B. Kunde; Dr. Sangita A. Adchitre; Dr. Rajesh K. Dase
DOI : 10.5281/zenodo.8173970
Background: Participation of patients in medical education helps students to gain practical experience & also to improve their communication. Patients’ acceptance of involvement of medical students in their care depends on many factors.
Objectives: We assessed whether the patients accept or reject medical students for their care. This study determined reasons for acceptance or rejection of the medical students by patients. We also studied the relationship between the patients’ demographic factors and their decision regarding involvement of students in their care.
Methods: This study was conducted among patients attending Medicine, General Surgery, Ophthalmology and Obstetrics, and Gynecology outpatient departments of a tertiary care teaching hospital in Maharashtra from15thJune 2021 to 31st July 2021.
Results: The participants were aged between 18 and 70 years with the mean age34.99 years. Out of the 200 participants, 102(51%) were males while 98(49%) were females About half of the participants 101(50.5%) were Hindus. Majority of the participants174 (87%) were willing to allow students in their care. Patients’ education was significantly associated with their acceptance for medical students in their care (P< 0.05).
Conclusion: Most of the patients accepted medical students in their care.
A Comparative Study to Evaluate the Effect of Thermal Cycling on the Flexural Strength of Bis-Acryl Composite Resin, Light Cure Resin and Cad/Cam Resin for Provisional Restorations-An In Vitro Study
Thungbeni P Ngullie, MDS; Dr. Sounder Raj K, MDS; Dr. Vishwanath S K, MDS
DOI : 10.5281/zenodo.8178950
Aim: To compare the effect of thermal cycling on the flexural strength of Bis -acryl composite resin, light cure UDMA resin and CAD/CAM PMMA resin for provisional restorations.
Materials And Methods: This study included 60 specimens. Twenty bar-shaped specimens were fabricated for each group Bis-Acryl composite resin, Light cure UDMA Resin and CAD/CAM Resin with the use of a split acrylic mold. These specimens were stored in artificial saliva for 10 days. The specimens were then subjected to thermal cycling. Flexural strength was calculated using three point bending test under universal testing machine. Data were analyzed using student-ttest (α=0.05) @ 90% power.
Results: The highest mean and standard deviation before thermal cycling was seen in CAD/CAM Resin (106.74 ± 3.61 ) and the lowest in Bis-Acryl composite Resin (92.57± 1.36). The highest mean and standard deviation after thermal cycling was seen in CAD/CAM(94.83± 2.56) and the lowest in Bis-Acryl Composite Resin (81.34 ± 1.64).
Conclusion: Within the limitations of this study by analyzing the results, it was concluded that the Thermal cycling had shown significant impact on the flexural strength of all the materials. Group A Specimens (CAD/CAM PMMA Resin) exhibited highest flexural strength before and after thermal cycling followed by Group C Specimens (Bis- Acryl Composite Resin ) and Group B (UDMA Resin group ).
A Prospective Study for Comparison of Dosimetric Analysis, Radiation Induced Toxicities and Response in Flattening Filter Versus Flattening Filter Free Beam in Oral Cavity Cancers
Abhay Vimal; H.U. Ghori; Laveena Rajani; O.P. Singh; Veenita Yogi; SureshYadav
DOI : 10.5281/zenodo.8179305
Aim: This study aimed to compare the response, dosimetric parameters and toxicities of IMRT with Flattening Filter(FF) photon beam and Flattening Filter Free(FFF)photon beam in Oral Cavity cancers.
Material and Methods-This study was conducted as prospective observational study on total of 60 cases of oral cavity cancerat our institute during study period of 2 years. All 60 participants were randomly assigned into either of the two treatment group IMRT-FF and IMRT-FFF.Patients were followed and assessment of dosimetric parameters, response and toxicities grading was done.
Results- Two groups were comparable with respect to baseline variables and tumor characteristics and treatment (p>0.05). Mean number of fractions, as well as dose to brainstem, spinal cord and parotid were significantly higher in FF group as compared to FFF group (p<0.05). The response rate following radiation was found to be significantly better in FFF group as compared to FF group (p<0.05). Skin toxicities were significantly higher in FFF group at 3 months (p<0.05) whereas parotid as well as oral cavity were significantly higher in FF group at 3 and 6 months (p<0.05).
Conclusions-Intensity Modulated Radiation Therapy (IMRT) is common modality used for management of oral cavity cancer. FF photon beam and FFF photon beam, both modalities were compared in this study and we found that removal of flattening filter helps in equivalent delivery of dose of radiation to target tissue, with reduced scattering and leakage of radiation dose to adjacent normal tissues thereby reducing the risk of toxicities of organ at risks.
A Prospective Study to Compare the Intensity-Modulated Radiation Therapy Planning by Flattening Filter Versus Flattening Filter free Beam in Carcinoma Larynx
Dr. Laveena Rajani; Dr. H. U. Ghori; Dr. Abhay Vimal; Dr. O. P. Singh; Dr. Veenita Yogi; Dr. Suresh Yadav
DOI : 10.5281/zenodo.8179330
Aim: The application of Flattening Filter Free (FFF) mode of a linear accelerator may be utilized in management of carcinoma larynx. The study aimed to compare the dosimetric analysis, toxicities of patients treated as well as response rate among them with Flattening Filter (FF) and FFF beam for Carcinoma Larynx.
Material and Methods: This study was conducted as prospective observational study on 60 cases of carcinoma larynx at our institute during study period of 2 years. Patients were randomly treated by either FF beam (30 patients) or FFF beam (30 patients) and dosimetric parameters for both plans were assessed along with response and toxicities at 0, 3, and 6 months.
Results: Two groups were comparable with respect to baseline variables and tumor characteristics (p>0.05). We found dose of radiation to parotid gland, spinal cord, and oral cavity to be significantly higher in FF treatment group as compared to FFF treatment group (p<0.05). Complete response to therapy was significantly better in FFF beam therapy as compared to FF beam therapy (p<0.05). Parotid toxicities were significantly higher in FF group at 6 months and toxicities for oral cavity and larynx were found significantly higher in FF group at 3 as well as 6 months (p<0.05).
Conclusions: IMRT is one of the common treatment modalities used in management of patients with carcinoma larynx. FFF beam is as effective as FF beam therapy in delivering the dose of radiation to the target tissue, with minimum radiation leakage to the adjacent normal tissues thereby reducing the risk of toxicities of organ at risks (parotid and oral cavity) and inducing better clinical response. The most beneficial character of FFF beam plan is clinically desirable and physically acceptable treatment plan at lower dose for target coverage and reduction of peripheral dose around target without compromising the quality of beam.
Correlation Between PEFR and Pulmonary Score in Assessing Mild to Moderate Exacerbation of Bronchial Asthma in Children Aged 6-13 Years Treated at Government Medical College Ernakulam
Dr. Jyosilin Joy; Dr. Rose Tresa George; Dr. Shiji.K.Jacob
DOI : 10.5281/zenodo.8187204
Introduction: Asthma is a chronic inflammatory disorder characterized by cough, wheeze and breathlessness which is partly reversible. PEFR monitoring is a simpler tool to measure airflow obstruction. Pulmonary score is a useful scoring system to assess the asthma severity. As not much studies are available regarding the use of Pulmonary Score in grading the asthma exacerbations, we conducted a study on the correlation of PEFR values and Pulmonary score among children with mild and moderate exacerbation of bronchial asthma.
Methods: A descriptive diagnostic test evaluation was conducted in 50 children with acute exacerbation of asthma aged 6-13 years attending the Paediatric emergency room, Government Medical College Ernakulam over a period of 1 year. Children were classified according to PEFR and Pulmonary Score as mild and moderate exacerbation. Treatment was started according to standard protocol of asthma management. PEFR and pulmonary scoring were done again 20 minutes after bronchodilator therapy and improvement in both were statistically calculated and compared.
Conclusion: In our study there was a significant negative correlation between pre-treatment and post- treatment PEFR & PS with a pre-treatment correlation coefficient of -0.657 (P value 0.0001) and post-treatment coefficient of -0.543 (P value 0.0001). As pulmonary score correlates well with PEFR, it can be used as an easy tool to measure the severity of bronchial asthma especially in peripheral centres where a peak flow meter may not be available. This helps in early referral.
Analysis of Morphine Sulphate and Methadone Hydrochloride in Pain Management of Advanced Cancer Patients
Ghoghari Mayur; Umrania Ravi; Patel Bhavna C; Sanghavi Priti; Kukadia Savan; Pandey Nitin
DOI : 10.5281/zenodo.8194829
Introduction: - Pain is one of the most prevalent cancer symptoms. There is individual variability in analgesia and adverse effects to different opioids. So, we did this study to provide the comparative information about Morphine and Methadone for intractable pain control and their potential for adverse effects in advanced cancer patients.
Aims and Objectives: - To evaluate analgesic effect and safety of Morphine and Methadone for management of chronic sever pain. To identify adverse effects of study drugs
Method: - Total 50 patients were enrolled randomly and divided randomly in Morphine group and Methadone group of 25 patients in each. Patients were selected according to inclusion and exclusion criteria. Group 1: - received oral Morphine. Group 2: - received oral Methadone. We assessed pain control by monitoring VAS and escalated dose of opioids as required for adequate pain control, observed side effects and treated, did ECG to see QTc changes on follow-up.
Result: - As for adequate pain relief, we increased dose in both group of patients according to patients’ severity of pain. There was less average dose of methadone is required in terms of Morphine Milligram Equivalent (MME) than average dose of morphine. We find different side effects with different frequency and treated with rescue medication.
Conclusion: - Morphine and Methadone both are very effective in management of severe pain in advance cancer patients. We didn’t observe any major side effect. So, one should not hesitate to start either of them in advance cancer patients to treat pain.
Functional and Radiological Outcomes of Fixation of Postero-Medial Fractures of Proximal Tibia
Dr. Sanjay Baranwala; Dr. Sanjay Gaikwada; Dr. Kashyap Solankia; Dr. Rohan Killekar
DOI : 10.5281/zenodo.8194861
This study aimed to evaluate the outcomes of treating postero-medial proximal tibia fractures using postero-medial plating in combination with medial or lateral column fixation. Thirty patients with postero-medial fractures were included, and their fractures were managed with direct surgical approaches to achieve anatomical reduction and absolute stability. After 12 months of follow-up, functional and radiological outcomes were assessed. The study found that 66.6% of cases had a postero-medial fragment with additional condyle fractures, while 33.3% had an isolated postero-medial fragment. Anatomical intra-articular reduction was achieved in 26.6% of cases, and the majority (63.33%) of patients had a functional outcome score of 25-26 based on the Rasmussen score. Overall, fixation of posteromedial coronal shear fractures using this approach resulted in better functional outcomes, quicker patient recovery, and a low incidence of complications, including loss of reduction and non-union. The findings support the use of postero-medial plating for managing postero-medial proximal tibia fractures, providing valuable insights for clinical practice.
Impact of Internet use on students of medical college of central India
Dr. Shailesh D. Wakde; Dr. N. V. Pradnyakar
DOI : 10.5281/zenodo.8194937
Background: Internet use is one of the flourishing addictive behaviors and major public health concern affecting worldwide. University students have habit forming use of internet as well as its consequent negative effects. This study determined the prevalence of internet use, its addiction in medical students and its impact on depression, anxiety and stress levels of students by DASS-21 scale. Method: It is a cross sectional study done at NKPSIMS & RC & LMH, Nagpur, Maharashtra on 300 undergraduate medical students who consented for the study and chosen by simple random sampling. Self administered questionnaire was used to collect study data. Internet addiction measured using Young’s internet addiction test (IAT). Depression, anxiety and stress levels are measured by DASS-21. Result: Internet addiction was found in 02 % of participants. Maximum internet users visit social media applications and it is used least for educational purposes. Mobile phones are the most widely used devices to access the internet. Conclusion: Our study concluded that large number of students are using internet since long for non academic purpose with many of them having different levels of addiction resulting in negative impact on academics. Statistically significant relationship was seen between scores of IAT and Dass-21. Higher IAT scores were associated with poor academic performance and scoring, with higher depression anxiety and stress levels of students. Hence we recommend timely intervention of harmful consequences of excessive internet use. The association between internet addiction and its consequences should be dealt by undergoing more such studies.
A Study of Socio-demographical Profile and Pattern of Psychiatric Referrals of Patients from Intensive Care Unit (ICU )and Emergency at Medical College , Jaipur
Pooja Bansal; Tushar Jagawat; Vikas Gaur; Pankaj Kumar; Ritu Meena; Savita Jagawat
DOI : 10.5281/zenodo.8201779
Background: Consultation-liasion psychiatry has a specific place in a hospital setting. Analyzing the consultation-liasion psychiatry service was a goal of this study. Methodology: A hospital based descriptive Observational study was adopted and patients were selected using non-probability purposive sampling technique, over a 18 months period , patients who were referred from ICU and Emergency. In accordance with ICD-10 diagnostic criteria, a final psychiatric diagnosis was made after sociodemographic information and the referral source was recorded. Results: Among 220 patients, majority was male(n=140, 63.64%), maximum in the age group of 20-30 years (n=108, 49.09%), secondary education(n=120, 54.55%). Out of the 220 referrals in total, 134 (60.91%) were from various intensive care units(ICU) and 86(39.09%) came from emergency. The most prevalent psychiatric label noted among psychiatric referrals was depression (n=48, 21.8%), followed by bipolar disorder (n=26,11.8%). Conclusion: The present study summarizes that there is a high likelihood of presence of psychiatric manifestations in patients who come to different departments of the hospital. This goal of managing such patients can only be achieved through awareness about psychiatric disorders and in a hospital set-up through the medium of Consultation-Liaisonpsychiatry. So, that with the help of Consultation-Liaison, a patient is treated holistically and not merely as a bundle of symptoms.
Role of Habituation Exercises in Improvement of Balance and Quality of Life in Cervical Spondylosis Associated Vertigo
Kumar Arvind; Gupta Vivek; Khan A Mansoor
DOI : 10.5281/zenodo.8201789
Background: Vertigo is one of the common problems presented in OPD of ENT in which there occur swaying or rotational movement, loss of perception of body and or in space. Dizziness due to cervical spine pathology may give rise to poor balance, abnormal space orientation and, neck pain along with restricted movements of cervical spine and also sometimes headache.
Aim and objectives: Purpose of the study was to find out effective exercise regimen for the vertigo associated with cervical spondylosis. Objectives of the study were to compare the effects of habituation exercises on pain, balance and quality of life in subjects of cervical spondylosis associated vertigo.
Method and materials: A total of 38 patients of Cervical Spondylosis with Vertigo were selected as per sample size calculation. Subjects were allocated in control and experimental groups randomly and a conventional exercise protocol was followed by control group whereas habituation exercise regimen was followed by experimental group for 06 months.
Results: At the post-test stage, the mean BBS score was significantly higher for the experimental group (50.79) compared to the control group (47.32), and the mean DHI score was significantly higher for the experimental group (111.05) compared to the control group (101.37).
Discussion: In experimental group improvements are significantly higher than that of control group which could be attributed to the session that in experimental group habituation exercises were added so improvements of experimental group are higher than control group.
Study of Electrocardiographic (ECG) Changes in COPD (Chronic Obstructive Pulmonary Disease) Patients and Assessing the Severity of the Disease
Dr Kavya. D; Dr Basavaraju M.M
DOI : 10.5281/zenodo.8201799
Introduction: COPD is a common, preventable, and treatable chronic lung disease Characterized by airflow limitation that is not fully reversible causing breathing-related problems. Cardiovascular disease accounts for significant morbidity and mortality in COPD. Severe COPD can cause heart failure or long-term cardiac complications. Electrocardiography provides a rapid, non-invasive method to evaluate cardiac functions.
Aims and Objective: To study the ECG changes in COPD patients and assess these ECG changes with severity of the disease.
Materials and Methods: It is a cross sectional study from September 2022 to November 2022 done in Department of General Medicine, KR hospital, MMCRI, Mysore. Study conducted on 100 COPD patients confirmed by PFT. After taking institutional ethical clearance 12 lead ECG is performed and assessed with severity categorized by GOLD criteria into mild, moderate, severe, and very severe.
Statistical Analysis: Data obtained from the study will be entered in excel sheets and it will be double checked. Data analysed using SPSS software version 22.0 and it will be presented as descriptive statistics in form of frequency table and figures. Result will be expressed. Correlation of parameters is done by Pearson’s correlation formula. A p value of <0.05 is considered statistically significant.
Results and Conclusion: In our study 2 cases in mild, 48 cases in moderate, 39 cases in severe and 11 cases in very severe group.68% had RAD,60% had sinus tachycardia,63% had p pulmonale,44% has R/S(V1>1),36% had R/S(v6<1),33% had RBBB,17% had MAT,11% had lead 1 sign. Long smoking duration had very severe PFT changes and more prevalent ECG changes were in severe group. ECG can be used as a screening test in assessing the severity of the disease and further preventing morbidity.
Characteristics of Body Composition in Different Phenotypes of South Indian Women with Polycystic Ovary Syndrome and Relation with Body Image and Psychological Profile
Georgy Joy Eralil; Anoop Vincent; Dr. Chaithra T M
DOI : 10.5281/zenodo.8201815
Purpose of the study: To study characteristics of body composition in different phenotypes of South Indian women with polycystic ovary syndrome and relation with body image and psychological profile
Methods: Non-comparative cross-sectional open label study to be carried out over the period of 12 months on PCOS patients attending gynecology outpatient department. Personal medical history to be obtained from every woman according to a customized prepared questionnaire. Presence of at least two criteria from clinical, hormonal, and abdominal USG category were considered diagnostic of PCOS. Hirsutism was scored according to modified Ferriman Gallawayscore. Recruited women have their body fat percentage calculated using Health Sense BF 414 Ultra Lite Body Fat Monitor .The bioelectrical impedance analysis (BIA) method was used to estimate body fat percentage.
Results: The most common menstrual abnormality identified in study was irregular menstrual cycles followed by a combination of amenorrhea and irregular cycles. The commonest phenotype was ovulatory dysfunction with polycystic morphology in 42.7% cases. The body dysmorphic disorder was the commonest psychological problem in about 25.6%closely followed by major depressive illness.
Conclusion: Our study suggested that psychological and neurological factors may play a role in the pathophysiology of PCOS. Therefore, psychological intervention should be an aspect of PCOS management.
Synthesis of Substituted Triazine and Its metal complexes , with their Study of Antimicrobial Activity
Pratibha S. Deulkar; Ramkrushna P. Pawar
DOI : 10.5281/zenodo.8214654
The present work focused on synthesis of triazine and their metal complexes. Its characterisation and anti-microbial activity were studied. Widely scope in co-ordination, medicinal chemistry. Bidentate chelate complex of ML2 type have been synthesized from triazine based ligand 4-amino-1-(naphthalene-1-yl)-1,6-dihydro-1,2,4-triazine-5(4H)- one. Their spectral analysis of chelates were study. Various synthetic metal of complexes of triazine are prepared and evaluated for its biological activity. Structures of the products have been deduced from their elemental analysis and spectral data such as 1 H-NMR have studied for determination of structure of its molecule, X- ray diffraction which provide information about the arrangement of crystal and Fourier transform infrared spectroscopy has been used to detect functional group present the compound). Select new synthesized compounds were screened as antimicrobial activity against Escherichia coil, proteus mirabilis, staphylococcus aureas, and P. aeruginosa has been carried out and compared with standard one.
Comparative Study of Intracervical Dinoprostone Gel and Vaginal Misoprostol for Induction of Labour
Dr. Reshma Meena; Dr. Usha Shekhawat
DOI : 10.5281/zenodo.8227132
There has been a rise in the incidence of labour over the past decades and as per WHO Global survey,9.6% deliveries required induction and in developed countries the incidence is up to 25%. IOL using various methods may be associated with an increased risk of Failure to achieve labour, higher incidence of caesarean section, operative vaginal delivery, fetal distress, chorioamnionitis, cord prolapse with artificial rupture of membranes. In our study total 240 patients were induced, amongst them 170 were successfully induced & 24 were failed induction.
Neurological Manifestations of Community Acquired Staphylococcus Aureus Infection- A Case Series
Priya Logia; Vijayakumar .M; Renuka M.K
DOI : 10.5281/zenodo.8228912
Background: Community acquired Staphylococcus Aureus causing neurological manifestations is rare. Very few reports document presentations and outcomes of this disease. We present, a series of 4 patients with neurological manifestations of spontaneous community acquired Staphylococcal Aureus admitted to an adult intensive care unit (ICU)over one year period. Patterns of community acquired Staphylococcal Aureus related neurological manifestations, from different regions are needed to draft evidence based management guidelines.
Objectives: To document clinical, laboratory and radiological findings in a cohort of community acquired Staphylococcal Aureus patients hospitalised with neurological manifestations and compare their presentation and outcomes with previously published cases available.
Study design: Clinical, laboratory, demographic information and outcomes were collected from patients with confirmed CNS infections of community acquired Staphylococcal Aureus treated in an ICU, in a tertiary care hospital, from September 2021- August 2022.
Results: The case series had a male predominance(75%) and the mean age was 61.3 yrs. All 4 patients were diabetics.75% had an epidural abscess but none had features of infective endocarditis. All patients were positive for MRSA in blood and pus. They were treated with parenteral Vancomycin and surgical decompression whenever indicated. Out of the 4 patients 2 improved and were discharged, 1 patient was transferred to another centre and 1 patient died.
Conclusion: Awareness of neurological manifestations of community acquired Staphylococcal Aureus should allow its early recognition and institution of appropriate treatment. Reports on community acquired Staphylococcal Aureus, from different regions will help in formulating more evidence-based guidelines, for optimum evaluation and care of such patients. Our data contributes towards this goal.
Autoclaving: Current Practices, Problems and Solutions
Dr. B. K. Gupta; Dr. Isha Gupta; Dr. Bhawna Chawla; Dr. Kanav Gupta
DOI : 10.5281/zenodo.8229275
Aims: To evaluate different sterilization & monitoring practices among the ophthalmologists of Haryana and identify potential factors leading to failure of sterilization and possible remedies thereof.
Methods and Material: A questionnaire was sent to all eye hospitals of Haryana, responses were compiled and analyzed.
Results: Response was received from 100 such hospitals. Out of 100, majorly are using Two drum vertical autoclaves, followed by single drum autoclave. Horizontal autoclaves are being used by the least number of hospitals. Failure rate is maximum in single drum autoclaves, followed by vertical autoclaves. Common causes of failure of sterilization cycles are improper purging, faulty drum, faulty autoclave, improper settings.
Conclusions: We conclude that whatever autoclave we are using, with proper knowledge and technique regarding the autoclave use and indicators, we can safeguard ourselves and our patients by preventing the healthcare associated infections.
Impact of Online Classes and Home Confinement on Prevalence of Myopia in Children during COVID-19 Pandemic
Dr. Ujala Sharma; Dr. BK Gupta; Dr. Isha Gupta; Dr Kanav Gupta
DOI : 10.5281/zenodo.8229348
Purpose: The aim of this study was to assess the prevalence of myopia in children before and after the Covid -19 pandemic.
Methods: This is a comprehensive retrospective study conducted in a secondary eye care centre at Panipat. All the children of the age group between 5-18 years were who attended our OPD were included. Period of study was April and May months of Year 2018, 2019, 2021, 2022. Visual acuity (unaided & aided) was recorded in all the children. The data was extracted, compared and analysed for difference in prevalence of myopia
Results: During the post Covid period (April-May 22), 710 children attended the OPD. Among these, 324 (47%) were having the refractive error of more than 0.5 D. In comparison, in the same months of previous year 2021, only 349 children visited the OPD, out of these, 124 (38%) were having ref error. Secondly, in the months of April May 2022, 128 children of the age group of 5-11 years got the refractive errors, out of 321 (39.9%) of the total children of the same age group who came to OPD during that period. In comparison, in the year 2021, only 25 (17%) got the refractive errors out of 147. This figure was much lower in the years 2018(6.3%) & 2019(6.8%).
Conclusion: After the COVID-19 pandemic, myopia showed an alarming increase in pediatric age group. The change of myopia in younger children was comparatively greater than that in adolescents. Therefore, measures should be taken to prevent and control the progression of myopia after the COVID-19 pandemic
Intraocular Pressure Changes after Nd-Yag Laser Posterior Capsulotomy in a Tertiary Care Hospital of Haryana
Renu; Kanav Gupta; Brij K. Gupta; Soni Tarun
DOI : 10.5281/zenodo.8229363
Background: Posterior capsular opacification (PCO) is still one of the most common complication following cataract surgery. Although Nd-Yag laser is safe and effective, complications such as rise in intraocular pressure, cystoids macular odema and retinal detachment can occur after Nd-yag laser capsulotomy.
Material and Methods: A retrospective, observational study was conducted to evaluate the changes in the IOP after Nd-Yag laser capsulotomy in 200 eyes over a period of one year in a tertiary care hospital of Haryana. After assessing the visual acuity and posterior capsule opacification (PCO), IOP was measured with Applanation tonometry. Posterior capsulotomy was done with ND Yag laser. Post procedure IOP was measured after 24 hours, 1 week and 1 month.
Results: The mean IOP at baseline before posterior capsulotomy was 13.31 mmHg, then after capsulotomy at 24 hr 17.42 mmHg; 14.27 mmHg at 1 week and 13.40 mmHg at 1 month. There was a statistically significant (p=0.001) p value. We divided the patients into two groups according to energy level used in group one <2 millijoule and in group two energy level 2-4 millijoule, similarly we divided the patients into two groups according to no. of shots , in one group shots between 5-15 in another group 15-26 shots. We find a correlation between the increase in IOP with the energy level used and no. of shots, as p value was found statistically significant. We found that in about 7 patients PCO was thick and no of shots and energy level was used more and after the procedure IOP was raised even after 1 week, so along with timolol maleate 0.5%, latanoprost 0.005% was also given to these patients to lower the IOP.
Conclusion: Nd-Yag laser is still the gold standard treatment for posterior capsular opacification (PCO). There is a transient rise of IOP after the Nd-Yag laser capsulotomy mainly in 24 hrs and within 7 days but it comes to normal limits within 1 month. The rise of IOP depend upon the energy level and no of shots used during capsulotomy. The rise of IOP can be controlled with antiglaucoma drugs.
Comparison of Intraocular Pressure Changes among Pre-Menopausal and Post-Menopausal Women
Kritika; Abhilasha; Brij K. Gupta; Kanav Gupta
DOI : 10.5281/zenodo.8229392
Background: Glaucoma is the second leading cause of untreatable blindness. Due to decreased hormonal levels in post-menopausal women as compared to the pre-menopausal state, there is a high risk of glaucoma in post-menopausal women. Also, women with high BMI and BP have higher chances of raised IOP.
Aim: The study aims to compare intraocular pressure changes among pre-menopausal and post-menopausal women.
Material and Methods: This was a cross-sectional study conducted for a period of 3 months from April to June 2023 on 140 women of age group 40-55 years who were divided into 2 groups each having 70 women: pre-menopausal and post-menopausal. The study was started after getting clearance from the institutional ethics committee. Women underwent thorough examinations which includes BMI, BP, and IOP. All values were taken and compared using STATA and SPSS software.
Findings: The mean IOP in the pre-menopausal group was 11.75 mm of Hg and in the post-menopausal group was 13.42 mm of Hg which shows that in post-menopausal women the IOP is on the higher side and there are more chances of glaucoma in these women. The study has a p-value of 0.001.
Conclusion: The study concludes that IOP in post-menopausal is on the higher side in comparison to pre-menopausal women. It is due to the reduced estrogen levels as compared to the pre-menopausal state. It was also seen that the women in both groups who have raised BP and BMI have increased IOP in comparison to women with normal BP and BMI.
A Comparative Study Between Diagnostic Nasal Endoscopy And Computed Tomography Of PNS in Chronic Rhinosinusitis
Dr. Ramchandra; Dr. Anilkumar. Doddamani
DOI : 10.5281/zenodo.8229553
Background:Chronic rhino sinusitis affects a significant population worldwide, imposing a huge toll on the human economy as well as on quality of life.Chronic headache is one of the most common symptoms which are distressing to both patients and physicians. The investigative modalities available for an ENT surgeon are many like X-ray, CT scan, DNE, etc. Hence, this study is taken to compare the computed tomographic findings to the diagnostic nasal endoscopy findings in patients with chronic Rhinosinusitis.
Objectives: This study aims to compare CT scan findings and DNE findings in diagnosing Chronic Rhino sinusitis.
Material &Methods: 60Patients attending ENT OPD at ESIC Medical College & Hospitalwith any Sino-nasal complaints lasting for more than 4 weeks and not responding to medical line of management. Patients are selected by random sampling method.Patients were evaluated with CT scan and DNE.
Results:Sixty patients with chronic rhinosinusitis participated in the study. Their mean age + standard deviation was 38.5 + 10.19 years, ranging from 20 to 63 years. The median was 37.5 years. The largest proportion (45%) of the sample aged 30–39 years old, only 10% aged ≥50 years. The main symptoms of the patients were nasal obstruction (81.6%), Headache (78.3%), and nasal discharge (45%).
Conclusions:Nasal endoscopy have sensitivity and specificity almost as good as CT scanning, and being an outpatient procedure, it may reduce unnecessary diagnostic scanning procedures&define a cost-effective and easily available diagnostic tool.
Is Only Fine Needle Aspiration Cytology Justifiable For Salivary Gland Lesion Diagnosis? : 5 Year Medical Institutional Experience
Dr. Kuntal Devesh Patel; Dr. Jasmin Jasani; Dr. Shashikant Mavadiya
DOI : 10.5281/zenodo.8238486
Introduction: Fine needle aspiration cytology (FNAC) is being extensively used for pre- operative diagnosis of salivary gland lesions. It is a simple, safe and cost effective procedure that provides valuable information for planning suitable management. The aim was to study cyto- histo-pathological correlation of salivary gland lesions; to examine sensitivity, specificity and diagnostic accuracy of FNAC of salivary gland lesions.
Method And Material: Present study was a retrospective study comprised of FNAC samples of salivary glands which were verified by histo-pathological diagnosis over a five years period from July 2017 to June 2022 obtained from the archives of Department of Pathology, S.B.K.S.M.I. & R.C., Piparia, Vadodara.
Result: Out of 102 total studied cases, 66 have cyto-histological correlation. On cytological diagnosis commonest lesion was pleomorphic adenoma (46.96%). In non-neoplastic category, inflammatory lesion was common with 27.27% of cases (chronic sialadenitis – 13.63 %, acute sialadenitis -7.57 %, acute on chronic sialadenitis -1.51 % and granulomatous sialadenitis 4.54%). In neoplastic category (malignant neoplasm), there were 2 cases of (3.03 %) epithelial- myoepithelial carcinoma/ mucoepidermoid carcinoma , one (1.51 %) acinic cell carcinoma, adenoid cystic carcinoma and adenocarcinoma each. 2 other cases (3.03 %) were diagnosed as Suspicious of malignancy and one (1.51 %) Positive for malignancy without further typing of tumour. In one case (1.51 %) definitive cytological diagnosis was not possible.
Conclusion: A significant sensitivity, specificity, diagnostic accuracy, positive predictive values was assessed in the present study, thus emphasising the use of FNA for pre-operative management of salivary gland lesions. A careful cytological analysis helps the operating surgeons to have pre-operative data regarding the nature of the lesion. This helps proper planning of treatment and reduces overall cost of treatment and need for hospitalisation
Evaluation of Dexamethasone Versus Dexmedetomidine As Adjuvant to Levobupivacaine in Ultrasound Guided Infraclavicular Brachial Plexus Block for Upper Limb Surgery-A Prospective Randomized Double Blind Clinical Study
Dr Chhaya Joshi; Dr Shilpa Masur; Dr. Roopa Holkunde; Dr. Niraj Singh; Dr. S.Y. Hulkund
DOI : 10.5281/zenodo.8238551
Background: This study is to compare dexamethasone and dexmedetomidine as adjuvant to levobupivacaine in ultrasound guided (USG) infraclavicular brachial plexus block for distal upper limb surgery.
Methodology: Eighty ASA I−II patients posted for elective forearm and hand surgery under infraclavicular brachial plexus block were allocated into 2 equal groups in a random, double blinded fashion. Each group received 30 ml of 0.5% levobupivacaine either with 2 ml of dexamethasone(8mg) (D group, n = 40) or 2 ml of dexmedetomidine ( 50 microg diluted with normal saline) (DEX group, n = 40). USG guided infraclavicular brachial plexus block was given to all the patients. After performing the block vital parameters were recorded every 5 min until 30 min. The onset time and duration of sensory block, motor block and duration of analgesia were assessed.
Results: Demographic data and surgical characteristics were similar in both groups. The onset time of sensory block was similar in both groups. The onset time of motor block was earlier in DEX group . The durations of sensory and motor blockade were longer in group D than in group DEX (p<0.001). Mean arterial blood pressure levels at 5, 10, 15, 20, 25 and 30 minutes were statistically insignificant between the two groups (p>0.05). The mean pulse rate at different time intervals were also statistically insignificant between the groups (p>0.05).There were two failed blocks and excluded from the study and neither of the patients had any side effects.
Conclusion: Both dexmedetomidine and dexamethasone are good adjuvants to levobupivacaine in peripheral nerve blocks. The present study suggests that dexamethasone is a better choice as it prolongs the duration of sensory and motor blockade as well as duration of analgesia of infraclavicular brachial plexus block without any adverse side effects .
A Novel Study of Correlation of Lipid Parameters with Clinical Profile, Staging and Onset of Rhino Orbito Cerebral Mucormycosis in A Covid 19 Pandemic
Vijay V; Bhargav V Bhat; Sunil Kumar K; KavyaS T
DOI : 10.5281/zenodo.8242381
Objectives: Study was undertaken to Estimate the lipid levels in COVID associated mucormycosis (concurrent and post covid) patients ,To correlate the lipid levels with clinical profile and staging of mucormycosis patients and To correlate the lipid levels with onset of covid associated mucormycosis
Methods: One Hundred and Three patients diagnosed with COVID associated Mucormycosis treated in the Hospitals attached to Bangalore Medical College and Research Institute were studied. Information about systemic health condition with lipid profile and other biochemical parameters were collected. Data was analysed. Descriptive statistics including Chi Square test, Mann Whitney U test,Kruskalwallis test, Spearman’s correlation were used and level of significance was kept at 5%. Significance was considered if p<0.5.
Results: The age distribution varied from 22yrs to 75yrs with majority being males(83.4%). Most common symptom among all severity stages was nasal block(79.6%) followed by headache(75.7%). Most Common Comorbidity was DM(50.4%) followed by HTN and DM(36.8%) followed by HTN only (6.7%) followed by DM,HTN and IHD(4.8%) followed by IHD(0.9%).
Conclusion: The study showed a positive correlation between serum lipid profile and stage of Mucormycosis and negative correlation with COVID 19 onset to Mucormycosis onset duration. Hence our hypothesis proved that the patients with altered lipid parameters have higher chances to get severe form of the disease and faster onset of Mucormycosis post COVID 19 and therefore serum lipid profile can be used as a prognostic parameter in predicting the severity and prognosis of COVID 19 associated Mucormycosis.
Tug of War: DPP4 Inhibitors vs SGLT2 Inhibitors
Dr Anagha Sahasrabuddhe; Dr Shubhada Gade; Dr Shilpa Choudhary
DOI : 10.5281/zenodo.8246287
More than 90% of persons with type 2 diabetes will require more than metformin monotherapy to meet their glucose targets. The sodium–glucose cotransporter 2 (SGLT2) and dipeptidyl peptidase-4 (DPP-4) inhibitor classes are among the several second-line treatments for type 2 diabetes glucose management. In comparison to prior classes, these newer classes provide a number of advantages, including a lower risk of hypoglycemia and weight gain, as well as no requirement for dose titration. An SGLT2 inhibitor can cause rapid, considerable, and long-term weight reduction (about 2–3 kg in 6 months) by causing glucose and consequently calorie loss in the urine as compared with DPP4 inhibitors which are weight neutral. Also SGLT-2Is have shown better reno and cardio protective effects as compared with DPP4 inhibitors but contraindicated in setting of CKD as against DPP4 inhibitors.
Conclusion: To conclude SGLT2 inhibitor may be beneficial in a younger person with suboptimal blood glucose management early in their illness course, weight loss is a focus, and bladder dysfunction and comorbidities are not limiting factors while in an older person for whom weight loss is not a priority and bladder dysfuncjh6tion and comorbidity are commonly limiting factors, a DPP-4 inhibitor with good tolerance and efficacy could be beneficial. Now’-days since combination pills are also available, they can be used for their complementary beneficial effects.
Effects of Nutritional Anemia on Hba1c Levels
Nidhi .G; Sreejith .R; Jayesh Kumar
DOI : 10.5281/zenodo.8246324
Background and Objectives: HbA1C is measured in diabetics as well as in those with impaired glucose tolerance to assess the glycaemic status over the last two to three months. But there are numerous conditions causing falsely low or high HbA1c measurements. One condition that effect erythrocyte turnover is anemia. Here we aimed to estimate the levels of HbA1c in iron deficiency or mixed deficiency anemia patients without diabetes and to assess the changes in HbA1c levels 3 months after treatment of nutritional anemia.
Methods: It is a hospital based prospective interventional study done in Department of General medicine, Kozhikode medical college from June 2021 to December 2022. The study comprises 120 patients with nutritional anemia, including iron deficiency anemia and mixed deficiency anemia. We treated the patients with nutritional supplementation for three months and noted anemia parameters and HbA1c levels before and after the therapy. Data was collected using a semi structured questionnaire, entered in excel and analysed using SPSS software.
Results: The prevalence of nutritional anemia was found to be more common in females. After 3 months of treatment of anemia there was statistically significant increase in Hemoglobin, MCV and RBC count and a significant fall in RDW and Platelet count. The mean HbA1c of the study population decreased from 6.07(±0.53) % to 5.40(±0.52) % after 3 months of treatment which was statistically significant. (P<0.001). There was a noticeable, though statistically insignificant, inverse relationship between rising Hb levels and falling HbA1c levels in patients with anemia.
Interpretation and Conclusions: HbA1c in anemic subjects showed a significant decrease with appropriate therapy. As nutritional anemia and Diabetes mellitus both being frequent in India, anemia is to be taken in consideration while interpreting HbA1c in diagnosis and monitoring of Diabetes mellitus.
Maternal Heart Rate As A Predictor of Post-Spinal Hypotension in Parturients
Aravinth Thirumagal; Prathyusha Konderu
DOI : 10.5281/zenodo.8246356
Background: Spinal Anaesthesia is the most preferred route of anaesthesia in parturients for caesarean section. Maternal hypotension after spinal induction is the most common complication which may result in adverse maternal and foetal outcomes. The decrease in systemic vascular resistance due to the blockade of pre-ganglionic sympathetic fibres causes maternal hypotension. Analysis of heart rate is the most economical, easiest non-invasive method of assessment of the autonomic nervous system.
Material and Methods: This is a prospective observational study carried out at NSCB medical college and hospital, Jabalpur from March 2019 to August 2020 on 225 pregnant women who underwent elective caesarean section under spinal anaesthesia. All patients were explained in detail about the anaesthetic procedure and written informed consent was obtained. All the patients were pre-loaded with lactated Ringer’s solution (15ml/kg) 15 min prior to spinal anaesthesia. Basal HR was determined with pulse oximeter by taking average of five independent recordings, every minute in sequence. Immediately after subarachnoid block, blood pressure measurement was recorded and repeated every 3 min in first 30 min and cycled to 5 min till end of surgery. Patients developing more than 20% drop in themean arterial pressure (MAP) were treated with parenteral ephedrine 3 mg bolus. The foetuses were monitored immediately at 1 min and 5 mins immediately after birth and APGAR scores were calculated.
Results: Significant positive correlation of baseline maternal Heart Rate with post-spinal hypotension and vasopressor requirements was noted. Subjects with baseline HR ≥ 90 beats per minute had an 81% chance (Positive predictive value) of developing marked hypotension after SA. There was no significant difference in APGAR scores based on the degree of hypotension observed.
Conclusion: Baseline HR prior to hydration may be useful to predict post SA hypotension. Higher baseline HR, possibly reflecting a higher sympathetic tone, may be a useful parameter to predict postspinal hypotension.
Intracameral Phenocaine Plusr as a Supplement to Conventional Topical Anesthesia for Relieving Ocular Pain in Cataract Surgery
Dr. Sachin Mehta; Dr. Poonam Mehta
DOI : 10.5281/zenodo.8246413
Purpose: To evaluate safety and efficacy of intracameral Phenocaine plus as a supplement to conventional topical proparacaine anesthetic drops in cataract surgery.
Methods: A prospective and controlled study including 100 patients suffering with bilateral cataract were assigned to 2 different groups for the type of anesthesia received, 0.5% proparacaine hydrochloride drops in the first eye, and 0.5% proparacaine drops augmented with intracameral Phenocaine plus in the fellow eye for phacoemulsification surgery . At the end of surgery questionnaire were assigned to patient in both groups indicating the degree of pain (0-3) felt during the surgery.
Results: Thirty-six percent of patients in group 1 declared to have not felt any pain against the 84% of patients in group 2. Fifty-six percent of patients in group 1 complained about only a slight discomfort against 16% of group 2 patients. Only a small percentage of patients in group 1 (8%) admitted severe pain, while no patient in group 2 admitted severe pain. Postoperative day 1 unaided visual acuity was in the range of 6/18–6/9 for most of the patients. No adverse event like corneal decompensation or TASS were noted. Two patients in group 2 reported an episode of transient IOP spike, lasting several hours after surgery and 1 patient in group 2 had corneal edema resolving at end of 1 week after surgery
Conclusion: Intracameral administration of Phenocaine plus is a safe, simple and readily available method to increase the analgesia and in addition mydriasis during the cataract surgery, eliminating the discomfort and increasing the cooperation of the patients during surgery.
Study of Who Maternal Near Miss Using Organ Dysfunction to Predict Maternal Outcome
Madiha Khan; Shabana Sultan; Poorva Badkur
DOI : 10.5281/zenodo.8248105
Background and Aims: The objective of this study was to determine maternal near miss frequency and maternal near miss to mortality ratio by using organ dysfunction criteria to analyze the trends of maternal near miss and to compare the nature of near miss events with that of maternal mortality.
Methodology: The study was conducted during July 2021 – December 2021 on all the maternal near miss cases who were admitted in Sultania Zanana Hospital. The cases of “near miss” were compared to maternal death using organ dysfunction.
Results: During our study period, total number of obstetric admissions were 8667 out of which maternal near miss cases were 500 and so incidence of maternal near miss was 5.76%. Cardiovascular (30.38%) and Respiratory organ dysfunction (33.87%) were maximum which were responsible for maternal near miss. The maternal near miss: mortality ratio was 7.8.
Conclusion: In this study, we used WHO criteria which cover almost all possible organ systems which can be affected secondary to any pregnancy-related complications. The WHO criteria for maternal near miss showed to be able to identify all cases of death and almost all cases of organ failure. Therefore, they allow evaluation of the severity of the complication and consequently enable clinicians to build a plan of care or to provide an early transfer for appropriate reference centers.
Bacteriological Profile Andantibiogram of ICU Isolates in A Tertiary Care Institute in Manipur – A Six-Year Study
Preety Samom; Gurumayum Preeti; Supriya Laifangbam; Monika Nahakpam
DOI : 10.5281/zenodo.8248155
Introduction: Patients hospitalized in the intensive care units (ICUs) are 5 to 10 times more likely to acquire nosocomial infections than other patients admitted in the hospital. The frequency of infections at different anatomic sites and the risk of infection vary by the type of ICU, and the frequency of specific pathogens varies by infection site. Contributing to the seriousness of nosocomial infections, especially in ICUs, is the increasing incidence of infections caused by antibiotic-resistant pathogens.
Aims and objectives: To evaluate the bacteriological profile and their antibiotic sensitivity pattern in intensive care unit (ICU) settings of a tertiary care institute.
Material and methods: It is a6-yearretrospective study conducted in the Department of Microbiology, Jawaharlal Nehru Institute of Medical Sciences from 2017 January to 2023 January. The bacterial isolates from the clinical samples were identified and antibiotic susceptibility testing were done by Kirby Bauer disc diffusion method and VITEK 2 automated system. Data were recorded as numbers and proportions.
Result: Of the total 1547 samples received in 6 years, 508 were bacterial culture positive. Majority of the bacterial isolates were from urine followed by blood, sputum, surgical wounds, stool, CSF, etc. In our study, most of the bacterial isolates were found to be Gram-negative bacilli while the remaining were Gram-positive cocci. Out of the 508 bacterial isolates, the highest culture positivity was from Surgery ICU. The most frequently identified isolates were Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumanii, CoNS, Enterococcus faecalis, Proteus mirabilis, Salmonella typhi, etc.
Conclusion: Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus, Proteus mirabilis, Pseudomonas aeruginosa, etc were thecommon isolates from our study. The study alsoshows that the susceptibility of the first line drugs and second line drugs are low. Nosocomial infections, especially those caused by antibiotic-resistant pathogens, represent an important source of morbidity and mortality for the patients hospitalized in an ICU setting.
Functional Outcome of Single Dose of Platlet Rich Plasma Vs Steroid in the Treatment of Chronic Recalcitrant Lateral Epicondylitis
Dr. Chandanpreet Kaur; Dr. Neetu Kukar; Dr. Anshul Dahuja; Dr. Radhe Shyam Garg
DOI : 10.5281/zenodo.8248421
Background: Chronic recalcitrant lateral epicondylitis poses a therapeutic challenge. This study aimed to compare the efficacy of a single dose of Platelet-Rich Plasma (PRP) versus a single dose of steroid in the treatment of this condition.
Methods: A prospective comparative study was conducted on 92 patients with chronic lateral epicondylitis not responding to conservative management. Patients were randomized into PRP (46 subjects) and steroid injection groups (46 subjects) and followed for six months.
Results: The PRP group showed a significant reduction in Visual Analogue Scale (VAS) scores from baseline to six months (6.67 to 0.54; p < 0.001), compared to the steroid group (6.48 to 1.70; p < 0.001). Similarly, the Patient Related Tennis Elbow Evaluation (PRTEE) score in the PRP group improved significantly from baseline to six months (67.24 to 3.82; p < 0.001) versus the steroid group (64.54 to 14.74; p < 0.001).
Conclusion: Our findings suggest that PRP injections are more effective than steroid injections for pain reduction and functional improvement in patients with chronic recalcitrant lateral epicondylitis.
Study of Demographic Profile and Risk Factors for Cataract in Young Adults at a Tertiary Care Hospital
Dr. Satish K; Dr. Shilpa M
DOI : 10.5281/zenodo.8252993
Objective: To study the demographic profile and risk factors for cataract in young adults
Materials and methods: It’s a cross sectional observational study conducted between 2021-2022 at a tertiary health care centre.100 patients with cataract between age of 20-45 years were selected. Risk factors like diabetes, field work (exposure to sunlight), high myopia, smoking were noted. Morphological type of cataract was determined with slit lamp examination.
Results: Out of 100 patients there were 49males (mean age of 38) and 51 females (mean age of 36), most of them had unilateral cataract(73%).53 % of patients had idiopathic cataract where no risk factors were identified, among identifiable risk factors field work was the strongest risk factor(11%) followed by diabetes and smoking. Posteriorsubcapsular cataract was the most common type of cataract (51%).
Conclusion: In majority of patients risk factor for cataract was found to be idiopathic, field work or excessive sunlight exposure was the strongest identifiable risk factor for cataractogenesis in young adults followed by diabetes and smoking, and posterior subcapsular cataract was the most common type of cataract at presentation
Visual Outcome in Axial Myopes Following Cataract Surgery
Dr Prakash D N; Dr Raghavendra R; Dr Chaitra S
DOI : 10.5281/zenodo.8253022
Objective: To evaluate visual outcome following cataract surgery in axial myopes.
Methodology: In this prospective study 49 patients with axial myopia i.e, axial length >25mm were included. 49 eyes underwent lens extraction with Posterior chamber intraocular lens implantion (Small incision cataract surgery and phacoemulsification). Complete ophthalmic examination with slit lamp examination fundus examination were performed preoperatively. B scan was done in patients whose fundus had no glow to rule out posterior staphyloma. Biometry calculation was performed using SRK/T formula. Postoperatively visual outcome in terms of snellen’s acuity was performed.
Results: The mean age of patient operated was about 52. The study included 9 patients with nuclear cataract, 9 with mature cataracts, 10 with brown cataract and 21 with posterior sub capsular cataract which was common type of cataract. 71% subjects had 6/6 vision post cataract surgery. Intraoperatively no significant complications were noted.
Conclusion: Satisfactory snellen’s visual acuity was achieved in in patients with axial myopes following cataract surgery. And also both visual and refractive problems in patients with cataracts and high myopia is solved.
A Study on Effectiveness of Middle Meatalantrostomy in Treatment of Chronic Maxillary Sinusitis
Dr. Akash Anadure; Dr. Harsha Pandiyan; Dr. S. Sathish Kumar
DOI : 10.5281/zenodo.8253059
Background: Chronic maxillary sinusitis is an inflammation of the maxillary sinus lasting for more than 12 weeks. It is diagnosed by typical symptoms and/or a computed tomography scan and/or nasoendoscopic changes.
After failure of maximum conservative therapy, functional endoscopic sinus surgery (FESS) aims to restore normal sinus function and ventilation though natural ostia. Traditionally in maxillary sinus surgery, FESS was initiated with the removal of the uncinate combined with middle meatalantrostomy.
Aim: To study the effectiveness of middle meatalantrostomy in the treatment of chronic maxillary sinusitis, with respect to the treatment of nasal discharge, nasal obstruction, facial pain, headache, and olfactory alteration.
Material and Methods: 54 Patients with chronic maxillary rhinosinusitis refractory to medical line of treatment were the study subject. Patients symptom profile, CT PNS, DNE findings preoperatively were documented. All the 54 patients underwent middle meatalantrostomy. Post operatively patients were followed up on day 7, day 30 and day 90. They were assessed for relief in symptoms and DNE on each follow up day.
Results: 54 Patients with chronic maxillary sinusitis were assessed, 90 days after surgery 100% (n=54) of the patients had improvement in symptoms of nasal discharge, headache and olfactory alteration. 98% (n=53) of the patients appreciated improvement in nasal obstruction and facial pain.
Conclusion: Results suggest that middle meatalantrostomy is effective in relieving the symptoms of chronic maxillary sinusitis such as nasal obstruction, nasal discharge, facial pain, headache, and olfactory alteration.
''Intussusception”: Changing Trends in Management
DOI : 10.5281/zenodo.8264845
Background: In most children there is no abnormality present, and the cause of intussusception is unknown. We tried to find out the answer to question: Does surgery needed in all cases of intussusception? Aims and Objectives: In this study, the aim was to observe the results of the conservative management of 3 cases of intussusception admitted in Medeor Hospital, (formerly known as Rockland Hospital), Delhi, North India. The objective was to minimize the need for surgery for intussusception. Methods: For the present study, the demographic information, history, physical examination, investigations & management of 3 children suffering from intussusception & admitted at Pediatrics Department in Medeor hospital during the period from 01 January 2012 to 07 August 2014 were recorded & evaluated. Results: In this study, the results showed that two cases of intussusception were associated with acute gastroenteritis & one case of intussusception was associated with acute dysentery. All the 3 cases of intussusception were managed with intravenous (IV) fluids, IV antibiotics and other supportive treatment. In comparison to previous study in all the 3 children, the intussusception was completely resolved by conservative management. The two-tailed P value equals 0.0143*, in Chi-square test. By conventional criteria, this difference was considered to be statistically significant. Conclusion: In this study, it is concluded that in all the 3 children, the intussusception was completely resolved by conservative management, hence no active intervention or surgery was required in these cases. On follow up, there was no recurrence of intussusception in these 3 cases.
The Efficacy of Risk Factors for Predicting Wound Dehiscence: A Prospective and Retrospective Study
Dr Ravindra Singh Gound; Dr Chandan Tiwari; Dr Arvind Baghel
DOI : 10.5281/zenodo.8275162
INTRODUCTION: Wound dehiscence is among the most dreaded complications faced by surgeon and is of greatest concern because it leads to many other problems like increased morbidity and mortality ,prolonged hospital stay ,economic burden on society The mortality rate following wound dehiscence ranges from 9%-43%. .there are many factors related to patient, related to disease, and also related to treatment like emergency surgery, Intraabdominal infections, malnutrition, advance age, systemic disease, ascites, diabetes, postoperative coughing etc. METHOD and MATERIAL: These factors are studied in cases and there outcome are compared with control.thsi study was done in NSCB medical college Jabalpur from September 2018 to September 2020.100 cases and controls are takens and study is done Retrospective and prospective manner in those patients which are operated in institute. Details of patients are taken and compared with p value and chi square test applied and there results found. Samong all factors age, jaundice ,anaemia, hypoalbunemia, ascites, diabetes, postoperative coughing were found affecting wound dehiscence.
Predominance of Trichophyton Mentagrophytes from Superficial Mycoses Cases in Rural Population in North India: A Hospital Based Study
Sanjeev Sahai; Aditya Mishra
DOI : 10.5281/zenodo.8275225
Aim: A study was planned to know the prevalence of fungal isolates from superficial mycoses cases from rural population attending a tertiary care hospital in Lucknow. Materials and methods: A prospective study was conducted at a tertiary care hospital in Lucknow, Uttar Pradesh. Laboratory data of 75 clinically suspected cases of superficial mycoses attending Rural Health Training Centre of the institute were enrolled in the study. Results: Out of total 75 cases, majority 54 (72%) were male and 21 (28%) were female, most common age group affected was 31-40 years (28%), followed by 21-30 (21.3%), males were predominant (72%) and most common clinical presentation was tinea corporis in 38.7% cases, followed by T. cruris (22.8%), T. pedis (18.6%), T.capitis and T. barbae (4% each). On KOH examination, 52 (69.4%) samples were positive, while 23 (30.6%) cases were negative, 59 (78.6%) samples turned out to be culture positive. Most common etiological agent was T. mentagrophytes in 16 (27.1%) cases, followed by T. rubrum in 10 (16.9%), T. tonsurans and M. audouinii in 5(8.5%) cases each, T. interdigitale and T. schoenleinii in 2(3.8%) cases each. Eleven samples showed growth of contaminants while Candida spp.in 2(3.8%) and Malassezia spp. in 3(5.8%) and non dermatophyte was isolated from only 1(1.9%) case. Conclusion: In the current era of urbanization and globalization frequency of dermatophytes is changing from one region to other. Therefore, in a vast country like India, it is prudent for medical mycologists to remain update to diagnose uncommon species of dermatophytes for proper management of superficial mycoses cases
Comparison of Apache II And CT Scoring System In Predicting Early Outcome of Acute Pancreatitis
Dr. Umakant Chate; Dr. Rameshkumar Pandey; Dr. Prutha Javalekar; Dr. Dilip Gupta
DOI : 10.5281/zenodo.8276285
Acute pancreatitis (AP) is a common and frequent inflammatory disorder of the pancreas with variable involvement of other regional tissues or remote organ systems. Early diagnosis and precise staging of disease severity are important goals in the initial evaluation and management of AP.APACHE II is the most accurate predictor of mortality, CTSI is a good predictor of bothmortality and AP severity, therefore, we compared APACHE II and CT scoring system in predicting early outcome of AP.Patient’s demographic and clinical data/Laboratory /Radiological diagnosis of Acute pancreatitis were analysed. The patients were graded according to Balthazar grading and modified CT severity index. The patients were given a score according APACHE II scoring system. Based on APACHE II scoring and CT grading, the severity, complications and prognosis of the patients was assessed. Data was analyzed and found that, alcohol is the major cause of acute pancreatitis in the regional population, with gallstones being the second most common cause. Overall, APACHE II score is an effective tool for risk stratification and management of patients with AP. As APACHE II is a clinical study and calculated at the time of admission, clinically it can be valued higher than the CTSI which is usually done after 48 hours. APACHE II score of >8 or =8 in predicting severity of acute pancreatitis had sensitivity of 93.75% and negative predictive value of 97.6%. Mild pancreatitis as evidenced by CT score < 4 and APACHE II score < 8 have better prognosis. Oral diet is tolerated faster, sepsis is minimal and local complications are lesser. Severe pancreatitis as evidenced by CT scores > 4 and APACHE II score of ≥ 8 have severe metabolic and electrolyte disturbances. Prognosis is guarded, especially those who have acute respiratory distress syndrome and features of multi organ dysfunction syndrome. In conclusion, this study suggests that the use of APACHE II score is very useful in predicting the severity of acute pancreatitis in patients. This can help in determining the appropriate level of care and management for the patients, ultimately improving their outcomes and reducing the burden on healthcare facilities.
Ascites Post-Cesarean Section… Case Series
Dr. Amit Agrawal; Dr Deepa Kala; Dr Dipali patil; Dr Pranote phadtare
DOI : 10.5281/zenodo.8284149
Incidence of Caesarean section (CS) is rising due tomany reasons, which makes it one of the more common performed procedure. Common complications of this are hemorrhage, infection, pain, injury to bladder, bowel. Though severe complications are seen less frequently but as an obstetrician we need to have the skill set to diagnose it early and manage properly. Ascites is accumulation fluid in peritoneal cavity. Common causes are liver cirrhosis, malignancy, injury to bowel/bladder during surgery, vascular trauma, infection. Ascites after CS is very rare and very few cases have been reported. In this case series we are presenting 2 such cases of ascites after CS due to two different causes. One is Chylous ascites and other one is a case of appendicitis and each case was managed differently.
Pharmacovigilance Study of Antibiotics in a Tertiary Care Hospital
R B Jadhav; Dilara Parvin Ali; Pranali N Chavarkar; Sanjivani K Nagothkar
Background: Antibioticsare currently the most commonly prescribed drugs in hospitals, worldwide. Detecting ADRs and establishing preventive measures is essential for patient safety.
Methods: A prospective, Cross-sectional, Observational study was conducted at inpatient and outpatient Department of Medicine in tertiary health care centre. 96 patient’s relevant medical history were obtained from ADR forms (CDSCO forms) and patients files from 1 October 2022 to 31 December 2022.
Results: A total of 96ADR forms and patients’ files were collected, analysed and assessed on WHO causality assessment scale. It was observed that male patients 58(60.41%) predominated over females 38 (39.58%) in ADR occurrence. Age wise distribution of the ADRs revealed that the Middle-aged patients were more accounted 41 (42.70 %), followed by geriatric28 (29.16 %), and Adult 23 (23.95 %). ADRs reported with Beta-Lactams were 37(38.54%) followed by Aminoglycosides19 (19.79%), and Quinolones 15(15.62%). GIT 29(30.20%) was the most affected organ system by Adverse Drug Reactions. The most common ADR was Abdominal pain 13(13.54%), Dyspnoea, Diarrhoea, Rashes 08 (8.33%), Vomiting, allergic reactions 6 (6.25%) and Cough. Severity assessment showed that out of 96 ADRs, mild reactions were high followed by moderate and severe reaction.
Conclusion: This study concluded the spontaneous reporting of Adverse Drug Reactions to antibiotics and other drugs, proper documentation and periodic reporting to regional pharmacovigilance centres should be promoted to ensure drug safety.
Correlation between Morphological Typing of Anemia Based On RBC Indices and RDW Obtained from Sysmex KX-21, an Automated Hematological Analyser with Peripheral Blood Smear Examination
Dr. Kuntal Devesh Patel; Dr. Mihirkumar J. Bhalodia; Dr. Sunidhi Chauhan; Dr. Jasmin Jasani; Dr. Shashikant Mavadiya
DOI : 10.5281/zenodo.8286084
INTRODUCTION - Anemia affects millions of people globally. Once anemia is diagnosed clinically, a morphological typing of anemia pathologically helps the treating physician to come up to the cause of anemia. In the new era of laboratory diagnostics, the automated hematology analyzers give accurate results for the RBC indices and hence have replaced the manual methods in the majority. The expertise needed to see the peripheral blood smear is unquestionably far more than that needed to run the analyzers. Moreover, in morphological typing of anemia based on peripheral blood smear examination, there is intra and inter observer variation. Further peripheral blood smear review performed by pathologists hardly ever provide unique information and provide incremental helpful information in few of the cases. Hence, the aim of the present study was to correlate morphological typing of anemia based on RBC indices and RDW obtained from KX-21, an 3 –part automated hematology analyzer with peripheral blood smear evaluation and to discover if the rate of manual peripheral blood smear review in cases of anemia already morphologically typed on automated analyzer can be reduced.
METHODS - A total of 1100 cases of anemia were studied over a period of five years between January 2017 to December 2021 at Central Diagnostic Laboratory, Dhiraj hospital, Department of Pathology, Smt. B. K. Shah Medical Institute & Research Centre, Piparia, Vadodara. Anemia typing was done by two methods – to start with using RBC indices & RDW only. Subsequently on peripheral blood smear examination. The results were then correlated and analyzed.
RESULTS - All the cases were typed as Microcytic Hypochromic Anemia with normal and raised RDW, Macrocytic Anemia and Normocytic Normochromic Anemia with normal RDW (91.82 %) on RBC indices with RDW alone. Then all these were confirmed as the same by peripheral blood smear examination. However all cases typed as Normocytic Normochromic Anemia with raised RDW (8.18 %) on RBC indices with RDW alone were typed as either Dimorphic Anemia or Microcytic Hypochromic Anemia with polychromasia on subsequent peripheral blood smear examination.
CONCLUSION - Morphological typing of anemia in cases of Microcytic hypochromic anemia with normal and raised RDW and Macrocytic anemia using RBC indices and RDW from 3 part automated hematology analyzer shows very high specificity and high sensitivity. In cases of Normocytic normochromic anemia, the cases with normal RDW showed high specificity and sensitivity but the cases with high RDW were wrongly typed on indices alone and had a low sensitivity and specificity signifying that additional peripheral blood smear examination as an extremely essential tool in morphological typing of anemia.
Disseminated Nocardiosis caused by Nocardia concava in a post-renal transplant patient: A Case Report
Dr.Priya Periaiah; Dr.M.Shanthi; Dr.Uma Sekar; Dr.Sandhya; Dr.Jayakumar
DOI : 10.5281/zenodo.8286212
Disseminated nocardiosis is rare and often late presenting infection with a mortality rate of 85% in immunocompromised individuals. Case- A 50 year old male, post-renal transplant 6 months back, on maintenance immunosuppression with tacrolimus and prednisolone, following renal transplant he had multiple episodes of urinary tract infection with multidrug resistant Klebsiella pneumoniae. The patient presented with continuous fever with chills and rigor and cough for 7 days. Computed Tomography of Thorax revealed focal patchy areas, ground glass opacity and centrilobular nodules with tree in bud pattern, calcified subpleural nodules in right upper lobe and calcified mediastinal lymph nodes. On admission blood culture was sent, it flagged on day 2 of incubation. Gram stain revealed the presence of gram positive bacteria, modified acid fast bacilli smear was positive for weakly acid fast branching, filamentous bacilli. The growth on blood culture was confirmed to be Nocardia concava, by 16srRNA sequencing. Conclusion- Radiological evidence of nodular lesions in the lungs in a post-renal transplant recipient especially within 6 months should arise a high suspicion of pulmonary nocardiosis. Nocardia must be identified upto species level by 16srRNA sequencing, as treatment varies based on the species and some of the species can be resistant to cotrimoxazole. Infection with Nocardia concava must be treated with a combination of trimethoprim-sulfamethoxazole and linezolid.
Topical Application of Autologous PRP Dressing Versus Normal Saline Gauze Dressings in Management of Diabetic Foot Ulcer
Dr. Anjana R; Dr. Girish T U
DOI : 10.5281/zenodo.8286298
INTRODUCTION : Diabetes is a major health problem that is currently showing an alarming increase in its incidence and prevalence. Of Diabetic foot ulcers is a predominant complication of the disease.Appropriate treatment and wound careaccelerate the process of healing and prevents the infection and chronicity of the woundof which autologous platelet-rich plasma (PRP) has attracted a lot attention.
OBJECTIVE: To compare the efficacy between topical PRP dressings versus normal saline gauze dressing.
METHODOLOGY: This is a prospective study done in JSS HOSPITAL MYSURU for 18 months with sample size of 58 divided into 2 groups by using simple randomisation. Group A Underwent PRP and Group B- Sterile normal saline dressings were. Performa containing Questionnaire regarding medical history will be taken, general physical examination, local examination of ulcer, loco regional examination is done and noted . Wound Assessment was done to evaluate the rate of wound amongst the two groups.
RESULTS: The study showed significant decrease in size of the ulcer, decrease in exudate amount, peripheral tissue oedema and induration in patients treated with PRP dressing when compared with ulcers treated with Normal saline dressing. There was also significant increase in granulation tissue for the ulcers treated with PRP dressing. Most of the patients who underwent PRP dressing were found have no growth in the pus culture implying reduction in bacterial load of the ulcer.
CONCLUSION: The Approach of treatment to Diabetic foot ulcer is multidisciplinary which includes –local wound care with surgical debridement, regular dressings with infection control, use of offloading devices with proper vascular assessment and Good glycaemic control.
PRP Can be easily prepared using patients own blood and its Local application has significantly lead to faster healing by formation of granulation tissue and reducing the slough, discharge, bacterial load/ reducing the wound size. Thus, decreasing the duration of Hospital stay.
A Comprehensive Cross-Sectional Assessment of Hepatitis B Infection: Awareness, Knowledge, Transmission Insights and Vaccination Status among Medical Students and Graduates in Ahmedabad's diverse Medical Institutions
Poojan A. Parikh; Dr. Rajshree Bhatt; Yash D. Chauhan; Kalagi G. Panchal; Vasu R. Zalavadia; Kuru P. Patel
DOI : 10.5281/zenodo.8298769
Introduction: Hepatitis B virus (HBV) infection is a major global health problem affecting large number of people every year. WHO estimates that 296 million people were living with chronic hepatitis B infection in 2019, with 1.5 million new infections each year. Health-care workers and medical students in clinical years, who come in contact with the patients and their potentially infectious materials such as blood and other body fluids, are at highest risk of acquiring the infection and should be protected and they must have a proper knowledge about hepatitis B infection, modes of transmission, clinical features, complications, and preventive measures. Aims and Objectives: To assess Hepatitis B knowledge and vaccination status. Materials and Methods: A descriptive cross sectional study. Data including knowledge of Hepatitis B transmission, vaccination status was collected in a predesigned questionnaire. Results: 100% participants have taken at-least one dose of the vaccine and 78.7% (96/122) have taken all the three doses. 96.7% (118/122) and 95.1% (116/122) participants reported blood transfusion and needle prick to be one of the cause for transmission of Hepatitis B virus respectively. Conclusion: There was a significant level of awareness of hepatitis b virus transmission and vaccination status among this high risk group participants. Attitude towards getting themselves tested for serology is an important area that is good to address.
To Estimate Fertility Pattern and Service Utilization in Reproductive Age Group Women in Area Covered Under Jodhpur Urban Health Centre - A Descriptive Cross-Sectional Study
Yash D. Chauhan; Dr. Sonal Shah (Parikh); Kalagi G. Panchal; Dev K. Patel; Shreya N. Soni; Nuha Contractor
DOI : 10.5281/zenodo.8298793
Introduction: Assessing fertility on individual basis vs population basis is much different. Studying fertility behaviour of a given time gives shape to the future age-sex structure and studying fertility pattern can be used to plan various welfare programs, government programs. This study aims at estimating the fertility pattern of the study population and their various government services and program utilization in the area of Ranujanagar and Gokula was covered under Jodhpur Urban Health Training Centre. Aims and objectives: To estimate fertility pattern and various health care service utilization. Methodology: A descriptive cross sectional type of study design. From the sample frame of reproductive age group women a purposive random sampling of 250 participants was drawn. Results: Mean age of the study participants was 27.72 years with standard deviation of 8.56 years. 10.4% participants were illiterate, 6% were graduate and rest had achieved primary to secondary level of education. Out of 164 aanganwadi registered women bearing at-least 1 child 77 women (72%) were consuming IFA tablets. Most common reason for not consuming IFA tablets was unawareness of iron folic acid supplementation. Majority of study participants preferred going to private hospitals for availing various ANC related services. Conclusion: Significant proportion of early marriages and poor service utilization was reported among the study participants.
To Assess Mannheim Peritonitis Index (MPI) In Predicting Complications in Patients Who Presented with Features of Peritonitis
Dr.Roshan R. Patil; Dr. Anil Darokar; Dr. Rajiva M, Mulmule; Dr. Ameet D. Bhasme; Dr. Narendra O. Wankhede
DOI : 10.5281/zenodo.8300877
Introduction: The purpose of the study was to find the complications in post-operative patients of peritonitis using Mannheim’s Peritonitis index. An observational study conducted in a 60 patiens at tertiary care centre as emergency cases of perforation. Patients with clinical suspicion and investigatory support for the diagnosis of peritonitis (diffuse or localised) due to hollow viscous perforation who are later confirmed by intra- operative findings were included in study. Quantitative data was tested by Mean and Standard Deviation, difference between two means tested by ’Z’ test. Qualitative data was compared by Chi square test, Fisher’s exact test. P value <0.05 was considered significant. Conclusion: it seems that most peritonitis cases were of non-colonic sepsis origin and presented late I.e. after 24 hours of perforation, had to be managed with exploratory laparotomy and primary Closure. In the present study, recovery rate was 86.67% and death rate was 13.33%. MPI score of <21 was significantly more associated with recovery (p=0.0008) hence we observed more recovery rate, as most of the patients in our study had MPI score of <21. MPI score of >29 was significantly more associated with deaths (p=0.0001), hence we have observed deaths among those patients who had high MPI scores. So MPI (Mannheim Peritonitis Index) can be used for assessing severity and predicting prognosis of the peritonitis patients.
Comparative Study of Outcomes of Longitudinal and Torsional Modes in Phacoemulsification Using Gravity Fluidics along with Intrepid Balanced Tip
Atipriya Sethi; Mahima Panwar; Nupur Raina; J.K. Chouhan
DOI : 10.5281/zenodo.8300895
Purpose: To compare the outcomes of longitudinal and torsional modes of phacoemulsification with foldable intraocular lens implantation surgery using an intrepid balanced tip with gravity fluidics system.
Methods: This single-centre prospective study comprised a total of 80 eyes of 80 patients having senile cataract with nuclear opalescence (NO) grade II-IV (LOCS III). Cataracts of each grade were randomly assigned into 2 groups LPKE and TPKE mode. All the patients were operated by the same surgeon using the same machine having gravity fluidics using an intrepid balanced tip. Patients were evaluated on postoperative days (PODs) 1,7,15 and 30 for BCVA, CCT, and ECD. Intraoperative outcome measures were cumulative dissipated energy (CDE) and ultrasound time (UST). Postoperative outcome measures were best corrected visual acuity (BCVA), central corneal thickness (CCT), and endothelial cell density (ECD) on days 1,7,15, and 28.
Results: The difference of CDE and UST between the 2 modes was found to be significant (p<0.001) in favor of TPKE mode in all NO grades. TPKE mode performs better than LPKE mode regarding ECL, CCT change, and BCVA change, although the differences were insignificant (P > 0.05).
Conclusion: When using gravity fluidics along with the intrepid balanced tip, TPKE mode appeared to be a more efficient mode of PKE with reduced mean UST and CDE across all NO grades, as compared to LPKE mode. However, ECL, CCT change, and BCVA change seemed to be comparable between the two modes.
Schizophrenia and Marriage, Marital Quality of Life- A Study from Central India
Dr Mansi A; Dr Rathi P; Dr S. Reddy
DOI : 10.5281/zenodo.8300912
Schizophrenia is a severe, debilitating psychiatric disorder affecting not only the lives of the patients, but also of their caregivers. And in most adult patients, their caregivers are the spouses. It is a chronic and severe brain disorder that affects approximately one percent of the population worldwide. Our study was a cross-sectional observational study, aims at assessing the Anxiety, Depression and Marital quality in spouses with Schizophrenia, attending the Psychiatry Department at a tertiary care centre, in Central India.
The major chunk of our study population were Males in the age group of 21-40 years belonging to urban backgrounds, with higher secondary educational qualification, coming from a upper lower, lower middle socio-economic class. These individuals were hindu by religion, and most were employed in jobs or had small scale businesses.
Patients included in the study population were mostly females, with most of them having a duration of illness of 16-20 years and were married for >10years. Most of them had arranged marriages and were residing in extended nuclear families, with two or more children.
The assessment of prevalence of anxiety and depression revealed major study population with scores corresponding to mild anxiety and absence of depression. These were negatively related to Increase in age of spouses, male gender, higher educational and socio-economic status as well as the employment status.
Duration of illness and marriage had variable correlations, however Residing in urban areas, in nuclear or extended nuclear families with no children, and single earning member in the family and a comorbid substance use by patients had a positive correlation.
We observed that the scores on the marital quality scale, were positively related to a lower age, female gender, lower educational, and socio economic status, along with employment status of spouses, urban location of residence. These scores were worse for couples in nuclear families with no children and lacking any additional social support
These scores were positively associated with anxiety and depression grades.
However, the 12 factor scores revealed, a high score in affection and understanding but a low score for dissolution potential of the marriage.
An overall improvement in marital quality will not just improve the social functioning of these patients, but will also improve the understanding of their spouses about the psychiatric illnesses. This will indirectly improve the treatment adherence in these patients, as well as will help taking care of the care giver burdens among their spouses.
Prevalance of Hemoglobinopathies Amongst Pregnant Women in Tertiary Care Hospital, Vadodara
Dr. Mihirkumar J. Bhalodia; Dr. Kuntal D. Patel
DOI : 10.5281/zenodo.8308198
INTRODUCTION: Hemoglobinopathies may be either qualitative or quantitative defects of hemoglobin. The major hemoglobinopathies consist of Thalassemias (mainly alpha and beta) and variant haemoglobins (HbS, HbE, HbD, Punjab etc.). India has the largest number of children with Thalassemia major in the world – about 1to 1.5 lakhs and almost 42 million carriers of Beta thalassemia trait. About 10,000 – 15,000 babies with Thalassemia major are born every year. Pregnancy with hemoglobinopathies are at very high risk.
METHOD: This prospective cross-sectional study was conducted on pregnant females attending ANC (Anti Natal Care) OPD in Dhiraj Hospital, Vadodara for a period of one year (1 year) from July 2022 to July 2023. Consenting participants were interviewed using a pre-constructed questionnaire. All the data were charted and tabulated according to mentioned parameters like Name, Age, Address, Socioeconomic status sibling history, consanguinity, any family history of blood disorder etc.
RESULTS: The total number of pregnant women screened for hemoglobinopathies was 500 from the ANC OPD of Dhiraj Hospital, Piparia from July 2022 to June 2023. 475 out of total 500 women were positive for hemoglobinopathies. Out of these, 86% were positive for sickle cell trait while 7% showed sickle cell disease and 2% were positive for Beta thalassemia trait on the basis of their HPLC test result. In our study majority of Women demonstrated mild anaemia (60%) while Moderate (36%) and severe (4%) anaemia were seen in a total of 40 pregnant women, which is additional finding observed.
CONCLUSION: In the present study, gravid population has higher prevalence of hemoglobinopathy (95%) mainly Sickle cell trait (86%). More efforts are required to increased awareness in high risk populations concerning hemoglobinopathies before in order to control it in India
A Histomorphological and Immunohistochemical Study of Malignant Nodal Lymphomas
Burji Rutuja A; BR Vani; V Srinivas Murthy
DOI : 10.5281/zenodo.8313136
Background: Lymphomas are malignant clonal neoplasms of lymphocytes and their precursor forms. They are mainly of two types – non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL). Incidence of lymphomas, especially NHL is increasing worldwide and also in India, therefore morbidity due to the disease is also increasing. Thus, knowledge of its pathogenesis, histomorphology and immunophenotype will lead to possible early diagnosis and treatment of this potentially curable disease. In this background, a study has been conducted.
- To study the histomorphological features of malignant nodal lymphomas.
- To evaluate the expression of a panel of immunohistochemical markers for categorisation of nodal malignant lymphomas and their subtypes.
Methods: A study was conducted for a period of 6 and a half years from January 2012 to June 2018 at the Department of Pathology, ESIC Medical College and PGIMSR with a sample size of 75 cases.
All the cases diagnosed as nodal lymphomas during that period, were included in the study. Immunohistochemistry (IHC) was performed. Data was compiled onto a masterchart and descriptive statistics performed.
Results: Majority patients presented with cervical lymphadenopathy. NHL was more common than HL among nodal lymphomas. Among NHL, diffuse large B cell lymphoma was the most common. Among HL, nodular sclerosis was the most common subtype. Both HL and NHL had a male predominance. The mean age in HL was lower than that in NHL.
Interpretation and Conclusion: Clinicopathological correlation and a good histomorphological diagnosis, supplemented by immunohistochemistry will enable efficient diagnosis of malignant nodal lymphomas, and enable application of targeted therapy options
APLS and Recurrent Pregnancy Loss- A Case Series
Dr.Ariba; Dr. Ahmad Ghayas Ansari; Dr.M.Aslam
DOI : 10.5281/zenodo.8330211
Objectives: This is a Case Series of 3 patients of APLS with varied presentations who were diagnosed and improved following treatment. Antiphospholipid antibody syndrome is a heterogenous autoantibody mediated acquired thrombophilia, which is associated with severe life-threatening complications during pregnancy.
CASES: Case 1: A 29 yr old female presented to us with Generalised edema over body and shortness of breath over the past 2 months, with severe anemia and a history of 2 pregnancy losses at 4 weeks and at 10 weeks of pregnancy. On evaluation, she was diagnosed as SLE with Class V Lupus Nephritis and Secondary APLS.
Case 2: A 35 yr old female presented with multiple episodes of GTCS, had a history of 3 abortions at 4, 6 and 10 weeks of pregnancy, and had an episode of Left sided Hemiparesis 2 years back. MRI was suggestive of chronic venous infarcts and she was diagnosed as a case of Primary APLS.
Case 3: A 20 yr old primigravida presented with Antepartum eclampsia, she suffered from an Intrauterine Death and post LSCS, she developed sudden onset weakness of Left side of her body. On evaluation for hypercoagulable state, was diagnosed with APLS.
Results and Conclusions: Clinicians should have a high index of suspicion of APLS in patients with history of recurrent abortions or Intra uterine death with unexplained cause.
To Study Lipoprotein (A) As Risk Factor for Acute Ischaemic Stroke
Dr. Palash Gupta; Prof. Anjum Mirza Chughtai
DOI : 10.5281/zenodo.8330407
Background: Traditional cardiovascular risk factors, such as age, male sex, hypertension, diabetes mellitus, atrial fibrillation, and dyslipidemia, are associated with ischemic stroke. However, a significant fraction of strokes is still considered to be cryptogenic. Cryptogenic strokes make up roughly 40% of all ischemic stroke cases among stroke patients under the age of 55, highlighting the potential significance of additional, probably unidentified risk factors.
Objectives: To study the significance of lipoprotein (a) as a risk factor for acute ischaemic stroke with its levels in patients of different ages and sex.
Design: single center, cross-sectional, open hospital-based, observational study
Material Methods: 100 patients with acute ischaemic stroke taken who were >18 years of age and s. lipoprotein(a) levels were done. These levels were correlated with age, gender, and conventional risk factors like hypertension, smoking, and diabetes.
Results: In our study out of 100 81% of patients had abnormal lipoprotein(a) levels. The mean lp(a) levels were more in the younger age group [<55yr is 53.34 + 24.06 mg/dl and in >55yr is 45.93 + 24.19 mg/dl] and male sex but they were statistically insignificant.
A Clinical study of Risk Factors and Fetomaternal Outcome of Preterm Deliveries in a Tertiary Care Center
Dr. Varsha L. Deshmukh; Dr. Gouri A. Keni; Dr. L S Deshmukh; Dr. Shrinivas Gadappa
DOI : 10.5281/zenodo.8330472
Background: Spontaneous preterm delivery is India's leading cause of neonatal morbidityand is the most common reason for hospitalization during pregnancy. In the present study, we aim to evaluate the risk factors, maternal and neonatal outcomes of preterm birth in a homogenous obstetric population attending a tertiary referral hospital to highlight the areas where further research or intervention is required to prevent preterm birthand improve perinatal outcome.
Methods: This prospective observational study was conducted on 400 pregnant women diagnosed as preterm labor, fulfilling the inclusion and exclusion criteria in Government Medical College, Aurangabad between November 2019 and November 2021.The study is based on history, examination, and findings in women who delivered preterm(28-37 weeks of gestation).The age, parity, previous pregnancy outcome, andrisk factors are identified in this pregnancy, including PIH,GDM, or UTI, were noted. The neonatal outcome was recorded. The data is analyzed using the chi square test.
Results: In the present study, we found that in 72.5 % of preterm cases, the maternal age group was 18-25 years old, 152 (37.97%) participants were Gravida 2, and 232(58.22%) participants delivered between 34.1-37 weeks. Out of 400,168 (42.18%), participants had a history of abortion. According to the present study, the most common high-risk factor among mothers was PPROM (9 %). In addition, 96% of patients delivered vaginally, 4 % delivered by cesarean section. Out of vaginal deliveries, 72. 13 % were born spontaneously, and 27.87% were delivered by elective inductions.
In the present study, neonates with low birth weight (below 2500 gm )were 308 (75.85%) cases. Early preterm babies more frequently had low APGAR scores (<7) compared to late preterm babies. Out of 158 babies admitted to NICU, 28 (17.64%) neonates developed Respiratory distress syndrome, 26(16.42%) sepsis, 9(5.87%) intraventricular hemorrhage, 9(5.87%) jaundice, 8(5.29%) Necrotising enterocolitis, 9(5.69%) Hypoxic Ischaemic Encephalopathy, 6(3.52 %) pneumonia.
Conclusion: Preterm labor is challenging yet the unmet goal of maternal and neonatal development. Proper antenatal care will help identify high-risk cases for preterm delivery early and plays a major role in lowering preterm births and improving neonatal outcomes.
Analysis of Cytomorphological Pattern of Granulomatous Lesions Diagnosed by Fine Needle Aspiration Cytology
Dr. Rajashree K; Dr. Shashikala P; Dr. Neeta Y; Dr. Mallikarjuna V.J
DOI : 10.5281/zenodo.8330496
Introduction: Granulomatous inflammatory lesion on fine needle aspiration cytology is one of the common encountered entity. It can be easily diagnosed on fine needle aspiration cytology(FNAC) thereby having immense effect on initiation of treatment modalities.
Aim: To evaluate cytological features of granulomatous lesions diagnosed on FNAC
Method: This is a retrospective study done over a period of two years. Cytology records and slides were archived in detail and reviewed to categorize granulomatous inflammatory lesions into different categories
Results: Totally 43 cases were collected over a period of two years. Majority showed cytological pattern of presence of epithelial gramulomas with caseation necrosis. Stain for acid fast bacilli was positive in 4 cases(9.3%)
Conclusion: The predominant cytological pattern described was presence of epitheloid granulomas with caseation necrosis followed by epithelioid granulomas without necrosis and caseation necrosis without epitheliod cells.
A Comparative Study of Patellar Resurfacing Versus It's Retention in Total Knee Arthroplasty
Dr. Hrishikesh Desai; Dr. Nirav solanki
DOI : 10.5281/zenodo.8330536
Background: Total knee arthroplasty is one of the most successful operations in modern orthopedics with less than 5% complications. Unfortunately, half of them are patella complications which naturally make patellar resurfacing a topic of debate since the advent of this surgery. In this randomized prospective left right study, we try to evaluate the best means of overcoming this problem.
Materials and Methods: 60 knees were operated which were in a period of 3 years and followed up for a mean of 21 months. Randomisation was achieved by resurfacing all right knees while retaining all left knees. We had equal number of left and right knees and the results were evaluated with the help of Knee Society score, Patellar score, anterior knee pain and complication rate.
Results: The incidence of anterior pain in knees without patellar resurfacing (24%) was significantly higher than that in knees with patellar resurfacing (12%). This pain was not related to pre op pain and was not related to age, sex, obesity, or grade of chondromalacia of the patella. There were no patella-femoral complications in the resurfaced groups as such.
Conclusion: If equal time and importance is given to the third component of the total knee arthroplasty it helps in preventing the so often encountered patella-femoral complications. This leads to over all better functional results especially lesser incidence of post op anterior knee pain. More importantly selective knee resurfacing is no better as other indicators of resurfacing were proved to be not of much use in this study.
Clinical Profile of Dengue Fever In Children: A Hospital-Based Study
Dr. Nagalakshmi R; Dr. Rini Evangeline J
DOI : 10.5281/zenodo.8331037
Background: Dengue is a mosquito-borne arboviral disease that has become a global public health challenge, causing epidemics in tropical and sub-tropical countries during the rainy season. This study aimed to assess the clinical profile of dengue infection in children under 12 years of age and to evaluate the outcome of dengue fever.
Methods: The prospective observational study was conducted at Kanyakumari medical college on children with dengue fever admitted from 2020 to 2021. Demographics, clinical profiles, and outcomes of the children with dengue fever were studied. Based on the severity of the disease, children were categorized into three groups; group A has dengue fever. Group B; has dengue fever with warning signs, and group C; has severe dengue.
Results: A total of 63 children were enrolled in the study, with a male predominance (54%) and a highly affected age group of >8 years (65.1%). Fever, vomiting, and abdominal pain were the most common presenting complaints in children. Hepatomegaly was the most common clinical finding .Pleural effusion was reported in 5 children from group B and four children from group C, with significant differences based on the severity of dengue. Most children required 8-10 days of hospitalization, and treatment of antipyretic and intravenous fluids was majorly used. All children recovered from dengue with no mortality.
Conclusion: Early recognition of danger signs clinically and appropriate treatment can reduce mortality and improve patient outcome.
A Study on Association of Her2/neu and Ki - 67 Positivity with Extent of Disease in Breast Carcinoma
Dr Saman Bari; Dr Arvind Rai (MS); Dr Stella Karari; Dr R.S. Gupta (MS); Dr Bhoomika Agarwal; Dr. Devendra Chaudhary (MS); Dr. Reeni Malik (MD)
DOI : 10.5281/zenodo.8333307
Background: Breast carcinoma has become a serious threat worldwide, owing to the increasing incidence of the disease in both developing and developed countries.
Aims and objectives: To study the association between Her2/neu and Ki-67 values and the extent of disease in breast carcinoma.
Methods: This was a hospital based cross-sectional study conducted over the duration of 18 months. All the females admitted with breast cancer reporting the health facility were included in the study. Their detailed medical history, clinical information, and laboratory investigations were recorded in excel and analysed.
Results: Mean age of participants was found to be 49.12±10.64 years. 91.2% females were multiparous. History of breast feeding was reported in 88.2% females, 38.2% females had history of HRT/OCP intake and 32.4% females had positive history of chemoradiation for breast cancer. On histopathology. Majority (85.3%) of cancer were ductal carcinoma. PR, ER, Her2neu and Ki67 >14 expression was reported in 41.2%, 55.9%, 8.8% and 94.1% of findings respectively. 96.2%, 91.2% and 85.3 of grade 3 tumours reported Ki67 >14, Her2neu and Her2neu/Ki67 expressions respectively.
Conclusion: This study explored the association of Her2/neu and Ki-67 positivity with the extent of disease in breast carcinoma. Understanding various factors is essential for tailored management strategies and highlights the need for early detection and comprehensive screening programs to improve patient prognosis. Therefore, it is recommended that all individuals diagnosed with breast cancer should undergo testing for four specific markers.
OXTR Gene Polymorphism and Plasma Oxytocin Levels for Predicting Chronic Pain in Caesarean Delivery
Dr. Geetanjali Tolia Chilkoti; Tiwari S; Ashok Kumar Saxena; Brijesh Kumar Mishra; Neha Tawar; Basu Dev Banerjee; Mohta M; Sharma T; Agarwal R
DOI : 10.5281/zenodo.8334124
Background: To explore the role of oxytoc in receptor gene (OXTR gene) polymorphism and plasma oxytocin levels in predicting the incidence of chronic persistent post-surgical pain (CPSP) following caesarean delivery (CD).
Methods: This observational follow-up study was conducted following IEC-H approval, prospective CTRI registration and written informed consent from each participant.We included obstetric patients of ASA grade II or III undergoing CD under either SAB or GA and excluded if had chronic pain, neurological disorders or cognitive dysfunction. A base line venous blood sample for plasma oxytoc in levels and OXTR genepolymorphism study was withdrawn and conducted as per the standard protocol. The pain severity and neuropathic component were assessed at 6, 10 and 14th week, postoperatively. Statistical tests like unpaired student-test, Fisher-exact test, correlation tests and binary logistic regression were used.
Results: A total of 50 patients were included and24% (n=12) of them had CPSP. The risk score of alleles with respect to CPSP shows that T allele has OR of 0.43 (95%CI= 0.08-2.2, P value-0.3) and C allele has OR of 1.06 (95% CI=0.11-11.2, P-value 0.96).
A significant correlation between mean oxytocin levels and NRS at 6th (R-0.34, p-value: 0.015) and 10th week (R-0.26, p-value: 0.067) was observed; however, not at 14th week. The mean oxytocin level is significantly raised in patients undergoing emergency CD vs elective CD i.e. 2.22 ± 1.17 vs 1.02 ± 1.00; p-value=0.013. Amongst patients undergoing emergency CD, a significant negative correlation between oxytocin levels and NRS-R atall time points i.e.6th, 10th and 14th weeks and NRS-M at 6th week only were observed
Conclusion: We observed the protective effect of T allele of OXTR rs53576 and the antinociceptive effect of endogenous oxytocinin the pathogenesis of CPSP following CD.
Use of Near Peer Interactions for Anatomy Teaching by Online Method During Covid 19 Pandemic
Dr. Deepti Kulkarni; Dr. Kirti Solanke; Dr. Archana Shekokar
DOI : 10.5281/zenodo.8334323
Covid 19 pandemic lead to new teaching learning methods mainly by online and virtual mode. But learning Anatomy by online method was a difficult task as students had to face many challenges. Hence this study was done to see effectiveness of near peer interaction during online learning of Anatomy. Senior students from previous batch interacted with students regarding issues faced during online learning of Anatomy.
Google form was shared for the feedback and analysed for the result.
An Insight into Reasons For Increase in the Proportion of Hypermature Cataract and Its Complications on Presentation Due to Covid-19 Related Delay
Dr. Soumya M Malkhed; Dr DN Prakash
DOI : 10.5281/zenodo.8337650
Purpose: To assess the increase in the proportion of hypermature cataract ,associated complications and to evaluate the reasons for delayed presentation during the era of COVID 19 pandemic .
Materials and Methods: an observational and interview based study was undertaken among -398 patients with hypermature cataract, over a year (post COVID 19 lockdown) in the Ophthalmology department of Mysore medical college and research institute. Presence of complications like phacolytic glaucoma and subluxations was noted. Increase in the proportion of hypermature cataract was calculated and compared with the previous year morbidity , resulting from hypermaturity , from institutional records .Reasons for delayed presentation was evaluated with standard questionnaire.
Results: A two fold increase in the proportion of hypermature cataract was observed in our study during the study period. Among 398 cases, (152 )38.19 % were male patients and (246 ) 61.8% were female patients. Majority of patients belonged to age group of 61 to 70 years . About 69% ( 270) were hailing from rural area, whereas the remaining 31% (128) patients were from the urban area .76(19%)patients had more than one reason for delayed presentation . Elective OT shut down , lack of public transportation , lockdown , fear of being tested as COVID positive followed by isolation , systemic illness , reluctance by caretakers were some of the other reasons.
Conclusion: as a result of COVID 19 lockdown backlog, a statistical surge in the number of patients presenting with hypermature cataract and its complications was observed . Change in outlook of patient during the pandemic towards seeking medical attention was the most important factor for late presentation.
Association of Hba1c and Diabetic Foot Ulcer Outcomes In Patients Attending Tertiary Care Hospital
Dr. Rushikesh R. Shinde; Dr. Varsha N. Bijwe; Dr. Narendra O. Wankhede; Dr. Bhushan D. Thakare; Dr. Bharat P. Shete
DOI : 10.5281/zenodo.8358213
Introduction: Typically diabetic foot syndrome is characterized by foot infection, ulceration, or destruction of deep tissues in association with neurological abnormalities and divergent levels of peripheral vascular insufficiency. The factors that affect ulcer healing in diabetic patients are generally helpful in optimization of patient management strategy besides their routine application as predictors of the outcome. Hemoglobin A1c (HbA1c), an established marker to monitor blood glucose in diabetic patients, is currently being investigated for its association with ulcer healing.
Material and Method: A descriptive study was carried out in diabetic patients with foot ulceration (n = 70) to determine the role of HbA1c affecting the ulcer healing process. Ethical committee clearance was taken from the institution ethical committee. The study was conducted over 18month period from January 2021 to June 2022. Informed consent was obtained from the patients.
Conclusion: Our study results show that HbA1c levels have good association with the process of healing as well as time required for healing process to complete.
Prevalence of Mental Health Disorders During Pregnancy and Puerperium In A Tertiary Health Care In Ernakulam
Dr. Gokul T R; Dr. Georgy Joy Eralil
DOI : 10.5281/zenodo.8362456
Background and Objective: Pregnancy is a period in a women life where she undergoes physical and mental changes. In the recent era prevalence of mental health disorders are on the rise. Anxiety and depression are the most common faced by the pregnant women. Effect of mental health can affect the newborn care and can lead to long term behavioral and psychological impacts on the child. The objective of this study is to assess the prevalence of mental health disorders during pregnancy and puerperium in a tertiary health care in Ernakulam.
Methods: A cross sectional study conducted among 100 participants in a tertiary health care in Ernakulam Kerala. The study was conducted from July to August 2021. Data was collected using a questionnaire and analyzed. Approval was obtained from institutional ethics committee prior to the study.
Results: The prevalence of mental pressure or tension experienced by the women was found to be 32% antenatally which reduced to 9% postnatally. 37% women reported of having sleeplessness, depression or lack of interest at the period of pregnancy. This was found to reduce to 7% postnatally. One woman was found to show active suicidal thoughts, attempts or self-harm. The prevalence of women who experienced anxiety, palpitations or over sweating was found in 21% antenatally which reduced to 5% postnatally. A previous history of any mental health disorder or any episodes of seizure was reported only by one participant. From the data analysed from the bystander information, it was found that 34% women showed excessive anger or overtalkativeness antenatally which reduced to 4% postnatally. Antenatally 20% of women showed signs of underlying doubts or fear which was found to reduce to 5% postnatally. Only 2% of women were reported to laugh, talk or murmur to oneself during the period of pregnancy. Women showed good interest in child care after delivery as only one woman was reported to show lack of interest in child care. 1% of women was noticed to show any other mental disorders both antenatally and postnatally.
Interpretation and Conclusion: The study concludes by determining the various prevalence of mental health disorders during pregnancy and puerperium in a tertiary health care centre. Prevalence of various mental health issues were found to be more during the antenatal period. Antenatal depression, sleeplessness or lack of interest was the major problem followed by excessive anger and mental pressure or tension. The prevalence was seen to reduce postnatally