https://nepjol.info/index.php/AJMS/issue/feedAsian Journal of Medical Sciences2024-03-01T02:57:31+00:00Prof Dr Arun Kumarajmscience@gmail.comOpen Journal Systems<p>The inaugural issue of the Asian Journal of Medical Sciences was published in May 2010. Full text articles available. AJMS is both online and printed journal. The electronic -ISSN is 2091-0576 and Print-ISSN is 2467-9100.</p> <p>AJMS was added to <a href="https://doaj.org/toc/2091-0576" target="_blank" rel="noopener">DOAJ</a> on 26th May 2020.</p> <p>AJMS was added to CAB Abstracts and/or Global Health database on 15th December 2020. Coverage will start from Volume 11, No. 1, 2020 onwards.</p>https://nepjol.info/index.php/AJMS/article/view/61023Can concurrent use of king vision video laryngoscope and fiberoptic bronchoscope improve efficacy and safety of awake intubation in patients with limited mouth opening? - A case report2023-12-23T16:50:15+00:00Sunana Guptasunaynaarnav@yahoo.comRahul Guptarajaguptadr@rediffmail.comNandita Mehta drnanditamehta@gmail.comHeena Sainiheenasn50@gmail.com<p>Securing the airway by endotracheal intubation in a patient with a restrictive mouth opening poses a challenge to anesthesiologists. Awake tracheal intubation using flexible fiberoptic bronchoscopy is the gold standard in the anesthetic management of patients with restricted mouth openings. Awake video laryngoscopy (VL) is being increasingly used for the management of the anticipated difficult airways. We report a case of temporomandibular joint ankylosis with restrictive mouth opening posted for laparoscopic nephrectomy managed by awake intubation with the combined use of king vision VL (KVVL) and fiberoptic bronchoscope (FOB). KVVL provided an improved and clear view of the airway structures and FOB helped in guiding and maneuvering the tube safely into the larynx. The combined use of KVVL and FOB enhanced the effectiveness and safety of the procedure.</p>2024-03-01T00:00:00+00:00Copyright (c) 2024 Asian Journal of Medical Scienceshttps://nepjol.info/index.php/AJMS/article/view/60970Littoral cell angioma: An incidental finding in a traumatic spleen2023-12-22T01:04:40+00:00Madhurima Dasjbsam_ae@yahoo.comRupsha Dutta Paljbsam_ae@yahoo.comDwaipayan Samaddarjbsam_ae@yahoo.comJaya Bagchi Samaddarjbsam_ae@yahoo.comBidyut Krishna Goswamijbsam_ae@yahoo.com<p>Littoral cell angioma (LCA) of the spleen, a rare vascular tumor, is usually asymptomatic, often discovered incidentally and a majority of them are benign in nature. A 20-year-old boy with a history of blunt abdominal trauma, who underwent splenectomy showed the presence of a capsular tear and variegated outer surface on gross examination of the spleen. On the cut section, multiple nodular areas with areas of hemorrhage were noted. Microscopical examination revealed the proliferation of anastomosing, irregular, tortuous blood-filled channels with plenty of histiocytes in the splenic tissue and extensive areas of hemorrhage, inflammatory cell infiltration, and fibrinoid deposits. Immunohistochemistry revealed positivity for CD31 (endothelial differentiation), CD68, and lysozyme (histiocytic differentiation) but was negative for CD34. The final diagnosis was LCA in a case of ruptured spleen after ruling out angiosarcoma. The possibility of this benign entity to have contributed to the potentially fatal splenic injury cannot be overlooked.</p>2024-03-01T00:00:00+00:00Copyright (c) 2024 Asian Journal of Medical Scienceshttps://nepjol.info/index.php/AJMS/article/view/59927Accessory cavitated uterine mass in a young female with chronic pelvic pain and dysmenorrhea2023-11-15T06:05:03+00:00Deepti Naikdrdeepti2004@hotmail.com<p>Accessory and cavitated uterine mass is a rare form of developmental Mullerian anomaly seen in young females, which presents as chronic recurrent pelvic pain and severe dysmenorrhea. Hysterosalpingography (HSG), ultrasonography, and magnetic resonance imaging (MRI) are the mainstay of diagnostic imaging. This entity is often underdiagnosed; therefore, a high index of suspicion combined with HSG and MRI imaging can help in making an accurate and timely diagnosis and thus prevent unnecessary interventions.</p>2024-03-01T00:00:00+00:00Copyright (c) 2023 Asian Journal of Medical Scienceshttps://nepjol.info/index.php/AJMS/article/view/62513Dimensional advantage: How 3D organoids are re-shaping the oncology research2024-02-03T12:43:19+00:00Ruby Dharrubydhar2020@gmail.comArun Kumarprofdrarunk@gnsu.ac.inSubhradip Karmakarsubhradipaiims@gmail.com<p>Traditional in-vitro 2D cell culture-based models have limitations in cancer research, as they do not accurately reflect the complex 3D architecture and interactions we find in tumors. Cell-cell communications are vital for cancer growth and proliferation. Cancer cells communicate with each other and surrounding cells through various pathways, sending signals that promote their growth, survival, and proliferation through autocrine, paracrine, and endocrine. Fundamentally, this communication forms the basis of cancer survival. This can involve growth factors, cytokines, and other molecules that activate essential signaling pathways for tumor growth. Cancer cells need constant blood and nutrients to sustain such massive growth. This is again achieved by communication with endothelial cells to stimulate the formation of new blood vessels to sustain their energy and metabolic needs. The conventional 2D and 3D cultures play a role in oncology research, but each has its strengths and weaknesses when it comes to studying cancer. While 2D culture systems are simple, easier, and inexpensive to set up and maintain, 3D cultures are more realistic representations of actual tumors due to their 3D structure and cell-cell interactions. They can capture the genetic and functional heterogeneity of patient-derived tumors, thereby allowing for modeling the tumor microenvironment with various cell types and signaling and immune molecules. 2D culture fails to accurately reflect the complex 3D architecture and interactions of cells as seen in vivo due to their limited ability to model cell-cell interactions and the tumor microenvironment. 3D culture-derived organoids behave like miniature, simplified organs in vitro, which can be used for drug testing, disease modeling, and regenerative medicine applications. By creating conditions mimicking embryonic development, 3D culture can be used to study organogenesis and tissue morphogenesis.3D culture models can also be used to study the interaction between pathogens and host cells, providing a more accurate representation of in vivo conditions than traditional 2D cultures.</p> <p>Therefore, the use of 3D culture is multidimensional and spans multiple avenues, contributing to our advancements in understanding biology, disease mechanisms, oncology research, and the development of novel therapeutic strategies.</p>2024-03-01T00:00:00+00:00Copyright (c) 2024 Asian Journal of Medical Scienceshttps://nepjol.info/index.php/AJMS/article/view/59639Novel triple injection technique - Avante garde for costoclavicular block. A Case series2023-11-01T13:06:01+00:00Priyanka Bansaldr.priyankabansal1986@gmail.comNidhi Sultaniadr.priyankabansal1986@gmail.com<p>Costoclavicular block has garnered the attention of regional anesthesia enthusiasts because the cords are snuggly packed and consistently arranged in a particular pattern around the first part of the axillary artery. The single injection technique has been widely used conventionally, but the effect is unpredictable. The effect is unpredictable because of the septum that compartmentalizes cords in upper and lower compartments. We propose a triple injection technique targeting the individual cords separately. Onset time of sensory block from 16 min to 7 min. The average time for a complete motor block was 9.6 min. The chances of the median nerve sparing, as has been reported in some cases in previous studies, are almost nil by this technique–the corner pocket injection that involves the medial root of the median nerve and the lateral cord that is specifically blocked separately, covering the lateral root of the median nerve. The costoclavicular block has already carved a niche as an excellent choice for surgeries of the upper limb involving the elbow or below the elbow. The use of the triple injection technique makes the block effect more predictable and reliable.</p>2024-03-01T00:00:00+00:00Copyright (c) 2024 Asian Journal of Medical Scienceshttps://nepjol.info/index.php/AJMS/article/view/59875Outbreak analysis of meningococcal meningitis: A case series from a tertiary care hospital in Eastern India2023-11-10T07:46:43+00:00Pratiksha Khatuabdg95347@gmail.comSumon Poddarbdg95347@gmail.comBarnali Dasbdg95347@gmail.comSumana Kundagramibdg95347@gmail.comSumita Basubdg95347@gmail.comRohit Kapoorbdg95347@gmail.comHriday Debdg95347@gmail.comAshok Modibdg95347@gmail.comDinabondhu Sahanabdg95347@gmail.com<p>In a span of 4 months, there were 7 cases of meningococcal meningitis who presented with diagnostic dilemma and also a few atypical manifestations. A retrospective data analysis was carried out in children diagnosed with meningococcal meningitis who were admitted from October 2022 to January 2023. There were 7 confirmed cases of Neisseria meningitidis infections during the study period. The median age of presentation was 6 years (range: 4.5 months–9 years) with four males and three females. All the children presented with fever, but none had signs of meningeal irritation as such. Routine blood and cerebrospinal fluid (CSF) analysis were also near normal. Reverse transcriptase polymerase chain reaction (RT-PCR) for N. meningitidis was positive in the CSF samples of all the seven cases. All of the patients recovered completely, except that there were residues of neurodeficit in one patient. In endemic areas, pediatricians should have a low threshold of suspicion for N. meningitidis in children presenting with signs and symptoms involving the central nervous system and consider an RT-PCR of the CSF sample even if routine blood and CSF studies are near normal.</p>2024-03-01T00:00:00+00:00Copyright (c) 2024 Asian Journal of Medical Scienceshttps://nepjol.info/index.php/AJMS/article/view/59640Temporomandibular joint ankylosis - An anesthesiologist’s nightmare: Case series2023-11-01T13:12:30+00:00Priyanka Bansaldr.priyankabansal1986@gmail.comNidhi Sultaniadr.priyankabansal1986@gmail.comAmrish Bhagoldr.priyankabansal1986@gmail.com<p>Temporomandibular joint (TMJ) ankylosis is defined as bony or fibrous adhesion of the anatomic joint components accompanied by a limitation in opening the mouth. Airway management is a grueling task and has confronted anesthesiologists ever since. The challenge is even more exaggerated when it is a pediatric patient. We present a case series of five pediatric patients with TMJ ankylosis with age 7 years or less, who were posted for its corrective surgery. Although all patients belonged to the pediatric age group, the challenges faced and techniques employed to overcome them were different partly because of different age groups and partly the nature of the airway, with tailoring of each technique accordingly. Pediatric airway management is no less than waging a war as all necessary skills and expertise are put to the test. It combines fortuity with skills. We have to be prepared for the worst in any unforeseen scenario.</p>2024-03-01T00:00:00+00:00Copyright (c) 2024 Asian Journal of Medical Scienceshttps://nepjol.info/index.php/AJMS/article/view/60337Evaluation of SARS Cov-2 disease epidemiology, clinical and diagnostic profile-a regional study from tertiary care center of North India2023-12-01T08:33:25+00:00Arti Agrawalsanjeevchaudhary.aiims@gmail.comAsthasanjeevchaudhary.aiims@gmail.comVikas Kumarsanjeevchaudhary.aiims@gmail.comDharmendra Kumarsanjeevchaudhary.aiims@gmail.comNeelika Tripathisanjeevchaudhary.aiims@gmail.comSanjeev Kumarsanjeevchaudhary.aiims@gmail.com<p><strong>Background:</strong> A novel coronavirus severe acute respiratory syndrome coronavirus-2 (SARSCoV-2) that emerged in China in December 2019 has spread rapidly globally to many countries including India and World Health Organization declared it as a pandemic on March 11th, 2020.</p> <p><strong>Aims and Objectives:</strong> The current study endeavors to determine the SARS-CoV-2 positivity rate as well as epidemiological, clinical, and diagnostic profiles from the second wave.</p> <p><strong>Materials and Methods:</strong> We performed a retrospective analysis of all suspected COVID-19 cases from January 2021 to October 2021 presenting at a large testing center for SARS-CoV-2 infection by real-time polymerase chain reaction (RT-PCR). Descriptive analysis has been performed for profiling of clinical-epidemiological aspects of suspected cases.</p> <p><strong>Results:</strong> A total of 694427 participants were enrolled during the study from January 2021 to October 2021. Overall RT-PCR positivity rate was found to be 1.7% in the year 2021 and the positivity was maximum in April 2021 which represents the second wave of COVID-19 infection in India. In the study population, more than half (57.07%) of the persons screened for COVID-19 infection were between 21 and 40 years of age, and about two-thirds (65.20%) of the persons screened were male followed by 34.79% were female.</p> <p><strong>Conclusions:</strong> SARS-CoV-2 poses a high burden of infections in the community. Males had a higher RT-PCR detection rate as compared to females. The younger age group (<20 years) expressed the least RT-PCR positivity rate and the elderly population (>80 years) expressed the highest positivity rate.</p>2024-03-01T00:00:00+00:00Copyright (c) 2024 Asian Journal of Medical Scienceshttps://nepjol.info/index.php/AJMS/article/view/60185Association of inflammatory markers with clinical outcome in COVID-19 patients during the second wave in 100 bedded dedicated COVID MCH Hospital, Raigarh, Chhattisgarh State2023-11-26T00:18:56+00:00Pankaj Madhukar Lukaharishuraon26@gmail.comVed Prakash Gilleyharishuraon26@gmail.comAnmol Madhur Minzharishuraon26@gmail.comHarish Kumarharishuraon26@gmail.comManoj Kumar Minjharishuraon26@gmail.com<p><strong>Background:</strong> A novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) was the causative agent of coronavirus disease 2019 (COVID-19) pandemic 2019. SARS-CoV-2 affects respiratory tract and damages the tissue resulting in generation of inflammatory cells such as cytokines and chemokines such as IFN that damage the lung alveoli, causing severe acute respiratory syndrome.</p> <p><strong>Aims and Objectives:</strong> The aims and objectives of the study are to analyze the blood inflammatory markers of COVID-19 patients and association between clinical outcomes in COVID-19-positive patients with serum inflammatory markers during the second wave of COVID-19 pandemic in 100 bedded dedicated COVID MCH Raigarh CG.</p> <p><strong>Materials and Methods:</strong> In this hospital-based cross-sectional observational study, 90 patients with COVID-19 were enrolled and categorized into three groups: mild, moderate, and severe. Blood inflammatory markers such as C-reactive protein (CRP), lactate dehydrogenase (LDH), ferritin, CK-Nac as well as hemogram total leukocyte count (TLC), differential leukocyte count, and neutrophil: lymphocyte (N:L) were determined and analyzed.</p> <p><strong>Results:</strong> The results of the oxygen saturation (SpO2) severity strength of association with multiple variables taken in the study through logistic regression analysis of COVID-19 patient’s inflammatory markers serum levels of LDH (P<0.05, odds ratio [OR]=1.0146), ferritin (P<0.05, OR=0.9788), N:L (P<0.05, OR=4.1041), and other non-inflammatory parameters such as creatinine (P<0.05, OR=17.8039) were significant. SpO2 severity of COVID-19 patient’s with inflammatory markers LDH, ferritin, CK-Nac, and TLC associated with all severe, moderate, and mild groups. There was no significant association in the serum levels of CRP between the severe, moderate, and mild groups.</p> <p><strong>Conclusion:</strong> The findings of this study suggest that the levels of LDH, ferritin, CK-Nac, and TLC could be used to predict the severity of COVID-19 disease.</p>2024-03-01T00:00:00+00:00Copyright (c) 2024 Asian Journal of Medical Scienceshttps://nepjol.info/index.php/AJMS/article/view/55823Comparison of hemodynamic and analgesic effects of interscalene block with bupivacaine versus bupivacaine-dexmedetomidine combination for shoulder arthroscopy under general anesthesia2023-06-20T23:11:24+00:00Jahangir Mullickjahangirmullick.12@gmail.comAmit Kumar Rayraymit2005@gmail.comSoma Chakrabortydrsoma.chakraborty@gmail.comBidyut Bikas Gharamibibi.gharami74@gmail.com<p><strong>Background:</strong> The interscalene block in shoulder arthroscopy is a well-established procedure. Many drugs have been used as adjuvants to local anesthetics to increase the quality of block in regional anesthesia, with variable results.</p> <p><strong>Aims and Objectives:</strong> The present study was designed to evaluate the effect of dexmedetomidine as an adjuvant to bupivacaine during interscalene block in terms of intraoperative hemodynamic changes and postoperative analgesia.</p> <p><strong>Materials and Methods:</strong> Thirty patients, aged 20–55 years of either sex, American Society of Anesthesiologists physical status I-II, scheduled for shoulder arthroscopic surgery for <2 h, were allocated into two equal groups to receive inj. bupivacaine (0.25%) with inj. dexmedetomidine 1 μg/kg (Group BD, n=15) or inj. bupivacaine (0.25%) with 1 mL normal saline (Group BS, n=15), total volume 20 mL in each case. After settlement of the interscalene block, both groups received general anesthesia as per standard protocol. Hemodynamic parameters (heart rate [HR] and systolic blood pressure [SBP]) were assessed in the intraoperative period, and postoperative pain was assessed using a visual analog scale score in the postoperative period at stipulated time points.</p> <p><strong>Results:</strong> The mean values of HR and SBP were considerably low at all observed time points in the intraoperative period (i.e., at 10 min, 30 min, 60 min, 90 min, and120 min), in comparison with the saline group (P<0.0001). VAS scores between the two groups were considerably lower only at 8, 12, and 18 h in patients receiving dexmedetomidine (P<0.001).</p> <p><strong>Conclusion:</strong> Dexmedetomidine as an adjuvant with bupivacaine can achieve a better hemodynamic profile (lower HR and SBP) in the intraoperative period. Also, the use of dexmedetomidine provides better postoperative analgesia profiles in the later part of the postoperative period (8–18 h), and the effect usually wanes by 24 h.</p>2024-03-01T00:00:00+00:00Copyright (c) 2024 Asian Journal of Medical Scienceshttps://nepjol.info/index.php/AJMS/article/view/59955Monitoring of general anesthesia by qCON and qNOX indices versus conventional clinical parameters in urological surgery: A randomized controlled clinical trial2023-11-17T08:11:48+00:00Himalaya Duttahimalayadutta1995@gmail.comSuchismita Mallicksuchismita2175@gmail.comBaisakhi Lahablowfans@yahoo.co.inSarbari Swaikadr.s.swaika@gmail.comUday Sankar Mandalusankar75@gmail.comSarmila Ghoshsghoshblg13@gmail.com<p><strong>Background:</strong> Awareness during anesthesia is a major anesthetic concern. Depth of anesthesia is commonly assessed in clinical practice by the patient’s clinical signs and symptoms such as blood pressure, heart rate variability, and body movement. At present, many studies have focused on qCON monitoring for sedative depth, but only a few studies have focused on qNOX monitoring for analgesic depth.</p> <p><strong>Aims and Objectives:</strong> The aim of the present study was to evaluate the relative efficacy of qCON and qNOX versus commonly used vital signs such as blood pressure and heart rate in monitoring the anesthetic depth and analgesia.</p> <p><strong>Materials and Methods:</strong> A total of 100 patients of either sex and of ASA Physical status I & II, scheduled for urogenital surgeries, were selected and randomly placed into two groups. Group A was monitored by conventional clinical technique and Group B was monitored by qCON and qNOX indices. The primary outcome was the total dose of propofol and fentanyl required to maintain the depth of anesthesia and analgesia. The secondary outcomes were propofol and fentanyl adjustment frequency, infusion duration, and quality of recovery from anesthesia.</p> <p><strong>Results:</strong> Results showed statistically significant differences between the two groups in mean dose of both propofol (P=0.000) and fentanyl (P=0.006), adjustment frequency of both propofol (P=0.000) and fentanyl (P=0.010), time required to voluntary eye-opening (P=0.000) and extubation time (P=0.000) and visual analog scale score (P=0.000). There was no statistically significant difference found in infusion duration (P=0.317) and Ramsay Sedation Score (P=0.709) between the groups.</p> <p><strong>Conclusion:</strong> Using the qCON and qNOX indices, an anesthesiologist can monitor the depth of anesthesia and analgesia more effectively and can adjust the anesthetic or analgesic drug dosing in a better possible way with lesser requirement of drugs than with conventional clinical monitoring.</p>2024-03-01T00:00:00+00:00Copyright (c) 2023 Asian Journal of Medical Scienceshttps://nepjol.info/index.php/AJMS/article/view/62074Comparison of different methods of local anesthesia for platelet rich plasma injections to scalp in patients with hair loss - A prospective study2024-01-22T15:19:04+00:00Vishnu Sundar Ramachandranvishnuram35@gmail.comSingaravelu Viswanathandrvsvplastic@gmail.comKrithiga Sivakumarkrithigasivakumar@gmail.com<p><strong>Background:</strong> Platelet-rich plasma injection (PRP) for hair loss is a widely accepted treatment modality at present. The most common problem with PRP is the pain that is associated with the procedure. The type of anesthesia is decided mostly based on preference rather than protocol.</p> <p><strong>Aims and Objectives:</strong> The current study was undertaken to establish a standardized anesthetic protocol for PRP based on the response of the patients undergoing the treatment plan.</p> <p><strong>Materials and Methods:</strong> The study included 60 patients who underwent four sittings of PRP at 1-month intervals for hair loss treatment. The modality of anesthesia was different during each of the sessions - topical anesthesia, vibration anesthesia, nerve block, and ring block. The order of anesthetic modality was different in each patient, to avoid bias. Responses by the patients for the following questions related to anesthetic pain during the procedure was recorded and analyzed based on the type of anesthetic procedure adopted.</p> <p><strong>Results:</strong> Vibration anesthesia had the highest mean intra procedure numerical pain scale value. Nerve block was the least acceptable modality with maximal problems including the pain of the local anesthetic injection and the unsightly visible bulge in the supra orbital region. Post procedural pain was highest for vibration anesthesia and least for ring block. Highest acceptance was seen with the ring block technique.</p> <p><strong>Conclusion:</strong> This is a preliminary study aimed at standardizing the anesthetic protocol for PRP. This modality of treatment involves multiple sittings with long total duration. Improving patient comfort with adequate anesthesia will improve compliance to a great extent.</p>2024-03-01T00:00:00+00:00Copyright (c) 2024 Asian Journal of Medical Scienceshttps://nepjol.info/index.php/AJMS/article/view/59825Comparative evaluation between oral gabapentin and oral pregabalin premedication for attenuation of hemodynamic surge to laryngoscopy and endotracheal intubation in elective procedures under general anesthesia2023-11-07T17:48:01+00:00Kunal Chandra Dubeykunaldubey91@gmail.comNupur Bajpainupurbajpaiiiibhu.1@gmail.comRicheek Kumar Palricheek.rkp@gmail.comSubhrajyoti Chattopadhyaydrsubhra1972@gmail.comSunil Kumar Sahsunilnbmc@gmail.comSusanta Sarkardrssarkar4@gmail.com<p><strong>Background:</strong> Effective attenuation of the sympathetic surge due to laryngoscopy and endotracheal intubation is needed. We wanted to compare the role of oral gabapentin (600 mg) and oral pregabalin (150 mg) in controlling this sympathetic surge.</p> <p><strong>Aims and Objectives:</strong> To compare the role of oral gabapentin (600 mg) and oral pregabalin (150 mg) as premedications for attenuating hemodynamic surge to laryngoscopy and endotracheal intubation.</p> <p><strong>Materials and Methods:</strong> 90 patients aged 18–45 years with ASA grade I or II posted for elective surgical procedure under general anesthesia were randomly allocated to two equal groups (45 in each group) to receive either 600 mg oral gabapentin or 150 mg oral pregabalin 1 h prior to surgery. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and rate pressure product (RPP) were recorded after intubation at 1 (T1), 3 (T3), 5 (T5), and 10 (T10) min. Post-operative sedation and post-operative nausea and vomiting (PONV) were recorded and compared.</p> <p><strong> Results:</strong> Gabapentin attenuates hemodynamic surge in terms of HR, SBP, DBP, MAP, and RPP better than pregabalin during laryngoscopy and endotracheal intubation at 3, 5, and 10 min after intubation, while there was no significant difference between the two groups at 1 min after intubation. Post-operative sedation score and adverse effects like PONV and SpO2 fluctuations at different points in time were comparable.</p> <p><strong>Conclusion:</strong> Oral gabapentin (600 mg) was found to be more effective than oral pregabalin (150 mg) in attenuating the hemodynamic surge to laryngoscopy and intubation.</p>2024-03-01T00:00:00+00:00Copyright (c) 2024 Asian Journal of Medical Scienceshttps://nepjol.info/index.php/AJMS/article/view/59784Comparison of volume-controlled ventilation and pressure-limited ventilation in laparoscopic appendicectomy - a randomized controlled clinical trial2023-11-06T08:12:29+00:00Ilamparithi Jayaramandrila03@gmail.comGokul Rgokulramsamy@gmail.comArulanandam Raniarulraj78@gmail.comNirmaladevi Snirmalamd2510@gmail.com<p><strong>Background:</strong> Laparoscopic appendicectomy is a widely performed surgery globally, offering notable benefits such as reduced postoperative pain, quicker mobility, and shorter hospital stays.</p> <p><strong> Aims and Objectives:</strong> The study aimed to assess the changes in respiratory mechanics and compare the outcomes of volume-controlled and pressure-limited ventilation (PLV) in patients undergoing laparoscopic appendectomy.</p> <p><strong>Materials and Methods:</strong> This randomized, prospective, single-blinded control study was conducted at K.A.P.V. Government Medical College, Tiruchirapalli, on 60 ASA I and II patients scheduled to undergo laparoscopic appendicectomy under general anesthesia. The patients were randomly divided into two groups (volume-controlled ventilation [VCV] group and the PLV group) of 30 patients. A patient’s history includes age, sex, history of diabetes, hypertension, or any cardiovascular disease, respiratory tract infection, wheezing or chronic chest infections, seizures, neuromuscular disease or weakness, etc.</p> <p><strong>Results:</strong> There was no significant difference in gender, age, or body mass index between groups. There is no significant difference in the mean arterial pressure or ETCO2 between groups at various intervals. There was a significant difference in the mean heart rate between the VCV and the PLV groups at 5 and 20 min after induction. There was a significant difference in the peak airway pressure, dynamic compliance, and airway resistance between the VCV group and the PLV group at 10 min after induction (T1), 5 min after pneumoperitoneum (T2), 10 min after pneumoperitoneum (T3), and immediately after Trendelenburg position (T4).</p> <p><strong>Conclusion:</strong> The airway resistance and peak airway pressure do not increase, and the dynamic compliance was improved in the PLV during laparoscopic appendicectomy.</p>2024-03-01T00:00:00+00:00Copyright (c) 2024 Asian Journal of Medical Scienceshttps://nepjol.info/index.php/AJMS/article/view/59888Comparative study between 0.5% bupivacaine versus 0.5% ropivacaine in peribulbar anesthesia for cataract surgery2023-11-11T23:09:07+00:00Neel Rananeelrana.132@gmail.comShruti M. Shahshrutttisha@gmail.comShrutika Parag Vedshrutttukavwed@gmail.comSrushti R Shahresearchguide86@gmail.comPatel Kushal Umeshkumarkushalppateel@gmail.comPanchal Pratik Vijaybhaidrpnaanchal32@gmail.com<p><strong>Background:</strong> For intraocular surgery, the optimal local anesthetic agent must have a rapid onset of action and a sufficient duration of effect so as to enable a painless, motionless procedure without prolonging akinesia.</p> <p><strong>Aims and Objective:</strong> This prospective, comparative observational study compares ropivacaine and 0.5% bupivacaine for cataract surgery peribulbar block. Hyaluronidase is utilized in both groups because it promotes local anesthetic diffusion.</p> <p><strong>Material and Methods:</strong> Present prospective, observational, comparative study performed at the Department of Anesthesia Tertiary Care Teaching Institute of India for the duration of 1 year. All eligible patients were allocated in two groups as GROUP B and GROUP R. GROUP B: 10 mL of 0.5% bupivacaine and 15 I.U./mL of hyaluronidase. GROUP R: 10 mL of 0.5% ropivacaine and 15 I.U./mL of hyaluronidase. Patients were assessed for sensory block, eyelid, and ocular movements at an interval of 2 min, and Visual Analog Scale score for pain assessment.</p> <p><strong>Results:</strong> Age and gender did not differ significantly between the two study groups, according to the findings. Comparable and similar patient characteristics distinguished the two study groups. (P>0.05). The difference in onset of eyelid motor blockade between the two groups was not statistically significant. The difference in the onset of motor blockade [ocular movement] between the two groups was not statistically significant (P>0.05). (P>0.05) Analgesia duration differed significantly between the two groups in a statistical sense. Ropivacaine exhibits a significantly prolonged duration of analgesic effect than bupivacaine (P≤0.05).</p> <p><strong>Conclusion:</strong> Peribulbar block utilizing 0.5% ropivacaine is a more favorable and secure option for a local anesthetic that effectively extends postoperative pain alleviation, in comparison to the use of 0.5% bupivacaine.</p>2024-03-01T00:00:00+00:00Copyright (c) 2023 Asian Journal of Medical Scienceshttps://nepjol.info/index.php/AJMS/article/view/60017A comparative study of postoperative acidemia after intraoperative administration of balanced crystalloid (Plasma-lyte A@) versus 0.9% sodium chloride in gastrointestinal surgery2023-11-19T16:32:24+00:00Laxmi Narayan Dashdebadasbiswal@gmail.comJagannath Pandadebadasbiswal@gmail.comShibanee Jenadebadasbiswal@gmail.comHarikrishna Dalaidebadasbiswal@gmail.comPritish Chandan Sahudebadasbiswal@gmail.comDebadas Biswaldebadasbiswal@gmail.com<p><strong>Background:</strong> The administration of intravenous fluids is one of the most common and universal interventions in medicine. Fluid therapy is the most challenging and debated aspect of perioperative care. Plasma-lyte A® Injection (multiple electrolytes injection, type 1, USP) is indicated as a source of water and electrolytes or as an alkalinizing agent. 0.9% sodium chloride is an isotonic crystalloid solution having a sodium concentration higher is useful in replacing fluid and electrolyte loss.</p> <p><strong>Aims and Objectives:</strong> The study was designed to compare the effects of intraoperative administration of balanced crystalloid solution (Plasma-Lyte A®) and 0.9% NaCl on acid-base balance in the post-operative period in patients undergoing gastrointestinal surgery.</p> <p><strong>Materials and Methods:</strong> Eighty consenting patients of ASA-l and ASA-II who underwent Gastrointestinal surgery were at first randomly allocated to 2 groups. One group received Plasma-Lyte A® as the sole crystalloid and the other group received 0.9% sodium chloride.</p> <p><strong>Results:</strong> Serum Na+ conc. of the groups were comparable and no difference was shown at the time of induction, but postoperatively at 12 h, there was a significant increase in group 2. There was no significant difference in serum K+ concentration in both the groups except at 6 h postoperatively when there was an increase in K+ concentration in group 1. Serum Cl− concentration was having no significant difference at the time of induction and 1 h intraoperative, but postoperatively at 1, 6, and 12 h the Cl− concentration significantly increased in group 2. HCO3− concentration of the two groups had no difference between them throughout the study period. The pH of patients in both the groups showed no statistically significant difference during the entire procedure (P>0.05). A significant decrease in pH observed in 0.9% sodium chloride group in comparison to Plasma-Lyte® group when the duration of surgery increased to more than 120 min.</p> <p><strong>Conclusion:</strong> Both plasma-lyte A and 0.9% sodium chloride can be used safely as intravenous infusion fluid without altering pH status and blood electrolyte concentration in patients undergoing gastrointestinal surgery.</p>2024-03-01T00:00:00+00:00Copyright (c) 2024 Asian Journal of Medical Scienceshttps://nepjol.info/index.php/AJMS/article/view/60133Antishivering effect of intrathecal versus intravenous tramadol in patients undergoing urethroscopic lithotripsy under spinal anesthesia2023-11-23T12:10:28+00:00Manasa Mdrmanasa29@gmail.comJyoti Petkardrmanasa29@gmail.comDokku Kirtanadrmanasa29@gmail.comKarthik GSdrmanasa29@gmail.comRangalakshmi Sdrmanasa29@gmail.com<p><strong>Background:</strong> Shivering is the most common complication seen in the perioperative period in patients undergoing urological surgeries under spinal anesthesia. Intravenous tramadol is used for the treatment of shivering.</p> <p><strong>Aims and Objectives:</strong> In this study, we wanted to assess the prophylactic effect of tramadol, intrathecal (IT) versus intravenous with the control group, in decreasing the incidence of shivering.</p> <p><strong>Materials and Methods:</strong> Fifty-four eligible patients posted for urethroscopic lithotripsy (URSL) were randomly allocated into three equal groups – Group C: Received 2.5 mL 0.5% bupivacaine heavy + 0.5 mL normal saline intrathecally and 5 mL of normal saline intravenously, Group V: Received 2.5 mL of 0.5% bupivacaine heavy+0.5 mL normal saline intrathecally and 25 mg tramadol in 5 mL of normal saline intravenously, and Group T: Received 2.5 mL of 0.5% bupivacaine heavy + 25 mg (0.5 mL) of tramadol intrathecally and 5 mL of normal saline intravenously. The incidence and severity of shivering were noted. Onset of sensory and motor block, duration of post-operative analgesia, core body temperature, and adverse effects such as nausea, vomiting, and hypotension were noted.</p> <p><strong>Results:</strong> The incidence of intraoperative shivering was significantly lower in Group T versus C (P=0.014) but comparable among Group I versus C (P=0.502) and Group T versus I (P=0.06). The duration of analgesia was significantly higher in Group T compared to Groups I and C (P<0.001). The additional tramadol requirement was significantly lower in Group T versus I and in Group T versus C but comparable among Group I versus C.</p> <p><strong>Conclusion:</strong> The addition of 25 mg tramadol to IT 0.5% bupivacaine heavy is effective in preventing intraoperative shivering in patients undergoing urological surgeries like URSL.</p>2024-03-01T00:00:00+00:00Copyright (c) 2024 Asian Journal of Medical Scienceshttps://nepjol.info/index.php/AJMS/article/view/59931Safety and efficacy of general anesthesia versus spinal anesthesia in percutaneous nephrolithotomy2023-11-15T09:33:06+00:00Srinivasa VYanjudoct@gmail.comKailash P Devanjudoct@gmail.comAnjali Kumari Banjudoct@gmail.com<p><strong>Background:</strong> Percutaneous nephrolithotomy (PCNL) is the preferred treatment for the removal of large kidney stones, sized >20 mm. However, there is still an ongoing debate concerning the best anesthesia for PCNL.</p> <p><strong>Aims and Objectives:</strong> The objective of this study was to assess and compare the efficacy and safety of spinal anesthesia (SA) versus general anesthesia (GA) in PCNL.</p> <p><strong>Materials and Methods:</strong> A prospective randomized study included eighty-two patients who were enrolled to receive either SA or GA for PCNL. The study assessed patients’ characteristics, vital parameters, requirements for additional analgesia, and patient satisfaction. In addition, intraoperative and post-operative complications were documented. Patients’ satisfaction was also analyzed.</p> <p><strong>Results:</strong> In both groups, the vital parameters were consistently maintained at safe levels during the procedures. Patients in the SA group exhibited a lower analgesia consumption on the 1st post-operative day compared to the GA group (P<0.05). Post-operative hypotension was higher in the SA group than in the GA group (17% vs. 7%). Patients in the GA group reported higher patient satisfaction scores than the SA group (mean 4.39+0.59 vs. 3.81+0.64).</p> <p><strong>Conclusion:</strong> Both SA and GA are safe and effective in PCNL. SA is associated with fewer complications and reduced postoperative analgesia consumption. However, GA tends to offer higher satisfaction levels for patients. Each method of anesthesia has its own advantages and disadvantages. The final choice between general and SA should be based on the patient’s condition and surgical team preference.</p>2024-03-01T00:00:00+00:00Copyright (c) 2024 Asian Journal of Medical Scienceshttps://nepjol.info/index.php/AJMS/article/view/59348Capnography-assisted airway management by awake blind nasal intubation in maxillofacial surgeries: An observational study2023-10-17T09:22:54+00:00Minal Kokatedr.miinal2004@gmail.comVikram Kokatedr.miinal2004@gmail.comGaurav Dubeydr.miinal2004@gmail.comVijaya Borkardr.miinal2004@gmail.com<p><strong>Background:</strong> Maxillofacial surgery patients frequently pose challenges to airway management due to anatomical and functional constraints. While fiber-optic-aided nasotracheal intubation is considered the gold standard, not all medical facilities have access to fiber-optic bronchoscopes, particularly in low-resource settings. In such situations, awake nasal tracheal intubation is often the safest approach for managing patients with known or suspected difficult airways.</p> <p><strong>Aims and Objectives:</strong> (1) To assess the technique of capnography-assisted airway management by awake blind nasal intubation (ABNI) in maxillofacial surgeries. (2) To find out any complications encountered by the technique of capnography-assisted airway management by ABNI in maxillofacial surgeries.</p> <p><strong>Materials and Methods:</strong> 40 patients undergoing various maxillofacial surgeries and in whom blind nasotracheal intubation was attempted were included in this study. The institutional ethical committee approved the study, and informed consent was obtained from all the patients. The number of attempts for ABNI, successful versus failed ABNI, and complications encountered were studied. SSPS 21.0 software was used for statistical analysis.</p> <p><strong> Results:</strong> There were 23 (57.50%) males and 17 (42.50%) females. There was a male preponderance, with the M: F ratio being 1:0.73. The mean age of the patients was 40.97±8.92 years. In 36 (90%) of the patients, the intubation could be successfully done. In 19 (47.50%) patients, blind nasal intubation was successfully done in the first attempt; 2 attempts were required in 15 (37.50%) patients, and 3 attempts were required in 2 (5%) patients. Epistaxis (10%) and sore throats (7.5%) were the most common complications in the studied cases.</p> <p><strong>Conclusion:</strong> Capnography-assisted ABNI is an effective technique for airway control in patients undergoing maxillofacial surgeries with an acceptable complication rate.</p>2024-03-01T00:00:00+00:00Copyright (c) 2024 Asian Journal of Medical Scienceshttps://nepjol.info/index.php/AJMS/article/view/60683Risk factor profile and extubation outcomes in critically ill patients. A single-center prospective observational study2023-12-13T07:18:15+00:00Abdul Waheed Mirmirwaheed69@rediffmail.comShafat A Mirmir.shafatahmad@gmail.com Falak Arafalakara1220@gmail.comRashid Fazlisampg819@gmail.comSahu Mushtaqmirwaheed69@rediffmail.comM Akbar Shahdrmashah2014@gmail.comKhalid Sofikhalidsofi@gmail.com<p><strong>Background:</strong> The problem of extubation failure (EF) remains unexplored in low-resource settings, where predicting the extubation outcomes are more challenging.</p> <p><strong>Aims and Objectives:</strong> This study investigates the incidence of EF and its predictors among patients who received mechanical ventilation (MV) in a tertiary care intensive care unit (ICU).</p> <p><strong>Materials and Methods:</strong> This is a prospective observational study of 130 patients ≥18 years of age receiving MV for ≥48 h and tolerating spontaneous breathing trials in the ICU of a low-resource setting. We collected data on the baseline characteristics and clinical profiles. Patients were categorized into EF and extubation success (ES) groups. Multivariate logistic regression analyses were performed to identify independent predictors for EF. A p value of <0.05 is considered statistically significant.</p> <p><strong>Results:</strong> We included 130 patients, and 43 (35.3%) had developed EF. The identified predictors for EF: Moderate to copious secretions (adjusted odds ratio [AOR]: 3.426 [95% confidence interval [CI] 1.281–10.82]), age >60 years of age ([AOR]: 4.135 [95% CI 1.294–11.93]), and prolonged duration of MV ≥10 days ([AOR]: 4.571 [95% CI 1.392–15.33]).</p> <p><strong>Conclusion:</strong> Moderate to copious secretions, patients >60 years of age, and prolonged duration of MV ≥10 days were the best predictors of EF.</p>2024-03-01T00:00:00+00:00Copyright (c) 2024 Asian Journal of Medical Scienceshttps://nepjol.info/index.php/AJMS/article/view/59822Morphometry of proximal femur in South Indian Population2023-11-07T10:36:49+00:00Resmi Georgeresmirachelgeorge.rg@gmail.comNithin K Rajunithinkadakampallil@gmail.com<p><strong>Background:</strong> Proximal femur analysis plays a vital role in orthopedic surgery, implant design, fracture care, and research. Studying this complex bone helps surgeons select the right implants, plan fracture treatment, and understand bone strength. This growing field improves clinical outcomes and enhances scientific knowledge. Our study analyzes the morphometry of proximal femur, particularly the head and neck, to further explore its implications.</p> <p><strong>Aims and Objectives:</strong> To study the morphometric measurements of the proximal end of the femur quantitatively in the South Indian population from the dry femora available in the Department of Anatomy, Government Medical College, Kottayam.</p> <p><strong>Materials and Methods:</strong> This cross-sectional study was conducted in 101 dry femora available in the Department of Anatomy, Government Medical College, Kottayam. The measurements were taken with digital Vernier calipers and a goniometer. All continuous variables were expressed as mean with standard deviation. Statistical differences between the right and left sides were analyzed with Student’s independent sample t-test (for parametric variables) and Mann–Whitney U test (for non-parametric variables).</p> <p><strong>Results:</strong> The mean vertical and anteroposterior diameter of the femoral head, superior and inferior length of the femoral head, the anteroposterior and vertical diameter of the femoral neck, superior and inferior lengths of the femoral neck, neck-shaft angle, and intertrochanteric length were 39.61±3.29 mm, 40.17±3.14 mm, 33.01±3.6 mm, 23.88±4.32 mm, 24.22±3 mm, 29.59±3 mm, 21.75±3.81 mm, 32.03±5.58 mm, 124.11±6.37, 60.31±7.33 mm, respectively. There was a statistically significant difference in the mean of neck anteroposterior diameter and neck-shaft angle between the right and left sides where the left side had the higher value.</p> <p><strong>Conclusion:</strong> Notable skeletal metric variations exist amidst different populations. Proximal femoral dimensions can be acquired through either manual means or radiological information. These measurements can be used in designing orthopedic implants for the South Indian population.</p>2024-03-01T00:00:00+00:00Copyright (c) 2024 Asian Journal of Medical Scienceshttps://nepjol.info/index.php/AJMS/article/view/59845Morphological and morphometric analysis of lung: A cadaveric study2023-11-08T10:54:53+00:00Savita Kanaujeakanaujeas@gmail.comArvind Kumar Pankajdrarvindpankajcsmmu@yahoo.comKaweri Dandekdande03@gmail.comSehra Jabeensehra.naque@gmail.comNavneet Kumarnavneetchauhan@hotmail.com<p><strong>Background:</strong> The lung is a respiratory organ in which steady development begins during the embryonic period at 0–7 weeks’ gestation and continues into early childhood. Cardiothoracic surgeries and procedures such as lobectomy, segmental resection of bronchoscopy, require a thorough knowledge of the anatomy of the lung. Study of length, fissures and lobes of the lung can guide the surgeons for the above procedures and help them to prevent undue complications during surgery. Many variations are noted by researchers till date in both the lungs in regards to length, breadth, fissures, and lobes. In the current study, we have also observed variations in fissures of lung.</p> <p><strong>Aims and Objectives:</strong> To study the normal length, breadth, and thickness of both sides of lungs, variations in the length, breadth, and thickness of both sides of the lungs. To study the normal fissures, lobes and their variations, of both right and left lungs, and also to study the number of bronchi, pulmonary artery, and pulmonary vein.</p> <p><strong>Materials and Methods:</strong> 50 Right and 50 left lungs were obtained from embalmed cadavers, used for dissection in the Department of Anatomy, King George’s Medical University, Lucknow, UP, by using measuring tape and measuring scale. Photography was done by a DSLR camera.</p> <p><strong>Results:</strong> The left lung shows maximum variations in the hilum. Out of 50 left lungs, 6 showed the absence of oblique fissures, 2 lungs had 2 arteries, 2 lungs had 2 Veins, and 1 had 2 bronchi. Out of 50 right lungs, 2 lungs showed 2 arteries, 2 lungs had 2 veins, and 2 had 3 bronchi.</p> <p><strong>Conclusion:</strong> Knowledge of normal measurements of both sides of the lungs and their variations may help cardiothoracic surgeons avoid complications during surgery and it may help radiologists resolve uncertain radiographic findings.</p>2024-03-01T00:00:00+00:00Copyright (c) 2024 Asian Journal of Medical Scienceshttps://nepjol.info/index.php/AJMS/article/view/60753Surgical anatomy of superior gluteal artery in relation to lumbosacral plexus – A cadaveric study in the Indian population2023-12-18T12:17:01+00:00Anjali Shastryanju_shas@yahoo.comAnu Francisanusteve82@gmail.com<p><strong>Background:</strong> The superior gluteal artery (SGA) passes in between branches of the lumbosacral plexus after arising from the internal iliac artery. Variations in the course of SGA from the internal iliac artery till it passes out of the pelvis through the greater sciatic foramen are very important during pelvic surgeries. Pseudoaneurysm of SGA caused by iatrogenic injuries can compress branches of the lumbosacral plexus, causing foot drops and sciatica.</p> <p><strong>Aims and Objectives:</strong> The aim is to study the course of the SGA in relation to branches of the lumbosacral plexus.</p> <p><strong>Materials and Methods:</strong> A cross-sectional observational study was done on 25 formalin-fixed human adult cadavers. Dissections were performed in the pelvic region and branches of the internal iliac artery and lumbosacral plexus were identified. SGA was traced on both sides from origin till passing out of the greater sciatic foramen and its relation to branches of lumbosacral plexus was recorded.</p> <p><strong>Results:</strong> Three types of pathways taken by SGA were identified in relation to the lumbosacral plexus. The most common path taken by the SGA was between the lumbosacral trunk (LST) and the first sacral nerve. Thirty-five out of 50 were of this type (70%). Ten out of 50 had the second most common type which was between L4 and L5 branches of LST (20%). Five cadavers had SGA lateral to LST (10%). Ten cadavers out of 25 (40%) had side differences in the type of course taken by SGA in relation to the lumbosacral plexus.</p> <p><strong>Conclusion:</strong> A surgeon must keep in mind variations in the path taken by SGA in relation to the lumbosacral plexus to prevent pseudoaneurysms of SGA, which in turn can compress branches of lumbosacral plexus, causing foot drop and sciatica.</p>2024-03-01T00:00:00+00:00Copyright (c) 2024 Asian Journal of Medical Scienceshttps://nepjol.info/index.php/AJMS/article/view/59820A cadaveric study on prevalence, morphology, morphometry, and histology of os peroneum in the South Indian population2023-11-07T09:16:53+00:00Jincy Raj Cjincyrajc.27@gmail.comLizamma Alexlizammaalex@yahoo.co.inGaddam Vijaya Lakshmiseenuvijaylakshmi@gmail.comNithin K Rajunithinkadakampallil@gmail.com<p><strong>Background:</strong> The complex framework of the human foot enables movement and weight support. The os peroneum (OP) is a sesamoid bone located in the tendon of peroneus longus. Though tiny, it plays crucial roles in foot movement and arch stability injuries to the tendon are significant, and the OP itself can fracture, dislocate, or impinge. Its presence, size, and even histological type influence the proper functioning of the foot. Studying this sesamoid bone, with its variable prevalence and morphology, can fill gaps in foot and ankle pathology research. </p> <p><strong> Aims and Objectives:</strong> To analyze the prevalence, morphology, morphometry, and histology of OP in human adult cadavers in the South Indian population.</p> <p><strong>Materials and Methods:</strong> Forty-two formalin-fixed human adult cadaveric free lower limbs were selected and studied from the Department of Anatomy, Pushpagiri Institute of Medical Sciences and Research Centre, Tiruvalla, Kerala. The prevalence of OP in peroneus longus tendons (PLT) and its various configurations were carefully observed, along with their histological types, and then statistical analysis of the data was done using SPSS version 20.</p> <p><strong>Results:</strong> Thirty-nine out of the forty-two free lower limbs showed the presence of an OP bearing a smooth oval facet, except for one OP with a round facet. All OP were invariably present in the tunnel for PLT on the plantar surface of the cuboid bone. Three different histological types of this tissue were observed, i.e., osseous, cartilaginous, and fibrous.</p> <p><strong>Conclusion:</strong> The present study has attempted to fill the gap in the research data regarding OP in the adult South Indian population. In addition, the knowledge of OP and its configuration in PLT could provide a better radiological and clinical approach to mid- and fore-foot pathologies.</p>2024-03-01T00:00:00+00:00Copyright (c) 2024 Asian Journal of Medical Scienceshttps://nepjol.info/index.php/AJMS/article/view/59238Diabetes risk assessment with Indian Diabetes Risk Score: A cross-sectional study among adults in rural Mandya, Karnataka2023-11-07T12:28:03+00:00Shashikantha SKdrshashikanthkrishna@gmail.comSheethal MPsheethalmp86@gmail.comChandana Schandana.s24@gmail.com<p><strong>Background:</strong> Screening for diabetes using the Indian Diabetes Risk Score (IDRS) is an inexpensive yet effective way of early diagnosis.</p> <p><strong>Aims and Objectives:</strong> The present study was conducted to assess the risk of developing diabetes among individuals in rural field practice areas using IDRS.</p> <p><strong>Materials and Methods:</strong> A community-based observational study was conducted among persons aged 20 years and older in the rural field practice area for 2 months. A semi-structured interview schedule, including the “IDRS” questionnaire, was used to obtain the data.</p> <p><strong>Results:</strong> Out of 1100 subjects, around 50% were above 50 years, only 38.6% of the subjects had a waist circumference within the normal limits; 73.8% did moderate exercise; 86% of the subjects had no history of diabetes in their parents. The mean IDRS score of the subjects was 44.12±14.33, ranging from 10 to 90. Nearly 2/3rd (69.6%) of them were at moderate risk, and 21.2% were at high risk for developing diabetes. The IDRS score was significantly higher among those with diabetes and hypertension.</p> <p><strong>Conclusion:</strong> The majority of the subjects in our study had a moderate to high risk of developing diabetes as per the IDRS.</p>2024-03-01T00:00:00+00:00Copyright (c) 2024 Asian Journal of Medical Scienceshttps://nepjol.info/index.php/AJMS/article/view/59908Serum Vitamin D3 level in spontaneous abortion cases in comparison to ongoing viable pregnancies: A case–control study in a tertiary medical college2023-11-14T16:35:45+00:00Chaitali Senguptadrchaitalisengupta@gmail.comRitankar Sengupta drritankarsengupta@gmail.comDibyendu Datta dattadibs2010@gmail.comSantanu Ghoshreachgsan2013@gmail.comTapan Kumar Naskartknaskar1807@gmail.com<p><strong>Background:</strong> The immunoregulatory functions of Vitamin D3 play a vital role in the maintenance of normal pregnancy. Several studies have reported the association of low serum Vitamin D3 levels with spontaneous abortion.</p> <p><strong>Aims and Objectives:</strong> The purpose of the study was to determine the association between serum Vitamin D3 level and spontaneous abortion cases in a tertiary medical college.</p> <p><strong>Materials and Methods:</strong> The case–control study was conducted at the Department of Gynecology and Obstetrics, Medical College, Kolkata. The study population included 50 women with spontaneous abortion (cases) and 50 women with viable pregnancy beyond 20 weeks of gestation (controls). The cases and controls were matched with respect to age, socioeconomic status, and laboratory parameters. Investigations performed for both groups were ultrasonography for confirmation of abortion and viable pregnancy, serum Vitamin D3, and other biochemical markers. Data were compared between cases and controls using the Chi-square test and unpaired “t” test along with the calculation of odds ratios (OR).</p> <p><strong>Results:</strong> About 24% of cases and 10% of controls belonged to Vitamin D3 deficient category. The difference was statistically significant (P=0.009, d.f.=2) (OR: 2.84, 95% confidence intervals [CI]: 0.92–8.80). Bleeding PV was present in 50% of cases and 4% of controls (P=0.0001, d.f.=1) (OR: 24.00, 95% CI: 5.25–109.65). Abdominal pain was complained by 46% of cases and 10% of controls (P=0.0001, d.f.=1) (OR: 7.67, 95% CI: 2.61–22.54).</p> <p><strong>Conclusion:</strong> Vitamin D3 deficiency was present more in spontaneous abortion cases in comparison to viable pregnancies. Routine daily supplementation of vitamin D3 during the first trimester of pregnancy should be incorporated into the ongoing national program. Training of health workers to educate pregnant women and their family members regarding the importance of vitamin D3 is the need of the hour.</p>2024-03-01T00:00:00+00:00Copyright (c) 2023 Asian Journal of Medical Scienceshttps://nepjol.info/index.php/AJMS/article/view/59010Long-term hemodynamic response of carvedilol and simvastatin in compensated versus decompensated chronic liver disease with portal hypertension2023-10-09T08:38:21+00:00Shaheen Naziranayahshaheen@gmail.comZeeshan Ahmed Waniwzeeshanw@yahoo.comAfaq Ahmaddrafaqak@yahoo.co.inAsif IqbalFisalabqi@gmail.comAltaf Hussaindraltafshah@yahoo.com<p><strong>Background:</strong> A combination of carvedilol and Simvastatin have recognized their role as rescue therapy for carvedilol non-responders in chronic liver disease (CLD)-associated portal hypertension. However, there are scarce data regarding its role in specific subclasses, and stratification of response according to the computed tomographic perfusion (CTP) score has never been seen before.</p> <p><strong>Aims and Objective:</strong> (1) To compare hemodynamic response and side effects of a combination therapy in decompensated and compensated patients. (2) Stratify the effect of combination therapy according to CTP score.</p> <p><strong>Materials and Methods:</strong> In 102 consecutive patients of CLD with esophageal varices, the hepatic venous pressure gradient was measured at baseline and after 3 months of dose optimization of carvedilol. Simvastatin was added to non-responders and hemodynamics repeated at 1 month of dual therapy. The response of compensated CLD was compared with decompensated patients and was stratified as per the CTP on follow-up.</p> <p><strong>Results:</strong> Overall, out of 43 compensated patients, 21 responded acutely and response increased to 29 (67.44%) at 3 months. While 31 of 59 (52.54%) decompensated patients responded acutely but dose escalation did not increase response significantly after 3 months. The addition of Simvastatin did increase the response, although side effects were more in decompensated group. The addition of Simvastatin also decreased decompensation in the high-risk compensated group and maintained their MELD.Na.</p> <p><strong>Conclusion:</strong> Response in compensated CLD patients was more than in decompensated patients; however, it was statistically insignificant. Attrition was more in patients with CTP >10 due to drug intolerance, side effects, or deaths.</p>2024-03-01T00:00:00+00:00Copyright (c) 2023 Asian Journal of Medical Scienceshttps://nepjol.info/index.php/AJMS/article/view/60561A study of Vitamin D and parathyroid hormone levels in patients with prostatic cancer2023-12-10T03:17:14+00:00Md. Nasim Akhtardrnasim22@gmail.comKayyum Khandrnasim22@gmail.comShahnawaz Alamdrnasim22@gmail.comMohit Mishradrnasim22@gmail.comSachin Rathoddrnasim22@gmail.comWaqas Alauddindrnasim22@gmail.com<p><strong>Background:</strong> Vitamin D, a key nutrient in the body, has been linked to a decrease in prostate cancer (PCa) morbidity and mortality rates. The study concluded that any compensation mechanism may no longer be adequate for patients with PCa, and further research is needed to understand the mechanisms underlying the relationship between serum Vitamin D and parathyroid hormone (PTH) homeostasis. The findings will help determine cancer prevalence and trends in India and support public health initiatives to control cancer.</p> <p><strong>Aims and Objectives:</strong> The aim is to assess the mean values of Vitamin D and PTH in patients with PCa and also to compare these levels with that of healthy controls (non-PCa).</p> <p><strong> Materials and Methods:</strong> One hundred participants in the outpatient department of the Department of Biochemistry were assigned as control subjects, and another 100 participants were participants with PCa. 5 mL of fasting venous blood were drawn into red top vials using a disposable syringe and needle in an aseptic manner. PTH and serum Vitamin D were estimated.</p> <p><strong>Results:</strong> When comparing PCa patients to healthy controls, the observed Vitamin D level was significantly lower in the former group. Furthermore, a notable distinction in Vitamin D levels was noted between the two groups. Furthermore, we found that PCa patients had higher PTH values than healthy controls. When we compared the PTH values of the two groups, we found a substantial difference.</p> <p><strong>Conclusion:</strong> The authors conclude from the study that with alterations in the study parameters in patients with PCa, any compensation mechanism may become insufficient.</p>2024-03-01T00:00:00+00:00Copyright (c) 2024 Asian Journal of Medical Scienceshttps://nepjol.info/index.php/AJMS/article/view/60213Clinicopathological study of pigmented fungal lesions with special reference to subcutaneous phaeohyphomycosis: A 3-year study in a tertiary care hospital of Eastern India2023-11-27T23:36:51+00:00Rajashree Pradhanpradhanrajashree99@gmail.comSuman Chatterjeedr.sumanc2010@gmail.comBidisha Chakrabortydrbidisha27@gmail.comSajeeb Mondal sjbmondal@gmail.com<p><strong>Background:</strong> Fungal infections are predominantly opportunistic infections in immunocompromised patients and in immunocompetent adults with a history of trauma. Recently, there is an increase in trends of fungal infections in immunocompetent individuals also without any history of trauma. Pigmented fungi are a group of fungi that have pigment in their cell wall and also known as dematiaceous fungi. These pigmented fungi include phaeohyphomycosis with a differential diagnosis of chromoblastomycosis, cryptococcosis, mycetoma, and aspergillus. Phaeohyphomycosis is a subcutaneous or systemic infection characterized histologically by dark-colored fungal hyphae and yeast forms (black yeast).</p> <p><strong>Aims and Objectives:</strong> The aim of the present study is to analyze the clinicopathological features of pigmented fungal infections in biopsy specimen based on their histomorphology.</p> <p><strong>Materials and Methods:</strong> This was a prospective study in which we have analyzed the dematiaceous fungal species by their histomorphological characteristics in biopsy specimens.</p> <p><strong>Results:</strong> A total of 21 cases of biopsy specimens (with the clinical presentation of cutaneous/subcutaneous lesions) were studied histologically which showed 13 cases of phaeohyp homycosis, seven cases of eumycotic mycetoma, and one case of chromoblastomycosis. There was male predominance (17, 80.95%) and the majority of the patients were >60 years (16, 76.19%). Most common site of infection was foot with predominant clinical presentation as subcutaneous mass lesion.</p> <p><strong>Conclusion:</strong> All the cases of dematiaceous fungal infections were diagnosed by histopathological examination. Melanin in the cell wall of dematiaceous fungi is the pathogenic factor. Phaeohyphomycosis is no longer considered as a rare infection rather there is an increasingly incidence of recognized infection. Although culture and histopathological study remain important tools for final diagnosis, various molecular studies might be helpful for accurate diagnosis.</p>2024-03-01T00:00:00+00:00Copyright (c) 2023 Asian Journal of Medical Scienceshttps://nepjol.info/index.php/AJMS/article/view/60464Assessment of risk factors associated with anemia among pregnant women attending the obstetrics and gynecology department in a tertiary care hospital, Prakasam District, Andhra Pradesh, India2023-12-06T00:07:51+00:00Venkata Swarajya Lakshmi Adoctor2komc@gmail.comAnamula Sreedevidoctor2komc@gmail.comVenkata Srinivas Raodoctor2komc@gmail.comKrishna Chaitanya Botsadoctor2komc@gmail.com<p><strong>Background:</strong> Anemia in pregnancy is a pervasive health issue, particularly in developing countries.</p> <p><strong>Aims and Objectives:</strong> This study aims to assess various socio-demographic factors, nutritional intake, and other risk factors contributing to anemia among pregnant women attending a tertiary care hospital in Prakasam District, Andhra Pradesh, India.</p> <p><strong>Materials and Methods:</strong> A cross-sectional study was conducted involving 160 pregnant women. Data were collected on socio-demographic factors (family type, religion, caste, residence, education, socio-economic status, age, occupation), anemia prevalence, antenatal care, birth spacing, nutritional intake (caloric, protein, and iron), and gravida status. Chi-square tests were used for statistical analysis to determine associations between anemia and various risk factors.</p> <p><strong>Results:</strong> The study revealed a high prevalence of moderate anemia (74.4%) among the participants. Most women were from nuclear families (75%), lived in rural areas (89.4%), and were predominantly homemakers (83.1%) in the age group of 21–30 years. Nutritional analysis showed 74.6% of women had a calorie intake below 2000 K. Cal/day, 64.7% had a protein intake below 50 g/day, and 87.5% had an iron intake below 20 mg/day. A significant association was found between anemia and factors such as caloric intake (χ²=10.6654, P=0.001092), gravidity (χ²=7.0278, P=0.008025), and iron intake (χ²=27.277, P<0.00001), but not with protein intake (χ²=3.7547, P=0.052658).</p> <p><strong>Conclusion:</strong> The study highlights a high prevalence of anemia among pregnant women in the Prakasam District, primarily associated with inadequate caloric and iron intake and increased gravidity. These findings emphasize the need for enhanced nutritional counseling and healthcare interventions focusing on diet and family planning for pregnant women in this region.</p>2024-03-01T00:00:00+00:00Copyright (c) 2024 Asian Journal of Medical Scienceshttps://nepjol.info/index.php/AJMS/article/view/60339A study on correlation between neuroimaging and maternal outcome in eclampsia2023-12-01T11:29:12+00:00Mythreyi Kadambimythreyi95@gmail.comSushma V Devmythreyi95@gmail.com<p><strong>Background:</strong> Hypertensive disorders remain among the most significant complications of pregnancy. Neurological complications of eclampsia are a major contributor to morbidity and mortality that is associated with eclampsia. Neuroimaging studies have revolutionized visualization of hypertensive encephalopathy aids in timely intervention and a favorable maternal and perinatal outcome.</p> <p><strong>Aims and Objectives:</strong> (1) To study the spectrum of neuroimaging findings in patients with eclampsia. (2) To correlate these findings with the maternal outcome.</p> <p><strong>Materials and Methods:</strong> A prospective observational study was undertaken in the Department of Obstetrics and Gynecology, Mysore Medical College and research institute Mysore, for 18 months. All the eclamptic mothers during the study were included in the study. They were studied in terms of neuroimaging and its correlation with maternal outcomes.</p> <p><strong>Results:</strong> The incidence of eclampsia was 7.14% which is relatively high, attributed to the fact that being a tertiary care center many cases are referred. Higher incidence was seen in primigravida (72.4%) and lower maternal age of 18–20 years (48%). Cesarean section was indicated in 50% of deliveries indicating immediate action was necessary for better fetomaternal outcome. They presented with varied imminent symptoms such as headache in 20.4%, vomiting in 22.4%, and visual blurring in 22.4%. About 50% presented with altered sensorium. On non-contrast computed tomography brain, 64.3% (63) had normal findings, 17.3% (17) had posterior reversible encephalopathy syndrome (PRES) with a sensitivity of 68.42% and specificity of 85%, whereas on magnetic resonance imaging (MRI) brain, 36.26% had no abnormalities, 40.81% had PRES with a sensitivity of 86.84%, and specificity of 85%. About 58.6% had an uneventful maternal outcome. The others were hemolysis, elevated liver enzymes, and low platelet syndrome seen in 9.18% of patients, acute kidney injury in 6.12%, postpartum hemorrhage seen in 5.1%. The maternal mortality rate was 7.66%, the most common cause of death was intracranial hemorrhage.</p> <p><strong>Conclusion:</strong> The common neuroimaging findings in eclampsia are cerebral edema, PRES, cerebral venous thrombosis, infarcts, hemorrhage, and hypertensive leukoencephalopathy. Although some abnormalities seen in neuroimaging studies are incidental and transient without chronic neurologic sequelae, both CT and MRI findings correlate with the clinical presentation and maternal outcome but MRI correlates better compared to CT and can be a better imaging modality in eclampsia patients and is indicated in all patients of eclampsia.</p>2024-03-01T00:00:00+00:00Copyright (c) 2024 Asian Journal of Medical Scienceshttps://nepjol.info/index.php/AJMS/article/view/61973A minimally invasive fixation for boxers fracture – fifth metacarpal neck using antegrade K wire fixation – functional outcome study2024-01-17T05:41:18+00:00Pamarthi Srinivassrinupsg@gmail.comSai Phanindra Msaimalladi@yahoo.co.in<p style="margin: 0cm; line-height: 200%;"><strong>Background:</strong> Fifth metacarpal fractures are more common fractures in hand which are treated by conservative or surgical methods. Using retrograde k-wire fixation is associated with more complications due to damage to articular surface causing deformity or decreasing range of motion. Studies are done using single k-wire usage by antegrade technique, results vary due to k-wire complications and surgeon experience.</p> <p style="margin: 0cm; line-height: 200%;"><strong>Aims and Objectives:</strong> In this study, we are used a technique to bend a K wire in S-shaped fashion to negotiate through fracture to hold and reduce the fracture by rotating the tip of K-wire.</p> <p style="margin: 0cm; line-height: 200%;"><strong>Materials and Methods:</strong> This prospective study was done for fracture neck of fifth metacarpal presenting to outpatient department in 36 patients with dorsal angulation of more than 300 treated by passing a single k wire bent at the tip and shaft to form an S shape retrogradely with a follow-up period of 6 months following surgery.</p> <p style="margin: 0cm; line-height: 200%;"><strong>Results:</strong> Majority of injuries were in males in the dominant hand with a mean age group of 27.25 years. The mean pre-operative flexion angle of distal fragment was 44.11° (SD–4.12), and after the end of follow-up healing was achieved in all cases with a mean flexion angle improvement to 5.25° (SD–2.16). Disabilities of the arm, shoulder, and hand score measured at the end of study showed a mean of 6.25, and total active motions core showed excellent results in 25 cases (69.4%) cases and poor in 1 case (2.77%).</p> <p style="margin: 0cm; line-height: 200%;"><strong>Conclusion:</strong> This study emphasizes that bending a K wire in a lazy S fashion and passing antegradely will replicate results similar to using 2 K wires and have a better prognosis than retrograde wiring through the head of metacarpal. Furthermore, this procedure can be done in a primary care setting with minimal resources.</p>2024-03-01T00:00:00+00:00Copyright (c) 2024 Asian Journal of Medical Scienceshttps://nepjol.info/index.php/AJMS/article/view/58773A clinico-etiological profile of adult extrahepatic portal venous obstruction in patients from Northern India. Is it a novel subset of occult extrahepatic portal vein obstruction?2023-09-25T00:17:16+00:00Zeeshan Ahmad Waniwzeeshanw@yahoo.comMir Mohamad Muzzafermeermuzzafer@gmail.comKhan Afaq Ahmaddrafaqak@gmail.comLone Shaheen Naziranayahshaheen@gmail.com<p><strong>Background:</strong> Extrahepatic portal vein obstruction (EHPVO) is caused by occlusion and cavernomatous transformation of the portal vein. The EHPVO is well characterized in children. However, the same is not valid for adults. We aimed to evaluate the clinico-etiological profile along with the management of adult patients.</p> <p><strong>Aims and Objectives:</strong> We evaluated the clinico-etiological profile along with the management and outcomes of adult patients presenting with EHPVO.</p> <p><strong>Materials and Methods:</strong> In a descriptive, observational study, patients between ages 15 and 75 years diagnosed with EHPVO on ultrasonography abdomen were included in the study. Liver cirrhosis and malignancy were considered as an exclusion criterion. There was evaluation of clinical and imaging findings along with biochemical analysis, workup for thrombophilia, treatment given to the patients, and follow-up.</p> <p><strong>Results:</strong> Out of total 109 patients enrolled in the study, the median age of patients was ±40.25. Main clinical features were dyspepsia, abdominal discomfort, and splenomegaly. Out of 109, 27.5% patients showed fatty liver and 5.5% had both splanchnic vein thrombosis and fatty liver. Idiopathic EHPVO in majority of patients (80%), adult EHPVO with polycythemia rubra vera in 7.33% patients, adult EHPVO with heterozygous MTHFR mutation in 7.33% patients, and adult EHPVO with antiphospholipid antibody in 3.66%. No mortality was seen in this 5-year observational study and majority of the patients, i.e., 96 (88.1%) did not require any treatment.</p> <p><strong>Conclusion:</strong> Relatively benign nature of adult EHPVO was found in the selected group of patients. Majority of the cases in our study were idiopathic and few had positive thrombophilia profile.</p>2024-03-01T00:00:00+00:00Copyright (c) 2023 Asian Journal of Medical Scienceshttps://nepjol.info/index.php/AJMS/article/view/59788DECAF score at admission as a tool to predict clinical outcome in acute exacerbation of COPD2023-11-06T11:52:05+00:00Gogul Mathialagan Mgogulmmc07@gmail.comJacinth Preethi Jjacinthpreethi82@gmail.comManikandan Vmanichellam99@gmail.comVinoth Rvinothrc09@gmail.com<p><strong>Background:</strong> The Dyspnea, Eosinopenia, Consolidation, Acidemia, and Atrial Fibrillation (DECAF) score at presentation is designed to predict the risk of death in patients with chronic obstructive pulmonary disease (COPD).</p> <p><strong>Aims and Objectives:</strong> To study the DECAF score at admission to predict the clinical outcome of the patients during hospitalization for acute exacerbation of COPD (AE-COPD).</p> <p><strong>Materials and Methods:</strong> The study was conducted using a prospective cross-sectional observational study design in a tertiary care center in South India from April 2022 to March 2023. Patients were recruited based on specific inclusion and exclusion criteria. The data corresponding to the five variables of the DECAF score was obtained, and the relation to outcome measures such as survival, ventilation, and duration of stay was measured.</p> <p><strong>Results:</strong> Two hundred consecutive patients were assessed. Based on the DECAF score, 102 patients (51%) were classified as low-risk, and this group had no mortalities. In the intermediate-risk group, the mortality rate was 7.4%; in the high-risk group, the observed mortality rate was 38.6%. The differences noted were significant statistically. Higher dyspnea grade as measured by extended Modified Research Council criteria was related to DECAF score was significant and with the outcome.</p> <p><strong>Conclusion:</strong> Our study shows that the DECAF score at the initial presentation can be used as a reliable tool to predict the outcome of AE-COPD. Dyspnea grading can be used to predict mortality indirectly.</p>2024-03-01T00:00:00+00:00Copyright (c) 2024 Asian Journal of Medical Scienceshttps://nepjol.info/index.php/AJMS/article/view/60359Prospective randomized comparative study between EBRT alone and EBRT with ILRT boost in locally advanced unresectable esophageal cancer - Tertiary rural Indian cancer center experience2023-12-04T00:28:39+00:00Pinky Sarahiyapinkysarahiya@gmail.comShyamji Rawatdrshyamjirawat@yahoo.co.inLalit M Patelmail2drlalit@gmail.comHitesh Sharma hitesh29@gmail.comLaxmi Singotiasingotialaxmi@gmail.comRajesh Kumar Jaindrrajeshonco@gmail.comArkojyoti Raychaudhuri mearko27@gmail.com<p><strong>Background:</strong> Local recurrence within the gross tumor volume following a conventional radiation dose of 50 Gy is a major hurdle in achieving a better prognosis for esophageal carcinoma. Consequently, there remains a lack of consensus globally regarding the optimal dose for definitive concurrent chemoradiotherapy. Certain studies propose that radiation dose escalation could enhance clinical outcomes.</p> <p><strong>Aims and Objectives:</strong> The current study aimed to compare the safety and effectiveness of external beam radiotherapy (EBRT) alone versus EBRT with intraluminal radiotherapy (ILRT) boost.</p> <p><strong>Materials and Methods:</strong> A total of 60 patients with locally advanced unresectable squamous cell carcinoma of the esophagus were prospectively enrolled in this study. A comparison was conducted between 50 Gy EBRT alone and 50 Gy EBRT with 8 Gy ILRT boost, alongside weekly concurrent chemotherapy, to assess the response and toxicities.</p> <p><strong>Results:</strong> On initial assessment, a complete response (CR) was achieved in 76.66% of patients in the ILRT boost arm and 70% in the EBRT alone arm (P=0.559). At the 6th-month follow-up, 60% of patients in the ILRT boost arm and 50% in the EBRT alone arm still had a CR. No statistically significant differences were observed between the two arms in terms of leukopenia (P=0.576), nephrotoxicity (P=1.0), radiation dermatitis (P=0.615), vomiting (P=0.921), and diarrhea (P=1.0). Five patients in the ILRT boost arm and three in the EBRT alone arm experienced stricture, while no cases of fistula formation were reported.</p> <p><strong>Conclusion:</strong> Dose escalation with ILRT can result in an enhanced CR accompanied by manageable toxicity, ultimately leading to improved locoregional control.</p>2024-03-01T00:00:00+00:00Copyright (c) 2024 Asian Journal of Medical Scienceshttps://nepjol.info/index.php/AJMS/article/view/57709Early-stage endometrial carcinoma; risk factors for recurrence2023-08-17T06:10:48+00:00Asifa Andleebasifaandleeb29@gmail.comKaneez Fatimakanz10kgl24@gmail.comShahida Nasreenshahidanasreen630@gmail.comMushtaq Ahmad Sofisoficliniconcol786@gmail.comMalik Tariq Rasooldrmaliktariq@gmail.comArshad Manzoor Najmiarshadmanzoor99@gmail.comShaqul Qamar WaniDrsqamar1@gmail.com<p><strong>Background:</strong> Endometrial carcinoma (EC) is the most common gynecological malignancy in developed countries. The overall prognosis is excellent, as most cases are diagnosed at an early stage with low-grade histology, but once the recurrence occurs, the median survival decreases severely.</p> <p><strong>Aims and Objectives:</strong> The aim of this study was to identify the risk factors associated with recurrence in early-stage EC and explore their impact on overall survival (OS) after recurrence.</p> <p><strong>Materials and Methods:</strong> Records from patients diagnosed with EC were retrospectively reviewed. 220 patients were identified as early-stage, low-risk EC who underwent primary surgical treatment between January 2010 and December 2022, and their baseline characteristics were analyzed. Cox regression analysis was used to identify various factors for tumor recurrence. Survival analysis was done using the Kaplan-Meier method.</p> <p><strong>Results:</strong> In a cohort of 220 patients, we observed tumor recurrence in 44 (20%) patients and 34 (15.45%) deaths over a median follow-up of 72 months (range, 12–144 months). Multivariate analysis confirmed two risk factors: myometrial invasion (MMI) of any depth and lymphovascular invasion (LVI) as independent predictors of recurrence. The prognosis was worse for patients with recurrence than for those without. The OS for the recurrent group was 38.6%, compared to 96.0% in the non-recurrent group. In our study, the median time to recurrence was 19 months (confidence interval 18–30) months.</p> <p><strong>Conclusion:</strong> The presence of MMI and LVI are important predictors for recurrence in early-stage low-risk EC.</p>2024-03-01T00:00:00+00:00Copyright (c) 2023 Asian Journal of Medical Scienceshttps://nepjol.info/index.php/AJMS/article/view/59117Ileal perforation-etiopathology and outcome – An observational study2023-10-07T14:32:30+00:00Prabal Kanti Mandal mandalprabalkanti@gmail.comJoy Roydrrj75@gmail.comSomnath Biswasdrsomnathbiswas@yahoo.comArunima Mukhopadhyay ram_arunima@yahoo.co.in<p><strong>Background:</strong> Ileal perforations have a diverse etiology and often present with perforative peritonitis in the surgical emergency. This study is based on the scenario of management of ileal perforation encountered in a tertiary teaching hospital in West Bengal.</p> <p><strong> Aims and Objectives:</strong> The aim and objective of this study is to document and evaluate the post-operative outcome based on the diverse etiopathology, clinical presentation, and surgical management performed in patients having ileal perforation.</p> <p><strong>Materials and Methods:</strong> A prospective cross-sectional observational study was conducted in the Deben Mahata Government Medical College, Purulia, West Bengal, for a period of 2 years from February 2020 to January 2022 with 60 patients introperatively diagnosed with ileal perforation. Emergency exploratory laparotomy was done in all the cases presenting with perforative peritonitis. Ileal perforation was identified and an edge biopsy was taken. Appropriate surgical treatment in the forms of primary repair/resection-anastomosis/resection-ileostomy was done. The histopathological report was reviewed following surgery. The patients were evaluated in the post-operative period for post-operative morbidity and mortality.</p> <p><strong>Results:</strong> Typhoid fever (68.33%) was the predominant cause in our study. The most common symptoms were abdominal pain (93%), fever (85%), and abdominal distension (75%). Widal test was performed preoperatively and was positive in 41 cases (68.33%). In our study, primary repair (58.33%), resection-anastomosis (15%), and resection-ileostomy (26.67%) were the main surgical treatment performed. Sepsis, surgical site infections (SSIs), fecal fistula, and wound dehiscence were the common post-operative complications found. Among them, SSI (51.67%) was the most common post-operative complication (P<0.0001) found and fecal fistula was the most dreaded post-operative complication with 50% mortality. Histopathological reports following surgery showed cases were mainly due to enteric fever (51.67%) and tuberculosis (25%).</p> <p><strong>Conclusion:</strong> Early surgical intervention was the mainstay of treatment of ileal perforation. Delayed presentation of perforation is responsible for the development of surgical site infections (SSIs). Uncontrolled generalized sepsis, wound dehiscence, and fecal fistula were the main causes of post-operative mortality.</p>2024-03-01T00:00:00+00:00Copyright (c) 2023 Asian Journal of Medical Scienceshttps://nepjol.info/index.php/AJMS/article/view/61162Study of antibiotic susceptibility pattern of the isolated organisms in otitis media2023-12-29T00:29:54+00:00Ujwala A Lokhandemhsur18@gmail.comSuresh L Akulwarmhsur18@gmail.comAnnasaheb Lokhandemhsur18@gmail.com<p><strong>Background:</strong> Otitis media (OM) encompasses a spectrum of inflammatory conditions affecting the middle ear, contributing significantly to health-care visits and prescriptions. Complications arising from OM frequently result in avoidable hearing loss, particularly in developing nations.</p> <p><strong>Aims and Objectives:</strong> This study aims to ascertain the bacterial profile and antimicrobial susceptibility pattern of ear infections characterized by ear discharge complaints.</p> <p><strong>Materials and Methods:</strong> The present study was conducted in the microbiology department of a tertiary care hospital over a 2-year period. The study involved 581 samples diagnosed with OM. Trained nurses collected pertinent patient information, while both nurses and an ENT doctor collected samples during specimen collection, utilizing an otoscope and headlight. Thorough documentation of relevant history and physical examinations accompanied the meticulous collection of ear discharge.</p> <p><strong>Results:</strong> Culture-positive samples accounted for 96.39% (560 samples), with no growth observed in 3.61% (21 samples). Gram staining revealed 570 positive samples. Of the 581 OM samples, aerobes were isolated from 73.67% and anaerobes from 51.64%. The total isolates numbered 845, with 61.54% being aerobic and 38.46% anaerobic. Among the bacterial isolates, gram-negative bacteria slightly exceeded gram-positive bacteria, constituting 60.57% and 39.42%, respectively.</p> <p><strong>Conclusion:</strong> In conclusion, the isolated aerobes and anaerobes shed light on the prevalent organisms in our region causing OM. The antibiotic sensitivity analysis conducted in this study emphasizes the identification of drugs suitable for the earliest treatment of OM.</p>2024-03-01T00:00:00+00:00Copyright (c) 2024 Asian Journal of Medical Scienceshttps://nepjol.info/index.php/AJMS/article/view/59402Study on location of cerebral lesion among patients with hemorrhagic cerebrovascular accident2023-10-19T14:24:23+00:00Nabanita Chakrabortynabanita85rgkmc@yahoo.co.inBanani Kundudr.bmitra@yahoo.comSoham Chakrabortydebadasbiswal@gmail.comPrabir Kumar Kunduprabirkundu83@gmail.com<p><strong>Background:</strong> In hemorrhagic cerebrovascular accident, bleeding occurs directly into the brain parenchyma. Intracerebral hemorrhage usually occurs at certain sites in the brain, i.e., thalamus, putamen, cerebellum, and brain stem. The surrounding area of brain may be damaged by pressure produced by the mass effect of the hematoma. Increase in intracranial pressure occurs.</p> <p><strong>Aims and Objectives:</strong> The aim and objective of the study are to compare the localization of cerebral lesions with the frequency of intraventricular hemorrhage and to study the prognosis of hemorrhagic cerebrovascular accident (CVA) as per its anatomical location in computed tomography (CT) scan.</p> <p><strong>Materials and Methods:</strong> One-year observational cross-sectional study was conducted in 60 patients with CT scan diagnosed hemorrhagic CVA.</p> <p><strong>Results:</strong> Regarding the site of the hemorrhagic CVA, the most commonly affected area was basal ganglia (46.7%) followed by thalamus (18.3%); other areas include pons (8.3%), paraventricular (8.3%), cerebellar (6.7%), lobar (5%), internal capsule (3.3%), and intraventricular (3.3%).</p> <p><strong>Conclusion:</strong> This study reflects a spectrum of cerebral location of hemorrhagic stroke which may help in the management of hemorrhagic CVA patients.</p>2024-03-01T00:00:00+00:00Copyright (c) 2024 Asian Journal of Medical Scienceshttps://nepjol.info/index.php/AJMS/article/view/60356Post-operative complications in elderly patients undergoing hip fracture surgery: An observational study2023-12-02T15:07:11+00:00Sanjeev Kumar Karenagendrapsm77@gmail.comKorada Ravi Kumarnagendrapsm77@gmail.comLukalapu Prasanna Kumarnagendrapsm77@gmail.comNagendra Naidu Bnagendrapsm77@gmail.com<p><strong>Background:</strong> Hip fractures in elderly patients are a significant health-care concern due to their high morbidity and mortality rates.</p> <p><strong> Aims and Objectives:</strong> This study aims to analyze post-operative complications in this demographic to improve care strategies.</p> <p><strong>Materials and Methods:</strong> This observational study included 100 patients aged between 65 and 90 years, undergoing hip fracture surgery. The cohort comprised 40% males and 60% females. Patients underwent either total hip replacement (30%) or internal fixation (70%). We tracked post-operative complications within the first 30 days, mortality and reoperation rates, and recovery and rehabilitation outcomes over 6 months.</p> <p><strong>Results:</strong> Post-operative complications were reported in several categories: Infection (10%), cardiovascular (15%), respiratory (12%), renal (5%), neurological (8%), and gastrointestinal (6%). The most common infections were superficial wound infections (6%) and deep infections (4%). Cardiovascular complications included arrhythmias (8%), myocardial infarction (4%), and venous thromboembolism (3%). Pneumonia (7%), acute respiratory distress syndrome (3%), and pulmonary embolism (2%) were the primary respiratory complications. The study also recorded a 4% 30-day mortality rate and a 7% reoperation rate. The average hospital stay was 7 days, with 60% of patients requiring post-discharge rehabilitation. At 6-month post-surgery, 70% of patients had achieved complete recovery.</p> <p><strong>Conclusion:</strong> The study highlights a significant incidence of post-operative complications among elderly patients undergoing hip fracture surgery. The findings underscore the need for comprehensive perioperative care and vigilant monitoring to mitigate these risks. The data also stress the importance of post-discharge rehabilitation in enhancing recovery outcomes.</p>2024-03-01T00:00:00+00:00Copyright (c) 2023 Asian Journal of Medical Scienceshttps://nepjol.info/index.php/AJMS/article/view/60578Adverse transfusion reactions following transfusion of blood and blood products in a tertiary care hospital: A step toward hemovigilance2023-12-11T01:16:17+00:00Mrigen Choudhurymrigenchoudhury382@gmail.comZarika Ahmedmrigenchoudhury382@gmail.comAparna Duttamrigenchoudhury382@gmail.comAdity Sharmamrigenchoudhury382@gmail.com<p><strong>Background:</strong> Transfusion of blood and blood products is a double-edged sword, so it should be used judiciously. The primary aim of the centralized hemovigilance program is to improve transfusion safety.</p> <p><strong>Aims and Objectives:</strong> To determine the frequency, distribution, and types of transfusion reactions (TRs) occurring in patients, reported to the blood center in a tertiary care hospital in North East India.</p> <p><strong>Materials and Methods:</strong> A retrospective study was conducted in State of The Art Model Blood Center, Assam Medical College and Hospital for 1 year from July 2022 to June 2023. Data were collected from TR records as per the hemovigilance reporting format and analyzed.</p> <p><strong> Results:</strong> During the study, 38,165 blood products were issued. 41 (0.11%) TRs were recorded, out of which 25 (61%) occurred with packed red cell transfusion followed by whole blood transfusion (39%). The most common type was febrile non-hemolytic TR (51.2%) followed by allergic reactions (39%).</p> <p><strong>Conclusion:</strong> The frequency of adverse TRs was low (0.11%), which may be due to the management of a few cases by the treating clinician itself. Most reactions occurred with packed red blood cells (PRBC) transfusion, the most common type being febrile non-hemolytic TR, which may be due to the presence of leukocytes, inflammatory mediators in leftover plasma during PRBC preparation, which can be standardized by the use of leukoreduced blood products. Hemovigilance will help to strengthen the quality and safety of blood transfusion.</p>2024-03-01T00:00:00+00:00Copyright (c) 2024 Asian Journal of Medical Scienceshttps://nepjol.info/index.php/AJMS/article/view/60323Evaluation of optimum dose of anti-snake venom required and its outcome based on severity of envenomation in snakebite case2023-11-29T22:58:46+00:00Kavitha Sdrkavithas85@gmail.comNalini GKdrkavithas85@gmail.comSahana GNdrkavithas85@gmail.com<p><strong>Background:</strong> Snakebite is an important occupational hazard in India as it is always been a land of poisonous snakes. The isssue which the physician confronts while treating a snake bite patient is assesment of degree of envenomation and requirement of ASV dose.</p> <p><strong>Aims and Objectives:</strong> This study was taken to evaluate the optimum dose of anti-snake venom (ASV) required based on the severity of envenomation.</p> <p><strong> Materials and Methods:</strong> Patients with a history of snakebite brought to the Department of General Medicine, Hassan, were included in this study. The study was conducted during the period from December 2014 to June 2016. The sample size of 80 patients was included in the study after fulfilling the inclusion criteria.</p> <p><strong>Results:</strong> A total of 80 patients were included in the study. The majority of the victims were males (70%), age between 21 and 40 years (47.5%), and agriculture was the main occupation (67.3%). 51.25% did not identify the snake. The most poisonous were viper and cobra types which were 36.5% and 12.5%, respectively. A delay in lag time of 8.99±8.2 h was observed in severe envenomation. Overall, 51 cases (63.75%) had cellulitis, and 3 (3.75%) in the severe group required fasciotomy. Twenty percent had hematologic derangements. Ten percent of patients had developed renal failure and one required dialysis. 8.75% of patients developed respiratory failure and all required mechanical ventilation. The average dose of ASV vials used in mild, moderate, and severe envenomation was 9.04±3.51 vials, 18.5±5.27 vials, and 28.6±7.30 vials, respectively. The overall mortality rate was 5%.</p> <p><strong>Conclusions:</strong> The optimum dose of ASV required in mild, moderate, and severe envenomation is 9.04±3.51 vials, 18.5±5.27 vials, and 28.6±7.30 vials, respectively to neutralize the circulating venom and lower the risk of development of serious complications.</p>2024-03-01T00:00:00+00:00Copyright (c) 2024 Asian Journal of Medical Scienceshttps://nepjol.info/index.php/AJMS/article/view/59897Role of predictors in acceptance of post-exposure prophylaxis with single-dose rifampicin among contacts of leprosy in rural area of Bankura: An explanatory mixed-method study2023-11-13T07:27:02+00:00Prianka Mukhopadhyaydocprianka@yahoo.co.inTanushree Karmakartanushreekarmakar81@gmail.comAditya Prasad Sarkardradityaprasadsarkar@gmail.comManisha Sarkarmisdav2003@gmail.com<p><strong>Background:</strong> India achieved the elimination of leprosy two decades ago although its sustenance continues to be threatened by ongoing active transmission in few remaining pockets. There is a paucity of data regarding the acceptance of single-dose rifampicin (SDR) prophylaxis among healthy contacts.</p> <p><strong>Aims and Objectives:</strong> The aims and objectives of the study are to assess the factors influencing the acceptability of SDR among contacts.</p> <p><strong>Materials and Methods:</strong> A community-based, sequential, explanatory mixed-method study was conducted over 6 months from September 2022 to February 2023 among 168 contacts of leprosy patients from two blocks in Bankura district, West Bengal. Quantitative analysis was done for SDR acceptance and its predictors among contacts using the Chi-square test, Mann–Whitney U test, and Logistic regression. This was followed by qualitative assessment using focus group discussions and in-depth interviews among contacts to explain the findings through a thematic approach.</p> <p><strong>Results:</strong> Household contacts (aOR=13.72, 95% CI=2.09–90.19), increasing knowledge score of contacts (aOR=3.18, 95% CI=1.88–5.38), counseling by health workers (aOR=11.98, 95% CI=2.20–65.15), trust in health workers (aOR=152.96, 95% CI=13.17–1776.09), and not taking other medicines for comorbidity (aOR=35.82, 95% CI=2.94–436.02) were associated with increased SDR uptake among leprosy contacts. Barriers and facilitators of post-exposure prophylaxis (PEP)-SDR were categorized as contact, health workers, and program-related factors.</p> <p><strong>Conclusion:</strong> SDR acceptability among contacts was 77.4%. Facilitators of SDR-PEP were awareness of side-effects, follow-up, prompt support by health workers, IEC, belief in National programs, etc. Lack of knowledge of PEP-SDR and contraindications, ineffective counseling by health workers, stigma of the disease, the increased workload of health workers, etc., were the barriers to SDR-PEP implementation.</p>2024-03-01T00:00:00+00:00Copyright (c) 2023 Asian Journal of Medical Scienceshttps://nepjol.info/index.php/AJMS/article/view/59248A comparative study of psychiatric comorbidities and quality of life in patients with epilepsy and psychogenic non-epileptic seizures2023-10-18T12:21:00+00:00Mahadeb Mandalmahadeb007@gmail.comDurga Prasad Chakrabortyanneshachak@gmail.comRajesh Kumar Thakurrajeshkrthakur992@gmail.comNirmal Kumar Beradrbera@yahoo.co.in<p><strong>Background:</strong> Epilepsy and psychogenic non-epileptic seizures (PNES) are both common disease entities and psychiatric comorbidities are also high among the sufferers. Studies on the comparison of the levels of comorbidities between the two groups are few in number.</p> <p><strong>Aims and Objectives:</strong> The aims of this study were to investigate different psychiatric disorders like depression, anxiety, social functioning, and quality of life (QoL) in epilepsy and PNES patients and compare them statistically.</p> <p><strong>Materials and Methods:</strong> 38 epilepsy and 22 PNES patients were evaluated with clinical history and different tools like the mini international neuropsychiatric interview - 5, Beck’s Depression Inventory - 2,state and trait anxiety inventory, Social and Occupational functioning scale for epilepsy and QoL in epilepsy - 31 questionnaire. Comparisons were made between the groups regarding sociodemographic data, scores on different aspects of psychiatric disorders, social functioning, and QoL.</p> <p><strong> Results:</strong> The majority in the epilepsy group were males, and in the PNES group were females, while younger age group predominates in both groups. There was a high prevalence of depression and anxiety in both groups, while PNES subjects had significantly higher depression and trait anxiety scores. Social and occupational functions were comparable in the two groups, but QoL indexes were significantly worse in the PNES group.</p> <p><strong>Conclusion:</strong> Findings in this study indicate that psychiatric comorbidities like depression and anxiety disorders are much more common among patients with epilepsy and PNES. Occurrence of depression is even higher among patients with PNES. Both epilepsy/PNES and these psychiatric comorbidities affect Socio-occupational functions and their QoL. Thus, it is very important to look for these psychiatric comorbidities and QoL in these patients and implement proper management protocols to improve their mental health as well as their QoL.</p>2024-03-02T00:00:00+00:00Copyright (c) 2024 Asian Journal of Medical Scienceshttps://nepjol.info/index.php/AJMS/article/view/61006Effectiveness of Om chanting on perceived stress, negative affectivity, and social inhibition in individuals with pre-hypertension2023-12-23T10:09:15+00:00Deepa Chokkandrdeepac85@gmail.comAshish Bheldrashishbhel@rediffmail.comKalyani Ttkalyani1412@gmail.comRamesh Pdrramesh.jasmine@gmail.com<p><strong>Background:</strong> Akara, Ukara, Makara (OUM) chanting regulates emotions and removes negative emotions by inactivating the processing in the amygdala. At the same time, the prefrontal complex was inhibited followed by chanting OUM. Further, there was an increase in the oxygenation levels followed by chanting OUM. Hence, OUM chanting has multiple benefits and offers improvement in the quality of life. Though there are multiple benefits followed by chanting OUM, the scientific evidence for the same is comparatively less. Hence, there is a need for more studies in this area.</p> <p><strong>Aims and Objectives:</strong> The present study aimed to find out the variations in the perceived stress, negative affectivity, and social inhibition in pre-hypertensive individuals and also to observe the effectiveness of Om chanting on perceived stress, negative affectivity, and social inhibition in pre-hypertensive individuals.</p> <p><strong>Materials and Methods:</strong> The present study was conducted at the St Peter’s Medical College Hospital and Research Institute, Hosur, Tamil Nadu, India. A total of 50 young adults with pre-hypertension were recruited in the study after obtaining written informed consent. Age- and gender-matched 50 healthy participants were recruited after obtaining the voluntary, informed consent. Diamond digital sphygmomanometer was used to record the blood pressure. All the parameters were recorded at 9 am for the convenience of the participants and also to avoid diurnal variation. The perceived stress scale was used to assess the stress levels. Negative affectivity and social inhibition were recorded using a type D (DS-14) questionnaire. Cases practiced the OUM chanting for 6 weeks after they were trained by an expert yoga therapist.</p> <p><strong>Results:</strong> Perceived stress scores were significantly decreased followed by the OUM chanting. There was a significant decrease in the scores of negative affectivity of cases after the intervention when compared with control group participants. There was a significant decrease in the scores of social inhibition of cases after the intervention when compared with control group participants.</p> <p><strong>Conclusion:</strong> Perceived stress, negative affectivity, and social inhibition were significantly higher in the pre-hypertensive individuals. The study results provide further evidence that practicing OUM chanting causes stress relief and also decreases the negative emotions that is negative affectivity and social inhibition in pre-hypertensive individuals.</p>2024-03-01T00:00:00+00:00Copyright (c) 2024 Asian Journal of Medical Scienceshttps://nepjol.info/index.php/AJMS/article/view/60310Radiofrequency ablation versus stripping of great saphenous vein in the management of varicose veins2023-11-30T03:44:46+00:00Vikas Tyagidr.vikas.tyagi@gmail.comSaumya Choprasaumya.chopra1@gmail.comSamir Ahmadufacesamir@gmail.comSudhir Kumar Jainsudhirkumar11@gmail.comAmrita Duaoffbeater@gmail.com<p><strong>Background:</strong> Varicose veins are defined as dilated, tortuous subdermal veins >3 mm in diameter. It is a common entity affecting an estimated 10% of population.</p> <p><strong>Aims and Objectives:</strong> The aim was to compare the efficacy of radiofrequency ablation (RFA) with great saphenous vein (GSV) stripping in patients with lower limb varicose veins in terms of disappearance of visible varicosities.</p> <p><strong> Materials and Methods:</strong> It was a prospective randomized controlled study, conducted in a tertiary care medical college with the study population consisting of patients suffering from varicose veins. Totally 30 patients were enrolled and divided into 2 groups of 15 patients each. Group A underwent RFA while Group B underwent stripping of GSV with flush ligation of saphenofemoral junction.</p> <p><strong>Results:</strong> The mean duration of the procedure in Group A was 53.67±6.6 min while in Group B it was 101.4±11.85 min which was statistically significant (P<0.0001). The mean duration of return to routine activities and work was 2.2±0.41 days in Group A and 3.07±1.16 days in Group B which was statistically significant (P=0.024). Post-operative analgesic requirement was similar in both groups (P=0.224). Complete remission was observed in all patients at 12 months visit and there was no recurrence identified even after a follow-up period of 4 years.</p> <p><strong> Conclusion:</strong> RFA was found to be as effective as stripping of GSV in terms of obliteration of veins. The duration of procedure was found to be much less in RFA. Furthermore, cosmetic results, ulcer healing and patient satisfaction rate was better in RFA group. Patient return to normal activity was significantly earlier in RFA group.</p>2024-03-01T00:00:00+00:00Copyright (c) 2024 Asian Journal of Medical Scienceshttps://nepjol.info/index.php/AJMS/article/view/59747Utility of ultrasonography for prediction of difficult airway and assessment of dynamic airway changes2023-11-24T16:33:22+00:00Shehla Bashirdrbdar1@gmail.comSuhail Sidiqdrbdar1@gmail.comBashir Ahmad Dardrbdar1@gmail.comMajid Jehangirdrbdar1@gmail.comRazia Hamiddrbdar1@gmail.comFeroze Shaheendrbdar1@gmail.comAbdul Waheed Mirdrbdar1@gmail.com<p><strong>Background:</strong> Several clinical tools are used for preoperative airway assessment. Ultrasound is an emerging tool in anesthesia, and its role in the upper airway needs to be explored.</p> <p><strong>Aims and Objectives:</strong> We aimed to assess the role of airway ultrasound in predicting difficult laryngoscopy and airway changes following induction of anesthesia.</p> <p><strong>Materials and Methods:</strong> Clinical airway assessment was performed with a modified Mallampati score in 100 elective surgical patients. Ultrasound variables in pre- and post-induction of anesthesia were: distance between the skin and vocal cords at the hyoid bone (DSVC hb), distance from the skin to the thyroid isthmus, distance from the skin to the tracheal ring at suprasternal notch level, and distance between the skin and the cricothyroid (DSCM). Cormack–Lehane (CL) grades 3b and 4 were classified as having a DL. Association of clinical, ultrasonography (USG) indicators and CL grading was correlated. Dynamic changes in anterior neck tissues following induction of anesthesia were also measured.</p> <p><strong>Results:</strong> Pre-induction USG variables were significantly higher in the DL group compared to the NDL group (P<0.05), except DSCM. Post-induction all USG parameters were significantly higher in the DL group. Among USG variables, DSVC hb and DTSI had the highest AUCs of 0.801 and 0.772, respectively. DSVC hb had a sensitivity of 76% and a specificity of 100% for DL. DTSI had a sensitivity of 92% and a specificity of 72%. There was a significant increase in depth after anesthetic induction of all USG parameters except DSCM.</p> <p><strong> Conclusions:</strong> Ultrasound of anterior airway tissues can be considered for prediction of DL and allows dynamic airway assessment.</p>2024-03-01T00:00:00+00:00Copyright (c) 2023 Asian Journal of Medical Scienceshttps://nepjol.info/index.php/AJMS/article/view/61361Von Willebrand factor and gastric cancer – is there an association? – A pilot study from South India2024-01-02T14:15:58+00:00Karthikeyan Skarthikgaya@gmail.comNiyas Ahameddrniyas89@gmail.comSastha Aa_sastha@yahoo.comVillalan Rrexvillalan@yahoo.co.inRajnihedan KGr.nikzz@gmail.comPadmanabhan Ssgepadmanabhan@yahoo.co.inRamajayam Govindanendoibmsramajayam@gmail.comMahesh Kumarmakeshkumar87@gmail.com<p><strong>Background:</strong> Gastric adenocarcinoma in Indian patients’ is on the rise. A high level of plasma von Willebrand factor (vWF) is associated not only with the development of cancerassociated thrombosis but also with the degree of malignancy, the rate of metastasis, and<br />cancer prognosis.</p> <p><strong>Aims and Objectives:</strong> The aim of this study was to study the association of vWF with tumor location, TNM staging, and grades of tumor differentiation in gastric adenocarcinoma and to assess the usefulness of circulating vWF levels as a potential biomarker for gastric adenocarcinoma.</p> <p><strong>Materials and Methods:</strong> This study is a prospective observational study done in the Department of Surgical Gastroenterology, Madurai Medical College, Madurai, over a period of 2 years between September 2020 and August 2022. Fifty cases of gastric cancer and 50 controls were recruited and vWF levels were analyzed.</p> <p><strong>Results:</strong> Among the 50 gastric cancer patients, 8% belonged to Stage II, 62% belonged to Stage III, and 30% belonged to Stage IV. vWF was elevated in Gastric Cancer patients compared to control group. Mean value of vWF in Cases and Control population was 3.68 ng/ml and 0.58 ng/ml respectively (p value 0.0005). Pertaining to Stage, the vWF value was, Stage II – 4.7, Stage III – 3.3, and Stage IV – 4.1 ng/mL. With respect to tumor differentiation, the vWF values were, poorly differentiated – 4.7, moderately differentiated – 3.0, and well differentiated – 3.9 ng/mL.</p> <p><strong>Conclusion:</strong> vWF values were significantly elevated in gastric cancer patients. Based on the results, vWF can be used as a surrogate marker to predict the tumor differentiation in patients, thereby prognosticating the disease. Stage-wise, there was no significant<br />difference in the vWF values.</p>2024-03-01T00:00:00+00:00Copyright (c) 2024 Asian Journal of Medical Scienceshttps://nepjol.info/index.php/AJMS/article/view/60171Clinical study of mesh repair in ventral hernia with comorbidities (diabetes mellitus and/or obesity and/or hypothyroidism) in a tertiary care hospital2023-11-25T00:56:13+00:00Madhu BSdivyabhrt8@gmail.comMadhura divyabhrt8@gmail.comDivya Divyadivyabhrt8@gmail.comShilpa Vdivyabhrt8@gmail.com<p><strong>Background:</strong> Ventral hernias comprise the second-most common hernia presentation, or 21–35% of all hernia types in the surgical world. Ventral hernias include incisional, umbilical, epigastric, and spigelian hernias, among others. This study was undertaken to know the different clinical types, age incidence, and predisposing factors for ventral hernia and to study the complications.</p> <p><strong>Aims and Objectives:</strong> This study was undertaken to know the different clinical types, age incidence, and predisposing factors for ventral hernia and to study the complications.</p> <p><strong>Materials and Methods:</strong> Forty-five cases of ventral hernias treated were studied prospectively from January 2021 to June 2022, in which each patient was evaluated thoroughly and surgery was planned to obtain a satisfactory outcome. The distribution of ventral hernias with respect to age, sex, comorbidities, and risk was recorded. Common presenting symptoms of ventral hernias, diagnosis, and complications were studied. The data collected was entered in a proforma, tabulated, and statistically analyzed.</p> <p><strong>Results:</strong> Females were affected much more than males. Out of the three types of hernia that were studied, umbilical hernia showed more incidence (n=23/51%), followed by incisional hernia (n=15/33%), and epigastric hernia (n=7/16%). The most common age presentation was in the fourth and fifth decades. The most common type of mesh repair was pre-peritoneal repair in 28 (62%). The pain was relatively more common post-surgery complications, as noted in 11 (24%). In 100% of the cases, swelling was the complaint, followed by pain (18.8%). Obesity was the most common etiological factor in the development of ventral hernias (60%), followed by diabetes (35%).</p> <p><strong>Conclusion:</strong> The most common ventral hernia was an umbilical hernia. Ventral hernias are more common in females. Obesity and diabetes are observed to be the major predisposing risk factors. Good pre-operative evaluation and preparation, sound anatomical knowledge, and meticulous attention to surgical detail are the most important factors for the prevention of postoperative complications. In view of the limited period of follow-up, we were not in a position to comment on recurrence rates, but when proper surgical procedures are adopted along with pre-operative correction of comorbid factors, results will always be excellent.</p>2024-03-01T00:00:00+00:00Copyright (c) 2024 Asian Journal of Medical Scienceshttps://nepjol.info/index.php/AJMS/article/view/59601A prospective comparative study of the intraoperative difficulties during laparoscopic cholecystectomy in patients taking homeopathic medications for cholelithiasis versus cholelithiasis patients with no history of homeopathic medication2023-11-01T03:26:18+00:00Partha Pratim Mandaldrparthapratimmandal@gmail.comShivaji Mandalranashivaji@gmail.comNikhil Agrawalagrawalnikhil6687@gmail.comDebayan Chowdhurydbayn169@gmail.com<p><strong>Background:</strong> Gallstone disease is one of the most prevalent gastrointestinal diseases with a substantial burden to health-care systems. Patients present with right upper quadrant pain, dyspepsia, nausea or vomiting. Owing to the side effects of allopathic drugs, many patients resort to homeopathic treatment for relief of pain. There are several homeopathic drugs that decrease the pain of cholecystitis as well as high cholesterol in these patients but cannot cure them off the disease. Finally, they come to general surgeon for cholecystectomy. We have noticed that performing laparoscopic cholecystectomy (LC) in these patients is difficult and time consuming.</p> <p><strong>Aims and Objectives:</strong> To determine whether or not homeopathic medicine intake for treatment of cholelithiasis act as an independent factor that leads to intraoperative difficulties during LC.</p> <p><strong>Materials and Methods:</strong> Study design: A prospective randomized comparative study. Study period: July 2022–December 2023 (18 months). Study groups: Group H = Patients with history of (H/O) intake of homeopathic medicines for treatment of cholelithiasis = 60 patients, Group N = Patients with no H/O homeopathic medicine intake = 60 patients.</p> <p><strong>Results:</strong> Twenty-six (43.33%) patients in Group H and 11 (18.33%) patients in Group N had a difficult LC. 7 (11.67%) patients in Group H and 1 (1.67%) patient in Group N had dense adhesions around the gallbladder (GB). 13 (21.67%) patients of Group H and 3 (5%) patients of Group N had a Frozen Calot’s Triangle (fibrosis and difficult Calot’s triangle dissection). This was statistically significant.</p> <p><strong>Conclusion:</strong> Our study proved that intake of homeopathic medications for the treatment of cholelithiasis leads to dense adhesions around GB as well as fibrotic adhesions leading to difficult Calot’s triangle dissection leading to a difficult LC.</p>2024-03-01T00:00:00+00:00Copyright (c) 2023 Asian Journal of Medical Sciences