Asian Journal of Medical Sciences

Effects of administration of melatonin on agitation and duration of stay in patients of traumatic brain injury admitted to neurosurgical intensive care unit – A retrospective study

Sat, 01 Jun 2024 00:00:00 +0000

Background: Agitation is frequently encountered in patients recovering from traumatic brain injury (TBI) in the intensive care unit (ICU). The etiopathology for agitation is multifactorial. Melatonin has been widely used to study the effects of delirium in ICU, however, its effect on agitation is not well studied.

Aims and Objectives: The aim of this study was to assess the effect of melatonin administration on the prevalence of agitation and length of stay in patients with severe TBI, managed conservatively, or undergoing decompressive craniectomy.

Materials and Methods: A retrospective observational study with 70 patients undergoing various decompressive craniotomy or managed conservatively, and admitted to neurosurgical ICU was included in the study. Thirty-six patients were recruited from the control group and 34 patients received melatonin during their stay in the ICU. In this study, records of 70 patients who had suffered isolated TBI with no associated injuries were analyzed. The patients had a Glasgow coma score of 3–14 on admission to ICU. The patients were managed as per the standard protocols, as per the existing guidelines, and based on TBI guidelines.

Results: A non-significant decreasing trend of agitation and reduced duration of ICU stay was noted in patients who received melatonin compared with the control group. The prevalence of agitation observed on modified Ramsay scale (Mean±SD) in patients who received melatonin on Day 3, Day 4, Day 5, Day 6, Day 7, Day 8, and Day 9 were −1.67±3.01; −1.61±2.82; −1.2±2.55; −1.23±2.51; −1.23±2.11; −1.05±2.09; and 0.76±2.03, respectively. These scores were slightly lower than observed in the control group on Day 3, Day 4, Day 5, Day 6, Day 7, Day 8, and Day 9 as −1.58±3.16; −1.33±2.72; −1.08±2.46; −1.13±2.25; −0.94±1.87; −0.52±1.7; and 0.52±1.36, respectively. The mean±SD duration of stay in ICU of patients receiving melatonin (13.14±3.37) and not receiving melatonin (14.52±3.73) was comparable (P=0.1).

Conclusion: Although there was a decreased prevalence of agitation and a decrease in the mean duration of the ICU stay in patients who received oral melatonin, these beneficial effects did not show any statistical significance once compared with the control group.

The efficacy and safety of granisetron with ondansetron for the prevention of post-operative nausea and vomiting in patients undergoing cesarean section under spinal anesthesia

Supriya Singh, Sanni Deyol Gautam, Narendra Singh Bafila, Rajesh Kumar — Sat, 01 Jun 2024 00:00:00 +0000

Background: Spinal anesthesia often causes more post-operative nausea and vomiting (PONV). Cesarean-section patients have a significantly more PONV rate. Therefore, evidence-based knowledge about PONV prevention and care for high-risk individuals is urgently needed to reduce the consequences.

Aims and Objectives: The aim of the study was to compare the efficacy and safety of granisetron with that of ondansetron in the prevention of PONV in patients undergoing cesarean section under spinal anesthesia.

Materials and Methods: A total of 86 pregnant women with American Society of Anesthesiologists grade I–II scheduled for cesarean delivery under spinal anesthesia were enrolled. Patients were divided into two equal groups (n=43): Ten minutes before spinal anesthesia, patients in group B (granisetron) received 2 mg granisetron intravenously diluted to 10 mL with normal saline, whereas patients in group A (ondansetron) received 4 mg ondansetron.

Results: There was no significant difference between Groups A and B in terms of the number of vomiting episodes between 0 and 6 h. Group A had significantly more episodes of nausea after 2 h than Group B after 0–2 h. After 2–6 h, however, the nausea was similar in all groups. Of the patients in Group A, 4 (9.3%) required antiemetic medication, in Group B, it was 2 (4.7%). In Group A, 8 patients (18.6%) and 6 patients (14%) complained of headache and dizziness, respectively; in Group B, 3 patients (7.0%) and (0%), respectively. Dizziness was significantly more pronounced in Group A than in Group B.

Conclusion: The results of the study show that granisetron (2 mg) was more effective than ondansetron (4 mg) in minimizing PONV episodes in women undergoing spinal anesthesia for cesarean section. There were no significant side effects and both drugs were comparatively safe.

Cardiovascular risk score predictive accuracy and subclinical atherosclerosis correlation in the Indian population: A cross-sectional study

Sat, 01 Jun 2024 00:00:00 +0000

Background: Estimation of the risk of future atherosclerotic cardiovascular (CV) events is an important step in the primary prevention of CV events. However, the relative accuracy of the various currently available CV risk scores is not validated in Indians.

Aims and Objectives: The study was done to compare the accuracy of three clinically relevant CV risk assessment algorithms in the South Indian population and to validate the risk scores by correlating with the measures of subclinical atherosclerosis.

Materials and Methods: This cross-sectional study was conducted among patients attending a chest pain clinic at a Tertiary care center in South India. The study included subjects ≥30 years of age, with no previous coronary artery disease (CAD) and major cardiac illness. Totally 110 subjects were included in the study. Detailed clinical evaluation and routine investigations were done. The 10-year CV risk for each subject was calculated using the three risk scores – Framingham, American College of Cardiology/American Heart Association (ACC/AHA), and Q risk score. The risk scores of all patients were then correlated with their corresponding carotid intima-media thickness (CIMT) measured using carotid Doppler and coronary angiography results.

Results: The mean age of the study population was 51.45±9.01 years and the majority of them were females (57.2%). CAD patients demonstrated significantly increased CIMT. There was a significant positive correlation (P<0.001) between all three risk scores and carotid intimal medial thickness. As the carotid intimal medial thickness increases, the risk scores also increased (as shown by Pearsons’s correlation coefficient). Similarly, all three risk scores also showed a significant positive correlation (P<0.001) with the severity of CAD as assessed by CAG (as shown by one-way analysis of variance). The ACC/AHA score was the best score with a slightly higher accuracy of 69.9% than that of Q risk score (69.5%). The accuracy of Framingham’s score was found to be 68.3%.

Conclusion: ACC/AHA and Q risk score may be the most appropriate CV risk assessment algorithm for use in Indian populations at present. However, large-scale prospective studies are needed to confirm these findings.

Impact of side effect management, patient outcomes, and health-care costs in atorvastatin and rosuvastatin therapy: An observational study

Gayathri Elango, Varsha AP, Ganga Muruga Bharathi — Sat, 01 Jun 2024 00:00:00 +0000

Background: Statins are widely prescribed for the management of hyperlipidemia and the prevention of cardiovascular diseases. Atorvastatin and rosuvastatin are among the most commonly used statins, with varying impacts on lipid profiles, side effect profiles, patient adherence, and health-care costs. Understanding these differences within specific populations can inform more tailored and cost-effective treatment strategies.

Aims and Objectives: This study aimed to evaluate the differences in side effect management, patient outcomes, and health-care costs between atorvastatin and rosuvastatin therapies in a cohort from Coimbatore, Tamil Nadu, India.

Materials and Methods: An observational study was conducted with 100 patients at the Karpagam Faculty of Medical Sciences and Research, evenly split between atorvastatin (n=50) and rosuvastatin (n=50) groups. Data on demographic characteristics, side effects, low-density lipoprotein (LDL) cholesterol reduction, medication adherence, and health-care costs were collected and analyzed.

Results: The cohort had an average age of 62 years, with a higher prevalence of males (57%). Socioeconomic analysis showed 30% from low-income, 50% from middle-income, and 20% from high-income backgrounds. Side effects were more common in the atorvastatin group (35%) compared to the rosuvastatin group (28%), with muscle pain and gastrointestinal issues being predominant. Rosuvastatin treatment resulted in higher adherence rates (90%) and more significant LDL cholesterol reduction but incurred higher annual health-care costs (INR 28,000) versus atorvastatin (INR 25,000) (P=0.04).

Conclusion: Both statins effectively reduced LDL cholesterol; however, rosuvastatin demonstrated higher patient adherence but at an increased cost. These findings underscore the need for individualized statin therapy that considers both clinical outcomes and economic constraints, particularly in settings with limited health-care resources.

Sigma metrics application in clinical biochemistry: Practical requisite or unfeasible misadventure

Sat, 01 Jun 2024 00:00:00 +0000

Background: The application of the Six Sigma (σ) metric in biochemical laboratories is a powerful tool for reducing the occurrence of errors and prioritizing important improvements in laboratory quality control. The National Accreditation Board for Testing and Calibration Laboratories (NABL) is an accreditation body with an accreditation system established in accordance with ISO/IEC 17011, providing specialty- or scope-based certification based on the conformance of quality indices to medical laboratories. In this context, a study has been designed that considers the quality guidelines set by NABL as well as the sigma metric rule in the assessment of analytical performance.

Aims and Objectives: The aims of this study were to identify the gaps and need for strategy modification for quality improvement by assessing the performance of two NABL-accredited medical testing laboratories on a Sigma metric scale.

Materials and Methods: A retrospective analytical study was conducted over 6 months (January–June 2021). Internal quality control (IQC) and EQAS data were obtained from third-party QC providers (Bio-Rad, India) and analyzed by calculating sigma (σ) values based on the coefficient of variation, bias, and total error allowable in two NABL-accredited medical testing laboratories. To identify potential problems for analytes with poor sigma values, a quality goal index (QGI) analysis was performed.

Results: By analyzing the sigma values obtained by both NABL-accredited laboratories, we can see that laboratory 2 performed better than laboratory 1. After calculating the QGI, there was a problem of inaccuracy and imprecision in laboratory 1, and laboratory 2 had QGI values that indicated only imprecision.

Conclusion: Diagnostic laboratories should incorporate Six Sigma metrics to identify gaps in their performance to ensure better quality control and patient safety.

Prevalence of chronic kidney disease and its risk factors among Type 2 diabetes patients in a tertiary care hospital

Noor Mohamed Rasik B, Sakthi Suganya ST, Vikram Manamala Sudhakar, Vignesh C — Sat, 01 Jun 2024 00:00:00 +0000

Background: An increased chance of developing chronic kidney disease (CKD), which has higher morbidity and mortality, exists among patients with Type 2 diabetes (T2D).

Aims and Objectives: Our goal was to determine and classify the anthropometric, physiological, and demographic risk factors for CKD in individuals with T2D.

Materials and Methods: A cross-sectional research study was conducted at a tertiary care hospital involving 218 participants. Data were collected on various parameters including age, gender, education level, employment status, height, weight, blood pressure, hemoglobin levels, and estimated glomerular filtration rates (eGFRs). Participants were selected based on specific inclusion and exclusion criteria, and rigorous statistical analyses were applied to the collected data. Using the SPSS program, we analyzed the data, and when the P<0.05, we declared the results statistically significant.

Results: There were 218 people in the research, 58.3% of whom were male and 41.7% of whom were female. The mean age group was between 51 and 60 at 36.2%. The age group distribution among the patients showed significant value (P<0.0001). About 87.6% of the patients had normal weight. 49.5% were recorded in Stage 1 CKD. Fasting blood sugar has a negative correlation (−182) with glomerular filtration rate (GFR) and shows a significant result. The post-prandial blood sugar value is also statistically significant and negatively relates to GFR. In addition, random blood sugar and glycated hemoglobin also reported statistically significant values.

Conclusion: In individuals with T2D, it was determined that significant risk factors for the onset of CKD include eGFR, age, and the duration of diabetes. Males had a considerably greater incidence of CAD, peripheral neuropathy, and diabetic foot.

The prevalence of internet addiction and associated factors among undergraduate medical students in government medical college, Almora

Preeti, Masroof Hasan Khan, Sneha Mittal, Vikram Singh Dhapola — Sat, 01 Jun 2024 00:00:00 +0000

Background: The internet, computers, smartphones, and other electronic device’s use has increased suddenly over recent decades. Although this increase has benefits to the users, but also excessive use often leads negative health consequences.

Aims and Objectives: The objective of this study was to measure the prevalence of internet addiction (IA) and stress among undergraduate medical students.

Materials and Methods: A descriptive cross-sectional study was conducted among 299 undergraduate medical students enrolled in the government medical college, Almora. A 20-item Young’s IA test which is a Likert scale-based interview schedule was used to measure the prevalence of IA and the perceived stress scale 14 scale is used to assess stress among them.

Results: Among the 299 study subjects, 49.5% were males and 50.5% were females. Males were more addicted to the internet than females. The prevalence of IA among the study subjects in the present study was 45.4% mild, 13.8% moderate, while 40.8% of students reported normal internet usage.

Conclusion: IA is a growing health problem among medical students these days, thus necessary preventive and therapeutic interventions are very important to promote healthy and safe usage of the internet.

Clinicopathological spectrum and management of sinonasal masses – A prospective observational study in a tertiary care center

Mohsina Siddique, Debajit Sarma, Mridusmita Gohain, Rupanjita Sangma — Sat, 01 Jun 2024 00:00:00 +0000

Background: Sino nasal mass (SNM) is a common clinical entity in the ENT outpatient department. It affects all age groups. SNMs are mainly non-neoplastic inflammatory polyp, benign tumor, and malignant tumor, out of which inflammatory polyp is the most common entity. Radiological investigation plays a major role in SNM. Surgery is the treatment of choice in almost all cases. Functional endoscopic sinus surgery (FESS) is the most commonly employed approach for surgery.

Aims and Objectives: The aim of the current study is to analyze the clinicopathological aspects and enumerate the various management strategies of SNMs in patients attending the department of ENT in a tertiary care hospital in the upper Assam region.

Materials and Methods: The present study was conducted in Assam Medical College between May 2022 and October 2023. During the period of this prospective observational study, 100 patients presented with SNMs.

Results: Total 100 patients were reviewed, out of which 59 patients were male and 41 females. Overall, the most common affected age group was 31–40 years. Seventy-seven cases were non-neoplastic sinonasal polyps, 16 cases were benign tumors and seven were malignant tumors. Sixty-four patients had undergone FESS, 20 patients had endoscopic sinus surgery with or without medial maxillectomy and eight patients had lateral rhinotomy. Malignant cases were managed by radiotherapy and chemoradiation mainly.

Conclusion: Sinonasal polyp is a very common entity among all SNMs. Computed tomography scan is the main diagnostic tool. FESS is the most commonly used surgical procedure with less complication.

Clinicoetiological profile and outcome of patients of acute febrile encephalopathy in a tertiary care hospital in New Delhi - A prospective observational study

Sat, 01 Jun 2024 00:00:00 +0000

Background: Acute febrile encephalopathy (AFE) in spite of being a common clinical condition is less known to the general population thereby resulting in delay in seeking medical attention with detrimental consequences. The causes can range from infectious central nervous system (CNS) and systemic diseases to non-infectious conditions such as neuroleptic malignant syndrome, poisoning, and drug overdose. Early diagnosis and prompt medical management can result in good clinical outcome in terms of morbidity and mortality.

Aims and Objectives: The aims and objectives are to study the clinical profile, etiology, seasonal variation, and outcome in patients admitted as case of AFE in a tertiary care hospital.

Materials and Methods: All patients of AFE fulfilling the inclusion and exclusion criteria admitted in the departments of neurology and general medicine in Batra Hospital and Medical Research Centre (BHMRC) New Delhi, a tertiary care hospital were subjected to study analysis. The patients underwent detailed history, examination, baseline, and special investigations such as cerebrospinal fluid and magnetic resonance imaging brain whenever needed. Patients of AFE were studied according to the prevalence, etiological diagnosis, and seasonal variations. The final outcome at discharge was based on modified Rankin scale (mRs).

Results: About 122 serially admitted patients diagnosed with AFE were found eligible and included in the study. About 47 (45%) patients had acute pyogenic CNS infection while as 36 (35%) had non-pyogenic CNS infection followed by malarial, tubercular, and cryptococcal CNS infection. We found maximum number of cases (n=61, 50%) of AFE during monsoon followed by 36 patients (30%) in post-monsoon, 15 patients (12%) were in summer, and only 10 cases (8%) during winter. We found higher and statistically significant disability in CNS infection group, patients with delayed hospitalization (P=0.001), and lower Glasgow coma scale (0.00001).

Conclusion: AFE being a condition with serious consequences, we conclude that clinical suspicion, sensitization, and swift response from the treating physicians are required to avoid worse outcomes associated with the delayed diagnosis and late hospitalization of these patients.

Determining the factors which impact management of acute poisonings due to therapeutic medicines

Sat, 01 Jun 2024 00:00:00 +0000

Background: In a developing country such as India, intentional poisoning is associated with a high degree of morbidity and mortality. Historically, the use of agricultural poisons for attempted deliberate self-harm (DSH) has taken precedence. However, urbanization and stringent laws governing sale of agricultural chemicals, in recent years, may have shifted the focus of seekers toward commercially available therapeutic medications. Further, urbanization, high health-care seeking behavior, and poor regulation on sale of medicines, in Kerala, provide a conducive environment for such attempts.

Aims and Objectives: The objective of this study was to determine the contribution of therapeutic medication toward acute poisoning as a means of DSH and the factors contributing to the same.

Materials and Methods: Patients who obtained treatment for acute poisoning after DSH, between 2017 and 2023, were screened, those who employed therapeutic medication for the same were further determined. Sociodemographic details, clinical profile, and history of previous such attempts and treatment history including toxicological screening report were gathered and analyzed.

Results: In our study of 154 patients arriving at the emergency department with history of DSH, 41% used therapeutic medicines for the same. Majority were women (75%) and most had a high school education (64%) or above. The most common agents were determined as paracetamol (23%) and benzodiazepine (10.6%). Tox screen was performed for 45% of patients. Organ failure developed in 36% patients with drug levels above and 42% of those with levels below the therapeutic range. However, 48% of those who did not undergo toxicological screening developed organ failure. Organ failure developed in 42% of patients, with acute liver injury being the most common culprit (25%). Management was symptomatic unless an antidote was available.

Conclusion: Prescription drugs utilization for DSH was common in women and patients with higher educational status. Over-the-counter drugs and psychiatric medication were frequently used. Lack of prompt access to healthcare may contribute to organ failure. Tox-screen is recommended for drug detection.

A comparative study of clinical characteristics and quality of life between obese and non-obese asthmatics

Shobitha Rao, Rakesh Bilagi, Radhe B K, Ruchik Hiregoudar, Vishnu Narayanan — Sat, 01 Jun 2024 00:00:00 +0000

Background: Asthma is a chronic inflammatory disorder arising from heterogenic geneenvironment interactions. Obesity is one of the risk factors for asthma. Evidence shows that several inflammatory markers are active in obese and overweight patients. There is growing evidence that obesity can affect the course and control of asthma.

Aims and Objectives: The study was done to compare clinical characteristics, spirometry variables, and quality of life among obese and non-obese asthmatics.

Materials and Methods: The study was a crosssectional comparative study conducted in a tertiary care hospital using a semi-structured pre-tested questionnaire. Detailed history and examination, quality of life using AQLQ score, and spirometry severity were assessed.

Results: A total of 80 patients, 40 obese asthmatics and 40 non-obese asthmatics were included in the study. The study found that most subjects belonged to the age group of 31–40 years and body mass index of 30.89±1.94 among the obese group and 23.19±3.77 in non-obese, respectively. The majority had symptoms of breathlessness and wheezing in both groups. The mean forced expiratory volume in 1 s was similar in both groups. However, the mean forced vital capacity was lower in the obese group. The asthma control test (ACT) score was poorer in obese group as compared to nonobese group (7 in obese vs. 15 in non-obese). The dosage of inhaled steroids was higher in the obese group.

Conclusion: The symptomatology was similar among the two groups. Restrictive abnormalities, higher asthma symptoms with lower ACT scores, and higher dosages of medications were seen in obese asthmatics as compared to non-obese patients.

Effectiveness of adjunctive ultrasound after mammography in improving breast cancer screening findings from a study in Malaysian women

Mohamed Ibrahim Wahid, Nurul Alia Azmi, Pei Yun Tan, Bao Jing Chen — Sat, 01 Jun 2024 00:00:00 +0000

Background: Breast cancer is a significant health issue affecting women worldwide, including Malaysia, where the incidence of breast cancer is increasing. Early detection of breast cancer plays a crucial role in improving treatment outcomes and reducing mortality rates.

Aims and Objectives: This study examines the impact of adjunctive breast ultrasound (BUS) on screening for Malaysian women, offering evidence to enhance future protocols and decisions in the early detection.

Materials and Methods: This study involved 5807 women aged 40 and above undergoing breast screening at Beacon Hospital from January to December 2022. Data collected included mammography and BUS results, categorized by breast imaging reporting and data system (BI-RADS) and diagnostic criteria. Suspicious cases on both modalities had histopathology examination (HPE) for confirmation. A subset of 1690 cases underwent both mammography and BUS screening and was compared to those who only had mammography using BI-RADS scores.

Results: This study revealed that the majority of mammograms, 94.69% (5499 cases), were categorized as BI-RADS category 0, 1, 2, and 3, while 5.3% (307 cases) were classified as BI-RADS 4 and 5. Among the cases that underwent ultrasound (1688 cases), 23.43% of them were categorized as BI-RADS 4–5. Using ultrasound in addition to mammography increased the number of cases (BI-RADS 4–5) by 33.48%, resulting in a total of 460 cases identified compared to 307 cases, detected by mammography alone. Significantly, 39% (74 cases) of the 190 cases with confirmed malignancies (BI-RADS 6) by HPE were initially classified as negative mammography (BI-RADS 0–3) but were later identified as BI-RADS 5 on ultrasound.

Conclusion: Ultrasound as a supplementary screening method holds the potential for boosting breast cancer detection sensitivity and reducing false negatives, thereby aiding in early detection and better treatment outcomes.

Bacterial pathogens and treatment outcomes in neonatal sepsis: A comparative observational study across various hospital settings

Radhika B, Vijayasri BSS, Vidyasagar V, Jyothi Prakash Raju S — Sat, 01 Jun 2024 00:00:00 +0000

Background: Neonatal sepsis is a leading cause of neonatal morbidity and mortality globally, with variations in causative bacteria and treatment efficacy across health-care facilities.

Aims and Objectives: The aims and objectives of the study are to analyze the bacterial pathogens causing neonatal sepsis and the effectiveness of their treatment in diverse hospital environments. By highlighting the differences in treatment success rates, antibiotic resistance profiles, and the pathogens involved, this study demonstrate the impact of health-care practices and infrastructure on the management of neonatal sepsis.

Materials and Methods: The study encompassed 100 neonates with sepsis, evenly distributed across the three hospital types. It involved identifying bacterial pathogens through blood cultures, assessing antibiotic sensitivity, and examining treatment outcomes such as success rate, mortality, hospital stay duration, and complication rates. Statistical methods were employed to evaluate differences in outcomes among the settings.

Results: Seventy percent of neonates tested positive for bacterial pathogens, with a 60% predominance of Gram-positive over Gram-negative bacteria (40%). Staphylococcus aureus (22%) and Streptococcus agalactiae (18%) were the leading pathogens. Notably, resistance was high against ampicillin (65%) and gentamicin (40%) but lower for cephalosporins and vancomycin. The overall success rate of treatments was 80%, with the tertiary care hospital achieving an 88% success rate, significantly outperforming the private hospitals (72%). The mortality rate was 10%, and 30% of the cases developed complications, predominantly respiratory distress syndrome.

Conclusion: Hospital setting significantly influences the management and outcomes of neonatal sepsis, with tertiary care centers showing better results. These findings highlight the need for focused antimicrobial stewardship and the adoption of sophisticated care protocols in less advanced settings to improve neonatal sepsis outcomes.

Minimum inhibitory concentration creep in Enterobacterales – A rising concern

Sat, 01 Jun 2024 00:00:00 +0000

Background: The irrational use of antibiotics has led to the emergence of multidrug-resistant pathogens. The phenomenon of minimum inhibitory concentration (MIC) creeps occurs when organisms start showing raised MIC but within susceptible range giving an indication of the prevalence of rise in resistant pathogens in an area.

Aims and Objectives: The aims and objectives of the study are to observe the susceptibility pattern among uropathogens and the possibility of MIC creeps among the Escherichia coli isolates sensitive to nitrofurantoin.

Materials and Methods: This retrospective study was done in a tertiary care hospital in Kolkata to observe the susceptibility pattern among uropathogens and the possibility of MIC creeps. We took the data from all inpatient department and outpatient department patients sent for urine culture and sensitivity from October 1st, 2022, to September 30th, 2023. The antimicrobial susceptibility testing and MIC were conducted by VITEK Compact 2. The MIC of nitrofurantoin, one of the most widely used antibiotics for lower urinary tract infections, was calculated to investigate the phenomenon of MIC creep. All the statistical analyses were carried out using the Excel spreadsheet and OpenEpi version 3.01 platform.

Results: In our study, a total of 631 urine samples were analyzed: 368 were positive with the most common isolate being E. coli (53%) followed by Klebsiella spp. (12%). Two percent of resistance was observed for fosfomycin and 8% for nitrofurantoin. Extended spectrum beta-lactamase (ESBL) producers E. coli was 127 (35%). Overall, 23/368 samples had a MIC ≥128 for nitrofurantoin. Among the ESBL producers, 13/127 had MIC ≥128 for nitrofurantoin.

Conclusion: In the present study, it was observed that E. coli showed a reduced susceptibility for nitrofurantoin indicated by a creeping increase in MIC within normal range. Trends in rising MIC can be an alarming sign for using drugs such as nitrofurantoin judiciously. Antimicrobial stewardship practice should be strongly implemented in hospitals to curb rising resistance and for better prognosis of patients having infectious diseases.

Optimizing fracture management: The role of the Ellis plate in distal radius fractures

Sat, 01 Jun 2024 00:00:00 +0000

Background: Fractures at the distal end of the radius, a prevalent orthopedic concern, challenge clinicians due to their complex nature and the diverse patient demographics they affect. Primary stability is key, especially in cases involving osteoporotic bones or younger patients. The Ellis plate with a locking screw mechanism offers a promising solution to achieve this stability, potentially preventing secondary displacement regardless of bone quality.

Aims and Objectives: This study aims to rigorously assess the effectiveness of the Ellis volar locking compression plate in treating distal end radius fractures. It focuses on evaluating functional outcomes post-treatment, providing insights into the efficacy of this approach.

Materials and Methods: This study evaluated the efficacy of the Ellis plate in managing distal radius fractures, under ethical approval number KMC/IEC/Ortho/2021-5. Twenty adult patients with unstable fractures were included based on specific criteria and provided informed consent. Exclusion criteria included unwillingness for surgery, medical unsuitability, osteoporosis, minors, and compound fractures with vascular injury. Surgical outcomes were assessed using the Gartland and Werley scoring system, with follow-up appointments scheduled over 1 year to monitor progress and adherence to physiotherapy plans.

Results: The study encompassed 20 patients, with a gender distribution of 12 males and eight females and an average age of 43.3 years. Utilizing the Gartland and Werley demerit grading system, the study reported 45% superb outcomes, another 45% good outcomes, 10% fair outcomes, and no poor outcomes. This distribution highlights the potential of the Ellis plate technique in achieving positive results in fracture treatment.

Conclusion: The study concludes that the Ellis plate technique is a viable and effective option for stabilizing distal end radius fractures. However, achieving the best possible outcomes depends on several factors, including strict adherence to AO principles, maintaining high standards of aseptic practice, following appropriate post-operative rehabilitation protocols, and ensuring comprehensive patient education. This multifaceted approach is crucial for the successful treatment of these fractures.

Sensory processing patterns in children with attention-deficit hyperactivity disorder: A case–control study

Sat, 01 Jun 2024 00:00:00 +0000

Background: Sensory processing (SP) indicates the ability of the nervous system to receive, analyze, process, and respond to external sensory input and coordinates motor movements accordingly. Children with various neurodevelopmental disorders, like autism spectrum disorder, have SP issues. However, studies regarding SP issues in attention-deficit/hyperactivity disorder (ADHD) compared to typically developing children are relatively less.

Aims and Objectives: To study the SP pattern of children with ADHD, to compare with the control group, and to study the correlation of symptom severity with SP deficit in children with ADHD.

Materials and Methods: All children attending the child guidance clinic at R. G. Kar Medical College and Hospital were screened, and children with ADHD without any other comorbid disorder as diagnosed by Diagnostic and Statistical Manual 5 were selected. Their ADHD symptom severity was assessed using the ADHD test, and SP was assessed using the Short Sensory Profile (SSP).

Results: The SSP mean score of the children with ADHD was significantly different than the mean score of the control group, and the percentage of children having a definite difference in SP was significantly different in the ADHD children group compared to the control group. The severity of the SP deficit also correlates with the severity of ADHD symptoms, as found by the correlation study.

Conclusion: Children with ADHD have shown a definite difference in SP compared to controls, and the severity of the sensory problem is proportionate to the severity of the symptoms of ADHD.

Clinicopathological features and risk stratification by the sokal score of patients with chronic myeloid leukemia at a tertiary care hospital in North-East India: A prospective study

Sat, 01 Jun 2024 00:00:00 +0000

Background: Chronic myeloid leukemia (CML) is a hematologic malignancy characterized by excessive growth of myeloid cells and their progenitors. The incidence of CML is approximately 1–2/100,000 population per year.

Aims and Objectives: The aims and objectives of the study are to determine the clinicopathological features of patients with CML and their risk stratification by the Sokal score at a tertiary care hospital in North-East India.

Materials and Methods: This was a single-center prospective study conducted for 5 years (2018–2022). A total of 109 cases diagnosed with CML by qualitative analysis of BCR-ABL1 transcript reverse transcription-polymerase chain reaction were included in the study. The Sokal score was calculated using previously published formulae to classify the patients into different risk groups. The outcome (dead or alive) of CML patients was compared with their individual risk groups using Fisher’s exact test.

Results: Out of 109 CML patients, 73 were males and 36 were females. At the end of the study, 85 patients were alive whereas 24 died. The mean age at presentation was 42.08±15.06 years. The pediatric age group comprises 1.84% of total cases. The percentages of death were higher (79.17%) in patients aged 18–59 years, followed by 20.83% in ≥60 years age group, whereas no death was recorded in the pediatric age group (<18 years). The abdominal hard lump was the most common clinical presentation, followed by abdominal fullness, weakness, and pain abdomen. The Sokal score assigns the majority (66.06%) of patients to the intermediate risk (IR) category, followed by 25.69% and 8.26% in the high-risk (HR) and low-risk (LR) categories, respectively. It was observed that the majority (28.57%) of patients died in the HR group, followed by 20.83% in the IR group and 11.11% in the LR group.

Conclusion: The mean age of CML patients is lower than that observed in many Western countries. The Sokal score assigns the majority of patients to IR category and the maximum death were seen in the HR group.

Cytohistopathological evaluation of salivary gland lesions in tertiary care center of Eastern Nepal

Diksha Karki, Purbesh Adhikari, Mona Dahal — Sat, 01 Jun 2024 00:00:00 +0000

Background: Salivary gland tumors consist of a group of heterogeneous lesion with complex clinicopathological characteristics. Fine needle aspiration (FNA) cytology has been used as a quick, non-invasive diagnostic tool for the diagnosis of neoplastic and non-neoplastic lesion of salivary gland.

Aims and Objectives: The aims and objectives of the study are to perform the cytopathological evaluation of minor and major salivary gland lesions (neoplastic and non-neoplastic) in terms of its various types, frequency, site, demographic distribution and to correlate with histopathology findings whenever available.

Materials and Methods: This is a hospital-based 3-year study in which 155 cases of patient underwent FNA cytology for salivary gland swelling (non-neoplastic and neoplastic) of which seven cases were excluded due to scant and inadequate aspirate, and thus, only 148 cases were included in this study and histopathological correlation was available in 42 cases. Any metastatic lesion, repeat samples from same patient were excluded from the study.

Results: Out of 148 cases, male patients were 72 (49%) and female patients were 76 (51%) with M: F ratio of 0.9:1. Benign lesion was commonly seen in 31–40 years, non-neoplastic lesion at 41–60 years (n=18, 37.6%), and malignant lesions at 61–90 years (n=9, 37.5%). Parotid was the most common salivary gland involved by neoplastic and non-neoplastic lesion accounting 65.5% (n=97) followed by submandibular gland 29.7% (n=34). Pleomorphic adenoma was most frequently diagnosed among all salivary gland lesions (60%). Mucoepidermoid carcinoma outnumbered the category (14%) of malignant salivary gland lesion. On histopathology correlation, 33 cases were correctly diagnosed in cytopathology whereas 9 cases showed discordant result. FNA cytology sensitivity was 66.6%, specificity was 93.3%, positive predictive value was 80.0%, and negative predictive value was 87.5%, respectively. Diagnostic accuracy was found to be 85.7%.

Conclusion: Cytopathology examination of salivary gland can be used as safe and reliable method in primary diagnosis of lesions of salivary gland.

Children with bicytopenia and pancytopenia – clinical picture, etiological spectrum, and outcome

Vijay Anand M, Logeshwaran K, Srenivas A, Sathiya Suresh R — Sat, 01 Jun 2024 00:00:00 +0000

Background: Children who develop cytopenias present with several etiological causes, posing diagnosis, and management difficulties for both physicians and pathologists. With these in mind, we assessed the clinical profile and etiology of children who attended a healthcare facility in South India with bicytopenia or pancytopenia.

Aims and Objectives: (1) The primary objective of this study was to find out the clinical and etiological spectrum in children with bicytopenia and pancytopenia who were admitted to the Institute of Child Health and Research Center, Government Rajaji Hospital, Madurai. (2) The secondary objective of this study is to follow-up children with bicytopenia and pancytopenia to find out the outcome and prognosis.

Materials and Methods: This study was in the Department of Pediatrics at the Government Rajaji Hospital in Madurai, Madurai Medical College’s Institute of Child Health and Research Center, which is where we carried out the study. Two hundred and sixty-four patients with bicytopenia and 36 patients with pancytopenia were included in this study. Once in 2 weeks, all children with bicytopenia and pancytopenia were assessed in our Saturday hematology outpatient clinics.

Results: Fever was the most prevalent sign of both pancytopenia and bicytopenia in this investigation. Etiological variables among cases of pancytopenia, cancer, infections, non-infections, and idiopathic causes were recorded in 11%, 58%, 17%, and 14% of cases, respectively. Similarly, bicytopenia, malignancy, infections, non-infections, and idiopathic causes were found in 23%, 70%, 4%, and 3% of cases, respectively. According to the prognosis, 28%, 33%, 6%, and 33% of cases with pancytopenia recovered, passed away, were lost to follow-up, or were undergoing treatment, respectively. Similar to those individuals, 67%, 11%, 4%, and 18% of bicytopenia cases were treated, recovered, or lost to follow-up, respectively.

Conclusion: In children, there is a wide etiological range of cytopenias. Infections and dangerous diseases like acute leukemia are among the reasons. The geographical location of the hospital, the frequency of malnutrition, and the regional presence of certain diseases such as malaria and enteric fever determine the causes reported in a hospital environment.

Assessing the link between rivaroxaban concentration and the onset of renal impairment in elderly patients: A retrospective observational study

Motakatla Usha Rani, Chitra Karuppiah , Penupothu Sree Nagamani — Tue, 04 Jun 2024 00:00:00 +0000

Background: Rivaroxaban is a widely used anticoagulant, but its impact on renal function, particularly at varying plasma concentrations, remains a critical area of investigation. This study examines the relationship between rivaroxaban concentration and renal impairment in elderly patients.

Aims and Objectives: The aim of the study was to investigate the relationship between rivaroxaban plasma concentrations and the incidence of renal impairment in elderly patients.

Materials and Methods: A retrospective observational study was conducted on 100 elderly patients prescribed rivaroxaban for atrial fibrillation or venous thromboembolism prevention. Patients were categorized based on their rivaroxaban plasma concentrations into three groups: Low (<50 ng/mL), medium (between 50 and 200 ng/mL), and high (>200 ng/mL). Renal impairment was characterized as having an estimated glomerular filtration rate <60 mL/min/1.73 m². The analysis of the data consisted of Chi-square testing and multivariable logistic regression, with adjustments made for age, gender, baseline renal function, and treatment indication.

Results: The incidence of renal impairment escalated with increasing rivaroxaban concentrations, 20%, 40%, and 60% in low, medium, and high concentration groups, respectively. Statistical analysis revealed a significant association between rivaroxaban concentration and renal impairment (χ2=10.57, P=0.005). Patients with high concentrations had 2.8-fold higher odds of developing renal impairment compared to the low concentration group. Cox proportional hazards analysis showed a 2.2 times higher hazard of renal impairment in high versus low concentration groups over 18 months.

Conclusion: Higher trough plasma concentrations of rivaroxaban are associated with an increased risk of renal impairment in elderly patients. This finding highlights the importance of monitoring rivaroxaban levels to mitigate renal risks.

Cross-sectional study of the prevalence of inter-arm blood pressure difference in offspring of normotensive and hypertensive parents among students of tertiary care teaching hospital, Hyderabad

Prashanthi M, Santa Kumari A, Abdul Raoof Omer Siddiqui, Mudassir Mirza — Sat, 01 Jun 2024 00:00:00 +0000

Background: Hypertension (HTN) incidence and progression are monitored by regular blood pressure (BP) measurement; one of the most ignored components of regular check-up is the measurement of inter-arm difference (IAD) in BP.

Aims and Objectives: The objective of this study was to estimate the prevalence of IAD in BP among offspring of hypertensive parents compared to normotensive parents.

Materials and Methods: This cross-sectional study was conducted on 100 male students at Osmania Medical College, Hyderabad, Telangana for a period of 6 months. After IEC clearance, the subjects were divided into two groups, 50 students in each group: Group I had offspring with hypertensive parents and Group II had offspring with normotensive parents. Age, height, weight, and body mass index (BMI) were recorded. IAD was calculated as the difference between BP (Systolic BP [SBP] and diastolic BP [DBP]) in the right arm and left arm. Subjects with a history of structural, functional cardiovascular disease disorders, endocrine disorders, Diabetes mellitus, and addictions such as smoking and alcohol were excluded from the study. Data were statistically analyzed using Microsoft Excel software.

Results: Among 100 subjects, Group I and II IAD in SBP was 8.68±6.02 and 5.00±3.24 (P<0.0002), respectively, and Group I and II IAD in DBP was 5.12±4.48 4.79±3.56 (P<0.7117), respectively. BMI of the two groups is almost within the similar range (23.44±4.04, 22.098±3.15, respectively) and not statistically significant (P=0.0694), a positive correlation of 0.12, 011 was found between BMI, systolic IAD,and diastolic IAD, respectively.

Conclusion: The above results show a significant association between IAD in systolic BP and family history of HTN.

A prospective study of various pre-operative factors and the development of a scoring system in predicting difficult laparoscopic cholecystectomy

Usha Ramakrishna N, Radhika Potnuri, Raj Kumar Sahu, Hitesh Chavda — Sat, 01 Jun 2024 00:00:00 +0000

Background: Laparoscopic cholecystectomy (LC) is a common surgical procedure, the difficulty of which can vary significantly based on pre-operative factors. Identifying these factors can improve surgical planning, patient counseling, and outcomes.

Aims and Objectives: To develop a predictive scoring system for assessing the difficulty of LC preoperatively based on individual patient parameters. To employ operative time and intra-operative events to validate the accuracy of the scoring system in reflecting the technical difficulty of LCs.

Materials and Methods: This prospective study enrolled 104 patients scheduled for LC, assessing them with a pre-operative scoring system to predict operative difficulty. Patients were categorized into groups indicating expected levels of difficulty: Easy, difficult, and very difficult. Demographic information, clinical characteristics, and operative outcomes were analyzed to validate the scoring system’s predictive accuracy.

Results: Of the patients assessed, 68.3% were predicted to have an easy LC (scores 0–5), whereas 31.7% were anticipated to face a difficult LC (scores 6–10). Key predictors of operative difficulty included age, sex, history of previous hospitalization for acute cholecystitis, body mass index (BMI), the presence of an abdominal scar, palpable gallbladder (GB), thickened GB wall, pericholecystic collection, and impacted stone. The study found that operative outcomes closely aligned with pre-operative predictions, confirming the scoring system’s moderate predictive accuracy (area under the curve of 0.798).

Conclusion: The pre-operative scoring system demonstrated moderate effectiveness in predicting LC difficulty, with significant predictors including a history of hospitalization, BMI, palpable GB, and thickened GB wall. These findings can aid in pre-operative planning and optimizing patient outcomes.

To study the role of propranolol in infantile hemangioma: A prospective randomized study

Pokhariya BMS, Supriya Tiwari, Bhupesh Gogia — Sat, 01 Jun 2024 00:00:00 +0000

Background: Infantile capillary hemangiomas (IHs) are common, benign, self-limited tumors with a well-defined natural history, occurring most often on the head and neck. IHs are the most common soft-tissue tumors in infancy and occur in 5–10% of children. The main risk factors identified for IH include female sex and low birth weight. For many hemangioma patients, treatment is not required; however, there are many treatment options for IH, each with their own limitations and side effects.

Aims and Objectives: The study aimed to study the role, efficacy, and side effects of propranolol in infantile hemangioma.

Materials and Methods: Patients with infantile hemangioma at SN Medical College, Agra, in the Department of General Surgery and Pediatric Surgery with the required eligibility criteria are considered in this study from December 2021 to December 2023, in total 60 patients, prospectively randomized into three groups: Group A: Infants given propranolol only. Group B: Infants given steroids only Group C: Infants given a steroid plus propranolol.

Results: In our study, Group A taking propranolol alone 14 out of 20 (70%) responded well, Group B taking steroid alone 7 out of 20 (35%) responded well and Group C taking steroid and propranolol 16 out of 20 (80%) responded well, which shows that propranolol in a low dose (0.5–3 mg/kg/day) is an effective drug for infantile hemangioma.

Conclusion: In our study, we can conclude that propranolol is a safe, efficacious, and better drug than corticosteroid for infantile hemangioma when used in low doses, and the effects are better if started in the early phase.

Relationship between pupil to limbus diameter ratio with blood pressure and pulse rate in young adults: An observational study

Himanshu Sharma, Ishrat Khan, Varsha Porwal, Haneef Khan — Sat, 01 Jun 2024 00:00:00 +0000

Background: Autonomic function tests play a crucial role in the diagnosis and prognosis of clinical conditions. Although there are multiple autonomic function tests available, there is still a need for rapid and less expensive tests for the benefit of the general population. The pupil-to-limbus diameter (PLD) ratio is one such test that is simple and cost-effective. It uses the principle of pupil dilation and constriction due to the influence of the autonomic neurons’ activity.

Aims and Objectives: The present study aimed to observe a correlation between PLD ratio with blood pressure and pulse rate in young adults.

Materials and Methods: The present study was conducted at the Department of Physiology, Jhalawar Medical College, Jhalawar. The present study was an observational study conducted among 1st-year medical students in the age group of 18–24 years. PLD ratio was measured by the two-box method as described in the literature. After providing 3–5 min of rest, blood pressure and pulse were recorded in the right arm in the sitting position by a digital blood pressure monitor.

Results: Positive correlation was observed between the PLD ratio of right eye and pulse rate (r=0.9696). There is a weak negative correlation exists between the PLD ratio of right eye and systolic blood pressure (r value=−0.3802).

Conclusion: The study concludes that the PLD ratio correlates with autonomic activity. However, there is a need for a study with large population to confirm the correlation. Furthermore, there is a study to assess the autonomic responses in female participants in different phases of menstrual cycle.

Classic polyarteritis nodosa presenting initially as a case of cutaneous polyarteritis nodosa: A case report

Sabina Adhikari — Sat, 01 Jun 2024 00:00:00 +0000

Classic polyarteritis nodosa (PAN) is an uncommon form of aggressive systemic vasculitis involving small-to-medium sized arteries usually of renal vasculature and other visceral organs but characteristically sparing the lung vasculature. Cutaneous PAN (c-PAN) is still a rare type of small-to-medium vessel vasculitis with involvement of skin without any systemic or visceral involvement. However, extracutaneous features such as arthritis, arthralgia, myopathy, and myositis can co-exist with the cutaneous features. c-PAN can be confirmed histopathologically by the presence of polymorphonuclear leukocytes around the medium-sized vessels with evidence of fibrinoid necrosis and luminal thrombi at the bifurcations. While c-PAN has a benign but chronic course and can be managed with low doses of short-course oral steroids or anti-inflammatory drugs, systemic involvement has an aggressive course and needs adequate and prompt immunosuppression with high dose oral steroids, cyclophosphamide, rituximab, or other immunosuppressive. We present a case of a 33-year-old male who landed in our OPD with features of c-PAN and on further investigative workup was found to have a renal infarct.

Jejunogastric intussusception: A case report of unusual cause of upper gastrointestinal bleeding after gastrojejunostomy

Swaminathan Rajan, Sivasankar Amarapathy, Somasekar Durairajan — Sat, 01 Jun 2024 00:00:00 +0000

Upper gastrointestinal bleeding is following gastrojejunostomy due to stromal ulceration, marginal ulcer bleeding from anastomotic site, remnant cancer. Gastrojejunostomy done for benign gastric outlet obstruction has many complications. Jejunogastric intussusceptions (JGI) is a rare complication of gastrojejunostomy surgery (<0.1% of cases), yet requires an urgent diagnosis. Mortality rates range from 10% to 50% based on delay in diagnosis and surgical intervention. Vomiting, abdominal pain, and hematemesis are the most common symptoms. We report a 53-year-old man admitted to the emergency department, complaining of epigastric pain and recurrent hematemesis for 3 days. Abdominopelvic computed tomography scan also showed a target sign in favor of jejunal intussusception. Midline emergency laparotomy was done and the gangrenous jejunum was resected with reconstruction Roux en Y loop was done. The patient was discharged without any further complications. In patients presented with hematemesis and abdominal pain and a history of gastrojejunostomy, JGI must consider a possible cause because early diagnosis and treatment are necessary to prevent further complications.

Torsion of paraovarian cyst: An enigma

Latika, Pushpa Dahiya — Sat, 01 Jun 2024 00:00:00 +0000

Paraovarian cysts are extremely rare and represent approximately 10% of adnexal masses. They are found commonly in women of reproductive age group and arise from the mesothelium. Paraovarian cyst is an entity which is rarely diagnosed preoperatively and often remains undiagnosed and missed out even by radiologists. Most often they remain asymptomatic but when large in size may present with complications such as torsion, hemorrhage, and infection. Isolated torsion of paraovarian cyst is extremely rare. Its diagnosis is often missed out leading to complications.

Navigating the transition: Implementing competency-based medical education in medical curriculum in India

Aditi Aikat — Sat, 01 Jun 2024 00:00:00 +0000

The road to implementation of competency-based medical education (CBME) in the medical curriculum in India has both challenges and windows of opportunities in its folds. The hindrances identified were reluctance to change, capacity building of faculties, lack of infrastructural support, and methods of assessment. Notwithstanding, CBME has the potential to ensure that the Indian medical graduates are equipped with better clinical skills, and learner-centric education, that aligns well with individual competence, and community healthcare needs. Effective navigation through this transition calls for collaborative efforts among academicians, regulatory bodies, and related stakeholders while drawing from relevant successful models of our country itself. It is imperative to address the challenges concerning capacity building of faculties, resource allocation, and assessment methodology for successful implementation. Given appropriate adoption, the CBME-based curriculum can go a long way to deliver quality healthcare.

A comprehensive guide to pulmonary function tests for 1st-year medical students – Simplifying PFTS and their interpretation

Sat, 01 Jun 2024 00:00:00 +0000

Pulmonary function tests (PFTs) constitute a set of non-invasive diagnostic procedures designed to evaluate the functional capabilities of the respiratory system. These tests hold pivotal significance in the identification, tracking, and treatment of diverse respiratory conditions, including asthma, chronic obstructive pulmonary disease, interstitial lung diseases, and restrictive lung disorders. This review article aims to provide medical students with a comprehensive overview of PFTs and their interpretation, offering valuable insights into their crucial role in the diagnosis and management of respiratory ailments.

Effect of highly sensitive C-reactive protein on cardiovascular risk of Type 2 diabetes mellitus adults: A systematic review

Benoy Upreti, Mingma Lhamu Sherpa, Karma Lakhi Bhutia — Sat, 01 Jun 2024 00:00:00 +0000

Diabetes mellitus (DM) is a significant global health issue that affects nearly 537 million of people, with Type 2 DM (T2DM) accounting for the majority of cases. Death is frequently the result of diabetes-related complications, particularly cardiovascular illnesses, neuropathy, retinopathy, and nephropathy. Type 2 diabetes and cardiovascular events, such as coronary heart disease (CHD), are linked to a greater likelihood of creating when C-reactive protein (CRP), a representative acute phase inflammation response protein, is elevated. The purpose of this systematic review is to examine how T2DM adults’ cardiovascular risk is affected by highly sensitive CRP (hsCRP). The information found through searches of digital sources such as EBSCO, EMBASE, PubMed, Scopus, and Web of Science. The investigator separately reviewed each abstract and title in comparison to predetermined inclusion and exclusion standards. Google Scholar was used for further research. Using terms, a thorough search plan was created. The terms “hs-CRP,” “Type 2 diabetes mellitus,” and “cardiovascular disease” have been utilized. To translate the results for other databases, the original search was done in PubMed. To find additional pertinent papers, reference lists of the research included and previously released reviews were also examined. The findings state that people with DM have a higher risk of developing heart disease. Due to their elevated carbohydrate intake, unhealthy diet, and genetic disposition, Asian Indians are at a high risk of developing cardiovascular disease and DM. Diabetes patients’ cardiovascular risk is primarily determined by insulin sensitivity, which can be assessed using the markers hsCRP and tumor necrosis factor-. Lipid profile is important in cardiovascular diseases because high blood glucose levels encourage the body’s production of cholesterol, which increases the risk of heart malfunction in obese diabetic patients.

Bilateral superficial cervical plexus block as sole anesthesia for parathyroid surgeries in chronic kidney disease patients

Kanika Agarwal, Nidhi Sharma, Aseem Sharma, Manish Banjare — Sat, 01 Jun 2024 00:00:00 +0000

Chronic kidney disease (CKD), especially in stages III, IV, V patients presenting for surgical removal of parathyroid glands, has special concerns regarding anesthesia. Their renal disease restricts the choice of drugs that can be used for general anesthesia induction and management. Bilateral superficial cervical plexus block (SCPB) under ultrasound guidance can be an alternative mode of anesthesia in parathyroid surgeries in these patients. The aim of the present case series was to evaluate the effectiveness of bilateral SCPB in CKD (stages III, IV, V) patients undergoing parathyroid surgeries in terms of hemodynamic stability, intraoperative and post-operative analgesia, and surgeon’s satisfaction. In the present case series, USG-guided bilateral SCPB was performed under aseptic precautions and 10 mL of local anesthetic was injected on each side. Effect was confirmed with wet swab and blunt pin prick. Then, patient was handed over to the surgeon. Continuous hemodynamic monitoring was done and time of first rescue analgesia was noted. Bilateral SCPB proved to be a good alternative mode of anesthesia for CKD (stages III, IV, V) patients undergoing parathyroid surgeries.

A study on clinicoradiological correlation in patients with intrauterine contraceptive device

Divangini Yadav , Rachna Chaurasia — Sat, 01 Jun 2024 00:00:00 +0000

The aim of this study was to present the spectrum of radiological findings in patients with intrauterine contraceptive device (IUCD). The study was conducted over a period of 14 months (June 2022–August 2023) in the Department of Radiodiagnosis, M.L.B. College, Jhansi. A prospective study was conducted in the Department of Radiology in MLB Medical College Jhansi in 120 cases with IUCD, referred from various departments. These patients were primarily evaluated on transabdominal and transvaginal sonography (3D, 4D) (ultrasound machine-Medison sono Ace-X8, Vivid T8, and Hitachi Aloka SSDF-31), which is the first-line imaging for the evaluation of IUCD position. Out of 120 cases, in 100 cases, findings were confirmed on USG and the rest cases require further radiological modalities such as X-ray, CT scan, and MRI which were used accordingly the presenting symptoms of the patient and findings of ultrasound. As in one of our case, X-ray pelvis has shown completely inverted IUCD.

The craze with semaglutide

Ruby Dhar, Arun Kumar, Subhradip Karmakar — Sat, 01 Jun 2024 00:00:00 +0000

Semaglutide (Ozempic acid) belongs to a class of drugs called glucagon-like peptide-1 (GLP-1) receptor agonists. These medications mimic the action of a hormone called GLP-1, which helps regulate blood glucose and promotes weight loss. One role of GLP-1 is to prompt the body to produce more insulin, which reduces blood sugar (glucose). Because of this, doctors have been treating type 2 diabetes with semaglutide for more than 15 years. Higher doses of GLP-1, however, also cause anoxia by interacting with the brain regions responsible for appetite suppression. When combined with diet and exercise, it can help people who are obese or overweight lose a significant amount of weight and lower their risk of developing diabetes, heart disease, and cancer. This effect of Semaglutide made it an appropriate candidate for weight loss. At present, semaglutide is only approved for weight loss under the brand name Wegovy. Public demand and craze for weight loss have prompted the usage and misusage of semaglutide. As interest and obsession with weight loss programs continue to grow, health-care professionals are forced to improvise their strategy to manage the demand. One way to meet needs is to prescribe other brands of semaglutide, such as Ozempic and Rybelsus (using a Food and Drug Administration [FDA]-approved drug for a different reason). The FDA recommends Wegovy for weight loss if you meet one of the following criteria:

The FDA guidelines for semaglutide usage only if body mass index (BMI) is 27 kg/m2 or greater along with other co-morbidities such as high blood pressure, type 2 diabetes, or high cholesterol or a BMI >30 kg/m2. This has become so rampant that genuine users of semaglutide who need it for managing their blood sugar are finding it missing from the shelf. Overuse or improper use often comes with adverse consequences, such as hypoglycemia, confusion, dizziness, seizures, headache, and even loss of consciousness. The craze for semaglutide needs to be cautiously weighed before consumption.